Working group reports: Evaluation of the evidence to support practice guidelines for nutritional care of preterm infants-the Pre-B Project

Science.gov (United States)

The "Evaluation of the Evidence to Support Practice Guidelines for the Nutritional Care of Preterm Infants: The Pre-B Project" is the first phase in a process to present the current state of knowledge and to support the development of evidence-informed guidance for the nutritional care of preterm an...

Cost-effectiveness of particle therapy: Current evidence and future needs

International Nuclear Information System (INIS)

Pijls-Johannesma, Madelon; Pommier, Pascal; Lievens, Yolande

2008-01-01

Purpose: Questions are being raised regarding the cost of particle therapy (PT), and with them criticism that PT is too expensive to allow the expected gain in effectiveness. This paper aims to get more insight in the cost and cost-effectiveness of particle therapy and to discuss a future strategy that allows for critical assessment of this health technology. Material and methods: A systematic literature review based on an earlier published comprehensive review was performed and updated until June 1st 2008. Besides, current business plans of PT projects were examined. Additionally, results retrieved from a cost-simulation tool developed under auspice of the ENLIGHT were discussed. Results: The current literature on cost-effectiveness of PT is scarce, non-comparable, and largely not performed according to standard health technology assessment criteria. Besides, different perspectives for cost evaluations have been used, making it difficult to compare and to determine the relative impact in terms of costs for this new treatment modality. Conclusions: Evidence on the cost-effectiveness of PT is scarce. Adequate reimbursement is necessary to support such innovative yet costly treatments. For now, model-based economic evaluations performed at least from a health care perspective may help us to gain evidence-based insight into cost-effectiveness

A Systematic Review of the Economic Evidence for Home Support Interventions in Dementia.

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Clarkson, Paul; Davies, Linda; Jasper, Rowan; Loynes, Niklas; Challis, David

2017-09-01

Recent evidence signals the need for effective forms of home support to people with dementia and their carers. The cost-effectiveness evidence of different approaches to support is scant. To appraise economic evidence on the cost-effectiveness of home support interventions for dementia to inform future evaluation. A systematic literature review of full and partial economic evaluations was performed using the British National Health Service Economic Evaluation Database supplemented by additional references. Study characteristics and findings, including incremental cost-effectiveness ratios, when available, were summarized narratively. Study quality was appraised using the National Health Service Economic Evaluation Database critical appraisal criteria and independent ratings, agreed by two reviewers. Studies were located on a permutation matrix describing their mix of incremental costs/effects to aid decision making. Of the 151 articles retrieved, 14 studies met the inclusion criteria: 8 concerning support to people with dementia and 6 to carers. Five studies were incremental cost-utility analyses, seven were cost-effectiveness analyses, and two were cost consequences analyses. Five studies expressed incremental cost-effectiveness ratios as cost per quality-adjusted life-year (£6,696-£207,942 per quality-adjusted life-year). In four studies, interventions were dominant over usual care. Two interventions were more costly but more beneficial and were favorable against current acceptability thresholds. Occupational therapy, home-based exercise, and a carers' coping intervention emerged as cost-effective approaches for which there was better evidence. These interventions used environmental modifications, behavior management, physical activity, and emotional support as active components. More robust evidence is needed to judge the value of these and other interventions across the dementia care pathway. Copyright © 2017 International Society for Pharmacoeconomics and

Analysis of Evidence Supporting the Educational Leadership Constituent Council 2011 Educational Leadership Program Standards

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Tucker, Pamela D.; Anderson, Erin; Reynolds, Amy L.; Mawhinney, Hanne

2016-01-01

This document analysis provides a summary of the research from high-impact journals published between 2008 and 2013 with the explicit purpose of determining the extent to which the current empirical evidence supports the individual 2011 Educational Leadership Constituent Council Program Standards and their elements. We found that the standards are…

Organisational support for evidence-based practice: occupational therapists perceptions.

Science.gov (United States)

Bennett, Sally; Allen, Shelley; Caldwell, Elizabeth; Whitehead, Mary; Turpin, Merrill; Fleming, Jennifer; Cox, Ruth

2016-02-01

Barriers to the use of evidence-based practice extend beyond the individual clinician and often include organisational barriers. Adoption of systematic organisational support for evidence-based practice in health care is integral to its use. This study aimed to explore the perceptions of occupational therapy staff regarding the influence of organisational initiatives to support evidence-based practice on workplace culture and clinical practice. This study used semi-structured interviews with 30 occupational therapists working in a major metropolitan hospital in Brisbane, Australia regarding their perceptions of organisational initiatives designed to support evidence-based practice. Four themes emerged from the data: (i) firmly embedding a culture valuing research and EBP, (ii) aligning professional identity with the Research and Evidence in Practice model, (iii) experiences of change: pride, confidence and pressure and (iv) making evidence-based changes to clinical practices. Organisational initiatives for evidence-based practice were perceived as influencing the culture of the workplace, therapists' sense of identity as clinicians, and as contributing to changes in clinical practice. It is therefore important to consider organisational factors when attempting to increase the use of evidence in practice. © 2016 Occupational Therapy Australia.

Somatosensory tinnitus: Current evidence and future perspectives

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Greco, Antonio; Turchetta, Rosaria; Altissimi, Giancarlo; de Vincentiis, Marco; Cianfrone, Giancarlo

2017-01-01

In some individuals, tinnitus can be modulated by specific maneuvers of the temporomandibular joint, head and neck, eyes, and limbs. Neuroplasticity seems to play a central role in this capacity for modulation, suggesting that abnormal interactions between the sensory modalities, sensorimotor systems, and neurocognitive and neuroemotional networks may contribute to the development of somatosensory tinnitus. Current evidence supports a link between somatic disorders and higher modulation of tinnitus, especially in patients with a normal hearing threshold. Patients with tinnitus who have somatic disorders seems to have a higher chance of modulating their tinnitus with somatic maneuvers; consistent improvements in tinnitus symptoms have been observed in patients with temporomandibular joint disease following targeted therapy for temporomandibular disorders. Somatosensory tinnitus is often overlooked by otolaryngologists and not fully investigated during the diagnostic process. Somatic disorders, when identified and treated, can be a valid therapeutic target for tinnitus; however, somatic screening of subjects for somatosensory tinnitus is imperative for correct selection of patients who would benefit from a multidisciplinary somatic approach. PMID:28553764

Somatosensory tinnitus: Current evidence and future perspectives.

Science.gov (United States)

Ralli, Massimo; Greco, Antonio; Turchetta, Rosaria; Altissimi, Giancarlo; de Vincentiis, Marco; Cianfrone, Giancarlo

2017-06-01

In some individuals, tinnitus can be modulated by specific maneuvers of the temporomandibular joint, head and neck, eyes, and limbs. Neuroplasticity seems to play a central role in this capacity for modulation, suggesting that abnormal interactions between the sensory modalities, sensorimotor systems, and neurocognitive and neuroemotional networks may contribute to the development of somatosensory tinnitus. Current evidence supports a link between somatic disorders and higher modulation of tinnitus, especially in patients with a normal hearing threshold. Patients with tinnitus who have somatic disorders seems to have a higher chance of modulating their tinnitus with somatic maneuvers; consistent improvements in tinnitus symptoms have been observed in patients with temporomandibular joint disease following targeted therapy for temporomandibular disorders. Somatosensory tinnitus is often overlooked by otolaryngologists and not fully investigated during the diagnostic process. Somatic disorders, when identified and treated, can be a valid therapeutic target for tinnitus; however, somatic screening of subjects for somatosensory tinnitus is imperative for correct selection of patients who would benefit from a multidisciplinary somatic approach.

Bipolar disorder and complementary medicine: current evidence, safety issues, and clinical considerations.

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Sarris, Jerome; Lake, James; Hoenders, Rogier

2011-10-01

Bipolar disorder (BD) is a debilitating syndrome that is often undiagnosed and undertreated. Population surveys show that persons with BD often self-medicate with complementary and alternative medicine (CAM) or integrative therapies in spite of limited research evidence supporting their use. To date, no review has focused specifically on nonconventional treatments of BD. The study objectives were to present a review of nonconventional (complementary and integrative) interventions examined in clinical trials on BD, and to offer provisional guidelines for the judicious integrative use of CAM in the management of BD. PubMed, CINAHL,(®) Web of Science, and Cochrane Library databases were searched for human clinical trials in English during mid-2010 using Bipolar Disorder and CAM therapy and CAM medicine search terms. Effect sizes (Cohen's d) were also calculated where data were available. Several positive high-quality studies on nutrients in combination with conventional mood stabilizers and antipsychotic medications in BD depression were identified, while branched-chain amino acids and magnesium were effective (small studies) in attenuating mania in BD. In the treatment of bipolar depression, evidence was mixed regarding omega-3, while isolated studies provide provisional support for a multinutrient formula, n-acetylcysteine, and l-tryptophan. In one study, acupuncture was found to have favorable but nonsignificant effects on mania and depression outcomes. Current evidence supports the integrative treatment of BD using combinations of mood stabilizers and select nutrients. Other CAM or integrative modalities used to treat BD have not been adequately explored to date; however, some early findings are promising. Select CAM and integrative interventions add to established conventional treatment of BD and may be considered when formulating a treatment plan. It is hoped that the safety issues and clinical considerations addressed in this article may encourage the practice

Evidence and effects of a wave-driven nonlinear current in the equatorial electrojet

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M. Oppenheim

1997-07-01

Full Text Available Ionospheric two-stream waves and gradient-drift waves nonlinearly drive a large-scale (D.C. current in the E-region ionosphere. This current flows parallel to, and with a comparable magnitude to, the fundamental Pedersen current. Evidence for the existence and magnitude of wave-driven currents derives from a theoretical understanding of E-region waves, supported by a series of nonlinear 2D simulations of two-stream waves and by data collected by rocket instruments in the equatorial electrojet. Wave-driven currents will modify the large-scale dynamics of the equatorial electrojet during highly active periods. A simple model shows how a wave-driven current appreciably reduces the horizontally flowing electron current of the electrojet. This reduction may account for the observation that type-I radar echoes almost always have a Doppler velocity close to the acoustic speed, and also for the rocket observation that electrojet regions containing gradient-drift waves do not appear also to contain horizontally propagating two-stream waves. Additionally, a simple model of a gradient-drift instability shows that wave-driven currents can cause nonsinusoidal electric fields similar to those measured in situ.

Can suitable candidates for levodopa/carbidopa intestinal gel therapy be identified using current evidence?

Directory of Open Access Journals (Sweden)

Maria José Catalán

2017-09-01

In recent years, strong evidence has supported the use of LCIG in treating motor fluctuations associated with APD, and several clinical studies provide emerging evidence for additional benefits of LCIG treatment in certain patients. This article provides an overview of the published literature on the benefits, limitations, and drawbacks of LCIG in relation to PD symptoms, the psychosocial impact of the disease, and the quality of life of patients, with the aim of determining candidates for whom treatment with LCIG would be beneficial. According to current evidence, patients with APD (defined as inability to achieve optimal control of the disease with conventional oral treatment, a relatively well-preserved cognitive-behavioral status, and good family/caregiver would count as suitable candidates for LCIG treatment. Contraindications in the opinion of the authors are severe dementia and active psychosis.

Safety of Transcranial Direct Current Stimulation: Evidence Based Update 2016.

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Bikson, Marom; Grossman, Pnina; Thomas, Chris; Zannou, Adantchede Louis; Jiang, Jimmy; Adnan, Tatheer; Mourdoukoutas, Antonios P; Kronberg, Greg; Truong, Dennis; Boggio, Paulo; Brunoni, André R; Charvet, Leigh; Fregni, Felipe; Fritsch, Brita; Gillick, Bernadette; Hamilton, Roy H; Hampstead, Benjamin M; Jankord, Ryan; Kirton, Adam; Knotkova, Helena; Liebetanz, David; Liu, Anli; Loo, Colleen; Nitsche, Michael A; Reis, Janine; Richardson, Jessica D; Rotenberg, Alexander; Turkeltaub, Peter E; Woods, Adam J

2016-01-01

This review updates and consolidates evidence on the safety of transcranial Direct Current Stimulation (tDCS). Safety is here operationally defined by, and limited to, the absence of evidence for a Serious Adverse Effect, the criteria for which are rigorously defined. This review adopts an evidence-based approach, based on an aggregation of experience from human trials, taking care not to confuse speculation on potential hazards or lack of data to refute such speculation with evidence for risk. Safety data from animal tests for tissue damage are reviewed with systematic consideration of translation to humans. Arbitrary safety considerations are avoided. Computational models are used to relate dose to brain exposure in humans and animals. We review relevant dose-response curves and dose metrics (e.g. current, duration, current density, charge, charge density) for meaningful safety standards. Special consideration is given to theoretically vulnerable populations including children and the elderly, subjects with mood disorders, epilepsy, stroke, implants, and home users. Evidence from relevant animal models indicates that brain injury by Direct Current Stimulation (DCS) occurs at predicted brain current densities (6.3-13 A/m(2)) that are over an order of magnitude above those produced by conventional tDCS. To date, the use of conventional tDCS protocols in human trials (≤40 min, ≤4 milliamperes, ≤7.2 Coulombs) has not produced any reports of a Serious Adverse Effect or irreversible injury across over 33,200 sessions and 1000 subjects with repeated sessions. This includes a wide variety of subjects, including persons from potentially vulnerable populations. Copyright © 2016 Elsevier Inc. All rights reserved.

The current evidence and implications of lingual orthodontics

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Pratap Saini

2016-01-01

Full Text Available The purpose of this review is to investigate the current evidence and implications of lingual orthodontics. The electronic database search was done on PubMed, Cochrane Library, Embase, EBSCOhost, Web of Knowledge, and Google Scholar reporting on appliance design, bonding, and laboratory setup, biomechanics, survey studies, case reports, and treatment outcomes to find the current evidence of lingual orthodontics. The evidence available on lingual orthodontics traces a very clear and predictable pattern. The 80′s was devoted to the limitation and progression of the concept; the 90′s to the comparison between labial and lingual and the evolution of laboratory technique and bracket system. The last decade focuses on innovations, the predictability of outcomes, the impact of white spot lesion, and the patient acceptability. This review also shows that biomechanical principles of lingual orthodontics are well understood and established today, any case that can be treated with labial orthodontic appliance, can also be treated effectively with lingual orthodontic appliance as the completely customized lingual appliance can provide predetermined treatment outcome.

Metastatic non-small cell lung cancer Current treatment based on evidence (ONCOL Group)

International Nuclear Information System (INIS)

Castro, Carlos; Cardona, Andres Felipe; Reveiz, Ludovic; Serrano, Silvia Juliana; Carranza, Hernan; Vargas, Carlos Alberto; Reguart, Noemi; Campo, Felipe; Ospina, Edgar Guillermo; Sanchez, Oswaldo; Torres, Diana; Otero, Jorge Miguel

2010-01-01

to perform a review of evidence about the treatment of non-small cell lung cancer (NSCLC). Source of data: the information was obtained from searches conducted in Medline, CCTR, Biosis, Embase, Lilacs and CINHAL. We also collected the most representative references presented during the last five years at Asco, ESMO and IASLC. Data extraction: data were extracted by associate members to the ONCOL Group. The collection of information did not follow a uniform strategy. Results of data synthesis: therapy for NSCLC can prolong survival and improve quality of life, but the majority of advanced stage patients dies due to disease progression within 2 years, meaning that there is room for improvement. The standard chemotherapy for NSCLC involves one of a number of platinum-based doublets that have been shown to improve survival when compared with single agents or best supportive care. These doublets are generally comparable in terms of efficacy, differing primarily in their toxicity profiles. However, encouraging new options may be approaching, including therapies targeted to specific patient subpopulations, and the use of combinations of current and new drugs to produce synergistic effects. This review present a detailed analysis of current evidence regarding the treatment of NSCLC based on a representative case series. This review didn't conduct a systematic evaluation of the evidence. Conclusion: medical therapy for NSCLC produces positive changes in main outcomes, including quality of life

Supporting decision-making processes for evidence-based mental health promotion.

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Jané-Llopis, Eva; Katschnig, Heinz; McDaid, David; Wahlbeck, Kristian

2011-12-01

The use of evidence is critical in guiding decision-making, but evidence from effect studies will be only one of a number of factors that will need to be taken into account in the decision-making processes. Equally important for policymakers will be the use of different types of evidence including implementation essentials and other decision-making principles such as social justice, political, ethical, equity issues, reflecting public attitudes and the level of resources available, rather than be based on health outcomes alone. This paper, aimed to support decision-makers, highlights the importance of commissioning high-quality evaluations, the key aspects to assess levels of evidence, the importance of supporting evidence-based implementation and what to look out for before, during and after implementation of mental health promotion and mental disorder prevention programmes.

Male circumcision for HIV prevention: current evidence and implementation in sub-Saharan Africa

Science.gov (United States)

2011-01-01

Heterosexual exposure accounts for most HIV transmission in sub-Saharan Africa, and this mode, as a proportion of new infections, is escalating globally. The scientific evidence accumulated over more than 20 years shows that among the strategies advocated during this period for HIV prevention, male circumcision is one of, if not, the most efficacious epidemiologically, as well as cost-wise. Despite this, and recommendation of the procedure by global policy makers, national implementation has been slow. Additionally, some are not convinced of the protective effect of male circumcision and there are also reports, unsupported by evidence, that non-sex-related drivers play a major role in HIV transmission in sub-Saharan Africa. Here, we provide a critical evaluation of the state of the current evidence for male circumcision in reducing HIV infection in light of established transmission drivers, provide an update on programmes now in place in this region, and explain why policies based on established scientific evidence should be prioritized. We conclude that the evidence supports the need to accelerate the implementation of medical male circumcision programmes for HIV prevention in generalized heterosexual epidemics, as well as in countering the growing heterosexual transmission in countries where HIV prevalence is presently low. PMID:22014096

Sulfonylureas in type 2 diabetes mellitus: current evidence, conflicts ...

African Journals Online (AJOL)

Introduction: We sought to explore the current state of evidence on sulfonylurea therapy in type 2 diabetes mellitus (T2DM) and critically examine the recommendations of major practice guidelines,and the overall ramifications of the issues thereof in current clinical practice. Method: We searched PUBMED, MEDLINE and ...

Current Guidelines Have Limited Applicability to Patients with Comorbid Conditions: A Systematic Analysis of Evidence-Based Guidelines

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Lugtenberg, Marjolein; Burgers, Jako S.; Clancy, Carolyn; Westert, Gert P.; Schneider, Eric C.

2011-01-01

Background Guidelines traditionally focus on the diagnosis and treatment of single diseases. As almost half of the patients with a chronic disease have more than one disease, the applicability of guidelines may be limited. The aim of this study was to assess the extent that guidelines address comorbidity and to assess the supporting evidence of recommendations related to comorbidity. Methodology/Principal Findings We conducted a systematic analysis of evidence-based guidelines focusing on four highly prevalent chronic conditions with a high impact on quality of life: chronic obstructive pulmonary disease, depressive disorder, diabetes mellitus type 2, and osteoarthritis. Data were abstracted from each guideline on the extent that comorbidity was addressed (general comments, specific recommendations), the type of comorbidity discussed (concordant, discordant), and the supporting evidence of the comorbidity-related recommendations (level of evidence, translation of evidence). Of the 20 guidelines, 17 (85%) addressed the issue of comorbidity and 14 (70%) provided specific recommendations on comorbidity. In general, the guidelines included few recommendations on patients with comorbidity (mean 3 recommendations per guideline, range 0 to 26). Of the 59 comorbidity-related recommendations provided, 46 (78%) addressed concordant comorbidities, 8 (14%) discordant comorbidities, and for 5 (8%) the type of comorbidity was not specified. The strength of the supporting evidence was moderate for 25% (15/59) and low for 37% (22/59) of the recommendations. In addition, for 73% (43/59) of the recommendations the evidence was not adequately translated into the guidelines. Conclusions/Significance Our study showed that the applicability of current evidence-based guidelines to patients with comorbid conditions is limited. Most guidelines do not provide explicit guidance on treatment of patients with comorbidity, particularly for discordant combinations. Guidelines should be more

Publication Voting Power (PVP): method of finding Evidence-Support

African Journals Online (AJOL)

Background: Extracting the best evidence that support a procedure is a difficult, time consuming task that needs expert statistical knowledge. A way to make weighting evidence more simple and straight for busy clinicians is needed. Methods: The publications about the procedure under question are lined in an ascending ...

Supporting Evidence-Informed Teaching in Biomedical and Health Professions Education Through Knowledge Translation: An Interdisciplinary Literature Review.

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Tractenberg, Rochelle E; Gordon, Morris

2017-01-01

Phenomenon: The purpose of "systematic" reviews/reviewers of medical and health professions educational research is to identify best practices. This qualitative article explores the question of whether systematic reviews can support "evidence informed" teaching and contrasts traditional systematic reviewing with a knowledge translation (KT) approach to this objective. Degrees of freedom analysis (DOFA) is used to examine the alignment of systematic review methods with educational research and the pedagogical strategies and approaches that might be considered with a decision-making framework developed to support valid assessment. This method is also used to explore how KT can be used to inform teaching and learning. The nature of educational research is not compatible with most (11/14) methods for systematic review. The inconsistency of systematic reviewing with the nature of educational research impedes both the identification and implementation of "best-evidence" pedagogy and teaching. This is primarily because research questions that do support the purposes of review do not support educational decision making. By contrast to systematic reviews of the literature, both a DOFA and KT are fully compatible with informing teaching using evidence. A DOFA supports the translation of theory to a specific teaching or learning case, so could be considered a type of KT. The DOFA results in a test of alignment of decision options with relevant educational theory, and KT leads to interventions in teaching or learning that can be evaluated. Examples of how to structure evaluable interventions are derived from a KT approach that are simply not available from a systematic review. Insights: Systematic reviewing of current empirical educational research is not suitable for deriving or supporting best practices in education. However, both "evidence-informed" and scholarly approaches to teaching can be supported as KT projects, which are inherently evaluable and can generate

Pedagogical Scholarship in Public Health: A Call for Cultivating Learning Communities to Support Evidence-Based Education.

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Merzel, Cheryl; Halkitis, Perry; Healton, Cheryl

Public health education is experiencing record growth and transformation. The current emphasis on learning outcomes necessitates attention to creating and evaluating the best curricula and learning methods for helping public health students develop public health competencies. Schools and programs of public health would benefit from active engagement in pedagogical research and additional platforms to support dissemination and implementation of educational research findings. We reviewed current avenues for sharing public health educational research, curricula, and best teaching practices; we identified useful models from other health professions; and we offered suggestions for how the field of public health education can develop communities of learning devoted to supporting pedagogy. Our goal was to help advance an agenda of innovative evidence-based public health education, enabling schools and programs of public health to evaluate and measure success in meeting the current and future needs of the public health profession.

Staff views on supporting evidence based practice for children with ASD.

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Trembath, David; Sulek, Rhylee; Paynter, Jessica; Simpson, Kate; Keen, Deb

2017-11-22

A variety of empirically supported interventions are available for children with autism spectrum disorder (ASD), but previous research suggests that their selection and use within an evidence-based practice (EBP) framework in clinical settings is challenging. To date, research has primarily focused on identifying individual, organisational, and contextual barriers to EBP rather than identifying collaborative solutions to these barriers through consultation with staff. The aim of our study was to explore staff views on supporting EBP in their work with children with ASD. We conducted five focus groups involving 29 professional (e.g., speech pathologists, teachers), paraprofessional (e.g., childcare workers), and managerial staff to explore their views. Audio recordings were transcribed verbatim and analysed using thematic analysis. Two central themes, comprising six categories, emerged to account for the participants' views. Initiative and Effort accounted for the range of creative strategies staff had developed to support their engagement in EBP. They also expressed the need for A Better Way involving organisational-wide support such as this engagement, including peer-to-peer mentoring. The findings suggest that an organisational-wide model to support engagement in EBP, with peer-to-peer mentoring at its foundation, may provide a desirable, ecologically valid, and acceptable model. Implications for Rehabilitation Clinicians and educators recognise the importance of evidence-based practice. Efforts to support evidence-based practice have focused mostly on access to research evidence. Clinicians and educators in this study were developing their own strategies based on intuition. They identified a need for organisation-wide approaches to supporting evidence-based practice. Peer-to-peer mentoring appears to be an acceptable and viable strategy.

Twelve evidence-based principles for implementing self-management support in primary care.

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Battersby, Malcolm; Von Korff, Michael; Schaefer, Judith; Davis, Connie; Ludman, Evette; Greene, Sarah M; Parkerton, Melissa; Wagner, Edward H

2010-12-01

Recommendations to improve self-management support and health outcomes for people with chronic conditions in primary care settings are provided on the basis of expert opinion supported by evidence for practices and processes. Practices and processes that could improve self-management support in primary care were identified through a nominal group process. In a targeted search strategy, reviews and meta-analyses were then identifed using terms from a wide range of chronic conditions and behavioral risk factors in combination with Self-Care, Self-Management, and Primary Care. On the basis of these reviews, evidence-based principles for self-management support were developed. The evidence is organized within the framework of the Chronic Care Model. Evidence-based principles in 12 areas were associated with improved patient self-management and/or health outcomes: (1) brief targeted assessment, (2) evidence-based information to guide shared decision-making, (3) use of a nonjudgmental approach, (4) collaborative priority and goal setting, (5) collaborative problem solving, (6) self-management support by diverse providers, (7) self-management interventions delivered by diverse formats, (8) patient self-efficacy, (9) active followup, (10) guideline-based case management for selected patients, (11) linkages to evidence-based community programs, and (12) multifaceted interventions. A framework is provided for implementing these principles in three phases of the primary care visit: enhanced previsit assessment, a focused clinical encounter, and expanded postvisit options. There is a growing evidence base for how self-management support for chronic conditions can be integrated into routine health care.

Current clinical evidence on pioglitazone pharmacogenomics

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Marina eKawaguchi-Suzuki

2013-11-01

Full Text Available Pioglitazone is the most widely used thiazolidinedione and acts as an insulin-sensitizer through activation of the Peroxisome Proliferator-Activated Receptor-γ (PPARγ. Pioglitazone is approved for use in the management of type 2 diabetes mellitus, but its use in other therapeutic areas is increasing due to pleiotropic effects. In this hypothesis article, the current clinical evidence on pioglitazone pharmacogenomics is summarized and related to variability in pioglitazone response. How genetic variation in the human genome affects the pharmacokinetics and pharmacodynamics of pioglitazone was examined. For pharmacodynamic effects, hypoglycemic and anti-atherosclerotic effects, risks of fracture or edema, and the increase in body mass index in response to pioglitazone based on genotype were examined. The genes CYP2C8 and PPARG are the most extensively studied to date and selected polymorphisms contribute to respective variability in pioglitazone pharmacokinetics and pharmacodynamics. We hypothesized that genetic variation in pioglitazone pathway genes contributes meaningfully to the clinically observed variability in drug response. To test the hypothesis that genetic variation in PPARG associates with variability in pioglitazone response, we conducted a meta-analysis to synthesize the currently available data on the PPARG p.Pro12Ala polymorphism. The results showed that PPARG 12Ala carriers had a more favorable change in fasting blood glucose from baseline as compared to patients with the wild-type Pro12Pro genotype (p=0.018. Unfortunately, findings for many other genes lack replication in independent cohorts to confirm association; further studies are needed. Also, the biological functionality of these polymorphisms is unknown. Based on current evidence, we propose that pharmacogenomics may provide an important tool to individualize pioglitazone therapy and better optimize therapy in patients with T2DM or other conditions for which pioglitazone

What supports do health system organizations have in place to facilitate evidence-informed decision-making? A qualitative study.

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Ellen, Moriah E; Léon, Gregory; Bouchard, Gisèle; Lavis, John N; Ouimet, Mathieu; Grimshaw, Jeremy M

2013-08-06

Decisions regarding health systems are sometimes made without the input of timely and reliable evidence, leading to less than optimal health outcomes. Healthcare organizations can implement tools and infrastructures to support the use of research evidence to inform decision-making. The purpose of this study was to profile the supports and instruments (i.e., programs, interventions, instruments or tools) that healthcare organizations currently have in place and which ones were perceived to facilitate evidence-informed decision-making. In-depth semi-structured telephone interviews were conducted with individuals in three different types of positions (i.e., a senior management team member, a library manager, and a 'knowledge broker') in three types of healthcare organizations (i.e., regional health authorities, hospitals and primary care practices) in two Canadian provinces (i.e., Ontario and Quebec). The interviews were taped, transcribed, and then analyzed thematically using NVivo 9 qualitative data analysis software. A total of 57 interviews were conducted in 25 organizations in Ontario and Quebec. The main findings suggest that, for the healthcare organizations that participated in this study, the following supports facilitate evidence-informed decision-making: facilitating roles that actively promote research use within the organization; establishing ties to researchers and opinion leaders outside the organization; a technical infrastructure that provides access to research evidence, such as databases; and provision and participation in training programs to enhance staff's capacity building. This study identified the need for having a receptive climate, which laid the foundation for the implementation of other tangible initiatives and supported the use of research in decision-making. This study adds to the literature on organizational efforts that can increase the use of research evidence in decision-making. Some of the identified supports may increase the use of

Scientific Evidence on the Supportive Cancer Care with Chinese Medicine

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William CS CHO

2010-03-01

Full Text Available Complementary and alternative medicine has been increasingly utilized by cancer patients in developed countries. Among the various forms of complementary and alternative medicine, Traditional Chinese Medicine is one of the few that has a well constructed theoretical framework and established treatment approaches for diseases including cancer. Recent research has revealed growing evidence suggesting that Traditional Chinese Medicine is effective in the supportive care of cancer patients during and after major conventional cancer treatments. This paper succinctly summarizes some published clinical evidence and meta-analyses which support the usage of various Traditional Chinese Medicine treatment strategies including Chinese herbal medicine, acupuncture and Qigong in supportive cancer care.

Barriers, facilitators and views about next steps to implementing supports for evidence-informed decision-making in health systems: a qualitative study.

Science.gov (United States)

Ellen, Moriah E; Léon, Grégory; Bouchard, Gisèle; Ouimet, Mathieu; Grimshaw, Jeremy M; Lavis, John N

2014-12-05

Mobilizing research evidence for daily decision-making is challenging for health system decision-makers. In a previous qualitative paper, we showed the current mix of supports that Canadian health-care organizations have in place and the ones that are perceived to be helpful to facilitate the use of research evidence in health system decision-making. Factors influencing the implementation of such supports remain poorly described in the literature. Identifying the barriers to and facilitators of different interventions is essential for implementation of effective, context-specific, supports for evidence-informed decision-making (EIDM) in health systems. The purpose of this study was to identify (a) barriers and facilitators to implementing supports for EIDM in Canadian health-care organizations, (b) views about emerging development of supports for EIDM, and (c) views about the priorities to bridge the gaps in the current mix of supports that these organizations have in place. This qualitative study was conducted in three types of health-care organizations (regional health authorities, hospitals, and primary care practices) in two Canadian provinces (Ontario and Quebec). Fifty-seven in-depth semi-structured telephone interviews were conducted with senior managers, library managers, and knowledge brokers from health-care organizations that have already undertaken strategic initiatives in knowledge translation. The interviews were taped, transcribed, and then analyzed thematically using NVivo 9 qualitative data analysis software. Limited resources (i.e., money or staff), time constraints, and negative attitudes (or resistance) toward change were the most frequently identified barriers to implementing supports for EIDM. Genuine interest from health system decision-makers, notably their willingness to invest money and resources and to create a knowledge translation culture over time in health-care organizations, was the most frequently identified facilitator to

Working group reports: evaluation of the evidence to support practice guidelines for nutritional care of preterm infants-the Pre-B Project.

Science.gov (United States)

Raiten, Daniel J; Steiber, Alison L; Carlson, Susan E; Griffin, Ian; Anderson, Diane; Hay, William W; Robins, Sandra; Neu, Josef; Georgieff, Michael K; Groh-Wargo, Sharon; Fenton, Tanis R

2016-02-01

The "Evaluation of the Evidence to Support Practice Guidelines for the Nutritional Care of Preterm Infants: The Pre-B Project" is the first phase in a process to present the current state of knowledge and to support the development of evidence-informed guidance for the nutritional care of preterm and high-risk newborn infants. The future systematic reviews that will ultimately provide the underpinning for guideline development will be conducted by the Academy of Nutrition and Dietetics' Evidence Analysis Library (EAL). To accomplish the objectives of this first phase, the Pre-B Project organizers established 4 working groups (WGs) to address the following themes: 1) nutrient specifications for preterm infants, 2) clinical and practical issues in enteral feeding of preterm infants, 3) gastrointestinal and surgical issues, and 4) current standards of infant feeding. Each WG was asked to 1) develop a series of topics relevant to their respective themes, 2) identify questions for which there is sufficient evidence to support a systematic review process conducted by the EAL, and 3) develop a research agenda to address priority gaps in our understanding of the role of nutrition in health and development of preterm/neonatal intensive care unit infants. This article is a summary of the reports from the 4 Pre-B WGs. © 2016 American Society for Nutrition.

Proposal of a Holistic Model to Support Local-Level Evidence-Based Practice

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Said Shahtahmasebi

2010-01-01

Full Text Available In response to a central drive for evidence-based practice, there have been many research support schemes, setups, and other practices concentrating on facilitating access to external research, such as the Centre for Evidence Based Healthcare Aotearoa, the Cochrane Collaboration, and the York Centre for Reviews and Dissemination. Very little attention has been paid to supporting internal research in terms of local evidence and internal research capabilities. The whole evidence-based practice movement has alienated internal decision makers and, thus, very little progress has been made in the context of evidence informing local policy formation. Health and social policies are made centrally based on dubious claims and often evidence is sought after implementation. For example, on record, most health care practitioners appear to agree with the causal link between depression and mental illness (sometimes qualified with other social factors with suicide; off the record, even some psychiatrists doubt that such a link is applicable to the population as a whole. Therefore, be it through misplaced loyalty or a lack of support for internal researchers/decision makers, local evidence informing local decision making may have been ignored in favour of external evidence. In this paper, we present a practical holistic model to support local evidence-based decision making. This approach is more relevant in light of a new approach to primary health care of “local knowledge” complementing external evidence. One possible outcome would be to network with other regional programmes around the world to share information and identify “best” practices, such as the “Stop Youth Suicide Campaign”(www.stopyouthsuicide.com.

Culture, mind, and the brain: current evidence and future directions.

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Kitayama, Shinobu; Uskul, Ayse K

2011-01-01

Current research on culture focuses on independence and interdependence and documents numerous East-West psychological differences, with an increasing emphasis placed on cognitive mediating mechanisms. Lost in this literature is a time-honored idea of culture as a collective process composed of cross-generationally transmitted values and associated behavioral patterns (i.e., practices). A new model of neuro-culture interaction proposed here addresses this conceptual gap by hypothesizing that the brain serves as a crucial site that accumulates effects of cultural experience, insofar as neural connectivity is likely modified through sustained engagement in cultural practices. Thus, culture is "embrained," and moreover, this process requires no cognitive mediation. The model is supported in a review of empirical evidence regarding (a) collective-level factors involved in both production and adoption of cultural values and practices and (b) neural changes that result from engagement in cultural practices. Future directions of research on culture, mind, and the brain are discussed.

Supporting Implementation of Evidence-Based Practices through Practice-Based Coaching

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Snyder, Patricia A.; Hemmeter, Mary Louise; Fox, Lise

2015-01-01

In active implementation science frameworks, coaching has been described as an important competency "driver" to ensure evidence-based practices are implemented as intended. Empirical evidence also has identified coaching as a promising job-embedded professional development strategy to support implementation of quality teaching practices.…

When Is Statistical Evidence Superior to Anecdotal Evidence in Supporting Probability Claims? The Role of Argument Type

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Hoeken, Hans; Hustinx, Lettica

2009-01-01

Under certain conditions, statistical evidence is more persuasive than anecdotal evidence in supporting a claim about the probability that a certain event will occur. In three experiments, it is shown that the type of argument is an important condition in this respect. If the evidence is part of an argument by generalization, statistical evidence…

Capnography during cardiopulmonary resuscitation: Current evidence and future directions

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Bhavani Shankar Kodali

2014-01-01

Full Text Available Capnography continues to be an important tool in measuring expired carbon dioxide (CO 2 . Most recent Advanced Cardiac Life Support (ACLS guidelines now recommend using capnography to ascertain the effectiveness of chest compressions and duration of cardiopulmonary resuscitation (CPR. Based on an extensive review of available published literature, we selected all available peer-reviewed research investigations and case reports. Available evidence suggests that there is significant correlation between partial pressure of end-tidal CO 2 (PETCO 2 and cardiac output that can indicate the return of spontaneous circulation (ROSC. Additional evidence favoring the use of capnography during CPR includes definitive proof of correct placement of the endotracheal tube and possible prediction of patient survival following cardiac arrest, although the latter will require further investigations. There is emerging evidence that PETCO 2 values can guide the initiation of extracorporeal life support (ECLS in refractory cardiac arrest (RCA. There is also increasing recognition of the value of capnography in intensive care settings in intubated patients. Future directions include determining the outcomes based on capnography waveforms PETCO 2 values and determining a reasonable duration of CPR. In the future, given increasing use of capnography during CPR large databases can be analyzed to predict outcomes.

Hippocampal declarative memory supports gesture production: Evidence from amnesia.

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Hilverman, Caitlin; Cook, Susan Wagner; Duff, Melissa C

2016-12-01

Spontaneous co-speech hand gestures provide a visuospatial representation of what is being communicated in spoken language. Although it is clear that gestures emerge from representations in memory for what is being communicated (De Ruiter, 1998; Wesp, Hesse, Keutmann, & Wheaton, 2001), the mechanism supporting the relationship between gesture and memory is unknown. Current theories of gesture production posit that action - supported by motor areas of the brain - is key in determining whether gestures are produced. We propose that when and how gestures are produced is determined in part by hippocampally-mediated declarative memory. We examined the speech and gesture of healthy older adults and of memory-impaired patients with hippocampal amnesia during four discourse tasks that required accessing episodes and information from the remote past. Consistent with previous reports of impoverished spoken language in patients with hippocampal amnesia, we predicted that these patients, who have difficulty generating multifaceted declarative memory representations, may in turn have impoverished gesture production. We found that patients gestured less overall relative to healthy comparison participants, and that this was particularly evident in tasks that may rely more heavily on declarative memory. Thus, gestures do not just emerge from the motor representation activated for speaking, but are also sensitive to the representation available in hippocampal declarative memory, suggesting a direct link between memory and gesture production. Copyright © 2016 Elsevier Ltd. All rights reserved.

Educating physicians in evidence based medicine: current practices and curricular strategies

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Maggio, L.A.

2015-01-01

Evidence based medicine (EBM) is “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients.” The practice of EBM is an expectation of professional healthcare and requisite component in many medical school curricula. Yet, despite

Integration of evidence-based practice in bedside teaching paediatrics supported by e-learning.

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Potomkova, Jarmila; Mihal, Vladimir; Zapletalova, Jirina; Subova, Dana

2010-03-01

Bedside teaching with evidence-based practice elements, supported by e-learning activities, can play an important role in modern medical education. Teachers have to incorporate evidence from the medical literature to increase student motivation and interactivity. An integral part of the medical curricula at Palacky University Olomouc (Czech Republic) are real paediatric scenarios supplemented with a review of current literature to enhance evidence-based bedside teaching & learning. Searching for evidence is taught through librarian-guided interactive hands-on sessions and/or web-based tutorials followed by clinical case presentations and feedback. Innovated EBM paediatric clerkship demonstrated students' preferences towards web-based interactive bedside teaching & learning. In two academic years (2007/2008, 2008/2009), learning-focused feedback from 106 and 131 students, resp. was obtained about their attitudes towards evidence-based bedside teaching. The assessment included among others the overall level of instruction, quality of practical evidence-based training, teacher willingness and impact of instruction on increased interest in the specialty. There was some criticism about excessive workload. A parallel survey was carried out on the perceived values of different forms of information skills training (i.e. demonstration, online tutorials, and librarian-guided interactive search sessions) and post-training self-reported level of search skills. The new teaching/learning paediatric portfolio is a challenge for further activities, including effective knowledge translation, continuing medical & professional development of teachers, and didactic, clinically integrated teaching approaches.

Are advertisements in dental journals supported by an appropriate evidence-base?

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Chestnutt, Ivor G; Hardy, Robert

2013-09-01

Dental professionals are constantly exposed to advertisements in the dental literature. These promote products, either for use in the operatory or to recommend to patients. In an era of evidence-based practice, what references are provided to support claims made by the advertisers? This study aimed to determine if advertisements in four major dental journals, whose target audience is general dental practitioners, were supported by an appropriate evidence-base, readily accessible to readers. The 2010 printed volumes of the Australian Dental Journal, British Dental Journal, Dental Update and the Journal of the American Dental Association were hand searched to identify advertisements which made a claim of clinical benefit or superiority to competing products. Advertisements were categorized according to type of product being promoted and the availability, nature and number of any supporting references was recorded. Repeated advertisements were analyzed only once. A total of 390 advertisements were identified and 369 made a claim of benefit or superiority. When the 222 duplicates of the same advertisement were removed, 147 unique advertisements remained. Of these: 54 (37%) were advertisements related to dental devices for in-surgery use; 44 (30%) for dental materials, and 27 (18%) for dentifrices/medicaments. 113 (76.9%) advertisements offered no evidential support for claims made. Of the 34 advertisements that provided evidential support, only 20 provided a complete reference that could readily be sourced by an interested reader: 15 articles in refereed journals; 5 data on file; 3 in-house studies and combinations thereof. Four references were not accessible due to incomplete referencing. Two advertisements provided evidence that was not relevant to the product being advertised. The majority of advertisements in the dental literature do not provide an adequate evidence-base, readily available to readers, to support the claims being made. If evidence-based practice is

ICU nurses' oral-care practices and the current best evidence.

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DeKeyser Ganz, Freda; Fink, Naomi Farkash; Raanan, Ofra; Asher, Miriam; Bruttin, Madeline; Nun, Maureen Ben; Benbinishty, Julie

2009-01-01

The purpose of this study was to describe the oral-care practices of ICU nurses, to compare those practices with current evidence-based practice, and to determine if the use of evidence-based practice was associated with personal demographic or professional characteristics. A national survey of oral-care practices of ICU nurses was conducted using a convenience sample of 218 practicing ICU nurses in 2004-05. The survey instrument included questions about demographic and professional characteristics and a checklist of oral-care practices. Nurses rated their perceived level of priority concerning oral care on a scale from 0 to 100. A score was computed representing the sum of 14 items related to equipment, solutions, assessments, and techniques associated with the current best evidence. This score was then statistically analyzed using ANOVA to determine differences of EBP based on demographic and professional characteristics. The most commonly used equipment was gauze pads (84%), followed by tongue depressors (55%), and toothbrushes (34%). Chlorhexidine was the most common solution used (75%). Less than half (44%) reported brushing their patients' teeth. The majority performed an oral assessment before beginning oral care (71%); however, none could describe what assessment tool was used. Only 57% of nurses reported documenting their oral care. Nurses rated oral care of intubated patients with a priority of 67+/-27.1. Wide variations were noted within and between units in terms of which techniques, equipment, and solutions were used. No significant relationships were found between the use of an evidence-based protocol and demographic and professional characteristics or with the priority given to oral care. While nurses ranked oral care a high priority, many did not implement the latest evidence into their current practice. The level of research utilization was not related to personal or professional characteristics. Therefore attempts should be made to encourage all

Role of Environmental Chemicals in Obesity: A Systematic Review on the Current Evidence

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Roya Kelishadi

2013-01-01

Full Text Available The purpose of this paper is to systematically review the experimental and human studies on obesogenic chemicals and their mechanisms of action to provide a comprehensive view on the multifactorial aspects of obesity. The literatures were searched in available databases. The relevant papers were selected in three phases. After quality assessment, two reviewers extracted the data while another checked their extracted data. In this review, we summarized information regarding environmental chemicals that can be associated with obesity. Most evidence comes from experimental and laboratory studies; however a growing number of human studies also support the role of obesogenic chemicals. The current evidence proposes that the systemic responses to exposure to environmental factors could potentially increase the risk of excess weight. The effects of exposure to these chemicals are of crucial importance during developmental phases of life, when preprogramming for an adipogenic outcome may occur. By considering the adverse transgenerational effects of obesogen chemicals on human health, the global obesity epidemic should be considered as a multifactorial complex disorder necessitating the emphasis of public health interventions for environmental protection.

Organizational Supports for Research Evidence Use in State Public Health Agencies: A Latent Class Analysis.

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Hu, Hengrui; Allen, Peg; Yan, Yan; Reis, Rodrigo S; Jacob, Rebekah R; Brownson, Ross C

2018-05-30

Use of research evidence in public health decision making can be affected by organizational supports. Study objectives are to identify patterns of organizational supports and explore associations with research evidence use for job tasks among public health practitioners. In this longitudinal study, we used latent class analysis to identify organizational support patterns, followed by mixed logistic regression analysis to quantify associations with research evidence use. The setting included 12 state public health department chronic disease prevention units and their external partnering organizations involved in chronic disease prevention. Chronic disease prevention staff from 12 US state public health departments and partnering organizations completed self-report surveys at 2 time points, in 2014 and 2016 (N = 872). Latent class analysis was employed to identify subgroups of survey participants with distinct patterns of perceived organizational supports. Two classify-analyze approaches (maximum probability assignment and multiple pseudo-class draws) were used in 2017 to investigate the association between latent class membership and research evidence use. The optimal model identified 4 latent classes, labeled as "unsupportive workplace," "low agency leadership support," "high agency leadership support," and "supportive workplace." With maximum probability assignment, participants in "high agency leadership support" (odds ratio = 2.08; 95% CI, 1.35-3.23) and "supportive workplace" (odds ratio = 1.74; 95% CI, 1.10-2.74) were more likely to use research evidence in job tasks than "unsupportive workplace." The multiple pseudo-class draws produced comparable results with odds ratio = 2.09 (95% CI, 1.31-3.30) for "high agency leadership support" and odds ratio = 1.74 (95% CI, 1.07-2.82) for "supportive workplace." Findings suggest that leadership support may be a crucial element of organizational supports to encourage research evidence use. Organizational supports such

Current therapeutic interventions in the glycation pathway: evidence from clinical studies.

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Engelen, L; Stehouwer, C D A; Schalkwijk, C G

2013-08-01

The increased formation of advanced glycation endproducts (AGEs) constitutes a potential mechanism of hyperglycaemia-induced micro- and macrovascular disease in diabetes. In vitro and animal experiments have shown that various interventions can inhibit formation and/or actions of AGEs, in particular the specific AGE inhibitor aminoguanidine and the AGEs crosslink breaker alagebrium, and the B vitamins pyridoxamine and thiamine, and the latter's synthetic derivative, benfotiamine. The potential clinical value of these interventions, however, remains to be established. The present review provides, from the clinical point of view, an overview of current evidence on interventions in the glycation pathway relating to (i) the clinical benefits of specific AGE inhibitors and AGE breakers and (ii) the potential AGE-inhibiting effects of therapies developed for purposes unrelated to the glycation pathway. We found that safety and/or efficacy in clinical studies with the specific AGE inhibitor, aminoguanidine and the AGE breaker, alagebrium, appeared to be a concern. The clinical evidence on the potential AGE-inhibiting effects of B vitamins is still limited. Finally, current evidence for AGE inhibition by therapies developed for purposes unrelated to glycation is limited due to a large heterogeneity in study designs and/or measurement techniques, which have often been sub-optimal. We conclude that, clinical evidence on interventions to inhibit formation and/or action of AGEs is currently weak and unconvincing. © 2012 Blackwell Publishing Ltd.

Are claims made in orthodontic journal advertisements evidence-supported?

NARCIS (Netherlands)

Livas, Christos; Kouskoura, Thaleia; Ren, Yijin; Katsaros, Christos; Pandis, Nikolaos

Objective: To examine the supporting evidence of advertisements published in six leading orthodontic journals. Materials and Methods: The 2012-2013 printed issues of American Journal of Orthodontics and Dentofacial Orthopedics, Australian Orthodontic Journal, Journal of Orthodontics, European

Neonatal non-invasive respiratory support: synchronised NIPPV, non-synchronised NIPPV or bi-level CPAP: what is the evidence in 2013?

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Roberts, C T; Davis, P G; Owen, L S

2013-01-01

Nasal continuous positive airway pressure (NCPAP) has proven to be an effective mode of non-invasive respiratory support in preterm infants; however, many infants still require endotracheal ventilation, placing them at an increased risk of morbidities such as bronchopulmonary dysplasia. Several other modes of non-invasive respiratory support beyond NCPAP, including synchronised and non-synchronised nasal intermittent positive pressure ventilation (SNIPPV and nsNIPPV) and bi-level positive airway pressure (BiPAP) are now also available. These techniques require different approaches, and the exact mechanisms by which they act remain unclear. SNIPPV has been shown to reduce the rate of reintubation in comparison to NCPAP when used as post-extubation support, but the evidence for nsNIPPV and BiPAP in this context is less convincing. There is some evidence that NIPPV (whether synchronised or non-synchronised) used as primary respiratory support is beneficial, but the variation in study methodology makes this hard to translate confidently into clinical practice. There is currently no evidence to suggest a reduction in mortality or important morbidities such as bronchopulmonary dysplasia, with NIPPV or BiPAP in comparison to NCPAP, and there is a lack of appropriately designed studies in this area. This review discusses the different approaches and proposed mechanisms of action of SNIPPV, nsNIPPV and BiPAP, the challenges of applying the available evidence for these distinct modalities of non-invasive respiratory support to clinical practice, and possible areas of future research. © 2013 S. Karger AG, Basel.

A multi-site randomised controlled trial of evidence-based supported employment for adults with severe and persistent mental illness.

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Waghorn, Geoffrey; Dias, Shannon; Gladman, Beverley; Harris, Meredith; Saha, Sukanta

2014-12-01

The Individual Placement and Support (IPS) approach is an evidence-based form of supported employment for people with severe and persistent mental illness. This approach is not yet widely available in Australia even though there is mounting evidence of its generalisability outside the USA. One previous Australian randomised controlled trial found that IPS is effective for young people with first episode psychosis. The aim of the current trial was to assess the effectiveness of evidence-based supported employment when implemented for Australian adult consumers of public mental health services by utilising existing service systems. A four-site randomised control trial design (n = 208) was conducted in Brisbane (two sites), Townsville and Cairns. The intervention consisted of an IPS supported employment service hosted by a community mental health team. The control condition was delivered at each site by mental health teams referring consumers to other disability employment services in the local area. At 12 months, those in the IPS condition had 2.4 times greater odds of commencing employment than those in the control condition (42.5% vs. 23.5%). The conditions did not differ on secondary employment outcomes including job duration, hours worked, or job diversity. Attrition was higher than expected in both conditions with 28.4% completing the baseline interview but taking no further part in the study. The results support previous international findings that IPS-supported employment is more effective than non-integrated supported employment. IPS can be successfully implemented this way in Australia, but with a loss of effect strength compared to previous USA trials. © 2014 Occupational Therapy Australia.

What evidence and support do state-level public health practitioners need to address obesity prevention.

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Leeman, Jennifer; Teal, Randall; Jernigan, Jan; Reed, Jenica Huddleston; Farris, Rosanne; Ammerman, Alice

2014-01-01

Obesity has reached epidemic proportions. Public health practitioners are distinctly positioned to promote the environmental changes essential to addressing obesity. The Centers for Disease Control and Prevention (CDC) and other entities provide evidence and technical assistance to support this work, yet little is known about how practitioners use evidence and support as they intervene to prevent obesity. The study's purpose was to describe how practitioners and CDC project officers characterized the obesity prevention task, where practitioners accessed support and evidence, and what approaches to support and evidence they found most useful. APPROACH OR DESIGN: Mixed-methods, cross-sectional interviews, and survey. State-level public health obesity prevention programs. Public health practitioners and CDC project officers. We conducted 10 in-depth interviews with public health practitioners (n = 7) and project officers (n = 3) followed by an online survey completed by 62 practitioners (50% response rate). We applied content analysis to interview data and descriptive statistics to survey data. Practitioners characterized obesity prevention as uncertain and complex, involving interdependence among actors, multiple levels of activity, an excess of information, and a paucity of evidence. Survey findings provide further detail on the types of evidence and support practitioners used and valued. We recommend approaches to tailoring evidence and support to the needs of practitioners working on obesity prevention and other complex health problems.

Minimally Invasive Transforaminal Lumbar Interbody Fusion: A Perspective on Current Evidence and Clinical Knowledge

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Ali Habib

2012-01-01

Full Text Available This paper reviews the current published data regarding open transforaminal lumbar interbody fusion (TLIF in relation to minimally invasive transforaminal lumbar interbody fusion (MI-TLIF. Introduction. MI-TLIF, a modern method for lumbar interbody arthrodesis, has allowed for a minimally invasive method to treat degenerative spinal pathologies. Currently, there is limited literature that compares TLIF directly to MI-TLIF. Thus, we seek to discuss the current literature on these techniques. Methods. Using a PubMed search, we reviewed recent publications of open and MI-TLIF, dating from 2002 to 2012. We discussed these studies and their findings in this paper, focusing on patient-reported outcomes as well as complications. Results. Data found in 14 articles of the literature was analyzed. Using these reports, we found mean follow-up was 20 months. The mean patient study size was 52. Seven of the articles directly compared outcomes of open TLIF with MI-TLIF, such as mean duration of surgery, length of post-operative stay, blood loss, and complications. Conclusion. Although high-class data comparing these two techniques is lacking, the current evidence supports MI-TLIF with outcomes comparable to that of the traditional, open technique. Further prospective, randomized studies will help to further our understanding of this minimally invasive technique.

ADDIS: A decision support system for evidence-based medicine

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G. van Valkenhoef (Gert); T. Tervonen (Tommi); T. Zwinkels (Tijs); B. de Brock (Bert); H.L. Hillege (Hans)

2013-01-01

textabstractClinical trials are the main source of information for the efficacy and safety evaluation of medical treatments. Although they are of pivotal importance in evidence-based medicine, there is a lack of usable information systems providing data-analysis and decision support capabilities for

Diffuse layer effects on the current in galvanic cells containing supporting electrolyte

Energy Technology Data Exchange (ETDEWEB)

Soestbergen, M. van, E-mail: m.vansoestbergen@tudelft.n [Materials Innovation Institute, Mekelweg 2, 2628 CD Delft (Netherlands); Department of Precision and Microsystems Engineering, University of Technology Delft, Mekelweg 2, 2628 CD Delft (Netherlands)

2010-02-01

We study the effect of an inert supporting electrolyte on the steady-state ionic current through galvanic cells by solving the full Poisson-Nernst-Planck transport equation coupled to the generalized Frumkin-Butler-Volmer boundary equation for the electrochemical charge transfer at the electrodes. Consequently, the model presented here allows for non-zero space charge densities locally at the electrodes, thus extending the frequently used models based on the local electroneutrality condition by including diffuse layer (DL) effects. This extension is necessary since the DLs determine the ion concentration and electrical field at the reaction planes, which uniquely determine the charge transfer at the electrodes. In this work we present numerical results for systems which contain added inert supporting electrolyte using finite element discretization and compare those with semi-analytical results obtained using singular perturbation theory (limit of negligibly thin DLs). In case of negligibly thin DLs the presence of supporting electrolyte will introduce a limiting current below the classical diffusion-limiting current. Just as for systems without supporting electrolyte, the supporting electrolyte induced limiting current formally does not occur for systems having non-negligibly thin double DLs. For thin, however still finite, double layers this limit can still be seen as a steepening of the polarization curve for current vs. voltage.

Diffuse layer effects on the current in galvanic cells containing supporting electrolyte

International Nuclear Information System (INIS)

Soestbergen, M. van

2010-01-01

We study the effect of an inert supporting electrolyte on the steady-state ionic current through galvanic cells by solving the full Poisson-Nernst-Planck transport equation coupled to the generalized Frumkin-Butler-Volmer boundary equation for the electrochemical charge transfer at the electrodes. Consequently, the model presented here allows for non-zero space charge densities locally at the electrodes, thus extending the frequently used models based on the local electroneutrality condition by including diffuse layer (DL) effects. This extension is necessary since the DLs determine the ion concentration and electrical field at the reaction planes, which uniquely determine the charge transfer at the electrodes. In this work we present numerical results for systems which contain added inert supporting electrolyte using finite element discretization and compare those with semi-analytical results obtained using singular perturbation theory (limit of negligibly thin DLs). In case of negligibly thin DLs the presence of supporting electrolyte will introduce a limiting current below the classical diffusion-limiting current. Just as for systems without supporting electrolyte, the supporting electrolyte induced limiting current formally does not occur for systems having non-negligibly thin double DLs. For thin, however still finite, double layers this limit can still be seen as a steepening of the polarization curve for current vs. voltage.

Does Current Scientific Evidence Support a Link Between Light at Night and Breast Cancer Among Female Night-Shift Nurses?

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Dickerman, Barbra; Liu, Jianghong

2014-01-01

Breast cancer is increasingly prevalent in industrialized regions of the world, and exposure to light at night (LAN) has been proposed as a potential risk factor. Epidemiological observations have documented an increased breast cancer risk among female night-shift workers, and strong experimental evidence for this relationship has also been found in rodent models. Indirect support for the LAN hypothesis comes from studies involving blind women, sleep duration, bedroom light levels, and community nighttime light levels. This article reviews the literature, discusses possible mechanisms of action, and provides recommendations for occupational health nursing research, practice, and education. Research is needed to further explore the relationship between exposure to LAN and breast cancer risk and elucidate the mechanisms underlying this relationship before interventions can be designed for prevention and mitigation of breast cancer. PMID:22658734

Delivering "Just-In-Time" Smoking Cessation Support Via Mobile Phones: Current Knowledge and Future Directions.

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Naughton, Felix

2016-05-28

Smoking lapses early on during a quit attempt are highly predictive of failing to quit. A large proportion of these lapses are driven by cravings brought about by situational and environmental cues. Use of cognitive-behavioral lapse prevention strategies to combat cue-induced cravings is associated with a reduced risk of lapse, but evidence is lacking in how these strategies can be effectively promoted. Unlike most traditional methods of delivering behavioral support, mobile phones can in principle deliver automated support, including lapse prevention strategy recommendations, Just-In-Time (JIT) for when a smoker is most vulnerable, and prevent early lapse. JIT support can be activated by smokers themselves (user-triggered), by prespecified rules (server-triggered) or through sensors that dynamically monitor a smoker's context and trigger support when a high risk environment is sensed (context-triggered), also known as a Just-In-Time Adaptive Intervention (JITAI). However, research suggests that user-triggered JIT cessation support is seldom used and existing server-triggered JIT support is likely to lack sufficient accuracy to effectively target high-risk situations in real time. Evaluations of mobile phone cessation interventions that include user and/or server-triggered JIT support have yet to adequately assess whether this improves management of high risk situations. While context-triggered systems have the greatest potential to deliver JIT support, there are, as yet, no impact evaluations of such systems. Although it may soon be feasible to learn about and monitor a smoker's context unobtrusively using their smartphone without burdensome data entry, there are several potential advantages to involving the smoker in data collection. This commentary describes the current knowledge on the potential for mobile phones to deliver automated support to help smokers manage or cope with high risk environments or situations for smoking, known as JIT support. The article

NICU nurse educators: what evidence supports your teaching strategies?

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Pilcher, Jobeth

2013-01-01

One of our roles as nurse educators is to teach best practices related to patient care. However, have you ever stopped to think about what evidence supports your teaching strategies? Just as our patients deserve care that is based on the best available evidence, our learners also deserve education that is based on evidence.1-3 With so many advances in knowledge, technology, and even life itself, it is interesting that education has changed very little over the past 100 years. A study among 946 nurse educators documented that most teach the way they were taught.4 In addition, even after learning new strategies, educators often continue teaching in the manner they are most comfortable. However, this trend is beginning to change. Nurse educators are becoming increasingly aware of and willing to try new and innovative teaching strategies. Educators are also seeking out evidence-based teaching strategies and are becoming more involved in nursing education research.

Developing Traditional Chinese Medicine in the Era of Evidence-Based Medicine: Current Evidences and Challenges

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Fung, Foon Yin; Linn, Yeh Ching

2015-01-01

Evidence-based medicine (EBM), by integrating individual clinical expertise with the best available clinical evidence from systematic research, has in recent years been established as the standard of modern medical practice for greater treatment efficacy and safety. Traditional Chinese Medicine (TCM), on the other hand, evolved as a system of medical practice from ancient China more than 2000 years ago based on empirical knowledge as well as theories and concepts which are yet to be mapped by scientific equivalents. Despite the expanding TCM usage and the recognition of its therapeutic benefits worldwide, the lack of robust evidence from the EBM perspective is hindering acceptance of TCM by the Western medicine community and its integration into mainstream healthcare. For TCM to become an integral component of the healthcare system so that its benefits can be rationally harnessed in the best interests of patients, it is essential for TCM to demonstrate its efficacy and safety by high-level evidence in accordance with EBM, though much debate remains on the validity and feasibility of applying the EBM model on this traditional practice. This review aims to discuss the current status of research in TCM, explore the evidences available on its efficacy and safety, and highlight the issues and challenges faced in applying EBM to TCM. PMID:25949261

Ocean Acidification and the End-Permian Mass Extinction: To What Extent does Evidence Support Hypothesis?

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Marie-Béatrice Forel

2012-09-01

Full Text Available Ocean acidification in modern oceans is linked to rapid increase in atmospheric CO2, raising concern about marine diversity, food security and ecosystem services. Proxy evidence for acidification during past crises may help predict future change, but three issues limit confidence of comparisons between modern and ancient ocean acidification, illustrated from the end-Permian extinction, 252 million years ago: (1 problems with evidence for ocean acidification preserved in sedimentary rocks, where proposed marine dissolution surfaces may be subaerial. Sedimentary evidence that the extinction was partly due to ocean acidification is therefore inconclusive; (2 Fossils of marine animals potentially affected by ocean acidification are imperfect records of past conditions; selective extinction of hypercalcifying organisms is uncertain evidence for acidification; (3 The current high rates of acidification may not reflect past rates, which cannot be measured directly, and whose temporal resolution decreases in older rocks. Thus large increases in CO2 in the past may have occurred over a long enough time to have allowed assimilation into the oceans, and acidification may not have stressed ocean biota to the present extent. Although we acknowledge the very likely occurrence of past ocean acidification, obtaining support presents a continuing challenge for the Earth science community.

Derivation and validation of the Personal Support Algorithm: an evidence-based framework to inform allocation of personal support services in home and community care.

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Sinn, Chi-Ling Joanna; Jones, Aaron; McMullan, Janet Legge; Ackerman, Nancy; Curtin-Telegdi, Nancy; Eckel, Leslie; Hirdes, John P

2017-11-25

Personal support services enable many individuals to stay in their homes, but there are no standard ways to classify need for functional support in home and community care settings. The goal of this project was to develop an evidence-based clinical tool to inform service planning while allowing for flexibility in care coordinator judgment in response to patient and family circumstances. The sample included 128,169 Ontario home care patients assessed in 2013 and 25,800 Ontario community support clients assessed between 2014 and 2016. Independent variables were drawn from the Resident Assessment Instrument-Home Care and interRAI Community Health Assessment that are standardised, comprehensive, and fully compatible clinical assessments. Clinical expertise and regression analyses identified candidate variables that were entered into decision tree models. The primary dependent variable was the weekly hours of personal support calculated based on the record of billed services. The Personal Support Algorithm classified need for personal support into six groups with a 32-fold difference in average billed hours of personal support services between the highest and lowest group. The algorithm explained 30.8% of the variability in billed personal support services. Care coordinators and managers reported that the guidelines based on the algorithm classification were consistent with their clinical judgment and current practice. The Personal Support Algorithm provides a structured yet flexible decision-support framework that may facilitate a more transparent and equitable approach to the allocation of personal support services.

Derivation and validation of the Personal Support Algorithm: an evidence-based framework to inform allocation of personal support services in home and community care

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Chi-Ling Joanna Sinn

2017-11-01

Full Text Available Abstract Background Personal support services enable many individuals to stay in their homes, but there are no standard ways to classify need for functional support in home and community care settings. The goal of this project was to develop an evidence-based clinical tool to inform service planning while allowing for flexibility in care coordinator judgment in response to patient and family circumstances. Methods The sample included 128,169 Ontario home care patients assessed in 2013 and 25,800 Ontario community support clients assessed between 2014 and 2016. Independent variables were drawn from the Resident Assessment Instrument-Home Care and interRAI Community Health Assessment that are standardised, comprehensive, and fully compatible clinical assessments. Clinical expertise and regression analyses identified candidate variables that were entered into decision tree models. The primary dependent variable was the weekly hours of personal support calculated based on the record of billed services. Results The Personal Support Algorithm classified need for personal support into six groups with a 32-fold difference in average billed hours of personal support services between the highest and lowest group. The algorithm explained 30.8% of the variability in billed personal support services. Care coordinators and managers reported that the guidelines based on the algorithm classification were consistent with their clinical judgment and current practice. Conclusions The Personal Support Algorithm provides a structured yet flexible decision-support framework that may facilitate a more transparent and equitable approach to the allocation of personal support services.

Assessing Confidence in Performance Assessments Using an Evidence Support Logic Methodology: An Application of Tesla

International Nuclear Information System (INIS)

Egan, M.; Paulley, A.; Lehman, L.; Lowe, J.; Rochette, E.; Baker, St.

2009-01-01

The assessment of uncertainties and their implications is a key requirement when undertaking performance assessment (PA) of radioactive waste facilities. Decisions based on the outcome of such assessments become translated into judgments about confidence in the information they provide. This confidence, in turn, depends on uncertainties in the underlying evidence. Even if there is a large amount of information supporting an assessment, it may be only partially relevant, incomplete or less than completely reliable. In order to develop a measure of confidence in the outcome, sources of uncertainty need to be identified and adequately addressed in the development of the PA, or in any overarching strategic decision-making processes. This paper describes a trial application of the technique of Evidence Support Logic (ESL), which has been designed for application in support of 'high stakes' decisions, where important aspects of system performance are subject to uncertainty. The aims of ESL are to identify the amount of uncertainty or conflict associated with evidence relating to a particular decision, and to guide understanding of how evidence combines to support confidence in judgments. Elicitation techniques are used to enable participants in the process to develop a logical hypothesis model that best represents the relationships between different sources of evidence to the proposition under examination. The aim is to identify key areas of subjectivity and other sources of potential bias in the use of evidence (whether for or against the proposition) to support judgments of confidence. Propagation algorithms are used to investigate the overall implications of the logic according to the strength of the underlying evidence and associated uncertainties. (authors)

Evidence-based radiology (part 1): Is there sufficient research to support the use of therapeutic injections for the spine and sacroiliac joints?

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Peterson, Cynthia; Hodler, Juerg [Orthopaedic University Hospital of Balgrist, Radiology, Zuerich (Switzerland)

2010-01-15

This review article addresses the best evidence currently available for therapeutic injection therapy for conditions targeting the spine and sacroiliac joints. The article is presented by spinal region. Controversies and areas of interest for further studies are identified. There is conclusive evidence supporting the effectiveness of the caudal approach for the administration of epidural steroid injections for patients with low back pain from a variety of causes. In general, there is moderate-to-strong evidence supporting the use of transforaminal therapeutic epidural injections for lumbar nerve-root compression and facet injections for joint pain arising from these joints in the cervical, thoracic and lumbar spine, but further subgroup analysis is needed to help predict which specific patients may receive the most benefit from these procedures. No randomized controlled trials, meta-analyses or systematic reviews addressing the effectiveness of therapeutic sacroiliac joint injections have been found. For some injections, corticosteroids may not provide better outcomes compared to local anesthetic injections alone. (orig.)

Effective treatment options for musculoskeletal pain in primary care: A systematic overview of current evidence

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Hill, Jonathan C.; Foster, Nadine E.; Protheroe, Joanne

2017-01-01

Background & aims Musculoskeletal pain, the most common cause of disability globally, is most frequently managed in primary care. People with musculoskeletal pain in different body regions share similar characteristics, prognosis, and may respond to similar treatments. This overview aims to summarise current best evidence on currently available treatment options for the five most common musculoskeletal pain presentations (back, neck, shoulder, knee and multi-site pain) in primary care. Methods A systematic search was conducted. Initial searches identified clinical guidelines, clinical pathways and systematic reviews. Additional searches found recently published trials and those addressing gaps in the evidence base. Data on study populations, interventions, and outcomes of intervention on pain and function were extracted. Quality of systematic reviews was assessed using AMSTAR, and strength of evidence rated using a modified GRADE approach. Results Moderate to strong evidence suggests that exercise therapy and psychosocial interventions are effective for relieving pain and improving function for musculoskeletal pain. NSAIDs and opioids reduce pain in the short-term, but the effect size is modest and the potential for adverse effects need careful consideration. Corticosteroid injections were found to be beneficial for short-term pain relief among patients with knee and shoulder pain. However, current evidence remains equivocal on optimal dose, intensity and frequency, or mode of application for most treatment options. Conclusion This review presents a comprehensive summary and critical assessment of current evidence for the treatment of pain presentations in primary care. The evidence synthesis of interventions for common musculoskeletal pain presentations shows moderate-strong evidence for exercise therapy and psychosocial interventions, with short-term benefits only from pharmacological treatments. Future research into optimal dose and application of the most

Are claims made in orthodontic journal advertisements evidence-supported?

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Livas, Christos; Kouskoura, Thaleia; Ren, Yijin; Katsaros, Christos; Pandis, Nikolaos

2015-03-01

To examine the supporting evidence of advertisements published in six leading orthodontic journals. The 2012-2013 printed issues of American Journal of Orthodontics and Dentofacial Orthopedics, Australian Orthodontic Journal, Journal of Orthodontics, European Journal of Orthodontics, Journal of Clinical Orthodontics, and Journal of Orofacial Orthopedics were screened for advertisements implying superior performance compared with competitor products. Advertisements were classified according to type of product, availability, and currency of supporting references. A total of 99 unique advertisements claiming clinical benefit or superiority were identified. The overwhelming majority of the identified advertisements promoted appliance products (62.6%), orthodontic materials (14.1%), and dental operatory equipment, including imaging systems (12.1%). Advertisements were found to provide references or not regardless of the product type. Half of the advertisements referred to at least one peer-reviewed publication, whereas unpublished studies were cited by 25% of the advertisements. Most of the referenced articles were published within the past 5 years. The scientific background of advertisements in the orthodontic literature appears limited. While surveillance of journal advertising needs to be regulated, clinicians are urged to critically appraise the claims being made in orthodontic print advertisements by consulting the associated existing evidence.

Evidence Supporting Intralesional Stem Cell Therapy to Improve Equine Flexor Tendon Healing

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Sushmitha Durgam

2017-01-01

Full Text Available Clinical bottom lineCurrent experimental evidence suggests that intralesional stem cell administration improves the histological characteristics and matrix organisation of healing equine superficial digital flexor tendons (SDFT; however, the clinical relevance of these findings are not clear. Current case-based evidence suggests that cell-based therapies improve the quality of tendon healing and reduce the recurrence rates of SDFT injuries but the lack of any randomised, controlled prospective studies with function-based outcomes is still concerning, given the widespread advocacy for and use of ‘stem cell’ therapies for the treatment of equine tendon injuries. 

Is the evidence supporting dental procedures strong? A survey of Cochrane systematic reviews in oral health.

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Faggion, Clovis Mariano

2012-09-01

Every day a large number and variety of dental procedures are performed in clinical dental practice. There is, however, no information on the overall quality of evidence supporting these procedures. The objective of this study was to assess whether several common dental procedures are based on sound evidence. All Cochrane systematic reviews (CSR) published in dentistry were surveyed. The authors' conclusions about the quality of evidence supporting a specific clinical treatment were used as the measure of outcome. The evidence was considered adequate if the authors did not clearly state the evidence was weak in the conclusions while also suggesting some evidence of the effectiveness of the therapy. Of 120 CSRs assessed, in only 26 (22.0% of the reviews) was the quality of evidence regarded as adequate for supporting clinical decisions, although some methodological limitations were identified in the full text of these reviews. Moreover, the authors of most reviews reported weak or unavailable evidence. On the basis of CSRs, the overall quality of evidence can be regarded as low or nonexistent for most of the dental procedures assessed. The information reported may guide future research. Copyright © 2012 Elsevier Inc. All rights reserved.

The territorial approach to EU cohesion policy: Current issues and evidence from Greece

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Thoidou Elisavet

2011-01-01

Full Text Available The importance attributed to the territorial dimension of the European Union cohesion policy steadily influences its successive reforms and adaptations, while in recent years there has been an evolution in the way this particular dimension of cohesion policy is perceived. Important evidence for this is the way in which the Community Strategic Guidelines on cohesion 2007-13 take account of the territorial dimension of cohesion policy. This paper discusses the territorial approach to cohesion policy in relation to both policy and practice. Specifically, it examines the territorial dimension of regional development planning in Greece as it has emerged in the relevant official documents, namely the successive three Community Support Frameworks since 1989 and the National Strategic Reference Framework for the current 2007-13 period. The territorial dimension of the organization of the planning system is also considered in an effort to understand limitations and prospects, in light of the importance of the territorial approach to cohesion policy post-2013.

Toward an evidence-based system for innovation support for implementing innovations with quality: tools, training, technical assistance, and quality assurance/quality improvement.

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Wandersman, Abraham; Chien, Victoria H; Katz, Jason

2012-12-01

An individual or organization that sets out to implement an innovation (e.g., a new technology, program, or policy) generally requires support. In the Interactive Systems Framework for Dissemination and Implementation, a Support System should work with Delivery Systems (national, state and/or local entities such as health and human service organizations, community-based organizations, schools) to enhance their capacity for quality implementation of innovations. The literature on the Support System [corrected] has been underresearched and under-developedThis article begins to conceptualize theory, research, and action for an evidence-based system for innovation support (EBSIS). EBSIS describes key priorities for strengthening the science and practice of support. The major goal of EBSIS is to enhance the research and practice of support in order to build capacity in the Delivery System for implementing innovations with quality, and thereby, help the Delivery System achieve outcomes. EBSIS is guided by a logic model that includes four key support components: tools, training, technical assistance, and quality assurance/quality improvement. EBSIS uses the Getting To Outcomes approach to accountability to aid the identification and synthesis of concepts, tools, and evidence for support. We conclude with some discussion of the current status of EBSIS and possible next steps, including the development of collaborative researcher-practitioner-funder-consumer partnerships to accelerate accumulation of knowledge on the Support System.

Evidence-Based Literacy Support: The "Literacy Octopus" Trial. Evaluation Report and Executive Summary

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Lord, Pippa; Rabiasz, Adam; Roy, Palak; Harland, Jennie; Styles, Ben; Fowler, Katherine

2017-01-01

The Evidence-based Literacy Support-"Literacy Octopus" Trial tested a range of dissemination interventions and resources, all of which aimed to engage schools in using evidence-based materials to improve teaching and learning in Key Stage 2 literacy. Four delivery partners provided interventions. These included light-touch,…

Fried Food Consumption and Cardiovascular Health: A Review of Current Evidence

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Taraka V. Gadiraju

2015-10-01

Full Text Available Fried food consumption and its effects on cardiovascular disease are still subjects of debate. The objective of this review was to summarize current evidence on the association between fried food consumption and cardiovascular disease, diabetes, hypertension and obesity and to recommend directions for future research. We used PubMed, Google Scholar and Medline searches to retrieve pertinent publications. Most available data were based on questionnaires as a tool to capture fried food intakes, and study design was limited to case-control and cohort studies. While few studies have reported a positive association between frequencies of fried food intake and risk of coronary artery disease, heart failure, diabetes or hypertension, other investigators have failed to confirm such an association. There is strong evidence suggesting a higher risk of developing chronic disease when fried foods are consumed more frequently (i.e., four or more times per week. Major gaps in the current literature include a lack of detailed information on the type of oils used for frying foods, stratification of the different types of fried food, frying procedure (deep and pan frying, temperature and duration of frying, how often oils were reused and a lack of consideration of overall dietary patterns. Besides addressing these gaps, future research should also develop tools to better define fried food consumption at home versus away from home and to assess their effects on chronic diseases. In summary, the current review provides enough evidence to suggest adverse health effects with higher frequency of fried food consumption. While awaiting confirmation from future studies, it may be advisable to the public to consume fried foods in moderation while emphasizing an overall healthy diet.

An Overview of the Current Status of Talent Care and Talent Support in Hungary

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Csilla Fuszek

2014-09-01

Full Text Available After a short historical introduction, the article provides an overview of the current talent support trends in Hungary. It gives an insight into the legislation, guidelines and institutional system associated with the national talent support strategy, and presents the main NGO initiatives present in the early 21st century, in particular the organisations brought to life by the Hungarian Talent Support Council and their effect on current education policy. At the same time, the article seeks to present the strengths and weaknesses of the national talent support strategy and the Hungarian talent support cooperation model.

[Birth and succession of a current of learning in Korean medicine: the supporting yang current of learning].

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Oh, Chaekun

2014-04-01

In this study, I aim to reveal how Lee Gyoojoons medicine has given birth to a current of learning, the supporting yang current of learning, and describe its historical significance. Before anything, I'd like to throw the question of whether if there were any currents within the traditional Korean medicine. There are no records of medical currents being widely discussed until now in medical history of Korea; however, the current of Lee Jema's sasang medicine is the most noticeable one. Among the contemporaries of Lee Jema, during the late Chosun, there was also another famed medical practitioner called Lee Gyoojoon. Lee Gyoojoon mainly practiced his medicine within Pohang, Gyeongsangbuk-do area, his apprentices have formed a group and have succeeded his medical practice. Based on the analyses of Lee Gyoojoon's apprentices and the Somun Oriental Medical Society, which is known as a successor group to Lee Gyoojoon's medicine today, they are fully satisfying the five requirements to establish a medical current: first, they held Lee Gyoojoon as the first and foremost, representative practitioner of their current; second, they advocate the supporting yang theory suggested by Lee Gyoojoon, which is originated from his theory of Mind; third, books such as the Major Essentials of Huangdi's Internal Classic Plain Questions, and the Double Grinded Medical Mirror, were being used as the main textbooks to educate their students or to practice medicine. Fourth, Lee Gyoojoon's medical ideas were being transcended quite clearly within his group of apprentices, including Seo Byungoh, Lee Wonse, and the Somun Oriental Medical Society. Fifth, Lee Gyoojoon's apprentices were first produced through the Sukgok School, however, nowadays they are being produced through medical groups formed by Lee Wonse, the Somun Oriental Medical Society, regarding the propagation of medical theories, compilation of textbooks, publication of academic journals, etc. Then, what do the existence of the

Exploring Nurse Manager Support of Evidence-Based Practice: Clinical Nurse Perceptions.

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Caramanica, Laura; Spiva, LeeAnna

2018-05-01

The study identifies what constitutes nurse manager (NM) support and other resources that enable clinical nurses (CNs) to engage in evidence-based practice (EBP). Clinical nurses report that NM support enables them to use EBP but what constitutes NM support is still unclear. Nurse managers, CNs, and EBP mentors received specialized education and use a team approach for EBP. Data were collected preintervention, mid-intervention, and postintervention from observations, interviews, journaling, and surveys. Results demonstrate how NMs can perform their role responsibilities and still engage CNs to develop a spirit of inquiry, seek answers to their clinical questions using EBP, and advance their clinical performance to improve patient outcomes. Four NM supportive behaviors emerged: cultivating a shared EBP vision, ensuring use of EBP, communicating the value of EBP, and providing resources for EBP. Through education and support, NMs describe supportive behaviors necessary for the successful conduction of EBP by CNs.

Multi-criteria clinical decision support: A primer on the use of multiple criteria decision making methods to promote evidence-based, patient-centered healthcare.

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Dolan, James G

2010-01-01

Current models of healthcare quality recommend that patient management decisions be evidence-based and patient-centered. Evidence-based decisions require a thorough understanding of current information regarding the natural history of disease and the anticipated outcomes of different management options. Patient-centered decisions incorporate patient preferences, values, and unique personal circumstances into the decision making process and actively involve both patients along with health care providers as much as possible. Fundamentally, therefore, evidence-based, patient-centered decisions are multi-dimensional and typically involve multiple decision makers.Advances in the decision sciences have led to the development of a number of multiple criteria decision making methods. These multi-criteria methods are designed to help people make better choices when faced with complex decisions involving several dimensions. They are especially helpful when there is a need to combine "hard data" with subjective preferences, to make trade-offs between desired outcomes, and to involve multiple decision makers. Evidence-based, patient-centered clinical decision making has all of these characteristics. This close match suggests that clinical decision support systems based on multi-criteria decision making techniques have the potential to enable patients and providers to carry out the tasks required to implement evidence-based, patient-centered care effectively and efficiently in clinical settings.The goal of this paper is to give readers a general introduction to the range of multi-criteria methods available and show how they could be used to support clinical decision-making. Methods discussed include the balance sheet, the even swap method, ordinal ranking methods, direct weighting methods, multi-attribute decision analysis, and the analytic hierarchy process (AHP).

PRESCRIBING OF ANTIHYPERTENSIVE AGENTS IN PUBLIC PRIMARY CARE CLINICS – IS IT IN ACCORDANCE WITH CURRENT EVIDENCE?

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SAJARI J

2010-01-01

Full Text Available Background: Large population surveys in Malaysia have consistently shown minimal improvement of blood pressure control rates over the last 10 years. Poor adherence to antihypertensive medication has been recognized as a major reason for poor control of hypertension. This study aimed to describe the prescribing pattern of antihypertensive agents in 2 public primary care clinics and assess its appropriateness in relation to current evidence and guidelines. Methods: A cross-sectional survey to describe the prescribing pattern of antihypertensive agents was carried out in 2 publicprimary care clinics in Selangor from May to June 2009. Hypertensive patients on pharmacological treatment for ≥1 year who attended the clinics within the study period of 7 weeks were selected. Appropriate use of antihypertensive agents was defined based on current evidence and the recommendations by the Malaysian Clinical Practice Guidelines (CPG on the Management of Hypertension, 2008. Data were obtained from patients’ medical records and were analysed using the SPSS software version 16.0. Results: A total of 400 hypertensive patients on treatment were included. Mean age was 59.5 years (SD ±10.9, range 28 to91 years, of which 52.8% were females and 47.2% were males. With regards to pharmacotherapy, 45.7% were on monotherapy,43.3% were on 2 agents and 11.0% were on ≥3 agents. Target blood pressure of <140/90mmHg was achieved in 51.4% of patients on monotherapy, and 33.2% of patients on combination of ≥2 agents. The commonest monotherapy agents being prescribed were β-blockers (atenolol or propranolol, followed by the short-acting calcium channel blocker (nifedipine. The commonest combination of 2-drug therapy prescribed was β-blockers and short-acting calcium channel blocker. Conclusion: This study shows that the prescribing pattern of antihypertensive agents in the 2 primary care clinics was not in accordance with current evidence and guidelines. �

Addressing unwarranted clinical variation: A rapid review of current evidence.

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Harrison, Reema; Manias, Elizabeth; Mears, Stephen; Heslop, David; Hinchcliff, Reece; Hay, Liz

2018-05-15

Unwarranted clinical variation (UCV) can be described as variation that can only be explained by differences in health system performance. There is a lack of clarity regarding how to define and identify UCV and, once identified, to determine whether it is sufficiently problematic to warrant action. As such, the implementation of systemic approaches to reducing UCV is challenging. A review of approaches to understand, identify, and address UCV was undertaken to determine how conceptual and theoretical frameworks currently attempt to define UCV, the approaches used to identify UCV, and the evidence of their effectiveness. Rapid evidence assessment (REA) methodology was used. A range of text words, synonyms, and subject headings were developed for the major concepts of unwarranted clinical variation, standards (and deviation from these standards), and health care environment. Two electronic databases (Medline and Pubmed) were searched from January 2006 to April 2017, in addition to hand searching of relevant journals, reference lists, and grey literature. Results were merged using reference-management software (Endnote) and duplicates removed. Inclusion criteria were independently applied to potentially relevant articles by 3 reviewers. Findings were presented in a narrative synthesis to highlight key concepts addressed in the published literature. A total of 48 relevant publications were included in the review; 21 articles were identified as eligible from the database search, 4 from hand searching published work and 23 from the grey literature. The search process highlighted the voluminous literature reporting clinical variation internationally; yet, there is a dearth of evidence regarding systematic approaches to identifying or addressing UCV. Wennberg's classification framework is commonly cited in relation to classifying variation, but no single approach is agreed upon to systematically explore and address UCV. The instances of UCV that warrant investigation and

Altered Mental Status: Current Evidence-based Recommendations for Prehospital Care

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Ashley Sanello

2018-03-01

Full Text Available Introduction: In the United States emergency medical services (EMS protocols vary widely across jurisdictions. We sought to develop evidence-based recommendations for the prehospital evaluation and treatment of a patient with an acute change in mental status and to compare these recommendations against the current protocols used by the 33 EMS agencies in the State of California. Methods: We performed a literature review of the current evidence in the prehospital treatment of a patient with altered mental status (AMS and augmented this review with guidelines from various national and international societies to create our evidence-based recommendations. We then compared the AMS protocols of each of the 33 EMS agencies for consistency with these recommendations. The specific protocol components that we analyzed were patient assessment, point-of-care tests, supplemental oxygen, use of standardized scoring, evaluating for causes of AMS, blood glucose evaluation, toxicological treatment, and pediatric evaluation and management. Results: Protocols across 33 EMS agencies in California varied widely. All protocols call for a blood glucose check, 21 (64% suggest treating adults at <60mg/dL, and half allow for the use of dextrose 10%. All the protocols recommend naloxone for signs of opioid overdose, but only 13 (39% give specific parameters. Half the agencies (52% recommend considering other toxicological causes of AMS, often by using the mnemonic AEIOU TIPS. Eight (24% recommend a 12-lead electrocardiogram; others simply suggest cardiac monitoring. Fourteen (42% advise supplemental oxygen as needed; only seven (21% give specific parameters. In terms of considering various etiologies of AMS, 25 (76% give instructions to consider trauma, 20 (61% to consider stroke, and 18 (55% to consider seizure. Twenty-three (70% of the agencies have separate pediatric AMS protocols; others include pediatric considerations within the adult protocol. Conclusion: Protocols

Current methods of non-invasive ventilatory support for neonates.

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Mahmoud, Ramadan A; Roehr, Charles Christoph; Schmalisch, Gerd

2011-09-01

Non-invasive ventilatory support can reduce the adverse effects associated with intubation and mechanical ventilation, such as bronchopulmonary dysplasia, sepsis, and trauma to the upper airways. In the last 4 decades, nasal continuous positive airway pressure (CPAP) has been used to wean preterm infants off mechanical ventilation and, more recently, as a primary mode of respiratory support for preterm infants with respiratory insufficiency. Moreover, new methods of respiratory support have been developed, and the devices used to provide non-invasive ventilation (NIV) have improved technically. Use of NIV is increasing, and a variety of equipment is available in different clinical settings. There is evidence that NIV improves gas exchange and reduces extubation failure after mechanical ventilation in infants. However, more research is needed to identify the most suitable devices for particular conditions; the NIV settings that should be used; and whether to employ synchronized or non-synchronized NIV. Furthermore, the optimal treatment strategy and the best time for initiation of NIV remain to be identified. This article provides an overview of the use of non-invasive ventilation (NIV) in newborn infants, and the clinical applications of NIV. Copyright © 2011 Elsevier Ltd. All rights reserved.

Treatment of Scoliosis-Evidence and Management (Review of the Literature

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Weiss

2016-04-01

Full Text Available Context Scoliosis is a three-dimensional deformity of the spine and trunk which includes lateral deviation, rotation, and a disturbance of the sagittal profile. Treatment is indicated for scoliosis because it may lead to negative consequences with regard to the quality of life and other health issues for some patients. The purpose of this review was to gather current, up-to-date information, and to search the recent articles on scoliosis for evidence of the different modes of treatment. Evidence Acquisition A PubMed search for review articles, prospective controlled trials (PCT, and randomized controlled trials (RCT was performed. The search terms were: 1 scoliosis, treatment (12,045 items found; 2 scoliosis, physiotherapy (776 items found; 3 scoliosis, brace treatment (1,447 items found; and 4 scoliosis, surgery (10,485 items found. Results When looking at the current literature, high quality evidence (level I was found to support physical rehabilitation and brace treatments, while no evidence was found to support spinal fusion surgery. The numerous long-term complications that patients may face post-operation, and the lack of evidence for spinal fusion surgery indicate that there is no clear medical indication for this kind of treatment. Conclusions There is a high level of evidence for the conservative treatment of scoliosis, but there are varying levels of success in the different approaches. The better the correction of the curve, the better the end result and outcome for the patient. This is supported by the current evidence reviewed in this paper. Physiotherapy and bracing should be used and, specifically, those approaches using high corrective methods. Spinal fusion surgery is not supported by the current evidence. According to the literature, the long-term complications of surgery for scoliosis far outweigh the consequences of untreated scoliosis.

New evidence: data documenting parental support for earlier sexuality education.

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Barr, Elissa M; Moore, Michele J; Johnson, Tammie; Forrest, Jamie; Jordan, Melissa

2014-01-01

Numerous studies document support for sexuality education to be taught in high school, and often, in middle school. However, little research has been conducted addressing support for sexuality education in elementary schools. As part of the state Behavioral Risk Factor Surveillance System (BRFSS) Survey administration, the Florida Department of Health conducted the Florida Child Health Survey (FCHS) by calling back parents who had children in their home and who agreed to participate (N = 1715). Most parents supported the following sexuality education topics being taught specifically in elementary school: communication skills (89%), human anatomy/reproductive information (65%), abstinence (61%), human immunodeficiency virus (HIV)/sexually transmitted infections (STIs) (53%), and gender/sexual orientation issues (52%). Support was even greater in middle school (62-91%) and high school (72-91%) for these topics and for birth control and condom education. Most parents supported comprehensive sexuality education (40.4%), followed by abstinence-plus (36.4%) and abstinence-only (23.2%). Chi-square results showed significant differences in the type of sexuality education supported by almost all parent demographic variables analyzed including sex, race, marital status, and education. Results add substantial support for age-appropriate school-based sexuality education starting at the elementary school level, the new National Sexuality Education Standards, and funding to support evidence-based abstinence-plus or comprehensive sexuality education. © 2013, American School Health Association.

Evidence-informed health policy 1 - synthesis of findings from a multi-method study of organizations that support the use of research evidence.

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Lavis, John N; Oxman, Andrew D; Moynihan, Ray; Paulsen, Elizabeth J

2008-12-17

Organizations have been established in many countries and internationally to support the use of research evidence by producing clinical practice guidelines, undertaking health technology assessments, and/or directly supporting the use of research evidence in developing health policy on an international, national, and state or provincial level. Learning from these organizations can reduce the need to 'reinvent the wheel' and inform decisions about how best to organize support for such organizations, particularly in low- and middle-income countries (LMICs). We undertook a multi-method study in three phases - a survey, interviews, and case descriptions that drew on site visits - and in each of the second and third phases we focused on a purposive sample of those involved in the previous phase. We used the seven main recommendations that emerged from the advice offered in the interviews to organize much of the synthesis of findings across phases and methods. We used a constant comparative method to identify themes from across phases and methods. Seven recommendations emerged for those involved in establishing or leading organizations that support the use of research evidence in developing health policy: 1) collaborate with other organizations; 2) establish strong links with policymakers and involve stakeholders in the work; 3) be independent and manage conflicts of interest among those involved in the work; 4) build capacity among those working in the organization; 5) use good methods and be transparent in the work; 6) start small, have a clear audience and scope, and address important questions; and 7) be attentive to implementation considerations, even if implementation is not a remit. Four recommendations emerged for the World Health Organization (WHO) and other international organizations and networks: 1) support collaborations among organizations; 2) support local adaptation efforts; 3) mobilize support; and 4) create global public goods. This synthesis of

Breast-Feeding Analgesia in Infants: An Update on the Current State of Evidence.

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Benoit, Britney; Martin-Misener, Ruth; Latimer, Margot; Campbell-Yeo, Marsha

To provide an updated synthesis of the current state of the evidence for the effectiveness of breast-feeding and expressed breast milk feeding in reducing procedural pain in preterm and full-term born infants. A systematic search of key electronic databases (PubMed, CINAHL, EMBASE) was completed. Of the 1032 abstracts screened, 21 were found eligible for inclusion. Fifteen studies reported on the use of breast-feeding or expressed breast milk in full-term infants and 6 reported on preterm infants. Direct breast-feeding was more effective than maternal holding, maternal skin-to-skin contact, topical anesthetics, and music therapy, and was as or more effective than sweet tasting solutions in full-term infants. Expressed breast milk was not consistently found to reduce pain response in full-term or preterm infants. Studies generally had moderate to high risk of bias. There is sufficient evidence to recommend direct breast-feeding for procedural pain management in full-term infants. Based on current evidence, expressed breast milk alone should not be considered an adequate intervention.

Evidence-based radiology (part 2): Is there sufficient research to support the use of therapeutic injections into the peripheral joints?

Energy Technology Data Exchange (ETDEWEB)

Peterson, Cynthia; Hodler, Juerg [Orthopaedic University Hospital of Balgrist, Radiology, Zuerich (Switzerland)

2010-01-15

This review article addresses the best evidence currently available for the effectiveness of injection therapy for musculoskeletal conditions involving the peripheral joints. The research is presented by anatomical region and areas of controversy and the need for additional research are identified. Randomized controlled trials, meta-analyses and systematic reviews are lacking that address the effectiveness of therapeutic injections to the sternoclavicular, acromioclavicular, ankle and foot joints. No research studies of any kind have been reported for therapeutic injections of the sternoclavicular joint. With the exception of the knee, possibly the hip and patients with inflammatory arthropathies, research does not unequivocally support the use of therapeutic joint injections for most of the peripheral joints, including the shoulder. Additionally, controversy exists in some areas as to whether or not corticosteroids provide better outcomes compared to local anesthetic injections alone. When viscosupplementation injections are compared to corticosteroids in patients with osteoarthritis of the knee, the evidence supports the use of viscosupplementation for more prolonged improvement in outcomes, with corticosteroids being good for short-term relief. (orig.)

Evidence-based radiology (part 2): Is there sufficient research to support the use of therapeutic injections into the peripheral joints?

International Nuclear Information System (INIS)

Peterson, Cynthia; Hodler, Juerg

2010-01-01

This review article addresses the best evidence currently available for the effectiveness of injection therapy for musculoskeletal conditions involving the peripheral joints. The research is presented by anatomical region and areas of controversy and the need for additional research are identified. Randomized controlled trials, meta-analyses and systematic reviews are lacking that address the effectiveness of therapeutic injections to the sternoclavicular, acromioclavicular, ankle and foot joints. No research studies of any kind have been reported for therapeutic injections of the sternoclavicular joint. With the exception of the knee, possibly the hip and patients with inflammatory arthropathies, research does not unequivocally support the use of therapeutic joint injections for most of the peripheral joints, including the shoulder. Additionally, controversy exists in some areas as to whether or not corticosteroids provide better outcomes compared to local anesthetic injections alone. When viscosupplementation injections are compared to corticosteroids in patients with osteoarthritis of the knee, the evidence supports the use of viscosupplementation for more prolonged improvement in outcomes, with corticosteroids being good for short-term relief. (orig.)

Managing caries: the need to close the gap between the evidence base and current practice.

Science.gov (United States)

Schwendicke, F; Doméjean, S; Ricketts, D; Peters, M

2015-11-13

Underpinned by a changing knowledge of the aetiology of caries and its sequelae, and assisted by established and advancing dental materials, there is growing evidence supporting less invasive management of dental caries based on the principles of minimal intervention dentistry. This narrative review assesses both the evidence and the adoption of less invasive caries management strategies and describes ways in which the gap between evidence and practice might be overcome. While there is increasing data supporting less invasive management of carious lesions, these are not standard in most dental practices worldwide. Usually, clinical studies focused on efficacy as outcome, and did not take into consideration the views and priorities of other stakeholders, such as primary care dentists, educators, patients and those financing services. Involving these stakeholders into study design and demonstrating the broader advantages of new management strategies might improve translation of research into practice. In theory, clinical dentists can rely on a growing evidence in cariology regarding less invasive management options. In practice, further factors seem to impede adoption of these strategies. Future research should address these factors by involving major stakeholders and investigating their prioritised outcomes to narrow or close the evidence gap.

Evidence for current recommendations concerning the management of foot health for people with chronic long-term conditions: a systematic review

Directory of Open Access Journals (Sweden)

Katherine Edwards

2017-11-01

Full Text Available Abstract Background Research focusing on management of foot health has become more evident over the past decade, especially related to chronic conditions such as diabetes. The level of methodological rigour across this body of work however is varied and outputs do not appear to have been developed or translated into clinical practice. The aim of this systematic review was to assess the latest guidelines, standards of care and current recommendations relative to people with chronic conditions to ascertain the level of supporting evidence concerning the management of foot health. Methods A systematic search of electronic databases (Medline, Embase, Cinahl, Web of Science, SCOPUS and The Cochrane Library for literature on recommendations for foot health management for people with chronic conditions was performed between 2000 and 2016 using predefined criteria. Data from the included publications was synthesised via template analysis, employing a thematic organisation and structure. The methodological quality of all included publications was appraised using the Appraisal for Research and Evaluation (AGREE II instrument. A more in-depth analysis was carried out that specifically considered the levels of evidence that underpinned the strength of their recommendations concerning management of foot health. Results The data collected revealed 166 publications in which the majority (102 were guidelines, standards of care or recommendations related to the treatment and management of diabetes. We noted a trend towards a systematic year on year increase in guidelines standards of care or recommendations related to the treatment and management of long term conditions other than diabetes over the past decade. The most common recommendation is for preventive care or assessments (e.g. vascular tests, followed by clinical interventions such as foot orthoses, foot ulcer care and foot health education. Methodological quality was spread across the range of AGREE II

Sustainability of evidence-based healthcare: research agenda, methodological advances, and infrastructure support.

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Proctor, Enola; Luke, Douglas; Calhoun, Annaliese; McMillen, Curtis; Brownson, Ross; McCrary, Stacey; Padek, Margaret

2015-06-11

Little is known about how well or under what conditions health innovations are sustained and their gains maintained once they are put into practice. Implementation science typically focuses on uptake by early adopters of one healthcare innovation at a time. The later-stage challenges of scaling up and sustaining evidence-supported interventions receive too little attention. This project identifies the challenges associated with sustainability research and generates recommendations for accelerating and strengthening this work. A multi-method, multi-stage approach, was used: (1) identifying and recruiting experts in sustainability as participants, (2) conducting research on sustainability using concept mapping, (3) action planning during an intensive working conference of sustainability experts to expand the concept mapping quantitative results, and (4) consolidating results into a set of recommendations for research, methodological advances, and infrastructure building to advance understanding of sustainability. Participants comprised researchers, funders, and leaders in health, mental health, and public health with shared interest in the sustainability of evidence-based health care. Prompted to identify important issues for sustainability research, participants generated 91 distinct statements, for which a concept mapping process produced 11 conceptually distinct clusters. During the conference, participants built upon the concept mapping clusters to generate recommendations for sustainability research. The recommendations fell into three domains: (1) pursue high priority research questions as a unified agenda on sustainability; (2) advance methods for sustainability research; (3) advance infrastructure to support sustainability research. Implementation science needs to pursue later-stage translation research questions required for population impact. Priorities include conceptual consistency and operational clarity for measuring sustainability, developing evidence

The information infrastructure that supports evidence-based veterinary medicine: a comparison with human medicine.

Science.gov (United States)

Toews, Lorraine

2011-01-01

In human medicine, the information infrastructure that supports the knowledge translation processes of exchange, synthesis, dissemination, and application of the best clinical intervention research has developed significantly in the past 15 years, facilitating the uptake of research evidence by clinicians as well as the practice of evidence-based medicine. Seven of the key elements of this improved information infrastructure are clinical trial registries, research reporting standards, systematic reviews, organizations that support the production of systematic reviews, the indexing of clinical intervention research in MEDLINE, clinical search filters for MEDLINE, and point-of-care decision support information resources. The objective of this paper is to describe why these elements are important for evidence-based medicine, the key developments and issues related to these seven information infrastructure elements in human medicine, how these 7 elements compare with the corresponding infrastructure elements in veterinary medicine, and how all of these factors affect the translation of clinical intervention research into clinical practice. A focused search of the Ovid MEDLINE database was conducted for English language journal literature published between 2000 and 2010. Two bibliographies were consulted and selected national and international Web sites were searched using Google. The literature reviewed indicates that the information infrastructure supporting evidence-based veterinary medicine practice in all of the 7 elements reviewed is significantly underdeveloped in relation to the corresponding information infrastructure in human medicine. This lack of development creates barriers to the timely translation of veterinary medicine research into clinical practice and also to the conduct of both primary clinical intervention research and synthesis research.

Are current coaching recommendations for cricket batting technique supported by biomechanical research?

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Penn, Melissa J; Spratford, Wayne

2012-09-01

Coaching manuals are an invaluable tool for coaches, used in player skill and technique development, especially at grass-roots level. Commonly developed by former players and coaches, this information is generally based on anecdotal evidence and in general lacks the scientific rigour of a peer-reviewed journal. Thus there is a need to establish the level of agreement and support between the coaching and biomechanical literature. In doing so, evidence-based coaching practices can be optimally developed. Moreover, this will ensure the technique and skill development practices implemented at grass-roots level are supported by successful performance in the later stages of player development. The purpose of this review was to evaluate the latest batting biomechanics research, providing a comprehensive and up-to-date insight into the kinematic and kinetic aspects of batting in cricket. Furthermore, this review compared and contrasted this research with a selection of coaching literature, establishing a strong level of support and agreement between the coaching and biomechanical literature in recommendations for cricket batting technique. Although the ambiguity in a number of coaching concepts still exists, coaches and players can be confident in the successful implementation of both sources of information in a player's technical development.

Coherence of evidence from systematic reviews as a basis for evidence strength - a case study in support of an epistemological proposition

Directory of Open Access Journals (Sweden)

Mickenautsch Steffen

2012-01-01

Full Text Available Abstract Background This article aims to offer, on the basis of Coherence theory, the epistemological proposition that mutually supportive evidence from multiple systematic reviews may successfully refute radical, philosophical scepticism. Methods A case study including seven systematic reviews is presented with the objective of refuting radical philosophical scepticism towards the belief that glass-ionomer cements (GIC are beneficial in tooth caries therapy. The case study illustrates how principles of logical and empirical coherence may be applied as evidence in support of specific beliefs in healthcare. Results The results show that radical scepticism may epistemologically be refuted on the basis of logical and empirical coherence. For success, several systematic reviews covering interconnected beliefs are needed. In praxis, these systematic reviews would also need to be of high quality and its conclusions based on reviewed high quality trials. Conclusions A refutation of radical philosophical scepticism to clinical evidence may be achieved, if and only if such evidence is based on the logical and empirical coherence of multiple systematic review results. Practical application also requires focus on the quality of the systematic reviews and reviewed trials.

Sugars and health: a review of current evidence and future policy.

Science.gov (United States)

Evans, Charlotte Elizabeth Louise

2017-08-01

The automation of the process of extracting sugars in the 1900s reduced cost and increased availability of sugars leading to a dramatic rise in consumption, which reached a peak in the 1970s. There are different definitions for sugars not naturally available in foods, and free sugars is the term used by WHO. The epidemiological evidence of the associations between sugars and obesity and type 2 diabetes mellitus is fairly strong and consistent, particularly for sugar sweetened drinks in adults. The Department of Health in the UK and many other countries have recently updated their recommendations for free sugars as a result of this scientific evidence. In the UK the recommended amount of free sugars is currently 5 % of energy (reduced from 10 %), which is difficult to meet and very different from current British dietary patterns. Reducing intakes of free sugars is a challenge and will necessitate a range of different actions and policies. Public Health England has put forward eight suggestions but the four most likely to improve dietary behaviour based on available evidence are social marketing, reduction of marketing of high sugar foods and drinks to children, reformulation and reductions in portion size and a sugar excise tax. Any action taken needs to be evaluated to check inequalities are not widened. The new childhood obesity strategy has incorporated some but not all of these strategies and may not go far enough. It is likely that government policies alone will not be sufficient and a change in the food culture is necessary to see real progress.

Evidence for Anomalous Effects on the Current Evolution in Tokamak Operating Scenarios

Energy Technology Data Exchange (ETDEWEB)

Casper, T; Jayakumar, R; Allen, S; Holcomb, C; Makowski, M; Pearlstein, L; Berk, H; Greenfield, C; Luce, T; Petty, C; Politzer, P; Wade, M; Murakami, M; Kessel, C

2006-10-03

Alternatives to the usual picture of advanced tokamak (AT) discharges are those that form when anomalous effects alter the plasma current and pressure profiles and those that achieve stationary characteristics through mechanisms so that a measure of desired AT features is maintained without external current-profile control. Regimes exhibiting these characteristics are those where the safety factor (q) evolves to a stationary profile with the on-axis and minimum q {approx} 1 and those with a deeply hollow current channel and high values of q. Operating scenarios with high fusion performance at low current and where the inductively driven current density achieves a stationary configuration with either small or non-existing sawteeth may enhance the neutron fluence per pulse on ITER and future burning plasmas. Hollow current profile discharges exhibit high confinement and a strong ''box-like'' internal transport barrier (ITB). We present results providing evidence for current profile formation and evolution exhibiting features consistent with anomalous effects or with self-organizing mechanisms. Determination of the underlying physical processes leading to these anomalous effects is important for scaling of current experiments for application in future burning plasmas.

Trichloroethylene: Mechanistic, epidemiologic and other supporting evidence of carcinogenic hazard.

Science.gov (United States)

Rusyn, Ivan; Chiu, Weihsueh A; Lash, Lawrence H; Kromhout, Hans; Hansen, Johnni; Guyton, Kathryn Z

2014-01-01

The chlorinated solvent trichloroethylene (TCE) is a ubiquitous environmental pollutant. The carcinogenic hazard of TCE was the subject of a 2012 evaluation by a Working Group of the International Agency for Research on Cancer (IARC). Information on exposures, relevant data from epidemiologic studies, bioassays in experimental animals, and toxicity and mechanism of action studies was used to conclude that TCE is carcinogenic to humans (Group 1). This article summarizes the key evidence forming the scientific bases for the IARC classification. Exposure to TCE from environmental sources (including hazardous waste sites and contaminated water) is common throughout the world. While workplace use of TCE has been declining, occupational exposures remain of concern, especially in developing countries. The strongest human evidence is from studies of occupational TCE exposure and kidney cancer. Positive, although less consistent, associations were reported for liver cancer and non-Hodgkin lymphoma. TCE is carcinogenic at multiple sites in multiple species and strains of experimental animals. The mechanistic evidence includes extensive data on the toxicokinetics and genotoxicity of TCE and its metabolites. Together, available evidence provided a cohesive database supporting the human cancer hazard of TCE, particularly in the kidney. For other target sites of carcinogenicity, mechanistic and other data were found to be more limited. Important sources of susceptibility to TCE toxicity and carcinogenicity were also reviewed by the Working Group. In all, consideration of the multiple evidence streams presented herein informed the IARC conclusions regarding the carcinogenicity of TCE. © 2013.

Current Status of Mechanical Circulatory Support: A Systematic Review

Directory of Open Access Journals (Sweden)

Kyriakos Spiliopoulos

2012-01-01

Full Text Available Heart failure is a major public health problem and its management requires a significant amount of health care resources. Even with administration of the best available medical treatment, the mortality associated with the disease remains high. As therapeutical strategies for heart failure have been refined, the number of patients suffering from the disease has expanded dramatically. Although heart transplantation still represents the gold standard therapeutical approach, the implantation of mechanical circulatory support devices (MCSDs evolved to a well-established management for this disease. The limited applicability of heart transplantation caused by a shortage of donor organs and the concurrent expand of the patient population with end-stage heart failure led to a considerable utilization of MCSDs. This paper outlines the current status of mechanical circulatory support.

Current management of hypertrophic cardiomyopathy: evidence in pathophysiology, diagnosis and treatment

International Nuclear Information System (INIS)

Quesada Mena, Luis Diego

2013-01-01

Available literary evidence is reviewed on the current management of hypertrophic cardiomyopathy. The bibliographical search is carried out in physical and online texts, cardiology journals, databases (MEDLINE), original studies, reviews and metaanalysis. Literature in English and Spanish is included from the first descriptions of the disease in the fifties, until the date of the investigation. Clinical management of patients is compared and recommendations published by consensus groups of international associations [es

Transcranial direct current stimulation in obsessive-compulsive disorder: emerging clinical evidence and considerations for optimal montage of electrodes.

Science.gov (United States)

Senço, Natasha M; Huang, Yu; D'Urso, Giordano; Parra, Lucas C; Bikson, Marom; Mantovani, Antonio; Shavitt, Roseli G; Hoexter, Marcelo Q; Miguel, Eurípedes C; Brunoni, André R

2015-07-01

Neuromodulation techniques for obsessive-compulsive disorder (OCD) treatment have expanded with greater understanding of the brain circuits involved. Transcranial direct current stimulation (tDCS) might be a potential new treatment for OCD, although the optimal montage is unclear. To perform a systematic review on meta-analyses of repetitive transcranianal magnetic stimulation (rTMS) and deep brain stimulation (DBS) trials for OCD, aiming to identify brain stimulation targets for future tDCS trials and to support the empirical evidence with computer head modeling analysis. Systematic reviews of rTMS and DBS trials on OCD in Pubmed/MEDLINE were searched. For the tDCS computational analysis, we employed head models with the goal of optimally targeting current delivery to structures of interest. Only three references matched our eligibility criteria. We simulated four different electrodes montages and analyzed current direction and intensity. Although DBS, rTMS and tDCS are not directly comparable and our theoretical model, based on DBS and rTMS targets, needs empirical validation, we found that the tDCS montage with the cathode over the pre-supplementary motor area and extra-cephalic anode seems to activate most of the areas related to OCD.

Brain PET imaging in obesity and food addiction: current evidence and hypothesis.

Science.gov (United States)

Iozzo, Patricia; Guiducci, Letizia; Guzzardi, Maria Angela; Pagotto, Uberto

2012-01-01

The ongoing epidemics of obesity is one main health concern of the present time. Overeating in some obese individuals shares similarities with the loss of control and compulsive behavior observed in drug-addicted subjects, suggesting that obesity may involve food addiction. Here, we review the contributions provided by the use of positron emission tomography to the current understanding of the cerebral control of obesity and food intake in humans. The available studies have shown that multiple areas in the brain are involved with the reward properties of food, such as prefrontal, orbitofrontal, somatosensory cortices, insula, thalamus, hypothalamus, amygdala, and others. This review summarizes the current evidence, supporting the concepts that i) regions involved in the somatosensory response to food sight, taste, and smell are activated by palatable foods and may be hyperresponsive in obese individuals, ii) areas controlling executive drive seem to overreact to the anticipation of pleasure during cue exposure, and iii) those involved in cognitive control and inhibitory behavior may be resistant to the perception of reward after food exposure in obese subjects. All of these features may stimulate, for different reasons, ingestion of highly palatable and energy-rich foods. Though these same regions are similarly involved in drug abusers and game-addicted individuals, any direct resemblance may be an oversimplification, especially as the heterogeneities between studies and the prevalent exclusion of sensitive groups still limit a coherent interpretation of the findings. Further work is required to comprehensively tackle the multifaceted phenotype of obesity and identify the role of food dependency in its pathophysiology. Copyright © 2012 S. Karger GmbH, Freiburg.

The evidence for the use of nutritional support in liver disease.

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Koretz, Ronald L

2014-03-01

Although there is a well established association between malnutrition and poorer clinical outcomes in patients with liver disease, that fact alone does not prove that improving the malnutrition will improve outcome. The best way to determine if nutritional interventions are effective is to compare them to untreated control groups in well designed and executed randomized clinical trials. A recent systematic review assessed 37 trials that compared parenteral nutrition, enteral nutrition, or nutritional supplements to no nutritional therapy in patients with a variety of liver diseases. Since the publication of that review, an additional three trials have become available. Whereas all but one of the trials did have methodologic shortcomings that may have allowed the introduction of bias (which usually results in an overestimation of benefit), the trials failed to show much, if any, benefit. In fact, the single trial at low risk of bias found that more deaths occurred in the recipients of the supplements. Although malnutrition may be associated with a poor outcome, the current best evidence indicates that the provision of adjunctive nutritional support (parenteral or enteral nutrition, or nutritional supplements) to patients with a variety of liver diseases (alcoholic hepatitis, cirrhosis, hepatocellular carcinoma, liver surgery, liver transplantation, obstructive jaundice, hepatitis C antiviral treatment) does not improve clinical outcomes.

Current Evidence and Insights about Genetics in Thoracic Aorta Disease

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Muneretto, Claudio

2013-01-01

Thoracic aortic aneurysms have been historically considered to be caused by etiologic factors similar to those implied in abdominal aortic aneurysms. However, during the past decade, there has been increasing evidence that almost 20% of thoracic aortic aneurysms may be associated with a genetic disease, often within a syndromic or familial disorder. Moreover, the presence of congenital anomalies, such as bicuspid aortic valve, may have a unique common genetic underlying cause. Finally, also sporadic forms have been found to be potentially associated with genetic disorders, as highlighted by the analysis of rare variants and expression of specific microRNAs. We therefore sought to perform a comprehensive review of the role of genetic causes in the development of thoracic aortic aneurysms, by analyzing in detail the current evidence of genetic alterations in syndromes such as Marfan, Loeys-Dietz, and Ehler-Danlos, familial or sporadic forms, or forms associated with bicuspid aortic valve. PMID:24453931

Current concepts in adult aphasia.

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McNeil, M R

1984-01-01

This paper provides a review of recent research from the areas of speech and language pathology, cognitive psychology, psycholinguistics, neurology, and rehabilitation medicine which is used to refine and extend current definitions of aphasia. Evidence is presented from these diverse disciplines, which supports a multimodality, performance-based, verbal and non-verbal, cortical and subcortical, and cognitively multidimensional view of aphasia. A summary of current practice in the assessment and treatment of adult aphasia is summarized.

Perioperative antibiotic usage by facial plastic surgeons: national survey results and comparison with evidence-based guidelines.

Science.gov (United States)

Grunebaum, Lisa Danielle; Reiter, David

2006-01-01

To determine current practice for use of perioperative antibiotics among facial plastic surgeons, to determine the extent of use of literature support for preferences of facial plastic surgeons, and to compare patterns of use with nationally supported evidence-based guidelines. A link to a Web site containing a questionnaire on perioperative antibiotic use was e-mailed to more than 1000 facial plastic surgeons in the United States. Responses were archived in a dedicated database and analyzed to determine patterns of use and methods of documenting that use. Current literature was used to develop evidence-based recommendations for perioperative antibiotic use, emphasizing current nationally supported guidelines. Preferences varied significantly for medication used, dosage and regimen, time of first dose relative to incision time, setting in which medication was administered, and procedures for which perioperative antibiotic was deemed necessary. Surgical site infection in facial plastic surgery can be reduced by better conformance to currently available evidence-based guidelines. We offer specific recommendations that are supported by the current literature.

Reproducibility of current classifications of endometrial endometrioid glandular proliferations : further evidence supporting a simplified classification

NARCIS (Netherlands)

Ordi, Jaume; Bergeron, Christine; Hardisson, David; McCluggage, W. Glenn; Hollema, Harry; Felix, Ana; Soslow, Robert A.; Oliva, Esther; Tavassoli, Fattaneh A.; Alvarado-Cabrero, Isabel; Wells, Michael; Nogales, Francisco F.

AimsTo compare the reproducibility of the current (2003) World Health Organization (WHO), endometrial intraepithelial neoplasia (EIN) and European Working Group (EWG) classifications of endometrial endometrioid proliferations. Methods and resultsNine expert gynaecological pathologists from Europe

Measuring Clinical Decision Support Influence on Evidence-Based Nursing Practice.

Science.gov (United States)

Cortez, Susan; Dietrich, Mary S; Wells, Nancy

2016-07-01

To measure the effect of clinical decision support (CDS) on oncology nurse evidence-based practice (EBP).
. Longitudinal cluster-randomized design.
. Four distinctly separate oncology clinics associated with an academic medical center.
. The study sample was comprised of randomly selected data elements from the nursing documentation software. The data elements were patient-reported symptoms and the associated nurse interventions. The total sample observations were 600, derived from a baseline, posteducation, and postintervention sample of 200 each (100 in the intervention group and 100 in the control group for each sample).
. The cluster design was used to support randomization of the study intervention at the clinic level rather than the individual participant level to reduce possible diffusion of the study intervention. An elongated data collection cycle (11 weeks) controlled for temporary increases in nurse EBP related to the education or CDS intervention.
. The dependent variable was the nurse evidence-based documentation rate, calculated from the nurse-documented interventions. The independent variable was the CDS added to the nursing documentation software.
. The average EBP rate at baseline for the control and intervention groups was 27%. After education, the average EBP rate increased to 37%, and then decreased to 26% in the postintervention sample. Mixed-model linear statistical analysis revealed no significant interaction of group by sample. The CDS intervention did not result in an increase in nurse EBP.
. EBP education increased nurse EBP documentation rates significantly but only temporarily. Nurses may have used evidence in practice but may not have documented their interventions.
. More research is needed to understand the complex relationship between CDS, nursing practice, and nursing EBP intervention documentation. CDS may have a different effect on nurse EBP, physician EBP, and other medical professional EBP.

Regression analysis of pulsed eddy current signals for inspection of steam generator tube support structures

International Nuclear Information System (INIS)

Buck, J.; Underhill, P.R.; Mokros, S.G.; Morelli, J.; Krause, T.W.; Babbar, V.K.; Lepine, B.

2015-01-01

Nuclear steam generator (SG) support structure degradation and fouling can result in damage to SG tubes and loss of SG efficiency. Conventional eddy current technology is extensively used to detect cracks, frets at supports and other flaws, but has limited capabilities in the presence of multiple degradation modes or fouling. Pulsed eddy current (PEC) combined with principal components analysis (PCA) and multiple linear regression models was examined for the inspection of support structure degradation and SG tube off-centering with the goal of extending results to include additional degradation modes. (author)

Benefits of donor human milk for preterm infants: current evidence.

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Bertino, Enrico; Giuliani, Francesca; Occhi, Luciana; Coscia, Alessandra; Tonetto, Paola; Marchino, Federica; Fabris, Claudio

2009-10-01

It's undoubted that optimum nutrition for term infants is breastfeeding, exclusive for the first six months, then followed by a complementary diet and carried on, if possible, for the first year of life or even more. During the last decades several data confirmed the great advantages of fresh mother's milk use also for feeding very low and extremely low birthweight preterm infants. When mother's milk is unavailable or in short supply, pasteurized donor breast milk is widely used in neonatal intensive care units. Pasteurization partially affects nutritional and immunological properties of breast milk, however it is known that pasteurized milk maintains some biological properties and clinical benefits. The substantial benefits of mother's own milk feeding of preterm infants are supported by strong evidence. However, there is increasing evidence also on specific benefits of donor breast milk. Future research is needed to compare formula vs. nutrient fortified donor breast milk, to compare formula and DM as supplements to maternal milk rather than as sole diet and to compare effects of different methods of heat treatments on donor human milk quality.

Robotic general surgery: current practice, evidence, and perspective.

Science.gov (United States)

Jung, M; Morel, P; Buehler, L; Buchs, N C; Hagen, M E

2015-04-01

Robotic technology commenced to be adopted for the field of general surgery in the 1990s. Since then, the da Vinci surgical system (Intuitive Surgical Inc, Sunnyvale, CA, USA) has remained by far the most commonly used system in this domain. The da Vinci surgical system is a master-slave machine that offers three-dimensional vision, articulated instruments with seven degrees of freedom, and additional software features such as motion scaling and tremor filtration. The specific design allows hand-eye alignment with intuitive control of the minimally invasive instruments. As such, robotic surgery appears technologically superior when compared with laparoscopy by overcoming some of the technical limitations that are imposed on the surgeon by the conventional approach. This article reviews the current literature and the perspective of robotic general surgery. While robotics has been applied to a wide range of general surgery procedures, its precise role in this field remains a subject of further research. Until now, only limited clinical evidence that could establish the use of robotics as the gold standard for procedures of general surgery has been created. While surgical robotics is still in its infancy with multiple novel systems currently under development and clinical trials in progress, the opportunities for this technology appear endless, and robotics should have a lasting impact to the field of general surgery.

Evidence-informed health policy 1 – Synthesis of findings from a multi-method study of organizations that support the use of research evidence

Directory of Open Access Journals (Sweden)

Moynihan Ray

2008-12-01

Full Text Available Abstract Background Organizations have been established in many countries and internationally to support the use of research evidence by producing clinical practice guidelines, undertaking health technology assessments, and/or directly supporting the use of research evidence in developing health policy on an international, national, and state or provincial level. Learning from these organizations can reduce the need to 'reinvent the wheel' and inform decisions about how best to organize support for such organizations, particularly in low- and middle-income countries (LMICs. Methods We undertook a multi-method study in three phases – a survey, interviews, and case descriptions that drew on site visits – and in each of the second and third phases we focused on a purposive sample of those involved in the previous phase. We used the seven main recommendations that emerged from the advice offered in the interviews to organize much of the synthesis of findings across phases and methods. We used a constant comparative method to identify themes from across phases and methods. Results Seven recommendations emerged for those involved in establishing or leading organizations that support the use of research evidence in developing health policy: 1 collaborate with other organizations; 2 establish strong links with policymakers and involve stakeholders in the work; 3 be independent and manage conflicts of interest among those involved in the work; 4 build capacity among those working in the organization; 5 use good methods and be transparent in the work; 6 start small, have a clear audience and scope, and address important questions; and 7 be attentive to implementation considerations, even if implementation is not a remit. Four recommendations emerged for the World Health Organization (WHO and other international organizations and networks: 1 support collaborations among organizations; 2 support local adaptation efforts; 3 mobilize support; and 4 create

Developing genomic knowledge bases and databases to support clinical management: current perspectives.

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Huser, Vojtech; Sincan, Murat; Cimino, James J

2014-01-01

Personalized medicine, the ability to tailor diagnostic and treatment decisions for individual patients, is seen as the evolution of modern medicine. We characterize here the informatics resources available today or envisioned in the near future that can support clinical interpretation of genomic test results. We assume a clinical sequencing scenario (germline whole-exome sequencing) in which a clinical specialist, such as an endocrinologist, needs to tailor patient management decisions within his or her specialty (targeted findings) but relies on a genetic counselor to interpret off-target incidental findings. We characterize the genomic input data and list various types of knowledge bases that provide genomic knowledge for generating clinical decision support. We highlight the need for patient-level databases with detailed lifelong phenotype content in addition to genotype data and provide a list of recommendations for personalized medicine knowledge bases and databases. We conclude that no single knowledge base can currently support all aspects of personalized recommendations and that consolidation of several current resources into larger, more dynamic and collaborative knowledge bases may offer a future path forward.

Asthma and obesity in children: current evidence and potential systems biology approaches.

Science.gov (United States)

Frey, U; Latzin, P; Usemann, J; Maccora, J; Zumsteg, U; Kriemler, S

2015-01-01

Both obesity and asthma are highly prevalent, complex diseases modified by multiple factors. Genetic, developmental, lung mechanical, immunological and behavioural factors have all been suggested as playing a causal role between the two entities; however, their complex mechanistic interactions are still poorly understood and evidence of causality in children remains scant. Equally lacking is evidence of effective treatment strategies, despite the fact that imbalances at vulnerable phases in childhood can impact long-term health. This review is targeted at both clinicians frequently faced with the dilemma of how to investigate and treat the obese asthmatic child and researchers interested in the topic. Highlighting the breadth of the spectrum of factors involved, this review collates evidence regarding the investigation and treatment of asthma in obese children, particularly in comparison with current approaches in 'difficult-to-treat' childhood asthma. Finally, the authors propose hypotheses for future research from a systems-based perspective. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Democratic Values and Support for Militancy: Evidence from a National Survey of Pakistan

Science.gov (United States)

2011-06-14

our survey provides prima facie evidence that this technique reduced respondents’ concerns about reporting sensitive information.18 That the...the empirical underpinnings of popular support for militancy, researchers have a duty to minimize risk to all survey participants and enumerators

Automatic evidence quality prediction to support evidence-based decision making.

Science.gov (United States)

Sarker, Abeed; Mollá, Diego; Paris, Cécile

2015-06-01

Evidence-based medicine practice requires practitioners to obtain the best available medical evidence, and appraise the quality of the evidence when making clinical decisions. Primarily due to the plethora of electronically available data from the medical literature, the manual appraisal of the quality of evidence is a time-consuming process. We present a fully automatic approach for predicting the quality of medical evidence in order to aid practitioners at point-of-care. Our approach extracts relevant information from medical article abstracts and utilises data from a specialised corpus to apply supervised machine learning for the prediction of the quality grades. Following an in-depth analysis of the usefulness of features (e.g., publication types of articles), they are extracted from the text via rule-based approaches and from the meta-data associated with the articles, and then applied in the supervised classification model. We propose the use of a highly scalable and portable approach using a sequence of high precision classifiers, and introduce a simple evaluation metric called average error distance (AED) that simplifies the comparison of systems. We also perform elaborate human evaluations to compare the performance of our system against human judgments. We test and evaluate our approaches on a publicly available, specialised, annotated corpus containing 1132 evidence-based recommendations. Our rule-based approach performs exceptionally well at the automatic extraction of publication types of articles, with F-scores of up to 0.99 for high-quality publication types. For evidence quality classification, our approach obtains an accuracy of 63.84% and an AED of 0.271. The human evaluations show that the performance of our system, in terms of AED and accuracy, is comparable to the performance of humans on the same data. The experiments suggest that our structured text classification framework achieves evaluation results comparable to those of human performance

The Built Environment and Child Health: An Overview of Current Evidence.

Science.gov (United States)

Gascon, Mireia; Vrijheid, Martine; Nieuwenhuijsen, Mark J

2016-09-01

Urbanization and the shaping of the built environment have provided a number of socioeconomic benefits, but they have also brought unwanted side effects on health. We aimed to review the current epidemiological evidence of the associations between the built environment, closely related exposures, and child health. We focused on growth and obesity, neuropsychological development, and respiratory and immune health. We used existing review articles and supplemented these with relevant work published and not included in existing reviews. The present review shows that there is good evidence for an association between air pollution and fetal growth restriction and respiratory health, whereas for other exposure and outcome combinations, further evidence is needed. Future studies should make efforts to integrate the different built environment features and to include the evaluation of environments other than home, as well as accessibility, qualitative and perception assessment of the built environment, and, if possible, with improved and standardized tools to facilitate comparability between studies. Efforts are also needed to conduct longitudinal and intervention studies and to understand potential mechanisms behind the associations observed. Finally, studies in low- and middle-income countries are needed.

Supporting Better Evidence Generation and Use within Social Innovation in Health in Low- and Middle-Income Countries: A Qualitative Study.

Science.gov (United States)

Ballard, Madeleine; Tran, Jenny; Hersch, Fred; Lockwood, Amy; Hartigan, Pamela; Montgomery, Paul

2017-01-01

While several papers have highlighted a lack of evidence to scale social innovations in health, fewer have explored decision-maker understandings of the relative merit of different types of evidence, how such data are interpreted and applied, and what practical support is required to improve evidence generation. The objectives of this paper are to understand (1) beliefs and attitudes towards the value of and types of evidence in scaling social innovations for health, (2) approaches to evidence generation and evaluation used in systems and policy change, and (3) how better evidence-generation can be undertaken and supported within social innovation in health. Thirty-two one-on-one interviews were conducted between July and November 2015 with purposively selected practitioners, policymakers, and funders from low- and middle- income countries (LMICs). Data were analysed using a Framework Analysis Approach. While practitioners, funders, and policymakers said they held outcome evidence in high regard, their practices only bear out this assertion to varying degrees. Few have given systematic consideration to potential unintended consequences, in particular harm, of the programs they implement, fund, or adopt. Stakeholders suggest that better evidence-generation can be undertaken and supported within social innovation in health by supporting the research efforts of emerging community organizations; creating links between practitioners and academia; altering the funding landscape for evidence-generation; providing responsive technical education; and creating accountability for funders, practitioners, and policymakers. How better evidence-generation can be undertaken and supported within social innovation in health is a previously under-operationalised aspect of the policy-making process that remains essential in order to refrain from causing harm, enable the optimization of existing interventions, and ultimately, to scale and fund what works.

Evidence-informed health policy 4 – Case descriptions of organizations that support the use of research evidence

Directory of Open Access Journals (Sweden)

Oxman Andrew D

2008-12-01

Full Text Available Abstract Background Previous efforts to produce case descriptions have typically not focused on the organizations that produce research evidence and support its use. External evaluations of such organizations have typically not been analyzed as a group to identify the lessons that have emerged across multiple evaluations. Case descriptions offer the potential for capturing the views and experiences of many individuals who are familiar with an organization, including staff, advocates, and critics. Methods We purposively sampled a subgroup of organizations from among those that participated in the second (interview phase of the study and (once from among other organizations with which we were familiar. We developed and pilot-tested a case description data collection protocol, and conducted site visits that included both interviews and documentary analyses. Themes were identified from among responses to semi-structured questions using a constant comparative method of analysis. We produced both a brief (one to two pages written description and a video documentary for each case. Results We conducted 51 interviews as part of the eight site visits. Two organizational strengths were repeatedly cited by individuals participating in the site visits: use of an evidence-based approach (which was identified as being very time-consuming and existence of a strong relationship between researchers and policymakers (which can be challenged by conflicts of interest. Two organizational weaknesses – a lack of resources and the presence of conflicts of interest – were repeatedly cited by individuals participating in the site visits. Participants offered two main suggestions for the World Health Organization (and other international organizations and networks: 1 mobilize one or more of government support, financial resources, and the participation of both policymakers and researchers; and 2 create knowledge-related global public goods. Conclusion The findings from

Killing fields; The epidemiological evidence

Energy Technology Data Exchange (ETDEWEB)

Best, Simon

1990-02-01

The threat posed by low frequency fields emerged initially because a researcher, looking for environmental factors in childhood leukaemia, observed a link between low voltage, high current power lines and disease occurrence. Cellular evidence now supports the findings but epidemiology still leads the argument. (43 references). (author).

Therapeutic Use of Prebiotics, Probiotics, and Postbiotics to Prevent Necrotizing Enterocolitis: What is the Current Evidence?

Science.gov (United States)

Patel, Ravi Mangal; Denning, Patricia Wei

2013-01-01

Synopsis Necrotizing enterocolitis (NEC) is a leading cause of neonatal morbidity and mortality and preventative therapies that are both effective and safe are urgently needed. Current evidence from therapeutic trials suggests that probiotics are effective in decreasing NEC in preterm infants and probiotics are currently the most promising therapy on the horizon for this devastating disease. However, concerns regarding safety and optimal dosing have limited the widespread adoption of routine clinical use of probiotics in preterm infants. In addition, prebiotics and postbiotics may be potential alternatives or adjunctive therapies to the administration of live microorganisms, although studies demonstrating their clinical efficacy in preventing NEC are lacking. This review summarizes the current evidence regarding the use of probiotics, prebiotics and postbiotics in the preterm infant, including its therapeutic role in preventing NEC. PMID:23415261

Supporting Better Evidence Generation and Use within Social Innovation in Health in Low- and Middle-Income Countries: A Qualitative Study.

Directory of Open Access Journals (Sweden)

Madeleine Ballard

Full Text Available While several papers have highlighted a lack of evidence to scale social innovations in health, fewer have explored decision-maker understandings of the relative merit of different types of evidence, how such data are interpreted and applied, and what practical support is required to improve evidence generation. The objectives of this paper are to understand (1 beliefs and attitudes towards the value of and types of evidence in scaling social innovations for health, (2 approaches to evidence generation and evaluation used in systems and policy change, and (3 how better evidence-generation can be undertaken and supported within social innovation in health.Thirty-two one-on-one interviews were conducted between July and November 2015 with purposively selected practitioners, policymakers, and funders from low- and middle- income countries (LMICs. Data were analysed using a Framework Analysis Approach.While practitioners, funders, and policymakers said they held outcome evidence in high regard, their practices only bear out this assertion to varying degrees. Few have given systematic consideration to potential unintended consequences, in particular harm, of the programs they implement, fund, or adopt. Stakeholders suggest that better evidence-generation can be undertaken and supported within social innovation in health by supporting the research efforts of emerging community organizations; creating links between practitioners and academia; altering the funding landscape for evidence-generation; providing responsive technical education; and creating accountability for funders, practitioners, and policymakers.How better evidence-generation can be undertaken and supported within social innovation in health is a previously under-operationalised aspect of the policy-making process that remains essential in order to refrain from causing harm, enable the optimization of existing interventions, and ultimately, to scale and fund what works.

Ebola Virus Shedding and Transmission: Review of Current Evidence.

Science.gov (United States)

Vetter, Pauline; Fischer, William A; Schibler, Manuel; Jacobs, Michael; Bausch, Daniel G; Kaiser, Laurent

2016-10-15

 The magnitude of the 2013-2016 Ebola virus disease outbreak in West Africa was unprecedented, with >28 500 reported cases and >11 000 deaths. Understanding the key elements of Ebola virus transmission is necessary to implement adequate infection prevention and control measures to protect healthcare workers and halt transmission in the community.  We performed an extensive PubMed literature review encompassing the period from discovery of Ebola virus, in 1976, until 1 June 2016 to evaluate the evidence on modes of Ebola virus shedding and transmission.  Ebola virus has been isolated by cell culture from blood, saliva, urine, aqueous humor, semen, and breast milk from infected or convalescent patients. Ebola virus RNA has been noted in the following body fluids days or months after onset of illness: saliva (22 days), conjunctiva/tears (28 days), stool (29 days), vaginal fluid (33 days), sweat (44 days), urine (64 days), amniotic fluid (38 days), aqueous humor (101 days), cerebrospinal fluid (9 months), breast milk (16 months [preliminary data]), and semen (18 months). Nevertheless, the only documented cases of secondary transmission from recovered patients have been through sexual transmission. We did not find strong evidence supporting respiratory or fomite-associated transmission. © The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.

Is There Evidence to Support a Forefoot Strike Pattern in Barefoot Runners? A Review

OpenAIRE

Lorenz, Daniel S.; Pontillo, Marisa

2012-01-01

Context: Barefoot running is a trend among running enthusiasts that is the subject of much controversy. At this time, benefits appear to be more speculative and anecdotal than evidence based. Additionally, the risk of injuries is not well established. Evidence acquisition: A PubMed search was undertaken for articles published in English from 1980 to 2011. Additional references were accrued from reference lists of research articles. Results: While minimal data exist that definitively support b...

Cooptation of Peer Support Staff: Quantitative Evidence

Directory of Open Access Journals (Sweden)

Anthony J. Alberta

2014-03-01

Full Text Available Objective In 2007, the Centers for Medicare and Medicaid Services (CMS sent a letter to state Medicaid directors outlining requirements for implementing peer-based recovery support services (P-BRSS as a Medicaid-funded service. Since then, 30 states have implemented these services. Although the literature describing implementation of P-BRSS has identified the cooptation of peer support staff (PSS as a barrier to the effective provision of P-BRSS, the evidence for it remains anecdotal. This study attempts to determine if the context of employment in either a treatment organization or peer organization affected cooptation. Methods We conducted a survey of PSS in the fall of 2013. In all, 92 of the 181 respondents were working as PSS at the time, 53 in treatment organizations. Chi-square analysis was used to determine if the context of employment had an effect on the cooptation of peer staff. Results Peer staff working in treatment organizations reported that they were supervised by treatment staff and participated in employment-related training to improve their skills at providing treatment services more frequently than their counterparts in peer organizations. Peer staff working in treatment organizations also participated in training and education to prepare for employment as treatment professionals more frequently than peer staff working in peer organizations. Conclusions and Implications for Practice Peer staff members working in treatment organizations are subject to processes of acculturation into professional cultures that peer staff working in peer organizations are not. Effective implementation of P-BRSS should include specific efforts to minimize the cooptation of peer staff.

Vitamin E in Sarcopenia: Current Evidences on Its Role in Prevention and Treatment

Directory of Open Access Journals (Sweden)

Shy Cian Khor

2014-01-01

Full Text Available Sarcopenia is a geriatric syndrome that is characterized by gradual loss of muscle mass and strength with increasing age. Although the underlying mechanism is still unknown, the contribution of increased oxidative stress in advanced age has been recognized as one of the risk factors of sarcopenia. Thus, eliminating reactive oxygen species (ROS can be a strategy to combat sarcopenia. In this review, we discuss the potential role of vitamin E in the prevention and treatment of sarcopenia. Vitamin E is a lipid soluble vitamin, with potent antioxidant properties and current evidence suggesting a role in the modulation of signaling pathways. Previous studies have shown its possible beneficial effects on aging and age-related diseases. Although there are evidences suggesting an association between vitamin E and muscle health, they are still inconclusive compared to other more extensively studied chronic diseases such as neurodegenerative diseases and cardiovascular diseases. Therefore, we reviewed the role of vitamin E and its potential protective mechanisms on muscle health based on previous and current in vitro and in vivo studies.

Intermittent fasting and cardiovascular disease: current evidence and unresolved questions.

Science.gov (United States)

Tinsley, Grant M; Horne, Benjamin D

2018-01-01

Intermittent fasting has produced a variety of beneficial health effects in animal models, although high-quality research in humans has been limited. This special report examines current evidences for intermittent fasting in humans, discusses issues that require further examination, and recommends new research that can improve the knowledge base in this emerging research area. While potentially useful for health improvement, intermittent fasting requires further study prior to widespread implementation for health purposes. Randomized, longer-term studies are needed to determine whether using intermittent fasting as a lifestyle rather than a diet is feasible and beneficial for the health of some members of the human population.

Integrative Therapies and Pediatric Inflammatory Bowel Disease: The Current Evidence.

Science.gov (United States)

Misra, Sanghamitra M

2014-08-25

Inflammatory bowel disease (IBD) primarily describes two distinct chronic conditions with unknown etiology, ulcerative colitis (UC) and Crohn's disease (CD). UC is limited to the colon, while CD may involve any portion of the gastrointestinal tract from mouth to anus. These diseases exhibit a pattern of relapse and remission, and the disease processes are often painful and debilitating. Due to the chronic nature of IBD and the negative side effects of many of the conventional therapies, many patients and their families turn to complementary and alternative medicine (CAM) for symptom relief. This article focuses on the current available evidence behind CAM/integrative therapies for IBD.

The Current State of Empirical Support for the Pharmacological Treatment of Selective Mutism

Science.gov (United States)

Carlson, John S.; Mitchell, Angela D.; Segool, Natasha

2008-01-01

This article reviews the current state of evidence for the psychopharmacological treatment of children diagnosed with selective mutism within the context of its link to social anxiety disorder. An increased focus on potential medication treatment for this disorder has resulted from significant monetary and resource limitations in typical practice,…

Peer support and peer-led family support for persons living with schizophrenia.

Science.gov (United States)

Duckworth, Kenneth; Halpern, Lisa

2014-05-01

Peer support and peer-led family psychoeducation represent two distinct and complementary recovery-oriented models to support individuals who live with schizophrenia and their families, respectively. The goals of these models focus on improving knowledge, coping, self-care, social support, and self-management strategies. These models represent important capacity-building strategies for people who live with the illness and the people who love them. This brief article is intended to provide the practicing clinician, person living with schizophrenia, and policy maker with a working knowledge of the current state of the literature in these two related fields. Practitioners should consider these resources and integrate them into their care. A person living with schizophrenia could use this review to advocate for appropriate resources and to identify career opportunities. Policy makers could benefit from an understanding of the literature to mitigate financial and cultural barriers to adopting these practices. The last 5 years have seen a dramatic expansion of the application of randomized controlled trials (RCTs) to give evidence to match the experience of people in these programs. The field has seen Wellness Recovery Action Plan (WRAP) named as evidence-based practice by the National Registry of Evidence-Based Practices. A RCT was also conducted for another peer-developed and led program called Building Recovery of Individual Dreams & Goals through Education & Support. Family to Family, the largest peer-led family psychoeducation course, was also found to have significant impact after the study and also 6 months later in RCT. Family to Family has also been named as an evidence-based practice. The field of people who are living well with schizophrenia working as resources and supports to others living with the illness is an idea that is growing momentum. This momentum has been matched by the RCT evidence. Peer support as a professional role has an emerging literature

A framework for production of systematic review based briefings to support evidence-informed decision-making.

Science.gov (United States)

Chambers, Duncan; Wilson, Paul

2012-07-09

We have developed a framework for translating existing sources of synthesized and quality-assessed evidence, primarily systematic reviews, into actionable messages in the form of short accessible briefings. The service aims to address real-life problems in response to requests from decision-makers.Development of the framework was based on a scoping review of existing resources and our initial experience with two briefing topics, including models of service provision for young people with eating disorders. We also drew on previous experience in dissemination research and practice. Where appropriate, we made use of the SUPporting POlicy relevant Reviews and Trials (SUPPORT) tools for evidence-informed policymaking. To produce a product that it is fit for this purpose it has been necessary to go beyond a traditional summary of the available evidence relating to effectiveness. Briefings have, therefore, included consideration of cost effectiveness, local applicability, implications relating to local service delivery, budgets, implementation and equity. Our first evidence briefings produced under this framework cover diagnostic endoscopy by specialist nurses and integrated care pathways in mental healthcare settings. The framework will enable researchers to present and contextualize evidence from systematic reviews and other sources of synthesized and quality-assessed evidence. The approach is designed to address the wide range of questions of interest to decision-makers, especially those commissioning services or managing service delivery and organization in primary or secondary care. Evaluation of the use and usefulness of the evidence briefings we produce is an integral part of the framework and will help to fill a gap in the literature.

Dutch evidence statement for pelvic physical therapy in patients with anal incontinence.

Science.gov (United States)

Berghmans, L C M; Groot, J A M; van Heeswijk-Faase, I C; Bols, E M J

2015-04-01

To promote agreement among and support the quality of pelvic physiotherapists' skills and clinical reasoning in The Netherlands, an Evidence Statement Anal Incontinence (AI) was developed based on the practice-driven problem definitions outlined. We present a summary of the current state of knowledge and formulate recommendations for a methodical assessment and treatment for patients with AI, and place the evidence in a broader perspective of current developments. Electronic literature searches were conducted in relevant databases with regard to prevalence, incidence, costs, etiological and prognostic factors, predictors of response to therapy, prevention, assessment, and treatment. The recommendations have been formulated on the basis of scientific evidence and where no evidence was available, recommendations were consensus-based. The evidence statement incorporates a practice statement with corresponding notes that clarify the recommendations, and accompanying flowcharts, describing the steps and recommendations with regard to the diagnostic and therapeutic process. The diagnostic process consists of history-taking and physical examination supported by measurement instruments. For each problem category for patients with AI, a certain treatment plan can be distinguished dependent on the presence of pelvic floor dysfunction, awareness of loss of stools, comorbidity, neurological problems, adequate anorectal sensation, and (in)voluntary control. Available evidence and expert opinion support the use of education, pelvic floor muscle training, biofeedback, and electrostimulation in selected patients. The evidence statement reflects the current state of knowledge for a methodical and systematic physical therapeutic assessment and treatment for patients with AI.

Initiatives supporting evidence informed health system policymaking in Cameroon and Uganda: a comparative historical case study.

Science.gov (United States)

Ongolo-Zogo, Pierre; Lavis, John N; Tomson, Goran; Sewankambo, Nelson K

2014-11-29

There is a scarcity of empirical data on institutions devoted to knowledge brokerage and their influence in Africa. Our objective was to describe two pioneering Knowledge Translation Platforms (KTPs) supporting evidence informed health system policymaking (EIHSP) in Cameroon and Uganda since 2006. This comparative historical case study of Evidence Informed Policy Network (EVIPNet) Cameroon and Regional East African Community Health Policy Initiative (REACH-PI) Uganda using multiple methods comprised (i) a descriptive documentary analysis for a narrative historical account, (ii) an interpretive documentary analysis of the context, profiles, activities and outputs inventories and (iii) an evaluative survey of stakeholders exposed to evidence briefs produced and policy dialogues organized by the KTPs. Both initiatives benefited from the technical and scientific support from the global EVIPNet resource group. EVIPNet Cameroon secretariat operates with a multidisciplinary group of part-time researchers in a teaching hospital closely linked to the ministry of health. REACH-PI Uganda secretariat operates with a smaller team of full time staff in a public university. Financial resources were mobilized from external donors to scale up capacity building, knowledge management, and linkage and exchange activities. Between 2008 and 2012, twelve evidence briefs were produced in Cameroon and three in Uganda. In 2012, six rapid evidence syntheses in response to stakeholders' urgent needs were produced in Cameroon against 73 in Uganda between 2010 and 2012. Ten policy dialogues (seven in Cameroon and three in Uganda) informed by pre-circulated evidence briefs were well received. Both KTPs contributed to developing and testing new resources and tools for EIHSP. A network of local and global experts has created new spaces for evidence informed deliberations on priority health policy issues related to MDGs. This descriptive historical account of two KTPs housed in government

Sixty years of fear appeal research: current state of the evidence.

Science.gov (United States)

Ruiter, Robert A C; Kessels, Loes T E; Peters, Gjalt-Jorn Y; Kok, Gerjo

2014-04-01

Fear arousal is widely used in persuasive campaigns and behavioral change interventions. Yet, experimental evidence argues against the use of threatening health information. The authors reviewed the current state of empirical evidence on the effectiveness of fear appeals. Following a brief overview of the use of fear arousal in health education practice and the structure of effective fear appeals according to two main theoretical frameworks-protection motivation theory and the extended parallel process model-the findings of six meta-analytic studies in the effectiveness of fear appeals are summarized. It is concluded that coping information aimed at increasing perceptions of response effectiveness and especially self-efficacy is more important in promoting protective action than presenting threatening health information aimed at increasing risk perceptions and fear arousal. Alternative behavior change methods than fear appeals should be considered. © 2014 The Authors. International Journal of Psychology published by John Wiley © Sons Ltd on behalf of International Union of Psychological Science.

Social support and protection from depression: systematic review of current findings in Western countries.

Science.gov (United States)

Gariépy, Geneviève; Honkaniemi, Helena; Quesnel-Vallée, Amélie

2016-10-01

Numerous studies report an association between social support and protection from depression, but no systematic review or meta-analysis exists on this topic. To review systematically the characteristics of social support (types and source) associated with protection from depression across life periods (childhood and adolescence; adulthood; older age) and by study design (cross-sectional v cohort studies). A systematic literature search conducted in February 2015 yielded 100 eligible studies. Study quality was assessed using a critical appraisal checklist, followed by meta-analyses. Sources of support varied across life periods, with parental support being most important among children and adolescents, whereas adults and older adults relied more on spouses, followed by family and then friends. Significant heterogeneity in social support measurement was noted. Effects were weaker in both magnitude and significance in cohort studies. Knowledge gaps remain due to social support measurement heterogeneity and to evidence of reverse causality bias. © The Royal College of Psychiatrists 2016.

Evidence-based medicine is affordable: the cost-effectiveness of current compared with optimal treatment in rheumatoid and osteoarthritis.

Science.gov (United States)

Andrews, Gavin; Simonella, Leonardo; Lapsley, Helen; Sanderson, Kristy; March, Lyn

2006-04-01

To determine the cost-effectiveness of averting the burden of disease. We used secondary population data and metaanalyses of various government-funded services and interventions to investigate the costs and benefits of various levels of treatment for rheumatoid arthritis (RA) and osteoarthritis (OA) in adults using a burden of disease framework. Population burden was calculated for both diseases in the absence of any treatment as years lived with disability (YLD), ignoring the years of life lost. We then estimated the proportion of burden averted with current interventions, the proportion that could be averted with optimally implemented current evidence-based guidelines, and the direct treatment cost-effectiveness ratio in dollars per YLD averted for both treatment levels. The majority of people with arthritis sought medical treatment. Current treatment for RA averted 26% of the burden, with a cost-effectiveness ratio of dollar 19,000 per YLD averted. Optimal, evidence-based treatment would avert 48% of the burden, with a cost-effectiveness ratio of dollar 12,000 per YLD averted. Current treatment of OA in Australia averted 27% of the burden, with a cost-effectiveness ratio of dollar 25,000 per YLD averted. Optimal, evidence-based treatment would avert 39% of the burden, with an unchanged cost-effectiveness ratio of dollar 25,000 per YLD averted. While the precise dollar costs in each country will differ, the relativities at this level of coverage should remain the same. There is no evidence that closing the gap between evidence and practice would result in a drop in efficiency.

An Overview of the Current Status of Talent Care and Talent Support in Hungary

Science.gov (United States)

Fuszek, Csilla

2014-01-01

After a short historical introduction, the article provides an overview of the current talent support trends in Hungary. It gives an insight into the legislation, guidelines and institutional system associated with the national talent support strategy, and presents the main NGO initiatives present in the early 21st century, in particular the…

Review of current status for designing severe accident management support system

Energy Technology Data Exchange (ETDEWEB)

Jeong, Kwang Sub

2000-05-01

The development of operator support system (OSS) is ongoing in many other countries due to the complexity both in design and in operation for nuclear power plant. The computerized operator support system includes monitoring of some critical parameters, early detection of plant transient, monitoring of component status, plant maintenance, and safety parameter display, and the operator support system for these areas are developed and are being used in some plants. Up to now, the most operator support system covers the normal operation, abnormal operation, and emergency operation. Recently, however, the operator support system for severe accident is to be developed in some countries. The study for the phenomena of severe accident is not performed sufficiently, but, based on the result up to now, the operator support system even for severe accident will be developed in this study. To do this, at first, the current status of the operator support system for normal/abnormal/emergency operation is reviewed, and the positive aspects and negative aspects of systems are analyzed by their characteristics. And also, the major items that should be considered in designing the severe accident operator support system are derived from the review. With the survey of domestic and foreign operator support systems, they are reviewed in terms of the safety parameter display system, decision-making support system, and procedure-tracking system. For the severe accident, the severe accident management guideline (SAMG) which is developed by Westinghouse is reviewed; the characteristics, structure, and logical flow of SAMG are studied. In addition, the critical parameters for severe accident, which are the basis for operators decision-making in severe accident management and are supplied to the operators and the technical support center, are reviewed, too.

Review of current status for designing severe accident management support system

International Nuclear Information System (INIS)

Jeong, Kwang Sub

2000-05-01

The development of operator support system (OSS) is ongoing in many other countries due to the complexity both in design and in operation for nuclear power plant. The computerized operator support system includes monitoring of some critical parameters, early detection of plant transient, monitoring of component status, plant maintenance, and safety parameter display, and the operator support system for these areas are developed and are being used in some plants. Up to now, the most operator support system covers the normal operation, abnormal operation, and emergency operation. Recently, however, the operator support system for severe accident is to be developed in some countries. The study for the phenomena of severe accident is not performed sufficiently, but, based on the result up to now, the operator support system even for severe accident will be developed in this study. To do this, at first, the current status of the operator support system for normal/abnormal/emergency operation is reviewed, and the positive aspects and negative aspects of systems are analyzed by their characteristics. And also, the major items that should be considered in designing the severe accident operator support system are derived from the review. With the survey of domestic and foreign operator support systems, they are reviewed in terms of the safety parameter display system, decision-making support system, and procedure-tracking system. For the severe accident, the severe accident management guideline (SAMG) which is developed by Westinghouse is reviewed; the characteristics, structure, and logical flow of SAMG are studied. In addition, the critical parameters for severe accident, which are the basis for operators decision-making in severe accident management and are supplied to the operators and the technical support center, are reviewed, too

A framework for production of systematic review based briefings to support evidence-informed decision-making

Directory of Open Access Journals (Sweden)

Chambers Duncan

2012-07-01

Full Text Available Abstract Background We have developed a framework for translating existing sources of synthesized and quality-assessed evidence, primarily systematic reviews, into actionable messages in the form of short accessible briefings. The service aims to address real-life problems in response to requests from decision-makers. Development of the framework was based on a scoping review of existing resources and our initial experience with two briefing topics, including models of service provision for young people with eating disorders. We also drew on previous experience in dissemination research and practice. Where appropriate, we made use of the SUPporting POlicy relevant Reviews and Trials (SUPPORT tools for evidence-informed policymaking. Findings To produce a product that it is fit for this purpose it has been necessary to go beyond a traditional summary of the available evidence relating to effectiveness. Briefings have, therefore, included consideration of cost effectiveness, local applicability, implications relating to local service delivery, budgets, implementation and equity. Our first evidence briefings produced under this framework cover diagnostic endoscopy by specialist nurses and integrated care pathways in mental healthcare settings. Conclusions The framework will enable researchers to present and contextualize evidence from systematic reviews and other sources of synthesized and quality-assessed evidence. The approach is designed to address the wide range of questions of interest to decision-makers, especially those commissioning services or managing service delivery and organization in primary or secondary care. Evaluation of the use and usefulness of the evidence briefings we produce is an integral part of the framework and will help to fill a gap in the literature.

Scapulothoracic bursitis and snapping scapula syndrome: a critical review of current evidence.

Science.gov (United States)

Warth, Ryan J; Spiegl, Ulrich J; Millett, Peter J

2015-01-01

Symptomatic scapulothoracic disorders, such as painful scapular crepitus and/or bursitis, are uncommon; however, they can produce significant pain and disability in many patients. To review the current knowledge pertaining to snapping scapula syndrome and to identify areas of further research that may be helpful to improve clinical outcomes and patient satisfaction. Systematic review. We performed a preliminary search of the PubMed and Embase databases using the search terms "snapping scapula," "scapulothoracic bursitis," "partial scapulectomy," and "superomedial angle resection" in September 2013. All nonreview articles related to the topic of snapping scapula syndrome were included. The search identified a total of 167 unique articles, 81 of which were relevant to the topic of snapping scapula syndrome. There were 36 case series of fewer than 10 patients, 16 technique papers, 11 imaging studies, 9 anatomic studies, and 9 level IV outcomes studies. The level of evidence obtained from this literature search was inadequate to perform a formal systematic review or meta-analysis. Therefore, a critical review of current evidence is presented. Snapping scapula syndrome, a likely underdiagnosed condition, can produce significant shoulder dysfunction in many patients. Because the precise origin is typically unknown, specific treatments that are effective for some patients may not be effective for others. Nevertheless, bursectomy with or without partial scapulectomy is currently the most effective primary method of treatment in patients who fail nonoperative therapy. However, many patients experience continued shoulder disability even after surgical intervention. Future studies should focus on identifying the modifiable factors associated with poor outcomes after operative and nonoperative management for snapping scapula syndrome in an effort to improve clinical outcomes and patient satisfaction. © 2014 The Author(s).

Current practice patterns of drain usage amongst UK and Irish surgeons performing bilateral breast reductions: Evidence down the drain.

Science.gov (United States)

Sugrue, Conor M; McInerney, Niall; Joyce, Cormac W; Jones, Deidre; Hussey, Alan J; Kelly, Jack L; Kerin, Michael J; Regan, Padraic J

2015-01-01

Bilateral breast reduction (BBR) is one of the most frequently performed female breast operations. Despite no evidence supporting efficacy of drain usage in BBRs, postoperative insertion is common. Recent high quality evidence demonstrating potential harm from drain use has subsequently challenged this traditional practice. The aim of this study is to assess the current practice patterns of drains usage by Plastic & Reconstructive and Breast Surgeons in UK and Ireland performing BBRs. An 18 question survey was created evaluating various aspects of BBR practice. UK and Irish Plastic & Reconstructive and Breast Surgeons were invited to participate by an email containing a link to a web-based survey. Statistical analysis was performed with student t-test and chi-square test. Two hundred and eleven responding surgeons were analysed, including 80.1% (171/211) Plastic Surgeons and 18.9% (40/211) Breast Surgeons. Of the responding surgeons, 71.6% (151/211) routinely inserted postoperative drains, for a mean of 1.32 days. Drains were used significantly less by surgeons performing ≥20 BBRs (p = 0.02). With the majority of BBRs performed as an inpatient procedure, there was a trend towards less drain usage in surgeons performing this procedure as an outpatient; however, this was not statistically significant (p = 0.07). Even with the high level of evidence demonstrating the safety of BBR without drains, they are still routinely utilised. In an era of evidence- based medicine, surgeons performing breast reductions must adopt the results from scientific research into their clinical practice.

A Novel Wide-Area Backup Protection Based on Fault Component Current Distribution and Improved Evidence Theory

Directory of Open Access Journals (Sweden)

Zhe Zhang

2014-01-01

Full Text Available In order to solve the problems of the existing wide-area backup protection (WABP algorithms, the paper proposes a novel WABP algorithm based on the distribution characteristics of fault component current and improved Dempster/Shafer (D-S evidence theory. When a fault occurs, slave substations transmit to master station the amplitudes of fault component currents of transmission lines which are the closest to fault element. Then master substation identifies suspicious faulty lines according to the distribution characteristics of fault component current. After that, the master substation will identify the actual faulty line with improved D-S evidence theory based on the action states of traditional protections and direction components of these suspicious faulty lines. The simulation examples based on IEEE 10-generator-39-bus system show that the proposed WABP algorithm has an excellent performance. The algorithm has low requirement of sampling synchronization, small wide-area communication flow, and high fault tolerance.

A Novel Wide-Area Backup Protection Based on Fault Component Current Distribution and Improved Evidence Theory

Science.gov (United States)

Zhang, Zhe; Kong, Xiangping; Yin, Xianggen; Yang, Zengli; Wang, Lijun

2014-01-01

In order to solve the problems of the existing wide-area backup protection (WABP) algorithms, the paper proposes a novel WABP algorithm based on the distribution characteristics of fault component current and improved Dempster/Shafer (D-S) evidence theory. When a fault occurs, slave substations transmit to master station the amplitudes of fault component currents of transmission lines which are the closest to fault element. Then master substation identifies suspicious faulty lines according to the distribution characteristics of fault component current. After that, the master substation will identify the actual faulty line with improved D-S evidence theory based on the action states of traditional protections and direction components of these suspicious faulty lines. The simulation examples based on IEEE 10-generator-39-bus system show that the proposed WABP algorithm has an excellent performance. The algorithm has low requirement of sampling synchronization, small wide-area communication flow, and high fault tolerance. PMID:25050399

Arthroplasty knee registry of Catalonia: What scientific evidence supports the implantation of our prosthesis?

Science.gov (United States)

Samaniego Alonso, R; Gaviria Parada, E; Pons Cabrafiga, M; Espallargues Carreras, M; Martinez Cruz, O

2018-02-28

In our environment, it is increasingly necessary to perform an activity based on scientific evidence and the field of prosthetic surgery should be governed by the same principles. The national arthroplasty registries allow us to obtain a large amount of data in order to evaluate this technique. The aim of our study is to analyse the scientific evidence that supports the primary total knee arthroplasties implanted in Catalonian public hospitals, based on the Arthoplasty Registry of Catalonia (RACat) MATERIAL AND METHODS: A review of the literature was carried out on knee prostheses (cruciate retaining, posterior stabilized, constricted and rotational) recorded in RACat between the period 2005-2013 in the following databases: Orthopedic Data Evaluation Panel, PubMed, TripDatabase and Google Scholar. The prostheses implanted in fewer than 10 units (1,358 prostheses corresponding to 62 models) were excluded. 41,947 prostheses (96.86%) were analysed out of 43,305 implanted, corresponding to 74 different models. In 13 models (n = 4,715) (11.24%) no clinical evidence to support their use was found. In the remaining 36 models (n = 13,609) (32.45%), level iv studies were the most predominant evidence. There was a significant number of implanted prostheses (11.24%) for which no clinical evidence was found. The number of models should be noted, 36 out of 110, with fewer than 10 units implanted. The use of arthroplasty registries has proved an extremely useful tool that allows us to analyse and draw conclusions in order to improve the efficiency of this surgical technique. Copyright © 2018 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

The gut microbiome as a target for prevention and treatment of hyperglycaemia in type 2 diabetes: from current human evidence to future possibilities.

Science.gov (United States)

Brunkwall, Louise; Orho-Melander, Marju

2017-06-01

The totality of microbial genomes in the gut exceeds the size of the human genome, having around 500-fold more genes that importantly complement our coding potential. Microbial genes are essential for key metabolic processes, such as the breakdown of indigestible dietary fibres to short-chain fatty acids, biosynthesis of amino acids and vitamins, and production of neurotransmitters and hormones. During the last decade, evidence has accumulated to support a role for gut microbiota (analysed from faecal samples) in glycaemic control and type 2 diabetes. Mechanistic studies in mice support a causal role for gut microbiota in metabolic diseases, although human data favouring causality is insufficient. As it may be challenging to sort the human evidence from the large number of animal studies in the field, there is a need to provide a review of human studies. Thus, the aim of this review is to cover the current and future possibilities and challenges of using the gut microbiota, with its capacity to be modified, in the development of preventive and treatment strategies for hyperglycaemia and type 2 diabetes in humans. We discuss what is known about the composition and functionality of human gut microbiota in type 2 diabetes and summarise recent evidence of current treatment strategies that involve, or are based on, modification of gut microbiota (diet, probiotics, metformin and bariatric surgery). We go on to review some potential future gut-based glucose-lowering approaches involving microbiota, including the development of personalised nutrition and probiotic approaches, identification of therapeutic components of probiotics, targeted delivery of propionate in the proximal colon, targeted delivery of metformin in the lower gut, faecal microbiota transplantation, and the incorporation of genetically modified bacteria that express therapeutic factors into microbiota. Finally, future avenues and challenges for understanding the interplay between human nutrition, genetics

[Current recommendations for basic/advanced life support : Addressing unanswered questions and future prospects].

Science.gov (United States)

Fink, K; Schmid, B; Busch, H-J

2016-11-01

The revised guidelines for cardiopulmonary resuscitation were implemented by the European Resuscitation Council (ERC) in October 2015. There were few changes concerning basic and advanced life support; however, some issues were clarified compared to the ERC recommendations from 2010. The present paper summarizes the procedures of basic and advanced life support according to the current guidelines and highlights the updates of 2015. Furthermore, the article depicts future prospects of cardiopulmonary resuscitation that may improve outcome of patients after cardiac arrest in the future.

Radiation and breast cancer: a review of current evidence

International Nuclear Information System (INIS)

Ronckers, Cécile M; Erdmann, Christine A; Land, Charles E

2005-01-01

This paper summarizes current knowledge on ionizing radiation-associated breast cancer in the context of established breast cancer risk factors, the radiation dose–response relationship, and modifiers of dose response, taking into account epidemiological studies and animal experiments. Available epidemiological data support a linear dose–response relationship down to doses as low as about 100 mSv. However, the magnitude of risk per unit dose depends strongly on when radiation exposure occurs: exposure before the age of 20 years carries the greatest risk. Other characteristics that may influence the magnitude of dose-specific risk include attained age (that is, age at observation for risk), age at first full-term birth, parity, and possibly a history of benign breast disease, exposure to radiation while pregnant, and genetic factors

Current status of evidence-based sports medicine.

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Harris, Joshua D; Cvetanovich, Gregory; Erickson, Brandon J; Abrams, Geoffrey D; Chahal, Jaskarndip; Gupta, Anil K; McCormick, Frank M; Bach, Bernard R

2014-03-01

The purpose of this investigation is to determine the proportion of sports medicine studies that are labeled as Level I Evidence in 5 journals and compare the quality of surgical and nonsurgical studies using simple quality assessment tools (Consolidated Standards of Reporting Trials [CONSORT] and Jadad). By use of PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines over the prior 2 years in the top 5 (citation and impact factor based) sports medicine journals, only Level I Evidence studies were eligible for inclusion and were analyzed. All study types (therapeutic, prognostic, diagnostic, and economic) were analyzed. Study quality was assessed with the level of evidence, Jadad score, and CONSORT 2010 guidelines. Study demographic data were compared among journals and between surgical and nonsurgical studies by use of χ(2), 1-way analysis of variance, and 2-sample Z tests. We analyzed 190 Level I Evidence studies (10% of eligible studies) (119 randomized controlled trials [RCTs]). Therapeutic, nonsurgical, single-center studies from the United States were the most common studies published. Sixty-two percent of studies reported a financial conflict of interest. The knee was the most common body part studied, and track-and-field/endurance sports were the most common sports analyzed. Significant differences (P journals reviewed. Overall, the Jadad and CONSORT scores were 2.71 and 77%, respectively. No differences (P > .05) were shown among journals based on the proportion of Level I studies or appropriate randomization. Significant strengths and limitations of RCTs were identified. This study showed that Level I Evidence and RCTs comprise 10% and 6% of contemporary sports medicine literature, respectively. Therapeutic, nonsurgical, single-center studies are the most common publications with Level I Evidence. Significant differences across sports medicine journals were found in study quality. Surgical studies appropriately described

Prostate-specific antigen: does the current evidence support its use in prostate cancer screening?

LENUS (Irish Health Repository)

Duffy, Michael J

2012-02-01

Although widely used, the value of prostate-specific antigen (PSA) in screening asymptomatic men for prostate cancer is controversial. Reasons for the controversy relate to PSA being less than an ideal marker in detecting early prostate cancer, the possibility that screening for prostate cancer may result in the overdetection and thus overtreatment of indolent disease and the lack of clarity as to the definitive or best treatment for men diagnosed with localized prostate cancer. Although the results from some randomized prospective trials suggest that screening with PSA reduces mortality from prostate cancer, the overall benefit was modest. It is thus currently unclear as to whether the modest benefit of reduced mortality outweighs the harms of overdetection and overtreatment. Thus, prior to undergoing screening for prostate cancer, men should be informed of the risks and benefits of early detection. Newly emerging markers that may complement PSA in the early detection of prostate cancer include specific isoforms of PSA and PCA3.

Effectiveness of individual placement and support supported employment for young adults.

Science.gov (United States)

Bond, Gary R; Drake, Robert E; Campbell, Kikuko

2016-08-01

The individual placement and support (IPS) model of supported employment was first developed in community mental health centres for adults with severe mental illness. While IPS is an established evidence-based practice in this broad population, evidence on its effectiveness focused specifically on young adults has been limited. The current study aimed to address this gap. To investigate the effects of IPS on young adults, the authors conducted a secondary analysis on a pooled sample of 109 unemployed young adults (under age 30) from four randomized controlled trials employing a common research protocol that included a standardized measurement battery and rigorous fidelity monitoring. Researchers assessed these participants over 18 months on nine competitive employment outcome measures. On all measures, the IPS group had significantly better employment outcomes. Overall, 40 (82%) of IPS participants obtained employment during follow-up compared with 25 (42%) of control participants, χ(2) = 17.9, P < .001. IPS participants averaged 25.0 weeks of employment, compared with 7.0 weeks for control participants, t = 4.50, P < .001. The current analysis supports a small number of previous studies in showing that IPS is highly effective in helping young adults with severe mental illness to attain competitive employment. When young adults acquire competitive jobs and initiate a path towards normal adult roles, they may avoid the cycle of disability and psychiatric patient roles that are demeaning and demoralizing. © 2014 Wiley Publishing Asia Pty Ltd.

Complex interventions required to comprehensively educate allied health practitioners on evidence-based practice

Directory of Open Access Journals (Sweden)

Dizon JM

2011-05-01

Full Text Available Janine Margarita Dizon1,2, Karen Grimmer-Somers11International Centre for Allied Health Evidence, University of South Australia, Adelaide, SA, Australia; 2University of Santo Tomas, Manila, PhilippinesAbstract: There is currently no strong evidence regarding the most effective training approach for allied health professionals that will support them to consistently apply the best research evidence in daily practice. Current evidence-based practice training tends to be 'one size fits all', and is unlikely to be appropriate for all allied health disciplines because of the variability in their tasks and scope of practice. The scant body of evidence regarding the effectiveness of evidence-based practice training for allied health practitioners provides some support for improving knowledge and skills, but equivocal evidence about influencing behaviors and attitudes. We propose a new model of evidence-based practice training, based on the concept of complex interventions reported in the literature. We believe that by offering training in evidence-based practice based on complex interventions relevant to the needs of the attendees, using fixed and variable components, there may be greater success in significantly influencing knowledge skills, attitudes, and behaviors.Keywords: complex interventions, evidence-based practice training, allied health

Motivations for Botanical Use by Socioeconomically Diverse, Urban Adults: Does Evidence Support Motivation?

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Duffy, Grace F; Shupe, Emily Stave; Kuczmarski, Marie Fanelli; Zonderman, Alan B; Evans, Michele K

2017-10-01

The study objectives were to characterize botanical dietary supplement (BDS) use and to compare the motivations for botanical supplement (BS) use to the efficacy of the botanical in a socioeconomically and racially diverse urban adult population. Subjects were from the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study, a 20-year prospective health disparities study with African American and white adults from Baltimore, Maryland. All study participants completed two dietary recalls and a dietary supplement (DS) questionnaire in Wave 3 (n = 2140). Diet quality was evaluated by the Healthy Eating Index-2010 and the Mean Adequacy Ratio for 17 micronutrients. A comparison of reported motivations to efficacy reported in the literature of single BS was conducted. Approximately 50% (1062/2140) of participants took DS. Of these, 8% (n = 178) reported taking either BS or BDS. It was found that BDS users had better diet quality than DS users as well as nonusers of DS. The top three motivations for BDS users were to improve overall health, to maintain health, and to supplement the diet. There is limited evidence for the efficacy of most BS. Review of the efficacy of the 15 BS reported by ≥5% of the study population revealed beneficial health roles for only fiber, gingko biloba extract EGb 761, and hawthorn berry. To the authors' knowledge, this study is the first to report a better quality diet with BDS use for a racially diverse urban population. Yet, improvement in diet is needed because overall quality did not achieve current recommendations. To improve overall health, it may be beneficial for this population to focus on dietary modifications to reduce the risks associated with chronic diseases. In general, the reported motivations for BS use were not supported by clinical evidence.

Current perspectives on the ethics of selling international surrogacy support services

OpenAIRE

Fronek,Patricia

2018-01-01

Patricia Fronek1,2 1Law Futures Centre, 2School of Human Services and Social Work, Griffith University, Southport, QLD, Australia Abstract: This review presents current knowledge on selling surrogacy support services in developing countries. Rather than focusing on dichotomous positions, ethical issues that are present and unresolved are discussed by following the journey of surrogate mothers and highlighting the position of children whose well-being is generally assumed in surrogacy arrangem...

Postpartum family planning: current evidence on successful interventions.

Science.gov (United States)

Blazer, Cassandra; Prata, Ndola

2016-01-01

We reviewed existing evidence of the efficacy of postpartum family planning interventions targeting women in the 12 months postpartum period in low- and middle-income countries. We searched for studies from January 1, 2004 to September 19, 2015, using the US Preventive Services Task Force recommendations to assess evidence quality. Our search resulted in 26 studies: 11 based in sub-Saharan Africa, six in the Middle East and North Africa, and nine in Asia. Twenty of the included studies assessed health facility-based interventions. Three were focused on community interventions, two had community and facility components, and one was a workplace program. Overall quality of the evidence was moderate, including evidence for counseling interventions. Male partner involvement, integration with other service delivery platforms, such as prevention of mother-to-child transmission of HIV and immunization, and innovative product delivery programs may increase knowledge and use during the postpartum period. Community-based and workplace strategies need a much stronger base of evidence to prompt recommendations.

Evidence-informed health policy 3 - interviews with the directors of organizations that support the use of research evidence.

Science.gov (United States)

Lavis, John N; Oxman, Andrew D; Moynihan, Ray; Paulsen, Elizabeth J

2008-12-17

Only a small number of previous efforts to describe the experiences of organizations that produce clinical practice guidelines (CPGs), undertake health technology assessments (HTAs), or directly support the use of research evidence in developing health policy (i.e., government support units, or GSUs) have relied on interviews and then only with HTA agencies. Interviews offer the potential for capturing experiences in great depth, particularly the experiences of organizations that may be under-represented in surveys. We purposively sampled organizations from among those who completed a questionnaire in the first phase of our three-phase study, developed and piloted a semi-structured interview guide, and conducted the interviews by telephone, audio-taped them, and took notes simultaneously. Binary or categorical responses to more structured questions were counted when possible. Themes were identified from among responses to semi-structured questions using a constant comparative method of analysis. Illustrative quotations were identified to supplement the narrative description of the themes. We interviewed the director (or his or her nominee) in 25 organizations, of which 12 were GSUs. Using rigorous methods that are systematic and transparent (sometimes shortened to 'being evidence-based') was the most commonly cited strength among all organizations. GSUs more consistently described their close links with policymakers as a strength, whereas organizations producing CPGs, HTAs, or both had conflicting viewpoints about such close links. With few exceptions, all types of organizations tended to focus largely on weaknesses in implementation, rather than strengths. The advice offered to those trying to establish similar organizations include: 1) collaborate with other organizations; 2) establish strong links with policymakers and stakeholders; 3) be independent and manage conflicts of interest; 4) build capacity; 5) use good methods and be transparent; 6) start small and

Mobbing, Organizational Identification, and Perceived Support: Evidence from a Higher Education Institution

Science.gov (United States)

Coskuner, Selda; Costur, Recai; Bayhan-Karapinar, Pinar; Metin-Camgoz, Selin; Ceylan, Savas; Demirtas-Zorbaz, Selen; Aktas, Emine Feyza; Ciffiliz, Gonca

2018-01-01

Purpose: The aim of the current study is twofold. First, it investigates the relationship between mobbing and organizational identification (OI) as an organizational attitude. Second, it explores the moderating effect of perceived organizational support (POS) on the relationship between mobbing and organizational identification. We proposed that…

Renal denervation in the management of resistant hypertension: current evidence and perspectives.

Science.gov (United States)

Jin, Yu; Persu, Alexandre; Staessen, Jan A

2013-09-01

Catheter-based renal denervation has emerged as a novel treatment modality for resistant hypertension. This review summarizes the current evidence on this procedure in treatment of resistant hypertension, limitations of available evidence and questions to be answered. The SYMPLICITY studies showed that renal denervation is feasible in treating resistant hypertension, but failed to provide conclusive evidence on the size and durability of the antihypertensive, renal and sympatholytic effects, as well as the long-term safety. The definition of resistant hypertension was loose in the SYMPLICITY studies and the management of resistant hypertension was suboptimal. Future studies should have a randomized design and enroll truly resistant hypertension patients by excluding secondary hypertension, white-coat hypertension and nonadherent patients. Questions to be addressed by the ongoing and future trials include the long-term efficacy and safety of this procedure, identification of responders and uncovering of the underlying mechanisms. Only well-designed, randomized clinical trials addressing the limitations of the SYMPLICITY studies will be able to demonstrate whether renal denervation is an efficacious treatment modality in resistant hypertension and in which patients. For now, renal denervation remains an experimental procedure and should only be offered to truly resistant hypertensive patients in a research context after careful selection.

Animal Research on Nicotine Reduction: Current Evidence and Research Gaps.

Science.gov (United States)

Smith, Tracy T; Rupprecht, Laura E; Denlinger-Apte, Rachel L; Weeks, Jillian J; Panas, Rachel S; Donny, Eric C; Sved, Alan F

2017-09-01

A mandated reduction in the nicotine content of cigarettes may improve public health by reducing the prevalence of smoking. Animal self-administration research is an important complement to clinical research on nicotine reduction. It can fill research gaps that may be difficult to address with clinical research, guide clinical researchers about variables that are likely to be important in their own research, and provide policy makers with converging evidence between clinical and preclinical studies about the potential impact of a nicotine reduction policy. Convergence between clinical and preclinical research is important, given the ease with which clinical trial participants can access nonstudy tobacco products in the current marketplace. Herein, we review contributions of preclinical animal research, with a focus on rodent self-administration, to the science of nicotine reduction. Throughout this review, we highlight areas where clinical and preclinical research converge and areas where the two differ. Preclinical research has provided data on many important topics such as the threshold for nicotine reinforcement, the likelihood of compensation, moderators of the impact of nicotine reduction, the impact of environmental stimuli on nicotine reduction, the impact of nonnicotine cigarette smoke constituents on nicotine reduction, and the impact of nicotine reduction on vulnerable populations. Special attention is paid to current research gaps including the dramatic rise in alternative tobacco products, including electronic nicotine delivery systems (ie, e-cigarettes). The evidence reviewed here will be critical for policy makers as well as clinical researchers interested in nicotine reduction. This review will provide policy makers and clinical researchers interested in nicotine reduction with an overview of the preclinical animal research conducted on nicotine reduction and the regulatory implications of that research. The review also highlights the utility of

Equity and Blindness: Closing Evidence Gaps to Support Universal Eye Health.

Science.gov (United States)

Ramke, Jacqueline; Zwi, Anthony B; Palagyi, Anna; Blignault, Ilse; Gilbert, Clare E

2015-01-01

The World Health Organization Program for the Prevention of Blindness adopted the principles of universal health coverage (UHC) in its latest plan, Universal Eye Health: A Global Action Plan, 2014-2019. This plan builds on the achievements of Vision 2020, which aimed to reduce the global prevalence of avoidable blindness, and its unequal distribution, by the year 2020. We reviewed the literature on health equity and the generation and use of evidence to promote equity, particularly in eye health. We describe the nature and extent of the equity-focused evidence to support and inform eye health programs on the path to universal eye health, and propose ways to improve the collection and reporting of this evidence. Blindness prevalence decreased in all regions of the world between 1990 and 2010, albeit not at the same rate or to the same extent. In 2010, the prevalence of blindness in West Africa (6.0%) remained 15 times higher than in high-income regions (0.4%); within all regions, women had a higher prevalence of blindness than men. Beyond inter-regional and sex differences, there is little comparable data on the distribution of blindness across social groups within regions and countries, or on whether this distribution has changed over time. Similarly, interventions known to address inequity in blindness are few, and equity-relevant goals, targets and indicators for eye health programs are scarce. Equity aims of eye health programs can benefit from the global momentum towards achieving UHC, and the progress being made on collecting, communicating and using equity-focused evidence.

Does oxygen limit thermal tolerance in arthropods? A critical review of current evidence.

Science.gov (United States)

Verberk, Wilco C E P; Overgaard, Johannes; Ern, Rasmus; Bayley, Mark; Wang, Tobias; Boardman, Leigh; Terblanche, John S

2016-02-01

Over the last decade, numerous studies have investigated the role of oxygen in setting thermal tolerance in aquatic animals, and there has been particular focus on arthropods. Arthropods comprise one of the most species-rich taxonomic groups on Earth, and display great diversity in the modes of ventilation, circulation, blood oxygen transport, with representatives living both in water (mainly crustaceans) and on land (mainly insects). The oxygen and capacity limitation of thermal tolerance (OCLTT) hypothesis proposes that the temperature dependent performance curve of animals is shaped by the capacity for oxygen delivery in relation to oxygen demand. If correct, oxygen limitation could provide a mechanistic framework to understand and predict both current and future impacts of rapidly changing climate. In arthropods, most studies testing the OCLTT hypothesis have considered tolerance to thermal extremes. These studies likely operate from the philosophical viewpoint that if the model can predict these critical thermal limits, then it is more likely to also explain loss of performance at less extreme, non-lethal temperatures, for which much less data is available. Nevertheless, the extent to which lethal temperatures are influenced by limitations in oxygen supply remains unresolved. Here we critically evaluate the support and universal applicability for oxygen limitation being involved in lethal temperatures in crustaceans and insects. The relatively few studies investigating the OCLTT hypothesis at low temperature do not support a universal role for oxygen in setting the lower thermal limits in arthropods. With respect to upper thermal limits, the evidence supporting OCLTT is stronger for species relying on underwater gas exchange, while the support for OCLTT in air-breathers is weak. Overall, strongest support was found for increased anaerobic metabolism close to thermal maxima. In contrast, there was only mixed support for the prediction that aerobic scope

Clinical decision support systems in hospital care using ubiquitous devices: Current issues and challenges.

Science.gov (United States)

Baig, Mirza Mansoor; GholamHosseini, Hamid; Moqeem, Aasia A; Mirza, Farhaan; Lindén, Maria

2017-11-01

Supporting clinicians in decision making using advanced technologies has been an active research area in biomedical engineering during the past years. Among a wide range of ubiquitous systems, smartphone applications have been increasingly developed in healthcare settings to help clinicians as well as patients. Today, many smartphone applications, from basic data analysis to advanced patient monitoring, are available to clinicians and patients. Such applications are now increasingly integrating into healthcare for clinical decision support, and therefore, concerns around accuracy, stability, and dependency of these applications are rising. In addition, lack of attention to the clinicians' acceptability, as well as the low impact on the medical professionals' decision making, are posing more serious issues on the acceptability of smartphone applications. This article reviews smartphone-based decision support applications, focusing on hospital care settings and their overall impact of these applications on the wider clinical workflow. Additionally, key challenges and barriers of the current ubiquitous device-based healthcare applications are identified. Finally, this article addresses current challenges, future directions, and the adoption of mobile healthcare applications.

Evidence Supporting an Early as Well as Late Heavy Bombardment on the Moon

Science.gov (United States)

Frey, Herbert

2015-01-01

Evidence supporting an intense early bombardment on the Moon in addition to the traditional Late Heavy Bombardment at approx. 4 BY ago include the distribution of N(50) Crater Retention Ages (CRAs) for candidate basins, a variety of absolute age scenarios for both a "young" and an "old" Nectaris age, and the decreasing contrasts in both topographic relief and Bouguer gravity with increasing CRA.

The Role That Web 2.0 Currently Has and Could Have in the Future in Supporting the Teaching of ICT Design for All

Science.gov (United States)

Mitrea, Paulina; Mitrea, Delia

The main objective of the article is to highlight the role that Web2.0 currently has and could have in the future in supporting the teaching of ICT Design for All. According to this, first the concepts of Web2.0 and eLearning2.0 are clarified and connected. The new way of thinking about eLearning being inspired by the emergence of Web2.0, the term eLearning2.0 was introduced to identify a new paradigm. So, eLearning 2.0, by contrast to eLearning1.0 is built around collaboration, also eLearning2.0 assumes that knowledge is socially constructed. Related to the role of Web2.0 in supporting the teaching of ICT Design for All, the 4 steps involved by the ICT Design For All Teaching Principles are presented and detailed. Finally, some real world examples are shown, as evidence of how the new methods of communication offered by Web2.0 can be used to support students as they learn about Design for All.

Evidence of current impact of climate change on life : A walk from genes to the biosphere

NARCIS (Netherlands)

Penuelas, Josep; Sardans, Jordi; Estiarte, Marc; Ogaya, Roma; Carnicer, Jofre; Coll, Marta; Barbeta, Adria; Rivas-Ubach, Albert; Llusia, Joan; Garbulsky, Martin; Filella, Iolanda; Jump, Alistair S.

We review the evidence of how organisms and populations are currently responding to climate change through phenotypic plasticity, genotypic evolution, changes in distribution and, in some cases, local extinction. Organisms alter their gene expression and metabolism to increase the concentrations of

METEOR: An Enterprise Health Informatics Environment to Support Evidence-Based Medicine.

Science.gov (United States)

Puppala, Mamta; He, Tiancheng; Chen, Shenyi; Ogunti, Richard; Yu, Xiaohui; Li, Fuhai; Jackson, Robert; Wong, Stephen T C

2015-12-01

The aim of this paper is to propose the design and implementation of next-generation enterprise analytics platform developed at the Houston Methodist Hospital (HMH) system to meet the market and regulatory needs of the healthcare industry. For this goal, we developed an integrated clinical informatics environment, i.e., Methodist environment for translational enhancement and outcomes research (METEOR). The framework of METEOR consists of two components: the enterprise data warehouse (EDW) and a software intelligence and analytics (SIA) layer for enabling a wide range of clinical decision support systems that can be used directly by outcomes researchers and clinical investigators to facilitate data access for the purposes of hypothesis testing, cohort identification, data mining, risk prediction, and clinical research training. Data and usability analysis were performed on METEOR components as a preliminary evaluation, which successfully demonstrated that METEOR addresses significant niches in the clinical informatics area, and provides a powerful means for data integration and efficient access in supporting clinical and translational research. METEOR EDW and informatics applications improved outcomes, enabled coordinated care, and support health analytics and clinical research at HMH. The twin pressures of cost containment in the healthcare market and new federal regulations and policies have led to the prioritization of the meaningful use of electronic health records in the United States. EDW and SIA layers on top of EDW are becoming an essential strategic tool to healthcare institutions and integrated delivery networks in order to support evidence-based medicine at the enterprise level.

Evidence supporting the use of cone-beam computed tomography in orthodontics.

Science.gov (United States)

van Vlijmen, Olivier J C; Kuijpers, Mette A R; Bergé, Stefaan J; Schols, Jan G J H; Maal, Thomas J J; Breuning, Hero; Kuijpers-Jagtman, Anne Marie

2012-03-01

The authors conducted a systematic review of cone-beam computed tomography (CBCT) applications in orthodontics and evaluated the level of evidence to determine whether the use of CBCT is justified in orthodontics. The authors identified articles by searching the Cochrane Library, PubMed, MEDLINE, Embase, Scopus and Cumulative Index to Nursing and Allied Health Literature databases. They searched the articles' reference lists manually for additional articles and had no language limitations. They did not search the gray literature. Inclusion criteria were CBCT use in orthodontics and that the participants be human. The lowest level of evidence accepted for inclusion was a case series with five or more participants. The authors evaluated the studies' methodological quality according to 13 criteria related to study design, measurements and statistical analysis. The authors identified 550 articles, and 50 met the inclusion criteria. Study topics included temporary anchorage devices, cephalometry, combined orthodontic and surgical treatment, airway measurements, root resorption and tooth impactions, and cleft lip and palate. The methodological quality averaged 53 percent (range, 15-77 percent) of the maximum score. The authors found no high-quality evidence regarding the benefits of CBCT use in orthodontics. Limited evidence shows that CBCT offers better diagnostic potential, leads to better treatment planning or results in better treatment outcome than do conventional imaging modalities. Only the results of studies on airway diagnostics provided sound scientific data suggesting that CBCT use has added value. The additional radiation exposure should be weighed against possible benefits of CBCT, which have not been supported in the literature. In future studies, investigators should evaluate the effects of CBCT on treatment procedures, progression and outcome quantitatively.

Current trends in using Internet and mobile technology to support the treatment of substance use disorders.

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Cucciare, Michael A; Weingardt, Kenneth R; Greene, Carolyn J; Hoffman, Julia

2012-09-01

By allowing for the efficient delivery of instructional content and the secure collection of self-report data regarding substance use and related problems, the Internet has tremendous potential to improve the effectiveness and accessibility of Substance Use Disorder (SUD) treatment and recovery-oriented services. This article discusses some of the ways in which Internet and mobile technology can facilitate, complement and support the process of traditional clinician-delivered treatment for individuals with SUDs. Internet applications are being used to support a range of activities including (a) the assessment and feedback process that constitutes a key feature of brief motivational interventions; and (b) the concurrent monitoring of patients who are receiving treatment for SUDs, to support continuing care, and the ongoing recovery of SUD patients who have completed face-to-face treatment. Internet technology is also being used to (c) support efficient delivery of clinical training in evidence-based practices for treating individuals who may have SUDs. This emerging body of literature suggests that SUD treatment providers and program administrators can enhance the quality of clinician-delivered treatment by incorporating internet applications into existing processes of care and recovery oriented services. Internet applications provide an unparalleled opportunity to engage patients in the treatment process, incorporate real-time data into treatment planning, prevent relapse, and promote evidence-based treatment approaches.

Postpartum family planning: current evidence on successful interventions

Directory of Open Access Journals (Sweden)

Blazer C

2016-04-01

Full Text Available Cassandra Blazer, Ndola Prata Bixby Center for Population, Health, and Sustainability, School of Public Health, University of California, Berkeley, CA, USA Abstract: We reviewed existing evidence of the efficacy of postpartum family planning interventions targeting women in the 12 months postpartum period in low- and middle-income countries. We searched for studies from January 1, 2004 to September 19, 2015, using the US Preventive Services Task Force recommendations to assess evidence quality. Our search resulted in 26 studies: 11 based in sub-Saharan Africa, six in the Middle East and North Africa, and nine in Asia. Twenty of the included studies assessed health facility-based interventions. Three were focused on community interventions, two had community and facility components, and one was a workplace program. Overall quality of the evidence was moderate, including evidence for counseling interventions. Male partner involvement, integration with other service delivery platforms, such as prevention of mother-to-child transmission of HIV and immunization, and innovative product delivery programs may increase knowledge and use during the postpartum period. Community-based and workplace strategies need a much stronger base of evidence to prompt recommendations. Keywords: postpartum period, family planning, birth spacing, interventions, systematic review, contraception, less developed countries

Training the Next Generation of School Psychologists to Deliver Evidence Based Mental Health Practices: Current Challenges and Future Directions

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Shernoff, Elisa S.; Bearman, Sarah Kate; Kratochwill, Thomas R.

2017-01-01

School psychologists are uniquely positioned to support the delivery of evidence-based mental health practices (EBMHPs) to address the overwhelming mental health needs of children and youth. Graduate training programs can promote EBMHPs in schools by ensuring school psychologists enter the workplace prepared to deliver and support high-quality,…

The relationship of religious involvement indicators and social support to current and past suicidality among depressed older adults.

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Rushing, Nicole C; Corsentino, Elizabeth; Hames, Jennifer L; Sachs-Ericsson, Natalie; Steffens, David C

2013-01-01

Elderly people, particularly those with major depression, are at the highest risk for suicide than any other age group. Religious involvement is associated with a range of health outcomes including lower odds of death by suicide. However, not much is known about the effects of religious involvement on suicidal ideation in the elderly or which aspects of religiosity are beneficial. This study examined the relative influence of various conceptualizations of religious involvement, above and beyond the protective effects of social support, on current and past suicidality among depressed older adults. Participants were 248 depressed patients, 59 years and older, enrolled in the Neurocognitive Outcomes of Depression in the Elderly study. A psychiatrist assessed current suicidal ideation using the suicidal thoughts item from the Montgomery-Asberg Depression Rating Scale. Past history of suicide attempts, four religious involvement indicators, social support indicators, and control variables were assessed via self-report. Church attendance, above and beyond importance of religion, private religious practices, and social support, was associated with less suicidal ideation; perceived social support partially mediated this relationship. Current religious practices were not predictive of retrospective reports of past suicide attempts. Church attendance, rather than other religious involvement indicators, has the strongest relationship to current suicidal ideation. Clinicians should consider public religious activity patterns and perceived social support when assessing for other known risk and protective factors for suicide and in developing treatment plans.

Large dunes on the outer shelf off the Zambezi Delta, Mozambique: evidence for the existence of a Mozambique Current

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Flemming, Burghard W.; Kudrass, Hermann-Rudolf

2018-02-01

The existence of a continuously flowing Mozambique Current, i.e. a western geostrophic boundary current flowing southwards along the shelf break of Mozambique, was until recently accepted by oceanographers studying ocean circulation in the south-western Indian Ocean. This concept was then cast into doubt based on long-term current measurements obtained from current-meter moorings deployed across the northern Mozambique Channel, which suggested that southward flow through the Mozambique Channel took place in the form of successive, southward migrating and counter-clockwise rotating eddies. Indeed, numerical modelling found that, if at all, strong currents on the outer shelf occurred for not more than 9 days per year. In the present study, the negation of the existence of a Mozambique Current is challenged by the discovery of a large (50 km long, 12 km wide) subaqueous dune field (with up to 10 m high dunes) on the outer shelf east of the modern Zambezi River delta at water depths between 50 and 100 m. Being interpreted as representing the current-modified, early Holocene Zambezi palaeo-delta, the dune field would have migrated southwards by at least 50 km from its former location since sea level recovered to its present-day position some 7 ka ago and after the former delta had been remoulded into a migrating dune field. Because a large dune field composed of actively migrating bedforms cannot be generated and maintained by currents restricted to a period of only 9 days per year, the validity of those earlier modelling results is questioned for the western margin of the flow field. Indeed, satellite images extracted from the Perpetual Ocean display of NASA, which show monthly time-integrated surface currents in the Mozambique Channel for the 5 month period from June-October 2006, support the proposition that strong flow on the outer Mozambican shelf occurs much more frequently than postulated by those modelling results. This is consistent with more recent modelling

Social Support and Supervisory Quality Interventions in the Workplace: A Stakeholder-Centered Best-Evidence Synthesis of Systematic Reviews on Work Outcomes

Directory of Open Access Journals (Sweden)

SL Wagner

2015-10-01

Full Text Available Background: There is controversy surrounding the impact of workplace interventions aimed at improving social support and supervisory quality on absenteeism, productivity and financial outcomes. Objective: To determine the value of social support interventions for work outcomes. Methods: Databases were searched for systematic reviews between 2000 and 2012 to complete a synthesis of systematic reviews guided by the PRISMA statement and the IOM guidelines for systematic reviews. Assessment of articles for inclusion and methodological quality was conducted independently by at least two researchers, with differences resolved by consensus. Results: The search resulted in 3363 titles of which 3248 were excluded following title/abstract review, leaving 115 articles that were retrieved and underwent full article review. 10 articles met the set inclusion criteria, with 7 focusing on social support, 2 on supervisory quality and 1 on both. We found moderate and limited evidence, respectively, that social support and supervisory quality interventions positively impact workplace outcomes. Conclusion: There is moderate evidence that social support and limited evidence that supervisory quality interventions have a positive effect on work outcomes.

Social Support and Supervisory Quality Interventions in the Workplace: A Stakeholder-Centered Best-Evidence Synthesis of Systematic Reviews on Work Outcomes.

Science.gov (United States)

Wagner, S L; White, M I; Schultz, I Z; Williams-Whitt, K; Koehn, C; Dionne, C E; Koehoorn, M; Harder, H G; Pasca, R; Wärje, O; Hsu, V; McGuire, L; Lama, I; Schulz, W; Kube, D; Wright, M D

2015-10-01

There is controversy surrounding the impact of workplace interventions aimed at improving social support and supervisory quality on absenteeism, productivity and financial outcomes. To determine the value of social support interventions for work outcomes. Databases were searched for systematic reviews between 2000 and 2012 to complete a synthesis of systematic reviews guided by the PRISMA statement and the IOM guidelines for systematic reviews. Assessment of articles for inclusion and methodological quality was conducted independently by at least two researchers, with differences resolved by consensus. The search resulted in 3363 titles of which 3248 were excluded following title/abstract review, leaving 115 articles that were retrieved and underwent full article review. 10 articles met the set inclusion criteria, with 7 focusing on social support, 2 on supervisory quality and 1 on both. We found moderate and limited evidence, respectively, that social support and supervisory quality interventions positively impact workplace outcomes. There is moderate evidence that social support and limited evidence that supervisory quality interventions have a positive effect on work outcomes.

Evidence on acne therapy

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Caroline Sousa Costa

Full Text Available Among the current treatments available for acne vulgaris, many widely practiced options lack support from studies at the best level of scientific evidence. The aim of this narrative review was to present the very latest information on topical and systemic treatments for acne vulgaris. Information from systematic reviews and well-designed clinical trials, obtained through a systematic search of the major medical databases, is emphasized. There are important issues regarding the clinical management of acne that still lack consistent grounding in scientific evidence. Among these are the optimum dose and duration of treatment with oral antibiotics that can be given without inducing bacterial resistance, and the safety of oral isotretinoin.

Investigation assessing the publicly available evidence supporting postmarketing withdrawals, revocations and suspensions of marketing authorisations in the EU since 2012

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Lynn, Elizabeth; Shakir, Saad

2018-01-01

Objectives To assess the sources of publicly available evidence supporting withdrawal, revocation or suspension of marketing authorisations (‘regulatory actions’) due to safety reasons in the EU since 2012 and to investigate the time taken since initial marketing authorisation to reach these regulatory decisions. Setting This investigation examined the sources of evidence supporting 18 identified prescription medicinal products which underwent regulatory action due to safety reasons within the EU in the period 1 July 2012 to 31 December 2016. Results Eighteen single or combined active substances (‘medicinal products’) withdrawn, revoked or suspended within the EU for safety reasons between 2012 and 2016 met the inclusion criteria. Case reports were most commonly cited, supporting 94.4% of regulatory actions (n=17), followed by randomised controlled trial, meta-analyses, animal and in vitro, ex vivo or in silico study designs, each cited in 72.2% of regulatory actions (n=13). Epidemiological study designs were least commonly cited (n=8, 44.4%). Multiple sources of evidence contributed to 94.4% of regulatory decisions (n=17). Death was the most common adverse drug reaction leading to regulatory action (n=5; 27.8%), with four of these related to medication error or overdose. Median (IQR) time taken to reach a decision from the start of regulatory review was found to be 204.5 days (143, 535 days) and decreased across the study period. Duration of marketing prior to regulatory action, from the medicinal product’s authorisation date, increased across the period 2012–2016. Conclusions The sources of evidence supporting pharmacovigilance regulatory activities appear to have changed since implementation of Directive 2010/84/EU and Regulation (EU) No. 1235/2010. This, together with a small improvement in regulatory efficiency, suggests progress towards more rapid regulatory decisions based on more robust evidence. Future research should continue to monitor

Evidence to Support the Anti-Cancer Effect of Olive Leaf Extract and Future Directions

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Boss, Anna; Bishop, Karen S.; Marlow, Gareth; Barnett, Matthew P. G.; Ferguson, Lynnette R.

2016-01-01

The traditional Mediterranean diet (MD) is associated with long life and lower prevalence of cardiovascular disease and cancers. The main components of this diet include high intake of fruit, vegetables, red wine, extra virgin olive oil (EVOO) and fish, low intake of dairy and red meat. Olive oil has gained support as a key effector of health benefits and there is evidence that this relates to the polyphenol content. Olive leaf extract (OLE) contains a higher quantity and variety of polyphenols than those found in EVOO. There are also important structural differences between polyphenols from olive leaf and those from olive fruit that may improve the capacity of OLE to enhance health outcomes. Olive polyphenols have been claimed to play an important protective role in cancer and other inflammation-related diseases. Both inflammatory and cancer cell models have shown that olive leaf polyphenols are anti-inflammatory and protect against DNA damage initiated by free radicals. The various bioactive properties of olive leaf polyphenols are a plausible explanation for the inhibition of progression and development of cancers. The pathways and signaling cascades manipulated include the NF-κB inflammatory response and the oxidative stress response, but the effects of these bioactive components may also result from their action as a phytoestrogen. Due to the similar structure of the olive polyphenols to oestrogens, these have been hypothesized to interact with oestrogen receptors, thereby reducing the prevalence and progression of hormone related cancers. Evidence for the protective effect of olive polyphenols for cancer in humans remains anecdotal and clinical trials are required to substantiate these claims idea. This review aims to amalgamate the current literature regarding bioavailability and mechanisms involved in the potential anti-cancer action of olive leaf polyphenols. PMID:27548217

Evidence to Support the Anti-Cancer Effect of Olive Leaf Extract and Future Directions

Directory of Open Access Journals (Sweden)

Anna Boss

2016-08-01

Full Text Available The traditional Mediterranean diet (MD is associated with long life and lower prevalence of cardiovascular disease and cancers. The main components of this diet include high intake of fruit, vegetables, red wine, extra virgin olive oil (EVOO and fish, low intake of dairy and red meat. Olive oil has gained support as a key effector of health benefits and there is evidence that this relates to the polyphenol content. Olive leaf extract (OLE contains a higher quantity and variety of polyphenols than those found in EVOO. There are also important structural differences between polyphenols from olive leaf and those from olive fruit that may improve the capacity of OLE to enhance health outcomes. Olive polyphenols have been claimed to play an important protective role in cancer and other inflammation-related diseases. Both inflammatory and cancer cell models have shown that olive leaf polyphenols are anti-inflammatory and protect against DNA damage initiated by free radicals. The various bioactive properties of olive leaf polyphenols are a plausible explanation for the inhibition of progression and development of cancers. The pathways and signaling cascades manipulated include the NF-κB inflammatory response and the oxidative stress response, but the effects of these bioactive components may also result from their action as a phytoestrogen. Due to the similar structure of the olive polyphenols to oestrogens, these have been hypothesized to interact with oestrogen receptors, thereby reducing the prevalence and progression of hormone related cancers. Evidence for the protective effect of olive polyphenols for cancer in humans remains anecdotal and clinical trials are required to substantiate these claims idea. This review aims to amalgamate the current literature regarding bioavailability and mechanisms involved in the potential anti-cancer action of olive leaf polyphenols.

[Effort-reward imbalance at work and depression: current research evidence].

Science.gov (United States)

Siegrist, J

2013-01-01

In view of highly prevalent stressful conditions in modern working life, in particular increasing work pressure and job insecurity, it is of interest to know whether specific constellations of an adverse psychosocial work environment increase the risk of depressive disorder among employed people. This contribution gives a short overview of current research evidence based on an internationally established work stress model of effort-reward imbalance. Taken together, results from seven prospective epidemiological investigations demonstrate a two-fold elevated relative risk of incident depressive disorder over a mean observation period of 2.7 years among exposed versus non-exposed employees. Additional findings from experimental and quasi-experimental studies point to robust associations of effort-reward imbalance at work with proinflammatory cytokines and markers of reduced immune competence. These latter markers may indicate potential psychobiological pathways. In conclusion, incorporating this new knowledge into medical treatment and preventive efforts seems well justified.

Eddy current and mechanical support of the wendelstein 7-X thermal shield

International Nuclear Information System (INIS)

Shim, S. Y.; Nagel, M.; Schauer, F.

2004-01-01

The machine which equipped huge magnet such as fusion reactor must be in need of special care on the emergency process. Rapid drop down magnetic field generate noticeable induced current, eddy current, and it causes strong electromagnetic forces on mechanical structure. The Wendelstein 7-X consists with 5 pentagonal shaped modules, plasma vessel, and each module can be divided into two symmetric half modules. Each half-module is going to be covered by 20 pieces of plasma vessel thermal shield (PVTS). The subject of this calculation is to find appropriate support positions for PVTS which can withstand self-weight of PVTS and electromagnetic force during the emergency case within our design criterion. We report the calculation procedure and results with half-module of PVTS

Psychogenic Explanations of Physical Illness: Time to Examine the Evidence.

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Wilshire, Carolyn E; Ward, Tony

2016-09-01

In some patients with chronic physical complaints, detailed examination fails to reveal a well-recognized underlying disease process. In this situation, the physician may suspect a psychological cause. In this review, we critically evaluated the evidence for this causal claim, focusing on complaints presenting as neurological disorders. There were four main conclusions. First, patients with these complaints frequently exhibit psychopathology but not consistently more often than patients with a comparable "organic" diagnosis, so a causal role cannot be inferred. Second, these patients report a high incidence of adverse life experiences, but again, there is insufficient evidence to indicate a causal role for any particular type of experience. Third, although psychogenic illnesses are believed to be more responsive to psychological interventions than comparable "organic" illnesses, there is currently no evidence to support this claim. Finally, recent evidence suggests that biological and physical factors play a much greater causal role in these illnesses than previously believed. We conclude that there is currently little evidential support for psychogenic theories of illness in the neurological domain. In future research, researchers need to take a wider view concerning the etiology of these illnesses. © The Author(s) 2016.

An Evidence Based Approach to Designing Medical Support for Long Duration, Interplanetary Missions

Science.gov (United States)

Watkins, S. D.; McGrath, T. L.; Bauman, D. K.; Wu, J. H.; Barsten, K. N.; Barr, Y. R.; Kerstman, E. L.

2011-01-01

The Exploration Medical Capability (ExMC) element is one of six elements under NASA's Human Research Program (HRP). The goal of the ExMC element is to address the risk of the "inability to adequately recognize or treat an ill or injured crewmember." This poster highlights the evidence-based approach that the ExMC element has taken to address this goal, and the ExMC element's current areas of interest.

System Support for Forensic Inference

Science.gov (United States)

Gehani, Ashish; Kirchner, Florent; Shankar, Natarajan

Digital evidence is playing an increasingly important role in prosecuting crimes. The reasons are manifold: financially lucrative targets are now connected online, systems are so complex that vulnerabilities abound and strong digital identities are being adopted, making audit trails more useful. If the discoveries of forensic analysts are to hold up to scrutiny in court, they must meet the standard for scientific evidence. Software systems are currently developed without consideration of this fact. This paper argues for the development of a formal framework for constructing “digital artifacts” that can serve as proxies for physical evidence; a system so imbued would facilitate sound digital forensic inference. A case study involving a filesystem augmentation that provides transparent support for forensic inference is described.

ProVac Global Initiative: a vision shaped by ten years of supporting evidence-based policy decisions.

Science.gov (United States)

Jauregui, Barbara; Janusz, Cara Bess; Clark, Andrew D; Sinha, Anushua; Garcia, Ana Gabriela Felix; Resch, Stephen; Toscano, Cristiana M; Sanderson, Colin; Andrus, Jon Kim

2015-05-07

The Pan American Health Organization (PAHO) created the ProVac Initiative in 2004 with the goal of strengthening national technical capacity to make evidence-based decisions on new vaccine introduction, focusing on economic evaluations. In view of the 10th anniversary of the ProVac Initiative, this article describes its progress and reflects on lessons learned to guide the next phase. We quantified the output of the Initiative's capacity-building efforts and critically assess its progress toward achieving the milestones originally proposed in 2004. Additionally, we reviewed how country studies supported by ProVac have directly informed and strengthened the deliberations around new vaccine introduction. Since 2004, ProVac has conducted four regional workshops and supported 24 health economic analyses in 15 Latin American and Caribbean countries. Five Regional Centers of Excellence were funded, resulting in six operational research projects and nine publications. Twenty four decisions on new vaccine introductions were supported with ProVac studies. Enduring products include the TRIVAC and CERVIVAC cost-effectiveness models, the COSTVAC program costing model, methodological guides, workshop training materials and the OLIVES on-line data repository. Ten NITAGs were strengthened through ProVac activities. The evidence accumulated suggests that initiatives with emphasis on sustainable training and direct support for countries to generate evidence themselves, can help accelerate the introduction of the most valuable new vaccines. International and Regional Networks of Collaborators are necessary to provide technical support and tools to national teams conducting analyses. Timeliness, integration, quality and country ownership of the process are four necessary guiding principles for national economic evaluations to have an impact on policymaking. It would be an asset to have a model that offers different levels of complexity to choose from depending on the vaccine being

Do you do Damon®? What is the current evidence base underlying the philosophy of this appliance system?

Science.gov (United States)

Wright, Natasha; Modarai, Faranak; Cobourne, Martyn T; Dibiase, Andrew T

2011-09-01

Self-ligating bracket systems are increasing in popularity amongst orthodontists. This reflects their high quality engineering, improved reliability and relative ease of use. However, it might also be related to claims of superior function made by the manufacturers of these appliances. In particular, the Damon(®) appliance system claims to offer significant advantages to both orthodontist and patient over conventional-ligation and other forms of self-ligated appliances. We have reviewed current literature relating to use of the Damon(®) appliance system. There is some evidence to suggest this appliance may lead to reductions in chairside time for the orthodontist, particularly those experienced with this system, in comparison to conventional-ligation. However, evidence that pain experience is reduced for the patient when using Damon(®) brackets is not conclusive. In the presence of identical archwire sequences, there is no evidence that Damon(®) brackets can align teeth faster or in a qualitatively differently manner, when compared with conventional-ligation. There is no high quality evidence that treatment with the Damon(®) appliance takes place more rapidly or leads to a superior occlusal or aesthetic result. Indeed, the best available evidence would suggest there is no difference in treatment outcome or time, at least in extraction cases. There is no evidence that treatment with the Damon(®) appliance is more stable. Claims relating to improved clinical performance of the Damon(®) appliance system are currently being made to orthodontists and patients that are not substantiated in the scientific literature.

Social Support and Social Networks in COPD: A Scoping Review.

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Barton, Christopher; Effing, Tanya W; Cafarella, Paul

2015-01-01

A scoping review was conducted to determine the size and nature of the evidence describing associations between social support and networks on health, management and clinical outcomes amongst patients with COPD. Searches of PubMed, PsychInfo and CINAHL were undertaken for the period 1966-December 2013. A descriptive synthesis of the main findings was undertaken to demonstrate where there is current evidence for associations between social support, networks and health outcomes, and where further research is needed. The search yielded 318 papers of which 287 were excluded after applying selection criteria. Two areas emerged in which there was consistent evidence of benefit of social support; namely mental health and self-efficacy. There was inconsistent evidence for a relationship between perceived social support and quality of life, physical functioning and self-rated health. Hospital readmission was not associated with level of perceived social support. Only a small number of studies (3 articles) have reported on the social network of individuals with COPD. There remains a need to identify the factors that promote and enable social support. In particular, there is a need to further understand the characteristics of social networks within the broader social structural conditions in which COPD patients live and manage their illness.

A Scaffolding Framework to Support the Construction of Evidence-Based Arguments among Middle School Students

Science.gov (United States)

Belland, Brian R.; Glazewski, Krista D.; Richardson, Jennifer C.

2008-01-01

Problem-based learning (PBL) is an instructional approach in which students in small groups engage in an authentic, ill-structured problem, and must (1) define, generate and pursue learning issues to understand the problem, (2) develop a possible solution, (3) provide evidence to support their solution, and (4) present their solution and the…

An evidence-based approach to perioperative nutrition support in the elective surgery patient.

Science.gov (United States)

Miller, Keith R; Wischmeyer, Paul E; Taylor, Beth; McClave, Stephen A

2013-09-01

In surgical practice, great attention is given to the perioperative management of the elective surgical patient with regard to surgical planning, stratification of cardiopulmonary risk, and postoperative assessment for complication. However, growing evidence supports the beneficial role for implementation of a consistent and literature-based approach to perioperative nutrition therapy. Determining nutrition risk should be a routine component of the preoperative evaluation. As with the above issues, this concept begins with the clinician's first visit with the patient as risk is assessed and the severity of the surgical insult considered. If the patient is an appropriate candidate for benefit from preoperative support, a plan for initiation and reassessment should be implemented. Once appropriate nutrition end points have been achieved, special consideration should be given to beneficial practices the immediate day preceding surgery that may better prepare the patient for the intervention from a metabolic standpoint. In the operating room, consideration should be given to the potential placement of enteral access during the index operation as well as judicious and targeted intraoperative resuscitation. Immediately following the intervention, adequate resuscitation and glycemic control are key concepts, as is an evidence-based approach to the early advancement of an enteral/oral diet in the postoperative patient. Through the implementation of perioperative nutrition therapy plans in the elective surgery setting, outcomes can be improved.

Collectivism and coping: current theories, evidence, and measurements of collective coping.

Science.gov (United States)

Kuo, Ben C H

2013-01-01

A burgeoning body of cultural coping research has begun to identify the prevalence and the functional importance of collective coping behaviors among culturally diverse populations in North America and internationally. These emerging findings are highly significant as they evidence culture's impacts on the stress-coping process via collectivistic values and orientation. They provide a critical counterpoint to the prevailing Western, individualistic stress and coping paradigm. However, current research and understanding about collective coping appear to be piecemeal and not well integrated. To address this issue, this review attempts to comprehensively survey, summarize, and evaluate existing research related to collective coping and its implications for coping research with culturally diverse populations from multiple domains. Specifically, this paper reviews relevant research and knowledge on collective coping in terms of: (a) operational definitions; (b) theories; (c) empirical evidence based on studies of specific cultural groups and broad cultural values/dimensions; (d) measurements; and (e) implications for future cultural coping research. Overall, collective coping behaviors are conceived as a product of the communal/relational norms and values of a cultural group across studies. They also encompass a wide array of stress responses ranging from value-driven to interpersonally based to culturally conditioned emotional/cognitive to religion- and spirituality-grounded coping strategies. In addition, this review highlights: (a) the relevance and the potential of cultural coping theories to guide future collective coping research; (b) growing evidence for the prominence of collective coping behaviors particularly among Asian nationals, Asian Americans/Canadians and African Americans/Canadians; (c) preference for collective coping behaviors as a function of collectivism and interdependent cultural value and orientation; and (d) six cultural coping scales. This

Can current analytical quality performance of UK clinical laboratories support evidence-based guidelines for diabetes and ischaemic heart disease?--A pilot study and a proposal.

Science.gov (United States)

Jassam, Nuthar; Yundt-Pacheco, John; Jansen, Rob; Thomas, Annette; Barth, Julian H

2013-08-01

The implementation of national and international guidelines is beginning to standardise clinical practice. However, since many guidelines have decision limits based on laboratory tests, there is an urgent need to ensure that different laboratories obtain the same analytical result on any sample. A scientifically-based quality control process will be a pre-requisite to provide this level of analytical performance which will support evidence-based guidelines and movement of patients across boundaries while maintaining standardised outcomes. We discuss the finding of a pilot study performed to assess UK clinical laboratories readiness to work to a higher grade quality specifications such as biological variation-based quality specifications. Internal quality control (IQC) data for HbA1c, glucose, creatinine, cholesterol and high density lipoprotein (HDL)-cholesterol were collected from UK laboratories participating in the Bio-Rad Unity QC programme. The median of the coefficient of variation (CV%) of the participating laboratories was evaluated against the CV% based on biological variation. Except creatinine, the other four analytes had a variable degree of compliance with the biological variation-based quality specifications. More than 75% of the laboratories met the biological variation-based quality specifications for glucose, cholesterol and HDL-cholesterol. Slightly over 50% of the laboratories met the analytical goal for HBA1c. Only one analyte (cholesterol) had a performance achieving the higher quality specifications consistent with 5σ. Our data from IQC do not consistently demonstrate that the results from clinical laboratories meet evidence-based quality specifications. Therefore, we propose that a graded scale of quality specifications may be needed at this stage.

Additional Interventions to Enhance the Effectiveness of Individual Placement and Support: A Rapid Evidence Assessment

Directory of Open Access Journals (Sweden)

Naomi Boycott

2012-01-01

Full Text Available Topic. Additional interventions used to enhance the effectiveness of individual placement and support (IPS. Aim. To establish whether additional interventions improve the vocational outcomes of IPS alone for people with severe mental illness. Method. A rapid evidence assessment of the literature was conducted for studies where behavioural or psychological interventions have been used to supplement standard IPS. Published and unpublished empirical studies of IPS with additional interventions were considered for inclusion. Conclusions. Six published studies were found which compared IPS alone to IPS plus a supplementary intervention. Of these, three used skills training and three used cognitive remediation. The contribution of each discrete intervention is difficult to establish. Some evidence suggests that work-related social skills and cognitive training are effective adjuncts, but this is an area where large RCTs are required to yield conclusive evidence.

Shifting mindsets: a realist synthesis of evidence from self-management support training.

Science.gov (United States)

Davies, Freya; Wood, Fiona; Bullock, Alison; Wallace, Carolyn; Edwards, Adrian

2018-03-01

Accompanying the growing expectation of patient self-management is the need to ensure health care professionals (HCPs) have the required attitudes and skills to provide effective self-management support (SMS). Results from existing training interventions for HCPs in SMS have been mixed and the evidence base is weaker for certain settings, including supporting people with progressive neurological conditions (PNCs). We set out to understand how training operates, and to identify barriers and facilitators to training designed to support shifts in attitudes amongst HCPs. We undertook a realist literature synthesis focused on: (i) the influence of how HCPs, teams and organisations view and adopt self-management; and (ii) how SMS needs to be tailored for people with PNCs. A traditional database search strategy was used alongside citation tracking, grey literature searching and stakeholder recommendations. We supplemented PNC-specific literature with data from other long-term conditions. Key informant interviews and stakeholder advisory group meetings informed the synthesis process. Realist context-mechanism-outcome configurations were generated and mapped onto the stages described in Mezirow's Transformative Learning Theory. Forty-four original articles were included (19 relating to PNCs), from which seven refined theories were developed. The theories identified important training elements (evidence provision, building skills and confidence, facilitating reflection and generating empathy). The significant influence of workplace factors as possible barriers or facilitators was highlighted. Embracing SMS often required challenging traditional professional role boundaries. The integration of SMS into routine care is not an automatic outcome from training. A transformative learning process is often required to trigger the necessary mindset shift. Training should focus on how individual HCPs define and value SMS and how their work context (patient group and organisational

Calculation of the force acting on a drop in a nonuniform flow of a current-supporting fluid

International Nuclear Information System (INIS)

Korovin, V.M.

1993-01-01

In the context of wide use of intense electric currents in various technological process, it is of practical interest to investigate the characteristics of the force action of electromagnetic fields on a variety of inclusions - solid particles, drops, gas bubbles - suspended in current-supporting fluids. In the available studies one treats the simplest case, in which the vortical component of the electromagnetic forces, generated by the interaction of the current with the internal magnetic field, is nonvanishing only in small vicinities near these inclusions, and therefore these electromagnetic forces do not generate global motion of the homogeneous current-supporting fluid. In practice, in most cases the vortical component of electromagnetic forces plays a substantial role in the whole operating region of the technological device, and the motion of the current-supporting fluid is created specifically by electromagnetic forces. In the case of a varying electromagnetic field the forces acting on particles are located in the conducting fluid, moving under the field action, were calculated by Korovim (Korovim, V. M., open-quotes The calculation of forces acting on suspended particles during the flow of a conducting fluid in a varying electromagnetic field,close quotes Magn. Gidrodin, No. 1 95-102 (1991)). In the present study the authors generalize the method suggested by Korovin for calculating forces applied to both drops and particles and gas bubbles suspended in the gradient flow of a fluid moving under the action of a constant electromagnetic field. 6 refs

An evidence-based public health approach to climate change adaptation.

Science.gov (United States)

Hess, Jeremy J; Eidson, Millicent; Tlumak, Jennifer E; Raab, Kristin K; Luber, George

2014-11-01

Public health is committed to evidence-based practice, yet there has been minimal discussion of how to apply an evidence-based practice framework to climate change adaptation. Our goal was to review the literature on evidence-based public health (EBPH), to determine whether it can be applied to climate change adaptation, and to consider how emphasizing evidence-based practice may influence research and practice decisions related to public health adaptation to climate change. We conducted a substantive review of EBPH, identified a consensus EBPH framework, and modified it to support an EBPH approach to climate change adaptation. We applied the framework to an example and considered implications for stakeholders. A modified EBPH framework can accommodate the wide range of exposures, outcomes, and modes of inquiry associated with climate change adaptation and the variety of settings in which adaptation activities will be pursued. Several factors currently limit application of the framework, including a lack of higher-level evidence of intervention efficacy and a lack of guidelines for reporting climate change health impact projections. To enhance the evidence base, there must be increased attention to designing, evaluating, and reporting adaptation interventions; standardized health impact projection reporting; and increased attention to knowledge translation. This approach has implications for funders, researchers, journal editors, practitioners, and policy makers. The current approach to EBPH can, with modifications, support climate change adaptation activities, but there is little evidence regarding interventions and knowledge translation, and guidelines for projecting health impacts are lacking. Realizing the goal of an evidence-based approach will require systematic, coordinated efforts among various stakeholders.

Getting to uptake: do communities of practice support the implementation of evidence-based practice?

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Barwick, Melanie A; Peters, Julia; Boydell, Katherine

2009-02-01

Practitioners are increasingly encouraged to adopt evidence-based practices (EBP) leading to a need for new knowledge translation strategies to support implementation and practice change. This study examined the benefits of a community of practice in the context of Ontario's children's mental health sector where organizations are mandated to adopt a standardized outcome measure to monitor client response to treatment. Readiness for change, practice change, content knowledge, and satisfaction with and use of implementation supports were examined among practitioners newly trained on the measure who were randomly assigned to a community of practice (CoP) or a practice as usual (PaU) group. CoP practitioners attended 6 sessions over 12 months; PaU practitioners had access to usual implementation supports. Groups did not differ on readiness for change or reported practice change, although CoP participants demonstrated greater use of the tool in practice, better content knowledge and were more satisfied with implementation supports than PaU participants. CoPs present a promising model for translating EBP knowledge and promoting practice change in children's mental health that requires further study.

Processes of conscious and unconscious memory: evidence from current research on dissociation of memories within a test.

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Cheng, Chao-Ming; Huang, Chin-Lan

2011-01-01

The processes of conscious memory (CM) and unconscious memory (UM) are explored, based on the results of the current and previous studies in which the 2 forms of memory within a test were separated by either the process dissociation or metacognition-based dissociation procedure. The results assessing influences of shallow and deep processing, association, and self-generation on CM in explicit and implicit tests are taken as evidence that CM in a test is driven not only conceptually but also by the driving nature of the test, and CM benefits from an encoding condition to the extent that information processing for CM recapitulates that engaged in the encoding condition.Those influences on UM in explicit and implicit tests are taken to support the view that UM in a test is driven by the nature of the test itself, and UM benefits from an encoding condition to the extent that the cognitive environments at test and at study match to activate the same type of information (e.g., visual, lexical, or semantic) about memory items or the same content of a preexisting association or categorical structure.

Strategic analytics: towards fully embedding evidence in healthcare decision-making.

Science.gov (United States)

Garay, Jason; Cartagena, Rosario; Esensoy, Ali Vahit; Handa, Kiren; Kane, Eli; Kaw, Neal; Sadat, Somayeh

2015-01-01

Cancer Care Ontario (CCO) has implemented multiple information technology solutions and collected health-system data to support its programs. There is now an opportunity to leverage these data and perform advanced end-to-end analytics that inform decisions around improving health-system performance. In 2014, CCO engaged in an extensive assessment of its current data capacity and capability, with the intent to drive increased use of data for evidence-based decision-making. The breadth and volume of data at CCO uniquely places the organization to contribute to not only system-wide operational reporting, but more advanced modelling of current and future state system management and planning. In 2012, CCO established a strategic analytics practice to assist the agency's programs contextualize and inform key business decisions and to provide support through innovative predictive analytics solutions. This paper describes the organizational structure, services and supporting operations that have enabled progress to date, and discusses the next steps towards the vision of embedding evidence fully into healthcare decision-making. Copyright © 2014 Longwoods Publishing.

The Utilisation of Pisang Island as a Platform to Support the Current Safety and Security Needs of Marine Navigation in the Straits of Malacca

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Ahmad Faizal Ahmad Fuad

2017-06-01

Full Text Available Current marine navigational practice relies less on long-range visual marine signals such as lighthouses for reference purposes. This is due to the availability of Global Navigation Satellite Systems (GNSS, which are integrated with other navigational aids on ships. Therefore, the objective of this study is to review the function of Pisang Island lighthouse and to propose the most relevant use of Pisang Island for current navigational needs. The function of the lighthouse was reviewed according to the IALA Navigational Guide and the AIS data image. The result showed that the most suitable navigational use of the lighthouse is to act as a reference for Line of Position (LOP. The AIS data image indicated that mariners are not using Pisang Island lighthouse for LOP. The trend in the Straits of Malacca (SoM was compared with the trend in the Straits of Dover, UK. The selected experts verified that LOP was not practised there. As a specific example, a tanker ship route in the South China Sea was used to further support that LOP was not practised. This evidence supported the view that Pisang Island lighthouse is less relevant for current navigational practice and does not directly support the coastal state VTS operation and the establishment of the marine electronic highway. Furthermore, the existing shore-based VTS radar has limitations on range and the detection of targets near Pisang Island. Therefore, this study proposes the establishment of a new radar station on Pisang Island at the existing site of the lighthouse. The proposed new radar station on Pisang Island will add to the existing coverage of the VTS radar, bridging the coverage gaps to overcome the weakness of the existing shore-based radar and improve the safety and security of marine navigation in the SoM.

Current and future treatment options in osteoporosis.

LENUS (Irish Health Repository)

Brewer, Linda

2012-02-01

PURPOSE: The incidence of osteoporosis-related fractures will increase substantially over the coming decades as the population ages globally. This has important economic and public health implications, contributing substantially to morbidity and excess mortality in this population. METHODS: When prescribing for older patients the effectiveness profile of drugs needs to be balanced against their tolerability in individual patients. RESULTS: Currently we have good anti-fracture data to support the use of many available anti-resorptive and anabolic drugs including bisphosphonates, strontium ranelate and recombinant human parathyroid hormone. We also have evidence to demonstrate the importance of calcium and vitamin D repletion in these patients. However, in recent years our understanding of normal bone physiology and the mechanisms underlying the development of osteoporosis has significantly advanced and this has led to the development of new therapies. Novel agents, particularly denosumab, but also inhibitors of cathepsin K and anabolic agents that act on Wnt signalling, will increase the therapeutic options for clinicians in the coming years. CONCLUSION: This review discusses the evidence supporting the use of currently available treatment options for osteoporosis and potential future advances in drug therapy. Particular consideration should be given when prescribing for certain older patients who have issues with compliance or tolerance and also in those with co-morbidities or levels of frailty that may restrict the choice of therapy. Understanding the evidence for the benefit and possible harm of osteoporosis treatments is critical to appropriate management of this patient population.

The Evidence Base for How We Learn: Supporting Students' Social, Emotional, and Academic Development. Consensus Statements of Evidence from the Council of Distinguished Scientists

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Jones, Stephanie M.; Kahn, Jennifer

2017-01-01

"The Evidence Base for How We Learn: Supporting Students' Social, Emotional, and Academic Development" articulates the scientific consensus regarding how people learn. The research brief presents a set of consensus statements--developed and unanimously signed onto by the Commission's Council of Distinguished Scientists--that affirm the…

Learning from peer support schemes--can prison listeners support offenders who self-injure in custody?

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Griffiths, Louise; Bailey, Di

2015-01-01

The purpose of this paper is to critically evaluate the current evidence for peer support in prisons, in particular its contribution to working with prisoners who self-injure and the extent to which the success of peer support schemes such as the prison listeners, hinges upon staff's willingness to engage with the initiative. The review was constructed by using primary and secondary terms to search the literature. The studies focused on peer support in custody with reference to mental health and self-injury. Searches identified papers on the prison listener scheme and staff perspectives on prison peer support, as these formed a central focus of the review. Studies were excluded from the review if the participants' behaviours was explicitly linked to suicidal intent, as the review focused on self-injury as a coping strategy. A total of 24 studies were selected according to specific inclusion criteria (six were grey literature, 18 academic literature). Of the 24 studies ten studies focused on peer support and self-injury. Of the 24 studies the listener scheme was the focus of 16 studies, of these 16 studies self-injury and the listener scheme was a focus of eight studies. Evidence from the review suggests that prison peer support could be considered on a continuum depending on the different degrees of peer involvement.

Evidence Support and Guidelines for Using Heated, Humidified, High-Flow Nasal Cannulae in Neonatology: Oxford Nasal High-Flow Therapy Meeting, 2015.

Science.gov (United States)

Roehr, Charles C; Yoder, Bradley A; Davis, Peter G; Ives, Kevin

2016-12-01

Nasal high-flow therapy (nHFT) has become a popular form of noninvasive respiratory support in neonatal intensive care units. A meeting held in Oxford, UK, in June 2015 examined the evidence base and proposed a consensus statement. In summary, nHFT is effective for support of preterm infants following extubation. There is growing evidence evaluating its use in the primary treatment of respiratory distress. Further study is needed to assess which clinical conditions are most amenable to nHFT support, the most effective flow rates, and escalation and weaning strategies. Its suitability as first-line treatment needs to be further evaluated. Copyright © 2016 Elsevier Inc. All rights reserved.

The effects of scaffolding in the classroom : support contingency and student independent working time in relation to student achievement, task effort and appreciation of support

NARCIS (Netherlands)

van de Pol, Janneke; Volman, Monique; Oort, Frans; Beishuizen, Jos

2015-01-01

Teacher scaffolding, in which teachers support students adaptively or contingently, is assumed to be effective. Yet, hardly any evidence from classroom studies exists. With the current experimental classroom study we investigated whether scaffolding affects students’ achievement, task effort, and

Danish evidence-based clinical guideline for use of nutritional support in pulmonary rehabilitation of undernourished patients with stable COPD

DEFF Research Database (Denmark)

Beck, Anne Marie; Iepsen, Ulrik Winning; Topperup, Randi

2015-01-01

Background and aims Disease-related under-nutrition is a common problem in individuals with COPD. The rationale for nutritional support in pulmonary rehabilitation therefore seems obvious. However there is limited evidence regarding the patient-relevant outcomes i.e. activities of daily living (ADL......) or quality of life. Therefore the topic was included in The Danish Health and Medicines Authority's development of an evidence-based clinical guideline for rehabilitation of patients with stable COPD. Methods The methods were specified by The Danish Health and Medicines Authority as part of a standardized...... studies had been published. There were evidence of moderate quality that nutritional support for undernourished patients with COPD lead to a weight gain of 1.7 kg (95% confidence interval: 1.3 to 2.2 kg), but the effect was quantified as a mean change from baseline, which is less reliable. There were...

Evidence supporting the use of recombinant activated factor VII in congenital bleeding disorders

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Pär I Johansson

2010-06-01

Full Text Available Pär I Johansson, Sisse R OstrowskiCapital Region Blood Bank, Section for Transfusion Medicine, Rigshospitalet, University of Copenhagen, Copenhagen, DenmarkBackground: Recombinant activated factor VII (rFVIIa, NovoSeven® was introduced in 1996 for the treatment of hemophilic patients with antibodies against coagulation factor VIII or IX.Objective: To review the evidence supporting the use of rFVIIa for the treatment of patients with congenital bleeding disorders.Patients and methods: English-language databases were searched in September 2009 for reports of randomized controlled trials (RCTs evaluating the ability of rFVIIa to restore hemostasis in patients with congenital bleeding disorders.Results: Eight RCTs involving 256 hemophilic patients with antibodies against coagulation factors, also known as inhibitors, were identified. The evidence supporting the use of rFVIIa in these patients was weak with regard to dose, clinical setting, mode of administration, efficacy, and adverse events, given the limited sample size of each RCT and the heterogeneity of the studies.Conclusion: The authors suggest that rFVIIa therapy in hemophilic patients with inhibitors should be based on the individual’s ability to generate thrombin and form a clot, and not on the patient’s weight alone. Therefore, assays for thrombin generation, such as whole-blood thromboelastography, have the potential to significantly improve the treatment of these patients.Keywords: hemophilia, inhibitors, coagulation factor VIII, coagulation factor IX, rFVIIa, NovoSeven, FEIBA, hemostasis, RCT

Male circumcision to prevent syphilis in 1855 and HIV in 1986 is supported by the accumulated scientific evidence to 2015: Response to Darby.

Science.gov (United States)

Morris, Brian J; Wamai, Richard G; Krieger, John N; Banerjee, Joya; Klausner, Jeffrey D

2017-10-01

An article by Darby disparaging male circumcision (MC) for syphilis prevention in Victorian times (1837-1901) and voluntary medical MC programs for HIV prevention in recent times ignores contemporary scientific evidence. It is one-sided and cites outlier studies as well as claims by MC opponents that support the author's thesis, but ignores high quality randomised controlled trials and meta-analyses. While we agree with Darby that risky behaviours contribute to syphilis and HIV epidemics, there is now compelling evidence that MC helps reduce both syphilis and HIV infections. Although some motivations for MC in Victorian times were misguided, others, such as protection against syphilis, penile cancer, phimosis, balanitis and poor hygiene have stood the test of time. In the absence of a cure or effective prophylactic vaccine for HIV, MC should help lower heterosexually acquired HIV, especially when coupled with other interventions such as condoms and behaviour. This should save lives, as well as reducing costs and suffering. In contrast to Darby, our evaluation of the evidence leads us to conclude that MC would likely have helped reduce syphilis in Victorian times and, in the current era, will help lower both syphilis and HIV, so improving global public health.

Facilitating the implementation of evidence-based practice through contextual support and nursing leadership

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Kueny A

2015-06-01

Full Text Available Angela Kueny,1 Leah L Shever,2 Melissa Lehan Mackin,3 Marita G Titler4 1Luther College, Decorah, IA, 2The University of Michigan Hospital and Health Center, Ann Arbor, MI, 3University of Iowa College of Nursing, Iowa City, IA, 4University of Michigan School of Nursing, Ann Arbor, MI, USA Background/purpose: Nurse managers (NMs play an important role promoting evidence-based practice (EBP on clinical units within hospitals. However, there is a dearth of research focused on NM perspectives about institutional contextual factors to support the goal of EBP on the clinical unit. The purpose of this article is to identify contextual factors described by NMs to drive change and facilitate EBP at the unit level, comparing and contrasting these perspectives across nursing units. Methods: This study employed a qualitative descriptive design using interviews with nine NMs who were participating in a large effectiveness study. To stratify the sample, NMs were selected from nursing units designated as high or low performing based on implementation of EBP interventions, scores on the Meyer and Goes research use scale, and fall rates. Descriptive content analysis was used to identify themes that reflect the complex nature of infrastructure described by NMs and contextual influences that supported or hindered their promotion of EBP on the clinical unit. Results: NMs perceived workplace culture, structure, and resources as facilitators or barriers to empowering nurses under their supervision to use EBP and drive change. A workplace culture that provides clear communication of EBP goals or regulatory changes, direct contact with CEOs, and clear expectations supported NMs in their promotion of EBP on their units. High-performing unit NMs described a structure that included nursing-specific committees, allowing nurses to drive change and EBP from within the unit. NMs from high-performing units were more likely to articulate internal resources, such as quality

Reviewing the current evidence supporting early B-cells as the cellular origin of Merkel cell carcinoma.

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Sauer, C M; Haugg, A M; Chteinberg, E; Rennspiess, D; Winnepenninckx, V; Speel, E-J; Becker, J C; Kurz, A K; Zur Hausen, A

2017-08-01

Merkel cell carcinoma (MCC) is a highly malignant skin cancer characterized by early metastases and poor survival. Although MCC is a rare malignancy, its incidence is rapidly increasing in the U.S. and Europe. The discovery of the Merkel cell polyomavirus (MCPyV) has enormously impacted our understanding of its etiopathogenesis and biology. MCCs are characterized by trilinear differentiation, comprising the expression of neuroendocrine, epithelial and B-lymphoid lineage markers. To date, it is generally accepted that the initial assumption of MCC originating from Merkel cells (MCs) is unlikely. This is owed to their post-mitotic character, absence of MCPyV in MCs and discrepant protein expression pattern in comparison to MCC. Evidence from mouse models suggests that epidermal/dermal stem cells might be of cellular origin in MCC. The recently formulated hypothesis of MCC originating from early B-cells is based on morphology, the consistent expression of early B-cell lineage markers and the finding of clonal immunoglobulin chain rearrangement in MCC cells. In this review we elaborate on the cellular ancestry of MCC, the identification of which could pave the way for novel and more effective therapeutic regimens. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

Presenting Global Warming and Evolution as Public Health Issues to Encourage Acceptance of Scientific Evidence

Science.gov (United States)

Stover, Shawn K.; McArthur, Laurence B.; Mabry, Michelle L.

2013-01-01

Although evidence supporting anthropogenic global warming and evolution by natural selection is considerable, the public does not embrace these concepts. The current study explores the hypothesis that individuals will become more receptive to scientific viewpoints if evidence for evolution and implications of global warming are presented as issues…

In Dogs With a European Adder Bite, Does the Use of Antivenom With Supportive Treatment Compared to Supportive Treatment Alone Improve Time to Recovery?

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Lindsay Hodgson

2017-11-01

Full Text Available The current literature does not offer convincing evidence for the positive effect of antivenom on time to recovery in dogs envenomated by the European adder. It appears that the use of antivenom in addition to supportive treatment may positively affect local swelling if given within 24 hours of the bite, but the evidence is low quality and further studies are required before a more definitive answer can be reached.

How task characteristics and social support relate to managerial learning: empirical evidence from Dutch home care.

Science.gov (United States)

Ouweneel, A P Else; Taris, Toon W; Van Zolingen, Simone J; Schreurs, Paul J G

2009-01-01

Researchers have revealed that managers profit most from informal and on-the-job learning. Moreover, research has shown that task characteristics and social support affect informal learning. On the basis of these insights, the authors examined the effects of task characteristics (psychological job demands, job control) and social support from the supervisor and colleagues on informal on-the-job learning among 1588 managers in the Dutch home-care sector. A regression analysis revealed that high demands, high control, and high colleague and supervisor support were each associated with high levels of informal learning. The authors found no evidence for statistical interactions among the effects of these concepts. They concluded that to promote managers' informal workplace learning, employers should especially increase job control.

Brief Report: An Independent Replication and Extension of Psychometric Evidence Supporting the Theory of Mind Inventory

Science.gov (United States)

Greenslade, Kathryn J.; Coggins, Truman E.

2016-01-01

This study presents an independent replication and extension of psychometric evidence supporting the "Theory of Mind Inventory" ("ToMI"). Parents of 20 children with ASD (4; 1-6; 7 years; months) and 20 with typical development (3; 1-6; 5), rated their child's theory of mind abilities in everyday situations. Other parent report…

Is there evidence to support a forefoot strike pattern in barefoot runners? A review.

Science.gov (United States)

Lorenz, Daniel S; Pontillo, Marisa

2012-11-01

Barefoot running is a trend among running enthusiasts that is the subject of much controversy. At this time, benefits appear to be more speculative and anecdotal than evidence based. Additionally, the risk of injuries is not well established. A PubMed search was undertaken for articles published in English from 1980 to 2011. Additional references were accrued from reference lists of research articles. While minimal data exist that definitively support barefoot running, there are data lending support to the argument that runners should use a forefoot strike pattern in lieu of a heel strike pattern to reduce ground reaction forces, ground contact time, and step length. Whether there is a positive or negative effect on injury has yet to be determined. Unquestionably, more research is needed before definitive conclusions can be drawn.

How Is Working Memory Training Likely to Influence Academic Performance? Current Evidence and Methodological Considerations.

Science.gov (United States)

Bergman Nutley, Sissela; Söderqvist, Stina

2017-01-01

Working memory (WM) is one of our core cognitive functions, allowing us to keep information in mind for shorter periods of time and then work with this information. It is the gateway that information has to pass in order to be processed consciously. A well-functioning WM is therefore crucial for a number of everyday activities including learning and academic performance (Gathercole et al., 2003; Bull et al., 2008), which is the focus of this review. Specifically, we will review the research investigating whether improving WM capacity using Cogmed WM training can lead to improvements on academic performance. Emphasis is given to reviewing the theoretical principles upon which such investigations rely, in particular the complex relation between WM and mathematical and reading abilities during development and how these are likely to be influenced by training. We suggest two possible routes in which training can influence academic performance, one through an effect on learning capacity which would thus be evident with time and education, and one through an immediate effect on performance on reading and mathematical tasks. Based on the theoretical complexity described we highlight some methodological issues that are important to take into consideration when designing and interpreting research on WM training and academic performance, but that are nonetheless often overlooked in the current research literature. Finally, we will provide some suggestions for future research for advancing the understanding of WM training and its potential role in supporting academic attainment.

Integrating Radiology and Anatomy Teaching in Medical Education in the UK--The Evidence, Current Trends, and Future Scope.

Science.gov (United States)

Heptonstall, N B; Ali, T; Mankad, K

2016-04-01

This review article presents the current evidence of the importance of integrating radiology and anatomy in medical education in the UK, a recommendation by a number of key anatomy, education, and radiology organizations. Current evidence highlights that on average only 5% of total teaching time in medical education is dedicated to radiology. Often, radiology teaching does not adequately fulfill students' learning needs and potentially leaves them underprepared for medical practice. Benefits of integrating radiology and anatomy include improved clinical application of anatomy, an increase in student's interest in anatomy, and ultimately improved radiological interpretation. Various modalities exist for the integration of radiology and anatomy, facilitated by the vast portability of radiological images. It appears that combining radiological resources with traditional anatomy teaching methodology in a blended approach is most beneficial. Copyright © 2016 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.

PUBLIC SUPPORT FOR THE EUROPEAN UNION IN THE CURRENT CONTEXT: PRELIMINARY REMARKS

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Iuliana-Lacramioara TINCU

2017-12-01

Full Text Available The European Union appears, in the context of a conceptual and transformational change, in the shape of a fluid structure that is continuously shaped by a wide variety of factors. Under the current redefining process, the present article pursues the amplitude of the social force in the Union’s configuration. The EU can be currently viewed as a reality found at crossroads, due to a growing fragility of public support for integration and the increasing contestation of the EU through the amplification of Eurosceptic attitudes and the rising popularity of the populist-nationalist parties. In the conditions of a populism-terrorism-migration triad that is threatening the European integration project, this article represents an attempt to provide a preliminary insight on the forces that shape the configuration of this supranational structure, with regard to the factors that are accountable for the growing scepticism among the European citizens and have shifted the citizens’ approach on the EU from a permissive consensus to a constraining dissensus.

Low-Frequency Pulsed Current Versus Kilohertz-Frequency Alternating Current: A Scoping Literature Review.

Science.gov (United States)

Vaz, Marco Aurélio; Frasson, Viviane Bortoluzzi

2018-04-01

To compare the effectiveness of low-frequency pulsed current versus kilohertz-frequency alternating current in terms of evoked force, discomfort level, current intensity, and muscle fatigability; to discuss the physiological mechanisms of each neuromuscular electrical stimulation type; and to determine if kilohertz-frequency alternating current is better than low-frequency pulsed current for clinical treatment. Articles were obtained from PubMed, Scopus, Cochrane Central Register of Controlled Trials, CINAHL, MEDLINE, and SPORTSDiscus databases using the terms Russian current or kilohertz current or alternating current or pulsed current or Aussie current and torque or discomfort or fatigue or current intensity, and through citation tracking up to July 2017. Two independent reviewers selected studies comparing the use of the 2 neuromuscular electrical stimulation currents. Studies describing maximal current intensity tolerated and the main effects of the 2 different current types on discomfort, muscle force, and fatigability were independently reviewed. Data were systematized according to (1) methodology; (2) electrical current characteristics; and (3) outcomes on discomfort level, evoked force, current intensity, and muscle fatigability. The search revealed 15 articles comparing the 2 current types. Kilohertz-frequency alternated current generated equal or less force, similar discomfort, similar current intensity for maximal tolerated neuromuscular electrical stimulation, and more fatigue compared with low-frequency pulsed current. Similar submaximal levels of evoked force revealed higher discomfort and current intensity for kilohertz-frequency alternated current compared with low-frequency pulsed current. Available evidence does not support the idea that kilohertz-frequency alternated current is better than low-frequency pulsed current for strength training and rehabilitation. Copyright © 2017 American Congress of Rehabilitation Medicine. Published by Elsevier

Role of oral zinc supplementation for reduction of neonatal hyperbilirubinemia: a systematic review of current evidence.

Science.gov (United States)

Sharma, Deepak; Farahbakhsh, Nazanin; Sharma, Pradeep; Shastri, Sweta

2017-08-01

Neonatal hyperbilirubinemia is frequently seen condition in the NICU. Oral zinc has been tried for the prevention of hyperbilirubinemia. To evaluate the role of oral zinc supplementation for reduction of neonatal hyperbilirubinemia in term and preterm infants. The literature search was done for various randomized control trial (RCT) by searching the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, EMBASE, Web of Science, Scopus, Index Copernicus, African Index Medicus (AIM), Thomson Reuters (ESCI), Chemical Abstracts Service (CAS) and other data base. This review included six RCT that fulfilled inclusion criteria. One study evaluated the role of zinc in very low birth weight (VLBW) infants and remaining enrolled neonates  ≥35 weeks of gestation. The dose of zinc varied from 5 to 20 mg/day and duration from 5-7 days. All the studies used zinc sulfate, only one study used zinc gluconate. The total neonates enrolled in these different RCT are 749. Role of zinc in the prevention of neonatal hyperbilirubinemia is not supported by the current evidence. Only one study was able to show reduction in the mean TSB level and requirement of phototherapy with zinc, and the remaining studies did not report any positive effect. None of the studies showed any effect on the duration of phototherapy, incidence of phototherapy, age of starting of phototherapy and any serious adverse effect.

A Futures Orientation in the Australian Curriculum: Current Levels of Teacher Interest, Activity and Support in Western Australia

Science.gov (United States)

Paynter, Mark; Bruce, Neville

2014-01-01

The soon to be implemented Australian Curriculum aims to integrate a futures orientation across subject areas. Guidelines and support for this specific initiative are being finalized. Only a little is known about the current teaching of a futures orientation or of secondary teacher interest, understanding and support for this important but…

Encouraging prediction during production facilitates subsequent comprehension: Evidence from interleaved object naming in sentence context and sentence reading

NARCIS (Netherlands)

Hintz, F.; Meyer, A.S.; Hüttig, F.

2016-01-01

Many studies have shown that a supportive context facilitates language comprehension. A currently influential view is that language production may support prediction in language comprehension. Experimental evidence for this, however, is relatively sparse. Here we explored whether encouraging

Life support decision making in critical care: Identifying and appraising the qualitative research evidence.

Science.gov (United States)

Giacomini, Mita; Cook, Deborah; DeJean, Deirdre

2009-04-01

The objective of this study is to identify and appraise qualitative research evidence on the experience of making life-support decisions in critical care. In six databases and supplementary sources, we sought original research published from January 1990 through June 2008 reporting qualitative empirical studies of the experience of life-support decision making in critical care settings. Fifty-three journal articles and monographs were included. Of these, 25 reported prospective studies and 28 reported retrospective studies. We abstracted methodologic characteristics relevant to the basic critical appraisal of qualitative research (prospective data collection, ethics approval, purposive sampling, iterative data collection and analysis, and any method to corroborate findings). Qualitative research traditions represented include grounded theory (n = 15, 28%), ethnography or naturalistic methods (n = 15, 28%), phenomenology (n = 9, 17%), and other or unspecified approaches (n = 14, 26%). All 53 documents describe the research setting; 97% indicate purposive sampling of participants. Studies vary in their capture of multidisciplinary clinician and family perspectives. Thirty-one (58%) report research ethics board review. Only 49% report iterative data collection and analysis, and eight documents (15%) describe an analytically driven stopping point for data collection. Thirty-two documents (60%) indicated a method for corroborating findings. Qualitative evidence often appears outside of clinical journals, with most research from the United States. Prospective, observation-based studies follow life-support decision making directly. These involve a variety of participants and yield important insights into interactions, communication, and dynamics. Retrospective, interview-based studies lack this direct engagement, but focus on the recollections of fewer types of participants (particularly patients and physicians), and typically address specific issues (communication and

Medicinal mushroom science: Current perspectives, advances, evidences, and challenges

Directory of Open Access Journals (Sweden)

Solomon P Wasser

2014-12-01

Full Text Available The main target of the present review is to draw attention to the current perspectives, advances, evidences, challenges, and future development of medicinal mushroom science in the 21 st century. Medicinal mushrooms and fungi are thought to possess approximately 130 medicinal functions, including antitumor, immunomodulating, antioxidant, radical scavenging, cardiovascular, anti-hypercholesterolemic, antiviral, antibacterial, anti-parasitic, antifungal, detoxification, hepatoprotective, and antidiabetic effects. Many, if not all, higher Basidiomycetes mushrooms contain biologically active compounds in fruit bodies, cultured mycelium, and cultured broth. Special attention is paid to mushroom polysaccharides. The data on mushroom polysaccharides and different secondary metabolites are summarized for approximately 700 species of higher hetero- and homobasidiomycetes. Numerous bioactive polysaccharides or polysaccharide-protein complexes from the medicinal mushrooms described appear to enhance innate and cell-mediated immune responses, and exhibit antitumor activities in animals and humans. Whilst the mechanism of their antitumor actions is still not completely understood, stimulation and modulation of key host immune responses by these mushroom compounds appear central. Polysaccharides and low-molecular-weight secondary metabolites are particularly important due to their antitumor and immunostimulating properties. Several of the mushroom compounds have been subjected to Phase I, II, and III clinical trials, and are used extensively and successfully in Asia to treat various cancers and other diseases. Special attention is given to many important unsolved problems in the study of medicinal mushrooms.

Supporting Formulary Decisions: The Discovery of New Facts or Constructed Evidence?

Directory of Open Access Journals (Sweden)

Paul C Langley

2016-07-01

Full Text Available A critical question, given the growing importance of more targeted therapies to support personalized and precision medicine, is the credibility of the evidence base to support formulary decisions and pricing. On the one hand, for those who subscribe to the reference case model of the National Institute of Health and Care Excellence (NICE in the UK, the decision rests upon the creation of modeled or simulated imaginary worlds and the application of threshold willingness-to-pay cost-per-QALY thresholds. On the other hand, for those who subscribe to the standards of normal science, the decision rests upon the ability to evaluate competing claims, both clinical and cost-effective, in a timeframe that is meaningful to a formulary committee. If we subscribe to the scientific method where the focus is on the discovery of new facts, untestable claims for clinical benefit and cost-effectiveness, such as created claims for lifetime cost per-quality-adjusted discounted life years (QALYs, are properly relegated to the category of pseudoscience. We have no idea, and will never know, whether the claims are right or even if they are wrong. If formulary decisions are to respect the standards of normal science then there has to be a commitment to claims evaluation. A willingness to accept new products provisionally, subject to an agreed protocol to support the evaluation of clinical and cost-effectiveness claims. This dichotomy between the standards of normal science and pseudoscience is explored in the context of published claims for cost-effectiveness and recommendations for product pricing in the US.   Type: Commentary

Automated respiratory support in newborn infants.

Science.gov (United States)

Claure, Nelson; Bancalari, Eduardo

2009-02-01

A considerable proportion of premature infants requires mechanical ventilatory support and supplemental oxygen. Due to their immaturity, exposure to these forms of respiratory support contributes to the development of lung injury, oxidative stress and abnormal retinal development. These conditions are associated with poor long-term respiratory and neurological outcome. Mechanically ventilated preterm infants present with frequent fluctuations in ventilation and gas exchange. Currently available ventilatory modes and manual adjustment to the ventilator or supplemental oxygen cannot effectively adapt to these recurrent fluctuations. Moreover, the respiratory support often exceeds the infant's real needs. Techniques that adapt the mechanical ventilatory support and supplemental oxygen to the changing needs of preterm infants are being developed in order to improve stability of gas exchange, to minimise respiratory support and to reduce personnel workload. This article describes the preliminary evidence on the application of these new techniques in preterm infants and animal models.

A Review of Current Evidence of Olmesartan Medoxomil Mimicking Symptoms of Celiac Disease.

Science.gov (United States)

Sanford, Michele L; Nagel, Angela K

2015-04-01

Objective:To review the evidence of an association between olmesartan medoxomil and symptoms mimicking celiac disease.Data Sources:Literature was searched in PubMed (1965-November 2013) using the key words or MeSH terms olmesartan, enteropathy, celiac disease, sprue, and diarrhea. References from the Food and Drug Administration (FDA) and Dipiro's Pharmacotherapy eighth edition textbook were also reviewed.Data Synthesis:There have been recent implications of olmesartan medoxomil being linked to symptoms mimicking celiac disease. Investigators first identified the association in 22 patients who presented with presumed refractory celiac disease. Upon further evaluation, it was discovered that these symptoms improved when olmesartan was discontinued. In response to this report, additional case studies have been published. DeGaetani et al also further analyzed patients with seronegative villous atrophy from the Celiac Disease Center and found that olmesartan accounted for 22% of previously unclassified sprue cases. Conversely, the authors of the ROADMAP trial, which compared olmesartan to placebo, found no significant differences in the incidence of gastrointestinal adverse effects.Conclusions:There is growing evidence supporting the association between olmesartan and sprue-like symptoms; however, further research is warranted. These symptoms can be life threatening and clinicians should be aware of the potential association.

Evidence based guidelines and current practice for physiotherapy management of knee osteoarthritis.

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Walsh, Nicola E; Hurley, Michael V

2009-03-01

To document physiotherapy provision for patients with knee osteoarthritis (OA) in relation to the United Kingdom (UK) recently published National Institute of health and Clinical Excellence (NICE) guidelines for osteoarthritis. Questionnaire survey of chartered physiotherapists. 300 postal questionnaires were distributed to Physiotherapy Departments requesting information regarding source of referrals, treatment aims, preferred methods of treatment and service delivery. Responses were received from 83 physiotherapists (28 %), predominantly working in the UK National Health Service. Approximately equal numbers of referrals came from primary and secondary care. Aims of physiotherapy management were to; encourage self-management; increase strength and range of movement; reduce pain; and improve function. To achieve these, exercise was utilised by 100% of practitioners, often supplemented with electrotherapeutic modalities (66%), manual therapy (64%) and acupuncture (60%). The majority of patients received individual treatment for a total contact time of 1-2 hours, whilst most group interventions lasted 5-6 hours. Approximately half (54%) of respondents reported using outcome measures to determine treatment efficacy. Although knee OA is usually managed in primary care, the similar number of referrals from primary and secondary care may suggest a deviation from evidence-based management guidelines. The guidelines' recommendations of exercise, patient education and self-management are observed by physiotherapists, but other modalities are often used despite poor or no research evidence supporting their efficacy. Whether any of these interventions are clinically beneficial is speculative as treatment outcomes were frequently under-evaluated.

Developing and Evaluating Communication Strategies to Support Informed Decisions and Practice Based on Evidence (DECIDE): protocol and preliminary results.

Science.gov (United States)

Treweek, Shaun; Oxman, Andrew D; Alderson, Philip; Bossuyt, Patrick M; Brandt, Linn; Brożek, Jan; Davoli, Marina; Flottorp, Signe; Harbour, Robin; Hill, Suzanne; Liberati, Alessandro; Liira, Helena; Schünemann, Holger J; Rosenbaum, Sarah; Thornton, Judith; Vandvik, Per Olav; Alonso-Coello, Pablo

2013-01-09

Healthcare decision makers face challenges when using guidelines, including understanding the quality of the evidence or the values and preferences upon which recommendations are made, which are often not clear. GRADE is a systematic approach towards assessing the quality of evidence and the strength of recommendations in healthcare. GRADE also gives advice on how to go from evidence to decisions. It has been developed to address the weaknesses of other grading systems and is now widely used internationally. The Developing and Evaluating Communication Strategies to Support Informed Decisions and Practice Based on Evidence (DECIDE) consortium (http://www.decide-collaboration.eu/), which includes members of the GRADE Working Group and other partners, will explore methods to ensure effective communication of evidence-based recommendations targeted at key stakeholders: healthcare professionals, policymakers, and managers, as well as patients and the general public. Surveys and interviews with guideline producers and other stakeholders will explore how presentation of the evidence could be improved to better meet their information needs. We will collect further stakeholder input from advisory groups, via consultations and user testing; this will be done across a wide range of healthcare systems in Europe, North America, and other countries. Targeted communication strategies will be developed, evaluated in randomized trials, refined, and assessed during the development of real guidelines. Results of the DECIDE project will improve the communication of evidence-based healthcare recommendations. Building on the work of the GRADE Working Group, DECIDE will develop and evaluate methods that address communication needs of guideline users. The project will produce strategies for communicating recommendations that have been rigorously evaluated in diverse settings, and it will support the transfer of research into practice in healthcare systems globally.

Social support, volunteering and health around the world: cross-national evidence from 139 countries.

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Kumar, Santosh; Calvo, Rocio; Avendano, Mauricio; Sivaramakrishnan, Kavita; Berkman, Lisa F

2012-03-01

High levels of social capital and social integration are associated with self-rated health in many developed countries. However, it is not known whether this association extends to non-western and less economically advanced countries. We examine associations between social support, volunteering, and self-rated health in 139 low-, middle- and high-income countries. Data come from the Gallup World Poll, an internationally comparable survey conducted yearly from 2005 to 2009 for those 15 and over. Volunteering was measured by self-reports of volunteering to an organization in the past month. Social support was based on self-reports of access to support from relatives and friends. We started by estimating random coefficient (multi-level) models and then used multivariate logistic regression to model health as a function of social support and volunteering, controlling for age, gender, education, marital status, and religiosity. We found statistically significant evidence of cross-national variation in the association between social capital variables and self-rated health. In the multivariate logistic model, self-rated health were significantly associated with having social support from friends and relatives and volunteering. Results from stratified analyses indicate that these associations are strikingly consistent across countries. Our results indicate that the link between social capital and health is not restricted to high-income countries but extends across many geographical regions regardless of their national-income level. Copyright © 2012 Elsevier Ltd. All rights reserved.

Multiple Lines Of Evidence Supporting Natural Attenuation: Lines Of Inquiry Supporting Monitored Natural Attenuation And Enhanced Attenuatin Of Chlorinated Solvents

Energy Technology Data Exchange (ETDEWEB)

Vangelas, Karen; Widemeirer, T. H.; Barden, M.J.; Dickson, W. Z.; Major, David

2004-12-31

The Department of Energy (DOE) is sponsoring an initiative to facilitate efficient, effective and responsible use of Monitored Natural Attenuation (MNA) and Enhanced Attenuation (EA) for chlorinated solvents. This Office of Environmental Management (EM) ''Alternative Project,'' focuses on providing scientific and policy support for MNA/EA. A broadly representative working group of scientists supports the project along with partnerships with regulatory organizations such as the Interstate Technology Regulatory Council (ITRC) and the United States Environmental Protection Agency (USEPA). The initial product of the technical working group was a summary report that articulated the conceptual approach and central scientific tenants of the project, and that identified a prioritized listing of technical targets for field research. This report documented the process in which: (1) scientific ground rules were developed, (2) lines of inquiry were identified and then critically evaluated, (3) promising applied research topics were highlighted in the various lines of inquiry, and (4) these were discussed and prioritized. The summary report will serve as a resource to guide management and decision making throughout the period of the subject MNA/EA Alternative Project. To support and more fully document the information presented in the summary report, the DOE is publishing a series of supplemental documents that present the full texts from the technical analyses within the various lines of inquiry (see listing). The following report--documenting our evaluation of the state of the science for the lines of evidence for supporting decision-making for MNA--is one of those supplemental documents.

Positive and negative social support and HPA-axis hyperactivity: Evidence from glucocorticoids in human hair.

Science.gov (United States)

Iob, Eleonora; Kirschbaum, Clemens; Steptoe, Andrew

2018-06-12

While positive social support is associated with lower prevalence of disease and better treatment outcomes, negative social relationships can instead have unfavourable consequences for several physical and mental health conditions. However, the specific mechanisms by which this nexus might operate remain poorly understood. Hypothalamic-pituitary-adrenal (HPA) axis hyperactivity owing to psychosocial stress has been proposed as a potential pathway underlying the link between social support and health. Hair glucocorticoids such as cortisol and cortisone are emerging as promising biomarkers of long-term retrospective HPA activation. Therefore, the aim of this investigation was to examine the effects of positive and negative experiences of social support within key relationships (i.e. spouse/partner, children, other family members, and friends) on cortisol and cortisone. These associations were tested in a sample of 2520 older adults (mean age 68.1) from the English Longitudinal Study of Ageing. Hair samples were collected in wave 6 (2012/13). To understand the impact of cumulative exposure to poor social support, the analysis used self-reported data from waves 4 (2008/09) and 6. Covariates included demographic, socioeconomic, lifestyle, and hair characteristics. In cross sectional analyses, lower positive support from all sources and specifically from children were associated with higher cortisol. Additionally, lower positive support from children was positively associated with cortisone. Similarly, higher overall negative support was related to higher cortisol, and greater negative support from children was also positively associated with cortisone. In longitudinal analyses, there was evidence for positive associations between hair glucocorticoids and cumulative exposure to poorer social support. Experiences of low positive and high negative social support, particularly from children, were both related to higher hair glucocorticoids. Hence, social relationships of

Evidence Supporting Broader Access To Safe Legal Abortion

OpenAIRE

Faundes; Anibal; Shah; Iqbal H.

2016-01-01

Unsafe abortion continues to be a major cause of maternal death; it accounts for 14.5% of all maternal deaths globally and almost all of these deaths occur in countries with restrictive abortion laws. A strong body of accumulated evidence shows that the simple means to drastically reduce unsafe abortion-related maternal deaths and morbidity is to make abortion legal and institutional termination of pregnancy broadly accessible. Despite this evidence, abortion is denied even when the legal con...

Revisiting Antipsychotic-induced Akathisia: Current Issues and Prospective Challenges

Science.gov (United States)

Salem, Haitham; Nagpal, Caesa; Pigott, Teresa; Teixeira, Antonio Lucio

2017-01-01

Background: Akathisia continues to be a significant challenge in current neurological and psychiatric practice. Prompt and accurate detection is often difficult and there is a lack of consensus concerning the neurobiological basis of akathisia. No definitive treatment has been established for akathisia despite numerous preclinical and clinical studies. Method: We reviewed antipsychotic-induced akathisia including its clinical presentation, proposed underlying pathophysiology, current and under investigation therapeutic strategies. Conclusion: Despite the initial promise that second generation antipsychotics would be devoid of akathisia effects, this has not been confirmed. Currently, there are limited therapeutic options for the clinical practice and the evidence supporting the most widely used treatments (beta blockers, anticholinergic drugs) is still absent or inconsistent. PMID:27928948

Deficiencies in the transfer and availability of clinical trials evidence: a review of existing systems and standards

Directory of Open Access Journals (Sweden)

Valkenhoef Gert

2012-09-01

Full Text Available Abstract Background Decisions concerning drug safety and efficacy are generally based on pivotal evidence provided by clinical trials. Unfortunately, finding the relevant clinical trials is difficult and their results are only available in text-based reports. Systematic reviews aim to provide a comprehensive overview of the evidence in a specific area, but may not provide the data required for decision making. Methods We review and analyze the existing information systems and standards for aggregate level clinical trials information from the perspective of systematic review and evidence-based decision making. Results The technology currently used has major shortcomings, which cause deficiencies in the transfer, traceability and availability of clinical trials information. Specifically, data available to decision makers is insufficiently structured, and consequently the decisions cannot be properly traced back to the underlying evidence. Regulatory submission, trial publication, trial registration, and systematic review produce unstructured datasets that are insufficient for supporting evidence-based decision making. Conclusions The current situation is a hindrance to policy decision makers as it prevents fully transparent decision making and the development of more advanced decision support systems. Addressing the identified deficiencies would enable more efficient, informed, and transparent evidence-based medical decision making.

Current Account Adjustment: Some New Theory and Evidence

OpenAIRE

Jiandong Ju; Shang-Jin Wei

2007-01-01

This paper aims to provide a theory of current account adjustment that generalizes the textbook version of the intertemporal approach to current account and places domestic labor market institutions at the center stage. In general, in response to a shock, an economy adjusts through a combination of a change in the composition of goods trade (i.e., intra-temporal trade channel) and a change in the current account (i.e., intertemporal trade channel). The more rigid the labor market, the slower ...

How Quality Improvement Practice Evidence Can Advance the Knowledge Base.

Science.gov (United States)

OʼRourke, Hannah M; Fraser, Kimberly D

2016-01-01

Recommendations for the evaluation of quality improvement interventions have been made in order to improve the evidence base of whether, to what extent, and why quality improvement interventions affect chosen outcomes. The purpose of this article is to articulate why these recommendations are appropriate to improve the rigor of quality improvement intervention evaluation as a research endeavor, but inappropriate for the purposes of everyday quality improvement practice. To support our claim, we describe the differences between quality improvement interventions that occur for the purpose of practice as compared to research. We then carefully consider how feasibility, ethics, and the aims of evaluation each impact how quality improvement interventions that occur in practice, as opposed to research, can or should be evaluated. Recommendations that fit the evaluative goals of practice-based quality improvement interventions are needed to support fair appraisal of the distinct evidence they produce. We describe a current debate on the nature of evidence to assist in reenvisioning how quality improvement evidence generated from practice might complement that generated from research, and contribute in a value-added way to the knowledge base.

Extracorporeal membrane oxygenation: current clinical practice, coding, and reimbursement.

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Schuerer, Douglas J E; Kolovos, Nikoleta S; Boyd, Kayla V; Coopersmith, Craig M

2008-07-01

Extracorporeal membrane oxygenation (ECMO) is a technique for providing life support for patients experiencing both pulmonary and cardiac failure by maintaining oxygenation and perfusion until native organ function is restored. ECMO is used routinely at many specialized hospitals for infants and less commonly for children with respiratory or cardiac failure from a variety of causes. Its usage is more controversial in adults, but select medical centers have reported favorable findings in patients with ARDS and other causes of severe pulmonary failure. ECMO is also rarely used as a rescue therapy in a small subset of adult patients with cardiac failure. This article will review the current uses and techniques of ECMO in the critical care setting as well as the evidence supporting its usage. In addition, current practice management related to coding and reimbursement for this intensive therapy will be discussed.

Historic evidence to support a causal relationship between spirochetal infections and Alzheimer’s disease

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Judith eMiklossy

2015-04-01

Full Text Available Following previous observations a statistically significant association between various types of spirochetes and Alzheimer’s disease (AD fulfilled Hill’s criteria in favor of a causal relationship. If spirochetal infections can indeed cause AD, the pathological and biological hallmarks of AD should also occur in syphilitic dementia. To answer this question, observations and illustrations on the detection of spirochetes in the atrophic form of general paresis, which is known to be associated with slowly progressive dementia, were reviewed and compared with the characteristic pathology of AD. Historic observations and illustrations published in the first half of the 20th Century indeed confirm that the pathological hallmarks, which define AD, are also present in syphilitic dementia. Cortical spirochetal colonies are made up by innumerable tightly spiraled Treponema pallidum spirochetes, which are morphologically indistinguishable from senile plaques, using conventional light microscopy. Local brain amyloidosis also occurs in general paresis and, as in AD, corresponds to amyloid beta. These historic observations enable us to conclude that chronic spirochetal infections can cause dementia and reproduce the defining hallmarks of AD. They represent further evidence in support a causal relationship between various spirochetal infections and AD. They also indicate that local invasion of the brain by these helically shaped bacteria reproduce the filamentous pathology characteristic of AD. Chronic infection by spirochetes, and co-infection with other bacteria and viruses should be included in our current view on the etiology of AD. Prompt action is needed as AD might be prevented.

Peer-supported review of teaching: making the grade in midwifery and nursing education.

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Murphy Tighe, Sylvia; Bradshaw, Carmel

2013-11-01

This paper outlines the value of peer-supported review of teaching for nurse and midwifery educators in an academic environment. Reflection and continuing professional development are important tenets of an educators' practice and can be addressed via peer observation. Definitions and models of peer observation are presented. The strengths and challenges associated with peer-supported review of teaching are discussed. The reasons why peer observation is underutilised are explored with some suggestions on how to overcome these challenges. Recent developments in relation to peer observation and peer-supported review are outlined. The need for tangible evidence of development and enhancement of existing teaching expertise is very pronounced in the current economic climate, it is concluded that peer-supported review of teaching can provide such evidence. Copyright © 2012 Elsevier Ltd. All rights reserved.

Emerging Evidence for Instructional Practice: Repeated Viewings of Sign Language Models

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Beal-Alvarez, Jennifer S.; Huston, Sandra G.

2014-01-01

Current initiatives in education, such as No Child Left Behind and the National Common Core Standards movement, call for the use of evidence-based practices, or those instructional practices that are supported by documentation of their effectiveness related to student learning outcomes, including students with special needs. While hearing loss is…

Evidence supporting broader access to safe legal abortion.

Science.gov (United States)

Faúndes, Anibal; Shah, Iqbal H

2015-10-01

Unsafe abortion continues to be a major cause of maternal death; it accounts for 14.5% of all maternal deaths globally and almost all of these deaths occur in countries with restrictive abortion laws. A strong body of accumulated evidence shows that the simple means to drastically reduce unsafe abortion-related maternal deaths and morbidity is to make abortion legal and institutional termination of pregnancy broadly accessible. Despite this evidence, abortion is denied even when the legal condition for abortion is met. The present article aims to contribute to a better understanding that one can be in favor of greater access to safe abortion services, while at the same time not be "in favor of abortion," by reviewing the evidence that indicates that criminalization of abortion only increases mortality and morbidity without decreasing the incidence of induced abortion, and that decriminalization rapidly reduces abortion-related mortality and does not increase abortion rates. Copyright © 2015. Published by Elsevier Ireland Ltd.

Inhibiting PKM[zeta] Reveals Dorsal Lateral and Dorsal Medial Striatum Store the Different Memories Needed to Support Adaptive Behavior

Science.gov (United States)

Pauli, Wolfgang M.; Clark, Alexandra D.; Guenther, Heidi J.; O'Reilly, Randall C.; Rudy, Jerry W.

2012-01-01

Evidence suggests that two regions of the striatum contribute differential support to instrumental response selection. The dorsomedial striatum (DMS) is thought to support expectancy-mediated actions, and the dorsolateral striatum (DLS) is thought to support habits. Currently it is unclear whether these regions store task-relevant information or…

Infant Nutrition and Later Health: A Review of Current Evidence

Directory of Open Access Journals (Sweden)

Caroline Fall

2012-07-01

Full Text Available There is a growing recognition of the need for a lifecourse approach to understanding the aetiology of adult disease, and there is now significant evidence that links patterns of infant feeding to differences in health outcomes, both in the short and longer term. Breastfeeding is associated with lower rates of infection in infancy; in high-income populations, it is associated with reductions in blood pressure and total blood cholesterol, and lower risks of obesity and diabetes in adult life. Breastfeeding rates are suboptimal in many countries, and strategies to promote breastfeeding could therefore confer important benefits for health at a population level. However, there are particular challenges in defining nutritional exposures in infancy, including marked social gradients in initiation and duration of breastfeeding. In recent studies of low and middle-income populations of children and young adults, where the influences on infant feeding practice differ, beneficial effects of breastfeeding on blood pressure, BMI and risk of diabetes have not been confirmed, and further information is needed. Little is currently known about the long-term consequences of differences in the timing and nature of the weaning diet. Future progress will depend on new studies that provide detailed prospective data on duration and exclusivity of breastfeeding together with appropriate characterisation of the weaning diet.

Treatment of Graves' hyperthyroidism: evidence-based and emerging modalities

DEFF Research Database (Denmark)

Hegedüs, Laszlo

2009-01-01

Currently there are three well-established treatment options for hyperthyroid Graves' disease (GD): antithyroid drug therapy with thionamides (ATD), radioactive iodine treatment with (131)I, and thyroid surgery. This article reviews the current evidence so the reader can evaluate advantages...... and disadvantages of these treatment modalities. Surgery is rarely used, except for patients who have a large goiter or ophthalmopathy. Fewer than 50% of patients treated with ATD remain in long-term remission. Therefore, radioactive iodine is used increasingly. No data as yet support the routine use of biologic...

Evaluation of Organizational Readiness in Clinical Settings for Social Supporting Evidence-Based Information Seeking Behavior after Introducing IT in a Developing Country.

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Kahouei, Mehdi; Alaei, Safollah; Panahi, Sohaila Sadat Ghazavi Shariat; Zadeh, Jamileh Mahdi

2015-01-01

The health sector of Iran has endeavored to encourage physicians and medical students to use research findings in their practice. Remarkable changes have occurred, including: holding computer skills courses, digital library workshops for physicians and students, and establishing websites in hospitals. The findings showed that a small number of the participants completely agreed that they were supported by supervisors and colleagues to use evidence-based information resources in their clinical decisions. Health care organizations in Iran need other organizational facilitators such as social influences, organizational support, leadership, strong organizational culture, and climate in order to implement evidence-based practice.

A review of the evidence supporting the aesthetic orthodontic treatment need indices.

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Borzabadi-Farahani, Ali

2012-11-01

Aesthetic improvement and psychological enhancement have been cited as justifications for orthodontic treatment. This paper reviews the evidence that relates malocclusion to psychological health and quality of life and explores whether this evidence supports the most commonly used aesthetic Orthodontic Treatment Need Indices (OTNI). The relevant cited material from the MEDLINE, Web of Science, Scopus, Cochrane databases, and scientific textbooks were used. The citation rate was confirmed by using the Google Scholar. The subjective nature of aesthetic indices and the variable perception of attractiveness between clinicians and patients, and among various cultures or countries are a few limitations of aesthetic OTNI. The available evidence of mainly cross-sectional studies on the link between malocclusion and either psychosocial well-being or quality of life is not conclusive, and sometimes contradictory, to suggest these characteristics are affected by malocclusions. Further, the long-term longitudinal studies did not suggest that people with malocclusion are disadvantaged psychologically, or their quality of life would be worse off, which challenges using aesthetic OTNI to assess the social and psychological implications of malocclusion. The subjective nature of aesthetic OTNI and the minor contributory role of malocclusion in psychosocial health or quality of life undermine using aesthetic indices to assess the likely social and psychological implications of malocclusion. Consequently, using aesthetic OTNI, as a method to quantify malocclusion remains open to debate. Various soft and hard-tissue analyses are used before formulating a treatment plan (i.e., assessment of sagittal and vertical skeletal relationships). The addition of a shortened version of these analyses to the aesthetic OTNI can be a good substitute for the aesthetic components of OTNI, if an assessment of the aesthetic aspects of malocclusion is intended. This reduces subjectivity and improves the

Evidence for parity nonconservation in the weak neutral current

International Nuclear Information System (INIS)

Benvenuti, A.; Cline, D.; Messing, F.; Ford, W.; Imlay, R.; Ling, T.Y.; Mann, A.K.; Reeder, D.D.; Rubbia, C.; Stefanski, R.; Sulak, L.; Wanderer, P.

1976-01-01

Measurements of R/sup nu/ and R/sup nu-bar/, the ratios of neutral current to charged current ν and nu-bar cross sections, yield neutral current rates for ν and nu-bar that are consistent with a pure V-A interaction but 3 standard deviations from pure V or pure A, indicating the presence of parity nonconservation in the weak neutral current

Evidence of leopard predation on bonobos (Pan paniscus).

Science.gov (United States)

D'Amour, Danielle E; Hohmann, Gottfried; Fruth, Barbara

2006-01-01

Current models of social organization assume that predation is one of the major forces that promotes group living in diurnal primates. As large body size renders some protection against predators, gregariousness of great apes and other large primate species is usually related to other parameters. The low frequency of observed cases of nonhuman predation on great apes seems to support this assumption. However, recent efforts to study potential predator species have increasingly accumulated direct and indirect evidence of predation by leopards (Panthera pardus) on chimpanzees and gorillas. The following report provides the first evidence of predation by a leopard on bonobos (Pan paniscus). Copyright 2006 S. Karger AG, Basel.

The role of massage in sports performance and rehabilitation: current evidence and future direction.

Science.gov (United States)

Brummitt, Jason

2008-02-01

Massage is a popular treatment choice of athletes, coaches, and sports physical therapists. Despite its purported benefits and frequent use, evidence demonstrating its efficacy is scarce. To identify current literature relating to sports massage and its role in effecting an athlete's psychological readiness, in enhancing sports performance, in recovery from exercise and competition, and in the treatment of sports related musculoskeletal injuries. Electronic databases were used to identify papers relevant to this review. The following keywords were searched: massage, sports injuries, athletic injuries, physical therapy, rehabilitation, delayed onset muscle soreness, sports psychology, sports performance, sports massage, sports recovery, soft tissue mobilization, deep transverse friction massage, pre-event, and post exercise. RESEARCH STUDIES PERTAINING TO THE FOLLOWING GENERAL CATEGORIES WERE IDENTIFIED AND REVIEWED: pre-event (physiological and psychological variables), sports performance, recovery, and rehabilitation. Despite the fact clinical research has been performed, a poor appreciation exists for the appropriate clinical use of sports massage. Additional studies examining the physiological and psychological effects of sports massage are necessary in order to assist the sports physical therapist in developing and implementing clinically significant evidence based programs or treatments.

Environmental chemicals and DNA methylation in adults: a systematic review of the epidemiologic evidence

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Current evidence supports the notion that environmental exposures are associated with DNA-methylation and expression changes that can impact human health. Our objective was to conduct a systematic review of epidemiologic studies evaluating the association between environmental chemicals with DNA met...

Factor analysis methods and validity evidence: A systematic review of instrument development across the continuum of medical education

Science.gov (United States)

Wetzel, Angela Payne

Previous systematic reviews indicate a lack of reporting of reliability and validity evidence in subsets of the medical education literature. Psychology and general education reviews of factor analysis also indicate gaps between current and best practices; yet, a comprehensive review of exploratory factor analysis in instrument development across the continuum of medical education had not been previously identified. Therefore, the purpose for this study was critical review of instrument development articles employing exploratory factor or principal component analysis published in medical education (2006--2010) to describe and assess the reporting of methods and validity evidence based on the Standards for Educational and Psychological Testing and factor analysis best practices. Data extraction of 64 articles measuring a variety of constructs that have been published throughout the peer-reviewed medical education literature indicate significant errors in the translation of exploratory factor analysis best practices to current practice. Further, techniques for establishing validity evidence tend to derive from a limited scope of methods including reliability statistics to support internal structure and support for test content. Instruments reviewed for this study lacked supporting evidence based on relationships with other variables and response process, and evidence based on consequences of testing was not evident. Findings suggest a need for further professional development within the medical education researcher community related to (1) appropriate factor analysis methodology and reporting and (2) the importance of pursuing multiple sources of reliability and validity evidence to construct a well-supported argument for the inferences made from the instrument. Medical education researchers and educators should be cautious in adopting instruments from the literature and carefully review available evidence. Finally, editors and reviewers are encouraged to recognize

How good are we at implementing evidence to support the management of birth related perineal trauma? A UK wide survey of midwifery practice

Science.gov (United States)

2012-01-01

Background The accurate assessment and appropriate repair of birth related perineal trauma require high levels of skill and competency, with evidence based guideline recommendations available to inform UK midwifery practice. Implementation of guideline recommendations could reduce maternal morbidity associated with perineal trauma, which is commonly reported and persistent, with potential to deter women from a future vaginal birth. Despite evidence, limited attention is paid to this important aspect of midwifery practice. We wished to identify how midwives in the UK assessed and repaired perineal trauma and the extent to which practice reflected evidence based guidance. Findings would be used to inform the content of a large intervention study. Methods A descriptive cross sectional study was completed. One thousand randomly selected midwives were accessed via the Royal College of Midwives (RCM) and sent a questionnaire. Study inclusion criteria included that the midwives were in clinical practice and undertook perineal assessment and management within their current role. Quantitative and qualitative data were collated. Associations between midwife characteristics and implementation of evidence based recommendations for perineal assessment and management were examined using chi-square tests of association. Results 405 midwives (40.5%) returned a questionnaire, 338 (83.5%) of whom met inclusion criteria. The majority worked in a consultant led unit (235, 69.5%) and over a third had been qualified for 20 years or longer (129, 38.2%). Compliance with evidence was poor. Few (6%) midwives used evidence based suturing methods to repair all layers of perineal trauma and only 58 (17.3%) performed rectal examination as part of routine perineal trauma assessment. Over half (192, 58.0%) did not suture all second degree tears. Feeling confident to assess perineal trauma all of the time was only reported by 116 (34.3%) midwives, with even fewer (73, 21.6%) feeling confident to

Evidence for The Domains Supporting The Construct of Intrinsic Capacity.

Science.gov (United States)

Cesari, Matteo; Araujo de Carvalho, Islene; Amuthavalli Thiyagarajan, Jotheeswaran; Cooper, Cyrus; Martin, Finbarr C; Reginster, Jean-Yves; Vellas, Bruno; Beard, John R

2018-02-02

Healthy ageing can be defined as "the process of developing and maintaining the functional ability that enables wellbeing in older age". Functional ability (i.e., the health-related attributes that enable people to be and to do what they have reason to value) is determined by intrinsic capacity (i.e., the composite of all the physical and mental capacities of an individual), the environment (i.e., all the factors in the extrinsic world that form the context of an individual's life), and the interactions between the two. This innovative model recently proposed by the World Health Organization has the potential to substantially modify the way in which clinical practice is currently conducted, shifting from disease-centered towards function-centered paradigms. By overcoming the multiple limitations affecting the construct of disease, this novel framework may allow the worldwide dissemination of a more proactive and function-based approach towards achieving optimal health status.In order to facilitate the translation of the current theoretical model into practice, it is important to identify the inner nature of its constituting constructs. In this paper, we consider intrinsic capacity. Using the International Classification of Functioning, Disability and Health (ICF) framework as background and taking into account available evidence, five domains (i.e., locomotion, vitality, cognition, psychological, sensory) are identified as pivotal for capturing the individual's intrinsic capacity (and therefore also reserves) and, through this, pave the way for its objective measurement. © The Author(s) 2018. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Environmental stressors and cardio-metabolic disease: part I-epidemiologic evidence supporting a role for noise and air pollution and effects of mitigation strategies.

Science.gov (United States)

Münzel, Thomas; Sørensen, Mette; Gori, Tommaso; Schmidt, Frank P; Rao, Xiaoquan; Brook, Jeffrey; Chen, Lung Chi; Brook, Robert D; Rajagopalan, Sanjay

2017-02-21

Traffic noise and air pollution together represent the two most important environmental risk factors in urbanized societies. The first of this two-part review discusses the epidemiologic evidence in support of the existence of an association between these risk factors with cardiovascular and metabolic disease. While independent effects of these risk factors have now clearly been shown, recent studies also suggest that the two exposures may interact with each other and with traditional risk factors such as hypertension and type 2 diabetes. From a societal and policy perspective, the health effects of both air pollution and traffic noise are observed for exposures well below the thresholds currently accepted as being safe. Current gaps in knowledge, effects of intervention and their impact on cardiovascular disease, will be discussed in the last section of this review. Increased awareness of the societal burden posed by these novel risk factors and acknowledgement in traditional risk factor guidelines may intensify the efforts required for effective legislation to reduce air pollution and noise. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2017. For permissions please email: journals.permissions@oup.com.

Nutrition support in hospitals

DEFF Research Database (Denmark)

Kondrup, Jens

2005-01-01

Nutrition support in hospitals is becoming an area of focus because of the evidence showing improved clinical outcome with nutrition support, its status as a human rights issue and its integration into quality assurance.......Nutrition support in hospitals is becoming an area of focus because of the evidence showing improved clinical outcome with nutrition support, its status as a human rights issue and its integration into quality assurance....

Relationship between Added Sugars Consumption and Chronic Disease Risk Factors: Current Understanding.

Science.gov (United States)

Rippe, James M; Angelopoulos, Theodore J

2016-11-04

Added sugars are a controversial and hotly debated topic. Consumption of added sugars has been implicated in increased risk of a variety of chronic diseases including obesity, cardiovascular disease, diabetes and non-alcoholic fatty liver disease (NAFLD) as well as cognitive decline and even some cancers. Support for these putative associations has been challenged, however, on a variety of fronts. The purpose of the current review is to summarize high impact evidence including systematic reviews, meta-analyses, and randomized controlled trials (RCTs), in an attempt to provide an overview of current evidence related to added sugars and health considerations. This paper is an extension of a symposium held at the Experimental Biology 2015 conference entitled "Sweeteners and Health: Current Understandings, Controversies, Recent Research Findings and Directions for Future Research". We conclude based on high quality evidence from randomized controlled trials (RCT), systematic reviews and meta-analyses of cohort studies that singling out added sugars as unique culprits for metabolically based diseases such as obesity, diabetes and cardiovascular disease appears inconsistent with modern, high quality evidence and is very unlikely to yield health benefits. While it is prudent to consume added sugars in moderation, the reduction of these components of the diet without other reductions of caloric sources seems unlikely to achieve any meaningful benefit.

An online community of practice to support evidence-based physiotherapy practice in manual therapy.

Science.gov (United States)

Evans, Cathy; Yeung, Euson; Markoulakis, Roula; Guilcher, Sara

2014-01-01

The purpose of this study was to explore how a community of practice promoted the creation and sharing of new knowledge in evidence-based manual therapy using Wenger's constructs of mutual engagement, joint enterprise, and shared repertoire as a theoretical framework. We used a qualitative approach to analyze the discussion board contributions of the 19 physiotherapists who participated in the 10-week online continuing education course in evidence-based practice (EBP) in manual therapy. The course was founded on community of practice, constructivism, social, and situated learning principles. The 1436 postings on 9 active discussion boards revealed that the community of practice was a social learning environment that supported strong participation and mutual engagement. Design features such as consistent facilitation, weekly guiding questions, and collaborative assignments promoted the creation and sharing of knowledge. Participants applied research evidence to the contexts in which they worked through reflective comparison of what they were reading to its applicability in their everyday practice. Participants' shared goals contributed to the common ground established in developing collective knowledge about different study designs, how to answer research questions, and the difficulties of conducting sound research. An online longitudinal community of practice utilized as a continuing education approach to deliver an online course based on constructivist and social learning principles allowed geographically dispersed physiotherapists to be mutually engaged in a joint enterprise in evidence-based manual therapy. Advantages included opportunity for reflection, modeling, and collaboration. Future studies should examine the impact of participation on clinical practice. © 2014 The Alliance for Continuing Education in the Health Professions, the Society for Academic Continuing Medical Education, and the Council on Continuing Medical Education, Association for Hospital

The current place of probiotics and prebiotics in the treatment of pouchitis.

Science.gov (United States)

Lichtenstein, Lev; Avni-Biron, Irit; Ben-Bassat, Ofer

2016-02-01

Pouchitis is a common complication in patients undergoing restorative proctocolectomy for ulcerative colitis. Therapeutic attempts include manipulations of pouch flora composition. In this review, we bring together the evidence supporting the use of probiotics and prebiotics in pouchitis patients, to clarify the place of these treatments in current therapeutic regimens. Copyright © 2016 Elsevier Ltd. All rights reserved.

Current evidence on dietary pattern and cognitive function.

Science.gov (United States)

Cheung, Bernice H K; Ho, Ivan C H; Chan, Ruth S M; Sea, Mandy M M; Woo, Jean

2014-01-01

With global aging population, age-related cognitive decline becomes epidemic. Lifestyle-related factor is one of the key preventative measures. Dietary pattern analysis which considers dietary complexity has recently used to examine the linkage between nutrition and cognitive function. A priori approach defines dietary pattern based on existing knowledge. Results of several dietary pattern scores were summarized. The heterogeneity of assessment methods and outcome measurements lead to inconsistent results. Posteriori approach derives a dietary pattern independently of the existing nutrition-disease knowledge. It showed a dietary pattern abundant with plant-based food, oily fish, lower consumption of processed food, saturated fat, and simple sugar which appears to be beneficial to cognitive health. Despite inconclusive evidence from both approaches, diet and exercise, beneficial for other diseases, remains to be the two key modifiable factors for cognitive function. Large-scale prospective studies in multiethics population are required to provide stronger evidence in the future. © 2014 Elsevier Inc. All rights reserved.

Risk Aversion and Support for Merit Pay: Theory and Evidence from Minnesota's Q Comp Program

Science.gov (United States)

Nadler, Carl; Wiswall, Matthew

2011-01-01

Recent research attributes the lack of merit pay in teaching to the resistance of teachers. This article examines whether the structure of merit pay affects the types of teachers who support it. We develop a model of the relative utility teachers receive from merit pay versus the current fixed schedule of raises. We show that if teachers are risk…

Support and Against Historical Cost Accounting: Is it Value Relevance for Decision Making?

Directory of Open Access Journals (Sweden)

Evi Rahmawati

2016-01-01

Full Text Available This paper reviews the issues on the support and criticism of historical cost accounting (HCA and the incremental information content on current cost disclosures. Based on literature review this study find that historical cost is still relevant to use in decision making. Empirical studies show evidence both; supporting historical cost accounting and criticisms against the conventional historical cost based financial statements. Issues on historical cost are raised because of  economic condition, inflation, the change in high tech environment, price movements, and regulators statements. Studies shows that historical cost accounting. over the decade: still have power explanatory for investors, which indicates that its benefits outweigh its cost. However, Barth et al. (1996 provide strong evidence on incremental information of current cost disclosures for certain assets and liabilities. This paper concludes that even there are weaknesses (against HCA, still there are more benefits that we can gain through HCA.

Promoting Undergraduate Surgical Education: Current Evidence and Students' Views on ESMSC International Wet Lab Course.

Science.gov (United States)

Sideris, Michail; Papalois, Apostolos; Theodoraki, Korina; Dimitropoulos, Ioannis; Johnson, Elizabeth O; Georgopoulou, Efstratia-Maria; Staikoglou, Nikolaos; Paparoidamis, Georgios; Pantelidis, Panteleimon; Tsagkaraki, Ismini; Karamaroudis, Stefanos; Potoupnis, Michael E; Tsiridis, Eleftherios; Dedeilias, Panagiotis; Papagrigoriadis, Savvas; Papalois, Vassilios; Zografos, Georgios; Triantafyllou, Aggeliki; Tsoulfas, Georgios

2017-04-01

Undergraduate Surgical Education is becoming an essential element in the training of the future generation of safe and efficient surgeons. Essential Skills in the Management of Surgical Cases (ESMSC), is an international, joint applied surgical science and simulation-based learning wet lab course. We performed a review of the existing literature on the topic of undergraduate surgical education. Following that, we analyzed the feedback questionnaire received 480 from 2 recent series of ESMSC courses (May 2015, n = 49 and November 2015, n = 40), in order to evaluate European Union students' (UK, Germany, Greece) views on the ESMSC course, as well as on the undergraduate surgical education. Results Using a 10 point graded scale, the overall ESMSC concept was positively evaluated, with a mean score of 9.41 ± 0.72 (range: 8-10) and 8.94 ± 1.1 (range: 7-10). The majority of delegates from both series [9.86 ± 0.43 (range: 8-10) and 9.58 ± 0.91 (range: 6-10), respectively] believed that ESMSC should be incorporated in the undergraduate surgical curriculum. Comparison of responses from the UK to the Greek Medical Student, as well as the findings from the third and fourth year versus the fifth and sixth year Medical Students, revealed no statistically significant differences pertaining to any of the questions (p > 0.05). Current evidence in the literature supports the enhancement of surgical education through the systematic use of various modalities that provide Simulation-Based Training (SBT) hands-on experience, starting from the early undergraduate level. The findings of the present study are in agreement with these previous reports.

The role of chronic pain and current substance use in predicting negative social support among disadvantaged persons living with HIV/AIDS.

Science.gov (United States)

Mitchell, Mary M; Maragh-Bass, Allysha C; Nguyen, Trang Q; Isenberg, Sarina; Knowlton, Amy R

2016-10-01

Chronic pain and substance use can strain the supportive relationships of persons with serious chronic illness, which may increase the likelihood of receiving negative, rather than positive, social support from informal caregivers and social network members. To our knowledge, this is the first study to longitudinally examine the effects of chronic pain and substance use on negative social support. The sample (N = 383) comprised disadvantaged, primarily African-American, persons living with HIV/AIDS with a history of injection drug use, 32.4% of whom reported frequent or constant pain in the prior 6 months. Using factor analysis and structural equation modeling, current substance use and greater levels of chronic pain positively predicted negative social support 12 months later, after controlling for baseline negative support, viral load, age and sex. We also found a significant interaction effect such that among those not using substances, there was a significant positive association between pain and negative support, but no such association among those currently using substances. The findings emphasize the importance of treatment of chronic pain and substance use in the supportive functioning of social networks of a disadvantaged population with serious chronic conditions and persistent health disparities.

Implementing an evidence-based computerized decision support system to improve patient care in a general hospital: the CODES study protocol for a randomized controlled trial.

Science.gov (United States)

Moja, Lorenzo; Polo Friz, Hernan; Capobussi, Matteo; Kwag, Koren; Banzi, Rita; Ruggiero, Francesca; González-Lorenzo, Marien; Liberati, Elisa Giulia; Mangia, Massimo; Nyberg, Peter; Kunnamo, Ilkka; Cimminiello, Claudio; Vighi, Giuseppe; Grimshaw, Jeremy; Bonovas, Stefanos

2016-07-07

Computerized decision support systems (CDSSs) are information technology-based software that provide health professionals with actionable, patient-specific recommendations or guidelines for disease diagnosis, treatment, and management at the point-of-care. These messages are intelligently filtered to enhance the health and clinical care of patients. CDSSs may be integrated with patient electronic health records (EHRs) and evidence-based knowledge. We designed a pragmatic randomized controlled trial to evaluate the effectiveness of patient-specific, evidence-based reminders generated at the point-of-care by a multi-specialty decision support system on clinical practice and the quality of care. We will include all the patients admitted to the internal medicine department of one large general hospital. The primary outcome is the rate at which medical problems, which are detected by the decision support software and reported through the reminders, are resolved (i.e., resolution rates). Secondary outcomes are resolution rates for reminders specific to venous thromboembolism (VTE) prevention, in-hospital all causes and VTE-related mortality, and the length of hospital stay during the study period. The adoption of CDSSs is likely to increase across healthcare systems due to growing concerns about the quality of medical care and discrepancy between real and ideal practice, continuous demands for a meaningful use of health information technology, and the increasing use of and familiarity with advanced technology among new generations of physicians. The results of our study will contribute to the current understanding of the effectiveness of CDSSs in primary care and hospital settings, thereby informing future research and healthcare policy questions related to the feasibility and value of CDSS use in healthcare systems. This trial is seconded by a specialty trial randomizing patients in an oncology setting (ONCO-CODES). ClinicalTrials.gov, https://clinicaltrials.gov/ct2

Adjuvant chemotherapy for gastric cancer: Current evidence and future challenges

Science.gov (United States)

Miceli, Rosalba; Tomasello, Gianluca; Bregni, Giacomo; Di Bartolomeo, Maria; Pietrantonio, Filippo

2014-01-01

Gastric cancer still represents one of the major causes of cancer mortality worldwide. Patients survival is mainly related to stage, with a high proportion of patients with metastatic disease at presentation. Thus, the cure rate largely depend upon surgical resection. Despite the additional, albeit small, benefit of adjuvant chemotherapy has been clearly demonstrated, no general consensus has been reached on the best treatment option. Moreover, the narrow therapeutic index of adjuvant chemotherapy (i.e., limited survival benefit with considerable toxicity) requires a careful assessment of expected risks and benefits for individual patients. Treatment choices vary widely based on the different geographic areas, with chemotherapy alone more often preferred in Europe or Asia and chemoradiotherapy in the United States. In the present review we discuss the current evidence and future challenges regarding adjuvant chemotherapy in curatively resected gastric cancer with particular emphasis on the recently completed landmark studies and meta-analyses. The most recent patient-level meta-analysis demonstrated the benefit of adjuvant chemotherapy over curative surgery; the same Authors also showed that disease-free survival may be used as a surrogate end-point for overall survival. We finally discuss future research issues such as the need of economic evaluations, development of prognostic or predictive biomarkers, and the unmet clinical need of trials comparing perioperative chemotherapy with adjuvant treatment. PMID:24782604

Incretin-based therapies in prediabetes: Current evidence and future perspectives

Science.gov (United States)

Papaetis, Georgios S

2014-01-01

The prevalence of type 2 diabetes (T2D) is evolving globally at an alarming rate. Prediabetes is an intermediate state of glucose metabolism that exists between normal glucose tolerance (NGT) and the clinical entity of T2D. Relentless β-cell decline and failure is responsible for the progression from NGT to prediabetes and eventually T2D. The huge burden resulting from the complications of T2D created the need of therapeutic strategies in an effort to prevent or delay its development. The beneficial effects of incretin-based therapies, dipeptidyl peptidase-4 inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists, on β-cell function in patients with T2D, together with their strictly glucose-depended mechanism of action, suggested their possible use in individuals with prediabetes when greater β-cell mass and function are preserved and the possibility of β-cell salvage is higher. The present paper summarizes the main molecular intracellular mechanisms through which GLP-1 exerts its activity on β-cells. It also explores the current evidence of incretin based therapies when administered in a prediabetic state, both in animal models and in humans. Finally it discusses the safety of incretin-based therapies as well as their possible role in order to delay or prevent T2D. PMID:25512784

Previous success and current body condition determine breeding propensity in Lesser Scaup: evidence for the individual heterogeneity hypothesis

Science.gov (United States)

Warren, Jeffrey M.; Cutting, Kyle A.; Takekawa, John Y.; De La Cruz, Susan E. W.; Williams, Tony D.; Koons, David N.

2014-01-01

The decision to breed influences an individual's current and future reproduction, and the proportion of individuals that breed is an important determinant of population dynamics. Age, experience, individual quality, and environmental conditions have all been demonstrated to influence breeding propensity. To elucidate which of these factors exerts the greatest influence on breeding propensity in a temperate waterfowl, we studied female Lesser Scaup (Aythya affinis) breeding in southwestern Montana. Females were captured during the breeding seasons of 2007–2009, and breeding status was determined on the basis of (1) presence of an egg in the oviduct or (2) blood plasma vitellogenin (VTG) levels. Presence on the study site in the previous year, a proxy for adult female success, was determined with stable isotope signatures of a primary feather collected at capture. Overall, 57% of females had evidence of breeding at the time of capture; this increased to 86% for females captured on or after peak nest initiation. Capture date and size-adjusted body condition positively influenced breeding propensity, with a declining body-condition threshold through the breeding season. We did not detect an influence of age on breeding propensity. Drought conditions negatively affected breeding propensity, reducing the proportion of breeding females to 0.85 (SE = 0.05) from 0.94 (SE = 0.03) during normal-water years. A female that was present in the previous breeding season was 5% more likely to breed than a female that was not present then. The positive correlation between age and experience makes it difficult to differentiate the roles of age, experience, and individual quality in reproductive success in vertebrates. Our results indicate that individual quality, as expressed by previous success and current body condition, may be among the most important determinants of breeding propensity in female Lesser Scaup, providing further support for the individual heterogeneity hypothesis.

Scientific Evidence Supporting Policy Change: A Study on Secondhand Smoke Exposure in Non-smoking Areas of PC Rooms in Korea.

Science.gov (United States)

Hong, Soon-Yeol; Lim, Min Kyung; Yun, E Hwa; Park, Eun Young; Jeong, Bo Yoon; Yang, Wonho; Lee, Do-Hoon

2016-04-01

The objective of this study was to measure secondhand smoke (SHS) exposure in personal computer (PC) rooms with the purpose of determining the strength of scientific evidence supporting the legislative ban on smoking in PC rooms located in the Republic of Korea. From June to September 2012, particulate matter (PM2.5) and air nicotine concentration (ANC) were measured in the smoking and non-smoking areas of PC rooms in Goyang City, Korea. In 28 randomly sampled PC rooms, field investigators completed an observational questionnaire on building characteristics, smoking policies, and evidence of smoking. The geometric means (GM) of PM2.5 and ANC in smoking and non-smoking areas were compared. Evidence of smoking was identified in both the smoking and non-smoking areas of all PC rooms. The GMs of PM2.5 and ANC in both areas were high and did not differ significantly (174.77 μg/m(3) and 48.95 μg/m(3) in smoking areas; 93.38 μg/m(3) and 41.30 μg/m(3) in non-smoking areas). Overall PM2.5 concentrations were 5.5-fold higher than those listed in the World Health Organization guidelines. This study supported previous reports that a partial smoking ban did not protect individuals from SHS exposure. Furthermore, the results from our study suggest how research can support policy. Countries in which smoke-free policies are not yet comprehensive may find our results useful.

Diagnosis of feline infectious peritonitis: Update on evidence supporting available tests.

Science.gov (United States)

Tasker, Séverine

2018-03-01

Practical relevance: Feline coronavirus (FCoV) infection is very common in cats, usually causing only mild intestinal signs such as diarrhoea. Up to 10% of FCoV infections, however, result in the fatal disease feline infectious peritonitis (FIP). Clinical challenges: Obtaining a definitive diagnosis of FIP based on non-invasive approaches is difficult. Confirmation of the disease relies on finding appropriate cytological or histopathological changes in association with positive immunostaining for FCoV antigen. In FIP cases with effusions, cytology and immunostaining on effusion samples can be relatively easy to perform; otherwise obtaining diagnostic samples is more challenging and collection of biopsies from tissues with gross lesions is necessary. In the absence of a definitive diagnosis, a high index of suspicion of FIP may be obtained from the cat's signalment and history, combined with findings on clinical examination and laboratory test results. If largely consistent with FIP, these can be used as a basis for discussion with the owner about whether additional, more invasive, diagnostic tests are warranted. In some cases it may be that euthanasia is discussed as an alternative to pursuing a definitive diagnosis ante-mortem, especially if financial limitations exist or where there are concerns over a cat's ability to tolerate invasive diagnostic procedures. Ideally, the diagnosis should be confirmed in such patients from samples taken at post-mortem examination. Global importance: FIP occurs wherever FCoV infection is present in cats, which equates to most parts of the world. Evidence base: This review provides a comprehensive overview of how to approach the diagnosis of FIP, focusing on the tests available to the veterinary practitioner and recently published evidence supporting their use.

Evidence-based practice in physical therapy in Austria: current state and factors associated with EBP engagement.

Science.gov (United States)

Diermayr, Gudrun; Schachner, Herbert; Eidenberger, Margit; Lohkamp, Monika; Salbach, Nancy M

2015-12-01

Research examining the use of evidence-based practice (EBP) in physical therapy in many countries has revealed positive attitudes, varying degrees of EBP use and barriers at practitioner, patient and organizational levels. In contrast to these countries, Austria does not have an academic or research tradition in physical therapy. Engagement in EBP in countries such as Austria is unknown. The objectives of the study were to describe the current state of EBP engagement and identify factors associated with EBP engagement among Austrian physical therapists (PTs). A cross-sectional online survey was conducted. Existing questionnaires and the theory of planned behaviour guided questionnaire development. Face and content validity and ease of use of the questionnaire were evaluated in pilot tests. Item-level response frequencies and percentages were determined. Simple and multiple regressions were used to identify factors associated with EBP engagement. The final sample size was 588 (response rate: 17.5%). Ten percent of participants fully agreed that they regularly use guidelines and standardized assessment tools in clinical practice. While 49.9% reported not using electronic databases for literature searching, 41.9% reported reading research articles 2-5 times per month. Most frequently cited barriers to EBP engagement were lack of scientific skills, lack of time and insufficient organizational support. Research awareness, attitude, behavioural control, involvement in research and degree level were final correlates of EBP engagement. Austrian PTs show a low level of engagement in EBP. Initiatives to advance EBP in Austria and other countries with no academic or research tradition should primarily target practitioner-level factors. © 2015 John Wiley & Sons, Ltd.

Working memory training in older adults: Bayesian evidence supporting the absence of transfer.

Science.gov (United States)

Guye, Sabrina; von Bastian, Claudia C

2017-12-01

The question of whether working memory training leads to generalized improvements in untrained cognitive abilities is a longstanding and heatedly debated one. Previous research provides mostly ambiguous evidence regarding the presence or absence of transfer effects in older adults. Thus, to draw decisive conclusions regarding the effectiveness of working memory training interventions, methodologically sound studies with larger sample sizes are needed. In this study, we investigated whether or not a computer-based working memory training intervention induced near and far transfer in a large sample of 142 healthy older adults (65 to 80 years). Therefore, we randomly assigned participants to either the experimental group, which completed 25 sessions of adaptive, process-based working memory training, or to the active, adaptive visual search control group. Bayesian linear mixed-effects models were used to estimate performance improvements on the level of abilities, using multiple indicator tasks for near (working memory) and far transfer (fluid intelligence, shifting, and inhibition). Our data provided consistent evidence supporting the absence of near transfer to untrained working memory tasks and the absence of far transfer effects to all of the assessed abilities. Our results suggest that working memory training is not an effective way to improve general cognitive functioning in old age. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Current perspectives on therapeutic ultrasound in the management of chronic wounds: a review of evidence

Directory of Open Access Journals (Sweden)

Conner-Kerr T

2017-07-01

Full Text Available Teresa Conner-Kerr,1 Mary Ellen Oesterle2 1College of Health Sciences & Professions, 2Department of Physical Therapy, University of North Georgia, Dahlonega, GA, USA Abstract: Although therapeutic ultrasound has been in existence since the 1930s, questions remain as to its effectiveness in promoting tissue healing in various injured tissues. These tissues include soft tissues such as skin, tendons, ligaments, bursae, joint capsules and muscles. Limited evidence exists to support a role for therapeutic ultrasound in closed, soft tissue lesions. However, an evolving literature provides support for the role of therapeutic ultrasound in the treatment of chronic wounds, acute injuries such as fractures and split thickness graft donor sites as well as in the modulation of wound-related pain. Modern technology that uses low-frequency (kilohertz, long wave ultrasound appears promising compared to older, higher frequency ultrasound (megahertz devices. These newer devices appear to have positive effects on healing rates in various wound types, pain levels and the modulation of proinflammatory cytokines. Keywords: low-frequency ultrasound, non-contact ultrasound, KHz, acoustic, healing, cavitation

Support time-dependent transformations for surveying and GIS : current status and upcoming challenges

Science.gov (United States)

Mahmoudabadi, H.; Lercier, D.; Vielliard, S.; Mein, N.; Briggs, G.

2016-12-01

The support of time-dependent transformations for surveying and GIS is becoming a critical issue. We need to convert positions from the realizations of the International Terrestrial Reference Frame to any national reference frame. This problem is easy to solve when all of the required information is available. But it becomes really complicated in a worldwide context. We propose an overview of the current ITRF-aligned reference frames and we describe a global solution to support time-dependent transformations between them and the International Terrestrial Reference Frame. We focus on the uncertainties of station velocities used. In a first approximation, we use a global tectonic plate model to calculate point velocities. We show the impact of the velocity model on the coordinate accuracies. Several countries, particularly in active regions, are developing semi-dynamic reference frames. These frames include local displacement models updated regularly and/or after major events (such as earthquakes). Their integration into surveying or GIS applications is an upcoming challenge. We want to encourage the geodetic community to develop and use standard formats.

Support and Against Historical Cost Accounting: is IT Value Relevance for Decision Making?

OpenAIRE

Rahmawati, Evi

2006-01-01

This paper reviews the issues on the support and criticism of historical cost accounting (HCA) and the incremental information content on current cost disclosures. Based on literature review this study find that historical cost is still relevant to use in decision making. Empirical studies show evidence both; supporting historical cost accounting and criticisms against the conventional historical cost based financial statements. Issues on historical cost are raised because of economic condit...

Role of VEGF, Nitric Oxide and sympathetic neurotransmitters in the pathogenesis of tendinopathy: a review of the current evidences

Directory of Open Access Journals (Sweden)

Sebastiano Vasta

2016-08-01

Full Text Available Chronic tendinopathy is a painful common condition affecting athletes as well as the general population undergoing to tendon overuse. Although its huge prevalence, little is known about tendinopathy pathogenesis, and even cloudier is its treatment.Traditionally, tendinopathy has been defined as a lack of tendon ability to overcome stressing stimuli with appropriate adaptive changes. Histologic studies have demonstrated the absence of inflammatory infiltrates, as a consequence conventional antinflammatory drugs have shown little or no effectiveness in treating tendinopathies. New strategies should be therefore identified to address chronic tendon disorders. Angiofibroblastic changes have been highlighted as the main feature of tendinopathy, and vascular endothelial growth factor (VEGF has been demonstrated as one of the key molecules involved in vascular hyperplasia. More recently, attention has been focused on new peptides such as Substance P, nitric oxide and calcitonin gene-related peptide. Those new findings support the idea of a nerve-mediated disregulation of tendon metabolism. Each of those molecules could be a target for new treatment options. This study aimed to systematically review the current available clinical and basic science in order to summarize the latest evidences on the pathophysiology and its effect on treatment of chronic tendinopathy, and to spread suggestions for future research on its treatment.

Facilitating the implementation of evidence- based practice through contextual support and nursing leadership.

Science.gov (United States)

Kueny, Angela; Shever, Leah L; Lehan Mackin, Melissa; Titler, Marita G

2015-01-01

Nurse managers (NMs) play an important role promoting evidence-based practice (EBP) on clinical units within hospitals. However, there is a dearth of research focused on NM perspectives about institutional contextual factors to support the goal of EBP on the clinical unit. The purpose of this article is to identify contextual factors described by NMs to drive change and facilitate EBP at the unit level, comparing and contrasting these perspectives across nursing units. This study employed a qualitative descriptive design using interviews with nine NMs who were participating in a large effectiveness study. To stratify the sample, NMs were selected from nursing units designated as high or low performing based on implementation of EBP interventions, scores on the Meyer and Goes research use scale, and fall rates. Descriptive content analysis was used to identify themes that reflect the complex nature of infrastructure described by NMs and contextual influences that supported or hindered their promotion of EBP on the clinical unit. NMs perceived workplace culture, structure, and resources as facilitators or barriers to empowering nurses under their supervision to use EBP and drive change. A workplace culture that provides clear communication of EBP goals or regulatory changes, direct contact with CEOs, and clear expectations supported NMs in their promotion of EBP on their units. High-performing unit NMs described a structure that included nursing-specific committees, allowing nurses to drive change and EBP from within the unit. NMs from high-performing units were more likely to articulate internal resources, such as quality-monitoring departments, as critical to the implementation of EBP on their units. This study contributes to a deeper understanding of institutional contextual factors that can be used to support NMs in their efforts to drive EBP changes at the unit level.

Rebalancing; Evidence from Current Account Adjustment in Europe

OpenAIRE

Ruben V Atoyan; Jonathan F Manning; Jesmin Rahman

2013-01-01

After the 2003-2007 economic boom, European countries with large pre-crisis current account imbalances are undergoing adjustments. Countries are adjusting at different paces and ways reflecting the source and magnitude of imbalances, availability of financing, competitiveness of the tradable sector and external environment. While emerging European countries with large pre-crisis imbalances and a fixed exchange rate regime have seen sharp current account adjustments and a rebound in growth, ad...

The influence of patients' nutritional status on the prevalence, course and treatment outcomes of lower limb ischemia: an overview of current evidence.

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Spychalska-Zwolińska, Marta; Zwoliński, Tomasz; Anaszewicz, Marzena; Budzyński, Jacek

2018-04-01

The association of lower limb ischemia (LLI) with disturbances in nutritional status, in respect to over- or undernutrition, is still uncertain. The aim of this study was to present the current state of knowledge on this issue. Systematic review of papers published between 2006 and 2018. The literature shows inconclusive evidence regarding the impact of nutritional status on the risk, course, prognosis and outcomes of conservative and invasive treatment of LLI. The majority of publications available demonstrate greater LLI prevalence in overweight and obese patients, a worse prognosis both in malnourished and severely obese patients, poorer outcomes of invasive treatment in underweight patients, and better results for endovascular and surgical treatment in patients with overweight and class I obesity, although without such a relationship for conservative therapy. Possible explanations linking nutritional status and LLI seem to be: the endocrine, paracrine, and autocrine activity of adipose tissue, a decrease in physical activity, and the effect of diet-dependent comorbidities, e.g. diabetes mellitus, hypertension and dyslipidemia. There is a growing body of evidence concerning an association between LLI and patients' nutritional status. A so-called "obesity paradox" or "BMI paradox" seems to exist among patients with LLI and mainly concerns outcomes of endovascular and surgical treatment. However, further studies are needed to evaluate the clinical importance of body composition, the distribution and endocrine activity of adipose tissue, and the effect of weight reduction and/or nutritional support in the LLI patient group.

Advancing Implementation of Evidence-Based Public Health in China: An Assessment of the Current Situation and Suggestions for Developing Regions.

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Shi, Jianwei; Jiang, Chenghua; Tan, Duxun; Yu, Dehua; Lu, Yuan; Sun, Pengfei; Pan, Ying; Zhang, Hanzhi; Wang, Zhaoxin; Yang, Beilei

2016-01-01

Objective. Existing research shows a serious scarcity of EBPH practice in China and other developing regions; as an exploratory study, this study aimed to assess the current EBPH implementation status in Shanghai of China qualitatively. Methods. Using semistructured key informant interviews, we examined the status of and impediments to the lagging EBPH in China. Data were analyzed based on the Consolidated Framework for Implementation Research (CFIR). Results. Chinese public health practitioners knew more about evidence-based medicine but less about EBPH. The situation was worse in community healthcare centers. Participants perceived that evidence sources were limited and the quality of evidence was low. Concerning the inner setting factors, the structural characteristics, networks and communications, implementation climate, and leadership engagement were confronted with many problems. Among the outer setting factors, external government policies and incentives and low patient compliance were the key problems. Additionally, public health practitioners in Shanghai lacked sufficient awareness of EBPH. Furthermore, the current project-based EBPH lacks a systematic implementation system. Conclusions. Existing practical perspectives on EBPH indicate a lag in the advocacy of this new ideology in China. It would be advisable for healthcare institutions to take the initiative to explore feasible and multiple methods of EBPH promotion.

Advancing Implementation of Evidence-Based Public Health in China: An Assessment of the Current Situation and Suggestions for Developing Regions

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Jianwei Shi

2016-01-01

Full Text Available Objective. Existing research shows a serious scarcity of EBPH practice in China and other developing regions; as an exploratory study, this study aimed to assess the current EBPH implementation status in Shanghai of China qualitatively. Methods. Using semistructured key informant interviews, we examined the status of and impediments to the lagging EBPH in China. Data were analyzed based on the Consolidated Framework for Implementation Research (CFIR. Results. Chinese public health practitioners knew more about evidence-based medicine but less about EBPH. The situation was worse in community healthcare centers. Participants perceived that evidence sources were limited and the quality of evidence was low. Concerning the inner setting factors, the structural characteristics, networks and communications, implementation climate, and leadership engagement were confronted with many problems. Among the outer setting factors, external government policies and incentives and low patient compliance were the key problems. Additionally, public health practitioners in Shanghai lacked sufficient awareness of EBPH. Furthermore, the current project-based EBPH lacks a systematic implementation system. Conclusions. Existing practical perspectives on EBPH indicate a lag in the advocacy of this new ideology in China. It would be advisable for healthcare institutions to take the initiative to explore feasible and multiple methods of EBPH promotion.

Formulating evidence-based guidelines for certified nurse-midwives and certified midwives attending home births.

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Cook, Elizabeth; Avery, Melissa; Frisvold, Melissa

2014-01-01

Implementing national home birth guidelines for certified nurse-midwives (CNMs) and certified midwives (CMs) in the United States may facilitate a common approach to safe home birth practices. Guidelines are evidence-based care recommendations for specified clinical situations that can be modified by individual providers to meet specific client needs. Following a review of home birth guidelines from multiple countries, a set of home birth practices guidelines for US CNMs/CMs was drafted. Fifteen American Midwifery Certification Board, Inc. (AMCB)-certified home birth midwives who participate in the American College of Nurse-Midwives (ACNM) home birth electronic mailing list considered the use of such a document in their practices and reviewed and commented on the guidelines. The proposed guidelines addressed client screening, informed consent, antepartum care, routine intrapartum care, obstetric complications and hospital transports, postpartum care, neonatal care, gynecologic care, primary care, peer reviews, recordkeeping, and physician collaboration. The reviewers had varying assessments as to whether the guidelines reflected international standards and current best evidence. The primary concern expressed was that an adoption of national guidelines could compromise provider autonomy. Incorporation of evidence-based guidelines is an ACNM standard and was recommended by the Home Birth Consensus Summit. Clinical practice guidelines are informed by current evidence and supported by experts in a given discipline. Implementation of guidelines ensures optimal patient care and is becoming increasingly central to reimbursement and to medicolegal support. A set of practice guidelines based on current best evidence and internationally accepted standards was developed and reviewed by an interested group of US CNMs/CMs. Further discussion with home birth midwives and other stakeholders about the development and implementation of home birth guidelines is needed, especially in

A Review of the Evidence Supporting the Vitamin D-Cancer Prevention Hypothesis in 2017.

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Grant, William B

2018-02-01

The vitamin D-cancer prevention hypothesis has been evaluated through several types of studies, including geographical ecological studies related to indices of solar ultraviolet-B (UVB) dose (the primary source of vitamin D for most people), observational studies related to UVB exposure or serum 25-hydroxyvitamin D [25(OH)D] concentrations, laboratory studies of mechanisms, and clinical trials. Each approach has strengths and limitations. Ecological studies indirectly measure vitamin D production and incorporate the assumption that vitamin D mediates the effect of UVB exposure. Findings from observational studies with long follow-up times are affected by changing 25(OH)D concentrations over time. Most clinical trials have been poorly designed and conducted, based largely on guidelines for pharmaceutical drugs rather than on nutrients. However, three clinical trials do support the hypothesis. In general, the totality of the evidence, as evaluated using Hill's criteria for causality in a biological system, supports the vitamin D-cancer prevention hypothesis. Copyright© 2018, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.

Strength and balance training for adults with peripheral neuropathy and high risk of fall: current evidence and implications for future research.

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Tofthagen, Cindy; Visovsky, Constance; Berry, Donna L

2012-09-01

To evaluate the evidence for strength- and balance-training programs in patients at high risk for falls, discuss how results of existing studies might guide clinical practice, and discuss directions for additional research. A search of PubMed and CINAHL® databases was conducted in June 2011 using the terms strength, balance training, falls, elderly, and neuropathy. Only clinical trials conducted using specific strength- or balance-training exercises that included community-dwelling adults and examined falls, fall risk, balance, and/or strength as outcome measures were included in this review. One matched case-control study and two randomized, controlled studies evaluating strength and balance training in patients with diabetes-related peripheral neuropathy were identified. Eleven studies evaluating strength and balance programs in community-dwelling adults at high risk for falls were identified. The findings from the reviewed studies provide substantial evidence to support the use of strength and balance training for older adults at risk for falls, and detail early evidence to support strength and balance training for individuals with peripheral neuropathy. The evidence demonstrates that strength and balance training is safe and effective at reducing falls and improving lower extremity strength and balance in adults aged 50 years and older at high risk for falls, including patients with diabetic peripheral neuropathy. Future studies should evaluate the effects of strength and balance training in patients with cancer, particularly individuals with chemotherapy-induced peripheral neuropathy.

How experimental biology and ecology can support evidence-based decision-making in conservation: avoiding pitfalls and enabling application.

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Cooke, Steven J; Birnie-Gauvin, Kim; Lennox, Robert J; Taylor, Jessica J; Rytwinski, Trina; Rummer, Jodie L; Franklin, Craig E; Bennett, Joseph R; Haddaway, Neal R

2017-01-01

Policy development and management decisions should be based upon the best available evidence. In recent years, approaches to evidence synthesis, originating in the medical realm (such as systematic reviews), have been applied to conservation to promote evidence-based conservation and environmental management. Systematic reviews involve a critical appraisal of evidence, but studies that lack the necessary rigour (e.g. experimental, technical and analytical aspects) to justify their conclusions are typically excluded from systematic reviews or down-weighted in terms of their influence. One of the strengths of conservation physiology is the reliance on experimental approaches that help to more clearly establish cause-and-effect relationships. Indeed, experimental biology and ecology have much to offer in terms of building the evidence base that is needed to inform policy and management options related to pressing issues such as enacting endangered species recovery plans or evaluating the effectiveness of conservation interventions. Here, we identify a number of pitfalls that can prevent experimental findings from being relevant to conservation or would lead to their exclusion or down-weighting during critical appraisal in a systematic review. We conclude that conservation physiology is well positioned to support evidence-based conservation, provided that experimental designs are robust and that conservation physiologists understand the nuances associated with informing decision-making processes so that they can be more relevant.

Robotic-Assisted Procedures in Pediatric Surgery: A Critical Appraisal of the Current Best Evidence in Comparison to Conventional Minimally Invasive Surgery.

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Friedmacher, Florian; Till, Holger

2015-11-01

In recent years, the use of robotic-assisted surgery (RAS) has expanded within pediatric surgery. Although increasing numbers of pediatric RAS case-series have been published, the level of evidence remains unclear, with authors mainly focusing on the comparison with open surgery rather than the corresponding laparoscopic approach. The aim of this study was to critically appraise the published literature comparing pediatric RAS with conventional minimally invasive surgery (MIS) in order to evaluate the current best level of evidence. A systematic literature-based search for studies comparing pediatric RAS with corresponding MIS procedures was performed using multiple electronic databases and sources. The level of evidence was determined using the Oxford Centre for Evidence-based Medicine (OCEBM) criteria. A total of 20 studies met defined inclusion criteria, reporting on five different procedures: fundoplication (n=8), pyeloplasty (n=8), nephrectomy (n=2), gastric banding (n=1), and sleeve gastrectomy (n=1). Included publications comprised 5 systematic reviews and 15 cohort/case-control studies (OCEBM Level 3 and 4, respectively). No studies of OCEBM Level 1 or 2 were identified. Limited evidence indicated reduced operative time (pyeloplasty) and shorter hospital stay (fundoplication) for pediatric RAS, whereas disadvantages were longer operative time (fundoplication, nephrectomy, gastric banding, and sleeve gastrectomy) and higher total costs (fundoplication and sleeve gastrectomy). There were no differences reported for complications, success rates, or short-term outcomes between pediatric RAS and conventional MIS in these procedures. Inconsistency was found in study design and follow-up with large clinical heterogeneity. The best available evidence for pediatric RAS is currently OCEBM Level 3, relating only to fundoplication and pyeloplasty. Therefore, higher-quality studies and comparative data for other RAS procedures in pediatric surgery are required.

Thrombolytic treatment in the oldest-old patient with acute ischemic stroke: an update on current evidence

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Fabiola Maioli

2013-09-01

Full Text Available The incidence of ischemic stroke rises exponentially with age, with a steep increase in the age interval between 75 and 85 years. Thrombolytic therapy restores cerebral blood flow in patients with acute ischemic stroke of any etiology by using drugs that dissolve blood clots. Infusion for 1 h of alteplase at the dose of 0.9 mg/kg within 3 h of the start of the symptoms is associated to a 30% increase in the likelihood of gaining a favorable outcome with respect to placebo. There is strong evidence that selected patients with ischemic stroke may benefit from intravenous thrombolysis when treated within 3 h. The aim of the study was to evaluate available evidence for the efficacy and safety of thrombolytic therapy in patients with ischemic stroke aged 80 years and over. Compared to younger stroke patients treated with thrombolytic therapy, those aged 80 years and over have higher acute mortality due to symptomatic intracranial hemorrhage. However, functional outcome at six months is significantly better for over-80-year-olds than younger patients. There is a need for screening tools that take into account pre-stroke functional and cognitive status that are able to identify those over-80-year-old patients with ischemic stroke who can most benefit from thrombolytic treatment. Available evidence supports further recruitment of oldest-old patients into ongoing trials of thrombolysis.

Running retraining to treat lower limb injuries: a mixed-methods study of current evidence synthesised with expert opinion.

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Barton, C J; Bonanno, D R; Carr, J; Neal, B S; Malliaras, P; Franklyn-Miller, A; Menz, H B

2016-05-01

Running-related injuries are highly prevalent. Synthesise published evidence with international expert opinion on the use of running retraining when treating lower limb injuries. Mixed methods. A systematic review of clinical and biomechanical findings related to running retraining interventions were synthesised and combined with semistructured interviews with 16 international experts covering clinical reasoning related to the implementation of running retraining. Limited evidence supports the effectiveness of transition from rearfoot to forefoot or midfoot strike and increase step rate or altering proximal mechanics in individuals with anterior exertional lower leg pain; and visual and verbal feedback to reduce hip adduction in females with patellofemoral pain. Despite the paucity of clinical evidence, experts recommended running retraining for: iliotibial band syndrome; plantar fasciopathy (fasciitis); Achilles, patellar, proximal hamstring and gluteal tendinopathy; calf pain; and medial tibial stress syndrome. Tailoring approaches to each injury and individual was recommended to optimise outcomes. Substantial evidence exists for the immediate biomechanical effects of running retraining interventions (46 studies), including evaluation of step rate and strike pattern manipulation, strategies to alter proximal kinematics and cues to reduce impact loading variables. Our synthesis of published evidence related to clinical outcomes and biomechanical effects with expert opinion indicates running retraining warrants consideration in the treatment of lower limb injuries in clinical practice. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

EPA Leadership on Science, Innovation, and Decision Support Tools for Addressing Current and Future Challenges.

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Hecht, Alan D; Ferster, Aaron; Summers, Kevin

2017-10-16

When the U.S. Environmental Protection Agency (EPA) was established nearly 50 years ago, the nation faced serious threats to its air, land, and water, which in turn impacted human health. These threats were effectively addressed by the creation of EPA (in 1970) and many subsequent landmark environmental legislations which in turn significantly reduced threats to the Nation's environment and public health. A key element of historic legislation is research aimed at dealing with current and future problems. Today we face national and global challenges that go beyond classic media-specific (air, land, water) environmental legislation and require an integrated paradigm of action and engagement based on (1) innovation based on science and technology, (2) stakeholder engagement and collaboration, and (3) public education and support. This three-pronged approach recognizes that current environmental problems, include social as well as physical and environmental factors, are best addressed through collaborative problem solving, the application of innovation in science and technology, and multiple stakeholder engagement. To achieve that goal, EPA's Office of Research and Development (ORD) is working directly with states and local communities to develop and apply a suite of accessible decision support tools (DST) that aim to improve environmental conditions, protect human health, enhance economic opportunity, and advance a resilient and sustainability society. This paper showcases joint EPA and state actions to develop tools and approaches that not only meet current environmental and public health challenges, but do so in a way that advances sustainable, healthy, and resilient communities well into the future. EPA's future plans should build on current work but aim to effectively respond to growing external pressures. Growing pressures from megatrends are a major challenge for the new Administration and for cities and states across the country. The recent hurricanes hitting

Cognitive Enhancement Through Action Video Game Training: Great Expectations Require Greater Evidence

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Joseph eBisoglio

2014-02-01

Full Text Available Action video game training may hold promise as a cognitive intervention with the potential to enhance daily functioning and remediate impairments, but this must be more thoroughly evaluated through evidence-based practices. We review current research on the effect of action video game training on visual attention and visuospatial processing, executive functions, and learning and memory. Focusing on studies that utilize strict experimental controls and synthesize behavioral and neurophysiological data, we examine whether there is sufficient evidence to support a causal relationship between action video game training and beneficial changes in cognition. Convergent lines of behavioral and neurophysiological evidence tentatively support the efficacy of training, but the magnitude and specificity of these effects remain obscure. Causal inference is thus far limited by a lack of standardized and well-controlled methodology. Considering future directions, we suggest stringent adherence to evidence based practices and collaboration modeled after clinical trial networks. Finally, we recommend the exploration of more complex causal models, such as indirect causal relationships and interactions that may be masking true effects.

Impact of policy support on uptake of evidence-based continuous quality improvement activities and the quality of care for Indigenous Australians: a comparative case study.

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Bailie, Ross; Matthews, Veronica; Larkins, Sarah; Thompson, Sandra; Burgess, Paul; Weeramanthri, Tarun; Bailie, Jodie; Cunningham, Frances; Kwedza, Ru; Clark, Louise

2017-10-05

To examine the impact of state/territory policy support on (1) uptake of evidence-based continuous quality improvement (CQI) activities and (2) quality of care for Indigenous Australians. Mixed-method comparative case study methodology, drawing on quality-of-care audit data, documentary evidence of policies and strategies and the experience and insights of stakeholders involved in relevant CQI programmes. We use multilevel linear regression to analyse jurisdictional differences in quality of care. Indigenous primary healthcare services across five states/territories of Australia. 175 Indigenous primary healthcare services. A range of national and state/territory policy and infrastructure initiatives to support CQI, including support for applied research. PRIMARY AND SECONDARY OUTCOME MEASURES: (i) Trends in the consistent uptake of evidence-based CQI tools available through a research-based CQI initiative (the Audit and Best Practice in Chronic Disease programme) and (ii) quality of care (as reflected in adherence to best practice guidelines). Progressive uptake of evidence-based CQI activities and steady improvements or maintenance of high-quality care occurred where there was long-term policy and infrastructure support for CQI. Where support was provided but not sustained there was a rapid rise and subsequent fall in relevant CQI activities. Health authorities should ensure consistent and sustained policy and infrastructure support for CQI to enable wide-scale and ongoing improvement in quality of care and, subsequently, health outcomes. It is not sufficient for improvement initiatives to rely on local service managers and clinicians, as their efforts are strongly mediated by higher system-level influences. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Support and Against Historical Cost Accounting: is IT Value Relevance for Decision Making?

OpenAIRE

Rahmawati, Evi

2006-01-01

This paper reviews the issues on the support and criticism of historical cost accounting (HCA) and the incremental information content on current cost disclosures. Based on literature review this study find that historical cost is still relevant to use in decision making. Empirical studies show evidence both; supporting historical cost accounting and criticisms against the conventional historical cost based financial statements. Issues on historical cost are raised because of  economic condit...

The Juggling Act of Supervision in Community Mental Health: Implications for Supporting Evidence-Based Treatment.

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Dorsey, Shannon; Pullmann, Michael D; Kerns, Suzanne E U; Jungbluth, Nathaniel; Meza, Rosemary; Thompson, Kelly; Berliner, Lucy

2017-11-01

Supervisors are an underutilized resource for supporting evidence-based treatments (EBTs) in community mental health. Little is known about how EBT-trained supervisors use supervision time. Primary aims were to describe supervision (e.g., modality, frequency), examine functions of individual supervision, and examine factors associated with time allocation to supervision functions. Results from 56 supervisors and 207 clinicians from 25 organizations indicate high prevalence of individual supervision, often alongside group and informal supervision. Individual supervision serves a wide range of functions, with substantial variation at the supervisor-level. Implementation climate was the strongest predictor of time allocation to clinical and EBT-relevant functions.

Stakeholder Meeting: Integrated Knowledge Translation Approach to Address the Caregiver Support Gap.

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Holroyd-Leduc, Jayna M; McMillan, Jacqueline; Jette, Nathalie; Brémault-Phillips, Suzette C; Duggleby, Wendy; Hanson, Heather M; Parmar, Jasneet

2017-03-01

Family caregivers are an integral and increasingly overburdened part of the health care system. There is a gap between what research evidence shows is beneficial to caregivers and what is actually provided. Using an integrated knowledge translation approach, a stakeholder meeting was held among researchers, family caregivers, caregiver associations, clinicians, health care administrators, and policy makers. The objectives of the meeting were to review current research evidence and conduct multi-stakeholder dialogue on the potential gaps, facilitators, and barriers to the provision of caregiver supports. A two-day meeting was attended by 123 individuals. Three target populations of family caregivers were identified for discussion: caregivers of seniors with dementia, caregivers in end-of-life care, and caregivers of frail seniors with complex health needs. The results of this meeting can and are being used to inform the development of implementation research endeavours and policies targeted at providing evidence-informed caregiver supports.

Preventing skin cancer through reduction of indoor tanning: current evidence.

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Watson, Meg; Holman, Dawn M; Fox, Kathleen A; Guy, Gery P; Seidenberg, Andrew B; Sampson, Blake P; Sinclair, Craig; Lazovich, DeAnn

2013-06-01

Exposure to ultraviolet radiation from indoor tanning devices (tanning beds, booths, and sun lamps) or from the sun contributes to the risk of skin cancer, including melanoma, which is the type of skin cancer responsible for most deaths. Indoor tanning is common among certain groups, especially among older adolescents and young adults, adolescent girls and young women, and non-Hispanic whites. Increased understanding of the health risks associated with indoor tanning has led to many efforts to reduce use. Most environmental and systems efforts in the U.S. (e.g., age limits or requiring parental consent/accompaniment) have occurred at the state level. At the national level, the U.S. Food and Drug Administration and the Federal Trade Commission regulate indoor tanning devices and advertising, respectively. The current paper provides a brief review of (1) the evidence on indoor tanning as a risk factor for skin cancer; (2) factors that may influence use of indoor tanning devices at the population level; and (3) various environmental and systems options available for consideration when developing strategies to reduce indoor tanning. This information provides the context and background for the companion paper in this issue of the American Journal of Preventive Medicine, which summarizes highlights from an informal expert meeting convened by the CDC in August 2012 to identify opportunities to prevent skin cancer by reducing use of indoor tanning devices. Published by Elsevier Inc.

Evidence-based librarianship: searching for the needed EBL evidence.

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Eldredge, J D

2000-01-01

This paper discusses the challenges of finding evidence needed to implement Evidence-Based Librarianship (EBL). Focusing first on database coverage for three health sciences librarianship journals, the article examines the information contents of different databases. Strategies are needed to search for relevant evidence in the library literature via these databases, and the problems associated with searching the grey literature of librarianship. Database coverage, plausible search strategies, and the grey literature of library science all pose challenges to finding the needed research evidence for practicing EBL. Health sciences librarians need to ensure that systems are designed that can track and provide access to needed research evidence to support Evidence-Based Librarianship (EBL).

Problem-Based Learning and Argumentation: Testing a Scaffolding Framework to Support Middle School Students' Creation of Evidence-Based Arguments

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Belland, Brian R.; Glazewski, Krista D.; Richardson, Jennifer C.

2011-01-01

Students engaged in problem-based learning (PBL) units solve ill-structured problems in small groups, and then present arguments in support of their solution. However, middle school students often struggle developing evidence-based arguments (Krajcik et al., "J Learn Sci" 7:313-350, 1998). Using a mixed method design, the researchers examined the…

Belief in Food Addiction and Obesity-Related Policy Support

Science.gov (United States)

2016-01-01

Objectives This study examines whether belief in the food addiction construct is associated with support for obesity-related policies (e.g., restrictions on foods served in schools and workplace cafeterias, subsidies on fruits and vegetables), while simultaneously examining other factors associated with policy support (e.g., political party affiliation). Design Cross-sectional. Setting Online Community. Participants 200 individuals were recruited through Amazon Mechanical Turk. Measurements Participants (n = 193) responded to three questions about belief in food addiction and a measure evaluating support for 13 obesity-related policy initiatives. Individuals also completed the modified Yale Food Addiction Scale (mYFAS), self-reported height and weight, and provided demographic information (age, gender, race, political party affiliation). Results Belief in food addiction was significantly associated with greater support for obesity-related initiatives, even when accounting for the significant associations of age, gender, and political party. Belief in food addiction and political party both had moderate effect sizes for predicting support for obesity-related policy. There was an interaction between age and belief in food addiction, with significant associations with policy support for both younger and older individuals, though the effect was larger for younger participants. Conclusion The current study provides evidence that belief in food addiction is associated with increased obesity-related policy support, comparable to the influence of one’s political party. Growing evidence for the role of an addictive process in obesity may have important implications for public support of obesity-related policy initiatives. PMID:26808427

Moderating effects of nurses' organizational justice between organizational support and organizational citizenship behaviors for evidence-based practice.

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Chang, Ching-Sheng

2014-10-01

Lack of existing literature on the correlation among organizational justice, organizational support, and organizational citizenship behaviors has created a research gap in previous evidence-based practice (EBP) studies on nursing personnel. To investigate whether organizational justice among nurses has a moderating effect between their organizational support and organizational citizenship behaviors in order to bridge such a gap of existing literature with the EBP study on nursing personnel. Nursing staff of one large and influential hospital in Taiwan was surveyed. Four hundred questionnaires were distributed, and 386 were collected with a valid response rate of 96.50%. SPSS 17.0 and Amos 17.0 statistical software packages were used for data analysis. Nurses' organizational support positively influences their organizational citizenship behaviors, and their organizational justice perception has a positive moderating effect between organizational support and organizational citizenship behaviors. Results call hospitals' attention to the type of individual behaviors that may improve organizational performance. When nursing staff perceive fair and impartial treatment by the organization and supportive emotional attachment, behaviors beneficial for the organization are expressed in return. Subjective perceptions of nursing staff play an important role in organizational exchange relationship; the higher the degree of nursing staff's perceived organizational justice, the higher the degree of their organizational support, perception, and exhibition of organizational citizenship behaviors such as altruistic behavior and dedication to the work. © 2014 Sigma Theta Tau International.

A current view of serotonin transporters [version 1; referees: 3 approved

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Louis J. De Felice

2016-07-01

Full Text Available Serotonin transporters (SERTs are largely recognized for one aspect of their function—to transport serotonin back into the presynaptic terminal after its release. Another aspect of their function, however, may be to generate currents large enough to have physiological consequences. The standard model for electrogenic transport is the alternating access model, in which serotonin is transported with a fixed ratio of co-transported ions resulting in net charge per cycle. The alternating access model, however, cannot account for all the observed currents through SERT or other monoamine transporters.  Furthermore, SERT agonists like ecstasy or antagonists like fluoxetine generate or suppress currents that the standard model cannot support.  Here we survey evidence for a channel mode of transport in which transmitters and ions move through a pore. Available structures for dopamine and serotonin transporters, however, provide no evidence for a pore conformation, raising questions of whether the proposed channel mode actually exists or whether the structural data are perhaps missing a transient open state.

Efficacy and safety of haloperidol for in-hospital delirium prevention and treatment: A systematic review of current evidence.

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Schrijver, E J M; de Graaf, K; de Vries, O J; Maier, A B; Nanayakkara, P W B

2016-01-01

Haloperidol is generally considered the drug of choice for in-hospital delirium management. We conducted a systematic review to evaluate the evidence for the efficacy and safety of haloperidol for the prevention and treatment of delirium in hospitalized patients. PubMed, Embase, Cumulative Index to Nursing and Allied Health (CINAHL), PsycINFO, and the Cochrane Library were systematically searched up to April 21, 2015. We included English full-text randomized controlled trials using haloperidol for the prevention or treatment of delirium in adult hospitalized patients reporting on delirium incidence, duration, or severity as primary outcome. Quality of evidence was graded. Meta-analysis was not conducted because of between-study heterogeneity. Twelve studies met our inclusion criteria, four prevention and eight treatment trials. Methodological limitations decreased the graded quality of included studies. Results from placebo-controlled prevention studies suggest a haloperidol-induced protective effect for delirium in older patients scheduled for surgery: two studies reported a significant reduction in ICU delirium incidence and one study found a significant reduction in delirium severity and duration. Although placebo-controlled trials are missing, pharmacological treatment of established delirium reduced symptom severity. Haloperidol administration was not associated with treatment-limiting side-effects, but few studies used a systematic approach to identify adverse events. Although results on haloperidol for delirium management seem promising, current prevention trials lack external validity and treatment trials did not include a placebo arm on top of standard nonpharmacological care. We therefore conclude that the current use of haloperidol for in-hospital delirium is not based on robust and generalizable evidence. Copyright © 2015 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

Does knowledge of teen driving risks and awareness of current law translate into support for stronger GDL provisions? Lessons learned from one state.

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Campbell, Brendan T; Chaudhary, Neil K; Saleheen, Hassan; Borrup, Kevin; Lapidus, Garry

2009-08-01

Many states are considering strengthening their graduated driving licensing (GDL) systems for teenage drivers but most do not know the level of public support for proposed upgrades. This study provides a method for states to identify specific demographic groups that may differ with regard to their awareness of teen driving risks, knowledge of current GDL law, and support for GDL upgrades. A 28-item questionnaire was administered to Connecticut adults by phone survey during January 2008. We collected demographic information and whether respondents understood driving risks, were aware of the current GDL system, and whether they would support GDL upgrades. The state's motor vehicle crash file (1999-2006) was used to calculate motor vehicle crash rate among 16- and 17-year-old drivers by town and correlate that with support for GDL upgrades. Eight hundred seven people were interviewed. More women than men (92% vs. 86%, p towns (38%). Two thirds supported a passenger restriction upgrade with no differences based upon sex or geographic location. There was less support for an increased penalties in Fairfield County when compared to all other counties (55% vs. 63%, p County versus all other counties (70% vs. 58%, p < .05). Parents of Connecticut teens were more knowledgeable of current law but less supportive of GDL upgrades compared to other adults. Women were more apt to favor GDL upgrades than men. This study identifies subgroups that can be targeted for prevention activities and illustrates a useful method to assess public support for GDL upgrades.

18F-FDG PET/CT in breast cancer: Evidence-based recommendations in initial staging.

Science.gov (United States)

Caresia Aroztegui, Ana Paula; García Vicente, Ana María; Alvarez Ruiz, Soledad; Delgado Bolton, Roberto Carlos; Orcajo Rincon, Javier; Garcia Garzon, Jose Ramon; de Arcocha Torres, Maria; Garcia-Velloso, Maria Jose

2017-10-01

Current guidelines do not systematically recommend 18F-FDG PET/CT for breast cancer staging; and the recommendations and level of evidence supporting its use in different groups of patients vary among guidelines. This review summarizes the evidence about the role of 18F-FDG PET/CT in breast cancer staging and the therapeutic and prognostic impact accumulated in the last decade. Other related aspects, such as the association of metabolic information with biology and prognosis are considered and evidence-based recommendations for the use of 18F-FDG PET/CT in breast cancer staging are offered. We systematically searched MEDLINE for articles reporting studies with at least 30 patients related to clinical questions following the Problem/Population, Intervention, Comparison, and Outcome framework. We critically reviewed the selected articles and elaborated evidence tables structuring the summarized information into methodology, results, and limitations. The level of evidence and the grades of recommendation for the use of 18F-FDG PET/CT in different contexts are summarized. Level III evidence supports the use of 18F-FDG PET/CT for initial staging in patients with recently diagnosed breast cancer; the diagnostic and therapeutic impact of the 18F-FDG PET/CT findings is sufficient for a weak recommendation in this population. In patients with locally advanced breast cancer, level II evidence supports the use of 18F-FDG PET/CT for initial staging; the diagnostic and therapeutic impact of the 18F-FDG PET/CT findings is sufficient for a strong recommendation in this population. In patients with recently diagnosed breast cancer, the metabolic information from baseline 18F-FDG PET/CT is associated with tumor biology and has prognostic implications, supported by level II evidence. In conclusion, 18F-FDG PET/CT is not recommended for staging all patients with early breast cancer, although evidence of improved regional and systemic staging supports its use in locally advanced

Methodology for AACT evidence-based recommendations on the use of intravenous lipid emulsion therapy in poisoning

DEFF Research Database (Denmark)

Gosselin, Sophie; Morris, Martin; Miller-Nesbitt, Andrea

2015-01-01

Intravenous lipid emulsion (ILE) therapy is a novel treatment that was discovered in the last decade. Despite unclear understanding of its mechanisms of action, numerous and diverse publications attested to its clinical use. However, current evidence supporting its use is unclear and recommendati...

Hospital-based education support for students with chronic health conditions.

Science.gov (United States)

Hopkins, Liza J

2016-04-01

Objective To examine the evidence for best practice in educational support to hospitalised students and describe the existing supports available across each Australian state and territory. Methods A descriptive approach to the diversity of current practice and a review of the published evidence for best practice. Results We have constructed a model of best-practice in education support to hospitalised students. We found that education support services in each state met some of the criteria for best practice, but no one state service met all of the criteria. Conclusions All Australian states and territories make provision for hospitalised students to continue with their education, however the services in some states are closer to the best-practice model than others. What is known about the topic? It is well known that children and young people living with health conditions are at higher risk of educational underachievement and premature disengagement from school than their healthy peers. Although each state and territory across Australia offers some form of educational support to students during periods of hospitalisation, this support differs widely in each jurisdiction in fundamentals such as which students are eligible for support, where the support is delivered, how it is delivered and who coordinates the support. Published evidence in the literature suggests that the elements of good practice in education support have been well identified but, in practice, lack of policy direction can hinder the implementation of coordinated support. What does this paper add? This paper draws together the different models in place to support students in hospital in each state and territory and identifies the common issues that are faced by hospital education support services, as well as identifying areas where practice differs across settings. It also identifies the elements of good practice from the literature and links the elements of theory and practice to present a model of

The Significance of Ongoing Teacher Support in Earth Science Education Programs: Evidence from the GLOBE Program

Science.gov (United States)

Penuel, B.; Korbak, C.; Shear, L.

2003-12-01

study, SRI researchers used the data on student data reporting activity from different partners to identify candidate sites for case studies, where we might investigate the nature of follow-up activities provided by successful partners more closely. We worked to select 2 regional partners that had evidence of high percentages of teachers trained that reported data and that also offered follow-up to teachers. Case study researchers conducted observations within 2-3 active GLOBE schools supported by each regional partner organization and interviewed teachers, principals, and partner staff. On the basis of our observation data and transcripts from interviews, we compiled profiles of schools' implementation and analyzed the core activities of each regional partner. Researchers found that keys to promoting successful implementation in one partnership were: one partnership were: close alignment with state mathematics and science initiatives; mentors that helped teachers by modeling inquiry in GLOBE and by assisting with equipment set-up and curriculum planning; and allowing room for schools to adopt diverse goals for GLOBE. In the second partnership, keys to success included a strategic approach to developing funding for the program; a focus on integration of culturally-relevant knowledge into teacher preparation; follow-up support for teachers; and use of GLOBE as an opportunity to investigate local evidence of climate change. Both partner organizations were challenged by funding limitations that prevented them from providing as much follow-up support as they believe is necessary.

Review of Virtual Reality Treatment in Psychiatry: Evidence Versus Current Diffusion and Use.

Science.gov (United States)

Mishkind, Matthew C; Norr, Aaron M; Katz, Andrea C; Reger, Greg M

2017-09-18

This review provides an overview of the current evidence base for and clinical applications of the use of virtual reality (VR) in psychiatric practice, in context of recent technological developments. The use of VR in psychiatric practice shows promise with much of the research demonstrating clinical effectiveness for conditions including post-traumatic stress disorder, anxiety and phobias, chronic pain, rehabilitation, and addictions. However, more research is needed before the use of VR is considered a clinical standard of practice in some areas. The recent release of first generation consumer VR products signals a change in the viability of further developing VR systems and applications. As applications increase so will the need for good quality research to best understand what makes VR effective, and when VR is not appropriate for clinical services. As the field progresses, it is hopeful that the flexibility afforded by this technology will yield superior outcomes and a better understanding of the underlying mechanisms impacting those outcomes.

Genetic Evidence Supports the Multiethnic Character of Teopancazco, a Neighborhood Center of Teotihuacan, Mexico (AD 200-600.

Directory of Open Access Journals (Sweden)

Brenda A Álvarez-Sandoval

Full Text Available Multiethnicity in Teopancazco, Teotihuacan, is supported by foreign individuals found in the neighborhood center as well as by the diversity observed in funerary rituals at the site. Studies of both stable and strontium isotopes as well as paleodietary analysis, suggest that the population of Teopancazco was composed by three population groups: people from Teotihuacan, people from nearby sites (Tlaxcala-Hidalgo-Puebla, and people from afar, including the coastal plains. In an attempt to understand the genetic dynamics in Teopancazco we conducted an ancient DNA (aDNA analysis based on mtDNA. Our results show that the level of genetic diversity is consistent with the multiethnicity phenomenon at the neighborhood center. Levels of genetic diversity at different time periods of Teopancazco's history show that multiethnicity was evident since the beginning and lasted until the collapse of the neighborhood center. However, a PCA and a Neighbor-Joining tree suggested the presence of a genetically differentiated group (buried at the Transitional phase compared to the population from the initial phase (Tlamimilolpa as well as the population from the final phase (Xolalpan of the history of Teopancazco. Genetic studies showed no differences in genetic diversity between males and females in the adult population of Teopancazco, this data along with ample archaeological evidence, suggest a neolocal post-marital pattern of residence in Teopancazco. Nevertheless, genetic analyses on the infant population showed that the males are significantly more heterogeneous than the females suggesting a possible differential role in cultural practices by sex in the infant sector. Regarding interpopulation analysis, we found similar indices of genetic diversity between Teopancazco and heterogeneous native groups, which support the multiethnic character of Teopancazco. Finally, our data showed a close genetic relationship between Teopancazco and populations from the

An updated systematic review of the evolution of ALPPS and evaluation of its advantages and disadvantages in accordance with current evidence.

Science.gov (United States)

Cai, Yu-Long; Song, Pei-Pei; Tang, Wei; Cheng, Nan-Sheng

2016-06-01

The main obstacle to achieving an R0 resection after a major hepatectomy is inability to preserve an adequate future liver remnant (FLR) to avoid postoperative liver failure (PLF). Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) is a novel technique for resecting tumors that were previously considered unresectable, and this technique results in a vast increase in the volume of the FLR in a short period of time. However, this technique continues to provoke heated debate because of its high mortality and morbidity.The evolution of ALPPS and its advantages and disadvantages have been systematically reviewed and evaluated in accordance with current evidence. Electronic databases (PubMed and Medline) were searched for potentially relevant articles from January 2007 to January 2016.ALPPS has evolved into various modified forms. Some of these modified techniques have reduced the difficulty of the procedure and enhanced its safety. Current evidence indicates that the advantages of ALPPS are rapid hypertrophy of the FLR, the feasibility of the procedure, and a higher rate of R0 resection in comparison to other techniques. However, ALPPS is associated with worse major complications, more deaths, and early tumor recurrence.Hepatobiliary surgeons should carefully consider whether to perform ALPPS. Some modified forms of ALPPS have reduced the mortality and morbidity of the procedure, but they cannot be recommended over the original procedure currently. Portal vein embolization (PVE) is still the procedure of choice for patients with a tumor-free FLR, and ALPPS could be used as a salvage procedure when PVE fails. More persuasive evidence needs to be assembled to determine whether ALPPS or two-stage hepatectomy (TSH) is better for patients with a tumor involving the FLR. Evidence with regard to long-term oncological outcomes is still limited. More meticulous comparative studies and studies of the 5-year survival rate of ALPPS could ultimately

Marital status, childlessness, and social support among older Canadians.

Science.gov (United States)

Penning, Margaret J; Wu, Zheng

2014-12-01

Despite evidence of increasing diversification of family structures, little is known regarding implications of marital and parental status for access to social support in later life. Using data from Statistics Canada's 2007 General Social Survey, this study assessed the impact of marital and parental status intersections on social support among adults aged 60 and older (n = 11,503). Two-stage probit regression models indicated that among those who were currently married or separated/divorced, childless individuals were more likely to report instrumental (domestic, transportation) and emotional support from people outside the household. Conversely, among never-married or widowed older adults, being childless was associated with reduced domestic support but without differences in other support domains. Findings suggest that marital and parental status intersections are not uniformly positive, neutral, or negative regarding implications for extra-household social support. Future work should address complexities of these relationships in order to better understand rapidly changing family structures.

Family support programs and adolescent mental health: review of evidence

Directory of Open Access Journals (Sweden)

Kuhn ES

2014-07-01

Full Text Available Emily S Kuhn, Robert D Laird Department of Psychology, University of New Orleans, New Orleans, LA, USA Abstract: Family support programs aim to improve parent wellbeing and parenting as well as adolescent mental and behavioral health by addressing the needs of parents of adolescents experiencing or at risk for mental health problems. Family support programs can be part of the treatment for adolescents diagnosed with mental or behavioral health problems, or family support programs can be delivered as prevention programs designed to prevent the onset or escalation of mental or behavioral health problems. This review discusses the rationale for family support programs and describes the range of services provided by family support programs. The primary focus of the review is on evaluating the effectiveness of family support programs as treatments or prevention efforts delivered by clinicians or peers. Two main themes emerged from the review. First, family support programs that included more forms of support evidenced higher levels of effectiveness than family support programs that provided fewer forms of support. Discussion of this theme focuses on individual differences in client needs and program adaptions that may facilitate meeting diverse needs. Second, family support prevention programs appear to be most effective when serving individuals more in need of mental and behavioral health services. Discussion of this theme focuses on the intensity versus breadth of the services provided in prevention programs. More rigorous evaluations of family support programs are needed, especially for peer-delivered family support treatments. Keywords: intervention, parent, mental and behavioral health

Direct support workforce supporting individuals with IDD: current wages, benefits, and stability.

Science.gov (United States)

Bogenschutz, Matthew D; Hewitt, Amy; Nord, Derek; Hepperlen, Renee

2014-10-01

Abstract Direct support professionals (DSPs) and frontline supervisors (FLSs) play an integral role in the lives of people with intellectual and developmental disabilities (IDD) and are often the individuals directly responsible for assisting people with IDD to live and fully participate in their communities. These two groups of workers have typically been employed at lower wages with limited access to fringe benefits, contributing to high rates of turnover compared to a similarly skilled worker in the United States. This article summarizes findings and is the first investigation in several years to systematically examine the wages, fringe benefits, and stability of the DSP and FLS workforces supporting individuals with IDD. Findings suggest that a typical DSP may expect to earn about $11.25 per hour, while FLSs may expect wages of about $15.45 hourly. Of concern, however, is that fringe benefit provision was quite limited in this sample. Implications, including relation to past reports of DSP workforce development, are discussed.

Filamentary structures in dense plasma focus: Current filaments or vortex filaments?

Energy Technology Data Exchange (ETDEWEB)

Soto, Leopoldo, E-mail: lsoto@cchen.cl; Pavez, Cristian; Moreno, José [Comisión Chilena de Energía Nuclear, CCHEN, Casilla 188-D, Santiago (Chile); Center for Research and Applications in Plasma Physics and Pulsed Power, P4, Departamento de Ciencias Físicas, Facultad de Ciencias Exactas, Universidad Andrés Bello, República 220, Santiago (Chile); Castillo, Fermin [Universidad Nacional Autónoma de México, Cuernavaca, México (Mexico); Veloso, Felipe [Instituto de Física, Pontificia Universidad Católica de Chile, 7820436 Santiago (Chile); Auluck, S. K. H. [Bhabha Atomic Research Center, Mumbai 400 085 (India)

2014-07-15

Recent observations of an azimuthally distributed array of sub-millimeter size sources of fusion protons and correlation between extreme ultraviolet (XUV) images of filaments with neutron yield in PF-1000 plasma focus have re-kindled interest in their significance. These filaments have been described variously in literature as current filaments and vortex filaments, with very little experimental evidence in support of either nomenclature. This paper provides, for the first time, experimental observations of filaments on a table-top plasma focus device using three techniques: framing photography of visible self-luminosity from the plasma, schlieren photography, and interferometry. Quantitative evaluation of density profile of filaments from interferometry reveals that their radius closely agrees with the collision-less ion skin depth. This is a signature of relaxed state of a Hall fluid, which has significant mass flow with equipartition between kinetic and magnetic energy, supporting the “vortex filament” description. This interpretation is consistent with empirical evidence of an efficient energy concentration mechanism inferred from nuclear reaction yields.

The Evidence Movement

DEFF Research Database (Denmark)

Hansen, Hanne Foss; Rieper, Olaf

2009-01-01

The evidence movement and the idea of systematic reviews, defined as summaries of the results of already existing evaluation and research projects, have gained considerable support in recent years as many international as well as national evidence-producing organizations have been established...

Transcranial Direct Current Stimulation in Patients with Prolonged Disorders of Consciousness: Combined Behavioral and Event-Related Potential Evidence

Directory of Open Access Journals (Sweden)

Ye Zhang

2017-11-01

Full Text Available BackgroundThe electrophysiological evidence supporting the therapeutic efficacy of multiple transcranial direct current stimulation (tDCS sessions on consciousness improvement in patients with prolonged disorders of consciousness (DOCs has not been firmly established.ObjectivesTo assess the effects of repeated tDCS in patients with prolonged DOCs by Coma Recovery Scale-Revised (CRS-R score and event-related potential (ERP.MethodUsing a sham-controlled randomized double-blind design, 26 patients were randomly assigned to either a real [five vegetative state (VS and eight minimally conscious state (MCS patients] or sham (six VS and seven MCS patients stimulation group. The patients in the real stimulation group underwent 20 anodal tDCS sessions of the left dorsolateral prefrontal cortex (DLPFC over 10 consecutive working days. The CRS-R score and P300 amplitude and latency in a hierarchical cognitive assessment were recorded to evaluate the consciousness level before tDCS and immediately after the 20 sessions.ResultsThe intra-group CRS-R analysis revealed a clinically significant improvement in the MCS patients in the real stimulation group. The inter-group CRS-R analysis showed a significant difference in CRS-R between VS and MCS patients at baseline in both the real and sham stimulation groups. The intra-group ERP analysis revealed a significant increase in P300 amplitude after tDCS in the MCS patients in the real stimulation group, but no significant differences in P300 latency. For the inter-group ERP analysis, we observed significant differences regarding the presence of P300 at baseline between the VS and MCS patients in both groups.ConclusionThe repeated anodal tDCS of the left DLPFC could produce clinically significant improvements in MCS patients. The observed tDCS-related consciousness improvements might be related to improvements in attention resource allocation (reflected by the P300 amplitude. The findings support the use of tDCS in

Role of pelvic and para-aortic lymphadenectomy in endometrial cancer: Current evidence

Science.gov (United States)

Bogani, Giorgio; Dowdy, Sean C.; Cliby, William A.; Ghezzi, Fabio; Rossetti, Diego; Mariani, Andrea

2015-01-01

The aim of the present review is to summarize the current evidence on the role of pelvic and para-aortic lymphadenectomy in endometrial cancer. In 1988, the International Federation of Obstetrics and Gynecology recommended surgical staging for endometrial cancer patients. However, 25 years later, the role of lymph node dissection remains controversial. Although the findings of two large independent randomized trials suggested that pelvic lymphadenectomy provides only adjunctive morbidity with no clear influence on survival outcomes, the studies have many pitfalls that limit interpretation of the results. Theoretically, lymphadenectomy may help identify patients with metastatic dissemination, who may benefit from adjuvant therapy, thus reducing radiation-related morbidity. Also, lymphadenectomy may eradicate metastatic disease. Because lymphatic spread is relatively uncommon, our main effort should be directed at identifying patients who may potentially benefit from lymph node dissection, thus reducing the rate of unnecessary treatment and associated morbidity. This review will discuss the role of lymphadenectomy in endometrial cancer, focusing on patient selection, extension of the surgical procedure, postoperative outcomes, quality of life and costs. The need for new surgical studies and efficacious systemic drugs is recommended. PMID:24472047

How is research evidence used to support claims made in advertisements for wound care products?

Science.gov (United States)

Dumville, Jo C; Petherick, Emily S; O'Meara, Susan; Raynor, Pauline; Cullum, Nicky

2009-05-01

To investigate the amount, type and accuracy of citations use in support of product related claims from advertisements of wound care products. Although articles submitted to most medical journals are subjected to peer review, such scrutiny is often not required for the content of advertisements. A contents survey of advertisements from two wound care journals (Journal of Wound Care and Ostomy Wound Management) from 2002-2003 and the British Medical Journal, 2002-2003. Data collected from advertisements included identification of product related claims made and any corresponding citations. Where journal articles were cited to support claims, the articles were obtained. Where data on file were cited, this material was requested. In each case the accuracy of claims in relation to the content of the supporting citation was assessed. The use of citations to support product related claims was infrequent in advertisements from wound care journals, where 35% of advertisements containing a product related claim also contained at least one citation, compared with 63% of advertisements from the British Medical Journal. Of citations that were supplied, journal articles were less common in the wound journals (40% vs. 73% in the British Medical Journal) and data on file more common (38% vs. 6% in the British Medical Journal). Where journal articles were obtained, 56% of claims in the wound care journals advertisements were not supported by the cited article, compared with 12% of claims in the British Medical Journal. The wound journals advertised predominantly medical devices. The use and accuracy of referencing in advertisements from wound care journals was poor. Nurses have increasing responsibilities for the prescribing of both drugs and devices, which must be accompanied by the ability to interpret marketing materials and research evidence critically. Nurse educators must ensure that nurse education generally and nurse prescriber training particularly, builds skills of

Anticancer effects of Ganoderma lucidum: a review of scientific evidence.

Science.gov (United States)

Yuen, John W M; Gohel, Mayur Danny I

2005-01-01

"Lingzhi" (Ganoderma lucidum), a popular medicinal mushroom, has been used in China for longevity and health promotion since ancient times. Investigations into the anticancer activity of lingzhi have been performed in both in vitro and in vivo studies, supporting its application for cancer treatment and prevention. The proposed anticancer activity of lingzhi has prompted its usage by cancer patients. It remains debatable as to whether lingzhi is a food supplement for health maintenance or actually a therapeutic "drug" for medical proposes. Thus far there has been no report of human trials using lingzhi as a direct anticancer agent, despite some evidence showing the usage of lingzhi as a potential supplement to cancer patients. Cellular immune responses and mitogenic reactivity of cancer patients have been enhanced by lingzhi, as reported in two randomized and one nonrandomized trials, and the quality of life of 65% of lung cancer patients improved in one study. The direct cytotoxic and anti-angiogenesis mechanisms of lingzhi have been established by in vitro studies; however, clinical studies should not be neglected to define the applicable dosage in vivo. At present, lingzhi is a health food supplement to support cancer patients, yet the evidence supporting the potential of direct in vivo anticancer effects should not be underestimated. Lingzhi or its products can be classified as an anticancer agent when current and more direct scientific evidence becomes available.

The Acute Relationships Between Affect, Physical Feeling States, and Physical Activity in Daily Life: A Review of Current Evidence

OpenAIRE

Liao, Yue; Shonkoff, Eleanor T.; Dunton, Genevieve F.

2015-01-01

Until recently, most studies investigating the acute relationships between affective and physical feeling states and physical activity were conducted in controlled laboratory settings, whose results might not translate well to everyday life. This review was among the first attempts to synthesize current evidence on the acute (e.g., within a few hours) relationships between affective and physical feeling states and physical activity from studies conducted in free-living, naturalistic settings ...

Evidence accumulation as a model for lexical selection.

Science.gov (United States)

Anders, R; Riès, S; van Maanen, L; Alario, F X

2015-11-01

We propose and demonstrate evidence accumulation as a plausible theoretical and/or empirical model for the lexical selection process of lexical retrieval. A number of current psycholinguistic theories consider lexical selection as a process related to selecting a lexical target from a number of alternatives, which each have varying activations (or signal supports), that are largely resultant of an initial stimulus recognition. We thoroughly present a case for how such a process may be theoretically explained by the evidence accumulation paradigm, and we demonstrate how this paradigm can be directly related or combined with conventional psycholinguistic theory and their simulatory instantiations (generally, neural network models). Then with a demonstrative application on a large new real data set, we establish how the empirical evidence accumulation approach is able to provide parameter results that are informative to leading psycholinguistic theory, and that motivate future theoretical development. Copyright © 2015 Elsevier Inc. All rights reserved.

[Insufficient evidence supporting iron supplementation in anaemia during pregnancy].

Science.gov (United States)

Wiegerinck, Melanie M; Mol, Ben Willem J

2012-01-01

The Royal Dutch Organization of Midwives (KNOV) recently presented their practice guideline 'Anaemia in midwifery practice'. The guideline identified available evidence on diagnosis, prognosis and treatment of anaemia in pregnancy. Anaemia based on iron deficiency and subsequent treatment with iron supplementation are probably the most frequent aspects of care for pregnant women. However, there is surprisingly enough no evidence of the efficacy of iron supplementation treatment on relevant clinical outcomes in pregnant women with anaemia. We plead to make the next guideline a multidisciplinary one. Such a guideline may lead to a large pragmatic trial evaluating the efficacy of iron supplementation treatment for patients with anaemia.

Current evidence of methotrexate efficacy in childhood chronic uveitis: a systematic review and meta-analysis approach.

Science.gov (United States)

Simonini, Gabriele; Paudyal, Priyamvada; Jones, Gareth T; Cimaz, Rolando; Macfarlane, Gary J

2013-05-01

To summarize evidence regarding the effectiveness of MTX in the treatment of childhood autoimmune chronic uveitis (ACU). A systematic search of articles between January 1990 and June 2011 was conducted using EMBASE, Ovid MEDLINE, Evidence-Based Medicine Reviews-ACP Journal Club, the Cochrane Library and EBM Reviews. Studies investigating the efficacy of MTX as a single immunosuppressant medication in the treatment of ACU refractory to therapy with topical treatment and/or systemic treatment in children (≤16 years) were eligible for inclusion. The primary outcome measure was the improvement of intraocular inflammation, expressed as Tyndall, as defined by the Standardization of Uveitis Nomenclature working group criteria. The effect measure for each study was the proportion of people classified as responders. We determined a combined estimate of the proportion of children in the eligible studies responding to MTX. The initial search identified 246 articles of which 52 were potentially eligible. Nine eligible articles, all retrospective chart reviews, remained in the analysis. The number of children in studies ranged from 3 to 25, and the dose of MTX varied from 7.5 to 30 mg/m2. Altogether, 95 of 135 children responded to MTX. The pooled analysis suggested that MTX has a favourable effect in the improvement of intraocular inflammation: the proportion of responding subjects was 0.73 (95% CI 0.66, 0.81). Although randomized controlled trials are needed, the available evidence supports the use of MTX in the treatment of childhood ACU: approximately three-quarters of patients on MTX can expect improvement in intraocular inflammation.

Adoption of Evidence-Based Practices Among Substance Abuse Treatment Providers*

Science.gov (United States)

Haug, Nancy A.; Shopshire, Michael; Tajima, Barbara; Gruber, Valerie; Guydish, Joseph

2009-01-01

This research was conducted at a Substance Abuse Forum designed to address local community needs by focusing on Evidence-Based Practices (EBPs) in addiction treatment. The purpose of the study was to assess substance abuse treatment professionals’ readiness to adopt EBPs, experience with EBPs, and attitudes toward EBPs, as well as agency support for EBPs. A total of 119 addiction treatment providers completed pre-test measures, and 82% completed a post-test. Eighty-three percent of participants reported using some EBPs in the past year, and 75% reported currently using EBPs. Participants who were currently licensed or certified in addictions had less negative attitudes toward EBPs than those without credentials. While respondents reported agency support for EBPs, most expressed interest in further training. This study underscores the movement toward EBPs in addiction treatment and the need for effective dissemination and training in this area. PMID:18724657

A pulsed eddy current probe for inspection of support plates from within Alloy-800 steam generator tubes

International Nuclear Information System (INIS)

Krause, T. W.; Babbar, V. K.; Underhill, P. R.

2014-01-01

Support plate degradation and fouling in nuclear steam generators (SGs) can lead to SG tube corrosion and loss of efficiency. Inspection and monitoring of these conditions can be integrated with preventive maintenance programs, thereby advancing station-life management processes. A prototype pulsed eddy current (PEC) probe, targeting inspection issues associated with SG tubes in SS410 tube support plate structures, has been developed using commercial finite element (FE) software. FE modeling was used to identify appropriate driver and pickup coil configurations for optimum sensitivity to changes in gap and offset for Alloy-800 SG tubes passing through 25 mm thick SS410 support plates. Experimental measurements using a probe that was manufactured based on the modeled configuration, were used to confirm the sensitivity of differential PEC signals to changes in relative position of the tube within the tube support plate holes. Models investigated the effect of shift and tilt of tube with respect to hole centers. Near hole centers and for small shifts, modeled signal amplitudes from the differentially connected coil pairs were observed to change linearly with tube shift. This was in agreement with experimentally measured TEC coil response. The work paves the way for development of a system targeting the inspection and evaluation of support plate structures in steam generators

A pulsed eddy current probe for inspection of support plates from within Alloy-800 steam generator tubes

Science.gov (United States)

Krause, T. W.; Babbar, V. K.; Underhill, P. R.

2014-02-01

Support plate degradation and fouling in nuclear steam generators (SGs) can lead to SG tube corrosion and loss of efficiency. Inspection and monitoring of these conditions can be integrated with preventive maintenance programs, thereby advancing station-life management processes. A prototype pulsed eddy current (PEC) probe, targeting inspection issues associated with SG tubes in SS410 tube support plate structures, has been developed using commercial finite element (FE) software. FE modeling was used to identify appropriate driver and pickup coil configurations for optimum sensitivity to changes in gap and offset for Alloy-800 SG tubes passing through 25 mm thick SS410 support plates. Experimental measurements using a probe that was manufactured based on the modeled configuration, were used to confirm the sensitivity of differential PEC signals to changes in relative position of the tube within the tube support plate holes. Models investigated the effect of shift and tilt of tube with respect to hole centers. Near hole centers and for small shifts, modeled signal amplitudes from the differentially connected coil pairs were observed to change linearly with tube shift. This was in agreement with experimentally measured TEC coil response. The work paves the way for development of a system targeting the inspection and evaluation of support plate structures in steam generators.

The care unit in nursing home research: evidence in support of a definition.

Science.gov (United States)

Estabrooks, Carole A; Morgan, Debra G; Squires, Janet E; Boström, Anne-Marie; Slaughter, Susan E; Cummings, Greta G; Norton, Peter G

2011-04-14

Defining what constitutes a resident care unit in nursing home research is both a conceptual and practical challenge. The aim of this paper is to provide evidence in support of a definition of care unit in nursing homes by demonstrating: (1) its feasibility for use in data collection, (2) the acceptability of aggregating individual responses to the unit level, and (3) the benefit of including unit level data in explanatory models. An observational study design was used. Research (project) managers, healthcare aides, care managers, nursing home administrators and directors of care from thirty-six nursing homes in the Canadian prairie provinces of Alberta, Saskatchewan and Manitoba provided data for the study. A definition of care unit was developed and applied in data collection and analyses. A debriefing session was held with research managers to investigate their experiences with using the care unit definition. In addition, survey responses from 1258 healthcare aides in 25 of the 36 nursing homes in the study, that had more than one care unit, were analyzed using a multi-level modeling approach. Trained field workers administered the Alberta Context Tool (ACT), a 58-item self-report survey reflecting 10 organizational context concepts, to healthcare aides using computer assisted personal interviews. To assess the appropriateness of obtaining unit level scores, we assessed aggregation statistics (ICC(1), ICC(2), η², and ω²), and to assess the value of using the definition of unit in explanatory models, we performed multi-level modeling. In 10 of the 36 nursing homes, the care unit definition developed was used to align the survey data (for analytic purposes) to specific care units as designated by our definition, from that reported by the facility administrator. The aggregation statistics supported aggregating the healthcare aide responses on the ACT to the realigned unit level. Findings from the multi-level modeling further supported unit level aggregation. A

Practical considerations on the introduction of sacubitril/valsartan in clinical practice: Current evidence and early experience.

Science.gov (United States)

Farmakis, Dimitrios; Bistola, Vassiliki; Karavidas, Apostolos; Parissis, John

2016-11-15

The combination of neprilysin inhibitor sacubitril with the angiotensin II receptor 1 blocker valsartan is the first agent from the angiotensin receptor neprilysin inhibitors (ARNI) class authorized for clinical use in heart failure (HF) patients with reduced ejection fraction (HFrEF). Sacubitril/valsartan resulted in 20% reduction in the incidence rate of death or HF hospitalization compared to enalapril in symptomatic HFrEF patients in the seminal PARADIGM-HF trial. As a result, the recently updated European and American HF guidelines granted this agent a class IB indication for the treatment of ambulatory/chronic symptomatic HFrEF patients. However, translating the positive results of trials into true clinical benefit is often challenging. This is particularly true in the case of sacubitril/valsartan, as HF is a heterogeneous syndrome including many severely ill patients who are prone to decompensation, while this new agent comes to replace a cornerstone of current evidence-based HF therapy. In the present paper, we address a number of practical issues regarding the introduction of sacubitril/valsartan and propose an algorithm based on available evidence and early clinical experience. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

A novel transient rotor current control scheme of a doubly-fed induction generator equipped with superconducting magnetic energy storage for voltage and frequency support

Science.gov (United States)

Shen, Yang-Wu; Ke, De-Ping; Sun, Yuan-Zhang; Daniel, Kirschen; Wang, Yi-Shen; Hu, Yuan-Chao

2015-07-01

A novel transient rotor current control scheme is proposed in this paper for a doubly-fed induction generator (DFIG) equipped with a superconducting magnetic energy storage (SMES) device to enhance its transient voltage and frequency support capacity during grid faults. The SMES connected to the DC-link capacitor of the DFIG is controlled to regulate the transient dc-link voltage so that the whole capacity of the grid side converter (GSC) is dedicated to injecting reactive power to the grid for the transient voltage support. However, the rotor-side converter (RSC) has different control tasks for different periods of the grid fault. Firstly, for Period I, the RSC injects the demagnetizing current to ensure the controllability of the rotor voltage. Then, since the dc stator flux degenerates rapidly in Period II, the required demagnetizing current is low in Period II and the RSC uses the spare capacity to additionally generate the reactive (priority) and active current so that the transient voltage capability is corroborated and the DFIG also positively responds to the system frequency dynamic at the earliest time. Finally, a small amount of demagnetizing current is provided after the fault clearance. Most of the RSC capacity is used to inject the active current to further support the frequency recovery of the system. Simulations are carried out on a simple power system with a wind farm. Comparisons with other commonly used control methods are performed to validate the proposed control method. Project supported by the National Natural Science Foundation of China (Grant No. 51307124) and the Major Program of the National Natural Science Foundation of China (Grant No. 51190105).

Social support and leisure-time physical activity: longitudinal evidence from the Brazilian Pró-Saúde cohort study

Directory of Open Access Journals (Sweden)

Werneck Guilherme L

2011-07-01

Full Text Available Abstract Background Although social support has been observed to exert a beneficial influence on leisure-time physical activity (LTPA, multidimensional approaches examining social support and prospective evidence of its importance are scarce. The purpose of this study was to investigate how four dimensions of social support affect LTPA engagement, maintenance, type, and time spent by adults during a two-year follow-up. Methods This paper reports on a longitudinal study of 3,253 non-faculty public employees at a university in Rio de Janeiro (the Pró-Saúde study. LTPA was evaluated using a dichotomous question with a two-week reference period, and further questions concerning LTPA type (individual or group and time spent on the activity. Social support was measured by the Medical Outcomes Study Social Support Scale (MOS-SSS. To assess the association between social support and LTPA, two different statistical models were used: binary and multinomial logistic regression models for dichotomous and polytomous outcomes, respectively. Models were adjusted separately for those who began LTPA in the middle of the follow up (engagement group and for those who had maintained LTPA since the beginning of the follow up (maintenance group. Results After adjusting for confounders, statistically significant associations (p Conclusions All dimensions of social support influenced LTPA type or the time spent on the activity. However, our findings suggest that social support is more important in engagement than in maintenance. This finding is important, because it suggests that maintenance of LTPA must be associated with other factors beyond the individual's level of social support, such as a suitable environment and social/health policies directed towards the practice of LTPA.

Fracture flow modelling. Proof of evidence

International Nuclear Information System (INIS)

Hencher, S.R.

1996-01-01

Proof of Evidence by an expert witness is presented in support of the case by Friends of the Earth (FOE) against the proposed construction by UK Nirex Ltd of an underground Rock Characterisation Facility (RCF) at a site in the Sellafield area. The RCF is part of an investigation by Nirex into a suitable site for an underground repository for the disposal of radioactive waste. The objections were raised at a Planning Inquiry in 1995. The evidence points out that current understanding of the factors which control flow through a network of interconnecting fractures, such as that at the Sellafield site, is at a very early stage of development. Neither are the methods of investigation and analysis required for a post-closure performance assessment (PCPA) for a repository well developed. These issues are being investigated in international underground research laboratories but the proposed RCF is intended to be confirmatory rather than experimental. (23 references). (UK)

Danish evidence-based clinical guideline for use of nutritional support in pulmonary rehabilitation of undernourished patients with stable COPD.

Science.gov (United States)

Beck, Anne Marie; Iepsen, Ulrik Winning; Tobberup, Randi; Jørgensen, Karsten Juhl

2015-02-01

Disease-related under-nutrition is a common problem in individuals with COPD. The rationale for nutritional support in pulmonary rehabilitation therefore seems obvious. However there is limited evidence regarding the patient-relevant outcomes i.e. activities of daily living (ADL) or quality of life. Therefore the topic was included in The Danish Health and Medicines Authority's development of an evidence-based clinical guideline for rehabilitation of patients with stable COPD. The methods were specified by The Danish Health and Medicines Authority as part of a standardized approach to evidence-based national clinical practice guidelines. They included formulation of a PICO with pre-defined criteria for the Population, Intervention, Control and Outcomes. Existing guidelines or systematic reviews were used after assessment using the AGREE II tool or AMSTAR, if possible. We identified primary studies by means of a systematic literature search (July to December 2013), and any identified studies were then quality assessed using the Cochrane risk of bias tool and the GRADE approach. The extracted data on our pre-defined outcomes were summarized in meta-analyses when possible, or meta-analyses from existing guidelines or systematic reviews were adapted. The results were used for labeling and wording of the recommendations. Data from 12 randomized controlled trials were included in a systematic review, which formed the basis for our recommendations as no new primary studies had been published. There were evidence of moderate quality that nutritional support for undernourished patients with COPD lead to a weight gain of 1.7kg (95% confidence interval: 1.3 to 2.2kg), but the effect was quantified as a mean change from baseline, which is less reliable. There were evidence of moderate quality that nutritional therapy does not increase in the 6 minute walking distance of 13 m (95% confidence interval: -27 to 54 m) when results in the intervention and control groups were

The ARSQ: the athletes' received support questionnaire.

Science.gov (United States)

Freeman, Paul; Coffee, Pete; Moll, Tjerk; Rees, Tim; Sammy, Nadine

2014-04-01

To address calls for context-specific measurement of social support, this article reports the development of the Athletes' Received Support Questionnaire (ARSQ) and demonstrates initial evidence for its validity. Across four studies there was support for a four-dimensional structure reflecting emotional, esteem, informational, and tangible received support. There was also support for unidimensional and higher-order models. Further, Study 3 provided some support for convergent validity, with significant correlations between the corresponding dimensions of the ARSQ and the Inventory of Socially Supportive Behaviors. Study 4 provided evidence for the nomological validity of the ARSQ. Emotional and esteem support significantly predicted self-confidence and positive affect, and tangible support significantly moderated the relationship between stress and negative affect. Collectively, these results provide initial evidence for the validity of the ARSQ, and offer researchers flexibility to adopt either a multidimensional or aggregated approach to measuring received support.

Standard and biological treatment in large vessel vasculitis: guidelines and current approaches.

Science.gov (United States)

Muratore, Francesco; Pipitone, Nicolò; Salvarani, Carlo

2017-04-01

Giant cell arteritis and Takayasu arteritis are the two major forms of idiopathic large vessel vasculitis. High doses of glucocorticoids are effective in inducing remission in both conditions, but relapses and recurrences are common, requiring prolonged glucocorticoid treatment with the risk of the related adverse events. Areas covered: In this article, we will review the standard and biological treatment strategies in large vessel vasculitis, and we will focus on the current approaches to these diseases. Expert commentary: The results of treatment trials with conventional immunosuppressive agents such as methotrexate, azathioprine, mycophenolate mofetil, and cyclophosphamide have overall been disappointing. TNF-α blockers are ineffective in giant cell arteritis, while observational evidence and a phase 2 randomized trial support the use of tocilizumab in relapsing giant cell arteritis. Observational evidence strongly supports the use of anti-TNF-α agents and tocilizumab in Takayasu patients with relapsing disease. However biological agents are not curative, and relapses remain common.

Role of Ureaplasma Respiratory Tract Colonization in BPD Pathogenesis: Current Concepts and Update

Science.gov (United States)

Viscardi, Rose Marie; Kallapur, Suhas G.

2015-01-01

SYNOPSIS Respiratory tract colonization with the genital mycoplasma species Ureaplasma parvum and U. urealyticum in preterm infants is a significant risk factor for BPD. Recent studies of the ureaplasmal genome, animal infection models, and human infants have provided a better understanding of specific virulence factors, pathogen-host interactions, and variability in genetic susceptibility that contribute to chronic infection, inflammation, and altered lung development. This review will provide an update on the current evidence supporting a causal role of Ureaplasma infection in BPD pathogenesis. The current status of antibiotic trials to prevent BPD in Ureaplasma-infected preterm infants is also reviewed. PMID:26593075

Evidence and evidence gaps - an introduction.

Science.gov (United States)

Dreier, Gabriele; Löhler, Jan

2016-01-01

, databases, information portals with processed evidence as well as specific journals and finally teaching are appropriate vehicles. One problem is the multitude of information so that knowledge gaps may affect the clinical routine despite actually existing evidence. Generally, it still takes several years until new knowledge is implemented in daily routine. Tasks: The German Society of Oto-Rhino-Laryngology, Head and Neck Surgery (Deutsche Gesellschaft für Hals-, Nasen- und Ohren-Heilkunde, Kopf- und Hals-Chirurgie e.V., DGHNOKHC) and the Professional Association of Otolaryngologists (Deutscher Berufsverband der HNO-Ärzte e.V., BVHNO) have fundamental interest in supporting their members in generating, processing, and providing evidence as well as accompanying knowledge transfer. It encompasses the fields of diagnostics, therapy, and prognosis in the same way as prevention and applies to medicinal products as well as to medical devices or surgical procedures. The base for this is the regular assessment of evidence gaps, also in the area of established procedures, that has to be followed by a prioritization of research questions and the subsequent initiation of clinical research. In addition, large trials verifying therapies and diagnostics, for example in the context of daily conditions after approval, can only be conducted combining all resources in the ENT community. Method, results, and outlook: Together, the executive committees of the DGHNOKHC and the BVHNO founded the German Study Center of Oto-Rhino-Laryngology, Head and Neck Surgery (Deutsches Studienzentrum für Hals-, Nasen- und Ohren-Heilkunde, Kopf- und Hals-Chirurgie, DSZ-HNO). First projects have been initiated, among those a clinical trial on the therapy of sudden hearing loss supported by the BMBF and a survey on evidence gaps in oto-rhino-laryngology. It seems to be both reasonable and feasible to make available methodological expertise via such an infrastructure of a study center for physicians in

Supporting Evidence Use in Networked Professional Learning: The Role of the Middle Leader

Science.gov (United States)

LaPointe-McEwan, Danielle; DeLuca, Christopher; Klinger, Don A.

2017-01-01

Background: In Canada, contemporary collaborative professional learning models for educators utilise multiple forms of evidence to inform practice. Commonly, two forms of evidence are prioritised: (a) research-based evidence and (b) classroom-based evidence of student learning. In Ontario, the integration of these two forms of evidence within…

Self-Management Support Interventions for Stroke Survivors: A Systematic Meta-Review.

Directory of Open Access Journals (Sweden)

Hannah L Parke

Full Text Available There is considerable policy interest in promoting self-management in patients with long-term conditions, but it remains uncertain whether these interventions are effective in stroke patients.Systematic meta-review of the evidence for self-management support interventions with stroke survivors to inform provision of healthcare services.We searched MEDLINE, EMBASE, CINAHL, PsychINFO, AMED, BNI, Database of Abstracts of Reviews for Effectiveness, and Cochrane Database of Systematic Reviews for systematic reviews of self-management support interventions for stroke survivors. Quality was assessed using the R-AMSTAR tool, and data extracted using a customised data extraction form. We undertook a narrative synthesis of the reviews' findings.From 12,400 titles we selected 13 systematic reviews (published 2003-2012 representing 101 individual trials. Although the term 'self-management' was rarely used, key elements of self-management support such as goal setting, action planning, and problem solving were core components of therapy rehabilitation interventions. We found high quality evidence that supported self-management in the context of therapy rehabilitation delivered soon after the stroke event resulted in short-term (< 1 year improvements in basic and extended activities of daily living, and a reduction in poor outcomes (dependence/death. There is some evidence that rehabilitation and problem solving interventions facilitated reintegration into the community.Self-management terminology is rarely used in the context of stroke. However, therapy rehabilitation currently successfully delivers elements of self-management support to stroke survivors and their caregivers with improved outcomes. Future research should focus on managing the emotional, medical and social tasks of long-term survivorship.

Supporting middle school students' construction of evidence-based arguments: Impact of and student interactions with computer-based argumentation scaffolds

Science.gov (United States)

Belland, Brian Robert

Middle school students have difficulty creating evidence-based arguments (EBAs) during problem-based learning (PBL) units due to challenges (a) adequately representing the unit's central problem (Ge & Land, 2004; Liu & Bera, 2005), (b) determining and obtaining the most relevant evidence (Pedersen & Liu, 2002-2003), and (c) synthesizing gathered information to construct a sound argument (Cho & Jonassen, 2002). I designed and developed the Connection Log to support middle school students in this process. This study addressed (1) the Connection Log's impact on (a) argument evaluation ability, and (b) group argument quality and (2) how and why middle school science students used the Connection Log. Four sections of a 7th-grade science class participated. Student groups selected a stakeholder position related to the Human Genome Project (HGP) and needed to decide on and promote a plan to use $3 million to further their position as pertains to the HGP. I randomly assigned one higher-achieving and one lower-achieving class to Connection Log or no Connection Log conditions. Students completed an argument evaluation test, and impact on argument evaluation ability was determined using nested ANOVA. Two graduate students, blind to treatment conditions, rated group arguments, and impact on group argument quality was determined using nested MANOVA. To determine how and why students used the Connection Log, I videotaped and interviewed one small group from each class in the experimental condition. I coded transcripts and generated themes, triangulating the two data sources with informal observations during all class sessions and what students wrote in the Connection Log. I detected no significant differences on claim, evidence, or connection of claim to evidence ratings of debate performances. However, students used the Connection Log to counter different difficulties, and I found a significant main effect of the Connection Log on argument evaluation ability, as well as a

Extraperitoneal Robotic-Assisted Para-Aortic Lymphadenectomy in Gynecologic Cancer Staging: Current Evidence.

Science.gov (United States)

Bogani, Giorgio; Ditto, Antonino; Martinelli, Fabio; Signorelli, Mauro; Chiappa, Valentina; Sabatucci, Ilaria; Scaffa, Cono; Lorusso, Domenica; Raspagliesi, Francesco

2016-01-01

We reviewed the current evidence on the safety, effectiveness, and applicability of extraperitoneal robotic-assisted para-aortic lymphadenectomy (ExtRA-PAL) as the staging procedure of gynecologic malignancies. PubMed (MEDLINE), Scopus, Web of Science databases, and ClinicalTrials.gov were searched for original studies reporting outcomes of ExtRA-PAL. Quality of the included studies and their level of recommendation were assessed using the Grading of Recommendations, Assessment, Development, and Evaluation and the American College of Obstetricians and Gynecologists guidelines, respectively. Overall, 62 studies were identified; after a process of evidence acquisition 5 original investigations were available for this review that included 98 patients undergoing ExtRA-PAL. The main surgical indication was staging for cervical cancer (n = 71, 72%). The mean (SD) number of para-aortic node yielded was 15.4 (±4.7) nodes. Blood transfusion and intraoperative complication rates were 2% and 6%, respectively. ExtRA-PAL was completed in 88 patients (90%). Six (6%) and 4 (4%) patients had conversion to other minimally invasive procedures and open surgery, respectively. Success rate was 99% among patients undergoing ExtRA-PAL without concomitant procedures. Overall, mean (SD) length of hospital stay was 2.8 (±0.5) days. Twenty-four patients (24%) developed postoperative events. According to the Clavien-Dindo grading system, grades IIIa and IIIb morbidity rates were 12% and 2%, respectively. No grades IV and V morbidity occurred. ExtRA-PAL is associated with a high success rate and a relative low morbidity rate. However, because of the limited data on this issue, further studies are warranted to assess the long-term effectiveness of this procedure. Copyright © 2016 AAGL. Published by Elsevier Inc. All rights reserved.

Complementary medicines (herbal and nutritional products) in the treatment of Attention Deficit Hyperactivity Disorder (ADHD): a systematic review of the evidence.

Science.gov (United States)

Sarris, Jerome; Kean, James; Schweitzer, Isaac; Lake, James

2011-08-01

Complementary and Alternative Medicines (CAMs) are frequently given to children and adolescents for reputed benefits in the treatment of hyperkinetic and concentration disorders such as Attention Deficit Hyperactivity Disorder (ADHD). In such vulnerable populations high quality evidence is required to support such claims. The aim of the paper is to assess the current evidence of herbal and nutritional interventions for ADHD using a systematic search of clinical trials meeting an acceptable standard of evidence. PubMed, PsycINFO, Cochrane Library and CINAHL were searched up to May 26th, 2011 for randomised, controlled clinical trials using CAM products as interventions to treat ADHD. A quality analysis using a purpose-designed scale, and an estimation of effect sizes (Cohen's d) where data were available, were also calculated. The review revealed that 16 studies met inclusion criteria, with predominant evidentiary support found for zinc, iron, Pinus marinus (French maritime pine bark), and a Chinese herbal formula (Ningdong); and mixed (mainly inconclusive) evidence for omega-3, and l-acetyl carnitine. Current data suggest that Ginkgo biloba (ginkgo), and Hypercium perforatum (St. John's wort) are ineffective in treating ADHD. The research suggests only some CAMs may be beneficial in ADHD, thus clinicians need to be aware of the current evidence. Promising candidates for future research include Bacopa monniera (brahmi) and Piper methysticum (kava), providing potential efficacy in improving attentional and hyperkinetic disorders via a combination of cognitive enhancing and sedative effects. Copyright © 2011 Elsevier Ltd. All rights reserved.

The link between motor and cognitive development in children born preterm and/or with low birth weight : A review of current evidence

NARCIS (Netherlands)

Oudgenoeg-Paz, Ora; Mulder, Hanna; Jongmans, Marian J.; van der Ham, Ineke J.M.; Van der Stigchel, Stefan

2017-01-01

The current review focuses on evidence for a link between early motor development and later cognitive skills in children born preterm or with Low Birth Weight (LBW). Studies with term born children consistently show such a link. Motor and cognitive impairments or delays are often seen in children

Professional Development for Sessional Staff in Higher Education: A Review of Current Evidence

Science.gov (United States)

Hitch, Danielle; Mahoney, Paige; Macfarlane, Susie

2018-01-01

The aim of this study was to provide an integrated review of evidence published in the past decade around professional development for sessional staff in higher education. Using the Integrating Theory, Evidence and Action method, the review analysed recent evidence using the three principles of the Benchmarking Leadership and Advancement of…

The Healthcare Improvement Scotland evidence note rapid review process: providing timely, reliable evidence to inform imperative decisions on healthcare.

Science.gov (United States)

McIntosh, Heather M; Calvert, Julie; Macpherson, Karen J; Thompson, Lorna

2016-06-01

Rapid review has become widely adopted by health technology assessment agencies in response to demand for evidence-based information to support imperative decisions. Concern about the credibility of rapid reviews and the reliability of their findings has prompted a call for wider publication of their methods. In publishing this overview of the accredited rapid review process developed by Healthcare Improvement Scotland, we aim to raise awareness of our methods and advance the discourse on best practice. Healthcare Improvement Scotland produces rapid reviews called evidence notes using a process that has achieved external accreditation through the National Institute for Health and Care Excellence. Key components include a structured approach to topic selection, initial scoping, considered stakeholder involvement, streamlined systematic review, internal quality assurance, external peer review and updating. The process was introduced in 2010 and continues to be refined over time in response to user feedback and operational experience. Decision-makers value the responsiveness of the process and perceive it as being a credible source of unbiased evidence-based information supporting advice for NHSScotland. Many agencies undertaking rapid reviews are striving to balance efficiency with methodological rigour. We agree that there is a need for methodological guidance and that it should be informed by better understanding of current approaches and the consequences of different approaches to streamlining systematic review methods. Greater transparency in the reporting of rapid review methods is essential to enable that to happen.

The diagnosis of male infertility: an analysis of the evidence to support the development of global WHO guidance-challenges and future research opportunities.

Science.gov (United States)

Barratt, Christopher L R; Björndahl, Lars; De Jonge, Christopher J; Lamb, Dolores J; Osorio Martini, Francisco; McLachlan, Robert; Oates, Robert D; van der Poel, Sheryl; St John, Bianca; Sigman, Mark; Sokol, Rebecca; Tournaye, Herman

2017-11-01

Herein, we describe the consensus guideline methodology, summarize the evidence-based recommendations we provided to the World Health Organization (WHO) for their consideration in the development of global guidance and present a narrative review of the diagnosis of male infertility as related to the eight prioritized (problem or population (P), intervention (I), comparison (C) and outcome(s) (O) (PICO)) questions. Additionally, we discuss the challenges and research gaps identified during the synthesis of this evidence. The aim of this paper is to present an evidence-based approach for the diagnosis of male infertility as related to the eight prioritized PICO questions. Collating the evidence to support providing recommendations involved a collaborative process as developed by WHO, namely: identification of priority questions and critical outcomes; retrieval of up-to-date evidence and existing guidelines; assessment and synthesis of the evidence; and the formulation of draft recommendations to be used for reaching consensus with a wide range of global stakeholders. For each draft recommendation the quality of the supporting evidence was then graded and assessed for consideration during a WHO consensus. Evidence was synthesized and recommendations were drafted to address the diagnosis of male infertility specifically encompassing the following: What is the prevalence of male infertility and what proportion of infertility is attributable to the male? Is it necessary for all infertile men to undergo a thorough evaluation? What is the clinical (ART/non ART) value of traditional semen parameters? What key male lifestyle factors impact on fertility (focusing on obesity, heat and tobacco smoking)? Do supplementary oral antioxidants or herbal therapies significantly influence fertility outcomes for infertile men? What are the evidence-based criteria for genetic screening of infertile men? How does a history of neoplasia and related treatments in the male impact on (his and

The 'antisocial' person: an insight in to biology, classification and current evidence on treatment

Directory of Open Access Journals (Sweden)

Rajapakse Senaka

2010-07-01

Full Text Available Abstract Background This review analyses and summarises the recent advances in understanding the neurobiology of violence and empathy, taxonomical issues on defining personality disorders characterised by disregard for social norms, evidence for efficacy of different treatment modalities and ethical implications in defining 'at-risk' individuals for preventive interventions. Methods PubMed was searched with the keywords 'antisocial personality disorder', 'dissocial personality disorder' and 'psychopathy'. The search was limited to articles published in English over the last 10 years (1999 to 2009 Results Both diagnostic manuals used in modern psychiatry, the Diagnostic and Statistical Manual published by the American Psychiatric Association and the International Classification of Diseases published by the World Health Organization, identify a personality disorder sharing similar traits. It is termed antisocial personality disorder in the diagnostic and statistical manual and dissocial personality disorder in the International Classification of Diseases. However, some authors query the ability of the existing manuals to identify a special category termed 'psychopathy', which in their opinion deserves special attention. On treatment-related issues, many psychological and behavioural therapies have shown success rates ranging from 25% to 62% in different cohorts. Multisystemic therapy and cognitive behaviour therapy have been proven efficacious in many trials. There is no substantial evidence for the efficacy of pharmacological therapy. Currently, the emphasis is on early identification and prevention of antisocial behaviour despite the ethical implications of defining at-risk children. Conclusions Further research is needed in the areas of neuroendocrinological associations of violent behaviour, taxonomic existence of psychopathy and efficacy of treatment modalities.

Respiratory medicines for children: current evidence, unlicensed use and research priorities

DEFF Research Database (Denmark)

Smyth, A R; Barbato, A; Beydon, N

2010-01-01

deficiency. We hope that this summary of the evidence for respiratory medicines in children, highlighting gaps and research priorities, will be useful for the pharmaceutical industry, the paediatric committee of the European Medicines Agency, academic investigators and the lay public.......This European Respiratory Society task force has reviewed the evidence for paediatric medicines in respiratory disease occurring in adults and children. We describe off-licence use, research priorities and ongoing studies. Off-licence and off-label prescribing in children is widespread...

Current evidence for the use of N-acetylcysteine following liver resection.

Science.gov (United States)

Kemp, Richard; Mole, Jonathan; Gomez, Dhanny

2017-11-13

N-acetylcysteine (NAC) has many uses in medicine; notable in the management of paracetamol toxicity, acute liver failure and liver surgery. The aim of this review was to critically appraise the published literature for the routine use of NAC in liver resection surgery. An electronic search was performed of EBSCOhost (Medline and CINAHL database), PubMed and the Cochrane Library for the period 1990-2016. MeSH headings: 'acetyl-cysteine', 'liver resection' and 'hepatectomy' were used to identify all relevant articles published in English. Following the search criteria used, three articles were included. Two of these studies were randomized controlled trials. All the studies collated data on morbidity and mortality. All three studies did not show a significant difference in overall complications rates in patients that underwent hepatic resection that had NAC infusion compared with patients that did not. In one study, NAC administration was associated with a higher frequency of grade A post-hepatectomy liver failure. In another study, a significantly higher incidence of delirium was observed in the NAC group, which led to the trial to be terminated early. The current published data do not support the routine use of NAC following liver resection. © 2017 Royal Australasian College of Surgeons.

Influence of a new generation of operations support systems on current spacecraft operations philosophy: The users feedback

Science.gov (United States)

Darroy, Jean Michel

1993-01-01

Current trends in the spacecraft mission operations area (spacecraft & mission complexity, project duration, required flexibility are requiring a breakthrough for what concerns philosophy, organization, and support tools. A major evolution is related to space operations 'informationalization', i.e adding to existing operations support & data processing systems a new generation of tools based on advanced information technologies (object-oriented programming, artificial intelligence, data bases, hypertext) that automate, at least partially, operations tasks that used be performed manually (mission & project planning/scheduling, operations procedures elaboration & execution, data analysis & failure diagnosis). All the major facets of this 'informationalization' are addressed at MATRA MARCONI SPACE, operational applications were fielded and generic products are becoming available. These various applications have generated a significant feedback from the users (at ESA, CNES, ARIANESPACE, MATRA MARCONI SPACE), which is now allowing us to precisely measure how the deployment of this new generation of tools, that we called OPSWARE, can 'reengineer' current spacecraft mission operations philosophy, how it can make space operations faster, better, and cheaper. This paper can be considered as an update of the keynote address 'Knowledge-Based Systems for Spacecraft Control' presented during the first 'Ground Data Systems for Spacecraft Control' conference in Darmstadt, June 1990, with a special emphasis on these last two years users feedback.

Evidence gap maps -- a tool for promoting evidence-informed policy and prioritizing future research

OpenAIRE

Snilstveit, Birte; Vojtkova, Martina; Bhavsar, Ami; Gaarder, Marie

2013-01-01

Evidence-gap maps present a new addition to the tools available to support evidence-informed policy making. Evidence-gap maps are thematic evidence collections covering a range of issues such as maternal health, HIV/AIDS, and agriculture. They present a visual overview of existing systematic reviews or impact evaluations in a sector or subsector, schematically representing the types of int...

Revisiting reflexology: Concept, evidence, current practice, and practitioner training.

Science.gov (United States)

Embong, Nurul Haswani; Soh, Yee Chang; Ming, Long Chiau; Wong, Tin Wui

2015-10-01

Reflexology is basically a study of how one part of the human body relates to another part of the body. Reflexology practitioners rely on the reflexes map of the feet and hands to all the internal organs and other human body parts. They believe that by applying the appropriate pressure and massage certain spots on the feet and hands, all other body parts could be energized and rejuvenated. This review aimed to revisit the concept of reflexology and examine its effectiveness, practices, and the training for reflexology practitioners. PubMed, SCOPUS, Google Scholar, and SpringerLink databases were utilized to search the following medical subject headings or keywords: foot massage, reflexology, foot reflexotherapy, reflexological treatment, and zone therapy. The articles published for the last 10 years were included. Previous systematic reviews failed to show concrete evidence for any specific effect of reflexology in any conditions. Due to its non-invasive, non-pharmacological complementary nature, reflexology is widely accepted and anecdotal evidence of positive effect reflexology in a variety of health conditions are available. Adequate training for practitioners is necessary to ensure the consistency of service provided.

Revisiting reflexology: Concept, evidence, current practice, and practitioner training

Directory of Open Access Journals (Sweden)

Nurul Haswani Embong

2015-10-01

Full Text Available Reflexology is basically a study of how one part of the human body relates to another part of the body. Reflexology practitioners rely on the reflexes map of the feet and hands to all the internal organs and other human body parts. They believe that by applying the appropriate pressure and massage certain spots on the feet and hands, all other body parts could be energized and rejuvenated. This review aimed to revisit the concept of reflexology and examine its effectiveness, practices, and the training for reflexology practitioners. PubMed, SCOPUS, Google Scholar, and SpringerLink databases were utilized to search the following medical subject headings or keywords: foot massage, reflexology, foot reflexotherapy, reflexological treatment, and zone therapy. The articles published for the last 10 years were included. Previous systematic reviews failed to show concrete evidence for any specific effect of reflexology in any conditions. Due to its non-invasive, non-pharmacological complementary nature, reflexology is widely accepted and anecdotal evidence of positive effect reflexology in a variety of health conditions are available. Adequate training for practitioners is necessary to ensure the consistency of service provided.

Engaging Australian physicians in evidence-based medicine: a representative national survey.

Science.gov (United States)

Toulkidis, V; Donnelly, N J; Ward, J E

2005-01-01

To assess Australian adult physicians' views about evidence-based medicine (EBM) and quality improvement (QI). Cross-sectional postal survey of two hundred and forty-four randomly selected Australian physicians (78.5% response rate). Physicians' views about the promotion of EBM and QI and their impact on patient care, strategies to support better clinical practice and self-reported understanding of EBM terms. Sixty-eight per cent (95% confidence interval (CI): 62-74%) of physicians had a positive view of the current promotion of EBM in Australia. Significantly fewer (45%; 95% CI: 38-51%) were so positive about QI (P evidence, significantly fewer (21%; 95% CI: 17-27%) agreed they had sufficient time to do so (P Australian physicians have positive views of EBM, QI appears less well regarded. Initiatives to improve quality and safety that incorporate principles and language of EBM will likely be received better by physicians than isolated QI. Further enhancement of EBM requires concomitant attention to physician training, workplace infrastructure and supportive professional development.

Web 2.0 for health promotion: reviewing the current evidence.

Science.gov (United States)

Chou, Wen-ying Sylvia; Prestin, Abby; Lyons, Claire; Wen, Kuang-yi

2013-01-01

As Web 2.0 and social media make the communication landscape increasingly participatory, empirical evidence is needed regarding their impact on and utility for health promotion. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we searched 4 medical and social science databases for literature (2004-present) on the intersection of Web 2.0 and health. A total of 514 unique publications matched our criteria. We classified references as commentaries and reviews (n = 267), descriptive studies (n = 213), and pilot intervention studies (n = 34). The scarcity of empirical evidence points to the need for more interventions with participatory and user-generated features. Innovative study designs and measurement methods are needed to understand the communication landscape and to critically assess intervention effectiveness. To address health disparities, interventions must consider accessibility for vulnerable populations.

Evidence-based policy versus morality policy: the case of syringe access programs.

Science.gov (United States)

de Saxe Zerden, Lisa; O'Quinn, Erin; Davis, Corey

2015-01-01

Evidence-based practice (EBP) combines proven interventions with clinical experience, ethics, and client preferences to inform treatment and services. Although EBP is integrated into most aspects of social work and public health, at times EBP is at odds with social policy. In this article the authors explore the paradox of evidence-based policy using syringe access programs (SAP) as a case example, and review methods of bridging the gap between the emphasis on EBP and lack of evidence informing SAP policy. Analysis includes the overuse of morality policy and examines historical and current theories why this paradox exists. Action steps are highlighted for creating effective policy and opportunities for public health change. Strategies on reframing the problem and shifting target population focus to garner support for evidence-based policy change are included. This interdisciplinary understanding of the way in which these factors converge is a critical first step in moving beyond morality-based policy toward evidence-based policy.

Midwives' support for Complementary and Alternative Medicine: a literature review.

Science.gov (United States)

Hall, Helen G; McKenna, Lisa G; Griffiths, Debra L

2012-03-01

There is evidence that the use of Complementary and Alternative Medicine by childbearing women is becoming increasingly popular in industrialised countries. The aim of this is paper is to review the research literature investigating the midwives' support for the use of these therapies. A search for relevant research published from 2000 to 2009 was undertaken using a range of databases and by examining relevant bibliographies. A total of thirteen studies were selected for inclusion in this review. The findings indicate that the use of Complementary and Alternative Medicine is widespread in midwifery practice. Common indications for use include; labour induction and augmentation, nausea and vomiting, relaxation, back pain, anaemia, mal-presentation, perineal discomfort, postnatal depression and lactation problems. The most popular therapies recommended by midwives are massage therapy, herbal medicines, relaxation techniques, nutritional supplements, aromatherapy, homeopathy and acupuncture. Midwives support the use Complementary and Alternative Medicine because they believe it is philosophically congruent; it provides safe alternatives to medical interventions; it supports the woman's autonomy, and; incorporating Complementary and Alternative Medicine can enhance their own professional autonomy. There is considerable support by midwives for the use of Complementary and Alternative Medicine by expectant women. Despite this enthusiasm, currently there are few educational opportunities and only limited research evidence regarding CAM use in midwifery practice. These shortfalls need to be addressed by the profession. Midwives are encouraged to have an open dialogue with childbearing women, to document use and to base any advice on the best available evidence. Copyright © 2010 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

Electric Currents along Astrophysical Jets

Directory of Open Access Journals (Sweden)

Ioannis Contopoulos

2017-10-01

Full Text Available Astrophysical black holes and their surrounding accretion disks are believed to be threaded by grand design helical magnetic fields. There is strong theoretical evidence that the main driver of their winds and jets is the Lorentz force generated by these fields and their associated electric currents. Several researchers have reported direct evidence for large scale electric currents along astrophysical jets. Quite unexpectedly, their directions are not random as would have been the case if the magnetic field were generated by a magnetohydrodynamic dynamo. Instead, in all kpc-scale detections, the inferred electric currents are found to flow away from the galactic nucleus. This unexpected break of symmetry suggests that a battery mechanism is operating around the central black hole. In the present article, we summarize observational evidence for the existence of large scale electric currents and their associated grand design helical magnetic fields in kpc-scale astrophysical jets. We also present recent results of general relativistic radiation magnetohydrodynamic simulations which show the action of the Cosmic Battery in the vicinity of astrophysical black holes.

Chromium VI and stomach cancer: a meta-analysis of the current epidemiological evidence.

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Welling, Roberta; Beaumont, James J; Petersen, Scott J; Alexeeff, George V; Steinmaus, Craig

2015-02-01

Chromium VI (hexavalent chromium, Cr(VI)) is an established cause of lung cancer, but its association with gastrointestinal cancer is less clear. The goal of this study was to examine whether the current human epidemiological research on occupationally inhaled Cr(VI) supports the hypothesis that Cr(VI) is associated with human stomach cancer. Following a thorough literature search and review of individual studies, we used meta-analysis to summarise the current epidemiological literature on inhaled Cr(VI) and stomach cancer, explore major sources of heterogeneity, and assess other elements of causal inference. We identified 56 cohort and case-control studies and 74 individual relative risk (RR) estimates on stomach cancer and Cr(VI) exposure or work in an occupation associated with high Cr(VI) exposure including chromium production, chrome plating, leather work and work with Portland cement. The summary RR for all studies combined was 1.27 (95% CI 1.18 to 1.38). In analyses limited to only those studies identifying increased risks of lung cancer, the summary RR for stomach cancer was higher (RR=1.41, 95% CI 1.18 to 1.69). Overall, these results suggest that Cr(VI) is a stomach carcinogen in humans, which is consistent with the tumour results reported in rodent studies. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Restrictions on the use of e-cigarettes in public and private places-current practice and support among adults in Great Britain.

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Brose, Leonie S; McNeill, Ann; Arnott, Deborah; Cheeseman, Hazel

2017-08-01

Debates around policies regulating e-cigarette use make it important to obtain an overview of current practice, people's attitudes and correlates of policy support. Aims were to assess (i) current practices for e-cigarette use in homes and workplaces; (ii) characteristics associated with allowing e-cigarette use in the home; and (iii) level of, and characteristics associated with, support for extending smoke-free legislation to include e-cigarettes. Online survey in 2016, n = 11 389 adults in Great Britain. Descriptives for all measures; multivariable logistic regressions assessed correlates of allowing e-cigarette use and support for extension of legislation. Most (79%) reporting on workplace policies reported some level of restrictions on e-cigarette use. Small majorities would not allow e-cigarette use in their home (58%) and supported an extension of smoke-free legislation (52%; 21% opposed). Allowing use was less likely and supporting an extension more likely among men, respondents from a higher socio-economic status, ex-smokers, never-smokers, non-users of e-cigarettes and respondents with increased perceived harm of e-cigarettes or nicotine (all P e-cigarette use. Over half of adults would not allow use of e-cigarettes in their home and support prohibiting the use of e-cigarettes in smoke-free places. Adjusting for socio-demographics, more restrictive attitudes are more common among never-smokers, never-users and those with increased perception of relative harms of e-cigarettes or nicotine as cause of smoking-related illness. © The Author 2017. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

Do knowledge infrastructure facilities support Evidence-Based Practice in occupational health? An exploratory study across countries among occupational physicians enrolled on Evidence-Based Medicine courses

Directory of Open Access Journals (Sweden)

van Dijk Frank JH

2009-01-01

Full Text Available Abstract Background Evidence-Based Medicine (EBM is an important method used by occupational physicians (OPs to deliver high quality health care. The presence and quality of a knowledge infrastructure is thought to influence the practice of EBM in occupational health care. This study explores the facilities in the knowledge infrastructure being used by OPs in different countries, and their perceived importance for EBM practice. Methods Thirty-six OPs from ten countries, planning to attend an EBM course and to a large extent recruited via the European Association of Schools of Occupational Medicine (EASOM, participated in a cross-sectional study. Results Research and development institutes, and knowledge products and tools are used by respectively more than 72% and more than 80% of the OPs and they are rated as being important for EBM practice (more than 65 points (range 0–100. Conventional knowledge access facilities, like traditional libraries, are used often (69% but are rated as less important (46.8 points (range 0–100 compared to the use of more novel facilities, like question-and-answer facilities (25% that are rated as more important (48.9 points (range 0–100. To solve cases, OPs mostly use non evidence-based sources. However, they regard the evidence-based sources that are not often used, e.g. the Cochrane library, as important enablers for practising EBM. The main barriers are lack of time, payment for full-text articles, language barrier (most texts are in English, and lack of skills and support. Conclusion This first exploratory study shows that OPs use many knowledge infrastructure facilities and rate them as being important for their EBM practice. However, they are not used to use evidence-based sources in their practice and face many barriers that are comparable to the barriers physicians face in primary health care.

Evidence for neutral neutrino current coupling to right-handed quarks

International Nuclear Information System (INIS)

Allaby, J.V.; Amaldi, U.; Barbiellini, G.; Baubillier, M.; Bergsma, F.; Capone, A.; Flegel, W.; Lanceri, L.; Metcalf, M.; Nieuwenhuis, C.; Pain, R.; Panman, J.; Winter, K.; Abt, I.; Blobel, V.; Buengener, A.; Buesser, F.W.; Gall, P.D.; Hebbeker, T.; Niebergall, F.; Staehelin, P.; Borgia, B.; Diemoz, M.; Dionisi, C.; Dore, U.; Ferroni, F.; Longo, E.; Loverre, P.F.; Luminari, L.; Monacelli, P.; Morganti, S.; De Notaristefani, F.; Santacesaria, R.; Santoni, C.; Rome-1 Univ.

1989-01-01

Differential cross sections dσ/dy have been measured in semileptonic neutral- and charged-current reactions induced by neutrinos and antineutrinos. The comparison of the neutral- and the charged-current differential cross sections allows the direct determination of the chiral coupling of the neutral (νanti ν) current to left- and right-handed quarks. The result, with a value of g R 2 =0.042±0.010, is the first direct determination, with a significance of more than four standard deviations, of a non-zero value of g R . (orig.)

Mastery Motivation in Children with Intellectual Disability: Is There Evidence for a Down Syndrome Behavioural Phenotype?

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Gilmore, Linda; Cuskelly, Monica; Browning, Melissa

2015-01-01

The main purpose of the current study was to provide empirical evidence to support or refute assumptions of phenotypic deficits in motivation for children with Down syndrome (DS). Children with moderate intellectual disability (MID) associated with etiologies other than DS were recruited in an extension of a previous study that involved children…

Psychopharmacological and Other Treatments in Preschool Children with Attention-Deficit/Hyperactivity Disorder: Current Evidence and Practice

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Arnold, L. Eugene; Anthony, Bruno J.

2008-01-01

Abstract Objective This article reviews rational approaches to treating attention-deficit/hyperactivity disorder (ADHD) in preschool children, including pharmacological and nonpharmacological treatments. Implications for clinical practice are discussed. Data Sources We searched MEDLINE, PsychINFO, Cumulative Index to Nursing & Allied Health, Educational Resources Information Center, Cochrane Database of Systematic Reviews and Database of Abstracts of Reviews of Effects for relevant literature published in English from 1967 to 2007 on preschool ADHD. We also reviewed the references cited in identified reports. Study Selection Studies were reviewed if the sample included at least some children younger than 6 years of age or attending kindergarten, the study participants had a diagnosis of ADHD or equivalent symptoms, received intervention aimed at ADHD symptoms, and included a relevant outcome measure. Data Extraction Studies were reviewed for type of intervention and outcome relevant to ADHD and were rated for the level of evidence for adequacy of the data to inform clinical practice. Conclusions The current level of evidence for adequacy of empirical data to inform clinical practice for short-term treatment of ADHD in preschool children is Level A for methylphenidate and Level B for parent behavior training, child training, and additive-free elimination diet. PMID:18844482

Social networks, support and early psychosis: a systematic review.

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Gayer-Anderson, C; Morgan, C

2013-06-01

Background. There is strong evidence that those with a long-standing psychotic disorder have fewer social contacts and less social support than comparison groups. There is less research on the extent of social contacts and support prior to or at the onset of psychosis. In the light of recent evidence implicating a range of social experiences and contexts at the onset of psychosis, it is relevant to establish whether social networks and support diminished before or at the time of onset and whether the absence of such supports might contribute to risk, either directly or indirectly. We, therefore, conducted a systematic review of this literature to establish what is currently known about the relationship between social networks, support and early psychosis. Methods. We identified all studies investigating social networks and support in first episode psychosis samples and in general population samples with measures of psychotic experiences or schizotype by conducting systematic searches of electronic databases using pre-defined search terms and criteria. Findings were synthesized using non-quantitative approaches. Results. Thirty-eight papers were identified that met inclusion criteria. There was marked methodological heterogeneity, which limits the capacity to draw direct comparisons. Nonetheless, the existing literature suggests social networks (particularly close friends) and support diminished both among first episode samples and among non-clinical samples reporting psychotic experiences or with schizotype traits, compared with varying comparison groups. These differences may be more marked for men and for those from minority ethnic populations. Conclusions. Tentatively, reduced social networks and support appear to pre-date onset of psychotic disorder. However, the substantial methodological heterogeneity among the existing studies makes comparisons difficult and suggests a need for more robust and comparable studies on networks, support and early psychosis.

Cannabis and joints: scientific evidence for the alleviation of osteoarthritis pain by cannabinoids.

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O'Brien, Melissa; McDougall, Jason J

2018-04-07

Cannabis has been used for millennia to treat a multitude of medical conditions including chronic pain. Osteoarthritis (OA) pain is one of the most common types of pain and patients often turn to medical cannabis to manage their symptoms. While the majority of these reports are anecdotal, there is a growing body of scientific evidence which supports the analgesic potential of cannabinoids to treat OA pain. OA pain manifests as a combination of inflammatory, nociceptive, and neuropathic pain, each requiring modality-specific analgesics. The body's innate endocannabinoid system (ECS) has been shown to ameliorate all of these pain subtypes. This review summarizes the components of the ECS and details the latest research pertaining to plant-based and man-made cannabinoids for the treatment of OA pain. Recent pre-clinical evidence supporting a role for the ECS to control OA pain is described as well as current clinical evidence of the efficacy of cannabinoids for treating OA pain in mixed patient populations. Copyright © 2018 Elsevier Ltd. All rights reserved.

Treatment of intracerebral haemorrhage with tranexamic acid – A review of current evidence and ongoing trials

DEFF Research Database (Denmark)

Law, Zhe Kang; Meretoja, Atte; Engelter, Stefan T

2017-01-01

Purpose Haematoma expansion is a devastating complication of intracerebral haemorrhage (ICH) with no established treatment. Tranexamic acid had been an effective haemostatic agent in reducing post-operative and traumatic bleeding. We review current evidence examining the efficacy of tranexamic acid...... in improving clinical outcome after ICH. Method We searched MEDLINE, EMBASE, CENTRAL and clinical trial registers for studies using search strategies incorporating the terms ‘intracerebral haemorrhage’, ‘tranexamic acid’ and ‘antifibrinolytic’. Authors of ongoing clinical trials were contacted for further...... details. Findings We screened 268 publications and retrieved 17 articles after screening. Unpublished information from three ongoing clinical trials was obtained. We found five completed studies. Of these, two randomised controlled trials (RCTs) comparing intravenous tranexamic acid to placebo (n = 54...

Submissions to the Australian and New Zealand Review of Food Labelling Law and Policy support traffic light nutrition labelling.

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White, John; Signal, Louise

2012-10-01

Food labels to support healthier choices are an important potential intervention for improving population health by reducing obesity and diet-related disease. This study examines the use of research evidence about traffic light nutrition labelling in submissions to the Review of Food Labelling Law and Policy conducted in Australia and New Zealand. Content analysis of final submissions to the Review and a literature review of documents reporting research evidence about traffic light labelling. Sixty-two submitters to the Review were categorised as 'supporters' of traffic light labelling and 29 as 'opponents'. Supporters focused on studies showing traffic light labels were better than other systems at helping consumers identify healthier food options. Opponents cited evidence that traffic light labels were no better than other systems in this respect and noted a lack of evidence that they led to changes in food consumption. A literature review demonstrated that, as a group, submitters had drawn attention to most of the relevant research evidence on traffic light labelling. Both supporters and opponents were, however, selective in their use of evidence. The weight of evidence suggested that traffic light labelling has strengths in helping consumers to identify healthier food options. Further research would be valuable in informing the development of an interpretive front-of-pack labelling system. The findings have significant implications for the development of front-of-pack nutrition labelling currently being considered in Australia and New Zealand. © 2012 The Authors. ANZJPH © 2012 Public Health Association of Australia.

Support vector machine based estimation of remaining useful life: current research status and future trends

International Nuclear Information System (INIS)

Huang, Hong Zhong; Wang, Hai Kun; Li, Yan Feng; Zhang, Longlong; Liu, Zhiliang

2015-01-01

Estimation of remaining useful life (RUL) is helpful to manage life cycles of machines and to reduce maintenance cost. Support vector machine (SVM) is a promising algorithm for estimation of RUL because it can easily process small training sets and multi-dimensional data. Many SVM based methods have been proposed to predict RUL of some key components. We did a literature review related to SVM based RUL estimation within a decade. The references reviewed are classified into two categories: improved SVM algorithms and their applications to RUL estimation. The latter category can be further divided into two types: one, to predict the condition state in the future and then build a relationship between state and RUL; two, to establish a direct relationship between current state and RUL. However, SVM is seldom used to track the degradation process and build an accurate relationship between the current health condition state and RUL. Based on the above review and summary, this paper points out that the ability to continually improve SVM, and obtain a novel idea for RUL prediction using SVM will be future works.

The importance of associations with saprotrophic non-Rhizoctonia fungi among fully mycoheterotrophic orchids is currently under-estimated: novel evidence from sub-tropical Asia.

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Lee, Yung-I; Yang, Chih-Kai; Gebauer, Gerhard

2015-09-01

Most fully mycoheterotrophic (MH) orchids investigated to date are mycorrhizal with fungi that simultaneously form ectomycorrhizas with forest trees. Only a few MH orchids are currently known to be mycorrhizal with saprotrophic, mostly wood-decomposing, fungi instead of ectomycorrhizal fungi. This study provides evidence that the importance of associations between MH orchids and saprotrophic non-Rhizoctonia fungi is currently under-estimated. Using microscopic techniques and molecular approaches, mycorrhizal fungi were localized and identified for seven MH orchid species from four genera and two subfamilies, Vanilloideae and Epidendroideae, growing in four humid and warm sub-tropical forests in Taiwan. Carbon and nitrogen stable isotope natural abundances of MH orchids and autotrophic reference plants were used in order to elucidate the nutritional resources utilized by the orchids. Six out of the seven MH orchid species were mycorrhizal with either wood- or litter-decaying saprotrophic fungi. Only one orchid species was associated with ectomycorrhizal fungi. Stable isotope abundance patterns showed significant distinctions between orchids mycorrhizal with the three groups of fungal hosts. Mycoheterotrophic orchids utilizing saprotrophic non-Rhizoctonia fungi as a carbon and nutrient source are clearly more frequent than hitherto assumed. On the basis of this kind of nutrition, orchids can thrive in deeply shaded, light-limiting forest understoreys even without support from ectomycorrhizal fungi. Sub-tropical East Asia appears to be a hotspot for orchids mycorrhizal with saprotrophic non-Rhizoctonia fungi. © The Author 2015. Published by Oxford University Press on behalf of the Annals of Botany Company. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Evidence-based guidelines on the therapeutic use of transcranial direct current stimulation (tDCS).

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Lefaucheur, Jean-Pascal; Antal, Andrea; Ayache, Samar S; Benninger, David H; Brunelin, Jérôme; Cogiamanian, Filippo; Cotelli, Maria; De Ridder, Dirk; Ferrucci, Roberta; Langguth, Berthold; Marangolo, Paola; Mylius, Veit; Nitsche, Michael A; Padberg, Frank; Palm, Ulrich; Poulet, Emmanuel; Priori, Alberto; Rossi, Simone; Schecklmann, Martin; Vanneste, Sven; Ziemann, Ulf; Garcia-Larrea, Luis; Paulus, Walter

2017-01-01

A group of European experts was commissioned by the European Chapter of the International Federation of Clinical Neurophysiology to gather knowledge about the state of the art of the therapeutic use of transcranial direct current stimulation (tDCS) from studies published up until September 2016, regarding pain, Parkinson's disease, other movement disorders, motor stroke, poststroke aphasia, multiple sclerosis, epilepsy, consciousness disorders, Alzheimer's disease, tinnitus, depression, schizophrenia, and craving/addiction. The evidence-based analysis included only studies based on repeated tDCS sessions with sham tDCS control procedure; 25 patients or more having received active treatment was required for Class I, while a lower number of 10-24 patients was accepted for Class II studies. Current evidence does not allow making any recommendation of Level A (definite efficacy) for any indication. Level B recommendation (probable efficacy) is proposed for: (i) anodal tDCS of the left primary motor cortex (M1) (with right orbitofrontal cathode) in fibromyalgia; (ii) anodal tDCS of the left dorsolateral prefrontal cortex (DLPFC) (with right orbitofrontal cathode) in major depressive episode without drug resistance; (iii) anodal tDCS of the right DLPFC (with left DLPFC cathode) in addiction/craving. Level C recommendation (possible efficacy) is proposed for anodal tDCS of the left M1 (or contralateral to pain side, with right orbitofrontal cathode) in chronic lower limb neuropathic pain secondary to spinal cord lesion. Conversely, Level B recommendation (probable inefficacy) is conferred on the absence of clinical effects of: (i) anodal tDCS of the left temporal cortex (with right orbitofrontal cathode) in tinnitus; (ii) anodal tDCS of the left DLPFC (with right orbitofrontal cathode) in drug-resistant major depressive episode. It remains to be clarified whether the probable or possible therapeutic effects of tDCS are clinically meaningful and how to optimally perform t

Bayesian evidences for dark energy models in light of current observational data

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Lonappan, Anto. I.; Kumar, Sumit; Ruchika; Dinda, Bikash R.; Sen, Anjan A.

2018-02-01

We do a comprehensive study of the Bayesian evidences for a large number of dark energy models using a combination of latest cosmological data from SNIa, CMB, BAO, strong lensing time delay, growth measurements, measurements of Hubble parameter at different redshifts and measurements of angular diameter distance by Megamaser Cosmology Project. We consider a variety of scalar field models with different potentials as well as different parametrizations for the dark energy equation of state. Among 21 models that we consider in our study, we do not find strong evidences in favor of any evolving dark energy model compared to Λ CDM . For the evolving dark energy models, we show that purely nonphantom models have much better evidences compared to those models that allow both phantom and nonphantom behaviors. Canonical scalar field with exponential and tachyon field with square potential have highest evidences among all the models considered in this work. We also show that a combination of low redshift measurements decisively favors an accelerating Λ CDM model compared to a nonaccelerating power law model.

Maxillary complete denture outcome with two-implant supported mandibular overdentures. A systematic review.

Science.gov (United States)

Rutkunas, Vygandas; Mizutani, Hiroshi; Peciuliene, Vytaute; Bendinskaite, Ruta; Linkevicius, Tomas

2008-01-01

Research data regarding maxillary complete denture outcome with two-implant supported mandibular overdentures are not consistent. Considering multiple publications on implant supported mandibular overdentures, it was decided to summarize currently present evidence on the maxillary complete dentures opposed by implant-supported mandibular overdentures, and analyze factors that could potentially influence the outcomes. The articles from 1985 to 2007 related to the topic were identified in the online MEDLINE/Pubmed and other databases and manually. Primary articles were scanned, and irrelevant studies were excluded from the further review process. Potentially relevant titles and abstracts were provisionally included for consideration on the basis of full text articles. Full text articles were obtained from on-line and printed sources. The data from the studies were extracted and reviewed. The study has failed to identify any prospective satisfying inclusion/exclusion criteria RCT reporting on maxillary bone resorption. The number of maxillary complete denture relining incidences per patient was constantly increasing during the 10-year period. Maxillary complete denture remake incidences comprised 16-33 % of the number of patients followed during the 10-year period. Comparing patient satisfaction with upper dentures at the baseline and after two years, no decrease in satisfaction was noticed. There is no evidence that maxillary ridge resorption is accelerated with certain types of two-implant supported mandibular overdenture attachments. Most common complication for the maxilla - prosthetic maintenance. There is a risk of decreased patient satisfaction with bar-supported mandibular overdenture. Further studies are needed to provide evidence for the maxillary complete denture outcome with two-implant supported mandibular overdentures.

Evidence for Ancient Life in Mars Meteorites: Lessons Learned

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McKay, D. S.

1998-01-01

The lines of evidence we first proposed as supporting a hypothesis of early life on Mars are discussed by Treiman, who presents pros and cons of our hypothesis in the light of subsequent research by many groups. Our assessment of the current status of the many controversies over our hypothesis is given in reports by Gibson et al. Rather than repeat or elaborate on that information, I prefer to take an overview and present what I think are some of the "lessons learned" by our team in particular, and by the science community in general.

Music-supported therapy for stroke motor recovery: theoretical and practical considerations.

Science.gov (United States)

Chen, Joyce L

2018-05-08

Music may confer benefits for well-being and health. What is the state of knowledge and evidence for a role of music in supporting the rehabilitation of movements after stroke? In this brief perspective, I provide background context and information about stroke recovery in general, in order to spark reflection and discussion for how we think music may impact motor recovery, given the current clinical milieu. © 2018 New York Academy of Sciences.

Current Evidence for Developmental, Structural, and Functional Brain Defects following Prenatal Radiation Exposure

Directory of Open Access Journals (Sweden)

Tine Verreet

2016-01-01

Full Text Available Ionizing radiation is omnipresent. We are continuously exposed to natural (e.g., radon and cosmic and man-made radiation sources, including those from industry but especially from the medical sector. The increasing use of medical radiation modalities, in particular those employing low-dose radiation such as CT scans, raises concerns regarding the effects of cumulative exposure doses and the inappropriate utilization of these imaging techniques. One of the major goals in the radioprotection field is to better understand the potential health risk posed to the unborn child after radiation exposure to the pregnant mother, of which the first convincing evidence came from epidemiological studies on in utero exposed atomic bomb survivors. In the following years, animal models have proven to be an essential tool to further characterize brain developmental defects and consequent functional deficits. However, the identification of a possible dose threshold is far from complete and a sound link between early defects and persistent anomalies has not yet been established. This review provides an overview of the current knowledge on brain developmental and persistent defects resulting from in utero radiation exposure and addresses the many questions that still remain to be answered.

Creating infrastructure supportive of evidence-based nursing practice: leadership strategies.

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Newhouse, Robin P

2007-01-01

Nursing leadership is the cornerstone of successful evidence-based practice (EBP) programs within health care organizations. The key to success is a strategic approach to building an EBP infrastructure, with allocation of appropriate human and material resources. This article indicates the organizational infrastructure that enables evidence-based nursing practice and strategies for leaders to enhance evidence-based practice using "the conceptual model for considering the determinants of diffusion, dissemination, and implementation of innovations in health service delivery and organization." Enabling EBP within organizations is important for promoting positive outcomes for nurses and patients. Fostering EBP is not a static or immediate outcome, but a long-term developmental process within organizations. Implementation requires multiple strategies to cultivate a culture of inquiry where nurses generate and answer important questions to guide practice. Organizations that can enable the culture and build infrastructure to help nurses develop EBP competencies will produce a professional environment that will result in both personal growth for their staff and improvements in quality that would not otherwise be possible.

Social support and leisure-time physical activity: longitudinal evidence from the Brazilian Pró-Saúde cohort study.

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Oliveira, Aldair J; Lopes, Claudia S; de Leon, Antônio C Ponce; Rostila, Mikael; Griep, Rosane H; Werneck, Guilherme L; Faerstein, Eduardo

2011-07-26

Although social support has been observed to exert a beneficial influence on leisure-time physical activity (LTPA), multidimensional approaches examining social support and prospective evidence of its importance are scarce. The purpose of this study was to investigate how four dimensions of social support affect LTPA engagement, maintenance, type, and time spent by adults during a two-year follow-up. This paper reports on a longitudinal study of 3,253 non-faculty public employees at a university in Rio de Janeiro (the Pró-Saúde study). LTPA was evaluated using a dichotomous question with a two-week reference period, and further questions concerning LTPA type (individual or group) and time spent on the activity. Social support was measured by the Medical Outcomes Study Social Support Scale (MOS-SSS). To assess the association between social support and LTPA, two different statistical models were used: binary and multinomial logistic regression models for dichotomous and polytomous outcomes, respectively. Models were adjusted separately for those who began LTPA in the middle of the follow up (engagement group) and for those who had maintained LTPA since the beginning of the follow up (maintenance group). After adjusting for confounders, statistically significant associations (p time spent on LTPA (OR = 2.01; 95% CI 1.2-3.9). In the maintenance group, material support was associated with group LTPA (OR = 1.80; 95% CI; 1.1-3.1) and the positive social interaction dimension was associated with time spent on LTPA (OR = 1.65; 95% CI; 1.1-2.7). All dimensions of social support influenced LTPA type or the time spent on the activity. However, our findings suggest that social support is more important in engagement than in maintenance. This finding is important, because it suggests that maintenance of LTPA must be associated with other factors beyond the individual's level of social support, such as a suitable environment and social/health policies directed towards the

Supporting Students with Asperger Syndrome on College Campuses: Current Practices

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Barnhill, Gena P.

2016-01-01

With the increasing number of students with Asperger syndrome (AS) and high functioning autism (HFA) enrolling in college, it has become apparent that support services are greatly needed to assist these students in navigating college life, both academically and socially. Yet, there is a dearth of research describing the specific supports needed…

Teaching with Evidence

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Crocco, Margaret; Halvorsen, Anne-Lise; Jacobsen, Rebecca; Segall, Avner

2017-01-01

In this age of real and fake news, students need to be able to assess the trustworthiness of evidence. The authors' current research examines students' use of evidence in secondary social studies classrooms as students deliberate contemporary public policy issues. The authors found that students shifted their evaluations of the trustworthiness of…

Evidence-based management of ambulatory electronic health record system implementation: an assessment of conceptual support and qualitative evidence.

Science.gov (United States)

McAlearney, Ann Scheck; Hefner, Jennifer L; Sieck, Cynthia; Rizer, Milisa; Huerta, Timothy R

2014-07-01

While electronic health record (EHR) systems have potential to drive improvements in healthcare, a majority of EHR implementations fall short of expectations. Shortcomings in implementations are often due to organizational issues around the implementation process rather than technological problems. Evidence from both the information technology and healthcare management literature can be applied to improve the likelihood of implementation success, but the translation of this evidence into practice has not been widespread. Our objective was to comprehensively study and synthesize best practices for managing ambulatory EHR system implementation in healthcare organizations, highlighting applicable management theories and successful strategies. We held 45 interviews with key informants in six U.S. healthcare organizations purposively selected based on reported success with ambulatory EHR implementation. We also conducted six focus groups comprised of 37 physicians. Interview and focus group transcripts were analyzed using both deductive and inductive methods to answer research questions and explore emergent themes. We suggest that successful management of ambulatory EHR implementation can be guided by the Plan-Do-Study-Act (PDSA) quality improvement (QI) model. While participants did not acknowledge nor emphasize use of this model, we found evidence that successful implementation practices could be framed using the PDSA model. Additionally, successful sites had three strategies in common: 1) use of evidence from published health information technology (HIT) literature emphasizing implementation facilitators; 2) focusing on workflow; and 3) incorporating critical management factors that facilitate implementation. Organizations seeking to improve ambulatory EHR implementation processes can use frameworks such as the PDSA QI model to guide efforts and provide a means to formally accommodate new evidence over time. Implementing formal management strategies and incorporating

Palaeoart at Two Million Years Ago? A Review of the Evidence

Directory of Open Access Journals (Sweden)

James B. Harrod

2014-02-01

Full Text Available Current archaeological evidence supports the claim that symbolic behavior, including palaeoart, first emerged in human evolution around 1 million years ago. The purpose of this article is to review archaeological studies that might support the hypothesis that the earliest palaeoart actually is evident around 2 million years ago. This review identifies nine Oldowan artifacts that have been proposed as possible non-utilitarian and possibly symbolic behavior. Among seven stone tools, the three strongest candidates are the Olduvai Gorge, the FLK North grooved and pecked cobble, ~1.80 million years ago, and MNK Main subspheroid with hexagon shape framing an apparent natural dot-and-undulating-line motif, ~1.5–1.6 million years ago, both initially reported and described by Mary Leakey; and the curated Koobi Fora FxJj1 “broken core” with inner rhomboid shape, ~1.87 million years ago. All six stone tools from Olduvai Gorge need scientific re-examination to determine their chaîne opératoire and assess non-utilitarian features. If even one of the Olduvai Gorge artifacts were validated as symbolic behavior this would indicate the emergence of palaeoart one million years earlier than current proposals. It would also suggest that Homo habilis/rudolfensis or a very early Homo erectus had substantially more advanced cognitive, design and symbolic competencies than inferred in current theories. It would constitute a challenge to develop more advanced cognitive semiotic and art-theoretic analytical tools for illuminating the role of such palaeoart in hominin cultural evolution.

Does the scientific evidence support the advertising claims made for products containing Lactobacillus casei and Bifidobacterium lactis? A systematic review.

Science.gov (United States)

Meléndez-Illanes, Lorena; González-Díaz, Cristina; Chilet-Rosell, Elisa; Álvarez-Dardet, Carlos

2016-09-01

To analyse the scientific evidence that exists for the advertising claims made for two products containing Lactobacillus casei and Bifidobacterium lactis and to conduct a comparison between the published literature and what is presented in the corporate website. Systematic review, using Medline through Pubmed and Embase. We included human clinical trials that exclusively measured the effect of Lactobacillus casei or Bifidobacterium lactis on a healthy population, and where the objective was related to the health claims made for certain products in advertising. We assessed the levels of evidence and the strength of the recommendation according to the classification criteria established by the Oxford Centre for Evidence Based Medicine (CEBM). We also assessed the outcomes of the studies published on the website that did not appear in the search. Of the 440 articles identified, 16 met the inclusion criteria. Only four (25%) of these presented a level of evidence of 1b and a recommendation grade of A, all corresponding to studies on product containing Bifidobacterium lactis, and only 12 of the 16 studies were published on the corporate website (47). There is insufficient scientific evidence to support the health claims made for these products, especially in the case of product containing Lactobacillus casei. © The Author 2015. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Current State and Model for Development of Technology-Based Care for Attention Deficit Hyperactivity Disorder

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Riley, Steven J.; Calub, Catrina A.; Schweitzer, Julie B.

2016-01-01

Abstract Introduction: Care (i.e., evaluation and intervention) delivered through technology is used in many areas of mental health services, including for persons with attention deficit hyperactivity disorder (ADHD). Technology can facilitate care for individuals with ADHD, their parents, and their care providers. The adoption of technological tools for ADHD care requires evidence-based studies to support the transition from development to integration into use in the home, school, or work for persons with the disorder. The initial phase, which is development of technological tools, has begun in earnest; however, the evidence base for many of these tools is lacking. In some instances, the uptake of a piece of technology into home use or clinical practice may be further along than the research to support its use. Methods: In this study, we review the current evidence regarding technology for ADHD and also propose a model to evaluate the support for other tools that have yet to be tested. Results: We propose using the Research Domain Criteria as a framework for evaluating the tools' relationships to dimensions related to ADHD. Conclusion: This article concludes with recommendations for testing new tools that may have promise in improving the evaluation or treatment of persons with ADHD. PMID:26985703

Comparing a Mobile Decision Support System Versus the Use of Printed Materials for the Implementation of an Evidence-Based Recommendation: Protocol for a Qualitative Evaluation.

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Camacho, Jhon; Medina Ch, Ana María; Landis-Lewis, Zach; Douglas, Gerald; Boyce, Richard

2018-04-13

The distribution of printed materials is the most frequently used strategy to disseminate and implement clinical practice guidelines, although several studies have shown that the effectiveness of this approach is modest at best. Nevertheless, there is insufficient evidence to support the use of other strategies. Recent research has shown that the use of computerized decision support presents a promising approach to address some aspects of this problem. The aim of this study is to provide qualitative evidence on the potential effect of mobile decision support systems to facilitate the implementation of evidence-based recommendations included in clinical practice guidelines. We will conduct a qualitative study with two arms to compare the experience of primary care physicians while they try to implement an evidence-based recommendation in their clinical practice. In the first arm, we will provide participants with a printout of the guideline article containing the recommendation, while in the second arm, we will provide participants with a mobile app developed after formalizing the recommendation text into a clinical algorithm. Data will be collected using semistructured and open interviews to explore aspects of behavioral change and technology acceptance involved in the implementation process. The analysis will be comprised of two phases. During the first phase, we will conduct a template analysis to identify barriers and facilitators in each scenario. Then, during the second phase, we will contrast the findings from each arm to propose hypotheses about the potential impact of the system. We have formalized the narrative in the recommendation into a clinical algorithm and have developed a mobile app. Data collection is expected to occur during 2018, with the first phase of analysis running in parallel. The second phase is scheduled to conclude in July 2019. Our study will further the understanding of the role of mobile decision support systems in the implementation

Dangerous "spin": the probability myth of evidence-based prescribing - a Merleau-Pontyian approach.

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Morstyn, Ron

2011-08-01

The aim of this study was to examine logical positivist statistical probability statements used to support and justify "evidence-based" prescribing rules in psychiatry when viewed from the major philosophical theories of probability, and to propose "phenomenological probability" based on Maurice Merleau-Ponty's philosophy of "phenomenological positivism" as a better clinical and ethical basis for psychiatric prescribing. The logical positivist statistical probability statements which are currently used to support "evidence-based" prescribing rules in psychiatry have little clinical or ethical justification when subjected to critical analysis from any of the major theories of probability and represent dangerous "spin" because they necessarily exclude the individual , intersubjective and ambiguous meaning of mental illness. A concept of "phenomenological probability" founded on Merleau-Ponty's philosophy of "phenomenological positivism" overcomes the clinically destructive "objectivist" and "subjectivist" consequences of logical positivist statistical probability and allows psychopharmacological treatments to be appropriately integrated into psychiatric treatment.

Synergistic effects of Chinese herbal medicine: a comprehensive review of methodology and current research

Directory of Open Access Journals (Sweden)

Xian Zhou

2016-07-01

Full Text Available Traditional Chinese medicine is an important part of primary health care in Asian countries that has utilised complex herbal formulations (consisting 2 or more medicinal herbs for treating diseases over thousands of years. There seems to be a general assumption that the synergistic therapeutic effects of Chinese herbal medicine derive from the complex interactions between the multiple bioactive components within the herbs and/or herbal formulations. However, evidence to support these synergistic effects remains weak and controversial due to several reasons, including the very complex nature of Chinese herbal medicine, misconceptions about synergy, methodological challenges to study design. In this review, we clarify the definition of synergy, identify common errors in synergy research and describe current methodological approaches to test for synergistic interaction. We discuss the strengthen and weakness of these models in the context of Chinese herbal medicine and summarise the current status of synergy research in CHM. Despite the availability of some scientific data to support the synergistic effects of multi-herbal and/or herb-drug combinations, the level of evidence remains low and the clinical relevancy of most of these findings is undetermined. There remain significant challenges in the development of suitable methods for synergistic studies of complex herbal combinations.

Pivotal response treatment for autism spectrum disorder: current perspectives

Directory of Open Access Journals (Sweden)

Lei J

2017-06-01

Full Text Available Jiedi Lei, Pamela Ventola Yale Child Study Center, Yale University School of Medicine, New Haven, CT, USA Abstract: Pivotal response treatment (PRT is an evidence-based behavioral intervention based on applied behavior analysis principles aimed to improve social communication skills in individuals with autism spectrum disorder (ASD. PRT adopts a more naturalistic approach and focuses on using a number of strategies to help increase children’s motivation during intervention. Since its conceptualization, PRT has received much empirical support for eliciting therapeutic gains in greater use of functional social communication skills in individuals with ASD. Building upon the empirical evidence supporting PRT, recent advancements have increasingly turned to using interdisciplinary research integrating neuroimaging techniques and behavioral measures to help identify objective biomarkers of treatment, which have two primary purposes. First, neuroimaging results can help characterize how PRT may elicit change, and facilitate partitioning of the heterogeneous profiles of neural mechanisms underlying similar profile of behavioral changes observed over PRT. Second, neuroimaging provides an objective means to both map and track how biomarkers may serve as reliable and sensitive predictors of responder profiles to PRT, assisting clinicians to identify who will most likely benefit from PRT. Together, a better understanding of both mechanisms of change and predictors of responder profile will help PRT to serve as a more precise and targeted intervention for individuals with ASD, thus moving towards the goal of precision medicine and improving quality of care. This review focuses on the recent emerging neuroimaging evidences supporting PRT, offering current perspectives on the importance of interdisciplinary research to help clinicians better understand how PRT works and predict who will respond to PRT. Keywords: PRT, ASD, biomarkers, neuroimaging

Current Approaches to the Management of Pediatric Overweight and Obesity

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Ridolfi, Danielle R.; Hayes, Jacqueline F.; St Paul, Michelle; Wilfley, Denise E.

2015-01-01

Opinion Statement Family-based behavioral intervention has been demonstrated to be an effective and safe treatment for childhood obesity and should be considered a first-line treatment option. However, access to such intensive evidence-based treatment is limited and, currently, obesity care is dominated by high intensity behavioral treatment implemented in specialty clinics or less effective, low intensity treatments implemented in primary care. However, capitalizing on the established and ongoing relationship between primary care providers and families, primary care providers hold an invaluable role in early identification of overweight and obesity, and subsequent referral to an evidence-based treatment. key aspects of effective treatment include: early intervention, moderate- to high-intensity intervention of sufficient duration, multi-component intervention targeting dietary modification, physical activity and behavioral strategies, family involvement and goals targeting family members, and follow-up contact during maintenance. The purpose of this review is to present the current empirically supported treatment options for pediatric obesity including primary care-based interventions and diagnostic tools, multi-component behavioral intervention with a focus on family-based behavioral intervention, immersion treatment, and pharmacologic and surgical management. PMID:25205083

Science and evidence: separating fact from fiction.

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Hess, Dean R

2013-10-01

Evidence-based medicine (EBM) is the integration of individual clinical expertise with the best available research evidence from systematic research and the patient's values and expectations. A hierarchy of evidence can be used to assess the strength upon which clinical decisions are made. The efficient approach to finding the best evidence is to identify systematic reviews or evidence-based clinical practice guidelines. Respiratory therapies that evidence supports include noninvasive ventilation for appropriately selected patients, lung-protective ventilation, and ventilator discontinuation protocols. Evidence does not support use of weaning parameters, albuterol for ARDS, and high frequency oscillatory ventilation for adults. Therapy with equivocal evidence includes airway clearance, selection of an aerosol delivery device, and PEEP for ARDS. Although all tenets of EBM are not universally accepted, the principles of EBM nonetheless provide a valuable approach to respiratory care practice.

Family support programs and adolescent mental health: review of evidence

OpenAIRE

Laird, Robert; Kuhn,Emily

2014-01-01

Emily S Kuhn, Robert D Laird Department of Psychology, University of New Orleans, New Orleans, LA, USA Abstract: Family support programs aim to improve parent wellbeing and parenting as well as adolescent mental and behavioral health by addressing the needs of parents of adolescents experiencing or at risk for mental health problems. Family support programs can be part of the treatment for adolescents diagnosed with mental or behavioral health problems, or family support programs can be deli...

Can water, sanitation and hygiene help eliminate stunting? Current evidence and policy implications

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Cairncross, Sandy

2016-01-01

Abstract Stunting is a complex and enduring challenge with far‐reaching consequences for those affected and society as a whole. To accelerate progress in eliminating stunting, broader efforts are needed that reach beyond the nutrition sector to tackle the underlying determinants of undernutrition. There is growing interest in how water, sanitation and hygiene (WASH) interventions might support strategies to reduce stunting in high‐burden settings, such as South Asia and sub‐Saharan Africa. This review article considers two broad questions: (1) can WASH interventions make a significant contribution to reducing the global prevalence of childhood stunting, and (2) how can WASH interventions be delivered to optimize their effect on stunting and accelerate progress? The evidence reviewed suggests that poor WASH conditions have a significant detrimental effect on child growth and development resulting from sustained exposure to enteric pathogens but also due to wider social and economic mechanisms. Realizing the potential of WASH to reduce stunting requires a redoubling of efforts to achieve universal access to these services as envisaged under the Sustainable Development Goals. It may also require new or modified WASH strategies that go beyond the scope of traditional interventions to specifically address exposure pathways in the first 2 years of life when the process of stunting is concentrated. PMID:27187910

Chemonucleolysis and intradiscal electrothermal therapy: What is the current evidence?

International Nuclear Information System (INIS)

Relder-Puig, Rosemarie; Gyimesi, M.; Mittermayr, T.; Geiger-Gritsch, S.

2009-01-01

We evaluated the efficacy and safety of chemonucleolysis and intradiscal electrothermal therapy (IDET) on the basis of the data presented in recently published papers with respect to pain relief, function, and complication rates. Detailed searches for English and German articles published between 2003 and 2008 were performed in a number of electronic databases. Further publications were identified by manual search. For summarizing the evidence, we considered only systematic reviews and controlled studies. The internal validity of reviews and studies was judged by two authors independently. Data extraction was performed by one author, and the extracted data was checked for completeness and correctness by a second author. The evidence of the efficacy of chemonucleolysis using chymopapain or collagenase is summarized in two recent, high-quality systematic reviews. We found 5 controlled studies evaluating nucleolysis using an oxygen-ozone mixture (O 2 O 3 -nucleolysis). Some of those studies were of limited methodological quality, but all showed the efficacy of O 2 O 3 -nucleolysis in comparison to microdiscectomy or the use of alternative substances. There is hardly any data regarding O 2 O 3 -nucleolysis complications. Regarding IDET, the authors of the 6 identified systematic reviews come to different conclusions about the efficacy of the procedure. The results of the 3 included controlled IDET studies, of which 2 are of high methodological quality, are also conflicting. The complication rates range from 0 to 15%. In summary, the evidence of efficacy is presently more compelling for chemonucleolysis than for IDET. This may also be because indications for chemonucleolysis are more firmly established. However, safety aspects should be better evaluated and presented in the literature. (orig.)

Evidence and evidence gaps in tinnitus therapy

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Hesse, Gerhard

2016-01-01

A nearly endless number of procedures has been tried and in particular sold for the treatment of tinnitus, unfortunately they have not been evaluated appropriately in an evidence-based way. A causal therapy, omitting the tinnitus still does not exist, actually it cannot exist because of the various mechanisms of its origin. However or perhaps because of that, medical interventions appear and reappear like fashion trends that can never be proven by stable and reliable treatment success. This contribution will discuss and acknowledge all current therapeutic procedures and the existing or non-existing evidence will be assessed. Beside external evidence, the term of evidence also encompasses the internal evidence, i.e. the experience of the treating physician and the patient’s needs shall be included. While there is no evidence for nearly all direct procedures that intend modulating or stimulating either the cochlea or specific cervical regions such as the auditory cortex, there are therapeutic procedures that are acknowledged in clinical practice and have achieved at least a certain degree of evidence and generate measurable effect sizes. Those are in particular habituation therapy and psychotherapeutic measures, especially if they are combined with concrete measures for improved audio perception (hearing aids, CI, hearing therapies). PMID:28025604

Evidence Considerations for Mobile Devices in the Occupational Therapy Process

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Kelly Erickson

2015-04-01

Full Text Available Mobile app-based device utilization, including smartphones and handheld tablets, suggests a need to evaluate evidence to guide selection and implementation of these devices in the occupational therapy process. The purpose of the research was to explore the current body of evidence in relation to mobile app-based devices and to identify factors in the use of these devices throughout the occupational therapy process. Following review of available occupational therapy profession guidelines, assistive technology literature, and available mobile device research, practitioners using mobile app-based devices in occupational therapy should consider three areas: client needs, practitioner competence, and device factors. The purpose of this guideline is to identify factors in the selection and use of mobile app-based devices throughout the occupational therapy process based on available evidence. Considerations for mobile device implementation during the occupational therapy process is addressed, including evaluating outcomes needs, matching device with the client, and identifying support needs of the client.

Investigation of training and support needs in rural and remote disability and mainstream service providers: implications for an online training model.

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Johnsson, Genevieve; Kerslake, Rachel; Crook, Sarah; Cribb, Corinne

2017-12-01

Objectives It is known that there are difficulties in recruiting and retaining practitioners in rural and remote communities and that access to support and professional development can be key in breaking this cycle. Technology provides a possible solution not only for increasing access to these opportunities, but also in building community capacity to support children with autism. The aim of the present study was to investigate the current learning and support needs within rural and remote professionals prior to setting up a model of support. Methods An online survey was used to gather information from service providers in rural and remote communities on their demographics, current skills and confidence in working with clients on the autism spectrum, current supervision and professional development, identified learning and support needs, and the availability and uptake of technology for accessing professional development. Results Respondents reported below average levels of perceived confidence and skills when working with children with autism, most notably children with challenging behaviour. Half the respondents do not currently attend supervision sessions, with only 15% receiving regular supervision (fortnightly or more often), and 66% of respondents had travelled more than 3h to access professional development workshops. The majority of participants had access to technology and over half had already used this for online training. Conclusion Overall, service providers in rural and remote areas are generally not currently meeting their needs in terms of frequency of supervision and professional development. The present needs analysis identifies key areas for learning, the ideal frequency of support and the acceptability of using technology to deliver this support. This information will guide future researchers in the development of an evidence-based model that will be accessible and meaningful to its participants. What is known about the topic? It is known that

Evidence for intrinsic critical current density in high Tc superconductors

International Nuclear Information System (INIS)

Freltoft, T.; Minnhagen, P.; Jeldtoft Jensen, H.

1991-01-01

We present measurements of the voltage-current characteristics of high quality epitaxial YBaCuO films in zero magnetic field. According to the predictions of a current induced vortex pair breaking picture the voltage should follow the functional form V∝I(I-I c ) a-1 . An analysis designed to test this functional behavior is carried out. Consistency is found. (orig.)

Current evidence demonstrates similar effects of kilohertz-frequency and low-frequency current on quadriceps evoked torque and discomfort in healthy individuals: a systematic review with meta-analysis.

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da Silva, Vinicius Zacarias Maldaner; Durigan, João Luiz Quaglioti; Arena, Ross; de Noronha, Marcos; Gurney, Burke; Cipriano, Gerson

2015-01-01

Neuromuscular electrical stimulation (NMES) is widely utilized to enhance muscle performance. However, the optimal NMES waveform with respect to treatment effect has not been established. To investigate the effects of kilohertz-frequency alternating current (KFAC) and low-frequency pulsed current (PC) on quadriceps evoked torque and self-reported discomfort. PubMed, The Cochrane Library, EMBASE, MEDLINE, Physiotherapy Evidence Database (PEDro), SinoMed, ISI Web of Knowledge, and CINAHL were searched for randomized controlled trials (RCTs) and quasi-randomized controlled trials (QRCTs). Two reviewers independently selected potential studies according to the inclusion criteria, extracted data, and assessed methodological quality. Studies were eligible if they compared KFAC versus PC interventions. Studies that included outcome measures for percentage of maximal isometric voluntary contraction (%MIVC) torque and self-reported discomfort level were eligible for evaluation. Seven studies involving 127 individuals were included. The methodological quality of eligible trials was moderate, with a mean of 5 on the 10-point PEDro scale. Overall, PC was no better than KFAC in terms of evoked torque and there was no difference in self-reported discomfort level. KFAC and PC have similar effects on quadriceps evoked torque and self-reported discomfort level in healthy individuals. The small number and overall methodological quality of currently available studies included in this meta-analysis indicate that new RCTs are needed to better determine optimal NMES treatment parameters.

No histologic evidence of foetal cardiotoxicity following exposure to maternal hydroxychloroquine.

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Friedman, Deborah; Lovig, Leif; Halushka, Marc; Clancy, Robert M; Izmirly, Peter M; Buyon, Jill P

2017-01-01

It is currently recommended that hydroxychloroquine (HCQ) be maintained during pregnancy in patients with systemic lupus erythematosus. Recent data suggest that this Toll-like receptor inhibitor may also reduce the recurrence rate of anti-SSA/Ro associated congenital heart block (CHB). This case report describes a unique situation in which a CHB-afflicted, HCQ-exposed pregnancy was electively terminated. The heart did not reveal any characteristic features of cardiotoxicity, providing further evidence supporting the safety of foetal exposure to HCQ.

Medical School Librarians Need More Training to Support their Involvement in Evidence Based Medicine Curricula

Directory of Open Access Journals (Sweden)

Aislinn Conway

2016-04-01

Full Text Available Objective – To describe the self-perceived role of librarians in developing evidence based medicine (EBM curricula and identify their current and desired level of training to support these activities. Design – Multi-institutional qualitative study. Setting – Nine medical schools in Canada and the United States of America. Subjects – Nine librarians identified by medical school faculty as central to the provision of EBM training for medical students at their institution. Methods – The researchers designed a semi-structured interview schedule based on a review of the literature and their own experiences as librarians teaching EBM. The topics covered were; librarians’ perceptions of their roles in relation to the curriculum, the training required to enable them to undertake these roles, and their professional development needs. The interviews were conducted by telephone and then audio-recorded and transcribed verbatim. The authors present five main themes; curricular design, curricular deployment, curricular assessment, educational training, and professional development. Profiles were developed for each participant based on the latter two themes and from this information common characteristics were identified. Main Results – The participants described the importance of collaboration with faculty and student bodies when designing a curriculum. Information literacy instruction and specifically literature searching and forming a research question were taught by all of the participants to facilitate curricular deployment. Some of the librarians were involved or partly involved in curricular assessment activities such as formulating exam questions or providing feedback on assignments. Educational training of participants varied from informal observation to formal workshops offered by higher education institutions. All librarians indicated a willingness to partake in professional development focused on teaching and EBM. The subjects�

Physiological and comparative evidence fails to confirm an adaptive role for aging in evolution.

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Cohen, Alan A

2015-01-01

The longstanding debate about whether aging may have evolved for some adaptive reason is generally considered to pit evolutionary theory against empirical observations consistent with aging as a programmed aspect of organismal biology, in particular conserved aging genes. Here I argue that the empirical evidence on aging mechanisms does not support a view of aging as a programmed phenomenon, but rather supports a view of aging as the dysregulation of complex networks that maintain organismal homeostasis. The appearance of programming is due largely to the inadvertent activation of existing pathways during the process of dysregulation. It is argued that aging differs markedly from known programmed biological phenomena such as apoptosis in that it is (a) very heterogeneous in how it proceeds, and (b) much slower than it would need to be. Furthermore, the taxonomic distribution of aging across species does not support any proposed adaptive theories of aging, which would predict that aging rate would vary on a finer taxonomic scale depending on factors such as population density. Thus, while there are problems with the longstanding non-adaptive paradigm, current evidence does not support the notion that aging is programmed or that it may have evolved for adaptive reasons.

[Evidence and Evidence Gaps - an Introduction].

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Dreier, G; Löhler, J

2016-04-01

Treating patients requires the inclusion of existing evidence in any health care decision, to be able to choose the best diagnosis or treatment measure or to make valid prognosis statements for a particular patient in consideration of the physician's own expertise.The basis are clinical trials, the results of which are ideally gathered in systematic reviews, rated, summarized and published. In addition to the GCP (Good Clinical Practice)-compliant planning, conducting and analysis of clinical studies it is essential, that all study results are made publicly available, in order to avoid publication bias. This includes the public registration of planned and discontinued trials. In the last 25 years, the evidence-based medicine (EbM) has increasingly found its way into clinical practice and research. Here EbM is closely associated with the names Archibald Cochrane and David Sackett. In Germany, both the German Cochrane Centre (DCZ) and the network of evidence-based medicine (DNEbM) were established approximately 15 years ago. In the international Cochrane Collaboration clinicians and other scientists like statisticians interdisciplinary work side by side to develop the methods of evidence-based medicine and to address the topics of evidence generation and processing as well as the transfer of knowledge. Challenge: Existing evidence primarily serves doctors to support their decision-making, but is also the basis for providing scientific proof for a health care intervention's benefit to patients and ultimately payers/health insurances. The closure of existing evidence gaps requires substantial human and financial resources, a complex organizational structure and can only succeed with the involvement of clinical and methodological expertise and specific knowledge in the field of clinical research. In addition, the knowledge must be transferred into practice, using journals, guidelines, conferences, databases, information portals with processed evidence and not least the

The anatomy and relations of evidence-based medicine.

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McDonald, I G; Daly, J M

2000-06-01

Current tensions between evidence-based medicine (EBM) and some clinicians are counterproductive and unnecessary. The most contentious issues concern (a) the limitations of efficacy data from randomised trials as evidence; (b) differences in attitudes to medical diagnosis and clinical judgement; and (c) political concerns about the use of the concept of clinical evidence and guidelines to restrict physician autonomy. Health services research has evolved in response to a bureaucratic need to study health care, including clinical practice, in order to improve its effectiveness (defined mainly in terms of technological interventions), and to contain costs. Its perspective is from the top-down representing the interests of bureaucracy and managed care, and articulates with political demands for professional accountability and cost-containment. EBM has established its place as an important contributor to the methodological toolbox for health services research. There is a need for a corresponding coherent programme of clinical practice research which would locate EBM in the clinical environment beside quality assurance, the study of the appropriateness and effectiveness of interventions, and multidisciplinary research related to the art of medicine and supportive aspects of clinical care. EBM would then be seen as one organ in relation to many others making their contribution to the body of knowledge needed for clinical decisions and policy making. A 'centre for the study of clinical practice' would be an appropriate structure to support such a comprehensive programme of clinical practice research in a tertiary hospital. The bottom-up perspective of clinical practice research would complement the current top-down perspective of most health services research, providing information to doctors, patients and administrators concerning local quality of care and health outcomes, information which could also be aggregated for guidance of health policy makers. It would also

Parenting stress and parent support among mothers with high and low education

OpenAIRE

Parkes, Alison; Sweeting, Helen; Wight, Daniel

2015-01-01

Current theorizing and evidence suggest that parenting stress might be greater among parents from both low and high socioeconomic positions (SEP) compared with those from intermediate levels because of material hardship among parents of low SEP and employment demands among parents of high SEP. However, little is known about how this socioeconomic variation in stress relates to the support that parents receive. This study explored whether variation in maternal parenting stress in a population ...

Psychological First Aid: Rapid proliferation and the search for evidence.

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Shultz, James M; Forbes, David

2014-01-01

Psychological first aid (PFA) has become the flagship early intervention for disaster survivors, with recent adaptations for disaster responders, in the post-9/11 era. PFA is broadly endorsed by expert consensus and integrated into guidelines for mental health and psychosocial support in disasters and extreme events. PFA frameworks are proliferating, with increasing numbers of models developed for delivery by a range of providers for use with an expanding array of target populations. Despite popularity and promotion there remains a dearth of evidence for effectiveness and recent independent reviews of PFA have highlighted this important gap. This commentary juxtaposes the current propagation of PFA against the compelling need to produce evidence for effectiveness and suggests a series of actions to prioritize and expedite real-time, real-event field evaluation of PFA.

Evidence based mental healthcare and service innovation: review of concepts and challenges.

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Kouimtsidis, Ch; John-Smith, St; Kemp, P; Ikkos, G

2013-01-01

Health provision systems in the developed western nations are currently facing major financial challenges. In order to meet these challenges, a number of new approaches used to assist the provision of health have been introduced, including the practice of health professionals. These approaches utilize specific methods of data capture and summarization such as: evidence based medicine (EBM) and practice guidelines. Evidence is generated from systematic clinical research as well as reported clinical experience and individually case based empirical evidence. All types of research though (quantitative or qualitative) have limitations. Similarly all types of evidence have advantages and disadvantages and can be complimentary to each other. Evidencebased individual decision (EBID) making is the commonest evidence-based medicine as practiced by the individual clinician in making decisions about the care of the individual patient. It involves integrating individual clinical expertise with the best available external clinical evidence from systematic research. However this sort of evidence-based medicine, focuses excessively on the individual (potentially at the expense of others) in a system with limited budgets. Evidence-based guidelines (EBG) also support the practice of evidence-based medicine but at the organizational or institutional level. The main aim is to identify which interventions, over a range of patients, work best and which is cost-effective in order to guide service development and provision at a strategic level. Doing this effectively is a scientific and statistical skill in itself and the quality of guidelines is based primarily on the quality research evidence. It is important to note that lack of systematic evidence to support an intervention does not automatically mean that an intervention must instantly be abandoned. It is also important that guidelines are understood for what they are, i.e. not rules, or complete statements of knowledge. EBM will

Transcranial direct current stimulation for motor recovery of upper limb function after stroke.

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Lüdemann-Podubecká, Jitka; Bösl, Kathrin; Rothhardt, Sandra; Verheyden, Geert; Nowak, Dennis Alexander

2014-11-01

Changes in neural processing after stroke have been postulated to impede recovery from stroke. Transcranial direct current stimulation has the potential to alter cortico-spinal excitability and thereby might be beneficial in stroke recovery. We review the pertinent literature prior to 30/09/2013 on transcranial direct current stimulation in promoting motor recovery of the affected upper limb after stroke. We found overall 23 trials (they included 523 participants). All stimulation protocols pride on interhemispheric imbalance model. In a comparative approach, methodology and effectiveness of (a) facilitation of the affected hemisphere, (b) inhibition of the unaffected hemisphere and (c) combined application of transcranial direct current stimulation over the affected and unaffected hemispheres to treat impaired hand function after stroke are presented. Transcranial direct current stimulation is associated with improvement of the affected upper limb after stroke, but current evidence does not support its routine use. Copyright © 2014 Elsevier Ltd. All rights reserved.

Supporting patients in obtaining and oncologists in providing evidence-based health-related quality of life information prior to and after esophageal cancer surgery

NARCIS (Netherlands)

Jacobs, M.

2015-01-01

The overall aim of this thesis was to support patients in obtaining and oncologists in providing evidence-based HRQL data prior to and following esophageal cancer surgery. This thesis is divided in two parts. In Part I, we addressed the information needs of esophageal cancer patients prior to and

Role of Ureaplasma Respiratory Tract Colonization in Bronchopulmonary Dysplasia Pathogenesis: Current Concepts and Update.

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Viscardi, Rose Marie; Kallapur, Suhas G

2015-12-01

Respiratory tract colonization with the genital mycoplasma species Ureaplasma parvum and Ureaplasma urealyticum in preterm infants is a significant risk factor for bronchopulmonary dysplasia (BPD). Recent studies of the ureaplasmal genome, animal infection models, and human infants have provided a better understanding of specific virulence factors, pathogen-host interactions, and variability in genetic susceptibility that contribute to chronic infection, inflammation, and altered lung development. This review provides an update on the current evidence supporting a causal role of ureaplasma infection in BPD pathogenesis. The current status of antibiotic trials to prevent BPD in Ureaplasma-infected preterm infants is also reviewed. Copyright © 2015 Elsevier Inc. All rights reserved.

Current evidence of percutaneous nucleoplasty for the cervical herniated disk: a systematic review.

Science.gov (United States)

Wullems, Jorgen A; Halim, Willy; van der Weegen, Walter

2014-07-01

Although percutaneous cervical nucleoplasty (PCN) has been shown to be both safe and effective, its application is still debated. PCN applied in disk herniation has not been systematically reviewed before, resulting in a limited insight into its effectiveness and safety, and the quality of available evidence. Therefore, we systematically reviewed the evidence on the efficacy and safety of PCN in patients with a (contained) herniated disk. MEDLINE, EMBASE, and the Cochrane Library (Central Register of Controlled Trials) were searched for randomized controlled trials (RCTs) and nonrandomized studies using the following keywords: "Nucleoplasty," "Cervical," "Hernia," "Herniation," "Prolapse," "Protrusion," "Intervertebral disk," and "Percutaneous disk decompression." First, all articles were appraised for methodological quality, and then, RCTs were graded for the level of evidence according a best-evidence synthesis, because a meta-analysis was not possible. Finally, the RCTs' applicability and clinical relevance also was assessed. Of 75 identified abstracts, 10 full-text articles were included (3 RCTs and 7 nonrandomized studies). These studies represented a total of 1021 patients: 823 patients (≥ 892 disks) were treated by PCN. All studies showed low methodological quality, except for two. The level of evidence of the RCTs was graded as moderate, with low to moderate applicability and clinical relevance. All included studies showed PCN to be an effective and safe procedure in the treatment of (contained) herniated disks at short-, mid-, and long-term follow-up. However, the level of evidence is moderate and shows only low to moderate applicability and clinical relevance. © 2013 World Institute of Pain.

Exergaming and obesity in youth: current perspectives

Directory of Open Access Journals (Sweden)

Zeng N

2016-08-01

Full Text Available Nan Zeng, Zan Gao College of Education and Human Development, School of Kinesiology, University of Minnesota, Minneapolis, MN, USA Abstract: Although exergaming has been used as a physical activity modality among various populations, the evidence regarding its effectiveness on health-related outcomes in overweight/obese individuals remains unclear. The current study systematically reviewed literature and summarized findings of exergame-based interventions in overweight/obese populations with the goal of clarifying the current perspectives on exergaming and obesity. The initial search yielded 202 articles from six databases; 12 studies were included after evaluating for inclusion criteria and removing duplicates. Among these studies, seven were randomized controlled trials, two were control trials, and three were comparison studies. Overall, exergaming has the potential to attenuate weight gain and shows promise when used for physical activity and physical fitness promotion. Further, exergame play is positively associated with psychological well-being, but its effects on physiological outcomes are inconclusive. Finally, effects of exergaming on energy intake are not clear. Existing evidence supports that exergaming may elicit some health benefits in people who are overweight or/and obese. The limited number of available randomized controlled trials, however, restrict the ability to draw a conclusion that exergaming can trigger a change in all health-related outcomes. More research is warranted to make definitive conclusions regarding the effects of exergaming on health-related outcomes in such populations. Keywords: active video game, weight loss, children and adolescents, systematic review

Neutral currents

International Nuclear Information System (INIS)

Aubert, B.

1994-11-01

The evidence for the existence of weak neutral current has been a very controverted topics in the early 1970's, as well as the muon did in the 1930's. The history is very rich considering the evolution of the experimental techniques in high energy particle physics. The history of the discovery and the study of weak neutral current is reviewed. Later the quest of the intermediate vector boson continues with the decision of the community to build a large proton antiproton collider. (K.A.). 14 refs., 1 fig

Respiratory medicines for children: current evidence, unlicensed use and research priorities

DEFF Research Database (Denmark)

Smyth, A R; Barbato, A; Beydon, N

2010-01-01

deficiency. We hope that this summary of the evidence for respiratory medicines in children, highlighting gaps and research priorities, will be useful for the pharmaceutical industry, the paediatric committee of the European Medicines Agency, academic investigators and the lay public.......This European Respiratory Society task force has reviewed the evidence for paediatric medicines in respiratory disease occurring in adults and children. We describe off-licence use, research priorities and ongoing studies. Off-licence and off-label prescribing in children is widespread...... and potentially harmful. Research areas in asthma include novel formulations and regimens, and individualised prescribing. In cystic fibrosis, future studies will focus on screened infants and robust outcome measures are needed. Other areas include new enzyme and antibiotic formulations and the basic defect...

[Conservative treatment of nonspecific, chronic low back pain : Evidence of the efficacy - a systematic literature review].

Science.gov (United States)

Bredow, J; Bloess, K; Oppermann, J; Boese, C K; Löhrer, L; Eysel, P

2016-07-01

Non-specific chronic low back pain (NSCLBP): Which conservative therapy shows an evident effectiveness - A review of the current literature. Our results are based on literature reviews of current randomised control studies, reviews and meta-analysis drawn from the Cochrane Library and Medline-Database between the years 2004 until 2015. German and English Studies were included. We focused on different conservative Treatments of NSCLBP, which are listed at, the NVL-Guidelines. Based on the given evidence we evaluated their effectiveness. As part of the review we identified 4657 Publications, 85 were included in this study. Therapeutic options such as bed rest, TENS, Massage, Spine Supports, Back Schools and Antidepressants showed no evident effectiveness. Injections, NSAR analgesic therapy, Thermotherapy and Opioid analgesic therapy indicated a short-time effectiveness. A long term success (> 6 weeks) however, can not be shown. Only the Movement therapy can, in the summation of the included studies, postulate an evident (Evidence Level I) long-term effect treating NSCLBP. Only a few therapy options indicate a significant evident effectiveness for treating NSCLBP conservatively. At short notice methods such as injection therapy, thermo-therapy and analgesic therapies with NSAR and/or opioids help coping the acute phase. In the long term only movement therapy seems to provide an evident effectiveness. In the case of therapy-refractory NSCLBP a multimodal therapy should be considered.

Increasing the quantity and quality of searching for current best evidence to answer clinical questions: protocol and intervention design of the MacPLUS FS Factorial Randomized Controlled Trials.

Science.gov (United States)

Agoritsas, Thomas; Iserman, Emma; Hobson, Nicholas; Cohen, Natasha; Cohen, Adam; Roshanov, Pavel S; Perez, Miguel; Cotoi, Chris; Parrish, Rick; Pullenayegum, Eleanor; Wilczynski, Nancy L; Iorio, Alfonso; Haynes, R Brian

2014-09-20

Finding current best evidence for clinical decisions remains challenging. With 3,000 new studies published every day, no single evidence-based resource provides all answers or is sufficiently updated. McMaster Premium LiteratUre Service--Federated Search (MacPLUS FS) addresses this issue by looking in multiple high quality resources simultaneously and displaying results in a one-page pyramid with the most clinically useful at the top. Yet, additional logistical and educational barriers need to be addressed to enhance point-of-care evidence retrieval. This trial seeks to test three innovative interventions, among clinicians registered to MacPLUS FS, to increase the quantity and quality of searching for current best evidence to answer clinical questions. In a user-centered approach, we designed three interventions embedded in MacPLUS FS: (A) a web-based Clinical Question Recorder; (B) an Evidence Retrieval Coach composed of eight short educational videos; (C) an Audit, Feedback and Gamification approach to evidence retrieval, based on the allocation of 'badges' and 'reputation scores.' We will conduct a randomized factorial controlled trial among all the 904 eligible medical doctors currently registered to MacPLUS FS at the hospitals affiliated with McMaster University, Canada. Postgraduate trainees (n=429) and clinical faculty/staff (n=475) will be randomized to each of the three following interventions in a factorial design (AxBxC). Utilization will be continuously recorded through clinicians’ accounts that track logins and usage, down to the level of individual keystrokes. The primary outcome is the rate of searches per month per user during the six months of follow-up. Secondary outcomes, measured through the validated Impact Assessment Method questionnaire, include: utility of answers found (meeting clinicians’ information needs), use (application in practice), and perceived usefulness on patient outcomes. Built on effective models for the point

Selective mutism and anxiety: a review of the current conceptualization of the disorder.

Science.gov (United States)

Sharp, William G; Sherman, Colleen; Gross, Alan M

2007-01-01

Selective mutism (SM) is a rare and interesting condition that has been associated with a wide variety of childhood psychiatric conditions. Historically viewed as more of an oddity than a distinct diagnostic entity, early conceptualizations of the condition were based largely on case studies that tended to link SM with oppositional behavior. More recently, controlled studies have enhanced our understanding of SM. This review summarizes the current conceptualization of SM, highlighting evidence supporting the notion that SM is an anxiety-related condition.

Challenges of implementing fibromyalgia treatment guidelines in current clinical practice.

Science.gov (United States)

Arnold, Lesley M; Clauw, Daniel J

2017-09-01

The current diagnostic and treatment pathway for patients with fibromyalgia (FM) is lengthy, complex, and characterized by multiple physician visits with an average 2-year wait until diagnosis. It is clear that effective identification and appropriate treatment of FM remain a challenge in current clinical practice. Ideally, FM management involves a multidisciplinary approach with the preferable patient pathway originating in primary care but supported by a range of health care providers, including referral to specialist care when necessary. After the publication of individual clinical studies, high-quality reviews, and meta-analyses, recently published FM treatment guidelines have transitioned from an expert consensus to an evidence-based approach. Evidence-based guidelines provide a framework for ensuring early diagnosis and timely adoption of appropriate treatment. However, for successful outcomes, FM treatments must adopt a more holistic approach, which addresses more than just pain. Impact on the associated symptoms of fatigue and cognitive problems, sleep and mood disturbances, and lowered functional status are also important in judging the success of FM therapy. Recently published guidelines recommend the adoption of a symptom-based approach to guide pharmacologic treatment. Emerging treatment options for FM may be best differentiated on the basis of their effect on comorbid symptoms that are often associated with pain (e.g. sleep disturbance, mood, fatigue). The current review discusses the most recently published Canadian guidelines and the implications of the recent European League Against Rheumatism (EULAR) recommendations, with a focus on the challenges of implementing these guidelines in current clinical practice.

Evidence-Based Supplements for the Enhancement of Athletic Performance.

Science.gov (United States)

Peeling, Peter; Binnie, Martyn J; Goods, Paul S R; Sim, Marc; Burke, Louise M

2018-03-01

A strong foundation in physical conditioning and sport-specific experience, in addition to a bespoke and periodized training and nutrition program, are essential for athlete development. Once these underpinning factors are accounted for, and the athlete reaches a training maturity and competition level where marginal gains determine success, a role may exist for the use of evidence-based performance supplements. However, it is important that any decisions surrounding performance supplements are made in consideration of robust information that suggests the use of a product is safe, legal, and effective. The following review focuses on the current evidence-base for a number of common (and emerging) performance supplements used in sport. The supplements discussed here are separated into three categories based on the level of evidence supporting their use for enhancing sports performance: (1) established (caffeine, creatine, nitrate, beta-alanine, bicarbonate); (2) equivocal (citrate, phosphate, carnitine); and (3) developing. Within each section, the relevant performance type, the potential mechanisms of action, and the most common protocols used in the supplement dosing schedule are summarized.

Usage of Bone Replacement Grafts in Periodontics and Oral Implantology and Their Current Levels of Clinical Evidence - A Systematic Assessment.

Science.gov (United States)

Salem, Daliah; Natto, Zuhair; Elangovan, Satheesh; Karimbux, Nadeem

2016-08-01

The aim of this review is to evaluate the levels of clinical evidence for bone replacement grafts available in the United States for periodontics and oral implantology purposes. A search was performed using PubMed, the Cochrane Library, and Google Scholar for articles relating to the use of bone replacement grafts in implant and/or periodontics by two independent reviewers. Articles unrelated to the topic, not involving patients, not including abstracts, or in languages other than English were excluded. Selected articles were graded according to "levels of evidence" based on guidelines originally introduced by Wright et al. (2003). There was limited published peer-reviewed clinical literature available regarding US commercially available bone replacement grafts in periodontics and oral implantology. Of 144 bone replacement grafts available in the United States according to Avila-Ortiz et al. (2013), only 52 met the inclusion criteria. The majority of materials used were allografts (26 of 93 available in the United States), followed by alloplasts (15 of 30) and xenografts (11 of 21). Dental providers should be aware of the limited evidence that qualified for a strong rating supporting the clinical efficacy of these materials for periodontics and oral implantology purposes using the inclusion criteria selected in this study.

The ANKLE TRIAL (ANKLE Treatment after Injuries of the Ankle Ligaments): what is the benefit of external support devices in the functional treatment of acute ankle sprain?: a Randomised Controlled Trial

NARCIS (Netherlands)

Witjes, Suzanne; Gresnigt, Femke; van den Bekerom, Michel P. J.; Olsman, Jan G.; van Dijk, Niek C.

2012-01-01

Background: Acute lateral ankle ligament injuries are very common problems in present health care. Still there is no hard evidence about which treatment strategy is superior. Current evidence supports the view that a functional treatment strategy is preferable, but insufficient data are present to

Advanced electrical current measurements of microdischarges: evidence of sub-critical pulses and ion currents in barrier discharge in air

Science.gov (United States)

Synek, Petr; Zemánek, Miroslav; Kudrle, Vít; Hoder, Tomáš

2018-04-01

Electrical current measurements in corona or barrier microdischarges are a challenge as they require both high temporal resolution and a large dynamic range of the current probe used. In this article, we apply a simple self-assembled current probe and compare it to commercial ones. An analysis in the time and frequency domain is carried out. Moreover, an improved methodology is presented, enabling both temporal resolution in sub-nanosecond times and current sensitivity in the order of tens of micro-amperes. Combining this methodology with a high-tech oscilloscope and self-developed software, a unique statistical analysis of currents in volume barrier discharge driven in atmospheric-pressure air is made for over 80 consecutive periods of a 15 kHz applied voltage. We reveal the presence of repetitive sub-critical current pulses and conclude that these can be identified with the discharging of surface charge microdomains. Moreover, extremely low, long-lasting microsecond currents were detected which are caused by ion flow, and are analysed in detail. The statistical behaviour presented gives deeper insight into the discharge physics of these usually undetectable current signals.

Evidence-based practice in Occupational Health Psychology. Current status and further developments

Directory of Open Access Journals (Sweden)

Maricutoiu, Laurentiu P.

2012-04-01

Full Text Available The present paper discusses the status of evidence-based practice in Occupational Health Psychology (OHP. After several searches on large online databases, we have found that OHP papers that discuss interventions are less than 10% of the overall literature. Furthermore, quantitative reviews research that reports interventions on major OHP topics are generally absent. In the last part of the paper, we formulate some reccomendations for increasing the number of papers relevant for evidence-based practice in OHP.

The current situation of treatment systems for alcoholism in Korea.

Science.gov (United States)

Kim, Jee Wook; Lee, Boung Chul; Kang, Tae-Cheon; Choi, Ihn-Geun

2013-02-01

Alcoholism is becoming one of the most serious issues in Korea. The purpose of this review article was to understand the present status of the treatment system for alcoholism in Korea compared to the United States and to suggest its developmental direction in Korea. Current modalities of alcoholism treatment in Korea including withdrawal treatment, pharmacotherapy, and psychosocial treatment are available according to Korean evidence-based treatment guidelines. Benzodiazepines and supportive care including vitamin and nutritional support are mainly used to treat alcohol withdrawal in Korea. Naltrexone and acamprosate are the drugs of first choice to treat chronic alcoholism. Psychosocial treatment methods such as individual psychotherapy, group psychotherapy, family therapy, cognitive behavior therapy, cue exposure therapy, 12-step facilitation therapy, self-help group therapy, and community-based treatment have been carried out to treat chronic alcoholism in Korea. However, current alcohol treatment system in Korea is not integrative compared to that in the United States. To establish the treatment system, it is important to set up an independent governmental administration on alcohol abuse, to secure experts on alcoholism, and to conduct outpatient alcoholism treatment programs and facilities in an open system including some form of continuing care.