Evidence-based medicine combines the patient's preferences with clinical experience and the best research evidence. Randomized clinical trials are considered the most valid research design for evaluating health-care interventions. However, empirical research shows that intervention effects may...... practice. By investments in education, applied research, and The Cochrane Collaboration, evidence-based medicine may form a stronger basis for clinical practice....
Garattini, Silvio; Jakobsen, Janus C; Wetterslev, Jørn
Using the best quality of clinical research evidence is essential for choosing the right treatment for patients. How to identify the best research evidence is, however, difficult. In this narrative review we summarise these threats and describe how to minimise them. Pertinent literature was consi......Using the best quality of clinical research evidence is essential for choosing the right treatment for patients. How to identify the best research evidence is, however, difficult. In this narrative review we summarise these threats and describe how to minimise them. Pertinent literature...
This first of three articles on evidence-based dental practice discusses the historical background of evidence-based medicine/evidence-based dentistry, how to formulate clear clinical questions and how to track down (search) the available evidence in the literature databases. Nigerian Quarterly Journal of Hospital Medicine ...
Määttä, Sylvia; Wallmyr, Gudrun
The aim of this study was to explore nurses' and ward-based clinical librarians' reflections on ward-based clinical librarians as facilitators for nurses' use of evidences-based practice. Nurses' use of evidence-based practice is reported to be weak. Studies have suggested that clinical librarians may promote evidence-based practice. To date, little is known about clinical librarians participating nurses in the wards. A descriptive, qualitative design was adopted for the study. In 2007, 16 nurses who had been attended by a clinical librarian in the wards were interviewed in focus groups. Two clinical librarians were interviewed by individual interviews. In the analysis, a content analysis was used. Three themes were generated from the interviews with nurses: 'The grip of everyday work', 'To articulate clinical nursing issues' and 'The clinical librarians at a catalyst'. The nurses experienced the grip of everyday work as a hindrance and had difficulties to articulate and formulate relevant nursing issues. In such a state, the nurses found the clinical librarian presence in the ward as enhancing the awareness of and the use of evidence-based practice. Three themes emerged from the analysis with the librarians. They felt as outsiders, had new knowledge and acquired a new role as ward-based clinical librarians. Facilitation is needed if nurses' evidence-based practice is going to increase. The combined use of nurses and clinical librarians' knowledge and skills can be optimised. To achieve this, nurses' skills in consuming and implementing evidence ought to be strengthened. The fusion of the information and knowledge management skill of the ward-based clinical librarian and the clinical expertise of the nurses can be of value. With such a collaborative model, nurse and ward-based clinical librarian might join forces to increase the use of evidence-based practice. © 2010 Blackwell Publishing Ltd.
Evidence-based practice (EBP) is now the dominant model in health care; its aim is to increase the use of research evidence to inform clinical decision making. Clinical practice guidelines are the predominant method by which research is distilled into practice recommendations. Clinical psychology has its own model which promotes the integration of research evidence with clinical expertise, the scientist practitioner model (SPM). Recent developments within the United Kingdom health service, su...
Kessel, Line; Erngaard, Ditte; Flesner, Per
In 2013, the Danish Health and Medicines Authorities published a National Clinical Guideline on the treatment of age-related cataracts. The guideline provided evidence-based recommendations on the indication for cataract surgery, cataract surgery in patients with age-related macular degeneration...... medicine. Thus, evidence-based guidelines do change practice patterns unless they are counteracted by the reimbursement system....... likely to prescribe non-steroidal anti-inflammatory eye drops and to not prescribe topical antibiotic eye drops after the guideline was published. Other parameters, most notably the use of toric IOLs and use of postoperative examinations were more guided by reimbursement standards than by evidence-based...
Oude Rengerink, K
This thesis presents a number of research projects centred on ‘evidence-based medicine’. It consists of two parts. Part 1 focuses on improving recruitment of the necessary number of patients in clinical trials, as this is the major problem while evaluating the effectiveness of interventions in health care. To improve our understanding of patient recruitment we tried to identify obstacles and facilitators for successful recruitment. Part 2 focuses on improving integration of evidence-based dec...
Oude Rengerink, K.
This thesis presents a number of research projects centred on ‘evidence-based medicine’. It consists of two parts. Part 1 focuses on improving recruitment of the necessary number of patients in clinical trials, as this is the major problem while evaluating the effectiveness of interventions in
VanDeusen Lukas, Carol; Engle, Ryann L; Holmes, Sally K; Parker, Victoria A; Petzel, Robert A; Nealon Seibert, Marjorie; Shwartz, Michael; Sullivan, Jennifer L
Despite recognition that implementation of evidence-based clinical practices (EBPs) usually depends on the structure and processes of the larger health care organizational context, the dynamics of implementation are not well understood. This project's aim was to deepen that understanding by implementing and evaluating an organizational model hypothesized to strengthen the ability of health care organizations to facilitate EBPs. CONCEPTUAL MODEL: The model posits that implementation of EBPs will be enhanced through the presence of three interacting components: active leadership commitment to quality, robust clinical process redesign incorporating EBPs into routine operations, and use of management structures and processes to support and align redesign. In a mixed-methods longitudinal comparative case study design, seven medical centers in one network in the Department of Veterans Affairs participated in an intervention to implement the organizational model over 3 years. The network was selected randomly from three interested in using the model. The target EBP was hand-hygiene compliance. Measures included ratings of implementation fidelity, observed hand-hygiene compliance, and factors affecting model implementation drawn from interviews. Analyses support the hypothesis that greater fidelity to the organizational model was associated with higher compliance with hand-hygiene guidelines. High-fidelity sites showed larger effect sizes for improvement in hand-hygiene compliance than lower-fidelity sites. Adherence to the organizational model was in turn affected by factors in three categories: urgency to improve, organizational environment, and improvement climate. Implementation of EBPs, particularly those that cut across multiple processes of care, is a complex process with many possibilities for failure. The results provide the basis for a refined understanding of relationships among components of the organizational model and factors in the organizational context
Miwa, Hiroto; Kusano, Motoyasu; Arisawa, Tomiyasu; Oshima, Tadayuki; Kato, Mototsugu; Joh, Takashi; Suzuki, Hidekazu; Tominaga, Kazunari; Nakada, Koji; Nagahara, Akihito; Futagami, Seiji; Manabe, Noriaki; Inui, Akio; Haruma, Ken; Higuchi, Kazuhide; Yakabi, Koji; Hongo, Michio; Uemura, Naomi; Kinoshita, Yoshikazu; Sugano, Kentaro; Shimosegawa, Tooru
General interest in functional gastrointestinal disorders is increasing among Japanese doctors as well as patients. This increase can be attributed to a number of factors, including recent increased interest in quality of life and advances in our understanding of the pathophysiology of gastrointestinal disease. Japan recently became the world's first country to list "functional dyspepsia" as a disease name for national insurance billing purposes. However, recognition and understanding of functional dyspepsia (FD) remain poor, and no standard treatment strategy has yet been established. Accordingly, the Japanese Society of Gastroenterology (JSGE) developed an evidence-based clinical practice guideline for FD, consisting of five sections: concept, definition, and epidemiology; pathophysiology; diagnosis; treatment; and prognosis and complications. This article summarizes the Japanese guideline, with particular focus on the treatment section. Once a patient is diagnosed with FD, the doctor should carefully explain the pathophysiology and benign nature of this condition, establish a good doctor-patient relationship, and then provide advice for daily living (diet and lifestyle modifications, explanations, and reassurance). The proposed pharmacological treatment is divided into two steps: initial treatment including an acid inhibitory drug (H2RA or PPI) or prokinetics, (strong recommendation); second-line treatment including anxiolytics, antidepressants, and Japanese traditional medicine (weak recommendation). H. pylori eradication, strongly recommended with a high evidence level, is positioned separately from other treatment flows. Conditions that do not respond to these treatment regimens are regarded as refractory FD. Patients will be further examined for other organic disorders or will be referred to specialists using other approaches such as psychosomatic treatment.
Sowter, Julie; Cortis, Joseph; Clarke, David J
Although the use of portfolios is widespread within healthcare education, agreement on their purpose, content, assessment and value is still debated. The objective of this study was to achieve consensus on quality criteria for clinical practice portfolios that would act as guidance for students and lecturers. A Delphi survey was undertaken to seek consensus on the opinions of 23 'expert participants' through a series of rounds of structured questionnaires. The Delphi tool was produced as an on-line survey questionnaire and panel experts were invited to score statements using a discrete 7 point visual analogue scale. The statements were written as quality criteria relating to portfolio development which had been identified from the literature and by the research team. The survey employed three rounds of feedback and consensus was measured as 80% agreement for each quality criteria scoring 5 and above. Consensus was reached on 31 quality criteria which were categorised into 4 areas: structured collection of labelled evidence; nature of evidence; critical reflection; and assessment and judgement. Mean scores for the final wording of the quality criteria ranged from 5.3 to 6.8 with the standard deviation for all of the mean scores being below 1.5. There was consensus that these quality criteria were relevant to health and social care professionals involved in developing clinical practice portfolios. The Delphi process facilitated exchange of ideas amongst panel 'experts' about the content and evaluation of clinical practice portfolios, with most debate relating to judgement of competence and rewarding originality and creativity. These issues illustrate the tensions between educational values and professional constraints. The Delphi process proved to be an effective method for achieving consensus on quality criteria for clinical practice portfolios and enabled the development of validated guidelines. Copyright Â© 2011 Elsevier Ltd. All rights reserved.
Baker, Elise; McLeod, Sharynne
Purpose: This article provides both a tutorial and a clinical example of how speech-language pathologists (SLPs) can conduct evidence-based practice (EBP) when working with children with speech sound disorders (SSDs). It is a companion paper to the narrative review of 134 intervention studies for children who have an SSD (Baker & McLeod, 2011).…
Olsen, Nina R; Bradley, Peter; Lomborg, Kirsten; Nortvedt, Monica W
.... Few studies have explored reasons for this. The aim of this study was to explore beliefs, experiences and attitudes related to third year students' use of evidence-based practice in clinical physiotherapy education among students, clinical...
Mohide, E Ann; Coker, Esther
Organizational interventions are being suggested to increase the rate of quality research dissemination and uptake. This article describes how one tertiary institution is using an evidence-based nursing (EBN) committee as an organizational strategy to shift its nursing culture toward clinical scholarship. A number of approaches and activities that have stimulated the movement toward evidence-based practice (EBP) are examined: organizational commitment to EBP, strategic positioning of the EBN committee within nursing's administrative structure, articulation of a mission, conceptualization of a model for EBN practice, learning on the job, selection and adoption of an evidence-based model for implementing change, marketing for a change in culture toward clinical scholarship, and other selected examples of projects undertaken by the committee. Action-oriented principles associated with committee experiences are related to the approaches and activities.
The overall assessment of the guideline revealed that two-thirds of academic appraisers strongly recommended the guideline to be used in practice and most of practitioner nurses and practitioner physicians recommended the guideline to be in practice. Conclusion: The development of this guideline was based on the ...
Background Health care undergraduate students are expected to practice evidence-based after they graduate. Previous research indicates that students face several problems with transferring evidence-based practice to real patient situations. Few studies have explored reasons for this. The aim of this study was to explore beliefs, experiences and attitudes related to third year students’ use of evidence-based practice in clinical physiotherapy education among students, clinical instructors and visiting teachers. Methods In total, six focus group interviews were conducted: three with 16 students, two with nine clinical instructors and one with four visiting teachers. In addition, one individual interview and one interview in a pair were conducted with clinical instructors. Interviewing three different participant-categories ensured comparative analysis and enabled us to exploit differences in perspectives and interactions. Interpretive description guided this process. Results Four integrative themes emerged from the analysis: “attempt to apply evidence-based practice”, “novices in clinical practice”, “prioritize practice experience over evidence-based practice” and “lack role models in evidence-based practice”. Students tried to search for research evidence and to apply this knowledge during clinical placements; a behaviour that indicated a positive attitude towards evidence-based practice. At the same time, students were novices and required basic background information more than research information. As novices they tended to lean on their clinical instructors, and were more eager to gain practical experience than practicing evidence-based; a behaviour that clinical instructors and visiting teachers often supported. Students noticed a lack of an EBP culture. Both students and clinical instructors perceived a need for role models in evidence-based practice. Conclusions Clinical instructors are in a position to influence students during clinical
Evidence-based practice (EBP) is an influential interdisciplinary movement that originated in medicine as evidence-based medicine (EBM) about 1992. EBP is of considerable interest to library and information science (LIS) because it focuses on a thorough documentation of the basis for the decision...
Muttiah, Nimisha; Georges, Katie; Brackenbury, Tim
Purpose: Evidence-based practice (EBP) involves the incorporation of research evidence, clinical expertise, and client values in clinical decision making. One case in which these factors conflict is the use of nonspeech oral motor treatments (NSOMTs) for children with developmental speech sound disorders. Critical reviews of the research evidence…
Shreeve, Michael W.
Evidence-based practice has emerged as a driving factor in current curriculum development in chiropractic education. This commentary discusses educational strategies incorporating evidence-based practices in the doctor of chiropractic curriculum and explores whether all five steps of the evidence-based process and patient outcomes from evidence-based practice are being assessed.
Beth S. Brodsky
Full Text Available Suicide is reaching epidemic proportions, with over 44,000 deaths by suicide in the US, and 800,000 worldwide in 2015. This, despite research and development of evidence-based interventions that target suicidal behavior directly. Suicide prevention efforts need a comprehensive approach, and research must lead to effective implementation across public and mental health systems. A 10-year systematic review of evidence-based findings in suicide prevention summarized the areas necessary for translating research into practice. These include risk assessment, means restriction, evidence-based treatments, population screening combined with chain of care, monitoring, and follow-up. In this article, we review how suicide prevention research informs implementation in clinical settings where those most at risk present for care. Evidence-based and best practices address the fluctuating nature of suicide risk, which requires ongoing risk assessment, direct intervention and monitoring. In the US, the National Action Alliance for Suicide Prevention has put forth the Zero Suicide (ZS Model, a framework to coordinate a multilevel approach to implementing evidence-based practices. We present the Assess, Intervene and Monitor for Suicide Prevention model (AIM-SP as a guide for implementation of ZS evidence-based and best practices in clinical settings. Ten basic steps for clinical management model will be described and illustrated through case vignette. These steps are designed to be easily incorporated into standard clinical practice to enhance suicide risk assessment, brief interventions to increase safety and teach coping strategies and to improve ongoing contact and monitoring of high-risk individuals during transitions in care and high risk periods.
Chen, Kee-Hsin; Kao, Ching-Chiu; Chen, Chiehfeng
In 1992, Gordon Guyatt coined the term "evidence-based medicine", which has since attracted worldwide attention. In 2007, the Institute of Medicine's Roundtable on Evidence-Based Medicine set the goal that 90% of clinical decisions would be supported by accurate, timely, and up-to-date clinical information and would reflect the best available evidence by 2020. However, the chasm between knowing and doing remains palpable. In 2000, the Canadian Institute of Health Research applied the term "knowledge translation" to describe the bridge that is necessary to cross the gap between research knowledge and clinical practice. The present paper outlines the conceptual framework, barriers, and promotion strategies for evidence-based knowledge translation and shares clinical experience related to overcoming the seven layers of leakage (aware, accepted, applicable, able, acted on, agreed, and adhered to). We hope that this paper can enhance the public well-being and strengthen the future health care system.
Rath, Ana; Salamon, Valérie; Peixoto, Sandra
literature searches without meta-analyses and internal European Clinical Research Infrastructure Network (ECRIN) communications during face-to-face meetings and telephone conferences from 2013 to 2017 within the context of the ECRIN Integrating Activity (ECRIN-IA) project. RESULTS: Barriers specific to rare....... CONCLUSIONS: Evidence-based clinical practice for rare diseases should start by collecting clinical data in databases and registries; defining measurable patient-centred outcomes; and selecting appropriate study designs adapted to small study populations. Rare diseases constitute one of the most paradigmatic...... fields in which multi-stakeholder engagement, especially from patients, is needed for success. Clinical research infrastructures and expertise networks offer opportunities for establishing evidence-based clinical practice within rare diseases....
Alladin, Assen; Sabatini, Linda; Amundson, Jon K
This paper briefly surveys the trend of and controversy surrounding empirical validation in psychotherapy. Empirical validation of hypnotherapy has paralleled the practice of validation in psychotherapy and the professionalization of clinical psychology, in general. This evolution in determining what counts as evidence for bona fide clinical practice has gone from theory-driven clinical approaches in the 1960s and 1970s through critical attempts at categorization of empirically supported therapies in the 1990s on to the concept of evidence-based practice in 2006. Implications of this progression in professional psychology are discussed in the light of hypnosis's current quest for validation and empirical accreditation.
Romero, Lisa M; Middleton, Dawn; Mueller, Trisha; Avellino, Lia; Hallum-Montes, Rachel
The purposes of the study were to describe baseline data in the implementation of evidence-based clinical practices among health center partners as part of a community-wide teen pregnancy prevention initiative and to identify opportunities for health center improvement. Health center partner baseline data were collected in the first year (2011) and before program implementation of a 5-year community-wide teen pregnancy prevention initiative. A needs assessment on health center capacity and implementation of evidence-based clinical practices was administered with 51 health centers partners in 10 communities in the United States with high rates of teen pregnancy. Health centers reported inconsistent implementation of evidence-based clinical practices in providing reproductive health services to adolescents. Approximately 94.1% offered same-day appointments, 91.1% had infrastructure to reduce cost barriers, 90.2% offered after-school appointments, and 80.4% prescribed hormonal contraception without prerequisite examinations or testing. Approximately three quarters provided visual and audio privacy in examination rooms (76.5%) and counseling areas (74.5%). Fewer offered a wide range of contraceptive methods (67.8%) and took a sexual health history at every visit (54.9%). Only 45.1% reported Quick Start initiation of hormonal contraception, emergency contraception (43.1%), or intrauterine devices (12.5%) were "always" available to adolescents. The assessment highlighted opportunities for health center improvement. Strategies to build capacity of health center partners to implement evidence-based clinical practices may lead to accessibility and quality of reproductive health services for adolescents in the funded communities. Published by Elsevier Inc.
Roberts, Michael C; Blossom, Jennifer B; Evans, Spencer C; Amaro, Christina M; Kanine, Rebecca M
Evidence-based practice (EBP) has become a central focus in clinical child and adolescent psychology. As originally defined, EBP in psychology is the integration of the best available research evidence, patient characteristics, and clinical expertise. Although evidence-based perspectives have garnered widespread acceptance in recent years, there has also been some confusion and disagreement about the 3-part definition of EBP, particularly the role of research. In this article, we first provide a brief review of the development of EBP in clinical child and adolescent psychology. Next, we outline the following 4 points to help clarify the understanding of EBP: (a) knowledge should not be confused with epistemic processes, (b) research on clinician and client factors is needed for EBP, (c) research on assessment is needed for EBP, and (d) the 3-part conceptualization of EBP can serve as a useful framework to guide research. Based on these principles, we put forth a slightly revised conceptualization of EBP, in which the role of research is expanded and more clearly operationalized. Finally, based on our review of the literature, we offer illustrative examples of specific directions for future research to advance the evidence base for EBP in clinical child and adolescent psychology.
Afrashtehfar, Kelvin I; Assery, Mansour K
It has been claimed that in order to decrease the gap between what we know and what we do, research findings must be translated from knowledge to action. Such practices better enable dentists to make evidence-based decisions instead of personal ideas and judgments. To this end, this literature review aims to revisit the concepts of knowledge translation and evidence-based dentistry (EBD) and depict their role and influence within dental education. It addresses some possible strategies to facilitate knowledge translation (KT), encourage dental students to use EBD principles, and to encourage dental educators to create an environment in which students become self-directed learners. It concludes with a call to develop up-to-date and efficient online platforms that could grant dentists better access to EBD sources in order to more efficiently translate research evidence into the clinic.
Krainovich-Miller, Barbara; Haber, Judith; Yost, Jennifer; Jacobs, Susan Kaplan
The TREAD Evidence-Based Practice Model is a framework for faculty to use in graduate research courses so students can become excellent consumers of the best available evidence to use in their clinical decision making in the practice setting. This model is based on competency in information literacy as the basis for developing evidence-based search strategies to find, appraise, and synthesize Level I evidence, including systematic reviews, meta-analyses, and evidence-based practice guidelines. This model emphasizes the use of standardized critical appraisal tools, such as the Critical Appraisal Skills Programme (CASP) or Appraisal of Guidelines for Research and Evaluation (AGREE), to facilitate user-friendly rapid appraisal of Level I evidence. Faculty are challenged to embrace this paradigm shift, to unlearn how they learned, and to teach their graduate research course focusing on the importance of Level I evidence to enable their graduates to make informed advanced practice decisions and improve patient outcomes.
Ramos-Morcillo, Antonio J; Fernández-Salazar, Serafín; Ruzafa-Martínez, María; Del-Pino-Casado, Rafael
Barriers to the implementation of evidence-based practice (EBP) by nursing professionals include a lack of knowledge, inadequate skills in searching for and appraising evidence, and consulting research articles. However, few studies have addressed the effectiveness of educational interventions to improve their competence. To evaluate the effectiveness of a brief basic online and face-to-face educational intervention to promote EBP attitudes, knowledge and skills, and practice in clinical care nurses. This study was quasi-experimental, pretest-posttest design with a comparison group. The sample included registered nurses enrolled in the free continuing education courses offered in 2013 by the Nursing Council of Jaén (Spain). The study included 109 participants (54 in the intervention group and 55 in the comparison group). The intervention was a brief, basic EBP course with online and face-to-face learning. The comparison group received an educational intervention with different content. The evidence-based practice questionnaire (EBPQ) was used to evaluate EBP attitude, knowledge and skills, and practice before the intervention, and at 21 and 60 days following the intervention. Two-way mixed analysis of variance was conducted. There was a significant difference between intervention and comparison groups in the knowledge and skills dimension. The difference between groups was not significant in the EBP practice dimension. Both groups had high scores in the attitude dimension that did not change after the intervention. A brief basic educational intervention on EBP with online and face-to-face learning can produce improvements in the knowledge and skills of clinical nurses. © 2015 The Authors. Worldviews on Evidence-Based Nursing published by Wiley Periodicals, Inc. on behalf of Sigma Theta Tau International The Honor Society of Nursing.
Lilienfeld, Scott O; Ritschel, Lorie A; Lynn, Steven Jay; Cautin, Robin L; Latzman, Robert D
Psychotherapists are taught that when a client expresses resistance repeatedly, they must understand and address its underlying sources. Yet proponents of evidence-based practice (EBP) have routinely ignored the root causes of many clinical psychologists' reservations concerning the use of scientific evidence to inform clinical practice. As a consequence, much of the resistance to EBP persists, potentially widening the already large scientist-practitioner gap. Following a review of survey data on psychologists' attitudes toward EBP, we examine six sources underpinning resistance toward EBP in clinical psychology and allied domains: (a) naïve realism, which can lead clinicians to conclude erroneously that client change is due to an intervention itself rather than to a host of competing explanations; (b) deep-seated misconceptions regarding human nature (e.g., mistaken beliefs regarding the causal primacy of early experiences) that can hinder the adoption of evidence-based treatments; (c) statistical misunderstandings regarding the application of group probabilities to individuals; (d) erroneous apportioning of the burden of proof on skeptics rather than proponents of untested therapies; (e) widespread mischaracterizations of what EBP entails; and (f) pragmatic, educational, and attitudinal obstacles, such as the discomfort of many practitioners with evaluating the increasingly technical psychotherapy outcome literature. We advance educational proposals for articulating the importance of EBP to the forthcoming generation of clinical practitioners and researchers, and constructive remedies for addressing clinical psychologists' objections to EBP. Copyright © 2013 Elsevier Ltd. All rights reserved.
Neldon, Gayle B.
Evidence-based practice (EBP) is a strategy for the provision of high quality health care. The use of journals to document clinical experiences and reflection has been used in speech-language pathology as well as nursing and psychology. This study uses qualitative analysis to study what AuD students learn about evidence-based practice from writing…
Berke, David M; Rozell, Cassandra A; Hogan, Thomas P; Norcross, John C; Karpiak, Christie P
Evidence-based practice (EBP) requires that practitioners routinely access, appraise, and utilize the best available research. We surveyed a representative sample of the Society of Clinical Psychology; 549 psychologists (response rate = 46%) reported their frequency of engaging in EBP when offering psychological services, rated their current knowledge of 12 online research resources, and evaluated their current knowledge of 12 research methods and designs. These psychologists reported, on average, using EBP in 73.1% of their psychological services. With the exception of PsycINFO and MEDLINE, clinical psychologists related low to moderate knowledge of online research resources. By contrast, these psychologists reported considerable knowledge of most research methods and designs, except for odds ratios and structural equation modeling. Psychologists' theoretical orientation, clinical experience, and employment setting predicted knowledge of both online resources and research designs. We discuss the educational and practice ramifications of these results. © 2011 Wiley Periodicals, Inc.
Vidyarthi, Arpana R; Kamei, Robert; Chan, Kenneth; Goh, Sok-Hong; Lek, Ngee
To identify the factors associated with medical students' clinical reasoning (CR) use and evidence-based medicine (EBM) use in the clinical setting. Our cross-sectional study surveyed 44 final-year medical students at an emerging academic medical center in Singapore. We queried the students' EBM and CR value and experiences in the classroom and clinical settings. We compared this to their perceptions of supervisors' value and experiences using t-tests. We developed measures of teaching culture and practice culture by combining relevant questions into summary scores. Multivariate linear regression models were applied to identify factors associated with the students' CR and EBM clinical use. Eighty-nine percent of students responded (n=39). Students reported valuing CR (p=0.03) and EBM (p=0.001) more than their supervisors, but practiced these skills similarly (p=0.83; p=0.82). Clinical practice culture and classroom CR experience were independently associated with students' CR clinical use (p=0.05; p=0.04), and classroom EBM experience was independently associated with students' EBM clinical use (p=0.03). Clinical teaching culture was not associated with students' CR and EBM clinical use. Our study found that medical students' classroom experience and the clinical practice culture influenced their CR and EBM use. The clinical teaching culture did not. These findings suggest that in order to increase student CR and EBM use, in addition to providing classroom experience, medical educators may need to change the hospital culture by encouraging supervisors to use these skills in their clinical practice.
Full Text Available Abstract Background While the potential of clinical practice guidelines (CPGs to support implementation of evidence has been demonstrated, it is not currently being achieved. CPGs are both poorly developed and ineffectively implemented. To improve clinical practice and health outcomes, both well-developed CPGs and effective methods of CPG implementation are needed. We sought to establish whether there is agreement on the fundamental characteristics of an evidence-based CPG development process and to explore whether the level of guidance provided in CPG development handbooks is sufficient for people using these handbooks to be able to apply it. Methods CPG development handbooks were identified through a broad search of published and grey literature. Documents published in English produced by national or international organisations purporting to support development of evidence-based CPGs were included. A list of 14 key elements of a CPG development process was developed. Two authors read each handbook. For each handbook a judgement was made as to how it addressed each element; assigned as: 'mentioned and clear guidance provided', 'mentioned but limited practical detail provided ', or 'not mentioned'. Results Six CPG development handbooks were included. These were produced by the Council of Europe, the National Health and Medical Research Council of Australia, the National Institute for Health and Clinical Excellence in the UK, the New Zealand Guidelines Group, the Scottish Intercollegiate Guideline Network, and the World Health Organization (WHO. There was strong concordance between the handbooks on the key elements of an evidence-based CPG development process. All six of the handbooks require and provide guidance on establishment of a multidisciplinary guideline development group, involvement of consumers, identification of clinical questions or problems, systematic searches for and appraisal of research evidence, a process for drafting
Chen, Zheng-guang; Luo, Hui; Xu, Shan; Yang, Yan; Wang, Shou-chuan
At present, evidence-based clinical practice guideline (EBCPG) is the main mode of developing clinical practice guidelines (CPGs) in the world, but in China, most of CPGs of Chinese medicine (CM) are still guidelines based on expert consensus. The objective of this study is to construct initially the methodology of developing EBCPGs of CM and to promote the development of standardization of CM. Based on the development of "Guideline for Diagnosis and Treatment of Common Pediatric Diseases in CM", the methodology of developing EBCPG of CM was explored by analyzing the pertinent literature and considering the characteristics of CM. In this study, the key problem was to put forward the suggestion and strategies. However, due to the methodology study of developing EBCPG of CM is still in the initial stage, there are still some problems which need further study.
Van Biervliet, Jérôme
The practice of equine neurology has special challenges posed by the size of the animal being examined. Many diagnostic procedures routinely used in small animal practice are unsafe when applied to the equine patient or unavailable to the equine practitioner. Therefore, astute observation is the mainstay of making a neuroanatomic diagnosis, and detailed evidence on the deficits present may be difficult to obtain. Because clinical observation can sometimes be ambiguous and somewhat subjective, it is even more important to approach equine neurology from an evidence-based point of view. Here, such an approach is outlined for the diagnosis of cervical vertebral compressive myelopathy (CVCM), one of the most common noninfectious causes of equine neurologic disease. This article is an attempt to summarize all aspects of making a diagnosis of CVCM on the basis of signalment, clinical examination, ancillary diagnostic tests, and pathologic examination. Each of these considerations has inherent limitations regarding diagnostic accuracy, which are discussed.
Friesen-Storms, Jolanda H H M; Moser, Albine; van der Loo, Sandra; Beurskens, Anna J H M; Bours, Gerrie J J W
To describe the process of implementing evidence-based practice in a clinical nursing setting. Evidence-based practice has become a major issue in nursing, it is insufficiently integrated into daily practice and its implementation is complex. Participatory action research. The main participants were nurses working in a lung unit of a rural hospital. A multi-method process of data collection was used during the observing, reflecting, planning and acting phases. Data were continuously gathered during a 24-month period from 2010 to 2012, and analysed using an interpretive constant comparative approach. Patients were consulted to incorporate their perspective. A best-practice mode of working was prevalent on the ward. The main barriers to the implementation of evidence-based practice were that nurses had little knowledge of evidence-based practice and a rather negative attitude towards it, and that their English reading proficiency was poor. The main facilitators were that nurses wanted to deliver high-quality care and were enthusiastic and open to innovation. Implementation strategies included a tailored interactive outreach training and the development and implementation of an evidence-based discharge protocol. The academic model of evidence-based practice was adapted. Nurses worked according to the evidence-based practice discharge protocol but barely recorded their activities. Nurses favourably evaluated the participatory action research process. Action research provides an opportunity to empower nurses and to tailor evidence-based practice to the practice context. Applying and implementing evidence-based practice is difficult for front-line nurses with limited evidence-based practice competencies. Adaptation of the academic model of evidence-based practice to a more pragmatic approach seems necessary to introduce evidence-based practice into clinical practice. The use of scientific evidence can be facilitated by using pre-appraised evidence. For clinical practice
Full Text Available In the nursing profession, EBP makes a positive contribution to healthcare outcomes, care delivery, clinical teaching and research. The research objective was to determine the nurses' knowledge, attitude, practice towards EBP and barriers to use EBP in four (4 Government Hospitals in Malaysia, Hospital Universiti Sains Malaysia (HUSM, Hospital Pulau Pinang (HPP, Hospital Sultan Abdul Halim (HSAH and Hospital Seberang Jaya (HSJ. A cross-sectional study was conducted from January until December 2012 among (n=600 nurses working in all disciplines, on shift or day time duties in four selected hospitals. The questionnaire was adapted from a Singapore study (Majid, 2011. Results showed that among the nurses working in 4 different Malaysian hospitals, close to fifty percent (53 % knew what the evidence based practice meant. The items assessing the attitude showed a large number nurses responding that they did neither agree nor disagree with statements provided. The majority of the remaining nurses tended to show a rather positive attitude except when asked about how the workload interfered with their EBP practice. The practice level of EBP scored a mean of more than 3 out of maximal five for most items. Most nurses recognized there were many barriers to EBP in their working place. In conclusion, this study may have helped to increase our understanding of knowledge, attitudes, practice and barriers towards to use of EBP to the utilization of research by nurses through an exploration of perceived barriers and facilitators on the part of nurses.
Romero, Lisa M; Olaiya, Oluwatosin; Hallum-Montes, Rachel; Varanasi, Balalakshmi; Mueller, Trisha; House, L Duane; Schlanger, Karen; Middleton, Dawn
The purposes of this study were to describe changes in implementation of evidence-based clinical practices among health center partners as part of a multicomponent, community-wide teen pregnancy prevention initiative; to better understand the barriers to and facilitators of implementation of the evidence-based clinical practices; and to describe the technical assistance and training provided to the health center partners and key lessons learned. Health center data from the second and third years (2012 and 2013) of the teen pregnancy prevention community-wide initiative were analyzed from 10 communities (the first year was a planning year; program implementation began in the second year). Data were analyzed from 48 health center partners that contributed data in both years to identify evidence-based clinical practices that were being implemented and opportunities for improvement. In addition, data were analyzed from a purposive sample of 30 health center partners who were asked to describe their experiences in implementing evidence-based clinical practices in adolescent reproductive health care and barriers and facilitators to implementation. Across 48 health centers in the 10 communities, 52% reported an increase in the implementation of evidence-based clinical practices from 2012 to 2013, mostly in providing contraceptive access (23%) and offering Quick Start (19%). Among health centers that reported no change (13%), the majority reported that practices were already being implemented before the initiative. Finally, among health centers that reported a decrease in implementation of evidence-based clinical practices (35%), most reported a decrease in having either hormonal contraception or intrauterine devices available at every visit (15%), having HIV rapid testing available (10%), or participating in the federal 340B Drug Discount Program (2%). In addition, health systems and community-level factors influence health center implementation of evidence-based
Sayre, Jerry W; Toklu, Hale Z; Ye, Fan; Mazza, Joseph; Yale, Steven
Case reports and case series or case study research are descriptive studies that are prepared for illustrating novel, unusual, or atypical features identified in patients in medical practice, and they potentially generate new research questions. They are empirical inquiries or investigations of a patient or a group of patients in a natural, real-world clinical setting. Case study research is a method that focuses on the contextual analysis of a number of events or conditions and their relationships. There is disagreement among physicians on the value of case studies in the medical literature, particularly for educators focused on teaching evidence-based medicine (EBM) for student learners in graduate medical education. Despite their limitations, case study research is a beneficial tool and learning experience in graduate medical education and among novice researchers. The preparation and presentation of case studies can help students and graduate medical education programs evaluate and apply the six American College of Graduate Medical Education (ACGME) competencies in the areas of medical knowledge, patient care, practice-based learning, professionalism, systems-based practice, and communication. A goal in graduate medical education should be to assist residents to expand their critical thinking, problem-solving, and decision-making skills. These attributes are required in the teaching and practice of EBM. In this aspect, case studies provide a platform for developing clinical skills and problem-based learning methods. Hence, graduate medical education programs should encourage, assist, and support residents in the publication of clinical case studies; and clinical teachers should encourage graduate students to publish case reports during their graduate medical education.
Perdices, Michael; Tate, Robyn L
One could be forgiven for thinking that the only road to evidence-based clinical practice is the application of results from randomised controlled trials (or systematic reviews of such). By contrast, single-subject designs in the context of evidence-based clinical practice are believed by many to be strange bedfellows. In this paper, we argue that single-subject designs play an important role in evidence-based clinical practice. We survey the contents of Neuropsychological Rehabilitation in relation to single-subject designs and tackle the main criticisms that have been levelled against them. We offer practical guidance for rating the methodological quality of single-subject designs and applying statistical techniques to measure treatment efficacy. These guides are equally applicable to research studies and everyday clinical practice with individual patients.
Fujimoto, Shuhei; Kon, Noriko; Takasugi, Jun; Nakayama, Takeo
[Purpose] This study aimed to investigate Japanese physical therapists' attitudes of evidence-based practice and clinical practice guidelines. [Subjects and Methods] In 2014, a cross-sectional postal mail survey using a self-administered questionnaire was conducted. Of 2,982 physical therapists belonging to the Chiba Prefecture Physical Therapist Association, 1,000 were randomly selected. The questionnaire comprised 42 items pertaining to the attitudes of and behavior toward evidence-based practice and clinical practice guidelines. It was investigated to reveal the relationship between clinical practice guidelines/evidence-based practice and therapist characteristics. [Results] The response rate was 39.6%, and 384 questionnaires were available. The main results were as follows: 83.3% participants agreed to the importance of evidence-based practice, 77.1% agree to that evidence-based practice supports clinical decision of physical therapists, and about 11% agreed to have been educated about evidence-based practice. Then, 29.2% used, 54.9% agreed to the importance of, and 13.3% agreed to the utility of clinical practice guidelines. An important factor related mostly to a positive attitude, knowledge and behavior of evidence-based practice and clinical practice guidelines was participating in research activities. [Conclusion] Many of physical therapists do not use and understand the importance of clinical practice guidelines. Participating in research activities may partially contribute to improving these conditions.
Giovanni Abrahao Salum
Full Text Available The objective of this narrative review of the literature is to describe the epidemiology, etiology, pathophysiology, diagnosis, and treatment of pediatric anxiety disorders. We aim to guide clinicians in understanding the biology of anxiety disorders and to provide general guidelines for the proper diagnoses and treatment of these conditions early in life. Anxiety disorders are prevalent, associated with a number of negative life outcomes, and currently under-recognized and under-treated. The etiology involves both genes and environmental influences modifying the neural substrate in a complex interplay. Research on pathophysiology is still in its infancy, but some brain regions, such as the amygdala and the prefrontal cortex, have been implicated in fear and anxiety. Current practice is to establish diagnosis based purely on clinical features, derived from clinical interviews with the child, parents, and teachers. Treatment is effective using medication, cognitive behavioral therapy, or a combination of both. An introduction to the neuroscience behind anxiety disorders combined with an evidence-based approach may help clinicians to understand these disorders and treat them properly in childhood.
Seshia, Shashi S
The Users' Guides to the Medical Literature Manual has been a major influence on the teaching and practice of health care globally. The 3rd edition of the multi-authored Manual was reviewed using the principles outlined in Evidence-based Medicine (EBM) texts. One 'clinical scenario' was selected for critical appraisal, as were several chapters; objectivity was enhanced by citing references to support opinions. RESULTS (SUMMARY OF THE APPRAISAL): (1) Strengths: Clinical pearls, too numerous to list. (i) evidence is never enough to drive clinical decision making; (ii) do not rush to adopt new interventions; and (iii) question efficacy data based only on surrogate markers. (2) Weaknesses: The Manual shares shortcomings of textbooks discussed by Straus et al.: (i) references may not be current, important ones may be excluded and citations may be selective; (ii) often, opinion-based; and (iii) delays between revisions. (3) Notable omissions: Little or no discussion of: (i) important segments of the population: those 65 years of age and those with multimorbidity; (ii) surgical disciplines; (iii) Greenhalgh et al.'s essay on EBM; (iv) alternate views on the hierarchy of evidence; and (vi) critical thinking. (4) Additional issues: (i) Omission of important references on dabigatran (clinical scenario: chapter 13.1); (ii) authors' advice (Chapter 13.3) to 'bypass the discussion section of published research'; and (iii) the advocacy of pre-appraised sources of evidence and network meta-analysis without warnings about limitations, are critiqued. The Manual has several clinical pearls but readers should also be aware of shortcomings. © 2016 John Wiley & Sons, Ltd.
Anderson-Peacock, Elizabeth; Blouin, Jean-Sébastien; Bryans, Roland; Danis, Normand; Furlan, Andrea; Marcoux, Henri; Potter, Brock; Ruegg, Rick; Stein, Janice Gross; White, Eleanor
To provide an evidence-based clinical practice guideline for the chiropractic cervical treatment of adults with acute or chronic neck pain not due to whiplash. This is a considerable health concern considered to be a priority by stakeholders, and about which the scientific information was poorly organized. Cervical treatments: manipulation, mobilization, ischemic pressure, clinic- and home-based exercise, traction, education, low-power laser, massage, transcutaneous electrical nerve stimulation, pillows, pulsed electromagnetic therapy, and ultrasound. The primary outcomes considered were improved (reduced and less intrusive) pain and improved (increased and easier) ranges of motion (ROM) of the adult cervical spine. An "extraction" team recorded evidence from articles found by literature search teams using 4 separate literature searches, and rated it using a Table adapted from the Oxford Centre for Evidence-based Medicine. The searches were 1) Treatment; August, 2003, using MEDLINE, CINAHL, AMED, MANTIS, ICL, The Cochrane Library (includes CENTRAL), and EBSCO, identified 182 articles. 2) Risk management (adverse events); October, 2004, identified 230 articles and 2 texts. 3) Risk management (dissection); September, 2003, identified 79 articles. 4) Treatment update; a repeat of the treatment search for articles published between September, 2003 and November, 2004 inclusive identified 121 articles. To enable the search of the literature, the authors (Guidelines Development Committee [GDC]) regarded chiropractic treatment as including elements of "conservative" care in the search strategies, but not in the consideration of the range of chiropractic practice. Also, knowledge based only on clinical experience was considered less valid and reliable than good-caliber evidence, but where the caliber of the relevant evidence was low or it was non-existent, unpublished clinical experience was considered to be equivalent to, or better than the published evidence. REPORTED
Sandra van der Loo; Gerrie Bours; Anna Beurskens; Albine Moser; Jolanda Friesen-Storms
Aims and objectives: To describe the process of implementing evidence-based practice (EBP) in a clinical nursing setting. Background: EBP has become a major issue in nursing, it is insufficiently integrated in daily practice and its implementation is complex. Design: Participatory action
Papadopoulos, Moschos A.
Introduction: Aim of this systematic review was to assess the orthodontic related issues which currently provide the best evidence as documented by meta-analyses, by critically evaluating and discussing the methodology used in these studies. Material and Methods: Several electronic databases were searched and handsearching was also performed in order to identify the corresponding meta-analyses investigating orthodontic related subjects. In total, 197 studies were retrieved initially. After applying specific inclusion and exclusion criteria, 27 articles were identified as meta-analyses treating orthodontic-related subjects. Results: Many of these 27 papers presented sufficient quality and followed appropriate meta-analytic approaches to quantitatively synthesize data and presented adequately supported evidence. However, the methodology used in some of them presented weaknesses, limitations or deficiencies. Consequently, the topics in orthodontics which currently provide the best evidence, include some issues related to Class II or Class III treatment, treatment of transverse problems, external apical root resorption, dental anomalies, such as congenital missing teeth and tooth transposition, frequency of severe occlusal problems, nickel hypersensitivity, obstructive sleep apnea syndrome, and computer-assisted learning in orthodontic education. Conclusions: Only a few orthodontic related issues have been so far investigated by means of MAs. In addition, for some of these issues investigated in the corresponding MAs no definite conclusions could be drawn, due to significant methodological deficiencies of these studies. According to this investigation, it can be concluded that at the begin of the 21st century there is evidence for only a few orthodontic related issues as documented by meta-analyses, and more well-conducted high quality research studies are needed to produce strong evidence in order to support evidence-based clinical practice in orthodontics. PMID
This article presents evidence-based clinical recommendations for the use of pit-and-fissure sealants on the occlusal surfaces of primary and permanent molars in children and adolescents. A guideline panel convened by the American Dental Association (ADA) Council on Scientific Affairs and the American Academy of Pediatric Dentistry conducted a systematic review and formulated recommendations to address clinical questions in relation to the efficacy, retention, and potential side effects of sealants to prevent dental caries; their efficacy compared with fluoride varnishes; and a head-to-head comparison of the different types of sealant material used to prevent caries on pits-and-fissures of occlusal surfaces. This is an update of the ADA 2008 recommendations on the use of pit-and-fissure sealants on the occlusal surfaces of primary and permanent molars. The authors conducted a systematic search in MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and other sources to identify randomized controlled trials reporting on the effect of sealants (available on the U.S. market) when applied to the occlusal surfaces of primary and permanent molars. The authors used the Grading of Recommendations Assessment, Development, and Evaluation approach to assess the quality of the evidence and to move from the evidence to the decisions. The guideline panel formulated 3 main recommendations. They concluded that sealants are effective in preventing and arresting pit-and-fissure occlusal carious lesions of primary and permanent molars in children and adolescents compared with the nonuse of sealants or use of fluoride varnishes. They also concluded that sealants could minimize the progression of non-cavitated occlusal carious lesions (also referred to as initial lesions) that receive a sealant. Finally, based on the available limited evidence, the panel was unable to provide specific recommendations on the relative merits of 1 type of sealant material over the others
Reviews problems identified in previous research on evidence-based nursing practice; discusses conflicts between medical and nursing domains; explores the provenance and status of the clinical guideline as a translation artefact or bridging mechanism based on a social studies of science approach; and presents a case study of Scottish clinical…
Thangaratinam, Shakila; Barnfield, Gemma; Weinbrenner, Susanne; Meyerrose, Berit; Arvanitis, Theodoros N.; Horvath, Andrea R.; Zanrei, Gianni; Kunz, Regina; Suter, Katja; Walczak, Jacek; Kaleta, Anna; Oude Rengerink, Katrien; Gee, Harry; Mol, Ben W. J.; Khan, Khalid S.
ABSTRACT: BACKGROUND: Evidence based medicine (EBM) is considered an integral part of medical training, but integration of teaching various EBM steps in everyday clinical practice is uncommon. Currently EBM is predominantly taught through theoretical courses, workshops and e-learning. However,
Molina Mula, Jesús; Muñoz Navarro, Paulina; Vaca Auz, Janeth; Cabascango Cabascango, Carmita; Cabascango Cabascango, Katty
The research raises the need to increase understanding of organizational and personal factors that influence the attitude and aptitude of each professional, with respect to evidence-based clinical practice. The aim of this study is to describe the transfer of knowledge into clinical practice in hospital units in Imbabura (Ecuador) identifying the obstacles to implementing evidence-based clinical practice validated questionnaire EBPQ-19. A cross-sectional observational study was conducted in hospitals of the Ministry of Public Health of Imbabura of Ecuador took place, including a total of 281 nurses and physicians. Nurses and physicians showed positive attitudes toward evidence-based clinical practice (EBCP) and their use to support clinical decision-making. This research evidences perceptions of professionals on strategies for knowledge transfer and obstacles to carry it out. Significant differences between the perception of the use of EBCP strategies between nurses and physicians are observed. Physicians consider they use them frequently, while nurses acknowledge using them less (chi-square: 105.254, P=.018). In conclusion, we can say that these factors should be considered as necessary to improve the quality of care that is provided to users based on the best available evidence. It is necessary to start developing change interventions in this regard to remedy the current situation of clinical practice based not on evidence, but rather on experience only. Experimental studies demonstrating the effectiveness of strategies to eliminate barriers to scientific evidence-based clinical practice should be conducted. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.
Gudray, Kiran; Walmsley, Anthony Damien
This article informs readers of a method of implementing evidence-based dentistry in practice. Following these steps, practitioners should be able to use this skill in an efficient manner. The importance of evidence-based dentistry and its relevance to situations encountered in everyday practice is also highlighted. Clinical relevance: This article highlights a series of steps to be followed by practitioners to ensure that treatment provided is supported by the most recent, good quality evidence.
Full Text Available Intractable cancer pain not amenable to standard oral or parenteral analgesics is a horrifying truth in 10-15% of patients. Interventional pain management techniques are an indispensable arsenal in pain physician′s armamentarium for severe, intractable pain and can be broadly classified into neuroablative and neuromodulation techniques. An array of neurolytic techniques (chemical, thermal, or surgical can be employed for ablation of individual nerve fibers, plexuses, or intrathecalneurolysis in patients with resistant pain and short life-expectancy. Neuraxial administration of drugs and spinal cord stimulation to modulate or alter the pain perception constitutes the most frequently employed neuromodulation techniques. Lately, there is a rising call for early introduction of interventional techniques in carefully selected patients simultaneously or even before starting strong opioids. After decades of empirical use, it is the need of the hour to head towards professionalism and standardization in order to secure credibility of specialization and those practicing it. Even though the interventional management has found a definite place in cancer pain, there is a dearth of evidence-based practice guidelines for interventional therapies in cancer pain. This may be because of paucity of good quality randomized controlled trials (RCTs evaluating their safety and efficacy in cancer pain. Laying standardized guidelines based on existing and emerging evidence will act as a foundation step towards strengthening, credentialing, and dissemination of the specialty of interventional cancer pain management. This will also ensure an improved decision-making and quality of life (QoL of the suffering patients.
Beinortas, Tumas; Bauza, Karolis; Howick, Jeremy; Nunan, David; Mahtani, Kamal Ram
In post-Soviet countries, where medical practice largely relies on experience alone, the incorporation of the best research evidence in clinical practice is limited. In order to promote the awareness and utilization of evidence-based medicine (EBM) among Lithuanian doctors, we organized EBM conferences in each of the two Lithuanian medical schools. More than 500 medical professionals and students attended the conferences in Vilnius (2013) and Kaunas (2014) demonstrating that there is a high demand for formal EBM teaching. Building on the success of these seminal conferences, and to start addressing the lack of EBM practice in the country, the first Lithuanian Centre for Evidence-Based Medicine was established at Vilnius University Medical Faculty in 2014. The Centre will focus on the implementation of EBM teaching in medical school curriculum, formulating management guidelines, writing systematic reviews and supporting Lithuanian authors in doing so. © 2015 Chinese Cochrane Center, West China Hospital of Sichuan University and Wiley Publishing Asia Pty Ltd.
B. Spek; M. Wieringa-de Waard; C. Lucas; N. van Dijk
BACKGROUND: Worldwide speech-language therapy (SLT) students are educated in evidence-based practice (EBP). For students to use EBP in their future day-to-day clinical practice, they must value EBP as positive and must feel confident in using it. For curricula developers it is therefore important to
Kouhpayehzadeh, Jalil; Baradaran, Hamid; Arabshahi, Kamran Soltani; Knill-Jones, Robin
Introduction: Evidence-based medicine (EBM) has been introduced in medical schools worldwide, but there is little known about effective methods for teaching EBM skills, particularly in developing countries. This study assesses the impact of an EBM workshop on clinical teachers' attitudes and use of EBM skills. Methods: Seventy-two clinical…
Branstetter, M Laurie; Smith, Lynette S; Brooks, Andrea F
Over the past decade, the federal government has mandated healthcare providers to incorporate electronic health records into practice by 2015. This technological update in healthcare documentation has generated a need for advanced practice RN programs to incorporate information technology into education. The National Organization of Nurse Practitioner Faculties created core competencies to guide program standards for advanced practice RN education. One core competency is Technology and Information Literacy. Educational programs are moving toward the utilization of electronic clinical tracking systems to capture students' clinical encounter data. The purpose of this integrative review was to evaluate current research on advanced practice RN students' documentation of clinical encounters utilizing electronic clinical tracking systems to meet advanced practice RN curriculum outcome goals in information technology as defined by the National Organization of Nurse Practitioner Faculties. The state of the science depicts student' and faculty attitudes, preferences, opinions, and data collections of students' clinical encounters. Although electronic clinical tracking systems were utilized to track students' clinical encounters, these systems have not been evaluated for meeting information technology core competency standards. Educational programs are utilizing electronic clinical tracking systems with limited evidence-based literature evaluating the ability of these systems to meet the core competencies in advanced practice RN programs.
Majid, Shaheen; Foo, Schubert; Luyt, Brendan; Zhang, Xue; Theng, Yin-Leng; Chang, Yun-Ke; Mokhtar, Intan A
Objective: Evidence-based practice (EBP) provides nurses with a method to use critically appraised and scientifically proven evidence for delivering quality health care to a specific population. The objective of this study was to explore nurses' awareness of, knowledge of, and attitude toward EBP and factors likely to encourage or create barriers to adoption. In addition, information sources used by nurses and their literature searching skills were also investigated. Method: A total of 2,100 copies of the questionnaire were distributed to registered nurses in 2 public hospitals in Singapore, and 1,486 completed forms were returned, resulting in a response rate of 70.8%. Results: More than 64% of the nurses expressed a positive attitude toward EBP. However, they pointed out that due to heavy workload, they cannot keep up to date with new evidence. Regarding self-efficacy of EBP-related abilities, the nurses perceived themselves to possess moderate levels of skills. The nurses also felt that EBP training, time availability, and mentoring by nurses with EBP experience would encourage them to implement EBP. The top three barriers to adopting EBP were lack of time, inability to understand statistical terms, and inadequate understanding of the jargon used in research articles. For literature searching, nurses were using basic search features and less than one-quarter of them were familiar with Boolean and proximity operators. Conclusion: Although nurses showed a positive attitude toward EBP, certain barriers were hindering their smooth adoption. It is, therefore, desirable that hospital management in Southeast Asia, particularly in Singapore, develop a comprehensive strategy for building EBP competencies through proper training. Moreover, hospital libraries should also play an active role in developing adequate information literacy skills among the nurses. PMID:21753915
Kegel, Gary; Marshall, Astrid; Barron, O Alton; Catalano, Louis W; Glickel, Steven Z; Kuhn, Margaret
A survey regarding upper-extremity steroid injection practices was distributed to all active members of the American Society for Surgery of the Hand (ASSH) and American Shoulder and Elbow Surgeons (ASES) using SurveyMonkey. Response rates for the ASSH and ASES were 26% and 24%, respectively. The potency-adjusted dose of steroid injected for common hand and wrist injections ranged from 0.375 to 133.33 mg and for shoulder injections ranged from 0.375 to 250 mg. These ranges span 356-fold and 667-fold differences, respectively. Potency-adjusted doses differed significantly between steroid types for all injections evaluated in this study. American Society for Surgery of the Hand members gave significantly smaller doses of steroid for the glenohumeral and acromioclavicular joints than ASES members. Only 9% of respondents based injection practice on a scientific reference. Sixteen percent of ASSH and 31% of ASES respondents reported no specific rationale for their steroid injection practice; 78% of ASSH and 52% of ASES respondents attributed their rationale to some kind of instruction from their mentors or colleagues. Upper-extremity surgeons demonstrate substantial variability in their practice of steroid injections, with up to a 667-fold range in steroid dose. Experienced clinical opinion is the principal rationale for these injection practices; little rationale is based on formal scientific evidence. Copyright 2013, SLACK Incorporated.
Amorin-Woods, Lyndon G; Losco, Barrett E
Various models and decision-making aids exist for chiropractic clinical practice. "PICO-D Man" (Patient-Intervention-Comparator-Outcome-Duration Management) is a decision-aid developed in an educational setting which field practitioners may also find useful for applying defensible evidence-based practice. Clinical decision-making involves understanding and evaluating both the proposed clinicalintervention(s) and the relevant and available management options with respect to describing the patient and their problem, clinical and cost effectiveness, safety, feasibility and time-frame. For people consulting chiropractors this decision-aid usually requires the practitioner to consider a comparison of usual chiropractic care, (clinical management including a combination of active care and passive manual interventions), to usual medical care usually including medications, or other allied healthmanagement options while being mindful of the natural history of the persons' condition.
Thangaratinam, Shakila; Barnfield, Gemma; Weinbrenner, Susanne; Meyerrose, Berit; Arvanitis, Theodoros N; Horvath, Andrea R; Zanrei, Gianni; Kunz, Regina; Suter, Katja; Walczak, Jacek; Kaleta, Anna; Oude Rengerink, Katrien; Gee, Harry; Mol, Ben W J; Khan, Khalid S
Evidence based medicine (EBM) is considered an integral part of medical training, but integration of teaching various EBM steps in everyday clinical practice is uncommon. Currently EBM is predominantly taught through theoretical courses, workshops and e-learning. However, clinical teachers lack confidence in teaching EBM in workplace and are often unsure of the existing opportunities for teaching EBM in the clinical setting. There is a need for continuing professional development (CPD) courses that train clinical trainers to teach EBM through on-the-job training by demonstration of applied EBM real time in clinical practice. We developed such a course to encourage clinically relevant teaching of EBM in post-graduate education in various clinical environments. We devised an e-learning course targeting trainers with EBM knowledge to impart educational methods needed to teach application of EBM teaching in commonly used clinical settings. The curriculum development group comprised experienced EBM teachers, clinical epidemiologists, clinicians and educationalists from institutions in seven European countries. The e-learning sessions were designed to allow participants (teachers) to undertake the course in the workplace during short breaks within clinical activities. An independent European steering committee provided input into the process. The curriculum defined specific learning objectives for teaching EBM by exploiting educational opportunities in six different clinical settings. The e-modules incorporated video clips that demonstrate practical and effective methods of EBM teaching in everyday clinical practice. The course encouraged focussed teaching activities embedded within a trainer's personal learning plan and documentation in a CPD portfolio for reflection. This curriculum will help senior clinicians to identify and make the best use of available opportunities in everyday practice in clinical situations to teach various steps of EBM and demonstrate their
American Psychologist, 2006
The evidence-based practice movement has become an important feature of health care systems and health care policy. Within this context, the APA 2005 Presidential Task Force on Evidence-Based Practice defines and discusses evidence-based practice in psychology (EBPP). In an integration of science and practice, the Task Force's report describes…
Holt, Hannah; Beutler, Larry E; Kimpara, Satoko; Macias, Sandra; Haug, Nancy A; Shiloff, Nicole; Goldblum, Peter; Temkin, Rainey Sealey; Stein, Mickey
Supervision is the primary way in which psychotherapy trainees develop the skills of applying interventions, conceptualizing cases, and practicing self-reflection. Although critical to professional development, the nature and objectives of supervision can vary widely among supervisors, depending on idiosyncratic differences and the orientation used. As clinical psychology moves toward integrating science and practice, the need to teach students evidence-based principles of therapeutic change and how to use outcome measures to enhance progress is paramount. Furthermore, with hundreds of "evidence-based" interventions and widely diverse supervisors, the fact that cross-cutting interventions and common factors carry the burden of most therapeutic change is frequently lost. In this article, we outline an experimental training system that is being tested as a means to teach student-therapists to use empirically established moderators (treatment factors) and mediators of change to tailor their interventions to client differences. This experimental approach is derived from Systematic Treatment Selection (Beutler, Clarkin, & Bongar, 2000), a cross-cutting system that can be used to aid individualized treatment planning as well as to track and use client outcomes in clinical supervision within a graduate-level training clinic. (c) 2015 APA, all rights reserved).
The call for evidence-based policy is often accompanied by rather uncritical references to the success of evidence-based medicine, leading to often unsuccessful translation attempts. In this paper, I reflect on the practice of evidence-based medicine in an attempt to sketch a more productive approach to translating evidence into the practice of policy making. Discussing three episodes in the history of evidence-based medicine - clinical trials, and the production and use of clinical guidelines - I conclude that the success of evidence-based medicine is based on the creation of reflexive practices in which evidence and practice can be combined productively. In the conclusion, I discuss the prospects of such a practice for evidence-based policy.
Braman, Sidney S
The purpose of this review is to present the evidence for the diagnosis and treatment of cough due to acute bronchitis and make recommendations that will be useful for clinical practice. Acute bronchitis is one of the most common diagnoses made by primary care clinicians and emergency department physicians. It is an acute respiratory infection with a normal chest radiograph that is manifested by cough with or without phlegm production that lasts for up to 3 weeks. Respiratory viruses appear to be the most common cause of acute bronchitis; however, the organism responsible is rarely identified in clinical practice because viral cultures and serologic assays are not routinely performed. Fewer than 10% of patients will have a bacterial infection diagnosed as the cause of bronchitis. The diagnosis of acute bronchitis should be made only when there is no clinical or radiographic evidence of pneumonia, and the common cold, acute asthma, or an exacerbation of COPD have been ruled out as the cause of cough. Acute bronchitis is a self-limited respiratory disorder, and when the cough persists for >3 weeks, other diagnoses must be considered. Recommendations for this review were obtained from data using a National Library of Medicine (PubMed) search dating back to 1950, which was performed in August 2004. The search was limited to literature published in the English language and human studies, using search terms such as "cough," "acute bronchitis," and "acute viral respiratory infection." Unfortunately, most previous controlled trials guiding the treatment of acute bronchitis have not vigorously differentiated acute bronchitis and the common cold, and also have not distinguished between an acute exacerbation of chronic bronchitis and acute asthma as a cause of acute cough. For patients with the putative diagnosis of acute bronchitis, routine treatment with antibiotics is not justified and should not be offered. Antitussive agents are occasionally useful and can be offered as
Schaefer, Jessica D; Welton, John M
To analyse and define the concept "evidence based practice readiness" in nurses. Evidence based practice readiness is a term commonly used in health literature, but without a clear understanding of what readiness means. Concept analysis is needed to define the meaning of evidence based practice readiness. A concept analysis was conducted using Walker and Avant's method to clarify the defining attributes of evidence based practice readiness as well as antecedents and consequences. A Boolean search of PubMed and Cumulative Index for Nursing and Allied Health Literature was conducted and limited to those published after the year 2000. Eleven articles met the inclusion criteria for this analysis. Evidence based practice readiness incorporates personal and organisational readiness. Antecedents include the ability to recognize the need for evidence based practice, ability to access and interpret evidence based practice, and a supportive environment. The concept analysis demonstrates the complexity of the concept and its implications for nursing practice. The four pillars of evidence based practice readiness: nursing, training, equipping and leadership support are necessary to achieve evidence based practice readiness. Nurse managers are in the position to address all elements of evidence based practice readiness. Creating an environment that fosters evidence based practice can improve patient outcomes, decreased health care cost, increase nurses' job satisfaction and decrease nursing turnover. © 2018 John Wiley & Sons Ltd.
Amorin-Woods, Lyndon G; Losco, Barrett E
.... Results "PICO-D Man" (Patient-Intervention-Comparator-Outcome-Duration Management) is a decision-aid developed in an educational setting which field practitioners may also find useful for applying defensible evidence-based practice...
Braman, Sidney S
Chronic bronchitis is a disease of the bronchi that is manifested by cough and sputum expectoration occurring on most days for at least 3 months of the year and for at least 2 consecutive years when other respiratory or cardiac causes for the chronic productive cough are excluded. The disease is caused by an interaction between noxious inhaled agents (eg, cigarette smoke, industrial pollutants, and other environmental pollutants) and host factors (eg, genetic and respiratory infections) that results in chronic inflammation in the walls and lumen of the airways. As the disease advances, progressive airflow limitation occurs, usually in association with pathologic changes of emphysema. This condition is called COPD. When a stable patient experiences a sudden clinical deterioration with increased sputum volume, sputum purulence, and/or worsening of shortness of breath, this is referred to as an acute exacerbation of chronic bronchitis as long as conditions other than acute tracheobronchitis are ruled out. The purpose of this review is to present the evidence for the diagnosis and treatment of cough due to chronic bronchitis, and to make recommendations that will be useful for clinical practice. Recommendations for this section of the review were obtained from data using a National Library of Medicine (PubMed) search dating back to 1950, performed in August 2004, of the literature published in the English language. The search was limited to human studies, using the search terms "cough," "chronic bronchitis," and "COPD." The most effective way to reduce or eliminate cough in patients with chronic bronchitis and persistent exposure to respiratory irritants, such as personal tobacco use, passive smoke exposure, and workplace hazards is avoidance. Therapy with a short-acting inhaled beta-agonist, inhaled ipratropium bromide, and oral theophylline, and a combined regimen of inhaled long-acting beta-agonist and an inhaled corticosteroid may improve cough in patients with
Malik, Gulzar; McKenna, Lisa; Plummer, Virginia
Evidence-based practice (EBP) in the clinical setting is recognized as an approach that leads to improved patient outcomes. Nurse educators (NEs), clinical coaches (CCs) and nurse specialists are in key positions to promote and facilitate EBP within clinical settings and have opportunities to advance practice. Therefore, it is important to understand their perceptions of factors promoting EBP and perceived barriers in facilitating EBP in clinical settings, before developing educational programmes. This paper reports findings from a study that aimed to explore NEs' , CCs' and nurse specialists' knowledge, skills and attitudes associated with EBP. This study used a questionnaire containing quantitative and a small number of qualitative questions to capture data collected from NEs, CCs and nurse specialists working at a tertiary health-care facility in Victoria, Australia. The questionnaire was distributed to a total of 435 people, of whom 135 responded (31%). Findings revealed that the three senior nurse groups relied heavily on personal experience, organizational policies and protocols as formal sources of knowledge. Furthermore, they had positive attitudes towards EBP. However, participants demonstrated lack of knowledge and skills in appraising and utilizing evidence into practice. They indicated a desire to seek educational opportunities to upskill themselves in the process of EBP. © 2014 Wiley Publishing Asia Pty Ltd.
Grummich, K; Jensen, K; Obst, O; Seiler, C M; Diener, M K
Every day approximately 75 clinical trials and 11 systematic reviews are published in the health-care intervention and medical field. Due to this growing number of publications it is a challenge for every practicing clinician to keep track with the latest research. The implementation of new and effective diagnostic and therapeutic interventions into daily clinical routine may thus be delayed. Conversely, ineffective or even harmful interventions might still be in use. Decision-making in evidence-based medicine (EBM) requires consideration of the most recent high quality evidence. Randomised controlled trials (RCTs) are regarded as the "gold standard" to prove the efficacy of surgical interventions in patient-oriented research. Systematic reviews combine results from RCTs by summarising single RCTs which answer a particular clinical question. Some basic knowledge in systematic literature searching is required and helpful for detecting relevant publications. This article shows various possibilities for locating clinical studies and systematic reviews in the database Medline on the basis of illustrative step-by-step instructions. RESULTS AND CONCLUSION. Depending on the aim and topic of the literature search, the time required for the task may vary. In routine practice, a systematic literature search is unrealistic in most cases. Clinicians in need of a quick update of current evidence on a certain clinical topic may make use of up-to-date systematic reviews. During a systematic literature search, different approaches and strategies might be necessary. Georg Thieme Verlag KG Stuttgart · New York.
Adams, Susan; McCarthy, Ann Marie
School nurses need to demonstrate that their practice is based on the best evidence available, which is usually data obtained from research. Evidence-based practice involves combining the best evidence available with nursing expertise and patient and family preferences to determine optimum care. Evidence-based practice guidelines are developed by…
Herur, A; Kolagi, S; Ramadurg, U; Hiremath, C S; Hadimani, C P; Goudar, S S
A gap between best practice and actual clinical care exists and this can be overcome by evidence-based practice (EBP), which is essential to improve the clinical decision making. A strategy to reduce deficits in care provision is to train the postgraduate students in the practice of EBP in the journal clubs as evidence from medical colleges in India reveals that current format of journal club presentations is unsatisfactory. The aim of the present study was to refine the journal club presentations of postgraduate students of clinical departments and to study the effectiveness of EBP training in them for better EBP. This study was conducted in S. Nijalingappa Medical College, Bagalkot, Karnataka, India, and it was a pre- and post-trial. This study was a pre- and post-trial done during the journal club presentations of postgraduate students from clinical departments. Postgraduate students' understanding of concepts about EBP was assessed using Fresno test questionnaire in traditional journal club presentation. A hands-on session incorporating steps of EBP was imparted to them. Soon after the session, each student was assessed. In the next journal club presentation, 1 week later, the students were assessed again with the same questionnaire by the same faculty. Scores of the postgraduate students, before and after intervention (immediate and 1 week later), were compared. Data were analyzed by paired t-test using SPSS. An increase in mean posttest scores was seen immediately and also 1 week later as compared to the pretest scores. The scores also increased significantly, when each step of EBP was considered. Incorporating teaching of EBP in journal club presentations improved the competencies of postgraduate students in clinical decision making.
Celis-Rodríguez, E; Birchenall, C; de la Cal, M Á; Castorena Arellano, G; Hernández, A; Ceraso, D; Díaz Cortés, J C; Dueñas Castell, C; Jimenez, E J; Meza, J C; Muñoz Martínez, T; Sosa García, J O; Pacheco Tovar, C; Pálizas, F; Pardo Oviedo, J M; Pinilla, D I; Raffán-Sanabria, F; Raimondi, N; Righy Shinotsuka, C; Suárez, M; Ugarte, S; Rubiano, S
Optimal management of sedation, analgesia and delirium offers comfort and security for the critical care patient, allows support measures to be applied more easily and enables an integral approach of medical care, at the same time that lowers the incidence of complications, wich translates in better patient outcomes. To update the Guía de práctica clínica basada en la evidencia para el manejo de la sedoanalgesia en el paciente adulto críticamente enfermo published in Medicina Intensiva in 2007, and give recommendations for the management of sedation, analgesia, and delirium. A group of 21 intensivists from 9 countries of the Federación Panamericana e Ibérica de Sociedades de Medicina Crítica y Terapia Intensiva, 3 of them also specialists in clinical epidemiology and methodology, gathered for the development of guidelines. Assessment of evidence quality and recommendations were made based on the Grading of Recommendations Assessment, Development and Evaluation system. Strength of recommendations was classified as 1=strong, or 2=weak, and quality of evidence as A=high, B=moderate, or C=low. Two authors searched the following databases: MEDLINE through PUBMED, The Cochrane Library and Literatura Latinoamericana y del Caribe en Ciencias de la Salud and retrieved pertinent information. Members assigned to the 11 sections of the guidelines, based on the literature review, formulated the recommendations, that were discussed in plenary sessions. Only those recommendations that achieved more than 80% of consensus were approved for the final document. The Colombian Association of Critical Medicine and Intensive Care (AMCI) supported the elaboration of this guidelines. Four hundred sixty-seven articles were included for review. An increase in number and quality of publications was observed. This allowed to generate 64 strong recommendations with high and moderate quality of evidence in contrast to the 28 recommendations of the previous edition. This Guidelines
Hajebrahimi, Sakineh; Sadeghi-Ghyassi, Fatemeh; Olfati, Nahid; Dastgiri, Saeed; Maghbouli, Leili
To determine the attitudes and beliefs of Iranian urologists toward Evidence Based Medicine (EBM) and investigation of the barriers of evidence based practice (EBP). A self- administrated, Likert scale questionnaire designed in Persian and filled up by censuses selected urologist from Iranian Urology Association (IUA). Data were entered to Predictive Analytics Soft Ware version 18.0 and descriptive statistics were obtained for all parts of the questionnaire. A total of 111 out of 500 Iranian urologists who attended in IUA annual meeting, responded to the questionnaires. Mean attitude score of respondents was 30.4 (SD: 5.7, range 16-40). Attitude score showed statistically significant association to previous participation in EBM workshops (P = .01). Of participants 96% believed EBP will improve patient care and 76.2% of them appreciated the impact of use of research utilization and application of evidence based guidelines on clinical decision making and the outcome of surgery. The main barriers to EBP stated as lack of time (64.8%), facilities (53.4%), and training in EBM (29.4%). The urologists have positive attitudes towards EBP. However, regarding lack of time, pre-appraised databases or EBP guidelines can be helpful. Evidence based workshops and familiarity with evidence databases is recommended for Iranian urologists. In addition, health care system and policy makers could play a major role to provide a culture of EBP.
Johan A. Franck
Full Text Available The volume of information on new treatment techniques supporting the restoration of arm-hand function (AHF and arm-hand skill performance (ASHP in stroke survivors overwhelms therapists in everyday clinical practice when choosing the appropriate therapy. The Concise Arm and Hand Rehabilitation Approach in Stroke (CARAS is designed for paramedical staff to structure and implement training of AHF and AHSP in stroke survivors. The CARAS is based on four constructs: (a stratification according to the severity of arm–hand impairment (using the Utrecht Arm/Hand -Test [UAT], (b the individual’s rehabilitation goals and concomitant potential rehabilitation outcomes, (c principles of self-efficacy, and (d possibilities to systematically incorporate (new technology and new evidence-based training elements swiftly. The framework encompasses three programs aimed at treating either the severely (UAT 0-1, moderately (UAT 2-3, or mildly (UAT 4-7 impaired arm-hand. Program themes are: taking care of the limb and prevention of complications (Program 1, task-oriented gross motor grip performance (Program 2, and functional AHSP training (Program 3. Each program is preceded and followed by an assessment. Training modularity facilitates rapid interchange/adaptation of sub-elements. Proof-of-principle in clinical rehabilitation has been established. The CARAS facilitates rapid structured design and provision of state-of-the-art AHF and ASHP treatment in stroke patients.
Hotelling, Barbara A.
Childbirth educators are responsible for providing expectant parents with evidence-based information. In this column, the author suggests resources where educators can find evidence-based research for best practices. Additionally, the author describes techniques for childbirth educators to use in presenting research-based information in their classes. A sample of Web sites and books that offer evidence-based resources for expectant parents is provided.
Hamson-Utley, J. Jordan; Stiller-Ostrowski, Jennifer L.
Evidence-based practice (EBP) and educational technology have become fundamental skills within athletic training programs. The objective of this article is to share experiences implementing clinical orthopaedic evaluation applications ("apps") that can be integrated into classroom and clinical education to enhance students' proficiency…
Williamson, Kathleen M; Almaskari, Mohammed; Lester, Zanet; Maguire, Deborah
This collaborative study explored nurses' knowledge, attitudes, and skills related to the evidence-based practice (EBP) process. It also explored the nurses' perceptions of the barriers and facilitators that they face related to fully using EBP in the workplace. Findings will afford the healthcare system the information to develop, plan, and restructure the educational services to meet the demand of enhancing EBP strategies and utilization.
Full Text Available Abstract Background A variety of definitions of evidence-based practice (EBP exist. However, definitions are in themselves insufficient to explain the underlying processes of EBP and to differentiate between an evidence-based process and evidence-based outcome. There is a need for a clear statement of what Evidence-Based Practice (EBP means, a description of the skills required to practise in an evidence-based manner and a curriculum that outlines the minimum requirements for training health professionals in EBP. This consensus statement is based on current literature and incorporating the experience of delegates attending the 2003 Conference of Evidence-Based Health Care Teachers and Developers ("Signposting the future of EBHC". Discussion Evidence-Based Practice has evolved in both scope and definition. Evidence-Based Practice (EBP requires that decisions about health care are based on the best available, current, valid and relevant evidence. These decisions should be made by those receiving care, informed by the tacit and explicit knowledge of those providing care, within the context of available resources. Health care professionals must be able to gain, assess, apply and integrate new knowledge and have the ability to adapt to changing circumstances throughout their professional life. Curricula to deliver these aptitudes need to be grounded in the five-step model of EBP, and informed by ongoing research. Core assessment tools for each of the steps should continue to be developed, validated, and made freely available. Summary All health care professionals need to understand the principles of EBP, recognise EBP in action, implement evidence-based policies, and have a critical attitude to their own practice and to evidence. Without these skills, professionals and organisations will find it difficult to provide 'best practice'.
Chen, Yu-Chih; Tang, Lee-Chun; Chou, Shin-Shang
Evidence-based practice has been demonstrated to improve quality of care, increase patients' satisfaction, and reduce the costs of medical care. Therefore, evidence-based practice is now central to the clinical decision-making process and to achieving better quality of care. Today, it is one of the important indicators of core competences for healthcare providers and accreditation for healthcare and educational systems. Further, evidence-based practice encourages in-school and continuous education programs to integrate evidence-based elements and concepts into curricula. Healthcare facilities and professional organizations proactively host campaigns and encourage healthcare providers to participate in evidence-based related training courses. However, the clinical evidence-based practice progress is slow. The general lack of a model for organizational follow-up may be a key factor associated with the slow adoption phenomenon. The authors provide a brief introduction to the evidence-based practice model, then described how it may be successfully translated through a staged process into the evidence-based practices of organizational cultures. This article may be used as a reference by healthcare facilities to promote evidence-based nursing practice.
Full Text Available Abstract Background Evidence generated from reliable research is not frequently implemented into clinical practice. Evidence-based clinical practice guidelines are a potential vehicle to achieve this. A recent systematic review of implementation strategies of guideline dissemination concluded that there was a lack of evidence regarding effective strategies to promote the uptake of guidelines. Recommendations from this review, and other studies, have suggested the use of interventions that are theoretically based because these may be more effective than those that are not. An evidence-based clinical practice guideline for the management of acute low back pain was recently developed in Australia. This provides an opportunity to develop and test a theory-based implementation intervention for a condition which is common, has a high burden, and for which there is an evidence-practice gap in the primary care setting. Aim This study aims to test the effectiveness of a theory-based intervention for implementing a clinical practice guideline for acute low back pain in general practice in Victoria, Australia. Specifically, our primary objectives are to establish if the intervention is effective in reducing the percentage of patients who are referred for a plain x-ray, and improving mean level of disability for patients three months post-consultation. Methods/Design This study protocol describes the details of a cluster randomised controlled trial. Ninety-two general practices (clusters, which include at least one consenting general practitioner, will be randomised to an intervention or control arm using restricted randomisation. Patients aged 18 years or older who visit a participating practitioner for acute non-specific low back pain of less than three months duration will be eligible for inclusion. An average of twenty-five patients per general practice will be recruited, providing a total of 2,300 patient participants. General practitioners in the
Seferian Edward G
Full Text Available Abstract Background Recently completed clinical trials have shown that certain interventions improve the outcome of the critically ill. To facilitate the implementation of these interventions, professional organizations have developed guidelines. Although the impacts of the individual evidence-based interventions have been well described, the overall impact on outcome of introducing multiple evidence-based protocols has not been well studied. The objective of this study was to determine the impact of introducing multiple evidence-based protocols on patient outcome. Methods A retrospective, cohort study of 8,386 patients admitted to the medical intensive care unit (MICU of an academic, tertiary medical center, from January 2000 through June 2005 was performed. Four evidence-based protocols (lung protective strategy for acute lung injury, activated protein C for severe sepsis/septic shock, intravenous insulin for hyperglycemia control and a protocol for sedation/analgesia were introduced in the MICU between February 2002 and April 2004. We considered the time from January 2000 through January 2002 as the pre-protocol period, from February 2002 through March 2004 as the transition period and from April 2004 through June 2005 as the protocol period. We retrieved data including demographics, severity of illness as measured by the Acute Physiology and Chronic Health Evaluation (APACHE III, MICU length of stay and hospital mortality. Student's t, Kruskal-Wallis, Mann-Whitney U, chi square and multiple logistic regression analyses were used to compare differences between groups. P-values Results The predicted mean mortality rates were 20.7%, 21.1% and 21.8%, with the observed mortality rates of 19.3%, 18.0% and 16.9% during the pre-protocol, transition and protocol periods, respectively. Using the pre-protocol period as a reference, the severity-adjusted risk (95% confidence interval of dying was 0.777 (0.655 – 0.922 during the protocol period (P = 0
Monagle, Paul; Chalmers, Elizabeth; Chan, Anthony; deVeber, Gabrielle; Kirkham, Fenella; Massicotte, Patricia; Michelson, Alan D
This chapter about antithrombotic therapy in neonates and children is part of the Antithrombotic and Thrombolytic Therapy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Grade 1 recommendations are strong and indicate that the benefits do, or do not, outweigh risks, burden, and costs, and Grade 2 suggests that individual patient values may lead to different choices (for a full understanding of the grading, see Guyatt et al in this supplement, pages 123S-131S). In this chapter, many recommendations are based on extrapolation of adult data, and the reader is referred to the appropriate chapters relating to guidelines for adult populations. Within this chapter, the majority of recommendations are separate for neonates and children, reflecting the significant differences in epidemiology of thrombosis and safety and efficacy of therapy in these two populations. Among the key recommendations in this chapter are the following: In children with first episode of venous thromboembolism (VTE), we recommend anticoagulant therapy with either unfractionated heparin (UFH) or low-molecular-weight heparin (LMWH) [Grade 1B]. Dosing of IV UFH should prolong the activated partial thromboplastin time (aPTT) to a range that corresponds to an anti-factor Xa assay (anti-FXa) level of 0.35 to 0.7 U/mL, whereas LMWH should achieve an anti-FXa level of 0.5 to 1.0 U/mL 4 h after an injection for twice-daily dosing. In neonates with first VTE, we suggest either anticoagulation or supportive care with radiologic monitoring and subsequent anticoagulation if extension of the thrombosis occurs during supportive care (Grade 2C). We recommend against the use of routine systemic thromboprophylaxis for children with central venous lines (Grade 1B). For children with cerebral sinovenous thrombosis (CSVT) without significant intracranial hemorrhage (ICH), we recommend anticoagulation initially with UFH, or LMWH and subsequently with LMWH or vitamin K
Wigram, Tony; Gold, Christian
This chapter begins by outlining the challenges of preparing a chapter on evidence-based practice (EBP) to underpin the use of music as a therapeutic tool in treatment, in the overall frame of music, health, and wellbeing. It then reviews the terminology of EBP and evidence-based medicine...... practice as health, education, and social services tighten their belts and the demand on their resources grows, there is increasing interest in the value of music for health and wellbeing, despite even less ‘hard’ evidence that it is effective against illness and disability....
Gale, Barbara Van Patter; Schaffer, Marjorie A
This study explored factors that affect the adoption or rejection of evidence-based practice (EBP) changes and differences in nurse manager and staff nurse perceptions about those factors. Roger's Diffusion of Innovations Theory explains relevant organizational strategies for guiding practice change. The primary author developed the Evidence-Based Practice Changes Survey consisting of 12 items, completed by 92 nurses at a level 1 trauma center. Top barriers to EBP were insufficient time, lack of staff, and not having the right equipment and supplies. Top reasons to adopt EBP were having personal interest in the practice change, avoiding risk of negative consequences to the patient, and personally valuing the evidence. Several statistically significant differences emerged for demographic variables. Planning for EBP change must address barriers and facilitators to practice change and emphasize the benefit for patients and value of the practice change to nurses.
Postoperative Radiation Therapy for Endometrial Cancer: American Society of Clinical Oncology Clinical Practice Guideline Endorsement of the American Society for Radiation Oncology Evidence-Based Guideline.
Meyer, Larissa A; Bohlke, Kari; Powell, Matthew A; Fader, Amanda N; Franklin, Gregg E; Lee, Larissa J; Matei, Daniela; Coallier, Lourie; Wright, Alexi A
To provide guidance on the role of adjuvant radiation therapy in the treatment of endometrial cancer. "The Role of Postoperative Radiation Therapy for Endometrial Cancer: An ASTRO Evidence-Based Guideline" by Klopp et al, published in 2014 in Practical Radiation Oncology, was reviewed for developmental rigor by methodologists. The American Society for Radiation Oncology (ASTRO) guideline content and recommendations were further reviewed by the American Society of Clinical Oncology (ASCO) Endorsement Panel. The ASCO Endorsement Panel determined that the recommendations from the ASTRO guideline are clear, thorough, and based on the most relevant scientific evidence. ASCO endorsed the ASTRO guideline with several qualifying statements. Surveillance without adjuvant radiation therapy is a reasonable option for women without residual disease in the hysterectomy specimen and for women with grade 1 or 2 cancer and Endorsement Panel added qualifying statements to the ASTRO recommendations to provide stronger statements in favor of chemotherapy (with or without radiation therapy). © 2015 by American Society of Clinical Oncology.
Mesibov, Gary B.; Shea, Victoria
Interventions for autism are increasing being held to standards such as "evidence-based practice" in psychology and "scientifically-based research" in education. When these concepts emerged in the context of adult psychotherapy and regular education, they caused considerable controversy. Application of the concepts to autism treatments and special…
The idea of evidence- based practice is influential in public welfare services, including education. The idea is controversial, however, not least because it involves a poten tial redefinition of the relation ship between knowledge, authority and professionalism. This is discussed based on a study...... of evidence- based methods in Danish pre-school education and care. The management sees the use of these methods as strengthening pre- school teacher professionalism, but the actual practices in the day-careinstitutions are ambiguous. In some cases, using the methods becomes an end in itself and tends...... to displace important educational objectives. In other cases, the methods are reflectively adjusted to a given context. Used in this way only, evid ence-based practice and methodology is a valuable resource for professional practice in education. From such a perspective, at least some types of research based...
Abdellatif, Hoda; Dechow, Paul C; Jones, Daniel L
In an effort to improve patient care, there has been a growing trend across the nation and the world to embed the principles of evidence-based dentistry into mainstream care delivery by private practicing dentists. Evidence-based dentistry is an essential tool that is used to improve the quality of care and to reduce the gap between what we know, what is possible, and what we do. An evidence-based health care practice is one that includes the decision maker's ability to find, assess, and incorporate high-quality, valid information in diagnosis and treatment. The evidence is considered in conjunction with the clinician's experience and judgment, and the patient's preferences, values, and circumstances. This article introduces the basic skills of evidence-based dentistry. Their practice requires a discipline of lifelong learning in which recent and relevant scientific evidence are translated into practical clinical applications.
Full Text Available Abstract Background Psychological models are used to understand and predict behaviour in a wide range of settings, but have not been consistently applied to health professional behaviours, and the contribution of differing theories is not clear. This study explored the usefulness of a range of models to predict an evidence-based behaviour -- the placing of fissure sealants. Methods Measures were collected by postal questionnaire from a random sample of general dental practitioners (GDPs in Scotland. Outcomes were behavioural simulation (scenario decision-making, and behavioural intention. Predictor variables were from the Theory of Planned Behaviour (TPB, Social Cognitive Theory (SCT, Common Sense Self-regulation Model (CS-SRM, Operant Learning Theory (OLT, Implementation Intention (II, Stage Model, and knowledge (a non-theoretical construct. Multiple regression analysis was used to examine the predictive value of each theoretical model individually. Significant constructs from all theories were then entered into a 'cross theory' stepwise regression analysis to investigate their combined predictive value Results Behavioural simulation - theory level variance explained was: TPB 31%; SCT 29%; II 7%; OLT 30%. Neither CS-SRM nor stage explained significant variance. In the cross theory analysis, habit (OLT, timeline acute (CS-SRM, and outcome expectancy (SCT entered the equation, together explaining 38% of the variance. Behavioural intention - theory level variance explained was: TPB 30%; SCT 24%; OLT 58%, CS-SRM 27%. GDPs in the action stage had significantly higher intention to place fissure sealants. In the cross theory analysis, habit (OLT and attitude (TPB entered the equation, together explaining 68% of the variance in intention. Summary The study provides evidence that psychological models can be useful in understanding and predicting clinical behaviour. Taking a theory-based approach enables the creation of a replicable methodology for
Chi, Donald L
A growing number of parents are refusing topical fluoride for their children during preventive dental and medical visits. This nascent clinical and public health problem warrants attention from dental professionals and the scientific community. Clinical and community-based strategies are available to improve fluoride-related communications with parents and the public. In terms of future research priorities, there is a need to develop screening tools to identify parents who are likely to refuse topical fluoride and diagnostic instruments to uncover the reasons for topical fluoride refusal. This knowledge will lead to evidence-based strategies that can be widely disseminated into clinical practice. Copyright © 2017 Elsevier Inc. All rights reserved.
Laville, Martine; Segrestin, Berenice; Alligier, Maud
BACKGROUND: Evidence-based clinical research poses special barriers in the field of nutrition. The present review summarises the main barriers to research in the field of nutrition that are not common to all randomised clinical trials or trials on rare diseases and highlights opportunities...... as patient-centred outcomes may occur decennia into the future. The methodologies and regulations for drug trials are, however, applicable to nutrition trials. CONCLUSIONS: Research on clinical nutrition should start by collecting clinical data systematically in databases and registries. Measurable patient...
Full Text Available Evidence based library and information practice (EBLIP is a strategy to bridge research and practice. Generally EBLIP is seen as a movement to encourage and give practitioners the means to incorporate research into their practice, where it previously may have been lacking. The widely accepted definition of EBLIP (Booth, 2000 stresses three aspects that contribute to a practice that is evidence based: 1 "the best available evidence;" 2 "moderated by user needs and preferences;" 3 "applied to improve the quality of professional judgements." The area that the EBLIP movement has focused on is how to create and understand the best available research evidence. CE courses, critical appraisal checklists, and many articles have been written to address a need for librarian education in this area, and it seems that strides have been made.But very little in the EBLIP literature talks about how we make professional judgements, or moderate evidence based on our user needs and preferences. Likewise, how do we make good evidence based decisions when our evidence base is weak. These things seem to be elements we just take for granted or can’t translate into words. It is in keeping with tacit knowledge that librarians just seem to have or acquire skills with education and on the job experience. Tacit knowledge is "knowledge that is not easily articulated, and frequently involves knowledge of how to do things. We can infer its existence only by observing behaviour and determining that this sort of knowledge is a precondition for effective performance" (Patel, Arocha, & Kaufman, 1999, p.78. It is something that is difficult to translate into an article or guideline for how we work. I think of this area as the "art" of evidence based practice. And the art is crucial to being an evidence based practitioner.Science = systematized knowledge, explicit research, methodological examination, investigation, dataArt = professional knowledge of your craft, intuition
Practicing evidence based medicine at the bedside: a randomized controlled pilot study in undergraduate medical students assessing the practicality of tablets, smartphones, and computers in clinical life.
Friederichs, Hendrik; Marschall, Bernhard; Weissenstein, Anne
Practicing evidence-based medicine is an important aspect of providing good medical care. Accessing external information through literature searches on computer-based systems can effectively achieve integration in clinical care. We conducted a pilot study using smartphones, tablets, and stationary computers as search devices at the bedside. The objective was to determine possible differences between the various devices and assess students' internet use habits. In a randomized controlled pilot study, 120 students were divided in three groups. One control group solved clinical problems on a computer and two intervention groups used mobile devices at the bedside. In a questionnaire, students were asked to report their internet use habits as well as their satisfaction with their respective search tool using a 5-point Likert scale. Of 120 surveys, 94 (78.3%) complete data sets were analyzed. The mobility of the tablet (3.90) and the smartphone (4.39) was seen as a significant advantage over the computer (2.38, p computer (3.22) was rated superior to both tablet computers (2.13) and smartphones (1.68). No significant differences were detected between tablets and smartphones except satisfaction with screen size (tablet 4.10, smartphone 2.00, p computers. However, mobility is regarded as a substantial advantage, and therefore future applications might facilitate quick and simple searches at the bedside.
Cook, Bryan G.; Tankersley, Melody; Landrum, Timothy J.
Determining evidence-based practices is a complicated enterprise that requires analyzing the methodological quality and magnitude of the available research supporting specific practices. This article reviews criteria and procedures for identifying what works in the fields of clinical psychology, school psychology, and general education; and it…
Sher, David J; Adelstein, David J; Bajaj, Gopal K; Brizel, David M; Cohen, Ezra E W; Halthore, Aditya; Harrison, Louis B; Lu, Charles; Moeller, Benjamin J; Quon, Harry; Rocco, James W; Sturgis, Erich M; Tishler, Roy B; Trotti, Andy; Waldron, John; Eisbruch, Avraham
To present evidence-based guidelines for the treatment of oropharyngeal squamous cell carcinoma (OPSCC) with definitive or adjuvant radiation therapy (RT). The American Society for Radiation Oncology convened the OPSCC Guideline Panel to perform a systematic literature review investigating the following key questions: (1) When is it appropriate to add systemic therapy to definitive RT in the treatment of OPSCC? (2) When is it appropriate to deliver postoperative RT with and without systemic therapy following primary surgery for OPSCC? (3) When is it appropriate to use induction chemotherapy in the treatment of OPSCC? (4) What are the appropriate dose, fractionation, and volume regimens with and without systemic therapy in the treatment of OPSCC? Patients with stage IV and stage T3 N0-1 OPSCC treated with definitive RT should receive concurrent high-dose intermittent cisplatin. Patients receiving adjuvant RT following surgical resection for positive surgical margins or extracapsular extension should be treated with concurrent high-dose intermittent cisplatin, and individuals with these risk factors who are intolerant of cisplatin should not routinely receive adjuvant concurrent systemic therapy. Induction chemotherapy should not be routinely delivered to patients with OPSCC. For patients with stage IV and stage T3 N0-1 OPSCC ineligible for concurrent chemoradiation therapy, altered fractionation RT should be used. The successful management of OPSCC requires the collaboration of radiation, medical, and surgical oncologists. When high-level data are absent for clinical decision-making, treatment recommendations should incorporate patient values and preferences to arrive at the optimal therapeutic approach. Copyright © 2017 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.
Gaertner, Jan; Stamer, Ulrike M; Remi, Constanze; Voltz, Raymond; Bausewein, Claudia; Sabatowski, Rainer; Wirz, Stefan; Müller-Mundt, Gabriele; Simon, Steffen T; Pralong, Anne; Nauck, Friedemann; Follmann, Markus; Radbruch, Lukas; Meißner, Winfried
Dipyrone (metamizole) is one of the most widely used non-opioid analgesics for the treatment of cancer pain. Because evidence-based recommendations are not yet available, a systematic review was conducted for the German Guideline Program in Oncology to provide recommendations for the use of dipyrone in cancer pain. First, a systematic review for clinical trials assessing dipyrone in adult patients with cancer pain was conducted. Endpoints were pain intensity, opioid-sparing effects, safety, and quality of life. The search was performed in MedLine, Embase (via Ovid), and the Cochrane Library (1948-2013) and additional hand search was conducted. Finally, recommendations were developed and agreed in a formal structured consensus process by 53 representatives of scientific medical societies and 49 experts. Of 177 retrieved studies, 4 could be included (3 randomized controlled trials and 1 cohort study, n = 252 patients): dipyrone significantly decreased pain intensity compared to placebo, even if low doses (1.5-2 g/day) were used. Higher doses (3 × 2 g/day) were more effective than low doses (3 × 1 g/day), but equally effective as 60 mg oral morphine/day. Pain reduction of dipyrone and non-steroidal anti-inflammatory drugs did not differ significantly. Compared to placebo, non-steroidal anti-inflammatory drugs, and morphine, the incidence of adverse effects was not increased. Dipyrone can be recommended for the treatment of cancer pain as an alternative to other non-opioids either alone or in combination with opioids. It can be preferred over non-steroidal anti-inflammatory drugs due to the presumably favorable side effect profile in long-term use, but comparative studies are not available for long-term use.
Drahota, Amy; Stadnick, Nicole; Brookman-Frazee, Lauren
Therapist perspectives regarding delivery of evidence-based practice (EBP) strategies are needed to understand the feasibility of implementation in routine service settings. This qualitative study examined the perspectives of 13 therapists receiving training and delivering a package of EBPs to children with autism spectrum disorders (ASD) in community mental health clinics. Therapists perceived the training and intervention delivery as effective at improving their clinical skills, the psychotherapy process, and child and family outcomes. Results expand parent pilot study findings, and add to the literature on training community providers and limited research on training providers to deliver EBPs to children with ASD. PMID:23086499
Clinical management of comorbidities is a challenge, especially in a clinical decision support setting, as it requires the safe and efficient reconciliation of multiple disease-specific clinical procedures to formulate a comorbid therapeutic plan that is both effective and safe for the patient. In this paper we pursue the integration of multiple disease-specific Clinical Practice Guidelines (CPG) in order to manage co-morbidities within a computerized Clinical Decision Support System (CDSS). We present a CPG integration framework-termed as COMET (Comorbidity Ontological Modeling & ExecuTion) that manifests a knowledge management approach to model, computerize and integrate multiple CPG to yield a comorbid CPG knowledge model that upon execution can provide evidence-based recommendations for handling comorbid patients. COMET exploits semantic web technologies to achieve (a) CPG knowledge synthesis to translate a paper-based CPG to disease-specific clinical pathways (CP) that include specialized co-morbidity management procedures based on input from domain experts; (b) CPG knowledge modeling to computerize the disease-specific CP using a Comorbidity CPG ontology; (c) CPG knowledge integration by aligning multiple ontologically-modeled CP to develop a unified comorbid CPG knowledge model; and (e) CPG knowledge execution using reasoning engines to derive CPG-mediated recommendations for managing patients with comorbidities. We present a web-accessible COMET CDSS that provides family physicians with CPG-mediated comorbidity decision support to manage Atrial Fibrillation and Chronic Heart Failure. We present our qualitative and quantitative analysis of the knowledge content and usability of COMET CDSS.
Lee, Catherine M; Hunsley, John
Evidence-based practice (EBP) requires that clinicians be guided by the best available evidence. In this article, we address the impact of science and pseudoscience on psychotherapy in psychiatric practice. We describe the key principles of evidence-based intervention. We describe pseudoscience and provide illustrative examples of popular intervention practices that have not been abandoned, despite evidence that they are not efficacious and may be harmful. We distinguish efficacy from effectiveness, and describe modular approaches to treatment. Reasons for the persistence of practices that are not evidence based are examined at both the individual and the professional system level. Finally, we offer suggestions for the promotion of EBP through clinical practice guidelines, modelling of scientific decision making, and training in core skills.
Lee, Catherine M; Hunsley, John
Evidence-based practice (EBP) requires that clinicians be guided by the best available evidence. In this article, we address the impact of science and pseudoscience on psychotherapy in psychiatric practice. We describe the key principles of evidence-based intervention. We describe pseudoscience and provide illustrative examples of popular intervention practices that have not been abandoned, despite evidence that they are not efficacious and may be harmful. We distinguish efficacy from effectiveness, and describe modular approaches to treatment. Reasons for the persistence of practices that are not evidence based are examined at both the individual and the professional system level. Finally, we offer suggestions for the promotion of EBP through clinical practice guidelines, modelling of scientific decision making, and training in core skills. PMID:26720821
Vratny, Amy; Shriver, Deb
Nursing administration at a small medical center is developing and implementing an evidence-based practice (EBP) model of care to support a culture of quality care, clinical excellence, cost-effectiveness, critical thinking, empowerment of staff, and professional growth. The purpose of this article is to describe a conceptual model for EBP that addresses how to overcome barriers to implementation. Clinician expertise and values, experience, patient preference and expectation, and caring become grounded in a practice environment that must strive to become rooted in clinical research to evolve into a practice that is evidence-based. Education helps to nourish EBP, but leadership, enthusiasm, mentorship, clinical inquiry, and reflective practice make EBP thrive. The EBP ambassadors branch out to each department to grow journal clubs, EBP Web pages, EBP projects, research utilization projects, and staff-led practice reviews. The fruits are quality patient care and outcomes, clinical excellence, cost-effectiveness, critical thinking, empowerment of staff, and professional growth.
The Institute of Medicine has reported that it takes roughly 17 years for evidence generated through research to move into clinical practice. Bridging that gap is an urgent need and will require educators to rethink how nurses are prepared for evidence-based practice. The constructivist theory for learning--in which it is assumed that students construct knowledge and meaning for themselves as they learn--may provide a framework for a redesigned baccalaureate curriculum, one that supports evidence-based practice throughout a nursing student's education.
Kortekaas, M F; Bartelink, M E L; Zuithoff, N P A; van der Heijden, G J M G; de Wit, N J; Hoes, A W
Evidence-based medicine (EBM) is an important element in the general practice (GP) specialty training. Studies show that integrating EBM training into clinical practice brings larger benefits than stand-alone modules. However, these studies have neither been performed in GP nor assessed EBM behaviour of former trainees in daily clinical practice. GP specialty training in the Netherlands. All 82 third year GP trainees who started their final third year in 2011 were approached for inclusion, of whom 79 (96%) participated: 39 in the intervention group and 40 in the control group. Integrated EBM training, in which EBM is embedded closely within the clinical context by joint assignments for the trainee and supervisor in daily practice, and teaching sessions based on dilemmas from actual patient consultations. Stand-alone EBM training at the institute only. Our primary outcome was EBM behaviour, assessed by measuring guideline adherence (incorporating rational, motivated deviation) and information-seeking behaviour. Our secondary outcomes were EBM attitude and EBM knowledge. Data were acquired using logbooks and questionnaires, respectively. Analyses were performed using mixed models. Logbook data were available from 76 (96%) of the participating trainees at baseline (7614 consultations), 60 (76%) at the end of the third year (T1, 4973 consultations) and 53 (67%) 1 year after graduation (T2, 3307 consultations). We found no significant differences in outcomes between the 2 groups, with relative risks for guideline adherence varying between 0.96 and 0.99 (95% CI 0.86 to 1.11) at T1, and 0.99 and 1.10 (95% CI 0.92 to 1.25) at T2, and for information-seeking behaviour between 0.97 and 1.16 (95% CI 0.70 to 1.91) and 0.90 and 1.10 (95% CI 0.70 to 1.32), respectively. Integrated EBM training compared with stand-alone EBM training does not improve EBM behaviour, attitude or knowledge of (future) GPs. Published by the BMJ Publishing Group Limited. For permission to use (where
Romero, Bernadine; Fry, Margaret; Roche, Michael
To explore the number of patients presenting with sepsis before and after guideline implementation; the impact of sepsis guidelines on triage assessment, emergency department management and time to antibiotics. Sepsis remains one of the leading causes of mortality and morbidity within hospitals. Globally, strategies have been implemented to reduce morbidity and mortality rates, which rely on the early recognition and management of sepsis. To improve patient outcomes, the New South Wales government in Australia introduced sepsis guidelines into emergency departments. However, the impact of the guidelines on clinical practice remains unclear. A 12-month pre-post retrospective randomised medical record audit of adult patients with a sepsis diagnosis. Data were extracted from the emergency department database and paper medical record. Data included patient demographic (age, gender), clinical information (time of arrival, triage code, seen by time, disposition, time to antibiotic, pathology, time to intravenous fluids) and patient assessment data (heart rate, respiratory rate, blood pressure, temperature, oxygen saturations, medication). This study demonstrated a statistically significant 230-minute reduction in time to antibiotics post implementation of the guidelines. The post group (n = 165) received more urgent triage categories (n = 81; 49·1%), a 758-minute reduction in mean time to second litre of intravenous fluids and an improvement in collection of lactate (n = 112, 67·9%), also statistically significant. The findings highlight the impact the guidelines can have on clinician decision-making and behaviour that support best practice and positive patient outcomes. The sepsis guidelines improved the early assessment, recognition and management of patients presenting with sepsis in one tertiary referral emergency department. The use of evidenced-based guidelines can impact clinical decision-making and behaviour, resulting in the translation and support of
Greenlee, Heather; DuPont-Reyes, Melissa J; Balneaves, Lynda G; Carlson, Linda E; Cohen, Misha R; Deng, Gary; Johnson, Jillian A; Mumber, Matthew; Seely, Dugald; Zick, Suzanna M; Boyce, Lindsay M; Tripathy, Debu
Answer questions and earn CME/CNE Patients with breast cancer commonly use complementary and integrative therapies as supportive care during cancer treatment and to manage treatment-related side effects. However, evidence supporting the use of such therapies in the oncology setting is limited. This report provides updated clinical practice guidelines from the Society for Integrative Oncology on the use of integrative therapies for specific clinical indications during and after breast cancer treatment, including anxiety/stress, depression/mood disorders, fatigue, quality of life/physical functioning, chemotherapy-induced nausea and vomiting, lymphedema, chemotherapy-induced peripheral neuropathy, pain, and sleep disturbance. Clinical practice guidelines are based on a systematic literature review from 1990 through 2015. Music therapy, meditation, stress management, and yoga are recommended for anxiety/stress reduction. Meditation, relaxation, yoga, massage, and music therapy are recommended for depression/mood disorders. Meditation and yoga are recommended to improve quality of life. Acupressure and acupuncture are recommended for reducing chemotherapy-induced nausea and vomiting. Acetyl-L-carnitine is not recommended to prevent chemotherapy-induced peripheral neuropathy due to a possibility of harm. No strong evidence supports the use of ingested dietary supplements to manage breast cancer treatment-related side effects. In summary, there is a growing body of evidence supporting the use of integrative therapies, especially mind-body therapies, as effective supportive care strategies during breast cancer treatment. Many integrative practices, however, remain understudied, with insufficient evidence to be definitively recommended or avoided. CA Cancer J Clin 2017;67:194-232. © 2017 American Cancer Society. © 2017 American Cancer Society.
Radiation Therapy for Oropharyngeal Squamous Cell Carcinoma: American Society of Clinical Oncology Endorsement of the American Society for Radiation Oncology Evidence-Based Clinical Practice Guideline.
Quon, Harry; Vapiwala, Neha; Forastiere, Arlene; Kennedy, Erin B; Adelstein, David J; Boykin, Holly; Califano, Joseph A; Holsinger, F Chris; Nussenbaum, Brian; Rosenthal, David I; Siu, Lillian L; Waldron, John N
Purpose The American Society for Radiation Oncology (ASTRO) produced an evidence-based guideline on radiation therapy in oropharyngeal squamous cell carcinoma (OPSCC) that was determined to be relevant to the American Society of Clinical Oncology (ASCO) membership. After applying standard critical appraisal policy and endorsement procedures, ASCO chose to endorse the ASTRO guideline. Methods The ASTRO guideline was reviewed by ASCO content experts for clinical accuracy and by ASCO methodologists for developmental rigor. On favorable review, an ASCO Expert Panel was convened to review the guideline contents and recommendations. The ASCO guideline approval body, the Clinical Practice Guidelines Committee, approved the final endorsement. Results The ASCO Expert Panel determined that the ASTRO guideline recommendations, published in July 2017, are clear, thorough, and based upon the most relevant scientific evidence. ASCO endorsed the ASTRO guideline and added minor qualifying statements. Recommendations Recommendations for the addition of systemic therapy to definitive radiotherapy in the treatment of OPSCC, postoperative radiotherapy with and without systemic therapy following primary surgery of OPSCC, induction chemotherapy in the treatment of OPSCC, and the appropriate dose, fractionation, and volume regimens with and without systemic therapy in the treatment of OPSCC are outlined for a variety of disease stages and clinical scenarios. ASCO Endorsement Panel qualifying statements and minor modifications were made to the ASTRO recommendations. The staging system that is referenced in these guidelines is the American Joint Committee on Cancer Staging Manual, 7th edition. Additional information is available at: www.asco.org/head-neck-cancer-guidelines and www.asco.org/guidelineswiki .
Zeeman, Laetitia; Aranda, Kay; Grant, Alec
This paper aims to queer evidence-based practice by troubling the concepts of evidence, knowledge and mental illness. The evidence-based narrative that emerged within biomedicine has dominated health care. The biomedical notion of 'evidence' has been critiqued extensively and is seen as exclusive and limiting, and even though the social constructionist paradigm attempts to challenge the authority of biomedicine to legitimate what constitutes acceptable evidence or knowledge for those experiencing mental illness, biomedical notions of evidence appear to remain relatively intact. Queer theory offers theoretical tools to disrupt biomedical norms and challenges biomedical normativity to indicate how marginalisation occurs when normative truths about mental health classify those who differ from the norm as 'ill' or 'disordered'. Queer theory's emphasis on normativity serves the political aim to subvert marginalisation and bring about radical social and material change. Reference will be made to mental health subjects within each discourse by indicating how the body acts as a vehicle for knowing. Deleuzian notions of the rhizome are used as metaphor to suggest a relational approach to knowledge that does away with either/or positions in either biomedical, or queer knowledge to arrive at a both/and position where the biomedical, constructionist and queer are interrelated and entangled in needing the other for their own evolution. However, queer does not ask for assimilation but celebrates difference by remaining outside to disrupt that which is easily overlooked, assumed to be natural or represented as the norm. The task of queer knowledge is to do justice to the lives lived in the name of evidence-based practice and demands that we consider the relations of power where knowledge is produced. This pursuit creates different knowledge spaces where we identify new intersections that allow for socially just understandings of knowing or evidence to emerge. © 2013 John Wiley
Full Text Available Aims. To explore whether Astragalus or its formulations could prevent upper respiratory infection in children with nephrotic syndrome and how best to use it. Methods. We transformed a common clinical question in practice to an answerable question according to the PICO principle. Databases, including the Cochrane Library (Issue 5, 2012, PUBMED (1966–2012.8, CBM (1978–2012.8, VIP (1989–2012.8, and CNKI (1979–2012.8, were searched to identify Cochrane systematic reviews and clinical trials. Then, the quality of and recommendations from the clinical evidence were evaluated using the GRADEpro software. Results. The search yielded 537 papers. Only two studies with high validity were included for synthesis calculations. The results showed that Astragalus granules could effectively reduce URTI in children with nephrotic syndrome compared with prednisone treatment alone (23.9% versus 42.9%; RR = 0.56 and 95% CI = 0.33–0.93. The dose of Astragalus granules was 2.25 gram (equivalent to 15 gram crude Astragalus twice per day, at least for 3–6 months. The level of evidence quality was low, but we still recommended the evidence to the patient according to GRADEpro with the opinion of the expert. Followup showed the incidence of URTI in this child decreased significantly. Conclusions. Astragalus granules may reduce the incidence of URTI in children with nephrotic syndrome.
Nachamkin, Irving; Kirn, Thomas J; Westblade, Lars F; Humphries, Romney
As part of the American Society for Microbiology (ASM) Evidence-Based Laboratory Medicine Practice Guidelines Committee of the Professional Practice Committee, an ad hoc committee was formed in 2014 to assess guidelines published by the committee using an assessment tool, Appraisal of Guidelines for Research Evaluation II (AGREE II). The AGREE II assessment helps reviewers determine whether published guidelines are robust, transparent, and clear in presenting practice recommendations in a standardized manner. Identifying strengths and weaknesses of practice guidelines by ad hoc assessments helps with improving future guidelines through the participation of key stakeholders. This minireview describes the development of the ad hoc committee and results from their review of several ASM best practices guidelines and a non-ASM practice guideline from the Emergency Nurses Association. Copyright © 2017 American Society for Microbiology.
R.A. Bal (Roland)
textabstractThe call for evidence-based policy is often accompanied by rather uncritical references to the success of evidence-based medicine, leading to often unsuccessful translation attempts. In this paper, I reflect on the practice of evidence-based medicine in an attempt to sketch a more
Palinkas, Lawrence A; Um, Mee Young; Jeong, Chung Hyeon; Chor, Ka Ho Brian; Olin, Serene; Horwitz, Sarah M; Hoagwood, Kimberly E
This study examined how mental health clinic administrators decided whether or not to adopt evidence-based and other innovative practices by exploring their views of implementation barriers and facilitators and operation of these views in assessment of implementation costs and benefits. Semi-structured interviews were conducted with 75 agency chief executive officers and program directors of 34 New York State-licensed mental health clinics serving children and adolescents. Three interconnected themes relating to barriers and facilitators were identified, namely costs and benefits associated with adoption, capacity for adoption, and acceptability of new practices. The highest percentage of participants (86.7%) mentioned costs as a barrier, followed by limited capacity (55.9%) and lack of acceptability (52.9%). The highest percentage (82.3%) of participants identified available capacity as a facilitator, followed by acceptability (41.2%) and benefits or limited costs (24.0%). Assessment of costs and benefits exhibited several principles of behavioural economics, including loss aversion, temporal discounting use of heuristics, sensitivity to monetary incentives, decision fatigue, framing, and environmental influences. The results point to opportunities for using agency leader models to develop strategies to facilitate implementation of evidence-based and innovative practices for children and adolescents.
Ollendick, Thomas H.
Evidence-based practice has a long history; however attempts to bridge the gap between science and practice have been only partially effective and much work remains to be done. Part of the problem has been the unilateral approach associated with dissemination of research findings to clinical practitioners. In this special series, Goldfried and colleagues suggest a two-way bridge, in which practitioners are afforded the opportunity to disseminate their rich clinical experiences to researchers ...
Turner Tari J
Full Text Available Abstract Background Evidence-based clinical practice guidelines support clinical decision-making by making recommendations to guide clinical practice. These recommendations are developed by integrating the expertise of a multidisciplinary group of clinicians with the perspectives of consumers and the best available research evidence. However studies have raised concerns about the quality of guideline development, and particularly the link between research and recommendations. The reasons why guideline developers are not following the established development methods are not clear. We aimed to explore the barriers to developing evidence-based guidelines in eleven hospitals in Australia, Indonesia, Malaysia, the Philippines and Thailand, so as to better understand how evidence-based guideline development could be facilitated in these settings. The research aimed to identify the value clinicians place on guidelines, what clinicians want in guidelines developed in hospital settings and what factors limit rigorous evidence-based guideline development in these settings. Methods Semi-structured, face-to-face interviews were undertaken with senior and junior healthcare providers (nurses, midwives, doctors, allied health from the maternal and neonatal services of the eleven participating hospitals. Interviews were audio-recorded, transcribed and a thematic analysis undertaken. Results Ninety-three individual, 25 pair and eleven group interviews were conducted. Participants were clear that they want guidelines that are based on evidence and updated regularly. They were also clear that there are major barriers to this. Most of the barriers were shared across countries, and included lack of time, lack of skills in finding, appraising and interpreting evidence, lack of access to relevant evidence and difficulty arranging meetings and achieving consensus. Barriers that were primarily identified in Australian hospitals include cumbersome organisational
Falzon, Louise; Davidson, Karina W.; Bruns, Daniel
There is an increased awareness of evidence-based methodology among psychologists, but little exists in the literature about how to access the research. Moreover, the prohibitive cost of this information combined with limited time are barriers to the identification of evidence to answer clinical questions. This article presents an example of a question worked though in an evidence-based way. Methods are highlighted, including distinguishing background and foreground questions, breaking down questions into searchable statements, and adapting statements to suit both the question being asked and the resource being searched. A number of free, evidence-based resources are listed. Knowing how and where to access this information will enable practitioners to more easily use an evidence-based approach to their practice. PMID:21503266
Full Text Available Over the past 20 years our knowledge about evidence-based psychological interventions for pediatric chronic pain has dramatically increased. Overall, the evidence in support of psychological interventions for pediatric chronic pain is strong, demonstrating positive psychological and behavioral effects for a variety of children with a range of pain conditions. However, wide scale access to effective psychologically-based pain management treatments remains a challenge for many children who suffer with pain. Increasing access to care and reducing persistent biomedical biases that inhibit attainment of psychological services are a central focus of current pain treatment interventions. Additionally, as the number of evidence-based treatments increase, tailoring treatments to a child or family’s particular needs is increasingly possible. This article will (1 discuss the theoretical frameworks as well as the specific psychological skills and strategies that currently hold promise as effective agents of change; (2 review and summarize trends in the development of well-researched outpatient interventions over the past ten years; and (3 discuss future directions for intervention research on pediatric chronic pain.
Boluyt, Nicole; Bollen, Casper W; Bos, Albert P; Kok, Joke H; Offringa, Martin
To develop a clinical practice guideline that provides recommendations for the fluid, i.e. colloid or crystalloid, used for resuscitation in critically ill neonates and children up to the age of 18 years with hypovolemia. The guideline was developed through a comprehensive search and analysis of the pediatric literature. Recommendations were formulated by a national multidisciplinary committee involving all stakeholders in neonatal and pediatric intensive care and were based on research evidence from the literature and, in areas where the evidence was insufficient or lacking, on consensus after discussions in the committee. Because of the lack of evidence in neonates and children, trials conducted in adults were considered. We found several recent meta-analyses that show excess mortality in albumin-treated groups, compared with crystalloid-treated groups, and one recent large randomized controlled trial that found evidence of no mortality difference. We found no evidence that synthetic colloids are superior to crystalloid solutions. Given the state of the evidence and taking all other considerations into account, the guideline-developing group and the multidisciplinary committee recommend that in neonates and children with hypovolemia the first-choice fluid for resuscitation should be isotonic saline.
Guarino, Alfredo; Dupont, Christophe; Gorelov, Alexander V; Gottrand, Frederic; Lee, Jimmy K F; Lin, Zhihong; Lo Vecchio, Andrea; Nguyen, Thien D; Salazar-Lindo, Eduardo
Acute diarrhea remains a major problem in children and is associated with substantial morbidity, mortality and costs. While vaccination against rotavirus could reduce the burden of the disease, the persistent impact of intestinal infections requires effective treatment in adjunct to oral rehydration solutions, to reduce the severity and duration of diarrhea. Several therapeutic options have been proposed for acute diarrhea, but proof of efficacy is available for few of them, including zinc, diosmectite, selected probiotics and racecadotril. However, at present there is no universal drug, and therapeutic efficacy has only been shown for selected drugs in selected settings, such as: outpatients/inpatients, developed/developing countries and viral/bacterial etiology. This narrative review reports the opinions of experts from different countries of the world who have discussed strategies to improve the management of diarrhea. More data are needed to optimize the management of diarrhea and highlight the research priorities at a global level; such priorities include improved recommendations on oral rehydration solution composition, and the reevaluation of therapeutic options in the light of new trials. Therapeutic strategies need to be assessed in different settings, and pharmacoeconomic analyses based on country-specific data are needed. Transfer to clinical practice should result from the implementation of guidelines tailored at a local level, with an eye on costs.
Lindsay J. L. Forbes
Full Text Available Background. Women over 70 with breast cancer have poorer one-year survival and present at a more advanced stage than younger women. Promoting early symptomatic presentation in older women may reduce stage cost effectively and is unlikely to lead to overdiagnosis. After examining efficacy in a randomised controlled trial, we piloted a brief health professional-delivered intervention to equip women to present promptly with breast symptoms, as an integral part of the final invited mammogram at age ~70, in the English National Health Service Breast Screening Programme. Methods. We trained mammographers, who then offered the intervention to older women in four breast screening services. We examined breast cancer awareness at baseline and one month in women receiving the intervention, and also in a service where the intervention was not offered. Results. We trained 27 mammographers to deliver the intervention confidently to a high standard. Breast cancer awareness increased 7-fold at one month in women receiving the intervention compared with 2-fold in the comparison service (odds ratio 15.2, 95% confidence interval 10.0 to 23.2. Conclusions. The PEP Intervention can be implemented in routine clinical practice with a potency similar to that achieved in a randomised controlled trial. It has the potential to reduce delay in diagnosis for breast cancer in older women.
Rosen, A; O'Halloran, P
While mental health recovery is a very personal process, the approach also offers possibilities as a meta-framework for improving quality of services to support people with severe and enduring mental illness. This paper explores how a recovery paradigm offers opportunities to better understand how efforts within the personal, clinical, and psychosocial disability domains of well-being relate and need bridging and integration with an evidence-based framework of practice to optimise outcomes. Recovery from a severe and persisting mental illness such as schizophrenia is optimised by a holistic approach integrating the domains of clinical treatment and psychosocial rehabilitation with the personal efforts of individuals. For service providers, a monolithic or single paradigm approach with an exclusive or predominant biological, psychological, social, or cultural focus is unable to offer effective guidance on the treatment and rehabilitation support needed to enable community participation and ameliorate the impact which problems associated with mental illness have on individuals, their families, and their wider communities. Moreover, recovery-oriented services need to be effective, embracing evidence-based policy, practice and service delivery by providing treatment and support which actually work to improve outcomes for consumers and families.
Full Text Available Background. Evidence-based medicine employs systematic searching, evaluation and use of current research findings as the basis for clinical decision-making. However, there are some problems and uncertainties hindering introduction and spreading of the use of the method in clinical practice. Physicians often have no time for literature searching and for use of the method in practice. For certain questions in clinical practice there are no answers in medical literature. Most of the evidences in medical literature are only available in English. Introduction of the method is hampered also by the fact that clinical decision-making is complex and does not allow procedures prescribed in advance. Rigidity and universality of decisions resulting from the evidence may appear impersonal and may affect the relationship between the physician and the patient. Trends towards evidence based medicine are followed also by big multinational pharmaceutical corporations. They carry out large and expensive clinical trials using the results for promotional purposes. In this way, they get the competitive advantage and influence the objectivity of physicians’ clinical decision-making.Conclusions. With introduction of evidence based medicine into clinical practice physicians acquire new information and use a new form of continuing education by following new developments in their field. This way, new findings from medical literature get into clinical practice faster and more efficiently. In addition, physicians get more professional satisfaction and quality in clinical practice is higher.
JCTIC has used open source software to develop a unique school online environment that has made evidence based practice viable in their school. In this paper the proposition is made that eLearning enables evidence based practice which in turn leads to improved student outcomes. Much has been written about evidence based practice in schools, but…
Full Text Available Abstract Background Evidence-based obstetric care is widely promoted in developing countries, but the success of implementation is not known. Using selected childbirth care procedures in four hospitals in Shanghai, we compared practice against evidence-based information, and explored user and provider views about each procedure. Methods Observational study. Using the Cochrane Library, we identified six procedures that should be avoided as routine and two that should be encouraged. Procedure rate determined by exit interviews with women, verified using hospital notes. Views of women and providers explored with in depth interviews. The study sites were three hospitals in Shanghai and one in neighbouring province of Jiangsu. 150 women at each centre for procedure rate, and 48 in-depth interviews with women and providers. Results Vaginal births were 50% (303/599 of the total. Of the six practices where evidence suggests they should be avoided as routine, three were performed with rates above 70%: pubic shaving (3 hospitals, rectal examination (3 hospitals, and episiotomy (3 hospitals. Most women delivered lying down, pain relief was rarely given, and only in the urban district hospital did women routinely have a companion. Most women wanted support or companionship during labour and to be given pain relief; but current practice is insufficient to meet women's needs. Conclusion Obstetric practice is not following best available evidence in the hospitals studied. There is a need to adjust hospital policy to support the use of interventions proven to be of benefit to women during childbirth, and develop approaches that ensure clinical practice changes.
Anderson, K.; Aito, S.; Atkins, M.
BACKGROUND/OBJECTIVE: The end goal of clinical care and clinical research involving spinal cord injury (SCI) is to improve the overall ability of persons living with SCI to function on a daily basis. Neurologic recovery does not always translate into functional recovery. Thus, sensitive outcome m...
Rothgangel, Andreas; Braun, Susy; de Witte, Luc; Beurskens, Anna; Smeets, Rob
To describe the development and content of a clinical framework for mirror therapy (MT) in patients with phantom limb pain (PLP) following amputation. Based on an a priori formulated theoretical model, 3 sources of data collection were used to develop the clinical framework. First, a review of the literature took place on important clinical aspects and the evidence on the effectiveness of MT in patients with phantom limb pain. In addition, questionnaires and semi-structured interviews were used to analyze clinical experiences and preferences of physical and occupational therapists and patients suffering from PLP regarding the application of MT. All data were finally clustered into main and subcategories and were used to complement and refine the theoretical model. For every main category of the a priori formulated theoretical model, several subcategories emerged from the literature search, patient, and therapist interviews. Based on these categories, we developed a clinical flowchart that incorporates the main and subcategories in a logical way according to the phases in methodical intervention defined by the Royal Dutch Society for Physical Therapy. In addition, we developed a comprehensive booklet that illustrates the individual steps of the clinical flowchart. In this study, a structured clinical framework for the application of MT in patients with PLP was developed. This framework is currently being tested for its effectiveness in a multicenter randomized controlled trial. © 2015 World Institute of Pain.
Klem, Mary L; Weiss, Patricia M
The implementation of evidence-based practice (EBP) requires acquisition and use of a complex set of skills, including the ability to locate and critically evaluate clinically relevant research literature. In this article, we discuss information resources and tools that may be of value to educators faced with the task of teaching students to search for and evaluate research-based evidence. In addition, we discuss how health sciences librarians, with the use of new models of information instruction and delivery, can work with nursing faculty in developing curricula for training students in EBP.
The checklist included the evidence-based clinical practice guidelines for the HD vascular access, HD adequacy, anemia of chronic kidney disease (CKD), nutrition, cardiovascular risk assessment, and hepatitis B and C virus infection control. Implementation of these guidelines was evaluated, and further graded using a ...
Soltani Arabshahi, SeyyedKamran; Mohammadi Kenari, Hoorieh; Kordafshari, Gholamreza; Shams-Ardakani, MohammadReza; Bigdeli, Shoaleh
The major difference between Iranian traditional medicine and allopathic medicine is in the application of evidence and documents. In this study, criteria for evidence-based practice in Iranian traditional medicine and its rules of practice were studied. The experts' views were investigated through in- depth, semi-structured interviews and the results were categorized into four main categories including Designing clinical questions/clinical question-based search, critical appraisal, resource search criteria and clinical prescription appraisal. Although the application of evidence in Iranian traditional medicine follows Evidence Based Medicine (EBM) principles but it benefits from its own rules, regulations, and criteria that are compatible with EBM.
Health Education Journal, 2011
Objective: The purpose of this study was to develop guidelines and recommendations on patient education programmes of any type, targeted specially to individuals with OA and which were designed to improve the clinical effectiveness of managing OA. Methods: The Ottawa Methods Group contacted specialized organizations that focus on management for…
Maggio, Lauren A; Cate, Olle Ten; Irby, David M; O'Brien, Bridget C
Evidence-based medicine (EBM) skills, although taught in medical schools around the world, are not optimally practiced in clinical environments because of multiple barriers, including learners' difficulty transferring EBM skills learned in the classroom to clinical practice. This lack of skill transfer may be partially due to the design of EBM training. To facilitate the transfer of EBM skills from the classroom to clinical practice, the authors explore one instructional approach, called the Four Component Instructional Design (4C/ID) model, to guide the design of EBM training. On the basis of current cognitive psychology, including cognitive load theory, the premise of the 4C/ID model is that complex skills training, such as EBM training, should include four components: learning tasks, supportive information, procedural information, and part-task practice. The combination of these four components can inform the creation of complex skills training that is designed to avoid overloading learners' cognitive abilities; to facilitate the integration of the knowledge, skills, and attitudes needed to execute a complex task; and to increase the transfer of knowledge to new situations. The authors begin by introducing the 4C/ID model and describing the benefits of its four components to guide the design of EBM training. They include illustrative examples of educational practices that are consistent with each component and that can be applied to teaching EBM. They conclude by suggesting that medical educators consider adopting the 4C/ID model to design, modify, and/or implement EBM training in classroom and clinical settings.
Zhang, Qi; Zeng, Tieying; Chen, Ying; Li, Xiaopan
To equip undergraduate nursing students with basic knowledge and skills and foster positive attitudes toward evidence-based practice (EBP), a pilot learning program during their clinical practicum was developed in a teaching hospital in China. This article describes the specific learning process through which self-directed learning and workshop strategies were used, and a pre- and post-intervention survey were conducted to evaluate the effectiveness of the learning strategies. The findings show a significant improvement in their perceptions of EBP knowledge, attitudes and beliefs, and behavior levels. Beginning competencies in EBP were achieved. Participants reported great satisfaction and have found this program helpful in promoting their analytical and problem-solving abilities, independent learning ability, and cooperative and communication abilities as well. Copyright © 2011 Elsevier Ltd. All rights reserved.
Kaplan, Sandra L; Coulter, Colleen; Fetters, Linda
Congenital muscular torticollis (CMT) is an idiopathic postural deformity evident shortly after birth, typically characterized by lateral flexion of the head to one side and cervical rotation to the opposite side due to unilateral shortening of the sternocleidomastoid muscle. CMT may be accompanied by other neurological or musculoskeletal conditions. Infants with CMT are frequently referred to physical therapists (PTs) to treat their asymmetries. This evidence-based clinical practice guideline (CPG) provides guidance on which infants should be monitored, treated, and/or referred, and when and what PTs should treat. Based upon critical appraisal of literature and expert opinion, 16 action statements for screening, examination, intervention, and follow-up are linked with explicit levels of evidence. The CPG addresses referral, screening, examination and evaluation, prognosis, first-choice and supplemental interventions, consultation, discharge, follow-up, suggestions for implementation and compliance audits, flow sheets for referral paths and classification of CMT severity, and research recommendations.
Full Text Available Hale Zerrin Toklu Department of Pharmacology and Therapeutics, College of Medicine, University of Florida, Gainesville, FL, USA Abstract: Evidence-based medicine aims to optimize decision-making by using evidence from well-designed and conducted research. The concept of reliable evidence is essential, since the number of electronic information resources is increasing in parallel to the increasing number and type of drugs on the market. The decision-making process is a complex and requires an extensive evaluation as well as the interpretation of the data obtained. Different sources provide different levels of evidence for decision-making. Not all the data have the same value as the evidence. Rational use of medicine requires that the patients receive “medicines appropriate to their clinical needs, in doses that meet their own individual requirements, for an adequate period of time, and at the lowest cost to them and their community.” Pharmacists have a crucial role in the health system to maintain the rational use of medicine and provide pharmaceutical care to patients, because they are the drug experts who are academically trained for this purpose. The rational use of the pharmacist's workforce will improve the outcome of pharmacotherapy as well as decreasing the global health costs. Keywords: pharmacist, rational use of medicine, pharmacotherapy, pharmaceutical, outcome
Hungin, A P S; Mulligan, C; Pot, B; Whorwell, P; Agréus, L; Fracasso, P; Lionis, C; Mendive, J; Philippart de Foy, J-M; Rubin, G; Winchester, C; de Wit, N
Evidence suggests that the gut microbiota play an important role in gastrointestinal problems. To give clinicians a practical reference guide on the role of specified probiotics in managing particular lower gastrointestinal symptoms/problems by means of a systematic review-based consensus. Systematic literature searching identified randomised, placebo-controlled trials in adults; evidence for each symptom/problem was graded and statements developed (consensus process; 10-member panel). As results cannot be generalised between different probiotics, individual probiotics were identified for each statement. Thirty seven studies were included; mostly on irritable bowel syndrome [IBS; 19 studies; treatment responder rates: 18-80% (specific probiotics), 5-50% (placebo)] or antibiotic-associated diarrhoea (AAD; 10 studies). Statements with 100% agreement and 'high' evidence levels indicated that: (i) specific probiotics help reduce overall symptom burden and abdominal pain in some IBS patients; (ii) in patients receiving antibiotics/Helicobacter pylori eradication therapy, specified probiotics are helpful as adjuvants to prevent/reduce the duration/intensity of AAD; (iii) probiotics have favourable safety in patients in primary care. Items with 70-100% agreement and 'moderate' evidence were: (i) specific probiotics help relieve overall symptom burden in some patients with diarrhoea-predominant IBS, and reduce bloating/distension and improve bowel movement frequency/consistency in some IBS patients and (ii) with some probiotics, improved symptoms have led to improvement in quality of life. Specified probiotics can provide benefit in IBS and antibiotic-associated diarrhoea; relatively few studies in other indications suggested benefits warranting further research. This study provides practical guidance on which probiotic to select for a specific problem. © 2013 John Wiley & Sons Ltd.
Hungin, A P S; Mulligan, C; Pot, B; Whorwell, P; Agréus, L; Fracasso, P; Lionis, C; Mendive, J; Philippart de Foy, J-M; Rubin, G; Winchester, C; Wit, N
BackgroundEvidence suggests that the gut microbiota play an important role in gastrointestinal problems. AimTo give clinicians a practical reference guide on the role of specified probiotics in managing particular lower gastrointestinal symptoms/problems by means of a systematic review-based consensus. MethodsSystematic literature searching identified randomised, placebo-controlled trials in adults; evidence for each symptom/problem was graded and statements developed (consensus process; 10-member panel). As results cannot be generalised between different probiotics, individual probiotics were identified for each statement. ResultsThirty seven studies were included; mostly on irritable bowel syndrome [IBS; 19 studies; treatment responder rates: 18–80% (specific probiotics), 5–50% (placebo)] or antibiotic-associated diarrhoea (AAD; 10 studies). Statements with 100% agreement and ‘high’ evidence levels indicated that: (i) specific probiotics help reduce overall symptom burden and abdominal pain in some IBS patients; (ii) in patients receiving antibiotics/Helicobacter pylori eradication therapy, specified probiotics are helpful as adjuvants to prevent/reduce the duration/intensity of AAD; (iii) probiotics have favourable safety in patients in primary care. Items with 70–100% agreement and ‘moderate’ evidence were: (i) specific probiotics help relieve overall symptom burden in some patients with diarrhoea-predominant IBS, and reduce bloating/distension and improve bowel movement frequency/consistency in some IBS patients and (ii) with some probiotics, improved symptoms have led to improvement in quality of life. ConclusionsSpecified probiotics can provide benefit in IBS and antibiotic-associated diarrhoea; relatively few studies in other indications suggested benefits warranting further research. This study provides practical guidance on which probiotic to select for a specific problem. PMID:23981066
Full Text Available I love food. I love cooking, baking, testing, and eating. I read about food preparation, food facts, and food service. Over the years I’ve developed my fair share of knowledge about cooking and I’m a decent cook, but I’m no chef. I guess I’m what you’d call a “foodie”. However, I have the good fortune to have a friend who is a chef and owns one of the best, and certainly the most innovative, restaurants in town. During this summer I hosted a cooking class in my home for my family with my chef friend as instructor. The Tex-Mex barbecue theme was a big hit (you can contact me for recipes, if you like, but much more fascinating was the explanation of the science behind the cooking. It turns out that there is a term for this: molecular gastronomy. Another term, and hence the genesis of my “Eureka!” moment of the summer, is evidence based cooking. Good cooking is not just following a recipe (not all of which are evidence based but at its best is the culmination of heaps of tested information regarding why and how chemical and environmental factors work together to result in a gastronomical delight. For example, will brining or marinating a pork chop make it moister? And, if brining, what temperature should the water be, how long should it soak, and how much salt is needed? Why does pounding meat increase its tenderness? What will keep guacamole from browning better – the pit or lime juice? What does baking soda do in a chocolate cake? Eggs or no eggs in fresh pasta? Like most librarians, I tend not to take information at face value. I want to know where information comes from and whether or not it is valid, based on specific factors. I’ve come to notice that evidence based, or evidence informed, practice is everywhere and has a tremendous impact on our lives. Why do you rotate the tires on your car? Evidence shows that the front tires wear more quickly (think about all those 3-pointturns, the braking, etc and therefore
Full Text Available Abstract Background Psychological models can be used to understand and predict behaviour in a wide range of settings. However, they have not been consistently applied to health professional behaviours, and the contribution of differing theories is not clear. The aim of this study was to explore the usefulness of a range of psychological theories to predict health professional behaviour relating to management of upper respiratory tract infections (URTIs without antibiotics. Methods Psychological measures were collected by postal questionnaire survey from a random sample of general practitioners (GPs in Scotland. The outcome measures were clinical behaviour (using antibiotic prescription rates as a proxy indicator, behavioural simulation (scenario-based decisions to managing URTI with or without antibiotics and behavioural intention (general intention to managing URTI without antibiotics. Explanatory variables were the constructs within the following theories: Theory of Planned Behaviour (TPB, Social Cognitive Theory (SCT, Common Sense Self-Regulation Model (CS-SRM, Operant Learning Theory (OLT, Implementation Intention (II, Stage Model (SM, and knowledge (a non-theoretical construct. For each outcome measure, multiple regression analysis was used to examine the predictive value of each theoretical model individually. Following this 'theory level' analysis, a 'cross theory' analysis was conducted to investigate the combined predictive value of all significant individual constructs across theories. Results All theories were tested, but only significant results are presented. When predicting behaviour, at the theory level, OLT explained 6% of the variance and, in a cross theory analysis, OLT 'evidence of habitual behaviour' also explained 6%. When predicting behavioural simulation, at the theory level, the proportion of variance explained was: TPB, 31%; SCT, 26%; II, 6%; OLT, 24%. GPs who reported having already decided to change their management to
Krom, Zachary R; Batten, Janene; Bautista, Cynthia
The purpose of this article was to share how the collaboration of a clinical nurse specialist (CNS), a health science librarian, and a staff nurse can heighten staff nurses' awareness of the evidence-based practice (EBP) process. The staff nurse is expected to incorporate EBP into daily patient care. This expectation is fueled by the guidelines established by professional, accrediting, and regulatory bodies. Barriers to incorporating EBP into practice have been well documented in the literature. A CNS, a health science librarian, and a staff nurse collaborated to develop an EBP educational program for staff nurses. The staff nurse provides the real-time practice issues, the CNS gives extensive knowledge of translating research into practice, and the health science librarian is an expert at retrieving the information from the literature. The resulting collaboration at this academic medical center has increased staff nurse exposure to and knowledge about EBP principles and techniques. The collaborative relationship among the CNS, health science librarian, and staff nurse effectively addresses a variety of barriers to EBP. This successful collaborative approach can be utilized by other medical centers seeking to educate staff nurses about the EBP process.
Melick, N. van; Cingel, R.E. van; Brooijmans, F.; Neeter, C.; Tienen, T. van; Hullegie, W.; Sanden, M.W. van der
AIM: The Royal Dutch Society for Physical Therapy (KNGF) instructed a multidisciplinary group of Dutch anterior cruciate ligament (ACL) experts to develop an evidence statement for rehabilitation after ACL reconstruction. DESIGN: Clinical practice guideline underpinned by systematic review and
Nilsen, Per; Neher, Margit; Ellström, Per-Erik; Gardner, Benjamin
For many nurses and other health care practitioners, implementing evidence-based practice (EBP) presents two interlinked challenges: acquisition of EBP skills and adoption of evidence-based interventions and abandonment of ingrained non-evidence-based practices. The purpose of this study to describe two modes of learning and use these as lenses for analyzing the challenges of implementing EBP in health care. The article is theoretical, drawing on learning and habit theory. Adaptive learning involves a gradual shift from slower, deliberate behaviors to faster, smoother, and more efficient behaviors. Developmental learning is conceptualized as a process in the "opposite" direction, whereby more or less automatically enacted behaviors become deliberate and conscious. Achieving a more EBP depends on both adaptive and developmental learning, which involves both forming EBP-conducive habits and breaking clinical practice habits that do not contribute to realizing the goals of EBP. From a learning perspective, EBP will be best supported by means of adaptive learning that yields a habitual practice of EBP such that it becomes natural and instinctive to instigate EBP in appropriate contexts by means of seeking out, critiquing, and integrating research into everyday clinical practice as well as learning new interventions best supported by empirical evidence. However, the context must also support developmental learning that facilitates disruption of existing habits to ascertain that the execution of the EBP process or the use of evidence-based interventions in routine practice is carefully and consciously considered to arrive at the most appropriate response. © 2017 Sigma Theta Tau International.
Rodrigues, George; Choy, Hak; Bradley, Jeffrey; Rosenzweig, Kenneth E; Bogart, Jeffrey; Curran, Walter J; Gore, Elizabeth; Langer, Corey; Louie, Alexander V; Lutz, Stephen; Machtay, Mitchell; Puri, Varun; Werner-Wasik, Maria; Videtic, Gregory M M
To provide guidance to physicians and patients with regard to the use of adjuvant external beam radiation therapy (RT) in locally advanced non-small cell lung cancer (LA NSCLC) based on available medical evidence complemented by consensus-based expert opinion. A panel authorized by the American Society for Radiation Oncology (ASTRO) Board of Directors and Guidelines Subcommittee conducted 2 systematic reviews on the following topics: (1) indications for postoperative adjuvant RT and (2) indications for preoperative neoadjuvant RT. Practice guideline recommendations were approved using an a priori-defined consensus-building methodology supported by ASTRO and approved tools for the grading of evidence quality and the strength of guideline recommendations. For patients who have undergone surgical resection, high-level evidence suggests that use of postoperative RT does not influence survival, but optimizes local control for patients with N2 involvement, and its use in the setting of positive margins or gross primary/nodal residual disease is recommended. No high-level evidence exists for the routine use of preoperative induction chemoradiation therapy; however, modern surgical series and a post-hoc Intergroup 0139 clinical trial analysis suggest that a survival benefit may exist if patients are properly selected and surgical techniques/postoperative care is optimized. A consensus and evidence-based clinical practice guideline for the adjuvant radiotherapeutic management of LA NSCLC has been created addressing 2 important questions. Copyright © 2015 Elsevier Inc. All rights reserved.
Rodrigues, George; Choy, Hak; Bradley, Jeffrey; Rosenzweig, Kenneth E; Bogart, Jeffrey; Curran, Walter J; Gore, Elizabeth; Langer, Corey; Louie, Alexander V; Lutz, Stephen; Machtay, Mitchell; Puri, Varun; Werner-Wasik, Maria; Videtic, Gregory M M
To provide guidance to physicians and patients with regard to the use of definitive external beam radiation therapy (RT) in locally advanced non-small cell lung cancer (LA NSCLC) based on available medical evidence complemented by consensus-based expert opinion. A panel authorized by the American Society for Radiation Oncology (ASTRO) Board of Directors and Guidelines Subcommittee conducted 3 systematic reviews on the following topics: (1) ideal radical RT dose fractionation for RT alone; (2) ideal radical RT dose fractionation for chemoradiation; and (3) ideal timing of radical radiation therapy with systemic chemotherapy. Practice guideline recommendations were approved using an a priori-defined consensus-building methodology supported by ASTRO and approved tools for the grading of evidence quality and the strength of guideline recommendations. For patients managed by RT alone, a minimum dose of 60 Gy of RT is recommended. Dose escalation beyond 60 Gy in the context of combined modality concurrent chemoradiation has not been found to be associated with any clinical benefits. In the context of combined modality therapy, chemotherapy and radiation should ideally be given concurrently to maximize survival, local control, and disease response rate. A consensus and evidence-based clinical practice guideline for the definitive radiotherapeutic management of LA NSCLC has been created that addresses 3 important questions. Copyright © 2015 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.
Definitive and Adjuvant Radiotherapy in Locally Advanced Non-Small-Cell Lung Cancer: American Society of Clinical Oncology Clinical Practice Guideline Endorsement of the American Society for Radiation Oncology Evidence-Based Clinical Practice Guideline.
Bezjak, Andrea; Temin, Sarah; Franklin, Gregg; Giaccone, Giuseppe; Govindan, Ramaswamy; Johnson, Melissa L; Rimner, Andreas; Schneider, Bryan J; Strawn, John; Azzoli, Christopher G
The American Society for Radiation Oncology (ASTRO) produced an evidence-based guideline on external-beam radiotherapy for patients with locally advanced non-small-cell lung cancer (NSCLC). Because of its relevance to the American Society of Clinical Oncology (ASCO) membership, ASCO endorsed the guideline after applying a set of procedures and a policy that are used to critically examine and endorse guidelines developed by other guideline development organizations. The ASTRO guideline was reviewed by ASCO content experts for clinical accuracy and by ASCO methodologists for developmental rigor. On favorable review, an ASCO expert panel was convened and endorsed the guideline. The ASCO guideline approval body, the Clinical Practice Guideline Committee, approved the final endorsement. The recommendations from the ASTRO guideline, published in Practical Radiation Oncology, are clear, thorough, and based on the most relevant scientific evidence. The ASCO Endorsement Panel endorsed the guideline and added qualifying statements. For curative-intent treatment of locally advanced NSCLC, concurrent chemoradiotherapy improves local control and overall survival compared with sequential chemotherapy followed by radiation. The standard dose-fractionation of radiation is 60 Gy given in 2-Gy once-daily fractions over 6 weeks. There is no role for the routine use of induction therapy before chemoradiotherapy. Current data fail to support a clear role for consolidation therapy after chemoradiotherapy; however, consolidation therapy remains an option for patients who did not receive full systemic chemotherapy doses during radiotherapy. Important questions remain about the ideal concurrent chemotherapy regimen and optimal management of patients with resectable stage III disease. © 2015 by American Society of Clinical Oncology.
The establishment of evidence-based practice competencies for practicing registered nurses and advanced practice nurses in real-world clinical settings: proficiencies to improve healthcare quality, reliability, patient outcomes, and costs.
Melnyk, Bernadette Mazurek; Gallagher-Ford, Lynn; Long, Lisa English; Fineout-Overholt, Ellen
Although it is widely known that evidence-based practice (EBP) improves healthcare quality, reliability, and patient outcomes as well as reduces variations in care and costs, it is still not the standard of care delivered by practicing clinicians across the globe. Adoption of specific EBP competencies for nurses and advanced practice nurses (APNs) who practice in real-world healthcare settings can assist institutions in achieving high-value, low-cost evidence-based health care. The aim of this study was to develop a set of clear EBP competencies for both practicing registered nurses and APNs in clinical settings that can be used by healthcare institutions in their quest to achieve high performing systems that consistently implement and sustain EBP. Seven national EBP leaders developed an initial set of competencies for practicing registered nurses and APNs through a consensus building process. Next, a Delphi survey was conducted with 80 EBP mentors across the United States to determine consensus and clarity around the competencies. Two rounds of the Delphi survey resulted in total consensus by the EBP mentors, resulting in a final set of 13 competencies for practicing registered nurses and 11 additional competencies for APNs. Incorporation of these competencies into healthcare system expectations, orientations, job descriptions, performance appraisals, and clinical ladder promotion processes could drive higher quality, reliability, and consistency of healthcare as well as reduce costs. Research is now needed to develop valid and reliable tools for assessing these competencies as well as linking them to clinician and patient outcomes. © 2014 Sigma Theta Tau International.
Adams, Susan; McCarthy, Ann Marie
The use of evidence-based practice (EBP) has become the standard of health care practice. Nurses are expected to use best evidence on a wide range of topics, yet most nurses have limited time, resources, and/or skills to access and evaluate the quality of research and evidence needed to practice evidence-based nursing. EBP guidelines allow nurses…
Layne, Elliot I; Roffey, Darren M; Coyle, Matthew J; Phan, Philippe; Kingwell, Stephen P; Wai, Eugene K
Clinical practice guidelines (CPGs) are designed to ensure that evidence-based treatment is easily put into action. Whether patients and clinicians follow these guidelines is equivocal. The objectives of this study were to examine how many patients complaining of low back pain (LBP) underwent evidence-based medical interventional treatment in line with CPG recommendations before consultation with a spine surgeon, and to evaluate any associations between adherence to CPG recommendations and baseline factors. This is a cross-sectional cohort analysis at a tertiary care center. A total of 229 patients were referred for surgical consultation for an elective lumbar spinal condition. The outcome measures include the number of CPG-recommended treatments undertaken by patients at or before the time of referral, the validated pain score, the EuroQol-5D (EQ-5D) health status, and the Oswestry Disability Index (ODI) score. Questionnaires assessing demographic and functional characteristics as well as overall health-care use were sent to patients immediately after their referral was received by the surgeon's office. Medications were the most common modality before consultation (74.2% of patients), of which 46.3% received opioids. The number of medications taken was significantly related to a higher ODI score (R=0.23, p=.0004), a higher pain score (R=0.15, p=.026), and a lower EQ-5D health status (R=-0.15, p=.024). In contrast, a lower pain score (7.2 vs. 7.7, p=.037) and a lower ODI score (26.6 vs. 29.9, p=.0023) were associated with performing adequate amounts of exercise. There was a significant association between lower numbers of treatments received and higher numerical pain rating scores (R=-0.14, p=.035). The majority (61.1%) of patients received two or less forms of treatment. Evidence-based medical interventional treatments for patients with LBP are not being taken advantage of before spine surgery consultation. If more patients were to undertake CPG
I respond to Kamhi's (2011) conclusion in his article "Balancing Certainty and Uncertainty in Clinical Practice" that rational or critical thinking is an essential complement to evidence-based practice (EBP). I expand on Kamhi's conclusion and briefly describe what clinicians might need to know to think critically within an EBP profession. Specifically, I suggest how critical thinking is relevant to EBP, broadly summarize the relevant skills, indicate the importance of thinking dispositions, and outline the various ways our thinking can go wrong. I finish the commentary by suggesting that critical thinking skills should be considered a required outcome of our professional training programs.
Oh, Eui Geum; Yang, You Lee; Yoo, Jae Yong; Lim, Ji Yun; Sung, Ji Hyun
The current challenges faced by nurses in providing high quality and evidence-based practice (EBP) supported care require profound changes in nursing education. To understand the changes needed to strengthen EBP education, the researchers examined EBP self-efficacy, course needs, barriers, and facilitators for academic faculty and clinical nurse preceptors to teach EBP in undergraduate nursing curricula. For this study, mixed-method approach was used with survey data collected from 73 academic faculty members from 54 universities. Further, 17 clinical nurse preceptors in three academic hospitals provided qualitative data for exploration of barriers and facilitators to teaching EBP. Data analysis used SPSS/WIN 21.0 and content analysis. Quantitative data showed that although the overall level of self-efficacy among faculty was moderate, the implementation levels were relatively low. Most faculty members agreed with the need to integrate EBP courses into undergraduate nursing curricula. The qualitative data showed that the barriers to teaching EBP were lack of knowledge, skill, and initial investment for teaching EBP; hierarchical, rules-oriented nursing culture; potential learner overloads in processing EBP; limited research dissemination and application. Facilitators were identified as the importance of EBP to the profession of nursing; collaboration in schools and hospitals; and continuing education in teaching/utilizing EBP. The findings indicate that for successful integration of EBP ni nursing education there is a need for faculty training and integrated EBP courses.
Satterfield, Jason M; Spring, Bonnie; Brownson, Ross C; Mullen, Edward J; Newhouse, Robin P; Walker, Barbara B; Whitlock, Evelyn P
Context This article describes the historical context and current developments in evidence-based practice (EBP) for medicine, nursing, psychology, social work, and public health, as well as the evolution of the seminal “three circles” model of evidence-based medicine, highlighting changes in EBP content, processes, and philosophies across disciplines. Methods The core issues and challenges in EBP are identified by comparing and contrasting EBP models across various health disciplines. Then a unified, transdisciplinary EBP model is presented, drawing on the strengths and compensating for the weaknesses of each discipline. Findings Common challenges across disciplines include (1) how “evidence” should be defined and comparatively weighted; (2) how and when the patient's and/or other contextual factors should enter the clinical decision-making process; (3) the definition and role of the “expert”; and (4) what other variables should be considered when selecting an evidence-based practice, such as age, social class, community resources, and local expertise. Conclusions A unified, transdisciplinary EBP model would address historical shortcomings by redefining the contents of each model circle, clarifying the practitioner's expertise and competencies, emphasizing shared decision making, and adding both environmental and organizational contexts. Implications for academia, practice, and policy also are discussed. PMID:19523122
Ladeira, Carlos E; Cheng, M Samuel; da Silva, Rubens A
Study Design Electronic cross-sectional survey. Background The American Physical Therapy Association (APTA) evidence-based practice guideline for low back pain (LBP) elaborated on strategies to manage nonspecific LBP in routine physical therapy practice. This guideline described LBP associated with mobility deficit, leg pain and a directional preference, coordination impairment (lumbar instability), and fear-avoidance behavior. Objectives To assess American physical therapists' adherence to the clinical practice guidelines (CPGs) for LBP of the Orthopaedic Section of the APTA, and to compare adherence among physical therapists with different qualifications. Methods The investigators contacted 1861 members of the Orthopaedic Section of the APTA and 1000 members of the American Academy of Orthopaedic Manual Physical Therapists (AAOMPT). Participants made treatment choices for 4 clinical vignettes: LBP with mobility deficit, coordination impairment, leg pain (directional preference), or fear-avoidance behavior. The investigator used logistic regression analyses to compare guideline adherence among physical therapists with the following qualifications: orthopaedic clinical specialists (PTOs), Fellows of the AAOMPT (PTFs), PTOs and PTFs (PTFOs), and physical therapists without clinical specialization but with a musculoskeletal interest (PTMSs). Results A total of 410 physical therapists completed all sections of the survey (142 PTOs, 110 PTFOs, 74 PTFs, and 84 PTMSs). Adherence to the APTA's CPG was highest for LBP associated with leg pain and a directional preference (72.2%), followed by LBP with mobility deficit (57.1%), LBP with coordination impairment (46.1%), and fear-avoidance behavior (29.5%). Physical therapists who were PTFOs adhered better to the CPG for LBP than did PTMSs for all 4 patient vignettes. Orthopaedic clinical specialists adhered better to the CPG for LBP for the vignettes of mobility deficit and of LBP with fear-avoidance behavior than did PTMSs
religious acts of the prehistoric era to empirical-rational decisions of the Egyptian civilization, to modern day evidence-based medicine. Evidence-based medicine requires that clinical decisions and health policies on the prevention, diagnosis and ...
Ross J. Todd
Full Text Available Objective – This paper provides an overview of progress and developments surrounding evidence based practice in school librarianship, and seeks to provide a picture of current thinking about evidence based practice as it relates to the field. It addresses current issues and challenges facing the adoption of evidence based practice in school librarianship.Methods – The paper is based on a narrative review of a small but growing body of literature on evidence based practice in school librarianship, set within a broader perspective of evidence based education. In addition, it presents the outcomes of a collaborative process of input from 200 school libraries leaders collected at a School Library summit in 2007 specifically to address the emerging arena of evidence based practice in this field.Results – A holistic model of evidence based practice for school libraries is presented, centering on three integrated dimensions of evidence: evidence for practice, evidence in practice, and evidence of practice.Conclusion – The paper identifies key challenges ahead if evidence based school librarianship is to develop further. These include: building research credibility within the broader educational environment; the need for ongoing review and evaluation of the diverse body of research in education, librarianship and allied fields to make quality evidence available in ways that can enable practicing school librarians to build a culture of evidence based practice; development of tools, strategies, and exemplars to use to facilitate evidence based decision-making; and, ensuring that the many and diverse advances in education and librarianship become part of the practice of school librarianship.
Pring, Richard; Thomas, Gary
The book begins with an explication of evidence-based practice. Some of the ideas of its proponents are discussed, including the Campbell Collaboration, and the application to education of Cochrane-style reviews and meta-analyses. The thinking behind evidence-based practice has been the subject of much criticism, particularly in education, and…
Stuart, Richard B.; Lilienfeld, Scott O.
Comments on the report by the APA Presidential Task Force on Evidence-Based Practice (see record 2006-05893-001) entitled Evidence-based practice in psychology. Regrettably, the task force report was largely silent on three critical issues. As a consequence, it omitted much of the evidence necessary for a complete picture of evidence-based…
Ollendick, Thomas H
Evidence-based practice has a long history; however, attempts to bridge the gap between science and practice have been only partially effective and much work remains to be done. Part of the problem has been the unilateral approach associated with dissemination of research findings to clinical practitioners. In this special series, Goldfried and colleagues (2014--this issue) suggest a two-way bridge, in which practitioners are afforded the opportunity to disseminate their rich clinical experiences to researchers as well. In this manner, a more collaborative working relationship is espoused. Surveys of practitioners on the use of CBT procedures in the treatment of panic disorder, social anxiety disorder, and generalized anxiety disorder are described. The findings are reviewed and limitations associated with the surveys are noted. Finally, future directions are suggested for rapprochement, hopefully resulting in a greater synthesis of research and practice. © 2013.
Kenny, Deborah J; Richard, Maggie L; Ceniceros, Xochitl; Blaize, Kelli
Military medical treatment facilities offer a unique environment in which to develop a culture of evidence-based practice (EBP). Distinctive issues arise in the context of changed patient care demographics because of a war-injured population. These issues offer an opportunity to enhance the quality of care through the use and adaptation of research findings in this special nursing environment. In addition, the colocation of two military medical centers offers the prospect of collaborative efforts to create a regional culture for nursing EBP. The purposes of this study were to describe the processes of a collaborative project to train nurses in EBP and to share resources in developing and implementing evidence-based clinical nursing guidelines in two large military medical centers in the Northeastern United States and to discuss the collective efforts of nurse researchers, leadership, advanced practice nurses, and staff nurses in each hospital to facilitate the EBP process. A description of the organizational structure and the climate for EBP of each facility is provided followed by discussion of training efforts and the inculcation of an organizational culture for EBP. Contextual barriers and facilitators were encountered throughout the project. The two nurse researchers leading the projects were able to overcome the barriers and capitalize on opportunities to promote EBP. Three evidence-based clinical practice guidelines were developed at each facility and are currently in various stages of implementation. Despite the barriers, EBP continues to be at the forefront of military nursing practice in the U.S. National Capital Region. Clear communication and regular meetings were essential to the success of the collaborative project within and between the two military hospitals. Military-specific barriers to EBP included high team attrition and turnover because of the war mission and the usual high staff turnover at military hospitals. Military facilitators included a
Wolf, Fredric M.
Presents statistics of deaths caused by medical errors and argues the effects of misconceptions in diagnosis and treatment. Suggests evidence-based medicine to enhance the quality of practice and minimize error rates. Presents 10 evidence-based lessons and discusses the possible benefits of evidence-based medicine to evidence-based education and…
Friesen-Storms, J.H.; Bours, G.J.; Weijden, T.T. van der; Beurskens, A.J.
In the decision-making environment of evidence-based practice, the following three sources of information must be integrated: research evidence of the intervention, clinical expertise, and the patient's values. In reality, evidence-based practice usually focuses on research evidence (which may be
GJ Bours; T van der Weijden; JH Friesen-Storms; AJ Beurskens
In the decision-making environment of evidence-based practice, the following three sources of information must be integrated: research evidence of the intervention, clinical expertise, and the patient’s values. In reality, evidence-based practice usually focuses on research evidence (which may be
van Melick, Nicky; van Cingel, Robert E H; Brooijmans, Frans; Neeter, Camille; van Tienen, Tony; Hullegie, Wim; Nijhuis-van der Sanden, Maria W G
The Royal Dutch Society for Physical Therapy (KNGF) instructed a multidisciplinary group of Dutch anterior cruciate ligament (ACL) experts to develop an evidence statement for rehabilitation after ACL reconstruction. Clinical practice guideline underpinned by systematic review and expert consensus. A multidisciplinary working group and steering group systematically reviewed the literature and wrote the guideline. MEDLINE and the Cochrane Library were searched for meta-analyses, systematic reviews, randomised controlled trials and prospective cohort studies published between January 1990 and June 2015. Included literature must have addressed 1 of 9 predetermined clinical topics: (1) preoperative predictors for postoperative outcome, (2) effectiveness of physical therapy, (3) open and closed kinetic chain quadriceps exercises, (4) strength and neuromuscular training, (5) electrostimulation and electromyographic feedback, (6) cryotherapy, (7) measurements of functional performance, (8) return to play and (9) risk for reinjury. Ninety studies were included as the basis for the evidence statement. Rehabilitation after ACL injury should include a prehabilitation phase and 3 criterion-based postoperative phases: (1) impairment-based, (2) sport-specific training and (3) return to play. A battery of strength and hop tests, quality of movement and psychological tests should be used to guide progression from one rehabilitation stage to the next. Postoperative rehabilitation should continue for 9-12 months. To assess readiness to return to play and the risk for reinjury, a test battery, including strength tests, hop tests and measurement of movement quality, should be used. 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/.
Johannsen, Carl Gustav
The article examines problems concerning the introduction and future implementation of evidence-based practice (EBP) in libraries. It includes important conceptual distinctions and definitions, and it reviews the more controversial aspects of EBP, primarely based on experiences from Denmark...
Newhouse, Robin P; Dearholt, Sandi; Poe, Stephanie; Pugh, Linda C; White, Kathleen M
Evidence-based practice, a crucial competency for healthcare providers and a basic force in Magnet hospitals, results in better patient outcomes. The authors describe the strategic approach to support the maturation of The Johns Hopkins Nursing evidence-based practice model through providing leadership, setting expectations, establishing structure, building skills, and allocating human and material resources as well as incorporating the model and tools into undergraduate and graduate education at the affiliated university.
Kianifar, Hamid-Reza; Akhondian, Javad; Najafi-Sani, Mehri; Sadeghi, Ramin
Practicing medicine according to the best evidence is gaining popularity in the medical societies. Although this concept, which is usually called Evidence Based Medicine (EBM) has been explained in many resources, it has not been addressed enough in pediatrics. In this review, we briefly explained Evidence Based Medicine approach and its applications in pediatrics in order to help the pediatricians to efficiently integrate EBM into their daily practice. PMID:23056715
Wampold, Bruce E.; Goodheart, Carol D.; Levant, Ronald F.
Responds to comments by D. C. Wendt and B. D. Slife (see record 2007-13085-019), P. H. Hunsberger (see record 2007-13085-020), and R. B. Stuart and S. O. Lilienfeld (see record 2007-13085-021) regarding the report by the APA Presidential Task Force on Evidence-Based Practice (see record 2006-05893-001) entitled Evidence-based practice in…
Yadav, B L
Evidence-based practice places an emphasis on integration of clinical expertise with available best evidence, patient\\'s clinical information and preferences, and with local health resources. This paper reports the findings of a study that investigated the barriers, facilitators and skills in developing evidence-based practice among psychiatric nurses in Ireland. A postal survey was conducted among a random sample of Irish psychiatric nurses and survey data were collected using the Development of Evidence-Based Practice Questionnaire. Respondents reported that insufficient time to find and read research reports and insufficient resources to change practice were the greatest barriers to the development of evidence-based practice. Practice development coordinators were perceived as the most supportive resource for changing practice. Using the Internet to search for information was the highest-rated skill and using research evidence to change practice was the lowest-rated skill for developing evidence-based practice. Nurses\\' precursor skills for developing evidence-based practice, such as database searching and information retrieval, may be insufficient in themselves for promoting evidence-based practice if they cannot find evidence relating to their particular field of practice or if they do not have the time, resources and supports to develop their practice in response to evidence.
Full Text Available The patients with chronic pain are increasingly reporting to the physicians for its management. Chronic pain are associated with head, neck and shoulder pain, spinal pain, pain in the joints and extremities, complex regional pain syndrome and phantom pain. The chronic pain is being managed worldwide. The different specialty of medicine is producing a lot of evidence through the published literature but the same is not being published in the field of chronic pain management. Though some evidence is being reported as to different aspects of pain management from different parts of the world but same is lacking from Indian subcontinent. This is in contrast to much done clinical work in this field as well. We present here the available evidence in relation to chronic pain management.
Hilbert, Anja; Hoek, Hans W.; Schmidt, Ricarda
Purpose of review: The current systematic review sought to compare available evidence-based clinical treatment guidelines for all specific eating disorders. Recent findings: Nine evidence-based clinical treatment guidelines for eating disorders were located through a systematic search. The
Schaffer, Marjorie A; Sandau, Kristin E; Diedrick, Lee
To provide an overview, summary of key features and evaluation of usefulness of six evidence-based practice models frequently discussed in the literature. The variety of evidence-based practice models and frameworks, complex terminology and organizational culture challenges nurses in selecting the model that best fits their practice setting. The authors: (1) initially identified models described in a predominant nursing text; (2) searched the literature through CINAHL from 1998 to current year, using combinations of 'evidence', 'evidence-based practice', 'models', 'nursing' and 'research'; (3) refined the list of selected models based on the initial literature review; and (4) conducted a second search of the literature on the selected models for all available years to locate both historical and recent articles on their use in nursing practice. Authors described model key features and provided an evaluation of model usefulness based on specific criteria, which focused on facilitating the evidence-based practice process and guiding practice change. The evaluation of model usefulness can be used to determine the best fit of the models to the practice setting. The Johns Hopkins Model and the Academic Center for Evidence-Based Practice Star Model emphasize the processes of finding and evaluating evidence that is likely to appeal to nursing educators. Organizations may prefer the Promoting Action on Research Implementation in Health Services Framework, Advancing Research and Clinical Practice Through Close Collaboration, or Iowa models for their emphasis on team decision-making. An evidence-based practice model that is clear to the clinician and fits the organization will guide a systematic approach to evidence review and practice change. © 2012 Blackwell Publishing Ltd.
Spencer, Trina D.; Detrich, Ronnie; Slocum, Timothy A.
The research to practice gap in education has been a long-standing concern. The enactment of No Child Left Behind brought increased emphasis on the value of using scientifically based instructional practices to improve educational outcomes. It also brought education into the broader evidence-based practice movement that started in medicine and has…
A.J.G. Jansen (Gerard)
textabstractAfter the introduction of blood component therapy in the 1960s, more and more attention is given to clinical transfusion medicine. Although blood transfusion is an important treatment in different clinical settings, there are still lack of much randomized clinical trials. Nowadays
Saunders, Hannele; Vehviläinen-Julkunen, Katri
Although systematic implementation of evidence-based practice (EBP) is essential to effectively improve patient outcomes, quality, and value of care, nurses do not consistently use evidence in practice. Uptake is hampered by lack of nurses' readiness for EBP, including nurses' EBP beliefs and lack of EBP mentors. Favorable EBP beliefs are foundational to Registered Nurses' (RNs) use and integration of best evidence into clinical decision making, whereas EBP mentors are in a key role for strengthening RNs' beliefs in the value of EBP and confidence in their ability to implement EBP. Although nurses' EBP beliefs and role of BP mentors have been widely studied in countries leading the EBP movement, less is known about them in the non-English-speaking world. To determine RNs EBP beliefs and the role of EBP mentors at Finnish university hospitals and to explore the associations between RNs' EBP beliefs and sociodemographic factors. A cross-sectional descriptive survey was conducted in November-December 2014 at every university hospital in Finland with a convenience sample (n = 943) of practicing RNs. The data were collected via an electronic survey, and analyzed using descriptive and inferential statistics. RNs reported low levels of EBP beliefs in the degree to which they believed that clinical nursing practice and their own practice were based on evidence. EBP mentors worked in many professional nursing roles. Several significant differences were found between RN's EBP beliefs and sociodemographic variables. Although RNs were familiar with and believed in the value of EBP in improving care quality and patient outcomes, their ratings were low about the degree to which they believed that clinical nursing practice and their own practice were based on evidence, indicating a modest level of individual EBP readiness among Finnish RNs required for integrating best evidence into clinical care delivery. © 2016 Sigma Theta Tau International.
Mohamed, Mohamed; Wong, Christopher Kevin
Adolescents who have chronic pain after common orthopedic injuries such as ankle sprains may present a multidimensional clinical problem stemming from both physical and psychological issues. A traumatic incident such as a motor vehicle accident can produce clinical issues ranging from a specific tissue injury to multisystem complications such as complex regional pain syndrome (CRPS) or posttraumatic stress disorder (PTSD). The purpose of this retrospective case report on an adolescent with chronic ankle pain stemming from a motor vehicle accident is to demonstrate how reflection and the evidence base influenced the modification of the plan of care. Description of the screening methods, clinical findings, interventions, and outcomes of the case may help physical therapists identify and improve the quality of care in cases of suspected CRPS and PTSD. The patient was a 12-year-old girl with a medical diagnosis of recurrent right ankle sprain and with signs of potential CRPS and PTSD. Poor initial response to ankle sprain management led to reflective reconsideration of the diagnosis and plan of care. The revised plan of care supported by the evidence base emphasized empathetic consideration of the traumatic motor vehicle accident and focused on CRPS prevention and management of potential non-physical pain via mirror therapy and motor imagery therapy. Pain was relieved, behavior improved, and functional movement began to normalize after 3 sessions of mirror therapy and motor imagery therapy. Patient symptoms were inconsistent with the medical diagnosis, and the clinical outcome of the original plan of care was unsuccessful. Reflection inspired a more-detailed history and systems review, which led to greater understanding and more-effective care.
Nguyen, Thi Ngoc Minh; Wilson, Anne
Despite the fact that evidence-based practice has increasing emphasis in health care, organizations are not always prepared for its implementation. Identifying organizational preparedness for implementing evidence-based practice is desirable prior to application. A cross-sectional survey was developed to explore nurses' perception of organizational support for evidence-based practice and was implemented via a self-enumerated survey completed by 234 nurses. Data were analyzed with descriptive and inferential statistics. Nurses reported that implementation of evidence-based practice is complex and fraught with challenges because of a lack of organizational support. A conceptual framework comprising three key factors: information resources, nursing leadership, and organizational infrastructure was proposed to assist health authorities in the implementation of evidence-based practice. Suggestions of how organizations can be more supportive of research utilization in practice include establishing a library, journal clubs/mentoring programs, nurses' involvement in decision-making at unit level, and a local nursing association. © 2016 John Wiley & Sons Australia, Ltd.
Schwartz, Joseph; Winters, Jeffrey L; Padmanabhan, Anand; Balogun, Rasheed A; Delaney, Meghan; Linenberger, Michael L; Szczepiorkowski, Zbigniew M; Williams, Mark E; Wu, Yanyun; Shaz, Beth H
The American Society for Apheresis (ASFA) JCA Special Issue Writing Committee is charged with reviewing, updating and categorizating indications for therapeutic apheresis. Beginning with the 2007 ASFA Special Issue (Fourth Edition), the committee has incorporated systematic review and evidence-based approach in the grading and categorization of indications. This Sixth Edition of the ASFA Special Issue has further improved the process of using evidence-based medicine in the recommendations by consistently applying the category and GRADE system definitions, but eliminating the "level of evidence" criteria (from the University HealthCare Consortium) utilized in prior editions given redundancy between GRADE and University HealthCare Consortium systems. The general layout and concept of a fact sheet that was utilized in the Fourth and Fifth Editions, has been largely maintained in this edition. Each fact sheet succinctly summarizes the evidence for the use of therapeutic apheresis in a specific disease entity. This article consists of 78 fact sheets (increased from 2010) for therapeutic indications in ASFA categories I through IV, with many diseases categorized having multiple clinical presentations/situations which are individually graded and categorized. Copyright © 2013 Wiley Periodicals, Inc.
Chang, Zhong-Fu; Zhu, Ce; Tao, Dan-Ying; Feng, Xi-Ping; Lu, Hai-Xia
To investigate the knowledge, attitude and practice related to evidence-based dentistry among dental students, and to provide a reference for targeted evidence-based dentistry teaching and practice evidence-based dentistry in dental students. Dental students who attended the internship in Shanghai Ninth People's Hospital and Pudong People's Hospital were invited to attend this survey. Information on knowledge, attitude and practices related evidence-based dentistry was collected through questionnaires. SPSS 21.0 software package was used for data analysis. A total of 62 dental students attended this survey. Evidence-based dentistry related knowledge and attitude scores were 5.5±1.9 and 5.1±1.0, respectively. Over three quarters of students took courses on evidence-based medicine, while around half of students (56.5%) self-reported that they knew little about evidence-based medicine. 70.5% students practiced evidence-based dentistry less than once in the process of clinical decision making per week. The majority of students (80.3%) used MEDLINE or other databases to search for practice-related literature less than once per week. 63.9% students used practice guideline. The top three barriers to practice evidence-based dentistry were lack of information resources, insufficient time and lack of search skills. Evidence-based dentistry related knowledge and practice among dental students is deficient, whereas they hold positive attitude on practice. The top three barriers to practice evidence-based dentistry are lack of information resources, insufficient time and lack of search skills.
Buckwalter, Kathleen C; Cullen, Laura; Hanrahan, Kirsten; Kleiber, Charmaine; McCarthy, Ann Marie; Rakel, Barbara; Steelman, Victoria; Tripp-Reimer, Toni; Tucker, Sharon
The Iowa Model is a widely used framework for the implementation of evidence-based practice (EBP). Changes in health care (e.g., emergence of implementation science, emphasis on patient engagement) prompted the re-evaluation, revision, and validation of the model. A systematic multi-step process was used capturing information from the literature and user feedback via an electronic survey and live work groups. The Iowa Model Collaborative critically assessed and synthesized information and recommendations before revising the model. Survey participants (n = 431) had requested access to the Model between years 2001 and 2013. Eighty-eight percent (n = 379) of participants reported using the Iowa Model and identified the most problematic steps as: topic priority, critique, pilot, and institute change. Users provided 587 comments with rich contextual rationale and insightful suggestions. The revised model was then evaluated by participants (n = 299) of the 22nd National EBP Conference in 2015. They validated the model as a practical tool for the EBP process across diverse settings. Specific changes in the model are discussed. This user driven revision differs from other frameworks in that it links practice changes within the system. Major model changes are expansion of piloting, implementation, patient engagement, and sustaining change. The Iowa Model-Revised remains an application-oriented guide for the EBP process. Intended users are point of care clinicians who ask questions and seek a systematic, EBP approach to promote excellence in health care. © 2017 University of Iowa Hospitals and Clinics, Worldviews on Evidence-Based Nursing © 2017 Sigma Theta Tau International.
Pearce, Linda C
This article summarizes the evidence-based nutrition recommendations for diabetes published first in 2002 by the ADA, and identifies diet information that now should be recognized as misconception or myth. Home care clinicians must become cognizant of evidence-based guidelines and update clinical practices, care paths, and teaching materials accordingly.
Examines to what extent the skills and techniques of evidence-based practice are transferable to the areas of professional practice of librarians and information professionals? Is it desirable for information professionals to integrate research findings into their day-to-day decision making?
Falzon, Louise; Davidson, Karina W.; Bruns, Daniel
There is an increased awareness of evidence-based methodology among psychologists, but little exists in the literature about how to access the research. Moreover, the prohibitive cost of this information combined with limited time are barriers to the identification of evidence to answer clinical questions. This article presents an example of a question worked though in an evidence-based way. Methods are highlighted, including distinguishing background and foreground questions, breaking down q...
Hillegass, Ellen; Puthoff, Michael; Frese, Ethel M; Thigpen, Mary; Sobush, Dennis C; Auten, Beth
... & Pulmonary and Acute Care sections of APTA, have developed this clinical practice guideline to assist physical therapists in their decision-making process when treating patients at risk for venous thromboembolism (VTE...
Kennedy, Margaret Ann
Evidence-based practice in nursing is considered foundational to safe, competent care. To date, rigid traditional perceptions of what constitutes 'evidence' have constrained the recognition and use of practice-based evidence and the exploitation of novel forms of evidence from data rich environments. Advancements such as the conceptualization of clinical intelligence, the prevalence of increasingly sophisticated digital health information systems, and the advancement of the Big Data phenomenon have converged to generate a new contemporary context. In today's dynamic data-rich environments, clinicians have new sources of valid evidence, and need a new paradigm supporting clinical practice that is adaptive to information generated by diverse electronic sources. This opinion paper presents adaptive practice as the next generation of evidence-based practice in contemporary evidence-rich environments and provides recommendations for the next phase of evolution.
McAlister, Finlay A; Graham, Ian; Karr, Gerald W; Laupacis, Andreas
OBJECTIVE To assess the attitudes of practicing general internists toward evidence-based medicine (EBM—defined as the process of systematically finding, appraising, and using contemporaneous research findings as the basis for clinical decisions) and their perceived barriers to its use. DESIGN Cross-sectional, self-administered mail questionnaire conducted between June and October 1997. SETTING Canada. PARTICIPANTS Questionnaires were sent to all 521 physician members of the Canadian Society of Internal Medicine with Canadian mailing addresses; 296 (60%) of 495 eligible physicians responded. Exclusion of two incomplete surveys resulted in a final sample size of 294. MAIN RESULTS Mean age of respondents was 46 years, 80% were male, and 52% worked in large urban medical centers. Participants reported using EBM in their clinical practice always (33, 11%), often (173, 59%), sometimes (80, 27%), or rarely/never (8, 3%). There were no significant differences in demographics, training, or practice types or locales on univariate or multivariate analyses between those who reported using EBM often or always and those who did not. Both groups reported high usage of traditional (non-EBM) information sources: clinical experience (93%), review articles (73%), the opinion of colleagues (61%), and textbooks (45%). Only a minority used EBM-related information sources such as primary research studies (45%), clinical practice guidelines (27%), or Cochrane Collaboration Reviews (5%) on a regular basis. Barriers to the use of EBM cited by respondents included lack of relevant evidence (26%), newness of the concept (25%), impracticality for use in day-to-day practice (14%), and negative impact on traditional medical skills and “the art of medicine” (11%). Less than half of respondents were confident in basic skills of EBM such as conducting a literature search (46%) or evaluating the methodology of published studies (34%). However, respondents demonstrated a high level of interest
André, Beate; Aune, Anne G; Brænd, Jorunn A
Evidence-based practice is currently one of the most important developments in health care. Research in nursing science is rapidly growing; however, translating the knowledge based on this research into clinical practice is often hampered, and may be dependent on reflective skills. The aim of this study was to see how undergraduate nursing students in nursing should increase their skills and knowledge related to evidence-based practice through participation in clinical research projects. A qualitative approach was used in collecting and analyzing the data. Students participated in a pilot clinical research project and a received guidance related to their bachelor thesis. After the project was completed, all students filled in a questionnaire. The students' motivation to participate in this study was reported to be high, but they reported low knowledge related to evidence-based practice. All students reported that their attitude towards evidence-based practice changed in a positive direction during their participation in the project. Evidence-based practice influenced nursing practices by putting more focus on critical thinking, increasing pride and giving a sense of ownership in the clinical field. The curricula and the pedagogical perspectives in nursing education can influence the attitude towards evidence-based practice and skills among nursing bachelor students. Copyright © 2016 Elsevier Ltd. All rights reserved.
Sweeney, Jane K; Heriza, Carolyn B; Blanchard, Yvette; Dusing, Stacey C
(1) To outline frameworks for neonatal physical therapy based on 3 theoretical models, (2) to describe emerging literature supporting neonatal physical therapy practice, and (3) to identify evidence-based practice recommendations. Three models are presented as a framework for neonatal practice: (1) dynamic systems theory including synactive theory and the theory of neuronal group selection, (2) the International Classification of Functioning, Disability and Health, and (3) family-centered care. Literature is summarized to support neonatal physical therapists in the areas of examination, developmental care, intervention, and parent education. Practice recommendations are offered with levels of evidence identified. Neonatal physical therapy practice has a theoretical and evidence-based structure, and evidence is emerging for selected clinical procedures. Continued research to expand the science of neonatal physical therapy is critical to elevate the evidence and support practice recommendations.
Full Text Available Global acknowledgement of ecological restoration, as an important tool to complement conservation efforts, requires an effort to increase the effectiveness of restoration interventions. Evidence-based practice is purported to promote effectiveness. A central tenet of this approach is decision making that is based on evidence, not intuition. Evidence can be generated experimentally and in practice but needs to be linked to baseline information collection, clear goals and monitoring of impact. In this paper, we report on a survey conducted to assess practitioners’ perceptions of the evidence generated in restoration practice in South Africa, as well as challenges encountered in building this evidence base. Contrary to a recent assessment of this evidence base which found weaknesses, respondents viewed it as adequate and cited few obstacles to its development. Obstacles cited were mostly associated with planning and resource availability. We suggest that the disparity between practitioners’ perceptions and observed weaknesses in the evidence base could be a challenge in advancing evidence-based restoration. We explore opportunities to overcome this disparity as well as the obstacles listed by practitioners. These opportunities involve a shift from practitioners as users of scientific knowledge and evidence, to practitioners involved in the co-production of evidence needed to increase the effectiveness of restoration interventions.
Concept and practice of evidence-based psychiatry and its application in Nigerian psychiatry: a critical review. PO Onifade, LO Oluwole. Abstract. No Abstract. Nigerian Journal of Medicine Vol. 15(1) 2006: 16-19. Full Text: EMAIL FULL TEXT EMAIL FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT.
Boyington, Alice R; Ferrall, Sheila M; Sylvanus, Terry
Nurses should be engaged in evidence-based practice (EBP) to ensure that nursing care is efficient and effective. This article describes one cancer center's use of the Marketing Mix framework to educate staff nurses with the CROC™: Clinging Rigidly to Outdated Care campaign. As a result of the campaign, five EBP projects have been initiated in the cancer center.
Bates, Joanne; McClure, Janelle; Spinks, Andy
Evidence-based practice is the collection, interpretation, and use of data, such as collection statistics or assessment results, that measure the effectiveness of a library media program. In this article, the authors will present various forms of evidence and show that any library media specialist can use data to make informed decisions that…
Schaffner, Angela D.; Buchanan, Linda Paulk
This study examined the current issues relevant to implementing evidence-based practices in the context of outpatient treatment for eating disorders. The study also examined the effectiveness of an outpatient treatment program for eating disorders among a group of 196 patients presenting with anorexia nervosa, bulimia nervosa, or eating disorder…
Evidence-based medicine (EBM) is a rapidly expanding subject. The aim of this editorial is to give an overview and address some of the practical issues relevant to the developing world. EBM may be defined as the conscientious, explicit and judicious use of current best evidence in making decisions about the care of ...
Morrow, Michael T.; Lee, Hsin-Hua; Bartoli, Eleonora; Gillem, Angela R.
Evidence-based practice (EBP) is a core priority in counselor education. This paper details one United States' counselor education program's self-assessment of its EBP curriculum. Faculty members collaborated to identify challenges and generate solutions to strengthen the EBP emphasis within the program. This paper is intended as a resource for…
While research is needed and necessary, promoting the value of evidence-based practice (EBP), quality improvement (QI) and project evaluation (PE) initiatives could rapidly and economically further the development of nursing and midwifery disciplines globally, perhaps especially in resource constrained settings.
Byiers, Breanne J.; Reichle, Joe; Symons, Frank J.
Purpose: Single-subject experimental designs (SSEDs) represent an important tool in the development and implementation of evidence-based practice in communication sciences and disorders. The purpose of this article is to review the strategies and tactics of SSEDs and their application in speech-language pathology research. Method: The authors…
Full Text Available . In this paper, we report on a survey conducted to assess practitioners’ perceptions of the evidence generated in restoration practice in South Africa, as well as challenges encountered in building this evidence base. Contrary to a recent assessment...
Mehrdad, Neda; Joolaee, Soodabeh; Joulaee, Azadeh; Bahrani, Naser
Background: Evidence-based practice (EBP) is one of the main professional competencies for health care professionals and a priority for medicine and nursing curriculum as well. EBP leads to improve effective and efficient care and patient outcomes. Nurse educators have responsibility to teach the future nurses, and an opportunity to promote patient outcomes. Therefore, the aim of this study was to describe nurse educators’ knowledge and attitude on EBP. Materials and Methods: This was a descriptive study conducted in nursing faculties of two major universities of medical sciences affiliated to Ministry of Health and Medical Sciences in Tehran, Iran. Data were gathered using a three-section questionnaire. Content and face validity was further enhanced by submitting it to nursing research and education experts. Statistical analysis was carried out using SPSS 11 software. Results: According the results, nursing faculties’ knowledge of EBP was mainly moderate (47.1%). Significant statistical relationship was found between the level of knowledge with education and teaching experience in different nursing programs. Nurses generally held positive attitudes toward EBP (88.6%) and there was no statistical significant relationship with demographic variables. Conclusion: Nursing educators are in a position to influence nursing research in clinical practice in the future. Therefore, it is critical to achieve implementation of EBP and be a change agent for a paradigm shift toward EBP. PMID:23922597
Singleton, Joanne K
Doctors of Nursing Practice focus on leadership in evidence-based practice (EBP). EBP is influenced by one's beliefs in and implementation of EBP. Little is known to date about the EBP beliefs and implementation of Doctor of Nursing Practice students and outcomes of Doctor of Nursing Practice education. Guided by the Advancing Research and Clinical practice through close Collaboration (ARCC) Model, the Evidence-Based Practice Beliefs (EBPB) and Implementation (EBPI) tools were used to assess the impact of EBP as a program pillar, curricular thread, and content area on EBPB and EBPI of Doctor of Nursing Practice-Family Nurse Practitioner students. Five cohorts who completed the same curriculum were studied. Fifty-four of the 89 students across the five cohorts began and completed the study. Paired t-test for group effects showed statistical significance from pre- to post-measure in students overall EBPB, t = 4.4 (52), p students who are educated to be EBP leaders must have a curriculum that supports them in the knowledge and skill-set needed to translate evidence into practice. The ARCC Model can guide faculty in EBP curriculum development. EBPB and EBPI are valid and reliable measures to assess for gains across a curriculum. Through educational outcomes, educators can assess desired student outcomes for EBP across a curriculum and can build an evidence base for ongoing curriculum development. © 2017 Sigma Theta Tau International.
Cooper, Stewart E.; Benton, Sherry A.; Benton, Stephen L.; Phillips, Julia C.
This empirically based study sought to discover factors underlying diverse sources of information used to inform therapy practice, perceived salience of sources of evidence for clinical practice, importance of common factors to therapy efficiency, and beliefs about evidence-based practice, particularly in the form of evidence-supported treatments…
Lystbæk, Christian Tang
, cost-efficiency and measurable quality. Thus, today, evidence-based practice has become an expectation and fashion, often used to emphasize the grounding of practice in research based knowledge that provides measurable evidence for best practice. But at the same time, there is a growing distrust......“Knowledge” is of the utmost significance for professional practice and learning. Today, though, the established knowledge base is changing in all areas of the labour market (Alvesson, 2004). Work and society are dominated by commitment to demands for high levels of demonstrable accountability...
Evidence-based medicine aims to apply the best available evidence gained from the scientific method to medical decision making. It is a practice that uses statistical analysis of scientific methods and outcomes to drive further experimentation and diagnosis. The profusion of evidence-based medicine in medical practice and clinical research has produced a need for life scientists and clinical researchers to assimilate biostatistics into their work to meet efficacy and practical standards. Practical Biostatistics provides researchers, medical professionals, and students with a friendly, practica
Fernanda Carolina Camargo
Full Text Available Abstract Objective: To analyze the apprehensions of nurse managers in the implementation of the Evidence Based Practice in a Teaching Hospital of Triângulo Mineiro. Method: Qualitative research guided by the Theory of the Diffusion of Innovations. Five workshops were conducted per focal group (n = 18 participants, conducted by hermeneutic-dialectic interactions between August and September/2016. Textual records resulting from each workshop were analyzed by semantic categories. Results: Aspects conditioning to the implementation of the Evidence Based Practice permeate from elements related to the fragmentation of the care network to the necessary expansion of the governability of the nurse managers to put changes into practice in their sectors. Most importantly, timely access to the results of research conducted at the teaching hospital was mentioned as crucial to guide better practices. Final considerations: The approach allowed the recognition of contextual conditions for the implementation of the Evidence-Based Practice, which may coincide with similar scenarios, as well as increase the national scientific production on the subject, which is still scarce.
Slocum, Timothy A; Detrich, Ronnie; Wilczynski, Susan M; Spencer, Trina D; Lewis, Teri; Wolfe, Katie
Evidence-based practice (EBP) is a model of professional decision-making in which practitioners integrate the best available evidence with client values/context and clinical expertise in order to provide services for their clients. This framework provides behavior analysts with a structure for pervasive use of the best available evidence in the complex settings in which they work. This structure recognizes the need for clear and explicit understanding of the strength of evidence supporting intervention options, the important contextual factors including client values that contribute to decision making, and the key role of clinical expertise in the conceptualization, intervention, and evaluation of cases. Opening the discussion of EBP in this journal, Smith (The Behavior Analyst, 36, 7-33, 2013) raised several key issues related to EBP and applied behavior analysis (ABA). The purpose of this paper is to respond to Smith's arguments and extend the discussion of the relevant issues. Although we support many of Smith's (The Behavior Analyst, 36, 7-33, 2013) points, we contend that Smith's definition of EBP is significantly narrower than definitions that are used in professions with long histories of EBP and that this narrowness conflicts with the principles that drive applied behavior analytic practice. We offer a definition and framework for EBP that aligns with the foundations of ABA and is consistent with well-established definitions of EBP in medicine, psychology, and other professions. In addition to supporting the systematic use of research evidence in behavior analytic decision making, this definition can promote clear communication about treatment decisions across disciplines and with important outside institutions such as insurance companies and granting agencies.
Major depression disorder is most commonly treated with antidepressants. However, due to their side effects clinicians seek non-pharmacologic options, and one of these is exercise. The literature on the benefits of exercise for depression is extensive. Nevertheless, two recent reviews focusing on antidepressants vs. other therapies as a basis for clinical practice guidelines recommended mainly antidepressants, excluding exercise as a viable choice for treatment of depression. The aim of this ...
Evidence-based radiology: a new approach to evaluate the clinical practice of radiology; Evidenzbasierte Radiologie: Ein neuer Ansatz zur Bewertung von klinisch angewandter radiologischer Diagnostik und Therapie
Puig, S. [Univ.Klinik fuer Radiodiagnostik, Medizinische Univ. Wien (Austria); Forschungsprogramm fuer Evidenzbasierte Medizinische Diagnostik, Inst. fuer Public Health, Paracelsus Medizinische Privatuniversitaet, Salzburg (Austria); Felder-Puig, R. [Ludwig-Boltzmann-Inst. fuer Health Technology Assessment, Vienna (Austria)
Over the last several years, the concept and methodology of evidence-based medicine (EBM) have received significant attention in the scientific community. However, compared to therapeutic medical disciplines, EBM-based radiological publications are still underrepresented. This article summarizes the principles of EBM and discusses the possibilities of their application in radiology. The presented topics include the critical appraisal of studies on the basis on EBM principles, the explanation of EBM-relevant statistical outcome parameters (e.g., ''likelihood ratio'' for diagnostic and ''number needed to treat'' for interventional procedures), as well as the problems facing evidence-based radiology. Evidence-based evaluation of radiological procedures does not only address aspects of cost-effectiveness, but is also particularly helpful in identifying patient-specific usefulness. Therefore it should become an integral part of radiologist training. (orig.)
Byiers, Breanne J; Reichle, Joe; Symons, Frank J
Single-subject experimental designs (SSEDs) represent an important tool in the development and implementation of evidence-based practice in communication sciences and disorders. The purpose of this article is to review the strategies and tactics of SSEDs and their application in speech-language pathology research. The authors discuss the requirements of each design, followed by advantages and disadvantages. The logic and methods for evaluating effects in SSED are reviewed as well as contemporary issues regarding data analysis with SSED data sets. Examples of challenges in executing SSEDs are included. Specific exemplars of how SSEDs have been used in speech-language pathology research are provided throughout. SSED studies provide a flexible alternative to traditional group designs in the development and identification of evidence-based practice in the field of communication sciences and disorders.
Damarell, Raechel A; Tieman, Jennifer; Sladek, Ruth M; Davidson, Patricia M
Heart failure is a highly debilitating syndrome with a poor prognosis primarily affecting the elderly. Clinicians wanting timely access to heart failure evidence to provide optimal patient care can face many challenges in locating this evidence. This study developed and validated a search filter of high clinical utility for the retrieval of heart failure articles in OvidSP Medline. A Clinical Advisory Group was established to advise study investigators. The study set of 876 relevant articles from four heart failure clinical practice guidelines was divided into three datasets: a Term Identification Set, a Filter Development Set, and a Filter Validation Set. A further validation set (the Cochrane Validation Set) was formed using studies included in Cochrane heart failure systematic reviews. Candidate search terms were identified via word frequency analysis. The filter was developed by creating combinations of terms and recording their performance in retrieving items from the Filter Development Set. The filter's recall was then validated in both the Filter Validation Set and the Cochrane Validation Set. A precision estimate was obtained post-hoc by running the filter in Medline and screening the first 200 retrievals for relevance to heart failure. The four-term filter achieved a recall of 96.9% in the Filter Development Set; 98.2% in the Filter Validation Set; and 97.8% in the Cochrane Validation Set. Of the first 200 references retrieved by the filter when run in Medline, 150 were deemed relevant and 50 irrelevant. The post-hoc precision estimate was therefore 75%. This study describes an objective method for developing a validated heart failure filter of high recall performance and then testing its precision post-hoc. Clinical practice guidelines were found to be a feasible alternative to hand searching in creating a gold standard for filter development. Guidelines may be especially appropriate given their clinical utility. A validated heart failure filter is now
Johansson, Birgitta; Fogelberg-Dahm, Marie; Wadensten, Barbro
To describe evidence-based practice among head nurses and to explore whether number of years of duty is associated with such activities. Further to evaluate the effects of education on evidence-based practice and perceived support from immediate superiors. Registered nurses in Sweden are required by law to perform care based on research findings and best experiences. In order to achieve this, evidence-based practice (EBP) is of key importance. All 168 head nurses at two hospitals were asked to participate. Ninety-nine (59%) completed the survey. Data were collected using a study-specific web-based questionnaire. The majority reported a positive attitude towards EBP, but also a lack of time for EBP activities. A greater number of years as a head nurse was positively correlated with research utilization. Education in research methods and perceived support from immediate superiors were statistically and significantly associated with increased EBP activities. The present study highlights the value of education in research methods and the importance of supportive leadership. Education is an important factor in the employment of head nurses. We recommend interventions to create increased support for EBP among management, the goal being to deliver high-quality care and increase patient satisfaction.
Visovsky, Constance; Maguire, Denise J; Zambroski, Cheryl; Palacios, Linette
Evidence-based practice (EBP) continues to gain global attention. In the Latin American country of Panama, nursing practice has largely been guided by oral tradition and clinical experience rather than the use of best evidence. The authors used a conference-based approach in a joint effort between the University of South Florida and the University of Panama to introduce EBP to nursing leaders in Panama to bring change to the nursing curricula and, ultimately, change in nursing practice. J Contin Educ Nurs. 2017;48(11):512-516. Copyright 2017, SLACK Incorporated.
Full Text Available Although clinical pharmacy training in Pakistan is a novelty in the undergraduate pharmacy curriculum, it has significantly improved the practical knowledge of the undergraduate students with regards practice of pharmacy in health care settings. The implementation of the curriculum change was a major innovation but the possible negative implications were not contemplated at the time of execution and combined with a failure in regular review and assessment of the plan. This led to undesirable outcomes such as breaching of health care protocols and ethics by students, inadequate aptitude and poor clinical research skills. These shortcomings were analyzed and an evidence based improvement program known as the Evidence Based Improvement (EBI initiative was designed containing structured modules to empower undergraduates in those areas. It was implemented by the authorities and has led to positive outcomes which render it very useful and this improvement program can serve as a guide to develop clinical pharmacy training programs in those countries where the practice of pharmacy is evolving.
Weber, Clemens; Jakola, Asgeir S; Gulati, Sasha; Nygaard, Oystein P; Solheim, Ole
Evidence-based medicine (EBM) has become one of the pillars of modern patient care. However, neurosurgery has always been an experience-based and technology-driven discipline, and it remains unknown to which extent European neurosurgeons follow high-level evidence-based recommendations. We conducted a Web-based survey with a 15-item questionnaire about evidence-based clinical management and utilization of new technology among European neurosurgeons. Two different sum scores were calculated from the questions concerning clinical practice; evidence-based treatment score and new technology score. A high evidence-based treatment score means that more clinical conditions (i.e., study questions) were managed in compliance with the available highest levels of evidence from published clinical trials. A high new technology score reflects the use of a high number of modern tools in neurosurgical practice. A total of 239 neurosurgeons from 30 different European countries answered the questionnaire. There were large variations among European neurosurgeons in providing evidence-based care and in utilization of various modern tools. There were significant regional differences in evidence-based treatment scores and modern technology scores with higher scores in northern and western Europe. High-volume institutions were not associated with better evidence-based treatment scores, but had significantly higher new technology scores. There were significantly higher new technology scores at university hospitals and a trend towards higher evidence-based treatment scores compared to other hospitals. Clinical management in neurosurgery does not always comply with the best available evidence and there are large regional differences in clinical management and in utilization of various modern tools. The position of evidence-based medicine in European neurosurgery seems weak and this may be a threat to the quality of care.
Burgess, Alexandra M; Okamura, Kelsie H; Izmirian, Sonia C; Higa-McMillan, Charmaine K; Shimabukuro, Scott; Nakamura, Brad J
Despite the accumulated research support for the use of evidence-based practices (EBPs) with youth, these treatment approaches remain underutilized in community settings. Therapist attitudes towards EBPs play a pivotal role in their adoption and implementation of these practices. The present investigation employs joint exploratory factor analysis to evaluate the structure of two measures of therapist attitudes, the Evidence-Based Practices Attitudes Scale and the Modified Practice Attitude Scale. Results suggest three factors including (a) importance of clinical experience over EBPs, (b) clinician openness to change, and (c) problems with EBPs. Recommendations are provided for future evaluation of therapist attitudes and associated characteristics.
Visser, Claire; Hadley, Gina; Wee, Bee
There has been a paradigm shift in medicine away from tradition, anecdote and theoretical reasoning from the basic sciences towards evidence-based medicine (EBM). In palliative care however, statistically significant benefits may be marginal and may not be related to clinical meaningfulness. The typical treatment vs. placebo comparison necessitated by ‘gold standard’ randomised controlled trials (RCTs) is not necessarily applicable. The complex multimorbidity of end of life care involves cons...
Goodman, Kenneth W
... to their "clinical judgment." This tension- between eﬀorts to make medical practice more scientiﬁc and the suspicions of many clinicians- has caused one of the greatest practical and ethical challenges in the history of the health professions. This incisive book reviews the history and conceptual origins of evidence-based practice and discusses ...
Full Text Available Evidence-based dental practice requires the developmment and evaluation of protocols that en-sure translational effectiveness: that is, the efficient incorporation of the best available efficacy and effec-tiveness findings in specific clinical dentistry settings and environments. Evidence-based dentistry predi-cates the synthesis of research for obtaining the best available evidence in a validated, stringent, systematic and unbiased fashion. Research synthesis is now established as a science in its own right, precisely because it adheres to the scientific process that is driven by a research question and a hypothesis, follows through clearly defined methodology and design, yielding quantifiable data that are analyzed statistically, and from which stringent statistical inferences are drawn. The conclusions from the protocol of research synthesis define the best available evidence, which is used in the process of evidence-based revision of clinical practice guidelines. One important hurdle of the process of applying research synthesis in evidence-based dentistry lies in the fact that the statistical inferences produced by research must be translated into clinical relevance. Here, we present a model to circumvent this limitation by means of text analysis/mining protocols, which could lead the path toward a novel, valid and reliable ap-proach for the inferential analysis of clinical relevance.
Bauer, Michael G.; Peck, Chauney; Studebaker, Aubrey; Yu, Naomi
The purpose of this study was to examine the attitudes of practicing art therapists toward evidence-based practices (EBPs). EBPs, which have become an integral part of the managed care mental health system, refer to the use of empirically validated research to make clinical decisions that best meet the needs of each client. We used mixed methods…
Aarons, Gregory A; Cafri, Guy; Lugo, Lindsay; Sawitzky, Angelina
Mental health and social service provider attitudes toward evidence-based practice have been measured through the development and validation of the Evidence-Based Practice Attitude Scale (EBPAS; Aarons, Ment Health Serv Res 6(2):61-74, 2004). Scores on the EBPAS scales are related to provider demographic characteristics, organizational characteristics, and leadership. However, the EBPAS assesses only four domains of attitudes toward EBP. The current study expands and further identifies additional domains of attitudes towards evidence-based practice. A qualitative and quantitative mixed-methods approach was used to: (1) generate items from multiples sources (researcher, mental health program manager, clinician/therapist), (2) identify potential content domains, and (3) examine the preliminary domains and factor structure through exploratory factor analysis. Participants for item generation included the investigative team, a group of mental health program managers (n = 6), and a group of clinicians/therapists (n = 8). For quantitative analyses a sample of 422 mental health service providers from 65 outpatient programs in San Diego County completed a survey that included the new items. Eight new EBPAS factors comprised of 35 items were identified. Factor loadings were moderate to large and internal consistency reliabilities were fair to excellent. We found that the convergence of these factors with the four previously identified evidence-based practice attitude factors (15 items) was small to moderate suggesting that the newly identified factors represent distinct dimensions of mental health and social service provider attitudes toward adopting EBP. Combining the original 15 items with the 35 new items comprises the EBPAS 50-item version (EBPAS-50) that adds to our understanding of provider attitudes toward adopting EBPs. Directions for future research are discussed.
Anwer, Muhammad A; Al-Fahed, Ousama B; Arif, Samir I; Amer, Yasser S; Titi, Maher A; Al-Rukban, Mohammed O
Type 2 diabetes mellitus (T2DM) is a worldwide and national public health problem that has a great impact on the population in Saudi Arabia. High-quality clinical practice guidelines (CPGs) are cornerstones in improving the health care provided for patients with diabetes. This study evaluated the methodological rigour, transparency, and applicability of recently published CPGs. Our group conducted a systematic search for recently published CPGs for T2DM. The searching and screening for Source CPGs were guided by tools from the ADAPTE methods with specific inclusion/exclusion criteria. Five reviewers using the second version of the Appraisal of Guidelines for Research and Evaluation (AGREE II) Instrument independently assessed the quality of the retrieved Source CPGs. Domains of Scope and purpose and Clarity of presentation received the highest scores in all CPGs. Most of the assessed CPGs (86%) were considered with high overall quality and were recommended for use. Rigour of development and applicability domains were together highest in 3 CPGs (43%). The overall high quality of DM CPGs published in the last 3 years demonstrated the continuous development and improvement in CPG methodologies and standards. Health care professionals should consider the quality of any CPG for T2DM before deciding to use it in their daily clinical practice. Three CPGs have been identified, using the AGREE criteria, as high-quality and trustworthy. Ideally, the resources provided by the AGREE trust including the AGREE II Instrument should be used by a clinician to scan through the large number of published T2DM CPGs to identify the CPGs with high methodological quality and applicability. © 2017 John Wiley & Sons, Ltd.
Baker, Elise; McLeod, Sharynne
Purpose: This article provides a comprehensive narrative review of intervention studies for children with speech sound disorders (SSD). Its companion paper (Baker & McLeod, 2011) provides a tutorial and clinical example of how speech-language pathologists (SLPs) can engage in evidence-based practice (EBP) for this clinical population. Method:…
Zurdinova, A A
Improving quality of care in many countries is one of the priorities of health systems. At the same time one of the most important methods of improving quality of care is the widespread use of methods and principles of evidence-based medicine (EBM) . The implementation of EBM in public health practice provides for the optimization of quality of care in terms of safety, efficacy and cost, one way of which is the use of clinical guidelines. Clinical guidelines developed with the use of EBM, provide an opportunity to use the latest and accurate information to optimize or neutralize impact on physician decision-making of subjective factors such as intuition, expertise, opinion of respected colleagues, recommendations of popular manuals and handbooks, etc. To assess and analyze the developed clinical guidelines (CG) and protocols (CP) in the Kyrgyz Republic in the period from 2008 to 2014 and evaluate their implementation in practical healthcare. Retrospective analysis of the developed clinical guidelines and protocols according to the approved methodology, interviewing leaders, questioning doctors and patients for their implementation. All participants gave informed consent for voluntary participation in the study. Within the framework of the National Program "Manas Taalimi" "Strategy for development of evidence-based medicine in the Kyrgyz Republic for 2006-2010" (MOH Order №490 from 09.04.06) was developed and approved for use. Its main purpose was to create a sustainable system of development, deployment and monitoring of the CG and CP and further promotion of EBM into practical health care, education and science. As a result, a number of documents ("Expert Council for assessing the quality of clinical guidelines/protocols", "AGREE instrument to assess the methodological content of clinical guidelines" , "The methodology of development and adaptation of clinical guidelines based on evidence-based medicine") were approved by the Order of the Ministry of
Cook, Bryan G.; Cook, Lysandra
Evidence-based practice is among the most influential and compelling reforms in contemporary education. Despite their potential to improve the outcomes of students with disabilities, adoption and implementation of evidence-based reforms have been disappointing, with the gap between research and practice remaining wide. Practice-based evidence…
Mackey, April; Bassendowski, Sandra
Beginning with Florence Nightingale in the 1800s and evolving again within the medical community, evidence-based practice continues to advance along with the nursing discipline. Evidence-based practice is foundational to undergraduate and graduate nursing education and is a way for the nursing discipline to minimize the theory to practice gap. This article discusses the concept of evidence-based practice from a historical perspective as it relates to nursing in the educational and practice domains. The concept evidence-based practice is defined, and the similarities and differences to evidence-based medicine are discussed. It is crucial that registered nurses be proactive in their quest for research knowledge, so the gap between theory and practice continues to close. Utilizing nursing best practice guidelines, reviewing and implementing applicable research evidence, and taking advantage of technological advances are all ways in which nursing can move forward as a well-informed discipline. Copyright © 2016 Elsevier Inc. All rights reserved.
Song, Wenjia; Eaton, Linda H; Gordon, Debra B; Hoyle, Christine; Doorenbos, Ardith Z
It is important to ensure that cancer pain management is based on the best evidence. Nursing evidence-based pain management can be examined through an evaluation of pain documentation. The aim of this study was to modify and test an evaluation tool for nursing cancer pain documentation, and describe the frequency and quality of nursing pain documentation in one oncology unit via the electronic medical system. A descriptive cross-sectional design was used for this study at an oncology unit of an academic medical center in the Pacific Northwest. Medical records were examined for 37 adults hospitalized during April and May 2013. Nursing pain documentations (N = 230) were reviewed using an evaluation tool modified from the Cancer Pain Practice Index to consist of 13 evidence-based pain management indicators, including pain assessment, care plan, pharmacologic and nonpharmacologic interventions, monitoring and treatment of analgesic side effects, communication with physicians, and patient education. Individual nursing documentation was assigned a score ranging from 0 (worst possible) to 13 (best possible), to reflect the delivery of evidence-based pain management. The participating nurses documented 90% of the recommended evidence-based pain management indicators. Documentation was suboptimal for pain reassessment, pharmacologic interventions, and bowel regimen. The study results provide implications for enhancing electronic medical record design and highlight a need for future research to understand the reasons for suboptimal nursing documentation of cancer pain management. For the future use of the data evaluation tool, we recommend additional modifications according to study settings. Copyright © 2015 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.
El Sayed, Salah Mohamed; Baghdadi, Hussam; Zolaly, Mohammed; Almaramhy, Hamdi H; Ayat, Mongi; Donki, Jagadish G
3-Bromopyruvate (3BP) is a promising effective anticancer drug against many different tumors in children and adults. 3BP exhibited strong anticancer effects in both preclinical and human studies e.g. energy depletion, oxidative stress, anti-angiogenesis, anti-metastatic effects, targeting cancer stem cells and antagonizing the Warburg effect. There is no report about 3BP metabolism to guide researchers and oncologists to improve clinical practice and prevent drug resistance. In this article, we provide evidences that 3BP is metabolized through glutathione (GSH) conjugation as a novel report where 3BP was confirmed to be attached to GSH followed by permanent loss of pharmacological effects in a picture similar to cisplatin. Both cisplatin and 3BP are alkylating agents. Reported decrease in endogenous cellular GSH content upon 3BP treatment was confirmed to be due to the formation of 3BP-GSH complex i.e. GSH consumption for conjugation with 3BP. Cancer cells having high endogenous GSH exhibit resistance to 3BP while 3BP sensitive cells acquire resistance upon adding exogenous GSH. Being a thiol blocker, 3BP may attack thiol groups in tissues and serum proteins e.g. albumin and GSH. That may decrease 3BP-induced anticancer effects and the functions of those proteins. We proved here that 3BP metabolism is different from metabolism of hydroxypyruvate that results from metabolism of D-serine using D-amino acid oxidase. Clinically, 3BP administration should be monitored during albumin infusion and protein therapy where GSH should be added to emergency medications. GSH exerts many physiological effects and is safe for human administration both orally and intravenously. Based on that, reported GSH-induced inhibition of 3BP effects makes 3BP effects reversible, easily monitored and easily controlled. This confers a superiority of 3BP over many anticancer agents. Copyright © 2017 Elsevier Ltd. All rights reserved.
Bilder, Robert M.
Neuropsychology is poised for transformations of its concepts and methods, leveraging advances in neuroimaging, the human genome project, psychometric theory, and information technologies. It is argued that a paradigm shift towards evidence-based science and practice can be enabled by innovations, including: (1) formal definition of neuropsychological concepts and tasks in cognitive ontologies; (2) creation of collaborative neuropsychological knowledgebases; and (3) design of web-based assessment methods that permit free development, large-sample implementation, and dynamic refinement of neuropsychological tests and the constructs these aim to assess. This article considers these opportunities, highlights selected obstacles, and offers suggestions for stepwise progress towards these goals. PMID:21092355
Bishop, SueZanne Monique
Little research exists linking interview-appropriate attire to improved employment outcomes for women. Thus, it appears that the professional clothing bank has not been investigated as evidence-based practice. To provide preliminary evidence for clothing banks, in this article the author synthesizes findings from existing research on the provision of a professional clothing bank as a means for offering interview-appropriate attire to poor women in job readiness programming. For context, job readiness programs are explored and a case study of one program operating a professional clothing bank is presented. Finally, preliminary considerations for planning and implementing clothing banks based on this literature review are given.
The authoritarian standpoint in medicine has been under challenge by various groups and researchers since the 1980s. The challenges have been ethical, political and medical, with patient movements at the forefront. Over the past decade, however, a deep challenge has been posed by evidence-based...... medicine (EBM), which has challenged the entire strategy of medical treatment from the point of view of a self-critical, anti-authoritarian and hereby also (it has been claimed) a more democratic medical practice. Previously, the challenges arose out of the patient rights perspective. EBM, by contrast...
Formalising multidisciplinary peer review: developing a haematological malignancy-specific electronic proforma and standard operating procedure to facilitate procedural efficiency and evidence-based clinical practice.
Trotman, Judith; Trinh, Jimmy; Kwan, Yiu Lam; Estell, Jane A; Fletcher, Julie; Archer, Kate; Lee, Kenneth; Foo, Kerwin; Curnow, Jennifer; Bianchi, Alessandra; Wignall, Lynda; Verner, Emma; Gasiorowski, Robin; Siedlecka, Elizabeth; Cunningham, Ilona
Multidisciplinary team (MDT) meetings aimed at facilitating peer review have become standard practice in oncology. However, there is scant literature on the optimal structure and conduct of such meetings. To develop a process for formal peer review of patients with haematological malignancies and to audit any resulting changes made to the management recommendations of the treating physician. A standard operating procedure (SOP) for MDT meetings was developed essentially to integrate clinical peer review with weekly pathology and radiology meetings. The centrepiece is the electronic submission of a patient-specific proforma (Microsoft InfoPath) prior to the meeting. It serves as the template for presentation, discussion and recording of recommendations and conclusions. The final verified document is stored in the electronic patient record, and a copy is sent to the general practitioner. The proposed management plans were compared to the consensus recommendations of the meeting for the first 4 years since inception. Both SOP and proforma underwent continual improvements. These provided the framework for the conduct of a robust weekly MDT meeting for peer review of the management of patients with haematological malignancies. On 20% of occasions, patient management plans were altered to optimise patient care as a direct consequence on peer review at the MDT. Our streamlined process, in its ultimate format, has provided a mature and efficient forum for formal peer review in a genuine multidisciplinary environment. Both initial data and informal feedback support its ongoing activity as an integral component of delivering quality patient care. © 2016 Royal Australasian College of Physicians.
Full Text Available Family caregivers of the elderly are growing in number and the care they are called upon to deliver in industrialized countries is becoming increasingly demanding and complex. Empirical research shows that the caregiving situation can have a significant impact on the health of these caregivers often on account of stress, physical and psychological exhaustion, and a sense of being overwhelmed. In this context, the quality of life of these caregivers depends in large part on professional educational and support interventions. The purpose of this paper is to present three innovative psychoeducational intervention programs developed and empirically tested by the research team of the Université de Montréal’s (Québec, Canada Chair in Nursing Care for Seniors and Their Families over the past fifteen years. These interventions have been developed together with family caregivers experiencing different stressful situations across their care trajectory. The results of evaluative studies of these programs provide evidence to inform professional clinical practice. Future directions for caregiving research are discussed.
Mitchell, A. J.; Meader, N.; Davies, E.
Background: To examine the validity of screening and case-finding tools used in the identification of depression as defined by an ICD10/DSM-IV criterion standard. Methods: We identified 63 studies involving 19 tools (in 33 publications) designed to help clinicians identify depression in cancer...... as cases. The main cautions are the reliance on DSM-IV definitions of major depression, the large number of small studies and the paucity of data for many tools in specific settings. Conclusions: Although no single tool could be offered unqualified support, several tools are likely to improve upon...... unassisted clinical recognition. In clinical practice, all tools should form part of an integrated approach involving further follow-up, clinical assessment and evidence based therapy. (C) 2012 Elsevier B.V. All rights reserved....
Narra, Lekha; Sahama, Tony; Stapleton, Peta
Large volumes of heterogeneous health data silos pose a big challenge when exploring for information to allow for evidence based decision making and ensuring quality outcomes. In this paper, we present a proof of concept for adopting data warehousing technology to aggregate and analyse disparate health data in order to understand the impact various lifestyle factors on obesity. We present a practical model for data warehousing with detailed explanation which can be adopted similarly for studying various other health issues.
Evans, Cathy; Yeung, Euson; Markoulakis, Roula; Guilcher, Sara
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
Visser, Claire; Hadley, Gina; Wee, Bee
There has been a paradigm shift in medicine away from tradition, anecdote and theoretical reasoning from the basic sciences towards evidence-based medicine (EBM). In palliative care however, statistically significant benefits may be marginal and may not be related to clinical meaningfulness. The typical treatment vs. placebo comparison necessitated by 'gold standard' randomised controlled trials (RCTs) is not necessarily applicable. The complex multimorbidity of end of life care involves considerations of the patient's physical, psychological, social and spiritual needs. In addition, the field of palliative care covers a heterogeneous group of chronic and incurable diseases no longer limited to cancer. Adequate sample sizes can be difficult to achieve, reducing the power of studies and high attrition rates can result in inadequate follow up periods. This review uses examples of the management of cancer-related fatigue and death rattle (noisy breathing) to demonstrate the current state of EBM in palliative care. The future of EBM in palliative care needs to be as diverse as the patients who ultimately derive benefit. Non-RCT methodologies of equivalent quality, validity and size conducted by collaborative research networks using a 'mixed methods approach' are likely to pose the correct clinical questions and derive evidence-based yet clinically relevant outcomes.
In this paper the author gives his opinion about the problems of getting practices to change systems in order to institute clinical governance. There are many reasons why practices need to change and for this change to be monitored. This paper explains the need for change and the use of the evidence-based portfolio, which is produced by candidates for the Membership of the Faculty of General Dental Practice (UK) [MFGDP(UK)] examination. It can also be produced by individuals who are not taking the MFGDP(UK) examination in conjunction with the Faculty of General Dental Practice (UK)'s key skills programme. It provides a mechanism for demonstrating change and for assessing the quality of care provided by a general dental practice. The author concludes that the evidence-based portfolio will enable a practitioner to apply clinical governance in a practical way.
Aarons, Gregory A.; Glisson, Charles; Hoagwood, Kimberly; Kelleher, Kelly; Landsverk, John; Cafri, Guy
The Evidence-Based Practice Attitude Scale (EBPAS) assesses mental health and social service provider attitudes toward adopting evidence-based practices. Scores on the EBPAS derive from 4 subscales (i.e., Appeal, Requirements, Openness, and Divergence) as well as the total scale, and preliminary studies have linked EBPAS scores to clinic structure…
Rousseau, Denise M; Gunia, Brian C
Evidence-based practice (EBP) is an approach used in numerous professions that focuses attention on evidence quality in decision making and action. We review research on EBP implementation, identifying critical underlying psychological factors facilitating and impeding its use. In describing EBP and the forms of evidence it employs, we highlight the challenges individuals face in appraising evidence quality, particularly that of their personal experience. We next describe critical EBP competencies and the challenges underlying their acquisition: foundational competencies of critical thinking and domain knowledge, and functional competencies such as question formulation, evidence search and appraisal, and outcome evaluation. We then review research on EBP implementation across diverse fields from medicine to management and organize findings around three key contributors to EBP: practitioner ability, motivation, and opportunity to practice (AMO). Throughout, important links between psychology and EBP are highlighted, along with the contributions psychological research can make to further EBP development and implementation.
Simoff, Michael J; Lally, Brian; Slade, Mark G; Goldberg, Wendy G; Lee, Pyng; Michaud, Gaetane C; Wahidi, Momen M; Chawla, Mohit
Many patients with lung cancer will develop symptoms related to their disease process or the treatment they are receiving. These symptoms can be as debilitating as the disease progression itself. To many physicians these problems can be the most difficult to manage. A detailed review of the literature using strict methodologic review of article quality was used in the development of this article. MEDLINE literature reviews, in addition to Cochrane reviews and other databases, were used for this review. The resulting article lists were then reviewed by experts in each area for quality and finally interpreted for content. We have developed recommendations for the management of many of the symptom complexes that patients with lung cancer may experience: pain, dyspnea, airway obstruction, cough, bone metastasis, brain metastasis, spinal cord metastasis, superior vena cava syndrome, hemoptysis, tracheoesophageal fistula, pleural effusions, venous thromboembolic disease, depression, fatigue, anorexia, and insomnia. Some areas, such as dyspnea, are covered in considerable detail in previously created high-quality evidence-based guidelines and are identified as excellent sources of reference. The goal of this guideline is to provide the reader recommendations based on evidence supported by scientific study. Improved understanding and recognition of cancer-related symptoms can improve management strategies, patient compliance, and quality of life for all patients with lung cancer.
Hall, Courtney D; Herdman, Susan J; Whitney, Susan L; Cass, Stephen P; Clendaniel, Richard A; Fife, Terry D; Furman, Joseph M; Getchius, Thomas S D; Goebel, Joel A; Shepard, Neil T; Woodhouse, Sheelah N
Uncompensated vestibular hypofunction results in postural instability, visual blurring with head movement, and subjective complaints of dizziness and/or imbalance. We sought to answer the question, "Is vestibular exercise effective at enhancing recovery of function in people with peripheral (unilateral or bilateral) vestibular hypofunction?" A systematic review of the literature was performed in 5 databases published after 1985 and 5 additional sources for relevant publications were searched. Article types included meta-analyses, systematic reviews, randomized controlled trials, cohort studies, case control series, and case series for human subjects, published in English. One hundred thirty-five articles were identified as relevant to this clinical practice guideline. Based on strong evidence and a preponderance of benefit over harm, clinicians should offer vestibular rehabilitation to persons with unilateral and bilateral vestibular hypofunction with impairments and functional limitations related to the vestibular deficit. Based on strong evidence and a preponderance of harm over benefit, clinicians should not include voluntary saccadic or smooth-pursuit eye movements in isolation (ie, without head movement) as specific exercises for gaze stability. Based on moderate evidence, clinicians may offer specific exercise techniques to target identified impairments or functional limitations. Based on moderate evidence and in consideration of patient preference, clinicians may provide supervised vestibular rehabilitation. Based on expert opinion extrapolated from the evidence, clinicians may prescribe a minimum of 3 times per day for the performance of gaze stability exercises as 1 component of a home exercise program. Based on expert opinion extrapolated from the evidence (range of supervised visits: 2-38 weeks, mean = 10 weeks), clinicians may consider providing adequate supervised vestibular rehabilitation sessions for the patient to understand the goals of the program
Park, Alayna L.; Chorpita, Bruce F.; Regan, Jennifer; Weisz, John R
This study examined patterns of evidence-based treatment (EBT) implementation within community settings by evaluating integrity along separate dimensions of practice content (PC; a session included the prescribed procedure) and practice sequencing (a session occurred in the prescribed sequence) within a recent randomized effectiveness trial. We measured whether sessions showed integrity to PC and to flexible or linear practice sequences. Findings revealed that providers tended to incorporate ...
Diedrick, Lee A; Schaffer, Marjorie A; Sandau, Kristin E
The purpose of this study was to determine if a consistent communication strategy for implementation of evidence-based practice (EBP), developed with input from staff nurses, improved staff nurse satisfaction with communication of practice changes. Integration of EBP knowledge into clinical practice supports optimal nursing care. Awareness of a practice change and the ability to reference the information may be problematic. A quasi-experimental single group before-after design was used to survey all RNs of a level III neonatal ICU for satisfaction before and after implementation of the EBP communication strategy. Registered nurse satisfaction improved regarding the amount of communication (P strategy can improve nurse satisfaction with communication of EBP changes. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Avsar, Ummu Zeynep; Avsar, Umit; Cansever, Zeliha; Acemoglu, Hamit; Cayir, Yasemin; Khan, Abdul Sattar
To assess the level of understanding related to the significance of evidence-based medicine among physicians. The cross-sectional study was conducted between March and October 2012 using an online questionnaire that was sent out to physicians and academics working as faculty at training hospitals across Turkey. The questionnaire consisted of questions about the knowledge, attitude and behaviour towards evidence-based medicine. Seven of the questions pertained to the learning of evidence-based medicine, six were about teaching evidence-based medicine, and six were about its practice. SPSS 20 was used for statistical analyses. The questionnaire was returned duly filled by 79 physicians. Of them, 41 (51.9%) were males; and 57 (72.2%) were part of the faculty. Only 1(1.2%) participant had attended a course about evidence-based medicine during undergraduate education, while 19 (24.05)had attended one after graduation. Besides, 26 (32.9%) academics were teaching some concepts of evidence-based medicine, and 21 (26.6%) were giving some information about clinical guidelines. The study found that levels of learning and teaching of evidence-based medicine among physicians were inadequate. They should be emphasised at both pre- and post-graduate tiers.
Sandrey, Michelle A.; Bulger, Sean M.
Objective: The growing importance of evidence based practice in athletic training is necessitating academics and clinicians to be able to make judgments about the quality or lack of the body of research evidence and peer-reviewed standards pertaining to clinical questions. To assist in the judgment process, consensus methods, namely brainstorming,…
Keus, S.H.; Bloem, B.R.; Hendriks, E.J.M.; Bredero-Cohen, A.B.; Munneke, M.
Physical therapy is often prescribed in Parkinson's disease. To facilitate the uniformity and efficacy of this intervention, we analyzed current evidence and developed practice recommendations. We carried out an evidence-based literature review. The results were supplemented with clinical expertise
Medical and health sciences libraries have incorporated the elements of evidence-based practice (EBP) into their reference services, instruction, and online resource development for years. While EBP focuses on the use of medical and health sciences literature in the clinical environment (i.e., making decisions about how to treat a particular…
Stapleton, Drue; Hawkins, Andrew
Objective: The trend of utilizing evidence-based practice (EBP) in athletic training is now requiring clinicians, researchers, educators, and students to be equipped to both engage in and make judgments about research evidence. Single-case design (SCD) research may provide an alternative approach to develop such skills and inform clinical and…
For questions related to diagnosis, prognosis or causation, other study designs such as longitudinal studies, cohort studies or case-control studies are more appropriate. The present article discusses the levels and quality of evidence, and basic concepts of clinical research design in evidence-based dental practice based ...
Zaboski, Brian A.; Schrack, Anna P.; Joyce-Beaulieu, Diana; MacInnes, Jann W.
The proliferation of unsubstantiated or discredited interventions underscores the importance of the evidence-based practice (EBP) movement in school psychology. Although researchers have conducted several surveys on discredited interventions in counseling and clinical psychology, no studies have investigated the use of these treatments in school…
Rosenberg, Stephen A; Baschnagel, Andrew M; Bagley, Stephen J; Housri, Nadine
The landscape of non-small cell lung cancer (NSCLC) treatment has rapidly evolved over the past decade. This is exemplified by the use of molecular targeted agents, immunotherapies, and newer technologies such as stereotactic body radiotherapy (SBRT). As the translation of preclinical discoveries into clinical practice continues, the effective dissemination and implementation of evidence-based treatment of NSCLC will remain a foremost challenge for oncologists. To further extend evidence-based medicine into the community setting, community oncologists are being engaged on multiple fronts including leadership and participation in national clinical trials and utilization of internet-based resources.
Coleman, Brandon G; Johnson, Thomas M; Erley, Kenneth J; Topolski, Richard; Rethman, Michael; Lancaster, Douglas D
In recent years, evidence-based dentistry has become the ideal for research, academia, and clinical practice. However, barriers to implementation are many, including the complexity of interpreting conflicting evidence as well as difficulties in accessing it. Furthermore, many proponents of evidence-based care seem to assume that good evidence consistently exists and that clinicians can and will objectively evaluate data so as to apply the best evidence to individual patients' needs. The authors argue that these shortcomings may mislead many clinicians and that students should be adequately prepared to cope with some of the more complex issues surrounding evidence-based practice. Cognitive biases and heuristics shape every aspect of our lives, including our professional behavior. This article reviews literature from medicine, psychology, and behavioral economics to explore the barriers to implementing evidence-based dentistry. Internal factors include biases that affect clinical decision making: hindsight bias, optimism bias, survivor bias, and blind-spot bias. External factors include publication bias, corporate bias, and lack of transparency that may skew the available evidence in the peer-reviewed literature. Raising awareness of how these biases exert subtle influence on decision making and patient care can lead to a more nuanced discussion of addressing and overcoming barriers to evidence-based practice.
Raditic, Donna M; Bartges, Joseph W
Integrative medicine is the combined use of complementary and alternative medicine with conventional or traditional Western medicine systems. The demand for integrative veterinary medicine is growing, but evidence-based research on its efficacy is limited. In veterinary clinical oncology, such research could be translated to human medicine, because veterinary patients with spontaneous tumors are valuable translational models for human cancers. An overview of specific herbs, botanics, dietary supplements, and acupuncture evaluated in dogs, in vitro canine cells, and other relevant species both in vivo and in vitro is presented for their potential use as integrative therapies in veterinary clinical oncology. Published by Elsevier Inc.
Tod, Angela M; Bond, Beverly; Leonard, Niamh; Gilsenan, Irene J; Palfreyman, Simon
To examine the potential role of the Clinical Librarian in facilitating evidence-based practice of nurses in acute hospital settings and develop a model for the role. There is a growing policy and professional expectation that nurses will seek out and apply evidence in their clinical practice. Studies have demonstrated that nurses experience barriers in working with an evidence-based approach. The role of Clinical Librarian has been used in other countries and within medicine to overcome some of the barriers to evidence-based practice. There are limitations in the previous work in terms of rigour of evaluation, scope of the Clinical Librarian role and application to nursing in a UK setting. A qualitative consultation of 72 nurses in acute care settings. Six consultation group interviews of between 4-19 participants. Written records were recorded by the scribe. Content analysis was undertaken to identify the range and frequency of comments. Clinical questions currently go unanswered because of barriers of time, skills deficits and access to resources. Literature searching, skills training and evidence dissemination were the main areas of work the staff requested that a Clinical Librarian should undertake. It was anticipated that the Clinical Librarian could interact and work productively with nursing staff with a limited but regular presence on the ward. Interim communication could be via e-mail, phone and written suggestions and requests for work. It was seen to be vital that the Clinical Librarian worked in partnership with staff to build evidence-based practice capacity and ensure clinical relevance of the work. This study has generated the first model for the Clinical Librarian role with an emphasis on nursing. It is derived from the views of clinical nurses. Recommendations are made for the implementation and evaluation of such a role. The Clinical Librarian could be an invaluable support to promoting evidence-based nursing.
Aio’s huisartsgeneeskunde hebben adequate kennis ten aanzien van evidence-based medicine (geneeskunde op basis van bewijs). In de huisartspraktijk is evidence-based gedrag vaak niet direct zichtbaar, maar artsen kunnen wel aangeven op welk aspect van evidence-based medicine de voorgeschreven
Rosen, Alan; O'Halloran, Paul
.... This paper explores how a recovery paradigm offers opportunities to better understand how efforts within the personal, clinical, and psychosocial disability domains of well-being relate and need...
Monroe, Marcus M; Gross, Neil D
This article provides a critical review of the evidence surrounding the management of the clinical node-negative patient with early-stage oral cavity squamous cell carcinoma. Published by Elsevier Inc.
Full Text Available Background: The purpose of this discussion is to explore the theory, evidence base, and practice of Qigong for individuals with cancer. Questions addressed are: What is qigong? How does it work? What evidence exists supporting its practice in integrative oncology? What barriers to wide-spread programming access exist? Methods: Sources for this discussion include a review of scholarly texts, the Internet, PubMed, field observations, and expert opinion. Results: Qigong is a gentle, mind/body exercise integral within Chinese medicine. Theoretical foundations include Chinese medicine energy theory, psychoneuroimmunology, the relaxation response, the meditation effect, and epigenetics. Research supports positive effects on quality of life (QOL, fatigue, immune function and cortisol levels, and cognition for individuals with cancer. There is indirect, scientific evidence suggesting that qigong practice may positively influence cancer prevention and survival. No one Qigong exercise regimen has been established as superior. Effective protocols do have common elements: slow mindful exercise, easy to learn, breath regulation, meditation, emphasis on relaxation, and energy cultivation including mental intent and self-massage. Conclusions: Regular practice of Qigong exercise therapy has the potential to improve cancer-related QOL and is indirectly linked to cancer prevention and survival. Wide-spread access to quality Qigong in cancer care programming may be challenged by the availability of existing programming and work force capacity.
Lawson, Jennifer; Berrick, Jill Duerr
In this article the authors examine the evidentiary status of the Court Appointed Special Advocates (CASA) program through a review of current research findings and a critical analysis of the study methodologies used to produce those findings. Due to the equivocal research findings and widespread methodological weaknesses (most notably selection bias) in the literature base, it is determined that there is not currently enough evidence to establish CASA as an evidence-based practice. In spite of the challenges to the feasibility of such research, a future research agenda is suggested that calls for the execution of large randomized controlled trials in order to produce findings that will inform a deeper understanding of CASA effectiveness in improving child outcomes.
Full Text Available Background: The application of the concept of Evidenced Based Practice into clinical decision-making and practicehas outstanding benefits both to clinicians and the patient. However, the utilization of this concept has not been copiously utilized in most health facilities by the physiotherapists in Kenya. Therefore, the objectives for this study was to determine the level of awareness of evidence based practice among Physiotherapist, establish the availability of resource for Evidence Based Practice and to assess the challenges encountered by physiotherapist in engaging in evidence based practice at Moi Teaching and Referral Hospital. Methods: All physiotherapists working in Moi Teaching and Referral Hospital (42 took part in a cross-sectional descriptive survey. Questionnaires were used for data collection and analyzed by SPSS version 22. Results: there was high level of awareness on Evidence Based Practice (95 % and confidence in EBP (72.5 %. However, lack of information resources, poor skills to implement EBP, poor organization support 90%, insufficient authority to induct change in the practice setting 85%, inadequate facilities 74% and lack of time were identified as the major challenges in implementation of EBP Conclusion: Strategies should be developed to provide PTs with EBP resources, such as access to databases or links to guidelines, and continuous education regarding specific topics. Professional organizations and Associations should aim at changing the current practice to ensure full utilization of EBP.
Thiel, Linda; Ghosh, Yashowanto
As health care systems worldwide move toward instituting evidence-based practice (EBP), its implementation can be challenging. Conducting a baseline assessment to determine nurses' readiness for EBP presents opportunities to plan strategies before implementation. Although a growing body of research literature is focused on implementing EBP, little attention has been paid to assessing nurses' readiness for EBP. The purpose of this study was to assess registered nurses' readiness for EBP in a moderate-sized acute care hospital in the Midwestern United States before implementation of a hospital-wide nursing EBP initiative. A descriptive cross-sectional survey design was used; 121 registered nurses completed the survey. The participants (n= 121) completed the 64-item Nurses' Readiness for Evidence-Based Practice Survey that allowed measurement of information needs, knowledge and skills, culture, and attitudes. Data were analyzed using descriptive statistics and a post hoc analysis. The majority (72.5%) of respondents indicated that when they needed information, they consulted colleagues and peers rather than using journals and books; 24% of nurses surveyed used the health database, Cumulative Index to Nursing & Allied Health Literature (CINAHL). The respondents perceived their EBP knowledge level as moderate. Cultural EBP scores were moderate, with unit scores being higher than organizational scores. The nurses' attitudes toward EBP were positive. The post hoc analysis showed many significant correlations. Nurses have access to technological resources and perceive that they have the ability to engage in basic information gathering but not in higher level evidence gathering. The elements important to EBP such as a workplace culture and positive attitudes are present and can be built upon. A "site-specific" baseline assessment provides direction in planning EBP initiatives. The Nurses' Readiness for EBP Survey is a streamlined tool with established reliability and
Nana-Sinkam, Serge Patrick; Powell, Charles A
Based on recent bench and clinical research, the treatment of lung cancer has been refined, with treatments allocated according to histology and specific molecular features. For example, targeting mutations such as epidermal growth factor receptor (EGFR) with tyrosine kinase inhibitors has been particularly successful as a treatment modality, demonstrating response rates in selected patients with adenocarcinoma tumors harboring EGFR mutations that are significantly higher than those for conventional chemotherapy. However, the development of new targeted therapies is, in part, highly dependent on an improved understanding of the molecular underpinnings of tumor initiation and progression, knowledge of the role of molecular aberrations in disease progression, and the development of highly reproducible platforms for high-throughput biomarker discovery and testing. In this article, we review clinically relevant research directed toward understanding the biology of lung cancer. The clinical purposes of this research are (1) to identify susceptibility variants and field molecular alterations that will promote the early detection of tumors and (2) to identify tumor molecular alterations that serve as therapeutic targets, prognostic biomarkers, or predictors of tumor response. We focus on research developments in the understanding of lung cancer somatic DNA mutations, chromosomal aberrations, epigenetics, and the tumor microenvironment, and how they can advance diagnostics and therapeutics.
Crumley, Ellen; Koufogiannakis, Denise
Evidence-based librarianship (EBL) is a relatively new concept for librarians. This paper lays out a practical framework for the implementation of EBL. A new way of thinking about research in librarianship is introduced using the well-built question process and the assignment of librarian research questions to one of six domains specific to librarianship. As a profession, librarianship tends to reflect more qualitative, social sciences/humanities in its research methods and study types which tend to be less rigorous and more prone to bias. Randomised controlled trials (RCT) do not have to be placed at the top of an evidence 'hierarchy' for librarianship. Instead, a more encompassing model reflecting librarianship as a whole and the kind of research likely to be done by librarians is proposed. 'Evidence' from a number of disciplines including health sciences, business and education can be utilized by librarians and applied to their practice. However, access to and availability of librarianship literature needs to be further studied. While using other disciplines (e.g. EBHC) as a model for EBL has been explored in the literature, the authors develop models unique to librarianship. While research has always been a minor focus in the profession, moving research into practice is becoming more important and librarians need to consider the issues surrounding research in order to move EBL forward.
Wu, Shinyi; Duan, Naihua; Wisdom, Jennifer P; Kravitz, Richard L; Owen, Richard R; Sullivan, J Greer; Wu, Albert W; Di Capua, Paul; Hoagwood, Kimberly Eaton
Integrating two distinct and complementary paradigms, science and engineering, may produce more effective outcomes for the implementation of evidence-based practices in health care settings. Science formalizes and tests innovations, whereas engineering customizes and optimizes how the innovation is applied tailoring to accommodate local conditions. Together they may accelerate the creation of an evidence-based healthcare system that works effectively in specific health care settings. We give examples of applying engineering methods for better quality, more efficient, and safer implementation of clinical practices, medical devices, and health services systems. A specific example was applying systems engineering design that orchestrated people, process, data, decision-making, and communication through a technology application to implement evidence-based depression care among low-income patients with diabetes. We recommend that leading journals recognize the fundamental role of engineering in implementation research, to improve understanding of design elements that create a better fit between program elements and local context.
N. P. Kutishenko
Full Text Available Data of multicenter clinical trials on assessment of angiotensin converting enzyme inhibitor, lisinopril efficacy in therapy of patients with arterial hypertension, heart failure, myocardial infarction complicated with left ventricle dysfunction and diabetes (GISSI-3, ATLAS, ALLHAT, EUCLID are presented in the review. The results of these trials establish more active usage of lisinopril in clinical practice.
Render, Marta L; Brungs, Suzanne; Kotagal, Uma; Nicholson, Mary; Burns, Patricia; Ellis, Deborah; Clifton, Marla; Fardo, Rosie; Scott, Mark; Hirschhorn, Larry
In 2003, through the Greater Cincinnati Health Council nine health care systems agreed to participate and fund 50% of a two-year project to reduce hospital-acquired infections among patients in intensive care units (ICU) and following surgery (SIP). Hospitals were randomized to either the CR-BSI or SIP project in the first year, adding the alternative project in year 2. Project leaders, often the infection control professionals, implemented evidence-based practices to reduce catheter-related blood stream infections (CR-BSIs; maximal sterile barriers, chlorhexidine) at their hospitals using a collaborative approach. Team leaders entered process information in a secure deidentifled Web-based database. Of the four initial sites randomized to CR-BSI reduction, all reduced central line infections by 50% (CR-BSI, 1.7 to 0.4/1000 line days, p leadership and development of a local community of practice, facilitated cooperation of physicians, problem solving, and success. Use of forcing functions (removal of betadine in kits, creation of an accessory pack and a checklist for line insertion) improved reliability. The appropriate floor for central line infections in ICUs is < 1 infection /1,000 line days.
Hoagwood, Kimberly; Johnson, Jacqueline
Describes current perspectives on evidence-based practices in psychology, medicine, and education; discusses challenges in the implementation and dissemination of research-based findings into schools; describes differences between current models of organizational behavior as studied in children's mental health services and in education; and…
Malik, Gulzar; McKenna, Lisa; Griffiths, Debra
This paper is drawn from a grounded theory study that aimed to investigate processes undertaken by academics when integrating evidence-based practice into undergraduate curricula. This paper focuses on how nurse academics facilitated students to apply evidence-based practice in theory and practice. Facilitating undergraduate nursing students to develop skills within an evidence-based practice framework is vital to achieving evidence-based care. Studies on evidence-based practice conducted globally suggests that there is a need to investigate approaches used by nurse academics in facilitating students' understanding and use of evidence-based practice during their nurse education. Employing constructivist grounded theory approach, 23 nurse academics across Australian universities were interviewed and nine observed during their teaching. Some study participants shared their unit guides to enrich analysis. Data analysis was performed by following Charmaz's approach of coding procedures; as a result, four categories were constructed. This paper focuses on the category conceptualised as Envisaging the use of evidence-based practice. Findings revealed that most academics-assisted students to use evidence in academic-related activities. Recognising the importance of evidence-based practice in practice, some also expected students to apply evidence-based practice during clinical experiences. However, the level of students' appreciation for evidence-based practice during clinical experiences was unknown to participants and was influenced by practice-related barriers. Acknowledging these challenges, academics were engaged in dialogue with students and suggested the need for academia-practice collaboration in combating the cited barriers. Ensuring academics are supported to emphasise clinical application of evidence-based practice requires strategies at school and practice levels. Faculty development, engagement of clinical nurses with evidence-based practice, supportive
Sánchez-García, Inmaculada; López-Medina, Isabel M; Pancorbo-Hidalgo, Pedro L
To examine the obstacles perceived by nurses to implement an evidence-based clinical practice. A qualitative study through semi-structured interviews conducted in 2010-2011 including 11 nurses purposively selected from public hospitals and community centres in Jaén and Córdoba (Spain). A content analysis was performed, using Miles and Huberman as a reference and comprising the following steps: data reduction, data presentation, and data conclusion/verification. Data saturation was reached in these categories (obstacles). The obstacles perceived by nurses to introduce an evidence-based clinical practice (EBCP) were grouped into 3 major categories: obstacles related with professionals (routine-based practice, unwilling and stagnant attitudes, and lack of training in EBCP), obstacles related to the social context (reluctance from other professionals and from patients or families), and obstacles related to the organization (obsolete cultures that do not promote innovation in nursing care). This study highlights the persistence of various factors that hinder the use of research findings in clinical practice. The results underline the need to change the culture of healthcare organizations, to motivate professionals, and to break some of the resistance attitudes that hinder the implementation of evidence-based practice. Copyright © 2012 Elsevier España, S.L. All rights reserved.
Schmidt, Nola A; Brown, Janet M
The purpose of this article is to describe the innovation-decision process teaching strategy (I-DPTS) based on the model of diffusion of innovations [Rogers, E. M. (2003). Diffusion of innovations (5th ed.). New York: Free Press]. A goal of baccalaureate nursing education is to develop competencies required for evidence-based practice. Such practice merges clinician expertise, patient preferences, and critical evaluation of the literature to improve patient outcomes and reduce health care costs [Melnyk, B. M. (2005). A primer on evidence-based practice. Paper presented at the Purdue School of Nursing Seventh Annual Helen R. Johnson Leadership Conference, West Lafayette, IN]. Several strategies to promote evidence-based practice have appeared in the literature. However, when they are examined in light of the innovation-decision process (Rogers, 2003), they do not address all the essential steps for adoption to occur. The I-DPTS allows students to achieve competencies necessary to overcome barriers associated with implementing best practices. This strategy was successfully implemented in a senior-level introductory nursing research class. Community representatives identified practice issues that could be addressed by student groups. After conducting a search of the literature, students analyzed the evidence, determined best practice based on the evidence, and developed a policy for implementation in clinical settings. At course end, representatives were invited to attend oral and poster presentations. Use of the I-DPTS better prepares students to implement best practice as they embark on their professional careers.
van Twillert, Sacha; Geertzen, Jan; Hemminga, Titia; Postema, Klaas; Lettinga, Ant
A divide is experienced between producers and users of evidence in prosthetic rehabilitation. To discuss the complexity inherent in establishing evidence-based practice in a prosthetic rehabilitation team illustrated by the case of prosthetic prescription for elderly dysvascular transfemoral amputee patients. A qualitative research design was used, in which data from multiple sources was triangulated to extract themes for discussion. This discussion paper draws on empirical material gathered by individual and focus-group interviews with members of a prosthetic rehabilitation team, information on technological advancements presented on websites of orthopaedic industry, guidelines and literature study. A prosthetic rehabilitation team needs to deal with lack of evidence, contradictory results, various classification systems, diverging interests of different stakeholders and many modifying factors, and all of this in a continuous technological changing environment. Integrating research designs with different strengths but not sharing the same biases may help researchers to deal with the multimorbidity and multifaceted disability of the target group. Articulating clinical knowledge, patients' needs and values in a systematic way provides depth, detail, nuance and context for evidence-based practice issues in prosthetic rehabilitation. Reconsidering the relationship between evidence, technology and rehabilitation practice is an imperative shared enterprise for clinicians and researchers. Scientific, clinical and patient-related knowledge are seen as important knowledge practices that should inform and strengthen each other. This discussion paper puts the academic clinical debate on evidence-based practice in prosthetics and orthotics in another light. By demonstrating the complexities surrounding evidence-based practice, it is argued and illustrated how both researchers and clinicians can contribute to optimal patient care in which evidence, technology and
Reichenpfader, Ursula; Carlfjord, Siw; Nilsen, Per
This study aims to systematically review published empirical research on leadership as a determinant for the implementation of evidence-based practice (EBP) and to investigate leadership conceptualization and operationalization in this field. A systematic review with narrative synthesis was conducted. Relevant electronic bibliographic databases and reference lists of pertinent review articles were searched. To be included, a study had to involve empirical research and refer to both leadership and EBP in health care. Study quality was assessed with a structured instrument based on study design. A total of 17 studies were included. Leadership was mostly viewed as a modifier for implementation success, acting through leadership support. Yet, there was definitional imprecision as well as conceptual inconsistency, and studies seemed to inadequately address situational and contextual factors. Although referring to an organizational factor, the concept was mostly analysed at the individual or group level. The concept of leadership in implementation science seems to be not fully developed. It is unclear whether attempts to tap the concept of leadership in available instruments truly capture and measure the full range of the diverse leadership elements at various levels. Research in implementation science would benefit from a better integration of research findings from other disciplinary fields. Once a more mature concept has been established, researchers in implementation science could proceed to further elaborate operationalization and measurement. Although the relevance of leadership in implementation science has been acknowledged, the conceptual base of leadership in this field has received only limited attention.
Evidence-based practice (EBP) first appeared on the healthcare horizon just over a decade ago. In 2003 its presence has intensified and extended beyond its initial relation to medicine embracing as it does now, nursing and the allied health disciplines. In this paper, I contend that its appearance and subsequent growth and development are the effects of potent "regimes of truth", four of which bear the names: positivism, empiricism, pragmatism and economic rationalism. My aim is to show how EBP generates the controversy it does because its nature and methods are inextricably interwoven with the way it has become politicised and professionalised. This exegesis is an attempt to outline how the combined effects of the four forms of rationality mentioned above allow for both the methods and objectives of EBP to be constructed as they are, while at the same moment producing the particular effects of knowledge and power in terms of who sells and who buys the idea of EBP in the culture of contemporary healthcare.
Doran, Diane M; Haynes, R Brian; Kushniruk, André; Straus, Sharon; Grimshaw, Jeremy; Hall, Linda McGillis; Dubrowski, Adam; Di Pietro, Tammie; Newman, Kristine; Almost, Joan; Nguyen, Ha; Carryer, Jennifer; Jedras, Dawn
To evaluate the usability of mobile information terminals, such as personal digital assistants (PDAs) or Tablet personal computers, to improve access to information resources for nurses and to explore the relationship between PDA or Tablet-supported information resources and outcomes. The authors evaluated an initiative of the Nursing Secretariat, Ontario Ministry of Health and Long-Term Care, which provided nurses with PDAs and Tablet PCs, to enable Internet access to information resources. Nurses had access to drug and medical reference information, best practice guidelines (BPGs), and to abstracts of recent research studies. The authors took place over a 12-month period. Diffusion of Innovation theory and the Promoting Action on Research Implementation in Health Services (PARIHS) model guided the selection of variables for study. A longitudinal design involving questionnaires was used to evaluate the impact of the mobile technologies on barriers to research utilization, perceived quality of care, and on nurses' job satisfaction. The setting was 29 acute care, long-term care, home care, and correctional organizations in Ontario, Canada. The sample consisted of 488 frontline-nurses. Nurses most frequently consulted drug and medical reference information, Google, and Nursing PLUS. Overall, nurses were most satisfied with the Registered Nurses Association of Ontario (RNAO) BPGs and rated the RNAO BPGs as the easiest resource to use. Among the PDA and Tablet users, there was a significant improvement in research awareness/values, and in communication of research. There was also, for the PDA users only, a significant improvement over time in perceived quality of care and job satisfaction, but primarily in long-term care settings. It is feasible to provide nurses with access to evidence-based practice resources via mobile information technologies to reduce the barriers to research utilization.
Can psychological models bridge the gap between clinical guidelines and clinicians' behaviour? A randomised controlled trial of an intervention to influence dentists' intention to implement evidence-based practice.
Bonetti, D; Johnston, M; Pitts, N B; Deery, C; Ricketts, I; Bahrami, M; Ramsay, C; Johnston, J
The lag between publication of evidence for clinical practice and implementation by clinicians may be decades. Research using psychological models demonstrates that changing intention is very important in changing behaviour. This study examined an intervention (rehearsing alternative actions) to change dentists' intention to implement evidence-based practice (EBP) for third molar (TM) management. Randomised controlled trial / postal. Primary care. Dentists were randomly selected from the Scottish Dental Practice Board Register, then randomly allocated to intervention or control groups, and sent a questionnaire. The intervention group listed management alternatives to TM extraction prior to their TM extraction intention, and the control group did not. Based on psychological models for reducing a behaviour's frequency (EBP is weighted against TM extraction), prior listing of alternatives should decrease extraction intention. Intention to extract TMs. A total of 99 dentists - 70 Males, 29 Females; mean age = 41.42 years (SD = 8.62) participated in the study. The intervention significantly influenced intention to extract TMs, as desired. Despite similar background and knowledge of management alternatives, participants in the intervention group had significantly lower intention to extract: control group mean (SD) = 0.39 (1.99); intervention group mean (SD) = -0.78 (1.89); mean difference (SE) = 1.17 (0.42); 95% confidence interval for the difference = 0.34 to 1.99. Results suggest this intervention, which successfully influenced a proximal predictor of behaviour pertinent to dental EBP, may result in improved EBP in a service-level trial. Basing implementation interventions and trial methodology on psychological models may effectively bridge the gap between clinical guidelines and practice.
Gardner, Kevin; Kanaskie, Mary Louise; Knehans, Amy C; Salisbury, Sarah; Doheny, Kim K; Schirm, Victoria
The outcomes based emphasis in nursing and health care delivery requires identification of best available evidence in order to produce quality, safe, and effective patient care. Finding, critiquing, and ultimately implementing the best available evidence for practice is a formidable task for many clinical nurses. Development and implementation of a nursing journal club (NJC) became one organization's successful attempt to help clinical nurses better understand and use best available evidence in actual practice. The process and structure for the NJC evolved from an additional activity scheduled outside of work to a fully established endeavor of Nursing Research and Evidence Based Practice Council (NR&EBP). The Nursing Professional Practice Model was foundational to establishing the NJC as a formal component within the NR&EBP Council shared governance structure. Efforts to embed the NJC included taking advantage of resources available at an academic medical center and incorporating them into the council structure. Successful outcomes of the NJC include a quarterly schedule, with topics selected in advance that are based on nursing department as well as organizational driven goals and initiatives. The structure and process in place has eliminated frequently mentioned deterrents to evidence based practice such as not enough time, lack of knowledge, or no immediate application to practice. Incorporating the NJC as a component of NR&EBP Council has provided clinical nurses time away from clinical care that supports scholarship for nursing practice. Committed leadership and garnering of available resources have been key factors for success. Copyright © 2016 Elsevier Inc. All rights reserved.
Friesen-Storms, Jolanda H H M; Bours, Gerrie J J W; van der Weijden, Trudy; Beurskens, Anna J H M
In the decision-making environment of evidence-based practice, the following three sources of information must be integrated: research evidence of the intervention, clinical expertise, and the patient's values. In reality, evidence-based practice usually focuses on research evidence (which may be translated into clinical practice guidelines) and clinical expertise without considering the individual patient's values. The shared decision-making model seems to be helpful in the integration of the individual patient's values in evidence-based practice. We aim to discuss the relevance of shared decision making in chronic care and to suggest how it can be integrated with evidence-based practice in nursing. We start by describing the following three possible approaches to guide the decision-making process: the paternalistic approach, the informed approach, and the shared decision-making approach. Implementation of shared decision making has gained considerable interest in cases lacking a strong best-treatment recommendation, and when the available treatment options are equivalent to some extent. We discuss that in chronic care it is important to always invite the patient to participate in the decision-making process. We delineate the following six attributes of health care interventions in chronic care that influence the degree of shared decision making: the level of research evidence, the number of available intervention options, the burden of side effects, the impact on lifestyle, the patient group values, and the impact on resources. Furthermore, the patient's willingness to participate in shared decision making, the clinical expertise of the nurse, and the context in which the decision making takes place affect the shared decision-making process. A knowledgeable and skilled nurse with a positive attitude towards shared decision making—integrated with evidence-based practice—can facilitate the shared decision-making process. We conclude that nurses as well as other
Potomkova, Jarmila; Mihal, Vladimir; Zapletalova, Jirina; Subova, Dana
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.
Fernandez, Ritin S; Tran, Duong Thuy; Ramjan, Lucie; Ho, Carey; Gill, Betty
The aim of this study was to compare four teaching methods on the evidence-based practice knowledge and skills of postgraduate nursing students. Students enrolled in the Evidence-based Nursing (EBN) unit in Australia and Hong Kong in 2010 and 2011 received education via either the standard distance teaching method, computer laboratory teaching method, Evidence-based Practice-Digital Video Disc (EBP-DVD) teaching method or the didactic classroom teaching method. Evidence-based Practice (EBP) knowledge and skills were evaluated using student assignments that comprised validated instruments. One-way analysis of covariance was implemented to assess group differences on outcomes after controlling for the effects of age and grade point average (GPA). Data were obtained from 187 students. The crude mean score among students receiving the standard+DVD method of instruction was higher for developing a precise clinical question (8.1±0.8) and identifying the level of evidence (4.6±0.7) compared to those receiving other teaching methods. These differences were statistically significant after controlling for age and grade point average. Significant improvement in cognitive and technical EBP skills can be achieved for postgraduate nursing students by integrating a DVD as part of the EBP teaching resources. The EBP-DVD is an easy teaching method to improve student learning outcomes and ensure that external students receive equivalent and quality learning experiences. Copyright © 2012 Elsevier Ltd. All rights reserved.
Skela-Savič, Brigita; Hvalič-Touzery, Simona; Pesjak, Katja
To establish the connection between values, competencies, selected job characteristics and evidence-based practice use. Nurses rarely apply evidence-based practice in everyday work. A recent body of research has looked at various variables explaining the use of evidence-based practice, but not values and competencies. A cross-sectional, non-experimental quantitative explorative research design. Standardized instruments were used (Nurse Professional Values Scale-R, Nurse Competence Scale, Evidence-Based Practice Beliefs and Implementation Scale). The sample included 780 nurses from 20 Slovenian hospitals. The data were collected in 2015. The study identifies two new variables contributing to a better understanding of beliefs on and implementation of evidence-based practice, thus broadening the existing research evidence. These are the values of activism and professionalism and competencies aimed at the development and professionalization of nursing. Values of caring, trust and justice and competencies expected in everyday practice do not influence the beliefs and implementation of evidence-based practice. Respondents ascribed less importance to values connected with activism and professionalism and competencies connected with the development of professionalism. Nurses agree that evidence-based practice is useful in their clinical work, but they lack the knowledge to implement it in practice. Evidence-based practice implementation in nursing practice is low. Study results stress the importance of increasing the knowledge and skills on professional values of activism and professionalism and competencies connected to nursing development. The study expands the current understanding of evidence-based practice use and provides invaluable insight for nursing managers, higher education managers and the national nursing association. © 2017 John Wiley & Sons Ltd.
Ruzafa-Martínez, María; Molina-Salas, Yolanda; Ramos-Morcillo, Antonio Jesús
Evidence-based practice (EBP) learning has become a key issue for nurses. An EPB subject was included in the 4(th) year in the new syllabus of the Nursing Degree at University of Murcia (UM). To know the competence level in EBP of undergraduate nursing students at UM and compare the results between all four years. Observational descriptive study with a cross-sectional approach. undergraduate nursing students from all four years at Nursing Degree at the Faculty of Social and Healthcare Science at UM in the year 2013-14. EBP evaluation of competence of the nursing students consisted of attitude, skills and knowledge on EBP. A validated questionnaire, the EBP-COQ, was used. The scale range is 1 point «lowest level» to 5 points «higher level».The SPSS 21.0 program has been used to carry out descriptive and bivariate analyses. 144 students were included, 76.4% was female, and the median age was 23 years, 84.7% attended more than 75% class hours. The mean differences in the questionnaire between first and fourth years were 0.58 points in attitude, 0.60 in skills, 1.6 in knowledge and 0.83 in global competence in EBP. Significant differences in mean scores between the fourth and the remaining years in the global competence in EBP were observed, as well as in the three dimensions (p <0.05). The undergraduate-nursing students studied here have acquired an appropriate competence level in EBP, with a gradual increase by year. The biggest increase was in the fourth year students. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.
Case, Christina Anne
Promoting a culture of evidence-based practice within a health care facility is a priority for health care leaders and nursing professionals; however, tangible methods to promote translation of evidence to bedside practice are lacking. The purpose of this quality improvement project was to design and implement a nursing education intervention demonstrating to the bedside nurse how current evidence-based guidelines are used when creating standardized stroke order sets at a primary stroke center, thereby increasing confidence in the use of standardized order sets at the point of care and supporting evidence-based culture within the health care facility. This educational intervention took place at a 286-bed community hospital certified by the Joint Commission as a primary stroke center. Bedside registered nurse (RN) staff from 4 units received a poster presentation linking the American Heart Association's and American Stroke Association's current evidence-based clinical practice guidelines to standardized stroke order sets and bedside nursing care. The 90-second oral poster presentation was delivered by a graduate nursing student during preshift huddle. The poster and supplemental materials remained in the unit break room for 1 week for RN viewing. After the pilot unit, a pdf of the poster was also delivered via an e-mail attachment to all RNs on the participating unit. A preintervention online survey measured nurses' self-perceived likelihood of performing an ordered intervention based on whether they were confident the order was evidence based. The preintervention survey also measured nurses' self-reported confidence in their ability to explain how the standardized order sets are derived from current evidence. The postintervention online survey again measured nurses' self-reported confidence level. However, the postintervention survey was modified midway through data collection, allowing for the final 20 survey respondents to retrospectively rate their confidence
Price, Christopher P; Christenson, Robert H
The purpose of laboratory medicine is to facilitate better decision making in clinical practice and healthcare delivery. Decision making implies an unresolved issue, problem or unmet need. The most important criterion for any investigation to be of value in clinical practice is that it addresses an unmet need. The different ways in which laboratory investigations are utilized in patient care can be represented in the form of questions. It is important that these questions are articulated to highlight the variables that will impact on the effectiveness of the investigation in the scenario being considered. These variables include the characteristics of the patient (or population) and clinical setting, the nature of the decision and action taken on receipt of the test result and the expected outcome. Asking a question is the first step of the evidence-based laboratory medicine (EBLM) cycle, the other steps being acquiring the evidence, critically appraising the evidence, applying the evidence and auditing use of the evidence. Getting the question right determines the quality of the whole process, thus, defines the quality in practice of laboratory medicine. Whilst the main focus of the EBLM cycle is to provide a strong evidence base for use in clinical practice, it is clear that the five steps are equally applicable in commissioning, delivery and audit (performance management) of services. Asking the right question is crucial to improving the quality of evidence, and practice, in laboratory medicine, and should be used in routine laboratory medicine practice and management throughout healthcare.
As evidence-based practice sweeps the applied health professions, it is a good time to evaluate the generation of knowledge in Kinesiology and its transmission to professionals and the public. Knowledge transmission has been debated in the past from the perspectives of the theory-to-practice gap and the discipline versus profession emphasis.…
Abdelkarim, Ahmad; Sullivan, Donna
The study aimed at evaluating attitudes and perceptions of dental students and faculty toward evidence-based practice, integration of technology and social media, general practitioners' and specialists' scope of practice, and dental practice rewards and disadvantages. A survey instrument was designed with 10 statements rated on a five-point Likert scale (strongly agree to strongly disagree) and an optional comment section. The survey instrument was delivered through SurveyMonkey, whereby 401 students and 182 faculty members from ten U.S. dental schools participated (16% estimated response rate). Null hypotheses regarding the equality between the responses of the two groups were statistically tested using Mann-Whitney U test. Statistical significance was set at .05. Evidence-based practice is positively perceived by both groups, but with significantly higher support by faculty than students (P = 0.002). Both groups agreed that technological advancements are advantageous (P = 0.95), but do not constitute good dentistry and cannot mask poor clinical skills. Students showed higher support for social media than faculty (P = 0.000). Both groups perceived group practices positively. Faculty members showed higher agreement than students toward limitation of dental specialists' practices to their specialties (P = 0.000). Both groups are aware of practice disadvantages, such as increased litigation, health risks, and detriment to the dentist's posture. However, they both perceive dental practice positively despite all these challenges. Students and faculty share generally comparable perspectives toward dental practice. They are both in agreement with evidence-based practice and adoption of technology. They both acknowledge practice limitations. Copyright © 2014 Elsevier Inc. All rights reserved.
Evidence-Based Nursing (EBN) permits the highest quality of care in meeting the multifaceted needs of clients using the best available evidence from research findings, expert ideas from specialists in the various health care sectors and feedback from clients. However, in many instances, various challenges need to be ...
Objectives: The aim of this cross-sectional study was to determine the awareness and attitude of hospital resident doctors towards evidence-based medicine (EBM) and their related educational needs. Methods: A cross-sectional descriptive study was performed on a randomly selected sample of 141 hospital resident ...
Park, Jee-Won; Ahn, Jeong-Ah; Park, Mi-Mi
The purpose of this study was to describe Korean nurses' perceptions, attitudes and utilization intention for evidence-based nursing (EBN), and to explore what factors influence utilization intention. We conducted a cross-sectional survey in 2012. Registered nurses directly involved in clinical practice were recruited at a medical centre in Korea. A total of 420 nurses completed a self-report questionnaire. Results showed that participants reported moderate scores regarding their perceptions and attitudes towards EBN, and rated themselves as higher than the median for utilization intention. Furthermore, this study revealed that perceptions of and attitudes towards EBN, occupational view and previous EBN education were significant factors affecting utilization intention. Nurse educators and managers should encourage nurses to have better attitudes towards EBN, help them be more satisfied with their work and provide them with appropriate education for EBN to establish evidence-based practice as a part of daily nursing care. © 2014 Wiley Publishing Asia Pty Ltd.
Manchester, Julianne; Gray-Miceli, Deanna L; Metcalf, Judith A; Paolini, Charlotte A; Napier, Anne H; Coogle, Constance L; Owens, Myra G
Evidence based practices (EBPs) in clinical settings interact with and adapt to host organizational characteristics. The contextual factors themselves, surrounding health professions' practices, also adapt as practices become sustained. The authors assert the need for better planning models toward these contextual factors, the influence of which undergird a well-documented science to practice gap in literature on EBPs. The mechanism for EBP planners to anticipate contextual effects as programs Unfreeze their host settings, create Movement, and become Refrozen (Lewin, 1951) is present in Lewin's 3-step change model. Planning for contextual change appears equally important as planning for the actual practice outcomes among providers and patients. Two case studies from a Geriatric Education Center network will illustrate the synthesis of Lewin's three steps with collaborative evaluation principles. The use of the model may become an important tool for continuing education evaluators or organizations beginning a journey toward EBP demonstration projects in clinical settings. Copyright © 2014 Elsevier Ltd. All rights reserved.
Melnyk, Bernadette Mazurek; Fineout-Overholt, Ellen; Gallagher-Ford, Lynn; Kaplan, Louise
This descriptive survey assessed the perception of evidence-based practice (EBP) among nurses in the United States. Although evidence-based healthcare results in improved patient outcomes and reduced costs, nurses do not consistently implement evidence-based best practices. A descriptive survey was conducted with a random sample of 1015 RNs who are members of the American Nurses Association. Although nurses believe in evidence-based care, barriers remain prevalent, including resistance from colleagues, nurse leaders, and managers. Differences existed in responses of nurses from Magnet® versus non-Magnet institutions as well as nurses with master's versus nonmaster's degrees. Nurse leaders and educators must provide learning opportunities regarding EBP and facilitate supportive cultures to achieve the Institute of Medicine's 2020 goal that 90% of clinical decisions be evidence-based.
Shaffer, William O; Baisden, Jamie L; Fernand, Robert; Matz, Paul G
were formulated and addressed, and the answers are summarized in this article. The respective recommendations were graded by the strength of the supporting literature, which was stratified by levels of evidence. The clinical guideline for antibiotic prophylaxis in spine surgery has been created using the techniques of evidence-based medicine and best available evidence to aid practitioners in the care of patients undergoing spine surgery. The entire guideline document, including the evidentiary tables, suggestions for future research, and all the references, is available electronically on the NASS Web site at http://www.spine.org/Pages/PracticePolicy/ClinicalCare/ClinicalGuidlines/Default.aspx and will remain updated on a timely schedule. Copyright © 2013 Elsevier Inc. All rights reserved.
Martin, Sharon D.
Evidence-based practice is highly valued in health care literature at this time. But research suggests that U.S. RNs face many obstacles when implementing evidence-based practice including a lack of value for research in practice (Pravikoff et al, 2005). Additional obstacles may exist for traditional U.S. BSN nursing students who may not value the…
de Ruijter, D.; Smit, E.S.; de Vries, H.; Hoving, C.
Background: Practice nurses in general practice sub-optimally adhere to evidence-based smoking cessation treatment guidelines, but factors explaining their adherence have not yet been investigated. Understanding such factors is important to develop interventions improving practice nurses' smoking
Szucs, Kimberly A; Benson, Jeryl D; Haneman, Brianne
Journal clubs are used in both clinical and academic settings in order for clinicians and students to utilize current best-practices, become competent in evidence based practice and develop critical appraisal skills. Journal clubs encourage students to practice searching for relevant research, critically appraising articles, and contributing to open discussions with peers. Establishing the practice of reading and critiquing literature in the classroom can enable the creation of a habit of using current evidence when students enter practice. This article describes a strategy for delivering a structured academic journal club to support the learning of evidence based practice skills and students' perception of the journal club, including their overall satisfaction, knowledge base skills, and presentation skills. Students had an overall positive experience and perception of the guided journal club activity. From the instructor's perspective, this assignment was an excellent opportunity to engage students in learning the process of evidence based practice.
Rosen, Raymond C; Ruzek, Josef I; Karlin, Bradley E
There is a pressing global need for trained and competent mental health clinicians to deliver evidence-based psychological therapies to millions of trauma survivors in need of care. Three model, large-scale training programs were initiated a decade ago, one in the United Kingdom (U.K.), and two in the United States (U.S.), to disseminate high-quality, evidence-based psychological care to traumatized children and adults in need of assistance. Milestone contributions to implementation science have been made by each of these training programs, although limitations and challenges remain to be considered. In contrast, culturally adapted and simplified PTSD interventions and therapy training programs have also been developed and tested during the past decade, three of which show particular promise for broader implementation. These simplified but evidence-based interventions have been developed for use by lay counsellors or health technicians with minimal or no prior mental health training. Finally, a growing range of technology-based and technology-assisted training models for PTSD providers have also been developed and disseminated in the past decade. This trend is expected to accelerate as more providers become accustomed to acquiring clinical training in this modality or format, although significant barriers to technology-based training will need to be overcome. Copyright © 2016. Published by Elsevier Ltd.
Hu, Ling; Cai, Rong-Lin; Wu, Zi-Jian
The importance of evidence-based medicine (EBM) in clinical acupuncture-moxibustion research is discussed in the paper. The application of EBM and problems in clinical acupuncture-moxibustion research are reviewed. It is put forward that thinking and assumptions of the combination of the evaluation of clinical effectiveness and EBM. The characteristics of acupuncture-moxibustion theory determine that the design of clinical research of acupuncture cannot completely apply the methods of EBM. Future efforts should be made to explore the integrated research design which is adhering to the guidelines of clinical practice of acupuncture. The features and advantages of traditional therapeutic practices should be preserved, and the advanced methods in EBM should be applied. It is great to improve the reliability and repeatability of clinical acupuncture-moxibustion research and to improve the standard and the evaluation system of clinical acupuncture.
Watson, Amy C; Compton, Michael T; Draine, Jeffrey N
As academic researchers, we are often asked to opine on whether the Crisis Intervention Team model (CIT) is an evidence-based practice (EBP) or evidence-based policing. Our answer is that it depends on how you define evidence-based practice and what outcome you are interested in. In this commentary, we briefly describe the CIT model, examine definitions of evidence-based practice and evidence-based policing, and then summarize the existing research on what is known about the effectiveness of CIT to date. We conclude that CIT can be designated an EBP for officer-level cognitive and attitudinal outcomes, but more research is needed to determine if CIT can be designated an EBP for other outcomes. Using an evidence-based practice process approach, CIT may also be a justified strategy for many communities. Future directions to inform the field are discussed. Copyright © 2017 John Wiley & Sons, Ltd.
Juan Carlos Fernández-Domínguez
Full Text Available Most of the EBP measuring instruments available to date present limitations both in the operationalisation of the construct and also in the rigour of their psychometric development, as revealed in the literature review performed. The aim of this paper is to provide rigorous and adequate reliability and validity evidence of the scores of a new transdisciplinary psychometric tool, the Health Sciences Evidence-Based Practice (HS-EBP, for measuring the construct EBP in Health Sciences professionals.A pilot study and a subsequent two-stage validation test sample were conducted to progressively refine the instrument until a reduced 60-item version with a five-factor latent structure. Reliability was analysed through both Cronbach's alpha coefficient and intraclass correlations (ICC. Latent structure was contrasted using confirmatory factor analysis (CFA following a model comparison aproach. Evidence of criterion validity of the scores obtained was achieved by considering attitudinal resistance to change, burnout, and quality of professional life as criterion variables; while convergent validity was assessed using the Spanish version of the Evidence-Based Practice Questionnaire (EBPQ-19.Adequate evidence of both reliability and ICC was obtained for the five dimensions of the questionnaire. According to the CFA model comparison, the best fit corresponded to the five-factor model (RMSEA = 0.049; CI 90% RMSEA = [0.047; 0.050]; CFI = 0.99. Adequate criterion and convergent validity evidence was also provided. Finally, the HS-EBP showed the capability to find differences between EBP training levels as an important evidence of decision validity.Reliability and validity evidence obtained regarding the HS-EBP confirm the adequate operationalisation of the EBP construct as a process put into practice to respond to every clinical situation arising in the daily practice of professionals in health sciences (transprofessional. The tool could be useful for EBP
Fernández-Domínguez, Juan Carlos; de Pedro-Gómez, Joan Ernest; Morales-Asencio, José Miguel; Sastre-Fullana, Pedro; Sesé-Abad, Albert
Introduction Most of the EBP measuring instruments available to date present limitations both in the operationalisation of the construct and also in the rigour of their psychometric development, as revealed in the literature review performed. The aim of this paper is to provide rigorous and adequate reliability and validity evidence of the scores of a new transdisciplinary psychometric tool, the Health Sciences Evidence-Based Practice (HS-EBP), for measuring the construct EBP in Health Sciences professionals. Methods A pilot study and a subsequent two-stage validation test sample were conducted to progressively refine the instrument until a reduced 60-item version with a five-factor latent structure. Reliability was analysed through both Cronbach’s alpha coefficient and intraclass correlations (ICC). Latent structure was contrasted using confirmatory factor analysis (CFA) following a model comparison aproach. Evidence of criterion validity of the scores obtained was achieved by considering attitudinal resistance to change, burnout, and quality of professional life as criterion variables; while convergent validity was assessed using the Spanish version of the Evidence-Based Practice Questionnaire (EBPQ-19). Results Adequate evidence of both reliability and ICC was obtained for the five dimensions of the questionnaire. According to the CFA model comparison, the best fit corresponded to the five-factor model (RMSEA = 0.049; CI 90% RMSEA = [0.047; 0.050]; CFI = 0.99). Adequate criterion and convergent validity evidence was also provided. Finally, the HS-EBP showed the capability to find differences between EBP training levels as an important evidence of decision validity. Conclusions Reliability and validity evidence obtained regarding the HS-EBP confirm the adequate operationalisation of the EBP construct as a process put into practice to respond to every clinical situation arising in the daily practice of professionals in health sciences (transprofessional). The
Powers, Joelle D.; Bowen, Natasha K.; Bowen, Gary L.
In spite of multidisciplinary recommendations to use evidence-based interventions in schools and a growing knowledge base of such practices, most schools are not using empirically supported interventions. On the basis of a careful analysis of barriers to the implementation of the best researched programs, an online, free, and publicly available…
Choma, Kim; McKeever, Amy E
The literature reports great variation in the knowledge levels and application of the recent changes of cervical cancer screening guidelines into clinical practice. Evidence-based screening guidelines for the prevention and early detection of cervical cancer offers healthcare providers the opportunity to improve practice patterns among female adolescents by decreasing psychological distress as well as reducing healthcare costs and morbidities associated with over-screening. The purpose of this pilot intervention study was to determine the effects of a Web-based continuing education unit (CEU) program on advanced practice nurses' (APNs) knowledge of current cervical cancer screening evidence-based recommendations and their application in practice. This paper presents a process improvement project as an example of a way to disseminate updated evidence-based practice guidelines among busy healthcare providers. This Web-based CEU program was developed, piloted, and evaluated specifically for APNs. The program addressed their knowledge level of cervical cancer and its relationship with high-risk human papillomavirus. It also addressed the new cervical cancer screening guidelines and the application of those guidelines into clinical practice. Results of the study indicated that knowledge gaps exist among APNs about cervical cancer screening in adolescents. However, when provided with a CEU educational intervention, APNs' knowledge levels increased and their self-reported clinical practice behaviors changed in accordance with the new cervical cancer screening guidelines. Providing convenient and readily accessible up-to-date electronic content that provides CEU enhances the adoption of clinical practice guidelines, thereby decreasing the potential of the morbidities associated with over-screening for cervical cancer in adolescents and young women. © 2014 Sigma Theta Tau International.
Jenson, William R.; Clark, Elaine; Kircher, John C.; Kristjansson, Sean D.
Evidence-based practice approaches to interventions has come of age and promises to provide a new standard of excellence for school psychologists. This article describes several definitions of evidence-based practice and the problems associated with traditional statistical analyses that rely on rejection of the null hypothesis for the…
Lubas, Margaret; Mitchell, Jennifer; De Leo, Gianluca
Evidence-based practice related to autism research is a controversial topic. Governmental entities and national agencies are defining evidence-based practice as a specific set of interventions that educators should implement; however, large-scale efforts to generalize autism research, which are often single-subject case designs, may be a setback…
Wendt, Dennis C., Jr.; Slife, Brent D.
In its policy rationale for evidence-based practice in psychology (EBPP), the APA Presidential Task Force on Evidence-Based Practice (see record 2006-05893-001) claims to have constituted itself with "scientists and practitioners from a wide range of perspectives and traditions, reflecting the diverse perspectives within the field" (p. 273). We…
Stahmer, Aubyn C.; Rieth, Sarah; Lee, Ember; Reisinger, Erica M.; Mandell, David S.; Connell, James E.
The purpose of this study was to examine the extent to which public school teachers implemented evidence-based interventions for students with autism in the way these practices were designed. Evidence-based practices for students with autism are rarely incorporated into community settings, and little is known about the quality of implementation.…
Kenny, Deborah J; Goodman, Petra
Care of patients with enteral feeding tubes often is based on tradition and textbook guidance rather than best evidence. Care practices can vary widely both between and within institutions, and this was the case at a northeastern military medical center that served as the site for this evidence-based protocol development and implementation project. The purpose of this study was to describe the development and implementation of an evidence-based clinical protocol for care of patients with enteral feeding tubes. This was an evidence-based implementation project with pretest-posttest measures. Protocol data collection occurred both before and after implementation of the protocol. Data collection tools were based on the literature review and included three domains: (a) documentation of patient procedures, (b) nursing knowledge of each of the specific procedures, and (c) environment of care. Descriptive statistics and data were analyzed using independent samples t tests. Overall staff knowledge of enteral feedings and methods used to unclog both large- and small-bore feeding tubes differed significantly before and after implementation (p tubes. There was a 10% improvement in documentation of patient family education and a 15% improvement in recording fluid flushes during medication administration. After implementation, environment of care data collection showed 100% of patients with head of bed elevated and with functioning suction available, an improvement over levels before implementation. Care must be taken in the interpretation of these findings because it was generally not the same nurses who answered both surveys. High staff turnover within this military hospital also affected sustainment of the protocol implementation. Maintenance activities must be constant and visible within the organization. A champion for evidence-based practice greatly enhances uptake and maintenance of nursing practice change.
Markulin, Helena; Petrak, Jelka
It frequently happens that physicians do not have adequate skills or enough time for searching and evaluating evidence needed in their everyday practice. Medical librarian can serve as a mediator in enabling physicians to utilize the potential offered by contemporary evidence-based medicine. The Central Medical Library (CML) at University of Zagreb, School of Medicine, designed a web-based information service aimed at the promotion of evidence-based practice in the Croatian medical community. The users can ask for a help in finding information on their clinical problems. A responsible librarian will analyse the problem, search information resources and evaluate the evidence. The answer is returned to the user by an e-mail. In the 2008-2012 period 166 questions from 12 clinical fields were received and most of them (36.1%) came from internal medicine doctors. The share of treatment-related questions was 70.5%. In the setting of underdeveloped ICT infrastructure and inadequate EBM resources availability, such information service can help in transfer of scientific evidence into the everyday clinical practice.
Kaper, N.M.; Swennen, M.H.J.; van Wijk, A.J.; Kalkman, C.J.; van Rheenen, N.; van der Graaf, Y.; van der Heijden, G.J.M.G.
Objectives To design and validate a practical questionnaire for clinicians, to identify barriers and facilitators for evidence-based practice (EBP), that is, the use of research evidence in patient care. The inventory is ultimately intended for departments to assess local conditions for EBP, to aim
Kaper, Nina M; Swennen, Maartje H J; van Wijk, Arjen J; Kalkman, Cor J|info:eu-repo/dai/nl/078251818; van Rheenen, Nanda; van der Graaf, Yolanda|info:eu-repo/dai/nl/072825847; van der Heijden, Geert J M G
OBJECTIVES: To design and validate a practical questionnaire for clinicians, to identify barriers and facilitators for evidence-based practice (EBP), that is, the use of research evidence in patient care. The inventory is ultimately intended for departments to assess local conditions for EBP, to aim
Moher, David; Ravaud, Philippe
Biomedical journals continue to be the single most important conduit for disseminating biomedical knowledge. Unlike clinical medicine, where evidence is considered fundamental to practice, journals still operate largely in a 'black box' mode without sufficient evidence to drive their practice. We believe there is an immediate need to substantially increase the amount and quality of research by journals to ensure their practice is as evidence based as possible. To achieve this goal, we are proposing the development of an international 'best practice journal research network'. We invite journals and others to join the network. Such a network is likely to improve the quality of journals. It is also likely to address many unanswered questions in publication science, including peer review, which can provide robust and generalizable answers.
Hole, Grete Oline; Brenna, Sissel Johansson; Graverholt, Birgitte; Ciliska, Donna; Nortvedt, Monica Wammen
Health care professionals are expected to build decisions upon evidence. This implies decisions based on the best available, current, valid and relevant evidence, informed by clinical expertise and patient values. A multi-professional master's program in evidence-based practice was developed and offered. The aims of this study were to explore how students in this program viewed their ability to apply evidence-based practice and their perceptions of what constitute necessary conditions to implement evidence-based practice in health care organizations, one year after graduation. A qualitative descriptive design was chosen to examine the graduates' experiences. All students in the first two cohorts of the program were invited to participate. Six focus-group interviews, with a total of 21 participants, and a telephone interview of one participant were conducted. The data was analyzed thematically, using the themes from the interview guide as the starting point. The graduates reported that an overall necessary condition for evidence-based practice to occur is the existence of a "readiness for change" both at an individual level and at the organizational level. They described that they gained personal knowledge and skills to be "change-agents" with "self-efficacy, "analytic competence" and "tools" to implement evidence based practice in clinical care. An organizational culture of a "learning organization" was also required, where leaders have an "awareness of evidence- based practice", and see the need for creating "evidence-based networks". One year after graduation the participants saw themselves as "change agents" prepared to improve clinical care within a learning organization. The results of this study provides useful information for facilitating the implementation of EBP both from educational and health care organizational perspectives.
Boisvert, Isabelle; Clemesha, Jennifer; Lundmark, Erik; Crome, Erica; Barr, Caitlin; McMahon, Catherine M
Health-care service delivery models have evolved from a practitioner-centered approach toward a patient-centered ideal. Concurrently, increasing emphasis has been placed on the use of empirical evidence in decision-making to increase clinical accountability. The way in which clinicians use empirical evidence and client preferences to inform decision-making provides an insight into health-care delivery models utilized in clinical practice. The present study aimed to investigate the sources of information audiologists use when discussing rehabilitation choices with clients, and discuss the findings within the context of evidence-based practice and patient-centered care. To assess the changes that may have occurred over time, this study uses a questionnaire based on one of the few studies of decision-making behavior in audiologists, published in 1989. The present questionnaire was completed by 96 audiologists who attended the World Congress of Audiology in 2014. The responses were analyzed using qualitative and quantitative approaches. Results suggest that audiologists rank clinical test results and client preferences as the most important factors for decision-making. Discussion with colleagues or experts was also frequently reported as an important source influencing decision-making. Approximately 20% of audiologists mentioned utilizing research evidence to inform decision-making when no clear solution was available. Information shared at conferences was ranked low in terms of importance and reliability. This study highlights an increase in awareness of concepts associated with evidence-based practice and patient-centered care within audiology settings, consistent with current research-to-practice dissemination pathways. It also highlights that these pathways may not be sufficient for an effective clinical implementation of these practices.
Aarons, Gregory A
Leadership in organizations is important in shaping workers' perceptions, responses to organizational change, and acceptance of innovations, such as evidence-based practices. Transformational leadership inspires and motivates followers, whereas transactional leadership is based more on reinforcement and exchanges. Studies have shown that in youth and family service organizations, mental health providers' attitudes toward adopting an evidence-based practice are associated with organizational context and individual provider differences. The purpose of this study was to expand these findings by examining the association between leadership and mental health providers' attitudes toward adopting evidence-based practice. Participants were 303 public-sector mental health service clinicians and case managers from 49 programs who were providing mental health services to children, adolescents, and their families. Data were gathered on providers' characteristics, attitudes toward evidence-based practices, and perceptions of their supervisors' leadership behaviors. Zero-order correlations and multilevel regression analyses were conducted that controlled for effects of service providers' characteristics. Both transformational and transactional leadership were positively associated with providers' having more positive attitudes toward adoption of evidence-based practice, and transformational leadership was negatively associated with providers' perception of difference between the providers' current practice and evidence-based practice. Mental health service organizations may benefit from improving transformational and transactional supervisory leadership skills in preparation for implementing evidence-based practices.
Aarons, Gregory A.
Objective Leadership in organizations is important in shaping workers’ perceptions, responses to organizational change, and acceptance of innovations, such as evidence-based practices. Transformational leadership inspires and motivates followers, whereas transactional leadership is based more on reinforcement and exchanges. Studies have shown that in youth and family service organizations, mental health providers’ attitudes toward adopting an evidence-based practice are associated with organizational context and individual provider differences. The purpose of this study was to expand these findings by examining the association between leadership and mental health providers’ attitudes toward adopting evidence-based practice. Methods Participants were 303 public-sector mental health service clinicians and case managers from 49 programs who were providing mental health services to children, adolescents, and their families. Data were gathered on providers’ characteristics, attitudes toward evidence-based practices, and perceptions of their supervisors’ leadership behaviors. Zero-order correlations and multilevel regression analyses were conducted that controlled for effects of service providers’ characteristics. Results Both transformational and transactional leadership were positively associated with providers’ having more positive attitudes toward adoption of evidence-based practice, and transformational leadership was negatively associated with providers’ perception of difference between the providers’ current practice and evidence-based practice. Conclusions Mental health service organizations may benefit from improving transformational and transactional supervisory leadership skills in preparation for implementing evidence-based practices. PMID:16870968
Full Text Available This article explores professional discourses in the Norwegian residential child care system. It discusses how the discourses serve as constraints on and possibilities for evidence-based practice when different definitions of evidence-based practice are considered. Among the Nordic countries, Norway has been a forerunner in the implementation of evidence-based practice in child welfare. However, I argue that tensions exist, both within professional practice and between professional understandings and policy aims. I use discourse theory to analyze interviews with 19 professionals working in coercive residential child care. The results reveal two competing professional discourses: the discourse of technoscience and the discourse of indeterminacy. Possibilities of evidence-based practice in residential child care are found within both discourses if a wide and inclusive definition of evidence-based practice is applied. This study emphasizes the importance of engaging in constant reflection when discussing possibilities for evidence-based practice within residential child care. Keywords: professional discourses, residential child care, evidence-based practice, scientific knowledge, professional judgment, indeterminacy, discretion
Baldwin, David S
Evidence-based medicine (EBM) enables clinicians to justify decision making, enhances the quality of medical practice, identifies unanswered research questions, and ensures the efficient practice of medicine. Implementation of evidence-based mental health programs requires education, time, and improved effort by administration, regulatory, and clinical professionals. Essential to these efforts are consistent incentives for change, effective training materials, and clear clinical guidelines. Guidelines exist within the framework of EBM. Good guidelines are simple, specific, and user friendly, focus on key clinical decisions, are based on research evidence, and present evidence and recommendations in a concise and accessible format. Potential limitations of guidelines to improve clinical outcomes in anxiety disorders are the widespread distribution of anxiety symptoms in primary care, health inequalities across patient groups, persistent misconceptions regarding psychotropic drugs, and low confidence in using simple psychological treatments. Clinical guidelines generally specify therapeutic areas covered and not covered, but often there is no mention of cost or cost effectiveness of treatment. Guidelines can inform clinical decision making, but administrators of drug formularies may regard themselves as being primarily responsible for limiting costs and access to certain medications, even if these decisions are at odds with guideline recommendations.
Melnyk, Bernadette Mazurek; Hawkins-Walsh, Elizabeth; Beauchesne, Michelle; Brandt, Patricia; Crowley, Angela; Choi, Myunghan; Greenburg, Edward
The incidence of mental health/behavioral and developmental problems in children and teens is escalating. However, many primary care providers report inadequate skills to accurately screen, identify, and manage these problems using an evidence-based approach to care. Additionally, educational programs that prepare pediatric nurse practitioners (PNPs) have been slow to incorporate this content into their curriculums. The purpose of this project was to implement and evaluate a strengthened curriculum in 20 PNP programs from across the United States that focused on: (a) health promotion strategies for optimal mental/behavioral health and developmental outcomes in children, and (b) screening and evidence-based interventions for these problems. An outcomes evaluation was conducted with faculty and graduating students from the participating programs along with faculty and students from 13 PNP programs who did not participate in the project. Participating schools varied in the speed at which components of the strengthened curriculum were incorporated into their programs. Over the course of the project, faculty from participating programs increased their own knowledge in the targeted areas and reported that their students were better prepared to assess and manage these problems using an evidence-based approach. Although reports of screening for certain problems were higher in the graduating students from the participating schools than the non-participating schools, the overall use of screening tools by students in clinical practice was low. There is a need for educational programs to strengthen their curricula and clinical experiences to prepare students to screen for, accurately identify, prevent, and provide early evidence-based interventions for children and teens with mental health/behavioral and developmental problems. This project can serve as a national model for curriculum change.
Full Text Available Abstract Background Over the past years concerns are rising about the use of Evidence-Based Medicine (EBM in health care. The calls for an increase in the practice of EBM, seem to be obstructed by many barriers preventing the implementation of evidence-based thinking and acting in general practice. This study aims to explore the barriers of Flemish GPs (General Practitioners to the implementation of EBM in routine clinical work and to identify possible strategies for integrating EBM in daily work. Methods We used a qualitative research strategy to gather and analyse data. We organised focus groups between September 2002 and April 2003. The focus group data were analysed using a combined strategy of 'between-case' analysis and 'grounded theory approach'. Thirty-one general practitioners participated in four focus groups. Purposeful sampling was used to recruit participants. Results A basic classification model documents the influencing factors and actors on a micro-, meso- as well as macro-level. Patients, colleagues, competences, logistics and time were identified on the micro-level (the GPs' individual practice, commercial and consumer organisations on the meso-level (institutions, organisations and health care policy, media and specific characteristics of evidence on the macro-level (policy level and international scientific community. Existing barriers and possible strategies to overcome these barriers were described. Conclusion In order to implement EBM in routine general practice, an integrated approach on different levels needs to be developed.
Hillier, Susan; Grimmer-Somers, Karen; Merlin, Tracy; Middleton, Philippa; Salisbury, Janet; Tooher, Rebecca; Weston, Adele
Clinical practice guidelines are an important element of evidence-based practice. Considering an often complicated body of evidence can be problematic for guideline developers, who in the past may have resorted to using levels of evidence of individual studies as a quasi-indicator for the strength of a recommendation. This paper reports on the production and trial of a methodology and associated processes to assist Australian guideline developers in considering a body of evidence and grading the resulting guideline recommendations. In recognition of the complexities of clinical guidelines and the multiple factors that influence choice in health care, a working group of experienced guideline consultants was formed under the auspices of the Australian National Health and Medical Research Council (NHMRC) to produce and pilot a framework to formulate and grade guideline recommendations. Consultation with national and international experts and extensive piloting informed the process. The FORM framework consists of five components (evidence base, consistency, clinical impact, generalisability and applicability) which are used by guideline developers to structure their decisions on how to convey the strength of a recommendation through wording and grading via a considered judgement form. In parallel (but separate from the grading process) guideline developers are asked to consider implementation implications for each recommendation. The framework has now been widely adopted by Australian guideline developers who find it to be a logical and intuitive way to formulate and grade recommendations in clinical practice guidelines.
Full Text Available Abstract Background Clinical practice guidelines are an important element of evidence-based practice. Considering an often complicated body of evidence can be problematic for guideline developers, who in the past may have resorted to using levels of evidence of individual studies as a quasi-indicator for the strength of a recommendation. This paper reports on the production and trial of a methodology and associated processes to assist Australian guideline developers in considering a body of evidence and grading the resulting guideline recommendations. Methods In recognition of the complexities of clinical guidelines and the multiple factors that influence choice in health care, a working group of experienced guideline consultants was formed under the auspices of the Australian National Health and Medical Research Council (NHMRC to produce and pilot a framework to formulate and grade guideline recommendations. Consultation with national and international experts and extensive piloting informed the process. Results The FORM framework consists of five components (evidence base, consistency, clinical impact, generalisability and applicability which are used by guideline developers to structure their decisions on how to convey the strength of a recommendation through wording and grading via a considered judgement form. In parallel (but separate from the grading process guideline developers are asked to consider implementation implications for each recommendation. Conclusions The framework has now been widely adopted by Australian guideline developers who find it to be a logical and intuitive way to formulate and grade recommendations in clinical practice guidelines.
Liao, Xing; Wang, Gui-qian; Xie, Yan-ming
Good clinical practice should be based on evidence. Evidence quality should be based on critical appraisal in evidence based medicine (EBM). Evaluation of evidence quality plays an important role in evidence level clarifying, which is the core of EBM. Different recommendations for clinical practice often derive from evidence levels. Thus evidence quality evaluation is the first and most important step in EBM. There are lots of standards to evaluate evidence quality in the world. However there are two aspects of the evaluation, one is methodological evaluation and the other is reporting evaluation. This article collected a series of standards for clinical trials quality evaluation according to different research designs. It is hoped that the resource and introduction about the quality evaluation of clinical trials be helpful for medical researchers in China. Only being familiar with all kinds of standards of methodology and reporting, researchers could publish high quality scientific papers.
Leach, Matthew J; Hofmeyer, Anne; Bobridge, Amanda
To measure the impact of an undergraduate research education program on the attitude, skill and uptake of evidence-based practice among undergraduate student nurses. The contribution of evidence-based practice to clinical decision-making, quality of care and patient outcomes is well-documented. One approach to improving evidence-based practice uptake in clinical practice is through the provision of undergraduate research education; notwithstanding, the impact of research training on nursing practice is poorly established. Descriptive longitudinal survey. Three hundred and fifty four third-year nursing students enrolled in a Bachelor of Nursing program of a large Australian University were invited. Pre- (Phase 1) and post-completion (Phase 2) of a 16-week research education program, participants were asked to complete the Evidence-Based Practice Attitude and Utilization Survey; an 82-item online questionnaire measuring attitudes, skills and use of evidence-based practice, and barriers and facilitators of evidence-based practice uptake. The survey was completed by 84 (24%) participants in Phase 1 and 33 (39% of Phase 1) participants in Phase 2. Program exposure resulted in a significant improvement in median skill and use subscores, but not median attitude subscore. Participants perceived inadequate skills in the interpretation, appraisal and application of research findings to clinical practice as being less of a barrier to evidence-based practice uptake posteducation, and access to online critical appraisal tools as being significantly more useful in facilitating evidence-based practice uptake posteducation. The findings suggest that undergraduate research education may have a significant effect on nursing students' research skills and use of evidence-based practice, and minimise barriers to evidence-based practice uptake posteducation. Undergraduate research education may play an important role in improving student nurse uptake of evidence-based practice; whether
O'Connor, Siobhan; Pettigrew, Catharine M
There is currently a paucity of research investigating what speech and language therapists, in particular, perceive are the greatest barriers to implementing evidence-based practice. The purpose of this study was to investigate the perceived barriers that are faced by speech and language therapists in southern Ireland when attempting to implement evidence-based practice. A 34-item questionnaire was sent to 39 therapists working in several counties in southern Ireland. The survey received an 82.1% (n = 32) response rate. The results of the study indicated that certain barriers are perceived to prevent evidence-based practice being implemented successfully. The most significant barrier affecting evidence-based practice implementation was reported to be a lack of time to read research (71.9%). Additional barriers that were found to be the most significant were the research having methodological inadequacies (62.5%) and insufficient time to implement new ideas (59.4%). Other important factors identified as being significant barriers to the implementation of evidence-based practice were those associated with the quality and presentation of the research, workplace setting, and lack of skills of the therapist. Associations between specific barriers and workplace setting or grade were also investigated. Some possible reasons for these barriers and the implications for clinical practice are also discussed. This small study suggests that therapists agreed that evidence-based practice is essential to the practice of speech and language therapy. There are, however, barriers in place that are perceived to prevent its successful implementation. It is hoped that because these barriers have been identified, individual clinicians and organizations can be proactive in aiming to provide an evidence-based service to their clients.
Tucker, Jalie A; Reed, Geoffrey M
This paper examines the utility of evidentiary pluralism, a research strategy that selects methods in service of content questions, in the context of rehabilitation psychology. Hierarchical views that favor randomized controlled clinical trials (RCTs) over other evidence are discussed, and RCTs are considered as they intersect with issues in the field. RCTs are vital for establishing treatment efficacy, but whether they are uniformly the best evidence to inform practice is critically evaluated. We argue that because treatment is only one of several variables that influence functioning, disability, and participation over time, an expanded set of conceptual and data analytic approaches should be selected in an informed way to support an expanded research agenda that investigates therapeutic and extra-therapeutic influences on rehabilitation processes and outcomes. The benefits of evidentiary pluralism are considered, including helping close the gap between the narrower clinical rehabilitation model and a public health disability model. KEY WORDS: evidence-based practice, evidentiary pluralism, rehabilitation psychology, randomized controlled trials.
McGowan, Jessie; Hogg, William; Rader, Tamara; Salzwedel, Doug; Worster, Danielle; Cogo, Elise; Rowan, Margo
A librarian consultation service was offered to 88 primary care clinicians during office hours. This included a streamlined evidence-based process to answer questions in fewer than 20 min. This included a contact centre accessed through a Web-based platform and using hand-held devices and computers with Web access. Librarians were given technical training in evidence-based medicine, including how to summarise evidence. To describe the process and lessons learned from developing and operating a rapid response librarian consultation service for primary care clinicians. Evaluation included librarian interviews and a clinician exit satisfaction survey. Clinicians were positive about its impact on their clinical practice and decision making. The project revealed some important 'lessons learned' in the clinical use of hand-held devices, knowledge translation and training for clinicians and librarians. The Just-in-Time Librarian Consultation Service showed that it was possible to provide evidence-based answers to clinical questions in 15 min or less. The project overcame a number of barriers using innovative solutions. There are many opportunities to build on this experience for future joint projects of librarians and healthcare providers.
Shuman, Clayton J; Xie, Xian-Jin; Herr, Keela A; Titler, Marita G
Little is known regarding sustainability of evidence-based practices (EBPs) following implementation. This article reports sustainability of evidence-based acute pain management practices in hospitalized older adults following testing of a multifaceted Translating Research Into Practice (TRIP) implementation intervention. A cluster randomized trial with follow-up period was conducted in 12 Midwest U.S. hospitals (six experimental, six comparison). Use of evidence-based acute pain management practices and mean pain intensity were analyzed using generalized estimating equations across two time points (following implementation and 18 months later) to determine sustainability of TRIP intervention effects. Summative Index scores and six of seven practices were sustained. Experimental and comparison group differences for mean pain intensity over 72 hours following admission were sustained. Results revealed most evidence-based acute pain management practices were sustained for 18 months following implementation. Further work is needed to identify factors affecting sustainability of EBPs to guide development and testing of sustainability strategies.
Jameson, Jodi; Walsh, M Eileen
Information literacy is essential in facilitating evidence-based practice (EBP) activities. In vascular nursing, the implementation of EBP is of utmost importance. Best practice grounded in research evidence can contribute to improved patient care outcomes for individuals with vascular disease. The following paper discusses information literacy competencies for nurses to develop in the context of EBP, with an emphasis on formulating a clinical question and searching for evidence. Relevant health science information resources are described, including their value and purpose in the 6S model of evidence. Also discussed are practical and supportive solutions with proven effectiveness in ensuring nurses' success with EBP. Copyright © 2017 Society for Vascular Nursing, Inc. Published by Elsevier Inc. All rights reserved.
DiMeo, Michelle A.; Moore, G. Kurt; Lichtenstein, Carolyn
Evidence-based treatments (EBTs) are "interventions" that have been proven effective through rigorous research methodologies. Evidence-based practice (EBP), however, refers to a "decision-making process" that integrates the best available research, clinician expertise, and client characteristics. This study examined community mental health service…
Wanderley Marques Bernardo
the best evidence current available, exposing the patient to a unnecessary risk. Although not integrated around clinical problem areas in the convenient way of textbooks, current best evidence from specific studies of clinical problems can be found in an increasing number of Internet and electronic databases. The sources that have already undergone rigorous critical appraisal are classified as secondary information sources, others that provide access to original article or abstract, as primary information source, where the quality assessment of the article rely on the clinician oneself. The most useful primary information source are SciELO, the online collection of Brazilian scientific journals, and Medline, the most comprehensive database of the USA National Library of Medicine, where the search may start with use of keywords, that were obtained at the structured answer construction (P.I.C.O, with the addition of boolean operators «AND», «OR», «NOT». Between the secondary information sources, some of them provide critically appraised articles, like ACP Journal Club, Evidence Based Medicine and InfoPOEMs, others provide evidences organized as online texts, such as «Clinical Evidence» and «UpToDate», and finally, Cochrane Library are composed by systematic reviews of randomized controlled trials. To get studies that could answer the clinical question is part of a mindful practice, that is, becoming quicker and quicker and dynamic with the use of PDAs, Palmtops and Notebooks.
, individual perceptions that underpin clinical decision-making, lack of access to information required for EBP, inadequate sources to access evidence, inability to synthesise the literature available, and resistance to change. Barriers related to ...
Oct 13, 2014 ... Thus, as important as the practice of nursing that is based on evidence could be, there are however contending issues that should be addressed for success to be achieved. As a fairly new concept, Stetler, Brunnel,. Giuliano, Morsi, Prince and Newell-Stokes (2008) asserted that its meaning is not always ...
of atopic eczema in general practice. Atopic eczema is a common chronic condition characterised by dry, itchy skin associated with flares and remissions. .... atopy. This effect is lessened in the general population and neg- ligible in children without first- order atopic relatives. Breast- feeding should be strongly rec-.
Argimon-Pallàs, Josep M; Flores-Mateo, Gemma; Jiménez-Villa, Josep; Pujol-Ribera, Enriqueta
To assess the effectiveness (change in knowledge and skills measured by the Fresno test) of a short course in Evidence Based Practice (EBP) carried out in a group of family medicine residents Before-after study. Participants' were 152 Family Medicine residents in their second year of the training programme. Settings were Primary Care Teaching Units in Catalonia. Intervention was comprised of a four half-day training course designed to develop the knowledge and skills required to practice evidence-based care. The main outcome measure was change in EBP knowledge and skills, measured using the Spanish version of the Fresno test (score range, 0-212) The mean difference between pre-test and post-test was 47.7, a statistically significant result with 95% CI of 42.8-52.5 (p questions related to calculations such as sensitivity, specificity, the absolute risk reduction or the number needed to treat. A more modest increase was found in the residents' knowledge and skills in finding the best clinical evidence, and appraising the validity and applicability of an article. Finally, a weak and non-statistically significant improvement was found in formulating a clinical question. The study provides evidence for responsiveness to changes in knowledge and skills in EBP after an educational intervention.
Sarker, Abeed; Mollá, Diego; Paris, Cecile
Evidence-based medicine practice requires medical practitioners to rely on the best available evidence, in addition to their expertise, when making clinical decisions. The medical domain boasts a large amount of published medical research data, indexed in various medical databases such as MEDLINE. As the size of this data grows, practitioners increasingly face the problem of information overload, and past research has established the time-associated obstacles faced by evidence-based medicine practitioners. In this paper, we focus on the problem of automatic text summarisation to help practitioners quickly find query-focused information from relevant documents. We utilise an annotated corpus that is specialised for the task of evidence-based summarisation of text. In contrast to past summarisation approaches, which mostly rely on surface level features to identify salient pieces of texts that form the summaries, our approach focuses on the use of corpus-based statistics, and domain-specific lexical knowledge for the identification of summary contents. We also apply a target-sentence-specific summarisation technique that reduces the problem of underfitting that persists in generic summarisation models. In automatic evaluations run over a large number of annotated summaries, our extractive summarisation technique statistically outperforms various baseline and benchmark summarisation models with a percentile rank of 96.8%. A manual evaluation shows that our extractive summarisation approach is capable of selecting content with high recall and precision, and may thus be used to generate bottom-line answers to practitioners' queries. Our research shows that the incorporation of specialised data and domain-specific knowledge can significantly improve text summarisation performance in the medical domain. Due to the vast amounts of medical text available, and the high growth of this form of data, we suspect that such summarisation techniques will address the time
Full Text Available There is a vast literature on evidence-based practice (EBP in education. What function does evidence have in practical deliberations toward decisions about what to do? Most writers on EBP seem to think of evidence largely as quantitative data, serving as a foundation from which practice could and should be directly derived. In this paper I argue that we are better served by according a different and more indirect function to evidence in practical reasoning. To establish this claim I employ Toulmin’s model of argumentation. On this model the evidence-as-foundation view amounts to evidence as data/grounds. The model also offers a different function for evidence, as backing of the warrant, and I argue in this paper that this is a more adequate understanding of the function of evidence in practical reasoning
Burke, Kathleen G; Johnson, Tonya; Sites, Christine; Barnsteiner, Jane
: Background: The Institute of Medicine (IOM) and the Quality and Safety Education for Nurses (QSEN) project have identified six nursing competencies and supported their integration into undergraduate and graduate nursing curricula nationwide. But integration of those competencies into clinical practice has been limited, and evidence for the progression of competency proficiency within clinical advancement programs is scant. Using an evidence-based approach and building on the competencies identified by the IOM and QSEN, a team of experts at an academic health system developed eight competency domains and 186 related knowledge, skills, and attitudes (KSAs) for professional nursing practice. The aim of our study was to validate the eight identified competencies and 186 related KSAs and determine their developmental progression within a clinical advancement program. Using the Delphi technique, nursing leadership validated the newly identified competency domains and KSAs as essential to practice. Clinical experts from 13 Magnet-designated hospitals with clinical advancement programs then participated in Delphi rounds aimed at reaching consensus on the developmental progression of the 186 KSAs through four levels of clinical advancement. Two Delphi rounds resulted in consensus by the expert participants. All eight competency domains were determined to be essential at all four levels of clinical practice. At the novice level of practice, the experts identified a greater number of KSAs in the domains of safety and patient- and family-centered care. At more advanced practice levels, the experts identified a greater number of KSAs in the domains of professionalism, teamwork, technology and informatics, and continuous quality improvement. Incorporating the eight competency domains and the 186 KSAs into a framework for clinical advancement programs will likely result in more clearly defined role expectations; enhance accountability; and elevate and promote nursing practice
Full Text Available The study aim was to elicit the motivators, barriers, and benefits of participation in a Community of Practice (CoP for primary care physiotherapists. We used a qualitative approach using semistructured interviews. The participants were twelve physiotherapists partaking in a newly formed Shoulder CoP. A desire for peer support was the strongest motivator for joining, with improving clinical practice being less apparent. Barriers to participation included time and work pressures and poor research skills. The structure of the CoP, in terms of access to meetings and the provision of preparation work and deadlines for the journal clubs, was reported to be a facilitator. Multiple benefits ensued from participation. The role of teamwork was emphasised in relation to reducing isolation and achieving goals. The majority of participants reported positive clinical practice changes in terms of improved patient education, increased confidence, and availability of new resources. All participants reported some element of personal growth and development, in particular in their evidence-based practice skills. The results provide support for the use of CoPs as a means of continuing professional development for physiotherapists in the workplace, as significant benefits are gained in terms of evidence-based practice (EBP, patient care, and therapist personal development.
van Twillert, S.; Geertzen, J.; Hemminga, T.; Postema, K.; Lettinga, A.
Background: A divide is experienced between producers and users of evidence in prosthetic rehabilitation. Objective: To discuss the complexity inherent in establishing evidence-based practice in a prosthetic rehabilitation team illustrated by the case of prosthetic prescription for elderly
Reviewed by Yasin OZARSLAN
EFFECTIVE BLENDED LEARNING PRACTICES:Evidence-based Perspectives in ICT-facilitated EducationEdited by Elizabeth Stacey and Philippa Gerbic, Information ScienceReference; 1 edition (March 30, 2009), ISBN-10: 1605662968, 358...
This feature considers models of teaching and learning and how these can be used to support evidence based practice. © 2010 The authors. Health Information and Libraries Journal © 2010 Health Libraries Group.
Eric Barends; Josh Villanueva; Denise M Rousseau; Rob B Briner; Denise M Jepsen; Edward Houghton; Steven ten Have
Evidence-based practice (EBP) in management is still in its infancy. Several studies suggest that managers in businesses and other organizations do not consult the scientific evidence when making decisions...
Kirk, Jeanette W.; Nilsen, Per
BACKGROUND: An emergency department is typically a place of high activity where practitioners care for unanticipated presentations, which yields a flow culture so that actions that secure available beds are prioritised by the practitioners. OBJECTIVES: How does the flow culture in an emergency...... department influence nurses' use of a research-based clinical guideline and a nutrition screening routine. METHODS: Ethnographic fieldwork was carried out over three months. The first author followed nurses, medical secretaries and doctors in the emergency department. Data were also collected by means...
Walker, Sarah Cusworth; Lyon, Aaron R; Aos, Steve; Trupin, Eric W
As states increasingly establish the importance of evidence-based practice through policy and funding mandates, the definition of evidence-based practice can have a significant impact on investment decisions. Not meeting established criteria can mean a loss of funding for established programs and the implementation disruption of programs without a strong research base. Whether the definition of "evidence-based" is influenced by these high stakes contexts is an interesting question that can inform the larger field about the value and utility of evidence-based practice lists/inventories for disseminating knowledge. In this paper we review the development of the Washington State Inventory of Evidence-Based, Research-Based and Promising Practices as a case study for the process of defining evidence-based practice in a policy context. As part of this study we also present a comparison of other well-known evidence-based practice inventories and examine consistencies and differences in the process of identifying and developing program ratings.
Maricutoiu, Laurentiu P.
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.
Kim, Son C; Brown, Caroline E; Fields, Willa; Stichler, Jaynelle F
This paper is a report of a study to evaluate the effectiveness of the evidence-based practice (EBP)-focused interactive teaching (E-FIT) strategy. Although EBP is a mandatory competency for all healthcare professionals, little is known about the effectiveness of E-FIT in nursing. Aquasi-experimental, controlled, pre- and post-test study involving senior, 4th-year nursing students (N = 208) at two nursing schools in the USA was carried out from August 2007 to May 2008. The experimental group (n = 88) received the E-FIT strategy intervention and the control group (n = 120) received standard teaching. A Knowledge, Attitudes and Behaviors Questionnaire for Evidence-Based Practice was used to assess the effectiveness of the E-FIT strategy. Independent t-tests showed that the experimental group had statistically significant higher post-test Evidence-Based Practice Knowledge (mean difference = 0.25; P = 0.001) and Evidence-Based Practice Use (mean difference = 0.26; P = 0.015) subscale scores compared to the control group, but showed no statistically significant differences in Attitudes toward Evidence-Based Practice and Future Use of Evidence-Based Practice (mean difference = 0.12; P = 0.398 and mean difference = 0.13; P = 0.255 respectively). Hierarchical multiple regression analyses of the post-test data indicated that the intervention explained 7.6% and 5.1% of variance in Evidence-Based Practice Knowledge and Evidence-Based Practice Use respectively. The EBP-focused interactive teaching strategy was effective in improving the knowledge and use of EBP among nursing students but not attitudes toward or future use of EBP.
Hoagwood, Kimberly Eaton; Olin, S. Serene; Horwitz, Sarah; McKay, Mary; Cleek, Andrew; Gleacher, Alissa; Lewandowski, Eric; Nadeem, Erum; Acri, Mary; Chor, Ka Ho Brian; Kuppinger, Anne; Burton, Geraldine; Weiss, Dara; Frank, Samantha; Finnerty, Molly; Bradbury, Donna M.; Woodlock, Kristin M.; Hogan, Michael
Dissemination of innovations is widely considered the sine qua non for system improvement. At least two dozen states are rolling-out evidence-based mental health practices targeted at children and families using trainings, consultations, webinars, and learning collaboratives to improve quality and outcomes. In New York State (NYS) a group of researchers, policy-makers, providers and family support specialists have worked in partnership since 2002 to redesign and evaluate the children’s mental health system. Five system strategies driven by empirically-based practices and organized within a state-supported infrastructure have been used in the child and family service system with over 2,000 providers: (a) business practices; (b) use of health information technologies in quality improvement; (c) specific clinical interventions targeted at common childhood disorders; (d) parent activation; and (e) quality indicator development. The NYS system has provided a laboratory for naturalistic experiments. We describe these initiatives, key findings and challenges, lessons learned for scaling, and implications for creating evidence-based implementation policies in state systems. PMID:24460518
Regional Resource Center Program, 2014
One component of the recently required State Systemic Improvement Plan (SSIP) for State Departments of Education calls for the selection and implementation of evidence-based practices (EBPs). This report provides six steps to guide the process of selecting evidence based practices (EBP): (1) Begin with the End in Mind--Determine Targeted Outcomes;…
To assess the evidence showing that a specific method of toilet training (TT) is more effective than others, as any method of TT recommended by a physician faces obstacles because parents rarely request advice on TT from physicians, and TT practices vary tremendously across cultures and socioeconomic levels. Reports on the natural course of urinary incontinence in children and different methods of TT, published in English between 1946 and 2012, were reviewed. Specifically investigated were historical recommendations on TT, the prevalence of urinary incontinence during childhood, the outcome of TT methods, and the effect of culture and socioeconomic status on the choice of TT method and timing. TT now occurs at later ages than it did previously. This progression reflects changing ideas about normal childhood physiology and psychology. The prevalence of urinary incontinence in European countries progressively decreased in children aged between 6-7 years and 16-17 years old. TT methods change with increasing socioeconomic levels to 'child-centred' techniques applied at older ages, but the prevalence of urinary incontinence after 'parent-centred' techniques of TT at younger ages has not been studied. There is currently no evidence that a specific timing or method of TT is more effective or prevents voiding dysfunction. Follow-up studies of urinary continence in children toilet trained at 6-12 months of age might provide evidence for whether a given method or timing of TT is beneficial to prevent voiding dysfunction. The recommendations of physicians might be more readily adopted if they fit culturally accepted ideas of good parenting techniques.
Unger, Karen V.
Supported Education is a promising practice that helps people with mental illnesses who are interested in education and training return to school. Current research shows that Supported Education has demonstrated results. While more research is needed, Supported Education services show promise of becoming an evidence-based practice. Education…
Foster, Abby; Worrall, Linda; Rose, Miranda; O'Halloran, Robyn
An evidence-practice gap has been identified in current acute aphasia management practice, with the provision of services to people with aphasia in the acute hospital widely considered in the literature to be inconsistent with best-practice recommendations. The reasons for this evidence-practice gap are unclear; however, speech pathologists practising in this setting have articulated a sense of dissonance regarding their limited service provision to this population. A clearer understanding of why this evidence-practice gap exists is essential in order to support and promote evidence-based approaches to the care of people with aphasia in acute care settings. To provide an understanding of speech pathologists' conceptualization of evidence-based practice for acute post-stroke aphasia, and its implementation. This study adopted a phenomenological approach, underpinned by a social constructivist paradigm. In-depth interviews were conducted with 14 Australian speech pathologists, recruited using a purposive sampling technique. An inductive thematic analysis of the data was undertaken. A single, overarching theme emerged from the data. Speech pathologists demonstrated a sense of disempowerment as a result of their relationship with evidence-based practice for acute aphasia management. Three subthemes contributed to this theme. The first described a restricted conceptualization of evidence-based practice. The second revealed speech pathologists' strained relationships with the research literature. The third elucidated a sense of professional unease over their perceived inability to enact evidence-based clinical recommendations, despite their desire to do so. Speech pathologists identified a current knowledge-practice gap in their management of aphasia in acute hospital settings. Speech pathologists place significant emphasis on the research evidence; however, their engagement with the research is limited, in part because it is perceived to lack clinical utility. A sense
Contarino, Maria Fiorella; Van Den Dool, Joost; Balash, Yacov
issues still remain open in the clinical practice. We performed a systematic review of the literature on botulinum toxin treatment for CD based on a question-oriented approach, with the aim to provide practical recommendations for the treating clinicians. Key questions from the clinical practice were...... of anticoagulants, neurological comorbidities) should also be further explored....
Fox, Anthony W; Lewison, Grant
Background This is an appraisal of the impact of cited research evidence underpinning the development of cancer clinical practice guidelines (CPGs) by the professional bodies of the European Society for Medical Oncology (ESMO), the National Institute for Health and Care Excellence (NICE) and the Scottish Intercollegiate Guidelines Network (SIGN). Methods A total of 101 CPGs were identified from ESMO, NICE and SIGN websites across 13 cancer sites. Their 9486 cited references were downloaded from the Web of Science Clarivate Group database, analysed on Excel (2016) using Visual Basic Application macros and imported onto SPSS (V.24.0) for statistical tests. Results ESMO CPGs mostly cited research from Western Europe, while the NICE and SIGN ones from the UK, Canada, Australia and Scandinavian countries. The ESMO CPGs cited more recent and basic research (eg, drugs treatment), in comparison with NICE and SIGN CPGs where older and more clinical research (eg, surgery) papers were referenced. This chronological difference in the evidence base is also in line with that ESMO has a shorter gap between the publication of the research and its citation on the CPGs. It was demonstrated that ESMO CPGs report more chemotherapy research, while the NICE and SIGN CPGs report more surgery, with the results being statistically significant. Conclusions We showed that ESMO, NICE and SIGN differ in their evidence base of CPGs. Healthcare professionals should be aware of this heterogeneity in effective decision-making of tailored treatments to patients, irrespective of geographic location across Europe. PMID:29344408
Pallari, Elena; Fox, Anthony W; Lewison, Grant
This is an appraisal of the impact of cited research evidence underpinning the development of cancer clinical practice guidelines (CPGs) by the professional bodies of the European Society for Medical Oncology (ESMO), the National Institute for Health and Care Excellence (NICE) and the Scottish Intercollegiate Guidelines Network (SIGN). A total of 101 CPGs were identified from ESMO, NICE and SIGN websites across 13 cancer sites. Their 9486 cited references were downloaded from the Web of Science Clarivate Group database, analysed on Excel (2016) using Visual Basic Application macros and imported onto SPSS (V.24.0) for statistical tests. ESMO CPGs mostly cited research from Western Europe, while the NICE and SIGN ones from the UK, Canada, Australia and Scandinavian countries. The ESMO CPGs cited more recent and basic research (eg, drugs treatment), in comparison with NICE and SIGN CPGs where older and more clinical research (eg, surgery) papers were referenced. This chronological difference in the evidence base is also in line with that ESMO has a shorter gap between the publication of the research and its citation on the CPGs. It was demonstrated that ESMO CPGs report more chemotherapy research, while the NICE and SIGN CPGs report more surgery, with the results being statistically significant. We showed that ESMO, NICE and SIGN differ in their evidence base of CPGs. Healthcare professionals should be aware of this heterogeneity in effective decision-making of tailored treatments to patients, irrespective of geographic location across Europe.
Varaei, Shokoh; Salsali, Mahvash; Cheraghi, Mohammad Ali
Evidence-based nursing is recognized as an indicator of quality in nursing practice, a basis for accountability and the gold standard of professional nursing care. The aim of this study was to explore nurses' experiences and perceptions about evidence-based nursing practice in giving care to patients with diabetic foot ulcers. A qualitative research design was adopted, and content analysis was used to analyse data. Semistructured interviews were held with 19 bachelor-degree nurses working in a teaching hospital in an urban area of Iran. During data analysis, two main themes developed: 'structural backgrounds of the organization' and 'empowerment'. Accordingly, it was concluded that successful implementation of evidence-based nursing requires the reconfiguration of the administrative structure in the hospital. In addition, it requires the support of nurse leaders to facilitate the implementation of evidence-based nursing in the practice. © 2013 Wiley Publishing Asia Pty Ltd.
McKibbon, Kathleen Ann; Wilczynski, Nancy L; Haynes, Robert Brian
We conducted this analysis to determine i) which journals publish high-quality, clinically relevant studies in internal medicine, general/family practice, general practice nursing, and mental health; and ii) the proportion of clinically relevant articles in each journal. We performed an analytic survey of a hand search of 170 general medicine, general healthcare, and specialty journals for 2000. Research staff assessed individual articles by using explicit criteria for scientific merit for healthcare application. Practitioners assessed the clinical importance of these articles. Outcome measures were the number of high-quality, clinically relevant studies published in the 170 journal titles and how many of these were published in each of four discipline-specific, secondary "evidence-based" journals (ACP Journal Club for internal medicine and its subspecialties; Evidence-Based Medicine for general/family practice; Evidence-Based Nursing for general practice nursing; and Evidence-Based Mental Health for all aspects of mental health). Original studies and review articles were classified for purpose: therapy and prevention, screening and diagnosis, prognosis, etiology and harm, economics and cost, clinical prediction guides, and qualitative studies. We evaluated 60,352 articles from 170 journal titles. The pass criteria of high-quality methods and clinically relevant material were met by 3059 original articles and 1073 review articles. For ACP Journal Club (internal medicine), four titles supplied 56.5% of the articles and 27 titles supplied the other 43.5%. For Evidence-Based Medicine (general/family practice), five titles supplied 50.7% of the articles and 40 titles supplied the remaining 49.3%. For Evidence-Based Nursing (general practice nursing), seven titles supplied 51.0% of the articles and 34 additional titles supplied 49.0%. For Evidence-Based Mental Health (mental health), nine titles supplied 53.2% of the articles and 34 additional titles supplied 46.8%. For
Bradshaw, Wanda G
Our patients depend on us to do the best on their behalf. If we do not take accountability for our practice, continually examining what is the best way to deliver care, we are limiting our role to technical skills and not fully actualizing our professional role. [Evidence-based practice] is essential to practicing safely as nurses (p. 53).1.
Armfield, Nigel R; Gray, Leonard C; Smith, Anthony C
Skype is a popular and free software application that allows PCs and mobile devices to be used for video communication over the Internet. We reviewed the literature to determine whether the clinical use of Skype is supported by evidence. One small (n = 7) controlled clinical trial had assessed the effect of nursing communication using Skype on elderly patients with dementia and their carers. However, we were unable to identify any large, well-designed studies which had formally evaluated the safety, clinical effectiveness, security and privacy of Skype for the routine delivery of patient care. While there were many case reports and small studies, no firm evidence either in favour of, or against the use of Skype for clinical telehealth was found. The risks and benefits of using Skype for clinical purposes are not known.
Vidyarthi, Arpana; Lek, Ngee; Chan, Kenneth; Kamei, Robert
Although clinical reasoning (CR) and evidence-based medicine (EBM) are taught in some medical schools, the curricular details and students' clinical use of these skills are unknown. A detailed description of, and student experiences with, a practical CR and EBM curriculum delivering recommended content and pedagogy in an emerging academic environment may be broadly informative. To describe and characterise student experiences with a CR and EBM curriculum at a newly formed Academic Medical Centre (AMC). Applying expert recommended content and pedagogy, we developed a CR and EBM curriculum for final-year medical students delivered by existing clinical faculty members. We evaluated the course content by delineating the CR elements and EBM steps taught, and characterised student CR and EBM classroom and clinical experiences using a self-reported survey (1, strongly disagree; 5, strongly agree). Clinical faculty members, presenting real cases using active learning techniques, delivered all six recommended CR elements and three EBM steps throughout the course. Thirty-nine (89%) students completed a survey and agreed that the course added value to their clinical practice (3.90). Students agreed that they practised CR in the classroom (3.93) and in the clinical setting (3.78) similarly (p = 0.21). Their agreement differed for EBM practice (classroom 3.78, clinical 3.35; p = 0.002). Exploring factors that inhibit the application of EBM in a clinical setting [is] important Our curriculum addressed recommended CR and EBM elements, used clinical faculty members efficiently and was valued by students. Although our students practised these skills in the classroom and the clinical setting, exploring factors that inhibit the application of EBM in a clinical setting will be important in optimising both student learning and patient care. © 2015 John Wiley & Sons Ltd.
Underhill, Meghan; Roper, Kristin; Siefert, Mary Lou; Boucher, Jean; Berry, Donna
The purpose of evidence-based practice (EBP) in nursing is to improve patient outcomes, providing the best and most up-to-date care practices. In 2011, a nurse-led committee convened to develop an institute-wide initiative to promote EBP with oncology nurses at the Dana-Farber Cancer Institute. Compare and describe oncology nurse beliefs and perceived implementation of EBP and explore beliefs and implementation before and after implementing an institutional EBP initiative. Based on the Advancing Research and Clinical practice through close Collaboration (ARCC) Model, the Evidence-Based Practice Beliefs (EBP-B) and Implementation (EBP-I) scales were distributed to all Dana-Farber Cancer Institute registered and advanced practice nurses through an online survey in 2011 (T1) and again in 2013 (T2) after the implementation of an institute-wide nursing EBP initiative (orientation, poster presentations, education). Descriptive and correlation statistics were completed on total scores and demographics. Differences in beliefs and implementation scores based on demographics were analyzed with Mann-Whitney U tests. Open-ended item responses at each time point (T) were summarized for EBP barriers and promoters. Thirty-two percent (n = 112 at T1; n = 113 at T2) of 350 nurses began the survey. A history of formal EBP education and nurse role were associated with higher EBP-B and EBP-I scores (p nurses reported valuing EBP. Respondents acknowledged a lack of full preparation in the EBP process to engage in and implement EBP consistently. Nurse role, formal EBP education, and highest level of education were associated with perceptions of EBP beliefs and implementation. Nurses should be provided the mentorship and support to obtain continuing education about how to engage in EBP and about implementing EBP change. © 2015 Sigma Theta Tau International.
Yue, Liqing; Fan, Xuegong; Peng, Huan
To explore the abilities and barriers of practicing evidence-based nursing (EBN) for burn specialist nurses so as to provide rationales for its clinical training and practice. From January 2016 to March 2016, a cross-sectional survey was conducted with a self-designed questionnaire among burn specialist nurses in Hunan Province. Data analysis was performed with SPSS software (version 20). Burn specialist nurses in Hunan Province had diminished EBN abilities. The three procedures of EBN with the lowest score were "summarizing evidence through systematic reviews", "rigorous evaluations of evidence" and "systematic literature searches". And the three procedures of "clarifying problems", "disseminating evidence" and "introducing evidence" scored the highest. The systematic literature retrieval ability of nurses at class III general hospitals was higher than that of class II counterparts (P=0.001). Thus EBN ability was positively correlated with barriers to practicing EBN, English proficiency, research experiences and educator status. Burn specialist nurses at classes III & II general hospitals in Hunan Province had poor EBN abilities. Influencing factors of EBN ability included barriers to practicing EBN, English proficiency, research experiences and educator status. Therefore it is imperative to implement targeted trainings and integrated managements for improved ability of practicing EBN. Copyright © 2017 Elsevier Ltd and ISBI. All rights reserved.
Ángel García, Daniel; Martínez Nicolás, Ismael; Saturno Hernández, Pedro J
Efforts have been made to standardise evidence-based practice, but clinical practice guidelines do not always follow strict development methods. The objective of this review is to identify the current guidelines, analyse the variability of its recommendations and make a synthesis for clinical practice. A systematic review of clinical practice guidelines was made in electronic databases and guidelines databases; using "fibromyalgia" AND ["guideline" OR "Clinical Practice guideline"] as terms, from January for 2003 to July of 2013. Guidelines were selected according to the following criteria: a) aimed to fibromyalgia treatment in adults; b) based on scientific evidence, systematically searched; c) evidence levels and strength of recommendation included; d) written in English or Spanish. From 249 initial results, six guides fulfilled the inclusion criteria. Clinical practice guidelines analysed in this review show great variability both in the presence and level of evidence and in the strength of recommendation of many treatments. Physical exercise and cognitive-behavioural therapy are first-line treatments, showing high level of evidence. Amitriptyline, used for short periods of time for pain control, is the pharmacologic treatment with the most solid evidence. The multimodal approach reported better results than the isolated application of any treatment. Final recommendations in this review identify optimal treatments, facilitating the translation of evidence into practice and enabling more efficient and effective quality care. Copyright © 2014 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.
Philipsen, Nanya C
Childbirth educators have a duty to promote and implement best practices. Best practices are individualized and evidence-based, using quality research to optimize outcomes. This requires addressing change. The childbirth educator must model evidence-based practices by systematically engaging in activities to improve his or her own changing curriculum. The childbirth educator is also a professional in a core position to play an active role as a change agent in the system through evaluation and dissemination of information to parents, fellow childbirth educators, and other professionals on the health-care team. This information provides the basis for important health-care decisions for self and others.
Choi, Mona; Kim, Hee Sun; Chung, Su Kyoung; Ahn, Mee Jung; Yoo, Jae Yong; Park, Ok Sun; Woo, So Rah; Kim, So Sun; Kim, Sun Ah; Oh, Eui Geum
The purpose of this study is to implement an evidence utilization project using an audit and feedback approach to improve cancer pain management. A three-phased audit and feedback approach was used. A 46-bed oncology nursing unit in the university's cancer centre was selected as a research site. Nursing records extracted from 137 patients (65 for the baseline assessment and 72 for the follow-up audit) were used to examine nurse compliance with four audit criteria derived from best practice guidelines related to the assessment and management of pain. We observed a significant improvement in compliance from baseline to follow-up for the following criteria: documenting the side effects of opioids (2-83%), use of a formalized pain assessment tool (22-75%), and providing education for pain assessment and management to patients and caregivers (0-47%). The audit and feedback method was applicable to the implementation of clinical practice guidelines for cancer pain management. Leadership from both administrative personnel and staff nurses working together contributes to the spread of an evidence-based practice culture in clinical settings. As it was conducted in a single oncology nursing unit and was implemented over a short period of time, the results should be carefully interpreted. © 2013 Wiley Publishing Asia Pty Ltd.
Full Text Available Evidence-based medicine (EBM has become a hot topic in medical practice, education, and research. However, a large number of senior doctors did not have an opportunity to learn EBM in medical schools. Firstly, this article addresses the history of EBM and the principle of practicing EBM, i.e., asking, acquiring, appraisal, application, and auditing. Secondly, this article also provides a brief introduction to evidence-based dermatology and compares the introduction of clinical practice guidelines between Europe, the UK, and the US. Finally, this article addresses the present condition and future perspective of evidence-based dermatology in Taiwan.
Loring, David W; Bowden, Stephen C
Reporting appropriate research detail across clinical disciplines is often inconsistent or incomplete. Insufficient report detail reduces confidence in findings, makes study replication more difficult, and decreases the precision of data available for critical review including meta-analysis. In response to these concerns, cooperative attempts across multiple specialties have developed explicit research reporting standards to guide publication detail. These recommendations have been widely adopted by high impact medical journals, but have not yet been widely embraced by neuropsychology. The STROBE Statement (STrengthening the Reporting of Observational studies in Epidemiology) is particularly relevant to neuropsychology since clinical research is often based on non-funded studies of patient samples. In this paper we describe the STROBE Statement and demonstrate how STROBE criteria, applied to reporting of neuropsychological findings, will maintain neuropsychology's position as a leader in quantifying brain-behavior relationships. We also provide specific recommendations for data reporting and disclosure of perceived conflicts of interest that will further enhance reporting transparency for possible perceived sources of bias. In an era in which evidence-based practice assumes an increasingly prominent role, improved reporting standards will promote better patient care, assist in developing quality practice guidelines, and ensure that neuropsychology remains a vigorous discipline in the clinical neurosciences that consciously aspires to high methodological rigor.
Full Text Available This article seeks to help health professionals about the importance and usefulness of the Evidence-Based Medicine (EBM as a method for making clinical decisions in the practice of medicine. This article focuses on the first step of EBM’s method: ¿How a structured clinical question facilitates the access in the biomedical literature databases such as PubMed and the Cochrane Library? The use of structured questions is useful to save time and helps in retrieving relevant references from scientific literature to answer the question of intervention or treatment. The structured question consists of four components: Patient, Intervention, Comparison, and Outcomes. The structured query terms and the combination thereof is one of the elements of the search strategy, which is also useful for ellaborating the state of the art or a theoretical framework for a research project.
Shadish, William R.; Rindskopf, David M.
Good quantitative evidence does not require large, aggregate group designs. The authors describe ground-breaking work in managing the conceptual and practical demands in developing meta-analytic strategies for single subject designs in an effort to add to evidence-based practice. (Contains 2 figures.)
The aim of this study was to evaluate the effectiveness of the medium of videoconferencing for the delivery of a course for radiology residents in practice-based learning (PBL), including evidence-based practice, at centers geographically separated from the principal teaching site.
Ubbink, Dirk T.; Guyatt, Gordon H.; Vermeulen, Hester
Objectives: Evidence-based practice (EBP) may help improve healthcare quality. However, not all healthcare professionals and managers use EBP in their daily practice. We systematically reviewed the literature to summarise self-reported appreciation of EBP and organisational infrastructure solutions
DeWire, Tom; McKithen, Clarissa; Carey, Rebecca
What can the Investing in Innovation (i3) grantees tell us about scaling innovative educational practices? The newly released white paper "Scaling Up Evidence-Based Practices: Strategies from Investing in Innovation (i3)" captures the experiences of nine grantees whose projects collectively have reached over 1.2 million students across…
Bellamy, Jennifer L.; Mullen, Edward J.; Satterfield, Jason M.; Newhouse, Robin P.; Ferguson, Molly; Brownson, Ross C.; Spring, Bonnie
Evidence based practice (EBP) is reflected in social work publications, accreditation standards, research, and funding opportunities. However, implementing EBP in social work practice and education has proven challenging, highlighting the need for additional resources. This paper describes the Transdisciplinary Model of EBP, a model based on…
Wang, Mian; Lam, Yeana
Many issues arise in the discussion of the evidence-based practice (EBP) movement and implementation science in special education and specific educational practices for students with severe disabilities. Yet cultural adaptations of EBPs, which have emerged as an area of research in other fields, are being left out as a focus of EBP discourse. The…
Wilczynski, Susan M.
Evidence-based practice (EBP) represents an important approach to educating and treating individuals diagnosed with disabilities or disorders. Understanding research findings is the cornerstone of EBP. The methodology of systematic reviews, which involves carefully analyzing research findings, can result a practice guideline that recommends…
LeRoy, Adam Scott
Prior concerns have been raised about the ability of schools to access evidence-based practices, however, these practices are instrumental for addressing behavior concerns. This is particularly true at the secondary level, where students are more likely to be disproportionately identified for school removal. This review investigates studies of…
Wentworth, Laura; Mazzeo, Christopher; Connolly, Faith
Background: In the United States, an emphasis on evidence-based decision-making in education has received renewed interest with the recent passage of the Every Student Succeeds Act. However, how best, in practice, to support the use of evidence in educational decision-making remains unclear. Research Practice Partnerships (RPPs) are a popular…
Kozleski, Elizabeth B.
This article offers a rationale for the contributions of qualitative research to evidence-based practice in special education. In it, I make the argument that qualitative research encompasses the ability to study significant problems of practice, engage with practitioners in the conduct of research studies, learn and change processes during a…
Indonesia is continuously among the top ten countries worldwide in the number of people living with diabetes. Evidence-based practice (EBP) has the potential to improve the effectiveness and efficiency of diabetes care. However, the strategy to efficiently translate the best evidence into practice
Ballard, Susan D.
The author reveals in this article that her action research journey in the land of evidence-based practice was not her own idea. She writes that she was lured by the profession's finest scholars who advocated for reflective dispositions for practitioners to improve their practice and demonstrate the school librarian's critical role in teaching and…
Correa-Bautista, Jorge Enrique; Muñoz-Rodríguez, Diana Isabel; Ramírez, Lorena; González-Ruíz, Katherine; Domínguez-Sánchez, María Andrea; Durán-Palomino, Diana; Girabent-Farrés, Montserrat; Flórez-López, María Eugenia; Bagur-Calafat, M Caridad
Objective: The main purpose of this study was to describe a group of Colombian physical therapists' beliefs and attitudes towards Evidence-Based Practice (EBP), their education, knowledge and skills for implementing EBP, the use of relevant literature in clinical practice, access to and availability of scientific information and perceived barriers to including EBP in practice. Methods: This was a cross-sectional study which involved 1,064 Colombian physical therapists. The study used a 50-item screening questionnaire EBP developed to estimate attitudes, beliefs, knowledge and skills regarding. This instrument has been adapted and was validated previously in Colombia by Flórez-López et al. Results: The population mostly consisted of young females (77.2%) aged 22 to 29 years old (79.4%). Most respondents had an undergraduate degree (87.7%). The physical therapists stated that they had positive attitudes and beliefs regarding EBP, most of them answering that they agreed or strongly agreed that EBP is necessary (71.6%), the relevant literature is useful for practice (61.3%), EBP improves the quality of patient care (64.1%) and evidence helps in decision-making (44.5%). Forty-one percent of the respondents indicated that a lack of research skills was the most important barrier to the use of evidence in practice. Conclusion: The physical therapists reported that they had a positive attitude to EBP and were interested in learning about or improving the skills necessary to adopt EBP in their clinical practice. PMID:26019383
Vassallo, Patricia; Trohman, Richard G
Although amiodarone is approved by the US Food and Drug Administration only for refractory ventricular arrhythmias, it is one of the most frequently prescribed antiarrhythmic medications in the United States. To evaluate and synthesize evidence regarding optimal use of amiodarone for various arrhythmias. Systematic search of MEDLINE to identify peer-reviewed clinical trials, randomized controlled trials, meta-analyses, and other studies with clinical pertinence. The search was limited to human-participant, English-language reports published between 1970 and 2007. Amiodarone was searched using the terms adverse effects, atrial fibrillation, atrial flutter, congestive heart failure, electrical storm, hypertrophic cardiomyopathy, implantable cardioverter-defibrillator, surgery, ventricular arrhythmia, ventricular fibrillation, and Wolff-Parkinson-White. Bibliographies of identified articles and guidelines from official societies were reviewed for additional references. Ninety-two identified studies met inclusion criteria and were included in the review. Amiodarone may have clinical value in patients with left ventricular dysfunction and heart failure as first-line treatment for atrial fibrillation, though other agents are available. Amiodarone is useful in acute management of sustained ventricular tachyarrythmias, regardless of hemodynamic stability. The only role for prophylactic amiodarone is in the perioperative period of cardiac surgery. Amiodarone may be effective as an adjunct to implantable cardioverter-defibrillator therapy to reduce number of shocks. However, amiodarone has a number of serious adverse effects, including corneal microdeposits (>90%), optic neuropathy/neuritis (Amiodarone should be used with close follow-up in patients who are likely to derive the most benefit, namely those with atrial fibrillation and left ventricular dysfunction, those with acute sustained ventricular arrhythmias, those about to undergo cardiac surgery, and those with
Gary, Jodie C; Hudson, Cindy E
This article describes an innovative approach to introducing RN-to-BSN students to nursing research and evidence-based practice (EBP). Reverse engineering updates an existing EBP project to better emphasize the role of research and evidence to practicing RNs enrolled in an RN-to-BSN program. Reverse engineering of a nursing practice guideline offers a method for teaching an appreciation of research and supporting nursing practice with best evidence.
Martin, Donna; Albensi, Lisa; Van Haute, Stephanie; Froese, Maria; Montgomery, Mary; Lam, Mavis; Gierys, Kendra; Lajeunesse, Rob; Guse, Lorna; Basova, Nataliya
In 2013, an observational survey was conducted among 242 in-patients in a community hospital with a pressure ulcer (PU) prevalence of 34.3%. An evidence-based pressure ulcer prevention program (PUPP) was then implemented including a staff awareness campaign entitled "Healthy Skin Wins" with an online tutorial about PU prevention. To determine the effectiveness of the PUPP in reducing the prevalence of PUs, to determine the effectiveness of the online tutorial in increasing hospital staff's knowledge level about PU prevention, and to explore frontline staff's perspectives of the PUPP. This was a mixed methods study. A repeat observational survey discerned if the PUPP reduced PU prevalence. A pre-test post-test design was used to determine whether hospital staff's knowledge of PU prevention was enhanced by the online tutorial. Qualitative interviews were conducted with nurses, allied health professionals, and health care aides to explore staff's perspectives of the PUPP. A comparison of initial and repeat observational surveys (n = 239) identified a statistically significant reduction in the prevalence of PU to 7.53% (p tutorial enhanced staff knowledge level with a statistically significantly higher mean post-test score (n = 80). Thirty-five frontline staff shared their perspectives of the PUPP with "it's definitely a combination of everything" and "there's a disconnect between what's needed and what's available" as the main themes. Incorporating evidence-based PU prevention into clinical practice greatly reduced the prevalence of PUs among hospital in-patients. Due to the small sample size for the pre-test post-test component, the effectiveness of the online tutorial in improving the knowledge level of PU prevention among hospital staff requires further research. Evidence-based PU prevention strategies are facilitated by using a multidisciplinary approach. Educational tools about PU prevention must target all members of the healthcare team including healthcare
Spallek, Heiko; Song, Mei; Polk, Deborah E; Bekhuis, Tanja; Frantsve-Hawley, Julie; Aravamudhan, Krishna
Objective The purpose of this study is to identify barriers that early-adopting dentists perceive as common and challenging when implementing recommendations from evidence-based (EB) clinical guidelines. Method This is a cross-sectional study. Dentists who attended the 2008 Evidence-based Dentistry Champion Conference were eligible for inclusion. Forty-three dentists (34%) responded to a 22-item questionnaire administered online. Two investigators independently coded and categorized responses to open-ended items. Descriptive statistics were computed to assess the frequency of barriers and perceived challenges. Results The most common barriers to implementation are difficulty in changing current practice model, resistance and criticism from colleagues, and lack of trust in evidence or research. Barriers perceived as serious problems have to do with lack of up-to-date evidence, lack of clear answers to clinical questions, and contradictory information in the scientific literature. Conclusions Knowledge of barriers will help improve translation of biomedical research for dentists. Information in guidelines needs to be current, clear, and simplified for use at chairside; dentists’ fears need to be addressed. PMID:21093800
Sarto, F; Veronesi, G
A widespread assumption across health systems suggests that greater clinicians' involvement in governance and management roles would have wider benefits for the efficiency and effectiveness of healthcare organisations. However, despite growing interest around the topic, it is still poorly understood how managers with a clinical background might specifically affect healthcare performance outcomes. The purpose of this review is, therefore, to map out and critically appraise quantitatively-oriented studies investigating this phenomenon within the acute hospital sector. The review has focused on scientific papers published in English in international journals and conference proceedings. The articles have been extracted through a Boolean search strategy from ISI Web of Science citation and search source. No time constraints were imposed. A manual search by keywords and citation tracking was also conducted concentrating on highly ranked public sector governance and management journals. Nineteen papers were identified as a match for the research criteria and, subsequently, were classified on the basis of six items. Finally, a thematic mapping has been carried out leading to identify three main research sub-streams on the basis of the types of performance outcomes investigated. The analysis of the extant literature has revealed that research focusing on clinicians' involvement in leadership positions has explored its implications for the management of financial resources, the quality of care offered and the social performance of service providers. In general terms, the findings show a positive impact of clinical leadership on different types of outcome measures, with only a handful of studies highlighting a negative impact on financial and social performance. Therefore, this review lends support to the prevalent move across health systems towards increasing the presence of clinicians in leadership positions in healthcare organisations. Furthermore, we present an
Hauck, Sheila; Winsett, Rebecca P; Kuric, Judy
To assess the impact of leadership facilitation strategies on nurses' beliefs of the importance and frequency of using evidence in daily nursing practice and the perception of organizational readiness in an acute care hospital. Integrating evidence in practice is a prominent issue for hospital nursing as knowledge and skills, beliefs, organizational infrastructure and nursing leadership must all be addressed. Prospective, descriptive comparative. Three surveys were used in this prospective descriptive comparative study. Evidence-Based Practice Beliefs Scale, the Implementation Scale and Organizational Culture & Readiness for System-Wide Integration Survey measured change before and after facilitating strategies for evidence-based practice enculturation. Data were collected in December 2008 (N = 427) and in December 2010 (N = 469). Leadership facilitated infrastructure development in three major areas: incorporating evidence-based practice outcomes in the strategic plan; supporting mentors; and advocating for resources for education and outcome dissemination. With the interventions in place, the total group scores for beliefs and organizational readiness improved significantly. Analyses by job role showed that direct care nurses scores improved more than other role types. No differences were found in the implementation scores. Successful key strategies were evidence-based practice education and establishing internal opportunities to disseminate findings. Transformational nursing leadership drives organizational change and provides vision, human and financial resources and time that empowers nurses to include evidence in practice. © 2012 Blackwell Publishing Ltd.
Tolson, Debbie; Booth, Jo; Lowndes, Andrew
To determine the impact of the Caledonian Development Model, designed to promote evidence-based practice. The model features practice-development activities, benchmarking, knowledge pooling and translation through membership of a community of practice and a virtual college. Twenty-four nurses, from 18 practice sites formed three communities of practice, each selecting evidence-based guidance to implement. A modified group supervision framework empowered nurses to champion local implementation. Outcomes were determined at 6 months. Eighty per cent of the patient-related criteria and 35% of the facilities criteria were achieved. The Revised Nursing Work Index indicated these nurses experienced greater autonomy (P = 0.019) and increased organizational support (P = 0.037). Focus groups revealed a deepening organizational support for the initiative over time, illuminated work-based learning challenges and overall enthusiasm for the approach. Implementation of the model effectively promoted evidence-based practice, most notably at the level of the individual patient. Time and budgetary constraints necessitate smart, value for money approaches to developing evidence-based practice and improved care standards. This work demonstrates an effective model that strikes a balance between individual and group learning, virtual and real-time activities, coupled with resource pooling across organizations and sectors.
Rye, Marte; Torres, Elisa M; Friborg, Oddgeir; Skre, Ingunn; Aarons, Gregory A
Short and valid instruments for measuring factors facilitating or hindering implementation efforts are called for. This article describes (1) the adaptation of a shorter version of the Evidence-based Practice Attitude Scale (EBPAS-50 items), and (2) the psychometric properties of the shortened version in both US and Norwegian data. The US participants were mental health service providers (N = 418) recruited from clinics providing mental health services in San Diego County, California. The Norwegian participants were psychologists, psychiatric nurses, and psychology students (N = 838) recruited from the Norwegian Psychological Association and the Norwegian Nurses Organization. A confirmatory factor analysis (CFA) approach was used. The reduction resulted in 36 items named EBPAS-36, and the original 12 factor model was maintained. The EBPAS-36 had acceptable model fit, as indicated by a low degree of misspecification errors in both the US (RMSEA = .045 (CI 90% .040-.049); SRMR = .05) and the Norwegian data (RMSEA = .052 (CI 90% .047-.056, SRMR = .07). Incremental model fit was fair in the US (CFI = .93, TLI = .91) and in the Norwegian samples (CFI = .91, TLI = .89). The internal consistency (Cronbach's α) in the US and the Norwegian samples were good for the total EBPAS-36 score (.79 and .86, respectively) and were ranged from adequate to excellent for the subscales (US .60-.91 and Norway .61-.92). The EBPAS-36 has adequate psychometric properties both in US and Norwegian samples, hence indicating cross-cultural validity. It is a brief, pragmatic, and more user-friendly instrument than the EBPAS-50, yet maintains a broad scope by retaining the original 12 measurement domains.
Shiraev, Tim; Barclay, Gabriella
Aerobic exercise has a marked impact on cardiovascular disease risk. Benefits include improved serum lipid profiles, blood pressure and inflammatory markers as well as reduced risk of stroke, acute coronary syndrome and overall cardiovascular mortality. Most exercise programs prescribed for fat reduction involve continuous, moderate aerobic exercise, as per Australian Heart Foundation clinical guidelines. This article describes the benefits of exercise for patients with cardiovascular and metabolic disease and details the numerous benefits of high intensity interval training (HIIT) in particular. Aerobic exercise has numerous benefits for high-risk populations and such benefits, especially weight loss, are amplified with HIIT. High intensity interval training involves repeatedly exercising at a high intensity for 30 seconds to several minutes, separated by 1-5 minutes of recovery (either no or low intensity exercise). HIT is associated with increased patient compliance and improved cardiovascular and metabolic outcomes and is suitable for implementation in both healthy and 'at risk' populations. Importantly, as some types of exercise are contraindicated in certain patient populations and HIIT is a complex concept for those unfamiliar to exercise, some patients may require specific assessment or instruction before commencing a HIIT program.
Aronoff, Nell; Stellrecht, Elizabeth; Lyons, Amy G; Zafron, Michelle L; Glogowski, Maryruth; Grabowski, Jeremiah; Ohtake, Patricia J
The research assessed online learning modules designed to teach health professions students evidence-based practice (EBP) principles in an interprofessional context across two institutions. Students from nine health professions at two institutions were recruited to participate in this pilot project consisting of two online learning modules designed to prepare students for an in-person case-based interprofessional activity. Librarians and an instructional designer created two EBP modules. Students' competence in EBP was assessed before and after the modules as well as after the in-person activity. Students evaluated the online learning modules and their impact on the students' learning after the in-person session. A total of 39 students from 8 health professions programs participated in the project. Average quiz scores for online EBP module 1 and module 2 were 83% and 76%, respectively. Following completion of the learning modules, adapted Fresno test of competence in EBP scores increased ( p =0.001), indicating that the modules improved EBP skill competence. Student evaluations of the learning modules were positive. Students indicated that they acquired new information skills that contributed to their ability to develop a patient care plan and that they would use these information skills in their future clinical practice. Online EBP learning modules were effective in developing EBP knowledge and skills for health professions students. Using the same modules ensured that students from different health professions at different stages of their professional programs had consistent knowledge and enabled each student to fully engage in an interprofessional evidence-based activity. Student feedback indicated the modules were valued and beneficial.
Hutson, Elizabeth; Kelly, Stephanie; Militello, Lisa K
Cyberbullying is a new risk factor for the well-being of pediatric populations. Consequences of cyberbullying include both physical and mental health concerns such as depression, anxiety, and somatic concerns. Adolescents who have been victims of cyberbullying and developed secondary symptoms are often recommended to visit a healthcare provider to obtain effective, evidence-based treatment. To date, no interventions exist in the healthcare setting for adolescents who are victims of cyberbullying. The purpose of this project is to review interventional studies on cyberbullying that have components for adolescents who have been involved with cyberbullying and their parents and to provide recommendations on effective intervention components with the goal of guiding clinical practice. A systematic review was conducted using the Institute of Medicine guidelines. A comprehensive electronic literature search was completed targeting interventions of cyberbullying in any setting. No date limits were used. Literature was searched in MEDLINE, Cumulative Index of Nursing and Allied Health Literature (CINAHL), PubMed, Communication and Mass Media Complete, Education Information Resource Center (ERIC), and PsycINFO databases. The following search terms were applied "cyberbullying" + "intervention" or "treatment" or "therapy" or "program." Only articles with a pediatric population were selected for review. Seventeen cyberbullying intervention programs in 23 articles were found to meet the search criteria. The most frequently used intervention components included education on cyberbullying for the adolescent, coping skills, empathy training, communication and social skills, and digital citizenship. Parent education on cyberbullying was also found to be important and was included in programs with significant outcomes. As youth present to healthcare providers with symptoms related to cyberbullying, effective interventions are needed to guide evidence-based practice. This review
Hew, Khe Foon; Cheung, Wing Sum
Evidence-based practice in education entails making pedagogical decisions that are informed by relevant empirical research evidence. The main purpose of this paper is to discuss evidence-based pedagogical approaches related to the use of Web 2.0 technologies in both K-12 and higher education settings. The use of such evidence-based practice would…
Evidence-based practice requires that clinical decisions be based on evidence from rigorously controlled research studies. At this time, very few studies have directly examined the efficacy of clinical intervention methods for bilingual children. Clinical decisions for this population cannot, therefore, be based on the strongest forms of research evidence, but must be inferred from other sources. This article reviews the available intervention research on bilingual children, the current clinical recommendations for this population, and the strength of the empirical and theoretical support on which these recommendations are based. Finally, future directions are suggested for documenting current methods of intervention and developing optimal methods for different groups of bilingual children. Although the current research base is limited, the few studies available to date uniformly suggest that interventions that include a focus on both languages are superior to those that focus on only one language. The available research offers little guidance, however, as to the particular treatment methods that may be most appropriate. Further research is required to examine efficacy with larger numbers of children and children of various bilingual backgrounds. It is suggested that efforts to develop and test intervention methods for bilingual children must carefully consider the linguistic heterogeneity of bilingual children and the cultural variation in communication styles, child rearing practices, and child rearing beliefs. This will lead to the development of methods that may involve treatment methods that are more suitable for other languages and cultures. Readers will become familiar with current recommendations for the treatment of bilingual children with language impairment, including which language or languages to use, the requirement for cultural sensitivity, and specific procedures that may be beneficial for bilingual populations. The heterogeneity of the bilingual
Nunan, David; O'Sullivan, Jack; Heneghan, Carl; Pluddemann, Annette; Aronson, Jeffrey; Mahtani, Kamal
In this article we signpost readers to 10 papers we consider essential reading for anyone starting out on an evidence-based medicine journey. We have considered papers consisting a mix of old and new, seminal and cutting-edge that offer insight into what evidence-based medicine is, where it came from, why it matters and what it has achieved. This is balanced against some of the common criticisms of evidence-based medicine and efforts to tackle them. We have also highlighted papers acknowledging the importance of teaching and learning of the principles of evidence-based medicine and how health professionals can better use evidence in clinical decisions with patients. © 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.
Missal, Bernita; Schafer, Beth Kaiser; Halm, Margo A; Schaffer, Marjorie A
This article describes a partnership model between a university and health care organizations for teaching graduate nursing research from a framework of evidence-based practice. Nurses from health care organizations identified topics for graduate students to search the literature and synthesize evidence for guiding nursing practice. Nurse educators mentored graduate students in conducting critical appraisals of the literature. Students learned how to search for the evidence, summarize the existing research findings, and translate the findings into practice recommendations. Through presenting and discussing their findings with key stakeholders, students learned how nurses planned to integrate the evidence into practice. Nurses used the evidence-based results to improve their practice in the two partner hospitals. The partnership stimulated action for further inquiry into best practices.
Doran, Diane; Lefebre, Nancy; O'Brien-Pallas, Linda; Estabrook, Carole A; White, Peggy; Carryer, Jennifer; Sun, Winnie; Qian, Gan; Bai, Yu Qing; Li, Mingyang
Background There are gaps in knowledge about the extent to which home care nurses’ practice is based on best evidence and whether evidence-based practice impacts patient outcomes. Aim The purpose of this study was to investigate the relationship between evidence-based practice and client pain, dyspnea, falls, and pressure ulcer outcomes in the home care setting. Evidence-based practice was defined as nursing interventions based on best practice guidelines. Methods The Nursing Role Effectivene...
Patel, Minal R; Vichich, Jennifer; Lang, Ian; Lin, Jessica; Zheng, Kai
The introduction of health information technology systems, electronic health records in particular, is changing the nature of how clinicians interact with patients. Lack of knowledge remains on how best to integrate such systems in the exam room. The purpose of this systematic review was to (1) distill "best" behavioral and communication practices recommended in the literature for clinicians when interacting with patients in the presence of computerized systems during a clinical encounter, (2) weigh the evidence of each recommendation, and (3) rank evidence-based recommendations for electronic health record communication training initiatives for clinicians. We conducted a literature search of 6 databases, resulting in 52 articles included in the analysis. We extracted information such as study setting, research design, sample, findings, and implications. Recommendations were distilled based on consistent support for behavioral and communication practices across studies. Eight behavioral and communication practices received strong support of evidence in the literature and included specific aspects of using computerized systems to facilitate conversation and transparency in the exam room, such as spatial (re)organization of the exam room, maintaining nonverbal communication, and specific techniques that integrate the computerized system into the visit and engage the patient. Four practices, although patient-centered, have received insufficient evidence to date. We developed an evidence base of best practices for clinicians to maintain patient-centered communications in the presence of computerized systems in the exam room. Further work includes development and empirical evaluation of evidence-based guidelines to better integrate computerized systems into clinical care.
Foster, Margaret J; Shurtz, Suzanne; Pepper, Catherine
The research determined to what extent best practices are being followed by freely available online modules aimed at teaching critical thinking and evidence-based practices (EBPs) in health sciences fields. In phase I, an evaluation rubric was created after reviewing the literature. Individual rubric questions were assigned point values and grouped into sections, and the sections weighted. Phase II involved searching Internet platforms to locate online EBP modules, which were screened to determine if they met predetermined criteria for inclusion. Phase III comprised a first evaluation, in which two authors assessed each module, followed by a second evaluation of the top-scoring modules by five representatives from different health sciences units. The rubric's 28 questions were categorized into 4 sections: content, design, interactivity, and usability. After retrieving 170 online modules and closely screening 91, 42 were in the first evaluation and 8 modules were in the second evaluation. Modules in the first evaluation earned, on average, 59% of available points; modules in the second earned an average of 68%. Both evaluations had a moderate level of inter-rater reliability. The rubric was effective and reliable in evaluating the modules. Most modules followed best practices for content and usability but not for design and interactivity. By systematically collecting and evaluating instructional modules, the authors found many potentially useful elements for module creation. Also, by reviewing the limitations of the evaluated modules, the authors were able to anticipate and plan ways to overcome potential issues in module design.
Foster, Margaret J.; Shurtz, Suzanne; Pepper, Catherine
Objectives: The research determined to what extent best practices are being followed by freely available online modules aimed at teaching critical thinking and evidence-based practices (EBPs) in health sciences fields. Methods: In phase I, an evaluation rubric was created after reviewing the literature. Individual rubric questions were assigned point values and grouped into sections, and the sections weighted. Phase II involved searching Internet platforms to locate online EBP modules, which were screened to determine if they met predetermined criteria for inclusion. Phase III comprised a first evaluation, in which two authors assessed each module, followed by a second evaluation of the top-scoring modules by five representatives from different health sciences units. Results: The rubric's 28 questions were categorized into 4 sections: content, design, interactivity, and usability. After retrieving 170 online modules and closely screening 91, 42 were in the first evaluation and 8 modules were in the second evaluation. Modules in the first evaluation earned, on average, 59% of available points; modules in the second earned an average of 68%. Both evaluations had a moderate level of inter-rater reliability. Conclusions: The rubric was effective and reliable in evaluating the modules. Most modules followed best practices for content and usability but not for design and interactivity. Implications: By systematically collecting and evaluating instructional modules, the authors found many potentially useful elements for module creation. Also, by reviewing the limitations of the evaluated modules, the authors were able to anticipate and plan ways to overcome potential issues in module design. PMID:24415917
Green, Amy E; Aarons, Gregory A
The goal of this study was to assess potential differences between administrators/policymakers and those involved in direct practice regarding factors believed to be barriers or facilitating factors to evidence-based practice (EBP) implementation in a large public mental health service system in the United States. Participants included mental health system county officials, agency directors, program managers, clinical staff, administrative staff, and consumers. As part of concept mapping procedures, brainstorming groups were conducted with each target group to identify specific factors believed to be barriers or facilitating factors to EBP implementation in a large public mental health system. Statements were sorted by similarity and rated by each participant in regard to their perceived importance and changeability. Multidimensional scaling, cluster analysis, descriptive statistics and t-tests were used to analyze the data. A total of 105 statements were distilled into 14 clusters using concept-mapping procedures. Perceptions of importance of factors affecting EBP implementation varied between the two groups, with those involved in direct practice assigning significantly higher ratings to the importance of Clinical Perceptions and the impact of EBP implementation on clinical practice. Consistent with previous studies, financial concerns (costs, funding) were rated among the most important and least likely to change by both groups. EBP implementation is a complex process, and different stakeholders may hold different opinions regarding the relative importance of the impact of EBP implementation. Implementation efforts must include input from stakeholders at multiple levels to bring divergent and convergent perspectives to light.
Wright, John T; Crall, James J; Fontana, Margherita; Gillette, E Jane; Nový, Brian B; Dhar, Vineet; Donly, Kevin; Hewlett, Edmond R; Quinonez, Rocio B; Chaffin, Jeffrey; Crespin, Matt; Iafolla, Timothy; Siegal, Mark D; Tampi, Malavika P; Graham, Laurel; Estrich, Cameron; Carrasco-Labra, Alonso
This article presents evidence-based clinical recommendations for the use of pit-and-fissure sealants on the occlusal surfaces of primary and permanent molars in children and adolescents. A guideline panel convened by the American Dental Association (ADA) Council on Scientific Affairs and the American Academy of Pediatric Dentistry conducted a systematic review and formulated recommendations to address clinical questions in relation to the efficacy, retention, and potential side effects of sealants to prevent dental caries; their efficacy compared with fluoride varnishes; and a head-to-head comparison of the different types of sealant material used to prevent caries on pits and fissures of occlusal surfaces. This is an update of the ADA 2008 recommendations on the use of pit-and-fissure sealants on the occlusal surfaces of primary and permanent molars. The authors conducted a systematic search in MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and other sources to identify randomized controlled trials reporting on the effect of sealants (available on the US market) when applied to the occlusal surfaces of primary and permanent molars. The authors used the Grading of Recommendations Assessment, Development, and Evaluation approach to assess the quality of the evidence and to move from the evidence to the decisions. The guideline panel formulated 3 main recommendations. They concluded that sealants are effective in preventing and arresting pit-and-fissure occlusal carious lesions of primary and permanent molars in children and adolescents compared with the nonuse of sealants or use of fluoride varnishes. They also concluded that sealants could minimize the progression of noncavitated occlusal carious lesions (also referred to as initial lesions) that receive a sealant. Finally, based on the available limited evidence, the panel was unable to provide specific recommendations on the relative merits of 1 type of sealant material over the others. These
Undergraduate Information Literacy Instruction Is Not Enough to Prepare Junior Doctors for Evidence Based Practice. A Review of: Cullen, R., Clark, M., & Esson, R. (2011. Evidence-based information-seeking skills of junior doctors entering the workforce: An evaluation of the impact of information literacy training during pre-clinical years. Health Information & Libraries Journal, 28(2, 119-129. doi:10.1111/j.1471-1842.2011.00933.x
Carol D. Howe
systematic reviews as well as using “explode” and “focus”, which tied for the lowest rating. The observed searches on average were rated lower than the self-assessments on all but one parameter. None of the average scores for either the self-rating or the observer-rating approached “highly skilled”. Conclusion – The authors concluded that the information literacy instruction the participants received as undergraduates did not prepare them adequately for evidence-based practice. Even though most participants said they remembered their undergraduate information literacy instruction, neither the average scores for the self-rating nor the observer-rating approached “highly skilled”. From that they could surmise that the attainment of information literacy should be a career-long learning process, beginning with undergraduate instruction and extending throughout one’s clinical practice.The authors also found that the level of instruction cohorts received as undergraduates did not seem to correspond to their current ability. Cohort 1, who received no information literacy instruction as undergraduates, scored higher on average than cohorts 3 and 4 on the self-assessment and higher than cohorts 3, 4, and 5 on the observer assessment. Cohort 1 also used more evidence based sources than did cohort 4, who received the most training on evidence-based medicine. Cohorts 1 and 2 reported the most postgraduate information literacy instruction, leading the authors to postulate that the further along one is in his medical career, the more important evidence based practice, and thus information literacy instruction, becomes. Even with additional instruction, however, the participants did not seem prepared for evidence-based practice. The authors concluded that information literacy instruction during postgraduate training and clinical practice—possibly giving the doctor’s specialty consideration when designing instruction—might be more important than undergraduate
Middlebrooks, Reginald; Carter-Templeton, Heather; Mund, Angela R
. Describe interventions of the programs reviewed in the article that directly affect barriers to clinical nurses' adoption of EBP or the use of research. DISCLOSURE STATEMENT Neither the planners nor the author have any conflicts of interest to disclose. Individual barriers such as a lack of research awareness, electronic database navigation skills, and research comprehension prevent nurses from implementing evidence-based practice (EBP). The aim of this review article is to examine EBP programs and their influence on individual barriers among workforce nurses. A keyword search of online databases was conducted for original research published from 2004- 2015. A review of cited references and footnote searching of significant articles was conducted to identify additional relevant articles. Twenty articles met the inclusion criteria. Although there was great variation among EBP programs, the majority of participants reported increased awareness, value, belief, knowledge, and skill as it relates to research utilization and EBP. This review suggests that individual barriers to EBP may be influenced by clinically based EBP programs. However, a lack of randomized controlled studies and inconsistencies in measurement make it difficult to recommend best practices for developing EBP programs for nurses in the clinical setting. J Contin Educ Nurs. 2016;47(9):398-406. Copyright 2016, SLACK Incorporated.
Geng, V.; Cobussen-Boekhorst, H.; Farrell, J.; Gea Sánchez, Montserrat; PEARCE, I.; Schwennesen, T.; Vahr, S.; Vandewinkel, C.
Edició presentada al 13th International EAUN meeting, Paris 2012 Els autors son membres de la European Association of Urology Nurses Guidelines Office The EAUN Guidelines Working Group for indwelling catheters have prepared this guideline document to help nurses assess the evidence-based management of catheter care and to incorporate the guidelines’ recommendations into their clinical practice. These guidelines are not meant to be proscriptive, nor will adherence to these guidelines gua...
Kreiner, D Scott; Hwang, Steven W; Easa, John E; Resnick, Daniel K; Baisden, Jamie L; Bess, Shay; Cho, Charles H; DePalma, Michael J; Dougherty, Paul; Fernand, Robert; Ghiselli, Gary; Hanna, Amgad S; Lamer, Tim; Lisi, Anthony J; Mazanec, Daniel J; Meagher, Richard J; Nucci, Robert C; Patel, Rakesh D; Sembrano, Jonathan N; Sharma, Anil K; Summers, Jeffrey T; Taleghani, Christopher K; Tontz, William L; Toton, John F
. Twenty-nine clinical questions were formulated and addressed, and the answers are summarized in this article. The respective recommendations were graded by strength of the supporting literature, which was stratified by levels of evidence. The clinical guideline has been created using the techniques of evidence-based medicine and best available evidence to aid practitioners in the care of patients with symptomatic lumbar disc herniation with radiculopathy. The entire guideline document, including the evidentiary tables, suggestions for future research, and all the references, is available electronically on the NASS Web site at http://www.spine.org/Pages/PracticePolicy/ClinicalCare/ClinicalGuidlines/Default.aspx and will remain updated on a timely schedule. Copyright © 2014 Elsevier Inc. All rights reserved.
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
Farmer, Tod Allen
The study assessed the need for learning organizations to implement evidence-based policies and practices designed to enhance the academic and social success of Hispanic learners. Descriptive statistics and longitudinal data from the National Center for Educational Statistics (NCES) and the National Clearinghouse for English Language Acquisition…
Horner, Robert H.; Carr, Edward G.; Halle, James; McGee, Gail; Odom, Samuel; Wolery, Mark
Single-subject research plays an important role in the development of evidence-based practice in special education. The defining features of single-subject research are presented, the contributions of single-subject research for special education are reviewed, and a specific proposal is offered for using single-subject research to document…
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
Provan, K.; Beagles, J.; Mercken, L.; Leischow, S.J.
This research examines the awareness of evidence-based practices by the public organizations that fund services in the North American Quitline Consortium (NAQC). NAQC is a large, publicly funded, goal-directed “whole network,” spanning both Canada and the United States, working to get people to quit
Evidence based educational policy and practice means, first of all, that new programs use relevant scientific knowledge for design purposes, or for critical review of initial program ideas (ex ante evaluation). Secondly, before programs are implemented on a large scale it is considered desirable to
Becker, Sara J.; Spirito, Anthony; Vanmali, Roshani
Objective: Several national organisations in the USA have recently developed educational materials that encourage substance use disorder treatment consumers to seek out approaches supported by scientific evidence in order to promote the use of "evidence-based practice" (EBP). This study aimed to explore how adolescents (young people aged…
Haug, Nancy A.; Shopshire, Michael; Tajima, Barbara; Gruber, Valerie; Guydish, Joseph
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…
Bouffard, Marcel; Reid, Greg
The evidence-based practice (EBP) movement has been extremely influential over the last 20 years. Fields like medicine, physiotherapy, occupational therapy, nursing, psychology, and education have adopted the idea that policy makers and practitioners should use interventions that have demonstrated efficiency and effectiveness. This apparently…
Background: Current models of evidence-based practice marginalize and even silence the voices of those who are the potential beneficiaries of assessment and intervention. These missing voices can be found in the reflections of clients on their own life-world experiences. Aims: This paper examines how voices from the life-world are silenced in…
Leathers, Sonya J.; Strand, Tonya C.
Objective: This pilot study examined the effect of increasing field instructors access to information about evidence-based practices (EBPs) on their level of knowledge and attitudes about EBPs. Method: Eighteen field instructors received training and access to a library with extensive online journals. Half were randomly selected to also receive a…
Al-Almaie, Sameeh M.; Al-Baghli, Nadira
Introduction: Tremendous advances in health care have been made through the development of evidence-based medicine (EBM). Studies show that physicians face barriers in practice, preventing the effective use of the best evidence available. Insight into these barriers should pave the way for an action plan to remove them. The aim of this study was…
Griffiths, Yvonne; Stuart, Morag
There is now a strong evidence base from theory and research providing a "template" to inform practice at Wave 2, guiding the design and implementation of time-limited effective early intervention programmes for pupils identified as "at risk" of reading difficulties following initial literacy instruction (Rose, 2009). In…
Gromoske, Andrea N.; Berger, Lisa K.
Objective: To replicate the results of Parrish and Rubin's continuing education workshop in the evidence-based practice (EBP) process utilizing different workshop facilitators with participants in a different geographic location. Methods: We used a replicated, one-group pretest-posttest design with 3-month follow-up to evaluate the effectiveness…
Spooner, Fred; McKissick, Bethany R.; Knight, Victoria F.
The use of evidence-based practices (EBPs) was mandated with the passage of the No Child Left Behind Act of 2001 (NCLB), and continues with the Every Student Succeeds Act (ESSA). Accordingly, all children, including those with severe disabilities, must be taught both daily living and academic skills using EBPs. In this article, we synthesize,…
Background: The research on evidence-based practices (EBP) in special education has shifted over the last decade from identifying efficacious interventions to exploring issues that impede implementation in the classroom. Common barriers to implementation include absence of training and resources, limited collaboration between researchers and…
Madhavji, Asha; Araujo, Eustaquio A; Kim, Ki Beom; Buschang, Peter H
The purpose of this study was to evaluate the attitudes, awareness, and barriers toward evidence-based practice. A survey consisting of 35 questions pertaining to the use of scientific evidence in orthodontics was sent to 4771 members of the American Association of Orthodontists in the United States. Each respondent's age, attainment of a master's degree, and whether he or she was currently involved with teaching were ascertained. To minimize bias, the survey questions were phrased as an examination of the use of scientific literature in orthodontics. A total of 1517 surveys were received (response rate, 32%). Most respondents had positive attitudes toward, but a poor understanding of, evidence-based practice. The major barrier identified was ambiguous and conflicting research. Younger orthodontists were more aware, had a greater understanding, and perceived more barriers than did older orthodontists. Orthodontists involved in teaching were more aware, had a greater understanding, and reported fewer barriers than those not involved with teaching. Those with master's degrees had a greater understanding of evidence-based practice than those without degrees. Educational initiatives are needed to increase the understanding and use of evidence-based practice in orthodontics. Copyright © 2011 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.
Renshaw, Tyler L.; Young, K. Richard; Caldarella, Paul; Christensen, Lynnette
Researchers invested in school-wide positive behavior support (SWPBS) have been attempting to answer an important question: Is SWPBS an evidence-based practice (EBP; e.g., Sugai & Horner, 2007)? Given the context of educational policy, this question appears to be reasonable, as its answer could significantly influence funding and adoption of SWPBS…
Mitten, H. Rae
Evidence-based Practice Guidelines for Fetal Alcohol Spectrum Disorder (FASD) and Literacy and Learning are derived from an inductive analysis of qualitative data collected in field research. FASD is the umbrella term for a spectrum of neurocognitive and physical disabilities caused by prenatal exposure to alcohol. Data from a sample of N =150 was…
Barth, Richard P.; Lee, Bethany R.; Lindsey, Michael A.; Collins, Kathryn S.; Strieder, Frederick; Chorpita, Bruce F.; Becker, Kimberly D.; Sparks, Jacqueline A.
Social work is increasingly embracing evidence-based practice (EBP) as a decision-making process that incorporates the best available evidence about effective treatments given client values and preferences, in addition to social worker expertise. Yet, social work practitioners have typically encountered challenges with the application of…
Collins, Belva C.; Tekin-Iftar, Elif; Olcay-Gul, Seray
This article explores how international collaboration among researchers can contribute to developing evidence-based practices and disseminating knowledge in the field of special education. A review of a sample of special education journals published in English to identify articles written in collaboration by researchers from different countries is…
Wike, Traci L.; Bledsoe, Sarah E.; Bellamy, Jennifer L.; Grady, Melissa D.
Websites represent a visible medium for social work programs to communicate information about social work research, academics, and professional training priorities, including evidence-based practice (EBP). However, few studies have examined the content of social work program websites. This exploratory study aimed to answer the question: Are EBP…
Gillespie, Ann; Partridge, Helen; Bruce, Christine; Howlett, Alisa
Introduction: This paper presents the findings from a project that investigated the lived experiences of library and information professionals in relation to evidence-based practice within an Australian public library. Method: The project employed ethnography, which allows holistic description of people's experiences within a particular community…
Matthieu, Monica M.; Carter, Lorien; Casner, Robert W.; Edmond, Tonya E.
This study evaluated a continuing education training program designed to increase field educators' capacities to support students in their application of the evidence-based practice (EBP) process. A cohort of social work field instructors and task supervisors from agency-based settings (N = 186) attended a 1-day interactive skill-based training.…
Reddy, Linda A.; Forman, Susan G.; Stoiber, Karen C.; Gonzalez, Jorge E.
The present investigation examined 460 school psychology trainers' attitudes and beliefs about the conditions for the education and training of evidence-based practices (i.e., assessments and interventions) in training programs in the United States and Canada using an online survey. Trainer attitudes and beliefs about education and training in…
Troia, Gary A.; Olinghouse, Natalie G.
Although writing plays an important role in the academic, psychosocial, and economic success of individuals, typical writing instruction and assessment in the United States generally does not reflect evidence-based practices. The Common Core State Standards (CCSS) place a great deal of emphasis on written expression and may encourage an increased…
Cucciare, Michael A.; Weingardt, Kenneth R.
Information technology (IT) is increasingly being used to facilitate, complement, and support the implementation of evidence-based practices (EBP) in psychology. This article reviews recent randomised trials that evaluate the integration of IT applications into the process of delivering EBP. More specifically, we review 11 studies that illustrate…
Evidence-based treatments are increasingly important and necessary parts of many disciplines when working with very young children and their families. In using them, it is advantageous to be grounded in the principles and practices that research has shown are critical to children's healthy development, particularly the importance of supporting the…
Hoffman, LaVae M.; Ireland, Marie; Hall-Mills, Shannon; Flynn, Perry
Purpose: This study documented evidence-based practice (EBP) patterns as reported by speech-language pathologists (SLPs) employed in public schools during 2010-2011. Method: Using an online survey, practioners reported their EBP training experiences, resources available in their workplaces, and the frequency with which they engage in specific EBP…
Robinson, Deborah; Schulz, Ginny; Langley, Rachel; Donze, Kevin; Winchester, Kari
Hemorrhagic cystitis is a known complication of cyclophosphamide, an anti-neoplastic agent used to treat a variety of oncologic diseases in children. Hydration can prevent hemorrhagic cystitis; however, use varies in clinical practice. A team was assembled to develop evidence-based practice recommendations to address the following question: in a population of children with cancer, what is the appropriate pre and post hydration for the administration of different dose levels of intravenous cyclophosphamide to prevent bladder toxicity? The purpose was to identify the appropriate rate, duration and route of hydration to prevent bladder toxicity with low, intermediate and high dose cyclophosphamide. After a systematic search of the literature, 15 pieces of evidence were evaluated and used. There is a moderate level of quality evidence related to hydration for high dose cyclophosphamide and very low quality evidence related to intermediate or low dose cyclophosphamide. Three general recommendations were made for hydration associated with cyclophosphamide. There is a need for further research related to the prevention of bladder toxicity in children with cancer receiving cyclophosphamide. PMID:24799445
Boruff, Jill T; Thomas, Aliki
To ensure that physical and occupational therapy graduates develop evidence-based practice (EBP) competencies, their academic training must promote EBP skills, such as posing a clinical question and retrieving relevant literature, and the information literacy skills needed to practice these EBP skills. This article describes the collaborative process and outcome of integrating EBP and information literacy early in a professional physical therapy and occupational therapy programme. The liaison librarian and a faculty member designed an instructional activity that included a lecture, workshop and assignment that integrated EBP skills and information literacy skills in the first year of the programme. The assignment was designed to assess students' ability to conduct a search independently. The lecture and workshop were successful in their objectives, as 101 of the 104 students received at least 8 out of 10 points on the search assignment. The teaching activities developed for the students in this course appear to have achieved the goal of teaching students the EBP research cycle so that they might begin to emulate it. The collaboration between the faculty member and the librarian was integral to the success of this endeavour. Future work will include the evaluation of students' long-term retention of information literacy objectives. © 2011 The authors. Health Information and Libraries Journal © 2011 Health Libraries Group.
Ward, Alyssa M; Regan, Jennifer; Chorpita, Bruce F; Starace, Nicole; Rodriguez, Adriana; Okamura, Kelsie; Daleiden, Eric L; Bearman, Sarah Kate; Weisz, John R
This study sought to evaluate the agreement between therapist report and coder observation of therapy practices. The study sampled session data from a community-based, randomized trial of treatment for youth ages 7 to 13. We used therapist report of session content and coverage gathered using formal Consultation Records and developed complimentary records for coders to use when watching or listening to therapy tape. We established initial reliability between coders and then conducted a random, stratified, and comprehensive sample of sessions across youth (N = 121), therapists (N = 57), conditions (MATCH and Standard Manuals), and study sites (Honolulu and Boston) to code and compare with therapist record reports. Intraclass correlation coefficients (ICCs) representing coder versus therapist agreement on manual content delivered ranged from .42 to 1.0 across conditions and problem areas. Analyses revealed marked variability in agreement regarding whether behavioral rehearsals took place (ICCs from -.01 to 1.0) but strong agreement on client comprehension of therapy content and homework assignments. Overall, the findings indicate that therapists can be accurate reporters of the therapeutic practices they deliver, although they may need more support in reporting subtle but valuable aspects of implementation such as types of behavioral rehearsals. Developing means to support accurate reporting is important to developing future clinical feedback methodology applicable to the implementation of evidence-based treatments in the real world.
Drinkwater, Michael J.; Matthews, Kelly E.; Seiler, Jacob
While there is a wealth of research evidencing the benefits of active-learning approaches, the extent to which these teaching practices are adopted in the sciences is not well known. The aim of this study is to establish an evidential baseline of teaching practices across a bachelor of science degree program at a large research-intensive Australian university. Our purpose is to contribute to knowledge on the adoption levels of evidence-based teaching practices by faculty within a science degree program and inform our science curriculum review in practical terms. We used the Teaching Practices Inventory (TPI) to measure the use of evidence-based teaching approaches in 129 courses (units of study) across 13 departments. We compared the results with those from a Canadian institution to identify areas in need of improvement at our institution. We applied a regression analysis to the data and found that the adoption of evidence-based teaching practices differs by discipline and is higher in first-year classes at our institution. The study demonstrates that the TPI can be used in different institutional contexts and provides data that can inform practice and policy. PMID:28232589
Iwersen, Lisandra Fossari; Sperandio, Fabiana Flores; Toriy, Ariana Machado; Palú, Marina; Medeiros da Luz, Clarissa
Lower limb lymphedema (LLL) is characterized as a physical-functional chronic complication that impacts the quality of life of women who have gone through treatment for gynecological cancer. The present study aims to check the conservative treatments available for lymphedema after gynecological cancer in the context of evidence-based practice. The selection criteria included papers from May 1993 discussing treatment protocols used in LLL after treatment for gynecological cancer. The search was performed until October 2014 in MEDLINE, SciVerse, and PEDro using "rehabilitation," "treatment outcome," "therapeutics," "clinical protocol," "gynecologic surgery," "lower extremity," "lower limb," and "lymphedema" as keywords, focused on women with a previous diagnosis of gynecological cancer who received radiation and/or chemotherapy and/or surgery and/or lymphadenectomy as part of their treatment. From 110 studies found, 3 articles that used the complex decongestive therapy (CDT) as a treatment protocol were selected. There were no randomized clinical trials associated with the conservative treatment of LLL post-treatment of gynecological cancer. The three selected articles are retrospective, and had the same outcome - decreased volume of the affected limb lymphedema. Although LLL is more or as frequent and detrimental as upper limb lymphedema post-cancer treatment, there are only a few studies about this subject. Publications are even scarcer when considering studies with interventional approach. Randomized controlled trials are necessary to support rehabilitation resources on lymphedema post-gynecological cancer treatment.
Aasekjaer, Katrine; Waehle, Hilde Valen; Ciliska, Donna; Nordtvedt, Monica Wammen; Hjälmhult, Esther
Even though health professionals have a positive attitude toward evidence-based practice (EBP), they have limited skills when it comes to implementation of EBP. A postprofessional program in EPB has been offered at Bergen University College since 2004. To date, there is limited knowledge of how the graduates of the program implement and make use of the EBP principles in their working environment in different healthcare settings. The aim of the study was to explore the facilitators and strategies to successful implementation of the steps of EBP as experienced by health professionals who had completed a postgraduate program in EBP. Grounded theory was used in gathering and analyzing data from single and focus group interviews of 20 health professionals who had attended a postprofessional program in EBP. Inclusion criteria also required current clinical practice. This study identified a specific set of activities used by health professionals when implementing EBP within their service organization. Creating an interest and understanding of EBP amongst their colleagues appeared to be a challenge, which they addressed by using the generated grounded theory of "tailoring principles." The dominant condition of this theory was management involvement. This study highlighted the importance of middle-range managers' coordinating and supporting role as a decisive component in the process of implementing EBP to clinical settings in Norway. Moreover, the dynamic complex process of "tailoring principles" also showed how the production of a clinical protocol became an outcome of implementation effectiveness as well as input for further intervention effectiveness. Tailoring the principle of EBP to the organizational and cultural context facilitated the implementation of EBP. © 2016 Sigma Theta Tau International.
Hetrick, Sarah E; Parker, Alexandra G; Callahan, Patrick; Purcell, Rosemary
Within the field of evidence-based practice, a process termed 'evidence mapping' is emerging as a less exhaustive yet systematic and replicable methodology that allows an understanding of the extent and distribution of evidence in a broad clinical area, highlighting both what is known and where gaps in evidence exist. This article describes the general principles of mapping methodology by using illustrations derived from our experience conducting an evidence map of interventions for youth mental-health disorders. Evidence maps are based on an explicit research question relating to the field of enquiry, which may vary in depth, but should be informed by end-users. The research question then drives the search for, and collection of, appropriate studies utilizing explicit and reproducible methods at each stage. This includes clear definition of components of the research question, development of a thorough and reproducible search strategy, development of explicit inclusion and exclusion criteria, and transparent decisions about the level of information to be obtained from each study. Evidence mapping is emerging as a rigorous methodology for gathering and disseminating up-to-date information to end-users. Thoughtful planning and assessment of available resources (e.g. staff, time, budget) are required by those applying this methodology to their particular field of clinical enquiry given the potential scope of the work. The needs of the end-user need to be balanced with available resources. Information derived needs to be effectively communicated, with the uptake of that evidence into clinical practice the ultimate aim. © 2010 The Authors. Journal compilation © 2010 Blackwell Publishing Ltd.
Jablonski, Anita; Ersek, Mary
The purpose of this study was to determine the extent to which nursing home staff adhere to current evidence-based guidelines to assess and manage persistent pain experienced by elderly residents. A retrospective audit was conducted of the medical records of 291 residents of 14 long-term care facilities in western Washington State. Data revealed a gap between actual practice and current best practice. Assessment of persistent pain was limited primarily to intensity and location. Although pres...
Diaz, Clive; Drewery, Sian
In this article the authors consider how effective social work has been in terms of evidence-based policies and practice. They consider the role that "evidence" plays in policy making both in the wider context and, in particular, in relation to social work. The authors argue that there are numerous voices in the policy-making process and evidence only plays a minor role in terms of policy development and practice in social work.
S9 MOW CRD Graduate Health Sciences Education (GHSE) (SGS O&M); SGS R&D; Tri-Service Nursing Research Program (TSNRP): Defense Medical Research...Practice Program Implementation presented at/published to 2017 Triservice Nursing Research and Evidence-Based Practice Dissemination Course, Ellicott...residency programs. 3. Please know that if you are a Graduate Health Sciences Education student and your department has told you they cannot fund your
Vahideh Zareh Gavgani
Background and Objectives: Evidence based librarianship (EBL) was defined as “use of best available evidence from qualitative and quantitative research results and rational experience and decisions acquired from the daily practice of library”. However there are controversies about if the nature of EBL deals with library services or professional practice and if it needs a formal education or informal continuing education is enough? To shed light on this ambiguity, the aim of this study was to...
Lundgren, Lena; Amodeo, Maryann; Krull, Ivy; Chassler, Deborah; Weidenfeld, Rachel; de Saxe Zerden, Lisa; Gowler, Rebekah; Lederer, Jaime; Cohen, Alexander; Beltrame, Clelia
This national study of addiction-treatment organizations' implementation of evidence-based practices examines: (1) organizational/leadership factors associated with director (n = 212) attitudes regarding staff resistance to organizational change, and (2) organizational/staff factors associated with staff (n = 312) attitudes regarding evidence-based clinical training. Linear regression analyses, controlling for type of treatment unit, leadership/staff characteristics and organizational readiness to change, identified that directors who perceived their organization needed more guidance and had less staff cohesion and autonomy rated staff resistance to organizational change significantly higher. Staff with higher levels of education and greater agreement that their organization supported change had greater preference for evidence-based trainings. Federal addiction treatment policy should both promote education and training of treatment staff and organizational development of treatment CBOs. © American Academy of Addiction Psychiatry.
Anuradha, Chandramohan, E-mail: email@example.com [Department of Radiology, Christian Medical College, Vellore, Tamil Nadu 632 004 (India); Jacob, K.S., E-mail: firstname.lastname@example.org [Department of Psychiatry, Christian Medical College, Vellore, Tamil Nadu 632 004 (India); Specialist Mental Health Service for Older People, Suite 106, 64–68 Derby Street, Kingswood, Penrith 2750 (Australia); Shyamkumar, N.K., E-mail: email@example.com [Department of Radiology, Christian Medical College, Vellore, Tamil Nadu 632 004 (India); Sridhar, Gibikote, E-mail: firstname.lastname@example.org [Department of Radiology, Christian Medical College, Vellore, Tamil Nadu 632 004 (India)
Aim: We examinted the attitude, knowledge and perceived barriers to evidence-based practice of radiology (EBPR) among residents in radiology. Study design and setting: We used the McColl questionnaire (1) and the BARRIERS scale (2) to assess the issues among radiology trainees attending an annual refresher course. Ninety six residents from 32 medical colleges from Southern India attended the course. Results: Eighty (83.3%) residents, 55 male and 25 female of age range 24–34 years, consented and returned the questionnaire. The majority of the participants had a positive attitude towards EBPR. However, 45% were unaware of sources for evidence based literature although many had access to Medline (45%) and the internet (80%). The majority (70%) were aware of the common technical terms (e.g. odds ratio, absolute and relative risk) but other complex details (e.g. meta-analysis, clinical effectiveness, confidence interval, publication bias and number needed to treat) were poorly understood. Though majority of residents (59%) were currently following guidelines and protocols laid by colleagues within their departments, 70% of residents were interested in learning the skills of EBPR and were willing to appraise primary literature or systematic reviews by themselves. Insufficient time on the job to implement new ideas (70.1%); relevant literature is not being complied in one place (68.9%); not being able to understand statistical methods (68.5%) were considered to be the major barriers to EBPR. Training in critical appraisal significantly influence usage of bibliographic databases (p < 0.0001). Attitude of collegues (p = 0.006) influenced attitude of the trainees towards EBPR. Those with higher knowledge scores (p = 0.02) and a greater awareness of sources for seeking evidence based literature (p = 0.05) held stronger beliefs that EBPR significantly improved patient care. Conclusions: The large knowledge gap related to EBPR suggests the need to incorporate structured
Hafslund, Bjorg [Institute of Radiography, Faculty of Health and Social Sciences, Bergen University College, P.O. Box 7030, N-5020 Bergen (Norway)], E-mail: email@example.com; Clare, Judith; Graverholt, Birgitte; Wammen Nortvedt, Monica [Centre for Evidence Based Practice, Faculty of Health and Social Sciences, Bergen University College, Bergen (Norway)
Evidence-based practice (EBP) offers the integration of the best research evidence with clinical knowledge and expertise and patient values. EBP is a well known term in health care. This paper discusses the implementation of EBP into radiography and introduces the term evidence-based radiography. Evidence-based radiography is radiography informed and based on the combination of clinical expertise and the best available research-based evidence, patient preferences and resources available. In Norway, EBP in radiography is being debated and radiographers are discussing the challenges of implementing EBP in both academic and clinical practice. This discussion paper explains why EBP needs to be a basis for a radiography curriculum and a part of radiographers' practice. We argue that Norwegian radiographers must increase participation in research and developing practice within their specific radiographic domain.
Higa-McMillan, Charmaine; Kotte, Amelia; Jackson, David; Daleiden, Eric L
This study compared consistencies and discrepancies in usual care with practices derived from the evidence-base (PDEB) for youth anxiety in a public mental health system. Youth-level factors (diagnosis, functional impairment) as predictors of the discrepancies were also examined. Psychosocial and service data from 2485 youth with an anxiety disorder and/or receiving services for an anxiety treatment target were extracted. Therapists (N = 616) identified the treatment targets and practices youth received. Although many PDEB for youth anxiety were used by therapists in this sample, Exposure was only used in 15% of cases. Practices not consistent with youth anxiety treatment were also reported and included: PDEB for other conditions, practices common to all therapies, and practices that are not consistent with evidence-based care. Age and diagnosis predicted the delivery of PDEB for youth anxiety. Usual care incorporated many components of evidence-based care but was more diffuse and less focused on well-supported practices.
Background Evidence-based healthcare is not an easier approach to patient management, but should provide both clinicians and patients with greater confidence and trust in their mutual relationship. The intellectual embrace of evidence-based methods, coupled with clinical expertise and consideration of the patients individual uniqueness and requirements, is needed for all periodontal therapists if optimum care is the goal. One important element of evidence-based decision making in periodontology is the systematic review. Systematic reviews usually provide the periodontist with the highest level of evidence which should be taken into consideration when constructing any treatment plan in the dental clinic. However, reaching systematic reviews might be a time-consuming procedure that needs further personal skills. Methods In this paper, a chair-side novel approach to facilitate the incorporation of systematic reviews into daily periodontal practice is presented. It is based on three simple tools, namely, a list of suitable periodontics-related key words, a data bank of all up-to-date published systematic reviews in periodontology, and hand-made paper sheets to match the key words with their related systematic review statements. Results and Conclusions A primary validation of this method indicated the simplicity in learning and application. Keywords Chair-side; Evidence-based medicine; Periodontology; Systematic review PMID:22461868
Gone, Joseph P
The calls for evidence-based practice (EBP) and cultural competence (CC) represent two increasingly influential mandates within the mental health professions. Advocates of EBP seek to standardize clinical practice by ensuring that only treatment techniques that have demonstrated therapeutic outcomes under scientifically controlled conditions would be adopted and promoted in mental health services. Advocates of CC seek to diversify clinical practice by ensuring that treatment approaches are designed and refined for a multicultural clientele that reflects a wide variety of psychological orientations and life experiences. As these two powerful mandates collide, the fundamental challenge becomes how to accommodate substantive cultural divergences in psychosocial experience using narrowly prescriptive clinical practices and approaches, without trivializing either professional knowledge or cultural difference. In this Introduction to a special issue of Transcultural Psychiatry, the virtue of an interdisciplinary conversation between and among anthropologists, psychologists, psychiatrists, and social work researchers in addressing these tensions is extolled. © The Author(s) 2015.
Molfenter, Todd; Kim, Jee-Seon; Quanbeck, Andrew; Patel-Porter, Terry; Starr, Sandy; McCarty, Dennis
investigates the role of payers in evidence-based practice implementation using a randomized controlled design instead of case examples. The testing of the Advancing Recovery Framework is designed to broaden the understanding of the impact payers have on evidence-based practice (EBP) adoption. http://NCT01702142 (ClinicalTrials.gov registry, USA).
Netting, F; O'Connor, Mary
The need for using evidence-based macro practices is examined. EBP is viewed as practitioners recognizing client values and then using the most promising research to guide programmatic, organizational, community, and policy activities to facilitate change. There are multiple ways to search for evidence. The nature of evidence in macro practice will look different depending on the practice situation. Being able to assess the situation and recognize the context in which one is practicing will set the stage for how EBP should be defined. A set of questions are suggested to guide decision-making regarding the use and the management of evidence.
Hoagwood, Kimberly E; Kelleher, Kelly; Murray, Laura K; Jensen, Peter S
The present study examined implementation issues in adopting cognitive-behavioral therapies in routine clinical settings in four countries reflecting diverse cultures, languages, settings, and traditions. A Director's Systems Survey was administered prior to program implementation and one year later. Therapist ratings on attitudes about evidence-based practices and satisfaction were also gathered. All sites reported successful adoption of the program, although significant variations existed in fiscal support, family involvement, prior experience with cognitive-behavioral therapies, and plans for sustainability. Therapists' ratings indicated overall satisfaction with the implementation of the project. Findings from the Director's Systems Survey pointed to five factors facilitating implementation: 1) early adoption and guidance by innovative leaders (i.e., the Directors); 2) attention to the "fit" between the intervention model and local practices; 3) attention to front-end implementation processes (e.g., cultural adaptation, translation, training, fiscal issues); 4) attention to back-end processes early in the project (e.g., sustainability); and 5) establishing strong relationships with multiple stakeholders within the program setting. The implementation issues here mirror those identified in other studies of evidence-based practices uptake. Some of the obstacles to implementation of evidence-based practices may be generic, whereas issues such as the impact of political/economic instability, availability of translated materials, constitute unique stressors that differentially affect implementation efforts within specific countries.
Quanbeck, Andrew; Brown, Randall T; E Zgierska, Aleksandra; A Johnson, Roberta; Robinson, James M; Jacobson, Nora
Adoption of evidence-based practices takes place at a glacial place in healthcare. This research will pilot test an innovative implementation strategy - systems consultation -intended to speed the adoption of evidence-based practice in primary care. The strategy is based on tenets of systems engineering and has been extensively tested in addiction treatment. Three innovations have been included in the strategy - translation of a clinical practice guideline into a checklist-based implementation guide, the use of physician peer coaches ('systems consultants') to help clinics implement the guide, and a focus on reducing variation in practices across prescribers and clinics. The implementation strategy will be applied to improving opioid prescribing practices in primary care, which may help ultimately mitigate the increasing prevalence of opioid abuse and addiction. The pilot test will compare four intervention clinics to four control clinics in a matched-pairs design. A leading clinical guideline for opioid prescribing has been translated into a checklist-based implementation guide in a systematic process that involved experts who wrote the guideline in consultation with implementation experts and primary care physicians. Two physicians with expertise in family and addiction medicine are serving as the systems consultants. Each systems consultant will guide two intervention clinics, using two site visits and follow-up communication by phone and email, to implement the translated guideline. Mixed methods will be used to test the feasibility, acceptability, and preliminary effectiveness of the implementation strategy in an evaluation that meets standards for 'fully developed use' of the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, Maintenance). The clinic will be the primary unit of analysis. The systems consultation implementation strategy is intended to generalize to the adoption of other clinical guidelines. This pilot test is intended to prepare
Full Text Available Abstract Background Non-attendance rates in psychiatric outpatient clinics have been a topic of considerable interest. It is measured as an indicator of quality of service provision. Failed attendances add to the cost of care as well as having an adverse impact on patients leading to missing medications, delay in identifying relapses and increasing waiting list time. Recent trials have demonstrated that prompting letters sent to patients led to a decrease in non-attendance rates. We applied this evidence based practice in our community mental health setting to evaluate its impact. Methods Using a before and after study design, we sent prompting letters to all patients due to attend outpatient clinic appointments for a period of six months in 2007. Non-attendance rates were compared with the corresponding period in 2006. We also looked at trends of non-attendance prior to this intervention and compared results with other parts of our service where this intervention had not been applied. Results 1433 prompting letters were sent out to all out-patient appointments made from June to November 2007. This resulted in an average non-attendance rate of 17% which was significantly less compared to 27% between June and November 2006 (RR 0.65, 95% CI 0.56 to 0.76, NNT 11. No downward trend in non-attendance rate was identified either prior to the intervention or when compared with similar teams across the city. Conclusion Prompt letters have been shown to reduce non-attendance rates in previous RCTs and systematic reviews. Our findings demonstrate a reduction in non-attendance rates with prompting letters even under non-trial conditions. Majority of the patients were constant during the two periods compared although there were some changes in medical personnel. This makes it difficult to attribute all the change, solely to the intervention alone. Perhaps our work shows that the results of pragmatic randomised trials are easily applicable and produce similar
Rotheram-Fuller, Erin J; Swendeman, Dallas; Becker, Kimberly D; Daleiden, Eric; Chorpita, Bruce; Harris, Danielle M; Mercer, Neil T; Rotheram-Borus, Mary Jane
Introduction Strategies are needed to improve the efficacy of paraprofessional home visitors for pregnant women in the United States. This study evaluates the maternal and child outcomes when evidence-based practices (EBP) are replicated with flexibility, rather than fidelity to a manualized intervention. Methods Pregnant mothers (N = 203) in five clinics were recruited in the waiting rooms and randomized to standard clinic care as the control condition (n = 104) or standard care plus home visiting (n = 99). Home visitors (n = 9) were selected, trained in foundational skills common to EBP and four problem domains (weight control, breastfeeding, daily habits, and depression). Independent interviewers assessed targeted outcomes at birth (82%) and 6 months later (83%). Home visitors, called Mentor Mothers [MM], made an average of 14.9 home visits or telephone contacts (SD = 9; total contacts = 1491) addressing maternal daily habits, breastfeeding, and depression. Intervention and control mothers were similar in weight, Body Mass Index (BMI), depression and social support at baseline and 6 months later. The percentage of low birth weight babies was similar; intervention infants' growth (weight/height Z score) tended to be significantly better compared to the control condition. There are many explanations for the failure to find significant benefits: insufficient statistical power; the benefits of repeated assessments by warm, supportive peers to improve outcomes; or the failure of EBP and the need to maintain replication with fidelity. All study mothers had better outcomes than documented among comparable published samples of low-income, Latina and Korean-American mothers in Los Angeles, CA. ClinicalTrials.gov registration NCT01687634.
Shahtahmasebi, Said; Villa, Luis; Nielsen, Helen; Graham-Smith, Hilary
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).
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.
Newhouse, Robin P
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.
Full Text Available Abstract Background To assess the effectiveness (change in knowledge and skills measured by the Fresno test of a short course in Evidence Based Practice (EBP carried out in a group of family medicine residents Methods Before-after study. Participants' were 152 Family Medicine residents in their second year of the training programme. Settings were Primary Care Teaching Units in Catalonia. Intervention was comprised of a four half-day training course designed to develop the knowledge and skills required to practice evidence-based care. The main outcome measure was change in EBP knowledge and skills, measured using the Spanish version of the Fresno test (score range, 0-212 Results The mean difference between pre-test and post-test was 47.7, a statistically significant result with 95% CI of 42.8-52.5 (p Conclusions The study provides evidence for responsiveness to changes in knowledge and skills in EBP after an educational intervention.
Murphy, Tamara H; Labonte, Paula; Klock, Monica; Houser, Larry
The purpose of this article is to describe and measure the impact of a multifaceted program developed to reduce the falls rate on an acute medical unit at an academic tertiary care center. According to national benchmarks, this unit was one of the hospital's top 3 units for numbers of falls for several years. That distinction drove the hospital and unit leadership and a staff-led unit practice council to develop an evidence-based intervention plan. Interventions included a campaign to raise geriatric awareness, creation of "falls tool boxes," education of staff and family, and implementation of a structured hourly patient rounds schedule. The success of these interventions is discussed, including the effect on the falls rate benchmark. The discussion addresses implications and outcomes associated with the empowerment of nursing staff to respond to benchmarking measures, implement evidence-based practices, and use the same benchmarking procedure to measure outcomes.
Full Text Available Background: An experience serving jury duty prompted reflection on the parallels between evidenced based medicine and our legal system. Findings: The steps of the legal system can be tied to each step of the practice of evidenced based medicine. Implications: Patients should be included in evidence based decisions. Pharmacists can act as resources for other providers practicing evidenced based medicine. Educators can use this analogy to teach evidence based medicine. Conflict of Interest We declare no conflicts of interest or financial interests that the authors or members of their immediate families have in any product or service discussed in the manuscript, including grants (pending or received, employment, gifts, stock holdings or options, honoraria, consultancies, expert testimony, patents and royalties. Type: Commentary
Green Amy E
Full Text Available Abstract Background The goal of this study was to assess potential differences between administrators/policymakers and those involved in direct practice regarding factors believed to be barriers or facilitating factors to evidence-based practice (EBP implementation in a large public mental health service system in the United States. Methods Participants included mental health system county officials, agency directors, program managers, clinical staff, administrative staff, and consumers. As part of concept mapping procedures, brainstorming groups were conducted with each target group to identify specific factors believed to be barriers or facilitating factors to EBP implementation in a large public mental health system. Statements were sorted by similarity and rated by each participant in regard to their perceived importance and changeability. Multidimensional scaling, cluster analysis, descriptive statistics and t-tests were used to analyze the data. Results A total of 105 statements were distilled into 14 clusters using concept-mapping procedures. Perceptions of importance of factors affecting EBP implementation varied between the two groups, with those involved in direct practice assigning significantly higher ratings to the importance of Clinical Perceptions and the impact of EBP implementation on clinical practice. Consistent with previous studies, financial concerns (costs, funding were rated among the most important and least likely to change by both groups. Conclusions EBP implementation is a complex process, and different stakeholders may hold different opinions regarding the relative importance of the impact of EBP implementation. Implementation efforts must include input from stakeholders at multiple levels to bring divergent and convergent perspectives to light.
Ashktorab; Pashaeypoor; Rassouli; Alavi-Majd
Background Evidence-Based Practice (EBP) is one of the nursing professional roles that can lead them to provide the best and more effective care. However, no studies are available on nursing students’ competencies in EBP. Objectives This study aimed to investigate the nursing students’ knowledge, attitude and intention to implement EBP and its related factors in two nursing and midwifery faculties in Tehran, Iran. ...
Reviewed by Yasin OZARSLAN
EFFECTIVE BLENDED LEARNING PRACTICES:Evidence-based Perspectives in ICT-facilitated EducationEdited by Elizabeth Stacey and Philippa Gerbic, Information ScienceReference; 1 edition (March 30, 2009), ISBN-10: 1605662968, 358 pp.Reviewed by Yasin OZARSLANFaculty of Education,Eskisehir Osmangazi University,Eskisehir-TURKEYBlended learning refers to the integration of faceto-face and online learning activities with the goal of maximizing the value of students' experiences in both settings. This b...
Pipe, Teri Britt
An emerging challenge for nursing leadership is how to convey the importance of both evidence-based practice (EBP) and theory-driven care in ensuring patient safety and optimizing outcomes. This article describes a specific example of a leadership strategy based on Rosswurm and Larrabee's model for change to EBP, which was effective in aligning the processes of EBP and theory-driven care.
da Luz, Clarissa Medeiros; Deitos, Julia; Siqueira, Thais Cristina; Palú, Marina; Heck, Ailime Perito Feiber
Abstract Axillary web syndrome is characterized as a physical-functional complication that impacts the quality of life of women who have undergone treatment for breast cancer. The present study aims to verify the physiotherapy treatment available for axillary web syndrome after surgery for breast cancer in the context of evidence-based practice. The selection criteria included papers discussing treatment protocols used for axillary web syndrome after treatment for breast cancer. The search wa...
Rangachari, Pavani; Rissing, Peter; Rethemeyer, Karl
This article offers a scholarly review and perspective on the potential of "implementation research" to generate incremental, context-sensitive, evidence-based management strategies for the successful implementation of evidence-based practices (EBPs) (such as the "central line bundle"). Many hospitals have difficulty consistently implementing EBPs at the unit level. This problem has been broadly characterized as "change implementation failure" in health care organizations. The popular hospital response to this challenge has been to raise clinician awareness of EBPs through mandated educational programs. However, this approach has not always succeeded in changing practice. The health services research literature has emphasized the role of several organizational variables (eg, leadership, safety culture, organizational learning, teamwork and communication, and physician/staff engagement) in successful change implementation. Correspondingly, this literature has developed broad frameworks and programs for change in health care organizations. While these broad change frameworks have been successfully applied by some facilities to change practice, they are not incrementally actionable. As such, several facilities have not leveraged broad change frameworks because of resource and/or contextual limitations; a majority of hospitals continue to resort to mandated clinician education (awareness-building) for change implementation. The recent impetus toward "implementation research" in health care has the potential to generate incremental, context-sensitive, evidence-based management strategies for practice change. Authors discuss specific insights from a recently completed study on central line bundle implementation in 2 intensive care units in an academic health center. The study demonstrates that awareness of EBPs alone does not translate to implementation. More importantly, the study also identifies incremental, context-sensitive, evidence-based management strategies for
Maricutoiu, Laurentiu P.; Sava, Florin A.
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-bas...
Herr, Keela; Titler, Marita; Fine, Perry; Sanders, Sara; Cavanaugh, Joe; Swegle, John; Forcucci, Chris; Tang, Xiongwen
The aim of this article is to report on current provider evidence-based assessment and treatment practices for older adults with cancer in community-based hospice settings. Using the Cancer Pain Practices Index (CPPI), a tool developed by the researchers to measure evidence-based pain management practices, patients received an average of 32% of the those key evidence-based practices (EBPs) that were applicable to their situation. When examining individual practices, the majority of patients had their pain assessed at admission using a valid pain scale (69.7%) and had primary components of a comprehensive assessment completed at admission (52.7%); most patients with admission reports of pain had an order for pain medication (83.5%). However, data revealed a number of practice gaps including: additional components of a comprehensive assessment completed within 48 hours of admission (0%); review of the Pain Treatment Plan at each reassessment (35.7%); reassessment of moderate or greater pain (5.3%); consecutive pain reports of 5 or greater followed by pain medication increases (15.8%); monitoring of analgesic- induced side effects (19.3%); initiation of a bowel regimen for patients with an opioid order (32.3%); and documentation of both non-pharmacological therapies (22.5%) and written pain management plans (0.6%). Findings highlight positive EBPs and areas for improving the translation of EBPs into practice. Data suggest that cancer pain is not being documented as consistently assessed, reassessed or treated in a manner consistent with current EBP recommendations for older adults with cancer in community-based hospices. PMID:20471542
Shuval, Kerem; Shachak, Aviv; Linn, Shai; Brezis, Mayer; Reis, Shmuel
To date, primary care doctors' (PCDs) evidence-based medicine (EBM) skills have rarely been studied. We conducted a cross-sectional study to evaluate PCDs' practical EBM skills and to determine risk markers associated with these skills. The study sample consisted of 70 PCDs (70.7% response rate) practising in a busy urban setting from a large health maintenance organization. Participants were given a short validated questionnaire gauging attitudes, barriers, online medical resources utilization, as well as demographic and personal characteristics. Additionally, doctors completed an online and written exam evaluating their ability to formulate clinical questions, and retrieve medical information efficiently. Data analysis was performed using both bivariate and multivariate analysis (linear regression). PCDs found it difficult to formulate clinical questions both in the written and online exam, mostly neglecting to mention the Patient and Comparison components of PICO (patient, intervention, comparison and outcome). Search strategies primarily dispensed with the use of MeSH terms, ignoring appropriate limits. Doctors final scores were low (score = 41.5/100, SD = 16.2). In bivariate analysis clinical experience was negatively correlated with the final score (r = -0.36, P = 0.01), and specialists' scores were significantly higher than general practitioners' scores (46.7/100 and 31.5/100 respectively, P < 0.001). In multivariate analysis, doctors specialization was the only statistically significant predictor of the final score (B = 12.74, P = 0.002), while controlling for participating in a prior EBM course. This study emphasizes the need for enhancing PCDs practical EBM skills. Future research and interventions should focus on this population emphasizing the specific needs of subpopulations (i.e. general practitioners and doctors without previous EBM training).
Background The purpose of this article is to report on the quality of the existing evidence base regarding the effectiveness of clinical pathway (CPW) research in the hospital setting. The analysis is based on a recently published Cochrane review of the effectiveness of CPWs. Methods An integral component of the review process was a rigorous appraisal of the methodological quality of published CPW evaluations. This allowed the identification of strengths and limitations of the evidence base for CPW effectiveness. We followed the validated Cochrane Effective Practice and Organisation of Care Group (EPOC) criteria for randomized and non-randomized clinical pathway evaluations. In addition, we tested the hypotheses that simple pre-post studies tend to overestimate CPW effects reported. Results Out of the 260 primary studies meeting CPW content criteria, only 27 studies met the EPOC study design criteria, with the majority of CPW studies (more than 70 %) excluded from the review on the basis that they were simple pre-post evaluations, mostly comparing two or more annual patient cohorts. Methodologically poor study designs are often used to evaluate CPWs and this compromises the quality of the existing evidence base. Conclusions Cochrane EPOC methodological criteria, including the selection of rigorous study designs along with detailed descriptions of CPW development and implementation processes, are recommended for quantitative evaluations to improve the evidence base for the use of CPWs in hospitals. PMID:22709274
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.
Hugenholtz, Nathalie I R; Nieuwenhuijsen, Karen; Sluiter, Judith K; van Dijk, Frank J H
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. 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. 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. 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.
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
van Dijk Frank JH
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.
Blackman, Ian R; Giles, Tracey M
In order to meet national Australian nursing registration requisites, nurses need to meet competency requirements for evidence-based practices (EBPs). A hypothetical model was formulated to explore factors that influenced Australian nursing students' ability and achievement to understand and employ EBPs related to health care provision. A nonexperimental, descriptive survey method was used to identify self-reported EBP efficacy estimates of 375 completing undergraduate nursing students. Factors influencing participants' self-rated EBP abilities were validated by Rasch analysis and then modeled using the partial least squares analysis (PLS Path) program. Graduating nursing students' ability to understand and apply EBPs for clinical improvement can be directly and indirectly predicted by eight variables including their understanding in the analysis, critique and synthesis of clinically based nursing research, their ability to communicate research to others and whether they had actually witnessed other staff delivering EBP. Forty-one percent of the variance in the nursing students' self-rated EBP efficacy scores is able to be accounted for by this model. Previous exposure to EBP studies facilitates participants' confidence with EBP, particularly with concurrent clinical EBP experiences. © 2017 Sigma Theta Tau International.
Full Text Available Abstract Background Collaborative-care management is an evidence-based practice for improving depression outcomes in primary care. The Department of Veterans Affairs (VA has mandated the implementation of collaborative-care management in its satellite clinics, known as Community Based Outpatient Clinics (CBOCs. However, the organizational characteristics of CBOCs present added challenges to implementation. The objective of this study was to evaluate the effectiveness of evidence-based quality improvement (EBQI as a strategy to facilitate the adoption of collaborative-care management in CBOCs. Methods This nonrandomized, small-scale, multisite evaluation of EBQI was conducted at three VA Medical Centers and 11 of their affiliated CBOCs. The Plan phase of the EBQI process involved the localized tailoring of the collaborative-care management program to each CBOC. Researchers ensured that the adaptations were evidence based. Clinical and administrative staff were responsible for adapting the collaborative-care management program for local needs, priorities, preferences and resources. Plan-Do-Study-Act cycles were used to refine the program over time. The evaluation was based on the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance Framework and used data from multiple sources: administrative records, web-based decision-support systems, surveys, and key-informant interviews. Results Adoption: 69.0% (58/84 of primary care providers referred patients to the program. Reach: 9.0% (298/3,296 of primary care patients diagnosed with depression who were not already receiving specialty care were enrolled in the program. Fidelity: During baseline care manager encounters, education/activation was provided to 100% (298/298 of patients, barriers were assessed and addressed for 100% (298/298 of patients, and depression severity was monitored for 100% (298/298 of patients. Less than half (42.5%, 681/1603 of follow-up encounters during the acute
Hickman, Louise D; DiGiacomo, Michelle; Phillips, Jane; Rao, Angela; Newton, Phillip J; Jackson, Debra; Ferguson, Caleb
The nursing profession has a significant evidence to practice gap in an increasingly complex and dynamic health care environment. To evaluate effectiveness of teaching and learning strategies related to a capstone project within a Masters of Nursing program that encourage the development of evidence based practice capabilities. Systematic review that conforms to the PRISMA statement. Master's Nursing programs that include elements of a capstone project within a university setting. MEDLINE, CINAHL, Cochrane Database of Systematic Reviews, ERIC and PsycInfo were used to search for RCT's or quasi experimental studies conducted between 1979 and 9 June 2017, published in a peer reviewed journal in English. Of 1592 studies, no RCT's specifically addressed the development of evidence based practice capabilities within the university teaching environment. Five quasi-experimental studies integrated blended learning, guided design processes, small group work, role play and structured debate into Masters of Nursing research courses. All five studies demonstrated some improvements in evidence based practice skills and/or research knowledge translation, with three out of five studies demonstrating significant improvements. There is a paucity of empirical evidence supporting the best strategies to use in developing evidence based practice skills and/or research knowledge translation skills for Master's Nursing students. As a profession, nursing requires methodologically robust studies that are discipline specific to identify the best approaches for developing evidence-based practice skills and/or research knowledge translation skills within the university teaching environment. Provision of these strategies will enable the nursing profession to integrate the best empirical evidence into nursing practice. Copyright © 2018. Published by Elsevier Ltd.
Maria Tereza Scardua Mariano
of randomized allocation, blinding and control group is essential for a critical reading; selecting those articles that deserve credibility. Among so many publications one needs to identify precisely about what must be incorporated to his knowledge as well as to the clinical practices.
Ficarra, Laura; Quinn, Kevin
In the present investigation, teachers' self-reported knowledge and competency ratings for the evidence-based classroom management practices were analysed. Teachers also reflected on how they learned evidence-based classroom management practices. Results suggest that teachers working in schools that implement Positive Behavioural Interventions and…
Harper, Nevin J.
Evidence-based practice is an approach that narrowly classifies research results by utilising a hierarchy of evidence. This process renders much available knowledge and experience redundant within its value structure. Currently a dominating ideology across medical and health fields, evidence-based practice is now being promoted in adventure…
Bussières, André E; Al Zoubi, Fadi; Stuber, Kent; French, Simon D; Boruff, Jill; Corrigan, John; Thomas, Aliki
Evidence-based practice (EBP) gaps are widespread across health disciplines. Understanding factors supporting the uptake of evidence can inform the design of strategies to narrow these EBP gaps. Although research utilization (RU) and the factors associated with EBP have been reported in several health disciplines, to date this area has not been reviewed comprehensively in the chiropractic profession. The purpose of this review was to report on the current state of knowledge on EBP, RU, and knowledge translation (KT) in chiropractic. A scoping review using the Arksey and O'Malley framework was used to systematically select and summarize existing literature. Searches were conducted using a combination of keywords and MeSH terms from the earliest date available in each database to May 2015. Quantitative and thematic analyses of the selected literature were conducted. Nearly 85 % (56/67) of the included studies were conducted in Canada, USA, UK or Australia. Thematic analysis for the three categories (EBP, RU, KT) revealed two themes related to EBP (attitudes and beliefs of chiropractors; implementation of EBP), three related to RU (guideline adherence; frequency and sources of information accessed; and perceived value of websites and search engines), and three related to KT (knowledge practice gaps; barriers and facilitators to knowledge use; and selection, tailoring, and implementation of interventions). EBP gaps were noted in the areas of assessment of activity limitation, determination of psychosocial factors influencing pain, general health indicators, establishing a prognosis, and exercise prescription. While most practitioners believed EBP and research to be important and a few studies suggested that traditional and online educational strategies could improve patient care, use of EBP and guideline adherence varied widely. Findings suggest that the majority of chiropractors hold favourable attitudes and beliefs toward EBP. However, much remains to be done for
Beck, Anne Marie; Iepsen, Ulrik Winning; Topperup, Randi
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...... 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...
Pearce, Warren; Raman, Sujatha; Turner, Andrew
Randomised trials can provide excellent evidence of treatment benefit in medicine. Over the last 50 years, they have been cemented in the regulatory requirements for the approval of new treatments. Randomised trials make up a large and seemingly high-quality proportion of the medical evidence-base. However, it has also been acknowledged that a distorted evidence-base places a severe limitation on the practice of evidence-based medicine (EBM). We describe four important ways in which the evidence from randomised trials is limited or partial: the problem of applying results, the problem of bias in the conduct of randomised trials, the problem of conducting the wrong trials and the problem of conducting the right trials the wrong way. These problems are not intrinsic to the method of randomised trials or the EBM philosophy of evidence; nevertheless, they are genuine problems that undermine the evidence that randomised trials provide for decision-making and therefore undermine EBM in practice. Finally, we discuss the social dimensions of these problems and how they highlight the indispensable role of judgement when generating and using evidence for medicine. This is the paradox of randomised trial evidence: the trials open up expert judgment to scrutiny, but this scrutiny in turn requires further expertise.
Marshall, Joanne Gard
The lecture explores the origins of evidence-based practice (EBP) in health sciences librarianship beginning with examples from the work of Janet Doe and past Doe lecturers. Additional sources of evidence are used to document the rise of research and EBP as integral components of our professional work. FOUR SOURCES OF EVIDENCE ARE USED TO EXAMINE THE RISE OF EBP: (1) a publication by Doe and research-related content in past Doe lectures, (2) research-related word usage in articles in the Bulletin of the Medical Library Association and Journal of the Medical Library Association between 1961 and 2010, (3) Medical Library Association activities, and (4) EBP as an international movement. These sources of evidence confirm the rise of EBP in health sciences librarianship. International initiatives sparked the rise of evidence-based librarianship and continue to characterize the movement. This review shows the emergence of a unique form of EBP that, although inspired by evidence-based medicine (EBM), has developed its own view of evidence and its application in library and information practice. Health sciences librarians have played a key role in initiating, nurturing, and spreading EBP in other branches of our profession. Our close association with EBM set the stage for developing our own EBP. While we relied on EBM as a model for our early efforts, we can observe the continuing evolution of our own unique approach to using, creating, and applying evidence from a variety of sources to improve the quality of health information services.
This guest feature from Suzanne Lewis, a long-time advocate of evidence based library and information practice (EBLIP) in Australia, discusses a current trend within the movement that focuses on the skills, knowledge and competencies of health librarians. In particular, the feature describes three specific Australia-based research projects, on expert searching, indigenous health and future skills requirements for the health library workforce respectively, that exemplify this trend. These projects illustrate how the evidence base can be strengthened around the skills and knowledge required to deliver services that continue to meet the changing needs of health library and information users. © 2011 The authors. Health Information and Libraries Journal © 2011 Health Libraries Group.
M. Amparo Pérez-Campos
Full Text Available Objective. to determine the evidence-based practice (EBP competence of Spanish and Latin-American nurses participating in professional forums on the Internet and estimate the influence of socio-demographic and professional factors on their competence, which was defined as knowledge of, attitude towards, and implementation of EBP. Methodology: An online survey was administered to a convenience sample of nurses active in Internet forums, comprising validated Spanish versions of the Evidence-Based Practice Questionnaire (EBPQ and Practice Environment Scale of the Nursing Work Index (PES-NWI and socio-demographics and professional variables. Results: 314 questionnaires were obtained (76.96%. The mean EBPQ score was 5.02 out of 7 (95%CI, 4.89-5.14. The variables associated with a higher competence in EBP were academic level, (p<03001, professional category (p=0.001, country of work (p<0.001, perception of practice environment (p=0,018 and research activities (p<0,036. Conclusions: These nurses showed a moderate level of EBP competence. They revealed a positive attitude towards EBP and achieved intermediate scores in both EBP-related skills and knowledge and their implementation. Higher academic levels and professional categories were associated with greater EBP competence. A practice environment perceived to be unfavorable has a negative influence on EBP implementation.
Solomons, Nan M; Spross, Judith A
The purpose of the present study is to examine the barriers and facilitators to evidence-based practice (EBP) using Shortell's framework for continuous quality improvement (CQI). EBP is typically undertaken to improve practice. Although there have been many studies focused on the barriers and facilitators to adopting EBP, these have not been tied explicitly to CQI frameworks. CINAHL, Academic Search Premier, Medline, Psych Info, ABI/Inform and LISTA databases were searched using the keywords: nurses, information literacy, access to information, sources of knowledge, decision making, research utilization, information seeking behaviour and nursing practice, evidence-based practice. Shortell's framework was used to organize the barriers and facilitators. Across the articles, the most common barriers were lack of time and lack of autonomy to change practice which falls within the strategic and cultural dimensions in Shortell's framework. Barriers and facilitators to EBP adoption occur at the individual and institutional levels. Solutions to the barriers need to be directed to the dimension where the barrier occurs, while recognizing that multidimensional approaches are essential to the success of overcoming these barriers. The findings of the present study can help nurses identify barriers and implement strategies to promote EBP as part of CQI. © 2010 The Authors. Journal compilation © 2010 Blackwell Publishing Ltd.
Full Text Available Teaching Evidence Based Medicine (EBM helps medical students to develop their decision making skills based on current best evidence, especially when it is taught in a clinical context. Few medical schools integrate Evidence Based Medicine into undergraduate curriculum, and those who do so, do it at the academic years only as a standalone (classroom teaching but not at the clinical years. The College of Medicine at King Saud bin Abdulaziz University for Health Sciences was established in January 2004. The college adopted a four-year Problem Based Learning web-based curriculum. The objective of this paper is to present our experience in the integration of the EBM in the clinical phase of the medical curriculum. We teach EBM in 3 steps: first step is teaching EBM concepts and principles, second is teaching the appraisal and search skills, and the last step is teaching it in clinical rotations. Teaching EBM at clinical years consists of 4 student-centered tutorials. In conclusion, EBM may be taught in a systematic, patient centered approach at clinical rounds. This paper could serve as a model of Evidence Based Medicine integration into the clinical phase of a medical curriculum.
This article adds to the growing body of literature on the use of evidence-based practice (EBP) in social work. Specifically, it examines a 9-hour EBP educational model designed to prepare MSW students for appropriate decision-making strategies in working with multicultural client populations. The model places emphasis on identification and…
Sommerfeld David H
Full Text Available Abstract Background The goal of this study is to extend research on evidence-based practice (EBP implementation by examining the impact of organizational type (public versus private and organizational support for EBP on provider attitudes toward EBP and EBP use. Both organization theory and theory of innovation uptake and individual adoption of EBP guide the approach and analyses in this study. We anticipated that private sector organizations would provide greater levels of organizational support for EBPs leading to more positive provider attitudes towards EBPs and EBP use. We also expected attitudes toward EBPs to mediate the association of organizational support and EBP use. Methods Participants were mental health service providers from 17 communities in 16 states in the United States (n = 170. Path analyses were conducted to compare three theoretical models of the impact of organization type on organizational support for EBP and of organizational support on provider attitudes toward EBP and EBP use. Results Consistent with our predictions, private agencies provided greater support for EBP implementation, and staff working for private agencies reported more positive attitudes toward adopting EBPs. Organizational support for EBP partially mediated the association of organization type on provider attitudes toward EBP. Organizational support was significantly positively associated with attitudes toward EBP and EBP use in practice. Conclusion This study offers further support for the importance of organizational context as an influence on organizational support for EBP and provider attitudes toward adopting EBP. The study demonstrates the role organizational support in provider use of EBP in practice. This study also suggests that organizational support for innovation is a malleable factor in supporting use of EBP. Greater attention should be paid to organizational influences that can facilitate the dissemination and implementation of EBPs in
Lavoie-Tremblay, Mélanie; Richer, Marie-Claire; Marchionni, Caroline; Cyr, Guylaine; Biron, Alain D; Aubry, Monique; Bonneville-Roussy, Arielle; Vézina, Michel
The recent introduction of a project management office (PMO) in a major healthcare center, led by a nurse, provides a unique opportunity to understand how a PMO facilitates successful implementation of evidence-based practices in care delivery. A case study with embedded units (individuals, projects, and organization). In this study, the case is operationally defined as the PMO deployed in a Canadian healthcare center. The sources of evidence used in this study were diverse. They consisted of 38 individual interviews, internal documents, and administrative data. The data were collected from March 2009 to November 2011. Content analysis was used to analyze the qualitative data. PMO experts help improve practices, and the patients thus receive safer and better quality care. Several participants point out that they could not make the changes without the PMO's support. They mention that they succeeded in changing their practices based on the evidence and acquired knowledge of change management with the PMO members that can be transferred to their practice. With the leadership of the nurse director of the PMO, members provide a range of expertise and fields in evidence-based change management, project management, and evaluation. PMO facilitates the implementation of clinical and organizational practices based on evidence to improve the quality and safety of care provided to patients. © 2012 Sigma Theta Tau International.
Quimbo Stella A
Full Text Available Abstract Background Randomized trials have long been the gold-standard for evaluating clinical practice. There is growing recognition that rigorous studies are similarly needed to assess the effects of policy. However, these studies are rarely conducted. We report on the Quality Improvement Demonstration Study (QIDS, an example of a large randomized policy experiment, introduced and conducted in a scientific manner to evaluate the impact of large-scale governmental policy interventions. Methods In 1999 the Philippine government proposed sweeping reforms in the National Health Sector Reform Agenda. We recognized the unique opportunity to conduct a social experiment. Our ongoing goal has been to generate results that inform health policy. Early on we concentrated on developing a multi-institutional collaborative effort. The QIDS team then developed hypotheses that specifically evaluated the impact of two policy reforms on both the delivery of care and long-term health status in children. We formed an experimental design by randomizing matched blocks of three communities into one of the two policy interventions plus a control group. Based on the reform agenda, one arm of the experiment provided expanded insurance coverage for children; the other introduced performance-based payments to hospitals and physicians. Data were collected in household, hospital-based patient exit, and facility surveys, as well as clinical vignettes, which were used to assess physician practice. Delivery of services and health status were evaluated at baseline and after the interventions were put in place using difference-in-difference estimation. Results We found and addressed numerous challenges conducting this study, namely: formalizing the experimental design using the existing health infrastructure; securing funding to do research coincident with the policy reforms; recognizing biases and designing the study to account for these; putting in place a broad data
Yan, Xiu-feng; Ni, Qing; Wei, Jun-ping; Xu, Hao
An evidence-based practice method according to literature retrieval through PICO (Patients, Intervention, Comparison, Outcome) questions and complementary and alternative medicine (CAM) topics, which can obtain helpful evidence for guiding clinical practice, was introduced with a practical example in this paper. The knowledge of diseases and Western medicine treatment can be acquired by literature retrieval through PICO question, while searching by CAM topics may provide evidence for Chinese medicine (CM). Thus the author held that literature retrieval through both PICO question and CAM topics was an ideal evidence-based practice method for integrative Chinese and Western medicine (ICWM). However, since the standard in CM evidence hierarchy is still under study, the value of the CAM thematic retrieval method remains very limited. In the future, studies on the definition and hierarchy of CM evidences and the herb-drug interaction between Western and Chinese medicine during a combination therapy should be strengthened to improve the status of ICWM evidence-based practice.
Pérez-Campos, M Amparo; Sánchez-García, Inmaculada; Pancorbo-Hidalgo, Pedro L
to determine the evidence-based practice (EBP) competence of Spanish and Latin-American nurses participating in professional forums on the Internet and estimate the influence of socio-demographic and professional factors on their competence, which was defined as knowledge of, attitude towards, and implementation of EBP. An online survey was administered to a convenience sample of nurses active in Internet forums, comprising validated Spanish versions of the Evidence-Based Practice Questionnaire (EBPQ) and Practice Environment Scale of the Nursing Work Index (PES-NWI) and socio-demographics and professional variables. 314 questionnaires were obtained (76.96%). The mean EBPQ score was 5.02 out of 7 (95%CI, 4.89-5.14). The variables associated with a higher competence in EBP were academic level, (pnurses showed a moderate level of EBP competence. They revealed a positive attitude towards EBP and achieved intermediate scores in both EBP-related skills and knowledge and their implementation. Higher academic levels and professional categories were associated with greater EBP competence. A practice environment perceived to be unfavorable has a negative influence on EBP implementation.
Akinyemi, Oluwaseun O; Martineau, Tim; Tharyan, Prathap
The literature on the use of evidence-based practice is sparse, both in the public and private sectors in middle-and low-income countries, and the present literature shows that physician understanding and use of evidence-based practice is poor. The study aimed to explore the perception of medical practitioners in the private for-profit, private not-for-profit and government sectors in Vellore, India, on evidence-based practice, in order to explain the factors affecting the use of evidence-based practice among the practitioners and to inform local policy and management decisions for improvement in quality of care. Qualitative methodology was employed in the study. Sixteen in-depth and two key informant interviews were carried out with medical practitioners selected by purposive sampling in the private for-profit, private not-for-profit and government sectors. The interviews explored participants' knowledge of evidence-based practice, factors affecting its use and possible ways of improving the use of evidence-based practice among physicians in all the health sectors. Data from the in-depth and key informant interviews were analyzed with the NVIVO (version 8) software package using the framework approach. Although most practitioners interviewed have heard of evidence-based practice, knowledge about evidence-based practice seems inadequate. However, doctors in the private not-for-profit sector seem to be more familiar with the concept of evidence-based practice. Also, practitioners in the private not-for profit sector appear to use medical evidence more in their practices compared to government practitioners or doctors in the private for-profit sector. Perceived factors affecting physician use of evidence-based practice include lack of personal time for literature appraisal as a result of high case load, weak regulatory system, pressure from patients, caregivers and pharmaceutical companies, as well as financial considerations. Opinions of the respondents are that use
Khalil, Karima; Elnoury, Amr; Cherine, Mohamed; Sholkamy, Hania; Hassanein, Nevine; Mohsen, Lamia; Breebaart, Miral; Aziz Shoubary, Abdel
Little is known of common normal labor hospital practices in Egypt or of their relationship to evidence-based obstetrics. This study documented facility-based practices for normal labor and delivery in Egypt for the first time by categorizing 44 practices observed in a busy obstetric teaching hospital according to the World Health Organization (WHO) Technical Working Group on Normal Birth classification of normal birth practices. A multidisciplinary approach combined directly observing practices that were applied to individual laboring women and their newborns, observing ward activities, interviews, and focus groups. One hundred seventy-five normal births were observed in their entirety, over 28 days and nights, by medically trained observers using an observation checklist that documented 537 variables for each woman. Mothers were interviewed postpartum, and findings were shared with practitioners for their feedback. Observed practices were categorized according the 1999 WHO classification of 59 practices for normal birth, depending on their usefulness, effectiveness, or harmfulness. There was infrequent use of beneficial practices that should be encouraged and an unexpectedly high level of harmful practices that should be eliminated. Some beneficial practices were applied inappropriately, and practices of unproved benefit were also documented, some of which are potentially harmful to childbearing mothers and their babies. Hospital practices for normal labor were largely not in accordance with the WHO evidence-based classification of practices for normal birth. The findings are worrying, given the increasing proportion of hospital-based births in Egypt and the country's improved but relatively high maternal and neonatal mortality rates. Obstacles to following evidence-based protocols for normal labor require examination.
Andrews, Christina M.; D’Aunno, Thomas A.; Pollack, Harold A.; Friedmann, Peter D.
This article examines changes from 2005 to 2011 in the use of an evidence-based clinical innovation, buprenorphine use, among a nationally representative sample of opioid treatment programs and identifies characteristics associated with its adoption. We apply a model of the adoption of clinical innovations that focuses on the work needs and characteristics of staff; organizations’ technical and social support for the innovation; local market dynamics and competition; and state policies governing the innovation. Results indicate that buprenorphine use increased 24% for detoxification and 47% for maintenance therapy between 2005 and 2011. Buprenorphine use was positively related to reliance on private insurance and availability of state subsidies to cover its cost and inversely related to the percentage of clients who injected opiates, county size, and local availability of methadone. The results indicate that financial incentives and market factors play important roles in opioid treatment programs’ decisions to adopt evidence-based clinical innovations such as buprenorphine use. PMID:24051897
Renolen, Åste; Høye, Sevald; Hjälmhult, Esther; Danbolt, Lars Johan; Kirkevold, Marit
Evidence-based practice is considered a foundation for the provision of quality care and one way to integrate scientific knowledge into clinical problem-solving. Despite the extensive amount of research that has been conducted to evaluate evidence-based practice implementation and research utilization, these practices have not been sufficiently incorporated into nursing practice. Thus, additional research regarding the challenges clinical nurses face when integrating evidence-based practice into their daily work and the manner in which these challenges are approached is needed. The aim of this study was to generate a theory about the general patterns of behaviour that are discovered when clinical nurses attempt to integrate evidence-based practice into their daily work. We used Glaser's classical grounded theory methodology to generate a substantive theory. The study was conducted in two different medical wards in a large Norwegian hospital. In one ward, nurses and nursing assistants were developing and implementing new evidence-based procedures, and in the other ward, evidence-based huddle boards for risk assessment were being implemented. A total of 54 registered nurses and 9 assistant nurses were observed during their patient care and daily activities. Of these individuals, thirteen registered nurses and five assistant nurses participated in focus groups. These participants were selected through theoretical sampling. Data were collected during 90h of observation and 4 focus groups conducted from 2014 to 2015. Each focus group session included four to five participants and lasted between 55 and 65min. Data collection and analysis were performed concurrently, and the data were analysed using the constant comparative method. "Keeping on track" emerged as an explanatory theory for the processes through which the nurses handled their main concern: the risk of losing the workflow. The following three strategies were used by nurses when attempting to integrate evidence-based
Kao Uyen H
Full Text Available Abstract Background Evidence-based interventions that are being delivered in real-world settings are adapted to enhance the external validity of these interventions. The purpose of this study was to examine multiple intervention adaptations made during pre-implementation, implementation, maintenance, and evolution phases of human immunodeficiency virus HIV prevention technology transfer. We examined two important categories of adaptations -- modifications to key characteristics, such as activities or delivery methods of interventions and reinvention of the interventions including addition and deletion of core elements. Methods Study participants were thirty-four community-based organization staff who were implementing evidence-based interventions in Los Angeles, California. Participants were interviewed twice and interviews were professionally transcribed. Transcriptions were coded by two coders with good inter-rater reliability (kappa coefficient = 0.73. Sixty-two open-ended codes for adaptation activities, which were linked to 229 transcript segments, were categorized as modifications of key characteristics or reinvention. Results Participants described activities considered modifications to key characteristics and reinvention of evidence-based interventions during pre-implementation, implementation, and maintenance phases. None of the participants reported accessing technical assistance or guidance when reinventing their interventions. Staff executed many of the recommended steps for sound adaptation of these interventions for new populations and settings. Conclusion Staff reported modifying and reinventing interventions when translating HIV prevention programs into practice. Targeted technical assistance for formative evaluation should be focused on the pre-implementation phase during which frequent modifications occur. Continuous or repeated measurements of fidelity are recommended. Increased technical assistance and guidance are needed to
Veniegas, Rosemary C; Kao, Uyen H; Rosales, Ricki
Evidence-based interventions that are being delivered in real-world settings are adapted to enhance the external validity of these interventions. The purpose of this study was to examine multiple intervention adaptations made during pre-implementation, implementation, maintenance, and evolution phases of human immunodeficiency virus HIV prevention technology transfer. We examined two important categories of adaptations -- modifications to key characteristics, such as activities or delivery methods of interventions and reinvention of the interventions including addition and deletion of core elements. Study participants were thirty-four community-based organization staff who were implementing evidence-based interventions in Los Angeles, California. Participants were interviewed twice and interviews were professionally transcribed. Transcriptions were coded by two coders with good inter-rater reliability (kappa coefficient = 0.73). Sixty-two open-ended codes for adaptation activities, which were linked to 229 transcript segments, were categorized as modifications of key characteristics or reinvention. Participants described activities considered modifications to key characteristics and reinvention of evidence-based interventions during pre-implementation, implementation, and maintenance phases. None of the participants reported accessing technical assistance or guidance when reinventing their interventions. Staff executed many of the recommended steps for sound adaptation of these interventions for new populations and settings. Staff reported modifying and reinventing interventions when translating HIV prevention programs into practice. Targeted technical assistance for formative evaluation should be focused on the pre-implementation phase during which frequent modifications occur. Continuous or repeated measurements of fidelity are recommended. Increased technical assistance and guidance are needed to ensure that reinventions are evaluated and consistent with the
Canada, Amanda N
HOW TO OBTAIN CONTACT HOURS BY READING THIS ISSUE Instructions: 1.2 contact hours will be awarded by Villanova University College of Nursing upon successful completion of this activity. A contact hour is a unit of measurement that denotes 60 minutes of an organized learning activity. This is a learner-based activity. Villanova University College of Nursing does not require submission of your answers to the quiz. A contact hour certificate will be awarded after you register, pay the registration fee, and complete the evaluation form online at http://goo.gl/gMfXaf. In order to obtain contact hours you must: 1. Read the article, "Probing the Relationship Between Evidence-Based Practice Implementation Models and Critical Thinking in Applied Nursing Practice," found on pages 161-168, carefully noting any tables and other illustrative materials that are included to enhance your knowledge and understanding of the content. Be sure to keep track of the amount of time (number of minutes) you spend reading the article and completing the quiz. 2. Read and answer each question on the quiz. After completing all of the questions, compare your answers to those provided within this issue. If you have incorrect answers, return to the article for further study. 3. Go to the Villanova website to register for contact hour credit. You will be asked to provide your name, contact information, and a VISA, MasterCard, or Discover card number for payment of the $20.00 fee. Once you complete the online evaluation, a certificate will be automatically generated. This activity is valid for continuing education credit until March 31, 2019. CONTACT HOURS This activity is co-provided by Villanova University College of Nursing and SLACK Incorporated. Villanova University College of Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. • Describe the key components and characteristics related to evidence-based
Cai, Ronglin; Hu, Ling; Wu, Zijian
Evidence-based medicine (EBM) has been widely applied in clinical study of acupuncture and moxibustion, and the real-world study (RWS) has gradually become an important way of clinical research in the world in recent years. It is worthy of our in-depth study and discussion that how to evaluate the advantages and limitations of EBM and RWS as well as their reasonable application in clinical study of acupuncture and moxibustion. The characteristics and difference between RWS and EBM, and the situation of acupuncture clinical research methods are discussed in this paper. It is proposed that we should understand the advantages of RWS in acupuncture clinical research, fully realize the limitations of EBM and RWS, recognize the complexity and particularity of RWS, and apply EBM and RWS into acupuncture clinical research. Meanwhile acupuncture clinical manipulation standardization should be further promoted, which is benefit to develop clinical study, improve clinical efficacy and promote the popularization of acupuncture and moxibustion.
The long-term treatment of restless legs syndrome/Willis-Ekbom disease: evidence-based guidelines and clinical consensus best practice guidance: a report from the International Restless Legs Syndrome Study Group.
Garcia-Borreguero, Diego; Kohnen, Ralf; Silber, Michael H; Winkelman, John W; Earley, Christopher J; Högl, Birgit; Manconi, Mauro; Montplaisir, Jacques; Inoue, Yuichi; Allen, Richard P
A Task Force was established by the International Restless Legs Syndrome Study Group (IRLSSG) to develop evidence-based and consensus-based recommendations for the long-term pharmacologic treatment of restless legs syndrome/Willis-Ekbom disease (RLS/WED). The Task Force reviewed the results of all studies of RLS/WED treatments with durations of 6 months or longer presented at meetings over the past 2 years, posted on Web sites of pharmaceutical companies, or published in peer-reviewed journals, asking the questions, "What is the efficacy of this treatment in patients with RLS/WED?" and "What is the safety of this treatment in patients with RLS/WED?" The Task Force developed guidelines based on their review of 61 papers meeting inclusion criteria, and using a modified evidence-grading scheme. Pregabalin has been established as effective for up to 1 year in treating RLS/WED (Level A evidence). Pramipexole, ropinirole, and rotigotine have been established as effective for