Full Text Available Abstract The term "Geographic Information Systems" (GIS has been added to MeSH in 2003, a step reflecting the importance and growing use of GIS in health and healthcare research and practices. GIS have much more to offer than the obvious digital cartography (map functions. From a community health perspective, GIS could potentially act as powerful evidence-based practice tools for early problem detection and solving. When properly used, GIS can: inform and educate (professionals and the public; empower decision-making at all levels; help in planning and tweaking clinically and cost-effective actions, in predicting outcomes before making any financial commitments and ascribing priorities in a climate of finite resources; change practices; and continually monitor and analyse changes, as well as sentinel events. Yet despite all these potentials for GIS, they remain under-utilised in the UK National Health Service (NHS. This paper has the following objectives: (1 to illustrate with practical, real-world scenarios and examples from the literature the different GIS methods and uses to improve community health and healthcare practices, e.g., for improving hospital bed availability, in community health and bioterrorism surveillance services, and in the latest SARS outbreak; (2 to discuss challenges and problems currently hindering the wide-scale adoption of GIS across the NHS; and (3 to identify the most important requirements and ingredients for addressing these challenges, and realising GIS potential within the NHS, guided by related initiatives worldwide. The ultimate goal is to illuminate the road towards implementing a comprehensive national, multi-agency spatio-temporal health information infrastructure functioning proactively in real time. The concepts and principles presented in this paper can be also applied in other countries, and on regional (e.g., European Union and global levels.
Full Text Available Abstract Background An extensive West Nile virus surveillance program of dead birds, mosquitoes, horses, and human infection has been launched as a result of West Nile virus first being reported in Canada in 2001. Some desktop and web GIS have been applied to West Nile virus dead bird surveillance. There have been urgent needs for a comprehensive GIS services and real-time surveillance. Results A pilot system was developed to integrate real-time surveillance, real-time GIS, and Open GIS technology in order to enhance West Nile virus dead bird surveillance in Canada. Driven and linked by the newly developed real-time web GIS technology, this integrated real-time surveillance system includes conventional real-time web-based surveillance components, integrated real-time GIS components, and integrated Open GIS components. The pilot system identified the major GIS functions and capacities that may be important to public health surveillance. The six web GIS clients provide a wide range of GIS tools for public health surveillance. The pilot system has been serving Canadian national West Nile virus dead bird surveillance since 2005 and is adaptable to serve other disease surveillance. Conclusion This pilot system has streamlined, enriched and enhanced national West Nile virus dead bird surveillance in Canada, improved productivity, and reduced operation cost. Its real-time GIS technology, static map technology, WMS integration, and its integration with non-GIS real-time surveillance system made this pilot system unique in surveillance and public health GIS.
Background Competition and education are intimately related and can be combined in many ways. The role of competition in medical education of evidence-based medicine (EBM) has not been investigated. In order to enhance the dissemination and implementation of EBM in Taiwan, EBM competitions have been established among healthcare professionals. This study was to evaluate the impact of competition in EBM learning. Methods The EBM competition used PICO (patient, intervention, comparison, and outcome) queries to examine participants’ skills in framing an answerable question, literature search, critical appraisal and clinical application among interdisciplinary teams. A structured questionnaire survey was conducted to investigate EBM among participants in the years of 2009 and 2011. Participants completed a baseline questionnaire survey at three months prior to the competition and finished the same questionnaire right after the competition. Results Valid questionnaires were collected from 358 participants, included 162 physicians, 71 nurses, 101 pharmacists, and 24 other allied healthcare professionals. There were significant increases in participants’ knowledge of and skills in EBM (p evidence-based retrieval databases, including the Cochrane Library (p < 0.001), MD Consult (p < 0.001), ProQuest (p < 0.001), UpToDate (p = 0.001), CINAHL (p = 0.001), and MicroMedex (p = 0.024). Conclusions The current study demonstrates a method that successfully enhanced the knowledge of, skills in, and behavior of EBM. The data suggest competition using PICO queries may serve as an effective way to facilitate the learning of EBM. PMID:23651869
Choi, Sol Ji; Jo, Ae Jeong; Choi, Jin A [Div. for Healthcare Technology Assessment Research, National Evidence-Based Healthcare Collaborating Agency, Seoul (Korea, Republic of); and others
This paper is a summary of the methodology including protocol used to develop evidence-based clinical imaging guidelines (CIGs) in Korea, led by the Korean Society of Radiology and the National Evidence-based Healthcare Collaborating Agency. This is the first protocol to reflect the process of developing diagnostic guidelines in Korea. The development protocol is largely divided into the following sections: set-up, process of adaptation, and finalization. The working group is composed of clinical imaging experts, and the developmental committee is composed of multidisciplinary experts to validate the methodology. The Korean CIGs will continue to develop based on this protocol, and these guidelines will act for decision supporting tools for clinicians as well as reduce medical radiation exposure.
Karlin, Bradley E; Cross, Gerald
Replies to comments by H. Holt and L. E. Beutler (see record 2014-40532-003), M. M. Steenkamp and B. Litz (see record 2014-40532-004), and L. R. Greene (see record 2014-40532-006) on the original article by B. E. Karlin and G. Cross (see record 2013-31043-001) on the national dissemination and implementation of evidence-based psychotherapies in the U.S. Department of Veterans Affairs health care system. Karlin and Cross comment on and clarify key issues raised in the commentaries and related aspects of the dissemination and implementation model. At the same time, several of the issues raised in the commentaries are beyond the scope of the original article, including issues related to specific research or the relative effectiveness of psychotherapies, on which there is rich discussion and debate in other contexts. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
Awoonor-Williams, John Koku; Feinglass, Ellie S; Tobey, Rachel; Vaughan-Smith, Maya N; Nyonator, Frank K; Jones, Tanya C
Although experimental trials often identify optimal strategies for improving community health, transferring operational innovation from well-funded research programs to resource-constrained settings often languishes. Because research initiatives are based in institutions equipped with unique resources and staff capabilities, results are often dismissed by decisionmakers as irrelevant to large-scale operations and national health policy. This article describes an initiative undertaken in Nkwanta District, Ghana, focusing on this problem. The Nkwanta District initiative is a critical link between the experimental study conducted in Navrongo, Ghana, and a national effort to scale up the innovations developed in that study. A 2002 Nkwanta district-level survey provides the basis for assessing the likelihood that the Navrongo model is replicable elsewhere in Ghana. The effect of community-based health planning and services exposure on family planning and safe-motherhood indicators supports the hypothesis that Navrongo effects are transferable to impoverished rural settings elsewhere, confirming the need for strategies to bridge the gap between Navrongo evidence-based innovation and national health-sector reform.
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.
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.
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…
Aiello, Rachel; Ruble, Lisa; Esler, Amy
This study aimed to better understand predictors of evidence-based assessment practices for autism spectrum disorder (ASD). Nationwide, 402 school psychologists were surveyed for their knowledge of and training and experience with ASD on assessment practices, including reported areas of training needs. The majority of school psychologists reported…
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…
Sheppard, Maria K
Despite the unproven effectiveness of many practices that are under the umbrella term 'complementary alternative medicine' (CAM), there is provision of CAM within the English National Health Service (NHS). Moreover, although the National Institute for Health and Care Excellence was established to promote scientifically validated medicine in the NHS, the paradox of publicly funded, non-evidence based CAM can be explained as linked with government policy of patient choice and specifically patient treatment choice. Patient choice is useful in the political and policy discourse as it is open to different interpretations and can be justified by policy-makers who rely on the traditional NHS values of equity and universality. Treatment choice finds expression in the policy of personalised healthcare linked with patient responsibilisation which finds resonance in the emphasis CAM places on self-care and self-management. More importantly, however, policy-makers also use patient choice and treatment choice as a policy initiative with the objective of encouraging destabilisation of the entrenched healthcare institutions and practices considered resistant to change. This political strategy of system reform has the unintended, paradoxical consequence of allowing for the emergence of non-evidence based, publicly funded CAM in the NHS. The political and policy discourse of patient choice thus trumps evidence based medicine, with patients that demand access to CAM becoming the unwitting beneficiaries. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
Turner-Stokes, Lynne; Harding, Richard; Sergeant, Judith; Lupton, Carol; McPherson, Kath
The UK National Service Framework (NSF) for Long Term Conditions was published in May 2005. This article describes the challenges and some proffered solutions towards development of the evidence base to support best practice in the management of life-long neurological conditions, which are the principal focus of the NSF. The inherent limits in current systems for appraisal of evidence and their lack of applicability to these conditions are discussed. A new typology of evidence is proposed, which acknowledges the importance of expert opinion from users, carers and professionals as well as encompassing a broad range of research designs. To apply the typology, a brief evaluation tool is presented, which provides simple assessment of both qualitative and quantitative research evidence in terms of design, quality and applicability, and is practical for use by clinicians. Preliminary testing and application in development of the evidence base for the NSF are described.
O'Regan, Kevin; Marsden, Paul; Sayers, Gerardine; Morrissey, Mary; Hegarty, Heather; Allen, Michael; O'Connor, Owen J; Malone, Dermot; Maher, Michael M
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. Twenty-one participants (second-year radiology residents) at 8 centers in a radiology training program were included. The course in PBL was delivered over 16 weekly 1-hour sessions. There were 8 local education site coordinators (staff radiologists), who had completed an intensive 1-day course at the principal teaching site. The host site was linked to the participant sites using videoconferencing technology. Course evaluation included 1) a 5-point Likert-type scale and an open-ended evaluation questionnaire midway through the course (week 8) and a summation questionnaire after its completion (week 16) and 2) a consultation forum held during the penultimate session. The data responses to the questionnaires were entered in a spreadsheet, and the data were analyzed. Qualitative data were manually coded and analyzed for common themes. Descriptive statistical analyses were performed. Eighty-five percent of evaluation questionnaires and 53% of summation questionnaires were returned. The overall satisfaction of the participants with course content was high, with median rating of 4 on the 5-point scale. All participants agreed that videoconferencing as a medium did not hinder adequate discussion among centers and worked well as an interactive teaching method (median, 4). Local coordinators were satisfied with local technical support and training (median, 4), and overall, the module was rated highly, with ratings of 4 from both residents and local coordinators. Seventy-one percent of residents and 86% of local coordinators reported that they would have been unable to participate in the course without videoconferencing. All participants completed the course requirements satisfactorily. The
Nguyen, Natalie T.; Duff, J. Paul; Gavier-Widén, Dolores; Grillo, Tiggy; He, Hongxuan; Lee, Hang; Ratanakorn, Parntep; Rijks, Jolianne M.; Ryser-Degiorgis, Marie-Pierre; Sleeman, Jonathan M.; Stephen, Craig; Tana, Toni; Uhart, Marcela; Zimmer , Patrick
SummaryThis report summarizes a Wildlife Disease Association sponsored workshop held in 2016. The overall objective of the workshop was to use available evidence and selected subject matter expertise to define the essential functions of a National Wildlife Health Program and the resources needed to deliver a robust and reliable program, including the basic infrastructure, workforce, data and information systems, governance, organizational capacity, and essential features, such as wildlife disease surveillance, diagnostic services, and epidemiological investigation. This workshop also provided the means to begin the process of defining the essential attributes of a national wildlife health program that could be scalable and adaptable to each nation’s needs.
Wang, Tengfei; Ren, Xuezhu; Schweizer, Karl; Xu, Fen
The current research investigated the variability of school effects on intelligence development in considering two economically and socially distinct groups of children. The data came from a nationally representative sample of primary school children from urban and rural areas of China. Two standardised reasoning tests were used to assess fluid…
Kimman, Tjeerd G; Boot, Hein J; Berbers, Guy A M; Vermeer-de Bondt, Patricia E; Wit, G Ardine de; Melker, Hester E de
Among all public health provisions national immunization programs (NIPs) are beyond doubt one of the most effective in reducing mortality, morbidity, and costs associated with major infectious diseases. To maintain their success, NIPs have to modernize in response to many new and old demands
Cassey, Margaret Z
The National Guideline Clearinghouse (NGC) can be used as a means of integrating the constantly growing and changing body of scientific clinical evidence into the artful practice of nursing. The NGC offers an extensive collection of peer-reviewed, current, scientific standards to support clinical decision making in nursing practice. Nurse leaders should take a leadership role in bringing these relevant resources and new nursing knowledge to policy and procedure committees for active consideration.
Kimman, Tjeerd G; Boot, Hein J; Berbers, Guy A M; Vermeer-de Bondt, Patricia E; Ardine de Wit, G; de Melker, Hester E
Among all public health provisions national immunization programs (NIPs) are beyond doubt one of the most effective in reducing mortality, morbidity, and costs associated with major infectious diseases. To maintain their success, NIPs have to modernize in response to many new and old demands regarding efficacy, safety, availability of new vaccines, emerging and evolving pathogens, waning immunity, altered epidemiological situations, and the public's trust in the program. In this paper we present an evaluation model in the form of a checklist that may help in collecting relevant scientific information that is necessary for evaluation and decision making when considering changes in a NIP. Such a checklist points to relevant information on the vaccine-preventable disease, the pathogen causing it, the vaccine, and the cost-effectiveness ratio of the vaccine. However, the final judgment on a potential change in the NIP cannot be based on a simple algorithm, as the relevant information reflects factors of a very different kind and magnitude, to which different value judgements may be added, and which may have certain degrees of uncertainty. Because any change in the NIP may be accompanied by more or less unforeseen changes in the vaccine's efficacy, evolutionary consequences, including the antigenic composition of the pathogen, and the vaccine's safety profile, an intensive surveillance program should accompany any NIP. Elements thereof include clinical-epidemiological surveillance, surveillance of vaccination coverage, immune surveillance, surveillance of microbial population dynamics, and surveillance of adverse events and safety issues. We emphasize that the decision to introduce a vaccine in the NIP should be taken as seriously, both scientifically and ethically, as the decision to withhold a vaccine from the NIP. In the latter case one might be responsible for vaccine-preventable disease and mortality.
Aarons, Gregory A; Glisson, Charles; Green, Phillip D; Hoagwood, Kimberly; Kelleher, Kelly J.; Landsverk, John A; ,
AbstractBackgroundEvidence-based practices have not been routinely adopted in community mental health organizations despite the support of scientific evidence and in some cases even legislative or regulatory action. We examined the association of clinician attitudes toward evidence-based practice with organizational culture, climate, and other characteristics in a nationally representative sample of mental health organizations in the United States.MethodsIn-person, group-administered surveys ...
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…
Weng, Yi-Hao; Kuo, Ken N; Yang, Chun-Yuh; Lo, Heng-Lien; Shih, Ya-Hui; Chen, Chiehfeng; Chiu, Ya-Wen
Since the beginning of 2007, the National Health Research Institutes has been promoting the dissemination of evidence-based medicine (EBM). The current study examined longitudinal trends of behaviors in how hospital-based physicians and nurses have searched for medical information during the spread of EBM. Cross-sectional postal questionnaire surveys were conducted in nationally representative regional hospitals of Taiwan thrice in 2007, 2009, and 2011. Demographic data were gathered concerning gender, age, working experience, teaching appointment, academic degree, and administrative position. Linear and logistic regression models were used to examine predictors and changes over time. Data from physicians and nurses were collected in 2007 (n = 1156), 2009 (n = 2975), and 2011 (n = 3999). There were significant increases in the use of four Internet-based resources - Web portals, online databases, electronic journals, and electronic books - across the three survey years among physicians and nurses (p < 0.001). Access to textbooks and printed journals, however, did not change over the 4-year study period. In addition, there were significant relationships between the usage of Internet-based resources and users' characteristics. Age and faculty position were important predictors in relation to the usage among physicians and nurses, while academic degree served as a critical factor among nurses only. Physicians and nurses used a variety of sources to look for medical information. There was a steady increase in use of Internet-based resources during the diffusion period of EBM. The findings highlight the importance of the Internet as a prominent source of medical information for main healthcare professionals.
The implementation and evaluation of an evidence-based statewide prehospital pain management protocol developed using the national prehospital evidence-based guideline model process for emergency medical services.
Brown, Kathleen M; Hirshon, Jon Mark; Alcorta, Richard; Weik, Tasmeen S; Lawner, Ben; Ho, Shiu; Wright, Joseph L
In 2008, the National Highway Traffic Safety Administration funded the development of a model process for the development and implementation of evidence-based guidelines (EBGs) for emergency medical services (EMS). We report on the implementation and evaluation of an evidence-based prehospital pain management protocol developed using this model process. An evidence-based protocol for prehospital management of pain resulting from injuries and burns was reviewed by the Protocol Review Committee (PRC) of the Maryland Institute for Emergency Medical Services Systems (MIEMSS). The PRC recommended revisions to the Maryland protocol that reflected recommendations in the EBG: weight-based dosing and repeat dosing of morphine. A training curriculum was developed and implemented using Maryland's online Learning Management System and successfully accessed by 3,941 paramedics and 15,969 BLS providers. Field providers submitted electronic patient care reports to the MIEMSS statewide prehospital database. Inclusion criteria were injured or burned patients transported by Maryland ambulances to Maryland hospitals whose electronic patient care records included data for level of EMS provider training during a 12-month preimplementation period and a 12-month postimplementation period from September 2010 through March 2012. We compared the percentage of patients receiving pain scale assessments and morphine, as well as the dose of morphine administered and the use of naloxone as a rescue medication for opiate use, before and after the protocol change. No differences were seen in the percentage of patients who had a pain score documented or the percent of patients receiving morphine before and after the protocol change, but there was a significant increase in the total dose and dose in mg/kg administered per patient. During the postintervention phase, patients received an 18% higher total morphine dose and a 14.9% greater mg/kg dose. We demonstrated that the implementation of a revised
Background Evidence-based practices have not been routinely adopted in community mental health organizations despite the support of scientific evidence and in some cases even legislative or regulatory action. We examined the association of clinician attitudes toward evidence-based practice with organizational culture, climate, and other characteristics in a nationally representative sample of mental health organizations in the United States. Methods In-person, group-administered surveys were conducted with a sample of 1,112 mental health service providers in a nationwide sample of 100 mental health service institutions in 26 states in the United States. The study examines these associations with a two-level Hierarchical Linear Modeling (HLM) analysis of responses to the Evidence-Based Practice Attitude Scale (EBPAS) at the individual clinician level as a function of the Organizational Social Context (OSC) measure at the organizational level, controlling for other organization and clinician characteristics. Results We found that more proficient organizational cultures and more engaged and less stressful organizational climates were associated with positive clinician attitudes toward adopting evidence-based practice. Conclusions The findings suggest that organizational intervention strategies for improving the organizational social context of mental health services may contribute to the success of evidence-based practice dissemination and implementation efforts by influencing clinician attitudes. PMID:22726759
Aarons Gregory A
Full Text Available Abstract Background Evidence-based practices have not been routinely adopted in community mental health organizations despite the support of scientific evidence and in some cases even legislative or regulatory action. We examined the association of clinician attitudes toward evidence-based practice with organizational culture, climate, and other characteristics in a nationally representative sample of mental health organizations in the United States. Methods In-person, group-administered surveys were conducted with a sample of 1,112 mental health service providers in a nationwide sample of 100 mental health service institutions in 26 states in the United States. The study examines these associations with a two-level Hierarchical Linear Modeling (HLM analysis of responses to the Evidence-Based Practice Attitude Scale (EBPAS at the individual clinician level as a function of the Organizational Social Context (OSC measure at the organizational level, controlling for other organization and clinician characteristics. Results We found that more proficient organizational cultures and more engaged and less stressful organizational climates were associated with positive clinician attitudes toward adopting evidence-based practice. Conclusions The findings suggest that organizational intervention strategies for improving the organizational social context of mental health services may contribute to the success of evidence-based practice dissemination and implementation efforts by influencing clinician attitudes.
Gorgon, Edward James R; Basco, Mark David S; Manuel, Almira T
Early education on the foundations of evidence based practice (EBP) is advocated as a potent intervention toward enhancing EBP uptake among physical therapists. Little is known about the extent to which EBP is integrated in educational curricula in developing countries where the benefits of EBP are more acutely needed. This study sought to describe EBP education in Philippine physical therapy schools, including the challenges encountered by educators in teaching EBP. A national survey of higher education institutions offering an undergraduate degree program in physical therapy was conducted from August 2011 through January 2012. A 35-item questionnaire was developed to gather data on whether or not EBP was taught, specific EBP content covered and courses in which content was covered, teaching and evaluation methods, and challenges in teaching EBP. Data were analyzed descriptively. The study had a response rate of 55.7% (34/61). Majority of the participating educational institutions (82%, 28/34) reported teaching EBP by incorporating EBP content in the professional courses. Among those that did not teach EBP, inadequate educator competence was the leading barrier. Courses commonly used to teach EBP were those on research (78.6%, 22/28), therapy planning (71.4%, 20/28), treatment skills (57.1-64.3%, 16-18/28), and undergraduate thesis (60.7%, 17/28). Various EBP contents were covered, with statistical concepts more frequently taught compared with critical EBP content. Lectures and journal reports were the usual teaching methods (96.4%, 27/28 and 89.3%, 25/28, respectively) while written examinations, completion of an undergraduate thesis, and oral reports (82.1%, 23/28, 78.6%, 22/28, and 78.6%, 22/28, respectively) were often used in evaluation. Students' inadequate knowledge of statistics and lack of curricular structure for EBP were identified as leading challenges to teaching (75%, 21/28 and 50%, 14/28, respectively). Many physical therapy faculties across the
Florin, Jan; Ehrenberg, Anna; Wallin, Lars; Gustavsson, Petter
The aim of the study was to investigate Swedish university nursing students' experience of educational support for research utilization and capability beliefs regarding evidence-based practice skills. Nursing programmes are offered at 26 universities in Sweden and even though there are common regulations for nursing education at the national level, substantial variations are found in local curricula. Little is known about students' capability beliefs regarding evidence-based practice skills, particularly in comparison across universities. A cross-sectional survey design using self-administered postal questionnaires was conducted in 2006. A total of 1440 students (from 26 different universities) participated, constituting 68% of the national population of nursing students in their 6th and final semester. Campus education supported the students to a greater extent than clinical education in following the development of knowledge in an area of interest, using research findings, and acquiring knowledge on how to pursue changes in clinical practice. Perceived support during campus education varied between universities. Students reported high capability beliefs regarding evidence-based practice skills, but large differences were found between universities for: stating a searchable question, seeking out relevant knowledge and critically appraising and compiling best knowledge. The identified differences between universities concerning the students' perceived support for research utilization and their capability beliefs regarding evidence-based practice skills have implications for curricula, pedagogical perspectives in nursing education and the potential to implement evidence-based practice in healthcare settings. Further studies are warranted to investigate students' individual characteristics and organizational characteristics as determinants of research utilization support and capability beliefs regarding evidence-based practice skills. © 2011 The Authors. Journal of
Melnyk, Bernadette Mazurek; Gallagher-Ford, Lynn; Zellefrow, Cindy; Tucker, Sharon; Van Dromme, Laurel; Thomas, Bindu Koshy
Even though multiple positive outcomes are the result of evidence-based care, including improvements in healthcare quality, safety, and costs, it is not consistently delivered by clinicians in healthcare systems throughout the world. In an attempt to accelerate the implementation of evidence-based practice (EBP) across the United States, an invitational Interprofessional National EBP Forum to determine major priorities for the advancement of EBP was held during the launch of the newly established Helene Fuld Health Trust National Institute for Evidence-Based Practice in Nursing and Healthcare at The Ohio State University College of Nursing. Interprofessional leaders from national organizations and federal agencies across the United States were invited to participate in the Forum. A pre-Forum survey was disseminated to participants to assess their perceptions of the state of EBP and actions necessary to speed the translation of research into real-world clinical settings. Findings from a pre-Forum survey (n = 47) indicated ongoing low implementation of EBP in U.S. healthcare settings. These findings were shared with leaders from 45 organizations and agencies who attended the Forum. Breakout groups on practice, education, implementation science, and policy discussed the findings and responded to a set of standardized questions. High-priority action tactics were identified, including the need for: (a) enhanced reimbursement for EBP, (b) more interprofessional education and skills building in EBP, and (c) leaders to prioritize EBP and fuel it with resources. The delivery of and reimbursement for evidence-based care must become a high national priority. Academic faculty across all healthcare disciplines need to teach EBP, healthcare systems must invest in EBP resources, and payers must attach reimbursement to care that is evidence-based. An action collaborative of the participating organizations has been formed to accelerate EBP across the United States to achieve the
Full Text Available Abstract Background The development of evidence-based clinical practice guidelines has gained wide acceptance in high-income countries and reputable international organizations. Whereas this approach may be a desirable standard, challenges remain in low-income settings with limited capacity and resources for evidence synthesis and guideline development. We present our experience using the Grading of Recommendations Assessment, Development and Evaluation (GRADE approach for the recent revision of the Kenyan pediatric clinical guidelines focusing on antibiotic treatment of pneumonia. Methods A team of health professionals, many with minimal prior experience conducting systematic reviews, carried out evidence synthesis for structured clinical questions. Summaries were compiled and distributed to a panel of clinicians, academicians and policy-makers to generate recommendations based on best available research evidence and locally-relevant contextual factors. Results We reviewed six eligible articles on non-severe and 13 on severe/very severe pneumonia. Moderate quality evidence suggesting similar clinical outcomes comparing amoxicillin and cotrimoxazole for non-severe pneumonia received a strong recommendation against adopting amoxicillin. The panel voted strongly against amoxicillin for severe pneumonia over benzyl penicillin despite moderate quality evidence suggesting clinical equivalence between the two and additional factors favoring amoxicillin. Very low quality evidence suggesting ceftriaxone was as effective as the standard benzyl penicillin plus gentamicin for very severe pneumonia received a strong recommendation supporting the standard treatment. Conclusions Although this exercise may have fallen short of the rigorous requirements recommended by the developers of GRADE, it was arguably an improvement on previous attempts at guideline development in low-income countries and offers valuable lessons for future similar exercises where
Full Text Available Data from 1155 Czech women (493 using oral contraception, 662 non-users, obtained from the Czech National Survey of Sexual Behavior, were used to investigate evolutionary-based hypotheses concerning the predictive value of current oral contraceptive (OC use on extra-pair and dyadic (in-pair sexual behavior of coupled women. Specifically, the aim was to determine whether current OC use was associated with lower extra-pair and higher in-pair sexual interest and behavior, because OC use suppresses cyclical shifts in mating psychology that occur in normally cycling women. Zero-inflated Poisson (ZIP regression and negative binomial models were used to test associations between OC use and these sexual measures, controlling for other relevant predictors (e.g., age, parity, in-pair sexual satisfaction, relationship length. The overall incidence of having had an extra-pair partner or one-night stand in the previous year was not related to current OC use (the majority of the sample had not. However, among the women who had engaged in extra-pair sexual behavior, OC users had fewer one-night stands than non-users, and tended to have fewer partners, than non-users. OC users also had more frequent dyadic intercourse than non-users, potentially indicating higher commitment to their current relationship. These results suggest that suppression of fertility through OC use may alter important aspects of female sexual behavior, with potential implications for relationship functioning and stability.
Klapilová, Kateřina; Cobey, Kelly D; Wells, Timothy; Roberts, S Craig; Weiss, Petr; Havlíček, Jan
Data from 1155 Czech women (493 using oral contraception, 662 non-users), obtained from the Czech National Survey of Sexual Behavior, were used to investigate evolutionary-based hypotheses concerning the predictive value of current oral contraceptive (OC) use on extra-pair and dyadic (in-pair) sexual behavior of coupled women. Specifically, the aim was to determine whether current OC use was associated with lower extra-pair and higher in-pair sexual interest and behavior, because OC use suppresses cyclical shifts in mating psychology that occur in normally cycling women. Zero-inflated Poisson (ZIP) regression and negative binomial models were used to test associations between OC use and these sexual measures, controlling for other relevant predictors (e.g., age, parity, in-pair sexual satisfaction, relationship length). The overall incidence of having had an extra-pair partner or one-night stand in the previous year was not related to current OC use (the majority of the sample had not). However, among the women who had engaged in extra-pair sexual behavior, OC users had fewer one-night stands than non-users, and tended to have fewer partners, than non-users. OC users also had more frequent dyadic intercourse than non-users, potentially indicating higher commitment to their current relationship. These results suggest that suppression of fertility through OC use may alter important aspects of female sexual behavior, with potential implications for relationship functioning and stability.
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...
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.
Hertzum, Morten; Simonsen, Jesper
Systems development is replete with projects that represent substantial resource investments but result in systems that fail to meet users needs. Evidence-based development is an emerging idea intended to provide means for managing customer-vendor relationships and working systematically toward...... and electronic patient records for diabetes patients, this paper reports research in progress regarding the prospects and pitfalls of evidence-based development....
Rouprêt, Morgan; Karila, Laurent; Kerneis, Solen; Lefevre, Jérémie H
To investigate the baseline level of knowledge of evidence based medicine (EBM) concepts in a sample of French medical students in their sixth year of training. An "electronic-questionnaire" was proposed to 3125 sixth-year students from all 39 French medical schools in 2009. Overall, 1870 students (58.2% response rate) completed the questionnaire (women=1168; 63%). The concept of EBM was known by 1716 students (92%). Most students (n=1382; 74%) read at least one French medical article per year, but 1051 students (56%) never read international articles. Just over half of students (1030; 55%) knew of web-based medical information databases. Treatment guidelines were considered to be important by most students (97%). Only 24.3% and 29% of students said that they write or speak English. In multivariate analysis, studying in a Parisian University and/or knowledge of what a journal's "impact factor" is were both associated with a ranking in the top 20% of the National Ranking Exam practice session. Only the most successful students showed interest in obtaining more knowledge of EBM. The lack of education about EBM in this sample suggests a lack of efficacy in the current heterogeneous EBM teaching programs. Copyright 2010 Elsevier Masson SAS. All rights reserved.
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.
Bäck, A; Ståhl, C; von Thiele Schwarz, U; Richter, A; Hasson, H
Despite national policy recommending evidence-based practice (EBP), its application in social care has been limited. While local politicians can affect the process, little is known about their knowledge, attitudes and roles regarding EBP. The aim here is twofold: to explore the role of local politicians in the implementation of EBP in social care from both their own and a management perspective; and to examine factors politicians perceive as affecting their decisions and actions concerning the implementation of EBP policy. Local politicians (N = 13) and managers (N = 22) in social care were interviewed. Qualitative thematic analysis with both inductive and deductive codes was used. Politicians were rather uninformed regarding EBP and national policy. The factors limiting their actions were, beside the lack of awareness, lack of ability to question existing working methods, and a need for support in the steering of EBP. Thus, personal interest played a significant part in what role the politicians assumed. This resulted in some politicians taking a more active role in steering EBP while others were not involved. From the managers' perspective, a more active steering by politicians was desired. Setting budget and objectives, as well as active follow-up of work processes and outcomes, were identified as means to affect the implementation of EBP. However, the politicians seemed unaware of the facilitating effects of these actions. Local politicians had a possibility to facilitate the implementation of EBP, but their role was unclear. Personal interest played a big part in determining what role was taken. The results imply that social care politicians might need support in the development of their steering of EBP. Moving the responsibility for EBP facilitation upwards in the political structure could be an important step in developing EBP in social care.
Hoffmann, Sebastian; Hartung, Thomas; Stephens, Martin
Evidence-based toxicology (EBT) was introduced independently by two groups in 2005, in the context of toxicological risk assessment and causation as well as based on parallels between the evaluation of test methods in toxicology and evidence-based assessment of diagnostics tests in medicine. The role model of evidence-based medicine (EBM) motivated both proposals and guided the evolution of EBT, whereas especially systematic reviews and evidence quality assessment attract considerable attention in toxicology.Regarding test assessment, in the search of solutions for various problems related to validation, such as the imperfectness of the reference standard or the challenge to comprehensively evaluate tests, the field of Diagnostic Test Assessment (DTA) was identified as a potential resource. DTA being an EBM discipline, test method assessment/validation therefore became one of the main drivers spurring the development of EBT.In the context of pathway-based toxicology, EBT approaches, given their objectivity, transparency and consistency, have been proposed to be used for carrying out a (retrospective) mechanistic validation.In summary, implementation of more evidence-based approaches may provide the tools necessary to adapt the assessment/validation of toxicological test methods and testing strategies to face the challenges of toxicology in the twenty first century.
The Use of Evidence-Based Practices in the Provision of Social Skills Training for Students with Autism Spectrum Disorders: A National Survey of School Psychologists' Training, Attitudes, and Practices
Austin, Jennifer E.
The purpose of this exploratory study was to examine school psychologists' use of evidence- based practices (EBP), in general, and more specifically in the area of social skills training (SST) for students with autism spectrum disorders (ASD). Study participants, consisting of 498 school psychologists from across the nation, participated in…
New Graduate Nurses' Developmental Trajectories for Capability Beliefs Concerning Core Competencies for Healthcare Professionals: A National Cohort Study on Patient-Centered Care, Teamwork, and Evidence-based Practice.
Ehrenberg, Anna; Gustavsson, Petter; Wallin, Lars; Boström, Anne-Marie; Rudman, Ann
This study aimed to describe the developmental trajectories of registered nurses' capability beliefs during their first 3 years of practice. The focus was on three core competencies for health professionals-patient-centered care, teamwork, and evidence-based practice. A national cohort of registered nurses (n = 1,205) was recruited during their nursing education and subsequently surveyed yearly during the first 3 years of working life. The survey included 16 items on capability beliefs divided into three subscales for the assessment of patient-centered care, teamwork, and evidence-based practice, and the data were analyzed with linear latent growth modeling. The nurses' capability beliefs for patient-centered care increased over the three first years of working life, their capability beliefs for evidence-based practice were stable over the 3 years, and their capability beliefs for teamwork showed a downward trend. Through collaboration between nursing education and clinical practice, the transition to work life could be supported and competence development in newly graduated nurses could be enhanced to help them master the core competencies. Future research should focus on determining which factors impact the development of capability beliefs in new nurses and how these factors can be developed by testing interventions. © 2016 The Authors. Worldviews on Evidence-Based Nursing published by Wiley Periodicals, Inc. on behalf of Sigma Theta Tau International The Honor Society of Nursing.
James, Paul A; Oparil, Suzanne; Carter, Barry L; Cushman, William C; Dennison-Himmelfarb, Cheryl; Handler, Joel; Lackland, Daniel T; LeFevre, Michael L; MacKenzie, Thomas D; Ogedegbe, Olugbenga; Smith, Sidney C; Svetkey, Laura P; Taler, Sandra J; Townsend, Raymond R; Wright, Jackson T; Narva, Andrew S; Ortiz, Eduardo
Hypertension is the most common condition seen in primary care and leads to myocardial infarction, stroke, renal failure, and death if not detected early and treated appropriately. Patients want to be assured that blood pressure (BP) treatment will reduce their disease burden, while clinicians want guidance on hypertension management using the best scientific evidence. This report takes a rigorous, evidence-based approach to recommend treatment thresholds, goals, and medications in the management of hypertension in adults. Evidence was drawn from randomized controlled trials, which represent the gold standard for determining efficacy and effectiveness. Evidence quality and recommendations were graded based on their effect on important outcomes. There is strong evidence to support treating hypertensive persons aged 60 years or older to a BP goal of less than 150/90 mm Hg and hypertensive persons 30 through 59 years of age to a diastolic goal of less than 90 mm Hg; however, there is insufficient evidence in hypertensive persons younger than 60 years for a systolic goal, or in those younger than 30 years for a diastolic goal, so the panel recommends a BP of less than 140/90 mm Hg for those groups based on expert opinion. The same thresholds and goals are recommended for hypertensive adults with diabetes or nondiabetic chronic kidney disease (CKD) as for the general hypertensive population younger than 60 years. There is moderate evidence to support initiating drug treatment with an angiotensin-converting enzyme inhibitor, angiotensin receptor blocker, calcium channel blocker, or thiazide-type diuretic in the nonblack hypertensive population, including those with diabetes. In the black hypertensive population, including those with diabetes, a calcium channel blocker or thiazide-type diuretic is recommended as initial therapy. There is moderate evidence to support initial or add-on antihypertensive therapy with an angiotensin-converting enzyme inhibitor or angiotensin
Nejašmić, Danijel; Miošić, Ivana; Vrdoljak, Davorka; Permozer Hajdarović, Snježana; Tomičić, Marion; Gmajnić, Rudika; Diminić Lisica, Ines; Sironić Hreljanović, Jelena; Pleh, Vlatka; Cerovečki, Venija; Tomljenović, Anita; Bekić, Sanja; Jerčić, Minka; Tuđa, Karla; Puljak, Livia
To determine the use of evidence-based medicine (EBM) information and the level of awareness and knowledge of EBM among patients in Croatia. A cross-sectional study was conducted among 987 patients in 10 family medicine practices in Croatia. Patients from both urban (n=496) and rural (n=482) areas were surveyed. A 27-item questionnaire was used to collect data about sources that patients searched for medical information, patient awareness and use of Cochrane systematic reviews and other EBM resources, and their demographic characteristics. Half of the patients searched for medical information from sources other than physician. Internet was the most common place they searched for information. Very few patients indicated using EBM sources for medical information; one fifth of patients heard of EBM and 4% of the patients heard of the Cochrane Collaboration. Patients considered physician's opinion as the most reliable source of medical information. A logistic regression model showed that educational level and urban vs rural residence were the predictors of awareness about EBM and systematic reviews (P<0.001 for both). Our finding that patients consider a physician's opinion to be the most reliable source of health-related information could be used for promotion of high-quality health information among patients. More effort should be devoted to the education of patients in rural areas and those with less formal education. New avenues for knowledge translation and dissemination of high-quality health information among patients are necessary.
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....
Lee, Matthew K; Most, Sam P
Evidence-based medicine has become increasingly prominent in the climate of modern day healthcare. The practice of evidence-based medicine involves the integration of the best available evidence with clinical experience and expertise to help guide clinical decision-making. The essential tenets of evidence-based medicine can be applied to both functional and aesthetic rhinoplasty. Current outcome measures in functional and aesthetic rhinoplasty, including objective, subjective, and clinician-reported measures, is summarized and the current data is reviewed. Copyright © 2015 Elsevier Inc. All rights reserved.
Redesigning Radiotherapy Quality Assurance: Opportunities to Develop an Efficient, Evidence-Based System to Support Clinical Trials-Report of the National Cancer Institute Work Group on Radiotherapy Quality Assurance
Bekelman, Justin E., E-mail: firstname.lastname@example.org [University of Pennsylvania, Philadelphia, Pennsylvania (United States); Deye, James A.; Vikram, Bhadrasain [National Cancer Institute, Bethesda, Maryland (United States); Bentzen, Soren M. [University of Wisconsin, Madison, Wisconsin (United States); Bruner, Deborah [University of Pennsylvania, Philadelphia, Pennsylvania (United States); Curran, Walter J. [Emory University, Atlanta, Georgia (United States); Dignam, James [University of Chicago, Chicago, Illinois (United States); Efstathiou, Jason A. [Massachusetts General Hospital, Boston, Massachusetts (United States); FitzGerald, T.J. [University of Massachusetts, Boston, Massachusetts (United States); Hurkmans, Coen [European Organization for Research and Treatment of Cancer, Brussels (Belgium); Ibbott, Geoffrey S.; Lee, J. Jack [University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Merchant, Thomas E. [St. Jude Children' s Research Hospital, Memphis, Tennessee (United States); Michalski, Jeff [University of Washington, St. Louis, Missouri (United States); Palta, Jatinder R. [University of Florida, Miami, Florida (United States); Simon, Richard [National Institutes of Health, Bethesda, Maryland (United States); Ten Haken, Randal K. [University of Michigan, Ann Arbor, Michigan (United States); Timmerman, Robert [University of Texas Southwestern Medical Center, Dallas, Texas (United States); Tunis, Sean [Center for Medical Technology Policy, Baltimore, Maryland (United States); Coleman, C. Norman [National Cancer Institute, Bethesda, Maryland (United States); and others
Purpose: In the context of national calls for reorganizing cancer clinical trials, the National Cancer Institute sponsored a 2-day workshop to examine challenges and opportunities for optimizing radiotherapy quality assurance (QA) in clinical trial design. Methods and Materials: Participants reviewed the current processes of clinical trial QA and noted the QA challenges presented by advanced technologies. The lessons learned from the radiotherapy QA programs of recent trials were discussed in detail. Four potential opportunities for optimizing radiotherapy QA were explored, including the use of normal tissue toxicity and tumor control metrics, biomarkers of radiation toxicity, new radiotherapy modalities such as proton beam therapy, and the international harmonization of clinical trial QA. Results: Four recommendations were made: (1) to develop a tiered (and more efficient) system for radiotherapy QA and tailor the intensity of QA to the clinical trial objectives (tiers include general credentialing, trial-specific credentialing, and individual case review); (2) to establish a case QA repository; (3) to develop an evidence base for clinical trial QA and introduce innovative prospective trial designs to evaluate radiotherapy QA in clinical trials; and (4) to explore the feasibility of consolidating clinical trial QA in the United States. Conclusion: Radiotherapy QA can affect clinical trial accrual, cost, outcomes, and generalizability. To achieve maximum benefit, QA programs must become more efficient and evidence-based.
Shinagare, Atul B.; Khorasani, Ramin [Dept. of Radiology, Brigham and Women' s Hospital, Boston (Korea, Republic of)
With the advances in the field of oncology, imaging is increasingly used in the follow-up of cancer patients, leading to concerns about over-utilization. Therefore, it has become imperative to make imaging more evidence-based, efficient, cost-effective and equitable. This review explores the strategies and tools to make diagnostic imaging more evidence-based, mainly in the context of follow-up of cancer patients.
Smith, Tony [Senior Lecturer in Medical Radiation Science, University Department of Rural Health, School of Health Sciences, Faculty of Health, University of Newcastle, Locked Bag 9783 NEMSC, Tamworth, NSW 2348 (Australia)], E-mail: email@example.com
Background: The evidence based paradigm was first described about a decade ago. Previous authors have described a framework for the application of evidence based medicine which can be readily adapted to medical imaging practice. Purpose: This paper promotes the application of the evidence based framework in both the justification of the choice of examination type and the optimisation of the imaging technique used. Methods: The framework includes five integrated steps: framing a concise clinical question; searching for evidence to answer that question; critically appraising the evidence; applying the evidence in clinical practice; and, evaluating the use of revised practices. Results: This paper illustrates the use of the evidence based framework in medical imaging (that is, evidence based medical imaging) using the examples of two clinically relevant case studies. In doing so, a range of information technology and other resources available to medical imaging practitioners are identified with the intention of encouraging the application of the evidence based paradigm in radiography and radiology. Conclusion: There is a perceived need for radiographers and radiologists to make greater use of valid research evidence from the literature to inform their clinical practice and thus provide better quality services.
Lopez Alan D
Full Text Available Abstract Reliable, comparable information about the main causes of disease and injury in populations, and how these are changing, is a critical input for debates about priorities in the health sector. Traditional sources of information about the descriptive epidemiology of diseases, injuries and risk factors are generally incomplete, fragmented and of uncertain reliability and comparability. Lack of a standardized measurement framework to permit comparisons across diseases and injuries, as well as risk factors, and failure to systematically evaluate data quality have impeded comparative analyses of the true public health importance of various conditions and risk factors. As a consequence the impact of major conditions and hazards on population health has been poorly appreciated, often leading to a lack of public health investment. Global disease and risk factor quantification improved dramatically in the early 1990s with the completion of the first Global Burden of Disease Study. For the first time, the comparative importance of over 100 diseases and injuries, and ten major risk factors, for global and regional health status could be assessed using a common metric (Disability-Adjusted Life Years which simultaneously accounted for both premature mortality and the prevalence, duration and severity of the non-fatal consequences of disease and injury. As a consequence, mental health conditions and injuries, for which non-fatal outcomes are of particular significance, were identified as being among the leading causes of disease/injury burden worldwide, with clear implications for policy, particularly prevention. A major achievement of the Study was the complete global descriptive epidemiology, including incidence, prevalence and mortality, by age, sex and Region, of over 100 diseases and injuries. National applications, further methodological research and an increase in data availability have led to improved national, regional and global estimates
Muangchana, Charung; Riewpaiboon, Arthorn; Jiamsiri, Suchada; Thamapornpilas, Piyanit; Warinsatian, Porpit
Severe diarrhea caused by rotavirus is a health problem worldwide, including Thailand. The World Health Organization has recommended incorporating rotavirus vaccination into national immunization programs. This policy has been implemented in several countries, but not in Thailand where the mortality rate is not high. This leads to the question of whether it would be cost-effective to implement such a policy. The Thai National Vaccine Committee, through the Immunization Practice Subcommittee, has conducted an economic analysis. Their study aimed to estimate the costs of rotavirus diarrhea and of a rotavirus vaccination program, and the cost-effectiveness of such a program including budget impact analysis. The study was designed as an economic evaluation, employing modeling technique in both provider and societal perspectives. A birth cohort of Thai children in 2009 was used in the analysis, with a 5-year time horizon. Costs were composed of cost of the illness and the vaccination program. Outcomes were measured in the form of lives saved and DALYs averted. Both costs and outcomes were discounted at 3%. The study found the discounted number of deaths to be 7.02 and 20.52 for vaccinated and unvaccinated cohorts, respectively (13.5 deaths averted). Discounted DALYs were 263.33 and 826.57 for vaccinated and unvaccinated cohorts, respectively (563.24 DALYs averted). Costs of rotavirus diarrhea in a societal perspective were US$6.6 million and US$21.0 million for vaccinated and unvaccinated cohorts, respectively. At base case, the costs per additional death averted were US$5.1 million and US$5.7 for 2-dose and 3-dose vaccines, respectively, in a societal perspective. Costs per additional DALYs averted were US$128,063 and US$142,144, respectively. In a societal perspective, with a cost-effectiveness threshold at 1 GDP per capita per DALYs averted, vaccine prices per dose were US$4.98 and US$3.32 for 2-dose and 3-dose vaccines, respectively; in a provider perspective, they
Kovner, Anthony R; Rundall, Thomas G
Reports of medical mistakes have splashed across newspapers and magazines in the United States. At the same time, instances of overuse, underuse, and misuse of management tactics and strategies receive far less attention. The sense of urgency associated with improving the quality of medical care does not exist with respect to improving the quality of management decision making. A more evidence-based approach would improve the competence of the decision-makers and their motivation to use more scientific methods when making a decision. The authors of this article consider a study of 68 U.S. health services managers that found a low level of evidence-based management behaviors. From the findings, four strategies are suggested to increase health systems managers' use of research evidence to improve decision making: focusing evidence-based decision making on strategically important issues, developing committees and other structures to diffuse management research throughout the organization, building a management culture that values research, and training managers in the competencies required to apply research evidence to health services management decisions. To aid the manager in understanding and applying an evidenced-based approach to decision making, the article provides practical tools, techniques, and resources for immediate use.
Williams, D. R. R. (David Robert Rhys)
... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .ix 1. The Evidence Base for Diabetes Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Rhys Williams, William Herman, Ann-Louise Kinmonth...
Refshauge, Anne Dahl; Stigsdotter, Ulrika K.; Lamm, Bettina
This paper develops, explores and evaluates an evidence-based approach to playground design, with a public park playground (playlab Cph) in Copenhagen as a case study. In the increasingly urbanised world, park playgrounds are valuable places that support healthy child development by providing...... opportunities for play, nature exploration and sensory stimulation. As it is increasingly expected that designers base their decisions on research evidence, there is a need to develop approaches to facilitate this, which also applies to playground design. The design of PlayLab Cph was based on relevant evidence...
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...
Proponents of evidence-based medicine (EBM) have argued convincingly for applying this scientific method to medicine. However, the current methodological framework of the EBM movement has recently been called into question, especially in epidemiology and the philosophy of science. The debate has focused on whether the methodology of randomized controlled trials provides the best evidence available. This paper attempts to shift the focus of the debate by arguing that clinical reasoning involves a patchwork of evidential approaches and that the emphasis on evidence hierarchies of methodology fails to lend credence to the common practice of corroboration in medicine. I argue that the strength of evidence lies in the evidence itself, and not the methodology used to obtain that evidence. Ultimately, when it comes to evaluating the effectiveness of medical interventions, it is the evidence obtained from the methodology rather than the methodology that should establish the strength of the evidence. © 2014 John Wiley & Sons, Ltd.
This presentation will describe a concrete strategy for bridging the gap between the *science* of science communication and the practice of it. In recent years, social scientists have made substantial progress in identifying the psychological influences that shape public receptivity to scientific information relating to climate change and other public policy issues. That work, however, has consisted nearly entirely of laboratory experiments and public opinion surveys; these methods identify general mechanisms of information processing but do not yield concrete prescriptions for communication in field settings. In order to integrate the findings of the science of science communication with the practice of it, field communication must now be made into a meaningful site of science communication research. "Evidence-based science communication" will involve collaborative work between social scientists and practitioners aimed at formulating and testing scientifically informed communication strategies in real-world contexts.
Full Text Available This issue of Evidence Based Library and Information Practice includes three papers from the Evidence Based Scholarly Communication Conference (EBSCC that took place in March 2010i. Kroth, Philips and Eldredge have written a commentary that gives an overview of the conference, and introduces us to the research papers that were presented. As well, two research presentations from the conference appear in this issue, an article by Donahue about a potential new method of communicating between scholars, and a paper by Gilliland in our Using Evidence in Practice section, detailing a library’s Open Access Day preparations.Kroth, Philips and Eldredge note that “The EBSCC brought together librarians and information specialists to share evidence-based strategies for developing effective local scholarly communication support and training and, hopefully, form new coalitions to address this topic at a local and national level.” (p 108. This conference focused on translational medicine, and looked at how to promote new methods of scholarly communication, partially through the inclusion of research papers at the conference.The inclusion of these articles and the evidence based focus of the EBSCC conference, made me ask myself, can scholarly communication be evidence based? At its core, scholarly communication is anything but a scientific issue. It is charged with emotion; from authors, publishers, librarians and others involved in the business of publishing. The recent shift to look at new models of scholarly communication has been a threat to many of the established models and sparked much debate in the academic world, especially in relation to open access. In her 2006 EBLIP commentary on evidence based practice and open access, Morrison notes, “Open Access and evidence based librarianship are a natural combination” (p. 49, and outlines her perspective on many of the reasons why. Debate continues to rage, however, regarding how authors should
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…
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.
The guidelines of all international hernia societies recommend as procedures of choice the laparoendoscopic techniques total extraperitoneal patch plasty (TEP) and transabdominal preperitoneal patch plasty (TAPP) as well as the open Lichtenstein operation for elective inguinal hernia repair. The learning curve associated with the laparoendoscopic techniques, in particular TEP, is longer than that for the open Lichtenstein technique due to the complexity of the procedures. Accordingly, for laparoendoscopic techniques it is particularly important that the operations are conducted in a standardized manner in compliance with the evidence-based recommendations given for the technical details. When procedures are carried out in strict compliance with the guidelines of the international hernia societies, low rates of perioperative complications, complication-related reoperations, recurrences and chronic pain can be expected for TEP. Compliance with the guidelines can also positively impact mastery of the learning curve for TEP. The technical guidelines on TEP are based on study results and on the experiences of numerous experts; therefore, it is imperative that they are implemented in routine surgical practice.
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.
In this issue, Norwegian authors demonstrate that causes of early expulsion out the workforce are rooted in childhood. They reconstruct individual biographies in administrative databases linked by an unique national identification number, looking forward 15 years in early adulthood and looking back
Hernández F., Luis J.
Evidence based Public Health is the execution and evaluation of the efficiency of interventions, plans, programs, projects and politics in public health through the application of the scientific principles of reasoning, including the systematic use of information and information systems. Evidence based public health involves the use of methodologies similar to those applied in evidence-based clinical medicine, but differs in its contents. In public health two types of evidence are described. ...
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.
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…
Marcilly, Romaric; Peute, Linda W.; Beuscart-Zephir, Marie-Catherine; Jaspers, Monique W.
In a Health Information Technology (HIT) regulatory context in which the usability of this technology is more and more a critical issue, there is an increasing need for evidence based usability practice. However, a clear definition of evidence based usability practice and how to achieve it is still
Rees, Eliot; Sinha, Yashashwi; Chitnis, Abhishek; Archer, James; Fotheringham, Victoria; Renwick, Stephen
Many medical schools teach the principles of evidence-based medicine (EBM) as part of their undergraduate curriculum. Medical students perceive that EBM is valuable to their undergraduate and postgraduate career. Students may experience barriers to applying EBM principles, especially when searching for evidence or identifying high-quality resources. The UK National Institute for Health and Care Excellence (NICE) Evidence Search is a service that enables access to authoritative clinical and non-clinical evidence and best practice through a web-based portal. Evidence-based medicine workshops were organised and delivered by fourth-year medical students, having first received training from NICE to become NICE student champions. The workshops covered the basic principles of EBM and focused on retrieving EBM resources for study through the NICE Evidence Search portal. The scheme was evaluated using a pre-workshop survey and an 8-12 week post-workshop survey. Self-reported confidence in searching for evidence-based resources increased from 29 per cent before the workshop to 87 per cent after the workshop. Only 1 per cent of students rated evidence-based resources as their first preference pre-workshop, compared with 31 per cent post-workshop. The results show that although many students were aware of evidence-based resources, they tended not to use them as their preferred resource. Despite appreciating the value of evidence-based resources, few students were confident in accessing and using such resources for pre-clinical study. A peer-taught workshop in EBM improved students' confidence with, and use of, evidence-based resources. © 2014 John Wiley & Sons Ltd.
Toward an Evidence-Based Nonclinical Road Map for Evaluating the Efficacy of New Tuberculosis (TB) Drug Regimens: Proceedings of a Critical Path to TB Drug Regimens-National Institute of Allergy and Infectious Diseases In Vivo Pharmacology Workshop for TB Drug Development
Nuermberger, Eric; Sizemore, Christine; Romero, Klaus; Hanna, Debra
Novel tuberculosis (TB) drug regimens are urgently needed, and their development will be enabled by improved preclinical approaches that more effectively inform and ensure safe selection of clinical candidates and drug combination/regimens. An evidence-based approach for the assessment of nonclinical models supporting TB drug development has been proposed by a joint partnership between the National Institute of Allergy and Infectious Diseases (NIAID) and the Critical Path to TB Drug Regimens ...
Public attention to evidence-based health care (EBHC) has increased significantly in recent years. Key problems related to applying EBHC in current healthcare practice include the timely update of up-to-date knowledge and skills and the methodology used to implement EBHC in clinical settings. EBHC has been introduced to the Taiwan healthcare system for the past two decades. The annual EBM (Evidence based medicine) National Competition is a unique and important EBHC activity in Taiwan. EBHC has been promoted widely in medicine, nursing, pharmacy, public health and other professions, and EBHC-related organizations such as the Taiwan Evidence Based Medicine Association (TEBMA), and Taiwan Evidence Based Nursing Association (TEBNA), have increased in number and grown in membership. In addition to domestic developments, Taiwan is also actively involved in global organizations, such as the Cochrane Collaboration, East Asian Cochrane Alliance (EACA), and the International Society for Evidence Based Health Care (ISEHC). In Taiwan, most medical professionals work cooperatively to promote EBHC, which facilitates the gradual improvement of healthcare quality.
Full Text Available Abstract Background The reduction of health inequalities is a focus of many national and international health organisations. The need for pragmatic evidence-based approaches has led to the development of a number of evidence-based equity initiatives. This paper describes a new program that focuses upon evidence- based tools, which are useful for policy initiatives that reduce inequities. Methods This paper is based on a presentation that was given at the "Regional Consultation on Policy Tools: Equity in Population Health Reports," held in Toronto, Canada in June 2002. Results Five assessment tools were presented. 1. A database of systematic reviews on the effects of educational, legal, social, and health interventions to reduce unfair inequalities is being established through the Cochrane and Campbell Collaborations. 2 Decision aids and shared decision making can be facilitated in disadvantaged groups by 'health coaches' to help people become better decision makers, negotiators, and navigators of the health system; a pilot study in Chile has provided proof of this concept. 3. The CIET Cycle: Combining adapted cluster survey techniques with qualitative methods, CIET's population based applications support evidence-based decision making at local and national levels. The CIET map generates maps directly from survey or routine institutional data, to be used as evidence-based decisions aids. Complex data can be displayed attractively, providing an important tool for studying and comparing health indicators among and between different populations. 4. The Ottawa Equity Gauge is applying the Global Equity Gauge Alliance framework to an industrialised country setting. 5 The Needs-Based Health Assessment Toolkit, established to assemble information on which clinical and health policy decisions can be based, is being expanded to ensure a focus on distribution and average health indicators. Conclusion Evidence-based planning tools have much to offer the
Dufour, J-C; Mancini, J; Fieschi, M
The foundation of evidence-based medicine is critical analysis and synthesis of the best data available concerning a given health problem. These factual data are accessible because of the availability on the Internet of web tools specialized in research for scientific publications. A bibliographic database is a collection of bibliographic references describing the documents indexed. Such a reference includes at least the title, summary (or abstract), a set of keywords, and the type of publication. To conduct a strategically effective search, it is necessary to formulate the question - clinical, diagnostic, prognostic, or related to treatment or prevention - in a form understandable by the research engine. Moreover, it is necessary to choose the specific database or databases, which may have particular specificity, and to analyze the results rapidly to refine the strategy. The search for information is facilitated by the knowledge of the standardized terms commonly used to describe the desired information. These come from a specific thesaurus devoted to document indexing. The most frequently used is MeSH (Medical Subject Heading). The principal bibliographic database whose references include a set of describers from the MeSH thesaurus is Medical Literature Analysis and Retrieval System Online (Medline), which has in turn become a subpart of a still more vast bibliography called PubMed, which indexes an additional 1.4 million references. Numerous other databases are maintained by national or international entities. These include the Cochrane Library, Embase, and the PASCAL and FRANCIS databases.
Full Text Available Objective To evaluate the current treatments and possible adverse reactions of metabolic myopathy, and to develop the best solution for evidence-based treatment. Methods Taking metabolic myopathy, mitochondrial myopathy, lipid storage myopathy, glycogen storage diseases, endocrine myopathy, drug toxicity myopathy and treatment as search terms, retrieve in databases such as PubMed, Cochrane Library, ClinicalKey database, National Science and Technology Library (NSTL, in order to collect the relevant literature database including clinical guidelines, systematic reviews (SR, randomized controlled trials (RCT, controlled clinical trials, retrospective case analysis and case study. Jadad Scale was used to evaluate the quality of literature. Results Twenty-eight related articles were selected, including 6 clinical guidelines, 5 systematic reviews, 10 randomized controlled trials and 7 clinical controlled trials. According to Jadad Scale, 23 articles were evaluated as high-quality literature (≥ 4, and the remaining 5 were evaluated as low-quality literature (< 4. Treatment principles of these clinical trials, efficacy of different therapies and drug safety evaluation suggest that: 1 Acid α-glycosidase (GAA enzyme replacement therapy (ERT is the main treatment for glycogen storage diseases, with taking a high-protein diet, exercising before taking a small amount of fructose orally and reducing the patient's physical activity gradually. 2 Carnitine supplementation is used in the treatment of lipid storage myopathy, with carbohydrate and low fat diet provided before exercise or sports. 3 Patients with mitochondrial myopathy can take coenzyme Q10, vitamin B, vitamin K, vitamin C, etc. Proper aerobic exercise combined with strength training is safe, and it can also enhance the exercise tolerance of patients effectively. 4 The first choice to treat the endocrine myopathy is treating primary affection. 5 Myopathies due to drugs and toxins should
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
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'.
Roger L Sur
Full Text Available This essay reviews the historical circumstances surrounding the introduction and evolution of evidence-based medicine. Criticisms of the approach are also considered. Weaknesses of existing standards of clinical practice and efforts to bring more certainty to clinical decision making were the foundation for evidence-based medicine, which integrates epidemiology and medical research. Because of its utility in designing randomized clinical trials, assessing the quality of the literature, and applying medical research at the bedside, evidence-based medicine will continue to have a strong influence on everyday clinical practice.
Williams, D. R. R. (David Robert Rhys)
... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 3. Evidence-Based Deﬁnition and Classiﬁcation: A Commentary . . . . . . Steve O'Rahilly 37 PART II: PREVENTION OF DIABETES 4. Prevention of Type 1 Diabetes...
Full Text Available the engagement between science and policymaking. It is concluded that the issue of evidence-based policymaking remains unresolved and questions for future research on the science–policy interface are raised....
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.
The workshop titled, National Library of Medicine: Evidence-based Information At Your Fingertips, is a computer training class designed to meet the needs of nurses who require access to information on specific medical topics and on the adverse health effects of exposure to hazardous substances. The Specialized Information Services Division of the National Library of Medicine (NLM) is sponsoring this workshop for the National Black Nurses Association to increase the awareness of health professionals of the availability and value of the free NLM medical, environmental health, and toxicology databases.
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.
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…
Vijayalakshmi, R.; Anitha, V.; Ramakrishnan, T.; Sudhakar, Uma
Dentists need to make clinical decisions based on limited scientific evidence. In clinical practice, a clinician must weigh a myriad of evidences every day. The goal of evidence-based dentistry is to help practitioners provide their patients with optimal care. This is achieved by integrating sound research evidence with personal clinical expertise and patient values to determine the best course of treatment. Periodontology has a rich background of research and scholarship. Therefore, efficient use of this wealth of research data needs to be a part of periodontal practice. Evidence-based periodontology aims to facilitate such an approach and it offers a bridge from science to clinical practice. The clinician must integrate the evidence with patient preference, scientific knowledge, and personal experience. Most important, it allows us to care for our patients. Therefore, evidence-based periodontology is a tool to support decision-making and integrating the best evidence available with clinical practice. PMID:20142947
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....
Toward an Evidence-Based Nonclinical Road Map for Evaluating the Efficacy of New Tuberculosis (TB) Drug Regimens: Proceedings of a Critical Path to TB Drug Regimens-National Institute of Allergy and Infectious Diseases In Vivo Pharmacology Workshop for TB Drug Development.
Nuermberger, Eric; Sizemore, Christine; Romero, Klaus; Hanna, Debra
Novel tuberculosis (TB) drug regimens are urgently needed, and their development will be enabled by improved preclinical approaches that more effectively inform and ensure safe selection of clinical candidates and drug combination/regimens. An evidence-based approach for the assessment of nonclinical models supporting TB drug development has been proposed by a joint partnership between the National Institute of Allergy and Infectious Diseases (NIAID) and the Critical Path to TB Drug Regimens (CPTR) Consortium. Copyright © 2016, American Society for Microbiology. All Rights Reserved.
Full Text Available Evidence-based polices have important place for the educational development. Monitoring and reporting activities through national and international reports and surveys provide data sources for a comparable education in Europe and make contribution to a more effective policy making process. It is seen that only almost half of the European countries carry out such surveys and reports by the year of 2010/2011 within the context of teaching methods and low achievement in mathematics education. In order to reach to the common educational objectives, systematic data sources are required both in national and international level.
Kamalbekova, G; Kalieva, M
Understanding principles of evidence-based medicine is of vital importance for improving quality of care, promoting public health and health system development. Understanding principles of evidence-based medicine allows using the most powerful information source, which have ever existed in medicine. To evaluate the effectiveness of teaching Evidence-Based Medicine, including long-term outcomes of training. The study was conducted at the Medical University of Astana, where the Scientific and Educational Center of Evidence-Based Medicine was established in 2010 with the help of the corresponding project of the World Bank. The participants of the study were the faculty trained in Evidence-Based Medicine at the workshop "Introduction to Evidence-Based Medicine" for the period of 2010-2015 years. There were a total of 16 workshops during the period, and 323 employees were trained. All participants were asked to complete our questionnaire two times: before the training - pre-training (to determine the initial level of a listener) and after the training - post-training (to determine the acquired level and get the feedback). Questionnaires were prepared in such a way, that the majority of questions before and after training were identical. Thus, it provided a clear picture of the effectiveness of training. Questions in the survey were open-ended so that the respondents had the opportunity to freely and fully express their views. The main part of the questionnaires included the following questions: "Do you understand what evidence-based medicine is", "how do you understand what the study design means", "what is randomization", "how research is classified", "do you know the steps of decision-making according to Evidence-Based Medicine, list them", "what literature do you prefer to use when searching for information (print, electronic, etc.)", "what resources on the Internet do you prefer to use". Only 30-35% of respondents gave correct answers to the questions on
Australian and New Zealand national evidence-based recommendations for the investigation and follow-up of undifferentiated peripheral inflammatory arthritis: an integration of systematic literature research and rheumatological expert opinion.
Barrett, Claire; Bird, Paul; Major, Gabor; Romas, Evange; Portek, Ian; Taylor, Andrew; Zochling, Jane
To develop Australian and New Zealand (ANZ) recommendations for the investigation and follow-up of undifferentiated peripheral inflammatory arthritis (UPIA) using an evidence-based approach. Ten questions pertaining to the investigation and follow-up of patients with UPIA in daily rheumatological practice were defined by clinicians using a modified Delphi approach. A systematic literature search was conducted for each of the final questions. The results were presented to a workshop of 54 ANZ rheumatologists in May 2009. Discussions were held to develop consensus statements for each question, based on published evidence and clinical experience/expertise. Ten recommendations were made on diagnostic value of clinical features in the patient's history and examination, predictors of poor prognosis and persistence, synovial fluid analysis, serology, imaging and human leukocyte antigen B27 testing. The lack of specific research to inform recommendations presented a challenge. Dynamic discussion groups outlined individual experience in areas without good quality clinical trial evidence. The median strength of support for the final set of recommendations was 7/10 (interquartile range 6-8), ranging from 6 to 9 for individual statements. Ten ANZ recommendations for the investigation and follow-up of UPIA were formulated, based on available evidence and extensive clinical experience. The systematic literature review was of limited value while animated discussion of individual experience, with subsequent information exchange, highlighted the importance of merging clinical expertise with published literature to establish practical recommendations that can improve quality of care in rheumatology. © 2013 Asia Pacific League of Associations for Rheumatology and Wiley Publishing Asia Pty Ltd.
The differential diagnosis between pleural sarcomatoid mesothelioma and spindle cell/pleomorphic (sarcomatoid) carcinomas of the lung: evidence-based guidelines from the International Mesothelioma Panel and the MESOPATH National Reference Center.
Marchevsky, Alberto M; LeStang, Nolwenn; Hiroshima, Kenzo; Pelosi, Giuseppe; Attanoos, Richard; Churg, Andrew; Chirieac, Lucian; Dacic, Sanja; Husain, Aliya; Khoor, Andras; Klebe, Sonja; Lantuejoul, Silvie; Roggli, Victor; Vignaud, Jean-Michel; Weynard, Birgit; Sauter, Jennifer; Henderson, Douglas; Nabeshima, Kasuzi; Galateau-Salle, Francoise
Immunohistochemistry is used to distinguish sarcomatoid malignant mesotheliomas (SMM) from spindle cell and pleomorphic carcinomas (SPC) but there are no guidelines on how to interpret cases that show overlapping or equivocal immunohistochemical findings. A systematic literature review of the immunophenotype of these lesions was performed and the experience with 587 SMM and 46 SPC at MESOPATH was collected. Data were analyzed with Comprehensive Meta-Analysis 2.0 software (Biostat, Englewood, NJ). There were insufficient data to evaluate the differential diagnosis between SPC and localized SMM or peritoneal SMM. Meta-analysis showed considerable overlap in the immunophenotype of these neoplasms and significant data heterogeneity amongst many of the results. Survival data from MESOPATH patients showed no significant differences in overall survival between SMM and SPC patients. Best available evidence was used to formulate several evidence-based guidelines for the differential diagnosis between pleural SMM and SPC. These guidelines emphasize the need to correlate the histopathological findings with clinical and imaging information. Diffuse SMM can be diagnosed with certainty in the presence of malignant spindle cell pleural lesions showing immunoreactivity for cytokeratin and mesothelial markers and negative staining for epithelial markers. Criteria for the interpretation of various other combinations of immunoreactivity for cytokeratin and mesothelial and/or epithelial markers are proposed. Localized sarcomatoid mesotheliomas can only be diagnosed in the presence of spindle cell malignancies that exhibit immunoreactivity for cytokeratin and mesothelial markers and negative immunoreactivity for epithelial lesions, in patients that show no multifocal or diffuse pleural spread and no evidence for extrapleural lesions. Copyright © 2017. Published by Elsevier Inc.
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…
Winning, T.; Needleman, I.; Rohlin, M.; Carrassi, A.; Chadwick, B.; Eaton, K.; Hardwick, K.; Ivancakova, R.; Jallaludin, R.L.; Johnsen, D.; Kim, J.G.; Lekkas, D.; Li, D.; Onisei, D.; Pissiotis, A.; Reynolds, P.; Tonni, I.; Vanobbergen, J.; Vassileva, R.; Virtanen, J.; Wesselink, P.R.; Wilson, N.
An evidence-based (EB) approach has been a significant driver in reforming healthcare over the past two decades. This change has extended across a broad range of health professions, including oral healthcare. A key element in achieving an EB approach to oral healthcare is educating our
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
In this paper, a model for assessment and intervention is presented. This model explains how to perform theory- and evidence-based as well as practice-based assessment and intervention. The assessment model applies a holistic approach to treatment planning which includes recognition...
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…
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.
Nüssler, Emil Karl; Eskildsen, Jacob Kjær; Håkonsson, Dorthe Døjbak
Surgeons who perform prolapse surgeries face the dilemma of choosing to use mesh, with its assumed benefits, and the risks associated with mesh. In this paper, we examine whether decisions to use mesh is evidence based. Based on data of 30,398 patients from the Swedish National Quality Register...... of Gynecological Surgery we examine factors related to decisions to use mesh. Our results indicate that decisions to use mesh are not evidence based, and cannot be explained neither by FDA safety communications, nor by medical conditions usually assumed to predict its usage. Instead, decisions to use mesh...... are highly influenced by the geographical placement of surgeons. Therfore, decisions to use mesh are boundedly rationality, rather than rational....
Hoerle, S; Kroll, P
Evidence-based medicine is often misunderstood as 'cookbook medicine with standard recipes' that does not take clinical experience into account. It is, however, supposed to be a basis for decision making in caring for individual patients under consideration of patients' preferences. This seems to be very important, since diabetic retinopathy continues to be the most frequent cause of vision loss in working age adults with negative consequences for patients' quality of life and for health economics. The most important evidence-based therapy for diabetic retinopathy and maculopathy is laser coagulation. Vitrectomy for proliferative stages has also been proven effective by clinical studies. For more recent treatment options like triamcinolone injection and vitrectomy for diabetic macular edema there is a lower level of evidence so far. The Diabetic Retinopathy Study was the first to show the effectiveness of panfundus laser coagulation for a larger group of patients. The Early Treatment Diabetic Retinopathy Study in turn serves as a basis for laser coagulation of retinopathy and maculopathy. The Diabetic Retinopathy Vitrectomy Study could show the advantages of timely vitrectomy. Both the Diabetes Control and Complications Trial and the United Kingdom Prospective Diabetes Study could show the value of intensive blood glucose control. Evidence-based medicine on the basis of the studies mentioned above is practiced quite self-evidently in ophthalmo-diabetology. It should be regarded as a helpful tool for special therapeutic situations which still leaves room for one's personal clinical experience to be included. It is somewhat problematic that the term evidence-based medicine seems to be restricted to the results of large randomized studies, because even special problems and very individual, difficult therapeutic questions can be placed on an evidence-based foundation, although at a lower level of evidence, using today's modern means of literature research. Copyright (c
Full Text Available Nel corso dell’ultimo decennio, nel pensiero pedagogico anglosassone, si è affermata una cultura dell’evidenza cui ci si riferisce con l’espressione “evidence based education” (EBE. Secondo tale prospettiva, le decisioni in ambito educativo dovrebbero essere assunte sulla base delle conoscenze che la ricerca empirica offre in merito alla minore o maggiore efficacia delle differenti opzioni didattiche. Si tratta di un approccio (denominato “evidence based practice” che ha origine in ambito medico e che in seguito ha trovato applicazione in differenti domini delle scienze sociali. L’autore presenta un quadro introduttivo all’EBE, dando conto delle sue origini e dei differenti significati di cui è portatrice.
This book contains an evidence-based pedagogic guide to enable any motivated teaching/training professional to be able to teach effectively and creatively. It firstly summarises the extensive research field on human psychological functioning relating to learning and how this can be fully utilised in the design and facilitation of quality learning experiences. It then demonstrates what creativity actually 'looks like' in terms of teaching practices, modelling the underpinning processes of creative learning design and how to apply these in lesson planning. The book, having established an evidence-based and pedagogically driven approach to creative learning design, extensively focuses on key challenges facing teaching professionals today. These include utilising information technologies in blended learning formats, differentiating instruction, and developing self-directed learners who can think well. The main purpose of the book is to demystify what it means to teach creatively, explicitly demonstrating the pr...
The use of science for policy is at the core of a perfect storm generated by the insurgence of several concurrent crises: of science, of trust, of sustainability. The modern positivistic model of science for policy, known as evidence based policy, is based on dramatic simplifications and compressions of available perceptions of the state of affairs and possible explanations (hypocognition). This model can result in flawed prescriptions. The flaws become more evident when dealing with complex issues characterized by concomitant uncertainties in the normative, descriptive and ethical domains. In this situation evidence-based policy may concur to the fragility of the social system. Science plays an important role in reducing the feeling of vulnerability of humans by projecting a promise of protection against uncertainties. In many applications quantitative science is used to remove uncertainty by transforming it into probability, so that mathematical modelling can play the ritual role of haruspices. This epistem...
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.
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...
e-Health is experiencing a difficult time. On the one side, the forecast is for a bright digital health future created by precision medicine and smart devices. On the other hand, most large scale e-health projects struggle to make a difference and are often controversial. Both futures fail because they are not evidence-based. Medical informatics should follow the example of evidence-based medicine, i.e. conduct rigorous research that gives us evidence to solve real world problems, synthesise that evidence and then apply it strictly. We already have the tools for creating a different universe. What we need is evidence, will, a culture of learning, and hard work.
Cognitive hypnotherapy (CH) is a comprehensive evidence-based hypnotherapy for clinical depression. This article describes the major components of CH, which integrate hypnosis with cognitive-behavior therapy as the latter provides an effective host theory for the assimilation of empirically supported treatment techniques derived from various theoretical models of psychotherapy and psychopathology. CH meets criteria for an assimilative model of psychotherapy, which is considered to be an efficacious model of psychotherapy integration. The major components of CH for depression are described in sufficient detail to allow replication, verification, and validation of the techniques delineated. CH for depression provides a template that clinicians and investigators can utilize to study the additive effects of hypnosis in the management of other psychological or medical disorders. Evidence-based hypnotherapy and research are encouraged; such a movement is necessary if clinical hypnosis is to integrate into mainstream psychotherapy.
Fins, Joseph J
Medicine in the last decades of the twentieth century was ripe for a data sweep that would bring systematic analysis to treatment strategies that seemingly had stood the test of time but were actually unvalidated. Coalescing under the banner of evidence-based medicine, this process has helped to standardize care, minimize error, and promote patient safety. But with this advancement, something of the art of medicine has been lost. © 2016 The Hastings Center.
Wahlqvist, Mark L
The clinical nutrition case study is a neglected area of activity and publication. This may be in part because it is not regarded as a serious contributor to evidence-based nutrition (EBN). Yet it can play a valuable part in hypothesis formulation and in the cross-checking of evidence. Most of all, it is usually a point at which the operationalisation of nutrition evidence is granted best current practice status.
Jan Klusáček; Marie Klusáčková
The article deals with the evidence base of health policy in the Czech Republic. It focuses on articles published in peer-reviewed scholarly journals. It builds on a quantitative analysis of articles published between 2005 and 2010 in scholarly journals in the fields of social science, management and administration, public health and other relevant fields. The main finding is that almost half of the 161 articles with potential use for health policy were published in a single journal, Zdravotn...
Sardanelli, Francesco; Di Leo, Giovanni [Universita degli Studi di Milano, Dipartimento di Scienze Medico-Chirurgiche, Unita di Radiologia, IRCCS Policlinico San Donato, Via Morandi 30, San Donato Milanese, Milan (Italy); Hunink, Myriam G. [Erasmus University Medical Center, Department of Radiology, Rotterdam (Netherlands); Erasmus University Medical Center, Department of Epidemiology, Rotterdam (Netherlands); Harvard School of Public Health, Program for Health Decision Science, Boston, MA (United States); Gilbert, Fiona J. [University of Aberdeen, Aberdeen Biomedical Imaging Centre, Aberdeen (United Kingdom); Krestin, Gabriel P. [Erasmus University Medical Center, Department of Radiology, Rotterdam (Netherlands)
To provide an overview of evidence-based medicine (EBM) in relation to radiology and to define a policy for adoption of this principle in the European radiological community. Starting from Sackett's definition of EBM we illustrate the top-down and bottom-up approaches to EBM as well as EBM's limitations. Delayed diffusion and peculiar features of evidence-based radiology (EBR) are defined with emphasis on the need to shift from the demonstration of the increasing ability to see more and better, to the demonstration of a significant change in treatment planning or, at best, of a significant gain in patient outcome. The ''as low as reasonably achievable'' (ALARA) principle is thought as a dimension of EBR while EBR is proposed as part of the core curriculum of radiology residency. Moreover, we describe the process of health technology assessment in radiology with reference to the six-level scale of hierarchy of studies on diagnostic tests, the main sources of bias in studies on diagnostic performance, and levels of evidence and degrees of recommendations according to the Centre for Evidence-Based Medicine (Oxford, UK) as well as the approach proposed by the GRADE working group. Problems and opportunities offered by evidence-based guidelines in radiology are considered. Finally, we suggest nine points to be actioned by the ESR in order to promote EBR. Radiology will benefit greatly from the improvement in practice that will result from adopting this more rigorous approach to all aspects of our work. (orig.)
Martinón-Torres, F; Rodríguez Núñez, A; Martinón Sánchez, J M
Bronchiolitis is the leading cause of lower respiratory tract infection in infants and produces significant morbidity. Limited progress has been made in the treatment of this disease and, in many cases, the therapy employed is controversial and mainly based on general recommendations and not on evidence-based strategies. This report uses evidence-based methodology to provide a critical review of the data available on the treatment of acute bronchiolitis (understood as the first episode of respiratory syncytial virus bronchiolitis in a previously healthy infant). After this analysis, we conclude that the only justifiable therapeutic interventions in these patients are supportive treatment, nebulized epinephrine and mechanical ventilation. Other therapies such us physiotherapy, nebulization, heliox, anticholinergics or exogenous surfactant, among others, require further randomized controlled trials to determine their utility. No evidence supports the routine use of corticosteroids, beta-adrenergic drugs, antibiotics, immunoglobulins, interferon, vitamin A or ribavirin in these patients. Finally, we consider that a national consensus review for the implementation of evidence-based clinical practical guidelines on the management of acute bronchiolitis would be of great interest.
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.
Eldredge, J D
To demonstrate how the core characteristics of both evidence-based medicine (EBM) and evidence-based health care (EBHC) can be adapted to health sciences librarianship. Narrative review essay involving development of a conceptual framework. The author describes the central features of EBM and EBHC. Following each description of a central feature, the author then suggests ways that this feature applies to health sciences librarianship. First, the decision-making processes of EBM and EBHC are compatible with health sciences librarianship. Second, the EBM and EBHC values of favoring rigorously produced scientific evidence in decision making are congruent with the core values of librarianship. Third, the hierarchical levels of evidence can be applied to librarianship with some modifications. Library researchers currently favor descriptive-survey and case-study methods over systematic reviews, randomized controlled trials, or other higher levels of evidence. The library literature nevertheless contains diverse examples of randomized controlled trials, controlled-comparison studies, and cohort studies conducted by health sciences librarians. Health sciences librarians are confronted with making many practical decisions. Evidence-based librarianship offers a decision-making framework, which integrates the best available research evidence. By employing this framework and the higher levels of research evidence it promotes, health sciences librarians can lay the foundation for more collaborative and scientific endeavors.
Khong, T Y
The generation of a pathology test result must be based on criteria that are proven to be acceptably reproducible and clinically relevant to be evidence-based. This review de-constructs the umbilical cord coiling index to illustrate how it can stray from being evidence-based. Publications related to umbilical cord coiling were retrieved and analysed with regard to how the umbilical coiling index was calculated, abnormal coiling was defined and reference ranges were constructed. Errors and other influences that can occur with the measurement of the length of the umbilical cord or of the number of coils can compromise the generation of the coiling index. Definitions of abnormal coiling are not consistent in the literature. Reference ranges defining hypocoiling or hypercoiling have not taken those potential errors or the possible effect of gestational age into account. Even the way numerical test results in anatomical pathology are generated, as illustrated by the umbilical coiling index, warrants a critical analysis into its evidence base to ensure that they are reproducible or free from errors.
Wegwarth, Odette; Wagner, Gert G; Gigerenzer, Gerd
Informed decision making in medicine, defined as basing one's decision on the best current medical evidence, requires both informed physicians and informed patients. In cancer screening, however, studies document that these prerequisites are not yet met. Many physicians do not know or understand the medical evidence behind screening tests, do not adequately counsel (asymptomatic) people on screening, and make recommendations that conflict with existing guidelines on informed choice. Consistent with this situation, nation-wide studies showed that the general public misperceives the contribution of cancer screening but that understanding considerably improves when evidence-based information is provided. However, can evidence-based patient information about cancer screening make people also less likely to simply follow a physician's non-evidence-based advice? A national sample of 897 German citizens, surveyed in face-to-face computer-assisted personal interviews, received either evidence-based (e.g., absolute risks on benefits and harms; n = 451) or non-evidence-based (e.g., relative risks on benefits only; n = 446) patient information about a cancer screening test and were then asked to make their initial cancer screening choice. Thereafter, participants received a hypothetical physician's recommendation, which was non-evidence-based in terms of existing guidelines on informed decision making (i.e., reporting either benefits or harms but not both; no provision of numbers). When provided with non-evidence-based patient information (n = 446), a mean of 33.1% of 235 participants whose initial screening choice contradicted the hypothetical physician's non-evidence-based recommendation adjusted their choice in deference to that recommendation (95% CI: 27.4 to 39.4%), whereas with evidence-based patient information (n = 451), only half as many, a mean of 16.0% of 225 (95% CI: 11.8 to 21.4%), modified their choice. Thus, evidence-based patient information makes people less
Full Text Available Informed decision making in medicine, defined as basing one's decision on the best current medical evidence, requires both informed physicians and informed patients. In cancer screening, however, studies document that these prerequisites are not yet met. Many physicians do not know or understand the medical evidence behind screening tests, do not adequately counsel (asymptomatic people on screening, and make recommendations that conflict with existing guidelines on informed choice. Consistent with this situation, nation-wide studies showed that the general public misperceives the contribution of cancer screening but that understanding considerably improves when evidence-based information is provided. However, can evidence-based patient information about cancer screening make people also less likely to simply follow a physician's non-evidence-based advice? A national sample of 897 German citizens, surveyed in face-to-face computer-assisted personal interviews, received either evidence-based (e.g., absolute risks on benefits and harms; n = 451 or non-evidence-based (e.g., relative risks on benefits only; n = 446 patient information about a cancer screening test and were then asked to make their initial cancer screening choice. Thereafter, participants received a hypothetical physician's recommendation, which was non-evidence-based in terms of existing guidelines on informed decision making (i.e., reporting either benefits or harms but not both; no provision of numbers. When provided with non-evidence-based patient information (n = 446, a mean of 33.1% of 235 participants whose initial screening choice contradicted the hypothetical physician's non-evidence-based recommendation adjusted their choice in deference to that recommendation (95% CI: 27.4 to 39.4%, whereas with evidence-based patient information (n = 451, only half as many, a mean of 16.0% of 225 (95% CI: 11.8 to 21.4%, modified their choice. Thus, evidence-based patient information makes
Gausche-Hill, Marianne; Brown, Kathleen M; Oliver, Zoë J; Sasson, Comilla; Dayan, Peter S; Eschmann, Nicholas M; Weik, Tasmeen S; Lawner, Benjamin J; Sahni, Ritu; Falck-Ytter, Yngve; Wright, Joseph L; Todd, Knox; Lang, Eddy S
The management of acute traumatic pain is a crucial component of prehospital care and yet the assessment and administration of analgesia is highly variable, frequently suboptimal, and often determined by consensus-based regional protocols. To develop an evidence-based guideline (EBG) for the clinical management of acute traumatic pain in adults and children by advanced life support (ALS) providers in the prehospital setting. Methods. We recruited a multi-stakeholder panel with expertise in acute pain management, guideline development, health informatics, and emergency medical services (EMS) outcomes research. Representatives of the National Highway Traffic Safety Administration (sponsoring agency) and a major children's research center (investigative team) also contributed to the process. The panel used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology to guide the process of question formulation, evidence retrieval, appraisal/synthesis, and formulation of recommendations. The process also adhered to the National Prehospital Evidence-Based Guideline (EBG) model process approved by the Federal Interagency Council for EMS and the National EMS Advisory Council. Four strong and three weak recommendations emerged from the process; two of the strong recommendations were linked to high- and moderate-quality evidence, respectively. The panel recommended that all patients be considered candidates for analgesia, regardless of transport interval, and that opioid medications should be considered for patients in moderate to severe pain. The panel also recommended that all patients should be reassessed at frequent intervals using a standardized pain scale and that patients should be re-dosed if pain persists. The panel suggested the use of specific age-appropriate pain scales. GRADE methodology was used to develop an evidence-based guideline for prehospital analgesia in trauma. The panel issued four strong recommendations regarding 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
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
Lewis, Brennan; Allen, Stephanie
The purpose of this article was to provide a framework for evidence-based transition of patient populations within an acute care pediatric institution. Transition within a hospital is foreseeable, given the ever-changing needs of the patients within an evolving healthcare system. These changes include moving patient populations because of expansion, renovation, or cohorting similar patient diagnoses to provide care across a continuum. Over the past 1 to 2 years, Children's Health Children's Medical Center Dallas has experienced a wide variety of transition. To provide a smooth transition for patients and families into new care areas resulting in a healthy work environment for all team members. The planning phase for patient population moves, and transition should address key aspects to include physical location and care flow, supplies and equipment, staffing model and human resources (HR), education and orientation, change process and integrating teams, and family preparation. It is imperative to consider these aspects in order for transitions within a healthcare system to be successful. During a time of such transitions, the clinical nurse specialist (CNS) is a highly valuable team member offering a unique perspective and methodological approach, which is central to the new initiative's overall success. The themes addressed in this article on evidence-based transition are organized according to the CNS spheres of influence: system/organization, patient/family, and nursing. An evidence-based transition plan was developed and implemented successfully with the support from the CNS for 3 patient populations. Organizational leadership gained an increased awareness of the CNS role at the conclusion of each successful transition. The CNS plays a pivotal role as clinical experts and proponents of evidence-based practice and effects change in the system/organization, nursing, and patient/family spheres of influence. While transitions can be a source of stress for leaders
Small, B W
Separating hype from the truth in dental marketing can be frustrating and it is difficult at best for the average dentist to evaluate the safety and efficacy of new products and techniques. Keynote clinicians are presenting information and influencing other dentists without the scientific evidence to support their claims. For the benefit of our patients, the system needs to change. It will not come soon, but until more evidence-based testing is commonplace and made readily available to the practicing dentist, most dentists will continue tradition-based practices.
Jekl, Vladimir; Hauptman, Karel; Knotek, Zdenek
The number of exotic companion pet rodents seen in veterinary practices is growing very rapidly. According to the American Veterinary Medical Association's surveys, more than 2,093,000 pet rodents were kept in US households in 2007 and in 2012 it was more than 2,349,000 animals. This article summarizes the most important evidence-based knowledge in exotic pet rodents (diagnostics of the hyperadrenocorticism in guinea pigs, pituitary tumors in rats, urolithiasis in guinea pigs, use of itopride as prokinetics, use of deslorelin acetate in rodents, cause of dental disease, and prevention of mammary gland tumors in rats). Copyright © 2017 Elsevier Inc. All rights reserved.
Dougherty, William M; Christophel, John Jared; Park, Stephen S
This article provides the reader with a comprehensive review of high-level evidence-based medicine in facial trauma and highlights areas devoid of high-level evidence. The article is organized in the order one might approach a clinical problem: starting with the workup, followed by treatment considerations, operative decisions, and postoperative treatments. Individual injuries are discussed within each section, with an overview of the available high-level clinical evidence. This article not only provides a quick reference for the facial traumatologist, but also allows the reader to identify areas that lack high-level evidence, perhaps motivating future endeavors. Copyright © 2017 Elsevier Inc. All rights reserved.
Sir Arthur Conan Doyle, the creator of the fictional detective Sherlock Holmes, studied medicine at the University of Edinburgh between 1876 and 1881 under Doctor Joseph Bell who emphasised in his teaching the importance of observation, deduction and evidence. Sherlock Holmes was modelled on Joseph Bell. The modern notions of Evidence Based Medicine (EBM) are not new. A very brief indication of some of the history of EBM is presented including a discussion of the important and usually overlooked contribution of statisticians to the Popperian philosophy of EBM.
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...
Schwartz, Michael R
After reading this article, the participant should be able to: 1. Understand the key decisions in patient evaluation for cosmetic breast augmentation. 2. Cite key decisions in preoperative planning. 3. Discuss the risks and complications, and key patient education points in breast augmentation. Breast augmentation remains one of the most popular procedures in plastic surgery. The integral information necessary for proper patient selection, preoperative assessment, and surgical approaches are discussed. Current data regarding long term safety and complications are presented to guide the plastic surgeon to an evidence-based approach to the patient seeking breast enhancement to obtain optimal results.
Summa, Noémie M; Guzman, David Sanchez-Migallon
This article presents relevant advances in avian medicine and surgery over the past 5 years. New information has been published to improve clinical diagnosis in avian diseases. This article also describes new pharmacokinetic studies. Advances in the understanding and treatment of common avian disorders are presented in this article, as well. Although important progress has been made over the past years, there is still much research that needs to be done regarding the etiology, pathophysiology, diagnosis, and treatment of avian diseases and evidence-based information is still sparse in the literature. Copyright © 2017 Elsevier Inc. All rights reserved.
Summa, Noémie M; Brandão, João
Rabbit medicine has been continuously evolving over time with increasing popularity and demand. Tremendous advances have been made in rabbit medicine over the past 5 years, including the use of imaging tools for otitis and dental disease management, the development of laboratory testing for encephalitozoonosis, or determination of prognosis in rabbits. Recent pharmacokinetic studies have been published, providing additional information on commonly used antibiotics and motility-enhancer drugs, as well as benzimidazole toxicosis. This article presents a review of evidence-based advances for liver lobe torsions, thymoma, and dental disease in rabbits and controversial and new future promising areas in rabbit medicine. Copyright © 2017 Elsevier Inc. All rights reserved.
Chen, Li-Li; Lin, Jun-Dai
Acupressure is a traditional Chinese medicine approach to disease prevention and treatment that may be operated by nurses independently. Therefore, acupressure is being increasingly applied in clinical nursing practice and research. Recently, the implementation of evidence-based nursing (EBN) in clinical practice has been encouraged to promote nursing quality. Evidence-based nursing is a method-ology and process of implementation that applies the best-available evidence to clinical practice, which is acquired through the use of empirical nursing research. Therefore, in this paper, we address the topic of acupressure within the context of empirical nursing practice. We first introduce the current status of acupressure research and provide the locations of common acupoints in order to guide future empirical nursing research and to help nurses use these acupoints in clinical practice. Finally, we describe the steps that are necessary to apply the current empirical information on acupressure as well as provide suggestions to promote safety and efficacy in order to guide nurses in the accurate application of acupressure in nursing practice.
Underwood, J Michael; Lakhani, Naheed; Finifrock, DeAnna; Pinkerton, Beth; Johnson, Krystal L; Mallory, Sharon H; Migliore Santiago, Patricia; Stewart, Sherri L
One of six priorities of CDC's National Comprehensive Cancer Control Program (NCCCP) is to address the needs of cancer survivors within the local population served by individually funded states, tribes, and territories. This report examines cancer survivorship activities implemented in five NCCCP grantees, which have initiated evidence-based activities outlined in A National Action Plan for Cancer Survivorship: Advancing Public Health Strategies (NAP). NCCCP action plans, submitted annually to CDC, from 2010 to 2014 were reviewed in February 2015 to assess implementation of cancer survivorship activities and recommended strategies consistent with the NAP. Four state-level and one tribal grantee with specific activities related to one of each of the four NAP strategies were chosen for inclusion. Brief case reports describing the initiation and impact of implemented activities were developed in collaboration with each grantee program director. New Mexico, South Carolina, Vermont, Washington state, and Fond Du Lac Band of Lake Superior Chippewa programs each implemented activities in surveillance and applied research; communication, education, and training; programs, policies, and infrastructure; and access to quality care and services. This report provides examples for incorporating cancer survivorship activities within Comprehensive Cancer Control programs of various sizes, demographic makeup, and resource capacity. New Mexico, South Carolina, Vermont, Washington state, and Fond Du Lac Band developed creative cancer survivorship activities that meet CDC recommendations. NCCCP grantees can follow these examples by implementing evidence-based survivorship interventions that meet the needs of their specific populations. Published by Elsevier Inc.
Chin-Yee, Benjamin H
This article explores the philosophical implications of evidence-based medicine's (EBM's) epistemology in terms of the problem of underdetermination of theory by evidence as expounded by the Duhem-Quine thesis. EBM hierarchies of evidence privilege clinical research over basic science, exacerbating the problem of underdetermination. Because of severe underdetermination, EBM is unable to meaningfully test core medical beliefs that form the basis of our understanding of disease and therapeutics. As a result, EBM adopts an epistemic attitude that is sceptical of explanations from the basic biological sciences, and is relegated to a view of disease at a population level. EBM's epistemic attitude provides a limited research heuristic by preventing the development of a theoretical framework required for understanding disease mechanism and integrating knowledge to develop new therapies. Medical epistemology should remain pluralistic and include complementary approaches of basic science and clinical research, thus avoiding the limited epistemic attitude entailed by EBM hierarchies. © 2014 John Wiley & Sons, Ltd.
Pickrell, Brent B; Hollier, Larry H
After reading this article, the participant should be able to: 1. Explain the epidemiology of mandible fractures. 2. Discuss preoperative evaluation of the patient with a mandible fracture. 3. Compare the various modalities of fracture fixation. 4. Identify common complications after fracture repair. In this Maintenance of Certification/Continuing Medical Education article, the reader is provided with a review of the epidemiology, preoperative evaluation, perioperative management, and surgical outcomes of mandible fractures. The objective of this series is to present a review of the literature so that the practicing physician can remain up-to-date on key evidence-based guidelines to enhance management and improve outcomes. The physician can also seek further in-depth study of the topic through the references provided.
Duran-Vega, Héctor César
Evidence-based surgery is a tool that has been adopted worldwide by surgeons. As all decisions must be current and have a scientific basis, the approach for performing it must be standardised. Five important steps are required to perform surgery based on evidence. Convert the need for information into a question that can be answered, finding the best information to answer that question, critical evaluation of the evidence, and its validity, impact and applicability, integrating the evidence with your own experience, and with the evaluation of the patients. This should take into account their biology, values and specific circumstances, as well as to evaluate the effectiveness and efficiency of the execution of steps 1-4 and propose how to improve them. This article presents the main tools to perform surgery properly based on evidence. Copyright © 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.
Full Text Available The process of facilitating the uptake of evidence, for example, scientific research findings, into the policymaking process is multifaceted and thus complex. It is therefore important for scientists to understand this process in order to influence it more effectively. Similarly, policymakers need to understand the complexities of the scientific process to improve their interaction with the scientific sphere. This literature review addresses those factors that influence the uptake of scientific evidence into policymaking, the barriers to using science in policymaking, as well as recommendations for improved science–policymaking interaction. A visual diagram of the gears of a car is used to convey the message of the complexities around the engagement between science and policymaking. It is concluded that the issue of evidence-based policymaking remains unresolved and questions for future research on the science–policy interface are raised.
From a humanistic, social scientific perspective, the most complex task in evidence-based medicine lies in the communication of specialized medical knowledge to non-professionals. Information is never simply the neutral transmission of facts, not even when dealing with scientific knowledge and research. It is always interpreted and evaluated from a particular perspective in a specific context. That information can be neutral is thus a myth. In all medical consultations the process of communication is not just a matter of transmitting information from one who knows to one who does not. Knowledge created and formulated in a scientific context is thus recontextualised first in a clinical situation and then as an interpreted version in people's real lives. Furthermore there are difficulties when practice must be based on current research, in a situation in which no prior clinical experience exists and in which results are interpreted and used regardless of the relative certainty of current evidence.
Yadava B Jeve
Full Text Available Recurrent miscarriages are postimplantation failures in natural conception; they are also termed as habitual abortions or recurrent pregnancy losses. Recurrent pregnancy loss is disheartening to the couple and to the treating clinician. There has been a wide range of research from aetiology to management of recurrent pregnancy loss. It is one of the most debated topic among clinicians and academics. The ideal management is unanswered. This review is aimed to produce an evidence-based guidance on clinical management of recurrent miscarriage. The review is structured to be clinically relevant. We have searched electronic databases (PubMed and Embase using different key words. We have combined the searches and arranged them with the hierarchy of evidences. We have critically appraised the evidence to produce a concise answer for clinical practice. We have graded the evidence from level I to V on which these recommendations are based.
Smith, Tristram; Iadarola, Suzannah
This evidence base update examines the level of empirical support for interventions for children with autism spectrum disorder (ASD) younger than 5 years old. It focuses on research published since a previous review in this journal (Rogers & Vismara, 2008 ). We identified psychological or behavioral interventions that had been manualized and evaluated in either (a) experimental or quasi-experimental group studies or (b) systematic reviews of single-subject studies. We extracted data from all studies that met these criteria and were published after the previous review. Interventions were categorized across two dimensions. First, primary theoretical principles included applied behavior analysis (ABA), developmental social-pragmatic (DSP), or both. Second, practice elements included scope (comprehensive or focused), modality (individual intervention with the child, parent training, or classrooms), and intervention targets (e.g., spoken language or alternative and augmentative communication). We classified two interventions as well-established (individual, comprehensive ABA and teacher-implemented, focused ABA + DSP), 3 as probably efficacious (individual, focused ABA for augmentative and alternative communication; individual, focused ABA + DSP; and focused DSP parent training), and 5 as possibly efficacious (individual, comprehensive ABA + DSP; comprehensive ABA classrooms; focused ABA for spoken communication; focused ABA parent training; and teacher-implemented, focused DSP). The evidence base for ASD interventions has grown substantially since 2008. An increasing number of interventions have some empirical support; others are emerging as potentially efficacious. Priorities for future research include improving outcome measures, developing interventions for understudied ASD symptoms (e.g., repetitive behaviors), pinpointing mechanisms of action in interventions, and adapting interventions for implementation with fidelity by community providers.
Glober, Nancy K.; Sporer, Karl A.; Guluma, Kama Z.; Serra, John P.; Barger, Joe A.; Brown, John F.; Gilbert, Gregory H.; Koenig, Kristi L.; Rudnick, Eric M.; Salvucci, Angelo A.
Introduction In the United States, emergency medical services (EMS) protocols vary widely across jurisdictions. We sought to develop evidence-based recommendations for the prehospital evaluation and treatment of a patient with a suspected stroke and to compare these recommendations against the current protocols used by the 33 EMS agencies in the state of California. Methods We performed a literature review of the current evidence in the prehospital treatment of a patient with a suspected stroke and augmented this review with guidelines from various national and international societies to create our evidence-based recommendations. We then compared the stroke protocols of each of the 33 EMS agencies for consistency with these recommendations. The specific protocol components that we analyzed were the use of a stroke scale, blood glucose evaluation, use of supplemental oxygen, patient positioning, 12-lead electrocardiogram (ECG) and cardiac monitoring, fluid assessment and intravenous access, and stroke regionalization. Results Protocols across EMS agencies in California varied widely. Most used some sort of stroke scale with the majority using the Cincinnati Prehospital Stroke Scale (CPSS). All recommended the evaluation of blood glucose with the level for action ranging from 60 to 80mg/dL. Cardiac monitoring was recommended in 58% and 33% recommended an ECG. More than half required the direct transport to a primary stroke center and 88% recommended hospital notification. Conclusion Protocols for a patient with a suspected stroke vary widely across the state of California. The evidence-based recommendations that we present for the prehospital diagnosis and treatment of this condition may be useful for EMS medical directors tasked with creating and revising these protocols. PMID:26973735
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
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…
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 ...
van Enst, W.A.
Evidence-Based Medicine is the integration of best research evidence with clinical expertise and patient values. Systematic reviews have become the cornerstone of evidence-based medicine, which is reflected in the position systematic reviews have in the pyramid of evidence-based medicine. Systematic
Objective: The development of evidence-based health policy is challenging. This study has attempted to identify some of the underpinning factors that promote the development of evidence based health policy. Methods: A preliminary systematic literature review of published reviews with "evidence based health policy" in their title was conducted…
Objective: Evidence-based medicine has an important place in the teaching and practice of psychiatry. Attempts to teach evidence-based medicine skills can be weakened by conceptual confusions feeding a false polarization between traditional clinical skills and evidence-based medicine. Methods: The author develops a broader conception of clinical…
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…
The paper examined information provision in special libraries such as medical libraries. It provides an overview of evidence based practice as a concept for information provision by librarians. It specifically proffers meaning to the term evidence as used in evidence based practice and to evidence based medicine from where ...
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
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 ...
The fundamentals of Evidence-Based Medicine (EBM) are the clinical experience, the application of best evidences from research and the consideration of patient expectations. It enabled significant progresses in the management of diseases with a low or multifactorial causality. But it has also led to unintended negative consequences, partly related to conflicts of interest. The objective of this article is to bring the attention back to the scientific rigor that must sustain the medical practice, namely in the occurrence : 1) formulating a question that addresses all the elements of an individual clinical situation; 2) exploring the literature systematically; 3) estimating the degree of confidence in the conclusions of clinical trials. EBM provides intuitive tools to address some uncomfortable concepts of biostatistics and to identify the biases and the embellished data that invalidate many studies. However, it is difficult to decide of the care of a single patient from observations issued from the comparison of'heterogeneous groups. Personalized medicine should help to overcome this difficulty and should facilitate clinical decision making by targeting the patients who are most likely to benefit from an intervention without much inconvenience.
Full Text Available Evidence-based interactive management of change means hands-on experience of modified work processes, given evidence of change. For this kind of pro-active organizational development support we use an organisational process memory and a communication-based representation technique for role-specific and task-oriented process execution. Both are effective means for organizations becoming agile through interactively modelling the business at the process level and re-constructing or re-arranging process representations according to various needs. The tool allows experiencing role-specific workflows, as the communication-based refinement of work models allows for executable process specifications. When presenting the interactive processes to individuals involved in the business processes, changes can be explored interactively in a context-sensitive way before re-implementing business processes and information systems. The tool is based on a service-oriented architecture and a flexible representation scheme comprising the exchange of message between actors, business objects and actors (roles. The interactive execution of workflows does not only enable the individual reorganization of work but also changes at the level of the entire organization due to the represented interactions.
Kennedy, Suzanne; Bailey, Ryan; Jaffee, Katy; Markus, Anne; Gerstein, Maya; Stevens, David M; Lesch, Julie Kennedy; Malveaux, Floyd J; Mitchell, Herman
Researchers often struggle with the gap between efficacy and effectiveness in clinical research. To bridge this gap, the Community Healthcare for Asthma Management and Prevention of Symptoms (CHAMPS) study adapted an efficacious, randomized controlled trial that resulted in evidence-based asthma interventions in community health centers. Children (aged 5-12 years; N = 590) with moderate to severe asthma were enrolled from 3 intervention and 3 geographically/capacity-matched control sites in high-risk, low-income communities located in Arizona, Michigan, and Puerto Rico. The asthma intervention was tailored to the participant's allergen sensitivity and exposure, and it comprised 4 visits over the course of 1 year. Study visits were documented and monitored prospectively via electronic data capture. Asthma symptoms and health care utilization were evaluated at baseline, and at 6 and 12 months. A total of 314 intervention children and 276 control children were enrolled in the study. Allergen sensitivity testing (96%) and home environmental assessments (89%) were performed on the majority of intervention children. Overall study activity completion (eg, intervention visits, clinical assessments) was 70%. Overall and individual site participant symptom days in the previous 4 weeks were significantly reduced compared with control findings (control, change of -2.28; intervention, change of -3.27; difference, -0.99; P asthma in these high-need populations. Copyright © 2017 by the American Academy of Pediatrics.
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 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
Sharma, A; Hasan, K; Carter, A; Zaidi, R; Cro, S; Briggs, T; Goldberg, A
Evidence driven orthopaedics is gaining prominence. It enables better management decisions and therefore better patient care. The aim of our study was to review a selection of the leading publications pertaining to knee surgery to assess changes in levels of evidence over a decade. Articles from the years 2000 and 2010 in The Knee, the Journal of Arthroplasty, Knee Surgery, Sports Traumatology, Arthroscopy, the Journal of Bone and Joint Surgery (American Volume) and the Bone and Joint Journal were analysed and ranked according to guidelines from the Centre for Evidence-Based Medicine. The intervening years (2003, 2005 and 2007) were also analysed to further define the trend. The percentage of high level evidence (level I and II) studies increased albeit without reaching statistical significance. Following a significant downward trend, the latter part of the decade saw a major rise in levels of published evidence. The most frequent type of study was therapeutic. Although the rise in levels of evidence across the decade was not statistically significant, there was a significant drop and then rise in these levels in the interim. It is therefore important that a further study is performed to assess longer-term trends. Recent developments have made clear that high quality evidence will be having an ever increasing influence on future orthopaedic practice. We suggest that journals implement compulsory declaration of a published study's level of evidence and that authors consider their study designs carefully to enhance the quality of available evidence.
Kelly, M P; Atkins, L; Littleford, C; Leng, G; Michie, S
In 2013, many public health functions transferred from the National Health Service to local government in England. From 2006 NICE had produced public health guidelines based on the principles of evidence-based medicine. This study explores how the guidelines were received in the new environment in local government and related issues raised relating to the use of evidence in local authoritites. In depth, interviews with 31 elected members and officers, including Directors of Public Health, from four very different local government organizations ('local authorities'). Participants reported that (i) there were tensions between evidence-based, and political decision-making; (ii) there were differences in views about what constituted 'good' evidence and (iii) that organizational life is an important mediator in the way evidence is used. Democratic political decision-making does not necessarily naturally align with decision-making based on evidence from the international scientific literature, and local knowledge and local evidence are very important in the ways that public health decisions are made.
Straus, Sharon E.; McAlister, Finlay A.
Discussions about evidence-based medicine engender both negative and positive reactions from clinicians and academics. Ways to achieve evidence-based practice are reviewed here and the most common criticisms described. The latter can be classified as ”limitations universal to the practice of medicine,” ”limitations unique to evidence-based medicine” and ”misperceptions of evidence-based medicine.” Potential solutions to the true limitations of evidence-based medicine are discussed and areas f...
Stephens, Martin L; Andersen, Melvin; Becker, Richard A; Betts, Kellyn; Boekelheide, Kim; Carney, Ed; Chapin, Robert; Devlin, Dennis; Fitzpatrick, Suzanne; Fowle, John R; Harlow, Patricia; Hartung, Thomas; Hoffmann, Sebastian; Holsapple, Michael; Jacobs, Abigail; Judson, Richard; Naidenko, Olga; Pastoor, Tim; Patlewicz, Grace; Rowan, Andrew; Scherer, Roberta; Shaikh, Rashid; Simon, Ted; Wolf, Douglas; Zurlo, Joanne
The Evidence-based Toxicology Collaboration (EBTC) was established recently to translate evidence-based approaches from medicine and health care to toxicology in an organized and sustained effort. The EBTC held a workshop on "Evidence-based Toxicology for the 21st Century: Opportunities and Challenges" in Research Triangle Park, North Carolina, USA on January 24-25, 2012. The presentations largely reflected two EBTC priorities: to apply evidence-based methods to assessing the performance of emerging pathway-based testing methods consistent with the 2007 National Research Council report on "Toxicity Testing in the 21st Century" as well as to adopt a governance structure and work processes to move that effort forward. The workshop served to clarify evidence-based approaches and to provide food for thought on substantive and administrative activities for the EBTC. Priority activities include conducting pilot studies to demonstrate the value of evidence-based approaches to toxicology, as well as conducting educational outreach on these approaches.
Traditi, Lisa K; Le Ber, Jeanne Marie; Beattie, Michelle; Meadows, Susan E
The Colorado Health Outcomes (COHO) Department of the School of Medicine at the University of Colorado Health Sciences Center (UCHSC) coordinates the Rocky Mountain Evidence-Based Health Care (EBHC) Workshop, which has been held annually since 1999. The goals of the workshop include helping participants-physicians, pharmacists, health care policy makers, journalists and librarians-learn and apply skills for critically appraising medical research literature and for effective use of evidence-based information resources. Participants are encouraged to share ideas and to plan local services and instruction for those working in clinical settings. Each year, librarians from UCHSC Denison Memorial Library participate as faculty by teaching searching skills (PubMed, Cochrane Library, ACP Journal Club, etc.), providing support to small groups, and staffing two computer labs. In 2002, Denison Library received a National Network of Libraries of Medicine (NN/LM) MidContinental Region Impact Award to fund the attendance of three health sciences librarians from the MidContinental Region, an academic education librarian, a clinical medical librarian, and a department librarian. In this paper, the participating librarians share the lessons they learned about how health care practitioners approach evidence-based practice. The participating librarians also share how they incorporated these lessons into their support of evidence-based practice related to teaching about evidence-based resources, assisting health care practitioners with developing answerable questions, enhancing the clinician-librarian partnership, and assisting practitioners in selecting evidence-based resources for quick answers to clinical questions.
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.
Duclos, P; Durrheim, D N; Reingold, A L; Bhutta, Z A; Vannice, K; Rees, H
The Strategic Group of Advisory Experts (SAGE) on immunization is an independent advisory committee with a mandate to advise the World Health Organization (WHO) on the development of vaccine and immunization related policies. SAGE working groups are established on a time-limited basis to review and provide evidence-based recommendations, together with their implications, for open deliberation and decision-making by SAGE. In making its recommendations, SAGE takes into consideration: the epidemiologic and clinical characteristics of the disease; vaccine and immunization characteristics; economic analysis; health system considerations; the existence of and interaction with other intervention and control strategies; costing and social impacts; and legal and ethical concerns. Since 1998, WHO has produced evidence-based vaccine position papers for use primarily by national public health officials and immunization programme managers. Since April 2006 all new or updated position papers have been based on SAGE recommendations. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach has been adopted by WHO and, since 2008, GRADE tables that rate the quality of evidence have been produced in support of key recommendations. SAGE previously expressed concern that GRADE was not ideally suited to many immunization-specific issues such as the vaccine population level effect and the inclusion of surveillance system data, particularly for vaccine safety. Extensive productive interactions with various advisory groups including the US Advisory Committee on Immunization Practices, the European Centres for Disease Control, the German Standing Committee on Vaccination (STIKO), WHO's Global Advisory Committee on Vaccine Safety and the GRADE working group resulted in key enhancements to accommodate vaccine-relevant evidence. This facilitated integration and acceptability of the GRADE approach in the development of immunization related SAGE and WHO
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.
Full Text Available Objective To formulate the best treatment plan for multiple sclerosis (MS patients by evaluating the therapeutic efficacy and side effect of various evidence-based programs. Methods Key words were defined as multiple sclerosis, immunomodulatory therapy and therapy, etc. We searched MEDLINE, Cochrane Library, Wanfang data bases for Scientific Journals in China and National Knowledge Infrastructure for Chinese Scientific Journals Database. Additionally, we applied manual searching and screened out conference paper and academic dissertation, etc, from various references. After that we obtained and evaluated by Jadad scales on systematic reviews, randomized controlled trials, controlled clinical trials and observational study cases about glucocorticoids, plasmapheresis, intravenous immunoglobulin, IFN-β, glatiramer acetate, mitoxantrone, natalizumab, fingolimod. Results After screening, all seventeen selected resources included systematic reviews 6 articles, randomized controlled trials 7 articles, controlled clinical trials 2 articles, observational study cases 2 articles, among which fifteen articles were proved to be high quality (according to Jadad scoring system, five score 4, six score 5, four score 7, two chapters were judged to be low quality scoring 3. Finally, we summerize that: 1 The first choice of treatment for acute relapses is glucocorticoids and we suggest that plasmapheresis or intravenous immunoglobulin may be tried as an alternative therapy in acute MS relapse, especially in case of contraindications to intravenous methylprednisolone. 2 Immunomodulatory or immunosuppressive treatment (IFN-β, glatiramer acetate, mitoxantrone, natalizumab can be an option to prevent new relapses and progression of disability. 3 Fingolimod is an oral treatment for multiple sclerosis to improve treatment adherence. Conclusion Using evidence-based medicine methods can provide us best clinical evidence on MS treatment.
Full Text Available Objective To evaluate the effectiveness of the treatments for sleep disorders in neurodegenerative diseases so as to provide the best therapeutic regimens for the evidence-based treatment. Methods Search PubMed, MEDLINE, Cochrane Library, Wanfang Data and China National Knowledge Infrastructure (CNKI databases with "sleep disorder or sleep disturbance", "neurodegenerative diseases", "Parkinson's disease or PD", "Alzheimer's disease or AD", "multiple system atrophy or MSA" as retrieval words. The quality of the articles were evaluated with Jadad Scale. Results A total of 35 articles, including 2 systematic reviews, 5 randomized controlled trials, 13 clinical controlled trials, 13 case series and 2 epidemiological investigation studies were included for evaluation, 13 of which were high grade and 22 were low grade articles. Clinical evidences showed that: 1 advice on sleep hygiene, careful use of dopaminergic drugs and hypnotic sedative agents should be considered for PD. Bright light therapy (BLT may improve circadian rhythm sleep disorders and clonazepam may be effective for rapid eye movement sleep behavior disorder (RBD. However, to date, very few controlled studies are available to make a recommendation for the management of sleep disorders in PD; 2 treatments for sleep disorders in AD include drug therapy (e.g. melatonin, acetylcholinesterase inhibitors, antipsychotic drugs, antidepressants and non-drug therapy (e.g. BLT, behavior therapy, but very limited evidence shows the effectiveness of these treatments; 3 the first line treatment for sleep-related breathing disorder in MSA is nasal continuous positive airway pressure (nCPAP, and clonazepam is effective for RBD in MSA; 4 there is rare evidence related to the treatment of sleep disorders in dementia with Lewy body (DLB and amyotrophic lateral sclerosis (ALS. Conclusion Evidence-based medicine can provide the best clinical evidence on sleep disorders' treatment in neurodegenerative
Evidence-based medicine (EBM) is the conscientious, explicit, and judicious use of current best evidence in making decisions regarding the care of individual patients. This concept has gained popularity recently, and its applications have been steadily expanding. Nowadays, the term "evidence-based" is used in numerous situations and conditions, such as evidence-based medicine, evidence-based practice, evidence-based health care, evidence-based social work, evidence-based policy, and evidence-based education. However, many anesthesiologists and their colleagues have not previously been accustomed to utilizing EBM, and they have experienced difficulty in understanding and applying the techniques of EBM to their practice. In this article, the author discusses the brief history, definition, methods, and limitations of EBM. As EBM also involves making use of the best available information to answer questions in clinical practice, the author emphasizes the process of performing evidence-based medicine: generate the clinical question, find the best evidence, perform critical appraisal, apply the evidence, and then evaluate. Levels of evidence and strength of recommendation were also explained. The author expects that this article may be of assistance to readers in understanding, conducting, and evaluating EBM.
Evidence based medicine provides independent, validated advice about treatment options, but does it take sufficient account of individual patients' values to provide them with an optimal health outcome?
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.
Gimpel, John R; Horber, Dorothy; Sandella, Jeanne M; Knebl, Janice A; Thornburg, John E
To ensure that the Comprehensive Osteopathic Medical Licensing Examination-USA (COMLEX-USA) reflects the evolving practice of osteopathic medicine, the National Board of Osteopathic Medical Examiners has developed new content and format specifications for an enhanced, competency-based examination program to be implemented with COMLEX-USA Level 3 in 2018. This article summarizes the evidence-based design processes that served as the foundation for blueprint development and the evidence supporting its validity. An overview is provided of the blueprint's 2 dimensions: Competency Domains and Clinical Presentations. The authors focus on the evidence that supports interpretation of test scores for the primary and intended purpose of COMLEX-USA, which is osteopathic physician licensure. Important secondary uses and the educational and catalytic effect of assessments are also described. This article concludes with the National Board of Osteopathic Medical Examiners' plans to ensure that the COMLEX-USA series remains current and meets the needs of its stakeholders-the patients who seek care from osteopathic physicians.
Meats, Emma; Heneghan, Carl; Crilly, Mike; Glasziou, Paul
It is recognized that clinicians need training in evidence-based medicine (EBM), however there is considerable variation in the content and methods of the EBM curriculum in UK medical schools. To determine current practice and variation in EBM undergraduate teaching in UK medical schools and inform the strategy of medical schools and the National Knowledge Service. We contacted all 32 medical schools in the UK and requested that the person primarily responsible for EBM undergraduate teaching complete a short online survey and provide their EBM curriculum. The survey was completed by representatives from 20 (63%) medical schools and curriculum details were received from 5 (16%). There is considerable variation in the methods and content of the EBM curriculum. Although the majority of schools teach core EBM topics, relatively few allow students to practice the skills or assess such skills. EBM teaching is restricted by lack of curriculum time, trained tutors and teaching materials. Key elements to progress include the integration of EBM with clinical specialties, tutor training and the availability of high-quality teaching resources. The development of a national undergraduate EBM curriculum may help in promoting progress in EBM teaching and assessment in UK medical schools.
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…
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.
Recent reviews of evidence-based treatment for depression did not identify behavioral activation as an evidence-based practice. Therefore, this article conducted a systematic review of behavioral activation treatment of depression, which identified three meta-analyses, one recent randomized controlled trial and one recent follow-up of an earlier…
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…
Prins, David; Ingham, Roger J.
Purpose: To illustrate the way in which both fluency shaping (FS) and stuttering management (SM) treatments for developmental stuttering in adults are evidence based. Method: A brief review of the history and development of FS and SM is provided. It illustrates that both can be justified as evidence-based treatments, each treatment seeking…
School Library Journal's 2007 Leadership Summit, "Where's the Evidence? Understanding the Impact of School Libraries," focused on the topic of evidence-based practice. Evidence-based school librarianship is a systematic approach that engages research-derived evidence, school librarian-observed evidence, and user-reported evidence in the processes…
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
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…
Background: The principles of evidence-based medicine places case reports in the lower level of the hierarchy of scientific evidence. With the increased advocacy of evidence-based medicine, the survival of the case report has been threatened, prompting several authors to call for its preservation. Materials and methods: ...
To conduct an evidence-based analysis of the effectiveness and cost-effectiveness of bariatric surgery. Obesity is defined as a body mass index (BMI) of at last 30 kg/m(2).() Morbid obesity is defined as a BMI of at least 40 kg/m(2) or at least 35 kg/m(2) with comorbid conditions. Comorbid conditions associated with obesity include diabetes, hypertension, dyslipidemias, obstructive sleep apnea, weight-related arthropathies, and stress urinary incontinence. It is also associated with depression, and cancers of the breast, uterus, prostate, and colon, and is an independent risk factor for cardiovascular disease. Obesity is also associated with higher all-cause mortality at any age, even after adjusting for potential confounding factors like smoking. A person with a BMI of 30 kg/m(2) has about a 50% higher risk of dying than does someone with a healthy BMI. The risk more than doubles at a BMI of 35 kg/m(2). An expert estimated that about 160,000 people are morbidly obese in Ontario. In the United States, the prevalence of morbid obesity is 4.7% (1999-2000). In Ontario, the 2004 Chief Medical Officer of Health Report said that in 2003, almost one-half of Ontario adults were overweight (BMI 25-29.9 kg/m(2)) or obese (BMI ≥ 30 kg/m(2)). About 57% of Ontario men and 42% of Ontario women were overweight or obese. The proportion of the population that was overweight or obese increased gradually from 44% in 1990 to 49% in 2000, and it appears to have stabilized at 49% in 2003. The report also noted that the tendency to be overweight and obese increases with age up to 64 years. BMI should be used cautiously for people aged 65 years and older, because the "normal" range may begin at slightly above 18.5 kg/m(2) and extend into the "overweight" range. The Chief Medical Officer of Health cautioned that these data may underestimate the true extent of the problem, because they were based on self reports, and people tend to over-report their height and under-report their weight
Qiu, Yun-Liang; Peng, Ming-Qi
As an important component of judicial expertise, forensic science is broad and highly specialized. With development of network technology, increasement of information resources, and improvement of people's legal consciousness, forensic scientists encounter many new problems, and have been required to meet higher evidentiary standards in litigation. In view of this, evidence-based concept should be established in forensic medicine. We should find the most suitable method in forensic science field and other related area to solve specific problems in the evidence-based mode. Evidence-based practice can solve the problems in legal medical field, and it will play a great role in promoting the progress and development of forensic science. This article reviews the basic theory of evidence-based medicine and its effect, way, method, and evaluation in the forensic medicine in order to discuss the application value of forensic evidence-based medicine in computer communication networks.
Full Text Available Psychosocial interventions are an essential part of the treatment for people with severe mental illness such as schizophrenia. The criteria regarding what makes an intervention “evidence-based” along with a current list of evidence-based interventions are presented. Although many evidence-based interventions exist, implementation studies reveal that few, if any, are ever implemented in a given setting. Various theories and approaches have been developed to better understand and overcome implementation obstacles. Among these, merging two evidence-based interventions, or offering an evidence-based intervention within an evidence-based service, are increasingly being reported and studied in the literature. Five such merges are presented, along with their empirical support: cognitive behavior therapy (CBT with skills training; CBT and family psychoeducation; supported employment (SE and skills training; SE and cognitive remediation; and SE and CBT.
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.
McCrea, Michael; Guskiewicz, Kevin
Concussion is not only one of the most common injuries encountered by athletes participating in contact and collision sports, but also among the most complex injuries to manage in a sports medicine setting. Over the past two decades, we have made great progress in advancing the basic and clinical science of concussion. These advances have had enormous clinical translational value for developing evidence-based guidelines for management of concussion in sports. Applied clinical research has clarified the defining characteristics of sport-related concussion (SRC) that support new diagnostic criteria. At the same time, major advancements have been realized in the development and validation of clinical tools that allow a more objective and accurate assessment of concussion and performance-based measures of recovery. These tools provide clinicians with a more informed basis for determining an athlete's cognitive and physical fitness to return to competition after concussion. Standardized injury management protocols that systematically prescribe rest, graded activity, and return to play have been adopted in nearly all clinical settings. Herein, we briefly summarize the findings and recommendations from several national and international consensus guidelines and position statements on best practice in the evaluation and management of SRC. © 2014 S. Karger AG, Basel.
Dahdaleh, Nader S; Lawton, Cort D; El Ahmadieh, Tarek Y; Nixon, Alexander T; El Tecle, Najib E; Oh, Sanders; Fessler, Richard G; Smith, Zachary A
Evidence-based medicine is used to examine the current treatment options, timing of surgical intervention, and prognostic factors in the management of patients with traumatic central cord syndrome (TCCS). A computerized literature search of the National Library of Medicine database, Cochrane database, and Google Scholar was performed for published material between January 1966 and February 2013 using key words and Medical Subject Headings. Abstracts were reviewed and selected, with the articles segregated into 3 main categories: surgical versus conservative management, timing of surgery, and prognostic factors. Evidentiary tables were then assembled, summarizing data and quality of evidence (Classes I-III) for papers included in this review. The authors compiled 3 evidentiary tables summarizing 16 studies, all of which were retrospective in design. Regarding surgical intervention versus conservative management, there was Class III evidence to support the superiority of surgery for patients presenting with TCCS. In regards to timing of surgery, most Class III evidence demonstrated no difference in early versus late surgical management. Most Class III studies agreed that older age, especially age greater than 60-70 years, correlated with worse outcomes. No Class I or Class II evidence was available to determine the efficacy of surgery, timing of surgical intervention, or prognostic factors in patients managed for TCCS. Hence, there is a need to perform well-controlled prospective studies and randomized controlled clinical trials to further investigate the optimal management (surgical vs conservative) and timing of surgical intervention in patients suffering from TCCS.
Pulok K Mukherjee
Full Text Available Evidence based validation of the ethno-pharmacological claims on traditional medicine (TM is the need of the day for its globalization and reinforcement. Combining the unique features of identifying biomarkers that are highly conserved across species, this can offer an innovative approach to biomarker-driven drug discovery and development. TMs are an integral component of alternative health care systems. India has a rich wealth of TMs and the potential to accept the challenge to meet the global demand for them. Ayurveda, Yoga, Unani, Siddha and Homeopathy (AYUSH medicine are the major healthcare systems in Indian Traditional Medicine. The plant species mentioned in the ancient texts of these systems may be explored with the modern scientific approaches for better leads in the healthcare. TM is the best sources of chemical diversity for finding new drugs and leads. Authentication and scientific validation of medicinal plant is a fundamental requirement of industry and other organizations dealing with herbal drugs. Quality control (QC of botanicals, validated processes of manufacturing, customer awareness and post marketing surveillance are the key points, which could ensure the quality, safety and efficacy of TM. For globalization of TM, there is a need for harmonization with respect to its chemical and metabolite profiling, standardization, QC, scientific validation, documentation and regulatory aspects of TM. Therefore, the utmost attention is necessary for the promotion and development of TM through global collaboration and co-ordination by national and international programme.
Gerber, Andreas; Lungen, Markus; Lauterbach, Karl W
Evidence-based medicine (EbM) has been practised for about a decade now. Until now, it has generally been accepted that EbM has its roots in medical thinking of mid-19th century France. Due to the startling fact that France never was a centre of EbM, historical tradition was reconsidered. Since EbM has mainly been flourishing in Protestant countries, a qualitative historical investigation was conducted according to the approach of Max Weber's "The Protestant Ethics". Thus, it could be shown that there are three major prerequisites for EbM to evolve apart from current technical developments, such as the computer and the internet: (1) historical critical exegesis functioned as a methodology to balance contradictory passages; (2) both an equality based relationship among physicians and a Protestant concept that lay people are considered equal in the theologic debate were fundamental to EbM as a new approach of medical thinking; (3) mostly nationally funded health care systems are prone to practise EbM as they are obliged to provide health care which is both fair in access and allocation to the whole population. Against the background of historical exegesis, it has to be taken into account that EbM implies a twist in medicine towards a concept of textual criticism rather than the mere introduction of statistics. Moreover, it both relies upon and enhances a more equal relationship between physicians.
Packard, Thomas; Shih, Amber
Planned organizational change processes can be used to address the many challenges facing human service organizations (HSOs) and improve organizational outcomes. There is massive literature on organizational change, ranging from popular management books to academic research on specific aspects of change. Regarding HSOs, there is a growing literature, including increasing attention to implementation science and evidence-based practices. However, research which offers generalizable, evidence-based guidelines for implementing change is not common. The purpose of the authors was to assess the evidence base in this organizational change literature to lay the groundwork for more systematic knowledge development in this important field.
Full Text Available Evidence-based health care informs clinicians of choices regarding the most effective care based on the best available research evidence. However, concepts or instruments of evidence-based medicine are still fragmented for most clinicians. Substantial gaps between evidence and clinical practice remain. A knowledge translation roadmap may help clinicians to improve the quality of care by integration of various concepts in evidence-based health care. Improving research transparency and accuracy, conducting an updated systematic review, and shared decision making are the key points to diminish the gaps between research and practice.
Kowalski, Evan.; Chung, Kevin C.
Synopsis Evidence based medicine is analyzed from its inception. The authors take the reader through the early formation of ‘scientific medicine’ that has evolved into the multi-purpose tool it has become today. Early proponents and their intentions that sparked evidence base and outcomes are presented: the work of David Sackett, Brian Haynes, Peter Tugwell, and Victor Neufeld is discussed - how they perceived the need for better clinical outcomes that led to a more formalized evidence based practice. The fundamentals are discussed objectively in detail and potential flaws are presented that guide the reader to deeper comprehension. PMID:23506764
Dworkin, Robert H.; O'Connor, Alec B.; Backonja, Miroslav
Patients with neuropathic pain (NP) are challenging to manage and evidence-based clinical recommendations for pharmacologic management are needed. Systematic literature reviews, randomized clinical trials, and existing guidelines were evaluated at a consensus meeting. Medications were considered...
”. No evidence provided. Not evidence-based and impractical for a resource .... European Federation of. Neurological Sciences. Task Force. Non-acute headache. EEG is not routinely indicated in the diagnostic evaluation of headache.
Bracke, Paul J; Howse, David K; Keim, Samuel M
...) health sciences programs and to the University Medical Center. Librarians at AHSL collaborated with UA College of Medicine faculty to create an innovative search engine, Evidence-based Medicine (EBM...
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...
Abstract. This paper will explore the role of evidence-based medicine in ethical practice of health care professionals. It will also address some of its limitations and potential for negative impact on health care.
Ubbink, Dirk T.; Brölmann, Fleur E.; Go, Peter M. N. Y. H.; Vermeulen, Hester
Significance: Large variation and many controversies exist regarding the treatment of, and care for, acute wounds, especially regarding wound cleansing, pain relief, dressing choice, patient instructions, and organizational aspects. Recent Advances: A multidisciplinary team developed evidence-based
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
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.
Christina Ouzouni; Konstantinos Nakakis
Despite the fact that nursing research has been developed in Greece, nevertheless the provision of nursing care is not based on current research findings, but rather on the knowledge gained by nurses during their undergraduate education. The transition of medicine in the last decade towards evidence based practice had definitely an impact on the nursing profession.The aim of this article is to briefly present evidence based nursing as a process and perspective to Greek nurses.Method: A litera...
Joshi, G P; Neugebauer, E A M; Kehlet, Henrik
Haemorrhoidectomy is associated with intense postoperative pain, but optimal evidence-based pain therapy has not been described. The aim of this systematic review was to evaluate the available literature on the management of pain after haemorrhoidal surgery.......Haemorrhoidectomy is associated with intense postoperative pain, but optimal evidence-based pain therapy has not been described. The aim of this systematic review was to evaluate the available literature on the management of pain after haemorrhoidal surgery....
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.
Kehlet, Henrik; Wilkinson, Roseanne C; Fischer, H Barrie J; Camu, Frederic
Existing general guidelines for perioperative pain management do not consider procedure-specific differences in analgesic efficacy or applicability of a given analgesic technique. For the clinician, an evidence-based, procedure-specific guideline for perioperative pain management is therefore desirable. This chapter reviews the methodology and results of a public web site (www.postoppain.org) which provides information and recommendations for evidence-based procedure-specific postoperative pain management.
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
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...
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...
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…
Mihalic, Sharon F; Elliott, Delbert S
There is a growing demand for evidence-based programs to promote healthy youth development, but this growth has been accompanied by confusion related to varying definitions of evidence-based and mixed messages regarding which programs can claim this designation. The registries that identify evidence-based programs, while intended to help users sift through the findings and claims regarding programs, has oftentimes led to more confusion with their differing standards and program ratings. The advantages of using evidence-based programs and the importance of adopting a high standard of evidence, especially when taking programs to scale,are described. One evidence-based registry is highlighted--Blueprints for Healthy Youth Development hosted at the University of Colorado Boulder. Unlike any previous initiative of its kind, Blueprints established unmatched standards for identifying evidence-based programs and has acted in a way similar to the FDA--evaluating evidence, data and research to determine which programs meet their high standard of proven efficacy. Published by Elsevier Ltd.
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.
Çev.: Güler Demir
Full Text Available This study is a translation of the "Evidence-based librarianship Down Under: improving a nation's resource-sharing" section in the book headed "Evidence-based Librarianship: Case Studies and Active Learning Exercises." Roxanne Missingham, the author of the section in question, is a librarian with a work experience in the Australian Parliament and the National Library, who also has the responsibilities of the vice-presidency of the Australian Library and Information Association at the same time. In general, the book emphasizes the knowledge and evidence gained in the development of library services as a result of a combination of usercollected data, librarians' experiences, scientific, professional research and observations, and active learning practices that encourage critical thinking through case-based case studies. The purpose of the specifically translated section is to present an assessment of the development of countrywide resource sharing through a national benchmarking study in Australia on the subject and an evaluation of the impact from an evidence-based librarianship approach using a survey and data from libraries in 2006. It is hoped that it will both shed light on the application field of similar works and provide a contribution to the Turkish literature.
Sadeghi-Bazargani, Homayoun; Tabrizi, Jafar Sadegh; Azami-Aghdash, Saber
Evidence-based medicine (EBM) has emerged as an effective strategy to improve health care quality. The aim of this study was to systematically review and carry out an analysis on the barriers to EBM. Different database searching methods and also manual search were employed in this study using the search words ('evidence-based' or 'evidence-based medicine' or 'evidence-based practice' or 'evidence-based guidelines' or 'research utilization') and (barrier* or challenge or hinder) in the following databases: PubMed, Scopus, Web of Knowledge, Cochrane library, Pro Quest, Magiran, SID. Out of 2592 articles, 106 articles were finally identified for study. Research barriers, lack of resources, lack of time, inadequate skills, and inadequate access, lack of knowledge and financial barriers were found to be the most common barriers to EBM. Examples of these barriers were found in primary care, hospital/specialist care, rehabilitation care, medical education, management and decision making. The most common barriers to research utilization were research barriers, cooperation barriers and changing barriers. Lack of resources was the most common barrier to implementation of guidelines. The result of this study shows that there are many barriers to the implementation and use of EBM. Identifying barriers is just the first step to removing barriers to the use of EBM. Extra resources will be needed if these barriers are to be tackled. © 2014 John Wiley & Sons, Ltd.
Greenroyd, Fraser L; Hayward, Rebecca; Price, Andrew; Demian, Peter; Sharma, Shrikant
Using a case study of a pharmacy department rebuild in the South West of England, this article examines the use of evidence-based design to improve the efficiency and staff well-being with a new design. This article compares three designs, the current design, an anecdotal design, and an evidence-based design, to identify how evidence-based design can improve efficiency and staff well-being by reducing walking time and distance. Data were collected from the existing building and used to measure the efficiency of the department in its current state. These data were then mapped onto an anecdotal design, produced by architects from interviews and workshops with the end users, and an evidence-based design, produced by highlighting functions with high adjacencies. This changed the view on the working processes within the department, shifting away from a focus on the existing robotic dispensing system. Using evidence-based design was found to decrease the walking time and distance for staff by 24%, as opposed to the anecdotal design, which increased these parameters by 9%, and is predicted to save the department 248 min across 2 days in staff time spent walking. © The Author(s) 2016.
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.
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.
Kathleen Packard, PharmD, MS, BCPS
Full Text Available AbstractPurpose: The objective of the study was to compare a traditionally structured journal club with an evidence based structured journal club during an advanced clinical pharmacy rotation and to determine the best utilization that aligns with recent changes to the pharmacy school accreditation standards.Methods: The study included 21 students who completed journal club utilizing the traditional journal club format and 24 students who utilized an evidence based journal club format. Background characteristics, student reported beliefs, and mean critical evaluation skills scores were evaluated and compared in each group.Results: There were no statistically significant differences between the two cohorts in mean overall percentage grade for the activity. Students in the traditional cohort received significantly higher grades for the Study Analysis and Critique section (90.97 + 12.18 versus 81.25 + 11.18, P=0.01 as well as for the Preparedness section (96.11 + 8.03 versus 85.0 + 17.13, P=0.002. Students in the evidence based cohort received statistically superior grades for the Presentation Skills section (96.43 + 6.39 versus 82.47 + 14.12, P=0.0004.Conclusion: An evidence based journal club is a reasonable and effective alternative to the traditionally structured journal club when the primary objective is to assist students in understanding evidence based concepts and to apply current literature to clinical practice.
Gibbert, Wesley S; Keating, Shannon M; Jacobs, Julie A; Dodson, Elizabeth; Baker, Elizabeth; Diem, Gunter; Giles, Wayne; Gillespie, Kathleen N; Grabauskas, Vilius; Shatchkute, Aushra; Brownson, Ross C
The Prevention Research Center in St. Louis developed a course on evidence-based public health in 1997 to train the public health workforce in implementation of evidence-based public health. The objective of this study was to assess use and benefits of the course and identify barriers to using evidence-based public health skills as well as ways to improve the course. We used a mixed-method design incorporating on-site pre- and post-evaluations among US and international course participants who attended from 2008 through 2011 and web-based follow-up surveys among course participants who attended from 2005 through 2011 (n = 626). Respondents included managers, specialists, and academics at state health departments, local health departments, universities, and national/regional health departments. We found significant improvement from pre- to post-evaluation for 11 measures of knowledge, skill, and ability. Follow-up survey results showed at least quarterly use of course skills in most categories, majority endorsement of most course benefits, and lack of funding and coworkers who do not have evidence-based public health training as the most significant barriers to implementation of evidence-based public health. Respondents suggested ways to increase evidence-based decision making at their organization, focusing on organizational support and continued access to training. Although the evidence-based public health course is effective in improving self-reported measures of knowledge, skill, and ability, barriers remain to the implementation of evidence-based decision making, demonstrating the importance of continuing to offer and expand training in evidence-based public health.
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.
Schoemaker, Casper G; Smulders, Yvo M
In 1992, the Canadian physician Gordon Guyatt wrote an article that is generally regarded as the starting point of evidence-based medicine (EBM). He described the ideas behind the McMaster residency programme for 'evidence-based practitioners', founded by David Sackett. Eight years later, in 2000, Guyatt concluded that this programme was too ambitious. In a new publication he described most doctors as 'evidence-users'. This editorial marks the transition from an individual to a collective form of EBM, emphasizing the use of evidence-based guidelines. The starting point of this collective form of EBM is not the well-known 1992 paper, but the forgotten editorial in 2000, which was described by Guyatt's colleagues as the capitulation of EBM.
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
Atkins, Lou; Kelly, Michael P; Littleford, Clare; Leng, Gillian; Michie, Susan
In the UK, responsibility for many public health functions was transferred in 2013 from the National Health Service (NHS) to local government; a very different political context and one without the NHS history of policy and practice being informed by evidence-based guidelines. A problem this move presented was whether evidence-based guidelines would be seen as relevant, useful and implementable within local government. This study investigates three aspects of implementing national evidence-based recommendations for public health within a local government context: influences on implementation, how useful guidelines are perceived to be and whether the linear evidence-guidelines-practice model is considered relevant. Thirty-one councillors, public health directors and deputy directors and officers and other local government employees were interviewed about their experiences implementing evidence-based guidelines. Interviews were informed and analysed using a theoretical model of behaviour (COM-B; Capability, Opportunity, Motivation-Behaviour). Contextual issues such as budget, capacity and political influence were important influences on implementation. Guidelines were perceived to be of limited use, with concerns expressed about recommendations being presented in the abstract, lacking specificity and not addressing the complexity of situations or local variations. Local evidence was seen as the best starting point, rather than evidence-based guidance produced by the traditional linear 'evidence-guidelines-practice' model. Local evidence was used to not only provide context for recommendations but also replace recommendations when they conflicted with local evidence. Local government users do not necessarily consider national guidelines to be fit for purpose at local level, with the consequence that local evidence tends to trump evidence-based guidelines. There is thus a tension between the traditional model of guideline development and the needs of public health
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.
Shen, Jiantong; Yao, Leye; Li, Youping; Clarke, Mike; Gan, Qi; Li, Yifei; Fan, Yi; Gou, Yongchao; Wang, Li
To identify patterns in information sharing between a series of Chinese evidence based medicine (EBM) journals and the Cochrane Database of Systematic Reviews, to determine key evidence dissemination areas for EBM and to provide a scientific basis for improving the dissemination of EBM research. Data were collected on citing and cited from the Chinese Journal of Evidence-Based Medicine (CJEBM), Journal of Evidence-Based Medicine (JEBMc), Chinese Journal of Evidence Based Pediatrics (CJEBP), and the Cochrane Database of Systematic Reviews (CDSR). Relationships between citations were visualized. High-frequency key words from these sources were identified, to build a word co-occurrence matrix and to map research subjects. CDSR contains a large collection of information of relevance to EBM and its contents are widely cited across many journals, suggesting a well-developed citation environment. The content and citation of the Chinese journals have been increasing in recent years. However, their citation environments are much less developed, and there is a wide variation in the breadth and strength of their knowledge communication, with the ranking from highest to lowest being CJEBM, JEBMc and CJEBP. The content of CDSR is almost exclusively Cochrane intervention reviews examining the effects of healthcare interventions, so it's contribution to EBM is mostly in disease control and treatment. On the other hand, the Chinese journals on evidence-based medicine and practice focused more on areas such as education and research, design and quality of clinical trials, evidence based policymaking, evidence based clinical practice, tumor treatment, and pediatrics. Knowledge and findings of EBM are widely communicated and disseminated. However, citation environments and range of knowledge communication differ greatly between the journals examined in this study. This finds that Chinese EBM has focused mainly on clinical medicine, Traditional Chinese Medicine, pediatrics, tumor
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.
Lindoerfer, Doris; Mansmann, Ulrich
This paper discusses an evidence-based approach to software requirements engineering. The approach is called evidence-based, since it uses publications on the specific problem as a surrogate for stakeholder interests, to formulate risks and testing experiences. This complements the idea that agile software development models are more relevant, in which requirements and solutions evolve through collaboration between self-organizing cross-functional teams. The strategy is exemplified and applied to the development of a Software Requirements list used to develop software systems for patient registries.
Eldredge, J D
This paper discusses the challenges of finding evidence needed to implement Evidence-Based Librarianship (EBL). Focusing first on database coverage for three health sciences librarianship journals, the article examines the information contents of different databases. Strategies are needed to search for relevant evidence in the library literature via these databases, and the problems associated with searching the grey literature of librarianship. Database coverage, plausible search strategies, and the grey literature of library science all pose challenges to finding the needed research evidence for practicing EBL. Health sciences librarians need to ensure that systems are designed that can track and provide access to needed research evidence to support Evidence-Based Librarianship (EBL).
Stichler, Jaynelle F
The Evidence-Based Design Accreditation and Certification (EDAC) is a professional certification that validates that individuals have a core body of knowledge and experience necessary to lead and engage in an evidence-based design process for healthcare facilities. This bimonthly department expands nurse leaders' knowledge and competencies in health facility design and enables them to lead in design efforts. In this article, the vision and mission of EDAC and specific content are shared to increase nurse leaders' awareness of the certification when interviewing prospective architectural firms or for nurse leaders who aspire to have a career in the healthcare design field.
Evidence-based medicine's (EBM) quantitative methodologies reflect medical science's long-standing mistrust of the imprecision and subjectivity of ordinary descriptive language. However, EBM's attempts to replace subjectivity with precise empirical methods are problematic when clinicians must negotiate between scientific medicine and patients' experience. This problem is evident in the case of bibliotherapy (patient reading as treatment modality), a practice widespread despite its reliance on anecdotal evidence. While EBM purports to replace such flawed practice with reliable evidence-based methods, this essay argues that its aversion to subjective language prevents EBM from effectively evaluating bibliotherapy or making it amenable to clinical and research governance.
Kumar, Sameer; Thomas, Kory M
The purpose of this study was to quantify the difference between the current process flow model for a typical patient workup for chest pain and development of a new process flow model that incorporates DMAIC (define, measure, analyze, improve, control) Six Sigma and evidence-based medicine in a best practices model for diagnosis and treatment. The first stage, DMAIC Six Sigma, is used to highlight areas of variability and unnecessary tests in the current process flow for a patient presenting to the emergency department or physician's clinic with chest pain (also known as angina). The next stage, patient process flow, utilizes DMAIC results in the development of a simulated model that represents real-world variability in the diagnosis and treatment of a patient presenting with angina. The third and final stage is used to analyze the evidence-based output and quantify the factors that drive physician diagnosis accuracy and treatment, as well as review the potential for a broad national evidence-based database. Because of the collective expertise captured within the computer-oriented evidence-based model, the study has introduced an innovative approach to health care delivery by bringing expert-level care to any physician triaging a patient for chest pain anywhere in the world. Similar models can be created for other ailments as well, such as headache, gastrointestinal upset, and back pain. This updated way of looking at diagnosing patients stemming from an evidence-based best practice decision support model may improve workflow processes and cost savings across the health care continuum.
Embry, Dennis D.; Biglan, Anthony
This paper describes evidence-based kernels, fundamental units of behavioral influence that appear to underlie effective prevention and treatment for children, adults, and families. A kernel is a behavior-influence procedure shown through experimental analysis to affect a specific behavior and that is indivisible in the sense that removing any of…
Cychosz, Chris C.; Phisitkul, Phinit; Barg, Alexej; Nickisch, Florian; van Dijk, C. Niek; Glazebrook, Mark A.
The purpose of this study was to provide a comprehensive review of the current literature on tendoscopy of the foot and ankle and assign an evidence-based grade of recommendation for or against intervention. A comprehensive review of the literature was performed on May 26, 2013, using the PubMed,
Kortekaas, Marlous|info:eu-repo/dai/nl/357299817; Bartelink, Marie Louise|info:eu-repo/dai/nl/100449069
Aan de praktijk van evidence-based medicine (EBM) besteden we in de huisartsopleiding te weinig aandacht. Iedere huisarts die de adviezen uit een NHG-Standaard volgt, of ervan afwijkt, doet aan EBM: het wegen van beschikbare evidence met de eigen ervaring en met de voorkeuren van de patiënt.
Forrest, Jane L.; Miller, Syrene A.
Evidence-based decision making (EBDM) was incorporated into an institute for 42 dental hygiene, occupational therapy, and physical therapy faculty. The 4-day sessions addressed active teaching techniques, formulation of good questions, critical appraisal of evidence, and application, feedback, and evaluation. Most participants felt prepared to…
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 ...
Methadone maintenance therapy as evidence based drug abuse planning in developed countries: Can developing countries afford and learn from this experience? ... However, various studies and preventive approaches have been tried in the US on drug abusers in order to prevent the associated adverse health outcomes.
Rwanda Journal Series F: Medicine and Health Sciences Vol. 2 No. 2, 2015. Making Evidence Based Changes on the Labor Ward of Muhima Hospital: Staff Teaching Staff. Jossette Umucyo1, Rondi Anderson1. 1Muhima Hospital, Kigali, Rwanda. Background. In January 2014 it was noted that Muhima hospital was lagging ...
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.
Weisz, John R.; Ugueto, Ana M.; Cheron, Daniel M.; Herren, Jenny
Five decades of randomized trials research have produced dozens of evidence-based psychotherapies (EBPs) for youths. The EBPs produce respectable effects in traditional efficacy trials, but the effects shrink markedly when EBPs are tested in practice contexts with clinically referred youths and compared to usual clinical care. We considered why…
The project's three components include: -Build capacity for evidence-based public policy-making and analysis in all three countries through the university's Institute of Public Policy and Administration; -Support a group of regional researchers on issues of mountain economies and natural resource management through the ...
Evidence-based medicine has had a major impact on health care in the last 30 years. This approach has lead to the critical appraisal of therapeutic knowledge. Archie Cochrane, an epidemiologist, gave a series of lectures in 1972 regarding his reflections on the effectiveness and efficiency of health services.1 He ...
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.
LIRNEasia seeks to build the capacity of local researchers and policymakers for evidence-based ICT-related interventions in the public policy process. To this end, it undertakes action research on institutional constraints to the effective use of ICTs. The first phase of LIRNEasia was funded under project 103017. The current ...
Evidence-based ICT Policy for Development and Innovation. The cost of access to information and communication technologies (ITCs) in Africa remains the major impediment to the participation of Africans in the networked society. While Africa is the region with the fastest growing number of mobile phone subscribers in the ...
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…
Leipzig, Rosanne M.; Wallace, Eleanor Z.; Smith, Lawrence G.; Sullivant, Jean; Dunn, Kathel; McGinn, Thomas
Described and evaluated an interactive course designed to create a cadre of medical school faculty in New York who could integrate evidence-based medicine into their training programs. Findings for representatives of 30 internal medicine residency programs show the usefulness of the regional dissemination model used. (SLD)
Mottonen, Merja; Tapanainen, Paivi; Nuutinen, Matti; Rantala, Heikki; Vainionpaa, Leena; Uhari, Matti
Evidence-based medicine--the process of using research findings systematically as the basis for clinical decisions--can be taught using problem-solving teaching methods. Evaluates whether it was possible to motivate students to use the original literature by giving them selected patient problems to solve. (Author/ASK)
Dean, R; Brennan, M; Ewers, R; Hudson, C; Daly, J M; Baillie, S; Eisler, M C; Place, E J; Brearley, J; Holmes, M; Handel, I; Shaw, D; McLauchlan, G; McBrearty, A; Cripps, P; Jones, P; Smith, R; Verheyen, K
The Royal College of Veterinary Surgeons now lists 'How to evaluate evidence' as a day one competence for newly qualified vets. In this article, representatives from each of the veterinary schools in the UK discuss how the challenge of delivering and assessing the concepts of evidence-based veterinary medicine in a crowded undergraduate curriculum can be met. British Veterinary Association.
Veugelers, R.; van der Ploeg, F.; Dewatripont, M.; Thys-Clément, F.; Wilkin, L.
Universities are key players in the successful transition to a knowledge-based economy and society. However, this crucial sector of society needs restructuring if Europe is not to lose out in the global competition in education, research and innovation. To allow a more evidence based process of
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…
Grote, F.K.; Dommelen, P. van; Oostdijk, W.; Muinck Keizer-Schrama, S.M.P.F. de; Verkerk, P.H.; Wit, J.M.; Buuren, S. van
Objective: To establish evidence based guidelines for growth monitoring on a population basis. Study design: Several auxological referral criteria were formulated and applied to longitudinal growth data from four different patient groups, as well as three samples from the general population.
David-Ferdon, Corinne; Kaslow, Nadine J.
The evidence-base of psychosocial treatment outcome studies for depressed youth conducted since 1998 is examined. All studies for depressed children meet Nathan and Gorman's (2002) criteria for Type 2 studies whereas the adolescent protocols meet criteria for both Type 1 and Type 2 studies. Based on the Task Force on the Promotion and…
Book Review: Deployment Psychology: Evidence-based strategies to promote mental health in the Military. AB Adler, PD Bliese, CA Castro. Abstract. Washington, DC: American Psychological Association 2011 294 pages ISBN-13: 978-1-4338-0881-4. Full Text: EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT
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 ...
Acute otitis externa (AOE), or diffuse inflammation of the external ear canal, causes a range of symptoms, including otalgia, otorrhoea, hearing loss and itching. Despite AOE being common, with a 12-month prevalence of approximately 1%, there is a paucity of evidence-based treatment guidelines. This contributes to a wide ...
Evidence-based medicine - searching the medical literature. Part 1. ... psychological literature, but these are only available on payment of a subscription. Most of ... 2. Component terms (keywords/phrases) children drug resistant malaria treatment. 3. Alternative terms (synonyms) child drug-resistant resistance multidrug.
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?
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…
Schroeder, Torben Veith
Evidence-based medicine (EBM) is not a randomised controlled trial (RCT), but EBM seeks to apply evidence gained from scientific methods - which could be RCT - to daily medical practice. Any surgical treatment reflects a certain development technically as well as skills based. The procedure may...
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 ...
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 ...
Regional Educational Laboratory Southeast, 2011
Over the past decade, research on dropout prevention has become focused on using evidence-based practice, and data-driven decisions, to mitigate students' dropping out of high school and instead, support and prepare students for career and college. Early warning systems or on-track indicators, in which readily available student-level data are used…
into the evidence base. Data contributes to develop- ment. Health outcomes can be improved by investing in: □ 17,506 households. □ 203 health facilities. □ 15,606 pregnant women. Data on child health and immunization was gathered from: □ 13,220 households. □ 214 health facilities. □ 22,589 children under the.
This paper is an extension of the author's earlier work on developing management information services and creating a culture of assessment in libraries. The author will focus observations on the use of data in decision-making in libraries, specifically on the role of leadership in making evidence-based decision a reality, and will review new…
Background. The research methodology module was reviewed as part of the overall revision of the undergraduate physiotherapy curriculum of Stellenbosch University. This created an ideal platform from which to assess how to align the principles of evidence-based practice (EBP) with research methodology. Fostering the ...
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…
The need to integrate the accrued scientific evidence into clinical orthodontic practice is amongst the challenges facing orthodontists in the 21st century. The evidence-based health care approach aims to improve patient care based upon informed decision-making. This article therefore highlights the importance and ...
This article aims to summarise the available evidence in the wound management of diabetic foot ulcers to promote cost-effective evidence-based practice. Diabetic foot ulcers have a significant impact on the individual patient's quality of life, potential morbidity and even mortality. Diabetic foot ulcers also consume a.
This article aims to summarise the available evidence in the wound management of diabetic foot ulcers to promote cost-effective evidence-based practice. Diabetic foot ulcers have a significant impact on the individual patient's quality of life, potential morbidity and even mortality. Diabetic foot ulcers also consume a ...
Jun 1, 2012 ... Since limited resources are available for life-saving health services in Nigeria, those who plan health programs need to know which interventions are most effective and how to prioritise them. An important objective of the Nigeria Evidence-based Health. System Initiative (NEHSI) is to build the capacity of.
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
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.
Bates, Stacey L.
Fifteen studies of family-school interventions with preschool children conducted between 1980 and 2002, and published in peer-reviewed journals, were reviewed and evaluated according to the criteria developed by the Task Force on Evidence-Based Intervention in School Psychology (Division 16 and Society for the Study of School Psychology Task…
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…
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...
Hanley, Sean; Ringwalt, Chris; Vincus, Amy A; Ennett, Susan T; Bowling, J Michael; Haws, Susan W; Rohrbach, Louise A
It is widely recognized that teacher training affects the fidelity with which evidence-based substance use prevention curricula are implemented. We present the results of a 2005 survey of teachers from a nationally representative sample of 1721 public middle schools in the U.S. (78.1% response rate). We measured fidelity along two dimensions (adherence and dose) and also assessed the number of hours, recency, and perceived effectiveness of teachers' training, as well as the degree to which adherence was emphasized during training. Among teachers using evidence-based curricula, 35.3% reported following their curriculum guide very closely. The average proportion of lessons taught was 64.9%, and only 30.2% of teachers taught all the lessons in their curriculum. Analyses revealed that teachers whose training emphasized adherence were 5 times as likely to be more adherent. We present recommendations for training-related factors that may increase fidelity of implementation.
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.
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
Brown, Kathleen M; Macias, Charles G; Dayan, Peter S; Shah, Manish I; Weik, Tasmeen S; Wright, Joseph L; Lang, Eddy S
The burgeoning literature in prehospital care creates an opportunity to improve care through evidence-based guidelines (EBGs). Previously, an established process for the creation of such guidelines and adoption and implementation at the local level was lacking. This has led to great variability in the content of prehospital protocols in different jurisdictions across the globe. Recently the Federal Interagency Committee on Emergency Medical Services (FICEMS) and the National EMS Advisory Council (NEMSAC) approved a National Prehospital Evidence-based Guideline Model Process for the development, implementation, and evaluation of EBGs. The Model Process recommends the use of established guideline development tools such as Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). Objective. To describe the process of development of three prehospital EBGs using the National Prehospital EBG Model Process (EBG Model Process) and the GRADE EBG development tool. We conducted three unique iterations of the EBG Model Process utilizing the GRADE EBG development tool. The process involved 6 distinct and essential steps, including 1) assembling the expert panel and providing GRADE training; 2) defining the evidence-based guideline (EBG) content area and establishing the specific clinical questions to address in patient, intervention, comparison, and outcome (PICO) format; 3) prioritizing outcomes to facilitate systematic literature searches; 4) creating GRADE tables, or evidence profiles, for each PICO question; 5) vetting and endorsing GRADE evidence tables and drafting recommendations; and 6) synthesizing recommendations into an EMS protocol and visual algorithm. Feedback and suggestions for improvement were solicited from participants and relevant stakeholders in the process. We successfully used the process to create three separate prehospital evidence-based guidelines, formatted into decision tree algorithms with levels of evidence and graded
Dugdall, Hayley; Watson, Roger
To investigate qualified nurses' attitudes to evidence-based practice and whether this influenced their selection of wound care products. The literature shows that previous studies on attitudes to evidence-based practice tended to be part of a wider study. The general consensus was that there was a positive attitude to evidence-based practice. However, there appeared to be no published studies specifically addressing nurses' attitudes to evidence-based wound care. Survey design using a questionnaire completed by 156 qualified nurses working in three UK National Health Trusts. A statistically significant difference was seen between those nurses with a tissue viability link nurse role (p = 0.002) and those without a link nurse role; those educated to first degree (p attitude to evidence-based practice (p Nurses who had attained a higher level academic qualification, had a tissue viability link nurse role and those who had received formal tissue viability training scored generally higher in the wound care knowledge tests and in attitude to evidence-based practice. The care received by patients in relation to wound care could be dependent upon factors that are related to the individual characteristics of the nurse providing the care and these factors, in turn, are related to education and training with respect to wound care. Better general education and better specific training in wound care could lead to better wound care.
Nelson, Kyle S; Brearley, Ann M; Haines, Stephen J
The methods of evidence-based medicine are a relatively recent development in the understanding of clinical practice. They are criticized as not providing support for interventions long held to be highly effective based on experience that predated the availability of evidence-based analysis. To determine if the methods of evidence-based medicine can be successfully applied to interventions established before those methods were developed. Systematic review of English language literature on the natural history and treated prognosis of acute epidural hematoma and analysis of existing data on mortality associated with parachute use. Sources of data included Medline, Old Medline, Science Citation Index, British and US Parachute Associations, and Federal Aviation Administration and National Transportation Safety Board databases (both of the United States). Also included were national databases reporting mortality and total number of parachute uses. The estimated mortality of falling from an airplane with an ineffective parachute is 74% (69-79). Mortality associated with effective parachute deployment is between 0.0011% and 0.0017%. For acute epidural hematoma, estimated mortality is 98.54% (95.1-99.9) without treatment and 12.9% (10.5-15.3) with treatment. The number needed to treat to prevent 1 death for the parachute is estimated to be 1.35 (1.27-1.45) and for epidural hematoma 1.17 (1.13-1.22) (95% binomial confidence intervals in parentheses). The methods of evidence-based medicine are robust and can deal with interventions of great face validity and those considered well established before such methods were well developed. We propose initial criteria for evaluating the quality of evidence supporting long-established interventions.
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…
Kingston, Beverly; Bacallao, Martica; Smokowski, Paul; Sullivan, Terri; Sutherland, Kevin
This paper describes the strategic efforts of six National Centers of Excellence in Youth Violence Prevention (YVPC), funded by the U.S. Centers for Disease Control and Prevention, to work in partnership with local communities to create comprehensive evidence-based program packages to prevent youth violence. Key components of a comprehensive evidence-based approach are defined and examples are provided from a variety of community settings (rural and urban) across the nation that illustrate at...
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
National governments use evidence selectively to argue that a successful policy intervention in one local area should be emulated in others ("evidence-based best practice"). However, the value of such evidence is always limited because there is: disagreement on the best way to gather evidence of policy success, uncertainty regarding the…
Stender, David F., III
Alcohol consumption among college students can lead to negative consequences for those consuming alcohol as well as for their classmates. The 2002 report from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) Task Force on College Drinking described a "three-in-one" evidence-based approach for alcohol consumption reduction…
Aravamudhan, K; Frantsve-Hawley, Julie
Time and access have often been cited as barriers to implementing Evidence-Based Dentistry (EBD). This paper describes a new web-based resource launched by the American Dental Association to enable practitioners to incorporate evidence into treatment planning. The website offers a database of systematic reviews, critical summaries of systematic reviews, evidence-based clinical recommendations and links to external resources to enable practitioners to access evidence at the point of care. In addition the site offers an online space for clinicians to suggest clinical scenarios where evidence is lacking. This could potentially be a source of topics to drive future research. With the explosion in the use of information technology within a dental office, this web-site will serve as the one-stop resource for credible scientific information for practitioners.
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.
Lee, M W L; McPhee, R W; Stringer, M D
The dermatome is a fundamental concept in human anatomy and of major importance in clinical practice. There are significant variations in current dermatome maps in standard anatomy texts. The aim of this study was to undertake a systematic literature review of the available evidence for the distribution of human dermatomes. Particular emphasis was placed on the technique of ascertainment, the location and extent of each dermatome, the number of subjects studied, and methodologic limitations. Our findings demonstrate that current dermatome maps are inaccurate and based on flawed studies. After selecting the best available evidence, a novel evidence-based dermatome map was constructed. This represents the most consistent tactile dermatomal areas for each spinal dorsal nerve root found in most individuals. In addition to highlighting the orderly arrangement, areas of consistency and clinical usefulness of dermatomes, their overlap and variability deserve greater emphasis. This review demonstrates the validity of an evidence-based approach to an anatomical concept.
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.
Mühlhauser, Ingrid; Albrecht, Martina; Steckelberg, Anke
Consumers and patients want to be included in decisions regarding their own health and have an ethically justified claim on informed decisions. Therefore, sound information is required, but health information is often misleading and based on different interests. The risks of disease and the benefits of medical interventions tend to be overestimated, whereas harm is often underestimated. Evidence-based health information has to fulfil certain criteria, for instance, it should be evidence-based, independent, complete, true as well as understandable. The aim of a medical intervention has to be explained. The different therapeutic options including the option not to intervene have to be delineated. The probabilities for success, lack of success and unwanted side effects have to be communicated in a numerical and understandable manner. Patients have the right to reject medical interventions without any sanctions.
Hajebrahimi, Sakineh; Mostafaie, Ali
The goal of this article is to help develop, disseminate, and evaluate resources that can be used to practice and teach EBM for urology residents and continuing education of urologists to reduce the gap between research and clinical practice. Urology departments should build capacity for residents to shape the future of quality and safety in healthcare through translating evidence into practice. Cutting edge approaches require knowing how to teach Evidence-based urology, to make Bio-statistics easy to understanding and how to lead improvement at every level. The authors shared their experience about ‘what works’ in a surgical department to building an Evidence-based environment and high quality of cares. PMID:22279316
Mokhles, Sahar; Takkenberg, Johanna Jm; Treasure, Tom
Good clinical practice is an amalgamation of personalized medicine with evidence-based medicine in the best interests of patient. Hence, our title uses Boolean operators to indicate that it is [AND] not [OR]. This is the syntax of formal searching for systematic reviews, ensuring that all the evidence is found. Comprehensive evidence-based guidance can thus be formulated. Many residents and fellows around the world, and their chiefs, are now exposed to consensus documents, white papers, levels of appropriateness, and guidelines and are in many jurisdictions expected to comply with them. However, they are the summation of many forms of evidence, each of which has its place, and we consider them in turn in this article. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
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.
Mittman, Brian S
Intensive efforts are under way to improve health care quality and safety throughout the United States and abroad. Many of these efforts use the quality improvement collaborative method, an approach emphasizing collaborative learning and exchange of insights and support among a set of health care organizations. Unfortunately, the widespread acceptance and reliance on this approach are based not on solid evidence but on shared beliefs and anecdotal affirmations that may overstate the actual effectiveness of the method. More effective use of the collaborative method will require a commitment by users, researchers, and other stakeholders to rigorous, objective evaluation and the creation of a valid, useful knowledge and evidence base. Development of this evidence base will require improved conceptions of the nature of quality problems, quality improvement processes, and the types of research needed to elucidate these processes. Researchers, journal editors, and funding agencies must also cooperate to ensure that published evaluations are relevant, comprehensive, and cumulative.
Mitchell, Helen L; Aggett, Peter J; Richardson, David P; Stowell, Julian D
The present report summarises a meeting held by the Food & Health Forum at the Royal Society of Medicine, London, on 27 May 2010. The objective of the meeting was to review the problems associated with the use of evidence-based nutrition and to discuss what constitutes the efficacy for foods and food constituents and how the strength and consistency of the evidence can be assessed and adapted to circumstances in which health claims are to be used on food products. The meeting highlighted the limitations with the present evidence-based nutrition models with the prospect that this may have long-term consequences for nutrition science and ultimately the consumer who may not benefit from new science that could have an impact on health.
Rapp, Amy M.; Bergman, R. Lindsay; Piacentini, John; McGuire, Joseph F.
Obsessive–compulsive disorder (OCD) is a neuropsychiatric illness that often develops in childhood, affects 1%–2% of the population, and causes significant impairment across the lifespan. The first step in identifying and treating OCD is a thorough evidence-based assessment. This paper reviews the administration pragmatics, psychometric properties, and limitations of commonly used assessment measures for adults and youths with OCD. This includes diagnostic interviews, clinician-administered symptom severity scales, self-report measures, and parent/child measures. Additionally, adjunctive measures that assess important related factors (ie, impairment, family accommodation, and insight) are also discussed. This paper concludes with recommendations for an evidence-based assessment based on individualized assessment goals that include generating an OCD diagnosis, determining symptom severity, and monitoring treatment progress. PMID:27594793
Amy M. Rapp
Full Text Available Obsessive–compulsive disorder (OCD is a neuropsychiatric illness that often develops in childhood, affects 1%–2% of the population, and causes significant impairment across the lifespan. The first step in identifying and treating OCD is a thorough evidence-based assessment. This paper reviews the administration pragmatics, psychometric properties, and limitations of commonly used assessment measures for adults and youths with OCD. This includes diagnostic interviews, clinician-administered symptom severity scales, self-report measures, and parent/child measures. Additionally, adjunctive measures that assess important related factors (ie, impairment, family accommodation, and insight are also discussed. This paper concludes with recommendations for an evidence-based assessment based on individualized assessment goals that include generating an OCD diagnosis, determining symptom severity, and monitoring treatment progress.
Evidence-based management of medical disposable materials pays attention to collect evidence comprehensively and systematically, accumulate and create evidence through its own work and also evaluate evidence strictly. This can be used as a function to guide out job. Medical disposable materials evidence system contains product register qualification, product quality certification, supplier's behavior, internal and external communication evidence. Managers can find different ways in creating and using evidence referring to specific inside and outside condition. Evidence-based management can help accelerating the development of management of medical disposable materials from traditional experience pattern to a systematic and scientific pattern. It also has the very important meaning to improve medical quality, control the unreasonable growth of medical expense and make purchase and supply chain be more efficient.
Evidence-based medicine (EBM) as a health care practice is being incorporated into education programs across the spectrum of medical education to develop lifelong learning skills and to enhance the practice of evidence-based health care. Since improving the quality of patient care is the ultimate goal of EBM, EBM learning must be integrated with clinical application, and resulted outcomes must be reflected in learning transfer (or EBM practice) within the context of solving patient problems. Different factors may constitute the context or environment in which EBM is learned, practiced, and sustained. However, these contextual factors are seldom considered and examined in the development, implementation, and evaluation of EBM instruction for learners at different levels. This article will introduce several contextual factors as tips and strategies that affect EBM learning and transfer. Also included in the article are recommended practices for designing effective EBM instruction that would contribute to a sustainable change in learner behavior.
Background. Evidence-based medicine is a method that helps physicians find and critically evaluate evidences from the medical literature, and apply the evidences in clinical decision-making. In clinical practice the method supplements core medical skills, clinical experience and emphasizes the importance of clinical research evidence. Evidencebased medicine is characterised by two fundamental principles: first, the scientific evidences alone do not suffice for clinical decision-making, second...
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.
Sammut, Mario R.
Background In Malta smoking is widespread and associated with significant morbidity and mortality. Family doctors are well-placed to provide smoking cessation advice to their patients. Objective The aim of this review is to assist family doctors in helping their patients quit smoking by informing them of evidence-based therapies. Method The online Cochrane Database of Systematic Reviews within the Cochrane Library was searched for metaanalyses and systematic reviews related to various smoking...
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.
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.
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...
Reese, Robert J; Slone, Norah C; Soares, Neelkamal; Sprang, Rob
Families with a child diagnosed with attention-deficit hyperactivity disorder completed an 8-session parenting program, the Group Triple P Positive Parenting Program, provided by videoconferencing technology. Families reported improved child behavior (effect size of d = -1.23) and decreased parent distress (d = -0.34). Parent training implemented with videoconferencing technology can be an effective way of delivering evidence-based services to families with specialized needs. (c) 2012 APA, all rights reserved.
Alireza Moayyeri; Akbar Soltani; Hamideh Moosapour; Mohsin Raza
Physicians all through the world visit patients under time limitations. The most important troubled clinical skill under ?time constraint? is the diagnostic approach. In this situation, clinicians need some diagnostic approaches to reduce both diagnostic time and errors. It seems that highly experienced physicians utilize some special tactics in this regard. Evidence-based medicine (EBM) as a relatively new paradigm for clinical practice stresses on using research evidences in diagnostic eval...
Pagoto, Sherry; Schneider, Kristin; Jojic, Mirjana; DeBiasse, Michele; Mann, Devin
Physicians have limited time for weight-loss counseling, and there is a lack of resources to which they can refer patients for assistance with weight loss. Weight-loss mobile applications (apps) have the potential to be a helpful tool, but the extent to which they include the behavioral strategies included in evidence-based interventions is unknown. The primary aims of the study were to determine the degree to which commercial weight-loss mobile apps include the behavioral strategies included in evidence-based weight-loss interventions, and to identify features that enhance behavioral strategies via technology. Thirty weight-loss mobile apps, available on iPhone and/or Android platforms, were coded for whether they included any of 20 behavioral strategies derived from an evidence-based weight-loss program (i.e., Diabetes Prevention Program). Data on available apps were collected in January 2012; data were analyzed in June 2012. The apps included on average 18.83% (SD=13.24; range=0%-65%) of the 20 strategies. Seven of the strategies were not found in any app. The most common technology-enhanced features were barcode scanners (56.7%) and a social network (46.7%). Weight-loss mobile apps typically included only a minority of the behavioral strategies found in evidence-based weight-loss interventions. Behavioral strategies that help improve motivation, reduce stress, and assist with problem solving were missing across apps. Inclusion of additional strategies could make apps more helpful to users who have motivational challenges. © 2013 American Journal of Preventive Medicine.
Brand, Paul L P
A critical step in the development of evidence based guidelines is the interpretation and weighing-up of the epidemiological evidence. According to the model of human dynamic judgement formation, the personal views, convictions, and choices of the experts developing the guidelines play a part in determining this process. If such views, convictions, and choices are stated explicitly (as is recommended in the GRADE methodology for developing guidelines), physicians are more likely to really follow the guidelines.
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...
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 ...
Evidence-based dermatology is the application of high-quality evidence to the care of individual patients with skin diseases. The Centre of Evidence-Based Dermatology in the UK promotes activities in this field through its three interlinking cogs, composed of the international Cochrane Skin Group, the UK Dermatology Clinical Trials Network (UKDCTN), and the UK national electronic library for skin disorders. The Cochrane Skin Group summarises what is already known about health care interventions by supporting systematic reviews of relevant randomized controlled trials (RCTs). The UKDCTN then addresses the key research gaps identified in systematic reviews by coordinating and carrying out well-designed RCTs. The Skin Disorders specialist library then plays a key role in disseminating new knowledge from systematic reviews and RCTs to a community of clinical users. The electronic resources at the Centre of Evidence-Based Dermatology are all freely available to Indian Dermatologists who can use the resources in a way that could benefit their patients. Such new knoweldge only has value if it is shared and used. PMID:20101305
Dea, Nicolas; Fisher, Charles G
Treatment modalities for metastatic spine disease have significantly expanded over the last two decades. This expansion occurred in many different fields. Improvement in surgical techniques and instrumentation now allow the oncologic spine surgeons to effectively circumferentially decompress the neural elements without compromising stability. Percutaneous techniques, both vertebral augmentation and pre-operative endovascular embolization procedures, also greatly benefit patients suffering from spinal column metastasis. Imaging technology advances has contributed to better pre-operative planning and the development of highly conformational radiation techniques, thus permitting the delivery of high-dose radiation to tumors, while avoiding radiotoxicity to the spinal cord and other vital structures. These new developments, combined with evidence-based stability and disease-specific quality of life scores now allow not only better treatment, but also a solid foundation for high-quality research. Spine oncology literature currently suffers from a lack of high-quality evidence due to low prevalence of the disease and complex methodological issues. However, when following evidence-based medicine principles, which incorporate best available evidence, clinical expertise and patient preference, sound, evidence-based recommendations can be made regarding the abovementioned treatment modalities.
Perlstein, P H; Kotagal, U R; Bolling, C; Steele, R; Schoettker, P J; Atherton, H D; Farrell, M K
To describe the effect of implementing an evidence-based clinical practice guideline for the inpatient care of infants with bronchiolitis at the Children's Hospital Medical Center in Cincinnati, Ohio. A multidisciplinary team generated the guideline for infants first-time episode of typical bronchiolitis. The guideline was implemented January 15, 1997, and data on all patients admitted with bronchiolitis from that date through March 27, 1997, were compared with data on similar patients admitted in the same periods in the years 1993 through 1996. Data were extracted from hospital charts and clinical and financial databases. They included LOS and use and costs of resources ancillary to bed occupancy. After implementation of the guideline, admissions decreased 29% and mean LOS decreased 17%. Nasopharyngeal washings for respiratory syncytial virus were obtained in 52% fewer patients. Twenty percent fewer chest radiographs were ordered. There were significant reductions in the use of all respiratory therapies, with a 30% decrease in the use of at least 1 beta-agonist inhalation therapy. In addition, 51% fewer repeated inhalations were administered. Mean costs for all resources ancillary to bed occupancy decreased 37%. Mean costs for respiratory care services decreased 77%. An evidence-based clinical practice guideline for managing bronchiolitis was highly successful in modifying care during its first year of implementation.guideline, bronchiolitis, evidence-based medicine, pediatrics, outcome research.
ZHANG, QIANG; YANG, JIE; QIAN, QUN
Rectal cancer is a worldwide disease whose incidence has increased significantly. Evidence-based medicine is a category of medicine that optimizes decision making by using evidence from well-designed and conducted research. Evidence-based medicine can be used to formulate a reasonable treatment plan for newly diagnosed rectal cancer patients. The current review focuses on the application of evidence-based treatment on patients with rectal cancer. The relationship between perioperative blood transfusion and recurrence of rectal cancer after surgery, the selection between minimally invasive laparoscopic surgery and traditional laparotomy, choice of chemotherapy for patients with rectal cancer prior to surgery, selection between stapled and hand-sewn methods for colorectal anastomosis during rectal cancer resection, and selection between temporary ileostomy and colostomy during the surgery were addressed. Laparoscopy is considered to have more advantages but is time-consuming and has high medical costs. In addition, laparoscopic rectal cancer radical resection is preferred to open surgery. In radical resection surgery, use of a stapling device for anastomosis can reduce postoperative anastomotic fistula, although patients should be informed of possible anastomotic stenosis. PMID:26998054
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.
Full Text Available There has been renewed recognition that proactive strategies and interventions can address the social determinants of health, and the environmental health profession is well placed to effect positive change in many of these determinants. This qualitative research has revealed differences in the perceptions, experiences, and understandings of evidence-based practice among public health professionals from different backgrounds across different services in health care and local government in England. The absence of a strong tradition of evidence-based practice in environmental health appears to be a disadvantage in securing funding and playing a full role, as it has become the expectation in the new public health system. This has, at times, resulted in tensions between professionals with different backgrounds and frustration on the part of environmental health practitioners, who have a tradition of responding quickly to new challenges and “getting on with the job.” There is generally a willingness to develop evidence-based practice in environmental health; however, this will take time and investment.
Dijkzeul, Dennis; Hilhorst, Dorothea; Walker, Peter
This introductory paper sets the stage for this special issue of Disasters on evidence-based action in humanitarian crises. It reviews definition(s) of evidence and it examines the different disciplinary and methodological approaches to collecting and analysing evidence. In humanitarian action, the need for evidence-based approaches sometimes is viewed in tension with a principled approach, often unnecessarily. Choosing appropriate research methods depends on the objectives of the researcher, in particular whether the research focuses on the intervention and/or the context and the length and complexity of the causal chains involved. The paper concludes by defining some trends in evidence-based approaches in crises: the move away from inputs and outputs of humanitarian action towards outcomes and impacts; the shift towards a higher degree of partnerships in research, and the participation of users and target groups; and the acceptance of a broad array of approaches to establish evidence. © 2013 The Author(s). Journal compilation © Overseas Development Institute, 2013.
Prudhomme, Michael B; Ropp, Lincoln G; Sauer, Samual W; LaVan, Joseph T
Using concepts from evidence-based medicine, systems theory, and risk assessment, a standardized model was developed to accept or reject medications for use in flight. The model calculates the risk scores of medications, which can then be compared to an organization's acceptable risk tolerance. Risk scores for each medication were established by summing the products of incidence rates and severity scores for all published side effects. The incidence of each side effect was obtained in an evidence-based manner and each assigned a severity multiplier. Using statistical analysis of the calculated risk scores of approved medications, an acceptance control chart was generated. Range of calculated risk scores of historically approved medications was 10-9140. Six Sigma Acceptance Control Line was calculated at 1.5 SDs above the mean and was 9822. Risk score range of medications generally felt unsafe was 27,010-41,294. Risk score range of medications under consideration for approval was 986-6863. This novel approach to medication approval is the first in aerospace medicine to attempt to combine evidence-based medicine, risk analysis, and control charts to standardize and streamline the medication approval process within an organization. The model was validated by testing against medications generally accepted to be unsafe for use in flight. These medications fell several deviations above the control line. Other medications not yet authorized fall well below the acceptance line and could be considered for approval.
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.
Chiang, Li-Chi; Liao, Mei-Nan
As clinical scientists on the interdisciplinary healthcare team, nurses use the art and science of current nursing knowledge to provide evidence-based healthcare to each patient and his/her family. Nurses not only comprise the largest contingent of medical personnel and provide 24-hour patient care but are also professional scientists that develop unique nursing knowledge through reflective practice. Five strategies for expanding the body of current evidence-based nursing scientific knowledge include: (1) reflecting empirically on the practice-service domain, (2) developing nursing knowledge using rigorous methodology, (3) emancipating nursing knowledge using innovative transformation, (4) using collaborative interdisciplinary healthcare that is based in patient-centered care, and (5) initiating innovative transformation in nursing education. Nurses are critical healthcare providers that make important contributions to today's healthcare system. Nursing scientists provide frontline, evidence-based transforming care that deserves to be respected and valued on an equal basis with the care and services that are provided by other medical personnel.
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
Full Text Available The practice of "evidence-based medicine" aims at the conscientious, explicit and judicious use of the current best evidence in making decisions about the individualised patient care. The clinical genetics evolved from translational genetics research and contributes to the clinical care of patients and families through evidence-based health care in managing inherited disorders through accurate diagnosis, molecular pathology and assessing phenotypic correlations. Translational genetics and genomics research has led to the development of powerful tools for clinical diagnosis, assessing individual's genomic profile for disease prediction/prevention, high-throughput genome-wide screening for predisposition and/or protection to complex medical conditions, and discovery and development of new drugs and vaccines. Gene mapping and deciphering pathogenic mutations have helped in unravelling the basic biological mechanisms leading to new drug discovery and development. Targeted pharmacotherapy is now possible for managing the highly penetrant multi-system dominantly inherited conditions. Notable examples include rapamycin (sirolimus in suppressing the mTOR pathway associated hamartomas in dominantly inherited cancer family syndromes and angiotensin converting enzyme receptor blockers (ACE-RB in preventing aortic dilatation in Marfan syndrome and related familial arteriopathies. The translational genomic research is the essential prerequisite for developing sound evidence-based diagnostic, therapeutic and prognostic clinical protocols for the practice of personalised clinical medicine.
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.
Ostlie, Daniel J; St Peter, Shawn D
The efficiency of medical care in the United States has become intensely scrutinized with expectations from patients, families, payors, lawmakers, and, currently, the President. The most effective vehicle to bring more efficient care is the employment of evidence-based medicine whenever possible. Evidence-based medicine is dependent on best evidence, and best evidence is generated from prospective trials. To evaluate current state of evidence based practice in pediatric surgery we reviewed the literature for trials conducted in our field the past 10 years. All randomized controlled trials from January 1999 through December 2009 published in the English literature were identified through a literature search using PubMed (www.pubmed.com). We included only those in pediatric general surgery excluding transplant, oncology, and the other nongeneral subspecialties. The search criteria produced 56 manuscripts, of which 51 described appropriate randomization techniques. A definitive trial design with a sample size calculation was utilized in only 19 studies (34%). A statistically significant difference between treatment arms was identified in 29 of the 56 (52%) trials. There were 26 different journals of publication, with the Journal of Pediatric Surgery being most common (20) followed by Pediatric Surgery International (7). The combined total publications from January 1999 through December 2009 for the 26 journals these randomized trials represent 0.04% of all publications. Appendicitis was the most common condition that was studied (n = 10) followed by pyloric stenosis (n = 4). Trials originated in 19 different countries led by the United States (28%), United Kingdom (14%), and Turkey (12%). There was a generally progressive increase in published trials from 1999 to 2009, however, the percentage of prospective articles published in pediatric surgery was similar to a previous review published in 1999. The current state of evidence-based surgery in pediatric surgery has
Groce, James B
The evolution of evidence-based quality measures in healthcare, specific performance measures that have been developed by various groups for the prevention and treatment of venous thromboembolism (VTE), the objectives and potential benefits of a national quality improvement initiative designed to improve the care of high-risk patients with acute coronary syndrome (ACS), the reporting of performance data to the public to guide consumer choice, and the recent growth in pay-for-performance programs are described. Efforts to develop evidence-based quality measures began in the mid to late 1990s and have led to the creation of various safe practices, indicators, standards, and quality measures and initiatives. The prevention and treatment of VTE and the management of ACS have been the focus of some of these initiatives. Reporting of data for two surgery-related VTE process measures to the Centers for Medicare and Medicaid Services began January 1, 2007, and two additional measures may be used in the future. The Joint Commission and National Quality Forum have proposed eight core measures for the prevention and care of VTE that could eventually be used in hospital accreditation decisions. A national quality improvement initiative, CRUSADE, provides participating hospitals with feedback about performance in caring for high-risk patients with non-ST-segment elevation ACS. Reporting of performance data to the public facilitates healthcare decision making by consumers. The use of pay-for-performance programs that provide incentives and rewards for meeting quality goals has grown rapidly in recent years. The various initiatives under way using evidence-based performance measures to evaluate quality of care for VTE and ACS have the potential to improve patient outcomes.
The objective of the author in this article was to examine possible differences in knowledge and attitudes toward evidence-based practice (EBP) among social workers across geographic regions. A random national sample of 180 NASW members was obtained from mail and Internet groups. MANOVA analysis was performed to determine possible differences in knowledge and attitudes toward EBP among these social workers. Findings suggest that knowledge and attitude toward EBP did not differ among these practitioners. Despite increasing efficacy and widespread knowledge of EBPs, there is little or no empirical evidence to support any differences in attitudes and knowledge of EBP among social workers across geographic regions.
Weaver, Robert R
Evidence-based and patient-centred health care movements have each enhanced the discussion of how health care might best be delivered, yet the two have evolved separately and, in some views, remain at odds with each other. No clear model has emerged to enable practitioners to capitalize on the advantages of each so actual practice often becomes, to varying degrees, an undefined mishmash of each. When faced with clinical uncertainty, it becomes easy for practitioners to rely on formulas for care developed explicitly by expert panels, or on the tacit ones developed from experience or habit. Either way, these tendencies towards 'cookbook' medicine undermine the view of patients as unique particulars, and diminish what might be considered patient-centred care. The sequence in which evidence is applied in the care process, however, is critical for developing a model of care that is both evidence based and patient centred. This notion derives from a paradigm for knowledge delivery and patient care developed over decades by Dr. Lawrence Weed. Weed's vision enables us to view evidence-based and person-centred medicine as wholly complementary, using computer tools to more fully and reliably exploit the vast body of collective knowledge available to define patients' uniqueness and identify the options to guide patients. The transparency of the approach to knowledge delivery facilitates meaningful practitioner-patient dialogue in determining the appropriate course of action. Such a model for knowledge delivery and care is essential for integrating evidence-based and patient-centred approaches. © 2015 The Authors. Journal of Evaluation in Clinical Practice published by John Wiley & Sons, Ltd.
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.
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.
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.
Jagger, Susan L.; Yore, Larry D.
Science literacy for all is the central goal of science education reforms, and there is a growing importance of the language arts in science. Furthermore, there are strong calls for teacher professionalism and self-directed professional learning that involve evidence-based best practices. This raises questions about whether science teaching journals' recommendations are anchored to high-quality evidence. We found that (a) most National Science Teacher Association journals' science literacy recommendations have weak or no evidence base and (b) those with evidence reference teaching journals, teacher resource books, and literacy education more often than science education research. We concluded that all participants in the knowledge production cycle and transfer process—authors, editors, and reviewers—need to encourage evidence-based practices anchored to ongoing reforms and to literacy and science education research.
Lovelace, Kay A; Aronson, Robert E; Rulison, Kelly L; Labban, Jeffrey D; Shah, Gulzar H; Smith, Mark
We examined variation in the use of evidence-based decision-making (EBDM) practices across local health departments (LHDs) in the United States and the extent to which this variation was predicted by resources, personnel, and governance. We analyzed data from the National Association of County and City Health Officials Profile of Local Health Departments, the Association of State and Territorial Health Officials State Health Departments Profile, and the US Census using 2-level multilevel regression models. We found more workforce predictors than resource predictors. Thus, although resources are related to LHDs' use of EBDM practices, the way resources are used (e.g., the types and qualifications of personnel hired) may be more important.
Crawford, James M
Pathology is both a medical specialty and an investigative scientific discipline, concerned with understanding the essential nature of human disease. Ultimately, pathology is accountable as well, as measured by the accuracy of our diagnoses and the resultant patient care outcomes. As such, we must consider the evidence base underlying our practices. Within the realm of Laboratory Medicine, extensive attention has been given to testing accuracy and precision. Critical examination of the evidence base supporting the clinical use of specific laboratory tests or technologies is a separate endeavor, to which specific attention must be given. In the case of anatomic pathology and more specifically surgical pathology, the expertise required to render a diagnosis is derived foremost from experience, both personal and literature-based. In the first instance, knowledge of the linkage between one's own diagnoses and individual patient outcomes is required, to validate the role of one's own interpretations in the clinical course of patients. Experience comes from seeing this linkage first hand, from which hopefully comes wisdom and, ultimately, good clinical judgment. In the second instance, reading the literature and learning from experts is required. Only a minority of the relevant literature is published in pathology journals to which one may subscribe. A substantial portion of major papers relevant to the practice of anatomic pathology are published in collateral clinical specialty journals devoted to specific disease areas or organs. Active effort is therefore required to seek out the literature beyond the domain of pathology journals. In examining the published literature, the essential question then becomes: Does the practice of anatomic pathology fulfill the tenets of 'evidence-based medicine' (EBM)? If the pinnacle of EBM is 'systematic review of randomized clinical trials, with or without meta-analysis', then anatomic pathology falls far short. Our published
Mary M. Somerville
Full Text Available Objective – In response to unrelenting disruptions in academic publishing and higher education ecosystems, the Informed Systems approach supports evidence based professional activities to make decisions and take actions. This conceptual paper presents two core models, Informed Systems Leadership Model and Collaborative Evidence-Based Information Process Model, whereby co-workers learn to make informed decisions by identifying the decisions to be made and the information required for those decisions. This is accomplished through collaborative design and iterative evaluation of workplace systems, relationships, and practices. Over time, increasingly effective and efficient structures and processes for using information to learn further organizational renewal and advance nimble responsiveness amidst dynamically changing circumstances. Methods – The integrated Informed Systems approach to fostering persistent workplace inquiry has its genesis in three theories that together activate and enable robust information usage and organizational learning. The information- and learning-intensive theories of Peter Checkland in England, which advance systems design, stimulate participants’ appreciation during the design process of the potential for using information to learn. Within a co-designed environment, intentional social practices continue workplace learning, described by Christine Bruce in Australia as informed learning enacted through information experiences. In addition, in Japan, Ikujiro Nonaka’s theories foster information exchange processes and knowledge creation activities within and across organizational units. In combination, these theories promote the kind of learning made possible through evolving and transferable capacity to use information to learn through design and usage of collaborative communication systems with associated professional practices. Informed Systems therein draws from three antecedent theories to create an original
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.
BACKGROUND: The aim of this conference paper was to examine the evidence base for primary and secondary prevention of dental caries, erosions and dentin hypersensitivity through professional and self-care measures. METHODS: A mapping of systematic reviews (SR) of literature was carried out in Pub...... and preventive dentistry that must be addressed and bridged through clinical research of good quality....... review articles of potential interest. Meta-analyses, guidelines and treatment recommendations were considered only when SR's were lacking. In the event of updates or multiple systematic reviews covering the same topic, only the most recent article was included. No quality assessment of the systematic...
Gennari, Rosella; Marenzi, Ivana; Prieta, Fernando; Rodríguez, Juan
Research on Technology Enhanced Learning (TEL) investigates how information and communication technologies can be designed in order to support pedagogical activities. The workshop proceedings collects contributions concerning evidence based TEL systems, like their design following EBD principles as well as studies or best practices that educators, education stakeholders or psychologists used to diagnose or improve their students' learning skills, including students with specific difficulties. The international ebTEL’12 workshop wants to be a forum in which TEL researchers and practitioners alike can discuss ideas, projects, and lessons related to ebTEL. The workshop takes place in Salamanca, Spain, on March 28th-30th 2012.
Mold, James W; Hamm, Robert; Scheid, Dewey
Evidence-based medicine and goal-directed, patient-centered health care seem, at times, like parallel universes, though, at a conceptual level, they are perfectly compatible. Part of the problem is that many of the kinds of information required for decision making in primary care are often unavailable or difficult to find. Several case examples are used to illustrate this problem, and reasons and solutions are suggested. The goal-directed health care model could be helpful for directing the search for evidence that is relevant to the decisions that patients and their primary care physicians must make on a regular basis.
The Montessori educational method has existed for over 100 years, but evaluations of its effectiveness are scarce. This review paper has three aims, namely to (1) identify some key elements of the method, (2) review existing evaluations of Montessori education, and (3) review studies that do not explicitly evaluate Montessori education but which evaluate the key elements identified in (1). The goal of the paper is therefore to provide a review of the evidence base for Montessori education, with the dual aspirations of stimulating future research and helping teachers to better understand whether and why Montessori education might be effective.
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.
Saugel, Bernd; Malbrain, Manu L N G; Perel, Azriel
Hemodynamic instability frequently occurs in critically ill patients. Pathophysiological rationale suggests that hemodynamic monitoring (HM) may identify the presence and causes of hemodynamic instability and therefore may allow targeting therapeutic approaches. However, there is a discrepancy between this pathophysiological rationale to use HM and a paucity of formal evidence (as defined by the strict criteria of evidence-based medicine (EBM)) for its use. In this editorial, we discuss that this paucity of formal evidence that HM can improve patient outcome may be explained by both the shortcomings of the EBM methodology in the field of intensive care medicine and the shortcomings of HM itself.
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
A single 5-6 hours manualized abreactive ego state therapy session has recently been subjected to two placebo-controlled investigations meeting evidence-based criteria. Ego state therapy was found to be a highly effective and durable treatment for posttraumatic stress disorder. Apparently, ego state therapy works because it is emotion focused, activates sub-cortical structures, and because the supportive, interpretive therapist reconstructs the patient's personality to be resilient and adaptive. In this article the author reviews the treatment procedures and presents the findings of both studies.
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.
Thomas, Laurie Endicott
Medical students in the United States are taught little about nutrition and dietetics. Worse yet, their training biases them against the studies that show the power of dietary approaches to managing disease. The current approach to evidence-based medicine encourages physicians to ignore any information that does not come from a double-blind, randomized controlled trial. Yet human beings cannot be blinded to a dietary intervention. As a result, physicians are biased toward drug treatments and against dietary interventions for the management of chronic disease. Copyright © 2013 Elsevier Ltd. All rights reserved.
This work aims to deepen our understanding of the role played by technical guidelines and tools for the design, construction and operation of healthcare facilities, ultimately establishing the impact of the physical environment on staff and patient outcomes. Using case studies largely drawn from the UK, Europe, China and Australasia, design approaches such as sustainability (e.g. targets for energy efficiency, carbon neutrality, reduction of waste), evidence-based design (EBD), and Post-Project Evaluation (PPE) are examined in order to identify policies, mechanisms and strategies that can promote an integrated learning environment that in turn supports innovation in healthcare.
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...
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...
Christiansen, Ole B; Nybo Andersen, Anne-Marie; Bosch, Ernesto
OBJECTIVE: To give an overview of currently used investigations and treatments offered to women with recurrent pregnancy loss (RPL) and, from an evidence-based point of view, to evaluate the usefulness of these interventions. DESIGN: Ten experts on epidemiologic, genetic, anatomic, endocrinologic......, and an extensive investigation for all major factors should always be undertaken. There is an urgent need for agreement concerning the thresholds for detecting what is normal and abnormal, irrespective of whether laboratory tests or uterine abnormalities are concerned. A series of lifestyle factors should...
Vergneau-Grosset, Claire; Larrat, Sylvain
Fish and aquatic invertebrates deserve evidence-based medicine. Pharmacologic information is available; most pharmacokinetic studies are derived from the aquaculture industry and extrapolated to ornamental fish. Conversely, advanced diagnostics and information regarding diseases affecting only ornamental fish and invertebrates require more peer-reviewed experimental studies; the examples of carp edema virus, sea star wasting disease, seahorse nutrition, and gas bubble disease of fish under human care are discussed. Antinociception is also a controversial topic of growing interest in aquatic animal medicine. This article summarizes information regarding new topics of interest in companion fish and invertebrates and highlights some future avenues for research. Copyright © 2017 Elsevier Inc. All rights reserved.
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
Kouimtsidis, Ch; John-Smith, St; Kemp, P; Ikkos, G
Health provision systems in the developed western nations are currently facing major financial challenges. In order to meet these challenges, a number of new approaches used to assist the provision of health have been introduced, including the practice of health professionals. These approaches utilize specific methods of data capture and summarization such as: evidence based medicine (EBM) and practice guidelines. Evidence is generated from systematic clinical research as well as reported clinical experience and individually case based empirical evidence. All types of research though (quantitative or qualitative) have limitations. Similarly all types of evidence have advantages and disadvantages and can be complimentary to each other. Evidencebased individual decision (EBID) making is the commonest evidence-based medicine as practiced by the individual clinician in making decisions about the care of the individual patient. It involves integrating individual clinical expertise with the best available external clinical evidence from systematic research. However this sort of evidence-based medicine, focuses excessively on the individual (potentially at the expense of others) in a system with limited budgets. Evidence-based guidelines (EBG) also support the practice of evidence-based medicine but at the organizational or institutional level. The main aim is to identify which interventions, over a range of patients, work best and which is cost-effective in order to guide service development and provision at a strategic level. Doing this effectively is a scientific and statistical skill in itself and the quality of guidelines is based primarily on the quality research evidence. It is important to note that lack of systematic evidence to support an intervention does not automatically mean that an intervention must instantly be abandoned. It is also important that guidelines are understood for what they are, i.e. not rules, or complete statements of knowledge. EBM will
Yin, Chang Shik; Ko, Seong-Gyu
Objectives. Korean medicine, an integrated allopathic and traditional medicine, has developed unique characteristics and has been active in contributing to evidence-based medicine. Recent developments in Korean medicine have not been as well disseminated as traditional Chinese medicine. This introduction to recent developments in Korean medicine will draw attention to, and facilitate, the advancement of evidence-based complementary alternative medicine (CAM). Methods and Results. The history of and recent developments in Korean medicine as evidence-based medicine are explored through discussions on the development of a national standard classification of diseases and study reports, ranging from basic research to newly developed clinical therapies. A national standard classification of diseases has been developed and revised serially into an integrated classification of Western allopathic and traditional holistic medicine disease entities. Standard disease classifications offer a starting point for the reliable gathering of evidence and provide a representative example of the unique status of evidence-based Korean medicine as an integration of Western allopathic medicine and traditional holistic medicine. Conclusions. Recent developments in evidence-based Korean medicine show a unique development in evidence-based medicine, adopting both Western allopathic and holistic traditional medicine. It is expected that Korean medicine will continue to be an important contributor to evidence-based medicine, encompassing conventional and complementary approaches.
Hunt, Jennifer M; Lumley, Judith
To describe the variability and evidence base of recommendations in Australian protocols and national policies about six aspects of routine antenatal care. Comparison of recommendations from local protocols, national guidelines and research about number of visits, screening for gestational diabetes (GDM), syphilis, hepatitis C (HCV), and HIV, and advice on smoking cessation. Australian public hospitals with more than 200 births/year, some smaller hospitals in each State and Territory, and all Divisions of General Practice were contacted in 1999 and 2000. We reviewed 107 protocols, which included 80% of those requested from hospitals and 92% of those requested from Divisions. Frequency and consistency of recommendations. Recommendations about syphilis testing were notable in demonstrating consistency between local protocols, national policies and research evidence. Most protocols recommended screening for GDM, despite lack of good evidence of its effectiveness in improving outcomes. Specific approaches to screening for GDM varied widely. Coverage and specific recommendations about testing for HIV and HCV were also highly variable. Smoking-cessation information and advice was rarely included, despite good evidence of the effectiveness of interventions in improving outcomes. No national policies about the number of routine visits and smoking cessation could be identified. There were inconsistent national policies for both HIV and GDM screening. Antenatal care recommended in protocols used in Australia varies, and is not always consistent with national policies or research evidence. Producing and disseminating systematic reviews of research evidence and national guidelines might reduce this variability and improve the quality of Australian antenatal care.
Wang, Ting-Shun; Tsai, Tsen-Fang
Scalp psoriasis is commonly the initial presentation of psoriasis, and almost 80 % of patients with psoriasis will eventually experience it. Although several systematic reviews and guidelines exist, an up-to-date evidence-based review including more recent progress on the use of biologics and new oral small molecules was timely. Of the 475 studies initially retrieved from PubMed and the 845 from Embase (up to May 2016), this review includes 27 clinical trials, four papers reporting pooled analyses of other clinical trials, ten open-label trials, one case series, and two case reports after excluding non-English literature. To our knowledge, few randomized controlled trials (RCTs) are conducted specifically in scalp psoriasis. Topical corticosteroids provide good effects and are usually recommended as first-line treatment. Calcipotriol-betamethasone dipropionate is well tolerated and more effective than either of its individual components. Localized phototherapy is better than generalized phototherapy on hair-bearing areas. Methotrexate, cyclosporine, fumaric acid esters, and acitretin are well-recognized agents in the treatment of psoriasis, but we found no published RCTs evaluating these agents specifically in scalp psoriasis. Biologics and new small-molecule agents show excellent effects on scalp psoriasis, but the high cost of these treatments mean they may be limited to use in extensive scalp psoriasis. More controlled studies are needed for an evidence-based approach to scalp psoriasis.
Bracke, Paul J; Howse, David K; Keim, Samuel M
This paper reports on the development of a tool by the Arizona Health Sciences Library (AHSL) for searching clinical evidence that can be customized for different user groups. The AHSL provides services to the University of Arizona's (UA's) health sciences programs and to the University Medical Center. Librarians at AHSL collaborated with UA College of Medicine faculty to create an innovative search engine, Evidence-based Medicine (EBM) Search, that provides users with a simple search interface to EBM resources and presents results organized according to an evidence pyramid. EBM Search was developed with a web-based configuration component that allows the tool to be customized for different specialties. Informal and anecdotal feedback from physicians indicates that EBM Search is a useful tool with potential in teaching evidence-based decision making. While formal evaluation is still being planned, a tool such as EBM Search, which can be configured for specific user populations, may help lower barriers to information resources in an academic health sciences center.
Full Text Available In everyday clinical practice there is a constant need for valid information about diagnosis, prognosis, therapy and prevention of a variety of diseases. But there could be a disparity between the physician's diagnostic skills and his clinical judgment if he relies only on traditional sources of information. In the 1992, a group of scientists from the McMaster University in Ontario, Canada attempted to integrate individual clinical expertise with the best external evidence. They propose a process in which systematically finding, appraising and using of contemporaneous research were the base for proper clinical decision. They called this integration of personal clinical knowledge with research evidence - Evidence Based Medicine (EBM and since then interest in this field has growing exponentially. But 400 years before this important concept emerged a young physician from Koper, named Santorio Santorio (1561 - 1636 argued that a doctor should first rely on sense experience, then on reasoning, and only lastly on authority. Beside his numerous medical inventions he was the first to search justification to his practice by using some vital connection between measured parameters and a person's health state. He could be therefore credited as one of the beginners of modern concepts of science or evidence based medicine.
Eui Geum Oh, PhD, RN
Full Text Available As evidence-based practice has become an important issue in healthcare settings, the educational needs for knowledge and skills for the generation and utilization of healthcare evidence are increasing. Systematic review (SR, a way of evidence generation, is a synthesis of primary scientific evidence, which summarizes the best evidence on a specific clinical question using a transparent, a priori protocol driven approach. SR methodology requires a critical appraisal of primary studies, data extraction in a reliable and repeatable way, and examination for validity of the results. SRs are considered hierarchically as the highest form of evidence as they are a systematic search, identification, and summarization of the available evidence to answer a focused clinical question with particular attention to the methodological quality of studies or the credibility of opinion and text. The purpose of this paper is to introduce an overview of the fundamental knowledge, principals and processes in SR. The focus of this paper is on SR especially for the synthesis of quantitative data from primary research studies that examines the effectiveness of healthcare interventions. To activate evidence-based nursing care in various healthcare settings, the best and available scientific evidence are essential components. This paper will include some examples to promote understandings.
Full Text Available Sydney Y Rucker,1 Zulfukar Ozdogan,1 Morhaf Al Achkar2 1School of Education, Indiana University, Bloomington, IN, 2Department of Family Medicine, School of Medicine, University of Washington, Seattle, WA, USA Abstract: Journal club (JC, as a pedagogical strategy, has long been used in graduate medical education (GME. As evidence-based medicine (EBM becomes a mainstay in GME, traditional models of JC present a number of insufficiencies and call for novel models of instruction. A flipped classroom model appears to be an ideal strategy to meet the demands to connect evidence to practice while creating engaged, culturally competent, and technologically literate physicians. In this article, we describe a novel model of flipped classroom in JC. We present the flow of learning activities during the online and face-to-face instruction, and then we highlight specific considerations for implementing a flipped classroom model. We show that implementing a flipped classroom model to teach EBM in a residency program not only is possible but also may constitute improved learning opportunity for residents. Follow-up work is needed to evaluate the effectiveness of this model on both learning and clinical practice. Keywords: evidence-based medicine, flipped classroom, residency education
Talbot, Elizabeth A; Chen, Lin H; Sanford, Christopher; McCarthy, Anne; Leder, Karin
Travel medicine is the medical subspecialty which promotes healthy and safe travel. Numerous studies have been published that provide evidence for the practice of travel medicine, but gaps exist. The Research Committee of the International Society of Travel Medicine (ISTM) established a Writing Group which reviewed the existing evidence base and identified an initial list of research priorities through an interactive process that included e-mails, phone calls, and smaller meetings. The list was presented to a broader group of travel medicine experts, then was presented and discussed at the Annual ISTM Meeting, and further revised by the Writing Group. Each research question was then subject to literature search to ensure that adequate research had not already been conducted. Twenty-five research priorities were identified and categorized as intended to inform pre-travel encounters, safety during travel, and post-travel management. We have described the research priorities that will help to expand the evidence base in travel medicine. This discussion of research priorities serves to highlight the commitment that the ISTM has in promoting quality travel-related research. © 2010 International Society of Travel Medicine.
Han, Jung Yeon; Choi-Kwon, Smi
This study was designed to adapt a surgical wound care algorithm that is used to provide evidence-based surgical wound care in a critical care unit. This study used, the 'ADAPTE process', an international clinical practice guideline development method. The 'Bonnie Sue wound care algorithm' was used as a draft for the new algorithm. A content validity index (CVI) targeting 135 critical care nurses was conducted. A 5-point Likert scale was applied to the CVI test using a statistical criterion of .75. A surgical wound care algorithm comprised 9 components: wound assessment, infection control, necrotic tissue management, wound classification by exudates and depths, dressing selection, consideration of systemic factors, wound expected outcome, reevaluate non-healing wounds, and special treatment for non-healing wounds. All of the CVI tests were ≥.75. Compared to existing wound care guidelines, the new wound care algorithm provides precise wound assessment, reliabilities of wound care, expands applicability of wound care to critically ill patients, and provides evidence and strength of recommendations. The new surgical wound care algorithm will contribute to the advancement of evidence-based nursing care, and its use is expected as a nursing intervention in critical care.
Doumit, Gaby D; Papay, Frank A; Moores, Neal; Meisler, Eileen; Zins, James E
In health care, it is widely known that evidence-based medicine (EBM) has a significant impact on clinical practice, and opinion leaders can enhance the clinician's application of EBM in various disciplines. In this article, we examine the existence and impact of opinion leaders in craniofacial surgery as well as barriers to evidence-based practice. We compiled the answers of an Internet questionnaire, which was sent to 102 craniofacial surgeons. Our results demonstrate that opinion leaders most definitely can be identified in craniofacial surgery. They are tightly connected to their field's social network and promote EBM. In this survey, 44% of craniofacial surgeons reported that their greatest obstacle to clinical decision making in the management of nonsyndromic synostosis was lack of surgical consensus. In addition, craniofacial surgeons stated that EBM and opinion leaders are the most influential factors that caused them to change their management of craniosynostosis. We expect that the use of opinion leaders can further enhance the uptake of EBM in craniofacial surgery.
Full Text Available Abstract Background In resource-limited settings where laboratory capacity is limited and response strategy is non-specific, delayed or inappropriate intervention against outbreaks of Norovirus (NoV are common. Here we report interventions of two norovirus outbreaks, which highlight the importance of evidence-based modeling and assessment to identify infection sources and formulate effective response strategies. Methods Spatiotemporal scanning, mathematical and random walk modeling predicted the modes of transmission in the two incidents, which were supported by laboratory results and intervention outcomes. Results Simulation results indicated that contaminated water was 14 to 500 fold more infectious than infected individuals. Asymptomatic individuals were not effective transmitters. School closure for up to a week still could not contain the outbreak unless the duration was extended to 10 or more days. The total attack rates (TARs for waterborne NoV outbreaks reported in China (n = 3, median = 4.37 were significantly (p < 0.05 lower than worldwide (n = 14, median = 41.34. The low TARs are likely due to the high number of the affected population. Conclusions We found that school closure alone could not contain Norovirus outbreaks. Overlooked personal hygiene may serve as a hotbed for infectious disease transmission. Our results reveal that evidence-based investigations can facilitate timely interventions of Norovirus transmission.
Besag, Frank; Ettinger, Alan B.; Mula, Marco; Gobbi, Gabriella; Comai, Stefano; Aldenkamp, Albert P.; Steinhoff, Bernhard J.
Antiepileptic drugs (AEDs) have many benefits but also many side effects, including aggression, agitation, and irritability, in some patients with epilepsy. This article offers a comprehensive summary of current understanding of aggressive behaviors in patients with epilepsy, including an evidence-based review of aggression during AED treatment. Aggression is seen in a minority of people with epilepsy. It is rarely seizure related but is interictal, sometimes occurring as part of complex psychiatric and behavioral comorbidities, and it is sometimes associated with AED treatment. We review the common neurotransmitter systems and brain regions implicated in both epilepsy and aggression, including the GABA, glutamate, serotonin, dopamine, and noradrenaline systems and the hippocampus, amygdala, prefrontal cortex, anterior cingulate cortex, and temporal lobes. Few controlled clinical studies have used behavioral measures to specifically examine aggression with AEDs, and most evidence comes from adverse event reporting from clinical and observational studies. A systematic approach was used to identify relevant publications, and we present a comprehensive, evidence-based summary of available data surrounding aggression-related behaviors with each of the currently available AEDs in both adults and in children/adolescents with epilepsy. A psychiatric history and history of a propensity toward aggression/anger should routinely be sought from patients, family members, and carers; its presence does not preclude the use of any specific AEDs, but those most likely to be implicated in these behaviors should be used with caution in such cases. PMID:27255267
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.
Silveira, Dierci Marcio
In Human Factors and Ergonomics Science (HFES), it is difficult to identify what is the best approach to tackle the workplace and systems design problems which needs to be solved, and it has been also advocated as transdisciplinary and multidisciplinary the issue of "How to solve the human factors and ergonomics problems that are identified?". The proposition on this study is to combine the theoretical approach for Sustainability Science, the Taxonomy of the Human Factors and Ergonomics (HFE) discipline and the framework for Evidence-Based Medicine in an attempt to be applied in Human Factors and Ergonomics. Applications of ontologies are known in the field of medical research and computer science. By scrutinizing the key requirements for the HFES structuring of knowledge, it was designed a reference model, First, it was identified the important requirements for HFES Concept structuring, as regarded by Meister. Second, it was developed an evidence-based ergonomics framework as a reference model composed of six levels based on these requirements. Third, it was devised a mapping tool using linguistic resources to translate human work, systems environment and the complexities inherent to their hierarchical relationships to support future development at Level 2 of the reference model and for meeting the two major challenges for HFES, namely, identifying what problems should be addressed in HFE as an Autonomous Science itself and proposing solutions by integrating concepts and methods applied in HFES for those problems.
Full Text Available In the last twenty years the term “Evidence Based Medicine (EBM” has spread into all areas of medicine and is often used for decision-making in the medical and public health sector. It is also used to verify the significance and/or the effectiveness of different therapies. The definition of EBM is to use the physician’s individual expertise, the patient’s needs and the best external evidence for each individual patient. Today, however, the term EBM is often wrongly used as a synonym for best “external evidence”. This leads not only to a misuse of evidence based medicine but suggests a fundamental misunderstanding of the model which was created by Gordon Guyatt, David Sackett and Archibald Cochrane. This problem becomes even greater the more social insurance institutions, public healthcare providers and politicians use external evidence alone as a main guideline for financing therapies in physical medicine and general rehabilitation without taking into account the physician’s expertise and the patient’s needs.The wrong interpretation of EBM can lead to the following problems: well established clinical therapies are either questioned or not granted and are therefore withheld from patients (for example physical pain management. Absence of evidence for individual therapy methods does not prove their ineffectiveness! In this short statement the significance of EBM in physical medicine and general rehabilitation will be analysed and discussed.
Choe, Jae Gol [Korea University Hospital, Seoul (Korea, Republic of)
EBM is 'the conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient. It means integrating individual clinical expertise with the best available external clinical evidence from systematic research.' EBM is the integration of clinical expertise, patient values, and the best evidence into the decision making process for patient care. The practice of EBM is usually triggered by patient encounters which generate questions about the effects of therapy, the utility of diagnostic tests, the prognosis of diseases, or the etiology of disorders. The best evidence is usually found in clinically relevant research that has been conducted using sound methodology. Evidence-based medicine requires new skills of the clinician, including efficient literature-searching, and the application of formal rules of evidence in evaluating the clinical literature. Evidence-based medicine converts the abstract exercise of reading and appraising the literature into the pragmatic process of using the literature to benefit individual patients while simultaneously expanding the clinician's knowledge base. This review will briefly discuss about concepts of evidence medicine and method of critical appraisal of literatures.
Liu, Weiming; Ni, Ming; Jia, Wang; Wan, Weiqing; Tang, Jie
Although evidence-based medicine (EBM) has been progressively developing for decades in neurosurgery, there remains a lack of data to fully understand this topic. This study was aimed to evaluate extensively EBM related to neurosurgery through the analysis of neurosurgical EBM publications. We searched the Web of Science (WoS) Core Collection database for all EBM publications related to neurosurgery. The number of publications and other information were obtained. Data were extracted from the search results to obtain the following information: document type, countries/territories, funding agencies, organizations, publication year, source of titles, and research area. From among all of the publications, we extracted randomized controlled trials (RCTs) for further analysis at RCT characteristic and funding agencies. According to the search strategy, 6907 publications were related to EBM in neurosurgery. A total of 91 countries/territories participated in neurosurgical EBM publications. English-speaking countries (USA, England, and Canada) contributed most of the publications. "University of Toronto" is the organization which published the most EBM publications. In total, 1654 neurosurgical RCTs were found. We summarize their characteristics and record the highest cited (more than 400) RCTs, which we descript the distribution in different neurosurgical fields and stages. We also found that more than half of the RCTs were directly funded by industrial companies, and government-funded agencies accounted for no more than one fifth of the RCTs. EBM in neurosurgery has a good foundation but also needs to be constantly revised and improved to synchronize with evidence-based medicine development.
Kamel Remah M
Full Text Available Abstract Background Infertility is defined as inability of a couple to conceive naturally after one year of regular unprotected sexual intercourse. It remains a major clinical and social problem, affecting perhaps one couple in six. Evaluation usually starts after 12 months; however it may be indicated earlier. The most common causes of infertility are: male factor such as sperm abnormalities, female factor such as ovulation dysfunction and tubal pathology, combined male and female factors and unexplained infertility. Objectives The aim of this study is to provide the healthcare professionals an evidence-based management protocol for infertile couples away from medical information overload. Methods A comprehensive review where the literature was searched for "Management of infertility and/or infertile couples" at library website of University of Bristol (MetaLib by using a cross-search of different medical databases besides the relevant printed medical journals and periodicals. Guidelines and recommendations were retrieved from the best evidence reviews such as that from the American College of Obstetricians and Gynaecologists (ACOG, American Society for Reproductive Medicine (ASRM, Canadian Fertility and Andrology Society (CFAS, and Royal College of Obstetricians and Gynaecologists (RCOG. Results A simple guide for the clinicians to manage the infertile couples. Conclusions The study deploys a new strategy to translate the research findings and evidence-base recommendations into a simplified focused guide to be applied on routine daily practice. It is an approach to disseminate the recommended medical care for infertile couple to the practicing clinicians.
Full Text Available Rapid eye movement (REM sleep behavior disorder (RBD is characterized by dream enactment behavior resulting from a loss of REM skeletal muscle atonia. The neurobiology of REM sleep and the characteristic features of REM atonia have an important basis for understanding the aggravating etiologies the proposed pharmacological interventions in its management. This review outlines the evidence for behavioral and therapeutic measures along with evidence-based guidelines for their implementation, impact on falls, and effect on polysomnography (PSG while highlighting the non-motor, autonomic, and cognitive impact of this entity. PubMed databases were reviewed upto May 2013 in peer-reviewed scientific literature regarding the pathophysiology and management of RBD in adults. The literature was graded according to the Oxford centre of evidence-based Medicine Levels. An early intervention that helps prevent consequences such as falls and provides a base for intervention with neuroprotective mechanisms and allocates a unique platform that RBD portrays with its high risk of disease conversion with a sufficiently long latency. RBD provides a unique platform with its high risk of disease conversion with a sufficiently long latency, providing an opportunity for early intervention both to prevent consequences such as falls and provide a base for intervention with neuroprotective mechanisms.
Mezza, E; Piccoli, G B; Pacitti, A; Soragna, G; Bermond, F; Burdese, M; Gai, M; Motta, D; Jeantet, A; Merletti, F; Vineis, P; Segoloni, G P
Informed consent is crucial in therapeutic choices; however, the forms presented to patients are often locally developed and information may not be homogeneous. To prepare an evidence-based model for informed consent, applied in the case of erythropoietin therapy (EPO) as a teaching tool for medical students. Methodological tools of Evidence-Based Medicine (EBM) were developed within the EBM Course in the Medical School of Torino, Italy, as problem solving and patient information tools (5th year students work in small groups under the supervision of statisticians, epidemiologists and experts of internal medicine--nephrology in this case). Methodological and ethical problems were identified: in the pre-dialysis field, evidence from randomized clinical trials (RCT) is scant; how to use evidence gathered in dialysis? How to deal with implementation? How with the mass media? Do we need to discuss the drug choice with the patients? How to deal with rare and severe side effects?). The "evidence" was searched for on Medline/Embase, by using key-words and free terms. About 680 papers were retrieved and screened. Forms available on the Internet were retrieved and a general scheme was drawn: it included 5 areas: title, aim and targets (patients and family physicians); search strategies and updating; pros and cons of therapy; alternative options; open questions. EBM may offer valuable tools for systematically approaching patient information; the inclusion of this kind of exercise in the Medical School EBM courses may help enhance the awareness of future physicians of the correct communication with patients.
Masley, Samantha A; Gillanders, David T; Simpson, Susan G; Taylor, Morag A
Schema Therapy is becoming an increasingly popular psychological model for working with individuals who have a variety of mental health and personality difficulties. The aim of this review is to look at the current evidence base for Schema Therapy and highlight directions for further research. A systematic search of the literature was conducted up until January 2011. All studies that had clinically tested the efficacy of Schema Therapy as described by Jeffrey Young (1994 and 2003) were considered. These studies underwent detailed quality assessments based on Scottish Intercollegiate Guidelines Network (SIGN-50) culminating in 12 studies being included in the review. The culminative message (both from the popularity of this model and the medium-to-large effect sizes) is of a theory that has already demonstrated clinically effective outcomes in a small number of studies and that would benefit from ongoing research and development with complex client groups. It is imperative that psychological practice be guided by high-quality research that demonstrates efficacious, evidence-based interventions. It is therefore recommended that researchers and clinicians working with Schema Therapy seek to build on these positive outcomes and further demonstrate the clinical effectiveness of this model through ongoing research.
Zwickey, Heather; Schiffke, Heather; Fleishman, Susan; Haas, Mitch; Cruser, des Anges; LeFebvre, Ron; Sullivan, Barbara; Taylor, Barry; Gaster, Barak
As evidence-based medicine (EBM) becomes a standard in health care, it is essential that practitioners of complementary and alternative medicine (CAM) become experts in searching and evaluating the research literature. In support of this goal, the National Institutes of Health (NIH) National Center for Complementary and Alternative Medicine (NCCAM) provided R25 funding to nine CAM colleges to develop individual programs focused on teaching EBM. An overarching goal of these research education grants has been to provide CAM faculty and students with the skills they need to apply a rigorous evidence-based perspective to their training and practice. This paper reviews the competencies and teaching strategies developed and implemented to enhance research literacy at all nine R25-funded institutions. While each institution designed approaches suitable for its research culture, the guiding principles were similar: to develop evidence-informed skills and knowledge, thereby helping students and faculty to critically appraise evidence and then use that evidence to guide their clinical practice. Curriculum development and assessment included faculty-driven learning activities and longitudinal curricular initiatives to encourage skill reinforcement and evaluate progress. As the field of integrative medicine matures, the NIH-NCCAM research education grants provide essential training for future clinicians and clinician-researchers. Building this workforce will facilitate multidisciplinary collaborations that address the unique needs for research that informs integrative clinical practice.
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.
Hinton, Robert J.; Dechow, Paul C.; Abdellatif, Hoda; Jones, Daniel L.; McCann, Ann L.; Schneiderman, Emet D.; D’Souza, Rena
In the early years of the new millennium, the National Institute of Dental and Craniofacial Research of the National Institutes of Health began funding Oral Health Research Education Grants using the R25 mechanism to promote the application of basic and clinical research findings to clinical training and to encourage students to pursue careers in oral health research. This report describes the impact of an R25 grant awarded to the Texas A&M Health Science Center’s Baylor College of Dentistry (BCD) on its curriculum and faculty development efforts. At BCD, the R25 grant supports a multipronged initiative that employs clinical research as a vehicle for acquainting both students and faculty with the tools of evidence-based dentistry (EBD). New coursework and experiences in all four years of the curriculum plus a variety of faculty development offerings are being used to achieve this goal. Progress on these fronts is reflected in a nascent EBD culture characterized by increasing participation and buy-in by students and faculty. The production of a new generation of dental graduates equipped with the EBD skill set as well as a growing nucleus of faculty members who can model the importance of evidence-based practice is of paramount importance for the future of dentistry. PMID:21368252
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.
Liddle, Howard A
This article summarizes the 30+-year evidence base of Multidimensional Family Therapy (MDFT), a comprehensive treatment for youth substance abuse and antisocial behaviors. Findings from four types of MDFT studies are discussed: hybrid efficacy/effectiveness randomized controlled trials, therapy process studies, cost analyses, and implementation trials. This research has evaluated various versions of MDFT. These studies have systematically tested adaptations of MDFT for diverse treatment settings in different care sectors (mental health, substance abuse, juvenile justice, and child welfare), as well as adaptations according to treatment delivery features and client impairment level, including adolescents presenting with multiple psychiatric diagnoses. Many published scientific reviews, including meta-analyses, national and international government publications, and evidence-based treatment registries, offer consistent conclusions about the clinical effectiveness of MDFT compared with standard services as well as active treatments. The diverse and continuing MDFT research, the favorable, multi-source independent evaluations, combined with the documented receptivity of youth, parents, community-based clinicians and administrators, and national and international MDFT training programs (U.S.-based organization is MDFT International, www.mdft.org; and Europe-based organization is www.mdft.nl) all support the potential for continued transfer of MDFT to real-world clinical settings. © 2016 Family Process Institute.
Kreiner, D Scott; Baisden, Jamie; Mazanec, Daniel J; Patel, Rakesh D; Bess, Robert S; Burton, Douglas; Chutkan, Norman B; Cohen, Bernard A; Crawford, Charles H; Ghiselli, Gary; Hanna, Amgad S; Hwang, Steven W; Kilincer, Cumhur; Myers, Mark E; Park, Paul; Rosolowski, Karie A; Sharma, Anil K; Taleghani, Christopher K; Trammell, Terry R; Vo, Andrew N; Williams, Keith D
The North American Spine Society's (NASS) Evidence-Based Clinical Guideline for the Diagnosis and Treatment of Adult Isthmic Spondylolisthesis features evidence-based recommendations for diagnosing and treating adult patients with isthmic spondylolisthesis. The guideline is intended to reflect contemporary treatment concepts for symptomatic isthmic spondylolisthesis as reflected in the highest quality clinical literature available on this subject as of June 2013. NASS' guideline on this topic is the only guideline on adult isthmic spondylolisthesis accepted in the Agency for Healthcare Research and Quality's National Guideline Clearinghouse. The purpose of the guideline is to provide an evidence-based educational tool to assist spine specialists when making clinical decisions for adult patients with isthmic spondylolisthesis. This article provides a brief summary of the evidence-based guideline recommendations for diagnosing and treating patients with this condition. This is a guideline summary review. This guideline is the product of the Adult Isthmic Spondylolisthesis Work Group of NASS' Evidence-Based Clinical Guideline Development Committee. The methods used to develop this guideline are detailed in the complete guideline and technical report available on the NASS website. In brief, a multidisciplinary work group of spine care specialists convened to identify clinical questionsto address in the guideline. The literature search strategy was developed in consultation with medical librarians. Upon completion of the systematic literature search, evidence relevant to the clinical questions posed in the guideline was reviewed. Work group members utilized NASS evidentiary table templates to summarize study conclusions, identify study strengths and weaknesses, and assign levels of evidence. Work group members participated in webcasts and in-person recommendation meetings to update and formulate evidence-based recommendations and incorporate expert opinion when
'Evidence-based policy' has become the catch-cry of the drug policy field. A growing literature has been dedicated to better realising the goal of evidence-based drug policy: to maximise the use of the best quality research to inform policy decision-making and help answer the question of 'what works'. Alternative accounts in the policy processes literature conceptualise policy activity as an ambiguous and contested process, and the role of evidence as being only marginally influential. Multiple participants jostle for influence and seek to define what may be regarded as a policy problem, how it may be appropriately addressed, which participants may speak authoritatively, and what knowledge(s) may be brought to bear. The question posited in this article is whether the conceptual shift offered by thinking about policy activity as a process of social construction may be valuable for beginning to explore different perspectives of the evidence-based drug policy endeavour. Within a constructionist account of policy, what counts as valid 'evidence' will always be a constructed notion within a dynamic system, based on the privileging and silencing of participants and discourse, and the contestation of those many positions and perspectives. The social construction account shifts our focus from the inherent value of 'evidence' for addressing 'problems' to the ways in which policy knowledge is made valid, by whom and in what contexts. As such, social construction provides a framework for critically analysing the ways in which 'policy-relevant knowledge' may not be a stable concept but rather one which is constructed through the policy process, and, through a process of validation, is rendered useful. We have limited knowledge in the drug policy field about how this happens; how ambiguity about the problems to be addressed, which voices should be heard, and what activities may be appropriate is contested and managed. By unpicking the values and assumptions which underlie drug
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.
In recent years, there have been calls within the United Kingdom's National Health Service (NHS) for evidence-based health care. These resonate with long-standing calls for nursing to become a research-based profession. Evidence-based practice could enable nurses to demonstrate their unique contribution to health care outcomes, and support their seeking greater professionalization, in terms of enhanced authority and autonomy. Nursing's professionalization project, and, within this, various practices comprising the 'new nursing', whilst sometimes not delivering all that was hoped of them, have been important in developing certain conditions conducive to developing evidence-based practice, notably a critical perspective on practice and a reluctance merely to follow physicians' orders. However, nursing has often been hesitant in its adoption of quantitative and experimental research. This hesitancy, it is argued, has been influenced by the propounding by some authors within the new nursing of a stereotyped view of quantitative/experimental methods which equates them with a number of methodological and philosophical points which are deemed, by at least some of these authors, as inimical to, or problematic within, nursing research. It is argued that, not only is the logic on which the various stereotyped views are based flawed, but further, that the wider influence of these viewpoints on nurses could lead to a greater marginalization of nurses in research and evidence-based practice initiatives, thus perhaps leading to evidence-based nursing being led by other groups. In the longer term, this might result in a form of evidence-based nursing emphasizing routinization, thus--ironically--working against strategies of professional authority and autonomy embedded in the new nursing. Nursing research should instead follow the example of nurse researchers who already embrace multiple methods. While the paper describes United Kingdom experiences and debates, points raised about
Full Text Available Background: familial hypercholesterolemia (FH and familial hyperlipidemia combined (HFC are metabolic disorders of lipids associated with increase of the risk for cerebrovascular disease. Clinical case: 8-years-old Indigenous child with HFC presented right hemiparesis, motor aphasia and right central facial paralysis for a cerebral ischemic accident; in addition, he had altered lipid profile and family history of hypercholesterolemia. Methodology: this article used patient`s therapeutic approach using evidence-based medicine (EBM, started from a structured clinical question and PubMED search. Four systematic reviews were included. Discussion: statins are safe in children with HF and HFC are effective in improving lipid profile. EBM methodology could help to solve similar therapeutic problems.
Wright, Barry; Edginton, Elizabeth
Various interventions are used in clinical practice to address insecure or disorganized attachment patterns and attachment disorders. The most common of these are parenting interventions, but not all have a robust empirical evidence base. We undertook a systematic review of randomized trials comparing a parenting intervention with a control, where these used a validated attachment instrument, in order to evaluate the clinical and cost-effectiveness of interventions aiming to improve attachment in children with severe attachment problems (mean age parenting interventions included in our systematic review that were clinically effective in promoting secure attachment. For completeness, we also briefly discuss other interventions without randomized controlled trial evidence, identified in Patient Public Involvement workshops and expert groups at the point our review was completed as being used or recommended. We outline the key implications of our findings for clinical practice and future research. PMID:27583298
Rucker, Sydney Y; Ozdogan, Zulfukar; Al Achkar, Morhaf
Journal club (JC), as a pedagogical strategy, has long been used in graduate medical education (GME). As evidence-based medicine (EBM) becomes a mainstay in GME, traditional models of JC present a number of insufficiencies and call for novel models of instruction. A flipped classroom model appears to be an ideal strategy to meet the demands to connect evidence to practice while creating engaged, culturally competent, and technologically literate physicians. In this article, we describe a novel model of flipped classroom in JC. We present the flow of learning activities during the online and face-to-face instruction, and then we highlight specific considerations for implementing a flipped classroom model. We show that implementing a flipped classroom model to teach EBM in a residency program not only is possible but also may constitute improved learning opportunity for residents. Follow-up work is needed to evaluate the effectiveness of this model on both learning and clinical practice.
Eaton, Kevin P; Levy, Kathryn; Soong, Christine; Pahwa, Amit K; Petrilli, Christopher; Ziemba, Justin B; Cho, Hyung J; Alban, Rodrigo; Blanck, Jaime F; Parsons, Andrew S
Routine daily laboratory testing of hospitalized patients reflects a wasteful clinical practice that threatens the value of health care. Choosing Wisely initiatives from numerous professional societies have identified repetitive laboratory testing in the face of clinical stability as low value care. Although laboratory expenditure often represents less than 5% of most hospital budgets, the impact is far-reaching given that laboratory tests influence nearly 60% to 70% of all medical decisions. Excessive phlebotomy can lead to hospital-acquired anemia, increased costs, and unnecessary downstream testing and procedures. Efforts to reduce the frequency of laboratory orders can improve patient satisfaction and reduce cost without negatively affecting patient outcomes. To date, numerous interventions have been deployed across multiple institutions without a standardized approach. Health care professionals and administrative leaders should carefully strategize and optimize efforts to reduce daily laboratory testing. This review presents an evidence-based implementation blueprint to guide teams aimed at improving appropriate routine laboratory testing among hospitalized patients.
Djulbegovic, Benjamin; Guyatt, Gordon H
In response to limitations in the understanding and use of published evidence, evidence-based medicine (EBM) began as a movement in the early 1990s. EBM's initial focus was on educating clinicians in the understanding and use of published literature to optimise clinical care, including the science of systematic reviews. EBM progressed to recognise limitations of evidence alone, and has increasingly stressed the need to combine critical appraisal of the evidence with patient's values and preferences through shared decision making. In another progress, EBM incorporated and further developed the science of producing trustworthy clinical practice guidelines pioneered by investigators in the 1980s. EBM's enduring contributions to clinical medicine include placing the practice of medicine on a solid scientific basis, the development of more sophisticated hierarchies of evidence, the recognition of the crucial role of patient values and preferences in clinical decision making, and the development of the methodology for generating trustworthy recommendations. Copyright © 2017 Elsevier Ltd. All rights reserved.
The contrast between the efficiency of Evidence-Based Medicine (EBM), a scientific fact, and the popularity of Complementary and Alternative Medicines (CAM) is a paradox of the art of healing. EBM is based on the paradigm of positivism and materialism while CAM are based on those of relativism and vitalism. These paradigms are diametrically opposed and the aim of an integrative medicine is aporetic. However, EBM is today in a dead end. The objective proof of a disease according to the rules of EBM is often lacking face to the expectations of patients demanding their illness to be taken into account. EBM and CAM have thus to coexist. Lessons can be drawn from CAM : patient expectations should be given a meaning and be integrated in his or her psychosocial context.
Sisk, Angela; Fonteyn, Marsha
Introducing patients with cancer to the practice of yoga can be beneficial for coping with the side effects of treatment and the psychological aspects of cancer that are often difficult and distressing for patients. Oncology nurses can learn to use simple yoga techniques for themselves and as interventions with their patients. This article provides details about the development and implementation of a yoga class for patients with cancer and provides details about other ways nurses can integrate yoga into oncology nursing and cancer care. Current research literature was reviewed and synthesized to provide support for the use of yoga as an evidence-based nursing intervention. A detailed approach for implementing yoga into professional practice was delineated. Yoga techniques can be easily integrated into nursing practice and have been shown to be beneficial for patients and nurses.
Schroeder, T V
Evidence-based medicine (EBM) is not a randomised controlled trial (RCT), but EBM seeks to apply evidence gained from scientific methods - which could be RCT - to daily medical practice. Any surgical treatment reflects a certain development technically as well as skills based. The procedure may....... On the other hand, if started too late there is a chance that data may be lost because the technology has already been introduced into the daily clinics and physicians may be unwilling to recruit patients. Or the opposite, that the technique may have been rejected without a proper trial. In this situation...... it has been suggested to perform a so called tracker trial. In such trials protocols are more flexible without prefixed sample size and will require repeated interim analyses. Often, it will be relevant to supplement the clinical trials with data from large clinical databases - in particular when long...
Achenbach, Thomas M
This article presents multicultural ways to advance knowledge of children's problems, to fashion conceptual and practical mental health tools, and to use these tools to help children. Diagnostically based scales and statistically derived syndromes are scored from parallel forms completed by population samples of parents, caregivers, teachers, and youths in many societies. The scores are incorporated into multicultural norms for evaluating individual children, as rated by different respondents in relation to relevant norms, such as norms for host societies where immigrant children reside and norms for their families' home societies. Syndrome structures have been supported in 44 societies. Certain age, gender, and SES effects are consistent across many societies. As reported in over 7000 publications from 85 societies and cultural groups, evidence-based assessment provides a common data language for clinicians, trainees, and researchers around the world.
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.
Furberg Curt D
Full Text Available Abstract Contradictory statements about the non-steroidal anti-inflammatory drugs from the European Medicines Agency and the United States Food and Drug Administration have raised questions about whether regulatory decisions are evidence-based. For the selective COX-2 inhibitors, there are clear contraindications and warnings in Europe, but only a vaguely worded Black Box warning in the United States. All the non-selective agents are given an almost "clean bill of health" in Europe, while all of them are judged to have a similar risk-benefit ratio as celecoxib in the United States. The regulatory agencies have failed to recognize the clinical trial evidence that the risk of cardiovascular events varies substantially among the non-selective agents, with diclofenac carrying the highest risk of harm.
Horwitz, Ralph I; Hayes-Conroy, Allison; Caricchio, Roberto; Singer, Burton H
Evidence based medicine, using randomized controlled trials and meta-analyses as the major tools and sources of evidence about average results for heterogeneous groups of patients, developed as a reaction against poorly designed observational treatment research and physician reliance on personal experience with other patients as a guide to decision-making about a patient at hand. However, these tools do not answer the clinician's question: "Will a given therapeutic regimen help my patient at a given point in her/his clinical course?" We introduce fine-grained profiling of the patient at hand, accompanied by comparative evidence of responses from approximate matches to this patient on whom a contemplated treatment has/has not been administered. This represents medicine based evidence that is tuned to decision-making for the particular patient. Copyright © 2017 Elsevier Inc. All rights reserved.
Barry Wright MD, FRCPsych
Full Text Available Various interventions are used in clinical practice to address insecure or disorganized attachment patterns and attachment disorders. The most common of these are parenting interventions, but not all have a robust empirical evidence base. We undertook a systematic review of randomized trials comparing a parenting intervention with a control, where these used a validated attachment instrument, in order to evaluate the clinical and cost-effectiveness of interventions aiming to improve attachment in children with severe attachment problems (mean age <13 years. This article aims to inform clinicians about the parenting interventions included in our systematic review that were clinically effective in promoting secure attachment. For completeness, we also briefly discuss other interventions without randomized controlled trial evidence, identified in Patient Public Involvement workshops and expert groups at the point our review was completed as being used or recommended. We outline the key implications of our findings for clinical practice and future research.
Full Text Available Squamous cell carcinoma of head and neck (SCCHN is one of the commonest cancers seen in India, constituting up to 25% of their overall cancer burden. Advanced SCCHN is a bad disease with a poor prognosis and patients usually die of uncontrolled loco-regional disease. Curative intent management of loco-regionally advanced SCCHN has become more evidence-based with active clinical research in the form of large prospective randomized controlled trials and meta-analyses. However, little has been written about palliative radiotherapy (PRT in head and neck cancers. It is widely recognized that PRT provides effective palliation and improved quality-of-life in advanced incurable malignancies. It is in this context that this study proposes to review the existing literature on palliative radiotherapy in advanced incurable SCCHN to help formulate consensus guidelines and recommendations.
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.
Byrne, Michelle; Schroeter, Kathryn; Carter, Shannon; Mower, Julie
Competency assessment is critical for a myriad of disciplines, including medicine, law, education, and nursing. Many nurse managers and educators are responsible for nursing competency assessment, and assessment results are often used for annual reviews, promotions, and satisfying accrediting agencies' requirements. Credentialing bodies continually seek methods to measure and document the continuing competence of licensees or certificants. Many methods and frameworks for continued competency assessment exist. The portfolio process is one method to validate personal and professional accomplishments in an interactive, multidimensional manner. This article illustrates how portfolios can be used to assess competence. One specialty nursing certification board's process of creating an evidence-based portfolio for recertification or reactivation of a credential is used as an example. The theoretical background, development process, implementation, and future implications may serve as a template for other organizations in developing their own portfolio models. Copyright 2009, SLACK Incorporated.
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.
Full Text Available Cancer Research UK has developed PROforma, a formal language for modelling clinical processes, along with associated tools for creating decision support, care planning, clinical workflow management and other applications. The PROforma method has been evaluated in a variety of settings: in primary health care (prescribing, referral of suspected cancer patients, genetic risk assessment and in specialist care of patients with breast cancer, leukaemia, HIV infection and other conditions. About nine years of experience have been gained with PROforma technologies. Seven trials of decision support applications have been published or are in preparation. Each of these has shown significant positive effects on a variety of measures of quality and/or outcomes of care. This paper reviews the evidence base for the clinical effectiveness of these PROforma applications, and previews the CREDO project _a multi-centre trial of a complex PROforma application for supporting integrated breast cancer care across primary and secondary care settings.
J. O. Macaulay
Full Text Available Introduction and objectivesIt is has been widely accepted that assessment of learning is a critical component of education and that assessment drives/guides student learning through shaping study habits and student approaches to learning. However, although most academics would agree that assessment is a critical aspect of their roles as teachers it is often an aspect of teaching that is regarded more as an additional task rather than an integral component of the teaching/learning continuum. An additional impediment to high quality assessment is the non-evidence based-approach to the decision making process. The overall aim of this project was to improve the quality of assessment in Biochemistry and Molecular Biology undergraduate education by promoting high quality assessment.Materials and methodsTo do this we developed and trialled an audit tool for mapping assessment practices. The audit tool was designed to gather data on current assessment practices and identify areas of good practice in which assessment aligned with the learning objectives and areas in need of improvement. This evidence base will then be used to drive change in assessment.Results and conclusionsUsing the assessment mapping tool we have mapped the assessment regime in a Biochemistry and Molecular Biology major at Monash University. Criteria used included: assessment type, format, timing, assessors, provision of feedback, level of learning (Bloom’s, approaches taken to planning assessment. We have mapped assessment of content and the systematic development of higher order learning and skills progression throughout the program of study. The data has enabled us to examine the assessment at unit (course level as well as the vertical development across the major. This information is now being used to inform a review of the units and the major.
Hasan, Kamrul; Shankar, Shivakumar; Sharma, Aadhar; Carter, Alison; Zaidi, Razi; Cro, Suzie; Skinner, John; Goldberg, Andy
The burden of traumatic and elective hip surgery is set to grow. With an increasing number of techniques and implants against the background of an aging population, the emphasis on evidence-based treatment has never been greater. The purpose of this study was to assess changes in the levels of evidence in the hip literature over a decade. Articles pertaining to hip surgery from the years 2000 and 2010 in Hip International, Journal of Arthroplasty, Journal of Bone and Joint Surgery and The Bone and Joint Journal were analysed. Articles were ranked by a five-point level of evidence scale and by type of study, according to guidelines from the Centre for Evidence-based Medicine. 531 articles were analysed from 48 countries. The kappa value for the inter-observer reliability showed excellent agreement between the reviewers for study type (κ = 0.956, P < 0.01) and for levels of evidence (κ = 0.772, P < 0.01). Between 2000 and 2010, the overall percentage of high-level evidence (levels I and II) studies more than doubled (12 to 31 %, P < 0.001). The most frequent study type was therapeutic; the USA and UK were the largest producers of published work in these journals, with contributions from other countries increasing markedly over the decade. There has been a significant increase in high levels of evidence in hip surgery over a decade (P < 0.001). We recommend that all orthopaedic journals consider implementing compulsory declaration by authors of the level of evidence to help enhance quality of evidence. Level 2: economic and decision analysis.
Full Text Available Objective To evaluate the therapeutic efficacy and side effects of various treatment for sleep disorders in order to provide the best therapeutic regimen for the evidence-based treatment of sleep disorders. Methods Sleep disorder, insomnia, restless legs syndrome or RLS, obstructive sleep apnea or OSA, narcolepsy, REM behaviour disorder or RBD, treatment or therapy were used as retrieval words. Cochrane Library, MEDLINE, ScienceDirect were used for retrieval, and manual searching was also used. Related clinical guidelines, systematic reviews, randomized controlled clinical trials, retrospective case analysis, case-observation studies and reviews were collected and evaluated by Jadad Scale. Results Forty related articles were selected as following: 6 clinical guidelines, 12 systematic reviews, 5 randomized controlled trials, 2 retrospective case analysis, 1 case-observation study and 14 reviews. Thirty-three were of high quality, while 7 were of low quality with score. According to the evaluation of therapeutic efficacy and side effects of various therapies, it is suggested as following: 1 insomnia is the most common in sleep disorders; the treatment methods of insomnia mainly include drug therapy and cognitive behavioral treatment (CBT; the two kinds of therapy have their own advantages and disadvantages, and the combination therapy of drugs and CBT is the best treatment plan. 2 The first-line treatment of primary RLS is dopamine agonists and anti-seizure drugs; however, the treatment of secondary RLS is mainly etiologic treatment. 3 The main treatments of OSAS are nasal continuous positive airway pressure (nCPAP, oral orthotics and surgery, and nCPAP is the first-line treatments. 4 The medication of narcolepsy is mainly modafinil, hydroxy butyric acid sodium and antidepressants, and the specific choosingshould accord to clinical classifications. 5 The main treatments of RBD include general treatments such as avoiding triggers, insuring the
E. Carlos Rodriguez-Merchan
Full Text Available Background: Patellofemoral pain syndrome (PFPS is defined as pain surrounding the patella when sitting with bent knees for prolonged periods of time or when performing activities like ascending or descending stairs, squatting or athletic activities. Patella dislocation is not included in PFPS. Purpose: This review analyzes the evidence based conservative management of PFPS. Methods: A Cochrane Library search related to PFPS was performed until 18 January 2014. The key words were: patellofemoral pain syndrome. Eight papers were found, of which three were reviewed because they were focused on the topic of the article. We also searched the PubMed using the following keywords: evidence based conservative management of patellofemoral pain syndrome. Twelve articles were found, of which seven were reviewed because they were focused on the topic of the article. Overall ten articles were analyzed. Results: Different treatments can be tried for PFPS, including pharmacotherapy, therapeutic ultrasound, exercise therapy, and taping and braces. Conclusions: Non-steroidal anti-inflammatory drugs (NSAIDs may reduce pain in the short term, but pain does not improve after three months. Therapeutic ultrasound appears not to have a clinically important effect on pain relief for patients with PFPS. The evidence that exercise therapy is more effective in treating PFPS than no exercise is limited with respect to pain reduction, and conflicting with respect to functional improvement. No significant difference has been found between taping and non-taping. The role of knee braces is still controversial. More well-designed studies are needed.
Full Text Available Abstract Background Venous Thromboembolism (VTE is a cause of hospital mortality and managing its morbidity is associated with significant expenditure. Uptake of evidenced based guideline recommendations intended to prevent VTE in hospital settings is sub-optimal. This study was conducted to explore clinicians' attitudes and the clinical environment in which they work to understand their reluctance to adopt VTE prophylaxis guidelines. Methods Between February and November 2009, 40 hospital employed doctors from 2 Australian metropolitan hospitals were interviewed in depth. Qualitative data were analysed according to thematic methodology. Results Analysis of interviews revealed that barriers to evidence based practice include i the fragmented system of care delivery where multiple members of teams and multiple teams are responsible for each patient's care, and in the case of VTE, where everyone shares responsibility and no-one in particular is responsible; ii the culture of practice where team practice is tailored to that of the team head, and where medicine is considered an 'art' in which guidelines should be adapted to each patient rather than applied universally. Interviewees recommend clear allocation of responsibility and reminders to counteract VTE risk assessment being overlooked. Conclusions Senior clinicians are the key enablers for practice change. They will need to be convinced that guideline compliance adds value to their patient care. Then with the support of systems in the organisation designed to minimize the effects of care fragmentation, they will drive practice changes in their teams. We believe that evidence based practice is only possible with a coordinated program that addresses individual, cultural and organisational constraints.
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
Nelson, Michael; Breda, João
Following an international workshop on developing the evidence base for policy relating to school food held in London, UK, in January 2012, the objectives of the present paper were (i) to outline a rationale for school food research, monitoring and evaluation in relation to policy and (ii) to identify ways forward for future working. The authors analysed presentations, summaries of evidence, and notes from discussions held at the international workshop in London in 2012 to distil common themes and make recommendations for the development of coherent research programmes relating to food and nutrition in schools. International, with an emphasis on middle- and high-income countries. Overviews of existing school food and nutrition programmes from the UK, Hungary, Sweden, the USA, Australia, Brazil, China, Mexico and other countries were presented, along with information on monitoring, evaluation and other research to demonstrate the impact of school feeding on health, attainment, food sourcing, procurement and finances, in the context of interactions between the evidence base and policy decisions. This provided the material which, together with summaries and notes of discussions, was used to develop recommendations for the development and dissemination of robust approaches to sustainable and effective school food and nutrition programmes in middle- and high-income countries, including policy guidelines, standards, cost-effectiveness measures and the terms of political engagement. School food and nutrition can provide a cohesive core for health, education and agricultural improvement provided: (i) policy is appropriately framed and includes robust monitoring and evaluation; and (ii) all stakeholders are adequately engaged in the process. International exchange of information will be used to develop a comprehensive guide to the assessment of the impact of school food and nutrition policy and supporting infrastructure.
E. Carlos Rodriguez-Merchan
Full Text Available Background: Patellofemoral pain syndrome (PFPS is defined as pain surrounding the patella when sitting with bent knees for prolonged periods of time or when performing activities like ascending or descending stairs, squatting or athletic activities. Patella dislocation is not included in PFPS. Purpose: This review analyzes the evidence based conservative management of PFPS. Methods: A Cochrane Library search related to PFPS was performed until 18 January 2014. The key words were: patellofemoral pain syndrome. Eight papers were found, of which three were reviewed because they were focused on the topic of the article. We also searched the PubMed using the following keywords: evidence based conservative management of patellofemoral pain syndrome. Twelve articles were found, of which seven were reviewed because they were focused on the topic of the article. Overall ten articles were analyzed. Results: Different treatments can be tried for PFPS, including pharmacotherapy, therapeutic ultrasound, exercise therapy, and taping and braces. Conclusions: Non-steroidal anti-inflammatory drugs (NSAIDs may reduce pain in the short term, but pain does not improve after three months. Therapeutic ultrasound appears not to have a clinically important effect on pain relief for patients with PFPS. The evidence that exercise therapy is more effective in treating PFPS than no exercise is limited with respect to pain reduction, and conflicting with respect to functional improvement. No significant difference has been found between taping and non-taping. The role of knee braces is still controversial. More well-designed studies are needed.
Flynn, Simone; Hebert, Paul; Korenstein, Deborah; Ryan, Mark; Jordan, William B.
Importance New dissemination methods are needed to engage physicians in evidence-based continuing medical education (CME). Objective To examine the effectiveness of social media in engaging physicians in non-industry-sponsored CME. Design We tested the effect of different media platforms (e-mail, Facebook, paid Facebook and Twitter), CME topics, and different “hooks” (e.g., Q&A, clinical pearl and best evidence) on driving clicks to a landing site featuring non-industry sponsored CME. We modelled the effects of social media platform, CME topic, and hook using negative binomial regression on clicks to a single landing site. We used clicks to landing site adjusted for exposure and message number to calculate rate ratios. To understand how physicians interact with CME content on social media, we also conducted interviews with 10 physicians. Setting The National Physicians Alliance (NPA) membership. Participants NPA e-mail recipients, Facebook followers and friends, and Twitter followers. Main Outcomes and Measures Clicks to the NPA’s CME landing site. Results On average, 4,544 recipients received each message. Messages generated a total of 592 clicks to the landing site, for a rate of 5.4 clicks per 1000 recipients exposed. There were 5.4 clicks from e-mail, 11.9 clicks from Facebook, 5.5 clicks from paid Facebook, and 6.9 clicks from Twitter to the landing site for 1000 physicians exposed to each of 4 selected CME modules. A Facebook post generated 2.3x as many clicks to the landing site as did an e-mail after controlling for participant exposure, hook type and CME topic (psocial media might not be a preferred vehicle for disseminating CME. Conclusions Social media has a modest impact on driving traffic to evidence-based CME options. Facebook had a superior effect on driving physician web traffic to evidence-based CME compared to other social media platforms and email. PMID:28060854
P. Brian Savino
Full Text Available Introduction: In the United States, emergency medical services (EMS protocols vary widely across jurisdictions. We sought to develop evidence-based recommendations for the prehospital evaluation and treatment of chest pain of suspected cardiac origin and to compare these recommendations against the current protocols used by the 33 EMS agencies in the state of California. Methods: We performed a literature review of the current evidence in the prehospital treatment of chest pain and augmented this review with guidelines from various national and international societies to create our evidence-based recommendations. We then compared the chest pain protocols of each of the 33 EMS agencies for consistency with these recommendations. The specific protocol components that we analyzed were use of supplemental oxygen, aspirin, nitrates, opiates, 12-lead electrocardiogram (ECG, ST segment elevation myocardial infarction (STEMI regionalization systems, prehospital fibrinolysis and β-blockers. Results: The protocols varied widely in terms of medication and dosing choices, as well as listed contraindications to treatments. Every agency uses oxygen with 54% recommending titrated dosing. All agencies use aspirin (64% recommending 325mg, 24% recommending 162mg and 15% recommending either, as well as nitroglycerin and opiates (58% choosing morphine. Prehospital 12- Lead ECGs are used in 97% of agencies, and all but one agency has some form of regionalized care for their STEMI patients. No agency is currently employing prehospital fibrinolysis or β-blocker use. Conclusion: Protocols for chest pain of suspected cardiac origin vary widely across California. The evidence-based recommendations that we present for the prehospital diagnosis and treatment of this condition may be useful for EMS medical directors tasked with creating and revising these protocols.
Flynn, Simone; Hebert, Paul; Korenstein, Deborah; Ryan, Mark; Jordan, William B; Keyhani, Salomeh
New dissemination methods are needed to engage physicians in evidence-based continuing medical education (CME). To examine the effectiveness of social media in engaging physicians in non-industry-sponsored CME. We tested the effect of different media platforms (e-mail, Facebook, paid Facebook and Twitter), CME topics, and different "hooks" (e.g., Q&A, clinical pearl and best evidence) on driving clicks to a landing site featuring non-industry sponsored CME. We modelled the effects of social media platform, CME topic, and hook using negative binomial regression on clicks to a single landing site. We used clicks to landing site adjusted for exposure and message number to calculate rate ratios. To understand how physicians interact with CME content on social media, we also conducted interviews with 10 physicians. The National Physicians Alliance (NPA) membership. NPA e-mail recipients, Facebook followers and friends, and Twitter followers. Clicks to the NPA's CME landing site. On average, 4,544 recipients received each message. Messages generated a total of 592 clicks to the landing site, for a rate of 5.4 clicks per 1000 recipients exposed. There were 5.4 clicks from e-mail, 11.9 clicks from Facebook, 5.5 clicks from paid Facebook, and 6.9 clicks from Twitter to the landing site for 1000 physicians exposed to each of 4 selected CME modules. A Facebook post generated 2.3x as many clicks to the landing site as did an e-mail after controlling for participant exposure, hook type and CME topic (psocial media might not be a preferred vehicle for disseminating CME. Social media has a modest impact on driving traffic to evidence-based CME options. Facebook had a superior effect on driving physician web traffic to evidence-based CME compared to other social media platforms and email.
In human medicine, the information infrastructure that supports the knowledge translation processes of exchange, synthesis, dissemination, and application of the best clinical intervention research has developed significantly in the past 15 years, facilitating the uptake of research evidence by clinicians as well as the practice of evidence-based medicine. Seven of the key elements of this improved information infrastructure are clinical trial registries, research reporting standards, systematic reviews, organizations that support the production of systematic reviews, the indexing of clinical intervention research in MEDLINE, clinical search filters for MEDLINE, and point-of-care decision support information resources. The objective of this paper is to describe why these elements are important for evidence-based medicine, the key developments and issues related to these seven information infrastructure elements in human medicine, how these 7 elements compare with the corresponding infrastructure elements in veterinary medicine, and how all of these factors affect the translation of clinical intervention research into clinical practice. A focused search of the Ovid MEDLINE database was conducted for English language journal literature published between 2000 and 2010. Two bibliographies were consulted and selected national and international Web sites were searched using Google. The literature reviewed indicates that the information infrastructure supporting evidence-based veterinary medicine practice in all of the 7 elements reviewed is significantly underdeveloped in relation to the corresponding information infrastructure in human medicine. This lack of development creates barriers to the timely translation of veterinary medicine research into clinical practice and also to the conduct of both primary clinical intervention research and synthesis research.
-term immunosuppression. In Ontario, there are about 25,000 people living with HIV infection; more than 6,000 of these are women. About 28% of the newly diagnosed HIV infections are in women, a doubling since 1999. It has also been estimated that 1 of 3 people living with HIV do no know it. HEALTH TECHNOLOGY DESCRIPTION: Anal Pap test screening involves the blind insertion of a swab into the anal canal and fixing cells either on a slide or in fluid for cytological examination. Anal cytology classified by the standardized Bethesda System is the same classification used for cervical cytology. It has 4 categories: normal, atypical squamous cells of uncertain significance, or squamous intraepithelial lesions which are further classified into low- or high-grade lesions. Abnormal cytological findings are subjected to further evaluations by high-resolution anoscopy, a technique similar to cervical colposcopy, and biopsy. Several HPV deoxyribonucleic acid detection technologies such as the Hybrid 11 Capture and the polymerase chain reaction are available to detect and differentiate HPV viral strains. Unlike cervical cancer, there are no universally accepted guidelines or standards of care for anal dysplasia. Moreover, there are no formal screening programs provincially, nationally, or internationally. The New York State Department of Health AIDS Institute has recently recommended (March 2007) annual anal pap testing in high-risk groups. In Ontario, reimbursement exists only for Pap tests for cervical cancer screening. That is, there is no reimbursement for anal Pap testing in men or women, and HPV screening tests for cervical or anal cancer are also not reimbursed. The scientific evidence base was evaluated through a systematic literature review. Assessments of current practices were obtained through consultations with various agencies and individuals including the Ministry of Health and Long-Term Care AIDS Bureau; Public Health Infectious Diseases Branch, Ministry of Health and Long-Term Care
Malterud, Kirsti; Bjelland, Anne Karen; Elvbakken, Kari Tove
Evidence-based policy (EBP), a concept modelled on the principles of evidence-based medicine (EBM), is widely used in different areas of policymaking. Systematic reviews (SRs) with meta-analyses gradually became the methods of choice for synthesizing research evidence about interventions and judgements about quality of evidence and strength of recommendations. Critics have argued that the relation between research evidence and service policies is weak, and that the notion of EBP rests on a misunderstanding of policy processes. Having explored EBM standards and knowledge requirements for health policy decision-making, we present an empirical point of departure for discussing the relationship between EBM and EBP. In a case study exploring the Norwegian Knowledge Centre for the Health Services (NOKC), an independent government unit, we first searched for information about the background and development of the NOKC to establish a research context. We then identified, selected and organized official NOKC publications as an empirical sample of typical top-of-the-line knowledge delivery adhering to EBM standards. Finally, we explored conclusions in this type of publication, specifically addressing their potential as policy decision tools. From a total sample of 151 SRs published by the NOKC in the period 2004-2013, a purposive subsample from 2012 (14 publications) advised major caution about their conclusions because of the quality or relevance of the underlying documentation. Although the case study did not include a systematic investigation of uptake and policy consequences, SRs were found to be inappropriate as universal tools for health policy decision-making. The case study demonstrates that EBM is not necessarily suited to knowledge provision for every kind of policy decision-making. Our analysis raises the question of whether the evidence-based movement, represented here by an independent government organization, undertakes too broad a range of commissions using
Body, J.-J.; Bergmann, P.; Boonen, S.; Boutsen, Y.; Devogelaer, J.-P.; Goemaere, S.; Kaufman, J.-M.; Rozenberg, S.
Several drugs are available for the management of postmenopausal osteoporosis. This may, in daily practice, confuse the clinician. This manuscript offers an evidence-based update of previous treatment guidelines, with a critical assessment of the currently available efficacy data on all new chemical entities which were granted a marketing authorization. Osteoporosis is widely recognized as a major public health concern. The availability of new therapeutic agents makes clinical decision-making in osteoporosis more complex. Nation-specific guidelines are needed to take into consideration the specificities of each and every health care environment. The present manuscript is the result of a National Consensus, based on a systematic review and a critical appraisal of the currently available literature. It offers an evidence-based update of previous treatment guidelines, with the aim of providing clinicians with an unbiased assessment of osteoporosis treatment effect. PMID:20480148
Kaltoft, Mette Kjer; Dowie, Jack
’Evidence-based Health Care via Multi-Criteria Decision Analytic decision support: a Danish case study......’Evidence-based Health Care via Multi-Criteria Decision Analytic decision support: a Danish case study...
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.
Araujo de Carvalho, Islene; Byles, Julie; Aquah, Charles; Amofah, George; Biritwum, Richard; Panisset, Ulysses; Goodwin, James; Beard, John
Ghana's population is ageing. In 2011, the Government of Ghana requested technical support from the World Health Organization (WHO) to help revise national policies on ageing and health. We applied WHO's knowledge translation framework on ageing and health to assist evidence based policy-making in Ghana. First, we defined priority problems and health system responses by performing a country assessment of epidemiologic data, policy review, site visits and interviews of key informants. Second, we gathered evidence on effective health systems interventions in low- middle- and high-income countries. Third, key stakeholders were engaged in a policy dialogue. Fourth, policy briefs were developed and presented to the Ghana Health Services. Ghana has a well-structured health system that can adapt to meet the health care needs of older people. Six problems were selected as priorities, however after the policy dialogue, only five were agreed as priorities by the stakeholders. The key stakeholders drafted evidence-based policy recommendations that were used to develop policy briefs. The briefs were presented to the Ghana Health Service in 2014. The framework can be used to build local capacity on evidence-informed policy-making. However, knowledge translation tools need further development to be used in low-income countries and in the field of ageing. The terms and language of the tools need to be adapted to local contexts. Evidence for health system interventions on ageing populations is very limited, particularly for low- and middle-income settings.
Shah, Manish I; Macias, Charles G; Dayan, Peter S; Weik, Tasmeen S; Brown, Kathleen M; Fuchs, Susan M; Fallat, Mary E; Wright, Joseph L; Lang, Eddy S
The objective of this guideline is to recommend evidence-based practices for timely prehospital pediatric seizure cessation while avoiding respiratory depression and seizure recurrence. A multidisciplinary panel was chosen based on expertise in pediatric emergency medicine, prehospital medicine, and/or evidence-based guideline development. The panel followed the National Prehospital EBG Model using the GRADE methodology to formulate questions, retrieve evidence, appraise the evidence, and formulate recommendations. The panel members initially searched the literature in 2009 and updated their searches in 2012. The panel finalized a draft of a patient care algorithm in 2012 that was presented to stakeholder organizations to gather feedback for necessary revisions. Five strong and ten weak recommendations emerged from the process; all but one was supported by low or very low quality evidence. The panel sought to ensure that the recommendations promoted timely seizure cessation while avoiding respiratory depression and seizure recurrence. The panel recommended that all patients in an active seizure have capillary blood glucose checked and be treated with intravenous (IV) dextrose or intramuscular (IM) glucagon if intranasal) of benzodiazepines (0.2 mg/kg) be used as first-line therapy for status epilepticus, rather than the rectal route. Using GRADE methodology, we have developed a pediatric seizure guideline that emphasizes the role of capillary blood glucometry and the use of buccal, IM, or intranasal benzodiazepines over IV or rectal routes. Future research is needed to compare the effectiveness and safety of these medication routes.
Wu, Justine P; Gundersen, Daniel A; Pickle, Sarah
Our study aims were to: (1) describe the scope of contraceptive methods provided by US family medicine educators and (2) assess the extent to which US family medicine educators' recommendations regarding eligibility criteria for contraceptive methods are consistent with Centers for Disease Control and Prevention (CDC) guidelines. We contributed survey items as part of the 2014 Council of Academic Family Medicine Educational Research Alliance (CERA) omnibus survey, which is distributed annually to a national cohort of US family medicine educators. We created two summary scales, comprised of clinical scenarios, to assess the extent to which provider recommendations regarding eligibility criteria for oral contraceptive pills (OCPs, six scenarios) and the intrauterine device (IUD, eight scenarios) were consistent with CDC guidelines. Among the 1,054 respondents (33% response rate), 98% prescribe OCPs and 66% insert IUDs. The OCP scale mean was 4.6 ± SD 1.6 (range 0-6), and the IUD scale mean was 4.8 SD ± 2.3 (range 0-8). These scores reflect that 23% of providers' OCP recommendations and 40% of their IUD recommendations were inconsistent with CDC guidelines. The contraceptive recommendations of this cohort of family medicine educators only partially reflected evidence-based guidelines. More misconceptions were noted regarding eligibility criteria for the IUD than for OCPs. To avoid denying safe and effective contraception to otherwise appropriate candidates and putting women at risk of unintended pregnancy, evidence-based contraceptive recommendations must be improved among family medicine educators.
Mani, Karthik; Provident, Ingrid; Eckel, Emily
Work-related musculoskeletal disorders (WMSDs) related to computer work have become a serious public health concern. Literature revealed a positive association between computer use and WMSDs. The purpose of this evidence-based pilot project was to provide a series of evidence-based educational sessions on ergonomics to office computer workers to enhance the awareness of risk factors of WMSDs. Seventeen office computer workers who work for the National Board of Certification in Occupational Therapy volunteered for this project. Each participant completed a baseline and post-intervention ergonomics questionnaire and attended six educational sessions. The Rapid Office Strain Assessment and an ergonomics questionnaire were used for data collection. The post-intervention data revealed that 89% of participants were able to identify a greater number of risk factors and answer more questions correctly in knowledge tests of the ergonomics questionnaire. Pre- and post-intervention comparisons showed changes in work posture and behaviors (taking rest breaks, participating in exercise, adjusting workstation) of participants. The findings have implications for injury prevention in office settings and suggest that ergonomics education may yield positive knowledge and behavioral changes among computer workers.
Chan, Maria; Patwardhan, Aditi; Ryan, Catherine; Trevillian, Paul; Chadban, Steven; Westgarth, Fidye; Fry, Karen
The present article summarizes the key recommendations of the evidence-based guidelines developed for the nutritional management of adult kidney transplant recipients. Nutrition interventions play an important role in preventing and managing common health problems associated with renal transplantation such as obesity, hypertension, diabetes, and cardiovascular disease. Two sets of guidelines were developed by a working group of renal dietitians and nephrologists. They were subject to expert panel review, and public consultation by renal clinicians and consumers before final endorsement by 2 authorities in Australia--Caring for Australasians with Renal Impairment (CARI) and Dietitians Association of Australia (DAA). Protocol and rigor of guideline development were previously described and published in the Journal of Renal Nutrition, 2009. These guidelines address 13 priority topics identified by the renal community and complement each other with different emphasis, from research translation to day to day clinical practice recommendations. The published guidelines are available to the public through web-access of CARI and DAA, and journal publications. Information includes the guidelines themselves with level of evidence stated, grading of recommendations, suggestions for clinical care, search strategy, background and summary of evidence, recommendations of other guidelines, practice recommendations, appendices of useful tools, and suggestions for audits and future research. Two sets of comprehensive evidence-based nutrition guidelines from CARI and DAA are now available to help improve health outcomes of adult kidney transplant recipients. Copyright © 2011 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.
Full Text Available Objectives. Fibromyalgia syndrome (FMS, characterized by subjective complaints without physical or biomarker abnormality, courts controversy. Recommendations in recent guidelines addressing classification and diagnosis were examined for consistencies or differences. Methods. Systematic searches from January 2008 to February 2013 of the US-American National Guideline Clearing House, the Scottish Intercollegiate Guidelines Network, Guidelines International Network, and Medline for evidence-based guidelines for the management of FMS were conducted. Results. Three evidence-based interdisciplinary guidelines, independently developed in Canada, Germany, and Israel, recommended that FMS can be clinically diagnosed by a typical cluster of symptoms following a defined evaluation including history, physical examination, and selected laboratory tests, to exclude another somatic disease. Specialist referral is only recommended when some other physical or mental illness is reasonably suspected. The diagnosis can be based on the (modified preliminary American College of Rheumatology (ACR 2010 diagnostic criteria. Discussion. Guidelines from three continents showed remarkable consistency regarding the clinical concept of FMS, acknowledging that FMS is neither a distinct rheumatic nor mental disorder, but rather a cluster of symptoms, not explained by another somatic disease. While FMS remains an integral part of rheumatology, it is not an exclusive rheumatic condition and spans a broad range of medical disciplines.
Parker, G B; Graham, R K; Tavella, G
To examine the level of agreement across professionally auspiced evidence-based guidelines for managing the bipolar disorders. A literature search in PubMed, the National Guideline Clearinghouse, the Cochrane Database of Systematic Reviews and PsycInfo was undertaken using the search terms 'bipolar disorder' and 'guidelines', generating 11 evidence-based guidelines published by professional organisations over the 2002-2015 period. Each guideline was reviewed by two independent reviewers and key themes extracted via qualitative analyses. There was agreement on issues such as the first-line treatment of mania where mood-stabilising and/or an antipsychotic medication together with tapering or ceasing antidepressant medications was most commonly recommended. Differences included the extent to which (i) the different bipolar disorders were defined or not, (ii) there were separate recommendations for bipolar I and bipolar II disorders vs. non-differentiating general bipolar management strategies, (iii) 'general' vs. severity-based recommendations were made, and (iv) narrow vs. broad sets of candidate medications were nominated, while there was variable consideration of treatments such as electroconvulsive therapy (ECT). While there was some consistency across guidelines on key recommendations, there was also substantial inconsistencies, limiting the generation of any 'meta-consensus' model for managing the bipolar disorders. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Fritsche, L; Greenhalgh, T; Falck-Ytter, Y; Neumayer, H-H; Kunz, R
Objective To develop and validate an instrument for measuring knowledge and skills in evidence based medicine and to investigate whether short courses in evidence based medicine lead to a meaningful increase in knowledge and skills. Design Development and validation of an assessment instrument and before and after study. Setting Various postgraduate short courses in evidence based medicine in Germany. Participants The instrument was validated with experts in evidence based medicine, postgraduate doctors, and medical students. The effect of courses was assessed by postgraduate doctors from medical and surgical backgrounds. Intervention Intensive 3 day courses in evidence based medicine delivered through tutor facilitated small groups. Main outcome measure Increase in knowledge and skills. Results The questionnaire distinguished reliably between groups with different expertise in evidence based medicine. Experts attained a threefold higher average score than students. Postgraduates who had not attended a course performed better than students but significantly worse than experts. Knowledge and skills in evidence based medicine increased after the course by 57% (mean score before course 6.3 (SD 2.9) v 9.9 (SD 2.8), Pevidence based medicine. An intensive 3 day course in evidence based medicine led to a significant increase in knowledge and skills. What is already known on this topicNumerous observational studies have investigated the impact of teaching evidence based medicine to healthcare professionals, with conflicting resultsMost of the studies were of poor methodological qualityWhat this study addsAn instrument assessing basic knowledge and skills required for practising evidence based medicine was developed and validatedAn intensive 3 day course on evidence based medicine for doctors from various backgrounds and training level led to a clinically meaningful improvement of knowledge and skills PMID:12468485
Pfefferbaum, Betty; Jacobs, Anne K; Nitiéma, Pascal; Everly, George S
Debriefing, a controversial crisis intervention delivered in the early aftermath of a disaster, has not been well evaluated for use with children and adolescents. This report constitutes a review of the child debriefing evidence base. A systematic search of selected bibliographic databases (EBM Reviews, EMBASE, ERIC, Medline, Ovid, PILOTS, PubMed, and PsycINFO) was conducted in the spring of 2014 using search terms related to psychological debriefing. The search was limited to English language sources and studies of youth, aged 0 to 18 years. No time limit was placed on date of publication. The search yielded 713 references. Titles and abstracts were reviewed to select publications describing scientific studies and clinical reports. Reference sections of these publications, and of other literature known to the authors that was not generated by the search, were used to locate additional materials. Review of these materials generated 187 publications for more thorough examination; this assessment yielded a total of 91 references on debriefing in children and adolescents. Only 15 publications on debriefing in children and adolescents described empirical studies. Due to a lack of statistical analysis of effectiveness data with youth, and some articles describing the same study, only seven empirical studies described in nine papers were identified for analysis for this review. These studies were evaluated using criteria for assessment of methodological rigor in debriefing studies. Children and adolescents included in the seven empirical debriefing studies were survivors of motor-vehicle accidents, a maritime disaster, hostage taking, war, or peer suicides. The nine papers describing the seven studies were characterized by inconsistency in describing the interventions and populations and by a lack of information on intervention fidelity. Few of the studies used randomized design or blinded assessment. The results described in the reviewed studies were mixed in regard to
Full Text Available This paper describes the philosophy, development and framework of the body of elements formulated to provide an approach to evidence-based learning sustained by Learning Objects and web based technology Due to the demands for continuous improvement in the delivery of healthcare and in the continuous endeavour to improve the quality of life, there is a continuous need for practitioner's to update their knowledge by accomplishing accredited courses. The rapid advances in medical science has meant increasingly, there is a desperate need to adopt wireless schemes, whereby bespoke courses can be developed to help practitioners keep up with expanding knowledge base. Evidently, without current best evidence, practice risks becoming rapidly out of date, to the detriment of the patient. There is a need to provide a tactical, operational and effective environment, which allows professional to update their education, and complete specialised training, just-in-time, in their own time and location. Following this demand in the marketplace the information engineering group, in combination with several medical and dental schools, set out to develop and design a conceptual framework which form the basis of pioneering research, which at last, enables practitioner's to adopt a philosophy of life long learning. The body and structure of this framework is subsumed under the term Object oriented approach to Evidence Based learning, Just-in-time, via Internet sustained by Reusable Learning Objects (The OEBJIRLO Progression. The technical pillars which permit this concept of life long learning are pivoted by the foundations of object oriented technology, Learning objects, Just-in-time education, Data Mining, intelligent Agent technology, Flash interconnectivity and remote wireless technology, which allow practitioners to update their professional skills, complete specialised training which leads to accredited qualifications. This paper sets out to develop and
Pathak, Ram A; Rawal, Bhupendra; Li, Zhuo; Broderick, Gregory A
The primary aim of our study was to determine whether an evidence-based rationale could categorize cavernous venous occlusive disease into mild, moderate and severe erectile dysfunction. A total of 863 patients underwent color duplex Doppler ultrasound from January 2010 to June 2013 performed by a single urologist. We identified a cohort of 75 patients (8.7%) with a diagnosis of cavernous venous occlusive disease based on a unilateral resistive index less than 0.9, and right and left peak systolic velocity 35 cm per second or less after visual sexual stimulation. At a median followup of 13 months patients were evaluated for treatment efficacy. A total of 75 patients with a median age of 60 years (range 19 to 83) and a mean body mass index of 26.3 kg/m(2) (range 19.0 to 39.3) satisfied the criteria of cavernous venous occlusive disease. When substratified into tertiles, resistive index cutoffs were obtained, including mild cavernous venous occlusive disease-81.6 to 94.0, moderate disease-72.6 to 81.5 and severe disease-59.5 to 72.5. Using these 3 groups the phosphodiesterase type 5-inhibitor failure rate (p = 0.017) and SHIM (Sexual Health Inventory for Men) score categories (1 to 10 vs 11 to 20, p = 0.030) were statistically significantly different for mild, moderate and severe cavernous venous occlusive disease. Treatment satisfaction was also statistically significantly different. Penile prosthetic placement was a more common outcome among patients with erectile dysfunction and more severe cavernous venous occlusive disease. Our retrospective analysis supports a correlation between the phosphodiesterase type 5 inhibitor failure rate, SHIM score and the rate of surgical intervention using resistive index values. Our data further suggest that an evidence-based classification of cavernous venous occlusive disease by color Doppler ultrasound is possible and can triage patients to penile prosthetic placement. Copyright © 2016 American Urological Association
Supplee, Lauren H.; Metz, Allison
Despite a robust body of evidence of effectiveness of social programs, few evidence-based programs have been scaled for population-level improvement in social problems. Since 2010 the federal government has invested in evidence-based social policy by supporting a number of new evidence-based programs and grant initiatives. These initiatives…
Honeybul, S; Ho, K M
The introduction of evidence based medicine de-emphasised clinical experience and so-called "background information" and stressed the importance of evidence gained from clinical research when making clinical decisions. For many years randomised controlled trials have been seen to be the only way to advance clinical practice, however, applying this methodology in the context of severe trauma can be problematic. In addition, it is increasingly recognised that considerable clinical experience is required in order to critically evaluate the quality of the evidence and the validity of the conclusions as presented. A contemporary example is seen when considering the role of decompressive craniectomy in the management of neurotrauma. Although there is a considerable amount of evidence available attesting to the efficacy of the procedure, considerable clinical expertise is required in order to properly interpret the results of these studies and the implications for clinical practice. Given these limitations the time may have come for a redesign of the traditional pyramid of evidence, to a model that re-emphasises the importance of "background information" such as pathophysiology and acknowledges the role of clinical experience such that the evidence can be critically evaluated in its appropriate context and the subsequent implications for clinical practice be clearly and objectively defined. Crown Copyright © 2014. Published by Elsevier Ltd. All rights reserved.
Marshall, T A; Straub-Morarend, C L; Guzmán-Armstrong, S; Handoo, N
The integration of evidence-based dentistry (EBD) into pre-doctoral dental curricula requires the identification of desired outcomes, development of curricular content and design of assessment strategies which guide student performance whilst documenting achievement of desired curricular outcomes. Models for developing EBD curriculums have been described in the literature; however, the logistics of designing assessment instruments to progressively document student performance have received less attention. The objective of this article is to describe the University of Iowa's College of Dentistry's development and implementation of assessment strategies to guide student learning of EBD knowledge, application and assimilation to serve as a model for other institutions developing EBD assessment protocols. Desired EBD knowledge and behaviour outcomes guided the development of curricular content and progressive formative and summative assessment strategies. Vertically and horizontally integrated educational activities enabling students to demonstrate EBD knowledge whilst modelling desired behaviours were identified, whilst assessment principles guided development of learning guides and assessment instruments to document achievement of desired outcomes. Consistent EBD language and educational activities are utilised throughout the 4-year interdisciplinary curriculum with stepwise assessment protocols matched to the curriculum. Examples of student learning guides and assessment instruments are provided. Curricular design guides development of assessment strategies. Assessment protocols provide consistent formative and summative feedback to enable continuous student growth to become proficient EBD practitioners. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Breitbart, William; Alici, Yesne
Delirium is the most common neuropsychiatric complication seen in patients with cancer, and it is associated with significant morbidity and mortality. Increased health care costs, prolonged hospital stays, and long-term cognitive decline are other well-recognized adverse outcomes of delirium. Improved recognition of delirium and early treatment are important in diminishing such morbidity. There has been an increasing number of studies published in the literature over the last 10 years regarding delirium treatment as well as prevention. Antipsychotics, cholinesterase inhibitors, and alpha-2 agonists are the three groups of medications that have been studied in randomized controlled trials in different patient populations. In patients with cancer, the evidence is most clearly supportive of short-term, low-dose use of antipsychotics for controlling the symptoms of delirium, with close monitoring for possible adverse effects, especially in older patients with multiple medical comorbidities. Nonpharmacologic interventions also appear to have a beneficial role in the treatment of patients with cancer who have or are at risk for delirium. This article presents evidence-based recommendations based on the results of pharmacologic and nonpharmacologic studies of the treatment and prevention of delirium. PMID:22412123
Baird, Ruth Ann; Wiebe, Sam; Zunt, Joseph R.; Halperin, John J.; Gronseth, Gary; Roos, Karen L.
Objective: To review the evidence base for different treatment strategies in intraparenchymal neurocysticercosis in adults and children. Method: A literature search of Medline, EMBASE, LILACS, and the Cochrane Database from 1980 to 2008, updated in 2012, resulted in the identification of 10 Class I or Class II trials of cysticidal drugs administered with or without corticosteroids in the treatment of neurocysticercosis. Results: The available data demonstrate that albendazole therapy, administered with or without corticosteroids, is probably effective in decreasing both long-term seizure frequency and the number of cysts demonstrable radiologically in adults and children with neurocysticercosis, and is well-tolerated. There is insufficient information to assess the efficacy of praziquantel. Recommendations: Albendazole plus either dexamethasone or prednisolone should be considered for adults and children with neurocysticercosis, both to decrease the number of active lesions on brain imaging studies (Level B) and to reduce long-term seizure frequency (Level B). The evidence is insufficient to support or refute the use of steroid treatment alone in patients with intraparenchymal neurocysticercosis (Level U). PMID:23568997
Freddi, Goffredo; Romàn-Pumar, José Luis
Evidence-based medicine (EBM) is not a old hat, a "cookbook" medicine perpetrated by arrogant to serve cost cutters to suppress clinical freedom, a mandatory, deterministic, totalitarian practice of medicine, a way to control cost and to ignore patient preferences, a limit to personal/ humanistic/individual medicine. EBM is a reference of excellence to guide clinical decisions, the integration of own expertise with others' expertise and patient preferences, a way to improve medical practice and limit the variability and errors created when there is not evidence to identify the gold standard and differentiate among alternatives available. But evidences need to be integrated with a new thinking based on Complexity Science. Health care systems operates as complex adaptative systems rather than rigid, linear or mechanical organizations and innovation is a critical outcome of Complexity Science. How does EBM impact drug innovation? New drug approvals are not keeping pace with rising Research and Development spending, clinical approval success rate for new chemical entities (NCEs) is progressively dropping and maybe, through these indicators, we are seeing the worst face of EBM: its limiting, blocking, and controlling side. If that is the case, EBM is the main ally to keep the economy of health systems under control and the great excuse to block the access of the innovation to patients. Certainly not the best way to maximize the benefits of EBM.
Kim, Kwang-Il; Jung, Hye-Kyung; Kim, Chang Oh; Kim, Soo-Kyung; Cho, Hyun-Ho; Kim, Dae Yul; Ha, Yong-Chan; Hwang, Sung-Hee; Won, Chang Won; Lim, Jae-Young; Kim, Hyun Jung; Kim, Jae Gyu
Falls and fall-related injuries are common in older populations and have negative effects on quality of life and independence. Falling is also associated with increased morbidity, mortality, nursing home admission, and medical costs. Korea has experienced an extreme demographic shift with its population aging at the fastest pace among developed countries, so it is important to assess fall risks and develop interventions for high-risk populations. Guidelines for the prevention of falls were first developed by the Korean Association of Internal Medicine and the Korean Geriatrics Society. These guidelines were developed through an adaptation process as an evidence-based method; four guidelines were retrieved via systematic review and the Appraisal of Guidelines for Research and Evaluation II process, and seven recommendations were developed based on the Grades of Recommendation, Assessment, Development, and Evaluation framework. Because falls are the result of various factors, the guidelines include a multidimensional assessment and multimodal strategy. The guidelines were developed for primary physicians as well as patients and the general population. They provide detailed recommendations and concrete measures to assess risk and prevent falls among older people. PMID:28049285
Searching the literature, a core requirement of evidence-based medicine has been impossibly oversold. The literature search is supposed to provide evidence independent from expert opinion, which has been deemed to be low on the evidence hierarchy. Yet freedom from expertise is not free. Paradoxically, practitioners are told to search the literature to avoid authority, but because there is too much information and too little time, they are urged to rely on authoritative digests. But the chain of errors inherent in searching literature for decision making, whether in scoping the decision, finding relevant documents, or in the document content, cannot be ignored. This article explores those errors. With examples from signal theory and decision theory, the literature search is analyzed in light of fundamental limits in the nature of informaiton. You can run from expertise but you cannot hide. Expertise is inevitably required to deal with these errors. So do-it-yourself searching is inadequate in the absence of expertise. The best decisions result from collaboration with subject matter experts and decision-making experts.
McIlwaine, Maggie Patricia; Lee Son, Nicole Marie; Richmond, Melissa Lynn
To provide a comprehensive overview and evidence to support the role of physiotherapy in the management of individuals with cystic fibrosis (CF) including airway clearance, exercise, and musculoskeletal concerns which can affect activities of daily living and respiratory health. Several long-term studies have looked at the efficacy of airway clearance techniques, including active cycle of breathing techniques, autogenic drainage, high frequency chest wall oscillation, postural drainage, positive expiratory pressure (PEP), and oscillating PEP. Each of these studies reported some efficacy of airway clearance in maintaining health with no one technique being superior to another. However, one study suggested that high frequency chest wall oscillation was not as effective as PEP in maintaining health in CF patients. Individual preference needs to be considered when selecting a technique. Recent studies have found exercise to increase mucociliary clearance peripherally. Musculoskeletal issues, including posture, bone density, urinary incontinence, and pain should be assessed and managed in individuals to improve the mechanics of breathing and overall well-being. The role of physiotherapy in CF is complex and includes airway clearance, exercise, and management of the long-term sequelae of musculoskeletal issues. More rigorous physiotherapy studies are required to assist with evidence based practice.
Fernandez, Rosemarie; Vozenilek, John A; Hegarty, Cullen B; Motola, Ivette; Reznek, Martin; Phrampus, Paul E; Kozlowski, Steve W J
Current health care literature cites communication breakdown and teamwork failures as primary threats to patient safety. The unique, dynamic environment of the emergency department (ED) and the complexity of patient care necessitate the development of strong interdisciplinary team skills among emergency personnel. As part of the 2008 Academic Emergency Medicine Consensus Conference on "The Science of Simulation in Healthcare," our workshop group identified key theory and evidence-based recommendations for the design and implementation of team training programs. The authors then conducted an extensive review of the team training literature within the domains of organizational psychology, aviation, military, management, and health care. This review, in combination with the workshop session, formed the basis for recommendations and need for further research in six key areas: 1) developing and refining core competencies for emergency medicine (EM) teams; 2) leadership training for emergency physicians (EPs); 3) conducting comprehensive needs analyses at the organizational, personnel, and task levels; 4) development of training platforms to maximize knowledge transfer; 5) debriefing and provision of feedback; and 6) proper implementation of simulation technology. The authors believe that these six areas should form an EM team training research platform to advance the EM literature, while leveraging the unique team structures present in EM to expand team training theory and research.
Dheeraj D Kalra
Full Text Available Since past few years, there have been many strategies to combat dental caries, erosion, hypersensitivity, and many other oral conditions. The last decade has seen many advanced researches in the field of dentistry. The scope of dentistry has evolved from only a curative one to a largely preventive one. There have been technologies available for the minimal invasive cure of dental caries, early diagnosis and early reversal of the initial carious lesion using nonoperative techniques. There has also more focus being made to treat dental caries as a process rather than curing the lesion only. The role of saliva, demineralization and remineralization has been better understood. The aim of this paper is to review the contemporary nonfluoridated systems available for remineralization therapy and ideas for their implementation into clinical practice. A search of articles from "PubMed" and "Medline" and databases like Google and Google scholar, ScienceDirect and Wiley with the keywords remineralization, demineralization, nonfluoridated demineralizing agents was conducted in the month of August 2012 out of a total 114 articles, 86 articles have been used in the present evidence-based review.
Rothberg, Brian; Feinstein, Robert E; Guiton, Gretchen
Evidence-based medicine (EBM) has become an important part of residency education, yet many EBM curricula lack a valid and standardized tool to identify learners' prior knowledge and assess progress. We developed an EBM examination in psychiatry to measure our effectiveness in teaching comprehensive EBM to residents. We developed a psychiatry EBM test using the validated EBM Fresno Test of Competence for family medicine. The test consists of case scenarios with open-ended questions. We also developed a scoring rubric and obtained reliability with multiple raters. Fifty-seven residents provided test data after completing 3, 6, 25, or 31 EBM sessions. The number of sessions for each resident was based on their length of training in our program. The examination had strong interrater reliability, internal reliability, and item discrimination. Many residents showed significant improvement on their examination scores when data were compared from tests taken before and after a sequence of teaching sessions. Also, a threshold for the level of expert on the examination was established using test data from 5 EBM teacher-experts. We successfully developed a valid and reliable EBM examination for use with psychiatry residents to measure essential EBM skills as part of a larger project to encourage EBM practice for residents in routine patient care. The test provides information on residents' knowledge in EBM from entry level concepts through expert performance. It can be used to place incoming residents in appropriate levels of an EBM curriculum and to monitor the effectiveness of EBM instruction.
Full Text Available Objective. To perform an evidence-based review of treatments for Toxoplasma retinochoroiditis (TRC. Methods. A systematic literature search was performed using the PubMed database and the key phrase “ocular toxoplasmosis treatment” and the filter for “controlled clinical trial” and “randomized clinical trial” as well as OVID medline (1946 to May week 2 2014 using the keyword ‘‘ocular toxoplasmosis’’. The included studies were used to evaluate the various treatment modalities of TRC. Results. The electronic search yielded a total of 974 publications of which 44 reported on the treatment of ocular toxoplasmosis. There were 9 randomized controlled studies and an additional 3 comparative studies on the treatment of acute TRC with systemic or intravitreous antibiotics or on reducing the recurrences of TRC. Endpoints of studies included visual acuity improvement, inflammatory response, lesion size changes, recurrences of lesions, and adverse effects of medications. Conclusions. There was conflicting evidence as to the effectiveness of systemic antibiotics for TRC. There is no evidence to support that one antibiotic regimen is superior to another so choice needs to be informed by the safety profile. Intravitreous clindamycin with dexamethasone seems to be as effective as systemic treatments. There is currently level I evidence that intermittent trimethoprim-sulfamethoxazole prevents recurrence of the disease.
Jones, Deborah J.; Anton, Margaret; Gonzalez, Michelle; Honeycutt, Amanda; Khavjou, Olga; Forehand, Rex; Parent, Justin
Ownership of mobile phones is on the rise, a trend in uptake that transcends age, region, race, and ethnicity, as well as income. It is precisely the emerging ubiquity of mobile phones that has sparked enthusiasm regarding their capacity to increase the reach and impact of health care, including mental health care. Community-based clinicians charged with transporting evidence-based interventions beyond research and training clinics are in turn, ideally and uniquely situated to capitalize on mobile phone uptake and functionality to bridge the efficacy to effectiveness gap. As such, this article delineates key considerations to guide these frontline clinicians in mobile phone-enhanced clinical practice, including an overview of industry data on the uptake of and evolution in the functionality of mobile phone platforms, conceptual considerations relevant to the integration of mobile phones into practice, representative empirical illustrations of mobile-phone enhanced assessment and treatment, and practical considerations relevant to ensuring the feasibility and sustainability of such an approach. PMID:26213458
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
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.
Zesiewicz, T.A.; Elble, R.J.; Louis, E.D.; Gronseth, G.S.; Ondo, W.G.; Dewey, R.B.; Okun, M.S.; Sullivan, K.L.; Weiner, W.J.
Background: This evidence-based guideline is an update of the 2005 American Academy of Neurology practice parameter on the treatment of essential tremor (ET). Methods: A literature review using MEDLINE, EMBASE, Science Citation Index, and CINAHL was performed to identify clinical trials in patients with ET published between 2004 and April 2010. Results and Recommendations: Conclusions and recommendations for the use of propranolol, primidone (Level A, established as effective); alprazolam, atenolol, gabapentin (monotherapy), sotalol, topiramate (Level B, probably effective); nadolol, nimodipine, clonazepam, botulinum toxin A, deep brain stimulation, thalamotomy (Level C, possibly effective); and gamma knife thalamotomy (Level U, insufficient evidence) are unchanged from the previous guideline. Changes to conclusions and recommendations from the previous guideline include the following: 1) levetiracetam and 3,4-diaminopyridine probably do not reduce limb tremor in ET and should not be considered (Level B); 2) flunarizine possibly has no effect in treating limb tremor in ET and may not be considered (Level C); and 3) there is insufficient evidence to support or refute the use of pregabalin, zonisamide, or clozapine as treatment for ET (Level U). PMID:22013182
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.
Schuller, Kristin A; Kash, Bita A; Gamm, Larry D
The purpose of this paper is to analyze the implementation of an organizational change initiative--Studer Group®'s Evidence-Based Leadership (EBL)--in two large, US health systems by comparing and contrasting the factors associated with successful implementation and sustainability of the EBL initiative. This comparative case study assesses the responses to two pairs of open-ended questions during in-depth qualitative interviews of leaders and managers at both health systems. Qualitative content analysis was employed to identify major themes. Three themes associated with success and sustainability of EBL emerged at both health systems: leadership; culture; and organizational processes. The theme most frequently identified for both success and sustainability of EBL was culture. In contrast, there was a significant decline in salience of the leadership theme as attention shifts from success in implementation of EBL to sustaining EBL long term. Within the culture theme, accountability, and buy-in were most often cited by interviewees as success factors, while sense of accountability, buy-in, and communication were the most reported factors for sustainability. Cultural factors, such as accountability, staff support, and communication are driving forces of success and sustainability of EBL across both health systems. Leadership, a critical factor in several stages of implementation, appears to be less salient as among factors identified as important to longer term sustainability of EBL.
Full Text Available In the last twenty years the term “Evidence Based Medicine (EBM” has been increasingly applied in all areas of medicine and is often used for decision-making in the medical and public health sector. It is also used to verify the significance and/or the effectiveness of different therapies. The original definition of EBM rests on the following three pillars: the physician’s individual expertise, the patient’s needs and the best external evidence. Today, however, the term EBM is often wrongly used as a synonym for best external evidence, without taking into consideration the other two pillars of the model which was created by Gordon Guyatt, David Sackett and Archibald Cochrane. This problem becomes even greater the more social insurance institutions and politicians use external evidence alone as the main guideline for financing therapies and therapy guidelines in physical medicine and general rehabilitation without taking into account the physician’s expertise and the patient’s needs.The wrong interpretation of EBM can lead to the following problems: well established clinical therapies are either questioned or not granted and are therefore withheld from patients (for example physical pain management. An absence of evidence for individual therapy methods does not prove their ineffectiveness! In this short statement the significance of EBM in Physical Medicine and general rehabilitation will be analysed and discussed.
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.
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.
Shoja, Mohammadali M; Rashidi, Mohammad Reza; Tubbs, R Shane; Etemadi, Jalal; Abbasnejad, Feridoon; Agutter, Paul S
Although the term 'evidence-based medicine' (EBM) is of recent origin, its roots are generally agreed to lie in earlier times. Several writers have suggested that the 11th century CE physician and philosopher Avicenna (Ibn Sina) formulated an approach to EBM that broadly resembles modern-day principles and practice. The aim of this paper is to explore the origins and influence of Avicenna's version of EBM. A survey of the literature suggests that two influences on Avicenna's thought were crucial: the doctrine of Ijma; and Stoic logic, perhaps transmitted via the writings of Galen. In turn, Avicenna is known to have been a major influence on both medical practice and the development of logic in medieval Europe. Through this route, Avicennian logic (notably its inductive aspect) inspired the new style of thought associated with the scientific revolution, which later came to be reflected in 'scientific medicine', and may therefore have been an indirect source of EBM today. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.
Raimondi, N; Vial, M R; Calleja, J; Quintero, A; Cortés Alban, A; Celis, E; Pacheco, C; Ugarte, S; Añón, J M; Hernández, G; Vidal, E; Chiappero, G; Ríos, F; Castilleja, F; Matos, A; Rodriguez, E; Antoniazzi, P; Teles, J M; Dueñas, C; Sinclair, J; Martínez, L; Von der Osten, I; Vergara, J; Jiménez, E; Arroyo, M; Rodriguez, C; Torres, J; Fernandez-Bussy, S; Nates, J L
Provide evidence based guidelines for tracheostomy in critically ill adult patients and identify areas needing further research. A task force composed of representatives of 10 member countries of the Pan-American and Iberic Federation of Societies of Critical and Intensive Therapy Medicine and of the Latin American Critical Care Trial Investigators Network developed recommendations based on the Grading of Recommendations Assessment, Development and Evaluation system. The group identified 23 relevant questions among 87 issues that were initially identified. In the initial search, 333 relevant publications were identified of which 226 publications were chosen. The task force generated a total of 19 recommendations: 10 positive (1B=3, 2C=3, 2D=4) and 9 negative (1B=8, 2C=1). A recommendation was not possible in six questions. Percutaneous techniques are associated with a lower risk of infections compared to surgical tracheostomy. Early tracheostomy only seems to reduce the duration of ventilator use but not the incidence of pneumonia, the length of stay, or the long-term mortality rate. The evidence does not support the use of routine bronchoscopy guidance or laryngeal masks during the procedure. Finally, proper prior training is as important or even a more significant factor in reducing complications than the technique used. Copyright © 2017 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.
Full Text Available Psychosocial interventions that are applied in practice should be those that have received the best scientific evidence about their effectiveness. Evidence-Based Psychosocial Intervention is a methodological tool that aims to raise awareness among professionals and policy makers of the need for professional practice to be guided by the best evidence. For this purpose, systematic reviews and meta-analyses of empirical evaluation studies play an important role as they allow us to synthesize the results of numerous studies on the same issue to determine which are the best treatments and interventions for solving the problem. This article presents an overview of the meta-analyses and the information they can provide for professional practice. The phases in which a meta-analysis is carried out are outlined as follows: (a formulating the problem, (b searching for the studies, (c coding the studies, (d calculating the effect size, (e statistical techniques of integration and (f publishing the study. The scope of meta-analyses and their results are illustrated with an example and their implications for professional practice are discussed.
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.
Otero, Joel Joshi; Detriche, Olivier; Mommaerts, Maurice Yves
The aim of this study was to establish a fast-track protocol for bimaxillary orthognathic surgery (OGS). Fast-track surgery (FTS) is a multidisciplinary approach where the pre-, intra-, and postoperative management is focusing maximally on a quick patient recovery and early discharge. To enable this, the patients’ presurgical stress and postsurgical discomfort should be maximally reduced. Both referral patterns and expenses within the health-care system are positively influenced by FTS. University hospital-literature review through Medline, Embase, and the Cochrane Library (January 2000–July 2016) using the following words – “fast track, enhanced recovery, multimodal, and perioperative care” – to define a protocol evidence based for OGS, as well as evidenced-based medicine search of every term added to the protocol during the same period. The process has resulted in an OGS protocol that may improve the outcome of the patient through several nonoperative and operative measures such as preoperative patient education and intra/postoperative measures that should improve overall patient satisfaction, decrease morbidity such as postoperative nausea, headache, dizziness, pain, and intubation discomfort, and shorten hospital stay. A literature review allowed us to fine-tune a fast-track protocol for uncomplicated OGS that can be prospectively studied against currently applied ones. PMID:29264281
Full Text Available Evidence-based medicine (EBM is not a old hat, a "cookbook" medicine perpetrated by arrogant to serve cost cutters to suppress clinical freedom, a mandatory, deterministic, totalitarian practice of medicine, a way to control cost and to ignore patient preferences, a limit to personal/humanistic/individual medicine. EBM is a reference of excellence to guide clinical decisions, the integration of own expertise with others' expertise and patient preferences, a way to improve medical practice and limit the variability and errors created when there is not evidence to identify the gold standard and differentiate among alternatives available. But evidences need to be integrated with a new thinking based on Complexity Science. Health care systems operates as complex adaptative systems rather than rigid, linear or mechanical organizations and innovation is a critical outcome of Complexity Science. How does EBM impact drug innovation? New drug approvals are not keeping pace with rising Research and Development spending, clinical approval success rate for new chemical entities (NCEs is progressively dropping and maybe, through these indicators, we are seeing the worst face of EBM: its limiting, blocking, and controlling side. If that is the case, EBM is the main ally to keep the economy of health systems under control and the great excuse to block the access of the innovation to patients. Certainly not the best way to maximize the benefits of EBM.
Alcohol use is one the most important risk factors for illness and early death in Peru. Measures aimed at decreasing or controlling the great impact caused by alcohol in the Peruvian society are urgently needed. This article identifies and promotes the implementation of public health measures supported by sound scientific evidence of effectiveness or, in some cases, cost-effectiveness. The 10 evidence-based public health measures identified and described here represent a set if measures with high probability of success if implemented, as they are supported by scientific evidence. We recommend that governments, at the national or local levels, apply these measures not individually, but in combination, arranging them into a plan or roadmap, where the framework in which they will be applied must be established according to each context. Considering the available resources, some of these measures could be implemented in the short and medium term while the others can be set in the long-term.
Bayer, Ronald; Johns, David Merritt; Galea, Sandro
For more than four decades, starting in the late 1960s, a sometimes furious battle has raged among scientists over the extent to which elevated salt consumption has adverse implications for population health and contributes to deaths from stroke and cardiovascular disease. Various studies and trials have produced conflicting results. Despite this scientific controversy over the quality of the evidence implicating dietary salt in disease, public health leaders at local, national, and international levels have pressed the case for salt reduction at the population level. This article explores the development of this controversy. It concludes that the concealment of scientific uncertainty in this case has been a mistake that has served neither the ends of science nor good policy. The article poses questions that arise from this debate and frames the challenges of formulating evidence-based public health practice and policy, particularly when the evidence is contested.
Amodeo, Maryann; Ellis, Michael A; Samet, Jeffrey H
Dissemination of evidence-based practices (EBPs) in addiction settings is a national priority. We tested Organization Development (OD) methods for dissemination. Using OD in two addiction treatment programs we developed an organization-specific treatment plan using employee work teams with the goals of changes in organizational policies and procedures and improvement in practitioner skills. OD was effectively applied, but EBPs were premature for these addiction programs because they first needed to address more fundamental aspects of client-clinician interaction and agency treatment philosophy. The OD approach in addiction treatment is complementary to other technology transfer efforts by being: (a) "organization-centered," engaging practitioners at all levels; (b) "needs-focused," addressing concerns of the particular organization; (c) flexible in its responsiveness to readiness for change; and (d) relatively affordable. However, before absorbing EBPs, substance abuse treatment organizations must develop strengths in delivering fundamental aspects of care.
Merkel, Susan M
Numerous national reports have addressed the need for changing how science courses in higher education are taught, so that students develop a deeper understanding of critical concepts and the analytical and cognitive skills needed to address future challenges. This review presents some evidence-based approaches to curriculum development and teaching. Results from discipline-based education research indicate that it is critically important for educators to formulate learning goals, provide frequent and authentic assessments and actively engage students in their learning. Professional societies can play a role in helping to put these changes into practice. To this end, the American Society for Microbiology has developed a number of educational programs and resources, which are described here to encourage the implementation of student-centered learning in microbiology education. © FEMS 2016. All rights reserved. For permissions, please e-mail: firstname.lastname@example.org.
McGorry, Patrick D; Hamilton, Matthew P
Mortality from mental illnesses is increasing and, because they frequently occur early in the life cycle, they are the largest source of disability and reduced economic productivity of all non-communicable diseases. Successful mental health reform can reduce the mortality, morbidity, growing welfare costs and losses in economic productivity caused by mental illness. The government has largely adopted the recommendations of the National Mental Health Commission focusing on early intervention and stepwise care and will implement a reform plan that involves devolving commissioning of federally funded mental health services to primary health networks, along with a greater emphasis on e-mental health. Stepwise expanded investment in and structural support (data collection, evaluation, model fidelity, workforce training) for evidence-based care that rectifies high levels of undertreatment are essential for these reforms to succeed. However, the reforms are currently constrained by a cost-containment policy framework that envisages no additional funding. The early intervention reform aim requires financing for the next stage of development of Australia's youth mental health system, rather than redirecting funds from existing evidence-based programs. People with complex, enduring mental disorders need more comprehensive care. In the context of the National Disability Insurance Scheme, there is a risk that these already seriously underserved patients may paradoxically receive a reduction in coverage. E-health has a key role to play at all stages of illness but must be integrated in a complementary way, rather than as a barrier to access. Research and evaluation are the keys to cost-effective, sustainable reform.
Tapia-Conyer, Roberto; Betancourt-Cravioto, Miguel; Saucedo-Martínez, Rodrigo; Motta-Murguía, Lourdes; Gallardo-Rincón, Héctor
Despite many successes in the region, Latin American vaccination policies have significant shortcomings, and further work is needed to maintain progress and prepare for the introduction of newly available vaccines. In order to address the challenges facing Latin America, the Commission for the Future of Vaccines in Latin America (COFVAL) has made recommendations for strengthening evidence-based policy-making and reducing regional inequalities in immunisation. We have conducted a comprehensive literature review to assess the feasibility of these recommendations. Standardisation of performance indicators for disease burden, vaccine coverage, epidemiological surveillance and national health resourcing can ensure comparability of the data used to assess vaccination programmes, allowing deeper analysis of how best to provide services. Regional vaccination reference schemes, as used in Europe, can be used to develop best practice models for vaccine introduction and scheduling. Successful models exist for the continuous training of vaccination providers and decision-makers, with a new Latin American diploma aiming to contribute to the successful implementation of vaccination programmes. Permanent, independent vaccine advisory committees, based on the US Advisory Committee on Immunization Practices (ACIP), could facilitate the uptake of new vaccines and support evidence-based decision-making in the administration of national immunisation programmes. Innovative financing mechanisms for the purchase of new vaccines, such as advance market commitments and cost front-loading, have shown potential for improving vaccine coverage. A common regulatory framework for vaccine approval is needed to accelerate delivery and pool human, technological and scientific resources in the region. Finally, public-private partnerships between industry, government, academia and non-profit sectors could provide new investment to stimulate vaccine development in the region, reducing prices in the
Lakhanpaul, M; MacFaul, R; Werneke, U; Armon, K; Hemingway, P; Stephenson, T
The aim of this study was to develop an evidence-based guideline for use primarily by junior clinicians to assist with the management of children presenting to the hospital with an acute breathing difficulty. An overview of the literature provided a framework of clinical questions for the management of a child with an acute breathing difficulty on which to base a systematic literature review. Relevant articles were appraised by the research fellow and graded according to their quality. A national panel of 50 clinicians was provided, by post, with the clinical questions, research papers, appraisals and the grades of recommendations generated. They were asked to check the grades allocated to the recommendations and the accuracy of the language used. They were also provided with all the clinical questions for which there was insufficient evidence to reach a conclusion but for which a consensus recommendation was required. A Delphi method was used to formalise the consensus process. For all recommendations, panel members were asked to rate their level of agreement on a 1-9-point Likert scale. The results of the first round were fed back, and appropriate alterations to the recommendations made or additional recommendations included. The process of rating was repeated, and the final guideline was developed based on the consensus reached. Following two iterative rounds, the guideline was completed as a full technical document, with a series of key recommendations and an algorithm. It was based on 10 grade A (evidence from systematic review or meta-analyses), 5 grade B, 17 grade C and 31 grade D (consensus or expert opinion) recommendations. We have developed an evidence-based guideline that has subsequently been successfully implemented in the paediatric emergency departments and disseminated nationally. Results showing the effect of the guideline upon practice will be published separately.
Maclennan, Alastair H
Background and Objective The highest level of scientific evidence available for each therapy for menopausal symptoms was sought, for example, systematic reviews of randomised controlled trials (RCTs). Results There is reasonable evidence that some symptoms are modified by lifestyle, for example, cessation of smoking, exercise, reduction of alcohol, diet and alleviation of psychosocial stress. No complementary medicine, for example, phytoestrogens, black cohosh, herbal or homeopathic medicines or complementary therapies, for example, acupuncture, yoga, chiropractic manipulation, reflexology or magnetic devices have a greater effect than the usual placebo effect seen in quality blinded RCTs. Some have potential side-effects. So-called 'bioidentical hormones' have no evidence-base and potential for harm. None of the above therapies have evidence of efficacy and long-term safety. Selective serotonin and noradrenaline re-uptake inhibitors ameliorate vasomotor symptoms and sometimes menopausal depression better than placebo. The most effective therapy for menopausal (oestrogen) deficiency symptoms is oestrogen which is the main component of hormone replacement therapies (HRT). Compared with placebo HRT is highly effective in relieving hot flushes, night sweats, dry vagina and dyspareunia. It also improved joint pains, sexuality and sleeplessness and reduced subsequent fractures in RCTs. The increased risk of oral HRT for thromboembolism is small around menopause, for those without thrombotic risk factors, and is not elevated with non-oral routes. Cardiovascular disease may be reduced when HRT is initiated near menopause. Breast cancer risk increases after several years with the use of oral HRT containing progestogens at an annual rate of 8/10 000 (<0.1%). No increase in breast cancer risk was seen with oestrogen-only HRT. © 2009 The Author. Journal Compilation © Blackwell Publishing Asia Pty Ltd.
Full Text Available Evidence based medicine is the training of health care professionals to access, assess and apply the best scientific evidence to clinical practice. EBM is the conscientious, explicit and judicious use of current best evidence along with clinical expertise and patient values in making decisions about the case of individual patients. The current undergraduate curriculum of health profession is based on past knowledge accumulated for years. The scientific relevance of the mostly outdated information has never been questioned. The students passively absorb this available knowledge and apply it in their future professional life. There is no active learning on their part, by way of positive enquiry and critical analysis of the curriculum imposed on them. This has an undesirable impact on their competency as health professionals and the quality of the health care imparted by them. Hence there is need for emphasis on the teaching of EBM skills in undergraduate, postgraduate, and continuing medical education programs. Early introduction of EBM in the undergraduate medical curriculum, in the form of a short course, using various modes of instruction, enhances the competence of critical thinking and also influences change in attitude towards EBM positively in medical students. The EBM course is planned to introduce in the curriculum of medical undergraduates at the beginning of second phase when they enter clinical posting. Total number of student would be 100 per batch and the course duration will be of 1 year. Educational methods program incorporates multiple teaching methods like lectures, discussion sessions, demonstration, case based learning, timely feedback, real life exposure, role modeling and peer evaluation.
Kundrot, Craig; Steil, Jennifer; Lumpkins, Sarah; Pellis, Neal
NASA's Human Research Program (HRP) is focused on understanding and mitigating thirty two risks to crew health and performance in exploration missions beyond low Earth orbit. The HRP has developed an evidence report for each of the risks. Most evidence reports are a brief review article describing the evidence related to a specified risk, written at a level appropriate for the scientifically educated, non-specialist reader. Each evidence report captured the current state of knowledge from both research and operations. Two limitations of the evidence reports have become apparent: 1) they are updated infrequently and 2) they do not take full advantage of the expertise available in other space agencies and in related fields of terrestrial research. Therefore, the HRP is experimenting with the use of Wikipedia articles as a repository for evidence. Wikipedia's accessibility to the international space flight community and researchers in related terrestrial fields creates the opportunity to generate a more timely and comprehensive evidence base. Initial Wikipedia articles were populated for seven risks using a subset of the information in the HRP-approved evidence reports: Fatigue and Sleep Loss, Treating An Ill or Injured Crew Member, Radiation Carcinogenesis, Visual Impairment and Intracranial Pressure, Renal Stone Formation, Team Cohesion, and Intervertebral Disc Damage. Since the initial articles were created, there have been additions to these Wikipedia articles, including content from sources outside the HRP, and editorial changes to the pages. We will report on the nature of the contributions made after the initial articles were created, the comprehensiveness of the resulting Wikipedia articles, and the effort required to maintain quality control of the content. The Wikipedia approach will also be compared to wiki efforts that exert more traditional editorial control of content prior to posting.
Farzad, Ali; Radin, Bethany; Oh, Jason S; Teague, Heidi M; Euerle, Brian D; Nable, J V; Liferidge, Aisha T; Windsor, T Andrew; Witting, Michael D
The diagnosis of subarachnoid hemorrhage is of paramount concern in patients presenting to the Emergency Department (ED) with acute headache. Computed tomography followed by lumbar puncture is a time-honored practice, but recent technologic advances in magnetic resonance imaging with magnetic resonance angiography and computed tomography with computed tomography angiography can present alternatives for clinicians and patients. The aim of this article was to compare diagnostic strategies for ED patients in whom subarachnoid hemorrhage is suspected. We analyze and discuss current protocols, in addition to summarizing the advantages and disadvantages of each method. Through our residency's journal club, we organized an evidence-based debate that pitted proponents of the three subarachnoid hemorrhage diagnostic strategies against one another. Proponents of each strategy described its advantages and disadvantages. Briefly, computed tomography/lumbar puncture is time honored and effective, but is limited by complications and indeterminate lumbar puncture results. Magnetic resonance imaging with magnetic resonance angiography might be more effective in late presentations and can visualize aneurysms, yet has limited availability. Computed tomography with computed tomography angiography offers rapid diagnosis and is considered the most sensitive for diagnosing aneurysms, but has the highest radiation exposure. Each of the three strategies used to diagnose subarachnoid hemorrhage has advantages and disadvantages with which clinicians should be familiar. Patient factors (e.g., age, body habitus, and risk factors), presentation factors (e.g., time from headache onset and severity of presentation), and institutional factors (availability of magnetic resonance imaging with magnetic resonance angiography) can influence the choice of protocol. Copyright © 2013 Elsevier Inc. All rights reserved.
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.
McCart, Michael R.; Sheidow, Ashli J.
Objective This article updates the earlier reviews of evidence-based psychosocial treatments for disruptive behavior in adolescents (Brestan & Eyberg, 1998; Eyberg, Nelson, & Boggs, 2008), focusing primarily on the treatment literature published from 2007 to 2014. Method Studies were identified through an extensive literature search and evaluated using Journal of Clinical Child and Adolescent Psychology (JCCAP) level of support criteria, which classify studies as well established, probably efficacious, possibly efficacious, experimental, or of questionable efficacy based on existing evidence. The JCCAP criteria have undergone modest changes in recent years. Thus, in addition to evaluating new studies from 2007–2014 for this update, all adolescent-focused articles that had been included in the 1998 and 2008 reviews were re-examined. In total, 86 empirical papers published over a 48-year period and covering 50 unique treatment protocols were identified and coded. Results Two multicomponent treatments that integrate strategies from family, behavioral, and cognitive-behavioral therapy met criteria as well established. Summaries are provided for those treatments, as well as for two additional multicomponent treatments and two cognitive-behavioral treatments that met criteria as probably efficacious. Treatments designated as possibly efficacious, experimental, or of questionable efficacy are listed. Additionally, moderator/mediator research is summarized. Conclusions Results indicate that since the prior reviews, there has been a noteworthy expansion of research on treatments for adolescent disruptive behavior, particularly treatments that are multicomponent in nature. Despite these advances, more research is needed to address key gaps in the field. Implications of the findings for future science and clinical practice are discussed. PMID:27152911
McCart, Michael R; Sheidow, Ashli J
This article updates the earlier reviews of evidence-based psychosocial treatments for disruptive behavior in adolescents (Brestan & Eyberg, 1998; Eyberg, Nelson, & Boggs, 2008), focusing primarily on the treatment literature published from 2007 to 2014. Studies were identified through an extensive literature search and evaluated using Journal of Clinical Child and Adolescent Psychology (JCCAP) level of support criteria, which classify studies as well-established, probably efficacious, possibly efficacious, experimental, or of questionable efficacy based on existing evidence. The JCCAP criteria have undergone modest changes in recent years. Thus, in addition to evaluating new studies from 2007 to 2014 for this update, all adolescent-focused articles that had been included in the 1998 and 2008 reviews were reexamined. In total, 86 empirical papers published over a 48-year period and covering 50 unique treatment protocols were identified and coded. Two multicomponent treatments that integrate strategies from family, behavioral, and cognitive-behavioral therapy met criteria as well-established. Summaries are provided for those treatments, as well as for two additional multicomponent treatments and two cognitive-behavioral treatments that met criteria as probably efficacious. Treatments designated as possibly efficacious, experimental, or of questionable efficacy are listed. In addition, moderator/mediator research is summarized. Results indicate that since the prior reviews, there has been a noteworthy expansion of research on treatments for adolescent disruptive behavior, particularly treatments that are multicomponent in nature. Despite these advances, more research is needed to address key gaps in the field. Implications of the findings for future science and clinical practice are discussed.
Full Text Available Over the past decades, road safety in highly-motorised countries has made significant progress. Although we have a fair understanding of the reasons for this progress, we don't have conclusive evidence for this. A new generation of road safety management approaches has entered road safety, starting when countries decided to guide themselves by setting quantitative targets (e.g. 50% less casualties in ten years' time. Setting realistic targets, designing strategies and action plans to achieve these targets and monitoring progress have resulted in more scientific research to support decision-making on these topics. Three subjects are key in this new approach of evidence-based and data-driven road safety management: ex-post and ex-ante evaluation of both individual interventions and intervention packages in road safety strategies, and transferability (external validity of the research results. In this article, we explore these subjects based on recent experiences in four jurisdictions (Western Australia, the Netherlands, Sweden and Switzerland. All four apply similar approaches and tools; differences are considered marginal. It is concluded that policy-making and political decisions were influenced to a great extent by the results of analysis and research. Nevertheless, to compensate for a relatively weak theoretical basis and to improve the power of this new approach, a number of issues will need further research. This includes ex-post and ex-ante evaluation, a better understanding of extrapolation of historical trends and the transferability of research results. This new approach cannot be realized without high-quality road safety data. Good data and knowledge are indispensable for this new and very promising approach.
Mehta, Nikisha; Marshman, Zoe
BackgroundThis systematic appraisal was conducted to determine if the Evidence-Based Dentistry Journal (EBDJ) acts as a reliable and contemporary source of knowledge for practitioners across all disciplines within dentistry.ObjectivesThe main objectives were to determine i) the year the articles were published and included in the EBDJ; ii) if the articles published covered all fields equally within dentistry; iii) the type of study design of the articles reported in the journal and; iv) the level of expertise of the writers of the commentaries.MethodsThis study used a systematic approach to assess the articles included in the journal. Data were extracted on the difference in the year the article was originally published and the year the article was included in the EBDJ, the number of articles in each dental discipline, the type of study designs included in the journal and the expertise of the commentators of each article. The information provided by the journal was validated by accessing the original articles through electronic databases.ResultsThe appraisal considered the 582 articles that met the inclusion criteria. Overall, 45.3% of the articles were included in the EBDJ in the same year and 44.8% of the articles were included a year after they were originally published. The number of articles varied across disciplines within dentistry: 23.7% from dental public health, 18.4% from periodontology and 11.8% from orthodontics, with only 4.6% from prosthodontics, 1% from oral pathology and 0.5% from dental materials. Most of the articles were systematic reviews and randomised controlled trials at 72% and 22.3% respectively. The writers of the commentaries were mostly academics and hospital consultants (71.2% and 13.6% commentators).ConclusionsOn the whole, it can be concluded that the journal acts as a reliable and contemporary source of knowledge/evidence for dentists, however, not all specialities within dentistry had equal coverage.
The papers included in this section represent the effort of the Task Force on Nutrition of the International Society of Geriatric Oncology to synthetize the evidence-based concepts on nutritional support of the elderly cancer patients. In the attempt of presenting a comprehensive overview of the topic, the panel included experts from different specialties: basic researchers, nutritionists, geriatricians, nurses, dieticians, gastroenterologists, oncologists. Cancer in elderly people is a growing problem. Not only in almost every country, the proportion of people aged over 60 years is growing faster than any other age group, but cancer per se is also a disease of old adult-elderly people, hence the oncologists face an increasing number of these patients both now and in the next years. The are several studies on nutrition of elderly subjects and many other on nutrition of cancer patients but relatively few specifically devoted to the nutritional support of the elderly cancer patients. However, the awareness that elderly subjects account for a high proportion of the mixed cancer patients population, in some way legitimates us to extend some conclusions of the literature also to the elderly cancer patients. Although the topics of this Experts' Consensus have been written by specialists in different areas of nutrition, the final message is addressed to the oncologists. Not only they should be more directly involved in the simplest steps of the nutritional care (recognition of the potential existence of a "nutritional risk" which can compromise the planned oncologic program, use of some oral supplements, etc.) but, as the true experts of the natural history of their cancer patient, they should also coordinate the process of the nutritional support, integrating this approach in the overall multidisciplinary cancer care. Copyright © 2015 Elsevier Inc. All rights reserved.
Steele, Michael; Crabb, Nicholas P; Moore, Lynda J; Reyher, Kristen K; Baillie, Sarah; Eisler, Mark C
Evidence-based veterinary medicine (EBVM) is of interest and relevance to veterinary practitioners. Consequently, veterinary schools take responsibility for teaching students how to appraise scientific articles and for equipping them with the skills needed to obtain and evaluate the best evidence and to apply this approach to their own cases. As part of our farm animal clinical rotation, we train students in qualitative and quantitative EBVM methods using an e-learning environment, online teaching materials, a wiki (a Web site that allows its users to edit its content via a Web browser), and face-to-face tutorials that support learning. Students working in small groups use a wiki to record details of the history, clinical presentation, diagnostic tests, herd data, and management plans for their chosen farm animal clinical cases. Using a standardized patient, intervention, comparison, and outcome (PICO) format, each group formulates a patient question based on either a proposed intervention or diagnostic procedure for the case and conducts an online scientific literature database search. The students appraise the articles retrieved using EBVM approaches and record the information in the wiki. The summation of this body of work, the group's critically appraised topic (CAT), includes the original PICO, a standardized table of the scientific evidence for the effectiveness of the intervention or diagnostic procedure, a summary statement in the form of a clinical bottom line, and their reflections upon the CAT. At the end of the rotation, students take part in a structured "CAT Club" where they present and discuss their findings with fellow students and clinicians.
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.
Full Text Available Abstract Objective – The primary objective was to examine online journal database usage statistics for a provincial ministry of health in the context of evidence based decision-making. In addition, the study highlights implementation of the Journal Access Centre (JAC that is housed and powered by the Ontario Ministry of Health and Long-Term Care (MOHLTC to inform health systems policy-making. Methods – This was a prospective case study using descriptive analysis of the JAC usage statistics of journal articles from January 2009 to September 2013. Results – JAC enables ministry employees to access approximately 12,000 journals with full-text articles. JAC usage statistics for the 2011-2012 calendar years demonstrate a steady level of activity in terms of searches, with monthly averages of 5,129. In 2009-2013, a total of 4,759 journal titles were accessed including 1,675 journals with full-text. Usage statistics demonstrate that the actual consumption was over 12,790 full-text downloaded articles or approximately 2,700 articles annually. Conclusion – JAC’s steady level of activities, revealed by the study, reflects continuous demand for JAC services and products. It testifies that access to online journal databases has become part of routine government knowledge management processes. MOHLTC’s broad area of responsibilities with dynamically changing priorities translates into the diverse information needs of its employees and a large set of required journals. Usage statistics indicate that MOHLTC information needs cannot be mapped to a reasonably compact set of “core” journals with a subsequent subscription to those.
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
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.
Marshall, T A; Straub-Morarend, C L; Guzman-Armstrong, S; McKernan, S C; Marchini, L; Handoo, N Q; Cunningham, M A
Assessment of evidence-based dentistry (EBD) knowledge and behaviour is hampered by lack of explicit competency criteria. This void impedes instructional design and assessment of student growth during the educational process. Knowledge and cognitive domains supporting educational objectives in a pre-doctoral dental programme were identified for each level of the EBD five-step process. We articulated educational objectives with behavioural expectations for each level of skill acquisition at each step of the EBD process. Outcome evaluation criteria identify students' progressive level of skill acquisition from novice to expert. The educational objectives, type of knowledge, and nature of the cognitive process supporting these objectives are presented for each step of the EBD process. For example, educational objectives of the "Ask" step include (i) to construct a question from the patient presentation and knowledge limitations that addresses the clinical problem and (ii) to articulate the Problem, Intervention/Exposure, Comparison, Outcome (PICO) components. Achievement of these objectives requires both factual information regarding the PICO format and the cognitive process of understanding. Educational outcome criteria consistent with a competent clinician include clear articulation of the PICO with identifiable pieces that relate to the clinical situation. Assessment strategies for progression towards EBD competency are limited due to the complexity associated with evaluating EBD knowledge and behaviours. To evaluate performance, the EBD academic community must define competency expectations for entry into unsupervised general dental practice. This framework offers measurable outcome evaluation criteria to initiate a conversation with academic peers regarding current gaps in EBD assessment. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Cortese, I.; Chaudhry, V.; So, Y.T.; Cantor, F.; Cornblath, D.R.; Rae-Grant, A.
Objective: To reassess the role of plasmapheresis in the treatment of neurologic disorders. Methods: We evaluated the available evidence based on a structured literature review for relevant articles from 1995 through September 2009. In addition, due to revision of the definitions of classification of evidence since the publication of the previous American Academy of Neurology assessment in 1996, the evidence cited in that manuscript was reviewed and reclassified. Results and Recommendations: Plasmapheresis is established as effective and should be offered in severe acute inflammatory demyelinating polyneuropathy (AIDP)/Guillain-Barré syndrome (GBS) and in the short-term management of chronic inflammatory demyelinating polyneuropathy (Class I studies, Level A). Plasmapheresis is established as ineffective and should not be offered for chronic or secondary progressive multiple sclerosis (MS) (Class I studies, Level A). Plasmapheresis is probably effective and should be considered for mild AIDP/GBS, as second-line treatment of steroid-resistant exacerbations in relapsing forms of MS, and for neuropathy associated with immunoglobulin A or immunoglobulin G gammopathy, based on at least one Class I or 2 Class II studies (Level B). Plasmapheresis is probably not effective and should not be considered for neuropathy associated with immunoglobulin M gammopathy, based on one Class I study (Level B). Plasmapheresis is possibly effective and may be considered for acute fulminant demyelinating CNS disease (Level C). There is insufficient evidence to support or refute the use of plasmapheresis for myasthenia gravis, pediatric autoimmune neuropsychiatric disorders associated with streptococcus infection, and Sydenham chorea (Class III evidence, Level U). PMID:21242498
Bernert, Rebecca A; Kim, Joanne S; Iwata, Naomi G; Perlis, Michael L
Increasing research indicates that sleep disturbances may confer increased risk for suicidal behaviors, including suicidal ideation, suicide attempts, and death by suicide. Despite increased investigation, a number of methodological problems present important limitations to the validity and generalizability of findings in this area, which warrant additional focus. To evaluate and delineate sleep disturbances as an evidence-based suicide risk factor, a systematic review of the extant literature was conducted with methodological considerations as a central focus. The following methodologic criteria were required for inclusion: the report (1) evaluated an index of sleep disturbance; (2) examined an outcome measure for suicidal behavior; (3) adjusted for presence of a depression diagnosis or depression severity, as a covariate; and (4) represented an original investigation as opposed to a chart review. Reports meeting inclusion criteria were further classified and reviewed according to: study design and timeframe; sample type and size; sleep disturbance, suicide risk, and depression covariate assessment measure(s); and presence of positive versus negative findings. Based on keyword search, the following search engines were used: PubMed and PsycINFO. Search criteria generated N = 82 articles representing original investigations focused on sleep disturbances and suicide outcomes. Of these, N = 18 met inclusion criteria for review based on systematic analysis. Of the reports identified, N = 18 evaluated insomnia or poor sleep quality symptoms, whereas N = 8 assessed nightmares in association with suicide risk. Despite considerable differences in study designs, samples, and assessment techniques, the comparison of such reports indicates preliminary, converging evidence for sleep disturbances as an empirical risk factor for suicidal behaviors, while highlighting important, future directions for increased investigation.
Rayan, Nadine; Barnes, Sunni; Fleming, Neil; Kudyakov, Rustam; Ballard, David; Gentilello, Larry M; Shafi, Shahid
We have preciously demonstrated that trauma patients receive less than two-thirds of the care recommended by evidence-based medicine. The purpose of this study was to identify patients least likely to receive optimal care. Records of a random sample of 774 patients admitted to a Level I trauma center (2006-2008) with moderate to severe injuries (Abbreviated Injury Scale score ≥3) were reviewed for compliance with 25 trauma-specific processes of care (T-POC) endorsed by Advanced Trauma Life Support, Eastern Association for the Surgery of Trauma, the Brain Trauma Foundation, Surgical Care Improvement Project, and the Glue Grant Consortium based on evidence or consensus. These encompassed all aspects of trauma care, including initial evaluation, resuscitation, operative care, critical care, rehabilitation, and injury prevention. Multivariate logistic regression was used to identify patients likely to receive recommended care. Study patients were eligible for a total of 2,603 T-POC, of which only 1,515 (58%) were provided to the patient. Compliance was highest for T-POC involving resuscitation (83%) and was lowest for neurosurgical interventions (17%). Increasing severity of head injuries was associated with lower compliance, while intensive care unit stay was associated with higher compliance. There was no relationship between compliance and patient demographics, socioeconomic status, overall injury severity, or daily volume of trauma admissions. Little over half of recommended care was delivered to trauma patients with moderate to severe injuries. Patients with increasing severity of traumatic brain injuries were least likely to receive optimal care. However, differences among patient subgroups are small in relation to the overall gap between observed and recommended care. II.
The National Library of Medicine: Evidenced-Based Information at Your Fingertips workshop is designed specifically for physicians attending the Community Medicine and Public Health Section portion of the National Medical Association 2010 Annual Convention and Scientific Assembly. This course seeks to address the digital divide issue by teaching participants to use the NLM resources and to improve their ability to use health information echnology to treat their patients and develop strategies to eliminate race-based disparities in health.
Egorova, S N; Akhmetova, T
pharmaceutical counseling standards: Article 1.1 "Code of Ethics of the pharmaceutical worker of Russia" states: "The main task of the professional activity of the pharmaceutical worker - protection of human health", Article 1.3 states that a pharmaceutical worker must take professional decisions solely in the interests of a patient . However, the pharmacy is a trade organization, thus as a retailer the pharmacy is directly interested in making profits and increasing sales of pharmaceutical products, including non-prescription medicines. Moreover, while the clinical medicine is monitored for unjustified prescribing and measures are being taken to prevent polypharmacy, for a pharmacist the growing sales of over-the-counter drugs, active promotion of dietary supplements, homeopathic medicines, medical devices, and, consequently, an increase of financial indicators (particularly "average purchase size") - all are characteristics of success .Rational use of over-the-counter medicines requires introduction of pharmaceutical counseling standards (pharmaceutical care) according to symptoms - major reasons to visit a pharmacy as part of responsible self-medication (cold, sore throat, headache, diarrhea, etc.). Standards of pharmaceutical counseling should be objective, reliable and up-to-date and contain recommendations for the rational use of over-the-counter drugs as well as indications requiring treatment to the doctor. Standardization of pharmaceutical counseling in terms of Evidence-based Pharmacy would enhance the efficiency, safety and cost-effectiveness of over-the-counter medicines.Currently, the lack of clinical component in the higher pharmaceutical education and the lack of approved standards of pharmaceutical counseling lead to the introduction of cross-selling technologies (which are broadly applied in other areas of trade, for example, the offer of a boot-polish during the sale of shoes) to the pharmaceutical practice [2, 3]. However, drugs belong to a special group
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.
Sinclair, Donald C
Identify an evidence-based paradigm for the determination of causation of occupational injury and illness litigation. The Westlaw and LexisNexis databases were used to identify legal principles governing the admissibility of scientific evidence in legal proceedings. The Medline database was referenced to identify evidence-based methods for the determination of causation complying with legal precepts for the admissibility of scientific testimony. Expert witness testimony must be relevant and reliable. Testimony must be sufficiently based on reliable facts and data. Testimony must be the product of reliable principles or methods. The witness must have reliably applied the principles and methods to the facts of the case. Conscientious application of the National Institute for Occupational Safety and Health Guide for the Determination of Work-Relatedness of Disease, as adapted, comforts with legal prerequisites for the admissibility of scientific evidence in medicolegal proceedings.
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...
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.
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
Williams, Hywel C
The need for understanding and reflecting on evidence-based dermatology (EBD) has never been greater given the exponential growth of new external evidence to inform clinical practice. Like any other branch of medicine, dermatologists need to acquire new skills in constructing answerable questions, efficiently searching electronic bibliographic databases, and critically appraising different types of studies. Secondary summaries of evidence in the form of systematic reviews (SR), that is, reviews that are conducted in a systematic, unbiased and explicit manner, reside at the top of the evidence hierarchy, because they are less prone to bias than traditional expert reviews. In addition to providing summaries of the best external evidence, systematic reviews and randomized controlled trials (RCTs) are also powerful ways of identifying research gaps and ultimately setting the agenda of future clinical research in dermatology. But like any paradigm, EBD can have its limitations. Wrong application, misuse and overuse of EBD can have serious consequences. For example, mindless pooling together of data from dissimilar studies in a meta-analysis may render it a form of reductionism that does not make any sense. Similarly, even highly protocolised study designs such as SRs and RCTs are still susceptible to some degree of dishonesty and bias. Over-reliance on randomized controlled trials (RCT) may be inappropriate, as RCTs are not a good source for picking up rare but important adverse effects such as lupus syndrome with minocycline. A common criticism leveled against SRs is that these frequently conclude that there is lack of sufficient evidence to inform current clinical practice, but arguably, such a perception is grounded more on the interpretation of the SRs than anything else. The apparent absence of evidence should not paralyze the dermatologist to adopt a state of therapeutic nihilism. Poor primary data and an SR based on evidence that is not up-to-date are also
Full Text Available New dissemination methods are needed to engage physicians in evidence-based continuing medical education (CME.To examine the effectiveness of social media in engaging physicians in non-industry-sponsored CME.We tested the effect of different media platforms (e-mail, Facebook, paid Facebook and Twitter, CME topics, and different "hooks" (e.g., Q&A, clinical pearl and best evidence on driving clicks to a landing site featuring non-industry sponsored CME. We modelled the effects of social media platform, CME topic, and hook using negative binomial regression on clicks to a single landing site. We used clicks to landing site adjusted for exposure and message number to calculate rate ratios. To understand how physicians interact with CME content on social media, we also conducted interviews with 10 physicians.The National Physicians Alliance (NPA membership.NPA e-mail recipients, Facebook followers and friends, and Twitter followers.Clicks to the NPA's CME landing site.On average, 4,544 recipients received each message. Messages generated a total of 592 clicks to the landing site, for a rate of 5.4 clicks per 1000 recipients exposed. There were 5.4 clicks from e-mail, 11.9 clicks from Facebook, 5.5 clicks from paid Facebook, and 6.9 clicks from Twitter to the landing site for 1000 physicians exposed to each of 4 selected CME modules. A Facebook post generated 2.3x as many clicks to the landing site as did an e-mail after controlling for participant exposure, hook type and CME topic (p<0.001. Twitter posts (p = 0.13 and paid Facebook posts (p = 0.06 were not statistically different from e-mail in generating clicks to the landing site. Use of different hooks to engage physicians had no impact on clicks to the landing site. Interviews with physicians suggested that social media might not be a preferred vehicle for disseminating CME.Social media has a modest impact on driving traffic to evidence-based CME options. Facebook had a superior effect on
Little, Hannah Byrd
Why is it important to prove that school libraries add value to the school program? The National Center for Education Statistics reports that 20 percent of U.S. public schools lack a full or part-time certified librarian (NCES 2013). In California the ratio of certified school librarians to students is 1:7,374 (California Department of Education…
Full Text Available Abstract Background The objectives of this study were: a to examine physician attitudes to and experience of the practice of evidence-based medicine (EBM in primary care; b to investigate the influence of patient preferences on clinical decision-making; and c to explore the role of intuition in family practice. Method Qualitative analysis of semi-structured interviews of 15 family physicians purposively selected from respondents to a national survey on EBM mailed to a random sample of Canadian family physicians. Results Participants mainly welcomed the promotion of EBM in the primary care setting. A significant number of barriers and limitations to the implementation of EBM were identified. EBM is perceived by some physicians as a devaluation of the 'art of medicine' and a threat to their professional/clinical autonomy. Issues regarding the trustworthiness and credibility of evidence were of great concern, especially with respect to the influence of the pharmaceutical industry. Attempts to become more evidence-based often result in the experience of conflicts. Patient factors exert a powerful influence on clinical decision-making and can serve as trumps to research evidence. A widespread belief that intuition plays a vital role in primary care reinforced views that research evidence must be considered alongside other factors such as patient preferences and the clinical judgement and experience of the physician. Discussion Primary care physicians are increasingly keen to consider research evidence in clinical decision-making, but there are significant concerns about the current model of EBM. Our findings support the proposed revisions to EBM wherein greater emphasis is placed on clinical expertise and patient preferences, both of which remain powerful influences on physician behaviour.
Rico, María Antonieta; Kraychete, Durval Campos; Iskandar, Aziza Jreige; Colimon, Frantz; Lara-Solares, Argelia; Cantisani, José Alberto Flores; Amescua-García, César; Núñez, María del Rocío Guillén; Bonilla, Patricia; Lech, Osvandré; Hernández-Castro, John Jairo; Guerrero, Carlos; Barrera, William Delgado; Gallegos, Manuel Sempértegui; Cook, María Berenguel; Garcia, João Batista Santos; Hernández, Concepción Pérez
The subject of this publication has been focused on local considerations for facilitating regional best practice, including identifying and uniformly adopting the most relevant international guidelines on opioid use (OU) in chronic pain management. The Change Pain Latin America (CPLA) Advisory Panel conducted a comprehensive, robust, and critical analysis of published national and international reviews and guidelines of OU, considering those most appropriate for Latin America. A PubMed search was conducted using the terms "opioid," "chronic," and "pain" and then refined using the filters "practice guidelines" and "within the last 5 years" (2007-2012). Once the publications were identified, they were selected using five key criteria: "Evidence based," "Comprehensive," "From a well-recognized source," "Current publications," and "Based on best practice" and then critically analyzed considering 10 key criteria for determining the most relevant guidelines to be applied in Latin America. The initial PubMed search identified 177 reviews and guidelines, which was reduced to 16 articles using the five preliminary criteria. After a secondary analysis according to the 10 key criteria specific to OU in Latin America, 10 publications were selected for critical review and discussion. The CPLA advisory panel considered the "Safe and effective use of opioids for chronic non-cancer pain" (published in 2010 by the NOUGG of Canada) to be valid, relevant to Latin America, practical, evidence-based, concise, unambiguous, and sufficiently educational to provide clear instruction on OU and pain management and, thus, recommended for uniform adoption across the Latin America region. © 2015 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: email@example.com.
Full Text Available Abstract Background This study implemented and evaluated a point-of-care, wireless Internet access using smart phones for information retrieval during daily clinical rounds and academic activities of internal medicine residents in a community hospital. We did the project to assess the feasibility of using smart phones as an alternative to reach online medical resources because we were unable to find previous studies of this type. In addition, we wanted to learn what Web-based information resources internal medicine residents were using and whether providing bedside, real-time access to medical information would be perceived useful for patient care and academic activities. Methods We equipped the medical teams in the hospital wards with smart phones (mobile phone/PDA hybrid devices to provide immediate access to evidence-based resources developed at the National Library of Medicine as well as to other medical Websites. The emphasis of this project was to measure the convenience and feasibility of real-time access to current medical literature using smart phones. Results The smart phones provided real-time mobile access to medical literature during daily rounds and clinical activities in the hospital. Physicians found these devices easy to use. A post-study survey showed that the information retrieved was perceived to be useful for patient care and academic activities. Conclusion In community hospitals and ambulatory clinics without wireless networks where the majority of physicians work, real-time access to current medical literature may be achieved through smart phones. Immediate availability of reliable and updated information obtained from authoritative sources on the Web makes evidence-based practice in a community hospital a reality.
Full Text Available Introduction Epilepsy is a prolonged disorder characterized by repeated violent epileptic seizures. Its managements depend on proper classification of the seizure category and the epileptic pattern. Levetiracetam (Keppra® has been approved as monotherapy or for adjunctive management of partial onset seizures, juvenile myoclonic epilepsy, and idiopathic generalized epilepsy. Case reporting of levetiracetam polypharmacy shows adverse effects linked to evidence-based clinical and laboratory data in two patients with epilepsy. Case reporting of levetiracetam polypharmacy, based on evidence-based clinical and laboratory data was of interest that investigated. Case Presentation Two cases were studied, one patient was a 32-year-old male and the other was a 14-year-old female. The key words relevant to search topics were surveyed using PubMed (United States national library of medicine. Articles related to the levetiracetam prescription in epileptic patients were selected and considered separately. Pharmacotherapy based on levetiracetam, primidone, phenytoin, and topiramate in a 32-year-old epileptic male showed a decrease in white blood cell count (3400 cells/mcL, red blood cell count (4.4 mil/mm3 hemoglobin (11.8 g/dL and hematocrit (36.7%. The drug regimen for the 14-year-old epileptic female was a levetiracetam polypharmacy in combination with primidone and sodium-valproate simultaneously. In this patient, there was a decrease in hemoglobin (10.4 g/dL and hematocrit (34%. An increase in lymphocyte (84% was also observed. Conclusions Administration of AEDs in general and levetiracetam in particular should be based on attention to pharmacokinetic behavior in terms of monotherapy or polypharmacy.
León, Sergio A; Fontelo, Paul; Green, Linda; Ackerman, Michael; Liu, Fang
This study implemented and evaluated a point-of-care, wireless Internet access using smart phones for information retrieval during daily clinical rounds and academic activities of internal medicine residents in a community hospital. We did the project to assess the feasibility of using smart phones as an alternative to reach online medical resources because we were unable to find previous studies of this type. In addition, we wanted to learn what Web-based information resources internal medicine residents were using and whether providing bedside, real-time access to medical information would be perceived useful for patient care and academic activities. We equipped the medical teams in the hospital wards with smart phones (mobile phone/PDA hybrid devices) to provide immediate access to evidence-based resources developed at the National Library of Medicine as well as to other medical Websites. The emphasis of this project was to measure the convenience and feasibility of real-time access to current medical literature using smart phones. The smart phones provided real-time mobile access to medical literature during daily rounds and clinical activities in the hospital. Physicians found these devices easy to use. A post-study survey showed that the information retrieved was perceived to be useful for patient care and academic activities. In community hospitals and ambulatory clinics without wireless networks where the majority of physicians work, real-time access to current medical literature may be achieved through smart phones. Immediate availability of reliable and updated information obtained from authoritative sources on the Web makes evidence-based practice in a community hospital a reality.
Al-Taweel, Dalal M; Alsuwaidan, Mohammad
Background The goal of evidence-based clinical practice has led to an increased interest in the development of tools to measure adherence to national guidelines in different diseases. This aids in detecting and measuring inappropriate prescribing to specific patient groups by using quality standards extracted from evidence-based guidelines, and ultimately provide the basis of consistent standardized prescribing. Objective To design and validate a medication assessment tool to assess prescribers' adherence to international guideline recommendations in the management of bipolar disorder (MATBD). Setting Outpatient psychiatry clinic at a secondary healthcare setting in Kuwait. Method International guidelines concerned with the management of bipolar disorder were reviewed in order to develop MATBD. Face and content validity of the developed tool (MATBD) was performed with a research and expert group. A 4-point Likert scale was used to assess the expert group's level of agreement to individual criterion. Content validity ratio (CVR) was calculated for each criterion (n = 54) and the content validity index (CVI) was calculated for each section (n = 5) of the MATBD. Finally, feasibility testing was performed on 19 patient records to confirm the tool's fitness for purpose. Main Outcomes Measure Perceived relevance, utility, and clarity of individual criteria, and reliability of their application to clinical settings. Results Face validity and content validity were achieved with a research and expert group (n = 14). Content validity ratio (CVR) was demonstrated for 54 criteria; criteria with a negative CVR were removed. This resulted in a draft MATBD comprising of 52 criteria (CVI: 0.814). Feasibility testing on 19 patients' records resulted in a final MATBD comprising of 49 criteria divided into 3 sections: initial assessment, acute management and monitoring. Conclusion A medication assessment tool was developed and validated to be used as a means of profiling
This book considers all aspects of infusion therapy and provides a solid evidence base. Its 30 chapters are well organised into six sections covering physiological considerations, infusion therapies and nursing practice.
In April 2008, the Medical Advisory Secretariat began an evidence-based review of the literature concerning pressure ulcers.Please visit the Medical Advisory Secretariat Web site, http://www.health.gov.on.ca/english/providers/program/mas/tech/tech_mn.html to review these titles that are currently available within the Pressure Ulcers series.PRESSURE ULCER PREVENTION: an evidence based analysisThe cost-effectiveness of prevention strategies for pressure ulcers in long-term care homes in Ontario: projections of the Ontario Pressure Ulcer Model (field evaluation)MANAGEMENT OF CHRONIC PRESSURE ULCERS: an evidence-based analysis The Medical Advisory Secretariat (MAS) conducted a systematic review on interventions used to treat pressure ulcers in order to answer the following questions: Do currently available interventions for the treatment of pressure ulcers increase the healing rate of pressure ulcers compared with standard care, a placebo, or other similar interventions?Within each category of intervention, which one is most effective in promoting the healing of existing pressure ulcers? A pressure ulcer is a localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in conjunction with shear and/or friction. Many areas of the body, especially the sacrum and the heel, are prone to the development of pressure ulcers. People with impaired mobility (e.g., stroke or spinal cord injury patients) are most vulnerable to pressure ulcers. Other factors that predispose people to pressure ulcer formation are poor nutrition, poor sensation, urinary and fecal incontinence, and poor overall physical and mental health. The prevalence of pressure ulcers in Ontario has been estimated to range from a median of 22.1% in community settings to a median of 29.9% in nonacute care facilities. Pressure ulcers have been shown to increase the risk of mortality among geriatric patients by as much as 400%, to increase the frequency
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.
Kehlet, H.; Wilmore, D.W.
BACKGROUND: Optimization of postoperative outcome requires the application of evidence-based principles of care carefully integrated into a multimodal rehabilitation program. OBJECTIVE: To assess, synthesize, and discuss implementation of "fast-track" recovery programs. DATA SOURCES: Medline MBASE......, despite being based on a combination of evidence-based unimodal principles of care, recent surveys have demonstrated slow adaptation and implementation of the fast-track methodology. CONCLUSION: Multimodal evidence-based care within the fast-track methodology significantly enhances postoperative recovery...
.... It is illuminated how two opposing approaches to nursing of hhumanisticallyand pluralistically oriented caring, and evidence-based scientifically oriented curing inform nursing in the department...