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Sample records for evidence-based management strategies

  1. Strategies for Teaching Evidence-Based Management: What Management Educators Can Learn from Medicine

    Science.gov (United States)

    Wright, April L.; Middleton, Stuart; Greenfield, Geoffrey; Williams, Julian; Brazil, Victoria

    2016-01-01

    Evidence-based management (EBMgt) is a growing literature stream in management education which contends that management decision making should be informed by the best available scientific evidence (Rousseau, 2006). Encouraged by the success of evidence-based practice in the field of medicine, advocates of EBMgt have increasingly called for…

  2. Evidence-Based Medicine in Managed Care: A Survey of Current and Emerging Strategies

    Science.gov (United States)

    Keckley, Paul H

    2004-01-01

    Background Evidence-based medicine is the “conscientious application of scientific best practice by clinicians in concert with patient understanding and values.”[1] Recent studies by the Institute of Medicine, RAND, and others have called attention to the gap between scientifically supported approaches to care and day-to-day practice by clinicians. Compounding the problem of non-adherence by providers, researchers have observed that patient compliance also falls short. As a result, avoidable costs from inappropriate variability in practice patterns coupled with patient noncompliance are a significant focus of managed care. Managed care plans play a key role in the selection of providers by consumers and in the design of benefits programs by employers. Avoidable costs from misuse, overuse, and under-use of care from clinicians is a strategic focus for health plans. The evidence upon which a plan makes coverage decisions and the incorporation of evidence in programs targeting providers, employers, and consumers was a focus of this study. Methodology A Delphi survey and 2-day interactive sessions with 128 clinical program directors and medical officers from 89 health plans were the primary methods used in this descriptive analysis. To test participant applications of evidence-based medicine in health plan medical management strategy, 3 conditions were used for illustrative purpose: managing rheumatoid arthritis, increasing remission in depression, and reducing heart disease among diabetics. Each provided a unique challenge to plans in terms of condition prevalence, strength of evidence, and cost. Key Findings Health plans incorporate evidence-based medicine in 5 areas overseen by medical management: (1) coverage decisions wherein improvements in pharmaceutical and therapeutic review processes are sought, (2) disease management efforts wherein increased attention to secondary prevention is desirable, (3) provider profiling wherein increased use of adherence

  3. Evidence-based management reconsidered.

    Science.gov (United States)

    Kovner, Anthony R; Rundall, Thomas G

    2006-01-01

    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.

  4. Project management office in health care: a key strategy to support evidence-based practice change.

    Science.gov (United States)

    Lavoie-Tremblay, Mélanie; Bonneville-Roussy, Arielle; Richer, Marie-Claire; Aubry, Monique; Vezina, Michel; Deme, Mariama

    2012-01-01

    This article describes the contribution of a Transition Support Office (TSO) in a health care center in Canada to supporting changes in practice based on evidence and organizational performance in the early phase of a major organizational change. Semistructured individual interviews were conducted with 11 members of the TSO and 13 managers and clinicians from an ambulatory sector in the organization who received support from the TSO. The main themes addressed in the interviews were the description of the TSO, the context of implementation, and the impact. Using the Competing Value Framework by Quinn and Rohrbaugh [Public Product Rev. 1981;5(2):122-140], results revealed that the TSO is a source of expertise that facilitates innovation and implementation of change. It provides material support and human expertise for evidence-based projects. As a single organizational entity responsible for managing change, it gives a sense of cohesiveness. It also facilitates communication among human resources of the entire organization. The TSO is seen as an expertise provider that promotes competency development, training, and evidence-based practices. The impact of a TSO on change in practices and organizational performance in a health care system is discussed.

  5. The Caries Management System: an evidence-based preventive strategy for dental practitioners. Application for adults.

    Science.gov (United States)

    Evans, R W; Pakdaman, A; Dennison, P J; Howe, E L C

    2008-03-01

    In the absence of effective caries preventive methods, operative care became established as the means for caries control in general practice. Water fluoridation resulted in a declining caries incidence which decreased further following the advent of fluoridated toothpaste. The challenge today is to develop a non-invasive model of practice that will sustain a low level of primary caries experience in the younger generation and reduce risk of caries experience in the older generations. The Caries Management System is a ten step non-invasive strategy to arrest and remineralize early lesions. The governing principle of this system is that caries management must include consideration of the patient at risk, the status of each lesion, patient management, clinical management and monitoring. Both dental caries risk and treatment are managed according to a set of protocols that are applied at various steps throughout patient consultation and treatment. The anticipated outcome of implementing the Caries Management System in general dental practice is reduction in caries incidence and increased patient satisfaction. Since the attainment and maintenance of oral health is determined mainly by controlling both caries and periodontal disease, the implementation of the Caries Management System in general practice will promote both outcomes.

  6. Managing heat and immune stress in athletes with evidence-based strategies.

    Science.gov (United States)

    Pyne, David B; Guy, Joshua H; Edwards, Andrew M

    2014-09-01

    Heat and immune stress can affect athletes in a wide range of sports and environmental conditions. The classical thermoregulatory model of heat stress has been well characterized, as has a wide range of practical strategies largely centered on cooling and heat-acclimation training. In the last decade evidence has emerged of an inflammatory pathway that can also contribute to heat stress. Studies are now addressing the complex and dynamic interplay between hyperthermia, the coagulation cascade, and a systemic inflammatory response occurring after transient damage to the gastrointestinal tract. Damage to the intestinal mucosal membrane increases permeability, resulting in leakage of endotoxins into the circulation. Practical strategies that target both thermoregulatory and inflammatory causes of heat stress include precooling; short-term heat-acclimation training; nutritional countermeasures including hydration, energy replacement, and probiotic supplementation; pacing strategies during events; and postevent cooling measures. Cooperation between international, national, and local sporting organizations is required to ensure that heat-management policies and strategies are implemented effectively to promote athletes' well-being and performance.

  7. Increasing Teachers' Use of Evidence-Based Classroom Management Strategies through Consultation: Overview and Case Studies

    Science.gov (United States)

    MacSuga, Ashley S.; Simonsen, Brandi

    2011-01-01

    Many classroom teachers are faced with challenging student behaviors that impact their ability to facilitate learning in productive, safe environments. At the same time, high-stakes testing, increased emphasis on evidence-based instruction, data-based decision making, and response-to-intervention models have put heavy demands on teacher time and…

  8. Evidence-Based Management Education

    Science.gov (United States)

    Burke-Smalley, Lisa A.

    2014-01-01

    In this rejoinder to "Let's Burn Them All: Reflections on the Learning-Inhibitory Nature of Introduction to Management and Introduction to Organizational Behavior Textbooks," by Robert A. Snyder (see EJ1039748), Lisa Burke-Smalley touches upon a number of Snyder's claims and explores questions sparked by his essay. She argues…

  9. Alphabet Strategy for diabetes care: A multi-professional, evidence-based, outcome-directed approach to management.

    Science.gov (United States)

    Lee, James D; Saravanan, Ponnusamy; Patel, Vinod

    2015-06-25

    With the rising global prevalence in diabetes, healthcare systems are facing a growing challenge to provide efficient and effective diabetes care management in the face of spiralling treatment costs. Diabetes is a major cause of premature mortality and associated with devastating complications especially if managed poorly. Although diabetes care is improving in England and Wales, recent audit data suggests care remains imperfect with wide geographical variations in quality. Diabetes care is expensive with a sizeable amount of available expenditure used for treating the complications of diabetes. A target driven, long-term, multifactorial intervention in patients with type 2 diabetes has been shown to reduce mortality and morbidity. The alphabet strategy is a novel approach to effective diabetes care provision, aiming to address patient education and empowerment, provide consistent comprehensive care delivered in a timely fashion, and allowing multidisciplinary team work.

  10. Evidence-based management of recurrent miscarriages

    Directory of Open Access Journals (Sweden)

    Yadava B Jeve

    2014-01-01

    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.

  11. Perception Of Nursing Middle Managers About The Evidence-Based Management

    Directory of Open Access Journals (Sweden)

    Wilza Carla Spiri

    2017-02-01

    Full Text Available Objective: to comprehend the experience of nursing middle managers of an accredited public hospital, from São Paulo state, about the evidence-based management. Method: case study and analysis of thematic content in the stages of unity of meaning, condensed meaning unity, interpretation of the underlying meaning, sub-theme and theme. Nine manager nurses participated. The data collection was done through a script with questions that, according to the convenience of the participants, were answered by electronic mail. The data were analyzed in the light of the theoretical reference of the managerial process in nursing and the evidence-based management. Results: six themes were revealed: Evidence-based management and management process; Evidence-based management strengths; Evidence-based management challenges; the leader and the Evidence-based management; Hospital accreditation and evidence-based management and Experiences with the evidence-based management. Conclusion: the scientific knowledge and the experiences in the work are sources of evidences that interfere, positively, in the quality and safety of the patient. Leadership training, planning, team empowerment and involvement are essential for the development of this practice. Strategies need to be discussed and implemented so that the management process is based on evidences.

  12. Management of chronic recurrent osteitis pubis/pubic bone stress in a Premier League footballer: Evaluating the evidence base and application of a nine-point management strategy.

    Science.gov (United States)

    McAleer, Stephen S; Gille, Justus; Bark, Stefan; Riepenhof, Helge

    2015-08-01

    The aim of this paper was to use a clinical example to describe a treatment strategy for the management of recurrent chronic groin pain and evaluate the evidence of the interventions. A professional footballer presented with chronic recurrent OP/PBS. The injury was managed successfully with a nine-point programme - 1. Acute pharmacological management. 2. Tone reduction of over-active structures. 3. Improved ROM at hips, pelvis and thorax. 4. Adductor strength. 5. Functional movement assessment. 6. Core stability. 7. Lumbo-pelvic control. 8. Gym-based strengthening. 9. Field-based conditioning/rehabilitation. The evidence for these interventions is reviewed. The player returned to full training and match play within 41 and 50 days, respectively, and experienced no recurrence of his symptoms in follow up at 13 months. This case report displays a nine-point conservative management strategy for OP/PBS, with non-time dependent clinical objective markers as the progression criteria in a Premier League football player. Copyright © 2015 Elsevier Ltd. All rights reserved.

  13. Evidence-Based Interactive Management of Change

    Directory of Open Access Journals (Sweden)

    Albert Fleischmann

    2011-06-01

    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.

  14. Book Review: Deployment Psychology: Evidence-based strategies ...

    African Journals Online (AJOL)

    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

  15. Evidence-based strategies in weight-loss mobile apps.

    Science.gov (United States)

    Pagoto, Sherry; Schneider, Kristin; Jojic, Mirjana; DeBiasse, Michele; Mann, Devin

    2013-11-01

    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.

  16. Proposing an Evidence-Based Strategy for Software Requirements Engineering.

    Science.gov (United States)

    Lindoerfer, Doris; Mansmann, Ulrich

    2016-01-01

    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.

  17. Practice Patterns Compared with Evidence-based Strategies for the Management of Androgen Deprivation Therapy-Induced Side Effects in Prostate Cancer Patients: Results of a European Web-based Survey.

    Science.gov (United States)

    Bultijnck, Renée; Surcel, Cristian; Ploussard, Guillaume; Briganti, Alberto; De Visschere, Pieter; Fütterer, Jurgen; Ghadjar, Pirus; Giannarini, Gianluca; Isbarn, Hendrik; Massard, Christophe; Sooriakumaran, Prasanna; Valerio, Massimo; van den Bergh, Roderick; Ost, Piet

    2016-12-01

    Evidence-based recommendations are available for the management of androgen deprivation therapy (ADT)-induced side effects; however, there are no data on the implementation of the recommendations into daily practice patterns. To compare practice patterns in the management of ADT-induced side effects with evidence-based strategies. A European Web-based survey was conducted from January 16, 2015, to June 24, 2015. The 25-item questionnaire was designed with the aid of expert opinion and covered general respondent information, ADT preference per disease stage, patient communication on ADT-induced side effects, and strategies to mitigate side effects. All questions referred to patients with long-term ADT use. Reported practice patterns were compared with available evidence-based strategies. Following data collection, descriptive statistics were used for analysis. Frequency distributions were compiled and compared using a generalised chi-square test. In total, 489 eligible respondents completed the survey. Luteinising hormone-releasing hormone-agonist with or without an antiandrogen was the preferred method of ADT in different settings. Patients were well informed about loss of libido (90%), hot flushes (85%), fatigue (67%), and osteoporosis (63%). An osteoporotic and metabolic risk assessment prior to commencing ADT was done by one-quarter of physicians. The majority (85%) took preventive measures and applied at least one evidence-based strategy. Exercise was recommended by three-quarters of physicians who advocate its positive effects; however, only 25% of physicians had access to exercise programmes. Although the minimum sample size was set at 400 participants, the current survey remains susceptible to volunteer and nonresponder bias. Patients were well informed about several ADT-induced complications but uncommonly underwent an osteoporotic and metabolic risk assessment. Nevertheless, physicians partially provided evidence-based strategies for the management of the

  18. Pharmacologic management of neuropathic pain: Evidence-based recommendations

    DEFF Research Database (Denmark)

    Dworkin, Robert H.; O'Connor, Alec B.; Backonja, Miroslav

    2007-01-01

    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...

  19. Management of the infertile couple: an evidence-based protocol

    Directory of Open Access Journals (Sweden)

    Kamel Remah M

    2010-03-01

    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.

  20. PROSPECT: evidence-based, procedure-specific postoperative pain management.

    Science.gov (United States)

    Kehlet, Henrik; Wilkinson, Roseanne C; Fischer, H Barrie J; Camu, Frederic

    2007-03-01

    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.

  1. Evidence-based management of pain after haemorrhoidectomy surgery

    DEFF Research Database (Denmark)

    Joshi, G P; Neugebauer, E A M; Kehlet, Henrik

    2010-01-01

    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....

  2. Evidence-based management for preeclampsia.

    Science.gov (United States)

    von Dadelszen, Peter; Menzies, Jennifer; Gilgoff, Sarah; Xie, Fang; Douglas, M Joanne; Sawchuck, Diane; Magee, Laura A

    2007-05-01

    This review reflects both the variable presentation and the systemic nature of preeclampsia. Recommendations for the comprehensive evaluation and management of organ dysfunction associated with pre-eclampsia are included. The main points in the review are that: (1) Preeclampsia is a systemic disorder that may affect many organ systems. (2) For preeclampsia remote from term (management improves perinatal outcomes, but requires obsessive surveillance to mitigate maternal risks and is a "package." (3) Initial assessment and ongoing surveillance of women with preeclampsia should include assessment of all vulnerable maternal organs as well as of the fetus. (4) Initiate antihypertensive drug treatment immediately if sBP >160 mmHg or dBP more than 110 mmHg, or if sBP 140-159 mmHg and/or dBP 85-109 mmHg (prepregnancy renal disease or diabetes). (5) The treatment of nonsevere pregnancy hypertension should include a treatment goal of dBP 80-105 mmHg (depending on practitioner preference), with one of the following agents, Methyldopa, Labetalol, Nifedipine, or, with special indications (renal or cardiac diseases), diuretics. (6) Drugs to avoid: angiotensin-converting enzyme inhibitors; angiotensin II receptor antagonists; and atenolol. (7) For the acute management of severe hypertension, initially reduce dBP by 10 mmHg and maintain the blood pressure at or below that level with either Nifedipine or Labetalol. (8) For both prophylaxis against and treatment of eclampsia, MgSO4 (4 g IV stat, then 1 g/hr). (9) For recurrent seizures, MgSO4 (2g IV stat, then increase to 1.5 g/hr). (10) Total fluid intake should not exceed 80 ml/hr; tolerate urine outputs as low as 10 ml/hr. (11) Early-onset and/or severe preeclampsia predict later cardiovascular morbidity and mortality; it would seem prudent to offer such women screening and lipid lowering interventions.

  3. Evidence-Based Library Management: The Leadership Challenge

    Science.gov (United States)

    Lakos, Amos

    2007-01-01

    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…

  4. Diabetic foot ulcers – evidence-based wound management

    African Journals Online (AJOL)

    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.

  5. Diabetic foot ulcers – evidence-based wound management: A ...

    African Journals Online (AJOL)

    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 ...

  6. Evidence-based and data-driven road safety management

    Directory of Open Access Journals (Sweden)

    Fred Wegman

    2015-07-01

    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.

  7. [Evidence-based management of medical disposable materials].

    Science.gov (United States)

    Yang, Hai

    2009-03-01

    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.

  8. [Strategy for promoting evidence-based nursing practice in hospital].

    Science.gov (United States)

    Chen, Yu-Chih; Tang, Lee-Chun; Chou, Shin-Shang

    2013-10-01

    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.

  9. Sustainability of Evidence-Based Acute Pain Management Practices for Hospitalized Older Adults.

    Science.gov (United States)

    Shuman, Clayton J; Xie, Xian-Jin; Herr, Keela A; Titler, Marita G

    2017-11-01

    Little is known regarding sustainability of evidence-based practices (EBPs) following implementation. This article reports sustainability of evidence-based acute pain management practices in hospitalized older adults following testing of a multifaceted Translating Research Into Practice (TRIP) implementation intervention. A cluster randomized trial with follow-up period was conducted in 12 Midwest U.S. hospitals (six experimental, six comparison). Use of evidence-based acute pain management practices and mean pain intensity were analyzed using generalized estimating equations across two time points (following implementation and 18 months later) to determine sustainability of TRIP intervention effects. Summative Index scores and six of seven practices were sustained. Experimental and comparison group differences for mean pain intensity over 72 hours following admission were sustained. Results revealed most evidence-based acute pain management practices were sustained for 18 months following implementation. Further work is needed to identify factors affecting sustainability of EBPs to guide development and testing of sustainability strategies.

  10. 114: STRATEGIES FOR HOLDING SUCCESSFUL EVIDENCE-BASED JOURNAL CLUBS IN THE HEALTH MANAGEMENT AND MEDICAL INFORMATICS FACULTY OF KERMAN UNIVERSITY OF MEDICAL SCIENCES

    National Research Council Canada - National Science Library

    Fatemeh Motamedi; Leila Tavakkoli; Narges Khanjani

    2017-01-01

    ...; in different fields of medical sciences. Methods: This qualitative content analysis study was done by interviewing nine academics and graduate students at the Department of Librarianship at the Faculty of Health Management and Medical Informatics...

  11. Evaluation of Evidence-based Nursing Pain Management Practice.

    Science.gov (United States)

    Song, Wenjia; Eaton, Linda H; Gordon, Debra B; Hoyle, Christine; Doorenbos, Ardith Z

    2015-08-01

    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.

  12. Organizational change strategies for evidence-based practice.

    Science.gov (United States)

    Newhouse, Robin P; Dearholt, Sandi; Poe, Stephanie; Pugh, Linda C; White, Kathleen M

    2007-12-01

    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.

  13. Apprehensions of nurse managers on evidence-based practice

    Directory of Open Access Journals (Sweden)

    Fernanda Carolina Camargo

    2017-12-01

    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.

  14. Management of REM sleep behavior disorder: An evidence based review

    Directory of Open Access Journals (Sweden)

    Preeti Devnani

    2015-01-01

    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.

  15. Evidence-based management of central cord syndrome.

    Science.gov (United States)

    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

    2013-07-01

    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.

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

    Science.gov (United States)

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

    2010-12-01

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

  17. Evidence-based evaluation of treatment strategy for multiple sclerosis

    Directory of Open Access Journals (Sweden)

    LI Meng-qiu

    2012-04-01

    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.

  18. Evidence-based management of sport-related concussion.

    Science.gov (United States)

    McCrea, Michael; Guskiewicz, Kevin

    2014-01-01

    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.

  19. Evidence Based Conservative Management of Patello-femoral Syndrome

    Directory of Open Access Journals (Sweden)

    E. Carlos Rodriguez-Merchan

    2014-03-01

    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.

  20. Evidence Based Conservative Management of Patello-femoral Syndrome

    Directory of Open Access Journals (Sweden)

    E. Carlos Rodriguez-Merchan

    2014-03-01

    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.    

  1. Management of chronic pressure ulcers: an evidence-based analysis.

    Science.gov (United States)

    2009-01-01

    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

  2. Strategy for developing an evidence-based transdisciplinary vision rehabilitation team approach to treating vision impairment.

    Science.gov (United States)

    Grover, Lori Latowski

    2008-04-01

    Many individuals with vision impairment experience significant loss of the ability to perform daily living activities, which often results in a further decline and loss of quality of life. Appropriate rehabilitation of the population with vision impairment has the potential to both improve individual abilities for health and personal management as well as maximize utilization of available health care resources. The case for an evidence-based model for the vision rehabilitation health care team as a medical rehabilitation program is presented. The recommended strategy has 3 main components: development of a consensus team clinical practice guideline leading to a future evidence-based team guideline for vision rehabilitation; evaluation and measurement of the knowledge, attitudes, and practices of the involved vision rehabilitation professionals before and after implementation of the new paradigm; and measurement of outcomes that estimate the effects of the proposed paradigm on patient care by measuring both the improvement in visual ability of the patient and the economic impact of the model on optometric practice. Development of a state-of-the-art evidence-based transdisciplinary team model guideline will facilitate improvement in the quality of life of individuals with diseases that result in chronic vision impairment.

  3. Management strategies for fibromyalgia

    OpenAIRE

    Le Marshall, Kim Francis; Littlejohn, Geoffrey Owen

    2011-01-01

    Kim Francis Le Marshall, Geoffrey Owen LittlejohnDepartments of Rheumatology and Medicine, Monash Medical Centre and Monash University, Victoria, AustraliaDate of preparation: 14 June 2011Clinical question: What are the effective, evidence-based strategies available for the management of fibromyalgia?Conclusion: There are a number of management strategies available with robust evidence to support their use in clinical practice.Definition: Fibromyalgia is a complex pain syndrome characterized ...

  4. Anticoagulation strategies in continuous renal replacement therapy: can the choice be evidence based?

    NARCIS (Netherlands)

    Oudemans-van Straaten, H. M.; Wester, J. P. J.; de Pont, A. C. J. M.; Schetz, M. R. C.

    2006-01-01

    Critical illness increases the tendency to both coagulation and bleeding, complicating anticoagulation for continuous renal replacement therapy (CRRT). We analyzed strategies for anticoagulation in CRRT concerning implementation, efficacy and safety to provide evidence-based recommendations for

  5. [Surgery for pancreatic cancer: Evidence-based surgical strategies].

    Science.gov (United States)

    Sánchez Cabús, Santiago; Fernández-Cruz, Laureano

    2015-01-01

    Pancreatic cancer surgery represents a challenge for surgeons due to its technical complexity, the potential complications that may appear, and ultimately because of its poor survival. The aim of this article is to summarize the scientific evidence regarding the surgical treatment of pancreatic cancer in order to help surgeons in the decision making process in the management of these patients .Here we will review such fundamental issues as the need for a biopsy before surgery, the type of pancreatic anastomosis leading to better results, and the need for placement of drains after pancreatic surgery will be discussed. Copyright © 2014 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

  6. Evidence-based post-exercise recovery strategies in basketball.

    Science.gov (United States)

    Calleja-González, Julio; Terrados, Nicolás; Mielgo-Ayuso, Juan; Delextrat, Anne; Jukic, Igor; Vaquera, Alejandro; Torres, Lorena; Schelling, Xavier; Stojanovic, Marko; Ostojic, Sergej M

    2016-01-01

    Basketball can be described as a moderate-to-long duration exercise including repeated bouts of high-intensity activity interspersed with periods of low to moderate active recovery or passive rest. A match is characterized by repeated explosive activities, such as sprints, jumps, shuffles and rapid changes in direction. In top-level modern basketball, players are frequently required to play consecutive matches with limited time to recover. To ensure adequate recovery after any basketball activity (i.e., match or training), it is necessary to know the type of fatigue induced and, if possible, its underlying mechanisms. Despite limited scientific evidence to support their effectiveness in facilitating optimal recovery, certain recovery strategies are commonly utilized in basketball. It is particularly important to optimize recovery because players spend a much greater proportion of their time recovering than they do in training. Therefore, the main aim of this report is to facilitate useful information that may lead to practical application, based on the scientific evidence and applied knowledge specifically in basketball.

  7. An Evidence-based Approach to Developing a Management Strategy for Medical Contingencies on the Lunar Surface: The NASA/Haughton-Mars Project (HMP) 2006 Lunar Medical Contingency Simulation at Devon Island

    Science.gov (United States)

    Scheuring, R. A.; Jones, J. A.; Lee, P.; Comtois, J. M.; Chappell, S.; Rafiq, A.; Braham, S.; Hodgson, E.; Sullivan, P.; Wilkinson, N.; hide

    2007-01-01

    The lunar architecture for future sortie and outpost missions will require humans to serve on the lunar surface considerably longer than the Apollo moon missions. Although the Apollo crewmembers sustained few injuries during their brief lunar surface activity, injuries did occur and are a concern for the longer lunar stays. Interestingly, lunar medical contingency plans were not developed during Apollo. In order to develop an evidence-base for handling a medical contingency on the lunar surface, a simulation using the moon-Mars analog environment at Devon Island, Nunavut, high Canadian Arctic was conducted. Objectives of this study included developing an effective management strategy for dealing with an incapacitated crewmember on the lunar surface, establishing audio/visual and biomedical data connectivity to multiple centers, testing rescue/extraction hardware and procedures, and evaluating in suit increased oxygen consumption. Methods: A review of the Apollo lunar surface activities and personal communications with Apollo lunar crewmembers provided the knowledge base of plausible scenarios that could potentially injure an astronaut during a lunar extravehicular activity (EVA). Objectives were established to demonstrate stabilization and transfer of an injured crewmember and communication with ground controllers at multiple mission control centers. Results: The project objectives were successfully achieved during the simulation. Among these objectives were extraction from a sloped terrain by a two-member crew in a 1 g analog environment, establishing real-time communication to multiple centers, providing biomedical data to flight controllers and crewmembers, and establishing a medical diagnosis and treatment plan from a remote site. Discussion: The simulation provided evidence for the types of equipment and methods for performing extraction of an injured crewmember from a sloped terrain. Additionally, the necessary communications infrastructure to connect

  8. An Integrative Literature Review of Evidence-Based Teaching Strategies for Nurse Educators.

    Science.gov (United States)

    Breytenbach, Cecile; Ten Ham-Baloyi, Wilma; Jordan, Portia J

    The aim of the study was to explore and describe the best available literature on evidence-based teaching strategies that can be used by nurse educators. Evidence-based teaching strategies in nursing education are fundamental to promote an in-depth understanding of information. Although some teaching strategies for nurse educators were identified, no integrative literature review was found summarizing the best teaching strategies for nurse educators. Integrative literature review. Sixteen studies were included encompassing eight teaching strategies (e-learning, concept mapping, Internet-based learning, web-based learning, gaming, problem-based learning, case studies, and evidence-based learning). Of these, three (concept mapping, Internet-based learning, and evidence-based learning) significantly increased student knowledge. All teaching strategies increased knowledge in some way, indicating that faculties should use a variety of teaching strategies. However, more research is needed to compare the impact of a variety of teaching strategies and the best use of different teaching strategies.

  9. Evidence-based practice-focused interactive teaching strategy: a controlled study.

    Science.gov (United States)

    Kim, Son C; Brown, Caroline E; Fields, Willa; Stichler, Jaynelle F

    2009-06-01

    This paper is a report of a study to evaluate the effectiveness of the evidence-based practice (EBP)-focused interactive teaching (E-FIT) strategy. Although EBP is a mandatory competency for all healthcare professionals, little is known about the effectiveness of E-FIT in nursing. Aquasi-experimental, controlled, pre- and post-test study involving senior, 4th-year nursing students (N = 208) at two nursing schools in the USA was carried out from August 2007 to May 2008. The experimental group (n = 88) received the E-FIT strategy intervention and the control group (n = 120) received standard teaching. A Knowledge, Attitudes and Behaviors Questionnaire for Evidence-Based Practice was used to assess the effectiveness of the E-FIT strategy. Independent t-tests showed that the experimental group had statistically significant higher post-test Evidence-Based Practice Knowledge (mean difference = 0.25; P = 0.001) and Evidence-Based Practice Use (mean difference = 0.26; P = 0.015) subscale scores compared to the control group, but showed no statistically significant differences in Attitudes toward Evidence-Based Practice and Future Use of Evidence-Based Practice (mean difference = 0.12; P = 0.398 and mean difference = 0.13; P = 0.255 respectively). Hierarchical multiple regression analyses of the post-test data indicated that the intervention explained 7.6% and 5.1% of variance in Evidence-Based Practice Knowledge and Evidence-Based Practice Use respectively. The EBP-focused interactive teaching strategy was effective in improving the knowledge and use of EBP among nursing students but not attitudes toward or future use of EBP.

  10. Guidance for Schools Selecting Antibullying Approaches: Translating Evidence-Based Strategies to Contemporary Implementation Realities

    Science.gov (United States)

    Ansary, Nadia S.; Elias, Maurice J.; Greene, Michael B.; Green, Stuart

    2015-01-01

    This article synthesizes the current research on bullying prevention and intervention in order to provide guidance to schools seeking to select and implement antibullying strategies. Evidence-based best practices that are shared across generally effective antibullying approaches are elucidated, and these strategies are grounded in examples…

  11. Implementing evidence-based guidelines for managing depression in elderly patients: a Norwegian perspective.

    Science.gov (United States)

    Aakhus, E; Flottorp, S A; Oxman, A D

    2012-09-01

    Depression in the elderly is common and exhibits a distinctive phenomenology, due to neurobiological, physiological, psychological and social changes related to ageing. Most elderly with depression are managed in primary health care. Although the number of scientific publications related to geriatric psychiatry has increased, there are still important gaps. Implementation of evidence-based guidelines for managing depression in primary care has had limited success, but has led to improvements compared to standard care. It is logical that the determinants (barriers and enablers) of implementing depression guidelines can be identified and can guide the selection of more effective implementation strategies that are tailored to address those determinants. We are testing that logic as part of a multinational implementation research project called 'Tailored Implementation for Chronic Diseases' (TICD). Our focus in Norway is on the management of depression in the elderly in primary care. We will identify the determinants of implementing evidence-based recommendations using various methods and comparing those methods. We will then use different methods to match the implementation interventions to the identified determinants and compare those methods. Finally, we will evaluate the resulting tailored implementation strategy in a randomized trial.

  12. Managing Scalp Psoriasis: An Evidence-Based Review.

    Science.gov (United States)

    Wang, Ting-Shun; Tsai, Tsen-Fang

    2017-02-01

    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.

  13. Evidence-based Update of Pediatric Dental Restorative Procedures: Preventive Strategies.

    Science.gov (United States)

    Tinanoff, N; Coll, J A; Dhar, V; Maas, W R; Chhibber, S; Zokaei, L

    2015-01-01

    There has been significant advances in the understanding of preventive restorative procedures regarding the advantages and disadvantages for restorative procedures; the evidence for conservative techniques for deep carious lesions; the effectiveness of pit and fissure sealants; and the evidence for use of resin infiltration techniques. The intent of this review is to help practitioners use evidence to make decisions regarding preventive restorative dentistry in children and young adolescents. This evidence-based review appraises the literature, primarily between the years 1995-2013, on preventive restorative strategies. The evidence was graded as to strong evidence, evidence in favor, or expert opinion by consensus of authors Results: The preventive strategy for dental caries includes individualized assessment of disease progression and management with appropriate preventive and restorative therapy. There is strong evidence that restoration of teeth with incomplete caries excavation results in fewer signs and symptoms of pulpal disease than complete excavation. There is strong evidence that sealants should be placed on pit and fissure surfaces judged to be at risk for dental caries, and surfaces that already exhibit incipient, non-cavitated carious lesions. There is evidence in favor for resin infiltration to improve the clinical appearance of white spot lesions. Substantial evidence exists in the literature regarding the value of preventive dental restorative procedures.

  14. Management strategies for fibromyalgia.

    Science.gov (United States)

    Le Marshall, Kim Francis; Littlejohn, Geoffrey Owen

    2011-01-01

    What are the effective, evidence-based strategies available for the management of fibromyalgia? There are a number of management strategies available with robust evidence to support their use in clinical practice. Fibromyalgia is a complex pain syndrome characterized by widespread, chronic muscular pain and tenderness, disordered sleep, emotional distress, cognitive disturbance, and fatigue. Its prevalence is estimated to be 3%-5% in the population and higher yet in patients with comorbid rheumatic diseases. Systematic reviews, meta-analyses, randomized controlled trials (RCTs). PubMed, Cochrane Library, manual search. Key messages for patients and clinicians are: There are many effective pharmacological management strategies available for fibromyalgia.A nonpharmacological, multicomponent approach utilizing education, aerobic exercise, psychological therapy, and other strategies is also effective for fibromyalgia.Despite the significant and, at times, disabling physical and psychological symptoms, fibromyalgia can be a manageable condition with a potentially good outcome.

  15. The diagnosis and management of inhalation injury: An evidence based approach.

    Science.gov (United States)

    Deutsch, C J; Tan, A; Smailes, S; Dziewulski, P

    2018-02-01

    Smoke inhalation injury (II) is an independent risk factor for mortality in burns and its management is inherently complex. We aim to make recommendations for best practice in managing II and its sequelae by reviewing all available current evidence in order to provide an evidence-based approach. We conducted a systematic search of the Cochrane database and Embase using PRISMA guidelines with no patient population exclusion criteria. Published work was reviewed and evidence levels graded. We identified 521 abstracts for inclusion. Of the 84 articles identified for secondary review, 28 papers were excluded leaving 56 papers suitable for final inclusion. We are able to identify a number of strategies in both diagnosis and treatment of II that have support in the published literature, including the role of bronchoscopy, permissive hypercapnia, nebulized heparin and hydroxycobalamin. Other strategies have not been shown to be harmful, but their efficacy is also not firmly established, such as high frequency oscillatory ventilation and exogenous surfactant. Prophylactic antibiotics and corticosteroids are not recommended. In general, published evidence for II is mostly Level 3 or below, due to a noticeable lack of large-scale human studies. This represents a challenge for evidence-based burns practice as a whole. Copyright © 2017 Elsevier Ltd and ISBI. All rights reserved.

  16. Scaling up Evidence-Based Practices: Strategies from Investing in Innovation (i3)

    Science.gov (United States)

    DeWire, Tom; McKithen, Clarissa; Carey, Rebecca

    2017-01-01

    What can the Investing in Innovation (i3) grantees tell us about scaling innovative educational practices? The newly released white paper "Scaling Up Evidence-Based Practices: Strategies from Investing in Innovation (i3)" captures the experiences of nine grantees whose projects collectively have reached over 1.2 million students across…

  17. The PICO Game: An Innovative Strategy for Teaching Step 1 in Evidence-Based Practice.

    Science.gov (United States)

    Milner, Kerry A; Cosme, Sheryl

    2017-12-01

    This column shares the best evidence-based strategies and innovative ideas on how to facilitate the learning and implementation of EBP principles and processes by clinicians as well as nursing and interprofessional students. Guidelines for submission are available at https://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1741-6787. © 2017 Sigma Theta Tau International.

  18. Is there consensus across international evidence-based guidelines for the management of bipolar disorder?

    Science.gov (United States)

    Parker, G B; Graham, R K; Tavella, G

    2017-06-01

    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.

  19. Leadership facilitation strategies to establish evidence-based practice in an acute care hospital.

    Science.gov (United States)

    Hauck, Sheila; Winsett, Rebecca P; Kuric, Judy

    2013-03-01

    To assess the impact of leadership facilitation strategies on nurses' beliefs of the importance and frequency of using evidence in daily nursing practice and the perception of organizational readiness in an acute care hospital. Integrating evidence in practice is a prominent issue for hospital nursing as knowledge and skills, beliefs, organizational infrastructure and nursing leadership must all be addressed. Prospective, descriptive comparative. Three surveys were used in this prospective descriptive comparative study. Evidence-Based Practice Beliefs Scale, the Implementation Scale and Organizational Culture & Readiness for System-Wide Integration Survey measured change before and after facilitating strategies for evidence-based practice enculturation. Data were collected in December 2008 (N = 427) and in December 2010 (N = 469). Leadership facilitated infrastructure development in three major areas: incorporating evidence-based practice outcomes in the strategic plan; supporting mentors; and advocating for resources for education and outcome dissemination. With the interventions in place, the total group scores for beliefs and organizational readiness improved significantly. Analyses by job role showed that direct care nurses scores improved more than other role types. No differences were found in the implementation scores. Successful key strategies were evidence-based practice education and establishing internal opportunities to disseminate findings. Transformational nursing leadership drives organizational change and provides vision, human and financial resources and time that empowers nurses to include evidence in practice. © 2012 Blackwell Publishing Ltd.

  20. EULAR evidence-based recommendations for the management of fibromyalgia syndrome

    DEFF Research Database (Denmark)

    Carville, S.F.; Arendt-Nielsen, S.; Bliddal, H.

    2008-01-01

    Objective: To develop evidence-based recommendations for the management of fibromyalgia syndrome. Methods: A multidisciplinary task force was formed representing 11 European countries. The design of the study, including search strategy, participants, interventions, outcome measures, data collection...... and analytical method, was defined at the outset. A systematic review was undertaken with the keywords "fibromyalgia'', "treatment or management'' and "trial''. Studies were excluded if they did not utilise the American College of Rheumatology classification criteria, were not clinical trials, or included...... patients with chronic fatigue syndrome or myalgic encephalomyelitis. Primary outcome measures were change in pain assessed by visual analogue scale and fibromyalgia impact questionnaire. The quality of the studies was categorised based on randomisation, blinding and allocation concealment. Only the highest...

  1. Evidence-based diagnosis and management of acute bronchitis.

    Science.gov (United States)

    Hart, Ann Marie

    2014-09-18

    Acute bronchitis is a common respiratory infection seen in primary care settings. This article examines the current evidence for diagnosis and management of acute bronchitis in adults and provides recommendations for primary care clinical practice.

  2. Management of thyroid nodules: a clinicopathological, evidence-based approach

    Energy Technology Data Exchange (ETDEWEB)

    Pacini, Furio; Ciuoli, Cristina; Di Cairano, Giovanni; Guarino, Elisa [University of Siena, Section of Endocrinology and Metabolism, Siena (Italy); Burroni, Luca [University of Siena, Nuclear Medicine Unit, Siena (Italy)

    2004-10-01

    Management of thyroid nodules is one of the most controversial issues in thyroidology. Different approaches derive from geographical variation in presentation, inadequate or incomplete clinical diagnosis, lack of prospective controlled studies and, frequently, the different cultural backgrounds of physicians. This review aims to offer a practical approach to the management of nodular thyroid disorders, considering the way in which the pathophysiology of the disease provides clues to the correct clinical diagnosis and therapy. (orig.)

  3. Evidence-based guidelines for the nutritional management of adult kidney transplant recipients.

    Science.gov (United States)

    Chan, Maria; Patwardhan, Aditi; Ryan, Catherine; Trevillian, Paul; Chadban, Steven; Westgarth, Fidye; Fry, Karen

    2011-01-01

    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.

  4. The Students' Perceptions of School Success Promoting Strategies Inventory (SPSI): development and validity evidence based studies.

    Science.gov (United States)

    Moreira, Paulo A S; Oliveira, João Tiago; Dias, Paulo; Vaz, Filipa Machado; Torres-Oliveira, Isabel

    2014-08-04

    Students' perceptions about school success promotion strategies are of great importance for schools, as they are an indicator of how students perceive the school success promotion strategies. The objective of this study was to develop and analyze the validity evidence based of The Students' Perceptions of School Success Promoting Strategies Inventory (SPSI), which assesses both individual students' perceptions of their school success promoting strategies, and dimensions of school quality. A structure of 7 related factors was found, which showed good adjustment indices in two additional different samples, suggesting that this is a well-fitting multi-group model (p Educational Technologies and Extra-curricular activities (p students within schools) dimensions of school success. In addition, there is preliminary evidence for its adequacy for measuring school success promotion dimensions between schools for 4 dimensions. This study supports the validity evidence based of the SPSI (validity evidence based on test content, on internal structure, on relations to other variables and on consequences of testing). Future studies should test for within- and between-level variance in a bigger sample of schools.

  5. A Regional PD Strategy for EPR Systems: Evidence-Based IT Development

    DEFF Research Database (Denmark)

    Simonsen, Jesper; Hertzum, Morten

    2006-01-01

    One of the five regions in Denmark has initiated a remark-able and alternative strategy for the development of Elec-tronic Patient Record (EPR) systems. This strategy is driven by Participatory Design (PD) experiments and based on evidence of positive effects on the clinical practice when using EPR...... systems. We present this PD strategy and our related research on evidence-based IT development. We report from a newly completed PD experiment with EPR in the region conducted through a close collaboration compris-ing a neurological stroke unit, the region’s EPR unit, the vendor, as well as the authors....

  6. Evidence-based postoperative pain management after laparoscopic colorectal surgery

    DEFF Research Database (Denmark)

    Joshi, G P; Bonnet, F; Kehlet, H

    2013-01-01

    Aim  The aim of this systematic review was to evaluate the available literature on the management of pain after laparoscopic colorectal surgery. Method  Randomized studies, published in English between January 1995 and July 2011, assessing analgesic and anaesthetic interventions in adults undergo...

  7. Evidence-based and data-driven road safety management

    NARCIS (Netherlands)

    Wegman, F.; Berg, H.Y.; Cameron, I.; Thompson, C.; Siegrist, S.; Weijermans, W.

    2015-01-01

    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

  8. Evidence-based clinical management and utilization of new technology in European neurosurgery.

    Science.gov (United States)

    Weber, Clemens; Jakola, Asgeir S; Gulati, Sasha; Nygaard, Oystein P; Solheim, Ole

    2013-04-01

    Evidence-based medicine (EBM) has become one of the pillars of modern patient care. However, neurosurgery has always been an experience-based and technology-driven discipline, and it remains unknown to which extent European neurosurgeons follow high-level evidence-based recommendations. We conducted a Web-based survey with a 15-item questionnaire about evidence-based clinical management and utilization of new technology among European neurosurgeons. Two different sum scores were calculated from the questions concerning clinical practice; evidence-based treatment score and new technology score. A high evidence-based treatment score means that more clinical conditions (i.e., study questions) were managed in compliance with the available highest levels of evidence from published clinical trials. A high new technology score reflects the use of a high number of modern tools in neurosurgical practice. A total of 239 neurosurgeons from 30 different European countries answered the questionnaire. There were large variations among European neurosurgeons in providing evidence-based care and in utilization of various modern tools. There were significant regional differences in evidence-based treatment scores and modern technology scores with higher scores in northern and western Europe. High-volume institutions were not associated with better evidence-based treatment scores, but had significantly higher new technology scores. There were significantly higher new technology scores at university hospitals and a trend towards higher evidence-based treatment scores compared to other hospitals. Clinical management in neurosurgery does not always comply with the best available evidence and there are large regional differences in clinical management and in utilization of various modern tools. The position of evidence-based medicine in European neurosurgery seems weak and this may be a threat to the quality of care.

  9. Topical therapies in the management of chronic rhinosinusitis: an evidence-based review with recommendations.

    Science.gov (United States)

    Rudmik, Luke; Hoy, Monica; Schlosser, Rodney J; Harvey, Richard J; Welch, Kevin C; Lund, Valerie; Smith, Timothy L

    2013-04-01

    Topical therapies have become an integral component in the management plan for chronic rhinosinusitis (CRS). Several topical therapy strategies have been evaluated, but a formal comprehensive evaluation of the evidence has never been performed. The purpose of this article is to provide an evidence-based approach for the utilization of topical therapies in the management of CRS. A systematic review of the literature was performed and the guidelines for development of an evidence-based review with recommendations were followed. Study inclusion criteria were: adult population >18 years old; chronic rhinosinusitis (CRS) based on published diagnostic criteria; and clearly defined primary clinical end-point. We focused on reporting higher-quality studies (level 2b or higher), but reported on lower-level studies if the topic contained insufficient evidence. We excluded drug-eluting spacer and stent therapy from this review. This review identified and evaluated the literature on 5 topical therapy strategies for CRS: saline irrigation, topical steroid, topical antibiotic, topical antifungal, and topical alternatives (surfactant, manuka honey, and xylitol irrigations). Based on the available evidence, sinonasal saline irrigation and standard topical nasal steroid therapy are recommended in the topical treatment of CRS. Nonstandard (off-label) topical sinonasal steroid therapies can be an option for managing CRS. The evidence recommends against the use of topical antifungal therapy and topical antibiotic therapy delivered using nebulized and spray techniques in routine cases of CRS. There is insufficient clinical research to provide recommendations for alternative therapies or topical antibiotic therapy delivered using other delivery methods (eg, irrigations). © 2013 ARS-AAOA, LLC.

  10. Evidence-based healthcare management competency evaluation: alumni perceptions.

    Science.gov (United States)

    White, Kenneth R; Clement, Dolores G; Nayar, Preethy

    2006-01-01

    An ongoing concern of healthcare educators is how well students are prepared for practice after they are graduated. Curriculum design and pedagogical methods are central components for developing healthcare management and leadership competencies. Various stakeholders have identified competency domains and typologies that outline the requisite skills and expertise to manage and lead healthcare organizations. This study analyzes survey data over a ten-year period from alumni one-year post graduation to compare self-reported assessment of competency development. Trends across two graduate professional programs tailored to different students of healthcare administration are compared. A total of 302 alumni responded to the survey. A factor analysis is performed to evaluate how the skills, knowledge, and abilities of graduates fit into identified competency domains. Fourteen competencies on the survey load into four factor domains: leadership, communication, business skills, and technology.

  11. Use of the innovation-decision process teaching strategy to promote evidence-based practice.

    Science.gov (United States)

    Schmidt, Nola A; Brown, Janet M

    2007-01-01

    The purpose of this article is to describe the innovation-decision process teaching strategy (I-DPTS) based on the model of diffusion of innovations [Rogers, E. M. (2003). Diffusion of innovations (5th ed.). New York: Free Press]. A goal of baccalaureate nursing education is to develop competencies required for evidence-based practice. Such practice merges clinician expertise, patient preferences, and critical evaluation of the literature to improve patient outcomes and reduce health care costs [Melnyk, B. M. (2005). A primer on evidence-based practice. Paper presented at the Purdue School of Nursing Seventh Annual Helen R. Johnson Leadership Conference, West Lafayette, IN]. Several strategies to promote evidence-based practice have appeared in the literature. However, when they are examined in light of the innovation-decision process (Rogers, 2003), they do not address all the essential steps for adoption to occur. The I-DPTS allows students to achieve competencies necessary to overcome barriers associated with implementing best practices. This strategy was successfully implemented in a senior-level introductory nursing research class. Community representatives identified practice issues that could be addressed by student groups. After conducting a search of the literature, students analyzed the evidence, determined best practice based on the evidence, and developed a policy for implementation in clinical settings. At course end, representatives were invited to attend oral and poster presentations. Use of the I-DPTS better prepares students to implement best practice as they embark on their professional careers.

  12. Creating infrastructure supportive of evidence-based nursing practice: leadership strategies.

    Science.gov (United States)

    Newhouse, Robin P

    2007-01-01

    Nursing leadership is the cornerstone of successful evidence-based practice (EBP) programs within health care organizations. The key to success is a strategic approach to building an EBP infrastructure, with allocation of appropriate human and material resources. This article indicates the organizational infrastructure that enables evidence-based nursing practice and strategies for leaders to enhance evidence-based practice using "the conceptual model for considering the determinants of diffusion, dissemination, and implementation of innovations in health service delivery and organization." Enabling EBP within organizations is important for promoting positive outcomes for nurses and patients. Fostering EBP is not a static or immediate outcome, but a long-term developmental process within organizations. Implementation requires multiple strategies to cultivate a culture of inquiry where nurses generate and answer important questions to guide practice. Organizations that can enable the culture and build infrastructure to help nurses develop EBP competencies will produce a professional environment that will result in both personal growth for their staff and improvements in quality that would not otherwise be possible.

  13. Promoting Evidence-Based Practice at a Primary Stroke Center: A Nurse Education Strategy.

    Science.gov (United States)

    Case, Christina Anne

    before and after the educational intervention. This modification ensured that the responses for each individual participant in this group were matched. Registered nurses reported a significant increase in perceived confidence in ability to explain how standardized stroke order sets reflect current evidence after the intervention (n = 20, P strategy increased RNs' confidence in ability to explain the path from evidence to bedside nursing care by demonstrating how evidence-based clinical practice guidelines provide current evidence used to create standardized order sets. Although further evaluation of the intervention's effectiveness is needed, this educational intervention has the potential for generalization to different types of standardized order sets to increase nurse confidence in utilization of evidence-based practice.

  14. From Evidence-based Management to Management of Non-knowledge

    DEFF Research Database (Denmark)

    Knudsen, Morten

    2017-01-01

    Leadership and management are increasingly expected to base themselves on evidence, i.e. knowledge. This article does not disagree that knowledge may be beneficial. Yet, based on sociological insights on the complex relation between knowledge and ignorance, the article argues that more knowledge...... does not lead to less ignorance or non-knowledge. Building on Luhmann’s systems-theoretical concept of knowledge as selecting structures which reduce complexity, the article outlines a different approach to ignorance in management and leadership. It raises the question what an intelligent approach...... to ignorance looks like. Inspired by Foucault’s historical analysis of the emergence of liberal ideas of government, the article argues that managerial self-limitation is crucial in the development of a ‘management of non-knowledge’ to complement evidence based management....

  15. A practical communication strategy to improve implementation of evidence-based practice.

    Science.gov (United States)

    Diedrick, Lee A; Schaffer, Marjorie A; Sandau, Kristin E

    2011-11-01

    The purpose of this study was to determine if a consistent communication strategy for implementation of evidence-based practice (EBP), developed with input from staff nurses, improved staff nurse satisfaction with communication of practice changes. Integration of EBP knowledge into clinical practice supports optimal nursing care. Awareness of a practice change and the ability to reference the information may be problematic. A quasi-experimental single group before-after design was used to survey all RNs of a level III neonatal ICU for satisfaction before and after implementation of the EBP communication strategy. Registered nurse satisfaction improved regarding the amount of communication (P strategy can improve nurse satisfaction with communication of EBP changes. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

  16. IAP/APA evidence-based guidelines for the management of acute pancreatitis.

    Science.gov (United States)

    2013-01-01

    There have been substantial improvements in the management of acute pancreatitis since the publication of the International Association of Pancreatology (IAP) treatment guidelines in 2002. A collaboration of the IAP and the American Pancreatic Association (APA) was undertaken to revise these guidelines using an evidence-based approach. Twelve multidisciplinary review groups performed systematic literature reviews to answer 38 predefined clinical questions. Recommendations were graded using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. The review groups presented their recommendations during the 2012 joint IAP/APA meeting. At this one-day, interactive conference, relevant remarks were voiced and overall agreement on each recommendation was quantified using plenary voting. The 38 recommendations covered 12 topics related to the clinical management of acute pancreatitis: A) diagnosis of acute pancreatitis and etiology, B) prognostication/predicting severity, C) imaging, D) fluid therapy, E) intensive care management, F) preventing infectious complications, G) nutritional support, H) biliary tract management, I) indications for intervention in necrotizing pancreatitis, J) timing of intervention in necrotizing pancreatitis, K) intervention strategies in necrotizing pancreatitis, and L) timing of cholecystectomy. Using the GRADE system, 21 of the 38 (55%) recommendations, were rated as 'strong' and plenary voting revealed 'strong agreement' for 34 (89%) recommendations. The 2012 IAP/APA guidelines provide recommendations concerning key aspects of medical and surgical management of acute pancreatitis based on the currently available evidence. These recommendations should serve as a reference standard for current management and guide future clinical research on acute pancreatitis. Copyright © 2013 IAP and EPC. Published by Elsevier B.V. All rights reserved.

  17. Management strategies for fibromyalgia

    Directory of Open Access Journals (Sweden)

    Le Marshall KF

    2011-07-01

    Full Text Available Kim Francis Le Marshall, Geoffrey Owen LittlejohnDepartments of Rheumatology and Medicine, Monash Medical Centre and Monash University, Victoria, AustraliaDate of preparation: 14 June 2011Clinical question: What are the effective, evidence-based strategies available for the management of fibromyalgia?Conclusion: There are a number of management strategies available with robust evidence to support their use in clinical practice.Definition: Fibromyalgia is a complex pain syndrome characterized by widespread, chronic muscular pain and tenderness, disordered sleep, emotional distress, cognitive disturbance, and fatigue. Its prevalence is estimated to be 3%–5% in the population and higher yet in patients with comorbid rheumatic diseases.Level of evidence: Systematic reviews, meta-analyses, randomized controlled trials (RCTs.Search sources: PubMed, Cochrane Library, manual searchConsumer summary: Key messages for patients and clinicians are:1. There are many effective pharmacological management strategies available for fibromyalgia.2. A nonpharmacological, multicomponent approach utilizing education, aerobic exercise, psychological therapy, and other strategies is also effective for fibromyalgia.3. Despite the significant and, at times, disabling physical and psychological symptoms, fibromyalgia can be a manageable condition with a potentially good outcome.Keywords: fibromyalgia, pain, treatment, management, evidence 

  18. Do Bodybuilders Use Evidence-Based Nutrition Strategies to Manipulate Physique?

    Directory of Open Access Journals (Sweden)

    Lachlan Mitchell

    2017-09-01

    Full Text Available Competitive bodybuilders undergo strict dietary and training practices to achieve an extremely lean and muscular physique. The purpose of this study was to identify and describe different dietary strategies used by bodybuilders, their rationale, and the sources of information from which these strategies are gathered. In-depth interviews were conducted with seven experienced (10.4 ± 3.4 years bodybuilding experience, male, natural bodybuilders. Participants were asked about training, dietary and supplement practices, and information resources for bodybuilding strategies. Interviews were transcribed verbatim and analyzed using qualitative content analysis. During the off-season, energy intake was higher and less restricted than during the in-season to aid in muscle hypertrophy. There was a focus on high protein intake with adequate carbohydrate to permit high training loads. To create an energy deficit and loss of fat mass, energy intake was gradually and progressively reduced during the in-season via a reduction in carbohydrate and fat intake. The rationale for weekly higher carbohydrate refeed days was to offset declines in metabolic rate and fatigue, while in the final “peak week” before competition, the reasoning for fluid and sodium manipulation and carbohydrate loading was to enhance the appearance of leanness and vascularity. Other bodybuilders, coaches and the internet were significant sources of information. Despite the common perception of extreme, non-evidence-based regimens, these bodybuilders reported predominantly using strategies which are recognized as evidence-based, developed over many years of experience. Additionally, novel strategies such as weekly refeed days to enhance fat loss, and sodium and fluid manipulation, warrant further investigation to evaluate their efficacy and safety.

  19. Building the Evidence-Base of Effective Reading Strategies to Use with Deaf English-Language Learners

    Science.gov (United States)

    Guardino, Caroline; Cannon, Joanna E.; Eberst, Kimberley

    2014-01-01

    Nearly 25% of Deaf and Hard of Hearing (DHH) students come from homes where a language other than English is used and are known as English-Language Learners (ELLs). Evidence-based practices used to teach students who are DHH ELLs are imperative. To build an evidence-base, successful strategies must be examined across multiple researchers, sites,…

  20. Strategies for managing osteoarthritis.

    Science.gov (United States)

    Ng, Norman Tiong Meng; Heesch, Kristiann C; Brown, Wendy J

    2012-09-01

    Although there are recommendations for the management of osteoarthritis (OA), little is known about how people with OA actually manage this chronic condition. The aims of this study were to identify the non-pharmacological and pharmacological therapies most commonly used for the management of hip or knee OA, in a community-based sample of adults, and to compare these with evidence-based recommendations. A questionnaire was mailed to 2,200 adult members of Arthritis Queensland living in Brisbane, Australia. It included questions about OA symptoms, management therapies, and demographic characteristics. Of the 485 participants (192 men, 293 women) with hip or knee OA who completed the questionnaire, most had mild to moderate symptoms. Ninety-six percent of participants (aged 27-95 years) reported using at least one non-pharmacological therapy, and 78% reported using at least one pharmacological therapy. The most common currently used non-pharmacological strategy was range-of-motion exercises (men 52%, women 61%, p = 0.05) and the most common frequently used pharmacological strategy was glucosamine/chondroitin (men 51%, women 60%, ns). For the most highly recommended strategies, 65% of men and 54% of women had never attended an information/education course (p = 0.04), and fewer than half (46% of women and 42% of men, p = 0.03) were frequent users of anti-inflammatory agents. The findings suggest that many people with knee or hip OA do not follow the most highly endorsed of the Osteoarthritis Research Society International recommendations for management of OA. Health professionals should be encouraged to recommend evidence-based therapies to their patients.

  1. Community-based care for the management of type 2 diabetes: an evidence-based analysis.

    Science.gov (United States)

    2009-01-01

    In June 2008, the Medical Advisory Secretariat began work on the Diabetes Strategy Evidence Project, an evidence-based review of the literature surrounding strategies for successful management and treatment of diabetes. This project came about when the Health System Strategy Division at the Ministry of Health and Long-Term Care subsequently asked the secretariat to provide an evidentiary platform for the Ministry's newly released Diabetes Strategy.After an initial review of the strategy and consultation with experts, the secretariat identified five key areas in which evidence was needed. Evidence-based analyses have been prepared for each of these five areas: insulin pumps, behavioural interventions, bariatric surgery, home telemonitoring, and community based care. For each area, an economic analysis was completed where appropriate and is described in a separate report.To review these titles within the Diabetes Strategy Evidence series, please visit the Medical Advisory Secretariat Web site, http://www.health.gov.on.ca/english/providers/program/mas/mas_about.html,DIABETES STRATEGY EVIDENCE PLATFORM: Summary of Evidence-Based AnalysesContinuous Subcutaneous Insulin Infusion Pumps for Type 1 and Type 2 Adult Diabetics: An Evidence-Based AnalysisBehavioural Interventions for Type 2 Diabetes: An Evidence-Based AnalysisBARIATRIC SURGERY FOR PEOPLE WITH DIABETES AND MORBID OBESITY: An Evidence-Based SummaryCommunity-Based Care for the Management of Type 2 Diabetes: An Evidence-Based AnalysisHome Telemonitoring for Type 2 Diabetes: An Evidence-Based AnalysisApplication of the Ontario Diabetes Economic Model (ODEM) to Determine the Cost-effectiveness and Budget Impact of Selected Type 2 Diabetes Interventions in Ontario The objective of this report is to determine the efficacy of specialized multidisciplinary community care for the management of type 2 diabetes compared to usual care. TARGET POPULATION AND CONDITION Diabetes (i.e. diabetes mellitus) is a highly prevalent

  2. Educational strategies for teaching evidence-based practice to undergraduate health students: systematic review.

    Science.gov (United States)

    Kyriakoulis, Konstantinos; Patelarou, Athina; Laliotis, Aggelos; Wan, Andrew C; Matalliotakis, Michail; Tsiou, Chrysoula; Patelarou, Evridiki

    2016-01-01

    The aim of this systematic review was to find best teaching strategies for teaching evidence-based practice (EBP) to undergraduate health students that have been adopted over the last years in healthcare institutions worldwide. The authors carried out a systematic, comprehensive bibliographic search using Medline database for the years 2005 to March 2015 (updated in March 2016). Search terms used were chosen from the USNLM Institutes of Health list of MeSH (Medical Subject Headings) and free text key terms were used as well. Selected articles were measured based on the inclusion criteria of this study and initially compared in terms of titles or abstracts. Finally, articles relevant to the subject of this review were retrieved in full text. Critical appraisal was done to determine the effects of strategy of teaching evidence-based medicine (EBM). Twenty articles were included in the review. The majority of the studies sampled medical students (n=13) and only few conducted among nursing (n=2), pharmacy (n=2), physiotherapy/therapy (n=1), dentistry (n=1), or mixed disciplines (n=1) students. Studies evaluated a variety of educational interventions of varying duration, frequency and format (lectures, tutorials, workshops, conferences, journal clubs, and online sessions), or combination of these to teach EBP. We categorized interventions into single interventions covering a workshop, conference, lecture, journal club, or e-learning and multifaceted interventions where a combination of strategies had been assessed. Seven studies reported an overall increase to all EBP domains indicating a higher EBP competence and two studies focused on the searching databases skill. Followings were deduced from above analysis: multifaceted approach may be best suited when teaching EBM to health students; the use of technology to promote EBP through mobile devices, simulation, and the web is on the rise; and the duration of the interventions varying form some hours to even months was

  3. The Political Implications of Performance Management and Evidence-Based Policymaking

    DEFF Research Database (Denmark)

    Triantafillou, Peter

    2015-01-01

    Over the last few decades performance management (PM) has invaded the public sector in most Organisation for Economic Co-operation and Development (OECD) countries. More recently, we have seen increasing demands for evidence-based policymaking (EP). This article critically discusses the political...

  4. Teaching evidence-based medicine at complementary and alternative medicine institutions: strategies, competencies, and evaluation.

    Science.gov (United States)

    Zwickey, Heather; Schiffke, Heather; Fleishman, Susan; Haas, Mitch; Cruser, des Anges; LeFebvre, Ron; Sullivan, Barbara; Taylor, Barry; Gaster, Barak

    2014-12-01

    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.

  5. Comparing Client Outcomes for Two Evidence-Based Treatment Consultation Strategies.

    Science.gov (United States)

    Funderburk, Beverly; Chaffin, Mark; Bard, Elizabeth; Shanley, Jenelle; Bard, David; Berliner, Lucy

    2015-01-01

    Posttraining expert case consultation is a key component of transporting and scaling up evidence-based treatments, and hopefully retaining their efficacy. Live practice observation and in vivo coaching is a strategy used in academic training environments, but is rarely feasible in field settings. Post hoc telephone consultation is a substitute strategy but does not approximate many aspects of live coaching. Live video technology offers a closer approximation but has not yet been sufficiently tested. Using a roll-out experimental design, this study compared client outcomes across doses of two posttraining expert consultation strategies-standard telephone consultation and live video coaching. The study was conducted during a two-state, 30-agency implementation involving 80 therapists and 330 cases receiving Parent-Child Interaction Therapy (PCIT). Child behavior problems fell from well above to below clinical cutoff values, with about a 1 standard deviation improvement in 14 sessions, which is within the range reported in laboratory efficacy trials. Symptom improvement was augmented by increased therapist dose of live video consultations. Phone consultation dose had no association with client level outcomes. PCIT benefits appear to be retained when the model is transported at scale into the field, and live video consultation appeared to offer small but significant advantages over telephone consultation as one element of an overall transport strategy.

  6. Evidentiary Pluralism as a Strategy for Research and Evidence-Based Practice in Rehabilitation Psychology.

    Science.gov (United States)

    Tucker, Jalie A; Reed, Geoffrey M

    2008-08-01

    This paper examines the utility of evidentiary pluralism, a research strategy that selects methods in service of content questions, in the context of rehabilitation psychology. Hierarchical views that favor randomized controlled clinical trials (RCTs) over other evidence are discussed, and RCTs are considered as they intersect with issues in the field. RCTs are vital for establishing treatment efficacy, but whether they are uniformly the best evidence to inform practice is critically evaluated. We argue that because treatment is only one of several variables that influence functioning, disability, and participation over time, an expanded set of conceptual and data analytic approaches should be selected in an informed way to support an expanded research agenda that investigates therapeutic and extra-therapeutic influences on rehabilitation processes and outcomes. The benefits of evidentiary pluralism are considered, including helping close the gap between the narrower clinical rehabilitation model and a public health disability model. KEY WORDS: evidence-based practice, evidentiary pluralism, rehabilitation psychology, randomized controlled trials.

  7. [Pediatric pancreatitis. Evidence based management guidelines of the Hungarian Pancreatic Study Group].

    Science.gov (United States)

    Párniczky, Andrea; Czakó, László; Dubravcsik, Zsolt; Farkas, Gyula; Hegyi, Péter; Hritz, István; Kelemen, Dezső; Morvay, Zita; Oláh, Attila; Pap, Ákos; Sahin-Tóth, Miklós; Szabó, Flóra; Szentkereszti, Zsolt; Szmola, Richárd; Takács, Tamás; Tiszlavicz, László; Veres, Gábor; Szücs, Ákos; Lásztity, Natália

    2015-02-22

    Pediatric pancreatitis is a rare disease with variable etiology. In the past 10-15 years the incidence of pediatric pancreatitis has been increased. The management of pediatric pancreatitis requires up-to-date and evidence based management guidelines. The Hungarian Pancreatic Study Group proposed to prepare an evidence based guideline based on the available international guidelines and evidences. The preparatory and consultation task force appointed by the Hungarian Pancreatic Study Group translated and complemented and/or modified the international guidelines if it was necessary. In 8 clinical topics (diagnosis; etiology; prognosis; imaging; therapy; biliary tract management; complications; chronic pancreatitis) 50 relevant questions were defined. Evidence was classified according to the UpToDate(®) grading system. The draft of the guidelines was presented and discussed at the consensus meeting on September 12, 2014. All clinical statements were accepted with total (more than 95%) agreement. The present Hungarian Pancreatic Study Group guideline is the first evidence based pediatric pancreatitis guideline in Hungary. The present guideline is the first evidence-based pancreatic cancer guideline in Hungary that provides a solid ground for teaching purposes, offers quick reference for daily patient care in pediatric pancreatitis and guides financing options. The authors strongly believe that these guidelines will become a standard reference for pancreatic cancer treatment in Hungary.

  8. Barriers to evidence-based disaster management in Nepal: a qualitative study.

    Science.gov (United States)

    Lee, A C K

    2016-04-01

    Globally, the incidence of natural disasters is increasing with developing countries tending to be worst affected. Implementing best practices in disaster management that are evidence-based is essential in order to improve disaster resilience and response. This study explores the barriers to evidence-based disaster management encountered in Nepal. A qualitative study was conducted in Nepal involving interviews with key informants in the disaster management field. Government officials, academics, programme managers, disaster management practitioners and policymakers involved in disaster management were purposively sampled and invited to interview. 11 agreed to participate and were interviewed. The face-to-face interviews were recorded, transcribed and analysed using thematic analysis. The interviews uncovered population-level barriers such as contextual factors (e.g. poverty), local custom and culture, as well as community-level issues (e.g. level of engagement and understanding). System-level barriers included limited demand for, availability and accessibility of the evidence-base. The implementation of evidence was influenced by the configuration of the disaster management system and system processes. Political ownership and leadership is an essential determinant of practice. Several barriers to evidence-based practice in disaster management exist in Nepal. The relative influence of the different barriers varies with political determinants likely to have greater importance in countries such as Nepal where system governance and leadership is insufficiently developed. These issues affect a country's vulnerability to disasters and need to be addressed. Copyright © 2016 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

  9. Volume Overload in Heart Failure: An Evidence-Based Review of Strategies for Treatment and Prevention.

    Science.gov (United States)

    Houston, Brian A; Kalathiya, Rohan J; Kim, Daniel A; Zakaria, Sammy

    2015-09-01

    Acute decompensated heart failure is the leading cause of hospital admission in the United States, with a high risk of readmission within 30 days. Most acute decompensated heart failure admissions are driven by congestive signs and symptoms resulting from fluid and sodium overload. We reviewed the evidence base addressing the management and prevention of fluid overload in heart failure, focusing on recent clinical trials. All the references in this review were obtained through PubMed and had at least 1 of the following key words: heart failure and volume overload, congestion, loop diuretics, thiazide diuretics, aldosterone antagonists, dopamine, cardiorenal syndrome, nesiritide, vasopressin antagonists, ultrafiltration, sodium restriction, fluid restriction, telemonitoring, and invasive hemodynamic monitoring. We also reviewed relevant references cited in the obtained articles, especially articles addressing methods of treating or preventing volume overload in patients with heart failure. Copyright © 2015 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

  10. Public pharmacovigilance communication: a process calling for evidence-based, objective-driven strategies.

    Science.gov (United States)

    Bahri, Priya

    2010-12-01

    As a contribution to the debate on how best to communicate information on the effective and safe use of medicines to patients, healthcare professionals and the general public, this article proposes to distinguish between communication and transparency purposes, and to test a strategic health communication approach. Any organization aiming to improve medicines use could adapt this approach to its remits and legal obligations. The approach includes agreeing measurable communication objectives through shared problem ownership of all concerned parties, evidence-based design and a cyclic process for planning, implementation and evaluation of communication as a public health intervention. The evidence base, which supplements risk assessment for product- and situation-specific communication on safety concerns, would be derived from research into drug utilization, medical decision making and risk perception, as well as from the participation of patients and healthcare professionals. It is crucial to address the practical questions and concerns of medicine users and to find out why unfavourable patterns of medicine use persist, in order to develop behaviour change models for overcoming these obstacles. For this purpose, appropriate models for facilitating the participation of medicine users in the risk management process will need to be explored. Such two-way communication would inform risk assessment as well as the analysis of risk minimization options, allow for agreement upon communication objectives and enable understandable, attractive communication materials to be designed. The communication programme should use mixed media and repetition of messages for long-term success. This would require cooperation within healthcare and medical information systems. An evaluation of the effectiveness of the communication should support the sustainability of the programme and provide lessons for the future. Given its mission, the pharmacovigilance community has the standing and

  11. Management Involvement--A Decisive Condition When Implementing Evidence-Based Practice.

    Science.gov (United States)

    Aasekjaer, Katrine; Waehle, Hilde Valen; Ciliska, Donna; Nordtvedt, Monica Wammen; Hjälmhult, Esther

    2016-02-01

    Even though health professionals have a positive attitude toward evidence-based practice (EBP), they have limited skills when it comes to implementation of EBP. A postprofessional program in EPB has been offered at Bergen University College since 2004. To date, there is limited knowledge of how the graduates of the program implement and make use of the EBP principles in their working environment in different healthcare settings. The aim of the study was to explore the facilitators and strategies to successful implementation of the steps of EBP as experienced by health professionals who had completed a postgraduate program in EBP. Grounded theory was used in gathering and analyzing data from single and focus group interviews of 20 health professionals who had attended a postprofessional program in EBP. Inclusion criteria also required current clinical practice. This study identified a specific set of activities used by health professionals when implementing EBP within their service organization. Creating an interest and understanding of EBP amongst their colleagues appeared to be a challenge, which they addressed by using the generated grounded theory of "tailoring principles." The dominant condition of this theory was management involvement. This study highlighted the importance of middle-range managers' coordinating and supporting role as a decisive component in the process of implementing EBP to clinical settings in Norway. Moreover, the dynamic complex process of "tailoring principles" also showed how the production of a clinical protocol became an outcome of implementation effectiveness as well as input for further intervention effectiveness. Tailoring the principle of EBP to the organizational and cultural context facilitated the implementation of EBP. © 2016 Sigma Theta Tau International.

  12. Development of a Search Strategy for an Evidence Based Retrieval Service

    Science.gov (United States)

    Ho, Gah Juan; Liew, Su May; Ng, Chirk Jenn; Hisham Shunmugam, Ranita; Glasziou, Paul

    2016-01-01

    Background Physicians are often encouraged to locate answers for their clinical queries via an evidence-based literature search approach. The methods used are often not clearly specified. Inappropriate search strategies, time constraint and contradictory information complicate evidence retrieval. Aims Our study aimed to develop a search strategy to answer clinical queries among physicians in a primary care setting Methods Six clinical questions of different medical conditions seen in primary care were formulated. A series of experimental searches to answer each question was conducted on 3 commonly advocated medical databases. We compared search results from a PICO (patients, intervention, comparison, outcome) framework for questions using different combinations of PICO elements. We also compared outcomes from doing searches using text words, Medical Subject Headings (MeSH), or a combination of both. All searches were documented using screenshots and saved search strategies. Results Answers to all 6 questions using the PICO framework were found. A higher number of systematic reviews were obtained using a 2 PICO element search compared to a 4 element search. A more optimal choice of search is a combination of both text words and MeSH terms. Despite searching using the Systematic Review filter, many non-systematic reviews or narrative reviews were found in PubMed. There was poor overlap between outcomes of searches using different databases. The duration of search and screening for the 6 questions ranged from 1 to 4 hours. Conclusion This strategy has been shown to be feasible and can provide evidence to doctors’ clinical questions. It has the potential to be incorporated into an interventional study to determine the impact of an online evidence retrieval system. PMID:27935993

  13. Multiple strategy peer-taught evidence-based medicine course in a poor resource setting.

    Science.gov (United States)

    Sabouni, Ammar; Bdaiwi, Yamama; Janoudi, Saad L; Namous, Lubaba O; Turk, Tarek; Alkhatib, Mahmoud; Abbas, Fatima; Yafi, Ruba Zuhri

    2017-05-04

    Teaching Evidence Based Medicine (EBM) is becoming a priority in the healthcare process. For undergraduates, it has been proved that integrating multiple strategies in teaching EBM yields better results than a single, short-duration strategy. However, there is a lack of evidence on applying EBM educational interventions in developing countries. In this study, we aim to evaluate the effectiveness of a multiple strategy peer-taught online course in improving EBM awareness and skills among medical students in two developing countries, Syria and Egypt. We conducted a prospective study with pre- and post- course assessment of 84 medical students in three universities, using the Berlin questionnaire and a set of self-reported questions which studied the students' EBM knowledge, attitude and competencies. The educational intervention was a peer-taught online course consisting of six sessions (90 min each) presented over six weeks, and integrated with assignments, group discussions, and two workshops. The mean score of pre- and post-course Berlin tests was 3.5 (95% CI: 2.94-4.06) and 5.5 (95% CI: 4.74-6.26) respectively, increasing by 2 marks (95% CI: 1.112-2.888; p-value <0.001), which indicates a statistically significant increase in students' EBM knowledge and skill, similar to a previous expert-taught face to face contact course. Self-reported confidences also increased significantly. However, our course did not have a major effect on students' attitudes toward EBM (1.9-10.8%; p-value: 0.12-0.99). In developing countries, multiple strategy peer-taught online courses may be an effective alternative to face to face expert-taught courses, especially in the short term.

  14. Development of a Search Strategy for an Evidence Based Retrieval Service.

    Science.gov (United States)

    Ho, Gah Juan; Liew, Su May; Ng, Chirk Jenn; Hisham Shunmugam, Ranita; Glasziou, Paul

    2016-01-01

    Physicians are often encouraged to locate answers for their clinical queries via an evidence-based literature search approach. The methods used are often not clearly specified. Inappropriate search strategies, time constraint and contradictory information complicate evidence retrieval. Our study aimed to develop a search strategy to answer clinical queries among physicians in a primary care setting. Six clinical questions of different medical conditions seen in primary care were formulated. A series of experimental searches to answer each question was conducted on 3 commonly advocated medical databases. We compared search results from a PICO (patients, intervention, comparison, outcome) framework for questions using different combinations of PICO elements. We also compared outcomes from doing searches using text words, Medical Subject Headings (MeSH), or a combination of both. All searches were documented using screenshots and saved search strategies. Answers to all 6 questions using the PICO framework were found. A higher number of systematic reviews were obtained using a 2 PICO element search compared to a 4 element search. A more optimal choice of search is a combination of both text words and MeSH terms. Despite searching using the Systematic Review filter, many non-systematic reviews or narrative reviews were found in PubMed. There was poor overlap between outcomes of searches using different databases. The duration of search and screening for the 6 questions ranged from 1 to 4 hours. This strategy has been shown to be feasible and can provide evidence to doctors' clinical questions. It has the potential to be incorporated into an interventional study to determine the impact of an online evidence retrieval system.

  15. Nursing Home Staff Adherence to Evidence-Based Pain Management Practices

    OpenAIRE

    Jablonski, Anita; Ersek, Mary

    2009-01-01

    The purpose of this study was to determine the extent to which nursing home staff adhere to current evidence-based guidelines to assess and manage persistent pain experienced by elderly residents. A retrospective audit was conducted of the medical records of 291 residents of 14 long-term care facilities in western Washington State. Data revealed a gap between actual practice and current best practice. Assessment of persistent pain was limited primarily to intensity and location. Although pres...

  16. Teachers' Facility with Evidence-Based Classroom Management Practices: An Investigation of Teachers' Preparation Programmes and In-Service Conditions

    Science.gov (United States)

    Ficarra, Laura; Quinn, Kevin

    2014-01-01

    In the present investigation, teachers' self-reported knowledge and competency ratings for the evidence-based classroom management practices were analysed. Teachers also reflected on how they learned evidence-based classroom management practices. Results suggest that teachers working in schools that implement Positive Behavioural Interventions and…

  17. Enhancing health care equity with Indigenous populations: evidence-based strategies from an ethnographic study.

    Science.gov (United States)

    Browne, Annette J; Varcoe, Colleen; Lavoie, Josée; Smye, Victoria; Wong, Sabrina T; Krause, Murry; Tu, David; Godwin, Olive; Khan, Koushambhi; Fridkin, Alycia

    2016-10-04

    Structural violence shapes the health of Indigenous peoples globally, and is deeply embedded in history, individual and institutional racism, and inequitable social policies and practices. Many Indigenous communities have flourished, however, the impact of colonialism continues to have profound health effects for Indigenous peoples in Canada and internationally. Despite increasing evidence of health status inequities affecting Indigenous populations, health services often fail to address health and social inequities as routine aspects of health care delivery. In this paper, we discuss an evidence-based framework and specific strategies for promoting health care equity for Indigenous populations. Using an ethnographic design and mixed methods, this study was conducted at two Urban Aboriginal Health Centres located in two inner cities in Canada, which serve a combined patient population of 5,500. Data collection included in-depth interviews with a total of 114 patients and staff (n = 73 patients; n = 41 staff), and over 900 h of participant observation focused on staff members' interactions and patterns of relating with patients. Four key dimensions of equity-oriented health services are foundational to supporting the health and well-being of Indigenous peoples: inequity-responsive care, culturally safe care, trauma- and violence-informed care, and contextually tailored care. Partnerships with Indigenous leaders, agencies, and communities are required to operationalize and tailor these key dimensions to local contexts. We discuss 10 strategies that intersect to optimize effectiveness of health care services for Indigenous peoples, and provide examples of how they can be implemented in a variety of health care settings. While the key dimensions of equity-oriented care and 10 strategies may be most optimally operationalized in the context of interdisciplinary teamwork, they also serve as health equity guidelines for organizations and providers working in

  18. Synthesizing evidence-based strategies and community-engaged research: a model to address social determinants of health.

    Science.gov (United States)

    Hardy, Lisa Jane; Bohan, Kyle David; Trotter, Robert Talbot

    2013-11-01

    Addressing social determinants of health (SDH) requires multileveled intervention designs. Increasingly, organizations and coalitions face pressure to use evidence-based strategies when seeking to address SDH. Evidence-based strategies, however, must be locally relevant and integrated into existing systems to function efficiently. We propose the incorporation of an effective rapid assessment technique, Rapid Assessment, Response, and Evaluation (RARE), with evidence-based strategies, findings, and recommendations embedded in community-engaged research to increase the likelihood of success in addressing SDH. Our RARE project--a partnership among a community health center, a nonprofit funding agency, and academic faculty researchers--resulted in community- and policy-level interventions for the prevention of childhood obesity in a Southwestern U.S. city.

  19. Dietary Strategies to Reduce Environmental Impact: A Critical Review of the Evidence Base.

    Science.gov (United States)

    Ridoutt, Bradley G; Hendrie, Gilly A; Noakes, Manny

    2017-11-01

    The food system is a major source of environmental impact, and dietary change has been recommended as an important and necessary strategy to reduce this impact. However, assessing the environmental performance of diets is complex due to the many types of foods eaten and the diversity of agricultural production systems and local environmental settings. To assess the state of science and identify knowledge gaps, an integrative review of the broad topic of environment and diet was undertaken, with particular focus on the completeness of coverage of environmental concerns and the metrics used. Compared with the 14 discrete environmental areas of concern identified in the United Nations Sustainable Development Goals, the located journal literature mainly addressed greenhouse gas (GHG) emissions and, to a lesser extent, land and water use. Some relevant concerns were rarely addressed or not addressed at all. In the case of GHG emissions, changes in land use and soil carbon stocks were seldom considered. This represents a disconnect between the science informing strategic climate action in the agricultural sector and the science informing public health nutrition. In the case of land and water use, few studies used metrics that are appropriate in a life-cycle context. Some metrics produce inherently biased results, which misinform about environmental impact. The limited evidence generally points to recommended diets having lower environmental impacts than typical diets, although not in every case. This is largely explained by the overconsumption of food energy associated with average diets, which is also a major driver of obesity. A shared-knowledge framework is identified as being needed to guide future research on this topic. Until the evidence base becomes more complete, commentators on sustainable diets should not be quick to assume that a dietary strategy to reduce overall environmental impact can be readily defined or recommended. © 2017 American Society for

  20. Analysis of narrative functionality: toward evidence-based approaches in managed care settings.

    Science.gov (United States)

    Olness, Gloria Streit; Gyger, Jennifer; Thomas, Kathy

    2012-02-01

    The advent of managed health care has challenged rehabilitation professionals to guide their clients toward functionally meaningful outcomes in the least amount of time possible and to justify the evidence base for their intervention approaches. The ability to relate personal narratives in everyday contexts lies at the core of communicative functionality, but feasible clinical assessment of narrative has proven elusive. The purpose of this article is to offer an evidence-based framework for guiding assessments of the personal narratives of adults with aphasia, within a managed care model of service delivery. A literature-based model of narrative functionality is proposed, and a targeted set of criterion-referenced measures and behavioral observations derived from this model are suggested as potential metrics of narrative functionality. The authors do not intend to prescribe exact methods of narrative evaluation, but rather to suggest possible directions for professionals to develop evidence-based clinical narrative analysis tailored to the functional assessment needs of their clients across a variety of service settings. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  1. Ultraviolet Phototherapy Management of Moderate-to-Severe Plaque Psoriasis: An Evidence-Based Analysis.

    Science.gov (United States)

    2009-01-01

    comparing a combination therapy with phototherapy and psychological intervention involving simultaneous audiotape sessions on mindfulness and stress reduction. Two trials also examined the effect of treatment setting on effectiveness of phototherapy, one on inpatient versus outpatient therapy and one on outpatient clinic versus home-based phototherapy. The conclusions of the MAS evidence-based review are outlined in Table ES1. In summary, phototherapy provides good control of clinical symptoms in the short term for patients with moderate-to-severe plaque-type psoriasis that have failed or are unresponsive to management with topical agents. However, many of the evidence gaps identified in the NIHR 2000 evidence review on psoriasis management persisted. In particular, the lack of evidence on the comparative effectiveness and/or cost-effectiveness between the major treatment options for moderate-to-severe psoriasis remained. The evidence on effectiveness and safety of longer term strategies for disease management has also not been addressed. Evidence for the safety, effectiveness, or cost-effectiveness of phototherapy delivered in various settings is emerging but is limited. In addition, because all available treatments for psoriasis - a disease with a high prevalence, chronicity, and cost - are palliative rather than curative, strategies for disease control and improvements in self-efficacy employed in other chronic disease management strategies should be investigated. (ABSTRACT TRUNCATED)

  2. Translating addictions research into evidence-based practice: the Polaris CD outcomes management system.

    Science.gov (United States)

    Toche-Manley, L; Grissom, G; Dietzen, L; Sangsland, S

    2011-06-01

    Converting the findings from addictions studies into information actionable by (non-research) treatment programs is important to improving program outcomes. This paper describes the translation of the findings of studies on Patient-Services matching, prediction of patient response to treatment (Expected Treatment Response) and prediction of dropout to provide evidence-based decision support in routine treatment. The findings of the studies and their application to the development of an outcomes management system are described. Implementation issues in a network of addictions treatment programs are discussed. The work illustrates how outcomes management systems can play an important role in translating research into practice. Copyright © 2011 Elsevier Ltd. All rights reserved.

  3. Pain-Related Temporomandibular Disorder - Current Perspectives and Evidence-Based Management.

    Science.gov (United States)

    Ghurye, Supriya; McMillan, Roddy

    2015-01-01

    Pain-related temporomandibular disorder (TMD) is one of the top three most common chronic pain conditions, along with headaches and back pain. TMD has complex pathophysiology and significant associations with a variety of other chronic pain conditions, eg fibromyalgia, irritable bowel syndrome and migraine. Chronic TMD is associated with a negative impact upon quality of life and high levels of healthcare utility. It is important that clinicians are able to diagnose TMD correctly, provide appropriate management in keeping with current evidence-based practice, and identify when to refer patients to specialist care. The presence of risk factors, eg anxiety, depression, pain-related disability and chronic pain conditions elsewhere in the body, may help to identify which TMD patients require referral for multidisciplinary management. TMD should be managed using a holistic approach, incorporating patient education and encouragement towards self-management. TMD care pathways should consider using the three'pillars'of pain management: physical therapies, pharmacotherapy and clinical psychology.

  4. Nursing-led management of side effects of radiation: evidence-based recommendations for practice

    Directory of Open Access Journals (Sweden)

    Poirier P

    2013-03-01

    Full Text Available Patricia PoirierUniversity of Maine School of Nursing, Orono, ME, USAAbstract: It has been estimated that 50%–60% of patients diagnosed with cancer will receive radiation therapy at some point in their treatment. Although radiation therapy can play a significant role in the cure or control of cancer, and the palliation of symptoms, it also has side effects. Side effects of radiation therapy can interfere with patient quality of life and daily functioning. Severe side effects can lead to delays in treatment, potentially affecting the outcome of treatment. All patients receiving radiation therapy are at risk of fatigue and skin reactions in the area of the body being treated. Other side effects of radiation therapy are specific to the part of the body being treated. Radiation therapy to the head and neck area may cause oral mucositis, dryness, and nutritional deficiencies. Radiation therapy to the chest or lung area may lead to difficulty in swallowing and eating. Radiation therapy to the pelvis frequently causes diarrhea. There are many nursing interventions available to manage the side effects of treatment based on best available evidence and expert opinion. Nurses in all settings are essential in helping patients manage the side effects of treatment and maintain their quality of life. The purpose of this review is to provide nurses with evidence-based recommendations and suggestions for managing common acute side effects of radiation therapy.Keywords: evidence-based practice, radiation therapy, side effects, nursing management

  5. Multinational evidence-based recommendations for the diagnosis and management of gout

    DEFF Research Database (Denmark)

    Sivera, Francisca; Andrés, Mariano; Carmona, Loreto

    2014-01-01

    We aimed to develop evidence-based multinational recommendations for the diagnosis and management of gout. Using a formal voting process, a panel of 78 international rheumatologists developed 10 key clinical questions pertinent to the diagnosis and management of gout. Each question was investigated...... of evidence. Agreement and potential impact on clinical practice were assessed. Combining evidence and clinical expertise, 10 recommendations were produced. One recommendation referred to the diagnosis of gout, two referred to cardiovascular and renal comorbidities, six focused on different aspects...... of the management of gout (including drug treatment and monitoring), and the last recommendation referred to the management of asymptomatic hyperuricaemia. The level of agreement with the recommendations ranged from 8.1 to 9.2 (mean 8.7) on a 1-10 scale, with 10 representing full agreement. Ten recommendations...

  6. Randomized Trial of MST and ARC in a Two-Level Evidence-Based Treatment Implementation Strategy

    Science.gov (United States)

    Glisson, Charles; Schoenwald, Sonja K.; Hemmelgarn, Anthony; Green, Philip; Dukes, Denzel; Armstrong, Kevin S.; Chapman, Jason E.

    2010-01-01

    Objective: A randomized trial assessed the effectiveness of a 2-level strategy for implementing evidence-based mental health treatments for delinquent youth. Method: A 2 x 2 design encompassing 14 rural Appalachian counties included 2 factors: (a) the random assignment of delinquent youth within each county to a multisystemic therapy (MST) program…

  7. Management of fibromyalgia syndrome – an interdisciplinary evidence-based guideline

    Directory of Open Access Journals (Sweden)

    Sommer, Claudia

    2008-12-01

    Full Text Available The prevalence of fibromyalgia syndrome (FMS of 1–2% in the general population associated with high disease-related costs and the conflicting data on treatment effectiveness had led to the development of evidence-based guidelines designed to provide patients and physicians guidance in selecting among the alternatives. Until now no evidence-based interdisciplinary (including patients guideline for the management of FMS was available in Europe. Therefore a guideline for the management of fibromyalgia syndrome (FMS was developed by 13 German medical and psychological associations and two patient self-help organisations. The task was coordinated by two German scientific umbrella organisations, the Association of the Scientific Medical Societies in Germany AWMF and the German Interdisciplinary Association of Pain Therapy DIVS. A systematic search of the literature including all controlled studies, systematic reviews and meta-analyses of pharmacological and non-pharmacological treatments of FMS was performed in the Cochrane Library (1993–12/2006, Medline (1980–12/2006, PsychInfo (1966–12/2006 and Scopus (1980–12/ 2006. Levels of evidence were assigned according to the classification system of the Oxford-Centre for Evidence Based Medicine. Grading of the strengths of recommendations was done according to the German program for disease management guidelines. Standardized procedures were used to reach a consensus on recommendations. The guideline was reviewed and finally approved by the boards of the societies involved and published online by the AWMF on april 25, 2008: http://www.uni-duesseldorf.de/AWMF/ll/041-004.htm. A short version of the guideline for patients is available as well: http://www.uni-duesseldorf.de/AWMF/ll/041-004p.htm. The following procedures in the management of FMS were strongly recommended: information on diagnosis and therapeutic options and patient-centered communication, aerobic exercise, cognitive and operant

  8. Identifying and ranking implicit leadership strategies to promote evidence-based practice implementation in addiction health services.

    Science.gov (United States)

    Guerrero, Erick G; Padwa, Howard; Fenwick, Karissa; Harris, Lesley M; Aarons, Gregory A

    2016-05-14

    Despite a solid research base supporting evidence-based practices (EBPs) for addiction treatment such as contingency management and medication-assisted treatment, these services are rarely implemented and delivered in community-based addiction treatment programs in the USA. As a result, many clients do not benefit from the most current and efficacious treatments, resulting in reduced quality of care and compromised treatment outcomes. Previous research indicates that addiction program leaders play a key role in supporting EBP adoption and use. The present study expanded on this previous work to identify strategies that addiction treatment program leaders report using to implement new practices. We relied on a staged and iterative mixed-methods approach to achieve the following four goals: (a) collect data using focus groups and semistructured interviews and conduct analyses to identify implicit managerial strategies for implementation, (b) use surveys to quantitatively rank strategy effectiveness, (c) determine how strategies fit with existing theories of organizational management and change, and (d) use a consensus group to corroborate and expand on the results of the previous three stages. Each goal corresponded to a methodological phase, which included data collection and analytic approaches to identify and evaluate leadership interventions that facilitate EBP implementation in community-based addiction treatment programs. Findings show that the top-ranked strategies involved the recruitment and selection of staff members receptive to change, offering support and requesting feedback during the implementation process, and offering in vivo and hands-on training. Most strategies corresponded to emergent implementation leadership approaches that also utilize principles of transformational and transactional leadership styles. Leadership behaviors represented orientations such as being proactive to respond to implementation needs, supportive to assist staff members

  9. Evidence-based topical management of chronic wounds according to the T.I.M.E. principle.

    Science.gov (United States)

    Klein, Silvan; Schreml, Stephan; Dolderer, Juergen; Gehmert, Sebastian; Niederbichler, Andreas; Landthaler, Michael; Prantl, Lukas

    2013-09-01

    The number of patients suffering from chronic wound healing disorders in Germany alone is estimated to be 2.5-4 million. Therapy related expenses reach 5-8 billion Euros annually. This number is partially caused by costly dressing changes due to non-standardized approaches and the application of non-evidence-based topical wound therapies. The purpose of this paper is to elucidate a straightforward principle for the management of chronic wounds, and to review the available evidence for the particular therapy options. The T.I.M.E.-principle (Tissue management, Inflammation and infection control, Moisture balance, Epithelial [edge] advancement) was chosen as a systematic strategy for wound bed preparation. Literature was retrieved from the PubMed and Cochrane Library databases and subjected to selective analysis. Topical wound management should be carried out according to a standardized principle and should further be synchronized to the phases of wound healing. Despite the broad implementation of these products in clinical practice, often no benefit exists in the rate of healing, when evaluated in meta-analyses or systematic reviews. This insufficient evidence is additionally limited by varying study designs. In case of non-superiority, the results suggest to prefer relatively inexpensive wound dressings over expensive alternatives. Arbitrary endpoints to prove the effectiveness of wound dressings, contribute to the random use of such therapies. Defining rational endpoints for future studies as well as the deployment of structured therapy strategies will be essential for the economical and evidence-based management of chronic wounds. © The Authors | Journal compilation © Blackwell Verlag GmbH, Berlin.

  10. Strategies for Translating Evidence-Based Medicine in Lung Cancer into Community Practice.

    Science.gov (United States)

    Rosenberg, Stephen A; Baschnagel, Andrew M; Bagley, Stephen J; Housri, Nadine

    2017-01-01

    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.

  11. Using a Guided Journal Club as a Teaching Strategy to Enhance Learning Skills for Evidence-Based Practice.

    Science.gov (United States)

    Szucs, Kimberly A; Benson, Jeryl D; Haneman, Brianne

    2017-04-01

    Journal clubs are used in both clinical and academic settings in order for clinicians and students to utilize current best-practices, become competent in evidence based practice and develop critical appraisal skills. Journal clubs encourage students to practice searching for relevant research, critically appraising articles, and contributing to open discussions with peers. Establishing the practice of reading and critiquing literature in the classroom can enable the creation of a habit of using current evidence when students enter practice. This article describes a strategy for delivering a structured academic journal club to support the learning of evidence based practice skills and students' perception of the journal club, including their overall satisfaction, knowledge base skills, and presentation skills. Students had an overall positive experience and perception of the guided journal club activity. From the instructor's perspective, this assignment was an excellent opportunity to engage students in learning the process of evidence based practice.

  12. Evidence-based dietary management of functional gastrointestinal symptoms: The FODMAP approach.

    Science.gov (United States)

    Gibson, Peter R; Shepherd, Susan J

    2010-02-01

    Functional gastrointestinal symptoms are common and their management is often a difficult clinical problem. The link between food intake and symptom induction is recognized. This review aims to describe the evidence base for restricting rapidly fermentable, short-chain carbohydrates (FODMAPs) in controlling such symptoms. The nature of FODMAPs, their mode of action in symptom induction, results of clinical trials and the implementation of the diet are described. FODMAPs are widespread in the diet and comprise a monosaccharide (fructose), a disaccharide (lactose), oligosaccharides (fructans and galactans), and polyols. Their ingestion increases delivery of readily fermentable substrate and water to the distal small intestine and proximal colon, which are likely to induce luminal distension and induction of functional gut symptoms. The restriction of their intake globally (as opposed to individually) reduces functional gut symptoms, an effect that is durable and can be reversed by their reintroduction into the diet (as shown by a randomized placebo-controlled trial). The diet has a high compliance rate. However it requires expert delivery by a dietitian trained in the diet. Breath hydrogen tests are useful to identify individuals who can completely absorb a load of fructose and lactose so that dietary restriction can be less stringent. The low FODMAP diet provides an effective approach to the management of patients with functional gut symptoms. The evidence base is now sufficiently strong to recommend its widespread application.

  13. Pre-hospital care after a seizure: Evidence base and United Kingdom management guidelines.

    Science.gov (United States)

    Osborne, Andrew; Taylor, Louise; Reuber, Markus; Grünewald, Richard A; Parkinson, Martin; Dickson, Jon M

    2015-01-01

    Seizures are a common presentation to pre-hospital emergency services and they generate significant healthcare costs. This article summarises the United Kingdom (UK) Ambulance Service guidelines for the management of seizures and explores the extent to which these guidelines are evidence-based. Summary of the Clinical Practice Guidelines of the UK Joint Royal Colleges Ambulance Liaison Committee relating to the management of seizures. Review of the literature relating to pre-hospital management of seizure emergencies. Much standard practice relating to the emergency out of hospital management of patients with seizures is drawn from generic Advanced Life Support (ALS) guidelines although many patients do not need ALS during or after a seizure and the benefit of many ALS interventions in seizure patients remains to be established. The majority of studies identified pertain to medical treatment of status epilepticus. These papers show that benzodiazepines are safe and effective but it is not possible to draw definitive conclusions about the best medication or the optimal route of administration. The evidence base for current pre-hospital guidelines for seizure emergencies is incomplete. A large proportion of patients are transported to hospital after a seizure but many of these may be suitable for home management. However, there is very little research into alternative care pathways or criteria that could be used to help paramedics avoid transport to hospital. More research is needed to improve care for people after a seizure and to improve the cost-effectiveness of the healthcare systems within which they are treated. Copyright © 2014 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

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

    NARCIS (Netherlands)

    Maggio, L.A.

    2015-01-01

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

  15. Single-Case Research Design: An Alternative Strategy for Evidence-Based Practice

    Science.gov (United States)

    Stapleton, Drue; Hawkins, Andrew

    2015-01-01

    Objective: The trend of utilizing evidence-based practice (EBP) in athletic training is now requiring clinicians, researchers, educators, and students to be equipped to both engage in and make judgments about research evidence. Single-case design (SCD) research may provide an alternative approach to develop such skills and inform clinical and…

  16. Research Practice Partnerships: A Strategy for Promoting Evidence-Based Decision-Making in Education

    Science.gov (United States)

    Wentworth, Laura; Mazzeo, Christopher; Connolly, Faith

    2017-01-01

    Background: In the United States, an emphasis on evidence-based decision-making in education has received renewed interest with the recent passage of the Every Student Succeeds Act. However, how best, in practice, to support the use of evidence in educational decision-making remains unclear. Research Practice Partnerships (RPPs) are a popular…

  17. Evidence-based nursing: the role of the advanced practice registered nurse in the management of heart failure patients in the outpatient setting.

    Science.gov (United States)

    Case, Rachel; Haynes, Donna; Holaday, Bonnie; Parker, Veronica G

    2010-01-01

    Heart failure (HF) is a chronic debilitating illness that affects millions of Americans each year. Patients with HF are faced with chronic physical symptoms, emotional strain, and significant socioeconomic burden. Goals in the management of HF are to slow the disease progression, decrease symptom acuity, and prevent exacerbations that lead to hospital readmission. Management of HF remains a challenge for healthcare providers. There is a fine balance between optimizing patient functioning and minimizing healthcare expenditures. With the incidence of HF increasing annually, it is important to have effective disease management strategies in place. In any disease management program, it is important to follow those guidelines outlined by evidence-based practice. The purpose of this systematic review was to evaluate current evidence-based practice and determine what benefit exists of having an advanced practice registered nurse assist in the management of patients with HF.

  18. Desired attributes and skills of program managers in translation of evidence-based interventions.

    Science.gov (United States)

    Williams, Rhonda; Woodell, Carol; McCarville, Erin; Damitz, Maureen; Banks, Tinesha; Montoya, Jorge; Lesch, Julie Kennedy; Peretz, Patricia; Lara, Marielena

    2011-11-01

    Successful chronic disease project management, especially of multiyear initiatives using evidence-based interventions (EBIs), is of great importance to funders, health care decision makers, and researchers, particularly in light of limited funding. However, a gap in knowledge may exist regarding which attributes and skills are most desirable in a program manager to help him or her ensure successful implementation of EBIs. Although some literature examines the dynamics contributing to the success of community coalitions, public health leadership, and community health education, there is minimal literature exploring the significance of a program manager's role in the conceptualization, implementation, and sustainability of initiatives to improve patient and community health. The authors present their experiences as participants in a large-scale asthma initiative implemented in priority communities, as well as results of a survey distributed among all personnel of the program sites. The survey aimed to assess the key skills and attributes, in addition to contextual factors, that contribute to the strength of a program manager overseeing EBIs in asthma initiatives. The results suggest that certain attributes and skills are desirable in recruiting and hiring of a program manager, especially when augmented by ongoing skill-building training, and can help ensure program and research success.

  19. Reverse Engineering: Strategy to Teach Evidence-Based Practice to Online RN-to-BSN Students.

    Science.gov (United States)

    Gary, Jodie C; Hudson, Cindy E

    2016-01-01

    This article describes an innovative approach to introducing RN-to-BSN students to nursing research and evidence-based practice (EBP). Reverse engineering updates an existing EBP project to better emphasize the role of research and evidence to practicing RNs enrolled in an RN-to-BSN program. Reverse engineering of a nursing practice guideline offers a method for teaching an appreciation of research and supporting nursing practice with best evidence.

  20. Teaching evidence-based medicine to undergraduate medical students: a course integrating ethics, audit, management and clinical epidemiology.

    Science.gov (United States)

    Rhodes, Martin; Ashcroft, Richard; Atun, Rifat A; Freeman, George K; Jamrozik, Konrad

    2006-06-01

    A six-week full time course for third-year undergraduate medical students at Imperial College uniquely links evidence-based medicine (EBM) with ethics and the management of change in health services. It is mounted jointly by the Medical and Business Schools and features an experiential approach. Small teams of students use a problem-based strategy to address practical issues identified from a range of clinical placements in primary and secondary care settings. The majority of these junior clinical students achieve important objectives for learning about teamwork, critical appraisal, applied ethics and health care organisations. Their work often influences the care received by patients in the host clinical units. We discuss the strengths of the course in relation to other accounts of programmes in EBM. We give examples of recurring experiences from successive cohorts and discuss assessment issues and how our multi-phasic evaluation informs evolution of the course and the potential for future developments.

  1. Evidence-Based Psychological Interventions for the Management of Pediatric Chronic Pain: New Directions in Research and Clinical Practice

    Directory of Open Access Journals (Sweden)

    Rachael Coakley

    2017-02-01

    Full Text Available Over the past 20 years our knowledge about evidence-based psychological interventions for pediatric chronic pain has dramatically increased. Overall, the evidence in support of psychological interventions for pediatric chronic pain is strong, demonstrating positive psychological and behavioral effects for a variety of children with a range of pain conditions. However, wide scale access to effective psychologically-based pain management treatments remains a challenge for many children who suffer with pain. Increasing access to care and reducing persistent biomedical biases that inhibit attainment of psychological services are a central focus of current pain treatment interventions. Additionally, as the number of evidence-based treatments increase, tailoring treatments to a child or family’s particular needs is increasingly possible. This article will (1 discuss the theoretical frameworks as well as the specific psychological skills and strategies that currently hold promise as effective agents of change; (2 review and summarize trends in the development of well-researched outpatient interventions over the past ten years; and (3 discuss future directions for intervention research on pediatric chronic pain.

  2. Evidence-based disease management: its role in cardiovascular risk reduction.

    Science.gov (United States)

    Fanning, Etta L

    2004-01-01

    Cardiovascular disease remains the most pressing healthcare problem in the United States. Traditional risk factors--hypertension, obesity, and diabetes-are still unresolved issues; and new risk factors--pre-diabetes, insulin resistance, and pediatric and adolescent diabetes-have emerged. There is an urgent need to identify the risk factors for cardiovascular disease, and address risk reduction with disease management and treatment for each factor, based on qualitative and quantitative approaches for developing the evidence base for public health action. The objectives of this paper are to review (i) the burden of cardiovascular illness-morbidity, mortality, and cost; (ii) risk factors and the emerging epidemic of adolescent obesity; (iii) the challenges of attaining target endpoints; and (iv) the attributes of a successful programmatic healthcare initiative for potential impact on cardiovascular care and, eventually, public health.

  3. Multinational evidence-based recommendations for pain management by pharmacotherapy in inflammatory arthritis

    DEFF Research Database (Denmark)

    Whittle, Samuel L; Colebatch, Alexandra N; Buchbinder, Rachelle

    2012-01-01

    Objective. To develop evidence-based recommendations for pain management by pharmacotherapy in patients with inflammatory arthritis (IA).Methods. A total of 453 rheumatologists from 17 countries participated in the 2010 3e (Evidence, Expertise, Exchange) Initiative. Using a formal voting process......, 89 rheumatologists representing all 17 countries selected 10 clinical questions regarding the use of pain medications in IA. Bibliographic fellows undertook a systematic literature review for each question, using MEDLINE, EMBASE, Cochrane CENTRAL and 2008-09 European League Against Rheumatism (EULAR...... practice.Results. A total of 49¿242 references were identified, from which 167 studies were included in the systematic reviews. One clinical question regarding different comorbidities was divided into two separate reviews, resulting in 11 recommendations in total. Oxford levels of evidence were applied...

  4. Multinational evidence-based recommendations for pain management by pharmacotherapy in inflammatory arthritis

    DEFF Research Database (Denmark)

    Whittle, Samuel L; Colebatch, Alexandra N; Buchbinder, Rachelle

    2012-01-01

    Objective. To develop evidence-based recommendations for pain management by pharmacotherapy in patients with inflammatory arthritis (IA).Methods. A total of 453 rheumatologists from 17 countries participated in the 2010 3e (Evidence, Expertise, Exchange) Initiative. Using a formal voting process......, 89 rheumatologists representing all 17 countries selected 10 clinical questions regarding the use of pain medications in IA. Bibliographic fellows undertook a systematic literature review for each question, using MEDLINE, EMBASE, Cochrane CENTRAL and 2008-09 European League Against Rheumatism (EULAR...... practice.Results. A total of 49 242 references were identified, from which 167 studies were included in the systematic reviews. One clinical question regarding different comorbidities was divided into two separate reviews, resulting in 11 recommendations in total. Oxford levels of evidence were applied...

  5. Medical management of myxomatous mitral valve disease: An evidence-based veterinary medicine approach.

    Science.gov (United States)

    Burchell, Richard K; Schoeman, Johan

    2014-10-22

    Myxomatous mitral valve disease (MMVD) is the most common heart disease of dogs. The current management of MMVD in dogs is mostly pharmacological, and the recommendations for treatment are based on a number of veterinary studies. Notwithstanding the current consensus regarding the medical management of MMVD, there remains active debate as to which drugs are the most effective. In order to understand how recommendations are constructed in the pharmacological management of diseases, the veterinarian needs to understand the concept of evidence-based veterinary medicine, and how the findings of these studies can be applied in their own practices. This review summarises the current veterinary literature and explains how the consensus regarding the management of MMVD has been reached. This review highlights the limitations of veterinary studies in order to provide veterinary practitioners with a sense of the difficulty there is in establishing the benefit of one treatment over the other. Veterinarians should therefore apply treatment recommendations based on the best evidence, integrated with a pathomechanistic understanding of the disease process and clinical experience.

  6. Evidence-based management of otitis media: a 5S model approach.

    Science.gov (United States)

    Wasson, J D; Yung, M W

    2015-02-01

    The 5S model proposes five hierarchical levels (systems, summaries, synopses, syntheses and studies) of pre-appraised evidence to guide evidence-based practice. This review aimed to identify and summarise pre-appraised evidence at the highest available 5S level for the management of different subsets of otitis media: acute otitis media, otitis media with effusion, chronic suppurative otitis media and cholesteatoma in both adults and children. Data sources were pre-appraised evidence resources. Evidence freely available from sources at the highest available level of the 5S model were summarised for this review. System level evidence exists for acute otitis media and otitis media with effusion. Summary level evidence exists for recurrent acute otitis media and medical management of chronic suppurative otitis media. There is an absence of randomised controlled trials to prove the efficacy of surgical management of chronic suppurative otitis media and cholesteatoma. Until randomised controlled trial data are generated, consensus publications on the surgical management of chronic suppurative otitis media and cholesteatoma should be used to guide best practice.

  7. Evidence-based practice for pain management for cancer patients in an acute care setting.

    Science.gov (United States)

    Choi, Mona; Kim, Hee Sun; Chung, Su Kyoung; Ahn, Mee Jung; Yoo, Jae Yong; Park, Ok Sun; Woo, So Rah; Kim, So Sun; Kim, Sun Ah; Oh, Eui Geum

    2014-02-01

    The purpose of this study is to implement an evidence utilization project using an audit and feedback approach to improve cancer pain management. A three-phased audit and feedback approach was used. A 46-bed oncology nursing unit in the university's cancer centre was selected as a research site. Nursing records extracted from 137 patients (65 for the baseline assessment and 72 for the follow-up audit) were used to examine nurse compliance with four audit criteria derived from best practice guidelines related to the assessment and management of pain. We observed a significant improvement in compliance from baseline to follow-up for the following criteria: documenting the side effects of opioids (2-83%), use of a formalized pain assessment tool (22-75%), and providing education for pain assessment and management to patients and caregivers (0-47%). The audit and feedback method was applicable to the implementation of clinical practice guidelines for cancer pain management. Leadership from both administrative personnel and staff nurses working together contributes to the spread of an evidence-based practice culture in clinical settings. As it was conducted in a single oncology nursing unit and was implemented over a short period of time, the results should be carefully interpreted. © 2013 Wiley Publishing Asia Pty Ltd.

  8. Proposing evidence-based strategies to strengthen implementation of healthcare reform in resource-limited settings: a summative analysis.

    Science.gov (United States)

    Manyazewal, Tsegahun; Oosthuizen, Martha J; Matlakala, Mokgadi C

    2016-09-20

    Many resource-limited countries have adopted and implemented healthcare reform to improve the quality of healthcare, but few have had much impact and strategies in support of these efforts remain limited. We aimed to explore and propose evidence-based strategies to strengthen implementation of healthcare reform in resource-limited settings. Descriptive and exploratory designs in two phases. Phase I involved assessing the effectiveness of the healthcare reform implemented in Ethiopia in the form of business process reengineering, with evidence compiled from healthcare professionals through a self-administered questionnaire; and phase II involved proposing strategies and seeking consensus from experts using Delphi method. Public hospitals in central Ethiopia. 406 healthcare professionals and 10 senior health policy experts. The healthcare reform that we evaluated was able to restructure hospital departments into case teams, with the goal of adopting a 'one-stop shopping' approach. However, shortages of critical infrastructure, furniture and supplies and job dissatisfaction continued to hamper the system. The most important predictors that influenced implementation of the reform were financial resources, top management commitment and support, collaborative working environment and information technology (IT). Five strategies with 14 operational objectives and 67 potential interventions that could strengthen the reform are proposed based on their strategic priority, which are as follows: reinforce patient-centred quality of care services; foster a healthy and respectful workforce environment; efficient and accountable leadership and governance; efficient use of hospital financing and maximise innovations and the use of health technologies. Effective implementation of healthcare reform remained a challenge for governments in resource-limited settings. Resilient operational, clinical and governance functions of health systems, as well as a motivated and committed health

  9. Fostering critical thinking skills: a strategy for enhancing evidence based wellness care

    Directory of Open Access Journals (Sweden)

    Jamison Jennifer R

    2005-09-01

    Full Text Available Abstract Chiropractic has traditionally regarded itself a wellness profession. As wellness care is postulated to play a central role in the future growth of chiropractic, the development of a wellness ethos acceptable within conventional health care is desirable. This paper describes a unit which prepares chiropractic students for the role of "wellness coaches". Emphasis is placed on providing students with exercises in critical thinking in an effort to prepare them for the challenge of interfacing with an increasingly evidence based health care system. Methods This case study describes how health may be promoted and disease prevented through development of personalized wellness programs. As critical thinking is essential to the provision of evidence based wellness care, diverse learning opportunities for developing and refining critical thinking skills have been created. Three of the learning opportunities are an intrinsic component of the subject and, taken together, contributed over 50% of the final grade of the unit. They include a literature review, developing a client wellness contract and peer evaluation. In addition to these 3 compulsory exercises, students were also given an opportunity to develop their critical appraisal skills by undertaking voluntary self- and unit evaluation. Several opportunities for informal self-appraisal were offered in a structured self-study guide, while unit appraisal was undertaken by means of a questionnaire and group discussion at which the Head of School was present. Results Formal assessment showed all students capable of preparing a wellness program consistent with current thinking in contemporary health care. The small group of students who appraised the unit seemed to value the diversity of learning experiences provided. Opportunities for voluntary unit and self-appraisal were used to varying degrees. Unit evaluation provided useful feedback that led to substantial changes in unit structure

  10. Fostering critical thinking skills: a strategy for enhancing evidence based wellness care

    Science.gov (United States)

    Jamison, Jennifer R

    2005-01-01

    Chiropractic has traditionally regarded itself a wellness profession. As wellness care is postulated to play a central role in the future growth of chiropractic, the development of a wellness ethos acceptable within conventional health care is desirable. This paper describes a unit which prepares chiropractic students for the role of "wellness coaches". Emphasis is placed on providing students with exercises in critical thinking in an effort to prepare them for the challenge of interfacing with an increasingly evidence based health care system. Methods This case study describes how health may be promoted and disease prevented through development of personalized wellness programs. As critical thinking is essential to the provision of evidence based wellness care, diverse learning opportunities for developing and refining critical thinking skills have been created. Three of the learning opportunities are an intrinsic component of the subject and, taken together, contributed over 50% of the final grade of the unit. They include a literature review, developing a client wellness contract and peer evaluation. In addition to these 3 compulsory exercises, students were also given an opportunity to develop their critical appraisal skills by undertaking voluntary self- and unit evaluation. Several opportunities for informal self-appraisal were offered in a structured self-study guide, while unit appraisal was undertaken by means of a questionnaire and group discussion at which the Head of School was present. Results Formal assessment showed all students capable of preparing a wellness program consistent with current thinking in contemporary health care. The small group of students who appraised the unit seemed to value the diversity of learning experiences provided. Opportunities for voluntary unit and self-appraisal were used to varying degrees. Unit evaluation provided useful feedback that led to substantial changes in unit structure. Conclusion Students have demonstrated

  11. Controversies in the management of deep neck space infection in children: an evidence-based review.

    Science.gov (United States)

    Lawrence, R; Bateman, N

    2017-02-01

    Deep neck space infection (DNSI) is defined as infection in the potential spaces and fascial planes of the neck. Early recognition of DNSI can be challenging due to the complex head and neck anatomy; hence, a high index of suspicion is required to prevent a delay in diagnosis and appropriate management. There remains a lack of consensus on the management of paediatric DNSI with many advocating a more aggressive approach with immediate surgical drainage, while others favour a more conservative approach with medical management in the first instance. The current literature on the management of paediatric DNSI is reviewed. A literature review performed in November 2015 searched PubMed using the terms 'deep neck space', 'infection', 'paediatric', 'pediatric', 'children', 'imaging', 'conservative', 'antibiotic' and 'surgery'. Articles not in the English language were excluded. (i) Clinical presentation: Management of a compromised airway is the priority. Clinical history and examination enables the identification of the primary source of infection and presence of complications. (ii) Investigations: Laboratory and microbiological investigations should be appropriately targeted, and CT imaging is the modality utilised in most cases. The presence of specific complications may warrant other imaging modalities. (iii) Antibiotics: An evidence-based antibiotic regime is proposed. (iv) Conservative treatment: In children lacking indications for surgical intervention, a trial 48 h of intravenous antibiotics (IV Abx) should be commenced. v) Surgical intervention: Indications include signs of airway compromise, presence of complications, no clinical improvement after 48 h of IV Abx, abscess >2.2 cm on CT imaging, age <4 years and ITU admission. An appreciation of head and neck anatomy is vital to understanding disease pathology and potential complications of DNSI, which may be life threatening. Both conservative and surgical approaches are viable treatment options and may

  12. Evidence-based clinical practice guidelines for interventional pain management in cancer pain

    Directory of Open Access Journals (Sweden)

    Sushma Bhatnagar

    2015-01-01

    Full Text Available Intractable cancer pain not amenable to standard oral or parenteral analgesics is a horrifying truth in 10-15% of patients. Interventional pain management techniques are an indispensable arsenal in pain physician′s armamentarium for severe, intractable pain and can be broadly classified into neuroablative and neuromodulation techniques. An array of neurolytic techniques (chemical, thermal, or surgical can be employed for ablation of individual nerve fibers, plexuses, or intrathecalneurolysis in patients with resistant pain and short life-expectancy. Neuraxial administration of drugs and spinal cord stimulation to modulate or alter the pain perception constitutes the most frequently employed neuromodulation techniques. Lately, there is a rising call for early introduction of interventional techniques in carefully selected patients simultaneously or even before starting strong opioids. After decades of empirical use, it is the need of the hour to head towards professionalism and standardization in order to secure credibility of specialization and those practicing it. Even though the interventional management has found a definite place in cancer pain, there is a dearth of evidence-based practice guidelines for interventional therapies in cancer pain. This may be because of paucity of good quality randomized controlled trials (RCTs evaluating their safety and efficacy in cancer pain. Laying standardized guidelines based on existing and emerging evidence will act as a foundation step towards strengthening, credentialing, and dissemination of the specialty of interventional cancer pain management. This will also ensure an improved decision-making and quality of life (QoL of the suffering patients.

  13. Using Getting To Outcomes to facilitate the use of an evidence-based practice in VA homeless programs: a cluster-randomized trial of an implementation support strategy.

    Science.gov (United States)

    Chinman, Matthew; McCarthy, Sharon; Hannah, Gordon; Byrne, Thomas Hugh; Smelson, David A

    2017-03-09

    Incorporating evidence-based integrated treatment for dual disorders into typical care settings has been challenging, especially among those serving Veterans who are homeless. This paper presents an evaluation of an effort to incorporate an evidence-based, dual disorder treatment called Maintaining Independence and Sobriety Through Systems Integration, Outreach, and Networking-Veterans Edition (MISSION-Vet) into case management teams serving Veterans who are homeless, using an implementation strategy called Getting To Outcomes (GTO). This Hybrid Type III, cluster-randomized controlled trial assessed the impact of GTO over and above MISSION-Vet Implementation as Usual (IU). Both conditions received standard MISSION-Vet training and manuals. The GTO group received an implementation manual, training, technical assistance, and data feedback. The study occurred in teams at three large VA Medical Centers over 2 years. Within each team, existing sub-teams (case managers and Veterans they serve) were the clusters randomly assigned. The trial assessed MISSION-Vet services delivered and collected via administrative data and implementation barriers and facilitators, via semi-structured interview. No case managers in the IU group initiated MISSION-Vet while 68% in the GTO group did. Seven percent of Veterans with case managers in the GTO group received at least one MISSION-Vet session. Most case managers appreciated the MISSION-Vet materials and felt the GTO planning meetings supported using MISSION-Vet. Case manager interviews also showed that MISSION-Vet could be confusing; there was little involvement from leadership after their initial agreement to participate; the data feedback system had a number of difficulties; and case managers did not have the resources to implement all aspects of MISSION-Vet. This project shows that GTO-like support can help launch new practices but that multiple implementation facilitators are needed for successful execution of a complex evidence-based

  14. Mnemonic Strategies: Evidence-Based Practice and Practice-Based Evidence

    Science.gov (United States)

    Scruggs, Thomas E.; Mastropieri, Margo A.; Berkeley, Sheri L.; Marshak, Lisa

    2010-01-01

    This article presents information on using mnemonic strategies to enhance learning and memory of students with mild disabilities. Different types of mnemonic strategies are described, including the keyword method, the pegword method, and letter strategies. Following this, a number of teachers describe their own applications of mnemonic strategies…

  15. Evidence-based management of deep wound infection after spinal instrumentation.

    Science.gov (United States)

    Lall, Rishi R; Wong, Albert P; Lall, Rohan R; Lawton, Cort D; Smith, Zachary A; Dahdaleh, Nader S

    2015-02-01

    In this study, evidence-based medicine is used to assess optimal surgical and medical management of patients with post-operative deep wound infection following spinal instrumentation. A computerized literature search of the PubMed database was performed. Twenty pertinent studies were identified. Studies were separated into publications addressing instrumentation retention versus removal and publications addressing antibiotic therapy regimen. The findings were classified based on level of evidence (I-III) and findings were summarized into evidentiary tables. No level I or II evidence was identified. With regards to surgical management, five studies support instrumentation retention in the setting of early deep infection. In contrast, for delayed infection, the evidence favors removal of instrumentation at the time of initial debridement. Surgeons should be aware that for deformity patients, even if solid fusion is observed, removal of instrumentation may be associated with significant loss of correction. A course of intravenous antibiotics followed by long-term oral suppressive therapy should be pursued if instrumentation is retained. A shorter treatment course may be appropriate if hardware is removed. Copyright © 2014 Elsevier Ltd. All rights reserved.

  16. Use of evidence-based management in healthcare administration decision-making.

    Science.gov (United States)

    Guo, Ruiling; Berkshire, Steven D; Fulton, Lawrence V; Hermanson, Patrick M

    2017-07-03

    Purpose The purpose of this paper is to examine whether healthcare leaders use evidence-based management (EBMgt) when facing major decisions and what types of evidence healthcare administrators consult during their decision-making. This study also intends to identify any relationship that might exist among adoption of EBMgt in healthcare management, attitudes towards EBMgt, demographic characteristics and organizational characteristics. Design/methodology/approach A cross-sectional study was conducted among US healthcare leaders. Spearman's correlation and logistic regression were performed using the Statistical Package for the Social Sciences (SPSS) 23.0. Findings One hundred and fifty-four healthcare leaders completed the survey. The study results indicated that 90 per cent of the participants self-reported having used an EBMgt approach for decision-making. Professional experiences (87 per cent), organizational data (84 per cent) and stakeholders' values (63 per cent) were the top three types of evidence consulted daily and weekly for decision-making. Case study (75 per cent) and scientific research findings (75 per cent) were the top two types of evidence consulted monthly or less than once a month. An exploratory, stepwise logistic regression model correctly classified 75.3 per cent of all observations for a dichotomous "use of EBMgt" response variable using three independent variables: attitude towards EBMgt, number of employees in the organization and the job position. Spearman's correlation indicated statistically significant relationships between healthcare leaders' use of EBMgt and healthcare organization bed size ( rs = 0.217, n = 152, p making.

  17. Nursing journal clubs: A literature review on the effective teaching strategy for continuing education and evidence-based practice.

    Science.gov (United States)

    Lachance, Carly

    2014-12-01

    This literature review on nursing journal clubs evaluates the efficacy of the teaching strategy within the clinical setting. Peer-reviewed articles were retrieved using an online journal database. Inclusion criteria incorporated information on efficacy of the teaching strategy, evidence-based practices, and continuing education as they related to nursing journal club initiatives. The literature cited numerous benefits and proved to be in favor of nursing journal clubs. The most common benefits found were nurses remaining abreast of current research, skill development in reading and critically appraising research, and incorporation of evidenice-based practices to patient care. Due to the self-motivated and voluntary nature of this teaching strategy, a limitation commonly identified was lack of participation, and further research on this limitation often was suggested. Nursing journal clubs proved to be an effective teaching strategy; a finding that remains consistent with the medical pioneers of the movement.

  18. An Evidence-Based Review Literature About Risk Indicators and Management of Unknown-Origin Xerostomia

    Directory of Open Access Journals (Sweden)

    Farzaneh Agha-hosseini

    2013-01-01

    Full Text Available Objective: This evidence-based article reviews risk indicators and management of unknown-origin xerostomia. Xerostomia and hyposalivation refer to different aspects of dry mouth. Xerostomia is a subjective sensation of dry mouth, whilst hyposalivation is defined as an objective assessment of reduced salivary flow rate. About 30% of the elderly (65 years and older experience xerostomia and hyposalivation. Structural and functional factors, or both may lead to salivary gland dysfunction.Study Selection: The EBM literature search was conducted by using the medical literature database MEDLINE via PubMed and OvidMedline search engines. Results were limited to English language articles (1965 to present including clinical trials (CT, randomized controlled trials (RCT, systematic reviews and review articles. Case control or cohort studies were included for the etiology.Results: Neuropathic etiology such as localized oral alteration of thermal sensations, saliva composition change (for example higher levels of K, Cl, Ca, IgA, amylase, calcium, PTH and cortisol, lower levels of estrogen and progesterone, smaller salivary gland size, and illnesses such as lichen planus, are risk indicators for unknown-origin xerostomia. The management is palliative and preventative. Management of symptoms includes drug administration (systemic secretogogues, saliva substitutes and bile secretion-stimulator, night guard, diet and habit modifications. Other managements may be indicated to treat adverse effects.Conclusion: Neuropathic etiology, saliva composition change, smaller salivary gland size, and illnesses such as oral lichen planus can be suggestive causes for unknown-origin xerostomia. However, longitudinal studies will be important to elucidate the causes of unknown-origin xerostomia.

  19. An Evidence-Based Review Literature About Risk Indicators and Management of Unknown-Origin Xerostomia

    Science.gov (United States)

    Agha-Hosseini, Farzaneh; Moosavi, Mahdieh-Sadat

    2013-01-01

    This evidence-based article reviews risk indicators and management of unknown-origin xerostomia. Xerostomia and hyposalivation refer to different aspects of dry mouth. Xerostomia is a subjective sensation of dry mouth, whilst hyposalivation is defined as an objective assessment of reduced salivary flow rate. About 30% of the elderly (65 years and older) experience xerostomia and hyposalivation. Structural and functional factors, or both may lead to salivary gland dysfunction. The EBM literature search was conducted by using the medical literature database MEDLINE via PubMed and OvidMedline search engines. Results were limited to English language articles (1965 to present) including clinical trials (CT), randomized controlled trials (RCT), systematic reviews and review articles. Case control or cohort studies were included for the etiology. Neuropathic etiology such as localized oral alteration of thermal sensations, saliva composition change (for example higher levels of K, Cl, Ca, IgA, amylase, calcium, PTH and cortisol), lower levels of estrogen and progesterone, smaller salivary gland size, and illnesses such as lichen planus, are risk indicators for unknown-origin xerostomia. The management is palliative and preventative. Management of symptoms includes drug administration (systemic secretogogues, saliva substitutes and bile secretion-stimulator), night guard, diet and habit modifications. Other managements may be indicated to treat adverse effects. Neuropathic etiology, saliva composition change, smaller salivary gland size, and illnesses such as oral lichen planus can be suggestive causes for unknown-origin xerostomia. However, longitudinal studies will be important to elucidate the causes of unknown-origin xerostomia. PMID:25512755

  20. Reverse quality management: developing evidence-based best practices in health emergency management.

    Science.gov (United States)

    Lynch, Tim; Cox, Paul

    2006-01-01

    The British Columbia Ministry of Health's Framework for Core Functions in Public Health was the catalyst that inspired this review of best practices in health emergency management. The fieldwork was conducted in the fall of 2005 between hurricane Katrina and the South Asia earthquake. These tragedies, shown on 24/7 television news channels, provided an eyewitness account of disaster management, or lack of it, in our global village world. It is not enough to just have best practices in place. There has to be a governance structure that can be held accountable. This review of best practices lists actions in support of an emergency preparedness culture at the management, executive, and corporate/governance levels of the organization. The methodology adopted a future quality management approach of the emergency management process to identify the corresponding performance indictors that correlated with practices or sets of practices. Identifying best practice performance indictors needed to conduct a future quality management audit is described as reverse quality management. Best practices cannot be assessed as stand-alone criteria; they are influenced by organizational culture. The defining of best practices was influenced by doubt about defining a practice it is hoped will never be performed, medical staff involvement, leadership, and an appreciation of the resources required and how they need to be managed. Best practice benchmarks are seen as being related more to "measures" of performance defined locally and agreed on by 2 or more parties rather than to achieving industrial standards. Relating practices to performance indicators and then to benchmarks resulted in the development of a Health Emergency Management Best Practices Matrix that lists specific practice in the different phases of emergency management.

  1. Leadership succession planning: an evidence-based approach for managing the future.

    Science.gov (United States)

    Redman, Richard W

    2006-06-01

    Leadership succession planning is a key business strategy to help organizational leaders deal effectively with the future. Evidence from industry provides a variety of best practices that can ensure that a pipeline of leaders will be available when they are needed. The author addresses the essential needs that individuals face when developing a cadre of available leaders prepared for managing an uncertain future.

  2. Educators' Self-Reported Training, Use, and Perceived Effectiveness of Evidence-Based Classroom Management Practices

    Science.gov (United States)

    Cooper, Justin T.; Gage, Nicholas A.; Alter, Peter J.; LaPolla, Stefanie; MacSuga-Gage, Ashley S.; Scott, Terrance M.

    2018-01-01

    A survey study of 248 educators in four states was conducted to identify respondents' formal training, use, and perceived effectiveness of 37 evidence-based classroom management practices within four general categories: (a) antecedent-based, (b) instructionally based, (c) consequence-based, and (d) self-management. Results indicated that, on…

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

    Science.gov (United States)

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

    2015-11-13

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

  4. Evidence-based management of traumatic thoracolumbar burst fractures: a systematic review of nonoperative management.

    Science.gov (United States)

    Bakhsheshian, Joshua; Dahdaleh, Nader S; Fakurnejad, Shayan; Scheer, Justin K; Smith, Zachary A

    2014-01-01

    The overall evidence for nonoperative management of patients with traumatic thoracolumbar burst fractures is unknown. There is no agreement on the optimal method of conservative treatment. Recent randomized controlled trials that have compared nonoperative to operative treatment of thoracolumbar burst fractures without neurological deficits yielded conflicting results. By assessing the level of evidence on conservative management through validated methodologies, clinicians can assess the availability of critically appraised literature. The purpose of this study was to examine the level of evidence for the use of conservative management in traumatic thoracolumbar burst fractures. A comprehensive search of the English literature over the past 20 years was conducted using PubMed (MEDLINE). The inclusion criteria consisted of burst fractures resulting from a traumatic mechanism, and fractures of the thoracic or lumbar spine. The exclusion criteria consisted of osteoporotic burst fractures, pathological burst fractures, and fractures located in the cervical spine. Of the studies meeting the inclusion/exclusion criteria, any study in which nonoperative treatment was used was included in this review. One thousand ninety-eight abstracts were reviewed and 447 papers met inclusion/exclusion criteria, of which 45 were included in this review. In total, there were 2 Level-I, 7 Level-II, 9 Level-III, 25 Level-IV, and 2 Level-V studies. Of the 45 studies, 16 investigated conservative management techniques, 20 studies compared operative to nonoperative treatments, and 9 papers investigated the prognosis of conservative management. There are 9 high-level studies (Levels I-II) that have investigated the conservative management of traumatic thoracolumbar burst fractures. In neurologically intact patients, there is no superior conservative management technique over another as supported by a high level of evidence. The conservative technique can be based on patient and surgeon

  5. Systems consultation: protocol for a novel implementation strategy designed to promote evidence-based practice in primary care.

    Science.gov (United States)

    Quanbeck, Andrew; Brown, Randall T; E Zgierska, Aleksandra; A Johnson, Roberta; Robinson, James M; Jacobson, Nora

    2016-01-27

    Adoption of evidence-based practices takes place at a glacial place in healthcare. This research will pilot test an innovative implementation strategy - systems consultation -intended to speed the adoption of evidence-based practice in primary care. The strategy is based on tenets of systems engineering and has been extensively tested in addiction treatment. Three innovations have been included in the strategy - translation of a clinical practice guideline into a checklist-based implementation guide, the use of physician peer coaches ('systems consultants') to help clinics implement the guide, and a focus on reducing variation in practices across prescribers and clinics. The implementation strategy will be applied to improving opioid prescribing practices in primary care, which may help ultimately mitigate the increasing prevalence of opioid abuse and addiction. The pilot test will compare four intervention clinics to four control clinics in a matched-pairs design. A leading clinical guideline for opioid prescribing has been translated into a checklist-based implementation guide in a systematic process that involved experts who wrote the guideline in consultation with implementation experts and primary care physicians. Two physicians with expertise in family and addiction medicine are serving as the systems consultants. Each systems consultant will guide two intervention clinics, using two site visits and follow-up communication by phone and email, to implement the translated guideline. Mixed methods will be used to test the feasibility, acceptability, and preliminary effectiveness of the implementation strategy in an evaluation that meets standards for 'fully developed use' of the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, Maintenance). The clinic will be the primary unit of analysis. The systems consultation implementation strategy is intended to generalize to the adoption of other clinical guidelines. This pilot test is intended to prepare

  6. Assessing implementation of evidence-based childhood obesity prevention strategies in schools

    Directory of Open Access Journals (Sweden)

    Christine M.W. Totura

    2015-01-01

    Conclusion: Obesity prevention strategy implementation relies on the supportiveness and structure of school climates. Barriers to prevention can impede efforts despite school commitment toward prevention, while stakeholder collaboration can enhance the likelihood that practices are in place.

  7. An evidence-based approach to the evaluation and management of stress incontinence in women.

    Science.gov (United States)

    Gilleran, Jason P; Zimmern, Philippe

    2005-07-01

    The aim of this article is to use evidence-based criteria to review recent publications on the evaluation and management of stress urinary incontinence in women. Longitudinal studies suggest that a familial predisposition towards stress urinary incontinence may exist. There is mounting evidence that cesarean section may play a protective role against pelvic floor damage due to labor, but this continues to be investigated. Objective parameters in the evaluation of stress urinary incontinence, such as questionnaires, pad test, and urodynamic studies, continue to undergo refinements to become more clinically relevant outcome tools. Non-invasive and minimally-invasive therapies for stress urinary incontinence are expanding. The search continues for the optimal non-autologous material in the pubovaginal sling procedure. Despite concerns over the use of synthetic material and better defined early complications, midurethral slings continue to enjoy popularity with short-term and intermediate success. Further research into the cause of stress urinary incontinence is necessary. There is still no unified protocol in the evaluation of the condition and its severity. Mid-urethral slings appear to be as efficacious as more established procedures (bladder neck suspensions, pubovaginal slings), but long-term results on safety and efficacy remain scarce.

  8. Improving Awareness, Identification, and Management of Sarcopenic Obesity in Cancer Survivors: An Evidence-Based Toolbox.

    Science.gov (United States)

    Lindsey, Sarah; Astroth, Kim; Kumar, Pankaj

    2016-10-01

    Sarcopenic obesity, the dual condition of decreased muscle mass with increased fat mass, can affect morbidity, mortality, and quality of life in adult cancer survivors. The purpose of this project was to determine the effects of the use of an educational toolbox on advanced practice nurses' (APNs') confidence in identifying and managing adult cancer survivors at risk for sarcopenic obesity. APNs in an outpatient practice who care for adult cancer survivors received an educational toolbox with strategies to identify and manage adult cancer survivors at risk for sarcopenic obesity. APNs reported being more confident in their ability to identify adult patients with cancer at risk for sarcopenic obesity and in their ability to manage these patients compared to prior to the intervention. Educational resources provided an effective tool for identifying and managing patients at risk for sarcopenic obesity.

  9. Information exchange networks of health care providers and evidence-based cardiovascular risk management: an observational study.

    Science.gov (United States)

    Heijmans, Naomi; van Lieshout, Jan; Wensing, Michel

    2017-01-13

    Although a wide range of preventive and clinical interventions has targeted cardiovascular risk management (CVRM), outcomes remain suboptimal. Therefore, the question is what additional determinants of CVRM and outcomes can be identified and addressed to optimize CVRM. In this study, we aimed to identify new perspectives for improving healthcare delivery and explored associations between information exchange networks of health care providers and evidence-based CVRM. This observational study was performed parallel to a randomized clinical trial which aimed to improve professional performance of practice nurses in the Netherlands. Information exchange on medical policy for CVRM ("general information networks") and CVRM for individual patients ("specific information networks") of 180 health professionals in 31 general practices was measured with personalized questionnaires. Medical record audit was performed concerning 1620 patients in these practices to document quality of care delivery and two risk factors (systolic blood pressure (SBP) and LDL cholesterol level). Hypothesized effects of five network characteristics (density, frequency of contact, centrality of CVRM-coordinators, homophily on positive attitudes for treatment target achievement, and presence of an opinion leader for CVRM) constructed on both general and specific information exchange networks were tested and controlled for practice and patient factors using logistic multilevel analyses. Odds for adequate performance were enhanced in practices with an opinion leader for CVRM (OR 2.75, p based CVRM is associated with homophily of clinical attitudes and presence of opinion leaders in primary care teams. These results signal the potential of social networks to be taken into account in further attempts to improve the implementation of evidence-based care for CVRM. Future research is needed to identify and formulate optimal strategies for using opinion leaders to improve CVRM. Future interventions may be

  10. Constructing evidence-based treatment strategies using methods from computer science

    Science.gov (United States)

    Pineau, Joelle; Bellemare, Marc G.; Rush, A. John; Ghizaru, Adrian; Murphy, Susan A.

    2007-01-01

    This paper details a new methodology, instance–based reinforcement learning, for constructing adaptive treatment strategies from randomized trials. Adaptive treatment strategies are operationalized clinical guidelines which recommend the next best treatment for an individual based on his/her personal characteristics and response to earlier treatments. The instance-based reinforcement learning methodology comes from the computer science literature, where it was developed to optimize sequences of actions in an evolving, time varying system. When applied in the context of treatment design, this method provides the means to evaluate both the therapeutic and diagnostic effects of treatments in constructing an adaptive treatment strategy. The methodology is illustrated with data from the STAR*D trial, a multi-step randomized study of treatment alternatives for individuals with treatment-resistant major depressive disorder. PMID:17320311

  11. The Collaborative Assessment and Management of Suicidality (CAMS): An Evolving Evidence-Based Clinical Approach to Suicidal Risk

    Science.gov (United States)

    Jobes, David A.

    2012-01-01

    The Collaborative Assessment and Management of Suicidality (CAMS) is an evidence-based clinical intervention that has significantly evolved over 25 years of clinical research. CAMS is best understood as a therapeutic framework that emphasizes a unique collaborative assessment and treatment planning process between the suicidal patient and…

  12. A Standardized Method of Preventing and Managing Emergencies within the Context of Evidence-Based Therapy Implementation

    Science.gov (United States)

    Urgelles, Jessica; Donohue, Brad; Wilks, Chelsey; Van Hasselt, Vincent B.; Azrin, Nathan H.

    2012-01-01

    Families served within child welfare settings evidence a wide range of emergencies or unexpected crises or circumstances that may lead to danger and make it difficult for them to focus on treatment planning. Mental health treatment providers are often unprepared to effectively manage emergencies during implementation of evidence-based prescribed…

  13. Evidence based feeding strategies before and after the development of necrotizing enterocolitis

    Science.gov (United States)

    Good, Misty; Sodhi, Chhinder P.; Hackam, David J.

    2014-01-01

    Necrotizing enterocolitis (NEC) is a devastating disease of premature infants and is associated with significant morbidity and mortality. While the pathogenesis of NEC remains incompletely understood, it is well established that the risk of disease is increased by the administration of infant formula and decreased by the administration of breast milk. This review will focus on the mechanisms by which breast milk may serve to protect against NEC, and will review the evidence regarding various feeding strategies that may be utilized before and after an episode of NEC. PMID:24898361

  14. Update on portal vein embolization: evidence-based outcomes, controversies, and novel strategies.

    Science.gov (United States)

    May, Benjamin J; Talenfeld, Adam D; Madoff, David C

    2013-02-01

    Portal vein embolization (PVE) is an established therapy used to redirect portal blood flow away from the tumor-bearing liver to the anticipated future liver remnant (FLR) and usually results in FLR hypertrophy. PVE is indicated when the FLR is considered too small before surgery to support essential function after surgery. When appropriately applied, PVE reduces postoperative morbidity and increases the number of patients eligible for curative hepatic resection. PVE also has been combined with other therapies to improve patient outcomes. This article assesses more recent outcomes data regarding PVE, reviews the existing controversies, and reports on novel strategies currently being investigated. Copyright © 2013. Published by Elsevier Inc.

  15. Diagnosis and management of acute coronary syndrome: an evidence-based update.

    Science.gov (United States)

    Smith, Jennifer N; Negrelli, Jenna M; Manek, Megha B; Hawes, Emily M; Viera, Anthony J

    2015-01-01

    Acute coronary syndrome (ACS) describes the range of myocardial ischemic states that includes unstable angina, non-ST elevated myocardial infarction (MI), or ST-elevated MI. ACS is associated with substantial morbidity and mortality and places a large financial burden on the health care system. The diagnosis of ACS begins with a thorough clinical assessment of a patient's presenting symptoms, electrocardiogram, and cardiac troponin levels as well as a review of past medical history. Early risk stratification can assist clinicians in determining whether an early invasive management strategy or an initial conservative strategy should be pursued and can help determine appropriate pharmacologic therapies. Key components in the management of ACS include coronary revascularization when indicated; prompt initiation of dual antiplatelet therapy and anticoagulation; and consideration of adjuvant agents including β blockers, inhibitors of the renin angiotensin system, and HmG-coenzyme A reductase inhibitors. It is essential for clinicians to take an individualized approach to treatment and consider long-term safety and efficacy when managing patients with a history of ACS after hospital discharge. © Copyright 2015 by the American Board of Family Medicine.

  16. [Evidence-based public health: strategies aimed at increasing adherence to colorectal cancer screening programs].

    Science.gov (United States)

    Tarulli, Sabrina; Lepore, Anna Raffaella; Sansoni, Diana; Viviani, Giancarlo

    2007-01-01

    The ministerial decree 29/11/2001 included colorectal carcinoma screening procedures among the "essential" health care services that should be delivered free of charge to citizens. Secondary prevention programs for colorectal cancer must therefore be implemented in all Italian regions. An international literature search on colorectal cancer screening was performed in order to provide a resource for public health workers and decision makers, for selecting interventions to improve adherence to screening programs. The following interventions have been proven to be effective: reducing structural barriers to screening, active recall systems, multicomponent interventions involving active recall and health education, active reminder systems, periodic dissemination of results, and physician health education. Opportunistic screening by general practitioners, that is, performing faecal occult blood testing in asymptomatic patients consulting a GP for other reasons, is a strategy should also be implemented.

  17. Understanding and practice of evidence based search strategy among postgraduate dental students: a preliminary study.

    Science.gov (United States)

    Qureshi, Ambrina; Bokhari, Syed Akhtar Hussain; Pirvani, Madiha; Dawani, Narendar

    2015-06-01

    One of the core attributes of competent practice is the ability to locate and analyze high-quality evidence. Research on information seeking knowledge of dental graduates is scarce. The objective was to evaluate pertinent knowledge and skills on formulation of answerable questions and searching skills through the understanding and application of EBP. Participants' understanding and abilities to develop answerable questions in application of EBP were assessed through a quasi-experimental study design among freshly inducted postgraduate dental students at Dow University of Health Sciences. Pre and post workshop activity sessions were conducted and assessment was made through a tool that was an adaptation of the Fresno Test. The assessments performed were calculated for mean scores and standard deviations to draw descriptive results for the participants' understanding of the search items and clinical question formulation skills. Wilcoxon-signed rank test was performed to compare the pre and post workshop mean scores. Forty two participants (females = 20, males = 22) attended the workshop. Pre-workshop knowledge and understanding about the terminologies used in EBP was low among participants. Post-workshop performance of the participants to formulate a question, find evidence and search on PubMed was improved to a "Limited" level. The improvements were statistically significant but could not attain "Strong" and "Excellent" grades as far as the EBP skills were concerned. This study observed a potential to improve search skills of dental graduates after their training and exposure to search strategies available on databases. Copyright © 2015 Elsevier Inc. All rights reserved.

  18. IDS technology management strategies.

    Science.gov (United States)

    Halverson, K A

    1996-04-01

    The formation of integrated delivery systems has created new challenges for healthcare financial managers. Among these challenges is the need to respond to cost-cutting pressures related to technology acquisition, financing, and management. A well-developed technology management strategy can reduce technology costs and risks, free up capital for other strategic uses, and maintain the system's ability to adapt to change.

  19. Integration of evidence-based knowledge management in microsystems: a tele-ICU experience.

    Science.gov (United States)

    Rincon, Teresa A

    2012-01-01

    The Institute of Medicine's proposed 6 aims to improve health care are timely, safe, effective, efficient, equitable, and patient-centered care. Unfortunately, it also asserts that improvements in these 6 dimensions cannot be achieved within the existing framework of care systems. These systems are based on unrealistic expectations on human cognition and vigilance, and demonstrate a lack of dependence on computerized systems to support care processes and put information at the point of use. Knowledge-based care and evidence-based clinical decision-making need to replace the unscientific care that is being delivered in health care. Building care practices on evidence within an information technology platform is needed to support sound clinical decision-making and to influence organizational adoption of evidence-based practice in health care. Despite medical advances and evidence-based recommendations for treatment of severe sepsis, it remains a significant cause of mortality and morbidity in the world. It is a complex disease state that has proven difficult to define, diagnose, and treat. Supporting bedside teams with real-time knowledge and expertise to target early identification of severe sepsis and compliance to Surviving Sepsis Campaign, evidence-based practice bundles are important to improving outcomes. Using a centralized, remote team of expert nurses and an open-source software application to advance clinical decision-making and execution of the severe sepsis bundle will be examined.

  20. 'That doesn't translate': the role of evidence-based practice in disempowering speech pathologists in acute aphasia management.

    Science.gov (United States)

    Foster, Abby; Worrall, Linda; Rose, Miranda; O'Halloran, Robyn

    2015-07-01

    An evidence-practice gap has been identified in current acute aphasia management practice, with the provision of services to people with aphasia in the acute hospital widely considered in the literature to be inconsistent with best-practice recommendations. The reasons for this evidence-practice gap are unclear; however, speech pathologists practising in this setting have articulated a sense of dissonance regarding their limited service provision to this population. A clearer understanding of why this evidence-practice gap exists is essential in order to support and promote evidence-based approaches to the care of people with aphasia in acute care settings. To provide an understanding of speech pathologists' conceptualization of evidence-based practice for acute post-stroke aphasia, and its implementation. This study adopted a phenomenological approach, underpinned by a social constructivist paradigm. In-depth interviews were conducted with 14 Australian speech pathologists, recruited using a purposive sampling technique. An inductive thematic analysis of the data was undertaken. A single, overarching theme emerged from the data. Speech pathologists demonstrated a sense of disempowerment as a result of their relationship with evidence-based practice for acute aphasia management. Three subthemes contributed to this theme. The first described a restricted conceptualization of evidence-based practice. The second revealed speech pathologists' strained relationships with the research literature. The third elucidated a sense of professional unease over their perceived inability to enact evidence-based clinical recommendations, despite their desire to do so. Speech pathologists identified a current knowledge-practice gap in their management of aphasia in acute hospital settings. Speech pathologists place significant emphasis on the research evidence; however, their engagement with the research is limited, in part because it is perceived to lack clinical utility. A sense

  1. The use of an evidence-based portfolio in the management of change in dental practice.

    Science.gov (United States)

    Hall, John

    2006-10-01

    In this paper the author gives his opinion about the problems of getting practices to change systems in order to institute clinical governance. There are many reasons why practices need to change and for this change to be monitored. This paper explains the need for change and the use of the evidence-based portfolio, which is produced by candidates for the Membership of the Faculty of General Dental Practice (UK) [MFGDP(UK)] examination. It can also be produced by individuals who are not taking the MFGDP(UK) examination in conjunction with the Faculty of General Dental Practice (UK)'s key skills programme. It provides a mechanism for demonstrating change and for assessing the quality of care provided by a general dental practice. The author concludes that the evidence-based portfolio will enable a practitioner to apply clinical governance in a practical way.

  2. [Evidence-based medicine as a fundamental principle of health care management for workers].

    Science.gov (United States)

    Amirov, N Kh; Fatkhutdinova, L M

    2011-01-01

    Evidence-based principles in occupational medicine should include prevention, diagnosis, treatment and rehabilitation. Specific feature of occupational medicine is necessity to prove cause-effect relationships between occupational factor and the disease emerged. Important place is occupied by cohort and intervention studies, systematic reviews and meta-analysis. Information obtained by scientific society should be presented to practical specialists and put into everyday activities.

  3. Management of Axillary Web Syndrome after Breast Cancer: Evidence-Based Practice

    OpenAIRE

    da Luz, Clarissa Medeiros; Deitos, Julia; Siqueira, Thais Cristina; Palú, Marina; Heck, Ailime Perito Feiber

    2017-01-01

    Abstract Axillary web syndrome is characterized as a physical-functional complication that impacts the quality of life of women who have undergone treatment for breast cancer. The present study aims to verify the physiotherapy treatment available for axillary web syndrome after surgery for breast cancer in the context of evidence-based practice. The selection criteria included papers discussing treatment protocols used for axillary web syndrome after treatment for breast cancer. The search wa...

  4. Systematic reviews of and integrated report on the quantitative, qualitative and economic evidence base for the management of obesity in men.

    OpenAIRE

    Robertson, C; Archibald, D.; Avenell, A.; Douglas, F; Hoddinott, P.; van Teijlingen, Edwin; Boyers, D.; Stewart, F; Boachie, C.; Fioratou, E.; Wilkins, D.; Street, T.; Carroll, P.; Fowler, C.

    2014-01-01

    Background\\ud Obesity increases the risk of many serious illnesses such as coronary heart disease, type 2 diabetes and osteoarthritis. More men than women are overweight or obese in the UK but men are less likely to perceive their weight as a problem and less likely to engage with weight-loss services.\\ud Objective\\ud The aim of this study was to systematically review evidence-based management strategies for treating obesity in men and investigate how to engage men in obesity services by inte...

  5. Management of fibromyalgia: practical guides from recent evidence-based guidelines.

    Science.gov (United States)

    Häuser, Winfried; Ablin, Jacob; Perrot, Serge; Fitzcharles, Mary-Ann

    2017-01-04

    Fibromyalgia (FM) is a prevalent and costly condition worldwide, affecting approximately 2% of the general population. Recent evidence- and consensus‑based guidelines from Canada, Germany, Israel, and the European League Against Rheumatism aim to support physicians in achieving a comprehensive diagnostic workup of patients with chronic widespread (generalized) pain (CWP) and to assist patients and physicians in shared decision making on treatment options. Every patient with CWP requires, at the first medical evaluation, a complete history, medical examination, and some laboratory tests (complete blood count, measurement of C‑reactive protein, serum calcium, creatine phosphokinase, thyroid‑stimulating hormone, and 25‑hydroxyvitamin D levels) to screen for metabolic or inflammatory causes of CWP. Any additional laboratory or radiographic testing should depend on red flags suggesting some other medical condition. The diagnosis is based on the history of a typical cluster of symptoms (CWP, nonrestorative sleep, physical and/or mental fatigue) that cannot be sufficiently explained by another medical condition. Optimal management should begin with education of patients regarding the current knowledge of FM (including written materials). Management should be a graduated approach with the aim of improving health‑related quality of life. The initial focus should ensure active participation of patients in applying healthy lifestyle practices. Aerobic and strengthening exercises should be the foundation of nonpharmacologic management. Cognitive behavioral therapies should be considered for those with mood disorder or inadequate coping strategies. Pharmacologic therapies may be considered for those with severe pain (duloxetine, pregabalin, tramadol) or sleep disturbance (amitriptyline, cyclobenzaprine, pregabalin). Multimodal programs should be considered for those with severe disability.

  6. Valproic acid poisoning: an evidence-based consensus guideline for out-of-hospital management.

    Science.gov (United States)

    Manoguerra, Anthony S; Erdman, Andrew R; Woolf, Alan D; Chyka, Peter A; Caravati, E Martin; Scharman, Elizabeth J; Booze, Lisa L; Christianson, Gwenn; Nelson, Lewis S; Cobaugh, Daniel J; Troutman, William G

    2008-08-01

    A review of US poison center data for 2004 showed over 9000 ingestions of valproic acid. A guideline that determines the conditions for emergency department referral and prehospital care could potentially optimize patient outcome, avoid unnecessary emergency department visits, reduce health care costs, and reduce life disruption for patients and caregivers. An evidence-based expert consensus process was used to create the guideline. Relevant articles were abstracted by a trained physician researcher. The first draft of the guideline was created by the lead author. The entire panel discussed and refined the guideline before distribution to secondary reviewers for comment. The panel then made changes based on the secondary review comments. The objective of this guideline is to assist poison center personnel in the appropriate out-of-hospital triage and initial out-of-hospital management of patients with a suspected ingestion of valproic acid by 1) describing the process by which an ingestion of valproic acid might be managed, 2) identifying the key decision elements in managing cases of valproic acid ingestion, 3) providing clear and practical recommendations that reflect the current state of knowledge, and 4) identifying needs for research. This guideline applies to the acute ingestion and acute-on-chronic ingestion of immediate-release and extended-release dosage forms of valproic acid, divalproex, and valproate sodium alone. Co-ingestion of additional substances could require different referral and management recommendations depending on the combined toxicities of the substances. This review focuses on the ingestion of more than a single therapeutic dose and the effects of an overdose. Although therapeutic doses of valproic acid can cause adverse effects in adults and children, some idiosyncratic and some dose-dependent, these cases are not considered. This guideline is based on an assessment of current scientific and clinical information. The expert consensus

  7. A cluster randomized Hybrid Type III trial testing an implementation support strategy to facilitate the use of an evidence-based practice in VA homeless programs.

    Science.gov (United States)

    Smelson, David A; Chinman, Matthew; McCarthy, Sharon; Hannah, Gordon; Sawh, Leon; Glickman, Mark

    2015-05-28

    The Housing and Urban Development-Veterans Affairs Supportive Housing (HUD-VASH) program is one of the largest initiatives to end Veteran homelessness. However, mental health and substance use disorders continue to reduce client stability and impede program success. HUD-VASH programs do not consistently employ evidence-based practices that address co-occurring mental health and substance use disorders. This paper presents a study protocol to evaluate the implementation of an evidence-based, co-occurring disorder treatment called Maintaining Independence and Sobriety Through Systems Integration, Outreach, and Networking-Veterans Edition (MISSION-Vet) in HUD-VASH using an implementation strategy called Getting To Outcomes (GTO). In three large VA Medical Centers, this Hybrid Type III trial will randomize case managers and their clients by HUD-VASH sub-teams to receive either MISSION-Vet Implementation as Usual (IU-standard training and access to the MISSION-Vet treatment manuals) or MISSION-Vet implementation augmented by GTO. In addition to testing GTO, effectiveness of the treatment (MISSION-Vet) will be assessed using existing Veteran-level data from the HUD-VASH data monitoring system. This project will compare GTO and IU case managers and their clients on the following variables: (1) fidelity to the MISSION-Vet intervention; (2) proportion of time the Veteran is housed; (3) mental health, substance use, and functional outcomes among Veterans; and (4) factors key to the successful deployment of a new treatment as specified by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) model. This project is an important step for developing an implementation strategy to increase adoption of evidence-based practice use in VA homeless programs, and to further examine efficacy of MISSION-Vet in HUD-VASH. This project has important implications for program managers, policy makers, and researchers within the homelessness field. VA Central IRB approval

  8. Evaluating Effectiveness of evidence Based Decision-making Educational Course on Healthcare Domain Managers based Krick-Patrick Model

    OpenAIRE

    Behrouz soltany; Abol Hassan afkar; Seyedeh Hoda Mousavi; Tahereh Khazaei; Somaieh Roohani_Majd; Mohsen Nouri; Mohsen Mohammadi; Nasim Hatefi Moadab

    2016-01-01

    Introduction:Now a day, Increasing growth of information and increase in complexity of jobs has lead to an increasing importance of educating employees. Toffler believes that education is the most important action and way to face great changes in future life and accepting changes.present study aims to study the effect of evidence based decision making workshop on healthcare managers by means of Krick-Patrick model. Methods and Material:present study was executed among 60 of health...

  9. 2016 updated EULAR evidence-based recommendations for the management of gout.

    Science.gov (United States)

    Richette, P; Doherty, M; Pascual, E; Barskova, V; Becce, F; Castañeda-Sanabria, J; Coyfish, M; Guillo, S; Jansen, T L; Janssens, H; Lioté, F; Mallen, C; Nuki, G; Perez-Ruiz, F; Pimentao, J; Punzi, L; Pywell, T; So, A; Tausche, A K; Uhlig, T; Zavada, J; Zhang, W; Tubach, F; Bardin, T

    2017-01-01

    New drugs and new evidence concerning the use of established treatments have become available since the publication of the first European League Against Rheumatism (EULAR) recommendations for the management of gout, in 2006. This situation has prompted a systematic review and update of the 2006 recommendations. The EULAR task force consisted of 15 rheumatologists, 1 radiologist, 2 general practitioners, 1 research fellow, 2 patients and 3 experts in epidemiology/methodology from 12 European countries. A systematic review of the literature concerning all aspects of gout treatments was performed. Subsequently, recommendations were formulated by use of a Delphi consensus approach. Three overarching principles and 11 key recommendations were generated. For the treatment of flare, colchicine, non-steroidal anti-inflammatory drugs (NSAIDs), oral or intra-articular steroids or a combination are recommended. In patients with frequent flare and contraindications to colchicine, NSAIDs and corticosteroids, an interleukin-1 blocker should be considered. In addition to education and a non-pharmacological management approach, urate-lowering therapy (ULT) should be considered from the first presentation of the disease, and serum uric acid (SUA) levels should be maintained atgout. Allopurinol is recommended as first-line ULT and its dosage should be adjusted according to renal function. If the SUA target cannot be achieved with allopurinol, then febuxostat, a uricosuric or combining a xanthine oxidase inhibitor with a uricosuric should be considered. For patients with refractory gout, pegloticase is recommended. These recommendations aim to inform physicians and patients about the non-pharmacological and pharmacological treatments for gout and to provide the best strategies to achieve the predefined urate target to cure the disease. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  10. Human capital strategy: talent management

    National Research Council Canada - National Science Library

    Nagra, Michael

    2011-01-01

    .... This article elaborates the human capital management strategy within the Army Nurse Corps, which identifies, develops, and implements key talent management strategies under the umbrella of the Corps...

  11. Methylphenidate poisoning: an evidence-based consensus guideline for out-of-hospital management.

    Science.gov (United States)

    Scharman, Elizabeth J; Erdman, Andrew R; Cobaugh, Daniel J; Olson, Kent R; Woolf, Alan D; Caravati, E Martin; Chyka, Peter A; Booze, Lisa L; Manoguerra, Anthony S; Nelson, Lewis S; Christianson, Gwenn; Troutman, William G

    2007-01-01

    A review of US poison center data for 2004 showed over 8,000 ingestions of methylphenidate. A guideline that determines the conditions for emergency department referral and prehospital care could potentially optimize patient outcome, avoid unnecessary emergency department visits, reduce health care costs, and reduce life disruption for patients and caregivers. An evidence-based expert consensus process was used to create the guideline. Relevant articles were abstracted by a trained physician researcher. The first draft of the guideline was created by the lead author. The entire panel discussed and refined the guideline before distribution to secondary reviewers for comment. The panel then made changes based on the secondary review comments. The objective of this guideline is to assist poison center personnel in the appropriate out-of-hospital triage and initial out-of-hospital management of patients with suspected ingestions of methylphenidate by 1) describing the process by which a specialist in poison information should evaluate an exposure to methylphenidate, 2) identifying the key decision elements in managing cases of methylphenidate ingestion, 3) providing clear and practical recommendations that reflect the current state of knowledge, and 4) identifying needs for research. This review focuses on the ingestion of more than a single therapeutic dose of methylphenidate and the effects of an overdose and is based on an assessment of current scientific and clinical information. The expert consensus panel recognizes that specific patient care decisions may be at variance with this guideline and are the prerogative of the patient and the health professionals providing care, considering all of the circumstances involved. This guideline does not substitute for clinical judgment. Recommendations are in chronological order of likely clinical use. The grade of recommendation is in parentheses. 1) All patients with suicidal intent, intentional abuse, or in cases in which

  12. Caries management: technical solutions to biological problems or evidence-based care?

    Science.gov (United States)

    Baelum, V

    2008-02-01

    Caries-related clinical decision-making remains a centrepiece of clinical dentistry. However, the oral disease patterns are rapidly changing towards the better among major sections of the populations, most notably in the high-income countries. The caries decline is well documented among children and younger adults, and is gradually seen to trickle into middle and old age as well. Although it is tempting for the dental profession to take the credit for this development, the evidence points in a different direction. The major contribution of dentistry seems primarily related to changes in the treatment philosophies towards a less interventionist approach. This review aims to spur a further change in the diagnostic and treatment criteria used in the management of dental caries for the benefit of the oral health status of our patients. We must come to terms with the fact that our traditional core skills, our manual dexterity and technical competence, have less to offer to oral health than we have been accustomed to think. The dental schools and the professional dental organizations must carry the responsibility for promoting the necessary changes in the caries related clinical decision-making strategies to allow practicing dentists to provide appropriate oral health care to our populations.

  13. An Evidence-based Guideline for Pediatric Prehospital Seizure Management Using GRADE Methodology.

    Science.gov (United States)

    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

    2014-01-01

    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.

  14. Clinical practice guidelines for evidence-based management of sedoanalgesia in critically ill adult patients.

    Science.gov (United States)

    Celis-Rodríguez, E; Birchenall, C; de la Cal, M Á; Castorena Arellano, G; Hernández, A; Ceraso, D; Díaz Cortés, J C; Dueñas Castell, C; Jimenez, E J; Meza, J C; Muñoz Martínez, T; Sosa García, J O; Pacheco Tovar, C; Pálizas, F; Pardo Oviedo, J M; Pinilla, D I; Raffán-Sanabria, F; Raimondi, N; Righy Shinotsuka, C; Suárez, M; Ugarte, S; Rubiano, S

    2013-11-01

    contains recommendations and suggestions based on the best evidence available for the management of sedation, analgesia and delirium of the critically ill patient, including a bundle of strategies that serves this purpose. We highlight the assessment of pain and agitation/sedation through validated scales, the use of opioids initially to apropiate analgesic control, associated with multimodal strategies in order to reduce opioide consumption; to promote the lowest level of sedation necessary avoiding over-sedation. Also, in case of the need of sedatives, choose the most appropiate for the patient needs, avoiding the use of benzodiazepines and identify risk factors for delirium, in order to prevent its occurrence, diagnose delirium and treat it with the most suitable pharmacological agent, whether it is haloperidol, atypical antipsychotics or dexmedetomidine, once again, avoiding the use of benzodiazepines and decreasing the use of opioids. Copyright © 2013 Elsevier España, S.L. y SEMICYUC. All rights reserved.

  15. Evidence-Based Development

    DEFF Research Database (Denmark)

    Hertzum, Morten; Simonsen, Jesper

    2004-01-01

    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....

  16. Symptom management in patients with lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines.

    Science.gov (United States)

    Simoff, Michael J; Lally, Brian; Slade, Mark G; Goldberg, Wendy G; Lee, Pyng; Michaud, Gaetane C; Wahidi, Momen M; Chawla, Mohit

    2013-05-01

    Many patients with lung cancer will develop symptoms related to their disease process or the treatment they are receiving. These symptoms can be as debilitating as the disease progression itself. To many physicians these problems can be the most difficult to manage. A detailed review of the literature using strict methodologic review of article quality was used in the development of this article. MEDLINE literature reviews, in addition to Cochrane reviews and other databases, were used for this review. The resulting article lists were then reviewed by experts in each area for quality and finally interpreted for content. We have developed recommendations for the management of many of the symptom complexes that patients with lung cancer may experience: pain, dyspnea, airway obstruction, cough, bone metastasis, brain metastasis, spinal cord metastasis, superior vena cava syndrome, hemoptysis, tracheoesophageal fistula, pleural effusions, venous thromboembolic disease, depression, fatigue, anorexia, and insomnia. Some areas, such as dyspnea, are covered in considerable detail in previously created high-quality evidence-based guidelines and are identified as excellent sources of reference. The goal of this guideline is to provide the reader recommendations based on evidence supported by scientific study. Improved understanding and recognition of cancer-related symptoms can improve management strategies, patient compliance, and quality of life for all patients with lung cancer.

  17. Current pharmacological management of gastro-esophageal reflux in children: an evidence-based systematic review.

    Science.gov (United States)

    Tighe, Mark P; Afzal, Nadeem A; Bevan, Amanda; Beattie, R Mark

    2009-01-01

    Gastro-esophageal reflux (GER) is a common phenomenon, characterized by the regurgitation of the gastric contents into the esophagus. Gastro-esophageal reflux disease (GERD) is the term applied when GER is associated with sequelae or faltering growth. The main aims of treatment are to alleviate symptoms, promote normal growth, and prevent complications. Medical treatments for children include (i) altering the viscosity of the feeds with alginates; (ii) altering the gastric pH with antacids, histamine H(2) receptor antagonists, and proton pump inhibitors; and (iii) altering the motility of the gut with prokinetics, such as metoclopramide and domperidone. Our aim was to systematically review the evidence base for the medical treatment of gastro-oesophageal reflux in children. We searched PubMed, AdisOnline, MEDLINE, and EMBASE, and then manually searched reviews from the past 5 years using the key words 'gastro-esophageal' (or 'gastroesophageal'), 'reflux', 'esophagitis', and 'child$' (or 'infant') and 'drug$' or 'therapy'. Articles included were in English and had an abstract. We used the levels of evidence adopted by the Centre for Evidence-Based Medicine in Oxford to assess the studies for all reported outcomes that were meaningful to clinicians making decisions about treatment. This included the impact of clinical symptoms, pH study profile, and esophageal appearance at endoscopy. Five hundred and eight articles were reviewed, of which 56 papers were original, relevant clinical trials. These were assessed further. Many of the studies considered had significant methodological flaws, although based on available evidence the following statements can be made. For infant GERD, ranitidine and omeprazole and probably lansoprazole are safe and effective medications, which promote symptomatic relief, and endoscopic and histological healing of esophagitis. Gaviscon(R) Infant sachets are safe and can improve symptoms of reflux. There is less evidence to support the use of

  18. [An evidence based Iberic-Latin American guideline for acute gastroenteritis management in infants and prescholars].

    Science.gov (United States)

    Gutiérrez Castrellón, P; Polanco Allué, I; Salazar Lindo, E

    2010-03-01

    Acute gastroenteritis (AG) morbidity and mortality rates in infants and prescholars continue to be high in developing countries. Authors want to develop an evidence-based document that supports decision making regarding AG therapy in infants and children younger than 5 y/o. A systematic review of the literature was performed (May, 2008). Evidence grading was established according to Oxford guidelines and Latin American experts submitted their opinions on the recommendations generated. Oral rehydration solutions are the threatment's keystone for children with AG, showing lesser complications due to therapy than IV fluids. AG is no contraindication of a normal diet. Racecadotril, zinc and smectite can contribute to AG treatment, as well as Lactobacillus GG and Saccharomycces boulardii. No other drugs are recommended. It is recommended to treat children presenting AG with oral rehydration solutions among racecadotril, zinc or smectite as well as some probiotics. 2010. Published by Elsevier Espana.

  19. Social Learning Through Evaluation: from Evidence Based Management to Collective Action for Complex Problems

    OpenAIRE

    Thomas G Measham

    2008-01-01

    The role of evaluation in environmental management in Australia tends to be limited to restricted measures of program effectiveness rather than contributing towards supporting environmental managers in addressing complex environmental problems. This paper shows how a social learning approach can be incorporated into evaluating public investment in environmental management dealing with the complex environmental challenges which are inherently difficult to understand, predict and manage. The pa...

  20. A Strategy To Advance the Evidence Base in Palliative Medicine: Formation of a Palliative Care Research Cooperative Group

    Science.gov (United States)

    Aziz, Noreen M.; Basch, Ethan; Bull, Janet; Cleeland, Charles S.; Currow, David C.; Fairclough, Diane; Hanson, Laura; Hauser, Joshua; Ko, Danielle; Lloyd, Linda; Morrison, R. Sean; Otis-Green, Shirley; Pantilat, Steve; Portenoy, Russell K.; Ritchie, Christine; Rocker, Graeme; Wheeler, Jane L.; Zafar, S. Yousuf; Kutner, Jean S.

    2010-01-01

    Abstract Background Palliative medicine has made rapid progress in establishing its scientific and clinical legitimacy, yet the evidence base to support clinical practice remains deficient in both the quantity and quality of published studies. Historically, the conduct of research in palliative care populations has been impeded by multiple barriers including health care system fragmentation, small number and size of potential sites for recruitment, vulnerability of the population, perceptions of inappropriateness, ethical concerns, and gate-keeping. Methods A group of experienced investigators with backgrounds in palliative care research convened to consider developing a research cooperative group as a mechanism for generating high-quality evidence on prioritized, clinically relevant topics in palliative care. Results : The resulting Palliative Care Research Cooperative (PCRC) agreed on a set of core principles: active, interdisciplinary membership; commitment to shared research purposes; heterogeneity of participating sites; development of research capacity in participating sites; standardization of methodologies, such as consenting and data collection/management; agile response to research requests from government, industry, and investigators; focus on translation; education and training of future palliative care researchers; actionable results that can inform clinical practice and policy. Consensus was achieved on a first collaborative study, a randomized clinical trial of statin discontinuation versus continuation in patients with a prognosis of less than 6 months who are taking statins for primary or secondary prevention. This article describes the formation of the PCRC, highlighting processes and decisions taken to optimize the cooperative group's success. PMID:21105763

  1. Fault Management Design Strategies

    Science.gov (United States)

    Day, John C.; Johnson, Stephen B.

    2014-01-01

    Development of dependable systems relies on the ability of the system to determine and respond to off-nominal system behavior. Specification and development of these fault management capabilities must be done in a structured and principled manner to improve our understanding of these systems, and to make significant gains in dependability (safety, reliability and availability). Prior work has described a fundamental taxonomy and theory of System Health Management (SHM), and of its operational subset, Fault Management (FM). This conceptual foundation provides a basis to develop framework to design and implement FM design strategies that protect mission objectives and account for system design limitations. Selection of an SHM strategy has implications for the functions required to perform the strategy, and it places constraints on the set of possible design solutions. The framework developed in this paper provides a rigorous and principled approach to classifying SHM strategies, as well as methods for determination and implementation of SHM strategies. An illustrative example is used to describe the application of the framework and the resulting benefits to system and FM design and dependability.

  2. 2015 Evidence Analysis Library Evidence-Based Nutrition Practice Guideline for the Management of Hypertension in Adults.

    Science.gov (United States)

    Lennon, Shannon L; DellaValle, Diane M; Rodder, Susan G; Prest, Melissa; Sinley, Rachel C; Hoy, M Katherine; Papoutsakis, Constantina

    2017-09-01

    Hypertension (HTN) or high blood pressure (BP) is among the most prevalent forms of cardiovascular disease and occurs in approximately one of every three adults in the United States. The purpose of this Evidence Analysis Library (EAL) guideline is to provide an evidence-based summary of nutrition therapy for the management of HTN in adults aged 18 years or older. Implementation of this guideline aims to promote evidence-based practice decisions by registered dietitian nutritionists (RDNs), and other collaborating health professionals to decrease or manage HTN in adults while enhancing patient quality of life and taking into account individual preferences. The systematic review and guideline development methodology of the Academy of Nutrition and Dietetics were applied. A total of 70 research studies were included, analyzed, and rated for quality by trained evidence analysts (literature review dates ranged between 2004 and 2015). Evaluation and synthesis of related evidence resulted in the development of nine recommendations. To reduce BP in adults with HTN, there is strong evidence to recommend provision of medical nutrition therapy by an RDN, adoption of the Dietary Approaches to Stop Hypertension dietary pattern, calcium supplementation, physical activity as a component of a healthy lifestyle, reduction in dietary sodium intake, and reduction of alcohol consumption in heavy drinkers. Increased intake of dietary potassium and calcium as well as supplementation with potassium and magnesium for lowering BP are also recommended (fair evidence). Finally, recommendations related to lowering BP were formulated on vitamin D, magnesium, and the putative role of alcohol consumption in moderate drinkers (weak evidence). In conclusion, the present evidence-based nutrition practice guideline describes the most current recommendations on the dietary management of HTN in adults intended to support the practice of RDNs and other health professionals. Copyright © 2017 Academy of

  3. Evidence-based practice in the management of lower limb lymphedema after gynecological cancer.

    Science.gov (United States)

    Iwersen, Lisandra Fossari; Sperandio, Fabiana Flores; Toriy, Ariana Machado; Palú, Marina; Medeiros da Luz, Clarissa

    2017-01-01

    Lower limb lymphedema (LLL) is characterized as a physical-functional chronic complication that impacts the quality of life of women who have gone through treatment for gynecological cancer. The present study aims to check the conservative treatments available for lymphedema after gynecological cancer in the context of evidence-based practice. The selection criteria included papers from May 1993 discussing treatment protocols used in LLL after treatment for gynecological cancer. The search was performed until October 2014 in MEDLINE, SciVerse, and PEDro using "rehabilitation," "treatment outcome," "therapeutics," "clinical protocol," "gynecologic surgery," "lower extremity," "lower limb," and "lymphedema" as keywords, focused on women with a previous diagnosis of gynecological cancer who received radiation and/or chemotherapy and/or surgery and/or lymphadenectomy as part of their treatment. From 110 studies found, 3 articles that used the complex decongestive therapy (CDT) as a treatment protocol were selected. There were no randomized clinical trials associated with the conservative treatment of LLL post-treatment of gynecological cancer. The three selected articles are retrospective, and had the same outcome - decreased volume of the affected limb lymphedema. Although LLL is more or as frequent and detrimental as upper limb lymphedema post-cancer treatment, there are only a few studies about this subject. Publications are even scarcer when considering studies with interventional approach. Randomized controlled trials are necessary to support rehabilitation resources on lymphedema post-gynecological cancer treatment.

  4. Management of Axillary Web Syndrome after Breast Cancer: Evidence-Based Practice.

    Science.gov (United States)

    Luz, Clarissa Medeiros da; Deitos, Julia; Siqueira, Thais Cristina; Palú, Marina; Heck, Ailime Perito Feiber

    2017-11-01

    Axillary web syndrome is characterized as a physical-functional complication that impacts the quality of life of women who have undergone treatment for breast cancer. The present study aims to verify the physiotherapy treatment available for axillary web syndrome after surgery for breast cancer in the context of evidence-based practice. The selection criteria included papers discussing treatment protocols used for axillary web syndrome after treatment for breast cancer. The search was performed in the MEDLINE, Scopus, PEDro and LILACS databases using the terms axillary web syndrome, lymphadenectomy and breast cancer, focusing on women with a previous diagnosis of breast cancer who underwent surgery with lymphadenectomy as part of their treatment. From the 262 studies found, 4 articles that used physiotherapy treatment were selected. The physiotherapy treatment was based on lymphatic drainage, tissue mobilization, stretching and strengthening. The four selected articles had the same outcome: improvement in arm pain and shoulder function and/or dissipation of the axillary cord. Although axillary web syndrome seems to be as frequent and detrimental as other morbidities after cancer treatment, there are few studies on this subject. The publications are even scarcer when considering studies with an interventional approach. Randomized controlled trials are necessary to support the rehabilitation resources for axillary web syndrome. Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil.

  5. Patients speak out: development of an evidence-based model for managing orthopaedic postoperative pain.

    Science.gov (United States)

    Pulido, Pamela; Hardwick, Mary E; Munro, Michelle; May, Laura; Dupies-Rosa, Denise

    2010-01-01

    Perioperative pain management after total joint replacement continues to be a concern for orthopaedic nurses. In our institution, the results of routine post-hospital stay surveys had shown below average scores in the area of pain management. This began as a quality management issue, became a pain subcommittee issue, and drew in the research nurses to ask what we can learn from this process. Changing the method of handling pain management is not easy, but it makes a difference in patients' hospital experiences. We learned that cooperation and expertise from multiple departments within the institution and some organizations outside the institution is needed to bring about change. We learned that education of not just staff members but also patients on pain management affected the outcome. This article describes our journey to enhance pain management in our institution.

  6. Engaging foster parents in treatment: a randomized trial of supplementing trauma-focused cognitive behavioral therapy with evidence-based engagement strategies.

    Science.gov (United States)

    Dorsey, Shannon; Pullmann, Michael D; Berliner, Lucy; Koschmann, Elizabeth; McKay, Mary; Deblinger, Esther

    2014-09-01

    The goal of this study was to examine the impact of supplementing Trauma-focused Cognitive Behavioral Therapy (TF-CBT; Cohen et al., 2006) with evidence-based engagement strategies on foster parent and foster youth engagement in treatment, given challenges engaging foster parents in treatment. A randomized controlled trial of TF-CBT standard delivery compared to TF-CBT plus evidence-based engagement strategies was conducted with 47 children and adolescents in foster care and one of their foster parents. Attendance, engagement, and clinical outcomes were assessed 1 month into treatment, end of treatment, and 3 months post-treatment. Youth and foster parents who received TF-CBT plus evidence-based engagement strategies were more likely to be retained in treatment through four sessions and were less likely to drop out of treatment prematurely. The engagement strategies did not appear to have an effect on the number of canceled or no-show sessions or on treatment satisfaction. Clinical outcomes did not differ by study condition, but exploratory analyses suggest that youth had significant improvements with treatment. Strategies that specifically target engagement may hold promise for increasing access to evidence-based treatments and for increasing likelihood of treatment completion. Copyright © 2014 Elsevier Ltd. All rights reserved.

  7. An evidence-based algorithm for the management of common peroneal nerve injury associated with traumatic knee dislocation

    Science.gov (United States)

    Samson, Deepak; Ng, Chye Yew; Power, Dominic

    2016-01-01

    Traumatic knee dislocation is a complex ligamentous injury that may be associated with simultaneous vascular and neurological injury. Although orthopaedic surgeons may consider CPN exploration at the time of ligament reconstruction, there is no standardised approach to the management of this complex and debilitating complication. This review focusses on published evidence of the outcomes of common peroneal nerve (CPN) injuries associated with knee dislocation, and proposes an algorithm for the management. Cite this article: Deepak Samson, Chye Yew Ng, Dominic Power. An evidence-based algorithm for the management of common peroneal nerve injury associated with traumatic knee dislocation. EFORT Open Rev 2016;1:362-367. DOI: 10.1302/2058-5241.160012. PMID:28461914

  8. 'PICO-D Management'; a decision-aid for evidence-based chiropractic education and clinical practice.

    Science.gov (United States)

    Amorin-Woods, Lyndon G; Losco, Barrett E

    2016-01-01

    Various models and decision-making aids exist for chiropractic clinical practice. "PICO-D Man" (Patient-Intervention-Comparator-Outcome-Duration Management) is a decision-aid developed in an educational setting which field practitioners may also find useful for applying defensible evidence-based practice. Clinical decision-making involves understanding and evaluating both the proposed clinicalintervention(s) and the relevant and available management options with respect to describing the patient and their problem, clinical and cost effectiveness, safety, feasibility and time-frame. For people consulting chiropractors this decision-aid usually requires the practitioner to consider a comparison of usual chiropractic care, (clinical management including a combination of active care and passive manual interventions), to usual medical care usually including medications, or other allied healthmanagement options while being mindful of the natural history of the persons' condition.

  9. Safe refeeding management of anorexia nervosa inpatients: an evidence-based protocol.

    Science.gov (United States)

    Hofer, Michael; Pozzi, Antonio; Joray, Maya; Ott, Rebecca; Hähni, Florence; Leuenberger, Michéle; von Känel, Roland; Stanga, Zeno

    2014-05-01

    Anorexia nervosa is associated with several serious medical complications related to malnutrition, severe weight loss, and low levels of micronutrients. The refeeding phase of these high-risk patients bears a further threat to health and potentially fatal complications. The objective of this study was to examine complications due to refeeding of patients with anorexia nervosa, as well as their mortality rate after the implementation of guidelines from the European Society of Clinical Nutrition and Metabolism. We analyzed retrospective, observational data of a consecutive, unselected anorexia nervosa cohort during a 5-y period. The sample consisted of 65 inpatients, 14 were admitted more than once within the study period, resulting in 86 analyzed cases. Minor complications associated with refeeding during the first 10 d (replenishing phase) were recorded in nine cases (10.5%), four with transient pretibial edemas and three with organ dysfunction. In two cases, a severe hypokalemia occurred. During the observational phase of 30 d, 16 minor complications occurred in 14 cases (16.3%). Six infectious and 10 non-infectious complications occurred. None of the patients with anorexia nervosa died within a follow-up period of 3 mo. Our data demonstrate that the seriousness and rate of complications during the replenishment phase in this high-risk population can be kept to a minimum. The findings indicate that evidence-based refeeding regimens, such as our guidelines are able to reduce complications and prevent mortality. Despite anorexia nervosa, our sample were affected by serious comorbidities, no case met the full diagnostic criteria for refeeding syndrome. Copyright © 2014 Elsevier Inc. All rights reserved.

  10. IMPLEmenting a clinical practice guideline for acute low back pain evidence-based manageMENT in general practice (IMPLEMENT: Cluster randomised controlled trial study protocol

    Directory of Open Access Journals (Sweden)

    Francis Jill

    2008-02-01

    Full Text Available Abstract Background Evidence generated from reliable research is not frequently implemented into clinical practice. Evidence-based clinical practice guidelines are a potential vehicle to achieve this. A recent systematic review of implementation strategies of guideline dissemination concluded that there was a lack of evidence regarding effective strategies to promote the uptake of guidelines. Recommendations from this review, and other studies, have suggested the use of interventions that are theoretically based because these may be more effective than those that are not. An evidence-based clinical practice guideline for the management of acute low back pain was recently developed in Australia. This provides an opportunity to develop and test a theory-based implementation intervention for a condition which is common, has a high burden, and for which there is an evidence-practice gap in the primary care setting. Aim This study aims to test the effectiveness of a theory-based intervention for implementing a clinical practice guideline for acute low back pain in general practice in Victoria, Australia. Specifically, our primary objectives are to establish if the intervention is effective in reducing the percentage of patients who are referred for a plain x-ray, and improving mean level of disability for patients three months post-consultation. Methods/Design This study protocol describes the details of a cluster randomised controlled trial. Ninety-two general practices (clusters, which include at least one consenting general practitioner, will be randomised to an intervention or control arm using restricted randomisation. Patients aged 18 years or older who visit a participating practitioner for acute non-specific low back pain of less than three months duration will be eligible for inclusion. An average of twenty-five patients per general practice will be recruited, providing a total of 2,300 patient participants. General practitioners in the

  11. Marketing Management and Strategy

    DEFF Research Database (Denmark)

    This book gives readers an understanding of the factors that shape the marketing decisions of managers who operate in African economies. It brings together fifteen African cases written by scholars and executives with rich knowledge of business practices in Africa. By combining theoretical insights...... with practical information from the cases, the reader is introduced to issues relating to marketing strategy formulation, managerial actions in designing and implementing marketing decisions, as well as the operational contexts within which these actions are taken. The book is essential reading for both...... undergraduate and graduate students in marketing, international strategy and international business who require an understanding of African business...

  12. European evidence based consensus on the diagnosis and management of Crohn's disease : special situations

    NARCIS (Netherlands)

    Caprilli, R; Gassull, MA; Escher, JC; Moser, G; Munkholm, P; Forbes, A; Hommes, DW; Lochs, H; Angelucci, E; Cocco, A; Vucelic, B; Hildebrand, H; Kolacek, S; Riis, L; Lukas, M; de Franchis, R; Hamilton, M; Jantschek, G; Michetti, P; O'Morain, C; Anwar, M.M.; Freitas, JL; Mouzas, IA; Baert, F; Mitchel, R; Hawkey, CJ

    This third section of the European Crohn's and Colitis Organisation (ECCO) Consensus on the management of Crohn's disease concerns postoperative recurrence, fistulating disease, paediatrics, pregnancy, psychosomatics, extraintestinal manifestations, and alternative therapy. The first section on

  13. An evidence based review of the assessment and management of penetrating neck trauma.

    Science.gov (United States)

    Burgess, C A; Dale, O T; Almeyda, R; Corbridge, R J

    2012-02-01

    Although relatively uncommon, penetrating neck trauma has the potential for serious morbidity and an estimated mortality of up to 6%. The assessment and management of patients who have sustained a penetrating neck injury has historically been an issue surrounded by significant controversy. OBJECTIVES OF REVIEW: To assess recent evidence relating to the assessment and management of penetrating neck trauma, highlighting areas of controversy with an overall aim of formulating clinical guidelines according to a care pathway format. Structured, non-systematic review of recent medical literature. An electronic literature search was performed in May 2011. The Medline database was searched using the Medical Subject Headings terms 'neck injuries' and 'wounds, penetrating' in conjunction with the terms 'assessment' or 'management'. Embase was searched with the terms 'penetrating trauma' and 'neck injury', also in conjunction with the terms 'assessment' and 'management'. Results were limited to articles published in English from 1990 to the present day. Abstracts were reviewed by the first three authors to select full-text articles for further critical appraisal. The references and citation links of these articles were hand-searched to identify further articles of relevance. 147 relevant articles were identified by the electronic literature search, comprising case series, case reports and reviews. 33 were initially selected for further evaluation. Although controversy continues to surround the management of penetrating neck trauma, the role of selective non-operative management and the utility of CT angiography to investigate potential vascular injuries appears to be increasingly accepted. © 2011 Blackwell Publishing Ltd.

  14. Tactics for Teaching Evidence-Based Practice: Enhancing Active Learning Strategies With a Large Class of Graduate EBP Research in Nursing Students.

    Science.gov (United States)

    Vetter, Mary Jo; Latimer, Beth

    2017-10-01

    This column shares the best evidence-based strategies and innovative ideas on how to facilitate the learning and implementation of EBP principles and processes by clinicians as well as nursing and interprofessional students. Guidelines for submission are available at http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1741-6787. © 2017 Sigma Theta Tau International.

  15. What Is the Best Strategy "Evidence-Based Practice" to Teach Literacy Skills for Students with Multiple Disabilities? A Systematic Review

    Science.gov (United States)

    Almalki, Nabil

    2016-01-01

    A systematic review of literature was carried out on peer-reviewed journals published from 2000 to 2015 to help in determining the best strategy of evidence-based practice that can be applied in teaching literacy skills among students with multiple disabilities. A total of 12 studies were reviewed, some of which included science and mathematics…

  16. Factors affecting implementation of an evidence-based practice in the Veterans Health Administration: Illness management and recovery.

    Science.gov (United States)

    McGuire, Alan B; Salyers, Michelle P; White, Dominique A; Gilbride, Daniel J; White, Laura M; Kean, Jacob; Kukla, Marina

    2015-12-01

    Illness management and recovery (IMR) is an evidence-based practice that assists consumers in managing their illnesses and pursuing personal recovery goals. Although research has examined factors affecting IMR implementation facilitated by multifaceted, active roll-outs, the current study attempted to elucidate factors affecting IMR implementation outside the context of a research-driven implementation. Semi-structured interviews with 20 local recovery coordinators and 18 local IMR experts were conducted at 23 VA medical centers. Interviews examined perceived and experienced barriers and facilitators to IMR implementation. Data were analyzed via thematic inductive/deductive analysis in the form of crystallization/immersion. Six factors differed between sites implementing IMR from those not providing IMR: awareness of IMR, importer-champions, autonomy-supporting leadership, veteran-centered care, presence of a sensitive period, and presence of a psychosocial rehabilitation and recovery center. Four factors were common in both groups: recovery orientation, evidence-based practices orientation, perceived IMR fit within program structure, and availability of staff time. IMR can be adopted in lieu of active implementation support; however, knowledge dissemination appears to be key. Future research should examine factors affecting the quality of implementation. (c) 2015 APA, all rights reserved).

  17. Consensus evidence-based guidelines for management of gestational diabetes mellitus in India.

    Science.gov (United States)

    Seshiah, V; Banerjee, Samar; Balaji, V; Muruganathan, A; Das, Ashok Kumar

    2014-07-01

    Gestational diabetes mellitus represents both a clear pathological condition of glycaemic dysregulation and a factor aggravating the risk of future diabetes in both the mother and child. Thus it is of paramount importance to control and manage pregnancy complicated by diabetes to improve the health and well-being of the mother and avert the risk of diabetes across generations. Currently, a wide variety of national and international guidelines address clinical questions pertinent to diabetes management during pregnancy. Of them, the pioneering Diabetes in Pregnancy Study Group India (DIPSI) guideline for the management of diabetes during pregnancy has previously set new standards for quality diabetes care in India and around the world. The advent of insulin analogues, pen delivery devices and insulin pumps, has enriched our armamentarium to manage diabetes and thus warrants our due attention. The current guideline is an attempt to present an overview of current knowledge relating to the management of diabetes in pregnancy and to update available guidelines in view of advances in insulin therapy. These guidelines represent the amalgamation of updated clinical evidence with expert inputs in the context of Indian clinical practice.

  18. Management of anorexia and bulimia nervosa: An evidence-based review

    Science.gov (United States)

    Chakraborty, Kaustav; Basu, Debasish

    2010-01-01

    Anorexia nervosa and bulimia nervosa are primarily psychiatric disorders characterized by severe disturbances of eating behavior. Eating disorders are most prevalent in the Western culture where food is in abundance and female attractiveness is equated with thinness. Eating disorders are rare in countries like India. Despite a plethora of management options available to the mental health professionals, no major breakthrough has been achieved in recent years. Nutritional rehabilitation along with some form of re educative psychotherapy remains the mainstay of management of anorexia nervosa. In bulimia nervosa, both fluoxetine and cognitive behavior therapy have been found to be effective. Although the above-mentioned management options have been in use for decades, the active ingredient is still to be ascertained. PMID:20838508

  19. The current evidence based medical management of vesicoureteral reflux: The Sickkids protocol

    Directory of Open Access Journals (Sweden)

    Sumit Dave

    2007-01-01

    Full Text Available Vesicoureteral reflux is a common clinical entity and is one of the keystones of the establishment of pediatric urology as a urological subspeciality. There has been continued evolution in the management of vesicoureteral reflux as new insights are gained on its role in renal damage. The optimal treatment algorithm remains controversial. This review aims to highlight the current literature on VUR and its association with urinary tract infections and renal damage. The protocol of management of a child with VUR followed at The Hospital for Sick Children, Toronto is described.

  20. Promoting self-management and adherence during prophylaxis : evidence-based recommendations for haemophilia professionals

    NARCIS (Netherlands)

    Schrijvers, L. H.; Schuurmans, M. J.; Fischer, K.

    2016-01-01

    Introduction: Throughout life, a patient with severe haemophilia is confronted with many treatment-related challenges. Insight into self-management and non-adherence could improve the quality of care for these patients. The aim of this study was to provide an overview of the current evidence on

  1. IAP/APA evidence-based guidelines for the management of acute pancreatitis

    NARCIS (Netherlands)

    Goor, H. van

    2013-01-01

    BACKGROUND: There have been substantial improvements in the management of acute pancreatitis since the publication of the International Association of Pancreatology (IAP) treatment guidelines in 2002. A collaboration of the IAP and the American Pancreatic Association (APA) was undertaken to revise

  2. Optimal management of chronic cyclical pelvic pain: an evidence-based and pragmatic approach

    Directory of Open Access Journals (Sweden)

    Ha Ryun Won

    2010-08-01

    Full Text Available Ha Ryun Won, Jason AbbottDepartment of Endo-Gynecology, Royal Hospital for Women, Sydney, New South Wales, AustraliaAbstract: This article reviews the literature on management of chronic cyclical pelvic pain (CCPP. Electronic resources including Medline, PubMed, CINAHL, The Cochrane Library, Current Contents, and EMBASE were searched using MeSH terms including all ­subheadings and keywords: “cyclical pelvic pain”, “chronic pain”, “dysmenorrheal”, “nonmenstrual ­pelvic pain”, and “endometriosis”. There is a dearth of high-quality evidence for this common ­problem. Chronic pelvic pain affects 4%–25% of women of reproductive age. Dysmenorrhea of varying degree affects 60% of women. Endometriosis is the commonest pathologic cause of CCPP. Other gynecological causes are adenomyosis, uterine fibroids, and pelvic floor myalgia, although other systems disease such as irritable bowel syndrome or interstitial cystitis may be responsible. ­Management options range from simple to invasive, where simple medical ­treatment such as the combined oral contraceptive pill may be used as a first-line treatment prior to invasive ­management. This review outlines an approach to patients with CCPP through history, physical examination, and investigation to identify the cause(s of the pain and its optimal management.Keywords: cyclical pelvic pain, chronic pain, dysmenorrhea, nonmenstrual pelvic pain, endometriosis

  3. Optical Coherence Tomography Monitoring Strategies for A-VEGF—Treated Age-Related Macular Degeneration: An Evidence-Based Analysis

    Science.gov (United States)

    Pron, G

    2014-01-01

    Background New anti-angiogenesis pharmacotherapies have dramatically altered treatment of age-related macular degeneration (AMD), the leading cause of blindness in older adults. Monthly intraocular injections however, are extremely burdensome to ophthalmologists, patients, and their families. Repeated injections also increase risks of complications or adverse events. Although the pharmacokinetics of anti–vascular endothelial growth factor (A-VEGF) drugs are fairly well known, an individuals’ AMD presentation and their pharmacodynamics or response to the drug has been shown to be extremely variable. Therefore treating everyone on the same fixed or standard regimen has potential for undertreating or overtreating patients, and drug costs are not trivial. Objectives To review monitoring strategies and to evaluate the role of optical coherence tomography (OCT) in guiding management of A-VEGF–treated neovascular AMD (n-AMD) patients. Data Sources Systematic reviews of biographic databases for studies published between 2008 and February 2013 involving A-VEGF–treated n-AMD patients monitored in longitudinal follow-up. Review Methods Studies were grouped according to varying treatments, monitoring schedules, and re-treatment protocols reported for n-AMD patients treated with A-VEGF. Several outcomes were evaluated across strategies including visual acuity (VA), retinal anatomy, re-treatment criteria and frequencies of clinical follow-up, OCT imaging investigations, and intravitreal injections. Results were summarized qualitatively, as heterogeneity in study objectives and methods precluded formal meta-analysis. Results A systematic review identified 18 randomized controlled trials (RCTs) and 20 observational studies involving A-VEGF treatment employing various monitoring and as-needed (PRN) re-treatment protocols. Several maintenance strategies were unsuccessful, resulting in lower VA gains and stabilization than monthly injections in A-VEGF–treated n-AMD. These

  4. Evidence-based management of Kawasaki disease in the emergency department.

    Science.gov (United States)

    Seaton, Kara K; Kharbanda, Anupam

    2015-01-01

    Kawasaki disease, also known as mucocutaneous lymph node syndrome, was first described in Japan in 1967. It is currently the leading cause of acquired heart disease in children in the United States. Untreated Kawasaki disease may lead to the formation of coronary artery aneurysms and sudden cardiac death in children. This vasculitis presents with fever for ≥ 5 days, plus a combination of key criteria. Because each of the symptoms commonly occurs in other childhood illnesses, the disease can be difficult to diagnose, especially in children who present with an incomplete form of the disease. At this time, the etiology of the disease remains unknown, and there is no single diagnostic test to confirm the diagnosis. This issue reviews the presentation, diagnostic criteria, and management of Kawasaki disease in the emergency department. Emergency clinicians should consider Kawasaki disease as a diagnosis in pediatric patients presenting with prolonged fever, as prompt evaluation and management can significantly decrease the risk of serious cardiac sequelae.

  5. Teaching evidence-based management: where do we go from here?

    Science.gov (United States)

    Bigelow, Barbara; Arndt, Margarete

    2003-01-01

    Recently we talked with executive directors of healthcare organizations about the sources of information they use when conducting research. The responses were very similar. They preferred "googling," reading trusted trade journals, and reading more generic business literature such as Harvard Business Review. When asked if they ever read and used healthcare management research, they said the articles were often inaccessible. First, as CEOs faced with the responsibility for their organization's performance, they want to know whether there is anything in the research that will help them run their organizations better. Unfortunately, as observed by Gary Mecklenburg in this issue, the focus in healthcare research is too frequently on research implications, not on what a CEO wants and needs to know. As a result, the research is not always relevant. Further, by the time the research is conducted and published (it is not infrequent for more than a year to elapse from submission to actual publication in a journal, and by then the data may be two or more years old), executives have moved on to other decisions. As one of the CEOs observed, there is a gap between what she needs to know and what the health management literature has to say. Second, managers have limited time, and information needs to be succinct and to the point if it is to be useful. Research articles are very time consuming to read, and as the CEOs commented, time is a precious resource. Research articles frequently devote considerable space to conceptual development and methods, and even when managerial implications are addressed, managers

  6. Evidence-based management of postoperative pain in adults undergoing open inguinal hernia surgery

    DEFF Research Database (Denmark)

    Joshi, G P; Rawal, N; Kehlet, H

    2012-01-01

    BACKGROUND: Open inguinal hernia repair is associated with moderate postoperative pain, but optimal analgesia remains controversial. The aim of this systematic review was to evaluate the available literature on the management of pain after open hernia surgery. METHODS: Randomized studies......, in English, published between January 1966 and March 2009, assessing analgesic and anaesthetic interventions in adult open hernia surgery, and reporting pain scores, were retrieved from the Embase and MEDLINE databases. In addition to published evidence, clinical practice was taken into account to ensure...

  7. Diphtheria, pertussis, and tetanus: evidence-based management of pediatric patients in the emergency department

    Science.gov (United States)

    Zibners, Lara

    2017-02-01

    Diphtheria, pertussis, and tetanus are potentially deadly bacterial infections that are largely preventable through vaccination, though they remain in the population. This issue reviews the epidemiology, pathophysiology, diagnosis, and current recommended emergency management of these conditions. Disease-specific medications, as well as treatment of the secondary complications, are examined in light of the best current evidence. Resources include obtaining diphtheria antitoxin from the United States Centers for Disease Control and Prevention and best-practice recommendations with regard to testing, involvement of government health agencies, isolation of the patient, and identification and treatment of close contacts. Most importantly, issues regarding vaccination and prevention are highlighted.

  8. Alcohol Consumption among College Students: Chief Student Affairs Officers' Perspectives on Evidence-Based Alcohol Consumption Reduction Strategies

    Science.gov (United States)

    Stender, David F., III

    2014-01-01

    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…

  9. [Use of the evidence-based guidelines for management of bronchiolitis].

    Science.gov (United States)

    Oñate Ramírez, Ana Lorena; Rendón Macías, Mario Enrique; Iglesias Leboreiro, José; Bernárdez Zapata, Isabel

    The aim of this study was to analyze the medical care of childrenBronquiolitis, España (GPCBA). We evaluated 197 patients attended by 49 pediatricians. Of the recommended actions, in 110 patients (55.8%) aspirate secretions were indicated, 105 patients (53%) received supplemental oxygen and 63 patients (31.9%) used inhaled hypertonic solution. Non-recommended actions were carried out in 166 patients (84%) who received inhaled bronchodilators, 143 patients (72%) who inhaled steroids, 110 patients (55.8%) who were prescribed antibiotics, 76 patients (38%) who had nebulization and 52 patients (26.3%) were administered systemic steroids. Physicians with<10 years of expertise prescribed more systemic steroids. Despite the dissemination of good clinical practice guidelines for the management of acute bronchiolitis, its adoption has not been totally completed. Copyright © 2014 Hospital Infantil de México Federico Gómez. Publicado por Masson Doyma México S.A. All rights reserved.

  10. Management of alcohol withdrawal delirium. An evidence-based practice guideline.

    Science.gov (United States)

    Mayo-Smith, Michael F; Beecher, Lee H; Fischer, Timothy L; Gorelick, David A; Guillaume, Jeanette L; Hill, Arnold; Jara, Gail; Kasser, Chris; Melbourne, John

    2004-07-12

    Alcohol withdrawal delirium is the most serious manifestation of alcohol withdrawal. Evidence suggests that appropriate care improves mortality, but systematic reviews are unavailable. Articles with original data on management of alcohol withdrawal delirium underwent structured review and meta-analysis. Meta-analysis of 9 prospective controlled trials demonstrated that sedative-hypnotic agents are more effective than neuroleptic agents in reducing duration of delirium and mortality, with a relative risk of death when using neuroleptic agents of 6.6. Statistically significant differences among various benzodiazepines and barbiturates were not found. No deaths were reported in 217 patients from trials using benzodiazepines or barbiturates. Control of agitation should be achieved using parenteral rapid-acting sedative-hypnotic agents that are cross-tolerant with alcohol. Adequate doses should be used to maintain light somnolence for the duration of delirium. Coupled with comprehensive supportive medical care, this approach is highly effective in preventing morbidity and mortality.

  11. Summary of evidence-based guideline update: Evaluation and management of concussion in sports

    Science.gov (United States)

    Giza, Christopher C.; Kutcher, Jeffrey S.; Ashwal, Stephen; Barth, Jeffrey; Getchius, Thomas S.D.; Gioia, Gerard A.; Gronseth, Gary S.; Guskiewicz, Kevin; Mandel, Steven; Manley, Geoffrey; McKeag, Douglas B.; Thurman, David J.; Zafonte, Ross

    2013-01-01

    Objective: To update the 1997 American Academy of Neurology (AAN) practice parameter regarding sports concussion, focusing on 4 questions: 1) What factors increase/decrease concussion risk? 2) What diagnostic tools identify those with concussion and those at increased risk for severe/prolonged early impairments, neurologic catastrophe, or chronic neurobehavioral impairment? 3) What clinical factors identify those at increased risk for severe/prolonged early postconcussion impairments, neurologic catastrophe, recurrent concussions, or chronic neurobehavioral impairment? 4) What interventions enhance recovery, reduce recurrent concussion risk, or diminish long-term sequelae? The complete guideline on which this summary is based is available as an online data supplement to this article. Methods: We systematically reviewed the literature from 1955 to June 2012 for pertinent evidence. We assessed evidence for quality and synthesized into conclusions using a modified Grading of Recommendations Assessment, Development and Evaluation process. We used a modified Delphi process to develop recommendations. Results: Specific risk factors can increase or decrease concussion risk. Diagnostic tools to help identify individuals with concussion include graded symptom checklists, the Standardized Assessment of Concussion, neuropsychological assessments, and the Balance Error Scoring System. Ongoing clinical symptoms, concussion history, and younger age identify those at risk for postconcussion impairments. Risk factors for recurrent concussion include history of multiple concussions, particularly within 10 days after initial concussion. Risk factors for chronic neurobehavioral impairment include concussion exposure and APOE ε4 genotype. Data are insufficient to show that any intervention enhances recovery or diminishes long-term sequelae postconcussion. Practice recommendations are presented for preparticipation counseling, management of suspected concussion, and management of

  12. The Implementation of Targeted Temperature Management: An Evidence-Based Guideline from the Neurocritical Care Society.

    Science.gov (United States)

    Madden, Lori Kennedy; Hill, Michelle; May, Teresa L; Human, Theresa; Guanci, Mary McKenna; Jacobi, Judith; Moreda, Melissa V; Badjatia, Neeraj

    2017-12-01

    Targeted temperature management (TTM) is often used in neurocritical care to minimize secondary neurologic injury and improve outcomes. TTM encompasses therapeutic hypothermia, controlled normothermia, and treatment of fever. TTM is best supported by evidence from neonatal hypoxic-ischemic encephalopathy and out-of-hospital cardiac arrest, although it has also been explored in ischemic stroke, traumatic brain injury, and intracranial hemorrhage patients. Critical care clinicians using TTM must select appropriate cooling techniques, provide a reasonable rate of cooling, manage shivering, and ensure adequate patient monitoring among other challenges. The Neurocritical Care Society recruited experts in neurocritical care, nursing, and pharmacotherapy to form a writing Committee in 2015. The group generated a set of 16 clinical questions relevant to TTM using the PICO format. With the assistance of a research librarian, the Committee undertook a comprehensive literature search with no back date through November 2016 with additional references up to March 2017. The Committee utilized GRADE methodology to adjudicate the quality of evidence as high, moderate, low, or very low based on their confidence that the estimate of effect approximated the true effect. They generated recommendations regarding the implementation of TTM based on this systematic review only after considering the quality of evidence, relative risks and benefits, patient values and preferences, and resource allocation. This guideline is intended for neurocritical care clinicians who have chosen to use TTM in patient care; it is not meant to provide guidance regarding the clinical indications for TTM itself. While there are areas of TTM practice where clear evidence guides strong recommendations, many of the recommendations are conditional, and must be contextualized to individual patient and system needs.

  13. 3rd European Evidence-based Consensus on the Diagnosis and Management of Crohn's Disease 2016: Part 2: Surgical Management and Special Situations.

    Science.gov (United States)

    Gionchetti, Paolo; Dignass, Axel; Danese, Silvio; Magro Dias, Fernando José; Rogler, Gerhard; Lakatos, Péter Laszlo; Adamina, Michel; Ardizzone, Sandro; Buskens, Christianne J; Sebastian, Shaji; Laureti, Silvio; Sampietro, Gianluca M; Vucelic, Boris; van der Woude, C Janneke; Barreiro-de Acosta, Manuel; Maaser, Christian; Portela, Francisco; Vavricka, Stephan R; Gomollón, Fernando

    2017-02-01

    This paper is the second in a series of two publications relating to the European Crohn's and Colitis Organisation [ECCO] evidence-based consensus on the diagnosis and management of Crohn's disease [CD] and concerns the surgical management of CD as well as special situations including management of perianal CD and extraintestinal manifestations. Diagnostic approaches and medical management of CD of this ECCO Consensus are covered in the first paper [Gomollon et al JCC 2016]. Copyright © 2016 European Crohn’s and Colitis Organisation (ECCO). Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.

  14. Open knee joint injuries--an evidence-based approach to management.

    Science.gov (United States)

    Konda, Sanjit R; Davidovitch, Roy I; Egol, Kenneth A

    2014-01-01

    Open knee joint injuries are potentially devastating injuries if not properly diagnosed and treated. Current diagnostic techniques, such as the saline load test (SLT), are based on outdated literature. Diagnosis of traumatic arthrotomies via the presence of intra-articular air on computed tomography (CT) scan has recently been shown to be 100% sensitive and specific to detect these injuries. Additionally, open knee joint injuries have a high rate of associated periarticular fractures (51%). The workhorse open surgical approach to the knee is the medial parapatellar approach; however, arthroscopic irrigation and debridement (I&D) should be considered in the setting of small puncture wounds (e.g., gunshot wounds). Antibiotic therapy following I&D of an open knee joint injury includes 24 to 48 hours of intravenous antibiotics. Oral antibiotic therapy can be administered afterwards for 3 to 5 days if the original injury was grossly contaminated. Ultimately, a unified management algorithm for open knee joint injuries based on current literature should be followed to ensure appropriate diagnosis and treatment of this potentially devastating injury.

  15. Management of integration strategies

    Directory of Open Access Journals (Sweden)

    Nimer HAMAD

    2017-05-01

    Full Text Available At the current stage of socio-economic, globalization drives competitiveness, markets, imposing countries to review their international development strategies. Thus in the last decade, many actors have chosen be closer to their competitors, in order to be among the world leaders in their professional specialization. The recent period is marked, in particular, by a proliferation of cross-border mergers and a significant increase in the value of international operations. These phenomena and processes affect all areas of social and economic life. However, the performance achieved by operations conducted face strong difficulties, especially due to differences in cultural and organizational management between associates. Research on the experience of different countries and regions allows to make some predictions for the nation states. The purpose of research is to study the peculiarities of management processes in different regions and areas to draw conclusions and give recommendations organs, structures spring for process optimization.

  16. Australian and New Zealand evidence-based recommendations for pain management by pharmacotherapy in adult patients with inflammatory arthritis.

    Science.gov (United States)

    Richards, Bethan L; Whittle, Samuel; Buchbinder, Rachelle; Barrett, Claire; Lynch, Nora; Major, Gabor; Littlejohn, Geoffrey; Taylor, Andrew; Zochling, Jane

    2014-09-01

    To develop Australian and New Zealand evidence-based recommendations for pain management by pharmacotherapy in adult patients with optimally treated inflammatory arthritis (IA). Four hundred and fifty-three rheumatologists from 17 countries including 46 rheumatologists from Australia and New Zealand participated in the 2010 3e (Evidence, Expertise, Exchange) Initiative. Using a formal voting process, rheumatologists from 15 national scientific committees selected 10 clinical questions regarding the use of pain medications in IA. Bibliographic fellows undertook a systematic literature review for each question, using MEDLINE, EMBASE, Cochrane CENTRAL and 2008-09 EULAR/ACR abstracts. Relevant studies were retrieved for data extraction and risk of bias assessment. Rheumatologists from Australia and New Zealand used the evidence to develop a set of national recommendations. These recommendations were then formulated and assessed for agreement and the potential impact on clinical practice. The Oxford Levels of Evidence and Grade of Recommendation were applied to each recommendation. The systematic reviews identified 49 242 references, from which 167 studies which met the pre-specified inclusion criteria. Combining this evidence with expert opinion led to the development of 10 final Australian and New Zealand recommendations. The recommendations relate to pain measurement, and the use of analgesic medications in patients with and without co-morbidities and during pregnancy and lactation. The recommendations reflect the clinical practice of the majority of the participating rheumatologists (mean level of agreement 7.24-9.65). Ten Australian and New Zealand evidence-based recommendations regarding the management of pain by pharmacotherapy in adults with optimally treated IA were developed. They are supported by a large panel of rheumatologists, thus enhancing their utility in everyday clinical practice. © 2014 Asia Pacific League of Associations for Rheumatology and Wiley

  17. Expanding research to provide an evidence base for nutritional interventions for the management of inborn errors of metabolism.

    Science.gov (United States)

    Camp, Kathryn M; Lloyd-Puryear, Michele A; Yao, Lynne; Groft, Stephen C; Parisi, Melissa A; Mulberg, Andrew; Gopal-Srivastava, Rashmi; Cederbaum, Stephen; Enns, Gregory M; Ershow, Abby G; Frazier, Dianne M; Gohagan, John; Harding, Cary; Howell, R Rodney; Regan, Karen; Stacpoole, Peter W; Venditti, Charles; Vockley, Jerry; Watson, Michael; Coates, Paul M

    2013-08-01

    A trans-National Institutes of Health initiative, Nutrition and Dietary Supplement Interventions for Inborn Errors of Metabolism (NDSI-IEM), was launched in 2010 to identify gaps in knowledge regarding the safety and utility of nutritional interventions for the management of inborn errors of metabolism (IEM) that need to be filled with evidence-based research. IEM include inherited biochemical disorders in which specific enzyme defects interfere with the normal metabolism of exogenous (dietary) or endogenous protein, carbohydrate, or fat. For some of these IEM, effective management depends primarily on nutritional interventions. Further research is needed to demonstrate the impact of nutritional interventions on individual health outcomes and on the psychosocial issues identified by patients and their families. A series of meetings and discussions were convened to explore the current United States' funding and regulatory infrastructure and the challenges to the conduct of research for nutritional interventions for the management of IEM. Although the research and regulatory infrastructure are well-established, a collaborative pathway that includes the professional and advocacy rare disease community and federal regulatory and research agencies will be needed to overcome current barriers. Copyright © 2013. Published by Elsevier Inc. All rights reserved.

  18. Management strategy of enterprise

    Directory of Open Access Journals (Sweden)

    Osovskiy O.A.

    2017-03-01

    Full Text Available The development of market relations, increasing competition result in the accelerated necessity in strategic management as one of the most efficient and progressive means of organization management. The article deals with such researching methods as SWOT analysis (studying strength and weak points, manufacturing feasibilities of an enterprise and threats caused by environment, BCG matrix (while determining marketing roles of output, Mack Kinsey (determining branch attraction, the tree of aims (looking for perspective directions of development, and also other well-known tools of strategic management. SE «Zhytomyr distillery» is the enterprise with over century traditions of production quality of its output. The results of the SWOT analysis has allowed to determine the lines of behavior due to favorable and unfavorable factors of environment. At present, the enterprise has much strength and manufacturing feasibilities, therefore, the principal directions of its activity have to become the improvement of its technological base, the expansion of output range and sale at the expense of free financial resources. The calculations made by the authors allowed them to develop the main strategies for development of an enterprise. The practical value of the calculations lies in keeping competitive lines both on the domestic market of Ukraine and on the foreign international market.

  19. Evidence-Based Toxicology.

    Science.gov (United States)

    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.

  20. Evidence-based communications strategies: NWPERLC response to training on effectively reaching limited English-speaking (LEP) populations in emergencies.

    Science.gov (United States)

    DʼAmbrosio, Luann; Huang, Claire E; Sheng Kwan-Gett, Tao

    2014-01-01

    Identifying and overcoming barriers to effective emergency preparedness and response is one of the objectives for the Centers for Disease Control and Prevention's network of 14 Preparedness and Emergency Response Learning Centers (PERLCs) and 9 Preparedness and Response Research Centers (PERRCs). This report describes how a PERLC and a PERRC colocated at the Northwest Center for Public Health Practice responded to Los Angeles County Department of Public Health's (DPH's) request to improve emergency communications with limited English-proficient (LEP) populations. Activities included an assessment of training needs of the DPH preparedness workforce, a training series on social media and community engagement, and a toolkit of evidence-based findings to improve LEP populations' emergency communications and community resilience. Most respondents to the training needs assessment considered themselves essential personnel during an emergency and stated that they have received proper training. Respondents would like to receive further emergency preparedness training, including additional clarity on their role during an emergency. The majority of participants rated the training series as excellent/very good and agreed that they will be able to apply the course content to their work. The percentage of participants who reported confidence in their knowledge and skills related to each course learning objective increased from the precourse survey to the postcourse survey. This article discusses how the colocation of PERRC and PERLC offers efficiencies and expertise to accomplish multicomponent evidence-based requests. The ability to translate research findings quickly into evidence-based training and best practice resources is a strategic benefit to public health practice agencies working on emergency preparedness. LA County DPH was able to use knowledge and lessons learned gained from this work to design and prioritize education and training offerings to improve the capacity

  1. 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.

    Science.gov (United States)

    Brown, Kathleen M; Hirshon, Jon Mark; Alcorta, Richard; Weik, Tasmeen S; Lawner, Ben; Ho, Shiu; Wright, Joseph L

    2014-01-01

    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

  2. An evidence-based approach to the prevention and initial management of skin tears within the aged community setting: a best practice implementation project.

    Science.gov (United States)

    Beechey, Rebekah; Priest, Laura; Peters, Micah; Moloney, Clint

    2015-06-12

    Maintaining skin integrity in a community setting is an ongoing issue, as research suggests that the prevalence of skin tears within the community is greater than that in an institutional setting. While skin tear prevention and management principles in these settings are similar to those in an acute care setting, consideration of the environmental and psychological factors of the client is pivotal to prevention in a community setting. Evidence suggests that home environment assessment, education for clients and care givers, and being proactive in improving activities of daily living in a community setting can significantly reduce the risk of sustaining skin tears. The aim of this implementation project was to assess and review current skin tear prevention and management practices within the community setting, and from this, to implement an evidence-based approach in the education of clients and staff on the prevention of skin tears. As well. the project aims to implement evidence-based principles to guide clinical practice in relation to the initial management of skin tears, and to determine strategies to overcome barriers and non-compliance. The project utilized the Joanna Brigg's Institute Practical Application of Clinical Evidence System audit tool for promoting changes in the community health setting. The implementation of this particular project is based in a region within Anglicare Southern Queensland. A small team was established and a baseline audit carried out. From this, multiple strategies were implemented to address non-compliance which included education resources for clients and caregivers, staff education sessions, and creating skin integrity kits to enable staff members to tend to skin tears, and from this a follow-up audit undertaken. Baseline audit results were slightly varied, from good to low compliance. From this, the need for staff and client education was highlighted. There were many improvements in the audit criteria following client and

  3. Knowledge may not be the best target for strategies to influence evidence-based practice: using psychological models to understand RCT effects.

    Science.gov (United States)

    Bonetti, D; Johnston, M; Pitts, N B; Deery, C; Ricketts, I; Tilley, C; Clarkson, J E

    2009-01-01

    Interventions to enhance the implementation of evidence-based practice have a varied success rate. This may be due to a lack of understanding of the mechanism by which interventions achieve results. Use psychological models to further an understanding of trial effects by piggy-backing on a randomised controlled trial testing 2 interventions (Audit & Feedback and Computer-aided Learning) in relation to evidence-based third molar management. All participants of the parent trial (64 General Dental Practitioners across Scotland), regardless of intervention group, were invited to complete a questionnaire assessing knowledge and predictive measures from Theory of Planned Behaviour and Social Cognitive Theory. The main outcome was evidence-based extracting behaviour derived from patient records. Neither intervention significantly influenced behaviour in the parent trial. This study revealed that the interventions did enhance knowledge, but knowledge did not predict extraction behaviour. However, the interventions did not influence variables that did predict extraction behaviour (attitude, perceived behavioural control, self-efficacy). Results suggest both interventions failed because neither influenced possible mediating beliefs for the target behavior. Using psychology models elucidated intervention effects and allowed the identification of factors associated with evidence based practice, providing the basis for improving future intervention design.

  4. Parent Refusal of Topical Fluoride for Their Children: Clinical Strategies and Future Research Priorities to Improve Evidence-Based Pediatric Dental Practice.

    Science.gov (United States)

    Chi, Donald L

    2017-07-01

    A growing number of parents are refusing topical fluoride for their children during preventive dental and medical visits. This nascent clinical and public health problem warrants attention from dental professionals and the scientific community. Clinical and community-based strategies are available to improve fluoride-related communications with parents and the public. In terms of future research priorities, there is a need to develop screening tools to identify parents who are likely to refuse topical fluoride and diagnostic instruments to uncover the reasons for topical fluoride refusal. This knowledge will lead to evidence-based strategies that can be widely disseminated into clinical practice. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. Operator models for delivering municipal solid waste management services in developing countries. Part A: The evidence base.

    Science.gov (United States)

    Wilson, David C; Kanjogera, Jennifer Bangirana; Soós, Reka; Briciu, Cosmin; Smith, Stephen R; Whiteman, Andrew D; Spies, Sandra; Oelz, Barbara

    2017-08-01

    This article presents the evidence base for 'operator models' - that is, how to deliver a sustainable service through the interaction of the 'client', 'revenue collector' and 'operator' functions - for municipal solid waste management in emerging and developing countries. The companion article addresses a selection of locally appropriate operator models. The evidence shows that no 'standard' operator model is effective in all developing countries and circumstances. Each city uses a mix of different operator models; 134 cases showed on average 2.5 models per city, each applying to different elements of municipal solid waste management - that is, street sweeping, primary collection, secondary collection, transfer, recycling, resource recovery and disposal or a combination. Operator models were analysed in detail for 28 case studies; the article summarises evidence across all elements and in more detail for waste collection. Operators fall into three main groups: The public sector, formal private sector, and micro-service providers including micro-, community-based and informal enterprises. Micro-service providers emerge as a common group; they are effective in expanding primary collection service coverage into poor- or peri-urban neighbourhoods and in delivering recycling. Both public and private sector operators can deliver effective services in the appropriate situation; what matters more is a strong client organisation responsible for municipal solid waste management within the municipality, with stable political and financial backing and capacity to manage service delivery. Revenue collection is also integral to operator models: Generally the municipality pays the operator from direct charges and/or indirect taxes, rather than the operator collecting fees directly from the service user.

  6. Development of an Evidence-Based mHealth Weight Management Program Using a Formative Research Process.

    Science.gov (United States)

    Waterlander, Wilma; Whittaker, Robyn; McRobbie, Hayden; Dorey, Enid; Ball, Kylie; Maddison, Ralph; Myers Smith, Katie; Crawford, David; Jiang, Yannan; Gu, Yulong; Michie, Jo; Ni Mhurchu, Cliona

    2014-07-11

    There is a critical need for weight management programs that are effective, cost efficient, accessible, and acceptable to adults from diverse ethnic and socioeconomic backgrounds. mHealth (delivered via mobile phone and Internet) weight management programs have potential to address this need. To maximize the success and cost-effectiveness of such an mHealth approach it is vital to develop program content based on effective behavior change techniques, proven weight management programs, and closely aligned with participants' needs. This study aims to develop an evidence-based mHealth weight management program (Horizon) using formative research and a structured content development process. The Horizon mHealth weight management program involved the modification of the group-based UK Weight Action Program (WAP) for delivery via short message service (SMS) and the Internet. We used an iterative development process with mixed methods entailing two phases: (1) expert input on evidence of effective programs and behavior change theory; and (2) target population input via focus group (n=20 participants), one-on-one phone interviews (n=5), and a quantitative online survey (n=120). Expert review determined that core components of a successful program should include: (1) self-monitoring of behavior; (2) prompting intention formation; (3) promoting specific goal setting; (4) providing feedback on performance; and (5) promoting review of behavioral goals. Subsequent target group input confirmed that participants liked the concept of an mHealth weight management program and expressed preferences for the program to be personalized, with immediate (prompt) and informative text messages, practical and localized physical activity and dietary information, culturally appropriate language and messages, offer social support (group activities or blogs) and weight tracking functions. Most target users expressed a preference for at least one text message per day. We present the prototype m

  7. Teacher Progress Monitoring of Instructional and Behavioral Management Practices: An Evidence-Based Approach to Improving Classroom Practices

    Science.gov (United States)

    Reddy, Linda A.; Dudek, Christopher M.

    2014-01-01

    In the era of teacher evaluation and effectiveness, assessment tools that identify and monitor educators' instruction and behavioral management practices are in high demand. The Classroom Strategies Scale (CSS) Observer Form is a multidimensional teacher progress monitoring tool designed to assess teachers' usage of instructional and behavioral…

  8. School Psychology: A Public Health Framework: III. Managing Disruptive Behavior in Schools: The Value of a Public Health and Evidence-Based Perspective.

    Science.gov (United States)

    Hunter, Lisa

    2003-01-01

    This article emphasizes the value of an evidence-based and public health perspective in managing disruptive behavior. Information about comprehensive school-based programs and classroom management techniques for disruptive behavior disorders is presented and the important role school psychologists can play in implementing these programs discussed.…

  9. Human capital strategy: talent management.

    Science.gov (United States)

    Nagra, Michael

    2011-01-01

    Large organizations, including the US Army Medical Department and the Army Nurse Corps, are people-based organizations. Consequently, effective and efficient management of the human capital within these organizations is a strategic goal for the leadership. Over time, the Department of Defense has used many different systems and strategies to manage people throughout their service life-cycle. The current system in use is called Human Capital Management. In the near future, the Army's human capital will be managed based on skills, knowledge, and behaviors through various measurement tools. This article elaborates the human capital management strategy within the Army Nurse Corps, which identifies, develops, and implements key talent management strategies under the umbrella of the Corps' human capital goals. The talent management strategy solutions are aligned under the Nurse Corps business strategy captured by the 2008 Army Nurse Corps Campaign Plan, and are implemented within the context of the culture and core values of the organization.

  10. Do community pharmacists have the attitudes and knowledge to support evidence based self-management of low back pain?

    Directory of Open Access Journals (Sweden)

    Waddell Gordon

    2007-01-01

    Full Text Available Abstract Background In many countries, community pharmacists can be consulted without appointment in a large number of convenient locations. They are in an ideal position to give advice to patients at the onset of low back pain and also reinforce advice given by other healthcare professionals. There is little specific information about the quality of care provided in the pharmacy for people with back pain. The main objectives of this survey were to determine the attitudes, knowledge and reported practice of English pharmacists advising people who present with acute or chronic low back pain. Methods A questionnaire was designed for anonymous self-completion by pharmacists attending continuing education sessions. Demographic questions were designed to allow comparison with a national pharmacy workforce survey. Attitudes were measured with the Back Beliefs Questionnaire (BBQ and questions based on the Working Backs Scotland campaign. Questions about the treatment of back pain in the community pharmacy were written (or adapted to reflect and characterise the nature of practice. In response to two clinical vignettes, respondents were asked to select proposals that they would recommend in practice. Results 335 responses from community pharmacists were analysed. Middle aged pharmacists, women, pharmacy managers and locums were over-represented compared to registration and workforce data. The mean (SD BBQ score for the pharmacists was 31.37 (5.75, which was slightly more positive than in similar surveys of other groups. Those who had suffered from back pain seem to demonstrate more confidence (fewer negative feelings, more advice opportunities and better advice provision in their perception of advice given in the pharmacy. Awareness of written information that could help to support practice was low. Reponses to the clinical vignettes were generally in line with the evidence base. Pharmacists expressed some caution about recommending activity. Most

  11. Which is the best current guideline for the diagnosis and management of cystic pancreatic neoplasms? An appraisal using evidence-based practice methods.

    Science.gov (United States)

    Cahalane, Alexis M; Purcell, Y M; Lavelle, L P; McEvoy, S H; Ryan, E R; O'Toole, E; Malone, D E

    2016-09-01

    Cystic pancreatic neoplasms (CPNs) are an increasingly diagnosed entity. Their heterogeneity poses complex diagnostic and management challenges. Despite frequently encountering these entities, particularly in the context of the increased imaging of patients in modern medicine, doctors have to rely on incomplete and ambiguous published literature. The aim of this project was to review the guidelines relating to CPNs using evidence-based practice (EBP) methods. A search of both the primary and secondary literature was performed. Five sets of guidelines were identified which were then methodologically appraised by the AGREE II instrument, a validated and widely utilised tool for guideline development assessment. The 2014 'Italian consensus guidelines for the diagnostic work-up and follow-up of cystic pancreatic neoplasms' were found to be the most methodologically sound guidelines, on the basis of both the overall score and average weighted domain score. The current best guidelines were identified. The Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument can be used for retrospective review of published guidelines or as a roadmap for guideline-writing groups. All guidelines found were methodologically limited. Further longitudinal/prospective studies are required to improve the level of evidence. • Cystic pancreatic neoplasms (CPNs) are an increasingly encountered entity in modern medicine. • Clinical uncertainty remains with regard to optimal diagnostic and management strategies. • The Italian consensus guidelines for cystic pancreatic neoplasms are currently the best guidelines.

  12. [The journal club as a teaching strategy to develop evidence-based practice for undergraduate students in nursing].

    Science.gov (United States)

    Chouinard, Maud-christine; Lavoie, Mélissa; Poitras, Marie-éve; Sasseville, Maxime; De Jordy, Louise Catherine; Girard, Ariane

    2015-03-01

    Contemporary nursing practice requires constant updating of knowledge, especially in regards to research results found in academic or scientific papers. As part of the university curriculum in nursing, students must develop their skills in relation to the understanding and evaluation of research evidence. The objective of this study was to explore the appreciation and effects of a new teaching approach, the use of a journal club within a nursing research course, with undergraduate students in nursing sciences. As part of a qualitative exploratory descriptive design, a questionnaire with open-ended questions about their appreciation and perception of the effects of the journal club was administered to the participating students (n = 41) at the end of the course. Participation in the journal club appears to have provided an introduction to the scientific area of nursing, to have improved several skills related to the evaluation of scientific articles and has increased motivation to adopt evidence-based practice. The use of a journal club within an undergraduate research course in nursing was a relevant teaching method that aroused great interest in the undergraduate students in nursing.

  13. Therapist Perspectives on Training in a Package of Evidence-Based Practice Strategies for Children with Autism Spectrum Disorders Served in Community Mental Health Clinics

    Science.gov (United States)

    Drahota, Amy; Stadnick, Nicole; Brookman-Frazee, Lauren

    2012-01-01

    Therapist perspectives regarding delivery of evidence-based practice (EBP) strategies are needed to understand the feasibility of implementation in routine service settings. This qualitative study examined the perspectives of 13 therapists receiving training and delivering a package of EBPs to children with autism spectrum disorders (ASD) in community mental health clinics. Therapists perceived the training and intervention delivery as effective at improving their clinical skills, the psychotherapy process, and child and family outcomes. Results expand parent pilot study findings, and add to the literature on training community providers and limited research on training providers to deliver EBPs to children with ASD. PMID:23086499

  14. What can management theories offer evidence-based practice? A comparative analysis of measurement tools for organisational context

    Directory of Open Access Journals (Sweden)

    Pennington Lindsay

    2009-05-01

    Full Text Available Abstract Background Given the current emphasis on networks as vehicles for innovation and change in health service delivery, the ability to conceptualise and measure organisational enablers for the social construction of knowledge merits attention. This study aimed to develop a composite tool to measure the organisational context for evidence-based practice (EBP in healthcare. Methods A structured search of the major healthcare and management databases for measurement tools from four domains: research utilisation (RU, research activity (RA, knowledge management (KM, and organisational learning (OL. Included studies were reports of the development or use of measurement tools that included organisational factors. Tools were appraised for face and content validity, plus development and testing methods. Measurement tool items were extracted, merged across the four domains, and categorised within a constructed framework describing the absorptive and receptive capacities of organisations. Results Thirty measurement tools were identified and appraised. Eighteen tools from the four domains were selected for item extraction and analysis. The constructed framework consists of seven categories relating to three core organisational attributes of vision, leadership, and a learning culture, and four stages of knowledge need, acquisition of new knowledge, knowledge sharing, and knowledge use. Measurement tools from RA or RU domains had more items relating to the categories of leadership, and acquisition of new knowledge; while tools from KM or learning organisation domains had more items relating to vision, learning culture, knowledge need, and knowledge sharing. There was equal emphasis on knowledge use in the different domains. Conclusion If the translation of evidence into knowledge is viewed as socially mediated, tools to measure the organisational context of EBP in healthcare could be enhanced by consideration of related concepts from the organisational

  15. What can management theories offer evidence-based practice? A comparative analysis of measurement tools for organisational context.

    Science.gov (United States)

    French, Beverley; Thomas, Lois H; Baker, Paula; Burton, Christopher R; Pennington, Lindsay; Roddam, Hazel

    2009-05-19

    Given the current emphasis on networks as vehicles for innovation and change in health service delivery, the ability to conceptualize and measure organisational enablers for the social construction of knowledge merits attention. This study aimed to develop a composite tool to measure the organisational context for evidence-based practice (EBP) in healthcare. A structured search of the major healthcare and management databases for measurement tools from four domains: research utilisation (RU), research activity (RA), knowledge management (KM), and organisational learning (OL). Included studies were reports of the development or use of measurement tools that included organisational factors. Tools were appraised for face and content validity, plus development and testing methods. Measurement tool items were extracted, merged across the four domains, and categorised within a constructed framework describing the absorptive and receptive capacities of organisations. Thirty measurement tools were identified and appraised. Eighteen tools from the four domains were selected for item extraction and analysis. The constructed framework consists of seven categories relating to three core organisational attributes of vision, leadership, and a learning culture, and four stages of knowledge need, acquisition of new knowledge, knowledge sharing, and knowledge use. Measurement tools from RA or RU domains had more items relating to the categories of leadership, and acquisition of new knowledge; while tools from KM or learning organisation domains had more items relating to vision, learning culture, knowledge need, and knowledge sharing. There was equal emphasis on knowledge use in the different domains. If the translation of evidence into knowledge is viewed as socially mediated, tools to measure the organisational context of EBP in healthcare could be enhanced by consideration of related concepts from the organisational and management sciences. Comparison of measurement tools across

  16. An international survey on persistent pulmonary hypertension of the newborn: A need for an evidence-based management.

    Science.gov (United States)

    Nakwan, N; Chaiwiriyawong, P

    2016-09-16

    To assess the current practice preferences in diagnosis and management of persistent hypertension of the newborn (PPHN) of neonatologists or pediatricians with expertise in neonatal care. Investigators identified potential participants worldwide through a literature search. They were emailed the URL of an online 25-item questionnaire through the web survey site SurveyMonkey®. Additional respondents were also acquired through a professional online discussion group. The survey was conducted during July - September 2015. Overall, there were 200 respondents from 51 different countries. Of these, the average 2014 mortality rate of the 90 respondents who completed this section of the questionnaire was 8.3% (interquartile range (IQR): 0-20.3). Echocardiography together with pre-to-post ductal oxygen pulse oximetry (SpO2) gradient was the most common PPHN diagnostic method. The most frequent first-line pulmonary vasodilator was inhaled nitric oxide (155/199, 77.9%). Oral sildenafil was most commonly used as second-line adjunctive therapy by 46.3% (81/175). Dopamine (139/198, 70.2%) was chosen to be the initial inotropic agent and normal saline (191/199, 96.0%) was the preferred initial fluid resuscitation for hypotension. Sedation and analgesia were routinely used for PPHN treatment. Twenty-one percent (42/199) of respondents also used muscle relaxants to control respiratory distress. The most commonly used targets for partial pressure of oxygen, partial pressure of carbon dioxide, SpO2 and hemoglobin were 71-80 mmHg (60/197, 30.4%), 36-45 mmHg (100/199, 50.2%), 91-95% (111/199, 55.8%), and 13-15 gm/dL (156/196, 79.6%), respectively. This survey shows that the management of PPHN varies widely around the world. The major PPHN diagnostic method is echocardiography together with bedside SpO2 monitoring. The study numbers show the main differences are between developed and developing countries. Further studies exploring evidence-based principles of diagnosis and

  17. Impact of an evidence-based guideline on the management of community-acquired bacterial meningitis: a prospective cohort study.

    Science.gov (United States)

    Costerus, J M; Brouwer, M C; Bijlsma, M W; Tanck, M W; van der Ende, A; van de Beek, D

    2016-11-01

    To study the impact of an evidence-based guideline on the management of community-acquired bacterial meningitis. We performed an interrupted time series analysis in a prospective nationwide cohort study from 2006 to 2015. The guideline stresses the importance of cranial imaging before lumbar puncture (LP) in selected patients based on clinical criteria, and early treatment with amoxicillin and a third-generation cephalosporin for adults with suspected community-acquired bacterial meningitis. The guideline was published in April 2013. We included 1326 episodes before and 210 episodes after guideline introduction. Cranial imaging was performed before LP in 497 (84%) of 591 episodes with clinical criteria warranting computed tomography (CT). The guideline did not improve this (increase of 2%; 95% confidence interval (CI), -15 to 19). Without these criteria, imaging before LP occurred in 606 (67%) of 900 episodes, also without effect of the guideline (increase of 1%; 95% CI, -25 to 28). The estimate of effect of the guideline for treatment with the recommended antibiotic regimen was an increase of 19.5% (95% CI, 13.5 to 25.5), and there was a trend towards more frequent initiation of treatment before CT. There was no association between delay in antibiotic treatment due to imaging before LP and unfavourable outcome (odds ratio, 1.14; 95% CI 0.86 to 1.52). Cranial imaging is performed before LP in the majority of patients with bacterial meningitis, irrespective of guideline indications. The guideline introduction was associated with a trend towards early initiation of treatment before imaging and with increased adherence to antibiotic policy. Copyright © 2016 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

  18. Challenges of improving the evidence base in smaller surgical specialties, as highlighted by a systematic review of gastroschisis management.

    Directory of Open Access Journals (Sweden)

    Benjamin S R Allin

    Full Text Available To identify methods of improving the evidence base in smaller surgical specialties, using a systematic review of gastroschisis management as an example.Operative primary fascial closure (OPFC, and silo placement with staged reduction and delayed closure (SR are the most commonly used methods of gastroschisis closure. Relative merits of each are unclear.A systematic review and meta-analysis was performed comparing outcomes following OPFC and SR in infants with simple gastroschisis. Primary outcomes of interest were mortality, length of hospitalization and time to full enteral feeding.751 unique articles were identified. Eight met the inclusion criteria. None were randomized controlled trials. 488 infants underwent OPFC and 316 underwent SR. Multiple studies were excluded because they included heterogeneous populations and mixed intervention groups. Length of stay was significantly longer in the SR group (mean difference 8.97 days, 95% CI 2.14-15.80 days, as was number of post-operative days to complete enteral feeding (mean difference 7.19 days, 95%CI 2.01-12.36 days. Mortality was not statistically significantly different, although the odds of death were raised in the SR group (OR 1.96, 95%CI 0.71-5.35.Despite showing some benefit of OPFC over SR, our results are tempered by the low quality of the available studies, which were small and variably reported. Coordinating research through a National Paediatric Surgical Trials Unit could alleviate many of these problems. A similar national approach could be used in other smaller surgical specialties.

  19. Students Improve in Reading Comprehension by Learning How to Teach Reading Strategies. An Evidence-Based Approach for Teacher Education

    Science.gov (United States)

    Koch, Helvi; Spörer, Nadine

    2017-01-01

    In this intervention study, we investigated how we could teach university students who were majoring in education to teach reading strategies. The goal of the study was to analyze whether and to what extent students would benefit from the intervention with respect to their own learning. Did their own reading skills improve after they attended the…

  20. Strategies to reduce long-term postchemoradiation dysphagia in patients with head and neck cancer: an evidence-based review.

    NARCIS (Netherlands)

    Paleri, V.; Roe, J.W.; Strojan, P.; Corry, J.; Gregoire, V.; Hamoir, M.; Eisbruch, A.; Mendenhall, W.M.; Silver, C.E.; Rinaldo, A.; Takes, R.P.; Ferlito, A.

    2014-01-01

    BACKGROUND: Swallowing dysfunction following chemoradiation for head and neck cancer is a major cause of morbidity and reduced quality of life. This review discusses 3 strategies that may improve posttreatment swallowing function. METHODS: The literature was assessed by a multiauthor team that

  1. Evidence-based cancer imaging

    Energy Technology Data Exchange (ETDEWEB)

    Shinagare, Atul B.; Khorasani, Ramin [Dept. of Radiology, Brigham and Women' s Hospital, Boston (Korea, Republic of)

    2017-01-15

    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.

  2. Examining the effectiveness of psychological strategies on physiologic markers: evidence-based suggestions for holistic care of the athlete.

    Science.gov (United States)

    Dawson, Michelle A; Hamson-Utley, Jennifer Jordan; Hansen, Rodney; Olpin, Michael

    2014-01-01

    Current holistic rehabilitation blends both physical and psychological techniques. However, validation of the usefulness of psychological strategies is limited in the literature. To quantify the effects of psychological strategies on both physiologic (salivary cortisol) and subjective assessments of stress. Randomized controlled clinical trial. Laboratory. A total of 97 college-aged students (age = 20.65 ± 4.38 years), most with little to no experience with psychological strategies. A 15-minute script via an iPod led the participant through visual imagery (cognitive relaxation) or deep breathing exercises (somatic relaxation) cues. The control group listened to 15 minutes of ambient nature sounds. Two samples (pretest, posttest) of salivary cortisol were analyzed using an enzyme immunoassay kit; the average was used for statistical analysis. Descriptive statistics and correlations were conducted to examine group differences in time of day, salivary cortisol, sex, Stress-O-Meter values, and Perceived Stress Scale scores. Salivary cortisol levels were lower in the treatment group than the control group (F2,97 = 15.62, P Stress-O-Meter (5.15 ± 1.796) and the Perceived Stress Scale (18.31 ± 5.833) than males (4.25 ± 1.741 and 15.272 ± 5.390, respectively). Both cognitive and somatic relaxation strategies reduced cortisol levels. Participants who received verbal guidance achieved a larger cortisol reduction. However, the change in cortisol level was uncorrelated with the change in report of acute stress; females reported higher levels of stress. Clinical implications include attention to sex when assessing stress and providing coping skills during the rehabilitation process.

  3. AN EVIDENCE-BASED ANALYSIS OF SELF-REGULATED STRATEGY DEVELOPMENT WRITING INTERVENTIONS FOR STUDENTS WITH SPECIFIC LEARNING DISABILITIES

    Directory of Open Access Journals (Sweden)

    Areej ALHARBI

    2015-11-01

    Full Text Available Background: Approximately 5% of school-aged children in the United States receive special education services under the specific learning disabilities category. Additionally, 20% of all students experience difficulty with writing, spelling, and handwriting. Goal: This literature review provides a synthesis of single case studies evaluating the use of self-regulated strategy development (SRSD for students with specific learning disabilities. Methods: Percentage of non-overlapping data (PND and Percentage of Data Exceeding the Median (PEM were used as a common metric to evaluate studies meeting inclusion criteria. Results: Fifteen articles evaluating seven SRSD writing intervention strategies met study inclusion criteria. Both mean PND (89.69%, Range = 38% – 100% and mean PEM (0.98, Range = 0.91 – 1.00 suggest that SRSD writing interventions are effective to highly effective. Conclusion: Althoudh additional research is needed, the results suggest that self-regulated writing strategies are an effective intervention to support students with specific learning disabilities experiencing difficulty with writing.

  4. The role of state mental health authorities in managing change for the implementation of evidence-based practices.

    Science.gov (United States)

    Isett, Kimberley Roussin; Burnam, M Audrey; Coleman-Beattie, Brenda; Hyde, Pamela S; Morrissey, Joseph P; Magnabosco, Jennifer L; Rapp, Charles; Ganju, Vijay; Goldman, Howard H

    2008-06-01

    The evidence-based practice demonstration for services to adults with serious mental illness has ended its pilot stage. This paper presents the approaches states employed to combine traditional policy levers with more strategic/institutional efforts (e.g., leadership) to facilitate implementation of these practices. Two rounds of site visits were completed and extensive interview data collected. The data were analyzed to find trends that were consistent across states and across practices. Two themes emerged for understanding implementation of evidence-based practices: the support and influence of the state mental health authority matters and so does the structure of the mental health systems.

  5. Assisting undergraduate nursing students to learn evidence-based practice through self-directed learning and workshop strategies during clinical practicum.

    Science.gov (United States)

    Zhang, Qi; Zeng, Tieying; Chen, Ying; Li, Xiaopan

    2012-07-01

    To equip undergraduate nursing students with basic knowledge and skills and foster positive attitudes toward evidence-based practice (EBP), a pilot learning program during their clinical practicum was developed in a teaching hospital in China. This article describes the specific learning process through which self-directed learning and workshop strategies were used, and a pre- and post-intervention survey were conducted to evaluate the effectiveness of the learning strategies. The findings show a significant improvement in their perceptions of EBP knowledge, attitudes and beliefs, and behavior levels. Beginning competencies in EBP were achieved. Participants reported great satisfaction and have found this program helpful in promoting their analytical and problem-solving abilities, independent learning ability, and cooperative and communication abilities as well. Copyright © 2011 Elsevier Ltd. All rights reserved.

  6. Applying theories to better understand socio-political challenges in implementing evidence-based work disability prevention strategies.

    Science.gov (United States)

    Ståhl, Christian; Costa-Black, Katia; Loisel, Patrick

    2017-01-17

    This article explores and applies theories for analyzing socio-political aspects of implementation of work disability prevention (WDP) strategies. For the analysis, theories from political science are explained and discussed in relation to case examples from three jurisdictions (Sweden, Brazil and Québec). Implementation of WDP strategies may be studied through a conceptual framework that targets: (1) the institutional system in which policy-makers and other stakeholders reside; (2) the ambiguity and conflicts regarding what to do and how to do it; (3) the bounded rationality, path dependency and social systems of different stakeholders; and (4) coalitions formed by different stakeholders and power relations between them. In the case examples, the design of social insurance systems, the access to and infrastructure of healthcare systems, labor market policies, employers' level of responsibility, the regulatory environment, and the general knowledge of WDP issues among stakeholders played different roles in the implementation of policies based on scientific evidence. Future research may involve participatory approaches focusing on building coalitions and communities of practice with policy-makers and stakeholders, in order to build trust, facilitate cooperation, and to better promote evidence utilization. Implications for Rehabilitation Implementation of work disability prevention policies are subject to contextual influences from the socio-political setting and from relationships between stakeholders Stakeholders involved in implementing strategies are bound to act based on their interests and previous courses of action To promote research uptake on the policy level, stakeholders and researchers need to engage in collaboration and translational activities Political stakeholders at the government and community levels need to be more directly involved as partners in the production and utilization of evidence.

  7. The management of acute diarrhea in children in developed and developing areas: from evidence base to clinical practice.

    Science.gov (United States)

    Guarino, Alfredo; Dupont, Christophe; Gorelov, Alexander V; Gottrand, Frederic; Lee, Jimmy K F; Lin, Zhihong; Lo Vecchio, Andrea; Nguyen, Thien D; Salazar-Lindo, Eduardo

    2012-01-01

    Acute diarrhea remains a major problem in children and is associated with substantial morbidity, mortality and costs. While vaccination against rotavirus could reduce the burden of the disease, the persistent impact of intestinal infections requires effective treatment in adjunct to oral rehydration solutions, to reduce the severity and duration of diarrhea. Several therapeutic options have been proposed for acute diarrhea, but proof of efficacy is available for few of them, including zinc, diosmectite, selected probiotics and racecadotril. However, at present there is no universal drug, and therapeutic efficacy has only been shown for selected drugs in selected settings, such as: outpatients/inpatients, developed/developing countries and viral/bacterial etiology. This narrative review reports the opinions of experts from different countries of the world who have discussed strategies to improve the management of diarrhea. More data are needed to optimize the management of diarrhea and highlight the research priorities at a global level; such priorities include improved recommendations on oral rehydration solution composition, and the reevaluation of therapeutic options in the light of new trials. Therapeutic strategies need to be assessed in different settings, and pharmacoeconomic analyses based on country-specific data are needed. Transfer to clinical practice should result from the implementation of guidelines tailored at a local level, with an eye on costs.

  8. Stalking management strategies: implementation and efficacy

    OpenAIRE

    Storey, Jennifer Elizabeth

    2009-01-01

    The stalking literature lacks research regarding how stalking cases are resolved and which management strategies precipitate resolution. The present study focused on three aspects of case management; i) the management strategies employed, ii) the process by which police utilize management strategies, and iii) the efficacy of management strategies at promoting desistance. On average 19 management strategies were employed per case. Certain strategies (e.g. legal strategies), were more commonly ...

  9. An introduction to an evidence-based approach to interventional techniques in the management of chronic spinal pain.

    Science.gov (United States)

    Manchikanti, Laxmaiah; Singh, Vijay; Helm, Standiford; Schultz, David M; Datta, Sukdeb; Hirsch, Joshua A

    2009-01-01

    patient expectations reasonably, and form the basis of a therapeutic partnership between the patient, the provider, and payors. The ASIPP guidelines are based on evidence-based medicine (EBM). EBM is in turn based on 4 basic contingencies: the recognition of the patient's problem and the construction of a structured clinical question; the ability to efficiently and effectively search the medical literature to retrieve the best available evidence to answer the clinical question; clinical appraisal of the evidence; and integration of the evidence with all aspects of the individual patient's decision-making to determine the best clinical care of the patient. Evidence synthesis for guidelines includes the review of all relevant systematic reviews and individual articles, grading them for relevance, methodologic quality, consistency, and recommendations.

  10. Dietary strategies to optimize wound healing after periodontal and dental implant surgery: an evidence-based review.

    Science.gov (United States)

    Lau, Beatrice Y; Johnston, Bryan D; Fritz, Peter C; Ward, Wendy E

    2013-01-01

    Methods to optimize healing through dietary strategies present an attractive option for patients, such that healing from delicate oral surgeries occurs as optimally as possible with minimal patient-meditated complications through improper food choices. This review discusses findings from studies that have investigated the role of diet, either whole foods or individual dietary components, on periodontal health and their potential role in wound healing after periodontal surgery. To date, research in this area has largely focused on foods or individual dietary components that may attenuate inflammation or oxidant stress, or foster de novo bone formation. These studies suggest that a wide variety of dietary components, including macronutrients and micronutrients, are integral for optimal periodontal health and have the potential to accelerate oral wound healing after periodontal procedures. Moreover, this review provides guidance regarding dietary considerations that may help a patient achieve the best possible outcome after a periodontal procedure.

  11. Evidence-based decision-making within the context of globalization: A “Why–What–How” for leaders and managers of health care organizations

    Directory of Open Access Journals (Sweden)

    Véronique Lapaige

    2009-03-01

    Full Text Available Véronique LapaigeCanadian Health Services Research Foundation Fellow; PRO-ACTIVE Research Program (Participatory and Evaluative Research Program to Optimize Workplace Management: Application of Knowledge, Transfer of Expertise, Innovative Interventions, Training Transformational Leaders Pavillon Ferdinand-Vandry, CIFSS (Centre intégré de formation en sciences de la santé, Laval University, Quebec City, Quebec Canada Abstract: In the globalized knowledge economy, the challenge of translating knowledge into policy and practice is universal. At the dawn of the 21st century, the clinicians, leaders, and managers of health care organizations are increasingly required to bridge the research-practice gap. A shift from moving evidence to solving problems is due. However, despite a vast literature on the burgeoning field of knowledge translation research, the “evidence-based” issue remains for many health care professionals a day-to-day debate leading to unresolved questions. On one hand, many clinicians still resist to the implementation of evidence-based clinical practice, asking themselves why their current practice should be changed or expanded. On the other hand, many leaders and managers of health care organizations are searching how to keep pace with the demand of actionable knowledge. For example, they are wondering: (a if managerial and policy innovations are subjected to the same evidentiary standards as clinical innovations, and (b how they can adapt the scope of evidence-based medicine to the culture, context, and content of health policy and management. This paper focuses on evidence-based health care management within the context of contemporary globalization. In this paper, our heuristic hypothesis is that decision-making process related changes within clinical/managerial/policy environments must be given a socio-historical backdrop. We argue that the relationship between research on the transfer of knowledge and its uptake by

  12. Knowledge management: an innovative risk management strategy.

    Science.gov (United States)

    Zipperer, Lorri; Amori, Geri

    2011-01-01

    Knowledge management effectively lends itself to the enterprise risk process. The authors introduce the concept of knowledge management as a strategy to drive innovation and support risk management. They align this work with organizational efforts to improve patient safety and quality through the effective sharing of experience and lessons learned. The article closes with suggestions on how to develop a knowledge management initiative at an organization, who should be on the team, and how to sustain this effort and build the culture it requires to drive success. © 2011 American Society for Healthcare Risk Management of the American Hospital Association.

  13. Initial emergency nursing management of patients with severe traumatic brain injury: development of an evidence-based care bundle for the Thai emergency department context.

    Science.gov (United States)

    Damkliang, Jintana; Considine, Julie; Kent, Bridie; Street, Maryann

    2014-11-01

    Thai emergency nurses play a vital role in caring for patients with severe TBI, and are an important part of the healthcare team throughout the resuscitation phase. They are also responsible for continuous physiological monitoring, and detecting deterioration associated with increased intracranial pressure and preventing secondary brain injury. However, there is known variation in Thai nurses' knowledge and care practices for patients with severe TBI. In addition, there are no specific evidence-based practice guidelines available for emergency nursing management of patients with severe TBI. The aim of this paper is to describe the development of an evidence-based care bundle for initial emergency nursing management of patients with severe TBI for use in a Thai ED context. An evidence-based care bundle focused on seven major elements: (1) establish a secure airway along with c-spine protection, (2) maintain adequacy of oxygenation and ventilation, (3) maintain circulation and fluid balance, (4) assessment of GCS, and pupil size and reactivity, (5) maintain cerebral venous outflow, (6) management of pain, agitation, and irritability, and (7) administer for urgent CT scan. A care bundle is one method of promoting consistent, evidence-based emergency nursing care of patients with severe TBI, decreasing unnecessary variations in nursing care and reducing the risk of secondary brain injury from suboptimal care. Implementation of this evidence-based care bundle developed specifically for the Thai emergency nursing context has the potential to improve the care of the patients with severe TBI. Copyright © 2014 College of Emergency Nursing Australasia Ltd. Published by Elsevier Ltd. All rights reserved.

  14. Pharmaceutical pictograms for low-literate patients: Understanding, risk of false confidence, and evidence-based design strategies.

    Science.gov (United States)

    van Beusekom, Mara M; Land-Zandstra, Anne M; Bos, Mark J W; van den Broek, Jos M; Guchelaar, Henk-Jan

    2017-05-01

    This study aims to (1) evaluate ten pharmaceutical pictograms for low-literate patients on understandability, (2) assess the risk of false confidence in understanding, and (3) identify how the design can be improved to increase understandability. Interviews were conducted with n=197 pharmacy visitors in the Netherlands. Additional qualitative discussions were held with n=30 adequately and n=25 low-literate participants (assessed with REALM-D). Qualitative data were analysed using the Thematic Framework approach. Half of the pictograms reached 67% understanding (31.0%-98.5%); two did in the low-literate group. Three pictograms showed a risk for false confidence. Pictograms appeared to be most effective when people were familiar with their visual elements and messages. Low-literate people have more difficulty understanding pictograms than people with adequate literacy. While the risk of false confidence is low, for critical safety information, 67% understanding might not be sufficient. Design strategies for pharmaceutical pictograms should focus on familiarity, simplicity, and showing the intake and effect of medicine. Health professionals should go over the meaning of pictograms when providing drug information to patients to increase patients' familiarity with the message and to ensure that all pictograms are sufficiently understood. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  15. Effective and evidence-based management strategies for rosacea: summary of a Cochrane systematic review.

    Science.gov (United States)

    van Zuuren, E J; Kramer, S F; Carter, B R; Graber, M A; Fedorowicz, Z

    2011-10-01

    Rosacea is a common chronic skin disease affecting the face. There are numerous treatment options, but it is unclear which are the most effective. The aim of this review was to assess the evidence for the efficacy and safety of treatments for rosacea. Searches included the Cochrane Skin Group Specialised Register, the Cochrane Central Register of Controlled Trials in The Cochrane Library, MEDLINE, EMBASE, Science Citation Index, and Ongoing Trials Registers (updated February 2011). Randomized controlled trials in people with moderate to severe rosacea were included. Fifty-eight trials, including 27 from the original review, comprising 6633 participants were included in this updated review. Interventions included topical metronidazole, oral antibiotics, topical azelaic cream or gel, topical benzoyl peroxide and/or combined with topical antibiotics, sulphacetamide/sulphur, and others. There was some evidence that topical metronidazole and azelaic acid were more effective than placebo. Two trials indicated that doxycycline 40mg was more effective than placebo. There was no statistically significant difference in effectiveness between doxycycline 40mg and 100mg but there were fewer adverse effects. One study reported that ciclosporin ophthalmic emulsion was significantly more effective than artificial tears for treating ocular rosacea. Although the majority of included studies were assessed as being at high or unclear risk of bias, there was some evidence to support the effectiveness of topical metronidazole, azelaic acid and doxycycline (40mg) in the treatment of moderate to severe rosacea, and ciclosporin 0·05% ophthalmic emulsion for ocular rosacea. Further well-designed, adequately powered randomized controlled trials are required. © 2011 The Authors. BJD © 2011 British Association of Dermatologists 2011.

  16. The office of strategy management.

    Science.gov (United States)

    Kaplan, Robert S; Norton, David P

    2005-10-01

    There is a disconnect in most companies between strategy formulation and strategy execution. On average, 95% of a company's employees are unaware of, or do not understand, its strategy. If employees are unaware of the strategy, they surely cannot help the organization implement it effectively. It doesn't have to be like this. For the past 15 years, the authors have studied companies that achieved performance breakthroughs by adopting the Balanced Scorecard and its associated tools to help them better communicate strategy to their employees and to guide and monitor the execution of that strategy. Some companies, of course, have achieved better, longer-lasting improvements than others. The organizations that have managed to sustain their strategic focus have typically established a new corporate-level unit to oversee all activities related to strategy: an office of strategy management (OS M). The OSM, in effect, acts as the CEO's chief of staff. It coordinates an array of tasks: communicating corporate strategy; ensuring that enterprise-level plans are translated into the plans of the various units and departments; executing strategic initiatives to deliver on the grand design; aligning employees' plans for competency development with strategic objectives; and testing and adapting the strategy to stay abreast of the competition. The OSM does not do all the work, but it facilitates the processes so that strategy is executed in an integrated fashion across the enterprise. Although the companies that Kaplan and Norton studied use the Balanced Scorecard as the framework for their strategy management systems, the authors say the lessons of the OSM are applicable even to companies that do not use it.

  17. Selective serotonin reuptake inhibitor poisoning: An evidence-based consensus guideline for out-of-hospital management.

    Science.gov (United States)

    Nelson, Lewis S; Erdman, Andrew R; Booze, Lisa L; Cobaugh, Daniel J; Chyka, Peter A; Woolf, Alan D; Scharman, Elizabeth J; Wax, Paul M; Manoguerra, Anthony S; Christianson, Gwenn; Caravati, E Martin; Troutman, William G

    2007-05-01

    A review of US poison center data for 2004 showed over 48,000 exposures to selective serotonin reuptake inhibitors (SSRIs). A guideline that determines the conditions for emergency department referral and prehospital care could potentially optimize patient outcome, avoid unnecessary emergency department visits, reduce health care costs, and reduce life disruption for patients and caregivers. An evidence-based expert consensus process was used to create the guideline. Relevant articles were abstracted by a trained physician researcher. The first draft of the guideline was created by the lead author. The entire panel discussed and refined the guideline before distribution to secondary reviewers for comment. The panel then made changes based on the secondary review comments. The objective of this guideline is to assist poison center personnel in the appropriate out-of-hospital triage and initial management of patients with a suspected ingestion of an SSRI by 1) describing the process by which an ingestion of an SSRI might be managed, 2) identifying the key decision elements in managing cases of SSRI ingestion, 3) providing clear and practical recommendations that reflect the current state of knowledge, and 4) identifying needs for research. This guideline applies to ingestion of immediate-release forms of SSRIs alone. Co-ingestion of additional substances might require different referral and management recommendations depending on their combined toxicities. This guideline is based on an assessment of current scientific and clinical information. The expert consensus panel recognizes that specific patient care decisions may be at variance with this guideline and are the prerogative of the patient and the health professionals providing care, considering all of the circumstances involved. This guideline does not substitute for clinical judgment. Recommendations are in chronological order of likely clinical use. The grade of recommendation is in parentheses. 1) All

  18. Evidence-based decision-making within the context of globalization: A ?Why?What?How? for leaders and managers of health care organizations

    OpenAIRE

    Lapaige, V?ronique

    2009-01-01

    In the globalized knowledge economy, the challenge of translating knowledge into policy and practice is universal. At the dawn of the 21st century, the clinicians, leaders, and managers of health care organizations are increasingly required to bridge the research-practice gap. A shift from moving evidence to solving problems is due. However, despite a vast literature on the burgeoning field of knowledge translation research, the ?evidence-based? issue remains for many health care professional...

  19. Developing an evidence-based clinical pathway for the assessment, diagnosis and management of acute Charcot Neuro-Arthropathy: a systematic review

    Science.gov (United States)

    2013-01-01

    Background Charcot Neuro-Arthropathy (CN) is one of the more devastating complications of diabetes. To the best of the authors’ knowledge, it appears that no clinical tools based on a systematic review of existing literature have been developed to manage acute CN. Thus, the aim of this paper was to systematically review existing literature and develop an evidence-based clinical pathway for the assessment, diagnosis and management of acute CN in patients with diabetes. Methods Electronic databases (Medline, PubMed, CINAHL, Embase and Cochrane Library), reference lists, and relevant key websites were systematically searched for literature discussing the assessment, diagnosis and/or management of acute CN published between 2002-2012. At least two independent investigators then quality rated and graded the evidence of each included paper. Consistent recommendations emanating from the included papers were then fashioned in a clinical pathway. Results The systematic search identified 267 manuscripts, of which 117 (44%) met the inclusion criteria for this study. Most manuscripts discussing the assessment, diagnosis and/or management of acute CN constituted level IV (case series) or EO (expert opinion) evidence. The included literature was used to develop an evidence-based clinical pathway for the assessment, investigations, diagnosis and management of acute CN. Conclusions This research has assisted in developing a comprehensive, evidence-based clinical pathway to promote consistent and optimal practice in the assessment, diagnosis and management of acute CN. The pathway aims to support health professionals in making early diagnosis and providing appropriate immediate management of acute CN, ultimately reducing its associated complications such as amputations and hospitalisations. PMID:23898912

  20. A Policy-into-Practice Intervention to Increase the Uptake of Evidence-Based Management of Low Back Pain in Primary Care: A Prospective Cohort Study

    Science.gov (United States)

    Slater, Helen; Davies, Stephanie Joy; Parsons, Richard; Quintner, John Louis; Schug, Stephan Alexander

    2012-01-01

    Background Persistent non-specific low back pain (nsLBP) is poorly understood by the general community, by educators, researchers and health professionals, making effective care problematic. This study evaluated the effectiveness of a policy-into-practice intervention developed for primary care physicians (PCPs). Methods To encourage PCPs to adopt practical evidence-based approaches and facilitate time-efficient, integrated management of patients with nsLBP, we developed an interdisciplinary evidence-based, practical pain education program (gPEP) based on a contemporary biopsychosocial framework. One hundred and twenty six PCPs from primary care settings in Western Australia were recruited. PCPs participated in a 6.5-hour gPEP. Self-report measures recorded at baseline and at 2 months post-intervention included PCPs' attitudes, beliefs (modified Health Care Providers Pain and Impairment Relationship Scale (HC-PAIRS), evidence-based clinical practices (knowledge and skills regarding nsLBP management: 5-point Likert scale with 1 =  nil and 5 =  excellent) and practice behaviours (recommendations based on a patient vignette; 5-point Likert scale). Results Ninety one PCPs participated (attendance rate of 72%; post-intervention response rate 88%). PCP-responders adopted more positive, guideline-consistent beliefs, evidenced by clinically significant HC-PAIRS score differences (mean change  = −5.6±8.2, ppain education program set within a framework that aligns health policy and practice, encourages PCPs to adopt more self-reported evidence-based attitudes, beliefs and clinical behaviours in their management of patients with nsLBP. However, further research is required to determine cost effectiveness of this approach when compared with other modes of educational delivery and to examine PCP behaviours in actual clinical practice. PMID:22662264

  1. Optimizing diabetes management: managed care strategies.

    Science.gov (United States)

    Tzeel, E Albert

    2013-06-01

    Both the prevalence of type 2 diabetes mellitus (DM) and its associated costs have been rising over time and are projected to continue to escalate. Therefore, type 2 DM (T2DM) management costs represent a potentially untenable strain on the healthcare system unless substantial, systemic changes are made. Managed care organizations (MCOs) are uniquely positioned to attempt to make the changes necessary to reduce the burdens associated with T2DM by developing policies that align with evidence-based DM management guidelines and other resources. For example, MCOs can encourage members to implement healthy lifestyle choices, which have been shown to reduce DM-associated mortality and delay comorbidities. In addition, MCOs are exploring the strengths and weaknesses of several different benefit plan designs. Value-based insurance designs, sometimes referred to as value-based benefit designs, use both direct and indirect data to invest in incentives that change behaviors through health information technologies, communications, and services to improve health, productivity, quality, and financial trends. Provider incentive programs, sometimes referred to as "pay for performance," represent a payment/delivery paradigm that places emphasis on rewarding value instead of volume to align financial incentives and quality of care. Accountable care organizations emphasize an alignment between reimbursement and implementation of best practices through the use of disease management and/ or clinical pathways and health information technologies. Consumer-directed health plans, or high-deductible health plans, combine lower premiums with high annual deductibles to encourage members to seek better value for health expenditures. Studies conducted to date on these different designs have produced mixed results.

  2. Evidence-based decision-making within the context of globalization: A "Why-What-How" for leaders and managers of health care organizations.

    Science.gov (United States)

    Lapaige, Véronique

    2009-01-01

    In the globalized knowledge economy, the challenge of translating knowledge into policy and practice is universal. At the dawn of the 21st century, the clinicians, leaders, and managers of health care organizations are increasingly required to bridge the research-practice gap. A shift from moving evidence to solving problems is due. However, despite a vast literature on the burgeoning field of knowledge translation research, the "evidence-based" issue remains for many health care professionals a day-to-day debate leading to unresolved questions. On one hand, many clinicians still resist to the implementation of evidence-based clinical practice, asking themselves why their current practice should be changed or expanded. On the other hand, many leaders and managers of health care organizations are searching how to keep pace with the demand of actionable knowledge. For example, they are wondering: (a) if managerial and policy innovations are subjected to the same evidentiary standards as clinical innovations, and (b) how they can adapt the scope of evidence-based medicine to the culture, context, and content of health policy and management. This paper focuses on evidence-based health care management within the context of contemporary globalization. In this paper, our heuristic hypothesis is that decision-making process related changes within clinical/managerial/policy environments must be given a socio-historical backdrop. We argue that the relationship between research on the transfer of knowledge and its uptake by clinical, managerial and policy target audiences has undergone a shift, resulting in increasing pressures in health care for intense researcher-practitioner collaboration and the development of "integrative KT platforms" at the crossroads of different fields (the field of knowledge management and the field of knowledge translation). The objectives of this paper are: (a) to provide an answer to the questions that health professionals ask most frequently

  3. Formulation of evidence-based messages to promote the use of physical activity to prevent and manage Alzheimer’s disease

    Directory of Open Access Journals (Sweden)

    Kathleen A. Martin Ginis

    2017-02-01

    Full Text Available Abstract Background The impending public health impact of Alzheimer’s disease is tremendous. Physical activity is a promising intervention for preventing and managing Alzheimer’s disease. However, there is a lack of evidence-based public health messaging to support this position. This paper describes the application of the Appraisal of Guidelines Research and Evaluation II (AGREE-II principles to formulate an evidence-based message to promote physical activity for the purposes of preventing and managing Alzheimer’s disease. Methods A messaging statement was developed using the AGREE-II instrument as guidance. Methods included (a conducting a systematic review of reviews summarizing research on physical activity to prevent and manage Alzheimer’s disease, and (b engaging stakeholders to deliberate the evidence and formulate the messaging statement. Results The evidence base consisted of seven systematic reviews focused on Alzheimer’s disease prevention and 20 reviews focused on symptom management. Virtually all of the reviews of symptom management conflated patients with Alzheimer’s disease and patients with other dementias, and this limitation was reflected in the second part of the messaging statement. After deliberating the evidence base, an expert panel achieved consensus on the following statement: “Regular participation in physical activity is associated with a reduced risk of developing Alzheimer’s disease. Among older adults with Alzheimer’s disease and other dementias, regular physical activity can improve performance of activities of daily living and mobility, and may improve general cognition and balance.” The statement was rated favourably by a sample of older adults and physicians who treat Alzheimer’s disease patients in terms of its appropriateness, utility, and clarity. Conclusion Public health and other organizations that promote physical activity, health and well-being to older adults are encouraged to use

  4. Organizational readiness for evidence-based practice.

    Science.gov (United States)

    Gale, Barbara Van Patter; Schaffer, Marjorie A

    2009-02-01

    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.

  5. Concussion Care Practices and Utilization of Evidence-Based Guidelines in the Evaluation and Management of Concussion: A Survey of New England Emergency Departments.

    Science.gov (United States)

    Stern, Robert A; Seichepine, Daniel; Tschoe, Christine; Fritts, Nathan G; Alosco, Michael L; Berkowitz, Oren; Burke, Peter; Howland, Jonathan; Olshaker, Jonathan; Cantu, Robert C; Baugh, Christine M; Holsapple, James W

    2017-02-15

    Evidence-based clinical practice guidelines can facilitate proper evaluation and management of concussions in the emergency department (ED), often the initial and primary point of contact for concussion care. There is no universally adopted set of guidelines for concussion management, and extant evidence suggests that there may be variability in concussion care practices and limited application of clinical practice guidelines in the ED. This study surveyed EDs throughout New England to examine current practices of concussion care and utilization of evidence-based clinical practice guidelines in the evaluation and management of concussions. In 2013, a 32-item online survey was e-mailed to 149/168 EDs throughout New England (Connecticut, Rhode Island, Massachusetts, Vermont, New Hampshire, Maine). Respondents included senior administrators asked to report on their EDs use of clinical practice guidelines, neuroimaging decision-making, and discharge instructions for concussion management. Of the 72/78 respondents included, 35% reported absence of clinical practice guidelines, and 57% reported inconsistency in the type of guidelines used. Practitioner preference guided neuroimaging decision-making for 57%. Although 94% provided written discharge instructions, there was inconsistency in the recommended time frame for follow-up care (13% provided no specific time frame), the referral specialist to be seen (25% did not recommend any specialist), and return to activity instructions were inconsistent. There is much variability in concussion care practices and application of evidence-based clinical practice guidelines in the evaluation and management of concussions in New England EDs. Knowledge translational efforts will be critical to improve concussion management in the ED setting.

  6. Application of the principles of evidence-based practice in decision making among senior management in Nova Scotia's addiction services agencies.

    Science.gov (United States)

    Murphy, Matthew; MacCarthy, M Jayne; McAllister, Lynda; Gilbert, Robert

    2014-12-05

    Competency profiles for occupational clusters within Canada's substance abuse workforce (SAW) define the need for skill and knowledge in evidence-based practice (EBP) across all its members. Members of the Senior Management occupational cluster hold ultimate responsibility for decisions made within addiction services agencies and therefore must possess the highest level of proficiency in EBP. The objective of this study was to assess the knowledge of the principles of EBP, and use of the components of the evidence-based decision making (EBDM) process in members of this occupational cluster from selected addiction services agencies in Nova Scotia. A convenience sampling method was used to recruit participants from addiction services agencies. Semi-structured qualitative interviews were conducted with eighteen Senior Management. The interviews were audio-recorded, transcribed verbatim and checked by the participants. Interview transcripts were coded and analyzed for themes using content analysis and assisted by qualitative data analysis software (NVivo 9.0). Data analysis revealed four main themes: 1) Senior Management believe that addictions services agencies are evidence-based; 2) Consensus-based decision making is the norm; 3) Senior Management understand the principles of EBP and; 4) Senior Management do not themselves use all components of the EBDM process when making decisions, oftentimes delegating components of this process to decision support staff. Senior Management possess an understanding of the principles of EBP, however, when making decisions they often delegate components of the EBDM process to decision support staff. Decision support staff are not defined as an occupational cluster in Canada's SAW and have not been ascribed a competency profile. As such, there is no guarantee that this group possesses competency in EBDM. There is a need to advocate for the development of a defined occupational cluster and associated competency profile for this

  7. Pediatric Nurse Practitioner Management of Child Anxiety in a Rural Primary Care Clinic With the Evidence-Based COPE Program.

    Science.gov (United States)

    Kozlowski, Jessica L; Lusk, Pamela; Melnyk, Bernadette M

    2015-01-01

    Anxiety is the most common mental health disorder in children. Many communities have shortages of mental health providers, and the majority of children with anxiety are not receiving the evidence-based treatment they need. The purpose of this pilot study was to assess the feasibility and effects of a brief seven-session cognitive behavioral skills-building intervention, Creating Opportunities for Personal Empowerment (COPE), which was delivered to anxious children by a pediatric nurse practitioner in a primary care setting. A pre-experimental, one-group, pretest and post-test design was used. Children who participated had a significant decrease in anxiety symptoms (13.88 points, SD = 17.96, 95% confidence interval [CI] = -1.13-28.89), as well as an increase in knowledge of cognitive-behavioral coping skills (M = 11.38, CI = 5.99-8.26, p = .00) and improved functioning (at school and at home). Evaluations by parents and children were positive. COPE is a promising evidence-based intervention for children with anxiety with feasible delivery by pediatric nurse practitioners in primary care. Published by Elsevier Inc.

  8. Clinical Specialization and Adherence to Evidence-Based Practice Guidelines for Low Back Pain Management: A Survey of US Physical Therapists.

    Science.gov (United States)

    Ladeira, Carlos E; Cheng, M Samuel; da Silva, Rubens A

    2017-05-01

    Study Design Electronic cross-sectional survey. Background The American Physical Therapy Association (APTA) evidence-based practice guideline for low back pain (LBP) elaborated on strategies to manage nonspecific LBP in routine physical therapy practice. This guideline described LBP associated with mobility deficit, leg pain and a directional preference, coordination impairment (lumbar instability), and fear-avoidance behavior. Objectives To assess American physical therapists' adherence to the clinical practice guidelines (CPGs) for LBP of the Orthopaedic Section of the APTA, and to compare adherence among physical therapists with different qualifications. Methods The investigators contacted 1861 members of the Orthopaedic Section of the APTA and 1000 members of the American Academy of Orthopaedic Manual Physical Therapists (AAOMPT). Participants made treatment choices for 4 clinical vignettes: LBP with mobility deficit, coordination impairment, leg pain (directional preference), or fear-avoidance behavior. The investigator used logistic regression analyses to compare guideline adherence among physical therapists with the following qualifications: orthopaedic clinical specialists (PTOs), Fellows of the AAOMPT (PTFs), PTOs and PTFs (PTFOs), and physical therapists without clinical specialization but with a musculoskeletal interest (PTMSs). Results A total of 410 physical therapists completed all sections of the survey (142 PTOs, 110 PTFOs, 74 PTFs, and 84 PTMSs). Adherence to the APTA's CPG was highest for LBP associated with leg pain and a directional preference (72.2%), followed by LBP with mobility deficit (57.1%), LBP with coordination impairment (46.1%), and fear-avoidance behavior (29.5%). Physical therapists who were PTFOs adhered better to the CPG for LBP than did PTMSs for all 4 patient vignettes. Orthopaedic clinical specialists adhered better to the CPG for LBP for the vignettes of mobility deficit and of LBP with fear-avoidance behavior than did PTMSs

  9. Strategies of Regional Development Management

    Directory of Open Access Journals (Sweden)

    Bogdan Włodarczyk

    2009-12-01

    Full Text Available In the process of strategic planning the strategy of development as well as applications realizing it are formulated. Planning is the basis for preparing and taking decisions referring to principles, trends and the pace of far-reaching development. Elaboration of the strategy of regional development management is the undertaking of large scale complexity. It comprises decisions referring to development perspectives, formulating purposes and determining (choice the methods of their realization, analysis of social and political conditions, collecting and processing the information. Conditioning of defining the strategy has a versatile character. None of the above-mentioned areas can be regarded as less important. The purpose of this study is to attempt to identify basic problems of forming the strategy of regional development management. The study contains a brief description of planning regional development on the basis of the literature of the subject, and then empirical verification of the accepted hypothesis. Considerations and based upon them conclusions can be useful in working out the strategy of regional development management.

  10. Funding strategies for wilderness management

    Science.gov (United States)

    Carolyn Alkire

    2000-01-01

    Funding wilderness protection will continue to be a challenge for public land managers. With continuing competition for federal funds and balanced budget goals, other sources of funds may be necessary to supplement annual federal appropriations. This paper identifies and evaluates five potential funding strategies and provides examples of each that are currently in use...

  11. Management strategies for encouraging creativity.

    Science.gov (United States)

    Preston, P

    1998-01-01

    Change, chaos, and uncertainty touch every part of every institution. The laboratory is not immune. Managers content to continue on their familiar path soon will find themselves bypassed. To meet today's challenges, directors of technical operations, laboratory directors, team leaders, and coordinators need plenty of creativity--from everyone on their staff. It is no longer just "nice" to improve group output and problem-solving skills while staying within a "shoestring" budget. It is absolutely necessary. In this article, we explore strategies laboratory managers can use to tap the creative potential and commitment of their people. These strategies work. Whether it involves using humor, creating "idea centers," or "deconstructing the bureaucracy," the goal is the same: to encourage clinical managers to think beyond their technical and managerial experience. The examples in this article may not suit the needs, situations, or tastes of all laboratory managers. They are "food for thought." The concepts and strategies these examples illustrate are every laboratory manager's keys to adapting successfully to future challenges.

  12. Implementing evidence-based continuous quality improvement strategies in an urban Aboriginal Community Controlled Health Service in South East Queensland: a best practice implementation pilot.

    Science.gov (United States)

    Hogg, Sandra; Roe, Yvette; Mills, Richard

    2017-01-01

    The Institute for Urban Indigenous Health believes that continuous quality improvement (CQI) contributes to the delivery of high-quality care, thereby improving health outcomes for Aboriginal and Torres Strait Islander people. The opening of a new health service in 2015 provided an opportunity to implement best practice CQI strategies and apply them to a regional influenza vaccination campaign. The aim of this project was to implement an evidence-based CQI process within one Aboriginal Community Controlled Health Service in South East Queensland and use staff engagement as a measure of success. A CQI tool was selected from the Joanna Briggs Institute Practical Application of Clinical Evidence System (PACES) to be implemented in the study site. The study site was a newly established Aboriginal and Torres Strait Islander Community Controlled Health Service located in the northern suburbs of Brisbane. This project used the evidence-based information collected in PACES to develop a set of questions related to known variables resulting in proven CQI uptake. A pre implementation clinical audit, education and self-directed learning, using the Plan Do Study Act framework, included a total of seven staff and was conducted in April 2015. A post implementation audit was conducted in July 2015. There were a total of 11 pre- and post-survey respondents which included representation from most of the clinical team and medical administration. The results of the pre implementation audit identified a number of possible areas to improve engagement with the CQI process including staff training and support, understanding CQI and its impacts on individual work areas, understanding clinical data extraction, clinical indicator benchmarking, strong internal leadership and having an external data extractor. There were improvements to all audit criteria in the post-survey, for example, knowledge regarding the importance of CQI activity, attendance at education and training sessions on CQI

  13. Review of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: an evidence-based approach to diagnosis and management by clinicians.

    Science.gov (United States)

    Bested, Alison C; Marshall, Lynn M

    2015-01-01

    . The precise etiology of ME/CFS remains unknown, but recent advances and research discoveries are beginning to shed light on the enigma of this disease including the following contributors: infectious, genetic, immune, cognitive including sleep, metabolic and biochemical abnormalities. Management of patients with ME/CFS is supportive symptomatic treatment with a patient centered care approach that begins with the symptoms that are most troublesome for the patient. Pacing of activities with strategic rest periods is, in our opinion, the most important coping strategy patients can learn to better manage their illness and stop their post-exertional fatigue and malaise. Pacing allows patients to regain the ability to plan activities and begin to make slow incremental improvements in functionality.

  14. Opioid analgesics-related pharmacokinetic drug interactions: from the perspectives of evidence based on randomized controlled trials and clinical risk management

    Directory of Open Access Journals (Sweden)

    Feng XQ

    2017-05-01

    Full Text Available Xiu-qin Feng,1 Ling-ling Zhu,2 Quan Zhou3 1Nursing Administration Office, Division of Nursing, 2VIP Care Ward, Division of Nursing, 3Department of Pharmacy, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, People’s Republic of China Background: Multimorbidity results in complex polypharmacy which may bear a risk of drug interactions. A better understanding of opioid analgesics combination therapy used for pain management could help warrant medication safety, efficacy, and economic relevance. Until now there has been no review summarizing the opioid analgesics-related pharmacokinetic drug interactions from the perspective of evidence based on randomized controlled trials (RCTs. Method: A literature search was performed using PubMed, MEDLINE, and the Cochrane Library, using a PRISMA flowchart. Results: Fifty-two RCTs were included for data interpretation. Forty-two RCTs (80.8% were conducted in healthy volunteers, whereas 10 RCTs (19.2% enrolled true patients. None of the opioid–drug/herb pairs was listed as contraindications of opioids involved in this review. Circumstances in which opioid is comedicated as a precipitant drug include morphine–P2Y12 inhibitors, morphine–gabapentin, and methadone–zidovudine. Circumstances in which opioid is comedicated as an object drug include rifampin–opioids (morphine, tramadol, oxycodone, methadone, quinidine–opioids (morphine, fentanyl, oxycodone, codeine, dihydrocodeine, methadone, antimycotics–opioids (buprenorphine, fentanyl, morphine, oxycodone, methadone, tilidine, tramadol, protease inhibitors–opioids (ritonavir, ritonavir/lopinavir–oxycodone, ritonavir–fentanyl, ritonavir–tilidine, grapefruit juice–opioids (oxycodone, fentanyl, methadone, antidepressants–opioids (paroxetine–tramadol, paroxetine–hydrocodone, paroxetine–oxycodone, escitalopram–tramadol, metoclopramide–morphine, amantadine–morphine, sumatriptan

  15. Evidence based practice

    DEFF Research Database (Denmark)

    Hjørland, Birger

    2011-01-01

    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...

  16. Evidence-based decision-making within the context of globalization: A “Why–What–How” for leaders and managers of health care organizations

    Science.gov (United States)

    Lapaige, Véronique

    2009-01-01

    In the globalized knowledge economy, the challenge of translating knowledge into policy and practice is universal. At the dawn of the 21st century, the clinicians, leaders, and managers of health care organizations are increasingly required to bridge the research-practice gap. A shift from moving evidence to solving problems is due. However, despite a vast literature on the burgeoning field of knowledge translation research, the “evidence-based” issue remains for many health care professionals a day-to-day debate leading to unresolved questions. On one hand, many clinicians still resist to the implementation of evidence-based clinical practice, asking themselves why their current practice should be changed or expanded. On the other hand, many leaders and managers of health care organizations are searching how to keep pace with the demand of actionable knowledge. For example, they are wondering: (a) if managerial and policy innovations are subjected to the same evidentiary standards as clinical innovations, and (b) how they can adapt the scope of evidence-based medicine to the culture, context, and content of health policy and management. This paper focuses on evidence-based health care management within the context of contemporary globalization. In this paper, our heuristic hypothesis is that decision-making process related changes within clinical/managerial/policy environments must be given a socio-historical backdrop. We argue that the relationship between research on the transfer of knowledge and its uptake by clinical, managerial and policy target audiences has undergone a shift, resulting in increasing pressures in health care for intense researcher-practitioner collaboration and the development of “integrative KT platforms” at the crossroads of different fields (the field of knowledge management and the field of knowledge translation). The objectives of this paper are: (a) to provide an answer to the questions that health professionals ask most

  17. Strategies for pain management: a review.

    Science.gov (United States)

    Sollami, Alfonso; Marino, Leonardo; Fontechiari, Simona; Fornari, Marta; Tirelli, Pierangela; Zenunaj, Elisabetta

    2015-09-09

    PROBLEM/BACKGROUND: Pain management is a major worldwide health problem. It manifests itself in a variety of forms involving in turn a multiplicity of responses and therapeutic strategies. Following from this, the training of health personnel must deal with this situation and must not only offer technical assistance, but must also deal with the psychological and social aspects of the problem. In recent years various guidelines and protocols have become popular for pain management. The aim of this paper is to present a literature review of the major international databases. Type of research: Systematic review. To identify relevant studies in the literature on pain management and identify the guidelines recognized by the scientific community. A literature search was conducted using the keywords "pain management" and "nurse" published since 2000 in English and Italian in the following databases: PubMed, CINAHL, Med Line. Excluding items which did not meet the inclusion criteria, 49 articles were included in the review. Despite a growing availability of evidence-based guidelines, drugs for pain control and the enactment of legislation to promote the use of opioid analgesics in pain therapy, a substantial proportion of the European population continues to have pain. Estimates of the prevalence of pain symptoms in the literature show that between 40% and 63% of hospitalized patients reported pain, peaking at 82.3% in cancer patients in advanced stages of the disease or terminally ill (in hospital or at home). Several studies published in recent years have agreed on a definition of some key points in the management of pain. Studies agree that pain should be recognized as the 5th vital sign, hence the need for validated scales whether single or multi-dimensional, quantitative or qualitative. The approach to the management of pain must be multi-professional, and the use of pharmacology must be in accordance with the WHO three-step approach. Several studies have demonstrated

  18. Knowledge Management Implementation and the Tools Utilized in Healthcare for Evidence-Based Decision Making: A Systematic Review.

    Science.gov (United States)

    Shahmoradi, Leila; Safadari, Reza; Jimma, Worku

    2017-09-01

    Healthcare is a knowledge driven process and thus knowledge management and the tools to manage knowledge in healthcare sector are gaining attention. The aim of this systematic review is to investigate knowledge management implementation and knowledge management tools used in healthcare for informed decision making. Three databases, two journals websites and Google Scholar were used as sources for the review. The key terms used to search relevant articles include: "Healthcare and Knowledge Management"; "Knowledge Management Tools in Healthcare" and "Community of Practices in healthcare". It was found that utilization of knowledge management in healthcare is encouraging. There exist numbers of opportunities for knowledge management implementation, though there are some barriers as well. Some of the opportunities that can transform healthcare are advances in health information and communication technology, clinical decision support systems, electronic health record systems, communities of practice and advanced care planning. Providing the right knowledge at the right time, i.e., at the point of decision making by implementing knowledge management in healthcare is paramount. To do so, it is very important to use appropriate tools for knowledge management and user-friendly system because it can significantly improve the quality and safety of care provided for patients both at hospital and home settings.

  19. Sustaining Nurse-Led Task-Shifting Strategies for Hypertension Control: A Concept Mapping Study to Inform Evidence-Based Practice.

    Science.gov (United States)

    Blackstone, Sarah; Iwelunmor, Juliet; Plange-Rhule, Jacob; Gyamfi, Joyce; Quakyi, Nana Kofi; Ntim, Micheal; Ogedegbe, Gbenga

    2017-10-01

    The use of task-shifting is an increasingly widespread delivery approach for health interventions targeting prevention, treatment, and control of hypertension in adults living in sub-Saharan Africa (SSA). Addressing a gap in the literature, this research examined the sustainability of an ongoing task-shifting strategy for hypertension (TASSH) from the perspectives of community health nurses (CHNs) implementing the program. We used concept-mapping, a mixed-methods participatory approach to understand CHNs' perceptions of barriers and enablers to sustaining a task-shifting program. Participants responded to focal prompts, eliciting statements regarding perceived barriers and enablers to sustaining TASSH, and then rated these ideas based on importance to the research questions and feasibility to address. Twenty-eight community health nurses (21 women, 7 men) from the Ashanti region of Ghana completed the concept-mapping process. Factors influencing sustainability were grouped into five categories: Limited Drug Supply, Financial Support, Provision of Primary Health Care, Personnel Training, and Patient-Provider Communication. The limited supply of antihypertensive medication was considered by CHNs as the most important item to address, while providing training for intervention personnel was considered most feasible to address. This study's findings highlight the importance of examining nurses' perceptions of factors likely to influence the sustainability of evidence-based, task-shifting interventions. Nurses' perceptions can guide the widespread uptake and dissemination of these interventions in resource-limited settings. © 2017 Sigma Theta Tau International.

  20. Concise Arm and Hand Rehabilitation Approach in Stroke (CARAS: A practical and evidence-based framework for clinical rehabilitation management

    Directory of Open Access Journals (Sweden)

    Johan A. Franck

    2015-10-01

    Full Text Available The volume of information on new treatment techniques supporting the restoration of arm-hand function (AHF and arm-hand skill performance (ASHP in stroke survivors overwhelms therapists in everyday clinical practice when choosing the appropriate therapy. The Concise Arm and Hand Rehabilitation Approach in Stroke (CARAS is designed for paramedical staff to structure and implement training of AHF and AHSP in stroke survivors. The CARAS is based on four constructs: (a stratification according to the severity of arm–hand impairment (using the Utrecht Arm/Hand -Test [UAT], (b the individual’s rehabilitation goals and concomitant potential rehabilitation outcomes, (c principles of self-efficacy, and (d possibilities to systematically incorporate (new technology and new evidence-based training elements swiftly. The framework encompasses three programs aimed at treating either the severely (UAT 0-1, moderately (UAT 2-3, or mildly (UAT 4-7 impaired arm-hand. Program themes are: taking care of the limb and prevention of complications (Program 1, task-oriented gross motor grip performance (Program 2, and functional AHSP training (Program 3. Each program is preceded and followed by an assessment. Training modularity facilitates rapid interchange/adaptation of sub-elements. Proof-of-principle in clinical rehabilitation has been established. The CARAS facilitates rapid structured design and provision of state-of-the-art AHF and ASHP treatment in stroke patients.

  1. 2015-2018 Regional Prevention Plan of Lombardy (Northern Italy) and sedentary prevention: a cross-sectional strategy to develop evidence-based programmes.

    Science.gov (United States)

    Coppola, Liliana; Ripamonti, Ennio; Cereda, Danilo; Gelmi, Giusi; Pirrone, Lucia; Rebecchi, Andrea

    2016-01-01

    Cross-sector, life-course, and setting approaches are identified in the 2015-2018 Regional Prevention Plan (PRP) of Lombardy Region (Northern Italy) as valuable strategies to ensure the efficacy and sustainable prevention of the non-communicable disease (NCDs). The involvement of non-health sectors in health promotion activities represents a suitable strategy to affect on social, economic, and political determinants and to change environmental factors that could cause NCDs. A dialogue among communities, urban planning, and prevention know-how is a prerequisite to develop a system of policies suitable to promote healthy lifestyle in general and, specifically, active lifestyles. The 2015-2018 Lombardy PRP pursues its aims of health promotion and behavioural risk factors for NCDs prevention through programmes that implement their own setting networks (Health Promoting Schools - SPS; Workplace Health Promotion - WHP) and develop new networks. Sedentary lifestyle prevention and active lifestyle promotion are performed through the approach promoted by the Healthy Cities Programme (WHO), encouraging two main processes: 1. creating integrated capacity-building among health and social prevention services, academic research, and local stakeholders on different urban planning and design issues; 2. promoting community empowerment through active citizens participation. Through this process, Lombardy Region aims to orient its services developing evidence-based programmes and enhancing advocacy and mediating capacity skills in order to create a profitable partnership with non-health sectors. This paper reports the main impact data: 26,000 children that reach school by foot thanks to walking buses, 57% of 145 companies joining WHP are involved in promoting physical activity, 18,891 citizens who attend local walking groups.

  2. Using MeSH (medical subject headings) to enhance PubMed search strategies for evidence-based practice in physical therapy.

    Science.gov (United States)

    Richter, Randy R; Austin, Tricia M

    2012-01-01

    Evidence-based practice (EBP) is an important paradigm in health care. Physical therapists report lack of knowledge and time constraints as barriers to EBP. The purpose of this technical report is to illustrate how Medical Subject Headings (MeSH), a controlled vocabulary thesaurus of indexing terms, is used to efficiently search MEDLINE, the largest component of PubMed. Using clinical questions, this report illustrates how search terms common to physical therapist practice do or do not map to appropriate MeSH terms. A PubMed search strategy that takes advantage of text words and MeSH terms is provided. A search of 139 terms and 13 acronyms was conducted to determine whether they appropriately mapped to a MeSH term. The search results were categorized into 1 of 5 outcomes. Nearly half (66/139) of the search terms mapped to an appropriate MeSH term (outcome 1). When a search term did not appropriately map to a MeSH term, it was entered into the MeSH database to search for an appropriate MeSH term. Twenty-one appropriate MeSH terms were found (outcomes 2 and 4), and there were 52 search terms for which an appropriate MeSH term was not found (outcomes 3 and 5). Nearly half of the acronyms did not map to an appropriate MeSH term, and an appropriate MeSH term was not found in the database. The results are based on a limited number of search terms and acronyms. Understanding how search terms map to MeSH terms and using the PubMed search strategy can enable physical therapists to take full advantage of available MeSH terms and should result in more-efficient and better-informed searches.

  3. Ottawa Panel Evidence-Based Clinical Practice Guidelines for Patient Education Programmes in the Management of Osteoarthritis

    Science.gov (United States)

    Health Education Journal, 2011

    2011-01-01

    Objective: The purpose of this study was to develop guidelines and recommendations on patient education programmes of any type, targeted specially to individuals with OA and which were designed to improve the clinical effectiveness of managing OA. Methods: The Ottawa Methods Group contacted specialized organizations that focus on management for…

  4. Evidence-based dermatology

    Directory of Open Access Journals (Sweden)

    Ching-Chi Chi

    2013-03-01

    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.

  5. Systematic reviews of and integrated report on the quantitative, qualitative and economic evidence base for the management of obesity in men.

    Science.gov (United States)

    Robertson, Clare; Archibald, Daryll; Avenell, Alison; Douglas, Flora; Hoddinott, Pat; van Teijlingen, Edwin; Boyers, Dwayne; Stewart, Fiona; Boachie, Charles; Fioratou, Evie; Wilkins, David; Street, Tim; Carroll, Paula; Fowler, Colin

    2014-05-01

    Obesity increases the risk of many serious illnesses such as coronary heart disease, type 2 diabetes and osteoarthritis. More men than women are overweight or obese in the UK but men are less likely to perceive their weight as a problem and less likely to engage with weight-loss services. The aim of this study was to systematically review evidence-based management strategies for treating obesity in men and investigate how to engage men in obesity services by integrating the quantitative, qualitative and health economic evidence base. Electronic databases including MEDLINE, EMBASE, PsycINFO, the Cochrane Central Register of Controlled Trials, the Database of Abstracts of Reviews of Effects and the NHS Economic Evaluation Database were searched from inception to January 2012, with a limited update search in July 2012. Subject-specific websites, reference lists and professional health-care and commercial organisations were also consulted. Six systematic reviews were conducted to consider the clinical effectiveness, cost-effectiveness and qualitative evidence on interventions for treating obesity in men, and men in contrast to women, and the effectiveness of interventions to engage men in their weight reduction. Randomised controlled trials (RCTs) with follow-up data of at least 1 year, or any study design and length of follow-up for UK studies, were included. Qualitative and mixed-method studies linked to RCTs and non-randomised intervention studies, and UK-based, men-only qualitative studies not linked to interventions were included. One reviewer extracted data from the included studies and a second reviewer checked data for omissions or inaccuracies. Two reviewers carried out quality assessment. We undertook meta-analysis of quantitative data and a realist approach to integrating the qualitative and quantitative evidence synthesis. From a total of 12,764 titles reviewed, 33 RCTs with 12 linked reports, 24 non-randomised reports, five economic evaluations with two

  6. Opioid analgesics-related pharmacokinetic drug interactions: from the perspectives of evidence based on randomized controlled trials and clinical risk management.

    Science.gov (United States)

    Feng, Xiu-Qin; Zhu, Ling-Ling; Zhou, Quan

    2017-01-01

    Multimorbidity results in complex polypharmacy which may bear a risk of drug interactions. A better understanding of opioid analgesics combination therapy used for pain management could help warrant medication safety, efficacy, and economic relevance. Until now there has been no review summarizing the opioid analgesics-related pharmacokinetic drug interactions from the perspective of evidence based on randomized controlled trials (RCTs). A literature search was performed using PubMed, MEDLINE, and the Cochrane Library, using a PRISMA flowchart. Fifty-two RCTs were included for data interpretation. Forty-two RCTs (80.8%) were conducted in healthy volunteers, whereas 10 RCTs (19.2%) enrolled true patients. None of the opioid-drug/herb pairs was listed as contraindications of opioids involved in this review. Circumstances in which opioid is comedicated as a precipitant drug include morphine-P2Y12 inhibitors, morphine-gabapentin, and methadone-zidovudine. Circumstances in which opioid is comedicated as an object drug include rifampin-opioids (morphine, tramadol, oxycodone, methadone), quinidine-opioids (morphine, fentanyl, oxycodone, codeine, dihydrocodeine, methadone), antimycotics-opioids (buprenorphine, fentanyl, morphine, oxycodone, methadone, tilidine, tramadol), protease inhibitors-opioids (ritonavir, ritonavir/lopinavir-oxycodone, ritonavir-fentanyl, ritonavir-tilidine), grapefruit juice-opioids (oxycodone, fentanyl, methadone), antidepressants-opioids (paroxetine-tramadol, paroxetine-hydrocodone, paroxetine-oxycodone, escitalopram-tramadol), metoclopramide-morphine, amantadine-morphine, sumatriptan-butorphanol nasal sprays, ticlopidine-tramadol, St John's wort-oxycodone, macrolides/ketolides-oxycodone, and levomepromazine-codeine. RCTs investigating the same combination, almost unanimously, drew consistent conclusions, except two RCTs on amantadine-intravenous morphine combination where a different amantadine dose was used and two RCTs on morphine

  7. Individualisation of intervention for tubal ectopic pregnancy: historical perspectives and the modern evidence based management of ectopic pregnancy.

    Science.gov (United States)

    Odejinmi, Funlayo; Huff, Keren O; Oliver, Reeba

    2017-03-01

    Historically, ectopic pregnancy was a life-threatening condition where diagnosis was possible only at post mortem or laparotomy and maternal mortality was up to 90%. The evolution in the management of ectopic pregnancy has meant that diagnosis can be made using non-invasive techniques with an aim to identify the ectopic gestation before tubal rupture. This enables health care professionals to offer management options that consider not only maternal mortality, but morbidity and fertility outcomes as well. In spite of this, diagnostic techniques and management options are not without limitations. Research is currently focused on new tests with a single diagnostic capability, diagnostic and treatment algorithms and safe methods of triaging patients. This article aims to review the current literature on the diagnosis and management of ectopic pregnancy and to formulate a pathway to help individualise care and achieve the best possible outcome. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  8. Methodology and grading of the evidence for the diagnosis and management of cough: ACCP evidence-based clinical practice guidelines

    National Research Council Canada - National Science Library

    McCrory, Douglas C; Lewis, Sandra Zelman

    2006-01-01

    ... and primary care physicians, including recommendations covering many etiologies of cough, adult and pediatric evaluation and treatment, and empiric yet integrative algorithms for the management of the patient with cough...

  9. Evidence-based decision making : developing a knowledge base for successful program outcomes in transportation asset management.

    Science.gov (United States)

    2015-12-01

    MAP-21 and AASHTOs framework for transportation asset management (TAM) offer opportunities to use more : rigorous approaches to collect and apply evidence within a TAM context. This report documents the results of a study : funded by the Georgia D...

  10. Strengthening management and leadership practices to increase health-service delivery in Kenya: an evidence-based approach

    National Research Council Canada - National Science Library

    Seims, La Rue K; Alegre, Juan Carlos; Murei, Lily; Bragar, Joan; Thatte, Nandita; Kibunga, Peter; Cheburet, Sammuel

    2012-01-01

    The purpose of the study was to test the hypothesis that strengthening health systems, through improved leadership and management skills of health teams, can contribute to an increase in health-service delivery outcomes...

  11. Dutch evidence-based guidelines for amputation and prosthetics of the lower extremity : Amputation surgery and postoperative management. Part 1

    NARCIS (Netherlands)

    Geertzen, Jan; van der Linde, Harmen; Rosenbrand, Kitty; Conradi, Marcel; Deckers, Jos; Koning, Jan; Rietman, Hans S.; van der Schaaf, Dick; van der Ploeg, Rein; Schapendonk, Johannes; Schrier, Ernst; Duijzentkunst, Rob Smit; Spruit-van Eijk, Monica; Versteegen, Gerbrig; Voesten, Harrie

    2015-01-01

    Background: Surgeons still use a range of criteria to determine whether amputation is indicated. In addition, there is considerable debate regarding immediate postoperative management, especially concerning the use of immediate/delayed fitting' versus conservative elastic bandaging. Objectives: To

  12. Pharmacological management of alcohol withdrawal. A meta-analysis and evidence-based practice guideline. American Society of Addiction Medicine Working Group on Pharmacological Management of Alcohol Withdrawal.

    Science.gov (United States)

    Mayo-Smith, M F

    1997-07-09

    To provide an evidence-based practice guideline on the pharmacological management of alcohol withdrawal. English-language articles published before July 1, 1995, identified through MEDLINE search on "substance withdrawal--ethyl alcohol" and review of references from identified articles. Articles with original data on human subjects. Structured review to determine study design, sample size, interventions used, and outcomes of withdrawal severity, delirium, seizures, completion of withdrawal, entry into rehabilitation, adverse effects, and costs. Data from prospective controlled trials with methodologically sound end points corresponding to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, were abstracted by 2 independent reviewers and underwent meta-analysis. Benzodiazepines reduce withdrawal severity, reduce incidence of delirium (-4.9 cases per 100 patients; 95% confidence interval, -9.0 to -0.7; P=.04), and reduce seizures (-7.7 seizures per 100 patients; 95% confidence interval, -12.0 to -3.5; P=.003). Individualizing therapy with withdrawal scales results in administration of significantly less medication and shorter treatment (Pclonidine, and carbamazepine ameliorate withdrawal severity, but evidence is inadequate to determine their effect on delirium and seizures. Phenothiazines ameliorate withdrawal but are less effective than benzodiazepines in reducing delirium (P=.002) or seizures (PBenzodiazepines are suitable agents for alcohol withdrawal, with choice among different agents guided by duration of action, rapidity of onset, and cost. Dosage should be individualized, based on withdrawal severity measured by withdrawal scales, comorbid illness, and history of withdrawal seizures. beta-Blockers, clonidine, carbamazepine, and neuroleptics may be used as adjunctive therapy but are not recommended as monotherapy.

  13. School Leaders' Engagement with the Concept of Evidence-Based Practice as a Management Tool for School Improvement

    Science.gov (United States)

    Sheard, Mary K.; Sharples, Jonathan

    2016-01-01

    Strategies that encourage direct linkage and exchange between researchers and practitioners are more likely to support changes in educational practice informed by research evidence. Nevertheless, significant challenges remain in linking effectiveness education research to real-world practice: addressing the knowing-doing gap. The paper describes…

  14. Evidence-based medicine, systematic reviews, and guidelines in interventional pain management: Part 2: Randomized controlled trials.

    Science.gov (United States)

    Manchikanti, Laxmaiah; Hirsch, Joshua A; Smith, Howard S

    2008-01-01

    Evidence-based medicine (EBM) is a shift in medical paradigms and about solving clinical problems, acknowledging that intuition, unsystematic clinical experience, and pathophysiologic rationale are insufficient grounds for clinical decision-making. The importance of randomized trials has been created by the concept of the hierarchy of evidence in guiding therapy. Even though the concept of hierarchy of evidence is not absolute, in modern medicine, most researchers synthesizing the evidence may or may not follow the principles of EBM, which requires that a formal set of rules must complement medical training and common sense for clinicians to interpret the results of clinical research. N of 1 randomized controlled trials (RCTs) has been positioned as the top of the hierarchy followed by systematic reviews of randomized trials, single randomized trial, systematic review of observational studies, single observational study, physiologic studies, and unsystematic clinical observations. However, some have criticized that the hierarchy of evidence has done nothing more than glorify the results of imperfect experimental designs on unrepresentative populations in controlled research environments above all other sources of evidence that may be equally valid or far more applicable in given clinical circumstances. Design, implementation, and reporting of randomized trials is crucial. The biased interpretation of results from randomized trials, either in favor of or opposed to a treatment, and lack of proper understanding of randomized trials, leads to a poor appraisal of the quality. Multiple types of controlled trials include placebo-controlled and pragmatic trials. Placebo controlled RCTs have multiple shortcomings such as cost and length, which limit the availability for studying certain outcomes, and may suffer from problems of faulty implementation or poor generalizability, despite the study design which ultimately may not be the prime consideration when weighing evidence

  15. Evidence based practice readiness: A concept analysis.

    Science.gov (United States)

    Schaefer, Jessica D; Welton, John M

    2018-01-15

    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.

  16. Community strategies of women in educational management ...

    African Journals Online (AJOL)

    verbal communication; her us e of symbolic leaders hip strategies to manage her presence as a female manager in a male dominated environment; the constraints of traditional culture regarding communication and coping strategies to ...

  17. Emerging management strategies for obesity.

    Science.gov (United States)

    Kopelman, P G

    1998-08-01

    Management strategies for obesity, which include drug therapy, are emerging as a consequence of the increasing recognition of the medical seriousness of obesity. Obesity requires appropriate and effective management by suitably trained members of a multidisciplinary team, with treatment programmes putting equal importance on weight reduction and its maintenance. Such programmes must also take into account the reduction in risk from co-morbid conditions after modest weight loss (5-10% of initial body weight). The use of an anti-obesity drug may be justified for patients at risk from obesity where dietary methods, including exercise and behaviour modification, have failed to achieve a 10% reduction in initial body weight after at least three months from the start of the episode of managed care. Anti-obesity drugs must be prescribed in an appropriate setting, with patients being reviewed on a regular basis. Essential elements for managed weight loss include, a printed management programme, appropriate equipment, specified and realistic weight-loss goals, documentation of individual patient's health risks, and clearly defined follow-up procedures with explicit guidelines for the use of drugs and notification of other doctors involved in the patient's care. The process of drug treatment necessitates a system of regular medical audit. Many health-care professionals and lay persons remain sceptical about the scientific value of anti-obesity drugs. The emergence of increasingly specific and effective agents underlines the importance of ensuring appropriate use for patients at risk from obesity.

  18. Information exchange networks of health care providers and evidence-based cardiovascular risk management: an observational study

    NARCIS (Netherlands)

    Heijmans, N.; Lieshout, J. van; Wensing, M.

    2017-01-01

    BACKGROUND: Although a wide range of preventive and clinical interventions has targeted cardiovascular risk management (CVRM), outcomes remain suboptimal. Therefore, the question is what additional determinants of CVRM and outcomes can be identified and addressed to optimize CVRM. In this study, we

  19. Ottawa Panel Evidence-Based Clinical Practice Guidelines for Patient Education in the Management of Rheumatoid Arthritis (RA)

    Science.gov (United States)

    Brosseau, Lucie; Wells, George A.; Tugwell, Peter; Egan, Mary; Dubouloz, Claire-Jehanne; Welch, Vivian A.; Trafford, Laura; Sredic, Danjiel; Pohran, Kathryn; Smoljanic, Jovana; Vukosavljevic, Ivan; De Angelis, Gino; Loew, Laurianne; McEwan, Jessica; Bell, Mary; Finestone, Hillel M.; Lineker, Sydney; King, Judy; Jelly, Wilma; Casimiro, Lynn; Haines-Wangda, Angela; Russell-Doreleyers, Marion; Laferriere, Lucie; Lambert, Kim

    2012-01-01

    Background and purpose: The objective of this article is to create guidelines for education interventions in the management of patients ([greater than] 18 years old) with rheumatoid arthritis (RA). Methods: The Ottawa Methods Group identified and synthesized evidence from comparative controlled trials using Cochrane Collaboration methods. The…

  20. "That Doesn't Translate": The Role of Evidence-Based Practice in Disempowering Speech Pathologists in Acute Aphasia Management

    Science.gov (United States)

    Foster, Abby; Worrall, Linda; Rose, Miranda; O'Halloran, Robyn

    2015-01-01

    Background: An evidence-practice gap has been identified in current acute aphasia management practice, with the provision of services to people with aphasia in the acute hospital widely considered in the literature to be inconsistent with best-practice recommendations. The reasons for this evidence-practice gap are unclear; however, speech…

  1. Current status of radiation therapy. Evidence-based medicine (EBM) of radiation therapy. Current management of patients with esophageal cancer

    Energy Technology Data Exchange (ETDEWEB)

    Nemoto, Kenji [Tohoku Univ., Sendai (Japan). School of Medicine

    2002-03-01

    The best management for small mucosal esophageal cancer is generally endoscopic mucosal resection. However, for submucosal cancer and extensive mucosal caner, either radical surgery or radiation seems to be an equally efficacious option. Radiation therapy concurrent with chemotherapy is more effective than radiation therapy alone for patients with unresectable esophageal cancer. The key drugs are cisplatin and 5-fluorouracil. However, for patients with poor performance status or for aged patients, radiation therapy alone is still a choice of treatment. Surgery has generally been indicated for patients with resectable esophageal cancer. However, outcomes of concurrent chemoradiation therapy may be comparable with those of surgery. Therefore, a prospective randomized study should be performed to determine the best management for patients with resectable esophageal cancer. The usefulness of intra-cavitary irradiation for esophageal cancer has not been clarified. A prospective randomized trial with a large number of patients is necessary to determine the effectiveness of intra-cavitary irradiation. The best management for patients with loco-regionally recurrent esophageal cancer after surgery has not been determined. Intensive therapy should be considered if the site of recurrence is limited and the time interval from surgery to recurrence is long. Chemotherapy is essential in the management of patients with small cell esophageal cancer. However, the best local therapy has not been determined. (author)

  2. Cover-Copy-Compare: A Method for Enhancing Evidence-Based Instruction

    Science.gov (United States)

    Konrad, Moira; Joseph, Laurice M.

    2014-01-01

    Cover-copy-compare is a practical, low-cost, effective strategy for teachers to add to their repertoires of evidence-based practices. This article describes the cover-copy-compare strategy and how it can be applied to teach both self-management and basic academic skills. A variety of ways this strategy can be used across content areas are…

  3. Strengthening management and leadership practices to increase health-service delivery in Kenya: an evidence-based approach

    Directory of Open Access Journals (Sweden)

    Seims La Rue K

    2012-08-01

    Full Text Available Abstract Background The purpose of the study was to test the hypothesis that strengthening health systems, through improved leadership and management skills of health teams, can contribute to an increase in health-service delivery outcomes. The study was conducted in six provinces in the Republic of Kenya. Methods The study used a non-randomized design comparing measures of key service delivery indicators addressed by health teams receiving leadership and management training (the intervention against measures in comparison areas not receiving the intervention. Measurements were taken at three time periods: baseline, endline, and approximately six months post intervention. At the district level, health-service coverage was computed. At the facility level, the percentage change in the number of client visits was computed. The t-test was used to test for significance. Results Results showed significant increases in health-service coverage at the district level (p = P  Conclusions Strengthening the leadership and management skills of health teams, through team-based approaches focused on selected challenges, contributed to improved health service delivery outcomes and these improvements were sustained at least for six months.

  4. Applying psychological theories to evidence-based clinical practice: Identifying factors predictive of managing upper respiratory tract infections without antibiotics

    Directory of Open Access Journals (Sweden)

    Glidewell Elizabeth

    2007-08-01

    Full Text Available Abstract Background Psychological models can be used to understand and predict behaviour in a wide range of settings. However, they have not been consistently applied to health professional behaviours, and the contribution of differing theories is not clear. The aim of this study was to explore the usefulness of a range of psychological theories to predict health professional behaviour relating to management of upper respiratory tract infections (URTIs without antibiotics. Methods Psychological measures were collected by postal questionnaire survey from a random sample of general practitioners (GPs in Scotland. The outcome measures were clinical behaviour (using antibiotic prescription rates as a proxy indicator, behavioural simulation (scenario-based decisions to managing URTI with or without antibiotics and behavioural intention (general intention to managing URTI without antibiotics. Explanatory variables were the constructs within the following theories: Theory of Planned Behaviour (TPB, Social Cognitive Theory (SCT, Common Sense Self-Regulation Model (CS-SRM, Operant Learning Theory (OLT, Implementation Intention (II, Stage Model (SM, and knowledge (a non-theoretical construct. For each outcome measure, multiple regression analysis was used to examine the predictive value of each theoretical model individually. Following this 'theory level' analysis, a 'cross theory' analysis was conducted to investigate the combined predictive value of all significant individual constructs across theories. Results All theories were tested, but only significant results are presented. When predicting behaviour, at the theory level, OLT explained 6% of the variance and, in a cross theory analysis, OLT 'evidence of habitual behaviour' also explained 6%. When predicting behavioural simulation, at the theory level, the proportion of variance explained was: TPB, 31%; SCT, 26%; II, 6%; OLT, 24%. GPs who reported having already decided to change their management to

  5. The Breathing, Thinking, Functioning clinical model: a proposal to facilitate evidence-based breathlessness management in chronic respiratory disease.

    Science.gov (United States)

    Spathis, Anna; Booth, Sara; Moffat, Catherine; Hurst, Rhys; Ryan, Richella; Chin, Chloe; Burkin, Julie

    2017-04-21

    Refractory breathlessness is a highly prevalent and distressing symptom in advanced chronic respiratory disease. Its intensity is not reliably predicted by the severity of lung pathology, with unhelpful emotions and behaviours inadvertently exacerbating and perpetuating the problem. Improved symptom management is possible if clinicians choose appropriate non-pharmacological approaches, but these require engagement and commitment from both patients and clinicians. The Breathing Thinking Functioning clinical model is a proposal, developed from current evidence, that has the potential to facilitate effective symptom control, by providing a rationale and focus for treatment.

  6. Evidence-based radiography

    Energy Technology Data Exchange (ETDEWEB)

    Hafslund, Bjorg [Institute of Radiography, Faculty of Health and Social Sciences, Bergen University College, P.O. Box 7030, N-5020 Bergen (Norway)], E-mail: bhaf@hib.no; Clare, Judith; Graverholt, Birgitte; Wammen Nortvedt, Monica [Centre for Evidence Based Practice, Faculty of Health and Social Sciences, Bergen University College, Bergen (Norway)

    2008-11-15

    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.

  7. A systematic review of chiropractic management of adults with Whiplash-Associated Disorders: recommendations for advancing evidence-based practice and research.

    Science.gov (United States)

    Shaw, Lynn; Descarreaux, Martin; Bryans, Roland; Duranleau, Mireille; Marcoux, Henri; Potter, Brock; Ruegg, Rick; Watkin, Robert; White, Eleanor

    2010-01-01

    The literature relevant to the treatment of Whiplash-Associated Disorders (WAD) is extensive and heterogeneous. A Participatory Action Research (PAR) approach was used to engage a chiropractic community of practice and stakeholders in a systematic review to address a general question: 'Does chiropractic management of WAD clients have an effect on improving health status?' A systematic review of the empirical studies relevant to WAD interventions was conducted followed by a review of the evidence. The initial search identified 1,155 articles. Ninety-two of the articles were retrieved, and 27 articles consistent with specific criteria of WAD intervention were analyzed in-depth. The best evidence supporting the chiropractic management of clients with WAD is reported. Further review identified ways to overcome gaps needed to inform clinical practice and culminated in the development of a proposed care model: the WAD-Plus Model. There is a baseline of evidence that suggests chiropractic care improves cervical range of motion (cROM) and pain in the management of WAD. However, the level of this evidence relevant to clinical practice remains low or draws on clinical consensus at this time. The WAD-Plus Model has implications for use by chiropractors and interdisciplinary professionals in the assessment and management of acute, subacute and chronic pain due to WAD. Furthermore, the WAD-Plus Model can be used in the future study of interventions and outcomes to advance evidence-based care in the management of WAD.

  8. Management of suicidal and self-harming behaviors in prisons: systematic literature review of evidence-based activities.

    Science.gov (United States)

    Barker, Emma; Kõlves, Kairi; De Leo, Diego

    2014-01-01

    The purpose of this study was to systematically analyze existing literature testing the effectiveness of programs involving the management of suicidal and self-harming behaviors in prisons. For the study, 545 English-language articles published in peer reviewed journals were retrieved using the terms "suicid*," "prevent*," "prison," or "correctional facility" in SCOPUS, MEDLINE, PROQUEST, and Web of Knowledge. In total, 12 articles were relevant, with 6 involving multi-factored suicide prevention programs, and 2 involving peer focused programs. Others included changes to the referral and care of suicidal inmates, staff training, legislation changes, and a suicide prevention program for inmates with Borderline Personality Disorder. Multi-factored suicide prevention programs appear most effective in the prison environment. Using trained inmates to provide social support to suicidal inmates is promising. Staff attitudes toward training programs were generally positive.

  9. Management of outcomes in the ambulatory surgery center: the role of standard work and evidence-based medicine.

    Science.gov (United States)

    Merrill, Douglas

    2008-12-01

    Quality and safety in the manufacturing and airline industries have benefited from evidenced-based process-improvement strategies. This review investigates the rationale for application of these same processes in the ambulatory anesthesia setting. Application of quality methodologies in healthcare and other service industries has yielded similar quality and safety improvements as in the manufacturing and airline industries. Anesthesiologists have embraced the use of some mandated care plans, but many such opportunities have been rejected by the specialty, to the detriment of the safety and quality of patient care. Implementation of such mandates and team work training in healthcare would improve the safety and quality of medical practice as they have so dramatically in the airline and manufacturing industries over the preceding 30 years. Ambulatory surgery and anesthesia care is uniquely oriented to the application of repetitive processes in the provision of highly predictable and reproducible surgical services. Ambulatory anesthesiologists should lead the healthcare industry in the much wider adoption of standard practice protocols and team training to maximally improve the safety and quality of patients' experiences.

  10. Managing service quality: Human resource management strategies

    Directory of Open Access Journals (Sweden)

    K. K. Govender

    2000-06-01

    Full Text Available This article reports the results of an empirical evaluation of a conceptual service encounter management model (Govender, 1999. The various hypotheses proposed to show a relationship between formal and informal socialisation strategies, and the bank employees' perception of the organisational climate and their role are empirically evaluated. Furthermore, the mediated effects of these socialization tactics on the bank customers perception of the service quality was also ascertained by matching a random sample of 210 bank employees with 1050 customers. Opsomming Hierdie artikel rapporteer die resultate van n empiriese evaluering van n konseptuele dienservaringsbestuursmodel (Govender, 1999. Verskeie hipoteses word voorgehou om n verband tussen formele en informele sosialise- ringstrategiee aan te toon, en die bankwerkers se persepsie van die organisatoriese klimaat en hulle rolle word empirics geevalueer.Verder word die modererende effek van hierdie sosialiseringstrategie op die bankkliente se persepsie van dienskwaliteit bepaal deur 'n ewekansige steekproefvan 210 bankwerkers met 1050 kliente af te paar.

  11. Management Accounting and Supply Chain Strategy

    OpenAIRE

    Hald, Kim S.; Thrane, Sof

    2016-01-01

    Research positioned in the intersection between management accounting and supply chain management is increasing. However, the relationship between management accounting and supply chain strategies has been neglected in extant research. This research adds to literature on management accounting and supply chain management through exploring how supply chain strategy and management accounting is related, and how supply chain relationship structure modifies this relation. Building on a contingency...

  12. Configuration Management Process Assessment Strategy

    Science.gov (United States)

    Henry, Thad

    2014-01-01

    Purpose: To propose a strategy for assessing the development and effectiveness of configuration management systems within Programs, Projects, and Design Activities performed by technical organizations and their supporting development contractors. Scope: Various entities CM Systems will be assessed dependent on Project Scope (DDT&E), Support Services and Acquisition Agreements. Approach: Model based structured against assessing organizations CM requirements including best practices maturity criteria. The model is tailored to the entity being assessed dependent on their CM system. The assessment approach provides objective feedback to Engineering and Project Management of the observed CM system maturity state versus the ideal state of the configuration management processes and outcomes(system). center dot Identifies strengths and risks versus audit gotcha's (findings/observations). center dot Used "recursively and iteratively" throughout program lifecycle at select points of need. (Typical assessments timing is Post PDR/Post CDR) center dot Ideal state criteria and maturity targets are reviewed with the assessed entity prior to an assessment (Tailoring) and is dependent on the assessed phase of the CM system. center dot Supports exit success criteria for Preliminary and Critical Design Reviews. center dot Gives a comprehensive CM system assessment which ultimately supports configuration verification activities.*

  13. Endoscopic sphenopalatine artery ligation for acute idiopathic epistaxis. Do anatomical variation and a limited evidence base raise questions regarding its place in management?

    Science.gov (United States)

    Ellinas, A; Jervis, P; Kenyon, G; Flood, L M

    2017-04-01

    Endoscopic sphenopalatine artery ligation is widely accepted as effective and safe for acute spontaneous epistaxis that is unresponsive to conservative management. As with many new procedures, it has been progressively adopted as common practice, despite a limited evidence base for its efficacy. Early reviews called for comparative trials to support its adoption, but subsequent literature largely consists of case series and narrative reviews. These have attempted to derive an algorithm to establish its place in management, but consensus is still lacking. Intuitively, although there are theoretical objections, an operation regarded as relatively simple, fast and safe hardly seems to demand high-level evidence of efficacy. Rhinologists may be influenced by years of personal experience and success with the technique. However, estimates of the effect size and the added contribution to traditional surgical management are lacking. If the procedure could be shown to dramatically influence outcome, it should be standard practice and indispensable for all patients requiring operative intervention. This paper systematically examined the literature, appraising the anatomical basis for such an approach and evidence for its efficacy. It questions whether any units unable to consistently offer endoscopic sphenopalatine artery ligation should be undertaking surgical management of acute epistaxis.

  14. First Global Consensus for Evidence-Based Management of the Hematopoietic Syndrome Resulting From Exposure to Ionizing Radiation

    Science.gov (United States)

    Dainiak, Nicholas; Gent, Robert Nicolas; Carr, Zhanat; Schneider, Rita; Bader, Judith; Buglova, Elena; Chao, Nelson; Norman Coleman, C.; Ganser, Arnold; Gorin, Claude; Hauer-Jensen, Martin; Andrew Huff, L.; Lillis-Hearne, Patricia; Maekawa, Kazuhiko; Nemhauser, Jeffrey; Powles, Ray; Schünemann, Holger; Shapiro, Alla; Stenke, Leif; Valverde, Nelson; Weinstock, David; White, Douglas; Albanese, Joseph; Meineke, Viktor

    2013-01-01

    Objective Hematopoietic syndrome (HS) is a clinical diagnosis assigned to people who present with ≥1 new-onset cytopenias in the setting of acute radiation exposure. The World Health Organization convened a panel of experts to evaluate the evidence and develop recommendations for medical countermeasures for the management of HS in a hypothetical scenario involving the hospitalization of 100 to 200 individuals exposed to radiation. The objective of this consultancy was to develop recommendations for treatment of the HS based upon the quality of evidence. Methods English-language articles were identified in MEDLINE and PubMed. Reference lists of retrieved articles were distributed to panel members before the meeting and updated during the meeting. Published case series and case reports of individuals with HS, published randomized controlled trials of relevant interventions used to treat nonirradiated individuals, reports of studies in irradiated animals, and prior recommendations of subject matter experts were selected. Studies were extracted using the Grading of Recommendations Assessment Development and Evaluation (GRADE) system. In cases in which data were limited or incomplete, a narrative review of the observations was made. No randomized controlled trials of medical countermeasures have been completed for individuals with radiation-associated HS. The use of GRADE analysis of countermeasures for injury to hematopoietic tissue was restricted by the lack of comparator groups in humans. Reliance on data generated in nonirradiated humans and experimental animals was necessary. Results Based upon GRADE analysis and narrative review, a strong recommendation was made for the administration of granulocyte colony-stimulating factor or granulocyte macrophage colony-stimulating factor and a weak recommendation was made for the use of erythropoiesis-stimulating agents or hematopoietic stem cell transplantation. Conclusions Assessment of therapeutic interventions for HS in

  15. Systematic review: probiotics in the management of lower gastrointestinal symptoms in clinical practice -- an evidence-based international guide.

    Science.gov (United States)

    Hungin, A P S; Mulligan, C; Pot, B; Whorwell, P; Agréus, L; Fracasso, P; Lionis, C; Mendive, J; Philippart de Foy, J-M; Rubin, G; Winchester, C; de Wit, N

    2013-10-01

    Evidence suggests that the gut microbiota play an important role in gastrointestinal problems. To give clinicians a practical reference guide on the role of specified probiotics in managing particular lower gastrointestinal symptoms/problems by means of a systematic review-based consensus. Systematic literature searching identified randomised, placebo-controlled trials in adults; evidence for each symptom/problem was graded and statements developed (consensus process; 10-member panel). As results cannot be generalised between different probiotics, individual probiotics were identified for each statement. Thirty seven studies were included; mostly on irritable bowel syndrome [IBS; 19 studies; treatment responder rates: 18-80% (specific probiotics), 5-50% (placebo)] or antibiotic-associated diarrhoea (AAD; 10 studies). Statements with 100% agreement and 'high' evidence levels indicated that: (i) specific probiotics help reduce overall symptom burden and abdominal pain in some IBS patients; (ii) in patients receiving antibiotics/Helicobacter pylori eradication therapy, specified probiotics are helpful as adjuvants to prevent/reduce the duration/intensity of AAD; (iii) probiotics have favourable safety in patients in primary care. Items with 70-100% agreement and 'moderate' evidence were: (i) specific probiotics help relieve overall symptom burden in some patients with diarrhoea-predominant IBS, and reduce bloating/distension and improve bowel movement frequency/consistency in some IBS patients and (ii) with some probiotics, improved symptoms have led to improvement in quality of life. Specified probiotics can provide benefit in IBS and antibiotic-associated diarrhoea; relatively few studies in other indications suggested benefits warranting further research. This study provides practical guidance on which probiotic to select for a specific problem. © 2013 John Wiley & Sons Ltd.

  16. Systematic review: probiotics in the management of lower gastrointestinal symptoms in clinical practice – an evidence-based international guide

    Science.gov (United States)

    Hungin, A P S; Mulligan, C; Pot, B; Whorwell, P; Agréus, L; Fracasso, P; Lionis, C; Mendive, J; Philippart de Foy, J-M; Rubin, G; Winchester, C; Wit, N

    2013-01-01

    BackgroundEvidence suggests that the gut microbiota play an important role in gastrointestinal problems. AimTo give clinicians a practical reference guide on the role of specified probiotics in managing particular lower gastrointestinal symptoms/problems by means of a systematic review-based consensus. MethodsSystematic literature searching identified randomised, placebo-controlled trials in adults; evidence for each symptom/problem was graded and statements developed (consensus process; 10-member panel). As results cannot be generalised between different probiotics, individual probiotics were identified for each statement. ResultsThirty seven studies were included; mostly on irritable bowel syndrome [IBS; 19 studies; treatment responder rates: 18–80% (specific probiotics), 5–50% (placebo)] or antibiotic-associated diarrhoea (AAD; 10 studies). Statements with 100% agreement and ‘high’ evidence levels indicated that: (i) specific probiotics help reduce overall symptom burden and abdominal pain in some IBS patients; (ii) in patients receiving antibiotics/Helicobacter pylori eradication therapy, specified probiotics are helpful as adjuvants to prevent/reduce the duration/intensity of AAD; (iii) probiotics have favourable safety in patients in primary care. Items with 70–100% agreement and ‘moderate’ evidence were: (i) specific probiotics help relieve overall symptom burden in some patients with diarrhoea-predominant IBS, and reduce bloating/distension and improve bowel movement frequency/consistency in some IBS patients and (ii) with some probiotics, improved symptoms have led to improvement in quality of life. ConclusionsSpecified probiotics can provide benefit in IBS and antibiotic-associated diarrhoea; relatively few studies in other indications suggested benefits warranting further research. This study provides practical guidance on which probiotic to select for a specific problem. PMID:23981066

  17. Use of Information-Seeking Strategies for Developing Systematic Reviews and Engaging in Evidence-Based Practice: The Application of Traditional and Comprehensive Pearl Growing--A Review

    Science.gov (United States)

    Schlosser, Ralf W.; Wendt, Oliver; Bhavnani, Suresh; Nail-Chiwetalu, Barbara

    2006-01-01

    Background: Efficient library searches for research evidence are critical to practitioners who wish to engage in evidence-based practice (EBP) as well as researchers who seek to develop systematic reviews. Aims: This review will propose the benefits of the search technique "Pearl Growing" ("Traditional Pearl Growing") as well…

  18. Formula food-reducing diets:A new evidence-based addition to the weight management tool box.

    Science.gov (United States)

    Leeds, A R

    2014-09-01

    The changing pattern of obesity-related disease has created a need for a greater range of weight management options for the increasing number of people for whom weight loss and maintenance cannot be addressed by conventional dietary methods. Formula diet weight loss programmes [very low-calorie diets (VLCDs) (400-800 kcal/day) and low-calorie diets (LCDs) (800-1200 kcal/day)] can deliver weight loss at rates of 1-2 kg/week. This rate of weight loss can result in 10-20 kg weight loss in 8-12 weeks. Many health benefits associated with weight reduction seem to require between 10 and 20 kg weight loss. Formula diet programmes can result in weight loss, reduction of liver volume and reduction of visceral fat before bariatric surgery; weight loss before knee joint replacement surgery has also been shown. The benefit of pre-operative weight loss is still under investigation and such practices before bariatric surgery are variable in surgical units across the UK. Weight loss with formula diet in obesity-associated conditions where inflammation is an important component, such as osteoarthritis and psoriasis, has been demonstrated. Maintenance of about 10% of initial bodyweight loss, with symptom improvement in elderly obese people with knee osteoarthritis, has been shown over a period of 4 years. In obese people with psoriasis, weight loss with skin improvement has been maintained for 1 year. Clinical trials are currently underway to examine the merits of an initial weight loss with formula diet in pre-diabetes, in early type 2 diabetes and in insulin-treated type 2 diabetes. Rapid initial weight loss can result in rapid symptom improvement, such as reduced joint pain in osteoarthritis, improved sleep quality in obstructive sleep apnoea, reduced shortness of breath on exertion, reduced peripheral oedema and rapid improvement in metabolic control in diabetes, all changes that are highly motivating and conducive towards compliance. There is also some evidence for

  19. Formula food-reducing diets:A new evidence-based addition to the weight management tool box

    Science.gov (United States)

    Leeds, A R

    2014-01-01

    The changing pattern of obesity-related disease has created a need for a greater range of weight management options for the increasing number of people for whom weight loss and maintenance cannot be addressed by conventional dietary methods. Formula diet weight loss programmes [very low-calorie diets (VLCDs) (400–800 kcal/day) and low-calorie diets (LCDs) (800–1200 kcal/day)] can deliver weight loss at rates of 1–2 kg/week. This rate of weight loss can result in 10–20 kg weight loss in 8–12 weeks. Many health benefits associated with weight reduction seem to require between 10 and 20 kg weight loss. Formula diet programmes can result in weight loss, reduction of liver volume and reduction of visceral fat before bariatric surgery; weight loss before knee joint replacement surgery has also been shown. The benefit of pre-operative weight loss is still under investigation and such practices before bariatric surgery are variable in surgical units across the UK. Weight loss with formula diet in obesity-associated conditions where inflammation is an important component, such as osteoarthritis and psoriasis, has been demonstrated. Maintenance of about 10% of initial bodyweight loss, with symptom improvement in elderly obese people with knee osteoarthritis, has been shown over a period of 4 years. In obese people with psoriasis, weight loss with skin improvement has been maintained for 1 year. Clinical trials are currently underway to examine the merits of an initial weight loss with formula diet in pre-diabetes, in early type 2 diabetes and in insulin-treated type 2 diabetes. Rapid initial weight loss can result in rapid symptom improvement, such as reduced joint pain in osteoarthritis, improved sleep quality in obstructive sleep apnoea, reduced shortness of breath on exertion, reduced peripheral oedema and rapid improvement in metabolic control in diabetes, all changes that are highly motivating and conducive towards compliance. There is also some

  20. From continuing education to personal digital assistants: what do physical therapists need to support evidence-based practice in stroke management?

    Science.gov (United States)

    Salbach, Nancy M; Veinot, Paula; Jaglal, Susan B; Bayley, Mark; Rolfe, Danielle

    2011-08-01

    Understanding how to structure educational interventions and resources to facilitate physical therapists' application of the research literature is required. The objective of this study was to explore physical therapists' preferences for strategies to facilitate their access to, evaluation and implementation of the stroke research literature in clinical practice. In-depth, qualitative telephone interviews were conducted with 23 physical therapists who treat people with stroke in Ontario, Canada and who had participated in a previous survey on evidence-based practice. Data were analysed using a constant comparative approach to identify emergent themes. Participants preferred online access to research summaries or systematic reviews to save time to filter and critique research articles. To enable access in the workplace, an acceptable computer-to-staff ratio, permission to access web sites and protected work time were suggested. Participants considered personal digital assistants as excellent tools for quick access to online resources but were unsure of their advantage over a desktop computer. Therapists favoured use of non-technical language, glossaries of research terms and quality ratings of studies to ease understanding and appraisal. Teleconferencing or videoconferencing overcame geographical but not scheduling barriers to accessing education. To achieve behaviour change in clinical practice, therapists preferred multiple interactive, face-to-face education sessions in a group format, with opportunities for case-based learning and practice of new skills. Physical therapists prefer technology-assisted access to resources and education and favour attending multiple interactive, expert-facilitated education sessions incorporating opportunities for case-based learning and practice of new skills to change behaviour related to evidence-based practice. © 2010 Blackwell Publishing Ltd.

  1. A Knowledge-Modeling Approach to Integrate Multiple Clinical Practice Guidelines to Provide Evidence-Based Clinical Decision Support for Managing Comorbid Conditions.

    Science.gov (United States)

    Abidi, Samina

    2017-10-26

    Clinical management of comorbidities is a challenge, especially in a clinical decision support setting, as it requires the safe and efficient reconciliation of multiple disease-specific clinical procedures to formulate a comorbid therapeutic plan that is both effective and safe for the patient. In this paper we pursue the integration of multiple disease-specific Clinical Practice Guidelines (CPG) in order to manage co-morbidities within a computerized Clinical Decision Support System (CDSS). We present a CPG integration framework-termed as COMET (Comorbidity Ontological Modeling & ExecuTion) that manifests a knowledge management approach to model, computerize and integrate multiple CPG to yield a comorbid CPG knowledge model that upon execution can provide evidence-based recommendations for handling comorbid patients. COMET exploits semantic web technologies to achieve (a) CPG knowledge synthesis to translate a paper-based CPG to disease-specific clinical pathways (CP) that include specialized co-morbidity management procedures based on input from domain experts; (b) CPG knowledge modeling to computerize the disease-specific CP using a Comorbidity CPG ontology; (c) CPG knowledge integration by aligning multiple ontologically-modeled CP to develop a unified comorbid CPG knowledge model; and (e) CPG knowledge execution using reasoning engines to derive CPG-mediated recommendations for managing patients with comorbidities. We present a web-accessible COMET CDSS that provides family physicians with CPG-mediated comorbidity decision support to manage Atrial Fibrillation and Chronic Heart Failure. We present our qualitative and quantitative analysis of the knowledge content and usability of COMET CDSS.

  2. Health technologies for the improvement of chronic disease management: a review of the Medical Advisory Secretariat evidence-based analyses between 2006 and 2011.

    Science.gov (United States)

    Nikitovic, M; Brener, S

    2013-01-01

    As part of ongoing efforts to improve the Ontario health care system, a mega-analysis examining the optimization of chronic disease management in the community was conducted by Evidence Development and Standards, Health Quality Ontario (previously known as the Medical Advisory Secretariat [MAS]). The purpose of this report was to identify health technologies previously evaluated by MAS that may be leveraged in efforts to optimize chronic disease management in the community. The Ontario Health Technology Assessment Series and field evaluations conducted by MAS and its partners between January 1, 2006, and December 31, 2011. Technologies related to at least 1 of 7 disease areas of interest (type 2 diabetes, coronary artery disease, atrial fibrillation, chronic obstructive pulmonary disease, congestive heart failure, stroke, and chronic wounds) or that may greatly impact health services utilization were reviewed. Only technologies with a moderate to high quality of evidence and associated with a clinically or statistically significant improvement in disease management were included. Technologies related to other topics in the mega-analysis on chronic disease management were excluded. Evidence-based analyses were reviewed, and outcomes of interest were extracted. Outcomes of interest included hospital utilization, mortality, health-related quality of life, disease-specific measures, and economic analysis measures. Eleven analyses were included and summarized. Technologies fell into 3 categories: those with evidence for the cure of chronic disease, those with evidence for the prevention of chronic disease, and those with evidence for the management of chronic disease. The impact on patient outcomes and hospitalization rates of new health technologies in chronic disease management is often overlooked. This analysis demonstrates that health technologies can reduce the burden of illness; improve patient outcomes; reduce resource utilization intensity; be cost

  3. Homosexuality in Turkey: strategies for managing heterosexism.

    Science.gov (United States)

    Bakacak, Ayça Gelgeç; Oktem, Pinar

    2014-01-01

    The goal of this study was to identify the strategies used by young homosexuals to manage their sexual minority status in Turkey. In-depth interviews were conducted with 15 self-identified homosexual university students. The data on the strategies employed by homosexuals suggested a categorization of these strategies into four interrelated areas: strategies employed in the process of self-acceptance; strategies to manage sexual stigma and prejudice; strategies specific to the coming-out process; and the strategies used while openly expressing their sexual identities.

  4. A strategy model for management

    DEFF Research Database (Denmark)

    Friis, Ole Uhrskov; Holmgren, Jens; Eskildsen, Jacob Kjær

    2016-01-01

    Purpose: Developing a strategy model which explains what organisations should focus on in their strategy work, both in terms of the environment as well as how the strategy is implemented. In addition, the purpose is to demonstrate how this can influence and improve the organisations’ performance....... Methodology: Using different state-of-the-art strategy approaches to create and validate a solid and causal strategy model. Findings: The nature of strategy is complex, and organisations are indeed facing more complex tasks which require that internal resources are available to meet the environmental demands......, develop an effective strategy for today and tomorrow, implement the strategy and execute the action plans....

  5. Translating evidence-based guidelines into practice: a survey of practices of commissioners and managers of the English stop smoking services

    Directory of Open Access Journals (Sweden)

    McDermott Máirtín S

    2012-05-01

    Full Text Available Abstract Background The English National Health Service’s (NHS Stop Smoking Services (SSSs constitute one of the most highly developed behavioural support programmes in the world. However, there is significant variation in success rates across the approximately 150 services, some of which may be due to variation in practice. This study aimed to assess these differences in practice. Methods Two online surveys were administered. All commissioners (people who purchase services for the NHS and managers (those who run the services of NHS SSSs in England were invited to participate. Items included details of current practices and services provided, what informed the commissioning of SSSs, what targets were included within service specifications and whether the types of treatment model to be delivered were specified. Results Both surveys had a response rate of 35%, with 50 commissioners and 58 managers participating. There were no significant differences between the characteristics of the Primary Care Trusts (PCTs from which commissioners and managers responded to this survey and those PCTs from which there was no response. Managers reported that the treatment model most frequently offered by SSSs was one-to-one (98%. A total of 16% of managers reported that some approved medications were not available as first-line treatments. Just over one third (38% of commissioners reported consulting national guidelines or best evidence to inform local commissioning. Almost one third (30% of commissioners reported that they specified the types of stop smoking interventions to be delivered by the providers. Conclusions A substantial part of commissioning of Stop Smoking Services in England appears to take place without adequate consultation of evidence-based guidelines or specification of the service to be provided. This may account for at least some of the variation in success rates.

  6. A Randomized Controlled Dismantling Trial of Post-Workshop Consultation Strategies to Increase Effectiveness and Fidelity to an Evidence-Based Psychotherapy for Posttraumatic Stress Disorder

    Science.gov (United States)

    2013-08-01

    item self- report measure of three dimensions of client functio- ning in the past week: symptom distress (e.g., anxiety , depression), interpersonal ...illness. Psychiatr Serv 2007, 58(3):395. 37. Weissman MM, et al: National survey of psychotherapy training in psychiatry, psychology, and social work...to an evidence-based psychotherapy for Posttraumatic stress disorder Shannon Wiltsey Stirman1, Norman Shields2, Josh Deloriea3, Meredith SH Landy3

  7. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8).

    Science.gov (United States)

    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

    2014-02-05

    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

  8. Maritime Domain Awareness Architecture Management Hub Strategy

    National Research Council Canada - National Science Library

    2008-01-01

    This document provides an initial high level strategy for carrying out the responsibilities of the national Maritime Domain Awareness Architecture Management Hub to deliver a standards based service...

  9. Barriers to evidence-based medicine: a systematic review.

    Science.gov (United States)

    Sadeghi-Bazargani, Homayoun; Tabrizi, Jafar Sadegh; Azami-Aghdash, Saber

    2014-12-01

    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.

  10. Flood risk management strategies and resilience:

    OpenAIRE

    Atanga, Raphael Ane

    2017-01-01

    This study investigates the aspects of resilience in the management strategies of the key stakeholders of flood risk management in the city of Accra, Ghana. The overall objective is to analyse the response capacity in the strategies of the key stakeholders in flood risk management for managing the unexpected course of flood disasters in addition to the expected features of flood risk. To achieve the set objective, the following research questions are addressed: Who are the key stakeholders of...

  11. Multinational evidence-based recommendations for the diagnosis and management of gout: integrating systematic literature review and expert opinion of a broad panel of rheumatologists in the 3e initiative

    NARCIS (Netherlands)

    Sivera, Francisca; Andrés, Mariano; Carmona, Loreto; Kydd, Alison S. R.; Moi, John; Seth, Rakhi; Sriranganathan, Melonie; van Durme, Caroline; van Echteld, Irene; Vinik, Ophir; Wechalekar, Mihir D.; Aletaha, Daniel; Bombardier, Claire; Buchbinder, Rachelle; Edwards, Christopher J.; Landewé, Robert B.; Bijlsma, Johannes W.; Branco, Jaime C.; Burgos-Vargas, Rubén; Catrina, Anca I.; Elewaut, Dirk; Ferrari, Antonio J. L.; Kiely, Patrick; Leeb, Burkhard F.; Montecucco, Carlomaurizio; Müller-Ladner, Ulf; Ostergaard, Mikkel; Zochling, Jane; Falzon, Louise; van der Heijde, Désirée M.

    2014-01-01

    We aimed to develop evidence-based multinational recommendations for the diagnosis and management of gout. Using a formal voting process, a panel of 78 international rheumatologists developed 10 key clinical questions pertinent to the diagnosis and management of gout. Each question was investigated

  12. A strategy model for management

    DEFF Research Database (Denmark)

    Friis, Ole Uhrskov; Holmgren, Jens; Eskildsen, Jacob Kjær

    2016-01-01

    Purpose: Developing a strategy model which explains what organisations should focus on in their strategy work, both in terms of the environment as well as how the strategy is implemented. In addition, the purpose is to demonstrate how this can influence and improve the organisations’ performance...

  13. A systematic review of salivary gland hypofunction and xerostomia induced by cancer therapies: management strategies and economic impact

    DEFF Research Database (Denmark)

    Jensen, Siri Beier; Pedersen, Anne Marie Lynge; Vissink, Arjan

    2010-01-01

    This systematic review aimed to assess the literature for management strategies and economic impact of salivary gland hypofunction and xerostomia induced by cancer therapies and to determine the quality of evidence-based management recommendations. The electronic databases of MEDLINE/PubMed and E...

  14. A systematic review of salivary gland hypofunction and xerostomia induced by cancer therapies : management strategies and economic impact

    NARCIS (Netherlands)

    Jensen, S. B.; Pedersen, A. M. L.; Vissink, A.; Andersen, E.; Brown, C. G.; Davies, A. N.; Dutilh, J.; Fulton, J. S.; Jankovic, L.; Lopes, N. N. F.; Mello, A. L. S.; Muniz, L. V.; Murdoch-Kinch, C. A.; Nair, R. G.; Napenas, J. J.; Nogueira-Rodrigues, A.; Saunders, D.; Stirling, B.; von Bueltzingsloewen, I.; Weikel, D. S.; Spijkervet, F. K. L.; Brennan, M. T.; Elting, L.

    This systematic review aimed to assess the literature for management strategies and economic impact of salivary gland hypofunction and xerostomia induced by cancer therapies and to determine the quality of evidence-based management recommendations. The electronic databases of MEDLINE/PubMed and

  15. Evidence-based Science Communication

    Science.gov (United States)

    Kahan, D.

    2012-12-01

    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.

  16. There are big gaps in our knowledge, and thus approach, to zoo animal welfare: a case for evidence-based zoo animal management.

    Science.gov (United States)

    Melfi, V A

    2009-11-01

    There are gaps in knowledge that hinder our ability within zoos to provide good animal welfare. This does not mean that zoos cannot or do not provide good welfare, only that currently this goal is hindered. Three reasons for these gaps are identified as: (1) there is an emphasis on the identification and monitoring of indicators that represent poor welfare and it is assumed that an absence of poor welfare equates to good welfare. This assumption is overly simplistic and potentially erroneous; (2) our understanding of how housing and husbandry (H&H) affects animals is limited to a small set of variables determined mostly by our anthropogenic sensitivities. Thus, we place more value on captive environmental variables like space and companionship, ignoring other factors that may have a greater impact on welfare, like climate; (3) finally, whether intentional or not, our knowledge and efforts to improve zoo animal welfare are biased to very few taxa. Most attention has been focused on mammals, notably primates, large cats, bears, and elephants, to the exclusion of the other numerous species about which very little is known. Unfortunately, the extent to which these gaps limit our ability to provide zoo animals with good welfare is exacerbated by our over reliance on using myth and tradition to determine zoo animal management. I suggest that we can fill these gaps in our knowledge and improve our ability to provide zoo animals with good welfare through the adoption of an evidence-based zoo animal management framework. This approach uses evidence gathered from different sources as a basis for making any management decisions, as good quality evidence increases the likelihood that these decisions result in good zoo animal welfare.

  17. The notion of strategy in facility management

    DEFF Research Database (Denmark)

    Holzweber, Markus

    2013-01-01

    success. Based on a literature review, the findings of the study report a service-strategy classification grid. Such a service-strategy grid provides for a better understanding of the business environment. The study findings are intended to enhance business managers’ understandings of the issues behind FM......Strategy implementation is critical for any type of organization. Strategy implementation is complex despite previous research describing mechanisms related to the construction of strategy and strategy use of organizations. In this article I attempt to fill this vacuity by examining strategy...... and components of strategy in Facility Management (FM). Since strategy refers to a complex network of thoughts, insights, experiences, expertise, and expectations that provide general guidance for management action, organizations must keep pace with the changing environment to increase market shares and business...

  18. Impact of the implementation of an evidence-based guideline on diagnostic testing, management, and clinical outcomes for infants with bronchiolitis.

    Science.gov (United States)

    Henao-Villada, Ricardo; Sossa-Briceño, Monica P; Rodríguez-Martínez, Carlos E

    2016-10-01

    Although bronchiolitis poses a significant health problem in low- and middle-income countries (LMICs), to the best of our knowledge, to date it has not been determined whether evidence-based bronchiolitis clinical practice guidelines (CPGs) complemented by standardized educational strategies reduce the use of unnecessary diagnostic tests and medications and improve clinically important outcomes in LMICs. In an uncontrolled before and after study, we assessed the impact of the implementation of an evidence-based bronchiolitis CPG on physician behavior and the care of infants with bronchiolitis by comparing pre-guideline (March to August 2014) and post-guideline (March to August 2015) use of diagnostic tests and medications through an electronic medical record review in a children's hospital in Bogota, Colombia. We also sought to assess the impact of the implementation of the CPG on clinically important outcomes such as lengths of stay, hospital admissions, intensive care admissions, and hospital readmissions. Data from 662 cases of bronchiolitis (pre-guideline period) were compared with the data from 703 cases (post-guideline period). On comparing the pre- and post-guideline periods, it was seen that there was a significant increase in the proportion of patients with an appropriate diagnosis and treatment of bronchiolitis (36.4% versus 44.5%, p = 0.003), and there were statistically significant decreases in the use of a hemogram (33.2% versus 26.6%, p=0.010), procalcitonin (3.9% versus 1.6%, p=0.018), nebulized beta-2 agonists (45.6% versus 3.4%, p saline was seen (79.6% versus 91.7%, p bronchiolitis was not associated with significant changes in clinically important outcomes. The development and implementation of a good quality bronchiolitis CPG is associated with a significant increase in the proportion of cases with an appropriate diagnosis and treatment of the disease in the context of a university-based hospital located in the capital of an LMIC. However, we

  19. Comparative Analysis of Principals' Management Strategies in ...

    African Journals Online (AJOL)

    ... management strategies adopted by principals of schools in public and private secondary schools in Anambra State showed no significant differences. It was recommended among others that principals of secondary schools should adopt all the management strategies in this study as this will improve school administration ...

  20. Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline for the Management of Patients With Positional Plagiocephaly: The Role of Physical Therapy.

    Science.gov (United States)

    Baird, Lissa C; Klimo, Paul; Flannery, Ann Marie; Bauer, David F; Beier, Alexandra; Durham, Susan; Lin, Alexander Y; McClung-Smith, Catherine; Mitchell, Laura; Nikas, Dimitrios; Tamber, Mandeep S; Tyagi, Rachana; Mazzola, Catherine

    2016-11-01

    Evidence-based guidelines are not currently available for the treatment of positional plagiocephaly and, in particular, for the use of physical therapy for treatment. To answer the question: "does physical therapy provide effective treatment for positional plagiocephaly?" Treatment recommendations are created based on the available evidence. The PubMed and the Cochrane Library were queried using MeSH headings and key words relevant to the objective of this systematic review. Abstracts were reviewed, after which studies meeting the inclusion criteria were selected and graded according to their quality of evidence (Classes I-III). Evidentiary tables were constructed that summarized pertinent study results, and recommendations were made based on the quality of the literature (Levels I-III). Three studies met criteria for inclusion. Two randomized, controlled trials (Class I and Class II) and 1 prospective study assessing plagiocephaly as a secondary outcome measure (Class III) were included. Within the limits of this systematic review, physical therapy is significantly more effective than repositioning education as a treatment for positional plagiocephaly. There is no significant difference between physical therapy and a positioning pillow as a treatment for positional plagiocephaly. However, given the American Academy of Pediatrics' recommendation against soft pillows in cribs to ensure a safe sleeping environment for infants, physical therapy must be recommended over the use of a positioning pillow. The full guidelines document can be located at https://www.cns.org/guidelines/guidelines-management-patients-positional-plagiocephaly/Chapter_4.

  1. Guidelines: Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline for the Management of Patients With Positional Plagiocephaly: The Role of Physical Therapy.

    Science.gov (United States)

    Baird, Lissa C; Klimo, Paul; Flannery, Ann Marie; Bauer, David F; Beier, Alexandra; Durham, Susan; Lin, Alexander Y; McClung-Smith, Catherine; Mitchell, Laura; Nikas, Dimitrios; Tamber, Mandeep S; Tyagi, Rachana; Mazzola, Catherine

    2016-11-01

    Evidence-based guidelines are not currently available for the treatment of positional plagiocephaly and, in particular, for the use of physical therapy for treatment. To answer the question: "does physical therapy provide effective treatment for positional plagiocephaly?" Treatment recommendations are created based on the available evidence. The PubMed and the Cochrane Library were queried using MeSH headings and key words relevant to the objective of this systematic review. Abstracts were reviewed, after which studies meeting the inclusion criteria were selected and graded according to their quality of evidence (Classes I-III). Evidentiary tables were constructed that summarized pertinent study results, and recommendations were made based on the quality of the literature (Levels I-III). Three studies met criteria for inclusion. Two randomized, controlled trials (Class I and Class II) and 1 prospective study assessing plagiocephaly as a secondary outcome measure (Class III) were included. Within the limits of this systematic review, physical therapy is significantly more effective than repositioning education as a treatment for positional plagiocephaly. There is no significant difference between physical therapy and a positioning pillow as a treatment for positional plagiocephaly. However, given the American Academy of Pediatrics' recommendation against soft pillows in cribs to ensure a safe sleeping environment for infants, physical therapy must be recommended over the use of a positioning pillow. The full guidelines document can be located at https://www.cns.org/guidelines/guidelines-management-patients-positional-plagiocephaly/Chapter_4.

  2. Bologna Guidelines for Diagnosis and Management of Adhesive Small Bowel Obstruction (ASBO): 2010 Evidence-Based Guidelines of the World Society of Emergency Surgery

    Science.gov (United States)

    2011-01-01

    Background There is no consensus on diagnosis and management of ASBO. Initial conservative management is usually safe, however proper timing for discontinuing non operative treatment is still controversial. Open surgery or laparoscopy are used without standardized indications. Methods A panel of 13 international experts with interest and background in ASBO and peritoneal diseases, participated in a consensus conference during the 1st International Congress of the World Society of Emergency Surgery and 9th Peritoneum and Surgery Society meeting, in Bologna, July 1-3, 2010, for developing evidence-based recommendations for diagnosis and management of ASBO. Whenever was a lack of high-level evidence, the working group formulated guidelines by obtaining consensus. Recommendations In absence of signs of strangulation and history of persistent vomiting or combined CT scan signs (free fluid, mesenteric oedema, small bowel faeces sign, devascularized bowel) patients with partial ASBO can be managed safely with NOM and tube decompression (either with long or NG) should be attempted. These patients are good candidates for Water Soluble Contrast Medium (WSCM) with both diagnostic and therapeutic purposes. The appearance of water-soluble contrast in the colon on X-ray within 24 hours from administration predicts resolution. WSCM may be administered either orally or via NGT (50-150 ml) both immediately at admission or after an initial attempt of conservative treatment of 48 hours. The use of WSCM for ASBO is safe and reduces need for surgery, time to resolution and hospital stay. NOM, in absence of signs of strangulation or peritonitis, can be prolonged up to 72 hours. After 72 hours of NOM without resolution surgery is recommended. Patients treated non-operatively have shorter hospital stay, but higher recurrence rate and shorter time to re-admission, although the risk of new surgically treated episodes of ASBO is unchanged. Risk factors for recurrences are age surgery when

  3. Evidence-based recommendations on the role of dermatologists in the diagnosis and management of psoriatic arthritis: systematic review and expert opinion.

    Science.gov (United States)

    Richard, M-A; Barnetche, T; Rouzaud, M; Sevrain, M; Villani, A P; Aractingi, S; Aubin, F; Beylot-Barry, M; Joly, P; Jullien, D; Le Maître, M; Misery, L; Ortonne, J-P; Cantagrel, A; Paul, C

    2014-08-01

    Psoriatic arthritis (PsA) can develop at any time during the course of psoriasis. The aims of these practical recommendations are to help dermatologists identify patients at risk of PsA, to diagnose PsA in collaboration with rheumatologists and to gain a better understanding of initial PsA management. A scientific committee consisting of 10 dermatologists and a rheumatologist selected clinically relevant questions to be addressed by evidence-based recommendations using the DELPHI method. For each question, a systematic literature review was performed in Medline, Embase and the Cochrane Library databases. The levels of evidence of all selected and reviewed articles were appraised according to the Oxford levels of evidence. An expert board of 30 dermatologists reviewed and analysed the evidence and developed recommendations for the selected questions. Agreement among participants was assessed on a 10-point scale, and the potential impact of the recommendations on clinical practice was evaluated. Among the 6960 references identified, 190 relevant articles were included in the reviews. Three recommendations regarding risk factors for PsA and one regarding PsA prevalence were issued. The mean agreement score between participants varied from 7.8 to 9.6. Three recommendations on PsA screening tools that can be used by dermatologists were issued. The mean agreement score between participants varied from 7.7 to 9.4. Initial PsA treatment options according to published guidelines were critically appraised for axial and peripheral involvement and enthesitis/dactylitis. Three recommendations were issued. The mean agreement score between participants varied from 7.6 to 8.7. The systematic literature research and meta-analyses did not provide high-quality evidence to support recommendations regarding PsA screening. Conversely, PsA treatment options were supported by strong evidence. Cooperation between dermatologists and rheumatologists should be emphasized to better identify

  4. The Global Spine Care Initiative: applying evidence-based guidelines on the non-invasive management of back and neck pain to low- and middle-income communities.

    Science.gov (United States)

    Chou, Roger; Côté, Pierre; Randhawa, Kristi; Torres, Paola; Yu, Hainan; Nordin, Margareta; Hurwitz, Eric L; Haldeman, Scott; Cedraschi, Christine

    2018-02-19

    The purpose of this review was to develop recommendations for the management of spinal disorders in low-income communities, with a focus on non-invasive pharmacological and non-pharmacological therapies for non-specific low back and neck pain. We synthesized two evidence-based clinical practice guidelines for the management of low back and neck pain. Our recommendations considered benefits, harms, quality of evidence, and costs, with attention to feasibility in medically underserved areas and low- and middle-income countries. Clinicians should provide education and reassurance, advise patients to remain active, and provide information about self-care options. For acute low back and neck pain without serious pathology, primary conservative treatment options are exercise, manual therapy, superficial heat, and nonsteroidal anti-inflammatory drugs (NSAIDs). For patients with chronic low back and neck pain without serious pathology, primary treatment options are exercise, yoga, cognitive behavioral therapies, acupuncture, biofeedback, progressive relaxation, massage, manual therapy, interdisciplinary rehabilitation, NSAIDs, acetaminophen, and antidepressants. For patients with spinal pain with radiculopathy, clinicians may consider exercise, spinal manipulation, or NSAIDs; use of other interventions requires extrapolation from evidence regarding effectiveness for non-radicular spinal pain. Clinicians should not offer treatments that are not effective, including benzodiazepines, botulinum toxin injection, systemic corticosteroids, cervical collar, electrical muscle stimulation, short-wave diathermy, transcutaneous electrical nerve stimulation, and traction. Guidelines developed for high-income settings were adapted to inform a care pathway and model of care for medically underserved areas and low- and middle-income countries by considering factors such as costs and feasibility, in addition to benefits, harms, and the quality of underlying evidence. The selection of

  5. Development of theory-based knowledge translation interventions to facilitate the implementation of evidence-based guidelines on the early management of adults with traumatic spinal cord injury.

    Science.gov (United States)

    Bérubé, Mélanie; Albert, Martin; Chauny, Jean-Marc; Contandriopoulos, Damien; DuSablon, Anne; Lacroix, Sébastien; Gagné, Annick; Laflamme, Élise; Boutin, Nathalie; Delisle, Stéphane; Pauzé, Anne-Marie; MacThiong, Jean-Marc

    2015-12-01

    Optimal, early management following a spinal cord injury (SCI) can limit individuals' disabilities and costs related to their care. Several knowledge syntheses were recently published to guide health care professionals with regard to early interventions in SCI patients. However, no knowledge translation (KT) intervention, selected according to a behaviour change theory, has been proposed to facilitate the use of SCI guidelines in an acute care setting. To develop theory-informed KT interventions to promote the application of evidence-based recommendations on the acute care management of SCI patients. The first four phases of the knowledge-to-action model were used to establish the study design. Knowledge selection was based on the Grading of Recommendations Assessment, Development and Evaluation system. Knowledge adaptation to the local context was sourced from the ADAPTE process. The theoretical domains framework oriented the selection and development of the interventions based on an assessment of barriers and enablers to knowledge application. Twenty-nine recommendations were chosen and operationalized in measurable clinical indicators. Barriers related to knowledge, skills, perceived capacities, beliefs about consequences, social influences, and the environmental context and resources theoretical domains were identified. The mapping of behaviour change techniques associated with those barriers led to the development of an online educational curriculum, interdisciplinary clinical pathways as well as policies and procedures. This research project allowed us developing KT interventions according to a thorough behavioural change methodology. Exposure to the generated interventions will support health care professionals in providing the best care to SCI patients. © 2015 John Wiley & Sons, Ltd.

  6. Leadership Strategies for Managing Conflict.

    Science.gov (United States)

    Kormanski, Chuck

    1982-01-01

    Discusses the impact of conflict in small group development theory. Views conflict as a positive, normally occurring behavior and presents leadership strategies involving withdrawal, suppression, integration, compromise, and power. Examines situational contingencies and presents a rationale for strategy selection and intervention. (Author)

  7. Teaching evidence-based practice in a distance education occupational therapy doctoral program: strategies for professional growth and advancing the profession.

    Science.gov (United States)

    Reynolds, Stacey

    2010-01-01

    ABSTRACT The Centennial Vision of the American Occupational Therapy Association (AOTA) projects that by 2017 all occupational therapy (OT) practice areas will be supported by evidence. Achieving this goal requires preparing clinicians with the skills to assimilate, analyze, and apply research to their areas of practice and communicate the value of OT services to consumers and payers. These skills are at the heart of evidence-based practice (EBP). Educators must be prepared to teach EBP skills in both entry-level and postprofessional programs. This article outlines how EBP can be taught to postprofessional occupational therapy clinical doctoral students using a distance education format. Key features of a successful EBP course include having access to full-text electronic articles, opportunities for students to explore the literature in their own areas of interest, consistent and timely feedback on written work and discussion topics, and opportunities to collaborate with peers.

  8. Strategies for technology management in clinical engineering.

    Science.gov (United States)

    Hughes, J D

    1993-01-01

    Clinical and Biomedical Engineering managers are in a position to utilize their management skills and apply analytical strategies to identify and capture cost savings opportunities in their institutions. To do so, however, they may be required to expand their scope and extend beyond what may have been their traditional areas of responsibility. This paper examines how management skills, techniques, and strategies were applied to establish a program to manage the repair of rigid and flexible surgical scopes. The program resulted in substantial cost savings, as well as other significant quantitative and qualitative benefits, and further demonstrated the value of proper technology management in healthcare institutions.

  9. Pain management for chronic musculoskeletal conditions : the development of an evidence-based and theory-informed pain self-management course

    OpenAIRE

    Carnes, Dawn; Homer, Kate; Underwood, Martin; Pincus, Tamar; Rahman, A; Taylor, Stephanie J. C.

    2013-01-01

    Objective: To devise and test a self-management course for chronic pain patients based on evidence and underpinned by theory using the Medical Research Council (MRC) framework for developing complex interventions.\\ud \\ud Design: We used a mixed method approach. We conducted a systematic review of the effectiveness of components and characteristics of pain management courses. We then interviewed chronic pain patients who had attended pain and self-management courses. Behavioural change theorie...

  10. Overweight and obesity management strategies.

    Science.gov (United States)

    Kahan, Scott

    2016-06-01

    Comprehensive lifestyle interventions, including nutrition, physical activity, and behavioral therapy, are the foundation for clinical obesity management. New tools and treatment approaches help clinicians provide these interventions and support weight management in the primary care setting. Escalating treatment, such as using pharmacotherapy, medical devices, or bariatric surgery, are important considerations for appropriate patients who do not respond to lifestyle counseling. This article provides a review of obesity treatment in primary care and managed care settings. Principles of lifestyle changes for weight management, behavioral counseling, and options for pharmacotherapy, medical devices, and bariatric surgery are discussed.

  11. Recycling - Danish Waste Management Strategy

    DEFF Research Database (Denmark)

    Romann, Anne Funch; Thøgersen, John; Husmer, Lis

    The report challanges recycling as the only waste handling strategy. The tonnes of recycled materials should not be the only goal - it is essential to minimize the waste production and focus on eliminating hazardous materials.......The report challanges recycling as the only waste handling strategy. The tonnes of recycled materials should not be the only goal - it is essential to minimize the waste production and focus on eliminating hazardous materials....

  12. Management strategies in antithrombotic therapy

    National Research Council Canada - National Science Library

    Lincoff, A. Michael; Messerli, Adrian W; Askari, Arman

    2007-01-01

    ... in the management of non-st-elevation ACS 4.5 GP IIb/IIIa inhibitors in the management of acute STEMI 4.6 Safety of GP IIb/IIIa inhibitors 4.7 Summary 77 77 78 80 87 91 94 96 Chapter 5 Unfractionated Hepa...

  13. Evidence-based case selection: An innovative knowledge management method to cluster public technical and vocational education and training colleges in South Africa

    Directory of Open Access Journals (Sweden)

    Margaretha M. Visser

    2017-01-01

    Full Text Available Background: Case studies are core constructs used in information management research. A persistent challenge for business, information management and social science researchers is how to select a representative sample of cases among a population with diverse characteristics when convenient or purposive sampling is not considered rigorous enough. The context of the study is post-school education, and it involves an investigation of quantitative methods of clustering the population of public technical and vocational education and training (TVET colleges in South Africa into groups with a similar level of maturity in terms of their information systems.Objectives: The aim of the study was to propose an evidence-based quantitative method for the selection of cases for case study research and to demonstrate the use and usefulness thereof by clustering public TVET colleges.Method: The clustering method was based on the use of a representative characteristic of the context, as a proxy. In this context of management information systems (MISs, website maturity was used as a proxy and website maturity model theory was used in the development of an evaluation questionnaire. The questionnaire was used for capturing data on website characteristics, which was used to determine website maturity. The websites of the 50 public TVET colleges were evaluated by nine evaluators. Multiple statistical techniques were applied to establish inter-rater reliability and to produce clusters of colleges.Results: The analyses revealed three clusters of public TVET colleges based on their website maturity levels. The first cluster includes three colleges with no websites or websites at a low maturity level. The second cluster consists of 30 colleges with websites at an average maturity level. The third cluster contains 17 colleges with websites at a high maturity level.Conclusion: The main contribution to the knowledge domain is an innovative quantitative method employing a

  14. Comprehensive Self-Management Strategies.

    Science.gov (United States)

    Bourbeau, J; Lavoie, K L; Sedeno, M

    2015-08-01

    In this article, we provide a review of the literature on self-management interventions and we are giving some thought to how, when, and by whom they should be offered to patients. The present literature based on randomized clinical trials has demonstrated benefits (reduced hospital admissions and improved health status) for chronic obstructive pulmonary disease (COPD) patients undergoing self-management interventions, although there are still problems with the heterogeneity among interventions, study populations, follow-up time, and outcome measures that make generalization difficult in real life. Key to the success, self-management intervention has to target behavior change. Proper self-management support is a basic prerequisite, for example, techniques and skills used by health care providers "case manager" to instrument patients with the knowledge, confidence, and skills required to effectively self-manage their disease. To improve health behaviors and engagement in self-management, self-management interventions need to target enhancing intrinsic motivation to change. This will best be done using client-centered communication (motivational communication) that encourages patients to express what intrinsically motivates them (e.g., consistent with their values or life goals) to adopt certain health behavior, with the goal of helping them overcome their ambivalence about change. Finally, if we want to be able to design and implement self-management interventions that are integrated, coherent, and have a strong likelihood of success, we need to take a more careful look and give more attention at the case manager, the patient (patient evaluation), and the quality assurance. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  15. Multinational evidence-based recommendations for pain management by pharmacotherapy in inflammatory arthritis: integrating systematic literature research and expert opinion of a broad panel of rheumatologists in the 3e Initiative

    NARCIS (Netherlands)

    Whittle, Samuel L.; Colebatch, Alexandra N.; Buchbinder, Rachelle; Edwards, Christopher J.; Adams, Karen; Englbrecht, Matthias; Hazlewood, Glen; Marks, Jonathan L.; Radner, Helga; Ramiro, Sofia; Richards, Bethan L.; Tarner, Ingo H.; Aletaha, Daniel; Bombardier, Claire; Landewé, Robert B.; Müller-Ladner, Ulf; Bijlsma, Johannes W. J.; Branco, Jaime C.; Bykerk, Vivian P.; da Rocha Castelar Pinheiro, Geraldo; Catrina, Anca I.; Hannonen, Pekka; Kiely, Patrick; Leeb, Burkhard; Lie, Elisabeth; Martinez-Osuna, Píndaro; Montecucco, Carlomaurizio; Ostergaard, Mikkel; Westhovens, Rene; Zochling, Jane; van der Heijde, Désirée

    2012-01-01

    To develop evidence-based recommendations for pain management by pharmacotherapy in patients with inflammatory arthritis (IA). A total of 453 rheumatologists from 17 countries participated in the 2010 3e (Evidence, Expertise, Exchange) Initiative. Using a formal voting process, 89 rheumatologists

  16. Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2013 update of the evidence-based guidelines from the world society of emergency surgery ASBO working group

    NARCIS (Netherlands)

    S. Di Saverio (Salomone); F. Coccolini (Federico); M. Galati (Marica); N. Smerieri (Nazareno); W.L. Biffl (Walter); L. Ansaloni (Luca); G. Tugnoli (Gregorio); G.C. Velmahos (George ); M. Sartelli (Massimo); C. Bendinelli (Cino); G.P. Fraga (Gustavo); M.D. Kelly (Michael ); F.A. Moore (Frederick); V. Mandala; V. Mandalà (Vincenzo); M. Masetti (Michele); E. Jovine (Elio); A.D. Pinna (Antonio ); A.B. Peitzman (Andrew); A. Leppaniemi (Ari); P.H. Sugarbaker (Paul ); H. van Goor (Harry); E.E. Moore (Ernest); J. Jeekel (Hans); F. Catena (Fausto)

    2013-01-01

    textabstractBackground: In 2013 Guidelines on diagnosis and management of ASBO have been revised and updated by the WSES Working Group on ASBO to develop current evidence-based algorithms and focus indications and safety of conservative treatment, timing of surgery and indications for

  17. Waste Management Strategy in The Netherlands. Part 3. Strategy Selection

    Energy Technology Data Exchange (ETDEWEB)

    Haverkate, B.R.W

    2003-05-05

    This report reflects the Dutch input prepared in the framework of work package 3 of the EU thematic network COMPAS, which dealt with the evaluation and comparison of waste management strategies in EU member states and their applicant countries. Based on three generic decision trees the current strategy as well as the reason(s) for the selected options regarding radioactive waste management in The Netherlands is extensively described in this report. The trees are represented in terms of (numbered) decision nodes. Each node is discussed in the context of the Dutch situation, with relevant potential outcomes being highlighted where possible. After a short introduction (chapter 1) followed by a brief waste management policy overview (chapter 2), this approach is considered, in chapter 3, for: spent nuclear fuel and high level waste; low and intermediate level waste; disposal strategy.

  18. Strategies for transforming human service organizations into learning organizations: knowledge management and the transfer of learning.

    Science.gov (United States)

    Austin, Michael J

    2008-01-01

    This analysis describes the nature of a learning organization, defines the boundaries of evidence-informed practice, identifies the elements of knowledge management, and specifies the elements of the transfer of learning. A set of principles are presented to guide managers in transforming human service organizations into learning organizations along with a set of implementation strategies that can inform participants of the values and benefits of knowledge management. This analysis features concepts and principles adapted and synthesized from research in diverse fields, such as evidence-based health care and the for-profit sector related to learning organizations, knowledge management, and the transfer of learning.

  19. Rapid prototyping of energy management charging strategies

    Energy Technology Data Exchange (ETDEWEB)

    Ciulavu, Oana [Hella Electronics Romania, Timisoara (Romania); Starkmuth, Timo; Jesolowitz, Reinhard [Hella KGaA Hueck und Co., Lippstadt (Germany)

    2010-07-01

    This paper presents an approach to develop charging strategies to support a vehicle energy management aiming for the reduction of CO{sub 2} emissions and decreased fuel consumption by using the Hardware-in-the-loop (HIL) environment. (orig.)

  20. Conflict management strategies for effective performance of ...

    African Journals Online (AJOL)

    Also, there is significant relationship between the role of extension and survival strategies. All the extension agents interviewed were of the opinion that conflict resolution management strategies should be included in agricultural extension package for efficient and sustainable agricultural and rural development.

  1. Drought Management Strategies in Spain

    Directory of Open Access Journals (Sweden)

    Pilar Paneque

    2015-11-01

    Full Text Available The ongoing debate on water policies in Spain is characterised by a traditional paradigm, dominated by the intervention on hydrological systems through the construction and management of infrastructure, which is progressively being abandoned but is currently still strong while the emergence of new management approaches. Climate change and the Water Framework Directive (WFD are, in addition, the background to increasing challenges to traditional perspectives on drought, and important steps have been taken towards their replacement. This work analyzes the evolution of the normative structure and management models to identify recent shifts. The analysis is based on a fundamental conceptual change that places drought in the framework of risk, rather than that of crisis. I argue for the need to advance new prevention policies that can finally overcome productivist inertia and undertake essential tasks such as reallocating water flows, revising and controlling the water-concession system, and reinforcing and guaranteeing public participation.

  2. Breast cancer screening in the era of density notification legislation: summary of 2014 Massachusetts experience and suggestion of an evidence-based management algorithm by multi-disciplinary expert panel.

    Science.gov (United States)

    Freer, Phoebe E; Slanetz, Priscilla J; Haas, Jennifer S; Tung, Nadine M; Hughes, Kevin S; Armstrong, Katrina; Semine, A Alan; Troyan, Susan L; Birdwell, Robyn L

    2015-09-01

    Stemming from breast density notification legislation in Massachusetts effective 2015, we sought to develop a collaborative evidence-based approach to density notification that could be used by practitioners across the state. Our goal was to develop an evidence-based consensus management algorithm to help patients and health care providers follow best practices to implement a coordinated, evidence-based, cost-effective, sustainable practice and to standardize care in recommendations for supplemental screening. We formed the Massachusetts Breast Risk Education and Assessment Task Force (MA-BREAST) a multi-institutional, multi-disciplinary panel of expert radiologists, surgeons, primary care physicians, and oncologists to develop a collaborative approach to density notification legislation. Using evidence-based data from the Institute for Clinical and Economic Review, the Cochrane review, National Comprehensive Cancer Network guidelines, American Cancer Society recommendations, and American College of Radiology appropriateness criteria, the group collaboratively developed an evidence-based best-practices algorithm. The expert consensus algorithm uses breast density as one element in the risk stratification to determine the need for supplemental screening. Women with dense breasts and otherwise low risk (20% lifetime) should consider supplemental screening MRI in addition to routine mammography regardless of breast density. We report the development of the multi-disciplinary collaborative approach to density notification. We propose a risk stratification algorithm to assess personal level of risk to determine the need for supplemental screening for an individual woman.

  3. Applying knowledge management strategies to economic ...

    African Journals Online (AJOL)

    This paper examines economic development as one aspect of sustainability, with a focus on knowledge management as an economic development strategy. Using Grey's categories of knowledge management, the authors address sustainable economic development in the context of sub-Saharan Africa. Production ...

  4. Counterterrorism as Risk Management Strategies

    OpenAIRE

    Jore, Sissel Haugdal

    2012-01-01

    PhD thesis in Risk management and societal safety This thesis is based on the following papers, not available in UiS Brage due to copyright: Article 1: Jore, S. H. ; Nja, 0. (2010): Risk of Terrorism: A Scientifically Valid Phenomenon or a Wild Guess? The Impact of Different Approaches to Risk Assessment. Critical Approaches to Discourse Analysis across Disciplines. Vol 4 (2): 197 - 216. URL: http://cadaad.net/2010_volume_4_issue_2/65-56 Article 2: Jore,...

  5. Heat Management Strategy Trade Study

    Energy Technology Data Exchange (ETDEWEB)

    Nick Soelberg; Steve Priebe; Dirk Gombert; Ted Bauer

    2009-09-01

    This Heat Management Trade Study was performed in 2008-2009 to expand on prior studies in continued efforts to analyze and evaluate options for cost-effectively managing SNF reprocessing wastes. The primary objective was to develop a simplified cost/benefit evaluation for spent nuclear fuel (SNF) reprocessing that combines the characteristics of the waste generated through reprocessing with the impacts of the waste on heating the repository. Under consideration were age of the SNF prior to reprocessing, plutonium and minor actinide (MA) separation from the spent fuel for recycle, fuel value of the recycled Pu and MA, age of the remaining spent fuel waste prior to emplacement in the repository, length of time that active ventilation is employed in the repository, and elemental concentration and heat limits for acceptable glass waste form durability. A secondary objective was to identify and qualitatively analyze remaining issues such as (a) impacts of aging SNF prior to reprocessing on the fuel value of the recovered fissile materials, and (b) impact of reprocessing on the dose risk as developed in the Yucca Mountain Total System Performance Assessment (TSPA). Results of this study can be used to evaluate different options for managing decay heat in waste streams from spent nuclear fuel.

  6. Evidence based case selection: An innovative knowledge management method to cluster public technical and vocational education and training colleges in South Africa

    CSIR Research Space (South Africa)

    Visser, MM

    2017-03-01

    Full Text Available and vocational education and training (TVET) colleges in South Africa into groups with a similar level of maturity in terms of their information systems. Objectives: The aim of the study was to propose an evidence-based quantitative method for the selection...

  7. Strategies for psychosocial risk management in manufacturing

    OpenAIRE

    Guadix Martín, José; Carrillo Castrillo, Jesús Antonio; Onieva Giménez, Luis Gerardo; de Lucena, David

    2015-01-01

    Psychosocial risk is a concern for employers across Europe. Psychosocial risk management, however, is younger than other risk management fields such as safety, hygiene, and ergonomics. Psychosocial risk control prevents accidents and absenteeism. This study examines strategies for psychosocial risk management in manufacturing organizations. The study employs structural equation modeling to analyze results of the European Survey of Enterprises onNewand Emerging Risks (ESENER), a survey that fi...

  8. Pain management for chronic musculoskeletal conditions: the development of an evidence-based and theory-informed pain self-management course.

    Science.gov (United States)

    Carnes, Dawn; Homer, Kate; Underwood, Martin; Pincus, Tamar; Rahman, Anisur; Taylor, Stephanie J C

    2013-11-14

    To devise and test a self-management course for chronic pain patients based on evidence and underpinned by theory using the Medical Research Council (MRC) framework for developing complex interventions. We used a mixed method approach. We conducted a systematic review of the effectiveness of components and characteristics of pain management courses. We then interviewed chronic pain patients who had attended pain and self-management courses. Behavioural change theories were mapped onto our findings and used to design the intervention. We then conducted a feasibility study to test the intervention. Primary care in the inner city of London, UK. Adults (18 years or older) with chronic musculoskeletal pain. Related disability, quality of life, coping, depression, anxiety, social integration and healthcare resource use. The systematic reviews indicated that group-based courses with joint lay and healthcare professional leadership and that included a psychological component of short duration (social interaction and course location, and that timing and good tutoring were important determinants of attendance. We used behavioural change theories (social learning theory and cognitive behaviour approaches (CBA)) to inform course content. The course addressed: understanding and accepting pain, mood and pain, unhelpful thoughts and behaviour, problem solving, goal setting, action planning, movement, relaxation and social integration/reactivation. Attendance was 85%; we modified the recruitment of patients, the course and the training of facilitators as a result of testing. The MRC guidelines were helpful in developing this intervention. It was possible to train both lay and non-psychologists to facilitate the courses and deliver CBA. The course was feasible and well received.

  9. Evidence-based recommendations for the management of ankylosing spondylitis: systematic literature search of the 3E Initiative in Rheumatology involving a broad panel of experts and practising rheumatologists

    DEFF Research Database (Denmark)

    Sidiropoulos, P.I.; Hatemi, G.; Song, I.H.

    2008-01-01

    of enthesitis. The compiled agreement among experts ranged from 72% to 93%. CONCLUSION: Recommendations for the management of AS were developed using an evidence-based approach followed by expert/physician consensus with high level of agreement. Involvement of a larger and more representative group......OBJECTIVE: Recommendations and/or guidelines represent a popular way of integrating evidence-based medicine into clinical practice. The 3E Initiatives is a multi-national effort to develop recommendations for the management of rheumatic diseases, which involves a large number of experts combined...... with practising rheumatologists addressing specific questions relevant to clinical practice. METHODS: Ten countries participated in three rounds of discussions and votes concerning the management of AS. A set of nine questions was formulated in the domains of diagnosis, monitoring and treatment, after a Delphi...

  10. Methods for Evidence-Based Practice: Quantitative Synthesis of Single-Subject Designs

    Science.gov (United States)

    Shadish, William R.; Rindskopf, David M.

    2007-01-01

    Good quantitative evidence does not require large, aggregate group designs. The authors describe ground-breaking work in managing the conceptual and practical demands in developing meta-analytic strategies for single subject designs in an effort to add to evidence-based practice. (Contains 2 figures.)

  11. Management strategies for acne vulgaris

    Science.gov (United States)

    Whitney, Kristen M; Ditre, Chérie M

    2011-01-01

    Clinical question: What are the most effective treatment(s) for mild, moderate, severe, and hormonally driven acne? Results: Mild acne responds favorably to topical treatments such as benzoyl peroxide, salicylic acid, and a low-dose retinoid. Moderate acne responds well to combination therapy comprising-topical benzoyl peroxide, antibiotics, and/or retinoids, as well as oral antibiotics in refractory cases and oral contraceptive pills for female acne patients. Severe nodulocystic acne vulgaris responds best to oral isotretinoin therapy. In female patients with moderate to severe acne, facial hair, loss of scalp hair and irregular periods, polycystic ovarian syndrome should be considered and appropriate treatment with hormonal modulation given. Adjunctive procedures can also be considered for all acne patients. Implementation: Pitfalls to avoid when treating acne: treatment of acne in women of child-bearing age; familiarization of all acne treatments in order to individualize management for patients; indications for specialist referral. PMID:21691566

  12. Formative research and development of an evidence-based communication strategy: the introduction of Vi typhoid fever vaccine among school-aged children in Karachi, Pakistan.

    Science.gov (United States)

    Pach, Alfred; Tabbusam, Ghurnata; Khan, M Imran; Suhag, Zamir; Hussain, Imtiaz; Hussain, Ejaz; Mumtaz, Uzma; Haq, Inam Ul; Tahir, Rehman; Mirani, Amjad; Yousafzai, Aisha; Sahastrabuddhe, Sushant; Ochiai, R Leon; Soofi, Sajid; Clemens, John D; Favorov, Michael O; Bhutta, Zulfiqar A

    2013-01-01

    The authors conducted formative research (a) to identify stakeholders' concerns related to typhoid fever and the need for disease information and (b) to develop a communication strategy to inform stakeholders and address their concerns and motivate for support of a school-based vaccination program in Pakistan. Data were collected during interactive and semi-structured focus group discussions and interviews, followed by a qualitative analysis and multidisciplinary consultative process to identify an effective social mobilization strategy comprised of relevant media channels and messages. The authors conducted 14 focus group discussions with the parents of school-aged children and their teachers, and 13 individual interviews with school, religious, and political leaders. Parents thought that typhoid fever was a dangerous disease, but were unsure of their children's risk. They were interested in vaccination and were comfortable with a school-based vaccination if conducted under the supervision of trained and qualified staff. Teachers and leaders needed information on typhoid fever, the vaccine, procedures, and sponsors of the vaccination program. Meetings were considered the best form of information dissemination, followed by printed materials and mass media. This study shows how qualitative research findings can be translated into an effective social mobilization and communication approach. The findings of the research indicated the importance of increasing awareness of typhoid fever and the benefits of vaccination against the disease. Identification and dissemination of relevant, community-based disease and vaccination information will increase demand and use of vaccination.

  13. Information Technology Management Strategies to Implement Knowledge Management Systems

    Science.gov (United States)

    McGee, Mary Jane Christy

    2017-01-01

    More than 38% of the U.S. public workforce will likely retire by 2030, which may result in a labor shortage. Business leaders may adopt strategies to mitigate knowledge loss within their organizations by capturing knowledge in a knowledge management system (KMS). The purpose of this single case study was to explore strategies that information…

  14. Epilepsy during pregnancy: focus on management strategies

    Directory of Open Access Journals (Sweden)

    Borgelt LM

    2016-09-01

    Full Text Available Laura M Borgelt,1 Felecia M Hart,2 Jacquelyn L Bainbridge2 1Departments of Clinical Pharmacy and Family Medicine, 2Departments of Clinical Pharmacy and Neurology, University of Colorado Anschutz Medical Campus, Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA Abstract: In the US, more than one million women with epilepsy are of childbearing age and have over 20,000 babies each year. Patients with epilepsy who become pregnant are at risk of complications, including changes in seizure frequency, maternal morbidity and mortality, and congenital anomalies due to antiepileptic drug exposure. Appropriate management of epilepsy during pregnancy may involve frequent monitoring of antiepileptic drug serum concentrations, potential preconception switching of antiepileptic medications, making dose adjustments, minimizing peak drug concentration with more frequent dosing, and avoiding potentially teratogenic medications. Ideally, preconception planning will be done to minimize risks to both the mother and fetus during pregnancy. It is important to recognize benefits and risks of current and emerging therapies, especially with revised pregnancy labeling in prescription drug product information. This review will outline risks for epilepsy during pregnancy, review various recommendations from leading organizations, and provide an evidence-based approach for managing patients with epilepsy before, during, and after pregnancy. Keywords: epilepsy, teratogens, anticonvulsants, medication therapy management

  15. Management strategies for acne vulgaris

    Directory of Open Access Journals (Sweden)

    Whitney KM

    2011-04-01

    Full Text Available Kristen M Whitney1, Chérie M Ditre21Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA; 2Skin Enhancement Center and Cosmetic Dermatology, Department of Dermatology, University of Pennsylvania School of Medicine, Philadelphia, PA, USADate of preparation: 30th November 2010Conflicts of interest: None declaredClinical question: What are the most effective treatment(s for mild, moderate, severe, and hormonally driven acne?Results: Mild acne responds favorably to topical treatments such as benzoyl peroxide, salicylic acid, and a low-dose retinoid. Moderate acne responds well to combination therapy comprising-topical benzoyl peroxide, antibiotics, and/or retinoids, as well as oral antibiotics in refractory cases and oral contraceptive pills for female acne patients. Severe nodulocystic acne vulgaris responds best to oral isotretinoin therapy. In female patients with moderate to severe acne, facial hair, loss of scalp hair and irregular periods, polycystic ovarian syndrome should be considered and appropriate treatment with hormonal modulation given. Adjunctive procedures can also be considered for all acne patients.Implementation: Pitfalls to avoid when treating acne: treatment of acne in women of childbearing age; familiarization of all acne treatments in order to individualize management for patients; indications for specialist referral.Keywords: acne vulgaris, benzoyl peroxide, retinoids, antibiotics, light and laser therapy, photodynamic therapy, photopneumatic therapy, chemical peels

  16. Project management strategies for prototyping breakdowns

    DEFF Research Database (Denmark)

    Granlien, Maren Sander; Pries-Heje, Jan; Baskerville, Richard

    2009-01-01

    , managing the explorative and iterative aspects of prototyping projects is not a trivial task. We examine the managerial challenges in a small scale prototyping project in the Danish healthcare sector where a prototype breakdown and project escalation occurs. From this study we derive a framework...... of strategies for coping with escalation in troubled prototyping projects; the framework is based on project management triangle theory and is useful when considering how to manage prototype breakdown and escalation. All strategies were applied in the project case at different points in time. The strategies led......Prototyping is often presented as a universal solution to many intractable information systems project problems. Prototyping is known to offer at least three advantages (1) provide users with a concrete understanding, (2) eliminate the confusion, (3) cope with uncertainty. On the other hand...

  17. Momentum management strategy during Space Station buildup

    Science.gov (United States)

    Bishop, Lynda; Malchow, Harvey; Hattis, Philip

    1988-01-01

    The use of momentum storage devices to control effectors for Space Station attitude control throughout the buildup sequence is discussed. Particular attention is given to the problem of providing satisfactory management of momentum storage effectors throughout buildup while experiencing variable torque loading. Continuous and discrete control strategies are compared and the effects of alternative control moment gyro strategies on peak momentum storage requirements and on commanded maneuver characteristics are described.

  18. Managing the Operations-Strategy Interface through Programme Management

    DEFF Research Database (Denmark)

    Meulengracht Jensen, Peter; Johansen, John; Wæhrens, Brian Vejrum

    2011-01-01

    This paper explores how one company with globally distributed operations, strive to manage the operations-strategy interface through programme management. The paper focuses on how the organizational context affects the programme configuration and raises a number of propositions as to how programmes...

  19. Evidence-based clinical practice

    DEFF Research Database (Denmark)

    Gluud, Christian

    2002-01-01

    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....

  20. Role of management devices in enacting strategy

    DEFF Research Database (Denmark)

    Harritz, Daniel

    2016-01-01

    Purpose - This study illustrates the role of management devices in enacting strategy and strategic decisions, resulting in the development of a Shared Service Centre (SSC) in a Danish municipality. It shows how devices interact in defending, rejecting and reframing strategy, leading to the closure...... role of management devices. Practical implications - The findings facilitate a deeper understanding of factors triggering strategic development in the public sector. Also, it identifies aspects leading to failures by investigating how different devices allow local actors to stay connected and affect...

  1. Management of Behçet disease: a systematic literature review for the European League Against Rheumatism evidence-based recommendations for the management of Behçet disease.

    Science.gov (United States)

    Hatemi, G; Silman, A; Bang, D; Bodaghi, B; Chamberlain, A M; Gul, A; Houman, M H; Kötter, I; Olivieri, I; Salvarani, C; Sfikakis, P P; Siva, A; Stanford, M R; Stübiger, N; Yurdakul, S; Yazici, H

    2009-10-01

    To present and analyse the literature sources regarding the management of Behçet disease (BD) identified during the systematic literature research, which formed the basis for the European League Against Rheumatism (EULAR) evidence-based recommendations for the management of BD. Problem areas and related keywords regarding the management of BD were determined by the multidisciplinary expert committee commissioned by EULAR for developing the recommendations. A systematic literature research was performed using MedLine and Cochrane Library resources through to December 2006. Meta-analyses, systematic reviews, randomised controlled trials (RCTs), open studies, observational studies, case control studies and case series' involving > or = 5 patients were included. For each intervention the effect size and number needed to treat were calculated for efficacy. Odds ratios and numbers needed to harm were calculated for safety issues of different treatment modalities where possible. The literature research yielded 137 articles that met the inclusion criteria; 20 of these were RCTs. There was good evidence supporting the use of azathioprine and cyclosporin A in eye involvement and interferon (IFN)alpha in mucocutaneous involvement. There were no RCTs with IFNalpha or tumour necrosis factor (TNF)alpha antagonists in eye involvement. Similarly controlled data for the management of vascular, gastrointestinal and neurological involvement is lacking. Properly designed, controlled studies (new and confirmatory) are still needed to guide us in managing BD.

  2. CUSTOMER RELATIONSHIP MANAGEMENT AND BUSINESS STRATEGIES

    Directory of Open Access Journals (Sweden)

    Rozitta Chittaie

    2012-06-01

    Full Text Available Changing in the current competitive environment, increasing simplicity of penetrating into the competitive market, and rapid growing of information technology are essential motives for performing activities in an environment. Nowadays, some companies step into rapid and instant development of their markets in order to improve customer relationship. These companies through adopting customer relationship management (CRM systems can earn and retain their customers' loyalty. As a result, designing customer relationship management strategies can lead to market protection, customer value increase, and greater customer satisfaction opportunities for continuous promotion of the enterprise. Regarding the complexity and the variety of strategies associated with managing a business, information-related capability seems to be an essential capability for earning profit from companies' activities and competition among peers. Hence, relation and information are employed for managing the firms are vital tools for seizing opportunities and tackling future issues. Giving the information only employed to support a company’s performance, making crucial decision about surrounding environment, increasing competitive ability of the enterprise will be difficult for company. Furthermore, since increase of competitive ability is accompanied by making greater profit on the deal, methods of raising competitive ability is an interesting and critical issue. Therefore, companies through information technology, cost reduction, and development of low-level relations with customers can achieve greater profitability. This paper probes into customer relationship management and business strategies. The implications of CRM strategies are discussed in detail.

  3. Strategies for Managing a Multigenerational Workforce

    Science.gov (United States)

    Iden, Ronald

    The multigenerational workforce presents a critical challenge for business managers, and each generation has different expectations. A human resource management study of organizations with more than 500 employees reported 58% of the managers experiencing conflict between younger and older workers. The purpose of this single case study was to explore the multigenerational strategies used by 3 managers from a Franklin County, Ohio manufacturing facility with a population size of 6 participants. The conceptual framework for this study was built upon generational theory and cohort group theory. The data were collected through face-to-face semistructured interviews, company documents, and a reflexive journal. Member checking was completed to strengthen the credibility and trustworthiness of the interpretation of participants' responses. A modified van Kaam method enabled separation of themes following the coding of data. Four themes emerged from the data: (a) required multigenerational managerial skills, (b) generational cohort differences, (c) most effective multigenerational management strategies, and (d) least effective multigenerational management strategies. Findings from this study may contribute to social change through better understanding, acceptance, and appreciation of the primary generations in the workforce, and, in turn, improve community relationships.

  4. Strategies for successful software development risk management

    Directory of Open Access Journals (Sweden)

    Marija Boban

    2003-01-01

    Full Text Available Nowadays, software is becoming a major part of enterprise business. Software development is activity connected with advanced technology and high level of knowledge. Risks on software development projects must be successfully mitigated to produce successful software systems. Lack of a defined approach to risk management is one of the common causes for project failures. To improve project chances for success, this work investigates common risk impact areas to perceive a foundation that can be used to define a common approach to software risk management. Based on typical risk impact areas on software development projects, we propose three risk management strategies suitable for a broad area of enterprises and software development projects with different amounts of connected risks. Proposed strategies define activities that should be performed for successful risk management, the one that will enable software development projects to perceive risks as soon as possible and to solve problems connected with risk materialization. We also propose a risk-based approach to software development planning and risk management as attempts to address and retire the highest impact risks as early as possible in the development process. Proposed strategies should improve risk management on software development projects and help create a successful software solution.

  5. Management ethics and strategies towards sustainable tourism ...

    African Journals Online (AJOL)

    The study examined the management ethics and strategies adopted and maintained to harmonize income generation, conservation, ecological impact, visitor number, quality of visitor's experience and chances of citing games at the Jos Wildlife Park (JWLP) which have enabled it to remain open since the year 1977 till date.

  6. Community strategies of women in educational management

    African Journals Online (AJOL)

    Erna Kinsey

    under representation of women in education management abroad and in South Africa, gender differences in communication as a managerial function are discussed and the implications for the workplace outlined by means of a literature review. A qualitative investigation explored the communication strategies of a woman ...

  7. Common Sense Strategies for Managing Conflicts.

    Science.gov (United States)

    Fairman, Marvin; Clark, Elizabeth A.

    1983-01-01

    Describes the application by principals of situational leadership concepts to reduce conflict among groups participating in decision making. Factors covered include maturity levels of participants, flexibility of leadership style, and possible variations in conflict management strategies appropriate to different maturity levels of participants.…

  8. Electronic government: Rethinking channel management strategies

    NARCIS (Netherlands)

    Ebbers, Wolfgang E.; Pieterson, Willem Jan; Noordman, H.N.

    2008-01-01

    This article explores how an alternative multichannel management strategy can improve the way governments and citizens interact. Improvement is necessary because, based on empirical data from various sources, the conclusion can be drawn that there is a gap between the communication channels

  9. Management Strategies for Promoting Teacher Collective Learning

    Science.gov (United States)

    Cheng, Eric C. K.

    2011-01-01

    This paper aims to validate a theoretical model for developing teacher collective learning by using a quasi-experimental design, and explores the management strategies that would provide a school administrator practical steps to effectively promote collective learning in the school organization. Twenty aided secondary schools in Hong Kong were…

  10. Environmental risk management strategies: household response to ...

    African Journals Online (AJOL)

    The environmental risk management strategies used by farmers in response to rice yield variability in Ebonyi State, Nigeria was examined. A total of 108 rice farmers were interviewed using structured questionnaire. Data analysis shows that the mean age of the farmers was 45.9 years and majority (63%) had only primary ...

  11. Ovarian responses to lactation management strategies

    NARCIS (Netherlands)

    Soede, N.M.; Hazeleger, W.; Gerritsen, R.; Langendijk, P.; Kemp, B.

    2009-01-01

    A number of lactation management strategies can be applied to reduce negative effects of lactation on post-weaning fertility. This paper focuses on effects of lactation length, Intermittent Suckling and Split Weaning on follicle development and subsequent oestrus. It is concluded that a lactation

  12. The use of evidence-based practices for the management of shoulder impingement syndrome among Indian physical therapists: a cross-sectional survey

    Directory of Open Access Journals (Sweden)

    Vandana Phadke

    2015-12-01

    Full Text Available ABSTRACT Background: The understanding of the pathomechanics of shoulder impingement has evolved over the years. Likewise, assessment techniques and effective treatment strategies have also been developed. Physical therapists should keep up-to-date on the current evidence. Objective: This study explored the practices currently used by Indian physical therapists for the assessment and management of shoulder impingement syndrome (SIS. Method: Using an online questionnaire, therapists were asked to declare the causes, methods of assessment and their choices of physical therapy techniques for the management of SIS. The proportions of therapists using different techniques were analyzed descriptively, and comparisons across gender, experience level, and training were made. Data were analyzed to see if the choices of respondents compared with their responses for etiology. Results: A total of 211 responses were analyzed. Most respondents (>75% believed that overuse and abnormal motion/posture are the most significant causes of SIS. However, fewer respondents reported assessing posture (60.2% and dyskinesis, especially in women (24.2%. Ninety-four percent of the respondents reported using exercises, but exercise prescription was rather generic. Therapists additionally trained in the techniques of joint mobilization or taping declared using these techniques more frequently. The use of interferential therapy and ultrasound was reported by 89.5% and 98.4% of respondents, respectively Conclusion: Most therapists declared awareness of current recommended practices, but patient assessment, exercise prescription, and use of electrotherapy modalities were only partially based on current evidence. The study helps to identify gaps in current physical therapy approaches to SIS in India.

  13. The use of evidence-based practices for the management of shoulder impingement syndrome among Indian physical therapists: a cross-sectional survey

    Science.gov (United States)

    Phadke, Vandana; Makhija, Meena; Singh, Harpreet

    2015-01-01

    ABSTRACT Background: The understanding of the pathomechanics of shoulder impingement has evolved over the years. Likewise, assessment techniques and effective treatment strategies have also been developed. Physical therapists should keep up-to-date on the current evidence. Objective: This study explored the practices currently used by Indian physical therapists for the assessment and management of shoulder impingement syndrome (SIS). Method: Using an online questionnaire, therapists were asked to declare the causes, methods of assessment and their choices of physical therapy techniques for the management of SIS. The proportions of therapists using different techniques were analyzed descriptively, and comparisons across gender, experience level, and training were made. Data were analyzed to see if the choices of respondents compared with their responses for etiology. Results: A total of 211 responses were analyzed. Most respondents (>75%) believed that overuse and abnormal motion/posture are the most significant causes of SIS. However, fewer respondents reported assessing posture (60.2%) and dyskinesis, especially in women (24.2%). Ninety-four percent of the respondents reported using exercises, but exercise prescription was rather generic. Therapists additionally trained in the techniques of joint mobilization or taping declared using these techniques more frequently. The use of interferential therapy and ultrasound was reported by 89.5% and 98.4% of respondents, respectively Conclusion: Most therapists declared awareness of current recommended practices, but patient assessment, exercise prescription, and use of electrotherapy modalities were only partially based on current evidence. The study helps to identify gaps in current physical therapy approaches to SIS in India. PMID:26647749

  14. Evidence-Based Medicine: Rhinoplasty.

    Science.gov (United States)

    Lee, Matthew K; Most, Sam P

    2015-08-01

    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.

  15. Managing the Chronically Overworked Team: Twenty Strategies.

    Science.gov (United States)

    Hills, Laura

    2015-01-01

    Overwork, at first glance, seems like a problem that affects only the employee. But for medical practices and those who manage them, the problem is far greater than that. Chronically overworked employees may not be meeting their goals. They may be making more mistakes and letting things slip through the cracks. Ultimately, patients may have less-than-ideal experiences in a practice where the employees are stretched thin. And turnover may skyrocket in practices where employees are chronically overworked. This article offers practice managers 20 practical and affordable strategies they can use to manage a chronically overworked medical practice team. It suggests an effective technique they can use to tell their bosses that their employees are overworked. This article also suggests the costs to the practice of a chronically overworked staff, including a hidden cost many people overlook. It provides four coping strategies practice managers can teach to their overworked employees. It summarizes research exploring how overwork affects employees' sleep and eating habits, and additional research linking long hours of overwork to diminished productivity. Finally, this article provides five strategies practice managers can use to make their overworked employees feel valued.

  16. Social Media Strategies and Destination Management

    DEFF Research Database (Denmark)

    Munar, Ana Maria

    2012-01-01

    initiatives of DMOs of Denmark, Norway, Finland, Sweden and the Scandinavian Tourist Board Asia/Pacific in the Nordic European Region. The study provides empirical evidence of emerging social media strategies among DMOs and confirms the growing importance of these new media. The findings point...... to the conflicting relationship between corporate culture and social media culture, the challenges innovative communication tools present for traditional management structures, poor levels of formalization and the lack of a knowledge base which results in ad-hoc decision making. Overall, the paper discusses......This study provides insights into social media practices and strategic considerations used by destination management organizations (DMOs). It examines a theoretical model of generic social media strategies for destination management and applies qualitative methods to analyze the social media...

  17. Investigating the Usability of Classroom Management Strategies among Elementary Schoolteachers

    Science.gov (United States)

    Briesch, Amy M.; Briesch, Jacquelyn M.; Chafouleas, Sandra M.

    2015-01-01

    Although teachers are often asked to implement classroom interventions to address student behavior, little is known about their perceived usability of many evidence-based strategies. One thousand five elementary schoolteachers completed the Usage Rating Profile-Intervention-Revised (URP-IR) with regard to the use of one of five evidence-based…

  18. Beyond PARR - PMEL's Integrated Data Management Strategy

    Science.gov (United States)

    Burger, E. F.; O'Brien, K.; Manke, A. B.; Schweitzer, R.; Smith, K. M.

    2016-12-01

    NOAA's Pacific Marine Environmental Laboratory (PMEL) hosts a wide range of scientific projects that span a number of scientific and environmental research disciplines. Each of these 14 research projects have their own data streams that are as diverse as the research. With its requirements for public access to federally funded research results and data, the 2013 White House Office of Science and Technology memo on Public Access to Research Results (PARR) changed the data management landscape for Federal agencies. In 2015, with support from the PMEL Director, Dr. Christopher Sabine, PMEL's Science Data Integration Group (SDIG) initiated a multi-year effort to formulate and implement an integrated data-management strategy for PMEL research efforts. Instead of using external requirements, such as PARR, to define our approach, we focussed on strategies to provide PMEL science projects with a unified framework for data submission, interoperable data access, data storage, and easier data archival to National Data Centers. This improves data access to PMEL scientists, their collaborators, and the public, and also provides a unified lab framework that allows our projects to meet their data management objectives, as well as those required by the PARR. We are implementing this solution in stages that allows us to test technology and architecture choices before comitting to a large scale implementation. SDIG developers have completed the first year of development where our approach is to reuse and leverage existing frameworks and standards. This presentation will describe our data management strategy, explain our phased implementation approach, the software and framework choices, and how these elements help us meet the objectives of this strategy. We will share the lessons learned in dealing with diverse and complex datasets in this first year of implementation and how these outcomes will shape our decisions for this ongoing effort. The data management capabilities now

  19. [Acute bronchiolitis: evaluation of evidence-based therapy].

    Science.gov (United States)

    Martinón-Torres, F; Rodríguez Núñez, A; Martinón Sánchez, J M

    2001-10-01

    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.

  20. Managing strategy to enhance care for children.

    Science.gov (United States)

    Smith, Aaron; Mainland, Jeff; Blais, Irene

    2011-01-01

    The adoption of the Balanced Scorecard philosophy of measure, monitor and manage by The Hospital for Sick Children (SickKids) has resulted in SickKids' staff understanding, appreciating and ultimately being able to accept the enhanced transparency and accountability around performance, at both the system and hospital levels. The leadership of the organization observed these differences after initial SickKids scorecard update meetings, realizing this was not a flavour of the month but a totally new way of operating in a quest to achieve SickKids' vision and mission. Almost immediately, the internal culture began to shift as staff better understood how their roles actively contribute to the organization's ability to execute on its strategy. Based on 2010 staff engagement results, 70% of staff "see a direct link between personal work objectives and SickKids' strategy," while 60% were familiar with the newly released strategic plan, unprecedented results based on current benchmarks. This article provides an overview of the SickKids strategy management system, outlining both best practices and the journey from its launch to induction into the Balanced Scorecard Hall of Fame. Performance, at all levels across the enterprise, has shown measureable improvement with the introduction of the comprehensive strategy management system.

  1. Evidence based medical imaging (EBMI)

    Energy Technology Data Exchange (ETDEWEB)

    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: tony.smith@hnehealth.nsw.gov.au

    2008-08-15

    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.

  2. Risk management - unappreciated instrument of supply chain management strategy

    Directory of Open Access Journals (Sweden)

    Wojciech Machowiak

    2012-12-01

    Full Text Available Background: Unlike Enterprise Risk Management, which is certainly quite well rooted in business practice, Supply Chain Risk Management (SCRM still continues to be dynamically developing subject of academic research, whereas its practical applications are rather scarce. Material and methods: On the basis of broad review of the current state of the art in world literature, significant  relevancies to the core processes and enterprise strategy are discussed.   Results: The paper shows some interesting from the enterprise's performance and competitiveness point of view additional benefits, potentially resulting from the proactive, consistent and effective implementation of the SCRM system. Conclusions: Some additional advantages from proactive supply chain risk management account for perceiving SCRM as multifunctional instrument of strategic SC management, exceeding established understanding RM as security and threat-prevention  tool only. Positive influence from SCRM onto SC performance and competitiveness can make reasonable to enhance its position within SCM strategy.

  3. What's Wrong with Evidence-Based Medicine?

    Science.gov (United States)

    Fins, Joseph J

    2016-01-01

    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.

  4. Multinational evidence-based recommendations for the diagnosis and management of gout: integrating systematic literature review and expert opinion of a broad panel of rheumatologists in the 3e initiative.

    Science.gov (United States)

    Sivera, Francisca; Andrés, Mariano; Carmona, Loreto; Kydd, Alison S R; Moi, John; Seth, Rakhi; Sriranganathan, Melonie; van Durme, Caroline; van Echteld, Irene; Vinik, Ophir; Wechalekar, Mihir D; Aletaha, Daniel; Bombardier, Claire; Buchbinder, Rachelle; Edwards, Christopher J; Landewé, Robert B; Bijlsma, Johannes W; Branco, Jaime C; Burgos-Vargas, Rubén; Catrina, Anca I; Elewaut, Dirk; Ferrari, Antonio J L; Kiely, Patrick; Leeb, Burkhard F; Montecucco, Carlomaurizio; Müller-Ladner, Ulf; Ostergaard, Mikkel; Zochling, Jane; Falzon, Louise; van der Heijde, Désirée M

    2014-02-01

    We aimed to develop evidence-based multinational recommendations for the diagnosis and management of gout. Using a formal voting process, a panel of 78 international rheumatologists developed 10 key clinical questions pertinent to the diagnosis and management of gout. Each question was investigated with a systematic literature review. Medline, Embase, Cochrane CENTRAL and abstracts from 2010-2011 European League Against Rheumatism and American College of Rheumatology meetings were searched in each review. Relevant studies were independently reviewed by two individuals for data extraction and synthesis and risk of bias assessment. Using this evidence, rheumatologists from 14 countries (Europe, South America and Australasia) developed national recommendations. After rounds of discussion and voting, multinational recommendations were formulated. Each recommendation was graded according to the level of evidence. Agreement and potential impact on clinical practice were assessed. Combining evidence and clinical expertise, 10 recommendations were produced. One recommendation referred to the diagnosis of gout, two referred to cardiovascular and renal comorbidities, six focused on different aspects of the management of gout (including drug treatment and monitoring), and the last recommendation referred to the management of asymptomatic hyperuricaemia. The level of agreement with the recommendations ranged from 8.1 to 9.2 (mean 8.7) on a 1-10 scale, with 10 representing full agreement. Ten recommendations on the diagnosis and management of gout were established. They are evidence-based and supported by a large panel of rheumatologists from 14 countries, enhancing their utility in clinical practice.

  5. Strategy development management of Multimodal Transport Network

    Directory of Open Access Journals (Sweden)

    Nesterova Natalia S.

    2016-01-01

    Full Text Available The article gives a brief overview of works on the development of transport infrastructure for multimodal transportation and integration of Russian transport system into the international transport corridors. The technology for control of the strategy, that changes shape and capacity of Multi-modal Transport Network (MTN, is considered as part of the methodology for designing and development of MTN. This technology allows to carry out strategic and operational management of the strategy implementation based on the use of the balanced scorecard.

  6. Physical therapy management of congenital muscular torticollis: an evidence-based clinical practice guideline: from the Section on Pediatrics of the American Physical Therapy Association.

    Science.gov (United States)

    Kaplan, Sandra L; Coulter, Colleen; Fetters, Linda

    2013-01-01

    Congenital muscular torticollis (CMT) is an idiopathic postural deformity evident shortly after birth, typically characterized by lateral flexion of the head to one side and cervical rotation to the opposite side due to unilateral shortening of the sternocleidomastoid muscle. CMT may be accompanied by other neurological or musculoskeletal conditions. Infants with CMT are frequently referred to physical therapists (PTs) to treat their asymmetries. This evidence-based clinical practice guideline (CPG) provides guidance on which infants should be monitored, treated, and/or referred, and when and what PTs should treat. Based upon critical appraisal of literature and expert opinion, 16 action statements for screening, examination, intervention, and follow-up are linked with explicit levels of evidence. The CPG addresses referral, screening, examination and evaluation, prognosis, first-choice and supplemental interventions, consultation, discharge, follow-up, suggestions for implementation and compliance audits, flow sheets for referral paths and classification of CMT severity, and research recommendations.

  7. Free Access Does Not Necessarily Encourage Practitioners to Use Online Evidence Based Information Tools. A Review of: Buchan, H., Lourey, E., D’Este, C., & Sanson-Fisher, R. (2009. Effectiveness of strategies to encourage general practitioners to accept an offer of free access to online evidence-based information: A randomised controlled trial. Implementation Science, 4, article 68.

    Directory of Open Access Journals (Sweden)

    Heather Ganshorn

    2010-12-01

    Full Text Available Objectives – To determine which strategies were most effective for encouraging general practitioners (GPs to sign up for free access to an online evidence based information resource; and to determine whether those who accepted the offer differed in their sociodemographic characteristics from those who did not.Design – Descriptive marketing research study.Setting – Australia’s public healthcare system.Subjects – 14,000 general practitioners (GPs from all regions of Australia.Methods – Subjects were randomly selected by Medicare Australia from its list of GPs that bill it for services. Medicare Australia had 18,262 doctors it deemed eligible; 14,000 of these were selected for a stratified random sample. Subjects were randomized to one of 7 groups of 2,000 each. Each group received a different letter offering two years of free access to BMJ Clinical Evidence, an evidence based online information tool. Randomization was done electronically, and the seven groups were stratified by age group, gender, and location. The interventions given to each group differed as follows:• Group 1: Received a letter offering 2 years of free access, with no further demands on the recipient.• Group 2: Received a letter offering 2 years of free access, but on the condition that they complete an initial questionnaire and another one at 12 months, as well as allowing the publisher to provide de-personalized usage data to the researchers.• Group 3: Same as Group 2, but with the additional offer of an online tutorial to assist them with using the resource.• Group 4: Same as Group 2, but with an additional pamphlet with positive testimonials about the resource from Australian medical opinion leaders.• Group 5: Same as Group 2, but with an additional offer of professional development credits towards their required annual totals.• Group 6: Same as Group 2, but with an additional offer to be entered to win a prize of $500 towards registration at a

  8. Environmental management strategy: four forces analysis.

    Science.gov (United States)

    Doyle, Martin W; Von Windheim, Jesko

    2015-01-01

    We develop an analytical approach for more systematically analyzing environmental management problems in order to develop strategic plans. This approach can be deployed by agencies, non-profit organizations, corporations, or other organizations and institutions tasked with improving environmental quality. The analysis relies on assessing the underlying natural processes followed by articulation of the relevant societal forces causing environmental change: (1) science and technology, (2) governance, (3) markets and the economy, and (4) public behavior. The four forces analysis is then used to strategize which types of actions might be most effective at influencing environmental quality. Such strategy has been under-used and under-valued in environmental management outside of the corporate sector, and we suggest that this four forces analysis is a useful analytic to begin developing such strategy.

  9. Environmental Management Strategy: Four Forces Analysis

    Science.gov (United States)

    Doyle, Martin W.; Von Windheim, Jesko

    2015-01-01

    We develop an analytical approach for more systematically analyzing environmental management problems in order to develop strategic plans. This approach can be deployed by agencies, non-profit organizations, corporations, or other organizations and institutions tasked with improving environmental quality. The analysis relies on assessing the underlying natural processes followed by articulation of the relevant societal forces causing environmental change: (1) science and technology, (2) governance, (3) markets and the economy, and (4) public behavior. The four forces analysis is then used to strategize which types of actions might be most effective at influencing environmental quality. Such strategy has been under-used and under-valued in environmental management outside of the corporate sector, and we suggest that this four forces analysis is a useful analytic to begin developing such strategy.

  10. A Hybrid III stepped wedge cluster randomized trial testing an implementation strategy to facilitate the use of an evidence-based practice in VA Homeless Primary Care Treatment Programs.

    Science.gov (United States)

    Simmons, Molly M; Gabrielian, Sonya; Byrne, Thomas; McCullough, Megan B; Smith, Jeffery L; Taylor, Thom J; O'Toole, Tom P; Kane, Vincent; Yakovchenko, Vera; McInnes, D Keith; Smelson, David A

    2017-04-04

    Homeless veterans often have multiple health care and psychosocial needs, including assistance with access to housing and health care, as well as support for ongoing treatment engagement. The Department of Veterans Affairs (VA) developed specialized Homeless Patient Alignment Care Teams (HPACT) with the goal of offering an integrated, "one-stop program" to address housing and health care needs of homeless veterans. However, while 70% of HPACT's veteran enrollees have co-occurring mental health and substance use disorders, HPACT does not have a uniform, embedded treatment protocol for this subpopulation. One wraparound intervention designed to address the needs of homeless veterans with co-occurring mental health and substance use disorders which is suitable to be integrated into HPACT clinic sites is the evidence-based practice called Maintaining Independence and Sobriety through Systems Integration, Outreach, and Networking-Veterans Edition, or MISSION-Vet. Despite the promise of MISSION-Vet within HPACT clinics, implementation of an evidence-based intervention within a busy program like HPACT can be difficult. The current study is being undertaken to identify an appropriate implementation strategy for MISSION-Vet within HPACT. The study will test the implementation platform called Facilitation and compared to implementation as usual (IU). The aims of this study are as follows: (1) Compare the extent to which IU or Facilitation strategies achieve fidelity to the MISSION-Vet intervention as delivered by HPACT homeless provider staff. (2) Compare the effects of Facilitation and IU strategies on the National HPACT Performance Measures. (3) Compare the effects of IU and Facilitation on the permanent housing status. (4) Identify and describe key stakeholders' (patients, providers, staff) experiences with, and perspectives on, the barriers to, and facilitators of implementing MISSION. Type III Hybrid modified stepped wedge implementation comparing IU to Facilitation

  11. Evidence-Based Chiropractic Education: Are We Equipping Graduates for Clinical Practice with Improved Patient Outcomes?

    OpenAIRE

    Shreeve, Michael W.

    2012-01-01

    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.

  12. Negotiation strategies in Supply Chain Management

    DEFF Research Database (Denmark)

    Zachariassen, Frederik

    2008-01-01

    Purpose - This paper seeks to explore the impact of different negotiation strategies on then negotiation setting in different buyer-supplier relationships. So far, the extant supply chain management (SCM) literature has only briefly touched this subject, though such a study has been advocated...... on previous notes in the SCM literature. Design/methodology/approach - A qualitative research methodology was chosen in order to investigate a focal firm's negotiations with five of its suppliers. A total of 25 hours of interviews and 15 hours of observations were carried out at the focal firm...... and with a number of the firms' tier one suppliers in order to investigate the subject at hand. Findings - Explanation is given of when the use of different negotiation strategies can be considered expedient in different relational settings, pairing a distributive negotiation strategy with arm's length...

  13. The Evidence Base of Czech Health Policy

    OpenAIRE

    Jan Klusáček; Marie Klusáčková

    2012-01-01

    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...

  14. Suicidality in sleep disorders: prevalence, impact, and management strategies

    Directory of Open Access Journals (Sweden)

    Drapeau CW

    2017-09-01

    Full Text Available Christopher W Drapeau, Michael R Nadorff Department of Psychology, Mississippi State University, Mississippi State, MS, USA Abstract: Sleep disturbances are associated with suicide-related thoughts and behaviors, and the incidence of sleep concerns and suicide has increased recently in the US. Most published research exploring the sleep–suicidality relation is focused on select sleep disorders, with few reviews offering a comprehensive overview of the sleep–suicidality literature. This narrative review broadly investigates the growing research literature on sleep disorders and suicidality, noting the prevalence of suicide ideation and nonfatal and fatal suicide attempts, the impact of several sleep disorders on suicide risk, and potential sleep-disorder management strategies for mitigating suicide risk. Aside from insomnia symptoms and nightmares, there exist opportunities to learn more about suicide risk across many sleep conditions, including whether sleep disorders are associated with suicide risk independently of other psychiatric conditions or symptoms. Generally, there is a lack of randomized controlled trials examining the modification of suicide risk via evidence-based sleep interventions for individuals with sleep disorders. Keywords: sleep, suicide, suicidality, insomnia, nightmares, treatment

  15. Evidence-Based Treatment and Stuttering--Historical Perspective

    Science.gov (United States)

    Prins, David; Ingham, Roger J.

    2009-01-01

    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…

  16. Bologna Guidelines for Diagnosis and Management of Adhesive Small Bowel Obstruction (ASBO): 2010 Evidence-Based Guidelines of the World Society of Emergency Surgery

    NARCIS (Netherlands)

    F. Catena (Fausto); S. Di Saverio (Salomone); M.D. Kelly (Michael ); W.L. Biffl (Walter); L. Ansaloni (Luca); V. Mandalà (Vincenzo); G.C. Velmahos (George ); M. Sartelli (Massimo); G. Tugnoli (Gregorio); M. Lupo (Massimo); A.D. Pinna (Antonio ); P.H. Sugarbaker (Paul ); H. van Goor (Harry); E.E. Moore (Ernest); J. Jeekel (Hans)

    2011-01-01

    textabstractBackground: There is no consensus on diagnosis and management of ASBO. Initial conservative management is usually safe, however proper timing for discontinuing non operative treatment is still controversial. Open surgery or laparoscopy are used without standardized indications.Methods: A

  17. Bologna Guidelines for Diagnosis and Management of Adhesive Small Bowel Obstruction (ASBO): 2010 Evidence-Based Guidelines of the World Society of Emergency Surgery.

    NARCIS (Netherlands)

    Catena, F.; Saverio, S. Di; Kelly, M.D.; Biffl, W.L.; Ansaloni, L.; Mandala, V.; Velmahos, G.C.; Sartelli, M.; Tugnoli, G.; Lupo, M.; Mandala, S.; Pinna, A.D.; Sugarbaker, P.H.; Goor, H. van; Moore, E.E.; Jeekel, J.

    2011-01-01

    BACKGROUND: There is no consensus on diagnosis and management of ASBO. Initial conservative management is usually safe, however proper timing for discontinuing non operative treatment is still controversial. Open surgery or laparoscopy are used without standardized indications. METHODS: A panel of

  18. Hybrid electric vehicles energy management strategies

    CERN Document Server

    Onori, Simona; Rizzoni, Giorgio

    2016-01-01

    This SpringerBrief deals with the control and optimization problem in hybrid electric vehicles. Given that there are two (or more) energy sources (i.e., battery and fuel) in hybrid vehicles, it shows the reader how to implement an energy-management strategy that decides how much of the vehicle’s power is provided by each source instant by instant. Hybrid Electric Vehicles: •introduces methods for modeling energy flow in hybrid electric vehicles; •presents a standard mathematical formulation of the optimal control problem; •discusses different optimization and control strategies for energy management, integrating the most recent research results; and •carries out an overall comparison of the different control strategies presented. Chapter by chapter, a case study is thoroughly developed, providing illustrative numerical examples that show the basic principles applied to real-world situations. In addition to the examples, simulation code is provided via a website, so that readers can work on the actua...

  19. Management strategies in hospitals: scenario planning

    Directory of Open Access Journals (Sweden)

    Ghanem, Mohamed

    2015-06-01

    Full Text Available Background: Instead of waiting for challenges to confront hospital management, doctors and managers should act in advance to optimize and sustain value-based health. This work highlights the importance of scenario planning in hospitals, proposes an elaborated definition of the stakeholders of a hospital and defines the influence factors to which hospitals are exposed to. Methodology: Based on literature analysis as well as on personal interviews with stakeholders we propose an elaborated definition of stakeholders and designed a questionnaire that integrated the following influence factors, which have relevant impact on hospital management: political/legal, economic, social, technological and environmental forces. These influence factors are examined to develop the so-called critical uncertainties. Thorough identification of uncertainties was based on a “Stakeholder Feedback”. Results: Two key uncertainties were identified and considered in this study: According to the developed scenarios, complementary education of the medical staff as well as of non-medical top executives and managers of hospitals was the recommended core strategy. Complementary scenario-specific strategic options should be considered whenever needed to optimize dealing with a specific future development of the health care environment. Conclusion: Strategic planning in hospitals is essential to ensure sustainable success. It considers multiple situations and integrates internal and external insights and perspectives in addition to identifying weak signals and “blind spots”. This flows into a sound planning for multiple strategic options. It is a state of the art tool that allows dealing with the increasing challenges facing hospital management.

  20. Designing a fuzzy expert system for selecting knowledge management strategy

    Directory of Open Access Journals (Sweden)

    Ameneh Khadivar

    2014-12-01

    Full Text Available knowledge management strategy is mentioned as one of the most important success factors for implementing knowledge management. The KM strategy selection is a complex decision that requires consideration of several factors. For evaluation and selection of an appropriate knowledge management strategy in organizations, many factors must be considered. The identified factors and their impact on knowledge management strategy are inherently ambiguous. In this study, an overview of theoretical foundations of research regarding the different knowledge management strategies has been done And factors influencing the knowledge management strategy selection have been extracted from conceptual frameworks and models. How these factors influence the knowledge management strategy selection is extracted through the fuzzy Delphi. Next a fuzzy expert system for the selection of appropriate knowledge management strategy is designed with respect to factors that have an impact on knowledge management strategy. The factors which influence the selection of knowledge management strategy include: general business strategy, organizational structure, cultural factors, IT strategy, strategic human resource management, social level, the types of knowledge creation processes and release it. The factors which influence the knowledge management strategy selection include: business strategy general, organizational structure, cultural factors, IT strategy, human resource management strategies, socialization level, knowledge types and its creation and diffusion processes. According to identified factors which affect the knowledge management strategy, the final strategy is recommended based on the range of human-oriented and system-oriented by keep the balance of explicit and implicit knowledge. The Designed system performance is tested and evaluated by the information related to three Iranian organization.

  1. Designing a fuzzy expert system for selecting knowledge management strategy

    OpenAIRE

    Ameneh Khadivar; Shohreh Nasri Nasr Abadi; Elham Fallah

    2014-01-01

    knowledge management strategy is mentioned as one of the most important success factors for implementing knowledge management. The KM strategy selection is a complex decision that requires consideration of several factors. For evaluation and selection of an appropriate knowledge management strategy in organizations, many factors must be considered. The identified factors and their impact on knowledge management strategy are inherently ambiguous. In this study, an overview of theoretical found...

  2. Strategies used by respiratory nurses to stimulate self-management in patients with COPD.

    Science.gov (United States)

    Verbrugge, Remco; de Boer, Fijgje; Georges, Jean-Jacques

    2013-10-01

    To gain an insight into strategies, adopted by Dutch respiratory nurses during clinic sessions, to improve self-management of patients with chronic obstructive pulmonary disease. Chronic obstructive pulmonary disease is highly prevalent and a significant cause of morbidity and mortality, impacting on quality of life and healthcare expenditure. Health promotion is therefore an important consideration. By applying specific strategies, respiratory nurses can play a major role in the promotion of self-management. Research has shown that respiratory nurses, who run clinics, have insufficient knowledge of evidence-based strategies that can be adopted to promote self-management among chronic obstructive pulmonary disease patients. It appears that respiratory nurses adopt their own strategies during clinic sessions. A qualitative research study was carried out using Grounded Theory method. Data were collected during open interviews conducted by an external researcher with a nursing background. The interviews were analysed through coding after which categories were developed. Fourteen respiratory nurses were interviewed. The results show that respiratory nurses emphasise quitting smoking during the consult. Attention is also paid to inhalation medication and techniques. Other self-management strategies that respiratory nurses use are: application of specific interviewing techniques, referring to other healthcare professionals and providing tools for coping with the illness in everyday life. The main emphasis during the clinic session is directed at quitting smoking. Other self-management strategies such as providing information regarding nutrition and exercise, instilling confidence and becoming an equal discussion partner, gain less attention. During the clinic session, respiratory nurses should also focus on these self-management strategies in addition to quitting smoking. Further research should be directed at self-management strategies used by respiratory nurses in

  3. Advanced heart failure and management strategies.

    Science.gov (United States)

    Gaddam, Krishna K; Yelamanchili, Pridhvi; Sedghi, Yabiz; Ventura, Hector O

    2009-01-01

    The global healthcare burden attributable to heart failure is ever increasing. Patients presenting with refractory heart failure should be evaluated for compliance with medical regimens and sodium and/or fluid restriction, and every attempt should be made to optimize conventional strategies. Reversible causes such as ischemia should be identified and revascularization considered in persistently symptomatic patients, particularly those with a viable myocardium. Carefully selected patients who continue to deteriorate clinically in spite of optimization of medical therapy may be considered for advanced treatment strategies, such as continuous inotropic infusions, mechanical circulatory support devices, cardiac transplantation, or referral to hospice care. We discuss the clinical presentation and management of patients with advanced/refractory (Stage D) heart failure.

  4. Evidence-based practice: management of the clinical node-negative neck in early-stage oral cavity squamous cell carcinoma.

    Science.gov (United States)

    Monroe, Marcus M; Gross, Neil D

    2012-10-01

    This article provides a critical review of the evidence surrounding the management of the clinical node-negative patient with early-stage oral cavity squamous cell carcinoma. Published by Elsevier Inc.

  5. The Cancer Pain Practice Index (CPPI): A Measure of Evidence-Based Practice Adherence for Cancer Pain Management in Older Adults in Hospice Care

    OpenAIRE

    Fine, Perry; Herr, Keela; Titler, Marita; Sanders, Sara; Cavanaugh, Joe; Swegle, John; Forcucci, Chris; Tang, Xiongwen; Lane, Kari; Reyes, Jimmy

    2010-01-01

    Various clinical practice guidelines addressing pain assessment and management have been available for several years that pertain, at least to some extent, to older patients with cancer. Nonetheless, systematic evaluations or methodologically sound studies of adherence to pain management practice guidelines within Medicare-certified hospice programs are lacking. As part of a larger “translating research into practice” pain improvement study involving older patients with cancer in hospice prog...

  6. Professionalism and evidence-based practice

    DEFF Research Database (Denmark)

    Rasmussen, Palle

    2015-01-01

    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...

  7. Evidence-based hypnotherapy for depression.

    Science.gov (United States)

    Alladin, Assen

    2010-04-01

    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.

  8. Management strategies of Bring Your Own Device

    Directory of Open Access Journals (Sweden)

    Li Peixuan

    2017-01-01

    Full Text Available The rapid development of mobile Internet and mobile terminals promote business office system from PC to mobile terminals gradually. Thus Bring Your Own Device (BYOD has become one of the important development trends of enterprise office mode. We analyse the driving factors of implementing Bring Your Own Device, then point out some problems in the process of implementing Bring Your Own Device. Further, we propose the corresponding management strategies of Bring Your Own Device in order to provide references for enterprises to meet the need of mobile office.

  9. Strategies for risk management in cancer nursing.

    Science.gov (United States)

    Chamorro, T; Tarulli, D

    1990-01-01

    In the current social and legal climate, nurses are increasingly subject to litigation charging professional negligence. A higher professional standing for nursing and a larger role in the decision-making aspects of health care have helped to effect this revolution. There are inherent risks in providing health care that are intensified by the rapid growth in medical technology and complex treatment. Claims brought against nurses have been categorized in studies, and primary causes of patient injury in the healthcare facility are also identified. Using these and other data, areas within cancer nursing that predispose to the risk of increased liability can be anticipated. Issues that are unique to the acute care, ambulatory, or homecare setting in oncology are described. Risk management is a mechanism that addresses the prevention and control of financial loss resulting from claims of negligence. Using risk management concepts, strategies are developed to help the cancer nurse recognize intrinsic dangers and reduce the potential for liability.

  10. Oral cancer: review of current management strategies.

    Science.gov (United States)

    More, Yogesh; D'Cruz, Anil K

    2013-01-01

    India has one of the highest incidences of oral cancer and accounts for about 30% of all new cases annually. A high prevalence of smokeless tobacco use has led to an increasing incidence, which in combination with delayed presentation has made oral cancer a major health problem in India. Limited access to cancer care, relative lack of trained healthcare providers and financial resources are some of the challenges to the management of oral cancer in India despite improvements in diagnostic techniques and management strategies. We reviewed the literature pertaining to the epidemiology, aetiopathogenesis, pre-malignancy, tumour progression, management of the primary site, mandible, neck lymph node metastases, reconstruction options and screening of oral cancer. The parameters evaluated were overall survival, disease-free survival, recurrence and loco-regional control. Nine studies on surgical intervention were reviewed. There were 23 studies on the management of chemotherapy and 30 trials analysing radiotherapy as an intervention. India has one of the highest incidences of oral cancer and delayed stage presentation is common. Surgery remains the treatment of choice and adjuvant treatment is recommended in high-risk patients. Elective neck dissection is warranted in clinically lymph node-negative neck for patients with thick tumours, imaging-suspected lymph nodes and those who may not have a reliable follow-up. Functional outcomes and treatment-related morbidity needs to be considered, and reconstruction with free tissue transfer provides the best results. Copyright 2013, NMJI.

  11. Management Strategies for CLN2 Disease.

    Science.gov (United States)

    Williams, Ruth E; Adams, Heather R; Blohm, Martin; Cohen-Pfeffer, Jessica L; de Los Reyes, Emily; Denecke, Jonas; Drago, Kristen; Fairhurst, Charlie; Frazier, Margie; Guelbert, Norberto; Kiss, Szilárd; Kofler, Annamaria; Lawson, John A; Lehwald, Lenora; Leung, Mary-Anne; Mikhaylova, Svetlana; Mink, Jonathan W; Nickel, Miriam; Shediac, Renée; Sims, Katherine; Specchio, Nicola; Topcu, Meral; von Löbbecke, Ina; West, Andrea; Zernikow, Boris; Schulz, Angela

    2017-04-01

    CLN2 disease (neuronal ceroid lipofuscinosis type 2) is a rare, autosomal recessive, pediatric-onset, rapidly progressive neurodegenerative lysosomal storage disorder caused by tripeptidyl peptidase 1 (TPP1) enzyme deficiency, and is characterized by language delay, seizures, rapid cognitive and motor decline, blindness, and early death. No management guidelines exist and there is a paucity of published disease-specific evidence to inform clinical practice, which currently draws upon experience from the field of childhood neurodisability. Twenty-four disease experts were surveyed on CLN2 disease management and a subset met to discuss current practice. Management goals and strategies are consistent among experts globally and are guided by the principles of pediatric palliative care. Goals and interventions evolve as the disease progresses, with a shift in focus from maintenance of function early in the disease to maintenance of quality of life. A multidisciplinary approach is critical for optimal patient care. This work represents an initial step toward the development of consensus-based management guidelines for CLN2 disease. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

  12. The Cancer Pain Practice Index (CPPI): A Measure of Evidence-Based Practice Adherence for Cancer Pain Management in Older Adults in Hospice Care

    Science.gov (United States)

    Fine, Perry; Herr, Keela; Titler, Marita; Sanders, Sara; Cavanaugh, Joe; Swegle, John; Forcucci, Chris; Tang, Xiongwen; Lane, Kari; Reyes, Jimmy

    2010-01-01

    Various clinical practice guidelines addressing pain assessment and management have been available for several years that pertain, at least to some extent, to older patients with cancer. Nonetheless, systematic evaluations or methodologically sound studies of adherence to pain management practice guidelines within Medicare-certified hospice programs are lacking. As part of a larger “translating research into practice” pain improvement study involving older patients with cancer in hospice programs, we recognized the need to create a valid and reliable tool that can facilitate critical evaluation of hospice medical records for nurse and physician adherence to pain management guidelines in order to create a consolidated score for comparative and quality improvement purposes. We report the process used to create this tool, named the Cancer Pain Practice Index, and a guide to its use. PMID:20471541

  13. The cancer pain practice index: a measure of evidence-based practice adherence for cancer pain management in older adults in hospice care.

    Science.gov (United States)

    Fine, Perry; Herr, Keela; Titler, Marita; Sanders, Sara; Cavanaugh, Joe; Swegle, John; Forcucci, Chris; Tang, Xiongwen; Lane, Kari; Reyes, Jimmy

    2010-05-01

    Various clinical practice guidelines addressing pain assessment and management have been available for several years that pertain, at least to some extent, to older patients with cancer. Nonetheless, systematic evaluations or methodologically sound studies of adherence to pain management practice guidelines within Medicare-certified hospice programs are lacking. As part of a larger translating-research-into-practice pain improvement study involving older patients with cancer in hospice programs, we recognized the need to create a valid and reliable tool that can facilitate critical evaluation of hospice medical records for nurse and physician adherence to pain management guidelines to create a consolidated score for comparative and quality improvement purposes. We report the process used to create this tool, named the Cancer Pain Practice Index, and a guide to its use. Copyright 2010 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

  14. Improving Nursing Communication Skills in an Intensive Care Unit Using Simulation and Nursing Crew Resource Management Strategies: An Implementation Project.

    Science.gov (United States)

    Turkelson, Carman; Aebersold, Michelle; Redman, Richard; Tschannen, Dana

    Effective interprofessional communication is critical to patient safety. This pre-/postimplementation project used a multifaceted educational strategy with high-fidelity simulation to introduce evidence-based communication tools, adapted from Nursing Crew Resource Management, to intensive care unit nurses. Results indicated that participants were satisfied with the education, and their perceptions of interprofessional communication and knowledge improved. Teams (n = 16) that used the communication tools during simulation were more likely to identify the problem, initiate key interventions, and have positive outcomes.

  15. Commentary: Launch of a quality improvement network for evidence-based management of uncommon pediatric endocrine disorders: Turner syndrome as a prototype

    Science.gov (United States)

    Traditional, hypothesis-oriented research approaches have thus far failed to generate sufficient evidence to achieve consensus about the management of children with many endocrine disorders, partly because of the rarity of these disorders and because of regulatory burdens unique to research in child...

  16. Integrating knowledge management in the context of evidence based learning: two concept models for facilitating the assessment and acquisition of job knowledge

    NARCIS (Netherlands)

    Mol, S.T.; Kismihók, G.; Ansari, F.; Dornhöfer, M.; Fathi, M.

    2013-01-01

    Within the field of Human Resource Management (HRM), the role of individual knowledge has received limited research attention despite offering the promise of superior job performance and improved managerial decision-making. In part, this lack of research may be attributed to the difficulty and

  17. WITHDRAWN: Initial management strategies for dyspepsia.

    Science.gov (United States)

    Delaney, Brendan; Ford, Alex C; Forman, David; Moayyedi, Paul; Qume, Michelle

    2009-10-07

    This review considers management strategies (combinations of initial investigation and empirical treatments) for dyspeptic patients. Dyspepsia was defined to include both epigastric pain and heartburn. To determine the effectiveness, acceptability, and cost effectiveness of the following initial management strategies for patients presenting with dyspepsia (a) Initial pharmacological therapy (including endoscopy for treatment failures). (b) Early endoscopy. (c) Testing for Helicobacter pylori (H. pylori )and endoscope only those positive. (d) H. pylori eradication therapy with or without prior testing. Trials were located through electronic searches and extensive contact with trialists. All randomised controlled trials of dyspeptic patients presenting in primary care. Data were collected on dyspeptic symptoms, quality of life and use of resources. An individual patient data meta-analysis of health economic data was conducted Twenty-five papers reporting 27 comparisons were found. Trials comparing proton pump inhibitors (PPI) with antacids (three trials) and histamine H2-receptor antagonists (H2RAs) (three trials), early endoscopy with initial acid suppression (five trials), H. pylori test and endoscope versus usual management (three trials), H. pylori test and treat versus endoscopy (six trials), and test and treat versus acid suppression alone in H. pylori positive patients (four trials), were pooled. PPIs were significantly more effective than both H2RAs and antacids. Relative risks (RR) and 95% confidence intervals (CI) were; for PPI compared with antacid 0.72 (95% CI 0.64 to 0.80), PPI compared with H2RA 0.63 (95% CI 0.47 to 0.85). Results for other drug comparisons were either absent or inconclusive. Initial endoscopy was associated with a small reduction in the risk of recurrent dyspeptic symptoms compared with H. pylori test and treat (OR 0.75, 95% CI 0.58 to 0.96), but was not cost effective (mean additional cost of endoscopy US$401 (95% CI $328 to 474

  18. Multinational evidence-based recommendations for pain management by pharmacotherapy in inflammatory arthritis: integrating systematic literature research and expert opinion of a broad panel of rheumatologists in the 3e Initiative.

    Science.gov (United States)

    Whittle, Samuel L; Colebatch, Alexandra N; Buchbinder, Rachelle; Edwards, Christopher J; Adams, Karen; Englbrecht, Matthias; Hazlewood, Glen; Marks, Jonathan L; Radner, Helga; Ramiro, Sofia; Richards, Bethan L; Tarner, Ingo H; Aletaha, Daniel; Bombardier, Claire; Landewé, Robert B; Müller-Ladner, Ulf; Bijlsma, Johannes W J; Branco, Jaime C; Bykerk, Vivian P; da Rocha Castelar Pinheiro, Geraldo; Catrina, Anca I; Hannonen, Pekka; Kiely, Patrick; Leeb, Burkhard; Lie, Elisabeth; Martinez-Osuna, Píndaro; Montecucco, Carlomaurizio; Ostergaard, Mikkel; Westhovens, Rene; Zochling, Jane; van der Heijde, Désirée

    2012-08-01

    To develop evidence-based recommendations for pain management by pharmacotherapy in patients with inflammatory arthritis (IA). A total of 453 rheumatologists from 17 countries participated in the 2010 3e (Evidence, Expertise, Exchange) Initiative. Using a formal voting process, 89 rheumatologists representing all 17 countries selected 10 clinical questions regarding the use of pain medications in IA. Bibliographic fellows undertook a systematic literature review for each question, using MEDLINE, EMBASE, Cochrane CENTRAL and 2008-09 European League Against Rheumatism (EULAR)/ACR abstracts. Relevant studies were retrieved for data extraction and quality assessment. Rheumatologists from each country used this evidence to develop a set of national recommendations. Multinational recommendations were then formulated and assessed for agreement and the potential impact on clinical practice. A total of 49,242 references were identified, from which 167 studies were included in the systematic reviews. One clinical question regarding different comorbidities was divided into two separate reviews, resulting in 11 recommendations in total. Oxford levels of evidence were applied to each recommendation. The recommendations related to the efficacy and safety of various analgesic medications, pain measurement scales and pain management in the pre-conception period, pregnancy and lactation. Finally, an algorithm for the pharmacological management of pain in IA was developed. Twenty per cent of rheumatologists reported that the algorithm would change their practice, and 75% felt the algorithm was in accordance with their current practice. Eleven evidence-based recommendations on the management of pain by pharmacotherapy in IA were developed. They are supported by a large panel of rheumatologists from 17 countries, thus enhancing their utility in clinical practice.

  19. Evidence-based decision-making within the context of globalization: A “Why–What–How” for leaders and managers of health care organizations

    OpenAIRE

    Véronique Lapaige

    2009-01-01

    Véronique LapaigeCanadian Health Services Research Foundation Fellow; PRO-ACTIVE Research Program (Participatory and Evaluative Research Program to Optimize Workplace Management: Application of Knowledge, Transfer of Expertise, Innovative Interventions, Training Transformational Leaders) Pavillon Ferdinand-Vandry, CIFSS (Centre intégré de formation en sciences de la santé), Laval University, Quebec City, Quebec Canada Abstract: In the globalized kno...

  20. Research on Energy Management Strategy of Hybrid Electric Vehicle

    Directory of Open Access Journals (Sweden)

    Deng Tao

    2015-01-01

    Full Text Available To improve the fuel economy and reduce emissions of hybrid electric vehicles, energy management strategy has received high attention. In this paper, by analyzing the deficiency of existing energy management strategy for hybrid cars, it not only puts forward the minimal equivalent fuel consumption adaptive strategy, but also is the first time to consider the driving dynamics target simultaneously, and to explain the future development direction of China’s hybrid energy management strategy.

  1. A Knowledge Management Strategy To Achieve Organisation Competitiveness

    Directory of Open Access Journals (Sweden)

    Dr. St. Sukmawati.

    2015-08-01

    Full Text Available The purpose of this research is to study the influence of organizational environment on the selection of knowledge management strategies. The research focuses particularly on the relationship between business and knowledge management strategy and the success of the knowledge management initiatives. This research is a case study researching 2 South Sulawesi banking companies. The knowledge management initiatives were categorized by six criteria objectives processes problems content strategy knowledge type and their fit with the respective business strategy of the organizational unit was evaluated. The findings in this research suggest a relationship between the success of knowledge management and the alignment of knowledge management and business strategy. The research also shows that an organization whose business strategy requires process efficiency should rely primarily on a codification strategy. An organization whose business strategy requires productprocess innovation should rely primarily on a personalization strategy. The most successful knowledge management projects were driven by a strong business need and with the goal to add value to the organizational unit operations. The research shows there are limitations due to the qualitative nature of the research logical rather than statistical conclusions small sample size and subjectivity of interpretations. The research sees that a manager should be aware of the objectives and business processes of the organizational unit and chooses the knowledge management strategy and objective in accordance to the business strategy and objective. Originalityvalue. The research enhances understanding about the influence of organizational environment factors on the success of knowledge management initiatives.

  2. A Knowledge Management Strategy To Achieve Organisation Competitiveness

    OpenAIRE

    Dr. St. Sukmawati.; De, S

    2015-01-01

    The purpose of this research is to study the influence of organizational environment on the selection of knowledge management strategies. The research focuses particularly on the relationship between business and knowledge management strategy and the success of the knowledge management initiatives. This research is a case study researching 2 South Sulawesi banking companies. The knowledge management initiatives were categorized by six criteria objectives processes problems content strategy kn...

  3. Rational use of antibiotics for the management of children's respiratory tract infections in the ambulatory setting: an evidence-based consensus by the Italian Society of Preventive and Social Pediatrics.

    Science.gov (United States)

    Chiappini, Elena; Mazzantini, Rachele; Bruzzese, Eugenia; Capuano, Annalisa; Colombo, Maria; Cricelli, Claudio; Di Mauro, Giuseppe; Esposito, Susanna; Festini, Filippo; Guarino, Alfredo; Miniello, Vito Leonardo; Principi, Nicola; Marchisio, Paola; Rafaniello, Concetta; Rossi, Francesco; Sportiello, Liberata; Tancredi, Francesco; Venturini, Elisabetta; Galli, Luisa; de Martino, Maurizio

    2014-09-01

    Several guidelines for the management of respiratory tract infections in children are available in Italy, as well as in other European countries and the United States of America. However, poor adherence to guidelines and the sustained inappropriate use of antibiotics have been reported. In the outpatient setting, almost half of antibiotics are prescribed for the treatment of common respiratory tract infections. In Italy the antibiotic prescription rate is significantly higher than in other European countries, such as Denmark or the Netherlands, and also the levels of antibiotic resistance for a large variety of bacteria are higher. Therefore, the Italian Society of Preventive and Social Paediatrics organised a consensus conference for the treatment of respiratory tract infections in children to produce a brief, easily readable, evidence-based document. The conference method was used, according to the National Institute of Health and the National Plan Guidelines. A literature search was performed focusing on the current guidelines for the treatment of airway infections in children aged 1 month-18 years in the ambulatory setting. Recommendations for the treatment of acute pharyngitis, acute otitis media, sinusitis, and pneumonia have been summarized. Conditions for which antibiotic treatment should not be routinely prescribed have been highlighted. This evidence-based document is intended to accessible to primary care pediatricians and general practice physicians in order to make clinical practice uniform, in accordance with the recommendations of the current guidelines. Copyright © 2013 Elsevier Ltd. All rights reserved.

  4. The clinical management of hepatocellular carcinoma in the United States, Europe, and Asia: a comprehensive and evidence-based comparison and review.

    Science.gov (United States)

    Fong, Zhi Ven; Tanabe, Kenneth K

    2014-09-15

    Hepatocellular carcinoma (HCC), the most common primary malignancy of the liver, represents 1 of the leading causes of cancer deaths in the world with an estimated 21,670 deaths in the United States in 2013. In contrast to other malignancies, there is an array of treatment options for HCC involving several specialties in the multidisciplinary care of the patient. Consequently, vast heterogeneity in management tendencies has been observed. The objective of this report was to review and compare guidelines on the management of HCC from the United States (National Comprehensive Cancer Network), Europe (European Association for the Study of the Liver-European Organization for Research and Treatment of Cancer), and Asia (consensus statement from the 2009 Asian Oncology Summit). By and large, all 3 guidelines are similar, with some variance in surveillance and treatment allocation recommendations because of regional differences in disease and other variables (diagnosis, staging systems) secondary to the lack of a concrete, high level of evidence. In contrast to other cancers, the geographic differences in tumor biology and resources make it impractical to have a globally universal guideline for all patients with HCC. Recommendations from the 3 groups are influenced by geographic differences in the prevalence and biology of the disease (ie, areas of increased hepatitis B prevalence) and available resources (organ availability for transplantation, finances, and accessibility to treatment). It is important for both physicians and policy makers to include these considerations when treating patients with HCC as well when structuring policies and guidelines. © 2014 American Cancer Society.

  5. The evidence base for diabetes care

    National Research Council Canada - National Science Library

    Williams, D. R. R. (David Robert Rhys)

    2002-01-01

    ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .ix 1. The Evidence Base for Diabetes Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Rhys Williams, William Herman, Ann-Louise Kinmonth...

  6. Facilities Management a new strategy at CERN

    CERN Document Server

    Nonis, M; CERN. Geneva. ST Division

    2002-01-01

    Starting from 2002, the management of all the tertiary infrastructure of CERN in charge of ST Division shall be carried out through a single Contractor; this includes both maintenance activities on the buildings and their technical installations, and general services such as security, cleaning, gardening, and waste disposal. At present, all these activities are carried out by external contractors via several different contracts. The major purposes of the unification in one single contract is to transfer the coordination tasks of the contracts thus reducing the direct control operation costs, release internal resources in order to be better focused on the core business of the Division and the reduction of the costs of each activity by taking profit of the synergies among the different services. The authors will thoroughly report on the main aspects related to this new contract, focusing their attention in particular to the result oriented strategy through a Service Level Agreement, the key performance indicato...

  7. Evidence-Based Advances in Rabbit Medicine.

    Science.gov (United States)

    Summa, Noémie M; Brandão, João

    2017-09-01

    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.

  8. Summary of evidence-based guideline update: evaluation and management of concussion in sports: report of the Guideline Development Subcommittee of the American Academy of Neurology.

    Science.gov (United States)

    Giza, Christopher C; Kutcher, Jeffrey S; Ashwal, Stephen; Barth, Jeffrey; Getchius, Thomas S D; Gioia, Gerard A; Gronseth, Gary S; Guskiewicz, Kevin; Mandel, Steven; Manley, Geoffrey; McKeag, Douglas B; Thurman, David J; Zafonte, Ross

    2013-06-11

    To update the 1997 American Academy of Neurology (AAN) practice parameter regarding sports concussion, focusing on 4 questions: 1) What factors increase/decrease concussion risk? 2) What diagnostic tools identify those with concussion and those at increased risk for severe/prolonged early impairments, neurologic catastrophe, or chronic neurobehavioral impairment? 3) What clinical factors identify those at increased risk for severe/prolonged early postconcussion impairments, neurologic catastrophe, recurrent concussions, or chronic neurobehavioral impairment? 4) What interventions enhance recovery, reduce recurrent concussion risk, or diminish long-term sequelae? The complete guideline on which this summary is based is available as an online data supplement to this article. We systematically reviewed the literature from 1955 to June 2012 for pertinent evidence. We assessed evidence for quality and synthesized into conclusions using a modified Grading of Recommendations Assessment, Development and Evaluation process. We used a modified Delphi process to develop recommendations. Specific risk factors can increase or decrease concussion risk. Diagnostic tools to help identify individuals with concussion include graded symptom checklists, the Standardized Assessment of Concussion, neuropsychological assessments, and the Balance Error Scoring System. Ongoing clinical symptoms, concussion history, and younger age identify those at risk for postconcussion impairments. Risk factors for recurrent concussion include history of multiple concussions, particularly within 10 days after initial concussion. Risk factors for chronic neurobehavioral impairment include concussion exposure and APOE ε4 genotype. Data are insufficient to show that any intervention enhances recovery or diminishes long-term sequelae postconcussion. Practice recommendations are presented for preparticipation counseling, management of suspected concussion, and management of diagnosed concussion.

  9. Insulin Management Strategies for Exercise in Diabetes.

    Science.gov (United States)

    Zaharieva, Dessi P; Riddell, Michael C

    2017-10-01

    There is no question that regular exercise can be beneficial and lead to improvements in overall cardiovascular health. However, for patients with diabetes, exercise can also lead to challenges in maintaining blood glucose balance, particularly if patients are prescribed insulin or certain oral hypoglycemic agents. Hypoglycemia is the most common adverse event associated with exercise and insulin therapy, and the fear of hypoglycemia is also the greatest barrier to exercise for many patients. With the appropriate insulin dose adjustments and, in some cases, carbohydrate supplementation, blood glucose levels can be better managed during exercise and in recovery. In general, insulin strategies that help facilitate weight loss with regular exercise and recommendations around exercise adjustments to prevent hypoglycemia and hyperglycemia are often not discussed with patients because the recommendations can be complex and may differ from one individual to the next. This is a review of the current published literature on insulin dose adjustments and starting-point strategies for patients with diabetes in preparation for safe exercise. Copyright © 2017 Diabetes Canada. Published by Elsevier Inc. All rights reserved.

  10. Strategy of image management in retail shops

    Directory of Open Access Journals (Sweden)

    Sandra Soče Kraljević

    2007-12-01

    Full Text Available A sound positioning in consumers’ mind, along with strong promotion support, brought many retail shops to the top. This is mostly thanks to the image created in the consumers’ mind. A retail shop’s image may but need not conform to reality. Image often looks like a cliché. It overstates certain elements of the shop while simply omitting others. That is exactly why image is of great importance and often crucial to consumer behavior. This paper aims at determining the impact of image on customer behavior in the course of decision making about shopping and choosing a particular retail shop. Image is a significant factor of success of every company, hence also of a retail shops. It is a relatively strong value and a component of creating competitive advantage. But if we do not pay sufficient attention to image, it can become counterproductive. Instead to, like an additional value helps creating and maintaining the advantage in competition and realization of business aims, transforms into a limiting factor. Therefore, it is imperative to identify the elements of image that are of greatest importance to customers. Research has shown that customers choose the retail shop first and after that products and brands within this shop. When it comes to the supermarket, as a kind of retail shop, research has shown that two out of three shopping decisions are made by the customer on the spot, that is, without previous planning. That practically means that we can influence customers with different sales techniques. The paper suggests different strategies of image management for supermarkets and conventional shops. For supermarkets it is the “widest assortment” strategy, while for conventional shops the strategy is that of a “selected group of products“. Improvements to research methods will enable getting more information about customer behavior, while pressures of increased competition in the business environment will force retailers to get

  11. Effectiveness of alternative management strategies in meeting conservation objectives

    Science.gov (United States)

    Richards S. Holthausen; Carolyn Hull Sieg

    2007-01-01

    This chapter evaluates how well various management strategies meet a variety of conservation objectives, summarizes their effectiveness in meeting objectives for rare or little-known (RLK) species, and proposes ways to combine strategies to meet overall conservation objectives. We address two broad categories of management strategies. Species approaches result in...

  12. Evidence-based playground design

    DEFF Research Database (Denmark)

    Refshauge, Anne Dahl; Stigsdotter, Ulrika K.; Lamm, Bettina

    2015-01-01

    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...

  13. Preservice Teachers' Knowledge and Perceptions of Effective Behavior Management Strategies

    Science.gov (United States)

    Nields, Allison N.

    2014-01-01

    This study examined student teachers' perceptions and knowledge of behavior management strategies. A questionnaire that included questions about broad behavior management techniques, behavioral learning theory, and behavior management strategies related to behavioral learning theory was given to sixty-one student teacher candidates at a large…

  14. Strategies to Improve Management of Acute Watery Diarrhea during a Military Deployment: A Cost Effectiveness Analysis.

    Science.gov (United States)

    Schrader, Andrew J; Tribble, David R; Riddle, Mark S

    2017-12-01

    To inform policy and decision makers, a cost-effectiveness model was developed to predict the cost-effectiveness of implementing two hypothetical management strategies separately and concurrently on the mitigation of deployment-associated travelers' diarrhea (TD) burden. The first management strategy aimed to increase the likelihood that a deployed service member with TD will seek medical care earlier in the disease course compared with current patterns; the second strategy aimed to optimize provider treatment practices through the implementation of a Department of Defense Clinical Practice Guideline. Outcome measures selected to compare management strategies were duty days lost averted (DDL-averted) and a cost effectiveness ratio (CER) of cost per DDL-averted (USD/DDL-averted). Increasing health care and by seeking it more often and earlier in the disease course as a stand-alone management strategy produced more DDL (worse) than the base case (up to 8,898 DDL-gained per year) at an increased cost to the Department of Defense (CER $193). Increasing provider use of an optimal evidence-based treatment algorithm through Clinical Practice Guidelines prevented 5,299 DDL per year with overall cost savings (CER -$74). A combination of both strategies produced the greatest gain in DDL-averted (6,887) with a modest cost increase (CER $118). The application of this model demonstrates that changes in TD management during deployment can be implemented to reduce DDL with likely favorable impacts on mission capability and individual health readiness. The hypothetical combination strategy evaluated prevents the most DDL compared with current practice and is associated with a modest cost increase.

  15. Managing Metabolic Syndrome and CHD Risk Factors: Evidence based re-examination of macro nutrients from the Malaysian Population Prospective Study

    Directory of Open Access Journals (Sweden)

    Kalyana Sundram

    2014-11-01

    Full Text Available Our understanding of dietary factors and habits associated with coronary heart disease (CHD risk are undergoing dramatic rethinking in light of fast emerging new scientific data. Multiple risk assessments, especially in understanding Metabolic Syndrome triggers in the population have further confounded understanding and management of traditional risk factors. By far the largest change-impact is being made with regard to fat consumption, especially saturated fats. Emerging evidence, largely through meta-analysis and population studies have regularly challenged the association of saturated fats with increased CHD risk. Indeed there is a growing appreciation that saturates no longer glove-fit risk assessment especially when newer biochemical factors such as lipoprotein particle sizes have emerged to partially explain observed anomalies. The fats we eat may not necessarily be associated with making us fat (obese and obesity is a major health challenge globally. This has redirected dietary assessments more towards excess carbohydrate consumption and their possible adverse outcomes.Drawing on an ongoing population prospective study in Malaysia, such observations are similarly amplified in an urban Malaysian population. Significant carbohydrate associated negative impacts on CHD risk is seen emerging, especially when evaluated against more advanced biochemical markers. Differences in the ethnic groups of the population, modulated through cultural dietary preferences are similarly apparent. In this model, a surprisingly lower risk contributor is the prevailing fat consumption trends in the country. These observations are explained in this presentation aimed at creating better awareness of food factors impacting disease outcomes in an urban Malaysian environment whose make-up includes a substantive South Indian population as well.

  16. Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline on the Management of Patients With Positional Plagiocephaly: The Role of Repositioning.

    Science.gov (United States)

    Klimo, Paul; Lingo, Patrick Ryan; Baird, Lissa C; Bauer, David F; Beier, Alexandra; Durham, Susan; Lin, Alexander Y; McClung-Smith, Catherine; Mitchell, Laura; Nikas, Dimitrios; Tamber, Mandeep S; Tyagi, Rachana; Mazzola, Catherine; Flannery, Ann Marie

    2016-11-01

    located at https://www.cns.org/guidelines/guidelines-management-patients-positional-plagiocephaly/Chapter_3.

  17. Guidelines: Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline on the Management of Patients With Positional Plagiocephaly: The Role of Repositioning.

    Science.gov (United States)

    Klimo, Paul; Lingo, Patrick Ryan; Baird, Lissa C; Bauer, David F; Beier, Alexandra; Durham, Susan; Lin, Alexander Y; McClung-Smith, Catherine; Mitchell, Laura; Nikas, Dimitrios; Tamber, Mandeep S; Tyagi, Rachana; Mazzola, Catherine; Flannery, Ann Marie

    2016-11-01

    located at https://www.cns.org/guidelines/guidelines-management-patients-positional-plagiocephaly/Chapter_3.

  18. Engineering youth service system infrastructure: Hawaii's continued efforts at large-scale implementation through knowledge management strategies.

    Science.gov (United States)

    Nakamura, Brad J; Mueller, Charles W; Higa-McMillan, Charmaine; Okamura, Kelsie H; Chang, Jaime P; Slavin, Lesley; Shimabukuro, Scott

    2014-01-01

    Hawaii's Child and Adolescent Mental Health Division provides a unique illustration of a youth public mental health system with a long and successful history of large-scale quality improvement initiatives. Many advances are linked to flexibly organizing and applying knowledge gained from the scientific literature and move beyond installing a limited number of brand-named treatment approaches that might be directly relevant only to a small handful of system youth. This article takes a knowledge-to-action perspective and outlines five knowledge management strategies currently under way in Hawaii. Each strategy represents one component of a larger coordinated effort at engineering a service system focused on delivering both brand-named treatment approaches and complimentary strategies informed by the evidence base. The five knowledge management examples are (a) a set of modular-based professional training activities for currently practicing therapists, (b) an outreach initiative for supporting youth evidence-based practices training at Hawaii's mental health-related professional programs, (c) an effort to increase consumer knowledge of and demand for youth evidence-based practices, (d) a practice and progress agency performance feedback system, and (e) a sampling of system-level research studies focused on understanding treatment as usual. We end by outlining a small set of lessons learned and a longer term vision for embedding these efforts into the system's infrastructure.

  19. School Librarianship and Evidence Based Practice: Progress, Perspectives, and Challenges

    Directory of Open Access Journals (Sweden)

    Ross J. Todd

    2009-06-01

    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.

  20. Organizational change tactics: the evidence base in the literature.

    Science.gov (United States)

    Packard, Thomas; Shih, Amber

    2014-01-01

    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.

  1. Effect of caregiver characteristics on dementia management strategies

    OpenAIRE

    Dalpai,Débora; Reis,Ramon Castro; Pádua,Analuiza Camozzato de

    2016-01-01

    ABSTRACT Caregiving has an important influence on the prognosis of dementia, particularly regarding the management strategy implemented. Therefore, evaluating which characteristics of caregivers can influence the choice of a particular strategy for managing dementia is needed. Objective: To evaluate the association between characteristics of caregivers and their management strategies as applied to patients with dementia. Methods: A cross-sectional study involving 45 professional caregiver...

  2. Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on the Role of Imaging in the Diagnosis and Management of Patients With Vestibular Schwannomas.

    Science.gov (United States)

    Dunn, Ian F; Bi, Wenya Linda; Mukundan, Srinivasan; Delman, Bradley N; Parish, John; Atkins, Tyler; Asher, Anthony L; Olson, Jeffrey J

    2017-12-20

    are suggested; annual MRI scans may be reasonable for 5 yr. Imaging follow-up should be adjusted accordingly for continued surveillance if any change in nodular enhancement is demonstrated.  The full guideline can be found at https://www.cns.org/guidelines/guidelines-management-patients-vestibular-schwannoma/chapter_5.

  3. Can Scholarly Communication be Evidence Based? (Editorial

    Directory of Open Access Journals (Sweden)

    Denise Koufogiannakis

    2010-12-01

    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

  4. Towards an Effective Management Strategy for Passive RFID Implementation

    National Research Council Canada - National Science Library

    Fisch, John N; Koch, David M

    2004-01-01

    .... However, many issues central to passive RFID implementation remain unresolved. First and foremost, a comprehensive management strategy, including a complete redesign of business practices, must be developed...

  5. Strategy-driven talent management a leadership imperative

    CERN Document Server

    Silzer, Rob

    2009-01-01

    A Publication of the Society for Industrial and Organizational Psychology Praise for Strategy-Driven Talent Management ""Silzer and Dowell''s Strategy-Driven Talent Management provides a comprehensive overview of the different elements of the best talent management processes used in organizations today. This is a valuable resource for leaders and managers, HR practitioners and anyone involved in developing leadership talent.""-Ed Lawler, Professor, School of Business, University of Southern California ""Talent is the key to successful execution of a winning business strategy. Strategy-Driven T

  6. Integrated Weed Management Strategies for Control of Hydrilla

    National Research Council Canada - National Science Library

    Nelson, Linda S; Shearer, Judy F

    2009-01-01

    ...), and the fungal pathogen Mycoleptodiscus terrestris (Gerd.) Ostazeski, applied alone and in combination with one another, as an integrated weed management strategy against the nuisance aquatic plant, hydrilla...

  7. Evolutionary space station fluids management strategies

    Science.gov (United States)

    1989-01-01

    Results are summarized for an 11-month study to define fluid storage and handling strategies and requirements for various specific mission case studies and their associated design impacts on the Space Station. There are a variety of fluid users which require a variety of fluids and use rates. Also, the cryogenic propellants required for NASA's STV, Planetary, and Code Z missions are enormous. The storage methods must accommodate fluids ranging from a high pressure gas or supercritical state fluid to a sub-cooled liquid (and superfluid helium). These requirements begin in the year 1994, reach a maximum of nearly 1800 metric tons in the year 2004, and trail off to the year 2018, as currently planned. It is conceivable that the cryogenic propellant needs for the STV and/or Lunar mission models will be met by LTCSF LH2/LO2 tanksets attached to the SS truss structure. Concepts and corresponding transfer and delivery operations have been presented for STV propellant provisioning from the SS. A growth orbit maneuvering vehicle (OMV) and associated servicing capability will be required to move tanksets from delivery launch vehicles to the SS or co-orbiting platforms. Also, appropriate changes to the software used for OMV operation are necessary to allow for the combined operation of the growth OMV. To support fluid management activities at the Space Station for the experimental payloads and propellant provisioning, there must be truss structure space allocated for fluid carriers and propellant tanksets, and substantial beam strengthening may be required. The Station must have two Mobile Remote Manipulator Systems (MRMS) and the growth OMV propellant handling operations for the STV at the SS. Propellant needs for the Planetary Initiatives and Code Z mission models will most likely be provided by co-orbiting propellant platform(s). Space Station impacts for Code Z mission fluid management activities will be minimal.

  8. Corroborating evidence-based medicine.

    Science.gov (United States)

    Mebius, Alexander

    2014-12-01

    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.

  9. Evidence-Based Medicine: Mandible Fractures.

    Science.gov (United States)

    Pickrell, Brent B; Hollier, Larry H

    2017-07-01

    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.

  10. Awareness of evidence-based practices alone does not translate to implementation: insights from implementation research.

    Science.gov (United States)

    Rangachari, Pavani; Rissing, Peter; Rethemeyer, Karl

    2013-01-01

    This article offers a scholarly review and perspective on the potential of "implementation research" to generate incremental, context-sensitive, evidence-based management strategies for the successful implementation of evidence-based practices (EBPs) (such as the "central line bundle"). Many hospitals have difficulty consistently implementing EBPs at the unit level. This problem has been broadly characterized as "change implementation failure" in health care organizations. The popular hospital response to this challenge has been to raise clinician awareness of EBPs through mandated educational programs. However, this approach has not always succeeded in changing practice. The health services research literature has emphasized the role of several organizational variables (eg, leadership, safety culture, organizational learning, teamwork and communication, and physician/staff engagement) in successful change implementation. Correspondingly, this literature has developed broad frameworks and programs for change in health care organizations. While these broad change frameworks have been successfully applied by some facilities to change practice, they are not incrementally actionable. As such, several facilities have not leveraged broad change frameworks because of resource and/or contextual limitations; a majority of hospitals continue to resort to mandated clinician education (awareness-building) for change implementation. The recent impetus toward "implementation research" in health care has the potential to generate incremental, context-sensitive, evidence-based management strategies for practice change. Authors discuss specific insights from a recently completed study on central line bundle implementation in 2 intensive care units in an academic health center. The study demonstrates that awareness of EBPs alone does not translate to implementation. More importantly, the study also identifies incremental, context-sensitive, evidence-based management strategies for

  11. ADMINISTRATIVE INSTRUMENTS IN IMPLEMENTING FUNCTIONAL STRATEGIES COMPETITIVENESS MANAGEMENT

    Directory of Open Access Journals (Sweden)

    Iryna Stankovska

    2017-03-01

    Full Text Available The article explores the use of  аdministrative instruments in implementing functional strategies competitiveness management. Due to providing strategic financial management competitiveness the use of administrative levers of control in the formulation and implementation of financial strategies were investigated. System of financial policies forming by individual policies of  general financial strategy, which is an administrative levers of influence on implementation strategies, was proposed. Structure strategic alternatives of financial and investment strategy implementation based on the decomposition and decision tree was formed. To select strategic alternatives, to identify strategic gaps and evaluate deviations from specified target markers in the implementation of financial policies using GAP-analysis that is a tool of management analysis was proposed. Key words: functional strategy, financial strategy, competitiveness management, financial policy, administrative instruments, GAP-analysis.

  12. Global Strategy for the Diagnosis, Management and Prevention of Chronic Obstructive Pulmonary Disease, GOLD Executive Summary

    DEFF Research Database (Denmark)

    Vestbo, Jørgen; Hurd, Suzanne S; Agusti, Alvar G

    2013-01-01

    and this is done in a way that split COPD patients into 4 categories - A, B, C and D. Non-pharmacologic and pharmacologic management of COPD match this assessment in an evidence-based attempt to relieve symptoms and reduce risk of exacerbations. Identification and treatment of comorbidities must have high priority......Chronic obstructive pulmonary disease (COPD) is a global health problem and since 2001 the Global Initiative for Chronic Obstructive Lung Disease (GOLD) has published its strategy document for the diagnosis and management of COPD. This executive summary presents the main contents of the second 5......-year revision of the GOLD document that has implemented some of the vast knowledge about COPD accumulated over the last years. Today, GOLD recommends that spirometry is required for the clinical diagnosis of COPD in order to avoid misdiagnosis and to ensure proper evaluation of severity of airflow...

  13. Evidence Based Practice: Science? Or Art? (Editorial

    Directory of Open Access Journals (Sweden)

    Denise Koufogiannakis

    2011-03-01

    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

  14. The notion of strategy in facility management

    DEFF Research Database (Denmark)

    Holzweber, Markus

    Based on a literature review, the findings of the study report a service-strategy classification grid. Such a service-strategy grid provides for a better understanding of the business environment. The study findings are intended to enhance business managers’ understandings of the issues behind FM...... strategy....

  15. Self-Management Strategies for Stress and Anxiety Used by Nontreatment Seeking Veteran Primary Care Patients.

    Science.gov (United States)

    Shepardson, Robyn L; Tapio, Jennie; Funderburk, Jennifer S

    2017-07-01

    in this sample. Strengths of the study include its novelty, our sample of non-treatment seeking Veteran primary care patients with current symptoms, and the open-ended format of the strategies questions. Limitations include reliance on self-report data, dichotomous response options for the perceived effectiveness item, limited number of potential correlates, and sampling from a single medical center. Overall, this research highlights the opportunity that health care providers have to engage primary care patients around self-management to determine what strategies they are using and how effective those strategies may be. Future directions include identification of the most effective and feasible self-management strategies for anxiety to facilitate promotion of evidence-based self-management among primary care patients. Reprint & Copyright © 2017 Association of Military Surgeons of the U.S.

  16. Strategies for sustainable management of renewable resources during environmental change.

    Science.gov (United States)

    Lindkvist, Emilie; Ekeberg, Örjan; Norberg, Jon

    2017-03-15

    As a consequence of global environmental change, management strategies that can deal with unexpected change in resource dynamics are becoming increasingly important. In this paper we undertake a novel approach to studying resource growth problems using a computational form of adaptive management to find optimal strategies for prevalent natural resource management dilemmas. We scrutinize adaptive management, or learning-by-doing, to better understand how to simultaneously manage and learn about a system when its dynamics are unknown. We study important trade-offs in decision-making with respect to choosing optimal actions (harvest efforts) for sustainable management during change. This is operationalized through an artificially intelligent model where we analyze how different trends and fluctuations in growth rates of a renewable resource affect the performance of different management strategies. Our results show that the optimal strategy for managing resources with declining growth is capable of managing resources with fluctuating or increasing growth at a negligible cost, creating in a management strategy that is both efficient and robust towards future unknown changes. To obtain this strategy, adaptive management should strive for: high learning rates to new knowledge, high valuation of future outcomes and modest exploration around what is perceived as the optimal action. © 2017 The Author(s).

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

    Science.gov (United States)

    Eldredge, J D

    2000-01-01

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

  18. Evidence-Based Practice in Psychology

    Science.gov (United States)

    American Psychologist, 2006

    2006-01-01

    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…

  19. The Zero Suicide Model: Applying Evidence-Based Suicide Prevention Practices to Clinical Care

    Directory of Open Access Journals (Sweden)

    Beth S. Brodsky

    2018-02-01

    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.

  20. Evaluation of stem borer resistance management strategies for Bt ...

    African Journals Online (AJOL)

    Evaluation of stem borer resistance management strategies for Bt maize in Kenya based on alternative host refugia. ... However, for successful management of a refugia strategy, strict stewardship is required from appropriate government or community institutions. Key words: Refugia, cost-benefit analysis, Bt-maize, insect ...

  1. Farm Input Management Strategies In Small Scale Farming In Niger ...

    African Journals Online (AJOL)

    Farm Input Management Strategies In Small Scale Farming In Niger State, Nigeria. ... Tools used for analysis were frequency distribution tables and percentages. The results showed preference for the ... quality of their lives. Keywords: Adoption, effective farm input management, income generation, strategies, Niger State

  2. European Society for Pediatric Gastroenterology, Hepatology, and Nutrition/European Society for Pediatric Infectious Diseases evidence-based guidelines for the management of acute gastroenteritis in children in Europe: update 2014.

    Science.gov (United States)

    Guarino, Alfredo; Ashkenazi, Shai; Gendrel, Dominique; Lo Vecchio, Andrea; Shamir, Raanan; Szajewska, Hania

    2014-07-01

    These guidelines update and extend evidence-based indications for the management of children with acute gastroenteritis in Europe. The guideline development group formulated questions, identified data, and formulated recommendations. The latter were graded with the Muir Gray system and, in parallel, with the Grading of Recommendations, Assessment, Development and Evaluations system. Gastroenteritis severity is linked to etiology, and rotavirus is the most severe infectious agent and is frequently associated with dehydration. Dehydration reflects severity and should be monitored by established score systems. Investigations are generally not needed. Oral rehydration with hypoosmolar solution is the major treatment and should start as soon as possible. Breast-feeding should not be interrupted. Regular feeding should continue with no dietary changes including milk. Data suggest that in the hospital setting, in non-breast-fed infants and young children, lactose-free feeds can be considered in the management of gastroenteritis. Active therapy may reduce the duration and severity of diarrhea. Effective interventions include administration of specific probiotics such as Lactobacillus GG or Saccharomyces boulardii, diosmectite or racecadotril. Anti-infectious drugs should be given in exceptional cases. Ondansetron is effective against vomiting, but its routine use requires safety clearance given the warning about severe cardiac effects. Hospitalization should generally be reserved for children requiring enteral/parenteral rehydration; most cases may be managed in an outpatients setting. Enteral rehydration is superior to intravenous rehydration. Ultrarapid schemes of intravenous rehydration are not superior to standard schemes and may be associated with higher readmission rates. Acute gastroenteritis is best managed using a few simple, well-defined medical interventions.

  3. [Evidence-based TEP technique].

    Science.gov (United States)

    Köckerling, F

    2017-04-01

    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.

  4. Strategy Maps in University Management: A Comparative Study

    Science.gov (United States)

    Han, Shuangmiao; Zhong, Zhou

    2015-01-01

    In this study, the conceptual use of the strategy map approach and the strategy map which it produces have been adapted from the business sector and introduced as tools for achieving more effective strategic planning and management in higher education institutions (HEIs). This study discusses the development of strategy maps as transformational…

  5. Legitimation Endeavors: Impression Management Strategies Used by an Organization.

    Science.gov (United States)

    Allen, Myria Watkins; Caillouet, Rachel H.

    1994-01-01

    Investigates the impression management strategies embedded in the external discourse of an organization in crisis. Shows ingratiation to be the primary strategy. Finds that intimidation was used with special interest groups and that denouncement strategies were embedded in messages to competitors, special interest groups, and suppliers. (SR)

  6. A national cohesive wildland fire management strategy

    Science.gov (United States)

    Forest Service U.S. Department of Agriculture; Office of Wildland Fire Coordination. Department of the Interior

    2011-01-01

    Addressing wildfire is not simply a fire management, fire operations, or wildland-urban interface problem - it is a larger, more complex land management and societal issue. The vision for the next century is to: Safely and effectively extinguish fire, when needed; use fire where allowable; manage our natural resources; and as a Nation, live with wildland fire. Three...

  7. Can curriculum managers' reflections produce new strategies ...

    African Journals Online (AJOL)

    managers) who used Moodle visions to manage their school curriculum at a school in Durban, South Africa. The curriculum managers' main aim of using Moodle was to improve teacher and learner performance. The purpose of the study was to ...

  8. Building an Intranet Content Management Strategy

    OpenAIRE

    Tredinnick, Luke

    2001-01-01

    A step-by-step guide to the principals of creating content management processes and resources for Intranets, this article covers the creation of aims and objectives for Intranets, information management issues specific to Intranets, and how to turn those objectives and issues into working content management\\ud procedures.

  9. Strategies for Managing a Multigenerational Workforce

    Science.gov (United States)

    Iden, Ronald

    2016-01-01

    The multigenerational workforce presents a critical challenge for business managers, and each generation has different expectations. A human resource management study of organizations with more than 500 employees reported 58% of the managers experiencing conflict between younger and older workers. The purpose of this single case study was to…

  10. A workshop report on HIV mHealth synergy and strategy meeting to review emerging evidence-based mHealth interventions and develop a framework for scale-up of these interventions.

    Science.gov (United States)

    Karanja, Sarah; Mbuagbaw, Lawrence; Ritvo, Paul; Law, Judith; Kyobutungi, Catherine; Reid, Graham; Ram, Ravi; Estambale, Benson; Lester, Richard

    2011-01-01

    mHealth is a term used to refer to mobile technologies such as personal digital assistants and mobile phones for healthcare. mHealth initiatives to support care and treatment of patients are emerging globally and this workshop brought together researchers, policy makers, information, communication and technology programmers, academics and civil society representatives for one and a half days synergy meeting in Kenya to review regional evidence based mHealth research for HIV care and treatment, review mHealth technologies for adherence and retention interventions in anti-retroviral therapy (ART) programs and develop a framework for scale up of evidence based mHealth interventions. The workshop was held in May 2011 in Nairobi, Kenya and was funded by the Canadian Global Health Research Initiatives (GHRI) and the US Centre for Disease Control and Prevention (CDC). At the end of the workshop participants came up with a framework to guide mHealth initiatives in the region and a plan to work together in scaling up evidence based mHealth interventions. The participants acknowledged the importance of the meeting in setting the pace for strengthening and coordinating mHealth initiatives and unanimously agreed to hold a follow up meeting after three months.

  11. [Handbook for the preparation of evidence-based documents. Tools derived from scientific knowledge].

    Science.gov (United States)

    Carrión-Camacho, M R; Martínez-Brocca, M A; Paneque-Sánchez-Toscano, I; Valencia-Martín, R; Palomino-García, A; Muñoz-Durán, C; Tamayo-López, M J; González-Eiris-Delgado, C; Otero-Candelera, R; Ortega-Ruiz, F; Sobrino-Márquez, J M; Jiménez-García-Bóveda, R; Fernández-Quero, M; Campos-Pareja, A M

    2013-01-01

    This handbook is intended to be an accessible, easy-to-consult guide to help professionals produce or adapt Evidence-Based Documents. Such documents will help standardize both clinical practice and decision-making, the quality always being monitored in such a way that established references are complied with. Evidence-Based Health Care Committee, a member of "Virgen del Rocío" University Hospital quality structure, proposed the preparation of a handbook to produce Evidence-Based Documents including: a description of products, characteristics, qualities, uses, methodology of production, and application scope of every one of them. The handbook consists of seven Evidence-Based tools, one chapter on critical analysis methodology of scientific literature, one chapter with internet resources, and some appendices with different assessment tools. This Handbook provides general practitioners with a great opportunity to improve quality and as a guideline to standardize clinical healthcare, and managers with a strategy to promote and encourage the development of documents in an effort to reduce clinical practice variability, as well as giving patients the opportunity of taking part in planning their own care. Copyright © 2011 SECA. Published by Elsevier Espana. All rights reserved.

  12. Analysis of Solid Waste Management and Strategies for Bangkok Metropolitan

    Directory of Open Access Journals (Sweden)

    Palika Wannawilai

    2017-04-01

    Full Text Available This study aimed to examine and analyze strategic gaps and the environment of waste management of Bangkok Metropolitan Administration (BMA in order to suggest suitable waste management strategies for Bangkok Metropolitan. The study was conducted by interviewing BMA and districts’ administrators and officers, local leaders and people, and private sectors, conducting a focus group, as well as reviewing relevant documents. The data was analyzed by applying Gap analysis and SWOT analysis. The proposed five strategies are: 1 enhancement of efficiency in solid waste and hazardous waste management; 2 discipline, participation and responsibility of citizens and all sectors related to waste management; 3 appropriate and integrated waste management; 4 capacity building for BMA’s staff and improvement of solid waste management system; and 5 research and development of knowledge and technology in waste management. The study also suggested driving approaches for effective implementation of the strategies.

  13. Ten strategies for creating successful managed care relationships.

    Science.gov (United States)

    Alexander, K

    1997-06-01

    Among the many customers providers serve are managed care organizations. The strategic relationships providers develop with these payers greatly influence the long-term success of both organizations. Providers can implement 10 strategies to improve their managed care relationships: focusing on contracting with selected managed care organizations, fostering positive relationships, coordinating contract participation, establishing communication links, educating providers about managed care, providing high-quality customer service; understanding operating costs, demonstrating value, maintaining flexibility, and pursuing alternative competitive relationships with caution. At the same time, managed care organizations can implement the same strategies to develop win/win relationships with providers.

  14. Effects of new forest management strategies on squirrel populations.

    Science.gov (United States)

    Andrew B. Carey

    2000-01-01

    Two strategies for managing forests for multiple values have achieved prominence in debates in the Pacific Northwest: (1) legacy retention with passive management and long rotations, and (2) intensive management for timber with commercial thinnings and long rotations. Northern flying squirrels (Glaucomys sabrinus), Townsend's chipmunks (

  15. Clinicians' strategies for managing their emotions during difficult healthcare conversations.

    Science.gov (United States)

    Luff, Donna; Martin, Elliott B; Mills, Kelsey; Mazzola, Natalia M; Bell, Sigall K; Meyer, Elaine C

    2016-09-01

    To examine strategies employed by clinicians from different disciplines to manage their emotions during difficult healthcare conversations. Self-report questionnaires were collected prior to simulation-based Program to Enhance Relational and Communication Skills (PERCS) workshops for professionals representing a range of experience and specialties at a tertiary pediatric hospital. In response to an open-ended prompt, clinicians qualitatively described their own strategies for managing their emotions during difficult healthcare conversations. 126 respondents reported emotion management strategies. Respondents included physicians (42%), nurses (29%), medical interpreters (16%), psychosocial professionals (9%), and other (4%). Respondents identified 1-4 strategies. Five strategy categories were identified: Self-Care (51%), Preparatory and Relational Skills, (29%), Empathic Presence (28%), Team Approach (26%), and Professional Identity (20%). Across disciplines and experience levels, clinicians have developed strategies to manage their emotions when holding difficult healthcare conversations. These strategies support clinicians before, during and after difficult conversations. Understanding what strategies clinicians already employ to manage their emotions when holding difficult conversations has implications for educational planning and implementation. This study has potential to inform the development of education to support clinicians' awareness of their emotions and to enhance the range and effectiveness of emotion management during difficult healthcare conversations. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  16. Management Strategy Of Bank Credit Portfolio

    OpenAIRE

    Nenad Vunjak; Tamara Antonijevic

    2008-01-01

    Credit portfolio includes a credit group that is structured by bank management team according to credit users. Realizing the key targets of credit portfolio management imply the analysis of: (1) volume of credits, (2) portfolio structure, (3) credit services, (4) payment of credits, (5) credit price (interest rate), (6) realized profit. The credit portfolio modeling is the top management competence. Performance of credit portfolio depends from expect risks and returns estimate, having insight...

  17. CHANGE MANAGEMENT STRATEGIES RELATED TO THE GLOBAL ENVIRONMENT COMPLEXITY

    Directory of Open Access Journals (Sweden)

    Elena DOVAL

    2016-12-01

    Full Text Available The changes in organizations appear as a reaction to the organizational environment changes. In order to manage these changes successfully, the managers need to anticipate and design alternative strategies by preparing different options.  Nevertheless, the complexity of the global environment forces the managers to adopt strategies for their organizations that are facilitating the creation of new strategic competences and competitive advantages to face the environmental rapid changes. In this context, this paper is aiming to illustrate the main directions the change management may consider to change the organization strategies in order to harmonize them to the external environment, such as: integration versus externalization, flexible specialization and flexible organization, standardization versus adaptation, market segmentation, relationship building and maintaining and communication integration.  However, the new strategies are based on a changed attitude of the managers towards the competitive advantage that is dynamic and focused on creation rather then to operations.

  18. Community strategies of women in educational management

    African Journals Online (AJOL)

    Erna Kinsey

    dominated environment; the constraints of traditional culture regarding communication and coping strategies ..... logues, to explain a point. .... A teacher described this paradox ... staff, consistently maintain a social distance from subordinates to.

  19. IQC Laboratory management strategy for medical biology.

    Science.gov (United States)

    Bugni, Estelle; Cohen, Richard; Mazellier, Cécile

    2017-12-01

    Medical biology laboratories rely especially on internal quality control (IQC) to monitor the performance of equipment and ensure results reliability. Strategies for these controls vary considerably from one laboratory to another. Some laboratories use Westgard's rules to detect drifts and are faced with a large number of false rejections caused by frequent runs of control samples and strategies that activate all rejection rules, regardless of the analyte considered. To minimize these rejections, some laboratories have combined several theories, sometimes despite the relevance of the resulting strategy. In this article, we want to explain the foundations of the main IQC theories and set out a strategy to optimize the detection of problems while minimizing false IQC rejections. We will also address some frequently asked questions from laboratories as part of ISO 15189 accreditation.

  20. Environmental factors and health information technology management strategy.

    Science.gov (United States)

    Menachemi, Nir; Shin, Dong Yeong; Ford, Eric W; Yu, Feliciano

    2011-01-01

    : Previous studies have provided theoretical and empirical evidence that environmental forces influence hospital strategy. : Rooted in resource dependence theory and the information uncertainty perspective, this study examined the relationship between environmental market characteristics and hospitals' selection of a health information technology (HIT) management strategy. : A cross-sectional design is used to analyze secondary data from the American Hospital Association Annual Survey, the Healthcare Information and Management Systems Society Analytics Database, and the Area Resource File. Univariate and multinomial logistic regression analyses are used. : Overall, 3,221 hospitals were studied, of which 60.9% pursed a single-vendor HIT management strategy, 28.9% pursued a best-of-suite strategy, and 10.2% used a best-of-breed strategy. Multivariate analyses controlling for hospital characteristics found that measures of environmental factors representing munificence, dynamism, and/or complexity were systematically associated with various hospital HIT management strategy use. Specifically, the number of generalist physicians per capita was positively associated with the single-vendor strategy (B = -5.64, p = .10). Hospitals in urban markets were more likely to pursue the best-of-suite strategy (B = 0.622, p < .001). Dynamism, measured as the number of managed care contracts for a given hospital, was negatively associated with the single-vendor strategy (B = 0.004, p = .049). Lastly, complexity, measured as market competition, was positively associated with the best-of-breed strategy (B = 0.623, p = .042). : By and large, environmental factors are associated with hospital HIT management strategies in mostly theoretically supported ways. Hospital leaders and policy makers interested in influencing the adoption of hospital HIT should consider how market conditions influence HIT management decisions as part of programs to promote meaningful use.