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Sample records for finnish evidence-based guideline

  1. Evidence-based guidelines

    DEFF Research Database (Denmark)

    Rovira, Àlex; Wattjes, Mike P; Tintoré, Mar

    2015-01-01

    diagnosis in patients with MS. The aim of this article is to provide guidelines for the implementation of MRI of the brain and spinal cord in the diagnosis of patients who are suspected of having MS. These guidelines are based on an extensive review of the recent literature, as well as on the personal...

  2. Evidence-based guidelines

    DEFF Research Database (Denmark)

    Wattjes, Mike P; Rovira, Àlex; Miller, David

    2015-01-01

    for the prediction of long-term disability. With the introduction of a new generation of immunomodulatory and/or immunosuppressive drugs for the treatment of MS, MRI also makes an important contribution to the monitoring of treatment, and can be used to determine baseline tissue damage and detect subsequent repair....... This use of MRI can help predict treatment response and assess the efficacy and safety of new therapies. In the second part of the MAGNIMS (Magnetic Resonance Imaging in MS) network's guidelines on the use of MRI in MS, we focus on the implementation of this technique in prognostic and monitoring tasks. We...... present recommendations on how and when to use MRI for disease monitoring, and discuss some promising MRI approaches that may be introduced into clinical practice in the near future....

  3. Evidence-based guideline update

    DEFF Research Database (Denmark)

    Tfelt-Hansen, Peer Carsten

    2013-01-01

    Peer Carsten Tfelt-Hansen, Glostrup, Denmark: According to the recent American Academy of Neurology (AAN) guideline update, a drug can be recommended as possibly effective for migraine prevention if it had demonstrated efficacy in one Class II study.(1) Eight drugs are recommended as possibly...

  4. How occupational health care professionals experience evidence-based guidelines in Finland: a qualitative study.

    Science.gov (United States)

    Kinnunen-Amoroso, Maritta

    2013-08-01

    Evidence-based guidelines are currently the most relevant source of information in practice. The adherence to and use of guidelines is often influenced by attitudes towards the guidelines themselves, which have not been sufficiently explored in occupational health. This study examines the attitude of Finnish occupational nurses' and doctors' attitudes towards evidence-based guidelines. Ten occupational doctors and eight occupational nurses were interviewed in Southern Finland on their attitudes towards evidence-based guidelines in 2009. The nurses were not very familiar with the concept of evidence-based medicine. Rather, they used recommendations developed in their workplace or by their employer. The evidence base of these recommendations was not clear. The doctors considered the evidence-based guidelines reliable and practical, but did not always act according to them. Participants felt that they did not have time to check guidelines during their working hours. Participants wished for clearer, shorter guidelines on occupational health care topics, which would help in their practical daily work and clarify roles in teamwork. Based on these positive attitudes, the use of guidelines may be more common than it seems. The viewpoints of all occupational health professional groups should be taken into account in guideline development, particularly on the availability and usability of the guidelines. © 2012 John Wiley & Sons Ltd.

  5. Hypertension guideline implementation: experiences of Finnish primary care nurses

    DEFF Research Database (Denmark)

    Alanen, Seija; Ijäs, Jarja; Kaila, Minna;

    2008-01-01

    RATIONALE, AIMS AND OBJECTIVES: Evidence-based guidelines on hypertension have been developed in many western countries. Yet, there is little evidence of their impact on the clinical practices of primary care nurses. METHOD: We assessed the style of implementation and adoption of the national...... Hypertension Guideline (HT Guideline) in 32 Finnish health centres classified in a previous study as 'disseminators' (n = 13) or 'implementers' (n = 19). A postal questionnaire was sent to all nurses (n = 409) working in the outpatient services in these health centres. Additionally, senior nursing officers...... were telephoned to enquire if the implementation of the HT Guideline had led to a new division of labour between nurses and doctors. RESULTS: Questionnaires were returned from 327 nurses (80.0%), while all senior nursing officers (n = 32) were contacted. The majority of nurses were of the opinion...

  6. [Prevention of atopic eczema. Evidence based guidelines].

    Science.gov (United States)

    Schäfer, T

    2005-03-01

    With an estimated prevalence of 12% for preschool children and 3% for adults, atopic eczema is a serious public health problem. This disease severely jeopardizes quality of life and is associated with considerable costs. Since there is still no causal therapy, primary and secondary prevention are especially important. Here the evidence basis for recommendations on prevention of atopic eczema is discussed on the basis of the first evidence-based consensus guideline (S3) on allergy prevention. This recommends that babies should be breastfed exclusively for at least 4 months and exposure to passive smoking be avoided even during pregnancy; restriction of the maternal diet during pregnancy has no influence, though during breastfeeding it can lower the incidence of eczema among babies at risk. Thereby this measure should be balanced with potential consequences of malnutrition. There seems to be a positive correlation between keeping small rodents (rabbits, guinea pigs), and possibly cats, and the occurrence of atopic eczema, while keeping dogs has no effect or even a protective effect. Avoidance of an unfavorable indoor climate is probably also helpful in preventing eczema. There is no evidence to support deviating from the current recommendations of the standing committee for vaccination.

  7. Attitudes toward guidelines in Finnish primary care nursing: a questionnaire survey

    DEFF Research Database (Denmark)

    Seija, Alanen; Kaila, Minna; Välimäki, Marita

    2009-01-01

    BACKGROUND: Evidence-based clinical guidelines have attracted international interest as tools for improving the quality of health care. Attitudes toward these guidelines are of great importance because attitudes are proven to be important predictors of guideline use. Attitudes are also believed...... as a reliable source of advice in patient care in Finnish primary care. It seems that implementation interventions improve attitudes toward guidelines and enhance guideline use. These interventions might also be important from another point of view; they presumably improve familiarity with guidelines, which...... to be shaped by perceptions of others, which makes the role of organizational implementation interventions interesting. AIMS: This article describes primary care nurses' attitudes toward guidelines among Finnish primary care nurses and the associations between attitudes, implementation interventions...

  8. Annotating Evidence Based Clinical Guidelines: A Lightweight Ontology

    NARCIS (Netherlands)

    R. Hoekstra; A. de Waard; R. Vdovjak

    2012-01-01

    This paper describes a lightweight ontology for representing annotations of declarative evidence based clinical guidelines. We present the motivation and requirements for this representation, based on an analysis of several guidelines. The ontology provides the means to connect clinical questions an

  9. [Evidence-based clinical practice guidelines in oral care 2: process and content of evidence-based guideline development

    NARCIS (Netherlands)

    Mettes, T.G.P.H.; Loveren, C. van; Oirschot, B.A.J.A. van; Maanen-Schakel, N.W. van; Weijden, F.G. van der; Bruers, J.J.

    2015-01-01

    In 2014, an advisory report was published by a national working committee concerning how the current, applied method of evidence-based guideline development in healthcare can be used in oral care in a national guideline programme. In an independent Institute of Knowledge Translation in Oral Care, as

  10. How evidence-based are the recommendations in evidence-based guidelines?

    Directory of Open Access Journals (Sweden)

    Finlay A McAlister

    2007-08-01

    Full Text Available BACKGROUND: Treatment recommendations for the same condition from different guideline bodies often disagree, even when the same randomized controlled trial (RCT evidence is cited. Guideline appraisal tools focus on methodology and quality of reporting, but not on the nature of the supporting evidence. This study was done to evaluate the quality of the evidence (based on consideration of its internal validity, clinical relevance, and applicability underlying therapy recommendations in evidence-based clinical practice guidelines. METHODS AND FINDINGS: A cross-sectional analysis of cardiovascular risk management recommendations was performed for three different conditions (diabetes mellitus, dyslipidemia, and hypertension from three pan-national guideline panels (from the United States, Canada, and Europe. Of the 338 treatment recommendations in these nine guidelines, 231 (68% cited RCT evidence but only 105 (45% of these RCT-based recommendations were based on high-quality evidence. RCT-based evidence was downgraded most often because of reservations about the applicability of the RCT to the populations specified in the guideline recommendation (64/126 cases, 51% or because the RCT reported surrogate outcomes (59/126 cases, 47%. CONCLUSIONS: The results of internally valid RCTs may not be applicable to the populations, interventions, or outcomes specified in a guideline recommendation and therefore should not always be assumed to provide high-quality evidence for therapy recommendations.

  11. Do evidence-based guidelines change clinical practice patterns?

    DEFF Research Database (Denmark)

    Kessel, Line; Erngaard, Ditte; Flesner, Per;

    2017-01-01

    In 2013, the Danish Health and Medicines Authorities published a National Clinical Guideline on the treatment of age-related cataracts. The guideline provided evidence-based recommendations on the indication for cataract surgery, cataract surgery in patients with age-related macular degeneration...... sequential bilateral cataract surgery and on the postoperative check-up of patients. A questionnaire was sent to all members of the Danish Ophthalmological Society before and after publication of the guideline. The responses showed that the guideline had changed practice patterns so that surgeons were more...

  12. Evidence-based practice guidelines for plasma transfusion

    NARCIS (Netherlands)

    Roback, John D.; Caldwell, Stephen; Carson, Jeff; Davenport, Robertson; Drew, Mary Jo; Eder, Anne; Fung, Mark; Hamilton, Marilyn; Hess, John R.; Luban, Naomi; Perkins, Jeremy G.; Sachais, Bruce S.; Shander, Aryeh; Silverman, Toby; Snyder, Ed; Tormey, Christopher; Waters, John; Djulbegovic, Ben

    2010-01-01

    BACKGROUND: There is little systematically derived evidence-based guidance to inform plasma transfusion decisions. To address this issue, the AABB commissioned the development of clinical practice guidelines to help direct appropriate transfusion of plasma. STUDY DESIGN AND METHODS: A systematic rev

  13. Developing evidence-based guidelines for referral for short stature

    NARCIS (Netherlands)

    Grote, F.K.; Dommelen, P. van; Oostdijk, W.; Muinck Keizer-Schrama, S.M.P.F. de; Verkerk, P.H.; Wit, J.M.; Buuren, S. van

    2008-01-01

    Objective: To establish evidence based guidelines for growth monitoring on a population basis. Study design: Several auxological referral criteria were formulated and applied to longitudinal growth data from four different patient groups, as well as three samples from the general population. Results

  14. Evaluation of an evidence-based guideline for bronchiolitis.

    Science.gov (United States)

    Perlstein, P H; Kotagal, U R; Bolling, C; Steele, R; Schoettker, P J; Atherton, H D; Farrell, M K

    1999-12-01

    To describe the effect of implementing an evidence-based clinical practice guideline for the inpatient care of infants with bronchiolitis at the Children's Hospital Medical Center in Cincinnati, Ohio. A multidisciplinary team generated the guideline for infants financial databases. They included LOS and use and costs of resources ancillary to bed occupancy. After implementation of the guideline, admissions decreased 29% and mean LOS decreased 17%. Nasopharyngeal washings for respiratory syncytial virus were obtained in 52% fewer patients. Twenty percent fewer chest radiographs were ordered. There were significant reductions in the use of all respiratory therapies, with a 30% decrease in the use of at least 1 beta-agonist inhalation therapy. In addition, 51% fewer repeated inhalations were administered. Mean costs for all resources ancillary to bed occupancy decreased 37%. Mean costs for respiratory care services decreased 77%. An evidence-based clinical practice guideline for managing bronchiolitis was highly successful in modifying care during its first year of implementation.guideline, bronchiolitis, evidence-based medicine, pediatrics, outcome research.

  15. The development of evidence-based guidelines in dentistry.

    Science.gov (United States)

    Faggion, C M

    2013-02-01

    Use of guidelines is an important means of reducing the gap between research and clinical practice. Sound and unbiased information should be available to enable dental professionals to provide better clinical treatment for their patients. The development of clinical guidelines in dentistry should follow standard and transparent methodology. The purpose of this article is to propose important steps for developing evidence-based clinical recommendations in dentistry. Initially, dental guidelines should be extensively sought and assessed to answer focused clinical questions. If there is a paucity of guidelines or if existing guidelines are not of good methodological quality, systematic reviews should be searched or conducted to serve as a basis for the development of evidence-based guidelines. When systematic reviews are produced, they should be rigorous in order to provide the best evidence possible. In the last phase of the process, the overall quality of evidence should be scrutinized and assessed, together with other factors (balance between treatment effects and side effects, patients' values, and cost-effectiveness of therapy) to determine the strength of recommendations. It is expected this approach will result in the development of sound clinical guidelines and consequent improvement of dental treatment.

  16. [Pharmacist's requirements for evidence-based self-medication guidelines].

    Science.gov (United States)

    Laven, Anna; Läer, Stephanie

    2013-03-01

    Due to the removal of many pharmaceuticals from the prescription requirement, self-medication implies an increasing responsibility for pharmacists towards their patients. The application of evidence-based guidelines could be a responsible basis for consulting in pharmacies. Evidence-based guidelines represent the systematically accumulated and evaluated facts (the evidence) of desired and undesired effects of pharmaceuticals in the population. We wanted to find out which interest pharmaceutical professionals have in evidence-based guidelines and which are the exact requirements on their content, deducted from public pharmacies everyday demands. With this purpose, three surveys were conducted between March and August 2012, in which 365, 350, and 486 pharmaceutical professionals participated respectively. The results show that pharmacy staff is very interested in evidence based guidelines. Furthermore, they suggest that the pharmacy staff feel safe with the self-diagnosis of the customer, with the consideration of limits of self-medication, as well as with the selection of the--according to own assessment--appropriate active substance. For the selection of the correct active substance, the following criteria are named: self-security in the counselling, first-hand experiences as well as the wish of the customer. At the same time, it is striking that the most frequent critique the pharmacy staff gets from pharmacy customers is the lack of effectiveness of the selected medication. With that in mind, it is possible that not the appropriate medication was selected, and the chosen criteria as selection method should be replaced by an evidence-based decision. Secondly, the results show that in up to 52% of the cases, depending on the indications, the participating consultants felt less certain to uncertain with regards to possible interactions or contraindications. Also in this context, it is desirable to prepare the existing data in such a practical way, that the

  17. Clinicians adopting evidence based guidelines: a case study with thromboprophylaxis

    Directory of Open Access Journals (Sweden)

    Fry Margaret

    2011-09-01

    Full Text Available Abstract Background Venous Thromboembolism (VTE is a cause of hospital mortality and managing its morbidity is associated with significant expenditure. Uptake of evidenced based guideline recommendations intended to prevent VTE in hospital settings is sub-optimal. This study was conducted to explore clinicians' attitudes and the clinical environment in which they work to understand their reluctance to adopt VTE prophylaxis guidelines. Methods Between February and November 2009, 40 hospital employed doctors from 2 Australian metropolitan hospitals were interviewed in depth. Qualitative data were analysed according to thematic methodology. Results Analysis of interviews revealed that barriers to evidence based practice include i the fragmented system of care delivery where multiple members of teams and multiple teams are responsible for each patient's care, and in the case of VTE, where everyone shares responsibility and no-one in particular is responsible; ii the culture of practice where team practice is tailored to that of the team head, and where medicine is considered an 'art' in which guidelines should be adapted to each patient rather than applied universally. Interviewees recommend clear allocation of responsibility and reminders to counteract VTE risk assessment being overlooked. Conclusions Senior clinicians are the key enablers for practice change. They will need to be convinced that guideline compliance adds value to their patient care. Then with the support of systems in the organisation designed to minimize the effects of care fragmentation, they will drive practice changes in their teams. We believe that evidence based practice is only possible with a coordinated program that addresses individual, cultural and organisational constraints.

  18. Evidence-based clinical practice guidelines for cholelithiasis 2016.

    Science.gov (United States)

    Tazuma, Susumu; Unno, Michiaki; Igarashi, Yoshinori; Inui, Kazuo; Uchiyama, Kazuhisa; Kai, Masahiro; Tsuyuguchi, Toshio; Maguchi, Hiroyuki; Mori, Toshiyuki; Yamaguchi, Koji; Ryozawa, Shomei; Nimura, Yuji; Fujita, Naotaka; Kubota, Keiichi; Shoda, Junichi; Tabata, Masami; Mine, Tetsuya; Sugano, Kentaro; Watanabe, Mamoru; Shimosegawa, Tooru

    2017-03-01

    Cholelithiasis is one of the commonest diseases in gastroenterology. Remarkable improvements in therapeutic modalities for cholelithiasis and its complications are evident. The Japanese Society of Gastroenterology has revised the evidence-based clinical practice guidelines for cholelithiasis. Forty-three clinical questions, for four categories-epidemiology and pathogenesis, diagnosis, treatments, and prognosis and complications-were selected, and a literature search was performed for the clinical questions with use of the MEDLINE, Cochrane, and Igaku Chuo Zasshi databases for the period between 1983 and June 2012. The guidelines were developed with use of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. This article preferentially describes the clinical management of cholelithiasis and its complications. Following description of the diagnosis performed stepwise through imaging modalities, treatments of cholecystolithiasis, choledocholithiasis, and hepatolithiasis are introduced along with a flowchart. Since there have been remarkable improvements in endoscopic treatments and surgical techniques, the guidelines ensure flexibility in choices according to the actual clinical environment. The revised clinical practice guidelines are appropriate for use by clinicians in their daily practice.

  19. Evidence-based clinical guidelines in Kyrgyz Republic.

    Science.gov (United States)

    Zurdinova, A A

    2015-01-01

    Improving quality of care in many countries is one of the priorities of health systems. At the same time one of the most important methods of improving quality of care is the widespread use of methods and principles of evidence-based medicine (EBM) [1]. The implementation of EBM in public health practice provides for the optimization of quality of care in terms of safety, efficacy and cost, one way of which is the use of clinical guidelines. Clinical guidelines developed with the use of EBM, provide an opportunity to use the latest and accurate information to optimize or neutralize impact on physician decision-making of subjective factors such as intuition, expertise, opinion of respected colleagues, recommendations of popular manuals and handbooks, etc. To assess and analyze the developed clinical guidelines (CG) and protocols (CP) in the Kyrgyz Republic in the period from 2008 to 2014 and evaluate their implementation in practical healthcare. Retrospective analysis of the developed clinical guidelines and protocols according to the approved methodology, interviewing leaders, questioning doctors and patients for their implementation. All participants gave informed consent for voluntary participation in the study. Within the framework of the National Program "Manas Taalimi" "Strategy for development of evidence-based medicine in the Kyrgyz Republic for 2006-2010" (MOH Order №490 from 09.04.06) was developed and approved for use. Its main purpose was to create a sustainable system of development, deployment and monitoring of the CG and CP and further promotion of EBM into practical health care, education and science. As a result, a number of documents ("Expert Council for assessing the quality of clinical guidelines/protocols", "AGREE instrument to assess the methodological content of clinical guidelines" [2], "The methodology of development and adaptation of clinical guidelines based on evidence-based medicine") were approved by the Order of the Ministry of

  20. [Evidence-based clinical guidelines in dental practice 6. Guidelines for clinical practice in dental education].

    Science.gov (United States)

    van der Sanden, W J M; Gorter, R; Tams, J

    2015-09-01

    In response to the initiatives of the Kennisinstituut Mondzorg (Institute for Knowledge Translation in Oral Care), the importance of effective education in the area of guidelines is increasing. Future dentists will, after all, be confronted with new guidelines and need to be able to integrate them in their daily practice. Various guidelines and protocols have been established within the 3 dental schools. For students and instructors, however, the motivation for these guidelines and protocols is not always sufficiently clear. In addition, the terms guideline, clinical practice guideline and protocol are used interchangeably, resulting in terminological confusion. Embedding within and coordination with theoretical education is also still limited in all programmes and it is proposed that the 3 dental schools collaborate on this issue. Finally, it is advised to replace the term 'evidence-based' with 'evidence-informed' because this indicates more clearly that other factors (patients opinion, available financial means, etc.) play a role in the final choice of treatment in a specific situation.

  1. Validation of evidence-based clinical practice guideline: Nursing ...

    African Journals Online (AJOL)

    Amel Ibrahim Ahmed

    2012-01-31

    Jan 31, 2012 ... Introduction ... 5% of treatment outcome of new smear positive cases.7 Treat- ... well as, to operate the implementation of evidence-based prac- ... (nurses) and the end point beneficiaries (newly diagnosed pa- ..... through sputum test. Also ..... national Standards for tuberculosis care: Diagnosis, Treatment.

  2. Evidence-based guidelines for the wise use of computers by children: physical development guidelines.

    Science.gov (United States)

    Straker, L; Maslen, B; Burgess-Limerick, R; Johnson, P; Dennerlein, J

    2010-04-01

    Computer use by children is common and there is concern over the potential impact of this exposure on child physical development. Recently principles for child-specific evidence-based guidelines for wise use of computers have been published and these included one concerning the facilitation of appropriate physical development. This paper reviews the evidence and presents detailed guidelines for this principle. The guidelines include encouraging a mix of sedentary and whole body movement tasks, encouraging reasonable postures during computing tasks through workstation, chair, desk, display and input device selection and adjustment and special issues regarding notebook computer use and carriage, computing skills and responding to discomfort. The evidence limitations highlight opportunities for future research. The guidelines themselves can inform parents and teachers, equipment designers and suppliers and form the basis of content for teaching children the wise use of computers. STATEMENT OF RELEVANCE: Many children use computers and computer-use habits formed in childhood may track into adulthood. Therefore child-computer interaction needs to be carefully managed. These guidelines inform those responsible for children to assist in the wise use of computers.

  3. Diagnosis and pharmacotherapy of stable chronic obstructive pulmonary disease: the finnish guidelines.

    Science.gov (United States)

    Kankaanranta, Hannu; Harju, Terttu; Kilpeläinen, Maritta; Mazur, Witold; Lehto, Juho T; Katajisto, Milla; Peisa, Timo; Meinander, Tuula; Lehtimäki, Lauri

    2015-04-01

    The Finnish Medical Society Duodecim initiated and managed the update of the Finnish national guideline for chronic obstructive pulmonary disease (COPD). The Finnish COPD guideline was revised to acknowledge the progress in diagnosis and management of COPD. This Finnish COPD guideline in English language is a part of the original guideline and focuses on the diagnosis, assessment and pharmacotherapy of stable COPD. It is intended to be used mainly in primary health care but not forgetting respiratory specialists and other healthcare workers. The new recommendations and statements are based on the best evidence available from the medical literature, other published national guidelines and the GOLD (Global Initiative for Chronic Obstructive Lung Disease) report. This guideline introduces the diagnostic approach, differential diagnostics towards asthma, assessment and treatment strategy to control symptoms and to prevent exacerbations. The pharmacotherapy is based on the symptoms and a clinical phenotype of the individual patient. The guideline defines three clinically relevant phenotypes including the low and high exacerbation risk phenotypes and the neglected asthma-COPD overlap syndrome (ACOS). These clinical phenotypes can help clinicians to identify patients that respond to specific pharmacological interventions. For the low exacerbation risk phenotype, pharmacotherapy with short-acting β2 -agonists (salbutamol, terbutaline) or anticholinergics (ipratropium) or their combination (fenoterol-ipratropium) is recommended in patients with less symptoms. If short-acting bronchodilators are not enough to control symptoms, a long-acting β2 -agonist (formoterol, indacaterol, olodaterol or salmeterol) or a long-acting anticholinergic (muscarinic receptor antagonists; aclidinium, glycopyrronium, tiotropium, umeclidinium) or their combination is recommended. For the high exacerbation risk phenotype, pharmacotherapy with a long-acting anticholinergic or a fixed combination

  4. Guidelines and evidence based medicine. The importance of stakeholder involvement.

    Directory of Open Access Journals (Sweden)

    Francesco Massoni

    2014-07-01

    Full Text Available With the depenalization of professional conduct of the physician in case of adherence to the guidelines proposed by L. 189/2012 the discussion on the quality of the available guidelines in the literature has led the authors to a review with particular regard to stakeholder involvement in the elaboration process. Evident critical points arise in the accessible studies that have used as an assessment tool a scientifically validated questionnaire (Appraisal of Guidelines for Research and Evaluation – AGREE. As a result the solution of the legislature, although useful to contain the phenomenon of defensive medicine, may be useless and ineffective in criminal cases where fundamental and absolute rights, as the right to life and health of patients, are involved.http://dx.doi.org/10.7175/rhc.v5i3.893

  5. Evidence based guidelines for complex regional pain syndrome type 1

    NARCIS (Netherlands)

    Perez, Roberto S.; Zollinger, Paul E.; Dijkstra, Pieter U.; Thomassen-Hilgersom, Ilona L.; Zuurmond, Wouter W.; Rosenbrand, Kitty C. J.; Geertzen, Jan H.

    2010-01-01

    Background: Treatment of complex regional pain syndrome type I (CRPS-I) is subject to discussion. The purpose of this study was to develop multidisciplinary guidelines for treatment of CRPS-I. Method: A multidisciplinary task force graded literature evaluating treatment effects for CRPS-I according

  6. Evidence and guidelines in otorhinolaryngology: the merits of evidence-based case reports

    NARCIS (Netherlands)

    Aarts, M.C.J.

    2012-01-01

    Evidence-based medicine refers to the conscientious, explicit and judicious use of the current best evidence to support decision making at point of care. To facilitate the transition of evidence into daily practice several evidence-based otorhinolaryngology guidelines have been developed. In this th

  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. Evidence-based guidelines for teaching patient-centered interviewing.

    Science.gov (United States)

    Smith, R C; Marshall-Dorsey, A A; Osborn, G G; Shebroe, V; Lyles, J S; Stoffelmayr, B E; Van Egeren, L F; Mettler, J; Maduschke, K; Stanley, J M; Gardiner, J C

    2000-01-01

    In a rare study of effectiveness of an interviewing method, we previously reported a randomized controlled trial demonstrating that training in a step-by-step patient-centered interviewing method improved residents' knowledge, attitudes, and skills and had a consistently positive effect on trained residents' patients. For those who wish to use this evidence-based patient-centered method as a template for their own teaching, we describe here for the first time our training program--and propose that the training can be adapted for students, physicians, nurse practitioners, physician assistants, and other new learners as well. Training was skills-oriented and experiential, fostered positive attitudes towards patient-centered interviewing, and used a learner-centered approach which paid special attention to the teacher-resident relationship and to the resident's self-awareness. Skills training was guided by a newly identified patient-centered interviewing method that described the step-by-step use of specific behaviors.

  9. Evidence-based medicine meets democracy: the role of evidence-based public health guidelines in local government.

    Science.gov (United States)

    Kelly, M P; Atkins, L; Littleford, C; Leng, G; Michie, S

    2017-02-10

    In 2013, many public health functions transferred from the National Health Service to local government in England. From 2006 NICE had produced public health guidelines based on the principles of evidence-based medicine. This study explores how the guidelines were received in the new environment in local government and related issues raised relating to the use of evidence in local authoritites. In depth, interviews with 31 elected members and officers, including Directors of Public Health, from four very different local government organizations ('local authorities'). Participants reported that (i) there were tensions between evidence-based, and political decision-making; (ii) there were differences in views about what constituted 'good' evidence and (iii) that organizational life is an important mediator in the way evidence is used. Democratic political decision-making does not necessarily naturally align with decision-making based on evidence from the international scientific literature, and local knowledge and local evidence are very important in the ways that public health decisions are made.

  10. European Society of Anaesthesiology evidence-based and consensus-based guideline on postoperative delirium

    NARCIS (Netherlands)

    Aldecoa, César; Bettelli, Gabriella; Bilotta, Federico; Sanders, Robert D.; Audisio, Riccardo; Borozdina, Anastasia; Cherubini, Antonio; Jones, Christina; Kehlet, Henrik; Maclullich, Alasdair; Radtke, Finn; Riese, Florian; Slooter, Arjen J C|info:eu-repo/dai/nl/173059740; Veyckemans, Francis; Kramer, Sylvia; Neuner, Bruno; Weiss, Bjoern; Spies, Claudia D.

    2017-01-01

    The purpose of this guideline is to present evidence-based and consensus-based recommendations for the prevention and treatment of postoperative delirium. The cornerstones of the guideline are the preoperative identification and handling of patients at risk, adequate intraoperative care, postoperati

  11. NICE CG178 Psychosis and Schizophrenia in Adults: Treatment and Management - an evidence-based guideline?

    Science.gov (United States)

    Taylor, Mark; Perera, Udayanga

    2015-05-01

    National Institute for Health and Care Excellence (NICE) clinical guideline (CG)178 was published in 2014. NICE guidelines occupy an important international position. We argue that CG178 overemphasises the use of cognitive-behavioural therapy for schizophrenia and those 'at risk' of psychosis, with recommendations that do not always reflect the evidence base. The CG178 recommendations on medications are limited.

  12. European Society of Anaesthesiology evidence-based and consensus-based guidelines on postoperative delirium

    DEFF Research Database (Denmark)

    Aldecoa, César; Bettelli, Gabriella; Bilotta, Federico

    2017-01-01

    The purpose of this guideline is to present evidence-based and consensus-based recommendations for the prevention and treatment of postoperative delirium. The cornerstones of the guideline are the preoperative identification and handling of patients at risk, adequate intraoperative care, postoper......The purpose of this guideline is to present evidence-based and consensus-based recommendations for the prevention and treatment of postoperative delirium. The cornerstones of the guideline are the preoperative identification and handling of patients at risk, adequate intraoperative care......, postoperative detection of delirium and management of delirious patients. The scope of this guideline is not to cover ICU delirium. Considering that many medical disciplines are involved in the treatment of surgical patients, a team-based approach should be implemented into daily practice. This guideline...

  13. Consensus & Evidence-based INOSA Guidelines 2014 (First edition

    Directory of Open Access Journals (Sweden)

    Sharma SK

    2015-01-01

    Full Text Available Obstructive sleep apnoea (OSA and obstructive sleep apnoea syndrome (OSAS are subsets of sleepdisordered breathing. Awareness about OSA and its consequences amongst the general public as well as the majority of primary care physicians across India is poor. This necessiated the development of the INdian initiative on Obstructive Sleep Apnoea (INOSA guidelines under the auspices of Department of Health Research, Ministry of Health & Family Welfare, Government of India. OSA is the occurrence of an average five or more episodes of obstructive respiratory events per hour of sleep with either sleep related symptoms or co-morbidities or ≥15 such episodes without any sleep related symptoms or co- morbidities. OSAS is defined as OSA associated with daytime symptoms, most often excessive sleepiness. Patients undergoing routine health check-up with snoring, daytime sleepiness, obesity, hypertension, motor vehicular accidents and high risk cases should undergo a comprehensive sleep evaluation. Medical examiners evaluating drivers, air pilots, railway drivers and heavy machinery workers should be educated about OSA and should comprehensively evaluate applicants for OSA. Those suspected to have OSA on comprehensive sleep evaluation should be referred for a sleep study.Supervised overnight polysomnography (PSG is the “gold standard” for evaluation of OSA. Positive airway pressure (PAP therapy is the mainstay of treatment of OSA. Oral appliances are indicated for use in patients with mild to moderate OSAwho prefer oral appliances to PAP, or who do not respond to PAP or who fail treatment attempts with PAP or behavioural measures. Surgical treatment is recommended in patients who have failed or are intolerant to PAPtherapy.

  14. Consensus & Evidence-based INOSA Guidelines 2014 (First edition

    Directory of Open Access Journals (Sweden)

    Surendra K Sharma

    2014-01-01

    Full Text Available Obstructive sleep apnoea (OSA and obstructive sleep apnoea syndrome (OSAS are subsets of sleep-disordered breathing. Awareness about OSA and its consequences amongst the general public as well as the majority of primary care physcians across India is poor. This necessiated the development of the INdian initiative on Obstructive sleep apnoea (INOSA guidelines under the auspices of Department of Health Research, Ministry of Health & Family Welfare, Government of India. OSA is the occurrence of an average five or more episodes of obstructive respiratory events per hour of sleep with either sleep related symptoms or co-morbidities or ≥ 15 such episodes without any sleep related symptoms or co-morbidities. OSAS is defined as OSA associated with daytime symptoms, most often excessive sleepiness. Patients undergoing routine health check-up with snoring, daytime sleepiness, obesity, hypertension, motor vehicular accidents and high risk cases should undergo a comprehensive sleep evaluation. Medical examiners evaluating drivers, air pilots, railway drivers and heavy machinery workers should be educated about OSA and should comprehensively evaluate applicants for OSA. Those suspected to have OSA on comprehensive sleep evaluation should be referred for a sleep study. Supervised overnight polysomnography (PSG is the "gold standard" for evaluation of OSA. Positive airway pressure (PAP therapy is the mainstay of treatment of OSA. Oral appliances are indicated for use in patients with mild to moderate OSA who prefer oral appliances to PAP, or who do not respond to PAP or who fail treatment attempts with PAP or behavioural measures. Surgical treatment is recommended in patients who have failed or are intolerant to PAP therapy.

  15. [Acute pancreatitis. Evidence-based practice guidelines, prepared by the Hungarian Pancreatic Study Group].

    Science.gov (United States)

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

    2015-02-15

    Acute pancreatitis is one of the most common diseases of the gastrointestinal tract associated with significant morbidity and mortality that requires up-to-date and evidence based treatment guidelines. The Hungarian Pancreatic Study Group proposed to prepare evidence based guideline for the medical and surgical management of acute pancreatitis based on the available international guidelines and evidence. The preparatory and consultation task force appointed by the Hungarian Pancreatic Study Group translated and, if it was necessary, complemented and/or modified the international guidelines. All together 42 relevant clinical questions were defined in 11 topics (Diagnosis and etiology, Prognosis, Imaging, Fluid therapy, Intensive care management, Prevention of infectious complications, Nutrition, Biliary interventions, Post-endoscopic retrograde cholangio-pancreatography pancreatitis, Indication, timing and strategy for intervention in necrotizing pancreatitis, Timing of cholecystectomy [or endoscopic sphincterotomy]). Evidence was classified according to the UpToDate® grading system. The draft of the guideline was presented and discussed at the consensus meeting on September 12, 2014. 25 clinical questions with almost total (more than 95%) and 17 clinical questions with strong (more than 70%) agreement were accepted. The present guideline is the first evidence based acute pancreatitis guideline in Hungary. The guideline may provide important help for tuition, everyday practice and for establishment of proper finance of acute pancreatitis. Therefore, the authors believe that these guidelines will widely become as basic reference in Hungary.

  16. [Autoimmune pancreatitis. Evidence based management guidelines of the Hungarian Pancreatic Study Group].

    Science.gov (United States)

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

    2015-02-22

    Autoimmune pancreatitis is a rare disease which can even mimic pancreatic tumor, however, unlike the latter, it requires not surgical but conservative management. Correct diagnosis and differential diagnosis of autoimmune pancreatitis and treatment of these patients 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. 29 relevant clinical questions in 4 topics were defined (Basics; Diagnosis; Differential diagnostics; Therapy). 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 clinial questions were accepted with almost total (more than 95%) agreement. The present guideline is the first evidence based autoimmune pancreatitis guideline in Hungary. The guideline may provide very important and helpful data for tuition of autoimmune pancreatitis, for everyday practice and for establishing proper finance. Therefore, the authors believe that these guidelines will widely become a basic reference in Hungary.

  17. [Chronic pancreatitis. Evidence based management guidelines of the Hungarian Pancreatic Study Group].

    Science.gov (United States)

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

    2015-02-15

    Chronic pancreatitis is an inflammatory disease associated with structural and functional damage of the pancreas. In most cases pain, maldigestion and weight loss are the leading symptoms, which significantly worsen the quality of life. Correct diagnosis and differential diagnosis of chronic pancreatitis and treatment of these patients requires up-to-date and evidence based treatment guidelines. The Hungarian Pancreatic Study Group proposed to prepare an evidence based guideline based on the available international guidelines and evidence. 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. 123 relevant clinical questions in 11 topics were defined. Evidence was classified according to the UpToDate® grading system. The draft of the guidelines were presented and discussed at the consensus meeting in September 12, 2014. All clinical questions were accepted with total or strong agreement. The present guideline is the first evidence based guideline for chronic pancreatitis in Hungary. This guideline provides very important and helpful data for tuition, everyday practice and proper financing of chronic pancreatitis. Therefore, the authors believe that these guidelines will widely become a basic reference in Hungary.

  18. Evidence-based guidelines on the referral of visually impaired persons to low vision services

    NARCIS (Netherlands)

    de Boer, MR; Langelaan, M; Jansonius, NM; van Rens, GHMB

    2005-01-01

    PURPOSE. One to two percent of the population in the Western world is visually impaired or blind. For most of these people there is no curative therapy, Therefore, the Dutch Ophthalmic Society has taken the initiative to develop an evidence-based guideline for the referral of visually impaired

  19. Evidence-based guidelines on the referral of visually impaired persons to low vision services

    NARCIS (Netherlands)

    de Boer, MR; Langelaan, M; Jansonius, NM; van Rens, GHMB

    2005-01-01

    PURPOSE. One to two percent of the population in the Western world is visually impaired or blind. For most of these people there is no curative therapy, Therefore, the Dutch Ophthalmic Society has taken the initiative to develop an evidence-based guideline for the referral of visually impaired perso

  20. Evidence-Based Practice Guidelines for Fetal Alcohol Spectrum Disorder and Literacy and Learning

    Science.gov (United States)

    Mitten, H. Rae

    2013-01-01

    Evidence-based Practice Guidelines for Fetal Alcohol Spectrum Disorder (FASD) and Literacy and Learning are derived from an inductive analysis of qualitative data collected in field research. FASD is the umbrella term for a spectrum of neurocognitive and physical disabilities caused by prenatal exposure to alcohol. Data from a sample of N =150 was…

  1. [Development and Quality Evaluation of Evidence-based Clinical Practice Guidelines of Chinese Medicine].

    Science.gov (United States)

    Jiang, Yue-rong; Chen, Ke-ji

    2016-01-01

    More attentions have been paid to the development of evidence-based clinical practice guidelines (ECPGs) of Chinese medicine (CM). International guideline evaluation instruments such as Appraisal of Guidelines for Research and Evaluation (AGREE I) has been gradually applied in ECPGs quality evaluation of CM. Nowadays, there are some certain methodological defects in partial ECPGs of Chinese medicine, with relatively low applicability and slowly update. It is suggested to establish technical specifications of CM-ECPGs in accordance with the characteristics of CM and international general specification, strengthen the quality evaluation of CM-ECPGs, attach great importance to the regularly update as well as popularization and application of CM-ECPGs.

  2. Evidence-based guidelines for wise use of electronic games by children.

    Science.gov (United States)

    Straker, Leon; Abbott, Rebecca; Collins, Rachel; Campbell, Amity

    2014-01-01

    Electronic games (e-games) are widely used by children, often for substantial durations, yet to date there are no evidence-based guidelines regarding their use. The aim of this paper is to present guidelines for the wise use of e-games by children based on a narrative review of the research. This paper proposes a model of factors that influence child-e-games interaction. It summarises the evidence on positive and negative effects of use of e-games on physical activity and sedentary behaviour, cardio-metabolic health, musculoskeletal health, motor coordination, vision, cognitive development and psychosocial health. Available guidelines and the role of guidelines are discussed. Finally, this information is compiled into a clear set of evidence-based guidelines, about wise use of e-games by children, targeting children, parents, professionals and the e-game industry. These guidelines provide an accessible synthesis of available knowledge and pragmatic guidelines based on e-game specific evidence and related research.

  3. Classification and Clinical Diagnosis of Fibromyalgia Syndrome: Recommendations of Recent Evidence-Based Interdisciplinary Guidelines

    Directory of Open Access Journals (Sweden)

    Mary-Ann Fitzcharles

    2013-01-01

    Full Text Available Objectives. Fibromyalgia syndrome (FMS, characterized by subjective complaints without physical or biomarker abnormality, courts controversy. Recommendations in recent guidelines addressing classification and diagnosis were examined for consistencies or differences. Methods. Systematic searches from January 2008 to February 2013 of the US-American National Guideline Clearing House, the Scottish Intercollegiate Guidelines Network, Guidelines International Network, and Medline for evidence-based guidelines for the management of FMS were conducted. Results. Three evidence-based interdisciplinary guidelines, independently developed in Canada, Germany, and Israel, recommended that FMS can be clinically diagnosed by a typical cluster of symptoms following a defined evaluation including history, physical examination, and selected laboratory tests, to exclude another somatic disease. Specialist referral is only recommended when some other physical or mental illness is reasonably suspected. The diagnosis can be based on the (modified preliminary American College of Rheumatology (ACR 2010 diagnostic criteria. Discussion. Guidelines from three continents showed remarkable consistency regarding the clinical concept of FMS, acknowledging that FMS is neither a distinct rheumatic nor mental disorder, but rather a cluster of symptoms, not explained by another somatic disease. While FMS remains an integral part of rheumatology, it is not an exclusive rheumatic condition and spans a broad range of medical disciplines.

  4. Evidence-based practice guidelines--one way to enhance clinical practice.

    Science.gov (United States)

    Bailes, Barbara K

    2002-06-01

    Abdominoplasty and liposuction guidelines are just two of the guidelines that can be accessed and used to enhance patient care. Guidelines also can be used to increase your knowledge about many other health care topics. The NGC has approved guidelines for managing chronic pain, as well as guidelines on chronic diseases (e.g., diabetes mellitus, hypertension, chronic obstructive pulmonary disease). Many patients have chronic diseases, and you or your family members also may be affected by chronic disorders. These guidelines provide you with a quick overview of evidence-based treatment protocols. These guidelines are not a panacea for evidence-based practice, but using them is one way that perioperative nurses can enhance their clinical skills. Though not everyone has personal Internet access, most health care facilities do or can make access a reality. Other options include medical or public libraries. Then one simply has to access the NGC web site and join other professionals in improving the quality and timeliness of patient care.

  5. Evaluation of current care effectiveness: a survey of hypertension guideline implementation in Finnish health centres

    DEFF Research Database (Denmark)

    Alanen, Seija I; Johannala-Kemppainen, Riitta; Ijäs, Jarja J;

    2007-01-01

    OBJECTIVE: To assess the extent and style of implementation of the Hypertension Guideline (HT Guideline) in Finnish primary health centres, and to identify a scale of contrasting implementation styles in the health centres (with the two ends of the scale being referred to as information implement......OBJECTIVE: To assess the extent and style of implementation of the Hypertension Guideline (HT Guideline) in Finnish primary health centres, and to identify a scale of contrasting implementation styles in the health centres (with the two ends of the scale being referred to as information...... implementers or disseminators respectively). DESIGN: A cross-sectional study. Development of a questionnaire and criteria for assessing the extent and style of implementation of the HT Guideline. SETTING: Primary healthcare. SUBJECTS: All head physicians and senior nursing officers in Finnish health centres (n...... =290). MAIN OUTCOME MEASURES: The extent of adoption of the HT Guideline in health centres and the characteristics associated with the implementation style. RESULTS: Responses were received from 410 senior medical staff (246 senior nursing officers and 164 head physicians) representing altogether 264...

  6. 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.

  7. Pediatric hydrocephalus: systematic literature review and evidence-based guidelines. Part 1: Introduction and methodology.

    Science.gov (United States)

    Flannery, Ann Marie; Mitchell, Laura

    2014-11-01

    This clinical systematic review of and evidence-based guidelines for the treatment of pediatric hydrocephalus were developed by a physician volunteer task force. They are provided as an educational tool based on an assessment of current scientific and clinical information as well as accepted approaches to treatment. They are not intended to be a fixed protocol, because some patients may require more or less treatment. In Part 1, the authors introduce the reader to the complex topic of hydrocephalus and the lack of consensus on its appropriate treatment. The authors describe the development of the Pediatric Hydrocephalus Systematic Review and Evidence-Based Guidelines Task Force charged with reviewing the literature and recommending treatments for hydrocephalus, and they set out the basic methodology used throughout the specific topics covered in later chapters.

  8. [Evidence-based clinical guidelines in dental practice 6. Guidelines for clinical practice in dental education

    NARCIS (Netherlands)

    Sanden, W.J.M. van der; Gorter, R.; Tams, J.

    2015-01-01

    In response to the initiatives of the Kennisinstituut Mondzorg (Institute for Knowledge Translation in Oral Care), the importance of effective education in the area of guidelines is increasing. Future dentists will, after all, be confronted with new guidelines and need to be able to integrate them i

  9. Using an interdisciplinary approach to identify factors that affect clinicians' compliance with evidence-based guidelines.

    Science.gov (United States)

    Gurses, Ayse P; Marsteller, Jill A; Ozok, A Ant; Xiao, Yan; Owens, Sharon; Pronovost, Peter J

    2010-08-01

    Our objective was to identify factors that affect clinicians' compliance with the evidence-based guidelines using an interdisciplinary approach and develop a conceptual framework that can provide a comprehensive and practical guide for designing effective interventions. A literature review and a brainstorming session with 11 researchers from a variety of scientific disciplines were used to identify theoretical and conceptual models describing clinicians' guideline compliance. MEDLINE, EMBASE, CINAHL, and the bibliographies of the papers identified were used as data sources for identifying the relevant theoretical and conceptual models. Thirteen different models that originated from various disciplines including medicine, rural sociology, psychology, human factors and systems engineering, organizational management, marketing, and health education were identified. Four main categories of factors that affect compliance emerged from our analysis: clinician characteristics, guideline characteristics, system characteristics, and implementation characteristics. Based on these findings, we developed an interdisciplinary conceptual framework that specifies the expected interrelationships among these four categories of factors and their impact on clinicians' compliance. An interdisciplinary approach is needed to improve clinicians' compliance with evidence-based guidelines. The conceptual framework from this research can provide a comprehensive and systematic guide to identify barriers to guideline compliance and design effective interventions to improve patient safety.

  10. Evidence-based practice guideline: wheelchair biking for the treatment of depression.

    Science.gov (United States)

    Fitzsimmons, Suzanne; Schoenfelder, Deborah Perry

    2011-07-01

    Depression is a problem that will continue to burden older adults and challenge health care providers. Failing to recognize and effectively treat depression in institutionalized older adults is sanctioning these members of society to live their final years in despair and emotional suffering. The wheelchair biking program described in this evidence-based practice guideline provides a refreshing, safe, innovative tool to address depression and improve quality of life in older adults.

  11. Development of evidence-based clinical practice guidelines (CPGs: comparing approaches

    Directory of Open Access Journals (Sweden)

    Harris Claire

    2008-10-01

    Full Text Available Abstract Background While the potential of clinical practice guidelines (CPGs to support implementation of evidence has been demonstrated, it is not currently being achieved. CPGs are both poorly developed and ineffectively implemented. To improve clinical practice and health outcomes, both well-developed CPGs and effective methods of CPG implementation are needed. We sought to establish whether there is agreement on the fundamental characteristics of an evidence-based CPG development process and to explore whether the level of guidance provided in CPG development handbooks is sufficient for people using these handbooks to be able to apply it. Methods CPG development handbooks were identified through a broad search of published and grey literature. Documents published in English produced by national or international organisations purporting to support development of evidence-based CPGs were included. A list of 14 key elements of a CPG development process was developed. Two authors read each handbook. For each handbook a judgement was made as to how it addressed each element; assigned as: 'mentioned and clear guidance provided', 'mentioned but limited practical detail provided ', or 'not mentioned'. Results Six CPG development handbooks were included. These were produced by the Council of Europe, the National Health and Medical Research Council of Australia, the National Institute for Health and Clinical Excellence in the UK, the New Zealand Guidelines Group, the Scottish Intercollegiate Guideline Network, and the World Health Organization (WHO. There was strong concordance between the handbooks on the key elements of an evidence-based CPG development process. All six of the handbooks require and provide guidance on establishment of a multidisciplinary guideline development group, involvement of consumers, identification of clinical questions or problems, systematic searches for and appraisal of research evidence, a process for drafting

  12. Methodology for developing evidence-based clinical imaging guidelines: Joint recommendations by Korea society of radiology and national evidence-based healthcare collaborating agency

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Sol Ji; Jo, Ae Jeong; Choi, Jin A [Div. for Healthcare Technology Assessment Research, National Evidence-Based Healthcare Collaborating Agency, Seoul (Korea, Republic of); and others

    2017-01-15

    This paper is a summary of the methodology including protocol used to develop evidence-based clinical imaging guidelines (CIGs) in Korea, led by the Korean Society of Radiology and the National Evidence-based Healthcare Collaborating Agency. This is the first protocol to reflect the process of developing diagnostic guidelines in Korea. The development protocol is largely divided into the following sections: set-up, process of adaptation, and finalization. The working group is composed of clinical imaging experts, and the developmental committee is composed of multidisciplinary experts to validate the methodology. The Korean CIGs will continue to develop based on this protocol, and these guidelines will act for decision supporting tools for clinicians as well as reduce medical radiation exposure.

  13. Methodology for Developing Evidence-Based Clinical Imaging Guidelines: Joint Recommendations by Korean Society of Radiology and National Evidence-Based Healthcare Collaborating Agency

    Science.gov (United States)

    Choi, Sol Ji; Jeong, Woo Kyoung; Jo, Ae Jeong; Choi, Jin A; Kim, Min-Jeong; Lee, Min; Jung, Seung Eun; Do, Kyung Hyun; Yong, Hwan Seok; Sheen, Seungsoo

    2017-01-01

    This paper is a summary of the methodology including protocol used to develop evidence-based clinical imaging guidelines (CIGs) in Korea, led by the Korean Society of Radiology and the National Evidence-based Healthcare Collaborating Agency. This is the first protocol to reflect the process of developing diagnostic guidelines in Korea. The development protocol is largely divided into the following sections: set-up, process of adaptation, and finalization. The working group is composed of clinical imaging experts, and the developmental committee is composed of multidisciplinary experts to validate the methodology. The Korean CIGs will continue to develop based on this protocol, and these guidelines will act for decision supporting tools for clinicians as well as reduce medical radiation exposure. PMID:28096730

  14. National Prehospital Evidence-Based Guidelines Strategy: A Summary for EMS Stakeholders.

    Science.gov (United States)

    Martin-Gill, Christian; Gaither, Joshua B; Bigham, Blair L; Myers, J Brent; Kupas, Douglas F; Spaite, Daniel W

    2016-01-01

    Multiple national organizations have recommended and supported a national investment to increase the scientific evidence available to guide patient care delivered by Emergency Medical Services (EMS) and incorporate that evidence directly into EMS systems. Ongoing efforts seek to develop, implement, and evaluate prehospital evidence-based guidelines (EBGs) using the National Model Process created by a multidisciplinary panel of experts convened by the Federal Interagency Committee on EMS (FICEMS) and the National EMS Advisory Council (NEMSAC). Yet, these and other EBG efforts have occurred in relative isolation, with limited direct collaboration between national projects, and have experienced challenges in implementation of individual guidelines. There is a need to develop sustainable relationships among stakeholders that facilitate a common vision that facilitates EBG efforts. Herein, we summarize a National Strategy on EBGs developed by the National Association of EMS Physicians (NAEMSP) with involvement of 57 stakeholder organizations, and with the financial support of the National Highway Traffic Safety Administration (NHTSA) and the EMS for Children program. The Strategy proposes seven action items that support collaborative efforts in advancing prehospital EBGs. The first proposed action is creation of a Prehospital Guidelines Consortium (PGC) representing national medical and EMS organizations that have an interest in prehospital EBGs and their benefits to patient outcomes. Other action items include promoting research that supports creation and evaluates the impact of EBGs, promoting the development of new EBGs through improved stakeholder collaboration, and improving education on evidence-based medicine for all prehospital providers. The Strategy intends to facilitate implementation of EBGs by improving guideline dissemination and incorporation into protocols, and seeks to establish standardized evaluation methods for prehospital EBGs. Finally, the Strategy

  15. Evidence-based guidelines for use of probiotics in preterm neonates

    Science.gov (United States)

    2011-01-01

    Background Current evidence indicates that probiotic supplementation significantly reduces all-cause mortality and definite necrotising enterocolitis without significant adverse effects in preterm neonates. As the debate about the pros and cons of routine probiotic supplementation continues, many institutions are satisfied with the current evidence and wish to use probiotics routinely. Because of the lack of detail on many practical aspects of probiotic supplementation, clinician-friendly guidelines are urgently needed to optimise use of probiotics in preterm neonates. Aim To develop evidence-based guidelines for probiotic supplementation in preterm neonates. Methods To develop core guidelines on use of probiotics, including strain selection, dose and duration of supplementation, we primarily used the data from our recent updated systematic review of randomised controlled trials. For equally important issues including strain identification, monitoring for adverse effects, product format, storage and transport, and regulatory hurdles, a comprehensive literature search, covering the period 1966-2010 without restriction on the study design, was conducted, using the databases PubMed and EMBASE, and the proceedings of scientific conferences; these data were used in our updated systematic review. Results In this review, we present guidelines, including level of evidence, for the practical aspects (for example, strain selection, dose, duration, clinical and laboratory surveillance) of probiotic supplementation, and for dealing with non-clinical but important issues (for example, regulatory requirements, product format). Evidence was inadequate in some areas, and these should be a target for further research. Conclusion We hope that these evidence-based guidelines will help to optimise the use of probiotics in preterm neonates. Continued research is essential to provide answers to the current gaps in knowledge about probiotics. PMID:21806843

  16. 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.

  17. 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

  18. Rapid implementation of evidence-based guidelines for imaging after first urinary tract infection.

    Science.gov (United States)

    Jerardi, Karen E; Elkeeb, Dena; Weiser, Jason; Brinkman, William B

    2013-09-01

    The American Academy of Pediatrics published a new guideline for management of first urinary tract infection (UTI) in children aged 2 to 24 months in September 2011. The imaging evaluation changed from the previous guideline to recommend voiding cystourethrogram (VCUG) only for patients with an abnormal renal and bladder ultrasound (RBUS). The objective was to decrease the proportion of guideline-eligible children with a normal RBUS who underwent VCUG from median of 92% for patients treated as inpatients and 100% for patients treated in the emergency department to 5% in both settings. This was a quality improvement implementation study in a large academic medical center. Key drivers included: appropriate guideline knowledge, timely identification of guideline eligible patients, and effective communication with the community-based primary care provider. A multidisciplinary team developed and tested interventions. Impact was assessed with annotated run charts. Statistical comparisons were made with χ(2) analysis and Fisher's exact test. The proportion of children with first UTI and normal RBUS who underwent VCUG decreased from a median of 92% to 0% within 1 month of initiating the project among those hospitalized and from 100% to 40% within 4 months among those diagnosed in the emergency department. Rates have been sustained for 12 months and 8 months, respectively. Interventions using the electronic medical record and ordering system were most impactful. Rapid adoption of evidence-based UTI care across multiple settings is achievable. Practice change occurred faster and to a greater magnitude in the inpatient setting compared with the outpatient setting.

  19. Fresh Frozen Plasma Administration in the Neonatal Intensive Care Unit: Evidence-Based Guidelines.

    Science.gov (United States)

    Motta, Mario; Del Vecchio, Antonio; Chirico, Gaetano

    2015-09-01

    Neonates receiving fresh frozen plasma (FFP) should do so according to evidence-based guidelines so as to reduce inappropriate use of this life-saving and costly blood product and to minimize associated adverse effects. The consensus-based uses of FFP in neonatology involve neonates with active bleeding and associated coagulopathy. However, because of limited and poor-quality evidence, considerable FFP utilization occurs outside these recommendations. In this review, we describe what we conclude are currently the best practices for the use of FFP in neonates, including interpreting neonatal coagulation tests and strategies for reducing unnecessary FFP transfusions.

  20. epic3: national evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England.

    Science.gov (United States)

    Loveday, H P; Wilson, J A; Pratt, R J; Golsorkhi, M; Tingle, A; Bak, A; Browne, J; Prieto, J; Wilcox, M; UK Department of Health

    2014-01-01

    National evidence-based guidelines for preventing healthcare-associated infections (HCAI) in National Health Service (NHS) hospitals in England were originally commissioned by the Department of Health and developed during 1998-2000 by a nurse-led multi-professional team of researchers and specialist clinicians. Following extensive consultation, they were first published in January 2001(1) and updated in 2007.(2) A cardinal feature of evidence-based guidelines is that they are subject to timely review in order that new research evidence and technological advances can be identified, appraised and, if shown to be effective for the prevention of HCAI, incorporated into amended guidelines. Periodically updating the evidence base and guideline recommendations is essential in order to maintain their validity and authority. The Department of Health commissioned a review of new evidence and we have updated the evidence base for making infection prevention and control recommendations. A critical assessment of the updated evidence indicated that the epic2 guidelines published in 2007 remain robust, relevant and appropriate, but some guideline recommendations required adjustments to enhance clarity and a number of new recommendations were required. These have been clearly identified in the text. In addition, the synopses of evidence underpinning the guideline recommendations have been updated. These guidelines (epic3) provide comprehensive recommendations for preventing HCAI in hospital and other acute care settings based on the best currently available evidence. National evidence-based guidelines are broad principles of best practice that need to be integrated into local practice guidelines and audited to reduce variation in practice and maintain patient safety. Clinically effective infection prevention and control practice is an essential feature of patient protection. By incorporating these guidelines into routine daily clinical practice, patient safety can be enhanced and

  1. Which physician and practice characteristics are associated with adherence to evidence-based guidelines for depressive and anxiety disorders?

    NARCIS (Netherlands)

    Smolders, M.; Laurant, M.G.H.; Verhaak, P.; Prins, M.; Marwijk, H. van; Penninx, B.W.J.H.; Wensing, M.J.P.; Grol, R.P.T.M.

    2010-01-01

    BACKGROUND: Research on quality of care for depressive and anxiety disorders has reported low rates of adherence to evidence-based depression and anxiety guidelines. To improve this care, we need a better understanding of the factors determining guideline adherence. OBJECTIVE: To investigate how

  2. Which Physician and Practice Characteristics are Associated With Adherence to Evidence-Based Guidelines for Depressive and Anxiety Disorders?

    NARCIS (Netherlands)

    Smolders, Mirrian; Laurant, Miranda; Verhaak, Peter; Prins, Marijn; van Marwijk, Harm; Penninx, Brenda; Wensing, Michel; Grol, Richard

    Background: Research on quality of care for depressive and anxiety disorders has reported low rates of adherence to evidence-based depression and anxiety guidelines. To improve this care, we need a better understanding of the factors determining guideline adherence. Objective: To investigate how

  3. Respiratory clinical guidelines inform ward-based nurses' clinical skills and knowledge required for evidence-based care.

    Science.gov (United States)

    Johnson, Alisha M; Smith, Sheree M S

    2016-09-01

    Respiratory clinical guidelines provide clinicians with evidence-based guidance for practice. Clinical guidelines also provide an opportunity to identify the knowledge and technical and non-technical skills required by respiratory ward-based registered nurses. The aim of this review was to use a systematic process to establish the core technical and non-technical skills and knowledge identified in evidence-based clinical guidelines that enable the care of hospitalised adult respiratory patients. 17 guidelines were identified in our systematic review. The quality assessment demonstrated variability in these guidelines. Common core knowledge and technical and non-technical skills were identified. These include pathophysiology, understanding of physiological measurements and monitoring, education, counselling, and ward and patient management. The knowledge and skills extracted from respiratory clinical guidelines may inform a curriculum for ward-based respiratory nursing to ensure optimal care of adult patients.

  4. Development of evidence-based remote telemetry policy guidelines for a multifacility hospital system.

    Science.gov (United States)

    George, Karen J; Walsh-Irwin, Colleen; Queen, Caleb; Heuvel, Kimberly Vander; Hawkins, Carrie; Roberts, Susan

    2015-01-01

    Over 10 years ago, the standards for cardiac monitoring were set forth by the Councils on Cardiovascular Nursing, Clinical Cardiology, and Cardiovascular Disease in the Young. The standards were endorsed by the International Society of Computerized Electrocardiology and the American Association of Critical-Care Nurses. The American Heart Association printed the standards as an American Heart Association Scientific Statement. The standards provided direction related to remote telemetry monitoring to acute care hospitals. Since the standards were published, remote monitoring of cardiac patients has increased dramatically prompting research and literature related to appropriate utilization. Appropriate and safe telemetry monitoring requires clearly written evidence-based facility policies. This article describes the process whereby a team of Veterans Hospital Administration nurses from across the country reviewed 70 remote telemetry policies representing 75 Veterans Hospital Administration hospitals for clarity, consistency, and congruency to existing levels of evidence found in the literature. This article describes the processes, successes, and challenges of compiling an evidence-based remote telemetry policy guideline.

  5. Evidence-based clinical practice guidelines for nonalcoholic fatty liver disease/nonalcoholic steatohepatitis.

    Science.gov (United States)

    Watanabe, Sumio; Hashimoto, Etsuko; Ikejima, Kenichi; Uto, Hirofumi; Ono, Masafumi; Sumida, Yoshio; Seike, Masataka; Takei, Yoshiyuki; Takehara, Tetsuo; Tokushige, Katsutoshi; Nakajima, Atsushi; Yoneda, Masashi; Saibara, Toshiji; Shiota, Goshi; Sakaida, Isao; Nakamuta, Makoto; Mizuta, Toshihiko; Tsubouchi, Hirohito; Sugano, Kentaro; Shimosegawa, Tooru

    2015-04-01

    Nonalcoholic fatty liver disease (NAFLD) is currently the most common cause of chronic liver disease in industrialized countries worldwide, and has become a serious public health issue not only in Western countries but also in many Asian countries including Japan. Within the wide spectrum of NAFLD, nonalcoholic steatohepatitis (NASH) is a progressive form of disease, which often develops into liver cirrhosis and increases the risk of hepatocellular carcinoma. In turn, a large proportion of NAFLD/NASH is the liver manifestation of metabolic syndrome, suggesting that NAFLD/NASH plays a key role in the pathogenesis of systemic atherosclerotic diseases. Currently, a definite diagnosis of NASH requires liver biopsy, though various noninvasive measures are under development. The mainstays of prevention and treatment of NAFLD/NASH include dietary restriction and exercise; however, pharmacological approaches are often necessary. Currently, vitamin E and thiazolidinedione derivatives are the most evidence-based therapeutic options, although the clinical evidence for long-term efficacy and safety is limited. This practice guideline for NAFLD/NASH, established by the Japanese Society of Gastroenterology in cooperation with The Japan Society of Hepatology, covers lines of clinical evidence reported internationally in the period starting from 1983 to January 2012, and each clinical question was evaluated using the GRADE system. Based on the primary release of the full version in Japanese, this English summary provides the core essentials of this clinical practice guideline comprising the definition, diagnosis, and current therapeutic recommendations for NAFLD/NASH in Japan.

  6. Therapeutic guidelines for prescribing antibiotics in neonates should be evidence-based: a French national survey.

    Science.gov (United States)

    Leroux, Stéphanie; Zhao, Wei; Bétrémieux, Pierre; Pladys, Patrick; Saliba, Elie; Jacqz-Aigrain, Evelyne

    2015-04-01

    This survey aims to describe and analyse the dosage regimens of antibiotics in French neonatal intensive care units (NICUs). Senior doctors from 56 French NICUs were contacted by telephone and/or email to provide their local guidelines for antibiotic therapy. 44 (79%) NICUs agreed to participate in this survey. In total, 444 dosage regimens were identified in French NICUs for 41 antibiotics. The number of different dosage regimens varied from 1 to 32 per drug (mean 9, SD 7.8). 37% of intravenous dosage regimens used a unique mg/kg dose from preterm to full-term neonates. Doses and/or dosing intervals varied significantly for 12 antibiotics (amikacin, gentamicin, netilmicin, tobramycin, vancomycin administered as continuous infusion, ceftazidime, cloxacillin, oxacillin, penicillin G, imipenem/cilastatin, clindamycin and metronidazole). Among these antibiotics, 6 were used in more than 70% of local guidelines and had significant variations in (1) maintenance daily doses for amikacin, imipenem/cilastatin, ceftazidime and metronidazole; (2) loading doses for continuous infusion of vancomycin; and (3) dosing intervals for gentamicin and amikacin. A considerable inter-centre variability of dosage regimens of antibiotics exists in French NICUs. Developmental pharmacokinetic-pharmacodynamic studies are essential for the evaluation of antibiotics in order to establish evidence-based dosage regimens for effective and safe administration in neonates. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  7. 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.

  8. Evidence-based clinical practice guidelines for peptic ulcer disease 2015.

    Science.gov (United States)

    Satoh, Kiichi; Yoshino, Junji; Akamatsu, Taiji; Itoh, Toshiyuki; Kato, Mototsugu; Kamada, Tomoari; Takagi, Atsushi; Chiba, Toshimi; Nomura, Sachiyo; Mizokami, Yuji; Murakami, Kazunari; Sakamoto, Choitsu; Hiraishi, Hideyuki; Ichinose, Masao; Uemura, Naomi; Goto, Hidemi; Joh, Takashi; Miwa, Hiroto; Sugano, Kentaro; Shimosegawa, Tooru

    2016-03-01

    The Japanese Society of Gastroenterology (JSGE) revised the evidence-based clinical practice guidelines for peptic ulcer disease in 2014 and has created an English version. The revised guidelines consist of seven items: bleeding gastric and duodenal ulcers, Helicobacter pylori (H. pylori) eradication therapy, non-eradication therapy, drug-induced ulcer, non-H. pylori, non-nonsteroidal anti-inflammatory drug (NSAID) ulcer, surgical treatment, and conservative therapy for perforation and stenosis. Ninety clinical questions (CQs) were developed, and a literature search was performed for the CQs using the Medline, Cochrane, and Igaku Chuo Zasshi databases between 1983 and June 2012. The guideline was developed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Therapy is initially provided for ulcer complications. Perforation or stenosis is treated with surgery or conservatively. Ulcer bleeding is first treated by endoscopic hemostasis. If it fails, surgery or interventional radiology is chosen. Second, medical therapy is provided. In cases of NSAID-related ulcers, use of NSAIDs is stopped, and anti-ulcer therapy is provided. If NSAID use must continue, the ulcer is treated with a proton pump inhibitor (PPI) or prostaglandin analog. In cases with no NSAID use, H. pylori-positive patients receive eradication and anti-ulcer therapy. If first-line eradication therapy fails, second-line therapy is given. In cases of non-H. pylori, non-NSAID ulcers or H. pylori-positive patients with no indication for eradication therapy, non-eradication therapy is provided. The first choice is PPI therapy, and the second choice is histamine 2-receptor antagonist therapy. After initial therapy, maintenance therapy is provided to prevent ulcer relapse.

  9. 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.

  10. Facebook apps for smoking cessation: a review of content and adherence to evidence-based guidelines.

    Science.gov (United States)

    Jacobs, Megan A; Cobb, Caroline O; Abroms, Lorien; Graham, Amanda L

    2014-09-09

    Facebook is the most popular social network site, with over 1 billion users globally. There are millions of apps available within Facebook, many of which address health and health behavior change. Facebook may represent a promising channel to reach smokers with cessation interventions via apps. To date, there have been no published reports about Facebook apps for smoking cessation. The purpose of this study was to review the features and functionality of Facebook apps for smoking cessation and to determine the extent to which they adhere to evidence-based guidelines for tobacco dependence treatment. In August 2013, we searched Facebook and three top Internet search engines using smoking cessation keywords to identify relevant Facebook apps. Resultant apps were screened for eligibility (smoking cessation-related, English language, and functioning). Eligible apps were reviewed by 2 independent coders using a standardized coding scheme. Coding included content features (interactive, informational, and social) and adherence to an established 20-item index (possible score 0-40) derived from the US Public Health Service's Clinical Practice Guidelines for Treating Tobacco Use and Dependence. We screened 22 apps for eligibility; of these, 12 underwent full coding. Only 9 apps were available on Facebook. Facebook apps fell into three broad categories: public pledge to quit (n=3), quit-date-based calculator/tracker (n=4), or a multicomponent quit smoking program (n=2). All apps incorporated interactive, informational, and social features except for two quit-date-based calculator/trackers apps (lacked informational component). All apps allowed app-related posting within Facebook (ie, on self/other Facebook profile), and four had a within-app "community" feature to enable app users to communicate with each other. Adherence index summary scores among Facebook apps were low overall (mean 15.1, SD 7.8, range 7-30), with multicomponent apps scoring the highest. There are few

  11. The Case for Using Evidence Based Guidelines in Setting Hospital and Public Health Policy

    Directory of Open Access Journals (Sweden)

    Ross Hutchison Francis

    2016-03-01

    Full Text Available Objective: Hospital systems and regulating agencies enforce strict guidelines barring personal items from entering the Operating Room - touting surgical site infections and patient safety as the rationale. We sought to determine whether or not evidence supporting this recommendation exists by reviewing available literature.Background data: Rules and guidelines that are not evidence based may lead to increased hospital expenses and limitations on healthcare provider autonomyMethods: PubMed, Embase, Scopus, Cochrane Library, Web of Science, and CINAHL were searched in order to find articles that correlated personal items in the OR to documented surgical site infections. Articles that satisfied the following criteria were included: (1 studies looking at personal items in the OR such as handbags, purses, badges, pagers, backpacks, jewelry phones, and eyeglasses, etc., but not just operating room equipment; and (2 the primary outcome measure was infection at the surgical site.Results: Seventeen articles met inclusion criteria and were evaluated. Of the 17, the majority did not determine if personal items increased risk for surgical site infection. Only 1 article examined the correlation between a personal item near the operative site and surgical site infection, concluding that wedding rings worn in the OR had no impact on surgical site infections. Most studies examined colonization rates on personal items as potential infection risk; however, no personal items were causally linked to surgical site infection in any of these studies.Conclusion: There is no objective evidence to suggest that personal items in the OR increase risk for surgical site infections.

  12. [Evidence-based evaluation of present guidelines for the treatment of tennis elbow -- a review].

    Science.gov (United States)

    Theis, C; Herber, S; Meurer, A; Lehr, H-A; Rompe, J-D

    2004-08-01

    The guidelines of the German Orthopaedic Societies regarding the treatment of lateral elbow epicondylitis were analysed on the ground of recently published reviews or randomised placebo-controlled trials (RCT). For the acute phase, reviews or RCTs failed to show a clinical effect beyond placebo if follow-up was extended over 6 weeks. For the chronic phase a current Cochrane review failed to identify any controlled trial regarding surgical procedures during the last decades. Without an adequate control group, it is not possible to draw any meaningful conclusions about the value of this modality of treatment. Therefore surgery is not indicated before repetitive low-energy extracorporeal shock wave therapy (ESWT) has been applied. This novel treatment, under strictly standardized conditions, showed effects beyond placebo in independent randomised placebo-controlled trials for follow-up periods of 3 and 6 months. To date there exists no evidence-based therapeutic algorithm for the treatment of acute and chronic tennis elbow. Even medium-term effects should be regarded as either a placebo effect or natural regression to the mean.

  13. Experience developing national evidence-based clinical guidelines for childhood pneumonia in a low-income setting - making the GRADE?

    OpenAIRE

    Agweyu Ambrose; Opiyo Newton; English Mike

    2012-01-01

    Abstract Background The development of evidence-based clinical practice guidelines has gained wide acceptance in high-income countries and reputable international organizations. Whereas this approach may be a desirable standard, challenges remain in low-income settings with limited capacity and resources for evidence synthesis and guideline development. We present our experience using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach for the recent revisio...

  14. Treatment of Fibromyalgia Syndrome: Recommendations of Recent Evidence-Based Interdisciplinary Guidelines with Special Emphasis on Complementary and Alternative Therapies

    Directory of Open Access Journals (Sweden)

    Jacob Ablin

    2013-01-01

    Full Text Available Objective. Current evidence indicates that there is no single ideal treatment for fibromyalgia syndrome (FMS. First choice treatment options remain debatable, especially concerning the importance of complementary and alternative medicine (CAM treatments. Methods. Three evidence-based interdisciplinary guidelines on FMS in Canada, Germany, and Israel were compared for their first choice and CAM-recommendations. Results. All three guidelines emphasized a patient-tailored approach according to the key symptoms. Aerobic exercise, cognitive behavioral therapy, and multicomponent therapy were first choice treatments. The guidelines differed in the grade of recommendation for drug treatment. Anticonvulsants (gabapentin, pregabalin and serotonin noradrenaline reuptake inhibitors (duloxetine, milnacipran were strongly recommended by the Canadian and the Israeli guidelines. These drugs received only a weak recommendation by the German guideline. In consideration of CAM-treatments, acupuncture, hypnosis/guided imagery, and Tai Chi were recommended by the German and Israeli guidelines. The Canadian guidelines did not recommend any CAM therapy. Discussion. Recent evidence-based interdisciplinary guidelines concur on the importance of treatment tailored to the individual patient and further emphasize the need of self-management strategies (exercise, and psychological techniques.

  15. Evidence-based clinical practice guideline: inhaled nitric oxide for neonates with acute hypoxic respiratory failure.

    Science.gov (United States)

    DiBlasi, Robert M; Myers, Timothy R; Hess, Dean R

    2010-12-01

    Inhaled nitric oxide (INO) is a colorless, odorless gas that is also a potent pulmonary vasodilator. When given via the inhaled route it is a selective pulmonary vasodilator. INO is approved by the United States Food and Drug Administration (FDA) for the treatment of term and near-term neonates with hypoxemic respiratory failure associated with clinical or echocardiographic evidence of pulmonary arterial hypertension. A systematic review of the literature was conducted with the intention of making recommendations related to the clinical use of INO for its FDA-approved indication. Specifically, we wrote these evidence-based clinical practice guidelines to address the following questions: (1) What is the evidence for labeled use? (2) What are the specific indications for INO for neonates with acute hypoxemic respiratory failure? (3) Does the use of INO impact oxygenation, mortality, or utilization of extracorporeal membrane oxygenation (ECMO)? (4) Does INO affect long-term outcomes? (5) Is INO cost-effective therapy? (6) How is the appropriate dosing regimen and dose response to INO established? (7) How is the dose of INO titrated and weaned? (8) Which INO delivery system should be used? (9) How should INO be implemented with different respiratory support devices? (10) What adverse effects of INO should be monitored, and at what frequency? (11) What physiologic parameters should be monitored during INO? (12) Is scavenging of gases necessary to protect the caregivers? Using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) scoring system, 22 recommendations are developed for the use of INO in newborns.

  16. 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

  17. The pursuit of evidence-based practice: Comparisons of three guidelines on psychosocial interventions for alcohol problems

    Directory of Open Access Journals (Sweden)

    Bergmark Anders

    2014-06-01

    Full Text Available AIMS - In this article we scrutinise three prominent guidelines on psychosocial interventions for alcohol problems. We pay special attention to how congruent the guidelines are in terms of the interventions recommended, and the processes used in order to identify and rank the “evidence” underpinning these recommendations. DATA - The analysed guidelines are: 1 Practice Guideline for the Treatment of Patients with Substance Use Disorders, American Psychiatric Association (2006; 2 Alcohol-Use Disorders. The NICE Guideline on Diagnosis, Assessment and Management of Harmful Drinking and Alcohol Dependence (2011, National Collaborating Centre for Mental Health, UK; 3 Guidelines for the Treatment of Alcohol Problems, Australian Government, Department of Health and Ageing (2009. The purpose is not to review the three guidelines as such, but to study them as an example of the production of evidence. All report to be based on “best available evidence”, so the guidelines were compared both regarding the actual recommendations and the guideline production procedures and differences in these procedures with related consequences. RESULTS & CONCLUSIONS - Prestigious organisations in different national contexts have reached divergent conclusions about evidence-based practice and the quality of the scientific studies underpinning these conclusions. Differences in the guidelines regarding interpretations, limitations and grading illustrate the difficulties with the dilemmas of sensitivity (to include factors that are significant for how a psychological intervention is to be judged and specificity (that irrelevant studies are cleared off in the recommendations presented.

  18. British Dietetic Association evidence-based guidelines for the dietary management of irritable bowel syndrome in adults.

    Science.gov (United States)

    McKenzie, Y A; Alder, A; Anderson, W; Wills, A; Goddard, L; Gulia, P; Jankovich, E; Mutch, P; Reeves, L B; Singer, A; Lomer, M C E

    2012-06-01

     Irritable bowel syndrome (IBS) is a chronic debilitating functional gastrointestinal disorder. Diet and lifestyle changes are important management strategies. The aim of these guidelines is to systematically review key aspects of the dietary management of IBS, with the aim of providing evidence-based guidelines for use by registered dietitians. Questions relating to diet and IBS symptom management were developed by a guideline development group. These included the role of milk and lactose, nonstarch polysaccharides (NSP), fermentable carbohydrates in abdominal bloating, probiotics and empirical or elimination diets. A comprehensive literature search was conducted and relevant studies from January 1985 to November 2009 were identified using the electronic database search engines: Cinahl, Cochrane Library, Embase, Medline, Scopus and Web of Science. Evidence statements, recommendations, good practice points and research recommendations were developed. Thirty studies were critically appraised. A dietetic care pathway was produced following a logical sequence of treatment and formed the basis of these guidelines. Three lines of dietary management were identified. first line: Clinical and dietary assessment, healthy eating and lifestyle management with some general advice on lactose and NSP. Second line: Advanced dietary interventions to improve symptoms based on NSP, fermentable carbohydrates and probiotics. Third line: Elimination and empirical diets. Research recommendations were also identified relating to the need for adequately powered and well designed randomised controlled trials. These guidelines provide evidence-based details of how to achieve the successful dietary management of IBS. © 2012 The Authors. Journal of Human Nutrition and Dietetics © 2012 The British Dietetic Association Ltd.

  19. Evidence-based (S3) guideline for the treatment of androgenetic alopecia in women and in men.

    Science.gov (United States)

    Blumeyer, Anja; Tosti, Antonella; Messenger, Andrew; Reygagne, Pascal; Del Marmol, Veronique; Spuls, Phyllis I; Trakatelli, Myrto; Finner, Andreas; Kiesewetter, Franklin; Trüeb, Ralph; Rzany, Berthold; Blume-Peytavi, Ulrike

    2011-10-01

    Androgenetic alopecia is the most common hair loss disorder, affecting both men and women. Initial signs of androgenetic alopecia usually develop during teenage years leading to progressive hair loss with a pattern distribution. Moreover, its frequency increases with age and affects up to 80 % Caucasian men and 42 % of women. Patients diagnosed with androgenetic alopecia may undergo significant impairment of quality of life. Despite the high prevalence and the variety of therapeutic options available, there have been no national or international evidence-based guidelines for the treatment of androgenetic alopecia in men and women so far. Therefore, the European Dermatology Forum (EDF) initiated a project to develop an evidence-based S3 guideline for the treatment of andro-genetic alopecia. Based on a systematic literature research the efficacy of the currently available therapeutic options was assessed and therapeutic recommendations were passed in a consensus conference. The purpose of the guideline is to provide dermatologists as well as general practitioners with an evidence-based tool for choosing an efficacious and safe therapy for patients with androgenetic alopecia.

  20. Systematic review of evidence-based guidelines on medication therapy for upper respiratory tract infection in children with AGREE instrument.

    Directory of Open Access Journals (Sweden)

    Linan Zeng

    Full Text Available OBJECTIVES: To summarize recommendations of existing guidelines on the treatment of upper respiratory tract infections (URTIs in children, and to assess the methodological quality of these guidelines. METHODS: We searched seven databases and web sites of relevant academic agencies. Evidence-based guidelines on pediatric URTIs were included. AGREE II was used to assess the quality of these guidelines. Two researchers selected guidelines independently and extracted information on publication years, institutions, target populations, recommendations, quality of evidence, and strength of recommendations. We compared the similarities and differences of recommendations and their strength. We also analyzed the reasons for variation. RESULTS: Thirteen guidelines meeting our inclusion criteria were included. Huge differences existed among these 13 guidelines concerning the categorization of evidence and recommendations. Nearly all of these guidelines lacked the sufficient involvement of stake holders. Further, the applicability of these guidelines still needs to be improved. In terms of recommendations, penicillin and amoxicillin were suggested for group A streptococcal pharyngitis. Amoxicillin and amoxicillin-clavulanate were recommended for acute bacterial rhinosinusitis (ABRS. An observation of 2-3 days prior to antibiotic therapy initiation for mild acute otitis media (AOM was recommended with amoxicillin as the suggested first choice agent. Direct evidence to support strong recommendations on the therapy for influenza is still lacking. In addition, the antimicrobial durations for pharyngitis and ABRS were still controversial. No consensus was reached for the onset of antibiotics for ABRS in children. CONCLUSIONS: Future guidelines should use a consistent grading system for the quality of evidence and strength of recommendations. More effort needs to be paid to seek the preference of stake holders and to improve the applicability of guidelines

  1. The `WikiGuidelines' smartphone application: Bridging the gaps in availability of evidence-based smartphone mental health applications.

    Science.gov (United States)

    Zhang, Melvyn W B; Ho, Roger C M; Mcintyre, Roger S

    2016-07-27

    Over the past decade, there have been massive advances in technology. These advances in technology have significantly transformed various aspects of healthcare. The advent of E-health and its influence on healthcare practice also implies that there is a paradigm shift in the way healthcare professionals work. Conventionally, healthcare professionals would have to refer to books and journals for updates in treatment algorithms, but with the advent of technology, they could access this information via the web or via various smartphone applications on the go. In the field of Psychiatry, one of the commonest mental health disorder to date, with significant morbidity and mortality is that of Major depressive disorder. Routinely, clinicians and healthcare professionals are advised to refer to standard guidelines in guiding them with regards to their treatment options. Given the high prevalence of conditions like Major Depressive Disorder, it is thus of importance that whatever guidelines that clinicians and healthcare professionals refer to are constantly kept up to date, so that patients could benefit from latest evidence based therapy and treatment. A review of the current literature highlights that whilst there are a multitude of smartphone applications designed for mental health care, previous systematic review has highlighted a paucity of evidence based applications. More importantly, current literature with regards to provision of treatment information to healthcare professionals and patients are limited to web-based interventions. It is the aim of this technical note to highlight a methodology to which the authors have conceptualized in the implementation of an evidence based mental health guideline applications, known as the `Wiki Guidelines' smartphone application. The authors hope to illustrate the algorithms behind the development of the application, and how it could be easily updated by the guidelines working group.

  2. Prevention of venous thromboembolism, 2nd edition: Korean Society of Thrombosis and Hemostasis Evidence-based Clinical Practice Guidelines.

    Science.gov (United States)

    Bang, Soo-Mee; Jang, Moon Ju; Kim, Kyoung Ha; Yhim, Ho-Young; Kim, Yeo-Kyeoung; Nam, Seung-Hyun; Hwang, Hun Gyu; Bae, Sung Hwa; Kim, Sung-Hyun; Mun, Yeung-Chul; Kim, Yang-Ki; Kim, Inho; Choi, Won-Il; Jung, Chul Won; Park, Nan Hee; Choi, Nam-Kyong; Park, Byung-Joo; Oh, Doyeun

    2014-02-01

    In 2010, we proposed the first Korean Guidelines for the Prevention of Venous Thromboembolism (VTE). It was applicable to Korean patients, by modifying the contents of the second edition of the Japanese guidelines for the prevention of VTE and the 8th edition of the American College of Chest Physicians (ACCP) evidence-based clinical practice guidelines. From 2007 to 2011, we conducted a nationwide study regarding the incidence of VTE after major surgery using the Health Insurance Review and Assessment Service (HIRA) database. In addition, we have considered the 9th edition of the ACCP Evidenced-Based Clinical Practice Guidelines, published in 2012. It emphasized the importance of clinically relevant events as opposed to asymptomatic outcomes with preferences for both thrombotic and bleeding outcomes. Thus, in the development of the new Korean guidelines, three major points were addressed: 1) the new guidelines stratify patients into 4 risk groups (very low, low, moderate, and high) according to the actual incidence of symptomatic VTE from the HIRA databases; 2) the recommended optimal VTE prophylaxis for each group was modified according to condition-specific thrombotic and bleeding risks; 3) guidelines are intended for general information only, are not medical advice, and do not replace professional medical care and/or physician advice.

  3. Treatment of Acute Achilles Tendon Rupture in Scandinavia Does Not Adhere to Evidence-based Guidelines

    DEFF Research Database (Denmark)

    Barfod, Kristoffer W; Nielsen, Fredrik; Helander, Katarina N;

    2013-01-01

    and that adherence to evidence-based recommendations would not be as good as desired. The purpose of the present study was to investigate how acute Achilles tendon rupture is treated in Scandinavia. A questionnaire was distributed to all orthopedic departments treating acute Achilles tendon ruptures in Denmark...

  4. Comparison of consumer derived evidence with an omaha system evidence-based practice guideline for community dwelling older adults.

    Science.gov (United States)

    Pruinelli, Lisiane; Fu, Helen; Monsen, Karen A; Westra, Bonnie L

    2014-01-01

    Consumer involvement in healthcare is critical to support continuity of care for consumers to manage their health while transitioning from one care setting to another. Validation of evidence-based practice (EBP) guideline by consumers is essential to achieving consumer health goals over time that is consistent with their needs and preferences. The purpose of this study was to compare an Omaha System EBP guideline for community dwelling older adults with consumer-derived evidence of their ongoing needs, resources, and strategies after home care discharge. All identified problems were relevant for all patients except for Neglect and Substance use. Ten additional problems were identified from the interviews, five of which affected at least 10% of the participants. Consumer derived evidence both validated and expanded EBP guidelines; thus further emphasizing the importance of consumer involvement in the delivery of home healthcare.

  5. Evidence-based clinical practice guidelines for bladder cancer (summary - JUA 2009 Edition).

    Science.gov (United States)

    2010-02-01

    In Japan, until now, the treatment of bladder cancer has been based on guidelines from overseas. The problem with this practice is that the options recommended in overseas guidelines are not necessarily suitable for Japanese clinical practice. A relatively large number of clinical trials have been conducted in Japan in the field of bladder cancer, and the Japanese Urological Association (JUA) considered it appropriate to formulate their own guidelines. These Guidelines present an overview of bladder cancer at each clinical stage, followed by clinical questions that address problems frequently faced in everyday clinical practice. In this English translation of a shortened version of the original Guidelines, we have abridged each overview, summarized each clinical question and its answer, and only included the references we considered of particular importance.

  6. 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

  7. Evidence-based primary care treatment guidelines for skin infections in Europe: a comparative analysis.

    NARCIS (Netherlands)

    Bijnen, E.M.E. van; Paget, J.; Heijer, C.D.J. den; Stobberingh, E.E.; Bruggeman, C.A.; Schellevis, F.G.

    2014-01-01

    Background: In Europe, most antibiotics for human use are prescribed in primary care. Incorporating resistance data into treatment guidelines could improve appropriate prescribing, increase treatment effectiveness and control the development of resistance. Objectives: This study reviews primary care

  8. Evidence-based primary care treatment guidelines for skin infections in Europe: a comparative analysis

    NARCIS (Netherlands)

    Bijnen, E.M. van; Paget, J.; Heijer, C.D. den; Stobberingh, E.E.; Bruggeman, C.A.; Schellevis, F.G.

    2014-01-01

    BACKGROUND: In Europe, most antibiotics for human use are prescribed in primary care. Incorporating resistance data into treatment guidelines could improve appropriate prescribing, increase treatment effectiveness and control the development of resistance. OBJECTIVES: This study reviews primary care

  9. Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS)

    DEFF Research Database (Denmark)

    Lefaucheur, Jean-Pascal; André-Obadia, Nathalie; Antal, Andrea

    2014-01-01

    A group of European experts was commissioned to establish guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS) from evidence published up until March 2014, regarding pain, movement disorders, stroke, amyotrophic lateral sclerosis, multiple sclerosis, epilepsy...

  10. Evidence-based primary care treatment guidelines for skin infections in Europe: a comparative analysis.

    NARCIS (Netherlands)

    Bijnen, E.M.E. van; Paget, J.; Heijer, C.D.J. den; Stobberingh, E.E.; Bruggeman, C.A.; Schellevis, F.G.

    2014-01-01

    Background: In Europe, most antibiotics for human use are prescribed in primary care. Incorporating resistance data into treatment guidelines could improve appropriate prescribing, increase treatment effectiveness and control the development of resistance. Objectives: This study reviews primary care

  11. Evidence-based primary care treatment guidelines for skin infections in Europe: a comparative analysis

    NARCIS (Netherlands)

    Bijnen, E.M. van; Paget, J.; Heijer, C.D. den; Stobberingh, E.E.; Bruggeman, C.A.; Schellevis, F.G.

    2014-01-01

    BACKGROUND: In Europe, most antibiotics for human use are prescribed in primary care. Incorporating resistance data into treatment guidelines could improve appropriate prescribing, increase treatment effectiveness and control the development of resistance. OBJECTIVES: This study reviews primary care

  12. [Synopsis on clinical practice guideline of gastric cancer in Korea: an evidence-based approach].

    Science.gov (United States)

    Lee, Jun Haeng; Kim, Jae G; Jung, Hye Kyung; Kim, Jung Hoon; Jeong, Woo Kyoung; Jeon, Tae Joo; Kim, Joon Mee; Kim, Young Il; Ryu, Keun Won; Kong, Seong-Ho; Kim, Hyoung Il; Jung, Hwoon-Yong; Kim, Yong Sik; Zang, Dae Young; Cho, Jae Yong; Park, Joon Oh; Lim, Do Hoon; Jung, Eun Sun; Ahn, Hyeong Sik; Kim, Hyun Jung

    2014-02-01

    Although, gastric cancer is quite common in Korea, the treatment outcome is relatively favorable compared to that of Western countries. However, there is no Korean multidisciplinary guideline for gastric cancer and thus, a guideline adequate for domestic circumstances is required. Experts from related societies developed 22 recommendation statements for the diagnosis (n=9) and treatment (n=13) based on relevant key questions. Evidence levels based on systematic review of literatures were classified as five levels from A to E, and recommendation grades were classified as either strong or weak. The topics of this guideline cover diagnostic modalities (endoscopy, endoscopic ultrasound, radiologic diagnosis), treatment modalities (surgery, therapeutic endoscopy, chemotherapy, radiotherapy) and pathologic evaluation. External review of the guideline was conducted at the finalization phase.

  13. Evidence-based guidelines for the management of hypertension in children with chronic kidney disease.

    Science.gov (United States)

    Dionne, Janis M

    2015-11-01

    Hypertension is common in children with chronic kidney disease and early evidence suggests that it is a modifiable risk factor for renal and cardiovascular outcomes. Recommendations for blood pressure management in children with chronic kidney disease can be found in various clinical practice guidelines including the 4th Task Force Report, the European Society of Hypertension pediatric recommendations, and the National Kidney Foundation Kidney Disease Outcomes Quality Initiative (K/DOQI) and Kidney Disease: Improving Global Outcomes (KDIGO) guidelines for the management of blood pressure in chronic kidney disease. Unfortunately, as pediatric trial evidence is limited, there are discrepancies in the recommendations that may lead to inconsistent clinical care and practice variation. This article reviews the strength of evidence behind each of the clinical practice guideline recommendations regarding blood pressure assessment, treatment targets, and first-line antihypertensive medications. The benefits and cautions of use of clinical practice guidelines are described with emphasis on the importance of reading beyond the summary statements.

  14. Diet Assessment Methods in the Nurses' Health Studies and Contribution to Evidence-Based Nutritional Policies and Guidelines

    Science.gov (United States)

    Satija, Ambika; Rimm, Eric B.; Spiegelman, Donna; Sampson, Laura; Rosner, Bernard; Camargo, Carlos A.; Stampfer, Meir; Willett, Walter C.

    2016-01-01

    Objectives. To review the contribution of the Nurses’ Health Studies (NHSs) to diet assessment methods and evidence-based nutritional policies and guidelines. Methods. We performed a narrative review of the publications of the NHS and NHS II between 1976 and 2016. Results. Through periodic assessment of diet by validated dietary questionnaires over 40 years, the NHSs have identified dietary determinants of diseases such as breast and other cancers; obesity; type 2 diabetes; cardiovascular, respiratory, and eye diseases; and neurodegenerative and mental health disorders. Nutritional biomarkers were assessed using blood, urine, and toenail samples. Robust findings, from the NHSs, together with evidence from other large cohorts and randomized dietary intervention trials, have contributed to the evidence base for developing dietary guidelines and nutritional policies to reduce intakes of trans fat, saturated fat, sugar-sweetened beverages, red and processed meats, and refined carbohydrates while promoting higher intake of healthy fats and carbohydrates and overall healthful dietary patterns. Conclusions. The long-term, periodically collected dietary data in the NHSs, with documented reliability and validity, have contributed extensively to our understanding of the dietary determinants of various diseases, informing dietary guidelines and shaping nutritional policy. PMID:27459459

  15. Attitudes, knowledge and behavior of Japanese physical therapists with regard to evidence-based practice and clinical practice guidelines: a cross-sectional mail survey

    Science.gov (United States)

    Fujimoto, Shuhei; Kon, Noriko; Takasugi, Jun; Nakayama, Takeo

    2017-01-01

    [Purpose] This study aimed to investigate Japanese physical therapists’ attitudes of evidence-based practice and clinical practice guidelines. [Subjects and Methods] In 2014, a cross-sectional postal mail survey using a self-administered questionnaire was conducted. Of 2,982 physical therapists belonging to the Chiba Prefecture Physical Therapist Association, 1,000 were randomly selected. The questionnaire comprised 42 items pertaining to the attitudes of and behavior toward evidence-based practice and clinical practice guidelines. It was investigated to reveal the relationship between clinical practice guidelines/evidence-based practice and therapist characteristics. [Results] The response rate was 39.6%, and 384 questionnaires were available. The main results were as follows: 83.3% participants agreed to the importance of evidence-based practice, 77.1% agree to that evidence-based practice supports clinical decision of physical therapists, and about 11% agreed to have been educated about evidence-based practice. Then, 29.2% used, 54.9% agreed to the importance of, and 13.3% agreed to the utility of clinical practice guidelines. An important factor related mostly to a positive attitude, knowledge and behavior of evidence-based practice and clinical practice guidelines was participating in research activities. [Conclusion] Many of physical therapists do not use and understand the importance of clinical practice guidelines. Participating in research activities may partially contribute to improving these conditions. PMID:28265139

  16. Attitudes, knowledge and behavior of Japanese physical therapists with regard to evidence-based practice and clinical practice guidelines: a cross-sectional mail survey.

    Science.gov (United States)

    Fujimoto, Shuhei; Kon, Noriko; Takasugi, Jun; Nakayama, Takeo

    2017-02-01

    [Purpose] This study aimed to investigate Japanese physical therapists' attitudes of evidence-based practice and clinical practice guidelines. [Subjects and Methods] In 2014, a cross-sectional postal mail survey using a self-administered questionnaire was conducted. Of 2,982 physical therapists belonging to the Chiba Prefecture Physical Therapist Association, 1,000 were randomly selected. The questionnaire comprised 42 items pertaining to the attitudes of and behavior toward evidence-based practice and clinical practice guidelines. It was investigated to reveal the relationship between clinical practice guidelines/evidence-based practice and therapist characteristics. [Results] The response rate was 39.6%, and 384 questionnaires were available. The main results were as follows: 83.3% participants agreed to the importance of evidence-based practice, 77.1% agree to that evidence-based practice supports clinical decision of physical therapists, and about 11% agreed to have been educated about evidence-based practice. Then, 29.2% used, 54.9% agreed to the importance of, and 13.3% agreed to the utility of clinical practice guidelines. An important factor related mostly to a positive attitude, knowledge and behavior of evidence-based practice and clinical practice guidelines was participating in research activities. [Conclusion] Many of physical therapists do not use and understand the importance of clinical practice guidelines. Participating in research activities may partially contribute to improving these conditions.

  17. Review of Select Practice Parameters, Evidence-Based Treatment Algorithms, and International Guidelines for Hereditary Angioedema.

    Science.gov (United States)

    Jose, Jaison; Zacharias, Jamie; Craig, Timothy

    2016-10-01

    Hereditary angioedema (HAE) is a rare bradykinin-mediated disease that is characterized by recurrent attacks of subcutaneous or submucosal edema, which can be life threatening. HAE affects all ethnic groups equally and does not differentiate between age, sex, or race. However, the availability of therapies varies amongst countries resulting in a lack of uniformity of care. Not only is there a disparity of medication availability, but since HAE is a rare disease, it is frequently overlooked and the diagnosis is missed. Even with diagnosis, treatment and management is often less than optimal. For these reasons, it is essential to have practice parameters and guidelines. In this chapter, we focus on recent guidelines. These guidelines deal with recognition, diagnosis, medical care, patient management, and assessment, all which are essential to provide optimal care to people with a rare and orphan disease. The intent of the guidelines, and thus this chapter, is to reduce morbidity and mortality, and restore a normal quality of life for the patient with HAE. We will review the guidelines from various regions of the world as well as international group recommendations. In addition, specific patient populations such as the pregnant, elderly, and juvenile require modified treatment regimens, and for this reason, we have included these data as well. The intent of this chapter is to aid the practitioner in holistic care of the patient with HAE in order to ultimately provide the best standard of care possible.

  18. Performance improvement in practice: managing urinary incontinence in home health patients with the use of an evidence-based guideline.

    Science.gov (United States)

    Egnatios, Donna; Dupree, Linda; Williams, Cathy

    2010-01-01

    Urinary incontinence (UI) has a far-reaching impact on the medical, social, and psychological well-being of older adults. This article describes the steps taken to develop and implement a UI evidence-based guideline that achieved success in enhancing the Outcome and Assessment Information Set urinary outcome scores. It describes a process of putting evidence into practice, how it is related to the performance improvement process, specific barriers the authors faced in their performance improvement efforts, lessons learned, and the Home Health Compare outcomes data that ultimately proved the success of the efforts and challenges encountered after implementation.

  19. Evidence-based Danish guidelines for the treatment of Malassezia-related skin diseases

    DEFF Research Database (Denmark)

    Hald, Marianne; Arendrup, Maiken C; Svejgaard, Else L

    2015-01-01

    Internationally approved guidelines for the diagnosis and management of Malassezia-related skin diseases are lacking. Therefore, a panel of experts consisting of dermatologists and a microbiologist under the auspices of the Danish Society of Dermatology undertook a data review and compiled...... guidelines for the diagnostic procedures and management of pityriasis versicolor, seborrhoeic dermatitis and Malassezia folliculitis. Main recommendations in most cases of pityriasis versicolor and seborrhoeic dermatitis include topical treatment which has been shown to be sufficient. As first choice....... Maintenance therapy is often necessary to prevent relapses. In the treatment of Malassezia folliculitis systemic antifungal treatment is probably more effective than topical treatment but a combination may be favourable....

  20. 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 t

  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. Evidence-based review of diabetic macular edema management: Consensus statement on Indian treatment guidelines

    Science.gov (United States)

    Das, Taraprasad; Aurora, Ajay; Chhablani, Jay; Giridhar, Anantharaman; Kumar, Atul; Raman, Rajiv; Nagpal, Manish; Narayanan, Raja; Natarajan, Sundaram; Ramasamay, Kim; Tyagi, Mudit; Verma, Lalit

    2016-01-01

    The purpose of the study was to review the current evidence and design a diabetic macular edema (DME) management guideline specific for India. The published DME guidelines from different organizations and publications were weighed against the practice trends in India. This included the recently approved drugs. DME management consisted of control of diabetes and other associated systemic conditions, such as hypertension and hyperlipidemia, and specific therapy to reduce macular edema. Quantification of macular edema is precisely made with the optical coherence tomography and treatment options include retinal laser, intravitreal anti-vascular endothelial growth factors (VEGF), and implantable dexamethasone. Specific use of these modalities depends on the presenting vision and extent of macular involvement. Invariable eyes with center-involving macular edema benefit from intravitreal anti-VEGF or dexamethasone implant therapy, and eyes with macular edema not involving the macula center benefit from retinal laser. The results are illustrated with adequate case studies and frequently asked questions. This guideline prepared on the current published evidence is meant as a guideline for the treating physicians. PMID:26953019

  3. Optimal blood pressure targets in 2014 - Does the guideline recommendation match the evidence base?

    Science.gov (United States)

    Alviar, C L; Bangalore, S; Messerli, F H

    2015-01-01

    Various scientific societies have recently published practice guidelines for the diagnosis and management of arterial hypertension with no clear consensus on a blood pressure target. This article reviews those recommendations and critically examines if they are based on sound evidence. Copyright © 2015 SEHLELHA. Published by Elsevier Espana. All rights reserved.

  4. Hypertension guidelines: Evidence-based treatments for maintaining blood pressure control.

    Science.gov (United States)

    Davis, Leslie Louise

    2015-06-11

    Approximately one in three adults in the United States has hypertension. This article provides an update on the latest JNC-8 guideline for treating hypertension in adults. Emphasis is placed on new and updated information and implications for primary care clinicians to help patients achieve and maintain better blood pressure control.

  5. Towards evidence-based clinical practice: an international survey of 18 clinical guideline programs.

    NARCIS (Netherlands)

    Burgers, J.S.; Grol, R.P.T.M.; Klazinga, N.S.; Makela, M.; Zaat, J.O.M.

    2003-01-01

    OBJECTIVE: To describe systematically the structures and working methods of guideline programs. DESIGN: Descriptive survey using a questionnaire with 32 items based on a framework derived from the literature. Answers were tabulated and checked by participants. STUDY PARTICIPANTS: Key informants of 1

  6. Evidence-based clinical practice guidelines for managing depression in persons living with HIV.

    Science.gov (United States)

    Relf, Michael V; Eisbach, Shelly; Okine, Kayj Nash; Ward, Terry

    2013-01-01

    Depressive symptoms and depression are prevalent among persons living with HIV (PLWH). Depression among PLWH is associated with a lower quality of life, reduced adherence to antiretroviral treatment, poorer self-care, worsened treatment outcomes, greater impairment in social and vocational functioning, and increased social isolation. Assessment of depression in PLWH is critical to facilitate referral and management. Fortunately, two simple screening questions can be used to assess for depression, and evidence supports the effective management of depression for PLWH. First-line treatment regimens for depression include selective serotonin reuptake inhibitors (SSRIs), cognitive behavioral therapy (CBT), or a combination of SSRI and CBT. This paper examines the contemporary evidence related to depression in the context of HIV infection. A case study has been included to illustrate an application of evidence-based treatment interventions recommended for clinical practice.

  7. Evidence-based guidelines for pediatric clinical trials: focus on StaR Child Health.

    Science.gov (United States)

    Sampson, Mario R; Benjamin, Daniel K; Cohen-Wolkowiez, Michael

    2012-09-01

    Clinical trials in children are challenging and filled with important ethical considerations that differ from adults. Given difficulties associated with pediatric clinical trials, off-label prescribing is a common practice in pediatrics, which can lead to adverse safety events and efficacy failures. To overcome these consequences, in the past 15 years, legislation in the USA and Europe has provided incentives to industry and increased government funding to conduct pediatric trials. Pediatric trial networks have also been formed to decrease the knowledge gap. However, challenges to performing pediatric trials and lack of standardization and guidelines regarding studies in children still exist. Standards for Research (StaR) in Child Health, begun in 2009, aims to improve the design, conduct and reporting of pediatric trials. This organization uses a consensus guideline approach involving academic, government and industry stakeholders to identify and disseminate best practices for pediatric trials. Six out of 11 planned standards are currently published.

  8. Evidence-based guidelines for pressure ulcer management at the end of life.

    Science.gov (United States)

    Langemo, Diane; Haesler, Emily; Naylor, Wayne; Tippett, Aletha; Young, Trudie

    2015-05-01

    It is important to develop an individualised plan of care for people at the end of life to prevent pressure ulcers, and to treat them if they do occur. This article discusses patient and risk assessment, prevention and care for pressure ulcers for the palliative care patient and the recommendations given in the palliative care section of the Prevention and Treatment of Pressure Ulcers: Clinical Practice Guideline (National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel and Pan Pacific Pressure Injury Alliance, 2014).

  9. Dental Trauma Guide: a source of evidence-based treatment guidelines for dental trauma.

    Science.gov (United States)

    Andreasen, Jens Ove; Lauridsen, Eva; Gerds, Thomas Alexander; Ahrensburg, Søren Steno

    2012-10-01

    Diagnosis and treatment for traumatic dental injuries are very complex owing to the multiple trauma entities represented by six luxation types and nine fracture types affecting both the primary and the permanent dentition. When it is further considered that fracture and luxation injuries are often combined, the result is that more than 100 trauma scenarios exist, when the two dentitions are combined. Each of these trauma scenarios has a specific treatment demand and prospect for healing. With such a complexity in diagnosis and treatment, it is obvious that even experienced practitioners may have problems in selecting proper treatment for some of these trauma types. To remedy this situation, an Internet-based knowledge base consisting of 4000 dental trauma cases with long-term follow up is now available to the public and the professions on the Internet using the address http://www.DentalTraumaGuide.org. It is the aspiration that the use of this Guide may lead the practitioner to offer an evidence-based diagnosis and treatment.

  10. Bone Health in Patients with Breast Cancer: Recommendations from an Evidence-Based Canadian Guideline

    Directory of Open Access Journals (Sweden)

    Alexander H. G. Paterson

    2013-12-01

    Full Text Available Bone loss is common in patients with breast cancer. Bone modifying agents (BMAs, such as bisphosphonates and denosumab, have been shown to reverse or stabilize bone loss and may be useful in the primary and metastatic settings. The purpose of this review is to provide clear evidence-based strategies for the management of bone loss and its symptoms in breast cancer. A systematic review of clinical trials and meta-analyses published between 1996 and 2012 was conducted of MEDLINE and EMBASE. Reference lists were hand-searched for additional publications. Recommendations were developed based on the best available evidence. Zoledronate, pamidronate, clodronate, and denosumab are recommended for metastatic breast cancer patients; however, no one agent can be recommended over another. Zoledronate or any oral bisphosphonate and denosumab should be considered in primary breast cancer patients who are postmenopausal on aromatase inhibitor therapy and have a high risk of fracture and/or a low bone mineral density and in premenopausal primary breast cancer patients who become amenorrheic after therapy. No one agent can be recommended over another. BMAs are not currently recommended as adjuvant therapy in primary breast cancer for the purpose of improving survival, although a major Early Breast Cancer Cooperative Trialists’ Group meta-analysis is underway which may impact future practice. Adverse events can be managed with appropriate supportive care.

  11. Summary of evidence-based guideline: Complementary and alternative medicine in multiple sclerosis

    Science.gov (United States)

    Yadav, Vijayshree; Bever, Christopher; Bowen, James; Bowling, Allen; Weinstock-Guttman, Bianca; Cameron, Michelle; Bourdette, Dennis; Gronseth, Gary S.; Narayanaswami, Pushpa

    2014-01-01

    Objective: To develop evidence-based recommendations for complementary and alternative medicine (CAM) in multiple sclerosis (MS). Methods: We searched the literature (1970–March 2011; March 2011−September 2013 MEDLINE search), classified articles, and linked recommendations to evidence. Results and recommendations: Clinicians might offer oral cannabis extract for spasticity symptoms and pain (excluding central neuropathic pain) (Level A). Clinicians might offer tetrahydrocannabinol for spasticity symptoms and pain (excluding central neuropathic pain) (Level B). Clinicians should counsel patients that these agents are probably ineffective for objective spasticity (short-term)/tremor (Level B) and possibly effective for spasticity and pain (long-term) (Level C). Clinicians might offer Sativex oromucosal cannabinoid spray (nabiximols) for spasticity symptoms, pain, and urinary frequency (Level B). Clinicians should counsel patients that these agents are probably ineffective for objective spasticity/urinary incontinence (Level B). Clinicians might choose not to offer these agents for tremor (Level C). Clinicians might counsel patients that magnetic therapy is probably effective for fatigue and probably ineffective for depression (Level B); fish oil is probably ineffective for relapses, disability, fatigue, MRI lesions, and quality of life (QOL) (Level B); ginkgo biloba is ineffective for cognition (Level A) and possibly effective for fatigue (Level C); reflexology is possibly effective for paresthesia (Level C); Cari Loder regimen is possibly ineffective for disability, symptoms, depression, and fatigue (Level C); and bee sting therapy is possibly ineffective for relapses, disability, fatigue, lesion burden/volume, and health-related QOL (Level C). Cannabinoids may cause adverse effects. Clinicians should exercise caution regarding standardized vs nonstandardized cannabis extracts and overall CAM quality control/nonregulation. Safety/efficacy of other CAM

  12. Evidence-Based Practice Guideline: Changing the Practice of Physical Restraint Use in Acute Care.

    Science.gov (United States)

    Lach, Helen W; Leach, Kathy M; Butcher, Howard K

    2016-02-01

    Physical restraints continue to be used in acute care settings, despite the challenges and calls to reduce this practice. The current guideline on restraint use is updated with evidence that includes critical care settings and issues related to restraint use in acute care units. Nurses play a significant role in the use of restraints. Factors such as nurse's knowledge and patient characteristics combined with the culture and resources in health care facilities influence the practice of physical restraint use. Nurses can identify patients at high risk for restraint use; assess the potential causes of unsafe behaviors; and target interventions in the areas of physiological, psychological, and environmental approaches to address those unsafe behaviors. Members of the interdisciplinary team can provide additional consultation, and institutions can provide resources and education and implement monitoring processes and quality improvement practices to help reduce the practice of physical restraint use. [Journal of Gerontological Nursing, 42(2), 17-26.]. Copyright 2016, SLACK Incorporated.

  13. 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

    Optimal management of sedation, analgesia and delirium offers comfort and security for the critical care patient, allows support measures to be applied more easily and enables an integral approach of medical care, at the same time that lowers the incidence of complications, wich translates in better patient outcomes. To update the Guía de práctica clínica basada en la evidencia para el manejo de la sedoanalgesia en el paciente adulto críticamente enfermo published in Medicina Intensiva in 2007, and give recommendations for the management of sedation, analgesia, and delirium. A group of 21 intensivists from 9 countries of the Federación Panamericana e Ibérica de Sociedades de Medicina Crítica y Terapia Intensiva, 3 of them also specialists in clinical epidemiology and methodology, gathered for the development of guidelines. Assessment of evidence quality and recommendations were made based on the Grading of Recommendations Assessment, Development and Evaluation system. Strength of recommendations was classified as 1=strong, or 2=weak, and quality of evidence as A=high, B=moderate, or C=low. Two authors searched the following databases: MEDLINE through PUBMED, The Cochrane Library and Literatura Latinoamericana y del Caribe en Ciencias de la Salud and retrieved pertinent information. Members assigned to the 11 sections of the guidelines, based on the literature review, formulated the recommendations, that were discussed in plenary sessions. Only those recommendations that achieved more than 80% of consensus were approved for the final document. The Colombian Association of Critical Medicine and Intensive Care (AMCI) supported the elaboration of this guidelines. Four hundred sixty-seven articles were included for review. An increase in number and quality of publications was observed. This allowed to generate 64 strong recommendations with high and moderate quality of evidence in contrast to the 28 recommendations of the previous edition. This Guidelines

  14. Compliance with Evidence-Based Guidelines in Acute Pancreatitis: an Audit of Practices in University of Toronto Hospitals.

    Science.gov (United States)

    Greenberg, J A; Hsu, J; Bawazeer, M; Marshall, J; Friedrich, J O; Nathens, A; Coburn, N; Huang, H; McLeod, R S

    2016-02-01

    Despite existing evidence-based practice guidelines for the management of acute pancreatitis, clinical compliance with recommendations is poor. We conducted a retrospective review of 248 patients admitted between 2010 and 2012 with acute pancreatitis at eight University of Toronto affiliated hospitals. We included all patients admitted to ICU (52) and 25 ward patients from each site (196). Management was compared with the most current evidence used in the Best Practice in General Surgery Management of Acute Pancreatitis Guideline. Fifty-six patients (22.6 %) had only serum lipase tested for biochemical diagnosis. Admission ultrasound was performed in 174 (70.2 %) patients, with 69 (27.8 %) undergoing ultrasound and CT. Of non-ICU patients, 158 (80.6 %) were maintained nil per os, and only 18 (34.6 %) ICU patients received enteral nutrition, commencing an average 7.5 days post-admission. Fifty (25.5 %) non-ICU patients and 25 (48.1 %) ICU patients received prophylactic antibiotics. Only 24 patients (22.6 %) with gallstone pancreatitis underwent index admission cholecystectomy. ERCP with sphincterotomy was under-utilized among patients with biliary obstruction (16 [31 %]) and candidates for prophylactic sphincterotomy (18 [22 %]). Discrepancies exist between the most current evidence and clinical practice within the University of Toronto hospitals. A guideline, knowledge translation strategy, and assessment of barriers to clinical uptake are required to change current clinical practice.

  15. Development and Evaluation of an Improved Methodology for Assessing Adherence to Evidence-Based Drug Therapy Guidelines Using Claims Data

    Science.gov (United States)

    Kawamoto, Kensaku; Allen LaPointe, Nancy M.; Silvey, Garry M.; Anstrom, Kevin J.; Eisenstein, Eric L.; Lobach, David F.

    2007-01-01

    Non-adherence to evidence-based pharmacotherapy is associated with increased morbidity and mortality. Claims data can be used to detect and intervene on such non-adherence, but existing claims-based approaches for measuring adherence to pharmacotherapy guidelines have significant limitations. In this manuscript, we describe a methodology for assessing adherence to pharmacotherapy guidelines that overcomes many of these limitations. To develop this methodology, we first reviewed the literature to identify prior work on potential strategies for overcoming these limitations. We then assembled a team of relevant domain experts to iteratively develop an improved methodology. This development process was informed by the use of the proposed methodology to assess adherence levels for 14 pharmacotherapy guidelines related to seven common diseases among approximately 36,000 Medicaid beneficiaries. Finally, we evaluated the ability of the methodology to overcome the targeted limitations. Based on this evaluation, we conclude that the proposed methodology overcomes many of the limitations associated with existing approaches. PMID:18693865

  16. Evidence-based guideline: treatment of tardive syndromes: report of the Guideline Development Subcommittee of the American Academy of Neurology.

    Science.gov (United States)

    Bhidayasiri, Roongroj; Fahn, Stanley; Weiner, William J; Gronseth, Gary S; Sullivan, Kelly L; Zesiewicz, Theresa A

    2013-07-30

    To make evidence-based recommendations regarding management of tardive syndromes (TDS), including tardive dyskinesias (TDD), by addressing 5 questions: 1) Is withdrawal of dopamine receptor blocking agents (DRBAs) an effective TDS treatment? 2) Does switching from typical to atypical DRBAs reduce TDS symptoms? 3) What is the efficacy of pharmacologic agents in treating TDS? 4) Do patients with TDS benefit from chemodenervation with botulinum toxin? 5) Do patients with TDS benefit from surgical therapy? PsycINFO, Ovid MEDLINE, EMBASE, Web of Science, and Cochrane were searched (1966-2011). Articles were classified according to a 4-tiered evidence-rating scheme; recommendations were tied to the evidence. Clonazepam probably improves TDD and ginkgo biloba probably improves TDS (both Level B); both should be considered as treatment. Risperidone may improve TDS but cannot be recommended as treatment because neuroleptics may cause TDS despite masking symptoms. Amantadine and tetrabenazine might be considered as TDS treatment (Level C). Diltiazem should not be considered as TDD treatment (Level B); galantamine and eicosapentaenoic acid may not be considered as treatment (Level C). Data are insufficient to support or refute use of acetazolamide, bromocriptine, thiamine, baclofen, vitamin E, vitamin B6, selegiline, clozapine, olanzapine, melatonin, nifedipine, fluperlapine, sulpiride, flupenthixol, thiopropazate, haloperidol, levetiracetam, quetiapine, ziprasidone, sertindole, aripiprazole, buspirone, yi-gan san, biperiden discontinuation, botulinum toxin type A, electroconvulsive therapy, α-methyldopa, reserpine, and pallidal deep brain stimulation as TDS treatments (Level U). Data are insufficient to support or refute TDS treatment by withdrawing causative agents or switching from typical to atypical DRBA (Level U).

  17. Evidence-based guidelines on the therapeutic use of transcranial direct current stimulation (tDCS).

    Science.gov (United States)

    Lefaucheur, Jean-Pascal; Antal, Andrea; Ayache, Samar S; Benninger, David H; Brunelin, Jérôme; Cogiamanian, Filippo; Cotelli, Maria; De Ridder, Dirk; Ferrucci, Roberta; Langguth, Berthold; Marangolo, Paola; Mylius, Veit; Nitsche, Michael A; Padberg, Frank; Palm, Ulrich; Poulet, Emmanuel; Priori, Alberto; Rossi, Simone; Schecklmann, Martin; Vanneste, Sven; Ziemann, Ulf; Garcia-Larrea, Luis; Paulus, Walter

    2017-01-01

    A group of European experts was commissioned by the European Chapter of the International Federation of Clinical Neurophysiology to gather knowledge about the state of the art of the therapeutic use of transcranial direct current stimulation (tDCS) from studies published up until September 2016, regarding pain, Parkinson's disease, other movement disorders, motor stroke, poststroke aphasia, multiple sclerosis, epilepsy, consciousness disorders, Alzheimer's disease, tinnitus, depression, schizophrenia, and craving/addiction. The evidence-based analysis included only studies based on repeated tDCS sessions with sham tDCS control procedure; 25 patients or more having received active treatment was required for Class I, while a lower number of 10-24 patients was accepted for Class II studies. Current evidence does not allow making any recommendation of Level A (definite efficacy) for any indication. Level B recommendation (probable efficacy) is proposed for: (i) anodal tDCS of the left primary motor cortex (M1) (with right orbitofrontal cathode) in fibromyalgia; (ii) anodal tDCS of the left dorsolateral prefrontal cortex (DLPFC) (with right orbitofrontal cathode) in major depressive episode without drug resistance; (iii) anodal tDCS of the right DLPFC (with left DLPFC cathode) in addiction/craving. Level C recommendation (possible efficacy) is proposed for anodal tDCS of the left M1 (or contralateral to pain side, with right orbitofrontal cathode) in chronic lower limb neuropathic pain secondary to spinal cord lesion. Conversely, Level B recommendation (probable inefficacy) is conferred on the absence of clinical effects of: (i) anodal tDCS of the left temporal cortex (with right orbitofrontal cathode) in tinnitus; (ii) anodal tDCS of the left DLPFC (with right orbitofrontal cathode) in drug-resistant major depressive episode. It remains to be clarified whether the probable or possible therapeutic effects of tDCS are clinically meaningful and how to optimally perform t

  18. Hair pull test: Evidence-based update and revision of guidelines.

    Science.gov (United States)

    McDonald, Katherine A; Shelley, Amanda J; Colantonio, Sophia; Beecker, Jennifer

    2017-03-01

    The hair pull test lacks validation and has unclear pretest guidelines. We sought to quantify normal hair pull test values and elucidate the effect of pretest hair washing and brushing. The impact of hair texture and lifestyle was also examined. Participants (n = 181) completed a questionnaire recording demographics, medications, and hair health/history. A single hair pull test (scalp vertex) was performed. The mean number of hairs removed per pull was 0.44 (SD 0.75). There was no significant difference in the mean number of hairs removed regardless of when participants washed (P = .20) or brushed (P = .25) their hair. Hair pull test values were similar between Caucasian-, Asian-, and Afro-textured hair. There was no significant difference in hair pull values between participants taking medications affecting hair loss and participants not taking these medications (P = .33). Tight hairstyles did not influence hair pull test values. Participant hair washing and brushing could not be controlled during the study, but this information was documented and analyzed. Normal values for the hair pull test should be reduced to 2 hairs or fewer (97.2% of participants). The current 5-day restriction on pretest hair washing can be reduced and brushing be made permissible. Copyright © 2016 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

  19. Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS).

    Science.gov (United States)

    Lefaucheur, Jean-Pascal; André-Obadia, Nathalie; Antal, Andrea; Ayache, Samar S; Baeken, Chris; Benninger, David H; Cantello, Roberto M; Cincotta, Massimo; de Carvalho, Mamede; De Ridder, Dirk; Devanne, Hervé; Di Lazzaro, Vincenzo; Filipović, Saša R; Hummel, Friedhelm C; Jääskeläinen, Satu K; Kimiskidis, Vasilios K; Koch, Giacomo; Langguth, Berthold; Nyffeler, Thomas; Oliviero, Antonio; Padberg, Frank; Poulet, Emmanuel; Rossi, Simone; Rossini, Paolo Maria; Rothwell, John C; Schönfeldt-Lecuona, Carlos; Siebner, Hartwig R; Slotema, Christina W; Stagg, Charlotte J; Valls-Sole, Josep; Ziemann, Ulf; Paulus, Walter; Garcia-Larrea, Luis

    2014-11-01

    A group of European experts was commissioned to establish guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS) from evidence published up until March 2014, regarding pain, movement disorders, stroke, amyotrophic lateral sclerosis, multiple sclerosis, epilepsy, consciousness disorders, tinnitus, depression, anxiety disorders, obsessive-compulsive disorder, schizophrenia, craving/addiction, and conversion. Despite unavoidable inhomogeneities, there is a sufficient body of evidence to accept with level A (definite efficacy) the analgesic effect of high-frequency (HF) rTMS of the primary motor cortex (M1) contralateral to the pain and the antidepressant effect of HF-rTMS of the left dorsolateral prefrontal cortex (DLPFC). A Level B recommendation (probable efficacy) is proposed for the antidepressant effect of low-frequency (LF) rTMS of the right DLPFC, HF-rTMS of the left DLPFC for the negative symptoms of schizophrenia, and LF-rTMS of contralesional M1 in chronic motor stroke. The effects of rTMS in a number of indications reach level C (possible efficacy), including LF-rTMS of the left temporoparietal cortex in tinnitus and auditory hallucinations. It remains to determine how to optimize rTMS protocols and techniques to give them relevance in routine clinical practice. In addition, professionals carrying out rTMS protocols should undergo rigorous training to ensure the quality of the technical realization, guarantee the proper care of patients, and maximize the chances of success. Under these conditions, the therapeutic use of rTMS should be able to develop in the coming years.

  20. 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.

  1. Consensus and evidence-based Indian initiative on obstructive sleep apnea guidelines 2014 (first edition

    Directory of Open Access Journals (Sweden)

    Surendra K Sharma

    2015-01-01

    Full Text Available Obstructive sleep apnea (OSA and obstructive sleep apnea syndrome (OSAS are subsets of sleep-disordered breathing. Awareness about OSA and its consequences among the general public as well as the majority of primary care physicians across India is poor. This necessitated the development of the Indian initiative on obstructive sleep apnea (INOSA guidelines under the auspices of Department of Health Research, Ministry of Health and Family Welfare, Government of India. OSA is the occurrence of an average five or more episodes of obstructive respiratory events per hour of sleep with either sleep-related symptoms or co-morbidities or ≥15 such episodes without any sleep-related symptoms or co-morbidities. OSAS is defined as OSA associated with daytime symptoms, most often excessive sleepiness. Patients undergoing routine health check-up with snoring, daytime sleepiness, obesity, hypertension, motor vehicular accidents, and high-risk cases should undergo a comprehensive sleep evaluation. Medical examiners evaluating drivers, air pilots, railway drivers, and heavy machinery workers should be educated about OSA and should comprehensively evaluate applicants for OSA. Those suspected to have OSA on comprehensive sleep evaluation should be referred for a sleep study. Supervised overnight polysomnography is the "gold standard" for evaluation of OSA. Positive airway pressure (PAP therapy is the mainstay of treatment of OSA. Oral appliances (OA are indicated for use in patients with mild to moderate OSA who prefer OA to PAP, or who do not respond to PAP or who fail treatment attempts with PAP or behavioral measures. Surgical treatment is recommended in patients who have failed or are intolerant to PAP therapy.

  2. Guidelines for establishing a telemental health program to provide evidence-based therapy for trauma-exposed children and families.

    Science.gov (United States)

    Jones, Andrea M; Shealy, Kristen M; Reid-Quiñones, Kathryn; Moreland, Angela D; Davidson, Tatiana M; López, Cristina M; Barr, Simone C; de Arellano, Michael A

    2014-11-01

    Although similar rates of traumatic experiences exist in both rural and urban settings, mental health resources available to those living in rural areas are often scarce. Limited resources pose a problem for children and families living in rural areas, and several barriers to service access and utilization exist including reduced anonymity, few "after hours" services, decreased availability of evidence-based treatments, few specialty clinics, and expenses associated with travel, taking time off work, and provision of childcare. As a solution, the authors discuss the utility, use, and set-up of a telemental health program within an existing community outreach program. Suggestions for establishing a telemental health clinic are presented along with guidelines for the delivery of trauma-focused, cognitive-behavioral therapy (TF-CBT) via telemental health videoconferencing technology. Specific guidelines discussed include (1) establishing and using community partnerships, (2) Memoranda of Understanding (MOU), (3) equipment setup and technological resources, (4) videoconferencing software, (5) physical setup, (6) clinic administration, (7) service reimbursement and start-up costs, (8) therapy delivery modifications, and (9) delivering culturally competent services to rural and remote areas.

  3. Breast reconstruction following prophylactic or therapeutic mastectomy for breast cancer: Recommendations from an evidence-based provincial guideline

    Science.gov (United States)

    Shea-Budgell, Melissa; Quan, May Lynn; Mehling, Blair; Temple-Oberle, Claire

    2014-01-01

    The side effects of mastectomy can be significant. Breast reconstruction may alleviate some distress; however, there are currently no provincial recommendations regarding the integration of reconstruction with breast cancer therapy. The purpose of the present article is to provide evidence-based strategies for the management of patients who are candidates for reconstruction. A systematic review of meta-analyses, guidelines, clinical trials and comparative studies published between 1980 and 2013 was conducted using the PubMed and EMBASE databases. Reference lists of publications were manually searched for additional literature. The National Guidelines Clearinghouse and SAGE directory, as well as guideline developers’ websites, were also searched. Recommendations were developed based on the available evidence. Reconstruction consultation should be made available for patients undergoing mastectomy. Tumour characteristics, cancer therapy, patient comorbidities, body habitus and smoking history may affect reconstruction outcomes. Although immediate reconstruction should be considered whenever possible, delayed reconstruction is acceptable when immediate is not available or appropriate. The integration of reconstruction and postmastectomy radiotherapy should be addressed in a multidisciplinary setting. The decision as to which type of procedure to perform (autologous or alloplastic with or without acellular dermal matrices) should be left to the discretion of the surgeons and the patient after providing counselling. Skin-sparing mastectomy is safe and appropriate. Nipple-sparing is generally not recommended for patients with malignancy, but could be considered for carefully selected patients. Immediate reconstruction requires resources to coordinate operating room time between the general and plastic surgeons, to provide supplies including acellular dermal matrices, and to develop the infrastructure needed to facilitate multidisciplinary discussions. PMID:25114623

  4. Developing evidence-based clinical practice guidelines in hospitals in Australia, Indonesia, Malaysia, the Philippines and Thailand: values, requirements and barriers

    Directory of Open Access Journals (Sweden)

    Turner Tari J

    2009-12-01

    Full Text Available Abstract Background Evidence-based clinical practice guidelines support clinical decision-making by making recommendations to guide clinical practice. These recommendations are developed by integrating the expertise of a multidisciplinary group of clinicians with the perspectives of consumers and the best available research evidence. However studies have raised concerns about the quality of guideline development, and particularly the link between research and recommendations. The reasons why guideline developers are not following the established development methods are not clear. We aimed to explore the barriers to developing evidence-based guidelines in eleven hospitals in Australia, Indonesia, Malaysia, the Philippines and Thailand, so as to better understand how evidence-based guideline development could be facilitated in these settings. The research aimed to identify the value clinicians place on guidelines, what clinicians want in guidelines developed in hospital settings and what factors limit rigorous evidence-based guideline development in these settings. Methods Semi-structured, face-to-face interviews were undertaken with senior and junior healthcare providers (nurses, midwives, doctors, allied health from the maternal and neonatal services of the eleven participating hospitals. Interviews were audio-recorded, transcribed and a thematic analysis undertaken. Results Ninety-three individual, 25 pair and eleven group interviews were conducted. Participants were clear that they want guidelines that are based on evidence and updated regularly. They were also clear that there are major barriers to this. Most of the barriers were shared across countries, and included lack of time, lack of skills in finding, appraising and interpreting evidence, lack of access to relevant evidence and difficulty arranging meetings and achieving consensus. Barriers that were primarily identified in Australian hospitals include cumbersome organisational

  5. Health risks for ataxia-telangiectasia mutated heterozygotes: a systematic review, meta-analysis and evidence-based guideline.

    Science.gov (United States)

    van Os, N J H; Roeleveld, N; Weemaes, C M R; Jongmans, M C J; Janssens, G O; Taylor, A M R; Hoogerbrugge, N; Willemsen, M A A P

    2016-08-01

    Ataxia-telangiectasia (AT) is an autosomal recessive neurodegenerative disorder with immunodeficiency and an increased risk of developing cancer, caused by mutations in the ataxia-telangiectasia mutated (ATM) gene. Logically, blood relatives may also carry a pathogenic ATM mutation. Female carriers of such a mutation have an increased risk of breast cancer. Other health risks for carriers are suspected but have never been studied systematically. Consequently, evidence-based guidelines for carriers are not available yet. We systematically analyzed all literature and found that ATM mutation carriers have a reduced life expectancy because of mortality from cancer and ischemic heart diseases (RR 1.7, 95% CI 1.2-2.4) and an increased risk of developing cancer (RR 1.5, 95% CI 0.9-2.4), in particular breast cancer (RRwomen 3.0, 95% CI 2.1-4.5), and cancers of the digestive tract. Associations between ATM heterozygosity and other health risks have been suggested, but clear evidence is lacking. Based on these results, we propose that all female carriers of 40-50 years of age and female ATM c.7271T>G mutation carriers from 25 years of age onwards be offered intensified surveillance programs for breast cancer. Furthermore, all carriers should be made aware of lifestyle factors that contribute to the development of cardiovascular diseases and diabetes. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  6. Ottawa Panel Evidence-Based Clinical Practice Guidelines for Foot Care in the Management of Juvenile Idiopathic Arthritis.

    Science.gov (United States)

    Brosseau, Lucie; Toupin-April, Karine; Wells, George; Smith, Christine A; Pugh, Arlanna G; Stinson, Jennifer N; Duffy, Ciarán M; Gifford, Wendy; Moher, David; Sherrington, Catherine; Cavallo, Sabrina; De Angelis, Gino; Loew, Laurianne; Rahman, Prinon; Marcotte, Rachel; Taki, Jade; Bisaillon, Jacinthe; King, Judy; Coda, Andrea; Hendry, Gordon J; Gauvreau, Julie; Hayles, Martin; Hayles, Kay; Feldman, Brian; Kenny, Glen P; Li, Jing Xian; Briggs, Andrew M; Martini, Rose; Feldman, Debbie Ehrmann; Maltais, Désirée B; Tupper, Susan; Bigford, Sarah; Bisch, Marg

    2016-07-01

    To create evidence-based guidelines evaluating foot care interventions for the management of juvenile idiopathic arthritis (JIA). An electronic literature search of the following databases from database inception to May 2015 was conducted: MEDLINE (Ovid), EMBASE (Ovid), Cochrane CENTRAL, and clinicaltrials.gov. The Ottawa Panel selection criteria targeted studies that assessed foot care or foot orthotic interventions for the management of JIA in those aged 0 to ≤18 years. The Physiotherapy Evidence Database scale was used to evaluate study quality, of which only high-quality studies were included (score, ≥5). A total of 362 records were screened, resulting in 3 full-text articles and 1 additional citation containing supplementary information included for the analysis. Two reviewers independently extracted study data (intervention, comparator, outcome, time period, study design) from the included studies by using standardized data extraction forms. Directed by Cochrane Collaboration methodology, the statistical analysis produced figures and graphs representing the strength of intervention outcomes and their corresponding grades (A, B, C+, C, C-, D+, D, D-). Clinical significance was achieved when an improvement of ≥30% between the intervention and control groups was present, whereas P>.05 indicated statistical significance. An expert panel Delphi consensus (≥80%) was required for the endorsement of recommendations. All included studies were of high quality and analyzed the effects of multidisciplinary foot care, customized foot orthotics, and shoe inserts for the management of JIA. Custom-made foot orthotics and prefabricated shoe inserts displayed the greatest improvement in pain intensity, activity limitation, foot pain, and disability reduction (grades A, C+). The use of customized foot orthotics and prefabricated shoe inserts seems to be a good choice for managing foot pain and function in JIA. Copyright © 2016 American Congress of Rehabilitation

  7. Introducing Evidence-Based Medicine and guidelines for maternal and newborn care in the Republic of Moldova

    DEFF Research Database (Denmark)

    Bacci, A; Wyn Huws, D; Baltag, V;

    2005-01-01

    Familiarity with Evidence-Based Medicine (EBM) concepts is low amongst key maternal and newborn care clinicians in Moldova. Simple interventions can increase the knowledge of EBM concepts there.......Familiarity with Evidence-Based Medicine (EBM) concepts is low amongst key maternal and newborn care clinicians in Moldova. Simple interventions can increase the knowledge of EBM concepts there....

  8. Sleep apnoea: Finnish National guidelines for prevention and treatment 2002-2012.

    Science.gov (United States)

    Laitinen, L A; Anttalainen, U; Pietinalho, A; Hämäläinen, P; Koskela, K

    2003-04-01

    (1) After negotiations with the Finnish Ministry of Social Affairs and Health, a national programme to promote prevention, treatment and rehabilitation of sleep apnoea for the years 2002-2012 has been prepared by the Finnish Lung Health Association on the basis of extensive collaboration. The programme needs to be revised as necessary, because of the rapid development in medical knowledge, and in appliance therapy in particular. (2) Sleep apnoea deteriorates slowly. Its typical features are snoring, interruptions of breathing during sleep and daytime tiredness. Sleep apnoea affects roughly 3% of middle-aged men and 2% of women. In Finland, there are approx. 150,000 sleep apnea patients, of which 15,000 patients have a severe disease, 50,000 patients are moderate and 85,000 have a mild form of the disease. Children are also affected by sleep apnea. A typical sleep apnea patient is a middle-aged man or a postmenopausal woman. (3) The obstruction of upper airways is essential in the occurrence of sleep apnoea. The obstruction can be caused by structural and/or functional factors. As for structural factors, there are various methods of intervention, such as to secure children's nasal respiration, to remove redundant soft tissue, as well as to correct malocclusions. It is possible to have an effect on the functional factors by treating well diseases predisposing to sleep apnoea, by reducing smoking, the consumption of alcohol and the use of medicines impairing the central nervous system. The most important single risk factor for sleep apnoea is obesity. (4) Untreated sleep apnoea leads to an increase morbidity and mortality through heart circulatory diseases and through accidents by tiredness. Untreated or undertreated sleep apnoea deteriorates a person's quality of life and working capacity. (5) The goals of the Programme for the prevention and treatment of sleep apnoea are as follows: (1) to decrease the incidence of sleep apnoea, (2) to ensure that as many patients

  9. American Society for Apheresis guidelines on the use of apheresis in clinical practice: practical, concise, evidence-based recommendations for the apheresis practitioner.

    Science.gov (United States)

    Winters, Jeffrey L

    2014-08-01

    The 6th Guidelines on the use of therapeutic apheresis in clinical practice published by the American Society of Apheresis provide practical, concise, and evidence based guidance for the apheresis medicine practitioner. The overall format of the Guidelines has remained unchanged with the 6th edition, compared to the 5th edition, with enhancements in the committee process of creating the guidelines. Because of changes in the writing committee structure, a number of changes have occurred in the ASFA category and recommendation grade for the use of apheresis in the treatment for a number of previously categorized clinical indications. In addition, eight new indications for apheresis, twenty three new clinical situations for previously categorized diseases, and ten new apheresis treatments for previously categorized disorders have been added. The 6th Guidelines continue to be an invaluable resource for those involved in apheresis medicine.

  10. Clinical practice guideline dissemination and a new approach using Haddon matrix as a conceptual framework of evidence-based implementation strategies.

    Science.gov (United States)

    Pang, Peter

    2010-01-01

    To err is human. Clinical practice guidelines (CPGs) are often not followed and lead to adverse outcomes. The issue on implementation of CPG is complex. A review of CPG implementation is done to identify the barriers and enablers. For the first time, a fishbone diagram is used to delineate the root-causes. And Haddon matrix is applied to help understand the complexity of evidence-based implementation (EBI) strategies.

  11. Clinical practice guideline dissemination and a new approach using Haddon matrix as a conceptual framework of evidence-based implementation strategies

    Science.gov (United States)

    Pang, Peter

    2010-01-01

    To err is human. Clinical practice guidelines (CPGs) are often not followed and lead to adverse outcomes. The issue on implementation of CPG is complex. A review of CPG implementation is done to identify the barriers and enablers. For the first time, a fishbone diagram is used to delineate the root-causes. And Haddon matrix is applied to help understand the complexity of evidence-based implementation (EBI) strategies. PMID:25214934

  12. Characteristics of multiple-diseased elderly in Swedish hospital care and clinical guidelines: Do they make evidence-based priority setting a “mission impossible”?

    Directory of Open Access Journals (Sweden)

    Carlsson, Per

    2009-02-01

    Full Text Available In Sweden, an expected growing gap between available resources and greater potential for medical treatment has brought evidence-based guidelines and priority setting into focus. There are problems, however, in areas where the evidence base is weak and underlying ethical values are controversial. Based on a specified definition of multiple-diseased elderly patients, the aims of this study are: (i to describe and quantify inpatient care utilisation and patient characteristics, particularly regarding cardiovascular disease and co-morbidity; and (ii to question the applicability of evidence-based guidelines for these patients with regard to the reported characteristics (i.e. age and co-morbidity, and to suggest some possible strategies in order to tackle the described problem and the probable presence of ageism. We used data from three sources: (a a literature review, (b a register study, based on a unique population-based register of inpatient care in Sweden, and (c a national cost per patient database. The results show that elderly patients with multiple co-morbidities constitute a large and growing population in Swedish inpatient hospital care. They have multiple and complex needs and a large majority have a cardiovascular disease. There is a relationship between reported characteristics, i.e. age and co-morbidity, and limited applicability of evidence-based guidelines, and this can cause an under-use as well as an over-use of medical interventions. As future clinical studies will be rare due to methodological and financial factors, we consider it necessary to condense existing practical-clinical experiences of individual experts into consensus-based guidelines concerning elderly with multi-morbidity. In such priority setting, it will be important to consider co-morbidity and different degrees of frailty.

  13. 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

  14. 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 laparoscopy.Re

  15. 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 laparoscopy.Re

  16. The perioperative management of antithrombotic therapy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition).

    Science.gov (United States)

    Douketis, James D; Berger, Peter B; Dunn, Andrew S; Jaffer, Amir K; Spyropoulos, Alex C; Becker, Richard C; Ansell, Jack

    2008-06-01

    This article discusses the perioperative management of antithrombotic therapy and is part of the American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). The primary objectives of this article are the following: (1) to address the perioperative management of patients who are receiving vitamin K antagonists (VKAs) or antiplatelet drugs, such as aspirin and clopidogrel, and require an elective surgical or other invasive procedures; and (2) to address the perioperative use of bridging anticoagulation, typically with low-molecular-weight heparin (LMWH) or unfractionated heparin (UFH). A secondary objective is to address the perioperative management of such patients who require urgent surgery. The recommendations in this article incorporate the grading system that is discussed in this supplement (Guyatt G et al, CHEST 2008; 133:123S-131S). Briefly, Grade 1 recommendations are considered strong and indicate that the benefits do (or do not) outweigh risks, burden, and costs, whereas Grade 2 recommendations are referred to as suggestions and imply that individual patient values may lead to different management choices. The key recommendations in this article include the following: in patients with a mechanical heart valve or atrial fibrillation or venous thromboembolism (VTE) at high risk for thromboembolism, we recommend bridging anticoagulation with therapeutic-dose subcutaneous (SC) LMWH or IV UFH over no bridging during temporary interruption of VKA therapy (Grade 1C); in patients with a mechanical heart valve or atrial fibrillation or VTE at moderate risk for thromboembolism, we suggest bridging anticoagulation with therapeutic-dose SC LMWH, therapeutic-dose IV UFH, or low-dose SC LMWH over no bridging during temporary interruption of VKA therapy (Grade 2C); in patients with a mechanical heart valve or atrial fibrillation or VTE at low risk for thromboembolism, we suggest low-dose SC LMWH or no bridging over bridging with

  17. [From bedside to evidence - and back to bedside. 5 years evidence-based guidelines in South Tyrol: methods and experiences].

    Science.gov (United States)

    Langer, Gero; Siller, Marianne; Tappeiner, Waltraud

    2013-06-01

    In South Tyrol we developed guidelines with two different methodological approaches: one relates to the autonomous development of a nursing guideline for oral care using GRADE, and the other relates to the adaptation process of the NICE guideline on the prevention of venous thromboembolism. Both methods do have advantages and disadvantages: by autonomously developing guidelines the guideline panel identifies more with the product but time and effort is much higher than adapting and amending existing (high quality) guidelines. On the other hand there are only few high quality nursing guidelines. Additionally, the experiences in South Tyrol show that nursing guidelines seem to be not really suitable for a 1:1 application into practice because nearly half of the nurses have not changed their practice - although they knew the content of the guideline. Therefore, in order to promote the implementation process multimodal strategies on different organisational levels were adopted. Amongst these was the involvement of management through the negotiations of objectives, training and active participation of staff in the development of user-friendly application tools.

  18. ["All of us actually practice EBM!" - Attitudes of German GPs towards evidence-based medicine and clinical guidelines in daily practice: a focus group study].

    Science.gov (United States)

    Bücker, Bettina; Redaèlli, Marcus; Simic, Dusan; Wilm, Stefan

    2013-01-01

    Implementation of guidelines in general practice is difficult. Do general practitioners (GPs) reject evidence-based medicine (EBM) in general? Which attitudes do GPs have towards EBM and guidelines, and which value do they attach to EBM in daily routine? We conducted a qualitative study using five focus groups with 53 GPs. The study was set in the German federal states of Bavaria, Saxony, North Rhine-Westphalia, Hesse and Hamburg. Participants were selected according to area (rural/urban), region (North/South, East/West) and grade of professionalisation. Focus groups were digitally recorded and fully transcribed. Data were analysed in a multidisciplinary team using qualitative content analysis. Most participants felt positive towards EBM. Lack of feasibility was explicitly mentioned: the participants distinguished between "practised" and "true" EBM. Guidelines are often considered unsuitable for general practice. The GPs felt confident that their treatment of patients was evidence-based. Compared to older studies, German GPs have an increasingly favourable opinion about EBM. In order to enhance the practical application of EBM and guidelines the attitudes of GPs need to be considered. Copyright © 2013. Published by Elsevier GmbH.

  19. [Evidence-based guidelines as tools for medical knowledge transfer. The work mode of the Medical Knowledge Network evidence.de].

    Science.gov (United States)

    Vollmar, H C; Koneczny, N; Floer, B; Isfort, J; Kunstmann, W; Butzlaff, M

    2002-12-01

    The amount of medical knowledge is growing with increasing speed. Physicians are confronted with more and more--and often useless--information. However, the time lag between the creation of new knowledge and its implementation into daily medical practice is often exceeding a decade. In view of these challenges the knowledge network of the medical faculty of the University Witten/Herdecke is focusing on two different tasks: It provides evidence based medical guidelines in a format that is meant for easy access and use in daily practice. It scientifically explores different ways of presenting and transferring evidence based guidelines in order to develop better and easier ways of implementation. National and international guidelines and studies are screened, evaluated, updated and adapted for its use in the academic network by a team of five university based physicians. In addition, clinical specialists as well as primary care physicians provide expertise for detailed scientific adaptations and for adequate implementation strategies. The implementation process of the guidelines among the faculty based primary care physicians is continuously monitored and evaluated. The main goal of this concept is to create a learning environment for the complex process of medical knowledge transfer.

  20. Self-monitoring of blood glucose in patients with diabetes who do not use insulin--are guidelines evidence-based?

    Science.gov (United States)

    Aakre, K M; Watine, J; Bunting, P S; Sandberg, S; Oosterhuis, W P

    2012-10-01

    To evaluate if clinical practice guideline recommendations regarding self-monitoring of blood glucose in patients with diabetes not using insulin follow the principles of evidence-based medicine. After a search from 1999 to 2011, 18 clinical practice guidelines were included. Recommendations regarding self-monitoring of blood glucose were graded on a scale from one (strongly against self-monitoring) to four (strongly in favour of self-monitoring) and compared with the similarly graded conclusions of systematic reviews that were cited by the clinical practice guidelines. We also investigated how clinical practice guideline characteristics, for example funding sources, and quality of references cited could be related to the guideline recommendations. The clinical practice guidelines cited in total 15 systematic reviews, 14 randomized controlled trials, 33 non-randomized controlled trials papers and 18 clinical practice guidelines or position statements. The clinical practice guideline recommendations had an average grade of 3.4 (range 2.0-4.0). Higher grades were seen for clinical practice guidelines that acknowledged industry funding (mean value 4.0) or were issued by organizations depending on private funding (mean value 3.6 vs. 3.0 for governmental funding). The conclusions of the 15 systematic reviews had a mean grade of 2.2 (range 1.0-3.8). Systematic reviews with low grades were less cited. In total, 21 randomized controlled trials were included in the systematic reviews. Approximately half of these evaluated an educational intervention where the effect of self-monitoring of blood glucose could not be clearly isolated. Clinical practice guidelines were more in favour of self-monitoring use than the systematic reviews that were cited. The citation practice was non-systematic and industry funding seemingly led to a more positive attitude towards use of self-monitoring of blood glucose. © 2012 The Authors. Diabetic Medicine © 2012 Diabetes UK.

  1. 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

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

    Directory of Open Access Journals (Sweden)

    Lupo Massimo

    2011-01-01

    Full Text Available Abstract 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

  3. Development of a meta-algorithm for guiding primary care encounters for patients with multimorbidity using evidence-based and case-based guideline development methodology.

    Science.gov (United States)

    Muche-Borowski, Cathleen; Lühmann, Dagmar; Schäfer, Ingmar; Mundt, Rebekka; Wagner, Hans-Otto; Scherer, Martin

    2017-06-22

    The study aimed to develop a comprehensive algorithm (meta-algorithm) for primary care encounters of patients with multimorbidity. We used a novel, case-based and evidence-based procedure to overcome methodological difficulties in guideline development for patients with complex care needs. Systematic guideline development methodology including systematic evidence retrieval (guideline synopses), expert opinions and informal and formal consensus procedures. Primary care. The meta-algorithm was developed in six steps:1. Designing 10 case vignettes of patients with multimorbidity (common, epidemiologically confirmed disease patterns and/or particularly challenging health care needs) in a multidisciplinary workshop.2. Based on the main diagnoses, a systematic guideline synopsis of evidence-based and consensus-based clinical practice guidelines was prepared. The recommendations were prioritised according to the clinical and psychosocial characteristics of the case vignettes.3. Case vignettes along with the respective guideline recommendations were validated and specifically commented on by an external panel of practicing general practitioners (GPs).4. Guideline recommendations and experts' opinions were summarised as case specific management recommendations (N-of-one guidelines).5. Healthcare preferences of patients with multimorbidity were elicited from a systematic literature review and supplemented with information from qualitative interviews.6. All N-of-one guidelines were analysed using pattern recognition to identify common decision nodes and care elements. These elements were put together to form a generic meta-algorithm. The resulting meta-algorithm reflects the logic of a GP's encounter of a patient with multimorbidity regarding decision-making situations, communication needs and priorities. It can be filled with the complex problems of individual patients and hereby offer guidance to the practitioner. Contrary to simple, symptom-oriented algorithms, the meta

  4. Prophylaxis of Venous Thrombosis in Neurocritical Care Patients: An Evidence-Based Guideline: A Statement for Healthcare Professionals from the Neurocritical Care Society.

    Science.gov (United States)

    Nyquist, Paul; Bautista, Cynthia; Jichici, Draga; Burns, Joseph; Chhangani, Sanjeev; DeFilippis, Michele; Goldenberg, Fernando D; Kim, Keri; Liu-DeRyke, Xi; Mack, William; Meyer, Kim

    2016-02-01

    The risk of death from venous thromboembolism (VTE) is high in intensive care unit patients with neurological diagnoses. This is due to an increased risk of venous stasis secondary to paralysis as well as an increased prevalence of underlying pathologies that cause endothelial activation and create an increased risk of embolus formation. In many of these diseases, there is an associated risk from bleeding because of standard VTE prophylaxis. There is a paucity of prospective studies examining different VTE prophylaxis strategies in the neurologically ill. The lack of a solid evidentiary base has posed challenges for the establishment of consistent and evidence-based clinical practice standards. In response to this need for guidance, the Neurocritical Care Society set out to develop and evidence-based guideline using GRADE to safely reduce VTE and its associated complications.

  5. The impact of evidence-based sepsis guidelines on emergency department clinical practice: a pre-post medical record audit.

    Science.gov (United States)

    Romero, Bernadine; Fry, Margaret; Roche, Michael

    2017-01-10

    To explore the number of patients presenting with sepsis before and after guideline implementation; the impact of sepsis guidelines on triage assessment, emergency department management and time to antibiotics. Sepsis remains one of the leading causes of mortality and morbidity within hospitals. Globally, strategies have been implemented to reduce morbidity and mortality rates, which rely on the early recognition and management of sepsis. To improve patient outcomes, the New South Wales government in Australia introduced sepsis guidelines into emergency departments. However, the impact of the guidelines on clinical practice remains unclear. A 12-month pre-post retrospective randomised medical record audit of adult patients with a sepsis diagnosis. Data were extracted from the emergency department database and paper medical record. Data included patient demographic (age, gender), clinical information (time of arrival, triage code, seen by time, disposition, time to antibiotic, pathology, time to intravenous fluids) and patient assessment data (heart rate, respiratory rate, blood pressure, temperature, oxygen saturations, medication). This study demonstrated a statistically significant 230-minute reduction in time to antibiotics post implementation of the guidelines. The post group (n = 165) received more urgent triage categories (n = 81; 49·1%), a 758-minute reduction in mean time to second litre of intravenous fluids and an improvement in collection of lactate (n = 112, 67·9%), also statistically significant. The findings highlight the impact the guidelines can have on clinician decision-making and behaviour that support best practice and positive patient outcomes. The sepsis guidelines improved the early assessment, recognition and management of patients presenting with sepsis in one tertiary referral emergency department. The use of evidenced-based guidelines can impact clinical decision-making and behaviour, resulting in the translation and support of

  6. Royal College of Physicians Intercollegiate Stroke Working Party evidence-based guidelines for the nutritional support of patients who have had a stroke.

    Science.gov (United States)

    Gomes, F; Hookway, C; Weekes, C E

    2014-04-01

    Stroke affects 15 million people each year worldwide and is one of the world's leading causes of death and physical disability. Stroke can result in a decline in nutritional status and this is associated with increased mortality and poor outcomes. The present work aimed to systematically review key aspects of the nutritional support of stroke patients at risk of malnutrition and to provide evidence-based guidelines for use in clinical practice. The work was conducted as part of the process to develop the 4th edition of the Royal College of Physicians' (RCP) 'National Clinical Guideline (NCG) for Stroke'. Questions were generated by the search team, together with contributions from members of the Virtual Stroke Group and the RCP Intercollegiate Stroke Working Party Guideline Development Group. Six questions covering several areas of nutritional support after stroke were defined and searches were conducted through to 31 October 2011 using five electronic databases (Embase, Medline, CINAHL, Cochrane Library and Web of Science). All included studies were assessed for quality and risk of bias using the van Tulder criteria for randomised controlled trials (RCTs) and the Quorum criteria for systematic reviews. In total, 4215 abstracts were identified, 24 papers were reviewed and 13 systematic reviews and RCTs were included to provide evidence for the nutritional support components of the guidelines. For each question, evidence statements, recommendations and practical considerations were developed. This systematic review process has resulted in the development of evidence-based guidelines for use in clinical practice and has identified areas for further research. © 2013 The British Dietetic Association Ltd.

  7. EBMPracticeNet: A Bilingual National Electronic Point-Of-Care Project for Retrieval of Evidence-Based Clinical Guideline Information and Decision Support.

    Science.gov (United States)

    Van de Velde, Stijn; Vander Stichele, Robert; Fauquert, Benjamin; Geens, Siegfried; Heselmans, Annemie; Ramaekers, Dirk; Kunnamo, Ilkka; Aertgeerts, Bert

    2013-07-10

    In Belgium, the construction of a national electronic point-of-care information service, EBMPracticeNet, was initiated in 2011 to optimize quality of care by promoting evidence-based decision-making. The collaboration of the government, health care providers, evidence-based medicine (EBM) partners, and vendors of electronic health records (EHR) is unique to this project. All Belgian health care professionals get free access to an up-to-date database of validated Belgian and nearly 1000 international guidelines, incorporated in a portal that also provides EBM information from other sources than guidelines, including computerized clinical decision support that is integrated in the EHRs. The objective of this paper was to describe the development strategy, the overall content, and the management of EBMPracticeNet which may be of relevance to other health organizations creating national or regional electronic point-of-care information services. Several candidate providers of comprehensive guideline solutions were evaluated and one database was selected. Translation of the guidelines to Dutch and French was done with translation software, post-editing by translators and medical proofreading. A strategy is determined to adapt the guideline content to the Belgian context. Acceptance of the computerized clinical decision support tool has been tested and a randomized controlled trial is planned to evaluate the effect on process and patient outcomes. Currently, EBMPracticeNet is in "work in progress" state. Reference is made to the results of a pilot study and to further planned research including a randomized controlled trial. The collaboration of government, health care providers, EBM partners, and vendors of EHRs is unique. The potential value of the project is great. The link between all the EHRs from different vendors and a national database held on a single platform that is controlled by all EBM organizations in Belgium are the strengths of EBMPracticeNet.

  8. An initiative to improve adherence to evidence-based guidelines in the treatment of URIs, sinusitis, and pharyngitis

    Directory of Open Access Journals (Sweden)

    Richard Alweis

    2014-02-01

    Full Text Available Background: Upper respiratory infections, acute sinus infections, and sore throats are common symptoms that cause patients to seek medical care. Despite well-established treatment guidelines, studies indicate that antibiotics are prescribed far more frequently than appropriate, raising a multitude of clinical issues. Methods: The primary goal of this study was to increase guideline adherence rates for acute sinusitis, pharyngitis, and upper respiratory tract infections (URIs. This study was the first Plan-Do-Study-Act (PDSA cycle in a quality improvement program at an internal medicine resident faculty practice at a university-affiliated community hospital internal medicine residency program. To improve guideline adherence for respiratory infections, a package of small-scale interventions was implemented aimed at improving patient and provider education regarding viral and bacterial infections and the necessity for antibiotics. The data from this study was compared with a previously published study in this practice, which evaluated the adherence rates for the treatment guidelines before the changes, to determine effectiveness of the modifications. After the first PDSA cycle, providers were surveyed to determine barriers to adherence to antibiotic prescribing guidelines. Results: After the interventions, antibiotic guideline adherence for URI improved from a rate of 79.28 to 88.58% with a p-value of 0.004. The increase of adherence rates for sinusitis and pharyngitis were 41.7–57.58% (p=0.086 and 24.0–25.0% (p=0.918, respectively. The overall change in guideline adherence for the three conditions increased from 57.2 to 78.6% with the implementations (p<0.001. In planning for future PDSA cycles, a fishbone diagram was constructed in order to identify all perceived facets of the problem of non-adherence to the treatment guidelines for URIs, sinusitis, and pharyngitis. From the fishbone diagram and the provider survey, several potential

  9. Evidence-based guidelines for the pharmacological treatment of anxiety disorders : recommendations from the British Association for Psychopharmacology

    NARCIS (Netherlands)

    Baldwin, DS; Anderson, IM; Nutt, DJ; Bandelow, B; Bond, A; Davidson, JRT; den Boer, JA; Fineberg, NA; Knapp, M; Scott, J; Wittchen, HU

    2005-01-01

    These British Association for Psychopharmacology guidelines cover the range and aims of treatment for anxiety disorders. They are based explicitly on the available evidence and are presented as recommendations to aid clinical decision making in primary and secondary medical care. They may also serve

  10. 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…

  11. 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…

  12. 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…

  13. Evidence-based guidelines for the pharmacological treatment of anxiety disorders : recommendations from the British Association for Psychopharmacology

    NARCIS (Netherlands)

    Baldwin, DS; Anderson, IM; Nutt, DJ; Bandelow, B; Bond, A; Davidson, JRT; den Boer, JA; Fineberg, NA; Knapp, M; Scott, J; Wittchen, HU

    2005-01-01

    These British Association for Psychopharmacology guidelines cover the range and aims of treatment for anxiety disorders. They are based explicitly on the available evidence and are presented as recommendations to aid clinical decision making in primary and secondary medical care. They may also serve

  14. Cardiovascular risk management after reproductive and pregnancy-related disorders : A Dutch multidisciplinary evidence-based guideline

    NARCIS (Netherlands)

    Heida, Karst Y.; Bots, Michiel L.; De Groot, Christianne J M; Van Dunné, Frederique M.; Hammoud, Nurah M.; Hoek, Annemiek; Laven, Joop S E; Maas, Angela H E M; Roeters Van Lennep, Jeanine E.; Velthuis, Birgitta K.; Franx, Arie

    2016-01-01

    Background In the past decades evidence has accumulated that women with reproductive and pregnancy-related disorders are at increased risk of developing cardiovascular disease (CVD) in the future. Up to now there is no standardised follow-up of these women becausee guidelines on cardiovascular risk

  15. Spontaneous occlusion of the circle of Willis in children: pediatric moyamoya summary with proposed evidence-based practice guidelines. A review.

    Science.gov (United States)

    Smith, Edward R; Scott, R Michael

    2012-04-01

    Moyamoya is a progressive arteriopathy of unknown origin affecting the branches of the internal carotid artery (ICA). The arteriopathy can present as an isolated medical condition, affecting both sides of the brain ("moyamoya disease") or can be unilateral or found in association with systemic disorders ("moyamoya syndrome"). The ischemia resulting from luminal narrowing predisposes children to transient ischemic attacks and stroke-the primary presentations of affected patients. Although it is rare-affecting 1 in 1 million children in the US-moyamoya is implicated in 6% of all childhood strokes. Diagnosis is defined by characteristic findings on arteriograms, including stenosis of the branches of the ICA and a pathognomonic spray of small collateral vessels in this region, descriptively likened to a "puff of smoke" ("moyamoya" in Japanese). Treatment is predicated on restoration of cerebral blood flow by surgical revascularization. The rarity of this disorder has limited research and the development of evidence-based clinical management. While acknowledging these limitations, in this article the authors aim to summarize current studies of pediatric moyamoya, with the objective of providing a framework for construction of evidence-based guidelines for treatment. The compilation of current data in these guidelines should serve as a resource to aid pediatric neurosurgeons in their role as advocates for providing appropriate care to affected children.

  16. Evidence-based guidelines for the pharmacological treatment of schizophrenia: recommendations from the British Association for Psychopharmacology.

    Science.gov (United States)

    Barnes, Thomas R E

    2011-05-01

    These guidelines from the British Association for Psychopharmacology address the scope and targets of pharmacological treatment for schizophrenia. A consensus meeting, involving experts in schizophrenia and its treatment, reviewed key areas and considered the strength of evidence and clinical implications. The guidelines were drawn up after extensive feedback from the participants and interested parties, and cover the pharmacological management and treatment of schizophrenia across the various stages of the illness, including first-episode, relapse prevention, and illness that has proved refractory to standard treatment. The practice recommendations presented are based on the available evidence to date, and seek to clarify which interventions are of proven benefit. It is hoped that the recommendations will help to inform clinical decision making for practitioners, and perhaps also serve as a source of information for patients and carers. They are accompanied by a more detailed qualitative review of the available evidence. The strength of supporting evidence for each recommendation is rated.

  17. Evidence-Based Guideline: Treatment of Convulsive Status Epilepticus in Children and Adults: Report of the Guideline Committee of the American Epilepsy Society

    OpenAIRE

    Glauser, Tracy; Shinnar, Shlomo; Gloss, David; Alldredge, Brian; Arya, Ravindra; Bainbridge, Jacquelyn; Bare, Mary; Bleck, Thomas; Dodson, W. Edwin; Garrity, Lisa; Jagoda, Andy; Lowenstein, Daniel; Pellock, John; Riviello, James; Sloan, Edward

    2016-01-01

    CONTEXT: The optimal pharmacologic treatment for early convulsive status epilepticus is unclear. OBJECTIVE: To analyze efficacy, tolerability and safety data for anticonvulsant treatment of children and adults with convulsive status epilepticus and use this analysis to develop an evidence-based treatment algorithm. DATA SOURCES: Structured literature review using MEDLINE, Embase, Current Contents, and Cochrane library supplemented with article reference lists. STUDY SELECTION: Randomized cont...

  18. An empirical study of patient participation in guideline development: exploring the potential for articulating patient knowledge in evidence-based epistemic settings.

    Science.gov (United States)

    van de Bovenkamp, Hester M; Zuiderent-Jerak, Teun

    2015-10-01

    Patient participation on both the individual and the collective level attracts broad attention from policy makers and researchers. Participation is expected to make decision making more democratic and increase the quality of decisions, but empirical evidence for this remains wanting. To study why problems arise in participation practice and to think critically about the consequence for future participation practices. We contribute to this discussion by looking at patient participation in guideline development. Dutch guidelines (n = 62) were analysed using an extended version of the AGREE instrument. In addition, semi-structured interviews were conducted with actors involved in guideline development (n = 25). The guidelines analysed generally scored low on the item of patient participation. The interviews provided us with important information on why this is the case. Although some respondents point out the added value of participation, many report on difficulties in the participation practice. Patient experiences sit uncomfortably with the EBM structure of guideline development. Moreover, patients who develop epistemic credibility needed to participate in evidence-based guideline development lose credibility as representatives for 'true' patients. We conclude that other options may increase the quality of care for patients by paying attention to their (individual) experiences. It will mean that patients are not present at every decision-making table in health care, which may produce a more elegant version of democratic patienthood; a version that neither produces tokenistic practices of direct participation nor that denies patients the chance to contribute to matters where this may be truly meaningful. © 2013 John Wiley & Sons Ltd.

  19. Evidence-based concepts and procedures for bonded inlays and onlays. Part II. Guidelines for cavity preparation and restoration fabrication.

    Science.gov (United States)

    Rocca, Giovanni Tommaso; Rizcalla, Nicolas; Krejci, Ivo; Dietschi, Didier

    2015-01-01

    The second part of this article series presents an evidence-based update of clinical protocols and procedures for cavity preparation and restoration selection for bonded inlays and onlays. More than ever, tissue conservation dictates preparation concepts, even though some minimal dimensions still have to be considered for all restorative materials. In cases of severe bruxism or tooth fragilization, CAD/CAM composite resins or pressed CAD/CAM lithium disilicate glass ceramics are often recommended, although this choice relies mainly on scarce in vitro research as there is still a lack of medium- to long-term clinical evidence. The decision about whether or not to cover a cusp can only be made after a multifactorial analysis, which includes cavity dimensions and the resulting tooth biomechanical status, as well as occlusal and esthetic factors. The clinical impact of the modern treatment concepts that were outlined in the previous article - Dual Bonding (DB)/Immediate Dentin Sealing (IDS), Cavity Design Optimization (CDO), and Cervical Margins Relocation (CMR) - are described in detail in this article and discussed in light of existing clinical and scientific evidence for simpler, more predictable, and more durable results. Despite the wide choice of restorative materials (composite resin or ceramic) and techniques (classical or CAD/CAM), the cavity for an indirect restoration should meet five objective criteria before the impression.

  20. BAP updated guidelines: evidence-based guidelines for the pharmacological management of substance abuse, harmful use, addiction and comorbidity: recommendations from BAP.

    Science.gov (United States)

    Lingford-Hughes, A R; Welch, S; Peters, L; Nutt, D J

    2012-07-01

    The British Association for Psychopharmacology guidelines for the treatment of substance abuse, harmful use, addiction and comorbidity with psychiatric disorders primarily focus on their pharmacological management. They are based explicitly on the available evidence and presented as recommendations to aid clinical decision making for practitioners alongside a detailed review of the evidence. A consensus meeting, involving experts in the treatment of these disorders, reviewed key areas and considered the strength of the evidence and clinical implications. The guidelines were drawn up after feedback from participants. The guidelines primarily cover the pharmacological management of withdrawal, short- and long-term substitution, maintenance of abstinence and prevention of complications, where appropriate, for substance abuse or harmful use or addiction as well management in pregnancy, comorbidity with psychiatric disorders and in younger and older people.

  1. Report from AmSECT’s International Consortium for Evidence-Based Perfusion: American Society of ExtraCorporeal Technology Standards and Guidelines for Perfusion Practice: 2013

    Science.gov (United States)

    Baker, Robert A.; Bronson, Shahna L.; Dickinson, Timothy A.; Fitzgerald, David C.; Likosky, Donald S.; Mellas, Nicholas B.; Shann, Kenneth G.

    2013-01-01

    Abstract: One of the roles of a professional society is to develop standards and guidelines of practice as an instrument to guide safe and effective patient care. The American Society of Extracorporeal Technology (AmSECT) first published its Essentials for Perfusion Practice, Clinical Function: Conduct of Extracorporeal Circulation in 1993. The International Consortium for Evidence-Based Perfusion (ICEBP), a committee within AmSECT, was tasked with updating this document in 2010. The aim of this report is to describe the method of development and content of AmSECT’s new professional standards and guidelines. The ICEBP committee independently evaluated and provided input regarding the current “Essentials and Guidelines.” Structural changes were made to the entire document, and a draft document was developed, presented, and circulated to the AmSECT Board of Directors and broader membership for comment. Informed by these reviews, a revised document was then presented to the Society for a membership vote. The final document consists of 15 areas of practice covered by 50 Standards and 38 Guidelines (see Appendix 1) with the first standard focusing on the development of institutional protocols to support their implementation and use. A majority of the membership voted to accept the document (81.2% of the voting membership accepting, 18.8% rejecting). After an audit of the balloting process by AmSECT’s Ethics Committee, the results were reported to the membership and the document was officially adopted on July 24, 2013. The Standards and Guidelines will serve as a useful guide for cardiac surgical teams that wish to develop institution-specific standards and guidelines to improve the reliability, safety, and effectiveness of adult cardiopulmonary bypass. The ICEBP recognizes that the development of a Standards and Guidelines statement alone will not change care. Safe, reliable, and effective care will be best served through the development and implementation of

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

    DEFF Research Database (Denmark)

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

    2015-01-01

    Background and aims Disease-related under-nutrition is a common problem in individuals with COPD. The rationale for nutritional support in pulmonary rehabilitation therefore seems obvious. However there is limited evidence regarding the patient-relevant outcomes i.e. activities of daily living (ADL......, or meta-analyses from existing guidelines or systematic reviews were adapted. The results were used for labeling and wording of the recommendations. Results Data from 12 randomized controlled trials were included in a systematic review, which formed the basis for our recommendations as no new primary...... studies had been published. There were evidence of moderate quality that nutritional support for undernourished patients with COPD lead to a weight gain of 1.7 kg (95% confidence interval: 1.3 to 2.2 kg), but the effect was quantified as a mean change from baseline, which is less reliable. There were...

  3. Systematic review and evidence-based consensus guideline on prevention of allergy and atopic eczema of the German Network on Allergy Prevention (ABAP).

    Science.gov (United States)

    Schäfer, T; Borowski, C; Reese, I; Werfel, T; Gieler, U

    2008-06-01

    Allergies are a meaningful public-health problem. Until now no evidence-based recommendations for allergy prevention exist. An evidence based guideline for primary and secondary prevention of allergies was developed in the course of the German Network on Allergy Prevention (Aktionsbündnis Allergiepräven-tion, ABAP) with support of the German Ministry of Health. Results of the systematic evidence search and the consented recommendations are presented here. After an appropriate search strategy was developed, a systematic literature search was performed in electronic databases (Cochrane library, MEDLINE, EMBASE). Furthermore four selected journals were hand-searched and reference lists of actual reviews as well as grey literature was screened. Some 3 500 references were retrieved initially and a two-stage filter process on the relevance was applied by screening titles and abstracts and subsequently full-text papers. For the critical methodological appraisal modifications of international checklists were used. A total of 323 studies were included and evaluated. These comprised 3 Cochrane Reviews, 7 meta-analyses, 37 randomized controlled trials (RCTs) as well as 102 cohort and 174 case-control-studies. The following levels of evidence were applied: 3x1a, 21x1b, 5x2a, 59x2b, 1x3a, 45x3b, 189x4. These studies were summarized in a form of a systematic review and corresponding recommendations were formulated. The latter were consented by members of the abap steering committee in two consensus meeting where the method of a nominal group process was applied. For the first time recommendations for the prevention of allergies were developed on a high methodological standard. The content and modifications reflect the existing evidence.

  4. 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.

  5. Evidence-based pharmacological treatment of anxiety disorders, post-traumatic stress disorder and obsessive-compulsive disorder : A revision of the 2005 guidelines from the British Association for Psychopharmacology

    NARCIS (Netherlands)

    Baldwin, David S.; Anderson, Ian M.; Nutt, David J.; Allgulander, Christer; Bandelow, Borwin; den Boer, Johan A.; Christmas, David M.; Davies, Simon; Fineberg, Naomi; Lidbetter, Nicky; Malizia, Andrea; McCrone, Paul; Nabarro, Daniel; O'Neill, Catherine; Scott, Jan; van der Wee, Nic; Wittchen, Hans-Ulrich

    2014-01-01

    This revision of the 2005 British Association for Psychopharmacology guidelines for the evidence-based pharmacological treatment of anxiety disorders provides an update on key steps in diagnosis and clinical management, including recognition, acute treatment, longer-term treatment, combination treat

  6. The relative effectiveness of practice change interventions in overcoming common barriers to change: a survey of 14 hospitals with experience implementing evidence-based guidelines.

    Science.gov (United States)

    Simpson, Fiona; Doig, Gordon S

    2007-10-01

    Changing practice to reflect current best evidence can be costly and time-consuming. The purpose of this survey was to determine the optimal combination of practice change interventions needed to overcome barriers to practice change commonly encountered in the intensive care unit (ICU). A survey instrument delivered by mail with email follow-up reminders. Fourteen hospitals throughout Australia and New Zealand. Individuals responsible for implementing an evidence-based guideline for nutritional support in the ICU. Practice change interventions were ranked in order of effectiveness and barriers to change were ranked in order of how frequently they were encountered. A response rate of 100% was achieved. Interventions traditionally regarded as strong (academic detailing, active reminders) were ranked higher than those traditionally regarded as moderate (audit and feedback), or weak (posters, mouse mats). The high ranks of the site initiation visit (educational outreach, modest) and in-servicing (didactic lectures, weak) were unexpected, as was the relatively low rank of educationally influential, peer-nominated opinion leaders. Four hospitals reported the same doctor-related barrier as 'most common' and the remaining 10 hospitals reported three different doctor-related barriers, two nursing-related barriers and three organizational barriers as most common. When designing a multifaceted, multi-centre change strategy, the selection of individual practice change interventions should be based on: (1) an assessment of available resources; (2) recognition of the importance of different types of barriers to different sites; (3) the potential for combinations of interventions to have a synergistic effect on practice change, and (4) the potential for combinations of interventions to actually reduce workload.

  7. 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.

  8. A cluster randomized trial to improve adherence to evidence-based guidelines on diabetes and reduce clinical inertia in primary care physicians in Belgium: study protocol [NTR 1369

    Directory of Open Access Journals (Sweden)

    Ivanova Anna

    2008-10-01

    Full Text Available Abstract Background Most quality improvement programs in diabetes care incorporate aspects of clinician education, performance feedback, patient education, care management, and diabetes care teams to support primary care physicians. Few studies have applied all of these dimensions to address clinical inertia. Aim To evaluate interventions to improve adherence to evidence-based guidelines for diabetes and reduce clinical inertia in primary care physicians. Design Two-arm cluster randomized controlled trial. Participants Primary care physicians in Belgium. Interventions Primary care physicians will be randomly allocated to 'Usual' (UQIP or 'Advanced' (AQIP Quality Improvement Programs. Physicians in the UQIP will receive interventions addressing the main physician, patient, and office system factors that contribute to clinical inertia. Physicians in the AQIP will receive additional interventions that focus on sustainable behavior changes in patients and providers. Outcomes Primary endpoints are the proportions of patients within targets for three clinical outcomes: 1 glycosylated hemoglobin Primary and secondary analysis Statistical analyses will be performed using an intent-to-treat approach with a multilevel model. Linear and generalized linear mixed models will be used to account for the clustered nature of the data, i.e., patients clustered withinimary care physicians, and repeated assessments clustered within patients. To compare patient characteristics at baseline and between the intervention arms, the generalized estimating equations (GEE approach will be used, taking the clustered nature of the data within physicians into account. We will also use the GEE approach to test for differences in evolution of the primary and secondary endpoints for all patients, and for patients in the two interventions arms, accounting for within-patient clustering. Trial Registration number: NTR 1369.

  9. Application of the Dutch, Finnish and British Screening Guidelines in a Cohort of Children with Growth Failure

    NARCIS (Netherlands)

    Stalman, S.E.; Hellinga, I.; Dommelen, P. van; Hennekam, R.C.M.; Saari, A.; Sankilampi, U.; Dunkel, L.; Wit, J.M.; Kamp, G.A.; Plötz, F.B.

    2015-01-01

    Aims: To evaluate three guidelines for selecting short children for diagnostic workup in a general pediatric clinic. Methods: All patients (n = 131) aged 3.00-9.99 years who were referred for growth failure to a general pediatric clinic were evaluated for their medical history and growth and examine

  10. Assessing the Viability of Social Media for Disseminating Evidence-Based Nutrition Practice Guideline Through Content Analysis of Twitter Messages and Health Professional Interviews: An Observational Study

    Science.gov (United States)

    Kenne, Deric; Wolfram, Taylor M; Abram, Jenica K; Fleming, Michael

    2016-01-01

    Background Given the high penetration of social media use, social media has been proposed as a method for the dissemination of information to health professionals and patients. This study explored the potential for social media dissemination of the Academy of Nutrition and Dietetics Evidence-Based Nutrition Practice Guideline (EBNPG) for Heart Failure (HF). Objectives The objectives were to (1) describe the existing social media content on HF, including message content, source, and target audience, and (2) describe the attitude of physicians and registered dietitian nutritionists (RDNs) who care for outpatient HF patients toward the use of social media as a method to obtain information for themselves and to share this information with patients. Methods The methods were divided into 2 parts. Part 1 involved conducting a content analysis of tweets related to HF, which were downloaded from Twitonomy and assigned codes for message content (19 codes), source (9 codes), and target audience (9 codes); code frequency was described. A comparison in the popularity of tweets (those marked as favorites or retweeted) based on applied codes was made using t tests. Part 2 involved conducting phone interviews with RDNs and physicians to describe health professionals’ attitude toward the use of social media to communicate general health information and information specifically related to the HF EBNPG. Interviews were transcribed and coded; exemplar quotes representing frequent themes are presented. Results The sample included 294 original tweets with the hashtag “#heartfailure.” The most frequent message content codes were “HF awareness” (166/294, 56.5%) and “patient support” (97/294, 33.0%). The most frequent source codes were “professional, government, patient advocacy organization, or charity” (112/277, 40.4%) and “patient or family” (105/277, 37.9%). The most frequent target audience codes were “unable to identify” (111/277, 40.1%) and “other” (55

  11. Assessing the Viability of Social Media for Disseminating Evidence-Based Nutrition Practice Guideline Through Content Analysis of Twitter Messages and Health Professional Interviews: An Observational Study.

    Science.gov (United States)

    Hand, Rosa K; Kenne, Deric; Wolfram, Taylor M; Abram, Jenica K; Fleming, Michael

    2016-11-15

    Given the high penetration of social media use, social media has been proposed as a method for the dissemination of information to health professionals and patients. This study explored the potential for social media dissemination of the Academy of Nutrition and Dietetics Evidence-Based Nutrition Practice Guideline (EBNPG) for Heart Failure (HF). The objectives were to (1) describe the existing social media content on HF, including message content, source, and target audience, and (2) describe the attitude of physicians and registered dietitian nutritionists (RDNs) who care for outpatient HF patients toward the use of social media as a method to obtain information for themselves and to share this information with patients. The methods were divided into 2 parts. Part 1 involved conducting a content analysis of tweets related to HF, which were downloaded from Twitonomy and assigned codes for message content (19 codes), source (9 codes), and target audience (9 codes); code frequency was described. A comparison in the popularity of tweets (those marked as favorites or retweeted) based on applied codes was made using t tests. Part 2 involved conducting phone interviews with RDNs and physicians to describe health professionals' attitude toward the use of social media to communicate general health information and information specifically related to the HF EBNPG. Interviews were transcribed and coded; exemplar quotes representing frequent themes are presented. The sample included 294 original tweets with the hashtag "#heartfailure." The most frequent message content codes were "HF awareness" (166/294, 56.5%) and "patient support" (97/294, 33.0%). The most frequent source codes were "professional, government, patient advocacy organization, or charity" (112/277, 40.4%) and "patient or family" (105/277, 37.9%). The most frequent target audience codes were "unable to identify" (111/277, 40.1%) and "other" (55/277, 19.9%). Significant differences were found in the popularity of

  12. Evidence-based approach to the treatment of hidradenitis suppurativa/acne inversa, based on the European guidelines for hidradenitis suppurativa

    DEFF Research Database (Denmark)

    Gulliver, Wayne; Zouboulis, Christos C.; Prens, Errol

    2016-01-01

    Hidradenitis suppurativa/acne inversa (HS) is a chronic inflammatory skin disease characterized by painful, recurrent nodules and abscesses that rupture and lead to sinus tracts and scarring. To date, an evidence-based therapeutic approach has not been the standard of care and this is likely due ...

  13. Evidence-based approach to the treatment of hidradenitis suppurativa/acne inversa, based on the European guidelines for hidradenitis suppurativa

    NARCIS (Netherlands)

    W.P. Gulliver (Wayne P.); C.C. Zouboulis (Christos C.); E.P. Prens (Errol); G.B.E. Jemec (Gregor); T. Tzellos (Thrasivoulos)

    2016-01-01

    textabstractHidradenitis suppurativa/acne inversa (HS) is a chronic inflammatory skin disease characterized by painful, recurrent nodules and abscesses that rupture and lead to sinus tracts and scarring. To date, an evidence-based therapeutic approach has not been the standard of care and this is li

  14. 肾脏疾病的循证医学与个体化治疗——从指南到实践%Evidence-Based Medicine and Personalized Therapy for Kidney Diseases——from Guidelines to Practice

    Institute of Scientific and Technical Information of China (English)

    尹道馨; 刘文虎

    2012-01-01

    As a new modern medical model, evidence - based medicine ( EBM ) is of many advantages, and clinical application of EBM calls for evidence - base thinking. Over the past few years, many clinical studies and guidelines of various types of kidney diseases have been published and it is important for nephrologists to understand EMB correctly and put it into practice. When facing specific patients, nephrologists should individualize evidence - based guidelines and make joint decision for the treatment of the patients, thus promoting the development of EBM.%循证医学(EBM)作为新的现代医学模式具有很多优势,其正确运用需要正确的循证思维作基础.近年来,各类肾脏疾病的临床研究和治疗指南不断涌现.对于肾病医师来说,正确理解循证医学、运用循证思维进行科学的循证非常重要.在对肾病患者进行诊治时,临床肾病医师需将循证指南个体化应用,与患者共同决策,制定出适合患者的正确诊疗方案,同时促进循证医学不断发展.

  15. Evidence-based clinical practice update: practice guidelines for anterior cruciate ligament rehabilitation based on a systematic review and multidisciplinary consensus

    NARCIS (Netherlands)

    Melick, N. van; Cingel, R.E. van; Brooijmans, F.; Neeter, C.; Tienen, T. van; Hullegie, W.; Sanden, M.W. van der

    2016-01-01

    AIM: The Royal Dutch Society for Physical Therapy (KNGF) instructed a multidisciplinary group of Dutch anterior cruciate ligament (ACL) experts to develop an evidence statement for rehabilitation after ACL reconstruction. DESIGN: Clinical practice guideline underpinned by systematic review and exper

  16. An update of comprehensive evidence-based guidelines for interventional techniques in chronic spinal pain. Part I: introduction and general considerations.

    Science.gov (United States)

    Manchikanti, Laxmaiah; Falco, Frank J E; Singh, Vijay; Benyamin, Ramsin M; Racz, Gabor B; Helm, Standiford; Caraway, David L; Calodney, Aaron K; Snook, Lee T; Smith, Howard S; Gupta, Sanjeeva; Ward, Stephen P; Grider, Jay S; Hirsch, Joshua A

    2013-04-01

    In 2011, the Institute of Medicine (IOM) re-engineered its definition of clinical guidelines as follows: "clinical practice guidelines are statements that include recommendations intended to optimize patient care that are informed by a systematic review of evidence and an assessment of the benefit and harms of alternative care options." This new definition departs from a 2-decade old definition from a 1990 IOM report that defined guidelines as "systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances." The revised definition clearly distinguishes between the term "clinical practice guideline" and other forms of clinical guidance derived from widely disparate development processes, such as consensus statements, expert advice, and appropriate use criteria. The IOM committee acknowledged that for many clinical domains, high quality evidence was lacking or even nonexistent. Even though the guidelines are important decision-making tools, along with expert clinical judgment and patient preference, their value and impact remains variable due to numerous factors. Some of the many factors that impede the development of clinical practice guidelines include bias due to a variety of conflicts of interest, inappropriate and poor methodological quality, poor writing and ambiguous presentation, projecting a view that these are not applicable to individual patients or too restrictive with elimination of clinician autonomy, and overzealous and inappropriate recommendations, either positive, negative, or non-committal. Consequently, a knowledgeable, multidisciplinary panel of experts must develop guidelines based on a systematic review of the existing evidence, as recently recommended by the IOM. Chronic pain is a complex and multifactorial phenomenon associated with significant economic, social, and health outcomes. Interventional pain management is an emerging specialty facing a

  17. Evidence-based guidelines for the pharmacological management of attention deficit hyperactivity disorder: update on recommendations from the British Association for Psychopharmacology.

    Science.gov (United States)

    Bolea-Alamañac, Blanca; Nutt, David J; Adamou, Marios; Asherson, Phillip; Bazire, Stephen; Coghill, David; Heal, David; Müller, Ulrich; Nash, John; Santosh, Paramala; Sayal, Kapil; Sonuga-Barke, Edmund; Young, Susan J

    2014-03-01

    Attention deficit hyperactivity disorder (ADHD) is a common condition with a high societal burden. The present guidelines summarise current literature, generating expert consensus recommendations for the treatment of ADHD in children and adults. These guidelines also provide a review of recent research in the fields of neuroimaging, neuropsychology and genetics of ADHD. Novel discoveries in these areas have informed physiological models for the disease. Since the publication of the previous British Association for Psychopharmacology guidelines in 2008, new drugs have been licensed and further compounds are being investigated. The publication of randomised controlled trials of psychological interventions has contributed to the range of treatment options for ADHD. As the disorder has been diagnosed more frequently there has been greater focus on comorbid conditions and how they impact treatment. Services have continued to develop for the treatment of ADHD in adults and care agreements have been introduced to facilitate access to treatment.

  18. The importance of evidence-based supportive care practice guidelines in childhood cancer-a plea for their development and implementation.

    Science.gov (United States)

    Loeffen, E A H; Kremer, L C M; Mulder, R L; Font-Gonzalez, A; Dupuis, L L; Sung, L; Robinson, P D; van de Wetering, M D; Tissing, W J E

    2017-04-01

    As cure rates in pediatric oncology have improved substantially over the last decades, supportive care has become increasingly important to reduce morbidity and mortality and improve quality of life in children with cancer. Currently, large variations exist in pediatric oncology supportive care practice, which might negatively influence care. This plea underlines the importance of development and implementation of trustworthy supportive care clinical practice guidelines, which we believe is the essential next step towards better supportive care practice, and thus a higher quality of care. To facilitate international development and endorsement, the International Pediatric Oncology Guidelines in Supportive Care Network has been established.

  19. Guidelines on the use of therapeutic apheresis in clinical practice-evidence-based approach from the Writing Committee of the American Society for Apheresis: the sixth special issue.

    Science.gov (United States)

    Schwartz, Joseph; Winters, Jeffrey L; Padmanabhan, Anand; Balogun, Rasheed A; Delaney, Meghan; Linenberger, Michael L; Szczepiorkowski, Zbigniew M; Williams, Mark E; Wu, Yanyun; Shaz, Beth H

    2013-07-01

    The American Society for Apheresis (ASFA) JCA Special Issue Writing Committee is charged with reviewing, updating and categorizating indications for therapeutic apheresis. Beginning with the 2007 ASFA Special Issue (Fourth Edition), the committee has incorporated systematic review and evidence-based approach in the grading and categorization of indications. This Sixth Edition of the ASFA Special Issue has further improved the process of using evidence-based medicine in the recommendations by consistently applying the category and GRADE system definitions, but eliminating the "level of evidence" criteria (from the University HealthCare Consortium) utilized in prior editions given redundancy between GRADE and University HealthCare Consortium systems. The general layout and concept of a fact sheet that was utilized in the Fourth and Fifth Editions, has been largely maintained in this edition. Each fact sheet succinctly summarizes the evidence for the use of therapeutic apheresis in a specific disease entity. This article consists of 78 fact sheets (increased from 2010) for therapeutic indications in ASFA categories I through IV, with many diseases categorized having multiple clinical presentations/situations which are individually graded and categorized.

  20. Evidence-based pharmacological treatment of anxiety disorders, post-traumatic stress disorder and obsessive-compulsive disorder: a revision of the 2005 guidelines from the British Association for Psychopharmacology.

    Science.gov (United States)

    Baldwin, David S; Anderson, Ian M; Nutt, David J; Allgulander, Christer; Bandelow, Borwin; den Boer, Johan A; Christmas, David M; Davies, Simon; Fineberg, Naomi; Lidbetter, Nicky; Malizia, Andrea; McCrone, Paul; Nabarro, Daniel; O'Neill, Catherine; Scott, Jan; van der Wee, Nic; Wittchen, Hans-Ulrich

    2014-05-01

    This revision of the 2005 British Association for Psychopharmacology guidelines for the evidence-based pharmacological treatment of anxiety disorders provides an update on key steps in diagnosis and clinical management, including recognition, acute treatment, longer-term treatment, combination treatment, and further approaches for patients who have not responded to first-line interventions. A consensus meeting involving international experts in anxiety disorders reviewed the main subject areas and considered the strength of supporting evidence and its clinical implications. The guidelines are based on available evidence, were constructed after extensive feedback from participants, and are presented as recommendations to aid clinical decision-making in primary, secondary and tertiary medical care. They may also serve as a source of information for patients, their carers, and medicines management and formulary committees.

  1. Development of a theory- and evidence-based intervention to enhance implementation of physical therapy guidelines for the management of low back pain

    NARCIS (Netherlands)

    Rutten, G.M.J.; Harting, J.; Bartholomew, L.K.; Braspenning, J.C.C.; Dolder, R. van; Heijmans, M.F.; Hendriks, E.J.; Kremers, S.P.; Peppen, R.P. van; Rutten, S.T.; Schlief, A.; Vries, N.K. de; Oostendorp, R.A.B.

    2014-01-01

    BACKGROUND: Systematic planning could improve the generally moderate effectiveness of interventions to enhance adherence to clinical practice guidelines. The aim of our study was to demonstrate how the process of Intervention Mapping was used to develop an intervention to address the lack of adheren

  2. Development of a theory- and evidence-based intervention to enhance implementation of physical therapy guidelines for the management of low back pain

    NARCIS (Netherlands)

    Rutten, G.M.J.; Harting, J.; Bartholomew, L.K.; Braspenning, J.C.C.; Dolder, R. van; Heijmans, M.F.; Hendriks, E.J.; Kremers, S.P.; Peppen, R.P. van; Rutten, S.T.; Schlief, A.; Vries, N.K. de; Oostendorp, R.A.B.

    2014-01-01

    BACKGROUND: Systematic planning could improve the generally moderate effectiveness of interventions to enhance adherence to clinical practice guidelines. The aim of our study was to demonstrate how the process of Intervention Mapping was used to develop an intervention to address the lack of

  3. Study on Evidence Grading System in Evidence-based Clinical Practice Guidelines of Traditional Chinese Medicine%建立循证中医临床实践指南证据分级体系的构想

    Institute of Scientific and Technical Information of China (English)

    汪受传; 陈争光; 徐珊; 赵霞; 虞舜

    2013-01-01

    This article explained that the evidence grading system occupied an important position in the evidence-based clinical practice guidelines. Through the comparative analysis on characteristics of clinical evidences between traditional Chinese medicine (TCM) and modern medicine, different possible establishment ideas of evidence grading system in TCM evidence-based clinical practice guidelines were proposed . The design for evidence grading standard of Chinese medical literature which reflected the academic characteristics of TCM was suggested.%通过阐述证据分级体系在循证临床实践指南的重要地位,中医学和西医学临床证据特点的对比分析,评析了建立循证中医临床实践指南证据分级体系的各种设想,提出了具有本学科学术特点的中医文献证据分级标准。

  4. Guidelines on the Use of Therapeutic Apheresis in Clinical Practice-Evidence-Based Approach from the Writing Committee of the American Society for Apheresis: The Seventh Special Issue.

    Science.gov (United States)

    Schwartz, Joseph; Padmanabhan, Anand; Aqui, Nicole; Balogun, Rasheed A; Connelly-Smith, Laura; Delaney, Meghan; Dunbar, Nancy M; Witt, Volker; Wu, Yanyun; Shaz, Beth H

    2016-06-01

    The American Society for Apheresis (ASFA) Journal of Clinical Apheresis (JCA) Special Issue Writing Committee is charged with reviewing, updating, and categorizing indications for the evidence-based use of therapeutic apheresis in human disease. Since the 2007 JCA Special Issue (Fourth Edition), the Committee has incorporated systematic review and evidence-based approaches in the grading and categorization of apheresis indications. This Seventh Edition of the JCA Special Issue continues to maintain this methodology and rigor to make recommendations on the use of apheresis in a wide variety of diseases/conditions. The JCA Seventh Edition, like its predecessor, has consistently applied the category and grading system definitions in the fact sheets. The general layout and concept of a fact sheet that was used since the fourth edition has largely been maintained in this edition. Each fact sheet succinctly summarizes the evidence for the use of therapeutic apheresis in a specific disease entity. The Seventh Edition discusses 87 fact sheets (14 new fact sheets since the Sixth Edition) for therapeutic apheresis diseases and medical conditions, with 179 indications, which are separately graded and categorized within the listed fact sheets. Several diseases that are Category IV which have been described in detail in previous editions and do not have significant new evidence since the last publication are summarized in a separate table. The Seventh Edition of the JCA Special Issue serves as a key resource that guides the utilization of therapeutic apheresis in the treatment of human disease. J. Clin. Apheresis 31:149-162, 2016. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  5. Interpretation of Japan“Evidence-based Clinical Practice Guidelines for Peptic Ulcer Disease 2015”%日本《消化性溃疡循证临床实践指南(2015年)》解读

    Institute of Scientific and Technical Information of China (English)

    刘文忠

    2016-01-01

    2015年,日本胃肠病学会修订了消化性溃疡循证临床实践指南。修订的内容包括以下几项:出血性胃和十二指肠溃疡、幽门螺杆菌(Hp)根除治疗、非根除 Hp 治疗、药物诱发的溃疡、非 Hp-非非甾体消炎药(NSAID)溃疡和外科手术治疗。该指南详细陈述了上述内容,是我们临床实践中良好的参考材料。为此,本文对该指南作详细解读。%The Japanese Society of Gastroenterology revised the evidence-based clinical practice guidelines for peptic ulcer disease in 2015. The revised guidelines consist of the following items:bleeding gastric and duodenal ulcers, Helicobacter pylori(Hp)eradication therapy and non-eradication therapy,drug-induced ulcer,non-Hp/ non-nonsteroidal anti-inflammatory drug( NSAID)-induced ulcer,and surgical treatment. This guideline describes the abovementioned content in detail and is a good reference for clinical practice. A full interpretation of this guideline was performed in this paper.

  6. What do most erectile dysfunction guidelines have in common? No evidence-based discussion or recommendation of heart-healthy lifestyle changes and/or Panax ginseng

    Institute of Scientific and Technical Information of China (English)

    Mark A Moyad; Kwangsung Park

    2012-01-01

    Sexual health or erectile dysfunction (ED) state of the art guidelines provide a thorough overview of conventional prescription or other notable extrinsic treatment options.Yet,over the past 10-15 years,a plethora of international researchers have established that individual and comprehensive lifestyle changes can prevent and potentially improve ED.We review the lifestyle evidence that should equate to grade A or level 1 evidence recommendations for ED.We also review the evidence for Panax ginseng,an over-the-counter (OTC) dietary supplement with a 35-year history of laboratory investigations,multiple positive randomized trials over approximately 15 years and several independent meta-analyses and systematic reviews.Perhaps it is time to at least discuss and even emphasize lifestyle and other non-conventional interventions in ED guidelines so that patients can explore a diversity of potentially synergistic choices with their physicians and can improve their quality and quantity of life.Ignoring the consistent,positive data on lifestyle modifications in ED guidelines,for example,is tantamount to ignoring diet and lifestyle changes to reduce the risk of or ameliorate cardiovascular diseases.

  7. What do most erectile dysfunction guidelines have in common? No evidence-based discussion or recommendation of heart-healthy lifestyle changes and/or Panax ginseng

    Science.gov (United States)

    Moyad, Mark A; Park, Kwangsung

    2012-01-01

    Sexual health or erectile dysfunction (ED) state of the art guidelines provide a thorough overview of conventional prescription or other notable extrinsic treatment options. Yet, over the past 10–15 years, a plethora of international researchers have established that individual and comprehensive lifestyle changes can prevent and potentially improve ED. We review the lifestyle evidence that should equate to grade A or level 1 evidence recommendations for ED. We also review the evidence for Panax ginseng, an over-the-counter (OTC) dietary supplement with a 35-year history of laboratory investigations, multiple positive randomized trials over approximately 15 years and several independent meta-analyses and systematic reviews. Perhaps it is time to at least discuss and even emphasize lifestyle and other non-conventional interventions in ED guidelines so that patients can explore a diversity of potentially synergistic choices with their physicians and can improve their quality and quantity of life. Ignoring the consistent, positive data on lifestyle modifications in ED guidelines, for example, is tantamount to ignoring diet and lifestyle changes to reduce the risk of or ameliorate cardiovascular diseases. PMID:23001440

  8. Problems and Strategies in Developing Chinese Medicine Evidence-Based Clinical Practice Guidelines%中医循证临床实践指南制定面临的问题与应对策略

    Institute of Scientific and Technical Information of China (English)

    王波; 詹思延; 刘保延

    2011-01-01

    中医循证临床实践指南制定在个体化治疗、研究质量、报告偏倚、安全性评价等方面面临着一些问题.通过全面检索补充与替代医学领域现有的循证临床实践指南制定方法,并与目前公认标准的对抗医学循证临床实践指南制定方法进行优化组合,笔者提出了针对以上问题的应对策略:在个体化治疗方面,可考虑纳入实用性随机对照试验;在研究质量方面,提出了证据不足时形成指南建议的方法;在报告偏倚方面,列出了常用的补充与替代医学数据库;在安全性评价方面,建议采用GRADE系统.%Some problems are confronted in the development of Chinese medicine (CM) evidence-based clinical practice guidelines in the aspects of individualized treatment, quality of research, reporting bias, safety assessment, and so on. After comprehensive retrieving of current methods for developing evidence-based clinical practice guidelines in the field of complementary and alternative medicine, and an optimal combining with widely accepted standardized methods in evidence-based clinical practice guidelines for allopathic medicine, we put forward strategies for these aforesaid problems. In terms of individualized treatment, practical randomized control trials could be considered for inclusion. In terms of quality of research, the method to formulate guideline recommendations was proposed in case of insufficient evidence. In terms of reporting bias, commonly used databases in complementary and alternative medicine were listed. In terms of safety evaluation, GRADE system was suggested to adopt.

  9. Haemorrhagia post partum; an implementation study on the evidence-based guideline of the Dutch Society of Obstetrics and Gynaecology (NVOG) and the MOET (Managing Obstetric Emergencies and Trauma-course) instructions; the Fluxim study

    Science.gov (United States)

    2010-01-01

    Background One of the most important causes of maternal mortality and severe morbidity worldwide is post partum haemorrhage (PPH). Factors as substandard care are frequently reported in the international literature and there are similar reports in the Netherlands. The incidence of PPH in the Dutch population is 5% containing 10.000 women a year. The introduction of an evidence-based guideline on PPH by the Dutch society of Obstetrics and Gynaecology (NVOG) and the initiation of the MOET course (Managing Obstetrics Emergencies and Trauma) did not lead to a reduction of PPH. This implies the possibility of an incomplete implementation of both the NVOG guideline and MOET-instructions. Therefore, the aim of this study is to develop and test a tailored strategy to implement both the NVOG guideline and MOET-instructions Methods/Design One step in the development procedure is to evaluate the implementation of the guideline and MOET-instructions in the current care. Therefore measurement of the actual care will be performed in a representative sample of 20 hospitals. This will be done by prospective observation of the third stage of labour of 320 women with a high risk of PPH using quality indicators extracted from the NVOG guideline and MOET instructions. In the next step barriers and facilitators for guideline adherence will be analyzed by performance of semi structured interviews with 30 professionals and 10 patients, followed by a questionnaire study among all Dutch gynaecologists and midwives to quantify the barriers mentioned. Based on the outcomes, a tailored strategy to implement the NVOG guideline and MOET-instructions will be developed and tested in a feasibility study in 4 hospitals, including effect-, process- and cost evaluation. Discussion This study will provide insight into current Dutch practice, in particular to what extent the PPH guidelines of the NVOG and the MOET-instructions have been implemented in the actual care, and into the barriers and

  10. Haemorrhagia post partum; an implementation study on the evidence-based guideline of the Dutch Society of Obstetrics and Gynaecology (NVOG and the MOET (Managing Obstetric Emergencies and Trauma-course instructions; the Fluxim study

    Directory of Open Access Journals (Sweden)

    Grol Richard P

    2010-01-01

    Full Text Available Abstract Background One of the most important causes of maternal mortality and severe morbidity worldwide is post partum haemorrhage (PPH. Factors as substandard care are frequently reported in the international literature and there are similar reports in the Netherlands. The incidence of PPH in the Dutch population is 5% containing 10.000 women a year. The introduction of an evidence-based guideline on PPH by the Dutch society of Obstetrics and Gynaecology (NVOG and the initiation of the MOET course (Managing Obstetrics Emergencies and Trauma did not lead to a reduction of PPH. This implies the possibility of an incomplete implementation of both the NVOG guideline and MOET-instructions. Therefore, the aim of this study is to develop and test a tailored strategy to implement both the NVOG guideline and MOET-instructions Methods/Design One step in the development procedure is to evaluate the implementation of the guideline and MOET-instructions in the current care. Therefore measurement of the actual care will be performed in a representative sample of 20 hospitals. This will be done by prospective observation of the third stage of labour of 320 women with a high risk of PPH using quality indicators extracted from the NVOG guideline and MOET instructions. In the next step barriers and facilitators for guideline adherence will be analyzed by performance of semi structured interviews with 30 professionals and 10 patients, followed by a questionnaire study among all Dutch gynaecologists and midwives to quantify the barriers mentioned. Based on the outcomes, a tailored strategy to implement the NVOG guideline and MOET-instructions will be developed and tested in a feasibility study in 4 hospitals, including effect-, process- and cost evaluation. Discussion This study will provide insight into current Dutch practice, in particular to what extent the PPH guidelines of the NVOG and the MOET-instructions have been implemented in the actual care, and into

  11. Evidence-based guidelines for the informal use of computers by children to promote the development of academic, cognitive and social skills.

    Science.gov (United States)

    Tran, Phuoc; Subrahmanyam, Kaveri

    2013-01-01

    The use of computers in the home has become very common among young children. This paper reviews research on the effects of informal computer use and identifies potential pathways through which computers may impact children's development. Based on the evidence reviewed, we present the following guidelines to arrange informal computer experiences that will promote the development of children's academic, cognitive and social skills: (1) children should be encouraged to use computers for moderate amounts of time (2-3 days a week for an hour or two per day) and (2) children's use of computers should (a) include non-violent action-based computer games as well as educational games, (b) not displace social activities but should instead be arranged to provide opportunities for social engagement with peers and family members and (c) involve content with pro-social and non-violent themes. We conclude the paper with questions that must be addressed in future research. This paper reviews research on the effects of informal computer use on children's academic, cognitive and social skills. Based on the evidence presented, we have presented guidelines to enable parents, teachers and other adults to arrange informal computer experiences so as to maximise their potential benefit for children's development.

  12. Evidence-based guideline update: determining brain death in adults: report of the Quality Standards Subcommittee of the American Academy of Neurology.

    Science.gov (United States)

    Wijdicks, Eelco F M; Varelas, Panayiotis N; Gronseth, Gary S; Greer, David M

    2010-06-08

    To provide an update of the 1995 American Academy of Neurology guideline with regard to the following questions: Are there patients who fulfill the clinical criteria of brain death who recover neurologic function? What is an adequate observation period to ensure that cessation of neurologic function is permanent? Are complex motor movements that falsely suggest retained brain function sometimes observed in brain death? What is the comparative safety of techniques for determining apnea? Are there new ancillary tests that accurately identify patients with brain death? A systematic literature search was conducted and included a review of MEDLINE and EMBASE from January 1996 to May 2009. Studies were limited to adults. In adults, there are no published reports of recovery of neurologic function after a diagnosis of brain death using the criteria reviewed in the 1995 American Academy of Neurology practice parameter. Complex-spontaneous motor movements and false-positive triggering of the ventilator may occur in patients who are brain dead. There is insufficient evidence to determine the minimally acceptable observation period to ensure that neurologic functions have ceased irreversibly. Apneic oxygenation diffusion to determine apnea is safe, but there is insufficient evidence to determine the comparative safety of techniques used for apnea testing. There is insufficient evidence to determine if newer ancillary tests accurately confirm the cessation of function of the entire brain.

  13. Role of Physical Therapists in the Management of Individuals at Risk for or Diagnosed With Venous Thromboembolism: Evidence-Based Clinical Practice Guideline.

    Science.gov (United States)

    Hillegass, Ellen; Puthoff, Michael; Frese, Ethel M; Thigpen, Mary; Sobush, Dennis C; Auten, Beth

    2016-02-01

    The American Physical Therapy Association (APTA), in conjunction with the Cardiovascular & Pulmonary and Acute Care sections of APTA, have developed this clinical practice guideline to assist physical therapists in their decision-making process when treating patients at risk for venous thromboembolism (VTE) or diagnosed with a lower extremity deep vein thrombosis (LE DVT). No matter the practice setting, physical therapists work with patients who are at risk for or have a history of VTE. This document will guide physical therapist practice in the prevention of, screening for, and treatment of patients at risk for or diagnosed with LE DVT. Through a systematic review of published studies and a structured appraisal process, key action statements were written to guide the physical therapist. The evidence supporting each action was rated, and the strength of statement was determined. Clinical practice algorithms, based on the key action statements, were developed that can assist with clinical decision making. Physical therapists, along with other members of the health care team, should work to implement these key action statements to decrease the incidence of VTE, improve the diagnosis and acute management of LE DVT, and reduce the long-term complications of LE DVT.

  14. Spanish evidence-based guidelines on the treatment of psoriasis with biologic agents, 2013. Part 1: on efficacy and choice of treatment. Spanish Psoriasis Group of the Spanish Academy of Dermatology and Venereology.

    Science.gov (United States)

    Puig, L; Carrascosa, J M; Carretero, G; de la Cueva, P; Lafuente-Urrez, R F; Belinchón, I; Sánchez-Regaña, M; García-Bustínduy, M; Ribera, M; Alsina, M; Ferrándiz, C; Fonseca, E; García-Patos, V; Herrera, E; López-Estebaranz, J L; Marrón, S E; Moreno, J C; Notario, J; Rivera, R; Rodriguez-Cerdeira, C; Romero, A; Ruiz-Villaverde, R; Taberner, R; Vidal, D

    2013-10-01

    Biologic therapy is a well-established strategy for managing moderate and severe psoriasis. Nevertheless, the high cost of such therapy, the relatively short span of clinical experience with biologics, and the abundance of literature now available on these agents have made evidence-based and consensus-based clinical guidelines necessary. The ideal goal of psoriasis treatment is to achieve complete or nearly complete clearing of lesions and to maintain it over time. Failing that ideal, the goal would be to reduce involvement to localized lesions that can be controlled with topical therapy. Although current evidence allows us to directly or indirectly compare the efficacy or risk of primary or secondary failure of available biologics based on objective outcomes, clinical trial findings cannot be directly translated to routine practice. As a result, the prescribing physician must tailor the treatment regimen to the individual patient. This update of the clinical practice guidelines issued by the Spanish Academy of Dermatology and Venereology (AEDV) on biologic therapy for psoriasis incorporates information from the most recent publications on this topic.

  15. 世界各国高血压临床指南的现状分析和循证评价%Analysis on current status of clinical guidelines for hypertension in the world and evaluation on evidence-based clinical guidelines with Appraisal of Guidelines for Research and Evaluation instrument

    Institute of Scientific and Technical Information of China (English)

    唐海沁; 符赵鑫; 张勇; 丁琳; 李瑾

    2014-01-01

    Objective To assess and analyze the current status of clinical guidelines for hypertension in the world by using the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument.Methods The clinical guidelines for hypertension were identified and approved by searching China hownet,WANFANG database,PUBMED database,MEDLINE,Embase and related institutions and authorization web site from 1995 to January 2012,and relevant Web sites of agencies and organizations that produce and/or endorse guidelines.Names of the guidelines,published years and organizations,methodology of development and reference number were descriptively analyzed.AGREE instrument was used to evaluate the qualities of latest edited clinical guidelines for hypertension in countries all over the world.Results Nine guidelines were enrolled.The results showed that the hypertension guidelines scored the highest average of 88.4% for clarity of presentation and reliability field; for applicability fields,scored an average of 86.1%; the scope and goal field scored an average of 83.8%; participants field scored an average of 71.7%; editorial independence field scored an average of 64.1% ; rigor of development field scored the lowest average of 62.9%.The overall assessment showed that NICE 2011,Canada 2012,ESC 2009,Australia 2010 editions were the positively recommended guidelines,JNC7,Japan 2009,China Taiwan 2010,China 2010,South Africa 2011 editions were the recommended guidelines (still need to supplement and improve).No recommend or uncertain guide was found.Conclusions The quality of the hypertension guidelines is higher in general,but some common deficiency in the rigor of development and editorial independence in Asian and African guidelines formulated by the states still exists.There still exist certain gaps in evidence-based medical requirement.And the contents and quality are needed for further regulating and enhancing.A set of scientific systemic hypertension clinical guidelines

  16. Evidence-based Guidelines on Medication Therapy for Purulent Meningitis in Children:A Systematic Review%儿童化脓性脑膜炎药物治疗循证指南的系统评价

    Institute of Scientific and Technical Information of China (English)

    张宏亮; 李南; 黄振光; 廖乙媚; 刘滔滔

    2016-01-01

    OBJECTIVE:To systematically review the related evidence-based guidelines of purulent meningitis in children,and to provide evidence-based reference for clinical treatment. METHODS:Retrieved from PubMed,EMBase,CBM,Wanfang Data-base,CJFD and VIP,NGC,GIN,TRIP and websites of domestic and international medical associations and industry bodies,the treatment guidelines about purulent meningitis in children were collected. Evidence-based evaluation was performed after data extrac-tion and quality evaluation. RESULTS:Finally 3 guidelines were enrolled in total,with development time ranging from 2004 to 2012,from USA,Britain and Australia,respectively. All of the recommendations were level B,"scope and purpose" and "clarity"showed the higher scores in AGREEⅡ,more than 70%,and "applicability" showed generally low scores. Penicillin and cefotaxi-me were recommended in purulent meningitis of neonates,and vancomycin combined with cefotaxime or ceftriaxone were recom-mended for infants and children(it was combined with vancomycin when Streptococcus pneumoniae infection was suspected). The dose and duration of each guideline were certain different,and the period of treatment should be longer in neonates. In addition, the glucocorticoid was recommended in all guidelines. CONCLUSIONS:The recommendations of medicines for the treatment of pu-rulent meningitis are basically unanimous,with no regional difference,but there are some differences about dose and the course of treatment. In addition,the classification criteria of the levels of evidence and recommendation are still suboptimal,which needs fur-ther improvement. And guidelines on purulent meningitis should be improved in"rigour"and"applicability"in future.%目的:系统评价儿童化脓性脑膜炎药物治疗的相关循证指南,为临床治疗提供循证参考。方法:计算机检索PubMed、EMBase、中国生物医学文献数据库、万方数据库、中文科技期刊数据库、中国期刊全文数据库、

  17. Meta-analysis provides evidence-based interpretation guidelines for the clinical significance of mean differences for the FACT-G, a cancer-specific quality of life questionnaire

    Directory of Open Access Journals (Sweden)

    Madeleine T King

    2010-09-01

    Full Text Available Madeleine T King1, David Cella2, David Osoba3, Martin Stockler4, David Eton5, Joanna Thompson6, Amy Eisenstein71Psycho-oncology Co-operative Research Group School of Psychology, University of Sydney, New South Wales, Australia; 2Department of Medical Social Sciences, Northwestern University, Illinois, USA; 3QOL Consulting, Vancouver, British Columbia, Canada; 4NHMRC Clinical Trials Centre, University of Sydney, New South Wales, Australia; 5Mayo Clinic, Rochester, Minnesota, USA; 6Centre for Health Economics Research and Evaluation, University of Technology, Sydney, New South Wales, Australia; 7Center on Outcomes Research and Education (CORE, Evanston Northwestern Healthcare (ENH, Evanston, Illinois, USAAbstract: Our aim was to develop evidence-based interpretation guidelines for the Functional Assessment of Cancer Therapy-General (FACT-G, a cancer-specific health-related quality of life (HRQOL instrument, from a range of clinically relevant anchors, incorporating expert judgment about clinical significance. Three clinicians with many years’ experience managing cancer patients and using HRQOL outcomes in clinical research reviewed 71 papers. Blinded to the FACT-G results, they considered the clinical anchors associated with each FACT-G mean difference, predicted which dimensions of HRQOL would be affected, and whether the effects would be trivial, small, moderate, or large. These size classes were defined in terms of clinical relevance. The experts’ judgments were then linked with FACT-G mean differences, and inverse-variance weighted mean differences were calculated for each size class. Small, medium, and large differences (95% confidence interval from 1,118 cross-sectional comparisons were as follows: physical well-being 1.9 (0.6–3.2, 4.1 (2.7–5.5, 8.7 (5.2–12; functional well-being 2.0 (0.5–3.5, 3.8 (2.0–5.5, 8.8 (4.3–13; emotional well-being 1.0 (0.1–2.6, 1.9 (0.3–3.5, no large differences; social well-being 0.7 (-0.7 to 2

  18. Exploration of knowledge of, adherence to, attitude and barriers toward evidence-based guidelines (EBGs for prevention of ventilator-associated pneumonia (VAP in healthcare workers of pediatric cardiac intensive care units (PCICUs: A Quali-Quantitative survey

    Directory of Open Access Journals (Sweden)

    Leila Jahansefat

    2016-09-01

    Full Text Available Implementation of evidence-based guidelines (EBGs is an effective measure for prevention of ventilator-associated pneumonia (VAP. Appropriate knowledge, attitude and adherence of healthcare workers (HCWs to EBGs are necessary factors for implementation of EBGs. This study was conducted with objective of evaluation of knowledge, attitude, and adherence of HCWs to EBGs for prevention of VAP and exploration of the barriers of their implementation in clinical practice. Totally, a total number of 45 HCWs of two pediatric cardiac surgery ICU (PCICUs participated in this quali-quantitative survey. Knowledge, attitude and adherence of participants was evaluated by a validated multiple-choice questionnaire and barriers of implementation of EBGs was extracted from participants’ answer to an open-ended question of our self-made questionnaire. Knowledge of HCWs was poor and significantly different between nurse assistants (RAs, nurses (RNs, and physicians (MDs (respectively, 1.25±0.95, 4.53±1.73, and 5.54±2.01, P=0.001. Likewise, attit ude of HCWs is not positive and significantly different between NAs, RNs, and MDs (respectively, 32.96±2.42, 34.00±2.44, 36.81±4.35, P=0.003. The adherence of HCWs is not good and different between RAs, RNs, and MDs (respectively, 11.50±1.00, 13.13±1.83, and 17.18±6.06, P= 0.17. The Barriers of implementation of EBGs was categorized into four category of individual, organizational, social, and educational factors. Unsatisfying status of knowledge, attitude, and adherence of HCWs is a challenging concern of health-care system, especially in PICUs. In addition to these well-known factors, poor implementation of EBGs is related to many other barriers which should recognized and taken into consideration for designation of infection controlling programs.

  19. Evidence-Based Dentistry: What's New?

    Directory of Open Access Journals (Sweden)

    A. Ballini, S. Capodiferro, M. Toia, S. Cantore, G. Favia, G. De Frenza, F.R. Grassi

    2007-01-01

    Full Text Available The importance of evidence for every branch of medicine in teaching in order to orient the practitioners among the great amount of most actual scientific information's, and to support clinical decisions, is well established in health care, including dentistry. The practice of evidence-based medicine is a process of lifelong, self-directed, problem-based learning which leads to the need for clinically important information about diagnosis, prognosis, therapy and other clinical and health care issues. Nowadays the practice of dentistry is becoming more complex and challenging because of the continually changing in dental materials and equipments, an increasingly litigious society, an increase in the emphasis of continuing professional development, the information explosion and the consumer movement associated with advances on the Internet. The need for reliable information and the electronic revolution have come together to allow the “paradigm shift” towards evidence-based health care. Recent years have seen an increase in the importance of evidence-based dentistry, aiming to reduce to the maximum the gap between clinical research and real world dental practice. Aim of evidence-based practice is the systematic literature review, which synthesizes the best evidences and provides the basis for clinical practice guidelines. These practice guidelines give a brief review of what evidence-based dentistry is and how to use it.

  20. Evidence-based dentistry: what's new?

    Science.gov (United States)

    Ballini, A; Capodiferro, S; Toia, M; Cantore, S; Favia, G; De Frenza, G; Grassi, F R

    2007-06-06

    The importance of evidence for every branch of medicine in teaching in order to orient the practitioners among the great amount of most actual scientific information's, and to support clinical decisions, is well established in health care, including dentistry. The practice of evidence-based medicine is a process of lifelong, self-directed, problem-based learning which leads to the need for clinically important information about diagnosis, prognosis, therapy and other clinical and health care issues. Nowadays the practice of dentistry is becoming more complex and challenging because of the continually changing in dental materials and equipments, an increasingly litigious society, an increase in the emphasis of continuing professional development, the information explosion and the consumer movement associated with advances on the Internet. The need for reliable information and the electronic revolution have come together to allow the "paradigm shift" towards evidence-based health care. Recent years have seen an increase in the importance of evidence-based dentistry, aiming to reduce to the maximum the gap between clinical research and real world dental practice. Aim of evidence-based practice is the systematic literature review, which synthesizes the best evidences and provides the basis for clinical practice guidelines. These practice guidelines give a brief review of what evidence-based dentistry is and how to use it.

  1. 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...... meeting customer needs. We are suggesting that the effects of the use of a system should play a prominent role in the contractual definition of IT projects and that contract fulfilment should be determined on the basis of evidence of these effects. Based on two ongoing studies of home-care management...

  2. The long-term treatment of restless legs syndrome/Willis-Ekbom disease: evidence-based guidelines and clinical consensus best practice guidance: a report from the International Restless Legs Syndrome Study Group.

    Science.gov (United States)

    Garcia-Borreguero, Diego; Kohnen, Ralf; Silber, Michael H; Winkelman, John W; Earley, Christopher J; Högl, Birgit; Manconi, Mauro; Montplaisir, Jacques; Inoue, Yuichi; Allen, Richard P

    2013-07-01

    A Task Force was established by the International Restless Legs Syndrome Study Group (IRLSSG) to develop evidence-based and consensus-based recommendations for the long-term pharmacologic treatment of restless legs syndrome/Willis-Ekbom disease (RLS/WED). The Task Force reviewed the results of all studies of RLS/WED treatments with durations of 6 months or longer presented at meetings over the past 2 years, posted on Web sites of pharmaceutical companies, or published in peer-reviewed journals, asking the questions, "What is the efficacy of this treatment in patients with RLS/WED?" and "What is the safety of this treatment in patients with RLS/WED?" The Task Force developed guidelines based on their review of 61 papers meeting inclusion criteria, and using a modified evidence-grading scheme. Pregabalin has been established as effective for up to 1 year in treating RLS/WED (Level A evidence). Pramipexole, ropinirole, and rotigotine have been established as effective for up to 6 months in treating RLS/WED (Level A). The following drugs have been established as probably effective (Level B) in treating RLS/WED for durations ranging from 1 to 5 years: gabapentin enacarbil, pramipexole, and ropinirole (1 year); levodopa (2 years); and rotigotine (5 years). Because of associated safety concerns, pergolide and cabergoline should not be used in the treatment of RLS/WED unless the benefits clearly outweigh the risks. Other pharmacologic therapies have insufficient evidence to support their long-term use in treating RLS/WED. The IRLSSG Task Force also developed consensus-based strategies for the prevention and treatment of complications (such as augmentation, loss of efficacy, excessive daytime sleepiness, and impulse control disorders) that may develop with the long-term pharmacologic treatment of RLS/WED. The use of either a dopamine-receptor agonist or α2δ calcium-channel ligand is recommended as the first-line treatment of RLS/WED for most patients, with the choice of

  3. Implementing evidence-based practices in an emergency department

    DEFF Research Database (Denmark)

    Kirk, Jeanette W.; Nilsen, Per

    2016-01-01

    and screening routines provided a flow stop. Four associated contradictions were identified: insufficient time to implement guidelines; guilty conscience due to perceived nonadherence to evidence-based practices; newcomers having different priorities; and conflicting views of what constituted being...

  4. Why be an evidence-based dentistry champion?

    Science.gov (United States)

    Clarkson, Jan E; Bonetti, Debbie

    2009-09-01

    Evidence-based dentistry champions are committed to improving the quality, effectiveness, and appropriateness of dental care through the application of evidence-based principles and tools. They share knowledge and skills to promote evidence-based dentistry (EBD) in practice, guiding colleagues, patients and policy makers in the application of critical thinking skills and evidence-based decision-making. Being an evidence-based champion requires furthering an understanding of the full process and the challenges of evidence based dentistry, including the development of an evidence base, evidence synthesis and summary, the creation of best practice guidelines, as well as evidence implementation. Efforts to improve the quality, effectiveness, and appropriateness of dental care need to occur at, and be coordinated across, multiple levels of dentistry, including the patient, clinician, team, organization, and policy.

  5. Evidence-Based Radiology (EBR

    Directory of Open Access Journals (Sweden)

    Mansoor Fatehi

    2009-01-01

    Full Text Available   "nRecent increase in scientific advancements has led to inability to cover many scientific data and remain “up-to-date”. Nowadays doubling time of scientific data production is remarkably reduced, so that there is no adequate time to find this information and it seems inevitable to use resources which periodically assess most published papers or web-based data in that particular field to finally provide evidence-based knowledge, namely “Evidence-Based Medicine (EBM” in medical sciences. EBM is the systematic, scientific and explicit use of current best evidence in making decisions about the care of individual patients. Medical practice is largely based on clinical anecdotes, uncontrolled investigations and expert opinion. In radiology, the situation is especially problematic. "nRadiologists require to be able to evaluate studies in the literature, i.e., how reliable is this information and does it apply to patients in the radiologist’s practice? "nWe may find that our textbooks are out of date, guidelines are non-specific and there are conflicting "nor unreliable reports in the literature. Expert opinions vary from centre to centre. "nWhen we go to the literature ourselves, the first problem we encounter is the volume of literature being published and the next (at least for most of us is lack of training in how to separate good studies from weak ones. Evidence-based radiology (EBR can be a solution. "nThere are 5 steps in applying an approach as a solution: "n1. Ask - Information needs relevant to individual patients are converted into ‘answerable’ or ‘focused’ questions. "n2. Search - A comprehensive literature search is performed to find the best evidence to help answer these questions. "n3. Appraise - The evidence must then be critically appraised, in an explicit and structured manner, in order to establish its validity, reliability and usefulness in practice. "n4. Apply - The results of this critical appraisal are then

  6. Finnish bioenergy research programme

    Energy Technology Data Exchange (ETDEWEB)

    Asplund, D. [VTT Energy, Jyvaeskylae (Finland)

    1996-12-31

    Finland is a leading country in the use of biofuels and has excellent opportunities to increase the use of biofuels by up to 25-30 %. The Finnish Government has set an objective for the promotion of bioenergy. The aim is to increase the use of bioenergy by about 25 % from the present level by 2005, and the increment corresponds to 1.5 million tonnes of oil equivalent (toe) per year. The R and D work has been considered as an important factor to achieve this ambitious goal. Energy research was organised into a series of research programmes in 1988 in accordance with the proposal of Finnish Energy Research Committee. The object of the research programmes is to enhance research activities and to bundle individual projects together into larger research packages. The common target of the Finnish energy research programmes is to proceed from basic and applied research to product development and pilot operation, and after that to the first commercial applications, e.g. demonstrations. As the organisation of energy research to programmes has led to good results, the Finnish Ministry of Trade and Industry decided to go on with this practice by launching new six-year programmes in 1993-1998. One of these programmes is the Bioenergy Research Programme and the co-ordination of this programme is carried out by VTT Energy. Besides VTT Energy the Finnish Forest Research Institute, Work Efficiency Institute, Metsaeteho and University of Joensuu are participating in the programme 7 refs.

  7. Evidence-based management.

    Science.gov (United States)

    Pfeffer, Jeffrey; Sutton, Robert I

    2006-01-01

    For the most part, managers looking to cure their organizational ills rely on obsolete knowledge they picked up in school, long-standing but never proven traditions, patterns gleaned from experience, methods they happen to be skilled in applying, and information from vendors. They could learn a thing or two from practitioners of evidence-based medicine, a movement that has taken the medical establishment by storm over the past decade. A growing number of physicians are eschewing the usual, flawed resources and are instead identifying, disseminating, and applying research that is soundly conducted and clinically relevant. It's time for managers to do the same. The challenge is, quite simply, to ground decisions in the latest and best knowledge of what actually works. In some ways, that's more difficult to do in business than in medicine. The evidence is weaker in business; almost anyone can (and many people do) claim to be a management expert; and a motley crew of sources--Shakespeare, Billy Graham,Jack Welch, Attila the Hunare used to generate management advice. Still, it makes sense that when managers act on better logic and strong evidence, their companies will beat the competition. Like medicine, management is learned through practice and experience. Yet managers (like doctors) can practice their craft more effectively if they relentlessly seek new knowledge and insight, from both inside and outside their companies, so they can keep updating their assumptions, skills, and knowledge.

  8. Evidence-based dentistry.

    Science.gov (United States)

    Chambers, David W

    2010-01-01

    Both panegyric and criticism of evidence-based dentistry tend to be clumsy because the concept is poorly defined. This analysis identifies several contributions to the profession that have been made under the EBD banner. Although the concept of clinicians integrating clinical epidemiology, the wisdom of their practices, and patients' values is powerful, its implementation has been distorted by a too heavy emphasis of computerized searches for research findings that meet the standards of academics. Although EBD advocates enjoy sharing anecdotal accounts of mistakes others have made, faulting others is not proof that one's own position is correct. There is no systematic, high-quality evidence that EBD is effective. The metaphor of a three-legged stool (evidence, experience, values, and integration) is used as an organizing principle. "Best evidence" has become a preoccupation among EBD enthusiasts. That overlong but thinly developed leg of the stool is critiqued from the perspectives of the criteria for evidence, the difference between internal and external validity, the relationship between evidence and decision making, the ambiguous meaning of "best," and the role of reasonable doubt. The strongest leg of the stool is clinical experience. Although bias exists in all observations (including searches for evidence), there are simple procedures that can be employed in practice to increase useful and objective evidence there, and there are dangers in delegating policy regarding allowable treatments to external groups. Patient and practitioner values are the shortest leg of the stool. As they are so little recognized, their integration in EBD is problematic and ethical tensions exist where paternalism privileges science over patient's self-determined best interests. Four potential approaches to integration are suggested, recognizing that there is virtually no literature on how the "seat" of the three-legged stool works or should work. It is likely that most dentists

  9. Evidence-based management of ANCA vasculitis.

    Science.gov (United States)

    Carruthers, David; Sherlock, Jonathan

    2009-06-01

    The vasculitides associated with antineutrophil cytoplasmic antibodies (ANCAs) present to and are managed by a wide spectrum of physicians, reflecting the multi-organ nature of the conditions. Treatment strategies for these primary inflammatory vascular diseases have varied based on the outcomes of different clinical trials and practice reviews. The individual drugs used and their route of administration, dose, and duration of therapy have varied and have been the source of much debate. Advances in our understanding of disease immunopathogenesis, clinical assessment and outcome have formed the basis for several recent good-quality clinical trials. Now, with the results of these large-scale multicentre collaborative studies, there is a firmer evidence base to guide management decisions for individual patients. This evidence base, reviewed here, has led to the publication of treatment guidelines which importantly encompass many of the broader aspects of disease management.

  10. Time for evidence-based cytology

    Directory of Open Access Journals (Sweden)

    Dey Pranab

    2007-01-01

    Full Text Available Abstract Evidence-based medicine (EBM is a fashionable and an extremely hot topic for clinicians, patients and the health service planners. Evidence-based cytology (EBC is an offshoot of EBM. The EBC is concerned with generating a reproducible, high quality and clinically relevant test result in the field of cytology. This is a rapidly evolving area with high practical importance. EBC is based entirely on research data. The various professional bodies on cytology design and recommend guidelines on the basis of evidences. Once the guideline is implemented and practiced then the experiences of the practicing cytopathologists may be used as a feed back to alter the existing guideline. The various facets of EBC are sampling and specimen adequacy, morphological identification and computer based expert system, integrated reporting, identification of the controversial areas and high quality researches for evidences. It is the duty of the individuals and institutions to practice EBC for better diagnosis and management of the patients. In this present paper, the various aspects of EBC have been discussed.

  11. Evidence-Based Laboratory Medicine

    Institute of Scientific and Technical Information of China (English)

    Christopher P Price

    2004-01-01

    @@ Whilst there have been several definitions of Evidence-Based Medicine (EBM), the one given by David Sackett is probably the most accurate and well accepted; he stated that "evidence-based medicine is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients"[1].

  12. Sepsis management: An evidence-based approach.

    Science.gov (United States)

    Baig, Muhammad Akbar; Shahzad, Hira; Jamil, Bushra; Hussain, Erfan

    2016-03-01

    The Surviving Sepsis Campaign (SSC) guidelines have outlined an early goal directed therapy (EGDT) which demonstrates a standardized approach to ensure prompt and effective management of sepsis. Having said that, there are barriers associated with the application of evidence-based practice, which often lead to an overall poorer adherence to guidelines. Considering the global burden of disease, data from low- to middle-income countries is scarce. Asia is the largest continent but most Asian countries do not have a well-developed healthcare system and compliance rates to resuscitation and management bundles are as low as 7.6% and 3.5%, respectively. Intensive care units are not adequately equipped and financial concerns limit implementation of expensive treatment strategies. Healthcare policy-makers should be notified in order to alleviate financial restrictions and ensure delivery of standard care to septic patients.

  13. Interverntion, evidence-based research and everyday life

    DEFF Research Database (Denmark)

    Dreier, Ole

    2011-01-01

    for evidence-based research and practice, I argue that, while psychological interventions are primarily meant to work in people’s everyday lives, how interventions do so is barely addressed and poorly captured. Evidence-based research, as currently conceived, is an obstacle to overcome this shortcoming...... in clients’ everyday lives and point out consequences for reconceptualizing psychological intervention.......Intervention is a key concept in the technology of psychology and it plays a decisive role in evidence-based research. But analyses of this concept are remarkably sparse. Based on a critical analysis of the conception of intervention in the American Psychological Association’s guidelines...

  14. 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.

  15. Summary of Canadian Guidelines for the Initial Management of Community-Acquired Pneumonia: An Evidence-Based Update by the Canadian Infectious Disease Society and the Canadian Thoracic Society

    Directory of Open Access Journals (Sweden)

    Lionel A Mandell

    2000-01-01

    Full Text Available Community-acquired pneumonia (CAP is a serious illness with a significant impact on individual patients and society as a whole. Over the past several years, there have been significant advances in the knowledge and understanding of the etiology of the disease, and an appreciation of problems such as mixed infections and increasing antimicrobial resistance. The development of additional fluoroquinolone agents with enhanced activity against Streptococcus pneumoniae has been important as well. It was decided that the time had come to update and modify the previous CAP guidelines, which were published in 1993. The current guidelines represent a joint effort by the Canadian Infectious Diseases Society and the Canadian Thoracic Society, and they address the etiology, diagnosis and initial management of CAP. The diagnostic section is based on the site of care, and the treatment section is organized according to whether one is dealing with outpatients, inpatients or nursing home patients.

  16. Summary of Canadian Guidelines for the Initial Management of Community-Acquired Pneumonia: An Evidence-Based Update by the Canadian Infectious Diseases Society and the Canadian Thoracic Society

    Directory of Open Access Journals (Sweden)

    Lionel A Mandell

    2000-01-01

    Full Text Available Community-acquired pneumonia (CAP is a serious illness with a significant impact on individual patients and society as a whole. Over the past several years, there have been significant advances in our knowledge and understanding of the etiology of the disease, and an appreciation of problems such as mixed infections and increasing antimicrobial resistance. The development of additional fluoroquinolone agents with enhanced activity against Streptococcus pneumoniae has been important as well. It was decided that the time had come to update and modify the previous CAP guidelines, which were published in 1993. The current guidelines represent a joint effort by the Canadian Infectious Disease Society and the Canadian Thoracic Society, and they address the etiology, diagnosis and initial management of CAP. The diagnostic section is based on the site of care, and the treatment section is organized according to whether one is dealing with outpatients, inpatients or nursing home patients.

  17. The Treatment of Restless Legs Syndrome and Periodic Limb Movement Disorder in Adults—An Update for 2012: Practice Parameters with an Evidence-Based Systematic Review and Meta-Analyses: An American Academy of Sleep Medicine Clinical Practice Guideline

    OpenAIRE

    Aurora, R. Nisha; Kristo, David A.; Bista, Sabin R.; Rowley, James A.; Zak, Rochelle S.; Casey, Kenneth R.; Lamm, Carin I.; Tracy, Sharon L.; Rosenberg, Richard S.

    2012-01-01

    A systematic literature review and meta-analyses (where appropriate) were performed to update the previous AASM practice parameters on the treatments, both dopaminergic and other, of RLS and PLMD. A considerable amount of literature has been published since these previous reviews were performed, necessitating an update of the corresponding practice parameters. Therapies with a STANDARD level of recommendation include pramipexole and ropinirole. Therapies with a GUIDELINE level of recommendati...

  18. Evidence based psychosocial interventions in substance use

    Directory of Open Access Journals (Sweden)

    Sonali Jhanjee

    2014-01-01

    Full Text Available In recent years, there has been significant progress and expansion in the development of evidence-based psychosocial treatments for substance abuse and dependence. A literature review was undertaken using the several electronic databases (PubMed, Cochrane Database of systemic reviews and specific journals, which pertain to psychosocial issues in addictive disorders and guidelines on this topic. Overall psychosocial interventions have been found to be effective. Some interventions, such as cognitive behavior therapy, motivational interviewing and relapse prevention, appear to be effective across many drugs of abuse. Psychological treatment is more effective when prescribed with substitute prescribing than when medication or psychological treatment is used alone, particularly for opiate users. The evidence base for psychological treatment needs to be expanded and should also include research on optimal combinations of psychological therapies and any particular matching effects, if any. Psychological interventions are an essential part of the treatment regimen and efforts should be made to integrate evidence-based interventions in all substance use disorder treatment programs.

  19. Evidence-Based Cancer Imaging

    Science.gov (United States)

    Khorasani, Ramin

    2017-01-01

    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.

  20. Difficulties and Solutions in Compilation of Evidence-based Guidelines of Clinical Practice with Acupuncture and Moxibustion in the Treat-ment of Primary Trigeminal Neuralgia%《循证针灸临床实践指南(原发性三叉神经痛)》编制难点与对策

    Institute of Scientific and Technical Information of China (English)

    陈勤; 周传龙; 方剑乔

    2016-01-01

    [目的]总结《循证针灸临床实践指南(原发性三叉神经痛)》编制中的关键点、难点,介绍指南推荐意见产生的背景及依据,并为中医药循证临床实践指南的制定和解读提供参考。[方法]运用循证医学理念及方法,对针灸治疗原发性三叉神经痛的诊疗方案研究进行回顾性分析。充分探究2010~2015年编写原发性三叉神经痛针灸临床实践指南过程中遇到的难点,选择本指南制定过程中具有代表性的4个关键问题和难点,包括如何产生指南临床问题、指南目标人群的选择、文献检索策略的制定、文献评价及推荐标准的选择进行对策探讨。[结果]针灸治疗原发性三叉神经痛临床研究证据质量较低,现代研究证据难以回答指南中的全部问题、全面反映针灸治疗三叉神经痛的临床特色,中医药指南制定过程中有多个难点需要解决。中医药指南制定的过程不仅参考了现有循证医学指南制定方法,还选择了能够反映中医药特色的评价方法。在对文献进行循证评价的基础上,选择问卷调查、小组讨论、专家共识等方法为指南推荐意见的产生提供依据。[结论]中医药循证临床实践指南的制定需与中医药疗法自身具备的特点相符,目前循证针灸临床实践指南的制定方法还待进一步完善,针灸临床研究证据的论证强度还待进一步加强。%Objective] In order to promote the application of acupuncture in the treatment of primary trigeminal neuralgia, improving the proportion of doctors in standardized application of acupuncture and moxibustion therapy. The author summarized the difficulties and solutions in compilation of the guideline,"Evidence-based Guidelines of Clinical Practice in Acupuncture and Moxibustion" of trigeminal neuralgia; And introduce the background and basis for the recommendations of guideline. Further more,to provide new

  1. [Evidence-based recommendations on diagnostics and therapy of axial spondyloarthritis : S3 guidelines of the German Society of Rheumatology (DGRh) in cooperation with the Association of the Scientific Medical Societies in Germany (AWMF)].

    Science.gov (United States)

    Kiltz, U; Rudwaleit, M; Sieper, J; Braun, J

    2017-03-01

    The clinical course of axial spondyloarthritis (SpA) is variable and characterized by chronic back pain and extraspinal manifestations, such as asymmetrical arthritis, dactylitis and enthesitis. Extra-articular manifestations in the eyes (anterior uveitis), skin (psoriasis) and intestines (chronic inflammatory bowel disease) are also frequent manifestations in patients with SpA. Due to the heterogeneity of disease manifestations and the partial concentration on structural alterations in the sacroiliac joints visible in X‑ray images, the diagnosis is often delayed for many years. An important step in the direction of improved early recognition of axial SpA was establishment of the Assessment of SpondyloArthritis International Society (ASAS) classification criteria published in 2009, which focused on the initally deep-seated back pain and chronicity in relatively young patients as well as the importance of magnetic resonance imaging and HLA B 27 determination in the early stages of the disease. In order to achieve the foundations for an effective and timely therapy of affected patients, in 2014 on the initiative of the German Society of Rheumatology, S3 guidelines on axial SpA including Bechterew's disease and early forms were formulated in cooperation with other specialist societies. This article gives an overview of the contents of the S3 guidelines on axial SpA.

  2. Evidence-based guidelines for the management of large hemispheric infarction : a statement for health care professionals from the Neurocritical Care Society and the German Society for Neuro-intensive Care and Emergency Medicine.

    Science.gov (United States)

    Torbey, Michel T; Bösel, Julian; Rhoney, Denise H; Rincon, Fred; Staykov, Dimitre; Amar, Arun P; Varelas, Panayiotis N; Jüttler, Eric; Olson, DaiWai; Huttner, Hagen B; Zweckberger, Klaus; Sheth, Kevin N; Dohmen, Christian; Brambrink, Ansgar M; Mayer, Stephan A; Zaidat, Osama O; Hacke, Werner; Schwab, Stefan

    2015-02-01

    Large hemispheric infarction (LHI), also known as malignant middle cerebral infarction, is a devastating disease associated with significant disability and mortality. Clinicians and family members are often faced with a paucity of high quality clinical data as they attempt to determine the most appropriate course of treatment for patients with LHI, and current stroke guidelines do not provide a detailed approach regarding the day-to-day management of these complicated patients. To address this need, the Neurocritical Care Society organized an international multidisciplinary consensus conference on the critical care management of LHI. Experts from neurocritical care, neurosurgery, neurology, interventional neuroradiology, and neuroanesthesiology from Europe and North America were recruited based on their publications and expertise. The panel devised a series of clinical questions related to LHI, and assessed the quality of data related to these questions using the Grading of Recommendation Assessment, Development and Evaluation guideline system. They then developed recommendations (denoted as strong or weak) based on the quality of the evidence, as well as the balance of benefits and harms of the studied interventions, the values and preferences of patients, and resource considerations.

  3. Finnish care integrated?

    Directory of Open Access Journals (Sweden)

    Jouni Niskanen

    2002-06-01

    Full Text Available The public Finnish social and health care system has been challenged by the economic crisis, administrative reforms and increased demands. Better integration as a solution includes many examples, which have been taken to use. The most important are the rewritten national and municipals strategies and quality recommendations, where the different sectors and the levels of care are seen as one entity. Many reorganisations have taken place, both nationally and locally, and welfare clusters have been established. The best examples of integrated care are the forms of teamwork, care management, emphasis on non-institutional care and the information technology.

  4. Methods for staging non-small cell lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines.

    Science.gov (United States)

    Silvestri, Gerard A; Gonzalez, Anne V; Jantz, Michael A; Margolis, Mitchell L; Gould, Michael K; Tanoue, Lynn T; Harris, Loren J; Detterbeck, Frank C

    2013-05-01

    Correctly staging lung cancer is important because the treatment options and prognosis differ significantly by stage. Several noninvasive imaging studies and invasive tests are available. Understanding the accuracy, advantages, and disadvantages of the available methods for staging non-small cell lung cancer is critical to decision-making. Test accuracies for the available staging studies were updated from the second iteration of the American College of Chest Physicians Lung Cancer Guidelines. Systematic searches of the MEDLINE database were performed up to June 2012 with the inclusion of selected meta-analyses, practice guidelines, and reviews. Study designs and results are summarized in evidence tables. The sensitivity and specificity of CT scanning for identifying mediastinal lymph node metastasis were approximately 55% and 81%, respectively, confirming that CT scanning has limited ability either to rule in or exclude mediastinal metastasis. For PET scanning, estimates of sensitivity and specificity for identifying mediastinal metastasis were approximately 77% and 86%, respectively. These findings demonstrate that PET scanning is more accurate than CT scanning, but tissue biopsy is still required to confirm PET scan findings. The needle techniques endobronchial ultrasound-needle aspiration, endoscopic ultrasound-needle aspiration, and combined endobronchial ultrasound/endoscopic ultrasound-needle aspiration have sensitivities of approximately 89%, 89%, and 91%, respectively. In direct comparison with surgical staging, needle techniques have emerged as the best first diagnostic tools to obtain tissue. Based on randomized controlled trials, PET or PET-CT scanning is recommended for staging and to detect unsuspected metastatic disease and avoid noncurative resections. Since the last iteration of the staging guidelines, PET scanning has assumed a more prominent role both in its use prior to surgery and when evaluating for metastatic disease. Minimally invasive

  5. An Evidence Based Approach to Sepsis: Educational Program

    Science.gov (United States)

    Perez, Dolores

    2015-01-01

    Evidence-based guidelines for recognizing and treating sepsis have been available for decades, yet healthcare providers do not adhere to the recommendations. Sepsis can progress rapidly if not recognized early. Literature reports reveal that sepsis is the leading cause of death in non-cardiac intensive care units (ICUs), and it is one of the most…

  6. Evidence-based playground design

    DEFF Research Database (Denmark)

    Refshauge, Anne Dahl; Stigsdotter, Ulrika K.; Lamm, Bettina

    2015-01-01

    , best practice, and the theories of Affordances and Behaviour Settings. A post-occupancy evaluation was carried out through a questionnaire survey and observation studies, which revealed that a majority of the potential evidence-based affordances were actualised, and that the application of the theories...

  7. Evidence-based disability evaluation

    NARCIS (Netherlands)

    Kok, R.

    2014-01-01

    Rob Kok laat in zijn promotieonderzoek zien dat een intensieve 5-daagse Evidence Based Medicine training niet alleen leidt tot een verbetering van kennis en vaardigheden, maar ook tot een betere onderbouwing van arbeidsongeschiktheidsbeoordelingen in de praktijk door verzekeringsartsen. Daarnaast le

  8. Evidence-Based Psychological Assessment.

    Science.gov (United States)

    Bornstein, Robert F

    2016-11-03

    In recent years there has been increasing emphasis on evidence-based practice in psychology (EBPP), and as is true in most health care professions, the primary focus of EBPP has been on treatment. Comparatively little attention has been devoted to applying the principles of EBPP to psychological assessment, despite the fact that assessment plays a central role in myriad domains of empirical and applied psychology (e.g., research, forensics, behavioral health, risk management, diagnosis and classification in mental health settings, documentation of neuropsychological impairment and recovery, personnel selection and placement in organizational contexts). This article outlines the central elements of evidence-based psychological assessment (EBPA), using the American Psychological Association's tripartite definition of EBPP as integration of the best available research with clinical expertise in the context of patient characteristics, culture, and preferences. After discussing strategies for conceptualizing and operationalizing evidence-based testing and evidence-based assessment, 6 core skills and 3 meta-skills that underlie proficiency in psychological assessment are described. The integration of patient characteristics, culture, and preferences is discussed in terms of the complex interaction of patient and assessor identities and values throughout the assessment process. A preliminary framework for implementing EBPA is offered, and avenues for continued refinement and growth are described.

  9. Evidence-Based IT Development

    DEFF Research Database (Denmark)

    Simonsen, Jesper; Hertzum, Morten

    2005-01-01

    Evidence-based IT development aims at developing a new commercial contract model for IT projects where the cus-tomers payment is dependent on measurable effects of using the vendors system. The idea is to establish a strategic part-nership in which customer and IT vendor share the responsi-bility...

  10. Evidence-Based IT Development

    DEFF Research Database (Denmark)

    Simonsen, Jesper; Hertzum, Morten

    2005-01-01

    Evidence-based IT development aims at developing a new commercial contract model for IT projects where the cus-tomers payment is dependent on measurable effects of using the vendors system. The idea is to establish a strategic part-nership in which customer and IT vendor share the responsi-bility...

  11. 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 be...

  12. Evidence-based guidelines for management of attention-deficit/hyperactivity disorder in adolescents in transition to adult services and in adults: recommendations from the British Association for Psychopharmacology.

    Science.gov (United States)

    Nutt, D J; Fone, K; Asherson, P; Bramble, D; Hill, P; Matthews, K; Morris, K A; Santosh, P; Sonuga-Barke, E; Taylor, E; Weiss, M; Young, S

    2007-01-01

    Attention-deficit/hyperactivity disorder (ADHD) is an established diagnosis in children, associated with a large body of evidence on the benefits of treatment. Adolescents with ADHD are now leaving children's services often with no readily identifiable adult service to support them, which presents problems as local pharmacy regulations often preclude the prescription of stimulant drugs by general practitioners (GPs). In addition, adults with ADHD symptoms are now starting to present to primary care and psychiatry services requesting assessment and treatment. For these reasons, the British Association for Psychopharmacology (BAP) thought it timely to hold a consensus conference to review the body of evidence on childhood ADHD and the growing literature on ADHD in older age groups. Much of this initial guidance on managing ADHD in adolescents in transition and in adults is based on expert opinion derived from childhood evidence. We hope that, by the time these guidelines are updated, much evidence will be available to address the many directions for future research that are detailed here.

  13. The treatment of restless legs syndrome and periodic limb movement disorder in adults--an update for 2012: practice parameters with an evidence-based systematic review and meta-analyses: an American Academy of Sleep Medicine Clinical Practice Guideline.

    Science.gov (United States)

    Aurora, R Nisha; Kristo, David A; Bista, Sabin R; Rowley, James A; Zak, Rochelle S; Casey, Kenneth R; Lamm, Carin I; Tracy, Sharon L; Rosenberg, Richard S

    2012-08-01

    A systematic literature review and meta-analyses (where appropriate) were performed to update the previous AASM practice parameters on the treatments, both dopaminergic and other, of RLS and PLMD. A considerable amount of literature has been published since these previous reviews were performed, necessitating an update of the corresponding practice parameters. Therapies with a STANDARD level of recommendation include pramipexole and ropinirole. Therapies with a GUIDELINE level of recommendation include levodopa with dopa decarboxylase inhibitor, opioids, gabapentin enacarbil, and cabergoline (which has additional caveats for use). Therapies with an OPTION level of recommendation include carbamazepine, gabapentin, pregabalin, clonidine, and for patients with low ferritin levels, iron supplementation. The committee recommends a STANDARD AGAINST the use of pergolide because of the risks of heart valve damage. Therapies for RLS secondary to ESRD, neuropathy, and superficial venous insufficiency are discussed. Lastly, therapies for PLMD are reviewed. However, it should be mentioned that because PLMD therapy typically mimics RLS therapy, the primary focus of this review is therapy for idiopathic RLS.

  14. [Evidence-based Treatment for Vasculitic Neuropathies].

    Science.gov (United States)

    Koga, Michiaki

    2016-03-01

    Vasculitic neuropathies are caused by ischemic damage due to vessel wall inflammation. This damage may cause axonal degeneration leading to permanent neurological disabilities. Therefore, early initiation of effective treatment is crucial. For primary systemic vasculitis, a combined treatment of corticosteroid and immunosuppressive agents is recommended in the evidence-based guidelines as initial standard therapy for induction of remission. However, limited data are available regarding therapies for vasculitic neuropathies and it remains unclear whether combined treatment should be employed as an initial therapy for all patients with vasculitic neuropathies. In approximately half the patients with vasculitic neuropathies, monotherapy with corticosteroids is insufficient in preventing long-lasting neurological disabilities. Addition of intravenous immunoglobulin at an early stage of the disease may be a promising treatment option obviating the need for potent but potentially harmful immunosuppressive agents in some mild or localized cases.

  15. Evidence based practice guidelines for management of low back pain: physical therapy implications Diretrizes de prática clínica baseada em evidências para avaliação e tratamento de lombalgia: implicações para fisioterapia

    Directory of Open Access Journals (Sweden)

    Carlos E. Ladeira

    2011-06-01

    Full Text Available BACKGROUND: Low back pain (LBP is the most common disorder seen in physical therapy practice. There are several hundred clinical trials on the management of LBP. To summarize these trials, researchers wrote Evidence Based Practice (EBP guidelines. This article reviewed the implications of EBP guidelines recommendations for physical therapy practice. OBJECTIVES: To review the recommendations for conservative management of LBP published in EBP guidelines since 2002. METHODS: Searches were performed on the following databases: Google web searching engine, Medline, Cochrane Library, and the Guideline Clearing House. Guidelines published in English and addressing conservative management of LBP were included. RESULTS: Thirteen multidisciplinary and three mono-disciplinary guidelines met the inclusion criteria. LBP was triaged into three groups: with red flags, with radiculopathy, or non-specific. Patients without red flags could be safely managed without specialist referral. Patient education was recommended for all patients with LBP. There was an agreement to advise spine manipulation for patients with acute and sub-acute non-specific LBP. There was a consensus to recommend exercises for acute, sub-acute, and chronic LBP. Few guidelines addressed conservative management of LBP with radiculopathy. Overall, the guidelines did not offer specific advice for manipulation (hypomobility or instability and exercise (stabilization or directional preference. CONCLUSION: Multidisciplinary guidelines focused on primary care and lacked details significant for physical therapy practice. There is a need for mono-disciplinary physical therapy guidelines to improve the balance between evidence and professional relevance.CONTEXTUALIZAÇÃO: Lombalgia é o sintoma mais comum tratado por Fisioterapeutas. Existem centenas de estudos controlados aleatorizados que lidam com o tratamento de lombalgias. Para resumir tais centenas de artigos, pesquisadores escreveram guias de

  16. Implementing evidence-based practices in an emergency department

    DEFF Research Database (Denmark)

    Kirk, Jeanette W.; Nilsen, Per

    2016-01-01

    department influence nurses' use of a research-based clinical guideline and a nutrition screening routine. METHODS: Ethnographic fieldwork was carried out over three months. The first author followed nurses, medical secretaries and doctors in the emergency department. Data were also collected by means...... and screening routines provided a flow stop. Four associated contradictions were identified: insufficient time to implement guidelines; guilty conscience due to perceived nonadherence to evidence-based practices; newcomers having different priorities; and conflicting views of what constituted being...... a professional. CONCLUSION: We found that research-supported guidelines and screening routines were not used if they were perceived to stop the patient flow, suggesting that the practice was not fully evidence based....

  17. 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.

  18. Healthcare professionals' intentions to use clinical guidelines: a survey using the theory of planned behaviour

    Directory of Open Access Journals (Sweden)

    Komulainen Jorma

    2010-06-01

    Full Text Available Abstract Background Finnish clinical guidelines are evolving toward integration of knowledge modules into the electronic health record in the Evidence-Based Medicine electronic Decision Support project. It therefore became important to study which factors affect professionals' intention to use clinical guidelines generally in their decision-making on patient care. A theory-based approach is a possible solution to explore determinants of professionals' behaviour. The study's aim was to produce baseline information for developers and implementers by using the theory of planned behaviour. Methods A cross-sectional internet-based survey was carried out in Finnish healthcare organisations within three hospital districts. The target population (n = 2,252 included physicians, nurses, and other professionals, of whom 806 participated. Indicators of the intention to use clinical guidelines were observed by using a theory-based questionnaire. The main data analysis was done by means of multiple linear regressions. Results The results indicated that all theory-based variables--the attitude toward the behaviour, the subjective norm, and the perceived behaviour control--were important factors associated with the professionals' intention to use clinical practice guidelines for their area of specialisation in the decisions they would make on the care of patients in the next three months. In addition, both the nurse and the physician factors had positive (p Conclusions The results confirm suggestions that the theory of planned behaviour is a suitable theoretical basis for implementing clinical guidelines in healthcare practices. Our new finding was that, in general, profession had an effect on intention to use clinical guidelines in patient care. Therefore, the study reaffirms the general contention that different strategies need to be in place when clinical guidelines are targeted at different professional groups.

  19. 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...

  20. Guidelines International Network: toward international standards for clinical practice guidelines.

    NARCIS (Netherlands)

    Qaseem, A.; Forland, F.; Macbeth, F.; Ollenschlager, G.; Phillips, S.; Wees, P.J. van der

    2012-01-01

    Guideline development processes vary substantially, and many guidelines do not meet basic quality criteria. Standards for guideline development can help organizations ensure that recommendations are evidence-based and can help users identify high-quality guidelines. Such organizations as the U.S. In

  1. DIGITALISATION IN FINNISH MUSEUMS

    Directory of Open Access Journals (Sweden)

    Magdalena Laine-Zamojska

    2014-01-01

    Full Text Available W artykule omówiono generalny obraz digitalizacji w fińskim sektorze muzealnym. Przedstawiono szacunkowe liczby dotyczące digitalizacji dziedzictwa kulturowego na podstawie przeprowadzonych statystycznych badań, oraz zaprezentowano wiele projektów związanych z ucyfrowieniem fińskich muzeów.\tFiński sektor muzealny jest niezwykle zróżnicowany, podobnie jak stopień skatalogowania i zdigitalizowania kolekcji. W projektach rozwojowych aktywnie uczestniczy cały sektor muzealny. W ostatnich latach, dzięki wielu inicjatywom i badaniom udało się uzyskać szczegółowy obraz fińskiego sektora muzealnego. Największą inicjatywą jest projekt utworzenia Narodowej Biblioteki Cyfrowej, podlegający Ministerstwu Edukacji i Kultury. Celem projektu jest połączenie i udostępnienie zasobów z instytucji pamięci (bibliotek, archiwów i muzeów. Towarzyszą mu rozległe projekty digitalizacji.\tW związku z ogromną różnorodnością systemów do zarządzania kolekcją i praktykami katalogowymi w muzeach, w 2011 r. Państwowy Urząd Muzealny (Museovirasto / National Board of Antiquities, Fiński Związek Muzeów (Suomen museoliitto / Finnish Museums Association i Państwowa Galeria Sztuki (Valtion taidemuseo / Finnish National Gallery zainicjowały projekt Muzeum2015 (Museo2015 / Museum2015. Jego głównymi celami są: unifikacja procesów związanych z zarządzaniem kolekcją, stworzenie architektury korporacyjnej dla zarządzania muzealną kolekcją, stworzenie modelu zarządzania dla architektury korporacyjnej, oraz określenie i stworzenie warunków do zakupu i implementacji ogólnofińskiego systemu zarządzania kolekcją.\tRozwój cyfrowych narzędzi dla najmniejszych, prowadzonych przez wolontariuszy, muzeów lokalnych jest jednym z celów projektu badawczego ViMuseo, prowadzonego na Uniwersytecie w Jyväskylä (Jyväskylän yliopisto / University of Jyväskylä.

  2. 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

  3. Inconsistencies in clinical guidelines for obstetric anaesthesia for Caesarean section

    DEFF Research Database (Denmark)

    Winther, Lars; Mitchell, A U; Møller, Ann

    2013-01-01

    Anaesthetists need evidence-based clinical guidelines, also in obstetric anaesthesia. We compared the Danish, English, American, and German national guidelines for anaesthesia for Caesarean section. We focused on assessing the quality of guideline development and evaluation of the guidelines...

  4. CEC's Standards for Classifying the Evidence Base of Practices in Special Education

    Science.gov (United States)

    Cook, Bryan G.; Buysse, Virginia; Klingner, Janette; Landrum, Timothy J.; McWilliam, R. A.; Tankersley, Melody; Test, David W.

    2015-01-01

    As an initial step toward improving the outcomes of learners with disabilities, special educators have formulated guidelines for identifying evidence-based practices. We describe the Council of Exceptional Children's new set of standards for identifying evidence-based practices in special education and how they (a) were systematically vetted by…

  5. Evidence-based dentistry: fundamentals for the dentist.

    Science.gov (United States)

    Bauer, Janet; Chiappelli, Francesco; Spackman, Sue; Prolo, Paolo; Stevenson, Richard

    2006-06-01

    This article explains the fundamentals of evidence-based dentistry for the dentist. Evidence-based dentistry is a discipline whose primary participant is the translational researcher. Recent developments have emphasized the importance of this discipline (clinical and translational research) for improving health care. The process of evidence-based dentistry is the reciprocation of new and existing evidence between dentists and quantitative and qualitative researchers, facilitated by the translational researcher. The product of this reciprocation is the clinical practice guideline, or best evidence, that provides the patient options in choosing treatments or services. These options are quantified and qualified by decision, utility, and cost data. Using shared decision-making, the dentist and patient arrive at a mutual understanding of which option best meets an acceptable and preferred treatment course that is cost effective. This option becomes the clinical decision.

  6. Building the evidence base for postoperative and postpartum advice.

    Science.gov (United States)

    Minig, Lucas; Trimble, Edward L; Sarsotti, Carlos; Sebastiani, Mario M; Spong, Catherine Y

    2009-10-01

    Recommendations for activity after obstetric and gynecologic procedures remain based on tradition and anecdote. After reviewing the current evidence base, guidelines, and practice for postdischarge instructions related to physical activity after the most common obstetric and gynecologic surgical procedures, we conclude that the available data do not support many of the recommendations currently provided. Restrictions on lifting and climbing stairs should likely be abandoned. Guidance on driving should focus on the concern regarding cognitive function and analgesics rather than concerns of wound separation/dehiscence. Given the impact of these recommendations on daily life events, consistent, evidence-based advice on when and how women can safely resume exercise, driving, working, and sexual intercourse is critical. The evidence base informing advice for most of these issues is minimal; we need prospective, well-designed studies to help guide us and our patients.

  7. Evidence-Based Practice: Separating Science From Pseudoscience.

    Science.gov (United States)

    Lee, Catherine M; Hunsley, John

    2015-12-01

    Evidence-based practice (EBP) requires that clinicians be guided by the best available evidence. In this article, we address the impact of science and pseudoscience on psychotherapy in psychiatric practice. We describe the key principles of evidence-based intervention. We describe pseudoscience and provide illustrative examples of popular intervention practices that have not been abandoned, despite evidence that they are not efficacious and may be harmful. We distinguish efficacy from effectiveness, and describe modular approaches to treatment. Reasons for the persistence of practices that are not evidence based are examined at both the individual and the professional system level. Finally, we offer suggestions for the promotion of EBP through clinical practice guidelines, modelling of scientific decision making, and training in core skills.

  8. 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.

  9. A Finnish delegation visits CERN

    CERN Multimedia

    2001-01-01

    Minister Maija Rask (front, centre) led a Finnish delegation on a visit to CERN last week. Here the delegation inspects CMS preparations with the collaboration's spokesman Michel Della Negra (front, left). On 19 February Finnish Minister of Education, Mrs Maija Rask, visited CERN. She led a delegation composed of Mr. Pekka Huttaniemi, Permanent Representative of Finland to the United Nations, Mrs Pirjo Välinoro, Ministerial Counsellor (Economic affairs), Mr Markku Linna, Director General of the Ministry of Education, and Mr Tapio Kosunen, Special Adviser at the Ministry. Accompanied by Director General Luciano Maiani, the delegation visited CMS experiment and the LHC superconducting magnet test hall, and met Finnish students and scientists at CERN.

  10. Evidence-based treatment of metabolic myopathy

    Directory of Open Access Journals (Sweden)

    Yan LIN

    2014-05-01

    Full Text Available Objective To evaluate the current treatments and possible adverse reactions of metabolic myopathy, and to develop the best solution for evidence-based treatment.  Methods Taking metabolic myopathy, mitochondrial myopathy, lipid storage myopathy, glycogen storage diseases, endocrine myopathy, drug toxicity myopathy and treatment as search terms, retrieve in databases such as PubMed, Cochrane Library, ClinicalKey database, National Science and Technology Library (NSTL, in order to collect the relevant literature database including clinical guidelines, systematic reviews (SR, randomized controlled trials (RCT, controlled clinical trials, retrospective case analysis and case study. Jadad Scale was used to evaluate the quality of literature.  Results Twenty-eight related articles were selected, including 6 clinical guidelines, 5 systematic reviews, 10 randomized controlled trials and 7 clinical controlled trials. According to Jadad Scale, 23 articles were evaluated as high-quality literature (≥ 4, and the remaining 5 were evaluated as low-quality literature (< 4. Treatment principles of these clinical trials, efficacy of different therapies and drug safety evaluation suggest that: 1 Acid α-glycosidase (GAA enzyme replacement therapy (ERT is the main treatment for glycogen storage diseases, with taking a high-protein diet, exercising before taking a small amount of fructose orally and reducing the patient's physical activity gradually. 2 Carnitine supplementation is used in the treatment of lipid storage myopathy, with carbohydrate and low fat diet provided before exercise or sports. 3 Patients with mitochondrial myopathy can take coenzyme Q10, vitamin B, vitamin K, vitamin C, etc. Proper aerobic exercise combined with strength training is safe, and it can also enhance the exercise tolerance of patients effectively. 4 The first choice to treat the endocrine myopathy is treating primary affection. 5 Myopathies due to drugs and toxins should

  11. Evidence Based Nursing. A new perspective for Greek Nursing

    Directory of Open Access Journals (Sweden)

    Christina Ouzouni

    2008-07-01

    Full Text Available Despite the fact that nursing research has been developed in Greece, nevertheless the provision of nursing care is not based on current research findings, but rather on the knowledge gained by nurses during their undergraduate education. The transition of medicine in the last decade towards evidence based practice had definitely an impact on the nursing profession.The aim of this article is to briefly present evidence based nursing as a process and perspective to Greek nurses.Method: A literature search was performed in order to identify and review relevant articles concerning evidence based nursing.Conclusions: It has been supported that in the practice of evidence based nursing, a nurse has to decide whether the evidence is relevant for the individual patient. The incorporation of clinical expertise should balance the risks and benefits of a possible treatment and take into consideration the patient’s unique clinical circumstances and preferences. The stages to identify evidence for nursing practice follow firstly a question which must be addressed for a particular clinical problem. Then, a literature search is performed in order to access the evidence and critically appraise it and finally the best available evidence that fits into a particular case is utilized. Evidence based nursing bears benefits for patients, nurses and health care services, as well. In the process of implementing evidence based nursing in Greece there are several constraints. Taking these difficulties into consideration and until Greek nurses familiarize themselves with evidence based nursing care, it is necessary to constitute workgroups of nurse researchers aiming at forming clinical guidelines for nursing practice, which will based on the best available evidence.

  12. Finnish Teachers' Conceptions of Giftedness

    Science.gov (United States)

    Laine, Sonja; Kuusisto, Elina; Tirri, Kirsi

    2016-01-01

    This article presents two independent studies of Finnish teachers' conceptions of giftedness and considers whether it is a malleable or fixed quality. The first qualitative study examined elementary school teachers' (N = 212) conceptions via inductive-oriented content analysis, whereas the second study measured teachers' (elementary n = 184,…

  13. Finnish Teachers' Conceptions of Giftedness

    Science.gov (United States)

    Laine, Sonja; Kuusisto, Elina; Tirri, Kirsi

    2016-01-01

    This article presents two independent studies of Finnish teachers' conceptions of giftedness and considers whether it is a malleable or fixed quality. The first qualitative study examined elementary school teachers' (N = 212) conceptions via inductive-oriented content analysis, whereas the second study measured teachers' (elementary n = 184,…

  14. LEAN thinking in Finnish healthcare.

    Science.gov (United States)

    Jorma, Tapani; Tiirinki, Hanna; Bloigu, Risto; Turkki, Leena

    2016-01-01

    Purpose - The purpose of this study is to evaluate how LEAN thinking is used as a management and development tool in the Finnish public healthcare system and what kind of outcomes have been achieved or expected by using it. The main focus is in managing and developing patient and treatment processes. Design/methodology/approach - A mixed-method approach incorporating the Webropol survey was used. Findings - LEAN is quite a new concept in Finnish public healthcare. It is mainly used as a development tool to seek financial savings and to improve the efficiency of patient processes, but has not yet been deeply implemented. However, the experiences from LEAN initiatives have been positive, and the methodology is already quite well-known. It can be concluded that, because of positive experiences from LEAN, the environment in Finnish healthcare is ready for the deeper implementation of LEAN. Originality/value - This paper evaluates the usage of LEAN thinking for the first time in the public healthcare system of Finland as a development tool and a management system. It highlights the implementation and achieved results of LEAN thinking when used in the healthcare environment. It also highlights the expectations for LEAN thinking in Finnish public healthcare.

  15. Pressure ulcers: implementation of evidence-based nursing practice.

    Science.gov (United States)

    Clarke, Heather F; Bradley, Chris; Whytock, Sandra; Handfield, Shannon; van der Wal, Rena; Gundry, Sharon

    2005-03-01

    A 2-year project was carried out to evaluate the use of multi-component, computer-assisted strategies for implementing clinical practice guidelines. This paper describes the implementation of the project and lessons learned. The evaluation and outcomes of implementing clinical practice guidelines to prevent and treat pressure ulcers will be reported in a separate paper. The prevalence and incidence rates of pressure ulcers, coupled with the cost of treatment, constitute a substantial burden for our health care system. It is estimated that treating a pressure ulcer can increase nursing time up to 50%, and that treatment costs per ulcer can range from US$10,000 to $86,000, with median costs of $27,000. Although evidence-based guidelines for prevention and optimum treatment of pressure ulcers have been developed, there is little empirical evidence about the effectiveness of implementation strategies. The study was conducted across the continuum of care (primary, secondary and tertiary) in a Canadian urban Health Region involving seven health care organizations (acute, home and extended care). Trained surveyors (Registered Nurses) determined the prevalence and incidence of pressure ulcers among patients in these organizations. The use of a computerized decision-support system assisted staff to select optimal, evidence-based care strategies, record information and analyse individual and aggregate data. Evaluation indicated an increase in knowledge relating to pressure ulcer prevention, treatment strategies, resources required, and the role of the interdisciplinary team. Lack of visible senior nurse leadership; time required to acquire computer skills and to implement new guidelines; and difficulties with the computer system were identified as barriers. There is a need for a comprehensive, supported and sustained approach to implementation of evidence-based practice for pressure ulcer prevention and treatment, greater understanding of organization-specific barriers, and

  16. Interpretation for“2014 evidence-based guideline for the management of high blood pressure in adults”in the United States:discussion of the rational treatment of hypertension%美国《2014成人高血压循证管理指南》解读-探讨高血压的合理治疗

    Institute of Scientific and Technical Information of China (English)

    张磊; 姜红

    2015-01-01

    Hypertension is harmful to human health in the worldwide, which should be effectively controlled. Based on the results of high-quality randomized controlled trials, the“2014 evidence-based guideline for the management of high blood pressure in adults”(JNC8) in the United States brought us new ideas and perspectives that may be helpful in clinical practice. Because of the differences in epidemiological characteristics of hypertension between China and the United States or Europe, the characteristics of hypertensive patients in China should be taken into account in following the instruction of JNC8, so that we can promote the development in treatment of hypertension in China.%高血压严重危害全球人类健康,亟待有效控制。美国《2014成人高血压循证管理指南》(JNC8)是根据高质量临床随机对照试验的研究证据重新修订而成,带来诸多新理念和新观点,值得临床借鉴。然而,我国高血压流行病学特点与欧美国家之间存在差异,所以必须在符合我国国情的基础上,萃取其精髓,才能进一步有效推进我国临床高血压的防治工作。

  17. Evidence-based assessment: no more pride or prejudice.

    Science.gov (United States)

    Munro, Nancy

    2004-01-01

    Evidence-based practice is an important force in healthcare today. Its impact on the practice of the advanced practice nurse (APN) is becoming more apparent with the development of practice guidelines and protocols. The phrase, "That's the way I've always done it," is being replaced by, "This practice is evidence based." The philosophy of supporting practice with scientific evidence is not new but has been revitalized and emphasized as protocols have been developed to "mold" practice to achieve successful outcomes. This revolution is being applied to all areas of healthcare practice. Assessment of the patient is usually the first contact the APN has with the patient. It is an important time to gather information from the patient interview, physical examination, laboratory data, and test interpretation. Scientific evidence, properly interpreted, is applied in this step of assessment. The APN will then use clinical judgment and the knowledge gained from graduate education to assist with the formulation of a diagnosis. The APN has a unique opportunity to promote an evidence-based practice model at the grass roots level and persuade the bedside nurse to integrate this process into his or her practice. Ultimately, patients will receive better care and outcomes will be improved using evidence-based assessment.

  18. Finnish energy technology programmes 1998

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1998-12-01

    The Finnish Technology Development Centre (Tekes) is responsible for the financing of research and development in the field of energy production technology. A considerable part of the financing goes to technology programmes. Each technology programme involves major Finnish institutions - companies, research institutes, universities and other relevant interests. Many of the energy technology programmes running in 1998 were launched collectively in 1993 and will be completed at the end of 1998. They are complemented by a number of other energy-related technology programmes, each with a timetable of its own. Because energy production technology is horizontal by nature, it is closely connected with research and development in other fields, too, and is an important aspect in several other Tekes technology programmes. For this reason this brochure also presents technology programmes where energy is only one of the aspects considered but which nevertheless contribute considerably to research and development in the energy production sector

  19. Equality Work in Finnish Ministries

    OpenAIRE

    Tanhua, Inkeri

    2015-01-01

    The aim of this thesis is to contribute to knowledge about the equality work in public sector organisations. Especially, my aim is to bring light into everyday experiences of doing equality work. This is achieved through interviewing equality workers in Finnish ministries. The study draws also on my personal experiences as an equality consultant. The main question I ask is: Which issues influence the content of equality work? According to feminist research, promoting equality is always a poli...

  20. Evidence Locator: sources of evidence-based dentistry information.

    Science.gov (United States)

    Frantsve-Hawley, Julie

    2008-09-01

    Multiple resources are available to help practitioners access the latest scientific evidence. Evidence-based dentistry (EBD) is an approach to clinical decision making that incorporates the most current and comprehensive scientific evidence with the practitioner's judgment and the patient's needs and preferences. One challenge in implementing this approach is access to evidence, and there are multiple online resources that can be used in this endeavor. This article presents the Evidence Locator, a list of Web sites that provide access to "secondary sources" of evidence. Such "secondary sources" are typically summaries of systematic reviews and evidence-based clinical recommendations or guidelines. Also presented is a list of other Web sites that may be useful to the practitioner in implementing EBD.

  1. Finnish Society of Soil Sciences

    Science.gov (United States)

    Rankinen, Katri; Hänninen, Pekka; Soinne, Helena; Leppälammi-Kujansuu, Jaana; Salo, Tapio; Pennanen, Taina

    2017-04-01

    In 1998 the organization of the International Union of Soil Sciences (IUSS) was renewed to better support national activities. That was also the new start in the operation of the Finnish Society of Soil Sciences, which became affiliated to the IUSS. The society was originally established in 1971 but it remained relatively inactive. Currently, there are around 200 members in the Finnish Society of Soil Sciences. The members of the executive board cover different fields of soil science from geology to microbiology. Mission statement of the society is to promote the soil sciences and their application in Finland, to act as a forum for creation of better links between soil scientists, interested end users and the public, and to promote distribution and appreciation of general and Finnish research findings in soil science. Every second year the society organizes a national two-day long conference. In 2017 the theme 'circular economy' collected all together 57 presentations. The members of the incoming student division carried responsibility in practical co-ordination committee, acting also as session chairs. In the intervening years the society organizes a weekend excursion to neighboring areas. Lately we have explored the use of biochar in landscaping of Stockholm.

  2. Evidence-Based Practice: Management of Vertigo

    OpenAIRE

    Nguyen-Huynh, Anh T.

    2012-01-01

    The article focuses on the evidence basis for the management of benign paroxysmal positional vertigo (BPPV), the most common diagnosis of vertigo in both primary care and subspecialty settings. Like all articles in this compilation of evidence-based practice, an overview is presented along with evidence based clinical assessment, diagnosis, and management. Summaries of differential diagnosis of vertigo and outcomes are presented.

  3. Evidence-based practice voor verpleegkundigen

    NARCIS (Netherlands)

    Cox, C.M.M.; Louw, D.C.P. de; Verhoef, J.; Kuiper, C.

    2004-01-01

    Om goede en verantwoorde zorg te kunnen bieden, streeft de verpleegkundige naar evidence-based practice. Evidence-based practice is het gewetensvol, expliciet en oordeelkundig gebruik van het huidige beste bewijsmateriaal om beslissingen te nemen voor individuele patiënten. De praktijk van evidence-

  4. Evidence-based dentistry: a clinician's perspective.

    Science.gov (United States)

    Bauer, Janet; Spackman, Sue; Chiappelli, Francesco; Prolo, Paolo; Stevenson, Richard

    2006-07-01

    Evidence-based dentistry is a discipline that provides best, explicit-based evidence to dentists and their patients in shared decision-making. Currently, dentists are being trained and directed to adopt the role of translational researchers in developing evidence-based dental practices. Practically, evidence-based dentistry is not usable in its current mode for the provision of labor-intensive services that characterize current dental practice. The purpose of this article is to introduce a model of evidence-based dental practice. This model conceptualizes a team approach in explaining problems and solutions to change current dental practice. These changes constitute an evidence-based dental practice that involves the electronic chart, centralized database, knowledge management software, and personnel in optimizing effective oral health care to dental patients.

  5. Optimizing Personalized Bone Marrow Testing Using an Evidence-based, Interdisciplinary Team Approach

    OpenAIRE

    2013-01-01

    Personalized medicine requires physicians to employ complex and expensive diagnostic analyses. However, without evidence-based standards, there is over-utilization of testing that complicates patient care, diminishes quality, and increases costs. To address this, we implemented the diagnostic management team (DMT), a multi-disciplinary system for development and deployment of diagnostic testing guidelines for hematologic malignancies. The team created evidence-based standard ordering protocol...

  6. Sicily statement on evidence-based practice

    Directory of Open Access Journals (Sweden)

    Hopayian Kevork

    2005-01-01

    Full Text Available Abstract Background A variety of definitions of evidence-based practice (EBP exist. However, definitions are in themselves insufficient to explain the underlying processes of EBP and to differentiate between an evidence-based process and evidence-based outcome. There is a need for a clear statement of what Evidence-Based Practice (EBP means, a description of the skills required to practise in an evidence-based manner and a curriculum that outlines the minimum requirements for training health professionals in EBP. This consensus statement is based on current literature and incorporating the experience of delegates attending the 2003 Conference of Evidence-Based Health Care Teachers and Developers ("Signposting the future of EBHC". Discussion Evidence-Based Practice has evolved in both scope and definition. Evidence-Based Practice (EBP requires that decisions about health care are based on the best available, current, valid and relevant evidence. These decisions should be made by those receiving care, informed by the tacit and explicit knowledge of those providing care, within the context of available resources. Health care professionals must be able to gain, assess, apply and integrate new knowledge and have the ability to adapt to changing circumstances throughout their professional life. Curricula to deliver these aptitudes need to be grounded in the five-step model of EBP, and informed by ongoing research. Core assessment tools for each of the steps should continue to be developed, validated, and made freely available. Summary All health care professionals need to understand the principles of EBP, recognise EBP in action, implement evidence-based policies, and have a critical attitude to their own practice and to evidence. Without these skills, professionals and organisations will find it difficult to provide 'best practice'.

  7. Finnish Higher Education Reforms: Responding to Globalization

    Science.gov (United States)

    Tjeldvoll, Arild

    2009-01-01

    The international academic success of Finnish secondary schooling in the Program for International Student Assessment (PISA) and the triumph of the Finnish technology company NOKIA have stimulated national ambitions to improve higher education institutions in Finland. Because secondary schooling and technology in Finland receive world recognition,…

  8. TAPIR--Finnish national geochemical baseline database.

    Science.gov (United States)

    Jarva, Jaana; Tarvainen, Timo; Reinikainen, Jussi; Eklund, Mikael

    2010-09-15

    In Finland, a Government Decree on the Assessment of Soil Contamination and Remediation Needs has generated a need for reliable and readily accessible data on geochemical baseline concentrations in Finnish soils. According to the Decree, baseline concentrations, referring both to the natural geological background concentrations and the diffuse anthropogenic input of substances, shall be taken into account in the soil contamination assessment process. This baseline information is provided in a national geochemical baseline database, TAPIR, that is publicly available via the Internet. Geochemical provinces with elevated baseline concentrations were delineated to provide regional geochemical baseline values. The nationwide geochemical datasets were used to divide Finland into geochemical provinces. Several metals (Co, Cr, Cu, Ni, V, and Zn) showed anomalous concentrations in seven regions that were defined as metal provinces. Arsenic did not follow a similar distribution to any other elements, and four arsenic provinces were separately determined. Nationwide geochemical datasets were not available for some other important elements such as Cd and Pb. Although these elements are included in the TAPIR system, their distribution does not necessarily follow the ones pre-defined for metal and arsenic provinces. Regional geochemical baseline values, presented as upper limit of geochemical variation within the region, can be used as trigger values to assess potential soil contamination. Baseline values have also been used to determine upper and lower guideline values that must be taken into account as a tool in basic risk assessment. If regional geochemical baseline values are available, the national guideline values prescribed in the Decree based on ecological risks can be modified accordingly. The national geochemical baseline database provides scientifically sound, easily accessible and generally accepted information on the baseline values, and it can be used in various

  9. Evidence based policy-making: A review

    CSIR Research Space (South Africa)

    Strydom, FW

    2010-04-01

    Full Text Available and policy makers work together? J Epidemiol Community Health. 2005;59:632–637. 6. Lomas J. Using ‘linkage and exchange’ to move research into policy at a Canadian foundation. Health Aff. 2000;19:236– 240. 7. Solesbury W. Evidence based policy: Whence... it came and where it’s going? ESRC UK Centre for Evidence Based Policy and Practice: Working paper 1. London: University of London; 2001. 8. Zussman D. Evidence-based policy making: Some observations of recent Canadian experience. Soc Pol J New Zeal...

  10. History of evidence-based medicine

    Directory of Open Access Journals (Sweden)

    Roger L Sur

    2011-01-01

    Full Text Available This essay reviews the historical circumstances surrounding the introduction and evolution of evidence-based medicine. Criticisms of the approach are also considered. Weaknesses of existing standards of clinical practice and efforts to bring more certainty to clinical decision making were the foundation for evidence-based medicine, which integrates epidemiology and medical research. Because of its utility in designing randomized clinical trials, assessing the quality of the literature, and applying medical research at the bedside, evidence-based medicine will continue to have a strong influence on everyday clinical practice.

  11. Evidence-based treatment of stuttering: III. Evidence-based practice in a clinical setting.

    Science.gov (United States)

    Langevin, Marilyn; Kully, Deborah

    2003-01-01

    At the heart of evidence-based practice in stuttering treatment are four issues: (1) the collection of data to inform treatment; (2) the long standing concern with maintenance of treatment gains; (3) the need to demonstrate accountability to clients, payers and our profession as service providers; and (4) the desire to advance theoretical knowledge. This article addresses the first three of these issues from a practical point of view, illustrating how data collection for stuttering treatment outcome research in a clinical setting is intimately blended with that required for clinical purposes and providing an example of a process of evaluating data for clinical and research purposes. The reader will learn about and be able to (1) differentiate between treatment outcome and treatment efficacy research, (2) describe models for integrating data collection for treatment outcome and clinical purposes, and (3) utilize guidelines for treatment efficacy that are applicable to outcome research to evaluate data for use in treatment outcome studies and to design outcome studies.

  12. Romance Tourism and Finnish Women

    OpenAIRE

    Jussila, Johanna

    2015-01-01

    Romance tourism is a discussed quite a lot in media both in Finland and abroad. The media has create a certain kind of image of women`s romance tourism. The main aim of this study was to study how Finnish women perceive the romance tourism. The research questions were: does women travel to abroad to seek for holiday romance and why do they travel to abroad to seek for the romance. To find out women’s mental images of romance tourism was also one aim of the research. The phenomenon of women’s ...

  13. Romance Tourism and Finnish Women

    OpenAIRE

    Jussila, Johanna

    2015-01-01

    Romance tourism is a discussed quite a lot in media both in Finland and abroad. The media has create a certain kind of image of women`s romance tourism. The main aim of this study was to study how Finnish women perceive the romance tourism. The research questions were: does women travel to abroad to seek for holiday romance and why do they travel to abroad to seek for the romance. To find out women’s mental images of romance tourism was also one aim of the research. The phenomenon of women’s ...

  14. Evidence-based dentistry as it relates to dental materials.

    Science.gov (United States)

    Bayne, Stephen C; Fitzgerald, Mark

    2014-01-01

    Evidence-based dentistry (EBD) is reviewed in depth to underscore the limitations for evidence-based dental materials information that exist at this time. Anecdotal estimates of evidence for dental practice are in the range of 8 percent to 10 percent. While the process of evaluating the literature base for dental evidence began 20 years ago, it was not practical to implement it until high-speed wireless connections, open access to journals, and omnipresent connections via smart phones became a reality. EBD includes five stages of information collection and analysis, starting with a careful definition of a clinical question using the PICO(T) approach. Clinical evidence in randomized control trials is considered the best. Clinical trial perspectives (prospective, cross-sectional, retrospective) and outcome designs (RCTs, SCTs, CCTs, cohort studies, case-control studies) are quite varied. Aggregation techniques (including meta-analyses) allow meaningful combinations of clinical data from trials with similar designs but with fewer rigors. Appraisals attempt to assess the entire evidence base without bias and answer clinical questions. Varying intensities to these approaches, Cochrane Collaboration, ADA-EBD Library, UTHSCSA CATs Library, are used to answer questions. Dental materials evidence from clinical trials is infrequent, short-term, and often not compliant with current guidelines (registration, CONSORT, PRISMA). Reports in current evidence libraries indicate less than 5 percent of evidence is related to restorative dental materials.

  15. Extent of linkage disequilibrium and effective population size in Finnish Landrace and Finnish Yorkshire pig breeds.

    Science.gov (United States)

    Uimari, P; Tapio, M

    2011-03-01

    The extent of linkage disequilibrium (LD) and effective population size in Finnish Landrace and Finnish Yorkshire pig populations were studied using a whole genome SNP panel (Illumina PorcineSNP60 BeadChip) and pedigree data. Genotypic data included 86 Finnish Landrace and 32 Finnish Yorkshire boars. Pedigree data included 608,138 Finnish Landrace 554,237 and Finnish Yorkshire pigs, and on average 15 ancestral generations were known for the reference animals, born in 2005 to 2009. The breeding animals of the 2 populations have been kept separate in the breeding programs. Based on the pedigree data, the current effective population size for Finnish Landrace is 91 and for Finnish Yorkshire 61. Linkage disequilibrium measures (D' and r(2)) were estimated for over 1.5 million pairs of SNP. Average r(2) for SNP 30 kb apart was 0.47 and 0.49 and for SNP 5 Mb apart 0.09 and 0.12 for Finnish Landrace and Finnish Yorkshire, respectively. Average LD (r(2)) between adjacent SNP in the Illumina PorcineSNP60 BeadChip was 0.43 (57% of the adjacent SNP pairs had r(2) > 0.2) for Finnish Landrace and 0.46 (60% of the adjacent SNP pairs had r(2) > 0.2) for Finnish Yorkshire, and average r(2) > 0.2 extended to 1.0 and 1.5 Mb for Finnish Landrace and Finnish Yorkshire, respectively. Effective population size estimates based on the decay of r(2) with distance were similar to those based on the pedigree data: 80 and 55 for Finnish Landrace and Finnish Yorkshire, respectively. Thus, the results indicate that the effective population size of Finnish Yorkshire is smaller than of Finnish Landrace and has a clear effect on the extent of LD. The current effective population size of both breeds is above the recommended minimum of 50 but may get smaller than that in the near future, if no action is taken to balance the inbreeding rate and selection response. Because a moderate level of LD extends over a long distance, selection based on whole genome SNP markers (genomic selection) is expected

  16. Transparent Guideline Methodology Needed

    DEFF Research Database (Denmark)

    Lidal, Ingeborg; Norén, Camilla; Mäkelä, Marjukka

    2013-01-01

    As part of learning at the Nordic Workshop of Evidence-based Medicine, we have read with interest the practice guidelines for central venous access, published in your Journal in 2012.1 We appraised the quality of this guideline using the checklist developed by The Evidence-Based Medicine Working ...... are based on best currently available evidence. Our concerns are in two main categories: the rigor of development, including methodology of searching, evaluating, and combining the evidence; and editorial independence, including funding and possible conflicts of interest....... Group.2 Similar criteria for guideline quality have been suggested elsewhere.3 Our conclusion was that this much needed guideline is currently unclear about several aspects of the methodology used in developing the recommendations. This means potential users cannot be certain that the recommendations...

  17. Evidence-Based Practice: Management of Vertigo

    Science.gov (United States)

    Nguyen-Huynh, Anh T.

    2012-01-01

    Synopsis The article focuses on the evidence basis for the management of benign paroxysmal positional vertigo (BPPV), the most common diagnosis of vertigo in both primary care and subspecialty settings. Like all articles in this compilation of evidence-based practice, an overview is presented along with evidence based clinical assessment, diagnosis, and management. Summaries of differential diagnosis of vertigo and outcomes are presented. PMID:22980676

  18. Evidence based management ve zdravotnictví

    OpenAIRE

    Vydrová, Rosa

    2011-01-01

    Evidence-based management involves decision making based on the best available scientific knowledge about effective organization practice. This evidence can be obtained from internal or systematic external research. Analysis of measures to prevent infections in hemato-oncologic patients a Prague teaching hospital revealed, that current organization practices do not allow a high quality internal research assessing provided health care quality. Causes of barriers to practice evidence-based appr...

  19. Evaluating competency to stand trial with evidence-based practice.

    Science.gov (United States)

    Rogers, Richard; Johansson-Love, Jill

    2009-01-01

    Evaluations for competency to stand trial are distinguished from other areas of forensic consultation by their long history of standardized assessment beginning in the 1970s. As part of a special issue of the Journal on evidence-based forensic practice, this article examines three published competency measures: the MacArthur Competence Assessment Tool-Criminal Adjudication (MacCAT-CA), the Evaluation of Competency to Stand Trial-Revised (ECST-R), and the Competence Assessment for Standing Trial for Defendants with Mental Retardation (CAST-MR). Using the Daubert guidelines as a framework, we examined each competency measure regarding its relevance to the Dusky standard and its error and classification rates. The article acknowledges the past polarization of forensic practitioners on acceptance versus rejection of competency measures. It argues that no valuable information, be it clinical acumen or standardized data, should be systematically ignored. Consistent with the American Academy of Psychiatry and the Law Practice Guideline, it recommends the integration of competency interview findings with other sources of data in rendering evidence-based competency determinations.

  20. Reversing the pipeline? Implementing public health evidence-based guidance in english local government.

    Science.gov (United States)

    Atkins, Lou; Kelly, Michael P; Littleford, Clare; Leng, Gillian; Michie, Susan

    2017-05-12

    In the UK, responsibility for many public health functions was transferred in 2013 from the National Health Service (NHS) to local government; a very different political context and one without the NHS history of policy and practice being informed by evidence-based guidelines. A problem this move presented was whether evidence-based guidelines would be seen as relevant, useful and implementable within local government. This study investigates three aspects of implementing national evidence-based recommendations for public health within a local government context: influences on implementation, how useful guidelines are perceived to be and whether the linear evidence-guidelines-practice model is considered relevant. Thirty-one councillors, public health directors and deputy directors and officers and other local government employees were interviewed about their experiences implementing evidence-based guidelines. Interviews were informed and analysed using a theoretical model of behaviour (COM-B; Capability, Opportunity, Motivation-Behaviour). Contextual issues such as budget, capacity and political influence were important influences on implementation. Guidelines were perceived to be of limited use, with concerns expressed about recommendations being presented in the abstract, lacking specificity and not addressing the complexity of situations or local variations. Local evidence was seen as the best starting point, rather than evidence-based guidance produced by the traditional linear 'evidence-guidelines-practice' model. Local evidence was used to not only provide context for recommendations but also replace recommendations when they conflicted with local evidence. Local government users do not necessarily consider national guidelines to be fit for purpose at local level, with the consequence that local evidence tends to trump evidence-based guidelines. There is thus a tension between the traditional model of guideline development and the needs of public health

  1. From evidence to action. Understanding clinical practice guidelines.

    NARCIS (Netherlands)

    Poolman, R.W.; Verheyen, C.C.P.M.; Kerkhoffs, G.M.; Bhandari, M.; Schünemann, H.J.

    2009-01-01

    Good guidelines will help us to take evidence into practice. In a survey among Dutch orthopedic surgeons, development and use of evidence-based guidelines was perceived as one of the best ways of moving from opinion-based to evidence-based orthopedic practice. The increasing number of guidelines mea

  2. Guidelines for the diagnosis and management of gastroesophageal reflux disease: an evidence-based consensus Diretrizes para o diagnóstico e tratamento da doença do refluxo gastroesofágico: um consenso baseado em evidências

    Directory of Open Access Journals (Sweden)

    Joaquim Prado P. Moraes-Filho

    2010-03-01

    Full Text Available Gastroesophageal reflux disease (GERD is one of the most common disorders in medical practice. A number of guidelines and recommendations for the diagnosis and management of GERD have been published in different countries, but a Brazilian accepted directive by the standards of evidence-based medicine is still lacking. As such, the aim of the Brazilian GERD Consensus Group was to develop guidelines for the diagnosis and management of GERD, strictly using evidence-based medicine methodology that could be clinically used by primary care physicians and specialists and would encompass the needs of physicians, investigators, insurance and regulatory bodies. A total of 30 questions were proposed. Systematic literature reviews, which defined inclusion and/or exclusion criteria, were conducted to identify and grade the available evidence to support each statement. A total of 11,069 papers on GERD were selected, of which 6,474 addressed the diagnosis and 4,595, therapeutics. Regarding diagnosis, 51 met the requirements for the analysis of evidence-based medicine: 19 of them were classified as grade A and 32 as grade B. As for therapeutics, 158 met the evidence-based medicine criteria; 89 were classified as grade A and 69 as grade B. In the topic Diagnosis, answers supported by publications grade A and B were accepted. In the topic Treatment only publications grade A were accepted: answers supported by publications grade B were submitted to the voting by the Consensus Group. The present publication presents the most representative studies that responded to the proposed questions, followed by pertinent comments. Follow examples. In patients with atypical manifestations, the conventional esophageal pH-metry contributes little to the diagnosis of GERD. The sensitivity, however, increases with the use of double-channel pH-metry. In patients with atypical manifestations, the impedance-pHmetry substantially contributes to the diagnosis of GERD. The examination

  3. Evidence-based policymaking: a critique.

    Science.gov (United States)

    Greenhalgh, Trisha; Russell, Jill

    2009-01-01

    The idea that policy should be based on best research evidence might appear to be self-evident. But a closer analysis reveals a number of problems and paradoxes inherent in the concept of "evidence-based policymaking." The current conflict over evidence-based policymaking parallels a long-standing "paradigm war" in social research between positivist, interpretivist, and critical approaches. This article draws from this debate in order to inform the discussions over the appropriateness of evidence- based policymaking and the related question of what is the nature of policymaking. The positivist, empiricist worldview that underpins the theory and practice of evidence-based medicine (EBM) fails to address key elements of the policymaking process. In particular, a narrowly "evidence-based" framing of policymaking is inherently unable to explore the complex, context-dependent, and value-laden way in which competing options are negotiated by individuals and interest groups. Sociolinguistic tools such as argumentation theory offer opportunities for developing richer theories about how policymaking happens. Such tools also have potential practical application in the policymaking process: by enhancing participants' awareness of their own values and those of others, the quality of the collective deliberation that lies at the heart of policymaking may itself improve.

  4. 从循证医学角度谈腹腔镜腹股沟疝修补术20年进展%Progression of laparoscopic inguinal hernia repair in 20 years:Evidence based medicine interpretation for IEHS Guideline

    Institute of Scientific and Technical Information of China (English)

    陈鑫; 李健文

    2014-01-01

    解读国际腔镜疝协会(IEHS)发布的《腹腔镜腹股沟疝治疗指南(2011版)》,可以看到从循证医学角度评价腹腔镜腹股沟疝修补术(LIHR)在最初20年中(1990-2009年)的一些主要变化和进展。术式的进展包括:腹腔内修补术(IPOM)目前不作为腹股沟疝的主流术式(B级建议);而经腹腹膜前修补术(TAPP)或全腹膜外修补术(TEP)均为可选术式,无证据显示孰优孰劣,具全麻禁忌证病人可选择区域性麻醉行TEP(B级建议)。技术的进展包括:补片尺寸至少为10 cm×15 cm(A级建议),更大的缺损可应用更大的补片(≥12 cm×17 cm)(D级建议);Ⅰ、Ⅱ型疝可不固定补片,如固定,采用医用胶可降低急慢性疼痛的风险(B级建议);Ⅲ型直疝建议固定补片,但不能降低补片的尺寸(D级建议)。材料学进展包括:轻量型补片(LWM)至少可减少术后3个月内与补片相关的不适感(B级建议)。%To interpret the Guidelines for Laparoscopic (TAPP) and Endoscopic (TEP) Treatment of Inguinal Hernia constituted by International Endohernia Society (IEHS) in 2011,and evaluate the improvement and progression of laparoscopic inguinal hernia repair (LIHR) in the first 20 years (1990-2009) in an evidence-based way. Progression in operation methods:IPOM is not recommended for main stream inguinal hernia repair at present (Grade B). Both TAPP and TEP are acceptable options for inguinal hernia repair,but there is insufficient data to allow conclusion to be made about relative effectiveness of TAPP compared with TEP. In selected patients having a contraindication for general anesthesia,TEP in region anesthesia can be done (Grade B). Progression in surgical technique: A mesh size of at least 10 cm × 15 cm is recommended (Grade A); For larger hernias,a bigger mesh (12cm×17cm or greater) can be used (Grade D);In TAPP/TEP technique,nonfixation could be

  5. Cable ampacity. A Finnish perspective

    Energy Technology Data Exchange (ETDEWEB)

    Millar, R.J.; Lehtonen, M.

    2006-07-01

    This report is primarily the practical application of a new method to calculate cable conductor temperatures in real time. A brief summary of various thermal parameter measurements in southern Finland is provided, an algorithm to compute cable temperatures in real time when both moisture migration and overall moisture content change are occurring is outlined, potential outcomes of extended loading are demonstrated, installation configurations are compared, steady-state and cyclic ratings are given for HV and MV installations, and emergency loading scenarios are evaluated. A more rational approach to cable rating in Finnish conditions is established. Conservative transient-based rating tends to give back the ampacity that might be lost due to worst possible environmental conditions for installed cables. Nevertheless, it is suggested that MV cables be derated by 20 % from their nominal catalogue ratings. orig.)

  6. Crime prevention: more evidence-based analysis.

    Science.gov (United States)

    Garrido Genovés, Vicente; Farrington, David P; Welsh, Brandon C

    2008-02-01

    This paper introduces a new section of Psicothema dedicated to the evidence-based approach to crime prevention. Along with an original sexual-offender-treatment programme implemented in Spain, this section presents four systematic reviews of important subjects in the criminological arena, such as sexual offender treatment, the well-known programme, the effectiveness of custodial versus non-custodial sanctions in reoffending and the fight against terrorism. We also highlight some of the focal points that scientists, practitioners and governments should take into account in order to support this evidence-based viewpoint of crime prevention.

  7. 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...

  8. Finnish Kalevala and Estonian Kalevipoeg / Jaan Puhvel

    Index Scriptorium Estoniae

    Puhvel, Jaan, 1932-

    2003-01-01

    Tõlgitud kogumikust: The world of the Kalevala : essays in celebration of the 150 year jubilee of the publication of the Finnish national epic / ed. Kai Laitinen. Los Angeles : UCLA Centre for the Study of Folklore & Mythology, 1987

  9. Finnish Kalevala and Estonian Kalevipoeg / Jaan Puhvel

    Index Scriptorium Estoniae

    Puhvel, Jaan, 1932-

    2003-01-01

    Tõlgitud kogumikust: The world of the Kalevala : essays in celebration of the 150 year jubilee of the publication of the Finnish national epic / ed. Kai Laitinen. Los Angeles : UCLA Centre for the Study of Folklore & Mythology, 1987

  10. EULAR evidence-based recommendations on the management of systemic glucocorticoid therapy in rheumatic diseases

    National Research Council Canada - National Science Library

    Hoes, J N; Jacobs, J W G; Boers, M; Boumpas, D; Buttgereit, F; Caeyers, N; Choy, E H; Cutolo, M; Da Silva, J A P; Esselens, G; Guillevin, L; Hafstrom, I; Kirwan, J R; Rovensky, J; Russell, A; Saag, K G; Svensson, B; Westhovens, R; Zeidler, H; Bijlsma, J W J

    2007-01-01

    ... on proper use of GCs. Hence, a EULAR task force on GCs, including a patient, was formed to develop evidence-based recommendations, to provide a tool for the better use and management of GC-therapy in rheumatic diseases. METHODS Endorsed by EULAR-ESCISIT, a multidisciplinary guideline development committee on GCs was formed, consisting of 20 experts in...

  11. Evidence-based Tool for Triggering School Closures during Influenza Outbreaks, Japan

    Science.gov (United States)

    Hoen, Anne Gatewood; Ozonoff, Al; Suzuki, Hiroshi; Tanabe, Naohito; Seki, Nao; Saito, Reiko; Brownstein, John S.

    2009-01-01

    Guidelines available to school administrators to support school closure decisions during influenza outbreaks are usually not evidence-based. Using empirical data on absentee rates of elementary school students in Japan, we developed a simple and practical algorithm for determining the optimal timing of school closures for control of influenza outbreaks. PMID:19891880

  12. Evidence-Based and Best Practice Addiction Treatment Resources: A Primer for Librarians.

    Science.gov (United States)

    Lacroix, Sheila I.

    2002-01-01

    Introduces concepts, such as evidence-based medicine and best practices, explores these concepts in terms of addiction treatment, discusses practice guidelines, offers suggestions to find and select science-based resources, and explores the librarian's or information specialist's role in the dissemination of this information. (LRW)

  13. EVIDENCE-BASED REVIEW OF TREATMENT OPTIONS FOR PATIENTS WITH GLOTTIC CANCER

    NARCIS (Netherlands)

    Hartl, Dana M.; Ferlito, Alfio; Brasnu, Daniel F.; Langendijk, Johannes A.; Rinaldo, Alessandra; Silver, Carl E.; Wolf, Gregory T.

    2011-01-01

    Evidence-based medicine integrates the best available data in decision making, with the goal of minimizing physicians' and patients' subjectivity. In 2006, the American Society of Clinical Oncology edited clinical practice guidelines for the use of larynx preservation strategies. The objective of th

  14. Marketing communication in Finnish industrial companies

    OpenAIRE

    Vuorio, Mikko

    2010-01-01

    Marketing communication has a significant role for profitable businesses in industrial markets, and its role is only expected to rise in the future. Especially, integrated marketing communication (IMC) and customer-oriented approach are universally regarded fundamental developments in the field of marketing. Secondly, Finnish companies’ marketing competences are commonly considered insufficient in general. The purpose of this study was to describe how Finnish industrial companies execute t...

  15. Marketing communication in Finnish industrial companies

    OpenAIRE

    2010-01-01

    Marketing communication has a significant role for profitable businesses in industrial markets, and its role is only expected to rise in the future. Especially, integrated marketing communication (IMC) and customer-oriented approach are universally regarded fundamental developments in the field of marketing. Secondly, Finnish companies’ marketing competences are commonly considered insufficient in general. The purpose of this study was to describe how Finnish industrial companies execute t...

  16. Knowledge, attitudes and use of the guidelines for the treatment of moderate to severe plaque psoriasis among Dutch dermatologists.

    NARCIS (Netherlands)

    Wakkee, M.; Lugtenberg, M.; Spuls, P.I.; Jong, E.M.G.J. de; Thio, H.B.; Westert, G.P.; Nijsten, T.

    2008-01-01

    BACKGROUND: In 2003, the Dutch psoriasis guidelines were among the first evidence-based medicine guidelines in dermatology. Although pivotal, the implementation of dermatological guidelines has not been assessed. OBJECTIVES: To evaluate various aspects that affect implementation of clinical guidelin

  17. Evidence-based practice within nutrition

    DEFF Research Database (Denmark)

    Laville, Martine; Segrestin, Berenice; Alligier, Maud

    2017-01-01

    BACKGROUND: Evidence-based clinical research poses special barriers in the field of nutrition. The present review summarises the main barriers to research in the field of nutrition that are not common to all randomised clinical trials or trials on rare diseases and highlights opportunities for im...

  18. Evidence Based Education Request Desk. EBE #359

    Science.gov (United States)

    Regional Educational Laboratory Southeast, 2008

    2008-01-01

    This Evidence Based Education (EBE) response describes characteristics of graduation coach initiatives in three states (Georgia, Alabama, and California). Regional Educational Laboratory (REL) Southeast has received over 19 requests for information on various initiatives, programs or research related to improving graduation rates. For example, the…

  19. Evidence Based Education Request Desk. EBE #555

    Science.gov (United States)

    Regional Educational Laboratory Southeast, 2009

    2009-01-01

    This Evidence Based Education (EBE) Request seeks to provide an overview of recent research regarding school improvement and reform with special concentration on turning around chronically low-performing schools. The response is divided into four main sections: Research on Effective Methods for Turning Around Low-Performing Schools, Frameworks for…

  20. Evidence Based Education Request Desk. EBE #510

    Science.gov (United States)

    Regional Educational Laboratory Southeast, 2009

    2009-01-01

    This Evidence Based Education (EBE) request focused on research-supported vocabulary interventions for middle elementary students. Limited vocabulary is an important factor in underachievement of children in disadvantaged homes. Children with larger vocabularies find reading easier, read more widely, and do better in school (Lubliner & Smetana,…

  1. Evidence Based Education Request Desk. EBE #741

    Science.gov (United States)

    Regional Educational Laboratory Southeast, 2010

    2010-01-01

    This Evidence Based Education (EBE) request asks for information relating to funding for virtual schools. The EBE Request Desk was asked to provide a scan of states for information on how they fund virtual schools and what the current funding levels are (most current year for which such data is available). This paper provides answers to this…

  2. Evidence Based Education Request Desk. EBE #798

    Science.gov (United States)

    Regional Educational Laboratory Southeast, 2011

    2011-01-01

    Evidence Based Education (EBE) #555 was in response to the request "Is there any new compelling research for turning around low-performing schools?" The articles included in that document are on target, but include articles through 2009. This EBE Request seeks to provide an updated review of recent research (2009-present) regarding school…

  3. Improving evidence-based general practice

    NARCIS (Netherlands)

    Kortekaas, MF

    2016-01-01

    This thesis provides knowledge on how to improve the practice of evidence-based medicine (EBM) by general practitioners (GPs) and GP trainees. EBM is defined as the integration of clinical expertise, patient values and the best available clinical evidence in daily clinical practice. We describe the

  4. Evidence-based diagnosis in patch testing

    NARCIS (Netherlands)

    van der Valk, PGM; Devos, SA; Coenraads, PJ

    2003-01-01

    Evidence-based medicine (EBM) is defined as the integration of the best research evidence with clinical expertise and patient values. Based on the principles of EBM, we can conclude that patch testing is cost-effective only if patients are selected on the basis of a clear-cut clinical suspicion of c

  5. Evidence-Based Classroom Behaviour Management Strategies

    Science.gov (United States)

    Parsonson, Barry S.

    2012-01-01

    This paper reviews a range of evidence-based strategies for application by teachers to reduce disruptive and challenging behaviours in their classrooms. These include a number of antecedent strategies intended to help minimise the emergence of problematic behaviours and a range of those which provide positive consequences for appropriate student…

  6. Patient autonomy in evidence-based dentistry.

    Science.gov (United States)

    Ritwik, Priyanshi

    2014-01-01

    Evidence-based dentistry is the judicious integration of scientific information relating to the patient's oral health and medical condition with the dentist's clinical expertise and the patient's own treatment needs and preferences. In this triad of factors, we (the dentists) are least likely to be formally trained in recognizing our patient's preferences. Do we understand what shapes these preferences?

  7. Evidence-based practice in fluency disorders

    National Research Council Canada - National Science Library

    Kully, Deborah; Langevin, Marilyn

    2005-01-01

    ... individual who seeks our help. A widely used definition of EBP is offered by David Sackett and colleagues: "Evidence-based medicine is the integration of best research evidence with clinical expertise and patient values" (Sackett et al, 2000, p.1). The three elements of this definition are reflected in Christine Dollaghan's assertion that ...

  8. Are complementary medicine practitioners implementing evidence based practice?

    Science.gov (United States)

    Leach, Matthew J; Gillham, David

    2011-06-01

    Over the past few decades the health professions have witnessed increasing pressure to shift from a culture of delivering care based on tradition and intuition, to a situation where decisions are guided and justified by the best available evidence. While there are concerns that many complementary and alternative medicine (CAM) practitioners may be cautious about embracing such an approach, no studies to date have effectively tested this assumption. To identify the skills, attitude, training and use of evidence-based practice (EBP) amongst CAM practitioners. Descriptive survey, using the evidence-based practice attitude and utilisation survey (EBASE). Randomly selected nationwide sample of system-based, non-medically qualified CAM practitioners practicing in a clinical capacity within Australia. Practitioner skill, attitude, training and use of EBP. Of the 351 questionnaires successfully dispatched, 126 were returned (36%). Most practitioners believed EBP was useful (92%) and necessary (73%) in CAM practice. While the majority of clinicians (>74%) reported participation in EBP activities, albeit infrequently, only a small to moderate proportion of decisions were based on evidence from clinical trials, with most practitioners relying on traditional knowledge, textbooks and clinical practice guidelines. Lack of available evidence, time, industry support and skills were perceived as barriers to EBP uptake. While the small response rate limits the generalisability of these findings, the sample was considered representative of Australian CAM practitioners. What this study shows is that even though CAM practitioners may be supportive of EBP, education and training is needed to further improve clinician understanding and application of evidence-based practice. Copyright © 2011 Elsevier Ltd. All rights reserved.

  9. Librarian contributions to clinical practice guidelines.

    Science.gov (United States)

    Cruse, Peggy; Protzko, Shandra

    2014-01-01

    Librarians have become more involved in developing high quality systematic reviews. Evidence-based practice guidelines are an extension of systematic reviews and offer another significant area for librarian involvement. This column highlights opportunities and challenges for the librarian working on guideline panels and provides practical considerations for meaningful contributions to the guideline creation process.

  10. Evidence-based medicine and quality of care.

    Science.gov (United States)

    Dickenson, Donna; Vineis, Paolo

    2002-01-01

    In this paper we set out to examine the arguments for and against the claim that Evidence-Based Medicine (EBM) will improve the quality of care. In particular, we examine the following issues: 1. Are there hidden ethical assumptions in the methodology of EBM? 2. Is there a tension between the duty of care and EBM? 3. How can patient preferences be incorporated into quality guidelines and effectiveness studies? 4. Is there a tension between the quality of a particular intervention and overall quality of care? 5. Are certain branches of medicine and patient groups innately or prima facie disadvantaged by a shift to EBM? In addition we consider a case study in the ethics of EBM, on a clinical trial concerning the collection of umbilical cord blood in utero and ex utero, during or after labour in childbirth.

  11. Palliative radiotherapy in head and neck cancers: Evidence based review

    Directory of Open Access Journals (Sweden)

    Talapatra Kaustav

    2006-01-01

    Full Text Available Squamous cell carcinoma of head and neck (SCCHN is one of the commonest cancers seen in India, constituting up to 25% of their overall cancer burden. Advanced SCCHN is a bad disease with a poor prognosis and patients usually die of uncontrolled loco-regional disease. Curative intent management of loco-regionally advanced SCCHN has become more evidence-based with active clinical research in the form of large prospective randomized controlled trials and meta-analyses. However, little has been written about palliative radiotherapy (PRT in head and neck cancers. It is widely recognized that PRT provides effective palliation and improved quality-of-life in advanced incurable malignancies. It is in this context that this study proposes to review the existing literature on palliative radiotherapy in advanced incurable SCCHN to help formulate consensus guidelines and recommendations.

  12. A systematic review of the evidence base for Schema Therapy.

    Science.gov (United States)

    Masley, Samantha A; Gillanders, David T; Simpson, Susan G; Taylor, Morag A

    2012-01-01

    Schema Therapy is becoming an increasingly popular psychological model for working with individuals who have a variety of mental health and personality difficulties. The aim of this review is to look at the current evidence base for Schema Therapy and highlight directions for further research. A systematic search of the literature was conducted up until January 2011. All studies that had clinically tested the efficacy of Schema Therapy as described by Jeffrey Young (1994 and 2003) were considered. These studies underwent detailed quality assessments based on Scottish Intercollegiate Guidelines Network (SIGN-50) culminating in 12 studies being included in the review. The culminative message (both from the popularity of this model and the medium-to-large effect sizes) is of a theory that has already demonstrated clinically effective outcomes in a small number of studies and that would benefit from ongoing research and development with complex client groups. It is imperative that psychological practice be guided by high-quality research that demonstrates efficacious, evidence-based interventions. It is therefore recommended that researchers and clinicians working with Schema Therapy seek to build on these positive outcomes and further demonstrate the clinical effectiveness of this model through ongoing research.

  13. 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.

  14. [Principles of evidence-based medicine applied to dentistry].

    Science.gov (United States)

    Stegenga, B; Dijkstra, P U

    2007-04-01

    During the past decades, major methodological developments have taken place with regard to the clinical domains of etiology, diagnosis, prognosis and therapy. As a result scientific journals set increasingly high standards for publications and the research designs on which they are based. The development of evidence based guidelines for clinical practice in oral health care has increased as well. An evidence based programme for clinical practice consists of a number of steps, the first of which is a search strategy which will lead to the identification of relevant publications, based on an answerable clinical question. After a critical evaluation of such publications according to their validity, reliability and applicability, the evidence can be judged. This evidence is subsequently incorporated in the formulation of an answer to the clinical question and its application to the individual patient. As a result of social developments, the increasing assertiveness of the patient as a clinical consumer and economizing in recent years on the part of (the Dutch) government and insurance companies, the impact of evidence derived from medical and oral health literature on clinical practice has increased enormously. It is, nevertheless, the clinician who makes the judgements, takes the decisions and accepts responsibility for them, on the basis of the available evidence and the quality of that evidence, the preferences and values of the patient, the specific clinical situation and social developments.

  15. [Severe pre-eclampsia. An evidence-based practice proposal].

    Science.gov (United States)

    Errando, C L; Pérez-Caballero, P; Verdeguer-Ribes, S; Vila-Montañés, M

    2013-01-01

    There are several treatment proposals for the obstetric patient with pre-eclampsia, but there is limited evidence on the adequacy of standard treatment. International healthcare organisations recommend that hospitals or anaesthesia departments have written guidelines, protocols or recommendations for dealing with common or severe situations. We propose evidence-based recommendations for the treatment of pre-eclampsia. A literature review was performed using several sources, bibliography databases, recommendations made by specialist societies, and reviews. Four anaesthesiologists reviewed the references selected, in order to design clinical questions (these were obtained from recent pre-eclampsia review articles). Consensus of at least 3 out of 4 experts was required. The Oxford criteria for evidence were chosen to classify the scientific articles, and the Jadad score was applied to the final articles selected. A total of 50 clinical questions were designed and answered. These were classified into: general questions, influence of the type of delivery, pre-anaesthesia evaluation, peripartum treatment (including analgesia and anaesthesia), eclampsia, post-delivery period, and intensive care and transport. Most of the responses showed low scientific evidence. Evidence-based recommendations for severe pre-eclampsia treatment were provided with special emphasis on the anaesthesiologist point of view. Copyright © 2012 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Published by Elsevier España. All rights reserved.

  16. Evidence-based Comprehensive Approach to Forearm Arterial Laceration

    Directory of Open Access Journals (Sweden)

    Janice N. Thai

    2015-12-01

    Full Text Available Introduction: Penetrating injury to the forearm may cause an isolated radial or ulnar artery injury, or a complex injury involving other structures including veins, tendons and nerves. The management of forearm laceration with arterial injury involves both operative and nonoperative strategies. An evolution in management has emerged especially at urban trauma centers, where the multidisciplinary resource of trauma and hand subspecialties may invoke controversy pertaining to the optimal management of such injuries. The objective of this review was to provide an evidence-based, systematic, operative and nonoperative approach to the management of isolated and complex forearm lacerations. A comprehensive search of MedLine, Cochrane Library, Embase and the National Guideline Clearinghouse did not yield evidence-based management guidelines for forearm arterial laceration injury. No professional or societal consensus guidelines or best practice guidelines exist to our knowledge. Discussion: The optimal methods for achieving hemostasis are by a combination approach utilizing direct digital pressure, temporary tourniquet pressure, compressive dressings followed by wound closure. While surgical hemostasis may provide an expedited route for control of hemorrhage, this aggressive approach is often not needed (with a few exceptions to achieve hemostasis for most forearm lacerations. Conservative methods mentioned above will attain the same result. Further, routine emergent or urgent operative exploration of forearm laceration injuries are not warranted and not cost-beneficial. It has been widely accepted with ample evidence in the literature that neither injury to forearm artery, nerve or tendon requires immediate surgical repair. Attention should be directed instead to control of bleeding, and perform a complete physical examination of the hand to document the presence or absence of other associated injuries. Critical ischemia will require expeditious

  17. Evidence-based evaluation of therapeutic measures for sleep disorders

    Directory of Open Access Journals (Sweden)

    LI Juan

    2013-05-01

    Full Text Available Objective To evaluate the therapeutic efficacy and side effects of various treatment for sleep disorders in order to provide the best therapeutic regimen for the evidence-based treatment of sleep disorders. Methods Sleep disorder, insomnia, restless legs syndrome or RLS, obstructive sleep apnea or OSA, narcolepsy, REM behaviour disorder or RBD, treatment or therapy were used as retrieval words. Cochrane Library, MEDLINE, ScienceDirect were used for retrieval, and manual searching was also used. Related clinical guidelines, systematic reviews, randomized controlled clinical trials, retrospective case analysis, case-observation studies and reviews were collected and evaluated by Jadad Scale. Results Forty related articles were selected as following: 6 clinical guidelines, 12 systematic reviews, 5 randomized controlled trials, 2 retrospective case analysis, 1 case-observation study and 14 reviews. Thirty-three were of high quality, while 7 were of low quality with score. According to the evaluation of therapeutic efficacy and side effects of various therapies, it is suggested as following: 1 insomnia is the most common in sleep disorders; the treatment methods of insomnia mainly include drug therapy and cognitive behavioral treatment (CBT; the two kinds of therapy have their own advantages and disadvantages, and the combination therapy of drugs and CBT is the best treatment plan. 2 The first-line treatment of primary RLS is dopamine agonists and anti-seizure drugs; however, the treatment of secondary RLS is mainly etiologic treatment. 3 The main treatments of OSAS are nasal continuous positive airway pressure (nCPAP, oral orthotics and surgery, and nCPAP is the first-line treatments. 4 The medication of narcolepsy is mainly modafinil, hydroxy butyric acid sodium and antidepressants, and the specific choosingshould accord to clinical classifications. 5 The main treatments of RBD include general treatments such as avoiding triggers, insuring the

  18. Surgical treatment of hepatocellular carcinoma:Evidence-based outcomes

    Institute of Scientific and Technical Information of China (English)

    Shintaro Yamazaki; Tadatoshi Takayama

    2008-01-01

    Surgeons may be severely criticized from the perspective of evidence-based medicine because the majority of surgical publications appear not to be convincing.In the top nine surgical journals in 1996,half of the 175publications refer to pilot studies lacking a control group,18% to animal experiments,and only 5% to randomized controlled trials (RCT).There are five levels of clinical evidence:level 1 (randomized controlled trial),level 2 (prospective concurrent cohort study),level 3 (retrospective historical cohort study),level 4(pre-post study),and level 5 (case report).Recently,a Japanese evidence-based guideline for the surgical treatment of hepatocellular carcinoma (HCC) was made by a committee (Chairman,Professor Makuuchi and five members).We searched the literature using the Medline Dialog System with four keywords:HCC,surgery,English papers,in the last 20 years.A total of 915 publications were identified systematically reviewed.At the first selection (in which surgery-dominant papers were Selected),478 papers survived.In the second selection (clearly concluded papers),181 papers survived.In the final selection (clinically significant papers),100 papers survived.The evidence level of the 100 surviving papers is shown here:level-1 papers (13%),level-2 papers (11%),level-3 papers (52%),and level-4 papers (24%);therefore,there were 24% prospective papers and 76%retrospective papers.Here,we present a part of the guideline on the five main surgical issues:indication to operation,operative procedure,peri-operative care,prognostic factor,and post-operative adjuvant therapy.

  19. [Diagnosis "risk of pneumonia" evidence-based evaluation and comparison of nursing interventions].

    Science.gov (United States)

    Haslinger-Baumann, Elisabeth; Burns, Evelin

    2007-12-01

    In home nursing care, professionally qualified nurses make decisions on their own which must be based on the latest scientific research. The goal of this systematic literature review was to examine if the interventions of the diagnosis "Risk of Pneumonia" as used by a home care service provider in Austria are based on scientific evidence. Based on the research question "Can the interventions of the diagnosis 'risk of pneumonia' be found in the scientific nursing literature?", four evidence-based guidelines from various databases and institutes were identified and evaluated using a standardized checklist. The result of the analysis is that the majority of the Nursing diagnosis interventions can be found in the guidelines. It is also recommended in the guidelines to advise and support clients to stop smoking and inoculate against influenza/pneumonia. Similarly, assessment tools should be used to estimate the severity of pneumonia. The intervention of oral hygiene as a prophylactic intervention against pneumonia should get particular attention.

  20. The religion of evidence-based practice

    DEFF Research Database (Denmark)

    Wigram, Tony; Gold, Christian

    2012-01-01

    , and discusses autism spectrum disorders and EBP. The chapter concludes that, based on last sixty years of the development of music therapy as a recognized and relevant intervention, there is no doubt that the honeymoon period is over, and EBP is here to stay. Despite examples of attrition in music therapy......This chapter begins by outlining the challenges of preparing a chapter on evidence-based practice (EBP) to underpin the use of music as a therapeutic tool in treatment, in the overall frame of music, health, and wellbeing. It then reviews the terminology of EBP and evidence-based medicine...... practice as health, education, and social services tighten their belts and the demand on their resources grows, there is increasing interest in the value of music for health and wellbeing, despite even less ‘hard’ evidence that it is effective against illness and disability....

  1. Professionalism and evidence-based practice

    DEFF Research Database (Denmark)

    Rasmussen, Palle

    2015-01-01

    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......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...

  2. A Corpus for Evidence Based Medicine Summarisation

    Directory of Open Access Journals (Sweden)

    Diego Mollá Aliod

    2012-09-01

    Full Text Available Background Automated text summarisers that find the best clinical evidence reported in collections of medical literature are of potential benefit for the practice of Evidence Based Medicine (EBM. Research and development of text summarisers for EBM, however, is impeded by the lack of corpora to train and test such systems. Aims To produce a corpus for research in EBM summarisation. Method We sourced the “Clinical Inquiries” section of the Journal of Family Practice (JFP and obtained a sizeable sample of questions and evidence based summaries. We further processed the summaries by combining automated techniques, human annotations, and crowdsourcing techniques to identify the PubMed IDs of the references. Results The corpus has 456 questions, 1,396 answer components, 3,036 answer justifications, and 2,908 references. Conclusion The corpus is now available for the research community at http://sourceforge.net/projects/ebmsumcorpus.

  3. Creative teaching an evidence-based approach

    CERN Document Server

    Sale, Dennis

    2015-01-01

    This book contains an evidence-based pedagogic guide to enable any motivated teaching/training professional to be able to teach effectively and creatively. It firstly summarises the extensive research field on human psychological functioning relating to learning and how this can be fully utilised in the design and facilitation of quality learning experiences. It then demonstrates what creativity actually 'looks like' in terms of teaching practices, modelling the underpinning processes of creative learning design and how to apply these in lesson planning. The book, having established an evidence-based and pedagogically driven approach to creative learning design, extensively focuses on key challenges facing teaching professionals today. These include utilising information technologies in blended learning formats, differentiating instruction, and developing self-directed learners who can think well. The main purpose of the book is to demystify what it means to teach creatively, explicitly demonstrating the pr...

  4. Evidence Based Education: un quadro storico

    Directory of Open Access Journals (Sweden)

    Giuliano Vivanet

    2013-08-01

    Full Text Available Nel corso dell’ultimo decennio, nel pensiero pedagogico anglosassone, si è affermata una cultura dell’evidenza cui ci si riferisce con l’espressione “evidence based education” (EBE. Secondo tale prospettiva, le decisioni in ambito educativo dovrebbero essere assunte sulla base delle conoscenze che la ricerca empirica offre in merito alla minore o maggiore efficacia delle differenti opzioni didattiche. Si tratta di un approccio (denominato “evidence based practice” che ha origine in ambito medico e che in seguito ha trovato applicazione in differenti domini delle scienze sociali. L’autore presenta un quadro introduttivo all’EBE, dando conto delle sue origini e dei differenti significati di cui è portatrice.

  5. Evidence-based equine dentistry: preventive medicine.

    Science.gov (United States)

    Carmalt, James L

    2007-08-01

    Dental problems are some of the most common reasons for a horse to be presented to an equine veterinarian. Despite the importance of anecdotal evidence as a starting point, the science of equine dentistry (especially prophylactic dentistry) has remained poorly supported by evidence-based approaches to diagnosis and treatment. In the 21st century, veterinarians have an ethical responsibility to promote and use the results of evidence-based research and not propagate statements attesting to the purported benefits of intervention without supporting research. Consider also that society is becoming more litigious and therefore is basing treatment plans and advice on published research, which protects the profession from legal challenges concerning our professional conduct. This article reviews the current published evidence concerning the role of equine dentistry in feed digestibility and performance.

  6. The fallacy of evidence based policy

    CERN Document Server

    Saltelli, Andrea

    2016-01-01

    The use of science for policy is at the core of a perfect storm generated by the insurgence of several concurrent crises: of science, of trust, of sustainability. The modern positivistic model of science for policy, known as evidence based policy, is based on dramatic simplifications and compressions of available perceptions of the state of affairs and possible explanations (hypocognition). This model can result in flawed prescriptions. The flaws become more evident when dealing with complex issues characterized by concomitant uncertainties in the normative, descriptive and ethical domains. In this situation evidence-based policy may concur to the fragility of the social system. Science plays an important role in reducing the feeling of vulnerability of humans by projecting a promise of protection against uncertainties. In many applications quantitative science is used to remove uncertainty by transforming it into probability, so that mathematical modelling can play the ritual role of haruspices. This epistem...

  7. Evidence-based Management of Glaucoma

    Institute of Scientific and Technical Information of China (English)

    Yangfan Yang; Minbin Yu

    2005-01-01

    Purpose: The evidence-based medicine (EBM) is a new medical mode that is completely different from traditional experience-based medicine. The core of EBM is that decision-making during clinical practices must be based on objective research results.With the rapid development of modern ophthalmology, some former viewpoints according to experience-based medicine face challenges. Evidence-based ophthalmology (EBO) is imperative under the situation. Glaucoma, as a disease resulting in blindness, which can not be cured by operation, is thought more and more of by medical management officials and doctors. One challenge for ophthalmologists entering the 21st century will be to make clinical decisions based on valid information or evidence rather than intuition, hearsay, or peer practice. How can we do? Here reviews the application of EBM in medical management of glaucoma since EBM' s naissance and give a reference.

  8. Evidence-Based Dentistry: What's New?

    OpenAIRE

    A. Ballini, S. Capodiferro, M. Toia, S. Cantore, G. Favia, G. De Frenza, F.R. Grassi

    2007-01-01

    The importance of evidence for every branch of medicine in teaching in order to orient the practitioners among the great amount of most actual scientific information's, and to support clinical decisions, is well established in health care, including dentistry. The practice of evidence-based medicine is a process of lifelong, self-directed, problem-based learning which leads to the need for clinically important information about diagnosis, prognosis, therapy and other clinical and health care ...

  9. Evidence-based practice of periodontics.

    Science.gov (United States)

    Cobb, Charles M; MacNeill, Simon R; Satheesh, Keerthana

    2010-01-01

    Evidence-based practice involves complex and conscientious decision making based not only on the available evidence but also on patient characteristics, situations, and preferences. It recognizes that care is individualized and ever-changing and involves uncertainties and probabilities. The specialty of periodontics has abundant high-level evidence upon which treatment decisions can be determined. This paper offers a brief commentary and overview of the available evidence commonly used in the private practice of periodontics.

  10. Evidence-based pathology: umbilical cord coiling.

    Science.gov (United States)

    Khong, T Y

    2010-12-01

    The generation of a pathology test result must be based on criteria that are proven to be acceptably reproducible and clinically relevant to be evidence-based. This review de-constructs the umbilical cord coiling index to illustrate how it can stray from being evidence-based. Publications related to umbilical cord coiling were retrieved and analysed with regard to how the umbilical coiling index was calculated, abnormal coiling was defined and reference ranges were constructed. Errors and other influences that can occur with the measurement of the length of the umbilical cord or of the number of coils can compromise the generation of the coiling index. Definitions of abnormal coiling are not consistent in the literature. Reference ranges defining hypocoiling or hypercoiling have not taken those potential errors or the possible effect of gestational age into account. Even the way numerical test results in anatomical pathology are generated, as illustrated by the umbilical coiling index, warrants a critical analysis into its evidence base to ensure that they are reproducible or free from errors.

  11. Evidence-based Medicine in Animal Reproduction.

    Science.gov (United States)

    Arlt, S P; Heuwieser, W

    2014-09-01

    With new knowledge being generated and published daily, the importance of evidence-based approaches in veterinary medicine is obvious. Clinicians must stay current or risk making poor decisions that clients may challenge. Especially in animal reproduction, several new substances and procedures to diagnose or treat reproductive disorders have been introduced in the last years. On the other hand, a closer look at the quality of published literature on animal reproduction reveals major deficits in methodology and reporting of many clinical trials. We strongly recommend systematically assessing the quality of scientific information when reading journal papers before using the given information in practice. The aim of evidence-based medicine (EBM) is to base the decisions in the practice of medicine on valid, clinically relevant research data. Therefore, we suggest that students should become familiar with the concepts of evidence-based veterinary medicine (EBVM) at the beginning of their veterinary education. Concepts and supporting tools such as checklists for literature assessment have been developed and validated. The purpose of this article is to review and discuss the importance of incorporating EBVM in animal reproduction. The need for further research that produces strong evidence in different fields of animal reproduction and better reporting of relevant study information is obvious.

  12. 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

  13. Rural Doctors' Views on and Experiences with Evidence-Based Medicine: The FrEEDoM Qualitative Study.

    Science.gov (United States)

    Hisham, Ranita; Liew, Su May; Ng, Chirk Jenn; Mohd Nor, Kamaliah; Osman, Iskandar Firzada; Ho, Gah Juan; Hamzah, Nurazira; Glasziou, Paul

    2016-01-01

    Evidence-based medicine is the integration of individual clinical expertise, best external evidence and patient values which was introduced more than two decades ago. Yet, primary care physicians in Malaysia face unique barriers in accessing scientific literature and applying it to their clinical practice. This study aimed to explore the views and experiences of rural doctors' about evidence-based medicine in their daily clinical practice in a rural primary care setting. Qualitative methodology was used. The interviews were conducted in June 2013 in two rural health clinics in Malaysia. The participants were recruited using purposive sampling. Four focus group discussions with 15 medical officers and three individual in-depth interviews with family medicine specialists were carried out. All interviews were conducted using a topic guide and were audio-recorded, transcribed verbatim, checked and analyzed using a thematic approach. Key themes identified were: (1) doctors viewed evidence-based medicine mainly as statistics, research and guidelines, (2) reactions to evidence-based medicine were largely negative, (3) doctors relied on specialists, peers, guidelines and non-evidence based internet sources for information, (4) information sources were accessed using novel methods such as mobile applications and (5) there are several barriers to evidence-based practice, including doctor-, evidence-based medicine-, patient- and system-related factors. These included inadequacies in knowledge, attitude, management support, time and access to evidence-based information sources. Participants recommended the use of online services to support evidence-based practice in the rural settings. The level of evidence-based practice is low in the rural setting due to poor awareness, knowledge, attitude and resources. Doctors use non-evidence based sources and access them through new methods such as messaging applications. Further research is recommended to develop and evaluate

  14. Evidence-based treatment strategies in idiopathic pulmonary fibrosis

    Directory of Open Access Journals (Sweden)

    Jürgen Behr

    2013-06-01

    Full Text Available Recently updated guidelines have provided revised recommendations, based on the GRADE criteria, for the diagnosis and pharmacological and non-pharmacological management of patients with idiopathic pulmonary fibrosis (IPF. Cochrane reviews are also a highly respected and reliable source of evidence-based information that identify and analyse all available data of overall treatment effects from appropriate studies. A recent update of one Cochrane review failed to identify any new evidence supporting the use of corticosteroids in IPF. Another review of data from 15 randomised controlled studies of non-steroid agents for the treatment of IPF identified two trials of interferon-γ-1b suitable for analysis. However, the pooled analysis revealed no treatment effect in terms of survival. A further meta-analysis of three phase III studies of pirfenidone treatment in IPF patients suggested a significant increase in progression-free survival. The interpretation of recent international and national European guideline updates and treatment recommendations, available clinical data from published and ongoing trials investigating potential pharmacological agents, and the individual patient's preferences, must be considered in the clinical management of this disease.

  15. Evidence based medicine in physical medicine and rehabilitation (German version

    Directory of Open Access Journals (Sweden)

    Helmut Kern

    2013-12-01

    Full Text Available In the last twenty years the term “Evidence Based Medicine (EBM” has been increasingly applied in all areas of medicine and is often used for decision-making in the medical and public health sector. It is also used to verify the significance and/or the effectiveness of different therapies. The original definition of EBM rests on the following three pillars: the physician’s individual expertise, the patient’s needs and the best external evidence. Today, however, the term EBM is often wrongly used as a synonym for best external evidence, without taking into consideration the other two pillars of the model which was created by Gordon Guyatt, David Sackett and Archibald Cochrane. This problem becomes even greater the more social insurance institutions and politicians use external evidence alone as the main guideline for financing therapies and therapy guidelines in physical medicine and general rehabilitation without taking into account the physician’s expertise and the patient’s needs.The wrong interpretation of EBM can lead to the following problems: well established clinical therapies are either questioned or not granted and are therefore withheld from patients (for example physical pain management. An absence of evidence for individual therapy methods does not prove their ineffectiveness! In this short statement the significance of EBM in Physical Medicine and general rehabilitation will be analysed and discussed.

  16. FINNISH-ENGLISH PHONETICS AND PHONOLOGY

    Directory of Open Access Journals (Sweden)

    Hannele Dufva

    2001-06-01

    Full Text Available This paper first gives a summary of the theoretical approaches to the role of phonetics and phonology in language learning and teaching as developed by the Finnish-English Cross-Language Project at the University of Jyvtkkyla. In the Finnish project, the analysis was extended over the the chains of connected speech to deal with all the phenomena that give them their rhythm in speech. The project did not find it sufficient to produce simple one-to-one equations between the best structural descriptions of the two languages because many of learners' difficulties in pronunciation cannot be assigned to phoneme paradigms. The paper also includes a survey of the findings of Finnish-English contrastive phonetics and phonology, and a description of potential sources of difficulties in Finns' pronunciation of English.

  17. [CPR--guidelines 2000. New international guidelines for cardiopulmonary resuscitation].

    Science.gov (United States)

    Gervais, H W

    2001-03-01

    The "Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. An International Consensus an Science" are the first true international CPR guidelines in the history of resuscitation medicine. Experts from major international resuscitation organizations (International Liaison Committee on Resuscitation, ILCOR) achieved a consensus of recommendations which had to pass a rigorous review procedure applying the tools of evidence-based medicine: all proposed guidelines or guideline changes had to be based on critically appraised pieces of evidence which had to be integrated into a final class of recommendations. The most important changes compared to previous recommendations from either the European Resuscitation Council or the American Heart Association are presented and commented upon.

  18. Evidence-based paediatric surgical oncology.

    Science.gov (United States)

    Losty, Paul D

    2016-10-01

    Surgeons play a pivotal role in the decision-making and multidisciplinary management of childhood solid tumours.(1) Evidence-based medicine-"aims to optimise decision making by emphasising on the use of best evidence from well-designed conducted research." This article offers a brief overview in an effort to demonstrate how a selection of well-conducted, recently published studies can help address some topical and controversial themes in paediatric surgical oncology practice. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. Evidence-Based Medicine: Breast Augmentation.

    Science.gov (United States)

    Schwartz, Michael R

    2017-07-01

    After reading this article, the participant should be able to: 1. Understand the key decisions in patient evaluation for cosmetic breast augmentation. 2. Cite key decisions in preoperative planning. 3. Discuss the risks and complications, and key patient education points in breast augmentation. Breast augmentation remains one of the most popular procedures in plastic surgery. The integral information necessary for proper patient selection, preoperative assessment, and surgical approaches are discussed. Current data regarding long term safety and complications are presented to guide the plastic surgeon to an evidence-based approach to the patient seeking breast enhancement to obtain optimal results.

  20. Theory- and evidence-based Intervention

    DEFF Research Database (Denmark)

    Nissen, Poul

    2011-01-01

    In this paper, a model for assessment and intervention is presented. This model explains how to perform theory- and evidence-based as well as practice-based assessment and intervention. The assessment model applies a holistic approach to treatment planning which includes recognition...... of the influence of community, school, peers, famely and the functional and structural domains of personality at the behavioural, psenomenological, intra-psychic and biophysical level in a dialectical process. One important aspect of the theoretical basis for presentation of this model is that the child...

  1. Managing and reviewing evidence-based changes.

    Science.gov (United States)

    Carter, Helen; Price, Lynda

    Nurses lead many projects to manage change aimed at improving patient safety and care. This two-part series offers practical guidance on how to bring about an evidence-based change in practice, and how to demonstrate the success, or otherwise, of that change. Part 2 is concerned with discovering why the practice is falling short, how to implement improvements and measure the effect of the changes. It also highlights ways in which nurses can use their work as part of the revalidation process.

  2. Theory- and evidence-based Intervention

    DEFF Research Database (Denmark)

    Nissen, Poul

    2011-01-01

    In this paper, a model for assessment and intervention is presented. This model explains how to perform theory- and evidence-based as well as practice-based assessment and intervention. The assessment model applies a holistic approach to treatment planning which includes recognition...... of the influence of community, school, peers, famely and the functional and structural domains of personality at the behavioural, psenomenological, intra-psychic and biophysical level in a dialectical process. One important aspect of the theoretical basis for presentation of this model is that the child...

  3. Observation, Sherlock Holmes, and Evidence Based Medicine.

    Science.gov (United States)

    Osborn, John

    2002-01-01

    Sir Arthur Conan Doyle, the creator of the fictional detective Sherlock Holmes, studied medicine at the University of Edinburgh between 1876 and 1881 under Doctor Joseph Bell who emphasised in his teaching the importance of observation, deduction and evidence. Sherlock Holmes was modelled on Joseph Bell. The modern notions of Evidence Based Medicine (EBM) are not new. A very brief indication of some of the history of EBM is presented including a discussion of the important and usually overlooked contribution of statisticians to the Popperian philosophy of EBM.

  4. Prevalence of asthma in Finnish young men.

    OpenAIRE

    Haahtela, T; Lindholm, H; Björkstén, F; Koskenvuo, K; Laitinen, L A

    1990-01-01

    OBJECTIVE--To determine the prevalence of asthma in cohorts of Finnish young men in the period 1926-89. DESIGN--A retrospective analysis using reports and statistics of Finnish defence forces. SETTING--Call up examinations of candidates for military conscription and examination of conscripts discharged because of poor health. SUBJECTS--Roughly 900,000 men--that is, 98% of men of conscription age--examined in 1966-89 and a proportional but unknown number examined in 1926-61. MAIN OUTCOME MEASU...

  5. Care Coordination From a Strengths Perspective: A Practice-Based Evidence Evaluation of Evidence-Based Practice.

    Science.gov (United States)

    Monsen, Karen A; Vanderboom, Catherine E; Olson, Kirstie S; Larson, Mary E; Holland, Diane E

    2017-02-01

    It is critical to accurately represent strengths interventions to improve data and enable intervention effectiveness research from a strengths perspective. However, it is challenging to understand strengths interventions from the multiple perspectives of computerized knowledge representation, evidence-based practice guidelines, and practice-based evidence narratives. Intervention phrases abstracted from nurse care coordinator practice narratives described strengths interventions with community-dwelling elders. This project aims were to (a) compare nurse care coordinator use of evidence-based interventions as described in the two guidelines (what to do and how to do it), (b) analyze nurse care coordinator intervention tailoring (individualized care), and (c) evaluate the usefulness of the Omaha System for comparison of narrative phrases to evidence-based guidelines. Phrases from expert nurse care coordinators were mapped to the Omaha System for comparison with the guidelines interventions and were analyzed using descriptive statistics. Venn diagrams were used to visually depict intervention overlap between the guidelines and the phrases. Empirical evaluation of 66 intervention phrases mapped to 14 problems using 3 category terms and 19 target terms showed alignment between guidelines and the phrases, with the most overlap across two guidelines and the phrases in categories, and the most diversity in care descriptions. These findings demonstrate the value in having both standardized guidelines and expert clinicians who see the whole person and can synthesize and apply guidelines in tailored ways. There is potential to create a feedback loop between practice-based evidence and evidence-based practice by expanding this approach to use of practice-generated Omaha System data as practice-based evidence. Further research is needed to refine and advance the use of these methods with additional practices and guidelines.

  6. [Acupressure and Evidence-Based Nursing].

    Science.gov (United States)

    Chen, Li-Li; Lin, Jun-Dai

    2015-12-01

    Acupressure is a traditional Chinese medicine approach to disease prevention and treatment that may be operated by nurses independently. Therefore, acupressure is being increasingly applied in clinical nursing practice and research. Recently, the implementation of evidence-based nursing (EBN) in clinical practice has been encouraged to promote nursing quality. Evidence-based nursing is a method-ology and process of implementation that applies the best-available evidence to clinical practice, which is acquired through the use of empirical nursing research. Therefore, in this paper, we address the topic of acupressure within the context of empirical nursing practice. We first introduce the current status of acupressure research and provide the locations of common acupoints in order to guide future empirical nursing research and to help nurses use these acupoints in clinical practice. Finally, we describe the steps that are necessary to apply the current empirical information on acupressure as well as provide suggestions to promote safety and efficacy in order to guide nurses in the accurate application of acupressure in nursing practice.

  7. Toward an evidence-based toxicology.

    Science.gov (United States)

    Hoffmann, S; Hartung, T

    2006-09-01

    The increasing demands on toxicology of large-scale risk assessment programmes for chemicals and emerging or expanding areas of chemical use suggest it is timely to review the toxicological toolbox. Like in clinical medicine, where an evidence-based medicine (EBM) is critically reviewing traditional approaches, toxicology has the opportunity to reshape and enlarge its methodology and approaches on the basis of compounded scientific knowledge. Such revision would have to be based on structured reviews of current practice, ie, assessment of test performance characteristics, mechanistic understanding, extended quality assurance, formal validation and the use of integrated testing strategies. This form of revision could optimize the balance between safety, costs and animal welfare, explicitly stating and, where possible, quantifying uncertainties. After a self-critical reassessment of current practices and evaluation of the thus generated information, such an evidence-based toxicology (EBT) promises to make better use of resources and to increase the quality of results, facilitating their interpretation. It shall open up hazard and also risk assessments to new technologies, flexibly accommodating current and future mechanistic understanding. An EBT will be better prepared to answer the continuously growing safety demands of modern societies.

  8. Evidence-Based Chinese Medicine for Hypertension

    Directory of Open Access Journals (Sweden)

    Jie Wang

    2013-01-01

    Full Text Available Hypertension is an important worldwide public -health challenge with high mortality and disability. Due to the limitations and concerns with current available hypertension treatments, many hypertensive patients, especially in Asia, have turned to Chinese medicine (CM. Although hypertension is not a CM term, physicians who practice CM in China attempt to treat the disease using CM principles. A variety of approaches for treating hypertension have been taken in CM. For seeking the best evidence of CM in making decisions for hypertensive patients, a number of clinical studies have been conducted in China, which has paved the evidence-based way. After literature searching and analyzing, it appeared that CM was effective for hypertension in clinical use, such as Chinese herbal medicine, acupuncture, moxibustion, cupping, qigong, and Tai Chi. However, due to the poor quality of primary studies, clinical evidence is still weak. The potential benefits and safety of CM for hypertension still need to be confirmed in the future with well-designed RCTs of more persuasive primary endpoints and high-quality SRs. Evidence-based Chinese medicine for hypertension still has a long way to go.

  9. Evidence-based medicine and hospital reform: tracing origins back to Florence Nightingale.

    Science.gov (United States)

    Aravind, Maya; Chung, Kevin C

    2010-01-01

    The use of reliable evidence to evaluate health care interventions has gained strong support within the medical community and in the field of plastic surgery in particular. Evidence-based medicine aims to improve health care and reduce costs through the use of sound clinical evidence in evaluating treatments, procedures, and outcomes. The field is hardly new, however, and most trace its origins back to the work of Cochrane in the 1970s and Sackett in the 1990s. Though she wouldn't know it, Florence Nightingale was applying the concepts of evidence-based reform to the medical profession more than a century before. She used medical statistics to reveal the nature of infection in hospitals and on the battlefield. Moreover, Nightingale marshaled data and evidence to establish guidelines for health care reform. Tracing the origins of evidence-based medicine back to Nightingale underscores how critical this movement is to improving the quality and effectiveness of patient care today.

  10. [Is evidence-based assessment fact or fiction? A bibliometric analysis of three German journals].

    Science.gov (United States)

    Petermann, Franz; Schüssler, Gerhard; Glaesmer, Heide

    2008-01-01

    Despite the ongoing process for the development and dissemination of empirically supported treatments, little attention has been paid to the development of evidence-based diagnostics. The article aims at evaluating diagnostic procedures and instruments in current clinical research in terms of evidence-based assessment. Volumes 2006 and 2007 of three German psychological journals "Psychotherapeut," "Psychotherapie, Psychosomatik und Medizinische Psychologie," and "Zeitschrift für Psychiatrie, Psychologie und Psychotherapie" were screened for empirical reports and articles dealing with diagnostic issues. 93 articles were identified and evaluated. Most studies used psychometrically valid and established instruments for assessment. However, diagnostic interviews were relatively scarce, as were multimodal assessments. Measures used for outcome evaluation often lacked evidence of sensitivity to change. Clinical assessment to date does not meet criteria for evidence-based diagnostics. Implications for research and guideline development are discussed.

  11. Nurses' experiences of guideline implementation

    DEFF Research Database (Denmark)

    Alanen, Seija; Välimäki, Marita; Kaila, Minna

    2009-01-01

    AIMS: The aim of the study was to address the following questions: What kind of experiences do primary care nurses have of guideline implementation? What do nurses think are the most important factors affecting the adoption of guidelines? BACKGROUND: The implementation of clinical guidelines seems...... to local circumstances, seems to be crucial for successful implementation. CONCLUSIONS: Clinical guidelines can be promising tools in enhancing evidence-based nursing practice, as nurses see them as practical work tools in patient care and so are willing to adopt them. However, support from management...... and physicians is needed to ensure the successful implementation of guidelines into nursing practices. RELEVANCE TO CLINICAL PRACTICE: Based on the findings of this study and previous knowledge of guideline implementation some practical recommendations are suggested. Select the most relevant guidelines...

  12. Learning Patient Safety in Academic Settings: A Comparative Study of Finnish and British Nursing Students' Perceptions.

    Science.gov (United States)

    Tella, Susanna; Smith, Nancy-Jane; Partanen, Pirjo; Turunen, Hannele

    2015-06-01

    Globalization of health care demands nursing education programs that equip students with evidence-based patient safety competences in the global context. Nursing students' entrance into clinical placements requires professional readiness. Thus, evidence-based learning activities about patient safety must be provided in academic settings prior to students' clinical placements. To explore and compare Finnish and British nursing students' perceptions of learning about patient safety in academic settings to inform nursing educators about designing future education curriculum. A purpose-designed instrument, Patient Safety in Nursing Education Questionnaire (PaSNEQ) was used to examine the perceptions of Finnish (n = 195) and British (n = 158) nursing students prior to their final year of registration. Data were collected in two Finnish and two English nursing schools in 2012. Logistic regressions were used to analyze the differences. British students reported more inclusion (p learning than what their programs had provided. Training patient safety skills in the academic settings were the strongest predictors for differences (odds ratio [OR] = 34.69, 95% confidence interval [CI] 7.39-162.83), along with work experience in the healthcare sector (OR = 3.02, 95% CI 1.39-6.58). To prepare nursing students for practical work, training related to clear communication, reporting errors, systems-based approaches, interprofessional teamwork, and use of simulation in academic settings requires comprehensive attention, especially in Finland. Overall, designing patient safety-affirming nursing curricula in collaboration with students may enhance their positive experiences on teaching and learning about patient safety. An international collaboration between educators could help to develop and harmonize patient safety education and to better prepare nurses for practice in the global context. © 2015 Sigma Theta Tau International.

  13. Canadian Schizophrenia Guidelines: Introduction and Guideline Development Process.

    Science.gov (United States)

    Pringsheim, Tamara; Addington, Donald

    2017-09-01

    The aim of the Canadian Schizophrenia Guidelines is to provide evidence-based recommendations for the treatment of schizophrenia and schizophrenia spectrum disorders. The target users are health care professionals. Recommendations are provided as guidance to physicians and patients, with the goal of improving the overall standard of care of individuals with schizophrenia. The guidelines were developed using the ADAPTE process, a systematic approach and alternative to de novo guideline development, in which an existing guideline is customised to suit the local context. We assembled a multidisciplinary team of experts, patients, and family carers from across Canada with the goal of involving individuals with diverse areas of expertise and offering different perspectives. We identified 6 guidelines that were suitable for adaptation. Recommendations from each guideline were extracted and, based on content, were reviewed by the relevant working group. Each working group examined the evidence from which the recommendation was derived and the acceptability and applicability of the recommendation to the Canadian context. Working groups also made decisions on modifications to recommendations when language or terms differed between the source guideline and the Canadian context. Each working group presented selected recommendations to the guideline panel at an in-person consensus meeting. Once the consensus process was completed, each working group created a manuscript with the recommendations adapted from the included guidelines, with the rationale for each recommendation. The process yielded an up-to-date list of evidence-based recommendations that are relevant and applicable in Canada.

  14. Finnish-English Phonetics and Phonology.

    Science.gov (United States)

    Sajavaara, Kari; Dufva, Hannele

    2001-01-01

    Gives a summary of the theoretical approaches to the role of phonetics and phonology in language learning and teaching as developed by the Finnish-English cross-language project at the University of Jyvaskyla, Finland. Analysis was extended over the chains of connected speech to deal with all the phenomena that give rhythm in speech. (Author/VWL)

  15. Draft Inventory of Finnish Mass Communications.

    Science.gov (United States)

    Elsila, Tapani, Comp.; And Others

    Media studied in this report include broadcasting (radio and television), press (newspapers and magazines), literature, motion pictures, and sound and video recordings. First, there is an overview of Finnish mass communications on a qualitative level. After this, quantitative data are presented, divided into categories of production and…

  16. Finnish-English Phonetics and Phonology.

    Science.gov (United States)

    Sajavaara, Kari; Dufva, Hannele

    2001-01-01

    Gives a summary of the theoretical approaches to the role of phonetics and phonology in language learning and teaching as developed by the Finnish-English cross-language project at the University of Jyvaskyla, Finland. Analysis was extended over the chains of connected speech to deal with all the phenomena that give rhythm in speech. (Author/VWL)

  17. "Bildung" and Music Education: A Finnish Perspective

    Science.gov (United States)

    Heimonen, Marja

    2014-01-01

    The article addresses "Bildung" from a Finnish perspective and asks: Are there specific meanings of Bildung that are typical of a certain time and place? The author applies a multi-layered theory of critical positivism, adapting its three-level structure to music education and the concept of "Bildung." First, she discusses…

  18. Finnish Higher Education Expansion and Regional Policy

    Science.gov (United States)

    Saarivirta, Toni

    2010-01-01

    This paper concentrates on the expansion of Finnish higher education between the 1960s and 1970s, exposes its background in the light of the policy decisions that were made, compares the unique features of this expansion with those of certain other countries, discusses the impact of the controlled "top down" governance of higher…

  19. Individualized Sex Equality in Transforming Finnish Academia

    Science.gov (United States)

    Lätti, Johanna

    2017-01-01

    This article examines the equality agenda in the context of Finnish university reform in the 21st century. In Finland, the academic regime went through an organizational transformation after the Universities Act in 2009. However, little attention has been paid to the questions of sex or equality. Since the policy influences on equality in…

  20. Evidence-based policymaking: A review

    Directory of Open Access Journals (Sweden)

    Karen Nortje

    2010-05-01

    Full Text Available The process of facilitating the uptake of evidence, for example, scientific research findings, into the policymaking process is multifaceted and thus complex. It is therefore important for scientists to understand this process in order to influence it more effectively. Similarly, policymakers need to understand the complexities of the scientific process to improve their interaction with the scientific sphere. This literature review addresses those factors that influence the uptake of scientific evidence into policymaking, the barriers to using science in policymaking, as well as recommendations for improved science–policymaking interaction. A visual diagram of the gears of a car is used to convey the message of the complexities around the engagement between science and policymaking. It is concluded that the issue of evidence-based policymaking remains unresolved and questions for future research on the science–policy interface are raised.

  1. EVIDENCE-BASED USE OF EPLERENONE

    Directory of Open Access Journals (Sweden)

    S. R. Gilyarevski

    2012-01-01

    Full Text Available Data of the negative effect of high concentrations of aldosterone in the blood for cardiovascular disease, which served as the theoretical basis for wider use in clinical practice of the drugs belonging to the class of aldosterone receptor blockers is presented. Evidence-based data on efficacy and safety of aldosterone receptor blockers, which were obtained in the course of several randomized clinical trials is performed. Particular attention is paid to aspects of the clinical use of selective aldosterone receptor blocker eplerenone, including current data, which makes reasonable extension of indications for its use in treating patients with chronic heart failure. Data on indications of eplerenone use in patients with hypertension, especially in the case of associated target organ damage is presented.

  2. [Evidence-based management of perinatal depression].

    Science.gov (United States)

    Chang, Mei-Yueh; Chen, Chung-Hey

    2008-04-01

    Perinatal depression, which may occur from pregnancy to one year after childbirth, is recognized by the World Health Organization as a significant health issue affecting women. Depression during the perinatal period can have enormous consequences, not only affecting the health of the woman herself but also influencing her interaction with her children and other family members. This article introduces several depression screening tools and evidence-based nonpharmacological managements of perinatal depression. There are some fairly valid and feasible screening methods, among which routinely screening perinatal women with EPDS (Edinburgh Perinatal Depression Scale) or BDI (Beck Depression Inventory) in the primary care setting is practicable. A survey of the limited literature available reveals that interpersonal psychotherapy, cognitive behavior therapy and listening to music provide quantifiable depression amelioration effects for perinatal women. More scientific research moderated by women's life experiences and preferences should be conducted, however, and applied to improve women's health.

  3. Evidence-based neuroethics for neurodevelopmental disorders.

    Science.gov (United States)

    Racine, Eric; Bell, Emily; Di Pietro, Nina C; Wade, Lucie; Illes, Judy

    2011-03-01

    Many neurodevelopmental disorders affect early brain development in ways that are still poorly understood; yet, these disorders can place an enormous toll on patients, families, and society as a whole and affect all aspects of daily living for patients and their families. We describe a pragmatic, evidence-based framework for engaging in empiric ethics inquiry for a large consortium of researchers in neurodevelopmental disorders and provide relevant case studies of pragmatic neuroethics. The 3 neurodevelopmental disorders that are at the focus of our research, cerebral palsy (CP), autism spectrum disorder (ASD), and fetal alcohol spectrum disorder (FASD), bring unique and intersecting challenges of translating ethically research into clinical care for children and neonates. We identify and discuss challenges related to health care delivery in CP; neonatal neurological decision making; alternative therapies; and identity, integrity, and personhood.

  4. Evidence-Based Education in Plastic Surgery.

    Science.gov (United States)

    Johnson, Shepard P; Chung, Kevin C; Waljee, Jennifer F

    2015-08-01

    Educational reforms in resident training have historically been driven by reports from medical societies and organizations. Although educational initiatives are well intended, they are rarely supported by robust evidence. The Accreditation Council for Graduate Medical Education recently introduced competency-based training, a form of outcomes-based education that has been used successfully in nonmedical professional vocations. This initiative has promise to advance the quality of resident education, but questions remain regarding implementation within plastic surgery. In particular, how will competency-based training impact patient outcomes, and will the methodologies used to assess competencies (i.e., milestones) be accurate and validated by literature? This report investigates resident educational reform and the need for more evidence-based educational initiatives in plastic surgery training.

  5. How to teach evidence-based surgery.

    Science.gov (United States)

    Fingerhut, Abe; Borie, Frédéric; Dziri, Chadli

    2005-05-01

    The objectives of teaching evidence-based surgery (EBS) are to inform and convince that EBS is a method of interrogation, reasoning, appraisal, and application of information to guide physicians in their decisions to best treat their patients. Asking the right, answerable questions, translating them into effective searches for the best evidence, critically appraising evidence for its validity and importance, and then integrating EBS with their patients' values and preferences are daily chores for all surgeons. Teaching and learning EBS should be patient-centered, learner-centered, and active and interactive. The teacher should be a model for students to become an expert clinician who is able to match and take advantage of the clinical setting and circumstances to ask and to answer appropriate questions. The process is multistaged. Teaching EBS in small groups is ideal. However, it is time-consuming for the faculty and must be clearly and formally structured. As well, evidence-based medicine (EBM) courses must cater to local institutional needs, must receive broad support from the instructors and the providers of information (librarians and computer science faculty), use proven methodologies, and avoid scheduling conflicts. In agreement with others, we believe that the ideal moment to introduce the concepts of EBM into the curriculum of the medical student is early, during the first years of medical school. Afterward, it should be continued every year. When this is not the case, as in many countries, it becomes the province of the surgeon in teaching hospitals, whether they are at the university, are university-affiliated, or not, to fulfill this role.

  6. Ethical reflections on Evidence Based Medicine

    Directory of Open Access Journals (Sweden)

    S. Corrao

    2013-05-01

    Full Text Available BACKGROUND According to Potter’s point of view, medical ethics is the science of survival, a bridge between humanistic and scientific culture. The working out of judgements on right or wrong referred to the human being are studied by this science. Methodological quality is fundamental in clinical research, and several technical issues are of paramount importance in trying to answer to the final question “what is the true, the right thing?”. We know they are essential aspects as in medical ethics as in evidence based practice. AIM OF THE STUDY The aim of this paper is to talk about relationships and implications between ethical issues and Evidence Based Medicine (EBM. DISCUSSION EBM represents a new paradigm that introduces new concepts to guide medical-decision making and health-care planning. Its principles are deeply rooted in clinical research methodology since information are derived from sound studies of strong quality. Health-care professionals have to deal with methodological concepts for critical appraisal of literature and implementation of evidences in clinical practice and healthcare planning. The central role of EBM in medical ethics is obvious, but a risk could be possible. The shift from Hippocratic point of view to community-centred one could lose sight of the centrality of the patient. CONCLUSION Both EBM principles and the needs to adequately response to economic restrictions urge a balance between individual and community ethics. All this has to represent an opportunity to place the patient at the centre of medical action considering at the same time community ethics as systemic aim, but without forgetting the risk that economic restrictions push towards veterinary ethics where herd is central and individual needs do not exist.

  7. Invasive candidiasis in the ICU: evidence based and on the edge of evidence.

    Science.gov (United States)

    Hollenbach, Eike

    2008-09-01

    Invasive candidiasis is a common nosocomial infection among critically ill patients, constitutes an important cause of sepsis, and is associated with significant morbidity and mortality. The Infectious Diseases Society of America (IDSA) has created evidence-based guidelines for the management of invasive candidiasis. However, several new antifungal agents with excellent activity against Candida spp. and favourable safety profiles have been introduced successfully in the clinical setting since the IDSA guidelines were published in late 2003. Further, the role of antifungals is not entirely clear in the intensive care unit (ICU) setting. Therefore, this article discusses daily problems in the prophylaxis and treatment of invasive candidasis in interdisciplinary ICUs.

  8. Applying Evidence-Based Medicine in Telehealth: An Interactive Pattern Recognition Approximation

    Directory of Open Access Journals (Sweden)

    Carlos Fernández-Llatas

    2013-10-01

    Full Text Available Born in the early nineteen nineties, evidence-based medicine (EBM is a paradigm intended to promote the integration of biomedical evidence into the physicians daily practice. This paradigm requires the continuous study of diseases to provide the best scientific knowledge for supporting physicians in their diagnosis and treatments in a close way. Within this paradigm, usually, health experts create and publish clinical guidelines, which provide holistic guidance for the care for a certain disease. The creation of these clinical guidelines requires hard iterative processes in which each iteration supposes scientific progress in the knowledge of the disease. To perform this guidance through telehealth, the use of formal clinical guidelines will allow the building of care processes that can be interpreted and executed directly by computers. In addition, the formalization of clinical guidelines allows for the possibility to build automatic methods, using pattern recognition techniques, to estimate the proper models, as well as the mathematical models for optimizing the iterative cycle for the continuous improvement of the guidelines. However, to ensure the efficiency of the system, it is necessary to build a probabilistic model of the problem. In this paper, an interactive pattern recognition approach to support professionals in evidence-based medicine is formalized.

  9. No evidence-based restoration without a sound evidence base: a reply to Guldemond et al.

    CSIR Research Space (South Africa)

    Ntshotsho, P

    2012-03-01

    Full Text Available -based. While we fully agree with them that there is a need to assess whether practitioners use evidence in their decision-making, we assert that use of evidence is the last step in the evidence-based approach. It is preceded by the generation (and documentation...

  10. Operationalizing Evidence-Based Practice: The Development of an Institute for Evidence-Based Social Work

    Science.gov (United States)

    Regehr, Cheryl; Stern, Susan; Shlonsky, Aron

    2007-01-01

    Although evidence-based practice (EBP) has received increasing attention in social work in the past few years, there has been limited success in moving from academic discussion to engaging social workers in the process of implementing EBP in practice. This article describes the challenges, successes, and future aims in the process of developing a…

  11. Evidence-based pediatric orthopaedics: an introduction, part I.

    Science.gov (United States)

    Wright, James G; Kocher, Mininder S; Sanders, James O

    2012-09-01

    Evidence-based medicine is a relatively new and sometimes controversial concept when applied to pediatric orthopaedics. This article provides pediatric orthopaedists with some basics to help them understand and apply evidence-based medicine to their clinical practice.

  12. "Evidence-based dentistry in oral surgery: could we do better?".

    Science.gov (United States)

    Nocini, Pier Francesco; Verlato, Giuseppe; Frustaci, Andrea; de Gemmis, Antonio; Rigoni, Giovanni; De Santis, Daniele

    2010-07-16

    Evidence-based Dentistry (EBD), like Evidence-based Medicine (EBM), was born in order to seek the "best available research evidence" in the field of dentistry both in research and clinical routine.BUT EVIDENCE IS NOT CLEARLY MEASURABLE IN ALL FIELDS OF HEALTHCARE: in particular, while drug effect is rather independent from clinician's characteristics, the effectiveness of surgical procedures is strictly related to surgeon's expertise, which is difficult to quantify. The research problems of dentistry have a lot in common with other surgical fields, where at the moment the best therapeutic recommendations and guidelines originates from an integration of evidence-based medicine and data from consensus conferences.To cope with these problems, new instruments have been developed, aimed at standardizing clinical procedures (CAD-CAM technology) and at integrating EBM achievements with the opinions of expert clinicians (GRADE System).ONE THING WE HAVE TO REMEMBER HOWEVER: it is necessary to use the instruments developed by evidence-based medicine but is impossible to produce sound knowledge without considering clinical expertise and quality of surgical procedures simultaneously. Only in this way we will obtain an evidence-based dentistry both in dental research and clinical practice, which is up to third millennium standards.

  13. Developing evidence-based maternity care in Iran: a quality improvement study

    Directory of Open Access Journals (Sweden)

    Mohammad Kazem

    2008-06-01

    Full Text Available Abstract Background Current Iranian perinatal statistics indicate that maternity care continues to need improvement. In response, we implemented a multi-faceted intervention to improve the quality of maternity care at an Iranian Social Security Hospital. Using a before-and-after design our aim was to improve the uptake of selected evidence based practices and more closely attend to identified women's needs and preferences. Methods The major steps of the study were to (1 identify women's needs, values and preferences via interviews, (2 select through a process of professional consensus the top evidence-based clinical recommendations requiring local implementation (3 redesign care based on the selected evidence-based recommendations and women's views, and (4 implement the new care model. We measured the impact of the new care model on maternal satisfaction and caesarean birth rates utilising maternal surveys and medical record audit before and after implementation of the new care model. Results Twenty women's needs and requirements as well as ten evidence-based clinical recommendations were selected as a basis for improving care. Following the introduction of the new model of care, women's satisfaction levels improved significantly on 16 of 20 items (p Conclusion The introduction of a quality improvement care model improved compliance with evidence-based guidelines and was associated with an improvement in women's satisfaction levels and a reduction in rates of caesarean birth.

  14. Evidence-based practice. The role of staff development.

    Science.gov (United States)

    Krugman, Mary

    2003-01-01

    Knowledge and use of evidence-based practice are essential to ensure best practices and safe patient outcomes. Staff development specialists must be leaders in this initiative to support clinical nurses toward improved practice outcomes. This article describes the background for understanding the historical evolution from research utilization to evidence-based practice, defines some key concepts related to evidence-based practice, and suggests essential components for building evidence-based practice programs in healthcare institutions.

  15. Evidence Based Dental Care: Integrating Clinical Expertise with Systematic Research

    OpenAIRE

    2014-01-01

    Clinical dentistry is becoming increasingly complex and our patients more knowledgeable. Evidence-based care is now regarded as the “gold standard” in health care delivery worldwide. The basis of evidence based dentistry is the published reports of research projects. They are, brought together and analyzed systematically in meta analysis, the source for evidence based decisions. Activities in the field of evidence-based dentistry has increased tremendously in the 21st century, more and more p...

  16. Evidence-Based Medicine in the Education of Psychiatrists

    Science.gov (United States)

    Srihari, Vinod

    2008-01-01

    Objective: Evidence-based medicine has an important place in the teaching and practice of psychiatry. Attempts to teach evidence-based medicine skills can be weakened by conceptual confusions feeding a false polarization between traditional clinical skills and evidence-based medicine. Methods: The author develops a broader conception of clinical…

  17. The ABCs of Evidence-Based Practice for Teachers

    Science.gov (United States)

    Kretlow, Allison G.; Blatz, Sharon L.

    2011-01-01

    It is critical teachers adhere to federal policies regarding evidence-based practices. Quickly identifying and effectively using evidence-based programs and practices is particularly important for special educators, because students in special education often already have academic or behavioral deficits. Using evidence-based practices with…

  18. Empirical methods for systematic reviews and evidence-based medicine

    NARCIS (Netherlands)

    van Enst, W.A.

    2014-01-01

    Evidence-Based Medicine is the integration of best research evidence with clinical expertise and patient values. Systematic reviews have become the cornerstone of evidence-based medicine, which is reflected in the position systematic reviews have in the pyramid of evidence-based medicine. Systematic

  19. E-Learning and Evidence Based Practice in Schools

    Science.gov (United States)

    Quong, Terrence

    2016-01-01

    JCTIC has used open source software to develop a unique school online environment that has made evidence based practice viable in their school. In this paper the proposition is made that eLearning enables evidence based practice which in turn leads to improved student outcomes. Much has been written about evidence based practice in schools, but…

  20. Guidelines on renal cell cancer

    NARCIS (Netherlands)

    Mickisch, G; Carballido, J; Hellsten, S; Schuize, H; Mensink, H

    2001-01-01

    Objectives., On behalf of the European Association of Urology (EAU), Guidelines for Diagnosis, Therapy and. Follow Up of Renal. Cell Carcinoma Patients were established. Criteria for recommendations were evidence based and included aspects of cost-effectiveness and clinical feasibility. Method: A sy

  1. Health care-associated pneumonia: an evidence-based review.

    Science.gov (United States)

    Attridge, Russell T; Frei, Christopher R

    2011-08-01

    Health care-associated pneumonia is a relatively new classification of pneumonia that includes community-dwelling pneumonia patients having contact with the health care system. Current data indicate that health care-associated pneumonia patients present with more severe disease, are more likely to be infected with drug-resistant pathogens, and suffer increased mortality compared with community-acquired pneumonia patients. Guidelines recommend that these patients receive empiric antibiotics similar to those recommended for nosocomial pneumonia; however, it is not currently known if outcomes are improved when health care-associated pneumonia patients are treated with these therapies. In addition, the individual health care-associated pneumonia risk factors are based on limited data and are a poor predictor of patients likely to be infected with drug-resistant pathogens. Many questions remain on how to most appropriately care for this growing group of pneumonia patients. This review is an evidence-based discussion of current health care-associated pneumonia data, the individual health care-associated pneumonia risk factors, and limitations and additional considerations for the health care-associated pneumonia classification system.

  2. EAU guidelines on primary urethral carcinoma

    NARCIS (Netherlands)

    Gakis, G.; Witjes, J.A.; Comperat, E.; Cowan, N.C.; Santis, M. de; Lebret, T.; Ribal, M.J.; Sherif, A.M.

    2013-01-01

    CONTEXT: The European Association of Urology (EAU) Guidelines Group on Muscle-Invasive and Metastatic Bladder Cancer prepared these guidelines to deliver current evidence-based information on the diagnosis and treatment of patients with primary urethral carcinoma (UC). OBJECTIVE: To review the curre

  3. Orthopaedic thromboprophylaxis: limitations of current guidelines

    DEFF Research Database (Denmark)

    Warwick, D.; Dahl, O.E.; Fisher, W.D.

    2008-01-01

    research into 'evidence-based' advice. Guidelines should, in theory, benefit patient care by ensuring that every patient routinely receives the best prophylaxis; without guidelines, it is argued, patients may fail to receive treatment or be exposed to protocols which are ineffective, dangerous or expensive...

  4. EAU Guidelines on Chronic Pelvic Pain

    NARCIS (Netherlands)

    Fall, Magnus; Baranowski, Andrew P.; Elneil, Sohier; Engeler, Daniel; Hughes, John; Messelink, Embert J.; Oberpenning, Frank; Williams, Amanda C. de C.

    2010-01-01

    Context: These guidelines were prepared on behalf of the European Association of Urology (EAU) to help urologists assess the evidence-based management of chronic pelvic pain (CPP) and to incorporate the recommendations into their clinical practice. Objective: To revise guidelines for the diagnosis,

  5. EAU Guidelines on Chronic Pelvic Pain

    NARCIS (Netherlands)

    Fall, Magnus; Baranowski, Andrew P.; Elneil, Sohier; Engeler, Daniel; Hughes, John; Messelink, Embert J.; Oberpenning, Frank; Williams, Amanda C. de C.

    2010-01-01

    Context: These guidelines were prepared on behalf of the European Association of Urology (EAU) to help urologists assess the evidence-based management of chronic pelvic pain (CPP) and to incorporate the recommendations into their clinical practice. Objective: To revise guidelines for the diagnosis,

  6. EAU Guidelines on Chronic Pelvic Pain

    NARCIS (Netherlands)

    Fall, Magnus; Baranowski, Andrew P.; Elneil, Sohier; Engeler, Daniel; Hughes, John; Messelink, Embert J.; Oberpenning, Frank; Williams, Amanda C. de C.

    Context: These guidelines were prepared on behalf of the European Association of Urology (EAU) to help urologists assess the evidence-based management of chronic pelvic pain (CPP) and to incorporate the recommendations into their clinical practice. Objective: To revise guidelines for the diagnosis,

  7. EAU guidelines on primary urethral carcinoma

    NARCIS (Netherlands)

    Gakis, G.; Witjes, J.A.; Comperat, E.; Cowan, N.C.; Santis, M. de; Lebret, T.; Ribal, M.J.; Sherif, A.M.

    2013-01-01

    CONTEXT: The European Association of Urology (EAU) Guidelines Group on Muscle-Invasive and Metastatic Bladder Cancer prepared these guidelines to deliver current evidence-based information on the diagnosis and treatment of patients with primary urethral carcinoma (UC). OBJECTIVE: To review the curre

  8. Subjective evidence based ethnography: method and applications.

    Science.gov (United States)

    Lahlou, Saadi; Le Bellu, Sophie; Boesen-Mariani, Sabine

    2015-06-01

    Subjective Evidence Based Ethnography (SEBE) is a method designed to access subjective experience. It uses First Person Perspective (FPP) digital recordings as a basis for analytic Replay Interviews (RIW) with the participants. This triggers their memory and enables a detailed step by step understanding of activity: goals, subgoals, determinants of actions, decision-making processes, etc. This paper describes the technique and two applications. First, the analysis of professional practices for know-how transferring purposes in industry is illustrated with the analysis of nuclear power-plant operators' gestures. This shows how SEBE enables modelling activity, describing good and bad practices, risky situations, and expert tacit knowledge. Second, the analysis of full days lived by Polish mothers taking care of their children is described, with a specific focus on how they manage their eating and drinking. This research has been done on a sub-sample of a large scale intervention designed to increase plain water drinking vs sweet beverages. It illustrates the interest of SEBE as an exploratory technique in complement to other more classic approaches such as questionnaires and behavioural diaries. It provides the detailed "how" of the effects that are measured at aggregate level by other techniques.

  9. Evidence Based Practice Outside the Box (Editorial

    Directory of Open Access Journals (Sweden)

    Lindsay Glynn

    2008-09-01

    Full Text Available I love food. I love cooking, baking, testing, and eating. I read about food preparation, food facts, and food service. Over the years I’ve developed my fair share of knowledge about cooking and I’m a decent cook, but I’m no chef. I guess I’m what you’d call a “foodie”. However, I have the good fortune to have a friend who is a chef and owns one of the best, and certainly the most innovative, restaurants in town. During this summer I hosted a cooking class in my home for my family with my chef friend as instructor. The Tex-Mex barbecue theme was a big hit (you can contact me for recipes, if you like, but much more fascinating was the explanation of the science behind the cooking. It turns out that there is a term for this: molecular gastronomy. Another term, and hence the genesis of my “Eureka!” moment of the summer, is evidence based cooking. Good cooking is not just following a recipe (not all of which are evidence based but at its best is the culmination of heaps of tested information regarding why and how chemical and environmental factors work together to result in a gastronomical delight. For example, will brining or marinating a pork chop make it moister? And, if brining, what temperature should the water be, how long should it soak, and how much salt is needed? Why does pounding meat increase its tenderness? What will keep guacamole from browning better – the pit or lime juice? What does baking soda do in a chocolate cake? Eggs or no eggs in fresh pasta? Like most librarians, I tend not to take information at face value. I want to know where information comes from and whether or not it is valid, based on specific factors. I’ve come to notice that evidence based, or evidence informed, practice is everywhere and has a tremendous impact on our lives. Why do you rotate the tires on your car? Evidence shows that the front tires wear more quickly (think about all those 3-pointturns, the braking, etc and therefore

  10. Teaching Evidence-Based Medicine More Effectively

    Directory of Open Access Journals (Sweden)

    Zinat Nadia Hatmi

    2010-10-01

    Full Text Available Evidence-based Medicine (EBM is becoming an integral component of graduate medical education competency and a requirement for grad medical education practice-based learning core competency. This study tries to compare the efficacy of conferences utilizing small-group discussions with the traditional conference method in enhancing EBM competency. The participants in this randomized controlled trial (RCT were 170 members of the medical faculty who were divided into two groups of 86 (intervention and 84 (control. Following the intervention, EBM competency was assessed by a written examination. statistical analysis made use of chi-square test, independent sample t-test and relative risks for univariate analysis. Mantel-Hanszel was used for bivariate analysis. Cox proportional hazard models were used to evaluate multivariate-adjusted associations between EBM educational intervention and EBM knowledge, attitude and skills. A new indicator of number needed to intervention (NNI was defined and computed. Results: The results proved conference along with small-group discussion to be a more effective teaching method with P=0.001 on knowledge, P

  11. [Searching for evidence-based data].

    Science.gov (United States)

    Dufour, J-C; Mancini, J; Fieschi, M

    2009-08-01

    The foundation of evidence-based medicine is critical analysis and synthesis of the best data available concerning a given health problem. These factual data are accessible because of the availability on the Internet of web tools specialized in research for scientific publications. A bibliographic database is a collection of bibliographic references describing the documents indexed. Such a reference includes at least the title, summary (or abstract), a set of keywords, and the type of publication. To conduct a strategically effective search, it is necessary to formulate the question - clinical, diagnostic, prognostic, or related to treatment or prevention - in a form understandable by the research engine. Moreover, it is necessary to choose the specific database or databases, which may have particular specificity, and to analyze the results rapidly to refine the strategy. The search for information is facilitated by the knowledge of the standardized terms commonly used to describe the desired information. These come from a specific thesaurus devoted to document indexing. The most frequently used is MeSH (Medical Subject Heading). The principal bibliographic database whose references include a set of describers from the MeSH thesaurus is Medical Literature Analysis and Retrieval System Online (Medline), which has in turn become a subpart of a still more vast bibliography called PubMed, which indexes an additional 1.4 million references. Numerous other databases are maintained by national or international entities. These include the Cochrane Library, Embase, and the PASCAL and FRANCIS databases.

  12. 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.

  13. Evidence Based Cataloguing: Moving Beyond the Rules

    Directory of Open Access Journals (Sweden)

    Kathy Carter

    2010-12-01

    Full Text Available Cataloguing is sometimes regarded as a rule-bound, production-based activity that offers little scope for professional judgement and decision-making. In reality, cataloguing involves challenging decisions that can have significant service and financial impacts. The current environment for cataloguing is a maelstrom of changing demands and competing visions for the future. With information-seekers turning en masse to Google and their behaviour receiving greater attention, library vendors are offering “discovery layer” products to replace traditional OPACs, and cataloguers are examining and debating a transformed version of their descriptive cataloguing rules (Resource Description and Access or RDA. In his “Perceptions of the future of cataloging: Is the sky really falling?” (2009, Ivey provides a good summary of this environment. At the same time, myriad new metadata formats and schema are being developed and applied for digital collections in libraries and other institutions. In today’s libraries, cataloguing is no longer limited to management of traditional AACR and MARC-based metadata for traditional library collections. And like their parent institutions, libraries cannot ignore growing pressures to demonstrate accountability and tangible value provided by their services. More than ever, research and an evidence based approach can help guide cataloguing decision-making.

  14. Guidelines International Network: toward international standards for clinical practice guidelines.

    Science.gov (United States)

    Qaseem, Amir; Forland, Frode; Macbeth, Fergus; Ollenschläger, Günter; Phillips, Sue; van der Wees, Philip

    2012-04-03

    Guideline development processes vary substantially, and many guidelines do not meet basic quality criteria. Standards for guideline development can help organizations ensure that recommendations are evidence-based and can help users identify high-quality guidelines. Such organizations as the U.S. Institute of Medicine and the United Kingdom's National Institute for Health and Clinical Excellence have developed recommendations to define trustworthy guidelines within their locales. Many groups charged with guideline development find the lengthy list of standards developed by such organizations to be aspirational but infeasible to follow in entirety. Founded in 2002, the Guidelines International Network (G-I-N) is a network of guideline developers that includes 93 organizations and 89 individual members representing 46 countries. The G-I-N board of trustees recognized the importance of guideline development processes that are both rigorous and feasible even for modestly funded groups to implement and initiated an effort toward consensus about minimum standards for high-quality guidelines. In contrast to other existing standards for guideline development at national or local levels, the key components proposed by G-I-N will represent the consensus of an international, multidisciplinary group of active guideline developers. This article presents G-I-N's proposed set of key components for guideline development. These key components address panel composition, decision-making process, conflicts of interest, guideline objective, development methods, evidence review, basis of recommendations, ratings of evidence and recommendations, guideline review, updating processes, and funding. It is hoped that this article promotes discussion and eventual agreement on a set of international standards for guideline development.

  15. Teaching strategies to support evidence-based practice.

    Science.gov (United States)

    Winters, Charlene A; Echeverri, Rebecca

    2012-06-01

    Evidence-based practice is an expected core competency of all health care clinicians regardless of discipline. Use of evidence-based practice means integrating the best research with clinical expertise and patient values to achieve optimal health outcomes. Evidence-based practice requires nurses to access and appraise evidence rapidly before integrating it into clinical practice. Role modeling and integrating the skills necessary to develop evidence-based practice into clinical and nonclinical courses is an important part in developing positive attitudes toward evidence-based practice, an essential first step to using evidence to guide practice decisions. The step-by-step approach to evidence-based practice proposed by Melnyk and colleagues provides an excellent organizing framework for teaching strategies specifically designed to facilitate nurses' knowledge and skill development in evidence-based practice.

  16. Entrepreneurship in a Finnish public institution

    Directory of Open Access Journals (Sweden)

    Marin Burcea

    2012-12-01

    Full Text Available During the last decades the idea of entrepreneurship in public institutions has been the subject of intense debates, activities and academic research. The scopes of our article are to briefly underline the importance of developing an entrepreneurial spirit by presenting a case study from a Finnish local public administration and making aware the proactive aspect in the process of managing public institutions in Romania. Our hypotheses have been mainly of an interrogative nature. Hypothesis testing was achieved through the analysis of statistical data and conducting a set of sociological interviews with key people from Finnish institutions which were used in the survey. The results of the research emphasize that where there is an entrepreneurial behaviour with the local administration management, the community undergoes a process of conservation and development. The way in which they relate to community partners (such as entrepreneurs, non-profit organizations, citizens is essential to the entrepreneurial spirit within the local public institution.

  17. Evaluation of the Finnish CERN activities panel report

    CERN Document Server

    Paul, Peter; Juuti, Pauli; Kullander, Sven; Ikonen, Eeva; Maalampi, Jukka

    2001-01-01

    The Academy of Finland decided in November 2000 that Finnish CERN-activities should be evaluated. The first ten years of the Finnish membership in CERN have been successful. Also in the future, Finland has great opportunities and benefits of the collaboration with CERN. The Finnish presentations clearly show the rapid development in experimental physics since the joining of CERN. Still, Finland can be considered as a relatively young Member State in CERN, but one of the most dynamic new partners for CERN.

  18. Overtreatment of asymptomatic bacteriuria: identifying provider barriers to evidence-based care.

    Science.gov (United States)

    Trautner, Barbara W; Petersen, Nancy J; Hysong, Sylvia J; Horwitz, Deborah; Kelly, P Adam; Naik, Aanand D

    2014-06-01

    Inappropriate use of antibiotics to treat asymptomatic bacteriuria (ASB) is a significant contributor to antibiotic overuse in hospitalized patients despite evidence-based guidelines on ASB management. We surveyed whether accurate knowledge of how to manage catheter-associated urine cultures was associated with level of training, familiarity with ASB guidelines, and various cognitive-behavioral constructs. We used a survey to measure respondents' knowledge of how to manage catheter-associated bacteriuria, familiarity with the content of the relevant Infectious Diseases Society of America guidelines, and cognitive-behavioral constructs. The survey was administered to 169 residents and staff providers. The mean knowledge score was 57.5%, or slightly over one-half of the questions answered correctly. The overall knowledge score improved significantly with level of training (P bacteriuria according to evidence-based guidelines increases with experience. Addressing both knowledge gaps and relevant cognitive biases early in training may decrease the inappropriate use of antibiotics to treat ASB. Published by Mosby, Inc.

  19. Finance strategies of Finnish entrepreneurial fashion companies

    OpenAIRE

    Hasi, Linda

    2013-01-01

    The intention of this study is to describe and explain how internationally focused, Finnish entrepreneurial fashion companies are financed. Fashion industry has been recognized as a viable industry in Finland, but it seems that these businesses suffer from lack of financing. Thus, many of the firms fail to expand to international markets, which is crucial for their future survival. The objective of this study is to understand how these fashion companies are financed from start-up until today,...

  20. The international Challenges and Finnish Corporate Taxation

    Directory of Open Access Journals (Sweden)

    Lindgren Juha

    2014-11-01

    Full Text Available One of the main trends in Finnish corporate taxation during the last ten years has been the lowering of the corporate tax rate. The decision to lower the corporate tax rate to 20% from the beginning of 2014 also changed the approach in reforming the corporate taxation as it was decided to stay on the grounds of a broad tax base and not to make loopholes in it with targeted exceptions.

  1. Attitudes Towards the Sexuality of Finnish Teenagers

    OpenAIRE

    Quarshie, Cecilia Naadensua

    2011-01-01

    The aim of this project based theses was to describe ‘Attitudes towards the Sexuality of Finnish Teenagers’. The primary target was to gather the knowledge the teenagers know about their sexuality and how they feel. The secondary target was to describe the attitudes other minorities have towards their sexuality. There was an introduction session on the entire topic about reproductive health issues, sexuality, attitudes and rights. In order to get both targets of this project to be successful,...

  2. Addition of a Decision Point in Evidence-Based Practice Process Steps to Distinguish EBP, Research and Quality Improvement Methodologies.

    Science.gov (United States)

    Mick, JoAnn

    2015-06-01

    This column shares the best evidence-based strategies and innovative ideas on how to facilitate the learning 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.

  3. The fatal case of a cocaine body-stuffer and a literature review - towards evidence based management.

    Science.gov (United States)

    Norfolk, G A

    2007-01-01

    The case of a 50-year old female body-stuffer who collapsed and died more than 10h after swallowing a plastic wrap of cocaine is reported. The case is discussed together with a review of the literature in order that guidelines on managing body-stuffers in police custody can be evidence based.

  4. Teaching evidence based medicine in family medicine

    Directory of Open Access Journals (Sweden)

    Davorka Vrdoljak

    2012-05-01

    Full Text Available The concept of evidence based medicine (EBM as the integrationof clinical expertise, patient values and the best evidence was introduced by David Sackett in the 1980’s. Scientific literature in medicine is often marked by expansion, acummulation and quick expiration. Reading all important articles to keep in touch with relevant information is impossible. Finding the best evidence that answers a clinical question in general practice (GP in a short time is not easy. Five useful steps are described –represented by the acronym “5A+E”: assess, ask, acquire, appraise, apply and evaluate.The habit of conducting an evidence search “on the spot’’ is proposed. Although students of medicine at University of Split School of Medicine are taught EBM from the first day of their study and in all courses, their experience of evidence-searching and critical appraisal of the evidence, in real time with real patient is inadequate. Teaching the final-year students the practical use of EBM in a GP’s office is different and can have an important role in their professional development. It can positively impact on quality of their future work in family practice (or some other medical specialty by acquiring this habit of constant evidence-checking to ensure that best practice becomes a mechanism for life-long learning. Conclusion. EBM is a foundation stone of every branch of medicine and important part of Family Medicine as scientific and professional discipline. To have an EB answer resulting from GP’s everyday work is becoming a part of everyday practice.

  5. Acute diarrhea: evidence-based management.

    Science.gov (United States)

    Brandt, Kátia Galeão; Castro Antunes, Margarida Maria de; Silva, Gisélia Alves Pontes da

    2015-01-01

    To describe the current recommendations on the best management of pediatric patients with acute diarrheal disease. PubMed, Scopus, Google Scholar. There has been little progress in the use of oral rehydration salts (ORS) in recent decades, despite being widely reported by international guidelines. Several studies have been performed to improve the effectiveness of ORS. Intravenous hydration with isotonic saline solution, quickly infused, should be given in cases of severe dehydration. Nutrition should be ensured after the dehydration resolution, and is essential for intestinal and immune health. Dietary restrictions are usually not beneficial and may be harmful. Symptomatic medications have limited indication and antibiotics are indicated in specific cases, such as cholera and moderate to severe shigellosis. Hydration and nutrition are the interventions with the greatest impact on the course of acute diarrhea. Copyright © 2015 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

  6. Factors influencing the development of evidence-based practice among nurses: a self-report survey

    Directory of Open Access Journals (Sweden)

    Dalheim Anne

    2012-10-01

    Full Text Available Abstract Background Health authorities in several countries have decided that the health care services should be evidence-based. Recent research indicates that evidence-based practice may be more successfully implemented if the interventions overcome identified barriers. Aims The present study aimed to examine factors influencing the implementation of evidence-based practice among nurses in a large Norwegian university hospital. Methods Cross-sectional data was collected from 407 nurses during the period November 8 to December 3, 2010, using the Norwegian version of Developing Evidence-based Practice questionnaire (DEBP. The DEBP included data on various sources of information used for support in practice, on potential barriers for evidence-based practice, and on self-reported skills on managing research-based evidence. The DEBP was translated into Norwegian in accordance with standardized guidelines for translation and cultural adaptation. Results Nurses largely used experienced-based knowledge collected from their own observations, colleagues and other collaborators for support in practice. Evidence from research was seldom used. The greatest barriers were lack of time and lack of skills to find and manage research evidence. The nurse’s age, the number of years of nursing practice, and the number of years since obtaining the last health professional degree influenced the use of sources of knowledge and self-reported barriers. Self-reported skills in finding, reviewing and using different sources of evidence were positively associated with the use of research evidence and inversely related to barriers in use of research evidence. Conclusion Skills in evidence-based practice seem to reduce barriers to using research evidence and to increase use of research evidence in clinical practice.

  7. [AWMF-guideline: disorders related to cannabis].

    Science.gov (United States)

    Bonnet, U; Harries-Hedder, K; Leweke, F M; Schneider, U; Tossmann, P

    2004-06-01

    Actually, guidelines for treatment of substance-related disorders were written under the overall control of the DG-Sucht e. V. and the DGPPN e. V. This appears within the framework of the Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaft (AWMF). The leading objective of these guidelines is the description of the current scientifically proven and evidence-based medicine in addiction to derive recommendations to therapy. In this context, the guideline for treatment of cannabis-related disorders is introduced.

  8. Guidelines in forensic odontology: legal aspects.

    Science.gov (United States)

    Vermylen, Y

    2006-05-15

    The task of the forensic dentist is ruled by an obligation to be diligent and prudent. If guidelines should exist which are recognised by the dental forensic community, they will probably be used to judge his work, even if guidelines are only considered as recommendations. The questions to be answered are: who issued these guidelines and are they conform to evidence-based forensic odontology.

  9. Evidence-based practice in pediatric surgery.

    Science.gov (United States)

    Hardin, W D; Stylianos, S; Lally, K P

    1999-05-01

    The current medical environment demands the provision of quality healthcare at an affordable cost. Both payors and regulators are committed to lowering cost through initiation of best practice strategies that include practice guidelines, clinical pathways, and standards of care. The only practical way to join this debate is through the use of objective, unbiased clinical data. This study was undertaken to review the current state of the pediatric surgery literature and its value in determining best clinical practice. The National Library of Medicine Medline database was accessed using the Ovid Internet client software. All references, abstracts, and keyword indexes from the core pediatric surgery literature, the Journal of Pediatric Surgery, the European Journal of Pediatric Surgery, Pediatric Surgery International, Zeitschrift fur Kinderchirurgie, and Seminars in Pediatric Surgery were downloaded and reviewed. Search criteria were defined to identify prospective, randomized, controlled studies. References were then categorized as case reports; retrospective case series; prospective case series; randomized, controlled studies; laboratory studies; review articles; or miscellaneous studies. As of March 1, 1998, there are 9,373 references, excluding citations of letters or comments, contained in the core pediatric surgery literature, as provided through Medline. Of these, 485 were identified as studies for review, possible prospective case series or prospective, randomized, controlled studies. After review, 34 studies (0.3%) were classified as prospective, randomized, controlled studies, whereas 139 (1.48%) were classified as prospective studies. There were 3,241 (34.6%) case reports, 5,619 (59.9%) retrospective case series, 1,109 (11.8%) laboratory studies, 195 (2.1%) review articles, and 36 (0.3%) miscellaneous studies that did not fit into other categories. When analyzed by decade of publication, prospective studies and prospective, randomized, controlled studies

  10. Evidence based mental healthcare and service innovation: review of concepts and challenges.

    Science.gov (United States)

    Kouimtsidis, Ch; John-Smith, St; Kemp, P; Ikkos, G

    2013-01-01

    Health provision systems in the developed western nations are currently facing major financial challenges. In order to meet these challenges, a number of new approaches used to assist the provision of health have been introduced, including the practice of health professionals. These approaches utilize specific methods of data capture and summarization such as: evidence based medicine (EBM) and practice guidelines. Evidence is generated from systematic clinical research as well as reported clinical experience and individually case based empirical evidence. All types of research though (quantitative or qualitative) have limitations. Similarly all types of evidence have advantages and disadvantages and can be complimentary to each other. Evidencebased individual decision (EBID) making is the commonest evidence-based medicine as practiced by the individual clinician in making decisions about the care of the individual patient. It involves integrating individual clinical expertise with the best available external clinical evidence from systematic research. However this sort of evidence-based medicine, focuses excessively on the individual (potentially at the expense of others) in a system with limited budgets. Evidence-based guidelines (EBG) also support the practice of evidence-based medicine but at the organizational or institutional level. The main aim is to identify which interventions, over a range of patients, work best and which is cost-effective in order to guide service development and provision at a strategic level. Doing this effectively is a scientific and statistical skill in itself and the quality of guidelines is based primarily on the quality research evidence. It is important to note that lack of systematic evidence to support an intervention does not automatically mean that an intervention must instantly be abandoned. It is also important that guidelines are understood for what they are, i.e. not rules, or complete statements of knowledge. EBM will

  11. Integrating evidence-based perfusion into practices: the International Consortium for Evidence-Based Perfusion.

    Science.gov (United States)

    Likosky, Donald S

    2006-12-01

    There is surmounting pressure for clinicians domestically and abroad not only to practice evidence-based perfusion, but also to supplement practice with documentation thereof. In this editorial, I shall describe an international initiative aimed at embracing this dictum from patients, regulatory bodies, and payers. "Research is the only hope that the future will be different than the past"- Daniel Mintz, MD "Practical men who believe themselves to be quite exempt from any intellectual influences are usually the slaves of some defunct economist.... It is ideas not vested interests which are dangerous for good or evil."-John Maynard Keynes.

  12. A discourse on the contributions of evidence-based medicine to wound care.

    Science.gov (United States)

    Al-Benna, Sammy

    2010-06-01

    Although a healthcare system crippled by lack of resources cannot perform effectively, spending more money in an ineffective system may not lead to better outcomes. To ensure systemwide resource maximization, evidence-based medicine and guidelines that consider treatment cost-effectiveness and recommend treatment for persons with the most to gain are required. To demonstrate that increasing use of evidence-based medicine can improve wound care, the effect of informed treatment decisions on improving patient care was reviewed. A Medline and OvidSP literature search was conducted of English-language literature using the MESH terms evidence-based practice and wounds and injuries. The adoption of evidence-based medicine by individual healthcare professionals can help ensure the limited resources available are used efficiently, enhancing confidence that additional funds will translate into more people receiving better wound care and having better health. Wound care professionals are encouraged to participate in conducting well-designed and controlled clinical studies of wound dressings and to resist the routine use of new, usually more expensive, dressings in the absence of good quality clinical evidence for their benefit over existing products.

  13. Evidence-Based Clinical Significance in Health Care: Toward an Inferential Analysis of Clinical Relevance

    Directory of Open Access Journals (Sweden)

    Mahsa Dousti

    2011-09-01

    Full Text Available Evidence-based dental practice requires the developmment and evaluation of protocols that en-sure translational effectiveness: that is, the efficient incorporation of the best available efficacy and effec-tiveness findings in specific clinical dentistry settings and environments. Evidence-based dentistry predi-cates the synthesis of research for obtaining the best available evidence in a validated, stringent, systematic and unbiased fashion. Research synthesis is now established as a science in its own right, precisely because it adheres to the scientific process that is driven by a research question and a hypothesis, follows through clearly defined methodology and design, yielding quantifiable data that are analyzed statistically, and from which stringent statistical inferences are drawn. The conclusions from the protocol of research synthesis define the best available evidence, which is used in the process of evidence-based revision of clinical practice guidelines. One important hurdle of the process of applying research synthesis in evidence-based dentistry lies in the fact that the statistical inferences produced by research must be translated into clinical relevance. Here, we present a model to circumvent this limitation by means of text analysis/mining protocols, which could lead the path toward a novel, valid and reliable ap-proach for the inferential analysis of clinical relevance.

  14. FACTORS AFFECTING IMPLEMENTATION OF EVIDENCE BASED PRACTICE AMONG PHYSIOTHERAPISTS IN MOI TEACHING REFFERAL HOSPITAL KENYA

    Directory of Open Access Journals (Sweden)

    Naomi Wanjiru

    2016-06-01

    Full Text Available Background: The application of the concept of Evidenced Based Practice into clinical decision-making and practicehas outstanding benefits both to clinicians and the patient. However, the utilization of this concept has not been copiously utilized in most health facilities by the physiotherapists in Kenya. Therefore, the objectives for this study was to determine the level of awareness of evidence based practice among Physiotherapist, establish the availability of resource for Evidence Based Practice and to assess the challenges encountered by physiotherapist in engaging in evidence based practice at Moi Teaching and Referral Hospital. Methods: All physiotherapists working in Moi Teaching and Referral Hospital (42 took part in a cross-sectional descriptive survey. Questionnaires were used for data collection and analyzed by SPSS version 22. Results: there was high level of awareness on Evidence Based Practice (95 % and confidence in EBP (72.5 %. However, lack of information resources, poor skills to implement EBP, poor organization support 90%, insufficient authority to induct change in the practice setting 85%, inadequate facilities 74% and lack of time were identified as the major challenges in implementation of EBP Conclusion: Strategies should be developed to provide PTs with EBP resources, such as access to databases or links to guidelines, and continuous education regarding specific topics. Professional organizations and Associations should aim at changing the current practice to ensure full utilization of EBP.

  15. [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.

  16. The importance of practice guidelines in clinical care.

    Science.gov (United States)

    Sciarra, Erica

    2012-01-01

    This position paper is a brief review of the importance of practice guidelines in clinical use. Emphasis is placed on evidence-based practice guidelines and research. This position paper attests to the importance of the use of guidelines that direct clinical nursing practice.

  17. Three-year follow-up of implementation of evidence-based transfusion practice in a tertiary hospital

    DEFF Research Database (Denmark)

    Nørgaard, Astrid; Stensballe, J; de Lichtenberg, T H

    2017-01-01

    BACKGROUND AND OBJECTIVES: Traditionally, Denmark has had a high rate of allogeneic red blood cell transfusion caused by a liberal transfusion practice despite the existence of restrictive guidelines. We established a Patient Blood Management programme in a tertiary hospital and report the results...... of the implementation of evidence-based transfusion practice. MATERIALS AND METHODS: Red blood cell transfusion quality indicators were compared with the evidence-based guideline at hospital and department level. Based on this evaluation, wards were selected for interventions targeting doctors and nurses....... The implementation process was monitored by transfusion quality and utilization data over a 3-year period with totally 166 341 admissions in 98 960 mixed, adult medical and surgical patients. RESULTS: At the hospital level, transfusion above the upper guideline limit decreased from 23 to 10% (P

  18. ESUR prostate MR guidelines 2012

    DEFF Research Database (Denmark)

    Barentsz, Jelle O; Richenberg, Jonathan; Clements, Richard

    2012-01-01

    The aim was to develop clinical guidelines for multi-parametric MRI of the prostate by a group of prostate MRI experts from the European Society of Urogenital Radiology (ESUR), based on literature evidence and consensus expert opinion. True evidence-based guidelines could not be formulated......, but a compromise, reflected by "minimal" and "optimal" requirements has been made. The scope of these ESUR guidelines is to promulgate high quality MRI in acquisition and evaluation with the correct indications for prostate cancer across the whole of Europe and eventually outside Europe. The guidelines...... provides guidelines for magnetic resonance imaging (MRI) in prostate cancer. Clinical indications, and minimal and optimal imaging acquisition protocols are provided. A structured reporting system (PI-RADS) is described....

  19. How to understand and conduct evidence-based medicine

    Science.gov (United States)

    2016-01-01

    Evidence-based medicine (EBM) is the conscientious, explicit, and judicious use of current best evidence in making decisions regarding the care of individual patients. This concept has gained popularity recently, and its applications have been steadily expanding. Nowadays, the term "evidence-based" is used in numerous situations and conditions, such as evidence-based medicine, evidence-based practice, evidence-based health care, evidence-based social work, evidence-based policy, and evidence-based education. However, many anesthesiologists and their colleagues have not previously been accustomed to utilizing EBM, and they have experienced difficulty in understanding and applying the techniques of EBM to their practice. In this article, the author discusses the brief history, definition, methods, and limitations of EBM. As EBM also involves making use of the best available information to answer questions in clinical practice, the author emphasizes the process of performing evidence-based medicine: generate the clinical question, find the best evidence, perform critical appraisal, apply the evidence, and then evaluate. Levels of evidence and strength of recommendation were also explained. The author expects that this article may be of assistance to readers in understanding, conducting, and evaluating EBM.

  20. Shaping professional identity for sustainability. Evidence in Finnish public catering.

    Science.gov (United States)

    Mikkola, Minna

    2009-08-01

    Catering for sustainability is often presented as a legitimate perspective for caterers to promote more equitable economic development locally and across distances through food procurement, integrated with environmental protection and concern for the welfare of customers and staff. Caterers are thus seen as agents responsible for sustainable food systems within their reach. This paper explores how public caterers use their position and productive intelligence in promoting a sustainable food system within the power field of their contextual networks. This article crystallises this 'agency for sustainability' as professional identity for sustainability, the shaping of which is analysed in Finnish public catering. The paper identifies eased and positive, troubled and critical as well as delimited and distancing approaches for sustainability, with respective views and efforts for sustainable food systems. The shaping of professional identity for sustainability could serve as co-operative platform for future contextual developments towards more sustainable food systems. Such progress could result in better alignment with political guidelines for sustainability and caterers' satisfaction due to their heightened professional position reaching beyond 'kitchen walls' to construct everyday sustainability.

  1. Exercise for ankylosing spondylitis: An evidence-based consensus statement.

    Science.gov (United States)

    Millner, Janet R; Barron, John S; Beinke, Kirsty M; Butterworth, Rachael H; Chasle, Briony E; Dutton, Lindsay J; Lewington, Margaret A; Lim, Errol G S; Morley, Tony B; O'Reilly, Jennie E; Pickering, Kathryn A; Winzenberg, Tania; Zochling, Jane

    2016-02-01

    Despite Level 1b evidence and international consensus that exercise is beneficial in ankylosing spondylitis (AS), there is a paucity of detailed information to guide exercise prescription, including the type and dosage of exercise required for the most benefit. This collaborative project, combining evidence with clinical expertise, was established to develop practical recommendations to guide sustainable exercise prescription for individuals with AS. Using a modified Delphi technique, 10 clinical questions were generated and a systematic literature review was conducted for each. Draft recommendations were developed at a 2-day meeting, based on the integration of evidence summaries and expert opinion. Feedback was obtained from patient and health professional groups prior to finalisation. Recommendations and practice points were developed for the following areas: assessment; monitoring; safety; disease management; AS-specific exercise; physical activity; dosage, adherence and setting. A framework was developed that could also be adapted for exercise in other chronic musculoskeletal conditions. Feedback suggests that the final consensus statement provides useful information for those seeking to provide best practice exercise prescription for people with AS. The recommendations provide an up-to-date, evidence-based approach to the full range of issues related to the use of exercise in AS, as well as identifying evidence gaps for further research. Most importantly, this includes investigation of aspects of exercise programme design required to produce the largest effect, long-term adherence with exercise programs and the specific exercise requirements of sub-groups of people with AS. Widespread dissemination and implementation of the guidelines will be required to optimise exercise outcomes. Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.

  2. Information literacy for evidence-based practice in perianesthesia nurses: readiness for evidence-based practice.

    Science.gov (United States)

    Ross, Jacqueline

    2010-04-01

    Information literacy, the recognition of information required, and the development of skills for locating, evaluating, and effectively using relevant evidence is needed for evidence-based practice (EBP). The purpose of this study was to examine perianesthesia nurses' perception of searching skills and access to evidence sources. The design was a descriptive, exploratory survey. The sample consisted of ASPAN members (n = 64) and nonmembers (n = 64). The Information Literacy for Evidence-Based Nursing Practice instrument was used. Findings were that ASPAN members read more journal articles, were more proficient with computers, and used Cumulative Index to Nursing and Allied Health Literature (CINAHL) more frequently than nonmembers. The three top barriers to use of research were: lack of understanding of organization or structure of electronic databases, lack of skills to critique and/or synthesize the literature, and difficulty in accessing research materials. In conclusion, education is needed for critiquing literature and understanding electronic databases and research articles to promote EBP in perianesthesia areas.

  3. Cellulite: an evidence-based review.

    Science.gov (United States)

    Luebberding, Stefanie; Krueger, Nils; Sadick, Neil S

    2015-08-01

    Cellulite is a multifactorial condition that is present in 80-90 % of post-pubertal women. Despite its high prevalence, it remains a major cosmetic concern for women. A wide range of products and treatments for cellulite reduction is available; however, no systematic review has been performed so far to evaluate the efficacy of the available treatment options for cellulite. The objective of this review is to provide a systematic evaluation of the scientific evidence of the efficacy of treatments for cellulite reduction. This systematic review followed the PRISMA guidelines for reporting systematic reviews and meta-analyses. Only original articles in English or German reporting data on the efficacy of cellulite treatments from in vivo human studies were considered. In total, 67 articles were analyzed for the following information: therapy, presence of a control group, randomization, blinding, sample size, description of statistical methods, results, and level of evidence. Most of the evaluated studies, including laser- and light-based modalities, radiofrequency, and others had important methodological flaws; some did not use cellulite severity as an endpoint or did not provide sufficient statistical analyses. Of the 67 studies analyzed in this review, only 19 were placebo-controlled studies with randomization. Some evidence for potential benefit was only seen for acoustic wave therapy (AWT) and the 1440 nm Nd:YAG minimally invasive laser. This article provides a systematic evaluation of the scientific evidence of the efficacy of treatment for cellulite reduction. No clear evidence of good efficacy could be identified in any of the evaluated cellulite treatments.

  4. Structural Development of Finnish Universities: Achieving Competitiveness and Academic Excellence

    Science.gov (United States)

    Tirronen, Jarkko; Nokkala, Terhi

    2009-01-01

    This paper discusses strategic instruments that are used to enhance the competitiveness of Finnish universities in the context of globalisation, internationalisation and commercialisation of research and education. The Finnish higher education system is currently undergoing a major policy reform, which aims to enhance the competitiveness of…

  5. A cohort effect on serum testosterone levels in Finnish men

    DEFF Research Database (Denmark)

    Perheentupa, A; Mäkinen, J; Laatikainen, T

    2013-01-01

    To investigate whether a population-level decline in serum testosterone exists in Finnish men. In comparison with other European populations, Finnish men have compared well in the studies of reproductive health (i.e. semen quality, incidence of cryptorchidism and testicular cancer); thus, we...

  6. Structural Development of Finnish Universities: Achieving Competitiveness and Academic Excellence

    Science.gov (United States)

    Tirronen, Jarkko; Nokkala, Terhi

    2009-01-01

    This paper discusses strategic instruments that are used to enhance the competitiveness of Finnish universities in the context of globalisation, internationalisation and commercialisation of research and education. The Finnish higher education system is currently undergoing a major policy reform, which aims to enhance the competitiveness of…

  7. British and Finnish Baseball: International Variations on an American Pastime

    Science.gov (United States)

    Williams, Emyr W.; Romar, Jan-Erik; Hartman, Michael

    2010-01-01

    Both British and Finnish baseball are easy to introduce, as the specific skills involved in both sports are identical to those used in traditional baseball. If students have the skills to play traditional baseball, they have the skills to play British and Finnish baseball as well. After a brief overview of the unique rules and strategies of these…

  8. Finnish Pupils' Views on the Place of Religion in School

    Science.gov (United States)

    Kuusisto, Arniika; Poulter, Saila; Kallioniemi, Arto

    2017-01-01

    This mixed method study examines Finnish pupils' (N = 825; age groups 12-13, 15-16) views on the place of religion in the public school. Religious landscape in Finnish society has changed significantly in recent years, as the "new" diversity (Vertovec 2015) has supplemented the "old" one. The role of institutionalized religion…

  9. The Last 40 Years in Finnish Teacher Education

    Science.gov (United States)

    Tirri, Kirsi

    2014-01-01

    This article sets out to identify and discuss the changes that have taken place in Finnish teacher education during the last 40 years (1974-2014). A brief history of teacher education in Finland is presented, followed by the goals and aims of current research-based teacher education in Finland. Finally, the major changes in Finnish teacher…

  10. How Do Finnish Teacher Educators Implement Entrepreneurship Education?

    Science.gov (United States)

    Seikkula-Leino, Jaana; Satuvuori, Timo; Ruskovaara, Elena; Hannula, Heikki

    2015-01-01

    Purpose: The purpose of this paper is to ascertain how the people who train Finnish teachers implement entrepreneurship education in the guidance they provide. The authors show how learning through, for and about entrepreneurship manifests in the self-evaluations of Finnish teacher educators. Design/methodology/approach: Data were collected in…

  11. HANSENULA WICKERHAMII SP. N., A NEW YEAST FROM FINNISH SOIL

    Science.gov (United States)

    Capriotti, Augusto

    1961-01-01

    Capriotti, Augusto (l'Università di Perugia, Perugia, Italy). Hansenula wickerhamii sp. n., a new yeast from Finnish soil. J. Bacteriol. 82:259–360. 1961.—Hansenula wickerhamii sp. n. is described; it was isolated from a Finnish soil, and is named in honor of Lynferd J. Wickerham. Images PMID:13690638

  12. How Do Finnish Teacher Educators Implement Entrepreneurship Education?

    Science.gov (United States)

    Seikkula-Leino, Jaana; Satuvuori, Timo; Ruskovaara, Elena; Hannula, Heikki

    2015-01-01

    Purpose: The purpose of this paper is to ascertain how the people who train Finnish teachers implement entrepreneurship education in the guidance they provide. The authors show how learning through, for and about entrepreneurship manifests in the self-evaluations of Finnish teacher educators. Design/methodology/approach: Data were collected in…

  13. Improving occupational physicians' adherence to a practice guideline : feasibility and impact of a tailored implementation strategy

    NARCIS (Netherlands)

    Joosen, Margot C. W.; van Beurden, Karlijn M.; Terluin, Berend; van Weeghel, Jaap; Brouwers, Evelien P. M.; van der Klink, Jac J. L.

    2015-01-01

    Background: Although practice guidelines are important tools to improve quality of care, implementation remains challenging. To improve adherence to an evidence-based guideline for the management of mental health problems, we developed a tailored implementation strategy targeting barriers perceived

  14. Improving the quality of medical care: the normativity of evidence-based performance standards.

    Science.gov (United States)

    Tanenbaum, Sandra J

    2012-08-01

    Poor quality medical care is sometimes attributed to physicians' unwillingness to act on evidence about what works best. Evidence-based performance standards (EBPSs) are one response to this problem, and they are increasingly employed by health care regulators and payers. Evidence in this instance is judged according to the precepts of evidence-based medicine (EBM); it is probabilistic, and the randomized controlled trial (RCT) is the gold standard. This means that EBPSs suffer all the infirmities of EBM generally-well rehearsed problems with the external validity of research findings as well as the inferential leap from study results in the aggregate to individual patient care. These theoretical weaknesses promise to have a practical impact on the care of patients. To avoid this, EBPSs should be understood as guidelines indicative of average effectiveness rather than standards to be applied in every case.

  15. Evidence that consumers are skeptical about evidence-based health care.

    Science.gov (United States)

    Carman, Kristin L; Maurer, Maureen; Yegian, Jill Mathews; Dardess, Pamela; McGee, Jeanne; Evers, Mark; Marlo, Karen O

    2010-07-01

    We undertook focus groups, interviews, and an online survey with health care consumers as part of a recent project to assist purchasers in communicating more effectively about health care evidence and quality. Most of the consumers were ages 18-64; had health insurance through a current employer; and had taken part in making decisions about health insurance coverage for themselves, their spouse, or someone else. We found many of these consumers' beliefs, values, and knowledge to be at odds with what policy makers prescribe as evidence-based health care. Few consumers understood terms such as "medical evidence" or "quality guidelines." Most believed that more care meant higher-quality, better care. The gaps in knowledge and misconceptions point to serious challenges in engaging consumers in evidence-based decision making.

  16. Assessing the Effectiveness of an Evidence-based Practice Pharmacology Course Using the Fresno Test.

    Science.gov (United States)

    Gardner, Alice; Lahoz, Monina R; Bond, Irena; Levin, Len

    2016-09-25

    Objective. To assess the effectiveness of an evidence-based practice (EBP) pharmacology elective course to teach EBP skills using the Fresno Test (FT). Methods. Pharmacy faculty members and medical librarians developed the elective course and offered it to two cohorts of doctor of pharmacy (PharmD) students. A pre/post intervention study design was used. Seven of 12 FT items were chosen to measure specific EBP skills: Ask, Access, Appraise and Apply. Pre/postcomposite and FT item mean scores were compared using Student's t test with p<0.05 set as significant a priori. Results. Composite FT mean scores increased significantly for both cohorts. Mean scores for both cohorts increased significantly in four of the seven FT items but on different FT items. Conclusion. As a profession that commonly uses evidence-based guidelines, developing and integrating an EBP course in the PharmD curriculum is worth considering.

  17. Musical Memories: translating evidence-based gerontological nursing into a children's picture book.

    Science.gov (United States)

    Gerdner, Linda A; Buckwalter, Kathleen C

    2013-01-01

    Individuals with Alzheimer's disease (AD) are often cared for within multigenerational families. More specifically, 26% of family caregivers have children younger than 18 living with them. This article describes an innovative model for translation of an evidence-based intervention into an engaging, realistic picture book that serves as a teaching tool for children and their families. The book, Musical Memories, focuses on the relationship between a granddaughter and her grandmother who has AD. The story applies basic principles of the Progressively Lowered Stress Threshold model to explain the underlying cause of grandmother's behaviors and models the evidence-based guideline "Individualized Music for Elders with Dementia" to empower the granddaughter in maintaining a relationship with her grandmother. Musical Memories is intended to serve as a valuable resource for families and the gerontological nurses who serve them. Copyright 2013, SLACK Incorporated.

  18. Implementation of coherent, evidence-based pathways in Danish rehabilitation practice

    DEFF Research Database (Denmark)

    Hounsgaard, Lise; Kristensen, H. K.

    2013-01-01

    a deeper understanding of how to facilitate the implementation of coherent and evidence-based guidelines in Danish rehabilitation contexts. METHOD: The study was based on a phenomenological hermeneutic approach and on theories within knowledge translation. Fifteen municipalities and four hospitals......-dependent variations. CONCLUSION: The PARIHS framework is based on concepts that capture factors of impact on clinical decision-making and interventions which enhance changes of daily practice in the participating rehabilitation settings. The rehabilitation pathways reinforced the foundation and ownership of the daily...... Evidence-based rehabilitation pathways updated the professional knowledge and reinforced the therapists' ownership of the daily practice. Appointed facilitators are key stakeholders and important elements in anchoring an implementation. Local implementation processes being part of a cross...

  19. Rational use of energy. Finnish technology cases

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1997-11-01

    This publication has been produced within the THERMIE B project `Interactive Promotion of Energy Technologies between Finland and Other EUCountries and to Estonia` (STR-0622-95-FI) as carried out for DG XVII of the European Commission. MOTIVA of Finntech Finnish Technology Ltd Oy has acted as the project co-ordinating body, with Ekono B.E., Ekono Energy Ltd and Friedemann and Johnson Consultants GmbH as partners. The main aim of the second phase of the project, as documented here, was to produce a publication in English on Finnish energy technologies, primarily in the building, industry and traffic sectors. The target distribution for this publication is primarily the EU countries through public and commercial information networks. During the work, the latest information on Finnish energy technologies has been collected, reviewed, screened and analysed in relation to the THERMIE programme. The following presentation consists of descriptions of case technologies; their background, technical aspects and energy saving potentials where applicable. The three RUE sectors; buildings, industry and traffic, are put forward in separate chapters. The building sector concentrates mostly in different control systems. New lighting and heating systems increase energy savings both in the large industrial sites and in private homes. In the industry sector new enhanced processes are introduced along with new products to increase energy efficiency. Traffic sector concentrates in traffic control and reducing exhaust gas emissions by new systems and programmes. The aim in Finland is to reduce exhaust gas emissions both by controlling the traffic efficiently and by developing fuels with lower emission levels. A lot is being done by educating the drivers and the public in efficient driving methods

  20. Editorial: can China master the guideline challenge?

    Directory of Open Access Journals (Sweden)

    Yang Kehu

    2013-01-01

    Full Text Available Abstract China is experiencing increased health care use and expenditures, without sufficient controls to ensure quality and value. Transparent, cost-conscious and patient-centered guidelines based on the best available evidence could help establishing these quality and practice measures. We examined how guidelines could support the Chinese health reform. Specifically, we summarized the current state of the art and related challenges in guideline development and explored possible solutions in the context of the Chinese health reform. China currently lacks capacity for evidence-based guideline development and coordination by a central agency. Most Chinese guideline users rely on recommendations developed by professional groups that lack demonstration of transparency (including conflict of interest management and evidence synthesis and quality. These deficiencies appear larger than in other regions of the world. In addition, misperceptions about the role of guidelines in assisting practitioners as opposed to providing rules requiring adherence, and a perception that traditional Chinese medicine (TCM cannot be appropriately incorporated in guidelines are present. China’s capacity could be strengthened by a central guideline agency to provide or coordinate evidence synthesis for guideline development and to oversee the work of guideline developers. China can build on what is known and work with the international community to develop methods to meet the challenges of evidence-based guideline development.

  1. Nurses' information retrieval skills in psychiatric hospitals - are the requirements for evidence-based practice fulfilled?

    Science.gov (United States)

    Koivunen, Marita; Välimäki, Maritta; Hätönen, Heli

    2010-01-01

    Nursing professionals have long recognized the importance to practice of research and the value of research evidence. Nurses still do not use research findings in practice. The purpose of this paper was to describe nurses' skills in using literature databases and the Internet in psychiatric hospitals and associations of nurses' gender, age, and job position with their information retrieval skills. The study was carried out in 2004 among nursing staff (N=183) on nine acute psychiatric wards in two psychiatric hospitals in Finland (n=180, response rate 98%). The Finnish version of the European Computer Driving Licence test (ECDL) was used as a data collection instrument. The study showed that there were clear deficits in information retrieval skills among nurses working in psychiatric hospitals. Thus, nurses' competence does not support the realization of evidence-based practice in the hospitals. Therefore, it is important to increase nurses' information retrieval skills by tailoring continuing education modules. It would be also advisable to develop centralized systems for the internal dissemination of research findings for the use of nursing staff.

  2. Finnish Play Becomes Chinese Local Opera

    Institute of Scientific and Technical Information of China (English)

    1993-01-01

    IN the fall of 1992 an unusualpremiere took place in Xi′an:Totisesti totisesti,adapted from aFinnish stage play,was performed asan opera in Chinese by the HuaOpera Troupe,a part of the ShaanxiOpera Research Institute.Ms.InkeriKilpinen,the playwright,and Ms.Leena Laulajainen,vice-chairman ofFinland Writers′Association,cameto see the performance.Hua opera,also known as“Wanwan Opera,”is one of the localforms of opera in Shaanxi Province.It was originally performed in theform of shadow play,and was for-

  3. Regulatory reform of Finnish environmental policy

    Energy Technology Data Exchange (ETDEWEB)

    Sairinen, R.

    2000-07-01

    The main question of this study concerns the regulatory reform i.e. formation and design of new policy instruments in the Finnish environmental policy. The research question is divided into two parts: (1) How have the new policy instruments evolved and been designed (2) What are the political, administrative, historical and ideological factors underlying the processes of policy instrument formation and design? Three main approaches for analysis are introduced: the model of policy instrument choice by Linder and Peters, the model of policy explanation by Jaenicke, and the concept of governmentality developed by Foucault. Within the developed theoretical framework, the general societal background of regulatory reform is composed of the various features of 'environmental governmentality'. The research questions are divided into two empirical research tasks. (1) Analysis of the historical development of Finnish environmental governing and policy style provides background information about the national institutional settings and policy cultures in order to understand the role of the new policy instruments in the Finnish environmental policy during last two decades. Here, Finnish environmental policy divides into consensual pollution policies and adversial nature conservation. Four main periods of environmental governmentality in Finland is presented: the early nature conservation initiatives (1800-1939), the neglect of environmental issues (1945-1969), the environmental institutionalisation (1970-1986), and the regulatory reform (1987-). (2) The contextual case studies concerns: the drafting of the EIA Act in 1982-1994; the formation of the carbon tax policy in 1989-1996; and the implementation of voluntary environmental agreements in 1987-99. The study shows that regulatory reform has not been an easy policy process in Finland. There has been no common environmental governmentality behind the on-going regulatory reform. The new policy instruments have been

  4. Use of opioid analgesics in the treatment of cancer pain: evidence-based recommendations from the EAPC.

    Science.gov (United States)

    Caraceni, Augusto; Hanks, Geoffrey; Kaasa, Stein; Bennett, Michael I; Brunelli, Cinzia; Cherny, Nathan; Dale, Ola; De Conno, Franco; Fallon, Marie; Hanna, Magdi; Haugen, Dagny Faksvåg; Juhl, Gitte; King, Samuel; Klepstad, Pål; Laugsand, Eivor A; Maltoni, Marco; Mercadante, Sebastiano; Nabal, Maria; Pigni, Alessandra; Radbruch, Lukas; Reid, Colette; Sjogren, Per; Stone, Patrick C; Tassinari, Davide; Zeppetella, Giovambattista

    2012-02-01

    Here we provide the updated version of the guidelines of the European Association for Palliative Care (EAPC) on the use of opioids for the treatment of cancer pain. The update was undertaken by the European Palliative Care Research Collaborative. Previous EAPC guidelines were reviewed and compared with other currently available guidelines, and consensus recommendations were created by formal international expert panel. The content of the guidelines was defined according to several topics, each of which was assigned to collaborators who developed systematic literature reviews with a common methodology. The recommendations were developed by a writing committee that combined the evidence derived from the systematic reviews with the panellists' evaluations in a co-authored process, and were endorsed by the EAPC Board of Directors. The guidelines are presented as a list of 16 evidence-based recommendations developed according to the Grading of Recommendations Assessment, Development and Evaluation system.

  5. 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…

  6. An innovative clinical practicum to teach evidence-based practice.

    Science.gov (United States)

    Brancato, Vera C

    2006-01-01

    A clinical practicum was successfully implemented for RN to BSN students to apply evidence-based practice to actual clinical problems affecting nursing practice. The author describes how this practicum was implemented and the requisite resources and support systems. This senior-level capstone course enabled students to understand and value a lifelong learning approach to evidence-based practice.

  7. Behavioral Activation Is an Evidence-Based Treatment for Depression

    Science.gov (United States)

    Sturmey, Peter

    2009-01-01

    Recent reviews of evidence-based treatment for depression did not identify behavioral activation as an evidence-based practice. Therefore, this article conducted a systematic review of behavioral activation treatment of depression, which identified three meta-analyses, one recent randomized controlled trial and one recent follow-up of an earlier…

  8. Illicit Drugs, Policing and the Evidence-Based Policy Paradigm

    Science.gov (United States)

    Ritter, Alison; Lancaster, Kari

    2013-01-01

    The mantra of evidence-based policy (EBP) suggests that endeavours to implement evidence-based policing will produce better outcomes. However there is dissonance between the rhetoric of EBP and the actuality of policing policy. This disjuncture is critically analysed using the case study of illicit drugs policing. The dissonance may be ameliorated…

  9. The Evidence-Based Manifesto for School Librarians

    Science.gov (United States)

    Todd, Ross

    2008-01-01

    School Library Journal's 2007 Leadership Summit, "Where's the Evidence? Understanding the Impact of School Libraries," focused on the topic of evidence-based practice. Evidence-based school librarianship is a systematic approach that engages research-derived evidence, school librarian-observed evidence, and user-reported evidence in the processes…

  10. Evidence-Based Assessment of Anxiety Disorders in Adults

    Science.gov (United States)

    Antony, Martin M.; Rowa, Karen

    2005-01-01

    This article discusses issues related to the development and dissemination of evidence-based assessment strategies for anxiety disorders and associated problems. It begins with a review of the criteria that should be considered when determining whether particular assessment procedures are evidence-based. These include such factors as reliability,…

  11. Teaching Evidence-Based Physical Diagnosis: Six Bedside Lessons.

    Science.gov (United States)

    McGee, Steven

    2016-12-01

    Evidence-based physical diagnosis is an essential part of the bedside curriculum. By using the likelihood ratio, a simple measure of diagnostic accuracy, teachers can quickly adapt this approach to their bedside teaching. Six recurring themes in evidence-based physical diagnosis are fully reviewed, with examples, in this article.

  12. Behavioral Activation Is an Evidence-Based Treatment for Depression

    Science.gov (United States)

    Sturmey, Peter

    2009-01-01

    Recent reviews of evidence-based treatment for depression did not identify behavioral activation as an evidence-based practice. Therefore, this article conducted a systematic review of behavioral activation treatment of depression, which identified three meta-analyses, one recent randomized controlled trial and one recent follow-up of an earlier…

  13. Evidence-Based Practice in Rehabilitation Counseling: Perceptions and Practices

    Science.gov (United States)

    Bezyak, Jill L.; Kubota, Coleen; Rosenthal, David

    2010-01-01

    This study describes certified rehabilitation counselors' attitudes (n=163) about evidence based practice, knowledge and skills related to obtaining and evaluating evidence, use of literature in practice, availability of information, and perceived barriers to evidence-based practice. Responses related to knowledge and skills were mixed with strong…

  14. The Evidence-Based Manifesto for School Librarians

    Science.gov (United States)

    Todd, Ross

    2008-01-01

    School Library Journal's 2007 Leadership Summit, "Where's the Evidence? Understanding the Impact of School Libraries," focused on the topic of evidence-based practice. Evidence-based school librarianship is a systematic approach that engages research-derived evidence, school librarian-observed evidence, and user-reported evidence in the processes…

  15. "Clinical approach to fibromyalgia: Synthesis of Evidence-based recommendations, a systematic review".

    Science.gov (United States)

    Ángel García, Daniel; Martínez Nicolás, Ismael; Saturno Hernández, Pedro J

    2016-01-01

    Efforts have been made to standardise evidence-based practice, but clinical practice guidelines do not always follow strict development methods. The objective of this review is to identify the current guidelines, analyse the variability of its recommendations and make a synthesis for clinical practice. A systematic review of clinical practice guidelines was made in electronic databases and guidelines databases; using "fibromyalgia" AND ["guideline" OR "Clinical Practice guideline"] as terms, from January for 2003 to July of 2013. Guidelines were selected according to the following criteria: a) aimed to fibromyalgia treatment in adults; b) based on scientific evidence, systematically searched; c) evidence levels and strength of recommendation included; d) written in English or Spanish. From 249 initial results, six guides fulfilled the inclusion criteria. Clinical practice guidelines analysed in this review show great variability both in the presence and level of evidence and in the strength of recommendation of many treatments. Physical exercise and cognitive-behavioural therapy are first-line treatments, showing high level of evidence. Amitriptyline, used for short periods of time for pain control, is the pharmacologic treatment with the most solid evidence. The multimodal approach reported better results than the isolated application of any treatment. Final recommendations in this review identify optimal treatments, facilitating the translation of evidence into practice and enabling more efficient and effective quality care. Copyright © 2014 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.

  16. [Forensic evidence-based medicine in computer communication networks].

    Science.gov (United States)

    Qiu, Yun-Liang; Peng, Ming-Qi

    2013-12-01

    As an important component of judicial expertise, forensic science is broad and highly specialized. With development of network technology, increasement of information resources, and improvement of people's legal consciousness, forensic scientists encounter many new problems, and have been required to meet higher evidentiary standards in litigation. In view of this, evidence-based concept should be established in forensic medicine. We should find the most suitable method in forensic science field and other related area to solve specific problems in the evidence-based mode. Evidence-based practice can solve the problems in legal medical field, and it will play a great role in promoting the progress and development of forensic science. This article reviews the basic theory of evidence-based medicine and its effect, way, method, and evaluation in the forensic medicine in order to discuss the application value of forensic evidence-based medicine in computer communication networks.

  17. Guidelines or gospels?

    Science.gov (United States)

    Sundt, Thoralf M

    2016-06-01

    In the interest of advancing evidenced-based medicine, enthusiasm for clinical practice guidelines has skyrocketed. They have a genuine impact on clinical practice and are frequently referenced in the literature. Their construction is complex and labor intensive, and has significant limitations given the necessary process as well as the data available. There has been less focus on their appropriate clinical application as dictated by these inherent limitations. It is worthwhile taking a step back and considering how we know what we think we know based on statistical analysis of biomedical data sets and the real implications of those population data for making predictions about the individual patient we encounter in the clinic. These data as used to establish guidelines for care should be the foundation and starting point for our thoughtful recommendations and decision making, not the final word. The importance of nuance in clinical judgment remains even in this "evidence-based" world.

  18. Learning Paths on Elementary University Courses in Finnish as a Second Language

    Science.gov (United States)

    Eloranta, Johanna; Jalkanen, Juha

    2015-01-01

    Along with the growing degree of internationalisation, Finnish university education needs to address issues related to learning and teaching Finnish as a second language. From the perspective of teaching Finnish and related pedagogical development, it is essential to recognise when, where and for which purposes learners need Finnish at the various…

  19. Association of Finnish Members of Parliament and Researchers: Social Democratic Parliamentary group MP K. Olin, Former Finnish MP M. Tiuri, Finnish Centre Party MP P. Vilkuna, Senior Assistant Professor I. Ruostetsaari and Finnish Parliament Committee of Future Researcher U. Gabrielsson at ATLAS experiment with P. Jenn, M. Nordberg and M. Kotamaki on 15 September 2006.

    CERN Document Server

    Maximilien Brice

    2006-01-01

    Association of Finnish Members of Parliament and Researchers: Social Democratic Parliamentary group MP K. Olin, Former Finnish MP M. Tiuri, Finnish Centre Party MP P. Vilkuna, Senior Assistant Professor I. Ruostetsaari and Finnish Parliament Committee of Future Researcher U. Gabrielsson at ATLAS experiment with P. Jenn, M. Nordberg and M. Kotamaki on 15 September 2006.

  20. Does evidence-based health care have room for the self?

    Science.gov (United States)

    Thomas, S Joshua

    2016-08-01

    Evidence-based health care (EBHC) has consistently been attacked by opponents for being perniciously reductive. Although these attacks are overwhelmingly framed as critiques of evidence-based medicine, they standardly target the research wing of EBHC upon which evidence-based medicine is dependent, and increasingly extend to adjacent health care disciplines, such as nursing. One of the most persistent forms this line of attack has taken is the allegation that EBHC, with its emphasis on the hierarchy of evidence, grounded in the use of randomized controlled trials, and the clinical guidelines developed on their basis, fails to recognize the patient as the complex self she is, treating her instead as merely a quantifiable, medical-scientific object. By reducing the patient to certain quantifiable dimensions, the patient as self is allegedly 'erased'. In short, the complaint is that an evidence-based approach to health care has no room for the self. Contrary to this persistently held view, it is argued here that EBHC does have room for the self. Review of these critiques suggests they can be categorized into two groups: soft critiques and strong critiques. Soft critiques tend to take a more measured tone grounded in empirical concerns about the dangers of an evidence-based approach to health care, whereas strong critiques tend to make sweeping claims grounded in theoretical commitments to anti-foundationalist philosophical frameworks. While both soft and strong critiques ultimately fail to make the case that EBHC has no room for the self, the empirical concerns of soft critiques nevertheless present a challenge EBHC advocates would do well to take seriously and address. © 2016 John Wiley & Sons, Ltd.

  1. 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.

  2. 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.

  3. [Expects for academic detailing from the standpoints of evidence-based medicine (EBM)].

    Science.gov (United States)

    Nakayama, Takeo

    2014-01-01

    Academic detailing, interactive information services by pharmacists for clinicians, has been getting interests in the US and European countries. A systematic review of randomized controlled trials supported the effectiveness of academic detailing. Knowledge of evidence-based medicine and clinical practice guidelines is one of the essential bases for pharmacists to promote these activities. In addition, pharmacists need to understand attitudes and ways of thinking of clinicians toward medicines. Through communications and information sharing between clinicians and pharmacists, collaborations to modify and improve the use of medicines should be facilitated. On these grounds, academic detailing will be able to play an important role in real healthcare circumstances.

  4. Bariatric surgery: an evidence-based analysis.

    Science.gov (United States)

    2005-01-01

    To conduct an evidence-based analysis of the effectiveness and cost-effectiveness of bariatric surgery. Obesity is defined as a body mass index (BMI) of at last 30 kg/m(2).() Morbid obesity is defined as a BMI of at least 40 kg/m(2) or at least 35 kg/m(2) with comorbid conditions. Comorbid conditions associated with obesity include diabetes, hypertension, dyslipidemias, obstructive sleep apnea, weight-related arthropathies, and stress urinary incontinence. It is also associated with depression, and cancers of the breast, uterus, prostate, and colon, and is an independent risk factor for cardiovascular disease. Obesity is also associated with higher all-cause mortality at any age, even after adjusting for potential confounding factors like smoking. A person with a BMI of 30 kg/m(2) has about a 50% higher risk of dying than does someone with a healthy BMI. The risk more than doubles at a BMI of 35 kg/m(2). An expert estimated that about 160,000 people are morbidly obese in Ontario. In the United States, the prevalence of morbid obesity is 4.7% (1999-2000). In Ontario, the 2004 Chief Medical Officer of Health Report said that in 2003, almost one-half of Ontario adults were overweight (BMI 25-29.9 kg/m(2)) or obese (BMI ≥ 30 kg/m(2)). About 57% of Ontario men and 42% of Ontario women were overweight or obese. The proportion of the population that was overweight or obese increased gradually from 44% in 1990 to 49% in 2000, and it appears to have stabilized at 49% in 2003. The report also noted that the tendency to be overweight and obese increases with age up to 64 years. BMI should be used cautiously for people aged 65 years and older, because the "normal" range may begin at slightly above 18.5 kg/m(2) and extend into the "overweight" range. The Chief Medical Officer of Health cautioned that these data may underestimate the true extent of the problem, because they were based on self reports, and people tend to over-report their height and under-report their weight

  5. Cutin composition of five finnish berries.

    Science.gov (United States)

    Kallio, Heikki; Nieminen, Riikka; Tuomasjukka, Saska; Hakala, Mari

    2006-01-25

    The raw cutin (i.e., extractive-free isolated cuticular membrane) fraction from Finnish berries, sea buckthorn (Hippophaë rhamnoides), black currant (Ribes nigrum), cranberry (Vaccinium oxycoccos), lingonberry (Vaccinium vitis-idaea), and bilberry (Vaccinium myrtillus), was depolymerized by NaOMe-catalyzed methanolysis. The composition of cutin monomers was determined by GC-(EI)MS analysis either as methyl esters or as TMSi esters, with OH groups derivatized to TMSi ethers. There was a notable difference in the degree of depolymerization, ranging from 6 to 47%. The extractive-free berry cuticle, that is, raw cutin, thus contains cutin. The predominant cutin monomers were C(16) and C(18) omega-hydroxy acids with midchain functionalities, mainly epoxy and hydroxyl groups. Typically, the major compounds were 9,10-epoxy-18-hydroxyoctadecanoic acid, 10,16-dihydroxyhexadecanoic acid, 9,10,18-trihydroxyoctadecanoic acid, 9,10-epoxy-18-hydroxyoctadec-12-enoic acid, and 18-hydroxyoctadec-9-enoic acid. The amount of epoxyacids was rather high in sea buckthorn ( approximately 70%) and cranberry ( approximately 60%), compared with the other berries. The black currant cutin differed from that of the other berries with a significant portion of hydroxyoxohexadecanoic acid ( approximately 12% of total monomers). This investigation of the cuticular hydroxy acids of five Finnish berries is part of the exploitation of the northern natural resources related to the chemical composition, nutritional value, and sensory properties.

  6. Weighted vowel prototypes in Finnish and German.

    Science.gov (United States)

    Savela, Janne; Eerola, Osmo; Aaltonen, Olli

    2014-03-01

    This study explores the perceptual vowel space of the Finnish and German languages, which have a similar vowel system with eight vowels, /ɑ/ /e/ /i/ /o/ /u/ /y/ /æ∼ε/ /ø/. Three different prototypicality measures are used for describing the internal structuring of the vowel categories in terms of the F1 and F2 formant frequencies: The arithmetic mean (centroid) of the F1-F2 space of the category (Pc), the absolute prototype of the category (Pa), and the weighted prototype of the category (Pω), in which the stimulus formant values are weighted by their goodness rating values. The study gave the following main results: (1) in both languages, the inter-subject differences were the smallest in Pω, and on the order of Difference Limen (DL) of F1-F2 frequencies for all of the three measures, (2) the Pa and Pω differed significantly from the centroid, with the absolute prototypes being the most peripheric, (3) the vowel systems of the two languages were similar (Euclidean distances in Pω of Finnish and German 7-34 mels) although minor differences were found in /e/, / ø/, and /u/, and (4) the mean difference of the prototypes from some earlier published production data was 100-150 mels.

  7. NCLEX-RN success: evidence-based strategies.

    Science.gov (United States)

    Thomas, Marie H; Baker, Susan Scott

    2011-01-01

    Evidence-based nursing requires that students think reflectively and use clinical inquiry to develop clinical reasoning and decision-making skills. Likewise, nursing students need a strategy to be successful in passing the NCLEX-RN. The authors identify strategies based on nursing research to facilitate student success. While learning the evidence-based nursing process, the student must begin to think like a nurse while answering clinical practice questions. Using the skills taught for evidence-based nursing can be a powerful tool to approach the NCLEX-RN and succeed.

  8. Evidence-based approach for prevention of radiocontrast-induced nephropathy.

    Science.gov (United States)

    Abu Jawdeh, Bassam G; Kanso, Abbas A; Schelling, Jeffrey R

    2009-10-01

    The frequency of radiocontrast administration is dramatically increasing, with over 80 million doses delivered annually worldwide. Although recently developed radiocontrast agents are relatively safe in most patients, contrast nephropathy (CN) is still a major source of in-hospital and long-term morbidity and mortality, particularly in patients with preexisting kidney disease. Multiple protocols for CN prevention have been studied; however, strict guidelines have not been established, in part because of conflicting efficacy data for most prevention approaches. In this work, we critically review the major trials that have addressed common CN prophylaxis strategies, including type of radiocontrast media, N-acetylcysteine administration, extracellular fluid volume expansion, and hemofiltration/hemodialysis. We conclude with evidence-based recommendations for CN prevention, which emphasize concurrent NaHCO3 infusion and N-acetylcysteine administration. These guidelines should be helpful to hospitalists, who frequently order radiocontrast studies, and could therefore have a significant impact on prevention of CN.

  9. Evidence based practice: laboratory feedback informs forensic specimen collection in NSW.

    Science.gov (United States)

    Nittis, Maria; Stark, Margaret

    2014-07-01

    The importance of having clear, evidence-based guidelines for the taking of forensic samples from suspects detained in police custody (persons of interest) and complainants of crime is essential for forensic practitioners. The need for such guidelines was seen as desirable in New South Wales (NSW) and a working group was set up comprising scientists, practitioners and police. Feedback from the laboratory regarding the results of the specimens taken by forensic practitioners throughout the State was received and analysed. This has resulted in changes to current practice and highlighted the need for further research in this area. It has also highlighted areas that have not changed in response to evidence A quality service demands transparency, process review, relevant research and feedback in order to progress. Examiners need to obtain the results for their cases in order to reinforce the value of the service they provide as well as to monitor and, where necessary, improve their forensic collection skills.

  10. STATINS USE IN THE PERIOPERATIVE PERIOD ACCORDING TO THE EVIDENCE-BASED MEDICINE

    Directory of Open Access Journals (Sweden)

    V. V. Samoylenko

    2015-09-01

    Full Text Available Optimization of pharmacotherapy in the preoperative period is the cornerstone of the risk modification of cardiovascular complications in the perioperative period. Particular attention has recently been focused on statins use. Evidence base of this drugs class use in the perioperative period serves as the basis for the development of clinical guidelines. However, the results of large randomized trials of statins are controversial. Ambiguous interpretations of these trials data has resulted in significant differences in the classes of recommendations and levels of evidence. Analysis of results of the basic clinical trials and the guidelines of international and national medical societies on the use of statins in patients with cardiovascular diseases to reduce the risk of cardiac complications in the perioperative period in planned extracardiac surgery is presented.

  11. [Preoperative fasting guidelines: an update].

    Science.gov (United States)

    López Muñoz, A C; Busto Aguirreurreta, N; Tomás Braulio, J

    2015-03-01

    Anesthesiology societies have issued various guidelines on preoperative fasting since 1990, not only to decrease the incidence of lung aspiration and anesthetic morbidity, but also to increase patient comfort prior to anesthesia. Some of these societies have been updating their guidelines, as such that, since 2010, we now have 2 evidence-based preoperative fasting guidelines available. In this article, an attempt is made to review these updated guidelines, as well as the current instructions for more controversial patients such as infants, the obese, and a particular type of ophthalmic surgery. Copyright © 2014 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  12. Managing Ulcerative Colitis – The Guidelines and Beyond

    Directory of Open Access Journals (Sweden)

    Mitchell RKL Lie

    2013-11-01

    Full Text Available Management guidelines offer clinicians clear, evidence-based and often succinct treatment advice. For ulcerative colitis these guidelines describe the use of 5-ASA, corticosteroids, thiopurines, cyclosporine, and anti-TNFα therapies. However, guidelines do have some drawbacks, mainly a lack of concrete advice concerning patients resistant to these aforementioned therapies. This review gives a short overview of current guidelines and addresses treatment alternatives for conventional therapies.

  13. Finnish and Swedish business cycles in a global context

    DEFF Research Database (Denmark)

    Bergman, Ulf Michael

    2008-01-01

    This paper evaluates the decisions made by the Finnish government to join EMU and the Swedish government not to join EMU in the early 1990s. Focusing on the characteristics of business cycles during the postwar period, we find that output fluctuations in Sweden and Finland are correlated to two...... measures of the international business cycle, a European and a non-European cycle. The Finnish cycle has become more synchronized to the European cycle but less synchronized to the non-EU cycle after 1999. For Sweden we find the opposite result. The decision by the Finnish government to join EMU...

  14. Quality and methods of developing practice guidelines

    Directory of Open Access Journals (Sweden)

    Clark Otavio

    2002-01-01

    Full Text Available Abstract Background It is not known whether there are differences in the quality and recommendations between evidence-based (EB and consensus-based (CB guidelines. We used breast cancer guidelines as a case study to assess for these differences. Methods Five different instruments to evaluate the quality of guidelines were identified by a literature search. We also searched MEDLINE and the Internet to locate 8 breast cancer guidelines. These guidelines were classified in three categories: evidence based, consensus based and consensus based with no explicit consideration of evidence (CB-EB. Each guideline was evaluated by three of the authors using each of the instruments. For each guideline we assessed the agreement among 14 decision points which were selected from the NCCN (National Cancer Comprehensive Network guidelines algorithm. For each decision point we recorded the level of the quality of the information used to support it. A regression analysis was performed to assess if the percentage of high quality evidence used in the guidelines development was related to the overall quality of the guidelines. Results Three guidelines were classified as EB, three as CB-EB and two as CB. The EB guidelines scored better than CB, with the CB-EB scoring in the middle among all instruments for guidelines quality assessment. No major disagreement in recommendations was detected among the guidelines regardless of the method used for development, but the EB guidelines had a better agreement with the benchmark guideline for any decision point. When the source of evidence used to support decision were of high quality, we found a higher level of full agreement among the guidelines' recommendations. Up to 94% of variation in the quality score among guidelines could be explained by the quality of evidence used for guidelines development. Conclusion EB guidelines have a better quality than CB guidelines and CB-EB guidelines. Explicit use of high quality evidence

  15. Evidence-based Practice in libraries - Principles and discussions

    DEFF Research Database (Denmark)

    Johannsen, Carl Gustav

    2012-01-01

    The article examines problems concerning the introduction and future implementation of evidence-based practice (EBP) in libraries. It includes important conceptual distinctions and definitions, and it reviews the more controversial aspects of EBP, primarely based on experiences from Denmark...

  16. Evidence-based Practice in libraries - Principles and discussions

    DEFF Research Database (Denmark)

    Johannsen, Carl Gustav

    2012-01-01

    The article examines problems concerning the introduction and future implementation of evidence-based practice (EBP) in libraries. It includes important conceptual distinctions and definitions, and it reviews the more controversial aspects of EBP, primarely based on experiences from Denmark...

  17. Evidence Based Practice: Valuable and Successful Examples from ...

    African Journals Online (AJOL)

    Keywords: evidence-based practice, nursing, midwifery, education, quality improvement, research. Introduction ... However, 15 papers and 46 poster presentations at the inaugural ... ic measurement tool, analyze process, adapt interven-.

  18. Evidence-based dentistry resources for dental practitioners.

    Science.gov (United States)

    Scarbecz, Mark

    2008-01-01

    The American Dental Association has taken an active role in support of an evidence-based approach to the practice of dentistry. This concept integrates clinically relevant scientific evidence into a clinician's decision-making process, along with the patient's oral and medical history, the dentist's own expertise and the patient's treatment needs and preferences. The purpose of this article is to assist dentists in locating and retrieving quality research reports and research evidence which can be integrated into the clinical decision making process. The research methodologies which constitute the foundation of evidence-based dentistry are described. The advantages and disadvantages associated with literature that summarizes research, such as the literature review, the systematic review and meta-analysis are described. Evidence-based resources for dentists are described, such as journals specializing in an evidence-based approach, online resources such as PubMed and the Cochrane Collaboration.

  19. Evidence-based medicine in health care reform.

    Science.gov (United States)

    Hughes, Gordon B

    2011-10-01

    The Patient Protection and Affordable Care Act of 2010 mandates a national comparative outcomes research project agenda. Comparative effectiveness research includes both clinical trials and observational studies and is facilitated by electronic health records. A national network of electronic health records will create a vast electronic data "warehouse" with exponential growth of observational data. High-quality associations will identify research topics for pragmatic clinical trials, and systematic reviews of clinical trials will provide optimal evidence-based medicine. Evidence-based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. Thus, health care reform will provide a robust environment for comparative effectiveness research, systematic reviews, and evidence-based medicine, and implementation of evidence-based medicine should lead to improved quality of care.

  20. Identifying Challenges to Building an Evidence Base for Restoration Practice

    CSIR Research Space (South Africa)

    Ntshotsho, P

    2015-11-01

    Full Text Available Global acknowledgement of ecological restoration, as an important tool to complement conservation efforts, requires an effort to increase the effectiveness of restoration interventions. Evidence-based practice is purported to promote effectiveness...

  1. Stroboscopy for benign laryngeal pathology in evidence based health care

    OpenAIRE

    Printza, A; Triaridis, S; Themelis, C; Constantinidis, J

    2012-01-01

    Background and Aims: Voice disorders are common. The aim of this study is to evaluate the diagnostic value of stroboscopy for voice disorders related with benign pathology and apply results in evidence based health care.

  2. Use of evidence-based treatment for posttraumatic stress disorder in Army behavioral healthcare.

    Science.gov (United States)

    Wilk, Joshua E; West, Joyce C; Duffy, Farifteh F; Herrell, Richard K; Rae, Donald S; Hoge, Charles W

    2013-01-01

    To identify the extent to which evidence-based psychotherapy (EBP) and psychopharmacologic treatments for posttraumatic stress disorder (PTSD) are provided to U.S. service members in routine practice, and the degree to which they are consistent with evidence-based treatment guidelines. We surveyed the majority of Army behavioral health providers (n = 2,310); surveys were obtained from 543 (26%). These clinicians reported clinical data on a total sample of 399 service member patients. Of these patients, 110 (28%) had a reported PTSD diagnosis. Data were weighted to account for sampling design and nonresponses. Army providers reported 86% of patients with PTSD received evidence-based psychotherapy (EBP) for PTSD. As formal training hours in EBPs increased, reported use of EBPs significantly increased. Although EBPs for PTSD were reported to be widely used, clinicians who deliver EBP frequently reported not adhering to all core procedures recommended in treatment manuals; less than half reported using all the manualized core EBP techniques. Further research is necessary to understand why clinicians modify EBP treatments, and what impact this has on treatment outcomes. More data regarding the implications for treatment effectiveness and the role of clinical context, patient preferences, and clinical decision-making in adapting EBPs could help inform training efforts and the ways that these treatments may be better adapted for the military.

  3. Evidence-based Frameworks for Teaching and Learning in Classical Singing Training: A Systematic Review.

    Science.gov (United States)

    Crocco, Laura; Madill, Catherine J; McCabe, Patricia

    2017-01-01

    The study systematically reviews evidence-based frameworks for teaching and learning of classical singing training. This is a systematic review. A systematic literature search of 15 electronic databases following the Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines was conducted. Eligibility criteria included type of publication, participant characteristics, intervention, and report of outcomes. Quality rating scales were applied to support assessment of the included literature. Data analysis was conducted using meta-aggregation. Nine papers met the inclusion criteria. No complete evidence-based teaching and learning framework was found. Thematic content analysis showed that studies either (1) identified teaching practices in one-to-one lessons, (2) identified student learning strategies in one-to-one lessons or personal practice sessions, and (3) implemented a tool to enhance one specific area of teaching and learning in lessons. The included studies showed that research in music education is not always specific to musical genre or instrumental group, with four of the nine studies including participant teachers and students of classical voice training only. The overall methodological quality ratings were low. Research in classical singing training has not yet developed an evidence-based framework for classical singing training. This review has found that introductory information on teaching and learning practices has been provided, and tools have been suggested for use in the evaluation of the teaching-learning process. High-quality methodological research designs are needed. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

  4. Evidence Base Update: 50 Years of Research on Treatment for Child and Adolescent Anxiety.

    Science.gov (United States)

    Higa-McMillan, Charmaine K; Francis, Sarah E; Rith-Najarian, Leslie; Chorpita, Bruce F

    2016-01-01

    Anxiety disorders are the most common mental health disorder among children and adolescents. We examined 111 treatment outcome studies testing 204 treatment conditions for child and adolescent anxiety published between 1967 and mid-2013. Studies were selected for inclusion in this review using the PracticeWise Evidence-Based Services database. Using guidelines identified by this journal (Southam-Gerow & Prinstein, 2014), studies were included if they were conducted with children and/or adolescents (ages 1-19) with anxiety and/or avoidance problems. In addition to reviewing the strength of the evidence, the review also examined indicators of effectiveness, common practices across treatment families, and mediators and moderators of treatment outcome. Six treatments reached well-established status for child and adolescent anxiety, 8 were identified as probably efficacious, 2 were identified as possibly efficacious, 6 treatments were deemed experimental, and 8 treatments of questionable efficacy emerged. Findings from this review suggest substantial support for cognitive-behavioral therapy (CBT) as an effective and appropriate first-line treatment for youth with anxiety disorders. Several other treatment approaches emerged as probably efficacious that are not primarily CBT based, suggesting that there are alternative evidence-based treatments that practitioners can turn to for children and adolescents who do not respond well to CBT. The review concludes with a discussion of treatments that improve functioning in addition to reducing symptoms, common practices derived from evidence-based treatments, mediators and moderators of treatment outcomes, recommendations for best practice, and suggestions for future research.

  5. Disinfection of the Access Orifice in NOTES: Evaluation of the Evidence Base

    Directory of Open Access Journals (Sweden)

    Mikael H. Sodergren

    2011-01-01

    Full Text Available Introduction. Appropriate prevention of infection is a key area of research in natural orifice translumenal endoscopic surgery (NOTES, as identified by the Natural Orifice Surgery Consortium for Assessment and Research (NOSCAR. Methods. A review of the literature was conducted evaluating the evidence base for access orifice preparation/treatment in NOTES procedures in the context of infectious complications. Recommendations based on the Oxford Centre for Evidence-Based Medicine guidelines were made. Results. The most robust evidence includes several experimental randomised controlled trials assessing infectious complications in the transgastric approach to NOTES. Transvaginal procedures are long established for accessing the peritoneal cavity following disinfection with antiseptic. Only experimental case series for transcolonic and transvesical approaches are described. Conclusion. Grade C recommendation requiring no preoperative preparation can be made for the transgastric approach. Antiseptic irrigation is recommended for transvaginal (grade C NOTES access, as is current practice. Further human trials need to be conducted to corroborate the current evidence base for transgastric closure. It is important that future trials are conducted in a methodologically robust fashion, with emphasis on clinical outcomes and standardisation of enterotomy closure and postoperative therapy.

  6. Simply the best: teaching gerontological nursing students to teach evidence-based practice. Creating tip sheets can help achieve the goal of implementing EBP in clinical facilities.

    Science.gov (United States)

    Schoenfelder, Deborah Perry

    2007-08-01

    This article describes a teaching strategy used in an undergraduate gerontological nursing clinical course to familiarize students with evidence-based practice. Students are required to read and summarize an assigned evidence-based practice guideline published by The University of Iowa Gerontological Nursing Interventions Research Center. They then develop a "tip sheet," based on the assigned guideline, to disseminate to health care staff at their practicum sites, which is either a long-term care facility or a hospital-based skilled nursing facility. Nursing students' reactions to the assignment and nursing staff's responses to the tip sheets are discussed.

  7. How to Reach Evidence-Based Usability Evaluation Methods.

    Science.gov (United States)

    Marcilly, Romaric; Peute, Linda

    2017-01-01

    This paper discusses how and why to build evidence-based knowledge on usability evaluation methods. At each step of building evidence, requisites and difficulties to achieve it are highlighted. Specifically, the paper presents how usability evaluation studies should be designed to allow capitalizing evidence. Reciprocally, it presents how evidence-based usability knowledge will help improve usability practice. Finally, it underlines that evaluation and evidence participate in a virtuous circle that will help improve scientific knowledge and evaluation practice.

  8. Putting the practice into evidence-based dentistry.

    Science.gov (United States)

    Coulter, Ian D

    2007-01-01

    Whenever a new field emerges in health care, a period is experienced in which the field tries to define itself. This is the position evidence-based dental practice finds itself in at the moment. In this paper, it is argued that, for dentistry to enter into the brave new world of evidence-based practice, it will require some rethinking of the research enterprise in the profession.

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

    Science.gov (United States)

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

    2016-02-01

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

  10. Strategic collaborative model for evidence-based nursing practice.

    Science.gov (United States)

    Olade, Rosaline A

    2004-01-01

    To describe a model that has been developed to guide nurses and other health professionals in collaborative efforts toward evidence-based nursing practice. A review of literature was conducted using MEDLINE and CINAHL to search for articles on research utilization for evidence-based practice in health care delivery. Empirical studies; reviews; and theoretical, opinion, and information articles were included in the review in order to provide a more comprehensive view of the state of evidence-based nursing internationally. Findings revealed a number of barriers to evidence-based nursing practice, which have persisted over the last two decades, including inadequate knowledge of research among practicing nurses, lack of administrative support for research activities in clinical settings, lack of empowerment of nurses, and lack of needed mentoring from nursing research consultants. Barriers in the areas of nursing education and administrative support appear to be major. A need was identified for a pragmatic model that encourages cooperation and collaboration between educators/researchers in academia and the administrative leaders in the clinical facilities if evidence-based nursing practice is to become the norm. FRAMEWORK OF MODEL: The Tyler Collaborative Model is based on an eclectic approach to planned change for creating evidence-based practice. This model identifies a step-by-step process for change, while allowing for the opportunity to integrate any of the previously available methods of critical appraisal to determine the best evidence for practice in each clinical setting.

  11. Alien species in the Finnish weed flora

    Directory of Open Access Journals (Sweden)

    T. HYVÖNEN

    2008-12-01

    Full Text Available The present study aimed at assessing the invasion of alien weed species in Finland based on a review of their occurrence in the Finnish weed flora. The evaluation was conducted for the three phases of the invasion process, i.e. introduction, naturalization and invasion. The literature review revealed that 815 alien weed species occur in Finland of which 314 are regarded as naturalized. Based on their occurrence in different climate zones, the risk of naturalization of new harmful alien weed species was deemed low for those species not currently found in Finland, but higher for species occurring as casual aliens in Finland. In the latter group, 10 species of concern were detected. Exploration of the distribution patterns of naturalized species within Finland revealed species occupancy to be dependent on the residence time of the species. Established neophytes can be expected to extend their ranges and to increase occupation of agricultural habitats in the future.;

  12. MULTILINGUALISM IN FINNISH SCHOOLS: POLICIES AND PRACTICES

    Directory of Open Access Journals (Sweden)

    Minna Suni

    2011-01-01

    Full Text Available This article provides an overview of multilingualism in Finnish schools. The focus is on the experiences gathered from the teachers of plurilingual students, i.e. students from immigrant backgrounds. The data in our study were collected by administering a web questionnaire, and the topics covered, for example,the status of languages and the teaching arrangements tailored for plurilingual students. In addition to reacting to the questionnaire’s statements, the respondents could freely comment on any of the topics, which enriched the quantitative data by offering many useful perspectives. Several respondents reported that during their working careers, noticeable progress has been made accommodating plurilingual students. On the other hand,the results showed that several challenges still remain, such as assuring a more uniform provision of L1 and L2 instruction. In some regions of Finland, such programmes have been functioning well, but in others, administrators are only just awakening to the increasing multilingualism in their schools.

  13. [Prevention of perioperative cardiac complications in non-cardiac surgery: an evidence-based guideline

    NARCIS (Netherlands)

    Damen, J.; Hagemeijer, J.W.; Broek, L van den; Poldermans, D.

    2008-01-01

    Approximately 2.5% of the patients undergoing non-cardiac surgery suffer from perioperative cardiac complications. These are associated with a mortality of 20.60%, a longer stay in hospital and higher costs. The risk factors for perioperative cardiac complications are: high-risk surgery, ischaemic h

  14. Diagnosis, treatment and prevention of ankle sprains : an evidence-based clinical guideline

    NARCIS (Netherlands)

    Kerkhoffs, Gino M.; van den Bekerom, Michel; Elders, Leon A. M.; van Beek, Peter A.; Hullegie, Wim A. M.; Bloemers, Guus M. F. M.; de Heus, Elly M.; Loogman, Masja C. M.; Rosenbrand, Kitty C. J. G. M.; Kuipers, Ton; Hoogstraten, J. W. A. P.; Dekker, Rienk; ten Duis, Henk-Jan; van Dijk, C. Niek; van Tulder, Maurits W.; van der Wees, Philip J.; de Bie, Rob A.

    2012-01-01

    Ankle injuries are a huge medical and socioeconomic problem. Many people have a traumatic injury of the ankle, most of which are a result of sports. Total costs of treatment and work absenteeism due to ankle injuries are high. The prevention of recurrences can result in large savings on medical cost

  15. Diagnosis, treatment and prevention of ankle sprains: an evidence-based clinical guideline.

    NARCIS (Netherlands)

    Kerkhoffs, G.M.; Bekerom, M. van den; Elders, L.A.; Beek, P.A. van; Hullegie, W.A.; Bloemers, G.M.; Heus, E.M. de; Loogman, M.C.; Rosenbrand, K.C.; Kuipers, T.; Hoogstraten, J.W.; Dekker, R.; Duis, H.J. Ten; Dijk, C.N. van; Tulder, M.W. van; Wees, P.J. van der; Bie, R.A. de

    2012-01-01

    Ankle injuries are a huge medical and socioeconomic problem. Many people have a traumatic injury of the ankle, most of which are a result of sports. Total costs of treatment and work absenteeism due to ankle injuries are high. The prevention of recurrences can result in large savings on medical cost

  16. Diagnosis, treatment and prevention of ankle sprains: An evidence-based clinical guideline

    NARCIS (Netherlands)

    J-L.H. Kerkhoffs (Jean-Louis); M.P.J. van den Bekerom (Michel); L.A.M. Elders (Leo); P.A. van Beek (Peter); Y. Hullegie; W. Bloemers; E.M. de Heus (Elly); M.C.M. Loogman (Masja C.); D. Rosenbrand (Dagmar); T. Kuipers; J.W.A.P. Hoogstraten (J. W A P); R. Dekker (Rienk); H.-J. ten Duis (Henk-Jan); C.N. van Dijk (Niek); M.W. van Tulder (Maurits); P. van der Wees (P.); R.A. de Bie (Robert)

    2012-01-01

    textabstractAnkle injuries are a huge medical and socioeconomic problem. Many people have a traumatic injury of the ankle, most of which are a result of sports. Total costs of treatment and work absenteeism due to ankle injuries are high. The prevention of recurrences can result in large savings on

  17. Diagnosis, treatment and prevention of ankle sprains: an evidence-based clinical guideline.

    NARCIS (Netherlands)

    Kerkhoffs, G.M.; Bekerom, M. van den; Elders, L.A.; Beek, P.A. van; Hullegie, W.A.; Bloemers, G.M.; Heus, E.M. de; Loogman, M.C.; Rosenbrand, K.C.; Kuipers, T.; Hoogstraten, J.W.; Dekker, R.; Duis, H.J. Ten; Dijk, C.N. van; Tulder, M.W. van; Wees, P.J. van der; Bie, R.A. de

    2012-01-01

    Ankle injuries are a huge medical and socioeconomic problem. Many people have a traumatic injury of the ankle, most of which are a result of sports. Total costs of treatment and work absenteeism due to ankle injuries are high. The prevention of recurrences can result in large savings on medical cost

  18. [Acute otitis media in children: an evidence-based practice guideline].

    Science.gov (United States)

    Koneczny, N; Schmidt-Troschke, S; Berger, T; Isfort, J; Floer, B; Vollmar, H C; Butzlaff, M

    2004-01-01

    Acute Otitis media is one of the most common acute respiratory infections managed in primary care and the most common infection among in children. Diagnostic criteria, however, do not always correspond to scientific evidence. They often differ depending on individual preferences and competences. Treatment, also, is controversial. In Germany, most children attending their pediatrician or primary care physician will be prescribed antibiotics. Evidence from several randomized studies and systematic reviews suggests that routine usage of antibiotics provides only modest benefit. The benefit of prescribing antibiotics should not only be balanced against the increased likelihood of side effects such as diarrhoea but also against the potential to contribute to longterm antibiotic resistance.

  19. [Acute otitis media and antibiotics. Evidence-based guidelines for antibiotic therapy?].

    Science.gov (United States)

    Thorøe, J; Lous, J

    1999-09-27

    Antibiotic treatment of acute otitis media is controversial. The questions are when to treat, with which antibiotic, and for how long? Within the last years three reviews attempting to discuss these questions have been published. All three found only a marginal effect of antibiotic treatment. The effect was less earache after the first day. The meta-analyses showed that between eight and 22 children had to be treated before one had any benefit of the treatment. The randomized studies did not find a greater effect of amoxicillin than of penicillin. The marginal effect of antibiotics on acute otitis media supports watchful waiting and individualized care and follow-up. There is a need for well-organized, randomized, placebo-controlled trials including the youngest children and the more severe cases of acute otitis media where the effect of antibiotic treatment may turn out to be most beneficial.

  20. Translating evidence-based guidelines to improve feedback practices: the interACT case study

    National Research Council Canada - National Science Library

    Barton, Karen L; Schofield, Susie J; McAleer, Sean; Ajjawi, Rola

    2016-01-01

    ...'. The aim of this paper is to present a case study demonstrating how an entire programme's assessment and feedback practices were re-engineered and evaluated in line with evidence from the literature in the interACT...