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Sample records for evidence based complementary

  1. An Evidence-Based Course in Complementary Medicines

    PubMed Central

    Hughes, Jeff

    2012-01-01

    Objective. To evaluate the impact of an evidence-based course in complementary medicines on the attitudes, knowledge, and professional practice behavior of undergraduate pharmacy students. Design. A required 12-week evidence-based complementary medicine course was designed and introduced into the third-year undergraduate pharmacy curriculum. The course included a combination of traditional lectures, interactive tutorial sessions, and a range of formal assessments. Assessment. Pre- and post-course survey instruments were administered to assess changes in students’ attitudes, perceptions, knowledge, and the likelihood they would recommend the use of complementary medicines in a pharmacy practice environment. Conclusion. Completion of a required evidence-based complementary medicines course resulted in a positive change in pharmacy students’ perceptions of the value of various complementary medicines as well as in their willingness to recommend them, and provided students with the required knowledge to make patient-centered recommendations for use of complementary medicines in a professional pharmacy practice setting. These findings support the need for greater evidence-based complementary medicine education within pharmacy curricula to meet consumer demand and to align with pharmacists’ professional responsibilities. PMID:23275665

  2. Complementary and Alternative Therapies: An Evidence-Based Framework

    ERIC Educational Resources Information Center

    Shaw, Steven R.

    2008-01-01

    Complementary and alternative medicine (CAM) has experienced a dramatic growth in use and acceptability over the last 20 years. CAM is a diverse collection of medical and healthcare systems, practices, and products that are not presently considered a component of conventional medicine. CAM traditionally has been practiced by informally educated…

  3. Evidence-Based Research in Complementary and Alternative Medicine III: Treatment of Patients with Alzheimer's Disease

    PubMed Central

    Chiappelli, Francesco; Navarro, Audrey M.; Moradi, David R.; Manfrini, Ercolano; Prolo, Paolo

    2006-01-01

    This paper presents the novel domain of evidence-based research (EBR) in the treatment of patients with Alzheimer's disease (AD) from the perspective of traditional medicine and of complementary and alternative medicine. In earlier lectures we have described the process of evidence-based medicine as a methodological approach to clinical practice that is directed to aid clinical decision-making. Here, we present a practical example of this approach with respect to traditional pharmacological interventions and to complementary and alternative treatments for patients with AD. PMID:17173104

  4. Cultural Competence and Evidence-Based Practice in Mental Health Services: A Complementary Perspective

    ERIC Educational Resources Information Center

    Whaley, Arthur L.; Davis, King E.

    2007-01-01

    The need for cultural competence and the need for evidence-based practice in mental health services are major issues in contemporary discourse, especially in the psychological treatment of people of color. Although these 2 paradigms are complementary in nature, there is little cross-fertilization in the psychological literature. The present…

  5. Evidence-based Research in Complementary and Alternative Medicine I: History

    PubMed Central

    2005-01-01

    Contemporary Western medicine has witnessed a fragmentation of our conceptualization of the medical endeavor into ‘traditional medicine’ and ‘non-traditional medicine’. The former is meant to refer to the Western medical tradition, the latter encompasses both ‘complementary’ and ‘alternative’ medical practices. Complementary medicine complements conventional medical treatments, and alternative modes of medical interventions are meant to replace traditional Western medicine. Evidence-based research must be directed at establishing the best available evidence in complementary and alternative medicine. This paper is the first of a set of four ‘lectures’ that reviews the process of evidence-based research, and discusses its implications and applications for the early decades of the 21st century. The purpose of this paper is to introduce the series by examining some of the historical and philosophical foundations of this research endeavor. PMID:16322801

  6. Teaching Evidence-Based Medicine at Complementary and Alternative Medicine Institutions: Strategies, Competencies, and Evaluation

    PubMed Central

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

    2014-01-01

    Abstract Background: As evidence-based medicine (EBM) becomes a standard in health care, it is essential that practitioners of complementary and alternative medicine (CAM) become experts in searching and evaluating the research literature. In support of this goal, the National Institutes of Health (NIH) National Center for Complementary and Alternative Medicine (NCCAM) provided R25 funding to nine CAM colleges to develop individual programs focused on teaching EBM. An overarching goal of these research education grants has been to provide CAM faculty and students with the skills they need to apply a rigorous evidence-based perspective to their training and practice. Methods/Results: This paper reviews the competencies and teaching strategies developed and implemented to enhance research literacy at all nine R25-funded institutions. While each institution designed approaches suitable for its research culture, the guiding principles were similar: to develop evidence-informed skills and knowledge, thereby helping students and faculty to critically appraise evidence and then use that evidence to guide their clinical practice. Curriculum development and assessment included faculty-driven learning activities and longitudinal curricular initiatives to encourage skill reinforcement and evaluate progress. Conclusion: As the field of integrative medicine matures, the NIH-NCCAM research education grants provide essential training for future clinicians and clinician-researchers. Building this workforce will facilitate multidisciplinary collaborations that address the unique needs for research that informs integrative clinical practice. PMID:25380144

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

    PubMed Central

    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

  8. Evidence-Based Evaluation of Complementary Health Approaches for Pain Management in the United States.

    PubMed

    Nahin, Richard L; Boineau, Robin; Khalsa, Partap S; Stussman, Barbara J; Weber, Wendy J

    2016-09-01

    Although most pain is acute and resolves within a few days or weeks, millions of Americans have persistent or recurring pain that may become chronic and debilitating. Medications may provide only partial relief from this chronic pain and can be associated with unwanted effects. As a result, many individuals turn to complementary health approaches as part of their pain management strategy. This article examines the clinical trial evidence for the efficacy and safety of several specific approaches-acupuncture, manipulation, massage therapy, relaxation techniques including meditation, selected natural product supplements (chondroitin, glucosamine, methylsulfonylmethane, S-adenosylmethionine), tai chi, and yoga-as used to manage chronic pain and related disability associated with back pain, fibromyalgia, osteoarthritis, neck pain, and severe headaches or migraines. PMID:27594189

  9. Complementary and Alternative Medicine and Cardiovascular Disease: An Evidence-Based Review

    PubMed Central

    Rabito, Matthew J.; Kaye, Alan David

    2013-01-01

    Complementary and alternative medicine (CAM) plays a significant role in many aspects of healthcare worldwide, including cardiovascular disease (CVD). This review describes some of the challenges of CAM in terms of scientific research. Biologically-based therapies, mind-body therapies, manipulative and body-based therapies, whole medical systems, and energy medicine are reviewed in detail with regard to cardiovascular risk factors and mediation or modulation of cardiovascular disease pathogenesis. CAM use among patients with CVD is prevalent and in many instances provides positive and significant effects, with biologically-based and mind-body therapies being the most commonly used treatment modalities. More rigorous research to determine the precise physiologic effects and long-term benefits on cardiovascular morbidity and mortality with CAM usage, as well as more open lines of communication between patients and physicians regarding CAM use, is essential when determining optimal treatment plans. PMID:23710229

  10. Complementary and integrative medicine for breast cancer patients - Evidence based practical recommendations.

    PubMed

    Witt, C M; Cardoso, M J

    2016-08-01

    On average half of the breast cancer patients' population uses complementary and integrative medicine (CIM) therapies and many of them would like to receive information on CIM from their conventional treatment team. However, often they don't feel comfortable in discussing CIM related questions, with their conventional treatment team, because they think they don't have enough expertise and available time to deal with this topic. Furthermore, information on the evidence of CIM is not easily accessible and the available information is not always reliable. The purpose of the current paper is to provide: 1) an overview about the CIM interventions that have shown positive effects in breast cancer patients and might be useful in supportive cancer care, 2) practical guidance on how to choose and find a qualified referral to a CIM treatment: 3) recommendations on how these interventions could be integrated into Breast Cancer Centers and which factors should be taken into consideration in this setting. This paper takes available CIM practice guidelines for cancer patients and previous research on CIM implementation models into account. There are CIM interventions that have shown a potential to reduce symptoms of cancer or cancer treatments in breast cancer patients and the vast majority uses a non-pharmacological approach and have a good potential for implementation. Nevertheless, further and more rigorous research is still needed. PMID:27203402

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

    PubMed Central

    Fitzcharles, Mary-Ann; Buskila, Dan; Shir, Yoram; Sommer, Claudia

    2013-01-01

    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). PMID:24348701

  12. Complementary medicine: where is the evidence?

    PubMed

    Ernst, Edzard

    2003-08-01

    Herbal medicines have been submitted to systematic reviews more frequently than any other complementary therapy, and it is here where the most positive evidence can be found. There is not much research into potential serious risks of complementary medicine. Possible risks range from the toxicity of herbs to vertebral artery dissection or nerve damage after chiropractic manipulation. Currently the Cochrane Library contains 34 systematic reviews of complementary medicine: 20 of herbal medicines, 7 of acupuncture, 3 of homeopathy, 2 of manual therapies, and 2 of other forms. PMID:12899818

  13. [Martin Heidegger, beneficence, health, and evidence based medicine--contemplations regarding ethics and complementary and alternative medicine].

    PubMed

    Oberbaum, Menachem; Gropp, Cornelius

    2015-03-01

    Beneficence is considered a core principle of medical ethics. Evidence Based Medicine (EBM) is used almost synonymously with beneficence and has become the gold standard of efficiency of conventional medicine. Conventional modern medicine and EBM in particular are based on what Heidegger called calculative thinking, whereas complementary medicine (CM) is often based on contemplative thinking according to Heidegger's distinction of different thinking processes. A central issue of beneficence is the striving for health and wellbeing. EBM is little concerned directly with wellbeing, though it does claim to aim at improving quality of life by correcting pathological processes and conditions like infectious diseases, ischemic heart disease but also hypertension and hyperlipidemia. On the other hand, wellbeing is central to therapeutic efforts of CM. Scientific methods to gauge results of EBM are quantitative and based on calculative thinking, while results of treatments with CM are expressed in a qualitative way and based on meditative thinking. In order to maximize beneficence it seems important and feasible to use both approaches, by combining EBM and CM in the best interest of the individual patient. PMID:25962251

  14. Complementary & Alternative Management of Parkinson’s Disease: An Evidence-Based Review of Eastern Influenced Practices

    PubMed Central

    Bega, Danny; Zadikoff, Cindy

    2014-01-01

    The prevalence of Parkinson’s disease (PD) appears to be lower in Asia compared to the Western world. It is unclear if this is related to the ubiquitous use of traditional medicine in Eastern healthcare, but the use of complementary and alternative medicine (CAM) modalities in countries like Korea may be as high as 76%. Among patients with PD, herbal medicines, health supplement foods, and acupuncture are interventions which are increasingly used throughout the world. Countries like Korea, China, India, and Japan have long embraced and incorporated traditional medicine into modern management of conditions such as PD, but research into various CAM modalities remains in its infancy limiting evidence-based recommendations for many treatments. We reviewed the literature on CAM treatments for PD, focusing on mind-body interventions and natural products. Based on evidence limited to randomized-controlled trials we found that mind-body interventions are generally effective forms of physical activity that are likely to foster good adherence and may reduce disability associated with PD. Based on the current data, modalities like Tai Chi and dance are safe and beneficial in PD, but better studies are needed to assess the effects of other frequently used modalities such as yoga and acupuncture. Furthermore, despite centuries of experience using medicinal herbs and plants in Eastern countries, and despite substantial preclinical data on the beneficial effects of nutritional antioxidants as neuroprotective agents in PD, there is insufficient clinical evidence that any vitamin, food additive, or supplement, can improve motor function or delay disease progression in PD. PMID:25360229

  15. Exposing the evidence gap for complementary and alternative medicine to be integrated into science-based medicine.

    PubMed

    Power, Michael; Hopayian, Kevork

    2011-04-01

    When people who advocate integrating conventional science-based medicine with complementary and alternative medicine (CAM) are confronted with the lack of evidence to support CAM they counter by calling for more research, diverting attention to the 'package of care' and its non-specific effects, and recommending unblinded 'pragmatic trials'. We explain why these responses cannot close the evidence gap, and focus on the risk of biased results from open (unblinded) pragmatic trials. These are clinical trials which compare a treatment with 'usual care' or no additional care. Their risk of bias has been overlooked because the components of outcome measurements have not been taken into account. The components of an outcome measure are the specific effect of the intervention and non-specific effects such as true placebo effects, cognitive measurement biases, and other effects (which tend to cancel out when similar groups are compared). Negative true placebo effects ('frustrebo effects') in the comparison group, and cognitive measurement biases in the comparison group and the experimental group make the non-specific effect look like a benefit for the intervention group. However, the clinical importance of these effects is often dismissed or ignored without justification. The bottom line is that, for results from open pragmatic trials to be trusted, research is required to measure the clinical importance of true placebo effects, cognitive bias effects, and specific effects of treatments. PMID:21502214

  16. Exposing the evidence gap for complementary and alternative medicine to be integrated into science-based medicine

    PubMed Central

    Power, Michael; Hopayian, Kevork

    2011-01-01

    When people who advocate integrating conventional science-based medicine with complementary and alternative medicine (CAM) are confronted with the lack of evidence to support CAM they counter by calling for more research, diverting attention to the ‘package of care’ and its non-specific effects, and recommending unblinded ‘pragmatic trials’. We explain why these responses cannot close the evidence gap, and focus on the risk of biased results from open (unblinded) pragmatic trials. These are clinical trials which compare a treatment with ‘usual care’ or no additional care. Their risk of bias has been overlooked because the components of outcome measurements have not been taken into account. The components of an outcome measure are the specific effect of the intervention and non-specific effects such as true placebo effects, cognitive measurement biases, and other effects (which tend to cancel out when similar groups are compared). Negative true placebo effects (‘frustrebo effects’) in the comparison group, and cognitive measurement biases in the comparison group and the experimental group make the non-specific effect look like a benefit for the intervention group. However, the clinical importance of these effects is often dismissed or ignored without justification. The bottom line is that, for results from open pragmatic trials to be trusted, research is required to measure the clinical importance of true placebo effects, cognitive bias effects, and specific effects of treatments. PMID:21502214

  17. The molecular immunology of mucositis: implications for evidence-based research in alternative and complementary palliative treatments.

    PubMed

    Chiappelli, Francesco

    2005-12-01

    The terms 'mucositis' and 'stomatitis' are often used interchangeably. Mucositis, however, pertains to pharyngeal-esophago-gastrointestinal inflammation that manifests as red, burn-like sores or ulcerations throughout the mouth. Stomatitis is an inflammation of the oral tissues proper, which can present with or without sores, and is made worse by poor dental hygiene. Mucositis is observed in a variety of immunosuppressed patients, but is most often consequential to cancer therapy. It appears as early as the third day of intervention, and is usually established by Day 7 of treatment. Mucositis increases mortality and morbidity and contributes to rising health care costs. The precise immune components involved in the etiology of mucositis are unclear, but evidence-based research (EBR) data has shown that applications of granulocyte-macrophage-colony stimulating factor prevent the onset or the exacerbation of oropharyngeal mucositis. The molecular implications of this observation are discussed from the perspective of future developments of complementary and alternative treatments for this condition. It must be emphasized that this article is meant to be neither a review on mucositis and the various treatments for it, nor a discussion paper on its underlying molecular immunology. It is a statement of the implications of EBR for CAM-based interventions for mucositis. It explores and discusses the specific domain of molecular immunology in the context of mucositis and its direct implications for EBR research in CAM-based treatments for mucositis. PMID:16322806

  18. Best Available Evidence: Three Complementary Approaches

    ERIC Educational Resources Information Center

    Slocum, Timothy A.; Spencer, Trina D.; Detrich, Ronnie

    2012-01-01

    The best available evidence is one of the three critical features of evidence-based practice. Best available evidence is often considered to be synonymous with extremely high standards for research methodology. However, this notion may limit the scope and impact of evidence based practice to those educational decisions on which high quality…

  19. Chloroform Extract of Rasagenthi Mezhugu, a Siddha Formulation, as an Evidence-Based Complementary and Alternative Medicine for HPV-Positive Cervical Cancers

    PubMed Central

    Riyasdeen, Anvarbatcha; Periasamy, Vaiyapuri S.; Paul, Preethy; Alshatwi, Ali A.; Akbarsha, Mohammad A.

    2012-01-01

    Rasagenthi Mezhugu (RGM) is a herbomineral formulation in the Siddha system of traditional medicine and is prescribed in the southern parts of India as a remedy for all kinds of cancers. However, scientific evidence for its therapeutic efficacy in cervical cancer is lacking, and it contains heavy metals. To overcome these limitations, RGM was extracted, and the fractions were tested on HPV-positive cervical cancer cells, ME-180 and SiHa. The extracts, free from the toxic heavy metals, affected the viability of both the cells. The chloroform fraction (cRGM) induced DNA damage and apoptosis. Mitochondria-mediated apoptosis was indicated. Though both the cells responded to the treatment, ME-180 was more responsive. Thus, this study brings up scientific evidence for the efficacy of RGM against the HPV-mediated cervical cancer cells and, if the toxic heavy metals are the limitation in its use, cRGM would be a suitable candidate as evidence-based complementary and alternative medicine for HPV-positive cervical cancers. PMID:22114617

  20. Teaching Evidence-Based Complementary and Alternative Medicine (EBCAM); Changing behaviours in the face of reticence: A cross-over trial

    PubMed Central

    Mills, Edward; Hollyer, Taras; Saranchuk, Ron; Wilson, Kumanan

    2002-01-01

    Background The effectiveness of teaching critical appraisal to students of Complementary and Alternative Medicine (CAM) has not been studied. In this study we attempt to determine if a workshop for final year students at a naturopathic college improved their ability to utilize critical appraisal concepts. Methods We assigned 83 Naturopathic Interns to two groups: Group A (n = 47) or Group B (n = 36). We conducted a baseline assessment of all subjects' critical appraisal skills. Group A was assigned to receive a 3 ½ hour workshop on Evidence Based Medicine (EBM) and Group B received a workshop on bioethics (control intervention). The groups critical appraisal skills were re-evaluated at this time. We then crossed over the intervention so that Group B received the EBM workshop while Group A received the bioethics workshop. Assessment of critical appraisal skills of the two groups was again performed. Results The students mean scores were similar in Group A (14.8) and Group B (15.0) after Group A had received the intervention and Group B had received the control (p = 0.75). Group scores were not significantly improved at the end of the trial compared to at the beginning of the study (Group A: 15.1 to 16.1) (Group B 15.6 to 15.9). Student's confidence in reading research papers also did not improve throughout the course of the study. Conclusion The final year is a difficult but important time to teach critical appraisal and evidence skills. Single, short intervention programs will likely yield negligible results. A multi-factorial approach may be better suited to implementing EBCAM than single short interventions. PMID:11818036

  1. Reiki and related therapies in the dialysis ward: an evidence-based and ethical discussion to debate if these complementary and alternative medicines are welcomed or banned

    PubMed Central

    2013-01-01

    Background Complementary and Alternative Medicines (CAMs) are increasingly practiced in the general population; it is estimated that over 30% of patients with chronic diseases use CAMs on a regular basis. CAMs are also used in hospital settings, suggesting a growing interest in individualized therapies. One potential field of interest is pain, frequently reported by dialysis patients, and seldom sufficiently relieved by mainstream therapies. Gentle-touch therapies and Reiki (an energy based touch therapy) are widely used in the western population as pain relievers. By integrating evidence based approaches and providing ethical discussion, this debate discusses the pros and cons of CAMs in the dialysis ward, and whether such approaches should be welcomed or banned. Discussion In spite of the wide use of CAMs in the general population, few studies deal with the pros and cons of an integration of mainstream medicine and CAMs in dialysis patients; one paper only regarded the use of Reiki and related practices. Widening the search to chronic pain, Reiki and related practices, 419 articles were found on Medline and 6 were selected (1 Cochrane review and 5 RCTs updating the Cochrane review). According to the EBM approach, Reiki allows a statistically significant but very low-grade pain reduction without specific side effects. Gentle-touch therapy and Reiki are thus good examples of approaches in which controversial efficacy has to be balanced against no known side effect, frequent free availability (volunteer non-profit associations) and easy integration with any other pharmacological or non pharmacological therapy. While a classical evidence-based approach, showing low-grade efficacy, is likely to lead to a negative attitude towards the use of Reiki in the dialysis ward, the ethical discussion, analyzing beneficium (efficacy) together with non maleficium (side effects), justice (cost, availability and integration with mainstream therapies) and autonomy (patients

  2. Arithmetic, mutually unbiased bases and complementary observables

    NASA Astrophysics Data System (ADS)

    Sheppeard, M. D.

    2010-02-01

    Complementary observables in quantum mechanics may be viewed as Frobenius structures in a dagger monoidal category, such as the category of finite dimensional Hilbert spaces over the complex numbers. On the other hand, their properties crucially depend on the discrete Fourier transform and its associated quantum torus, requiring only the finite fields that underlie mutually unbiased bases. In axiomatic topos theory, the complex numbers are difficult to describe and should not be invoked unnecessarily. This paper surveys some fundamentals of quantum arithmetic using finite field complementary observables, with a view considering more general axiom systems.

  3. Complementary Spiritist Therapy: Systematic Review of Scientific Evidence

    PubMed Central

    Lucchetti, Giancarlo; Lucchetti, Alessandra L. Granero; Bassi, Rodrigo M.; Nobre, Marlene Rossi Severino

    2011-01-01

    Spiritism is the third most common religion in Brazil, and its therapies have been used by millions worldwide. These therapies are based on therapeutic resources including prayer, laying on of hands, fluidotherapy (magnetized water), charity/volunteering, spirit education/moral values, and disobsession (spirit release therapy). This paper presents a systematic review of the current literature on the relationship among health outcomes and 6 predictors: prayer, laying on of hands, magnetized/fluidic water, charity/volunteering, spirit education (virtuous life and positive affect), and spirit release therapy. All articles were analyzed according to inclusion/exclusion criteria, Newcastle-Ottawa and Jadad score. At present, there is moderate to strong evidence that volunteering and positive affect are linked to better health outcomes. Furthermore, laying on of hands, virtuous life, and praying for oneself also seem to be associated to positive findings. Nevertheless, there is a lack of studies on magnetized water and spirit release therapy. In summary, science is indirectly demonstrating that some of these therapies can be associated to better health outcomes and that other therapies have been overlooked or poorly investigated. Further studies in this field could contribute to the disciplines of Complementary and Alternative Medicine by investigating the relationship between body, mind, and soul/spirit. PMID:21687790

  4. Reveal quantum correlation in complementary bases

    PubMed Central

    Wu, Shengjun; Ma, Zhihao; Chen, Zhihua; Yu, Sixia

    2014-01-01

    An essential feature of genuine quantum correlation is the simultaneous existence of correlation in complementary bases. We reveal this feature of quantum correlation by defining measures based on invariance under a basis change. For a bipartite quantum state, the classical correlation is the maximal correlation present in a certain optimum basis, while the quantum correlation is characterized as a series of residual correlations in the mutually unbiased bases. Compared with other approaches to quantify quantum correlation, our approach gives information-theoretical measures that directly reflect the essential feature of quantum correlation. PMID:24503595

  5. Reciprocal invisibility cloak based on complementary media

    NASA Astrophysics Data System (ADS)

    Yang, J. J.; Huang, M.; Yang, C. F.; Yu, J.

    2011-02-01

    The first invisibility cloak was proposed by Pendry et al. [Science 312, 1780 (2006)]. But the object enclosed in this original cloak is "blind", that is, it cannot see the outside world, since no electromagnetic waves can reach within the cloaked space. Based on the concept of complementary media, we propose a reciprocal invisibility cloak, in which the hidden object can see the outside world, but its presence cannot be detected by electromagnetic wave. The performance of the cloak has been verified by full-wave simulations.

  6. Alternative therapies and medical science: designing clinical trials of alternative/complementary medicines--is evidence-based traditional Chinese medicine attainable?

    PubMed

    Critchley, J A; Zhang, Y; Suthisisang, C C; Chan, T Y; Tomlinson, B

    2000-05-01

    Evidence-based traditional Chinese medicine is attainable. With good planning and a positive attitude, the remedies used in traditional Chinese medicine (TCM) and Chinese proprietary medicines can be studied at a standard acceptable to modern science. The identification of an active principal should not delay the search for effective remedies from the TCM pharmacopoeia. Herbal mixtures can be validly tested to establish their efficacy. Problems with potential batch-to-batch variation can be circumvented by appropriate randomization. Subsequent independent screening and randomization to treatment and placebo arms can allow for the individualization of treatments by TCM practitioners. However, clearly defined treatments are required and should be recorded in a manner that enables other suitably trained researchers to reproduce them reliably (e.g., using prescriptions in Chinese). Quality control of TCM is a prerequisite of credible clinical trials. Correct natural ingredients must be used without adulteration or erroneous substitution. Evidence of safety in man is essential, and in lieu of data from formal toxicity studies, clear, convincing, and impartial evidence of safety is needed based on their long-term use in mainstream TCM practice backed up by publications in the Chinese medical/scientific literature. PMID:10806598

  7. Complementary and Alternative Medicine in Cancer Treatment

    MedlinePlus

    ... Ask about Your Treatment Research Complementary and Alternative Medicine for Patients Complementary and alternative medicine (CAM) is ... based on scientific evidence from research studies. Complementary medicine refers to treatments that are used with standard ...

  8. Complementary/alternative medicine in dermatology: evidence-assessed efficacy of two diseases and two treatments.

    PubMed

    Ernst, Edzard; Pittler, Max H; Stevinson, Clare

    2002-01-01

    The objective of this article is to provide a brief, but critical, overview of the evidence related to complementary/alternative medicine (CAM) use, and to offer valid and useful information for dermatologists in clinical practice. Systematic literature searches were conducted on these databases: Medline, EMBASE, The Cochrane Library, CISCOM and AMED (until October 2000). Where appropriate, the evaluation of the published literature was based on systematic reviews and randomized controlled trials. After scanning the literature it was decided to focus on a selection of two conditions (atopic dermatitis and chronic venous insufficiency) and two treatment modalities (aloe vera gel and tea tree oil). Data for the life-time prevalence of CAM use by patients with dermatological disease ranges between 35 to 69%. The most popular modalities include herablism and (other) dietary supplements, while atopic dermatitis is one of the conditions most frequently treated with CAM. For patients with atopic dermatitis the evidence relates to autogenic training, hypnotherapy, diet, herbal medicine, and dietary supplements. Compelling evidence of effectiveness exists for none of these therapies. However, some promising data have been reported for those with a psychological component: autogenic training, biofeedback and hypnotherapy. For chronic venous insufficiency there is relatively convincing evidence for the effectiveness of oral horse chestnut seed extract. The data for aloe vera gel and tea tree oil indicate that for neither is there compelling evidence of effectiveness. The use of CAM treatments is not free of risk; direct and indirect risks associated with CAM must be considered. PMID:12069640

  9. Broadband planar Luneburg lens based on complementary metamaterials

    NASA Astrophysics Data System (ADS)

    Cheng, Qiang; Ma, Hui Feng; Cui, Tie Jun

    2009-11-01

    A two-dimensional broadband low-loss Luneburg lens has been designed based on the complementary metamaterials. The complementary I-shaped unit has been chosen as the basic cell due to its high resonant frequency, whose effective constitutive parameters are nearly constants at low frequencies. Numerical simulations are performed to determine the relationship between the unit geometry and the refraction index. The experimental sample has been fabricated and tested in a two-dimensional near-field microwave scanning apparatus, where the experiment and simulation results agree very well. Good focusing ability has been shown from the measured field distributions of the designed planar Luneburg lens.

  10. Complementary medicine.

    PubMed

    Ernst, E

    2003-03-01

    Complementary medicine has become an important subject for rheumatologists, not least because many patients try complementary treatments. Recent clinical trials yield promising results. In particular, evidence suggests that several herbal medicines and dietary supplements can alleviate the pain of osteoarthritis and rheumatoid arthritis. Clearly, rigorous testing of complementary treatments is possible, and considering their popularity, should be encouraged. PMID:12598804

  11. High prevalence but limited evidence in complementary and alternative medicine: guidelines for future research

    PubMed Central

    2014-01-01

    The use of complementary and alternative Medicine (CAM) has increased over the past two decades in Europe. Nonetheless, research investigating the evidence to support its use remains limited. The CAMbrella project funded by the European Commission aimed to develop a strategic research agenda starting by systematically evaluating the state of CAM in the EU. CAMbrella involved 9 work packages covering issues such as the definition of CAM; its legal status, provision and use in the EU; and a synthesis of international research perspectives. Based on the work package reports, we developed a strategic and methodologically robust research roadmap based on expert workshops, a systematic Delphi-based process and a final consensus conference. The CAMbrella project suggests six core areas for research to examine the potential contribution of CAM to the health care challenges faced by the EU. These areas include evaluating the prevalence of CAM use in Europe; the EU cititzens’ needs and attitudes regarding CAM; the safety of CAM; the comparative effectiveness of CAM; the effects of meaning and context on CAM outcomes; and different models for integrating CAM into existing health care systems. CAM research should use methods generally accepted in the evaluation of health services, including comparative effectiveness studies and mixed-methods designs. A research strategy is urgently needed, ideally led by a European CAM coordinating research office dedicated to fostering systematic communication between EU governments, the public, charitable and industry funders, researchers and other stakeholders. A European Centre for CAM should also be established to monitor and further a coordinated research strategy with sufficient funds to commission and promote high quality, independent research focusing on the public’s health needs and pan-European collaboration. There is a disparity between highly prevalent use of CAM in Europe and solid knowledge about it. A strategic approach on

  12. High prevalence but limited evidence in complementary and alternative medicine: guidelines for future research.

    PubMed

    Fischer, Felix H; Lewith, George; Witt, Claudia M; Linde, Klaus; von Ammon, Klaus; Cardini, Francesco; Falkenberg, Torkel; Fønnebø, Vinjar; Johannessen, Helle; Reiter, Bettina; Uehleke, Bernhard; Weidenhammer, Wolfgang; Brinkhaus, Benno

    2014-01-01

    The use of complementary and alternative Medicine (CAM) has increased over the past two decades in Europe. Nonetheless, research investigating the evidence to support its use remains limited. The CAMbrella project funded by the European Commission aimed to develop a strategic research agenda starting by systematically evaluating the state of CAM in the EU. CAMbrella involved 9 work packages covering issues such as the definition of CAM; its legal status, provision and use in the EU; and a synthesis of international research perspectives. Based on the work package reports, we developed a strategic and methodologically robust research roadmap based on expert workshops, a systematic Delphi-based process and a final consensus conference. The CAMbrella project suggests six core areas for research to examine the potential contribution of CAM to the health care challenges faced by the EU. These areas include evaluating the prevalence of CAM use in Europe; the EU cititzens' needs and attitudes regarding CAM; the safety of CAM; the comparative effectiveness of CAM; the effects of meaning and context on CAM outcomes; and different models for integrating CAM into existing health care systems. CAM research should use methods generally accepted in the evaluation of health services, including comparative effectiveness studies and mixed-methods designs. A research strategy is urgently needed, ideally led by a European CAM coordinating research office dedicated to fostering systematic communication between EU governments, the public, charitable and industry funders, researchers and other stakeholders. A European Centre for CAM should also be established to monitor and further a coordinated research strategy with sufficient funds to commission and promote high quality, independent research focusing on the public's health needs and pan-European collaboration. There is a disparity between highly prevalent use of CAM in Europe and solid knowledge about it. A strategic approach on CAM

  13. Complementary medicine.

    PubMed Central

    Spiegel, D; Stroud, P; Fyfe, A

    1998-01-01

    The widespread use of complementary and alternative medicine techniques, often explored by patients without discussion with their primary care physician, is seen as a request from patients for care as well as cure. In this article, we discuss the reasons for the growth of and interest in complementary and alternative medicine in an era of rapidly advancing medical technology. There is, for instance, evidence of the efficacy of supportive techniques such as group psychotherapy in improving adjustment and increasing survival time of cancer patients. We describe current and developing complementary medicine programs as well as opportunities for integration of some complementary techniques into standard medical care. PMID:9584661

  14. Complementary Medicine, Exercise, Meditation, Diet, and Lifestyle Modification for Anxiety Disorders: A Review of Current Evidence

    PubMed Central

    Sarris, J.; Moylan, S.; Camfield, D. A.; Pase, M. P.; Mischoulon, D.; Berk, M.; Jacka, F. N.; Schweitzer, I.

    2012-01-01

    Use of complementary medicines and therapies (CAM) and modification of lifestyle factors such as physical activity, exercise, and diet are being increasingly considered as potential therapeutic options for anxiety disorders. The objective of this metareview was to examine evidence across a broad range of CAM and lifestyle interventions in the treatment of anxiety disorders. In early 2012 we conducted a literature search of PubMed, Scopus, CINAHL, Web of Science, PsycInfo, and the Cochrane Library, for key studies, systematic reviews, and metaanalyses in the area. Our paper found that in respect to treatment of generalized anxiety or specific disorders, CAM evidence revealed current support for the herbal medicine Kava. One isolated study shows benefit for naturopathic medicine, whereas acupuncture, yoga, and Tai chi have tentative supportive evidence, which is hampered by overall poor methodology. The breadth of evidence does not support homeopathy for treating anxiety. Strong support exists for lifestyle modifications including adoption of moderate exercise and mindfulness meditation, whereas dietary improvement, avoidance of caffeine, alcohol, and nicotine offer encouraging preliminary data. In conclusion, certain lifestyle modifications and some CAMs may provide a beneficial role in the treatment of anxiety disorders. PMID:22969831

  15. A Methodological Framework for Evaluating the Evidence for Complementary and Alternative Medicine (CAM) for Cancer

    PubMed Central

    Zachariae, Robert; Johannessen, Helle

    2011-01-01

    In spite of lacking evidence for effects on cancer progression itself, an increasing number of cancer patients use various types of complementary and alternative medicine (CAM). There is disagreement between CAM practitioners, researchers and clinical oncologists, as to how evidence concerning effects of CAM can and should be produced, and how the existing evidence should be interpreted. This represents a considerable challenge for oncologists; both in terms of patient needs for an informed dialogue regarding CAM, and because some types of CAM may interact with standard treatments. There is a need for insight into which kinds of CAM may work, for whom they work, what the possible effects and side-effects are, and in what ways such effects may come about. The present article presents a framework for evaluating effects of CAM by suggesting a taxonomy of different levels of evidence related to different types of research questions and discussing the relevance of different research methodologies for different types of effects. PMID:24212640

  16. Integrating complementary/alternative medicine into primary care: evaluating the evidence and appropriate implementation

    PubMed Central

    Wainapel, Stanley F; Rand, Stephanie; Fishman, Loren M; Halstead-Kenny, Jennifer

    2015-01-01

    The frequency with which patients utilize treatments encompassed by the term complementary/alternative medicine (CAM) is well documented. A number of these therapies are beginning to be integrated into contemporary medical practice. This article examines three of them: osteopathic manipulation, yoga, and acupuncture, with a focus on their physiological effects, efficacy in treating medical conditions commonly encountered by practitioners, precautions or contraindications, and ways in which they can be incorporated into clinical practice. Physicians should routinely obtain information about use of CAM as part of their patient history and should consider their role based on physiological effects and clinical research results. PMID:26673479

  17. Complementary/Integrative Therapies That Work: A Review of the Evidence.

    PubMed

    Kligler, Benjamin; Teets, Raymond; Quick, Melissa

    2016-09-01

    Significant evidence supports the effectiveness and safety of several complementary or integrative treatment approaches to common primary care problems. Acupuncture is effective in the management of chronic low back pain. Mind-body interventions such as cognitive behavior therapy, yoga, tai chi, qi gong, and music therapy may be helpful for treating insomnia. Exercise can reduce anxiety symptoms. Herbal preparations and nutritional supplements can be useful as first-line therapy for certain conditions, such as fish oil for hypertriglyceridemia, St. John's wort for depression, and Ginkgo biloba extract for dementia, or as adjunctive therapy, such as coenzyme Q10 for heart failure. Probiotic supplementation can significantly reduce the likelihood of antibiotic-associated diarrhea. Physicians should caution patients about interactions, and counsel them about the quality and safety of herbal and nutritional supplements. PMID:27583423

  18. A complementary systems account of word learning: neural and behavioural evidence

    PubMed Central

    Davis, Matthew H.; Gaskell, M. Gareth

    2009-01-01

    In this paper we present a novel theory of the cognitive and neural processes by which adults learn new spoken words. This proposal builds on neurocomputational accounts of lexical processing and spoken word recognition and complementary learning systems (CLS) models of memory. We review evidence from behavioural studies of word learning that, consistent with the CLS account, show two stages of lexical acquisition: rapid initial familiarization followed by slow lexical consolidation. These stages map broadly onto two systems involved in different aspects of word learning: (i) rapid, initial acquisition supported by medial temporal and hippocampal learning, (ii) slower neocortical learning achieved by offline consolidation of previously acquired information. We review behavioural and neuroscientific evidence consistent with this account, including a meta-analysis of PET and functional Magnetic Resonance Imaging (fMRI) studies that contrast responses to spoken words and pseudowords. From this meta-analysis we derive predictions for the location and direction of cortical response changes following familiarization with pseudowords. This allows us to assess evidence for learning-induced changes that convert pseudoword responses into real word responses. Results provide unique support for the CLS account since hippocampal responses change during initial learning, whereas cortical responses to pseudowords only become word-like if overnight consolidation follows initial learning. PMID:19933145

  19. Planar terahertz waveguides based on complementary split ring resonators.

    PubMed

    Kumar, Gagan; Cui, Albert; Pandey, Shashank; Nahata, Ajay

    2011-01-17

    We experimentally demonstrate planar plasmonic THz waveguides using metal films that are periodically perforated with complementary split ring resonators (CSRRs). The waveguide transmission spectra exhibit numerous transmission resonances. While the geometry is commonly used in developing negative index materials, the excitation geometry used here does not allow for conventional metamaterial response. Instead, we show that all of the observed resonances can be determined from the geometrical properties of the CSRR apertures. Surprisingly, the Bragg condition does not appear to limit the frequency extent of the observed resonances. The results suggest that metamaterial-inspired geometries may be useful for developing THz guided-wave devices. PMID:21263646

  20. Evidence-based medicine.

    PubMed

    Sackett, D L

    1997-02-01

    Evidence-based medicine, whose philosophical origins extend back to mid-19th century Paris and earlier, is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence-based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research. By individual clinical expertise we mean the proficiency and judgment that we individual clinicians acquire through clinical experience and clinical practice. Increased expertise is reflected in many ways, but especially in more effective and efficient diagnosis and in the more thoughtful identification and compassionate use of individual patients' predicaments, rights, and preferences in making clinical decisions about their care. By best available external clinical evidence we mean clinically relevant research, often from the basic sciences of medicine, but especially from patient centered clinical research into the accuracy and precision of diagnostic tests (including the clinical examination), the power of prognostic markers, and the efficacy and safety of therapeutic, rehabilitative, and preventive regimens. External clinical evidence both invalidates previously accepted diagnostic tests and treatment and replaces them with new ones that are more powerful, more accurate, more efficacious, and safer. Good doctors use both individual clinical expertise and the best available external evidence, and neither alone is enough. Without clinical expertise, practice risks becoming tyrannized by external evidence, for even excellent external evidence may be inapplicable to or inappropriate for an individual patient. Without current best external evidence, practice risks becoming rapidly out of date, to the detriment of patients. The practice of evidence-based medicine is a process of life-long, self-directed learning in which caring for our own patients creates the need for

  1. Menopausal Symptoms and Complementary Health Practices

    MedlinePlus

    ... Audio) NCCIH Clinical Digest A monthly newsletter with evidence-based information on complementary and integrative practices and a ... review and meta-analysis of randomized controlled trials. Evidence-Based Complementary and Alternative Medicine. 2012;2012:863905. Dodin S, ...

  2. Evidence-Based Practice and Chiropractic Care

    PubMed Central

    LeFebvre, Ron; Peterson, David; Haas, Mitchell

    2013-01-01

    Evidence-based practice has had a growing impact on chiropractic education and the delivery of chiropractic care. For evidence-based practice to penetrate and transform a profession, the penetration must occur at 2 levels. One level is the degree to which individual practitioners possess the willingness and basic skills to search and assess the literature. Chiropractic education received a significant boost in this realm in 2005 when the National Center for Complementary and Alternative Medicine awarded 4 chiropractic institutions R25 education grants to strengthen their research/evidence-based practice curricula. The second level relates to whether the therapeutic interventions commonly employed by a particular health care discipline are supported by clinical research. A growing body of randomized controlled trials provides evidence of the effectiveness and safety of manual therapies. PMID:23875117

  3. An external cloak with arbitrary cross section based on complementary medium and coordinate transformation.

    PubMed

    Yang, Chengfu; Yang, Jingjing; Huang, Ming; Xiao, Zhe; Peng, Jinhui

    2011-01-17

    Electromagnetic cloak is a device which makes an object "invisible" for electromagnetic irradiation in a certain frequency range. Material parameters for the complementary medium-assisted external cylindrical cloak with arbitrary cross section are derived based on combining the concepts of complementary media and transformation optics. It can make the object with arbitrary shape outside the cloaking domain invisible, as long as an "antiobject" is embedded in the complementary media layer. Moreover, we find that the shape, size and the position of the "antiobject" is dependent on the contour of the cloak and the coordinate transformation. The external cloaking effect has been verified by full-wave simulation. PMID:21263655

  4. Complementary and alternative therapies for weight loss.

    PubMed

    Steyer, Terrence E; Ables, Adrienne

    2009-06-01

    Although many complementary therapies are promoted for the treatment of obesity, few are truly therapeutic. Evidence suggests that food containing diacylglycerol oil, acupuncture, and hypnosis are the only evidence-based complementary therapies for the treatment of obesity, and, at best, these should be used as adjuvants to the more conventional therapies of calorie restriction and exercise. PMID:19501250

  5. Evidence based vaccinology.

    PubMed

    Nalin, David R

    2002-02-22

    Evidence based vaccinology (EBV) is the identification and use of the best evidence in making and implementing decisions during all of the stages of the life of a vaccine, including pre-licensure vaccine development and post-licensure manufacture and research, and utilization of the vaccine for disease control. Vaccines, unlike most pharmaceuticals, are in a continuous process of development both before and after licensure. Changes in biologics manufacturing technology and changes that vaccines induce in population and disease biology lead to periodic review of regimens (and sometimes dosage) based on changing immunologic data or public perceptions relevant to vaccine safety and effectiveness. EBV includes the use of evidence based medicine (EBM) both in clinical trials and in national disease containment programs. The rationale for EBV is that the highest evidentiary standards are required to maintain a rigorous scientific basis of vaccine quality control in manufacture and to ensure valid determination of vaccine efficacy, field effectiveness and safety profiles (including post-licensure safety monitoring), cost-benefit analyses, and risk:benefit ratios. EBV is increasingly based on statistically validated, clearly defined laboratory, manufacturing, clinical and epidemiological research methods and procedures, codified as good laboratory practices (GLP), good manufacturing practices (GMP), good clinical research practices (GCRP) and in clinical and public health practice (good vaccination practices, GVP). Implementation demands many data-driven decisions made by a spectrum of specialists pre- and post-licensure, and is essential to maintaining public confidence in vaccines. PMID:11858871

  6. Evidence-based dentistry.

    PubMed

    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

  7. Complementary Reliability-Based Decodings of Binary Linear Block Codes

    NASA Technical Reports Server (NTRS)

    Fossorier, Marc P. C.; Lin, Shu

    1997-01-01

    This correspondence presents a hybrid reliability-based decoding algorithm which combines the reprocessing method based on the most reliable basis and a generalized Chase-type algebraic decoder based on the least reliable positions. It is shown that reprocessing with a simple additional algebraic decoding effort achieves significant coding gain. For long codes, the order of reprocessing required to achieve asymptotic optimum error performance is reduced by approximately 1/3. This significantly reduces the computational complexity, especially for long codes. Also, a more efficient criterion for stopping the decoding process is derived based on the knowledge of the algebraic decoding solution.

  8. Evidence-Based Integrative Dermatology

    PubMed Central

    Narahari, Saravu R; Prasanna, Kodimoole S; Sushma, Kandathu V

    2013-01-01

    American recognition for medical pluralism arrived in 1991. The National Center for Complementary and Alternative Medicine was established under the National Institutes of Health in 1998. Following this, patients and researchers began exploring use of integrative medicine. Terence Ryan with Gerry Bodeker in Europe, Brian Berman in America, and the Indian council of Medical Research advocated traditional medicine and integrative medicine. The Institute of Applied Dermatology (IAD), Kerala has developed integrated allopathic (biomedical) and ayurvedic therapies to treat Lymphatic Filariasis, Lichen planus, and Vitiligo. Studies conducted at the IAD have created a framework for evidence-based and integrative dermatology (ID). This paper gives an overview of advances in ID with an example of Lichen Planus, which was examined jointly by dermatologists and Ayurveda doctors. The clinical presentation in these patients was listed in a vikruthi table of comparable biomedical terms. A vikruthi table was used for drug selection in ayurvedic dermatology. A total of 19 patients were treated with ayurvedic prescriptions to normalize the vatha-kapha for 3 months. All patients responded and no side effects were recorded. In spite of advancing knowledge on ID, several challenges remain for its use on difficult to treat chronic skin diseases. The formation of new integrative groups and financial support are essential for the growth of ID in India. PMID:23716802

  9. Complementary Study

    SciTech Connect

    Yamada, H.

    2009-02-19

    In this lecture, it is emphasized that sufficient resolution of scientific issues for a fusion energy reactor can be given by complementary studies. Key scientific issues for a fusion energy reactor and ITER addressed by a complementary study in the Large Helical Device (LHD) are discussed. It should be noted that ITER is definitely a necessary condition but not a sufficient condition. Helical systems including stellarators and heliotrons are defined as alternative concepts. These approaches also aim at a fusion energy reactor based on their own concept and simultaneously benefit progress in tokamaks, more specifically ITER itself. The exact science to manage a 3-D geometry has been being developed in helical systems. A physical model with much accuracy and breadth will demonstrate its applicability to ITER. Topics to validate ''complementary'' approaches such as 3-D equilibrium, interchange MHD mode, control of radial electric field and structure formation, dynamics of a magnetic island, density limit and edge plasmas are discussed. Complementary is not Supplementary. ITER is complementary to development of a helical fusion energy reactor as well. Complementary approaches transcend existing disciplinary horizons and enable big challenges.

  10. Gain-Scheduled Complementary Filter Design for a MEMS Based Attitude and Heading Reference System

    PubMed Central

    Yoo, Tae Suk; Hong, Sung Kyung; Yoon, Hyok Min; Park, Sungsu

    2011-01-01

    This paper describes a robust and simple algorithm for an attitude and heading reference system (AHRS) based on low-cost MEMS inertial and magnetic sensors. The proposed approach relies on a gain-scheduled complementary filter, augmented by an acceleration-based switching architecture to yield robust performance, even when the vehicle is subject to strong accelerations. Experimental results are provided for a road captive test during which the vehicle dynamics are in high-acceleration mode and the performance of the proposed filter is evaluated against the output from a conventional linear complementary filter. PMID:22163824

  11. Self-electroforming and high-performance complementary memristor based on ferroelectric tunnel junctions

    NASA Astrophysics Data System (ADS)

    Yan, Z. B.; Yau, H. M.; Li, Z. W.; Gao, X. S.; Dai, J. Y.; Liu, J.-M.

    2016-08-01

    Complementary resistive switching (CRS) has potential applications in ultra-high density three-dimensional crossbar arrays for resistive random access memories and Logic-in-Memories. For real applications, the good stability and electroforming-free character have become essential pre-requisites. In this work, we investigate the resistance switching behaviors of a CRS device based on two anti-serial Au/BaTiO3/Nb:SrTiO3 ferroelectric tunnel junctions (FTJs). This FTJ-based CRS device shows a stable butterfly-like resistance-voltage hysteresis, as well as self-electroforming, multi-switching, and good performance complementary switching behaviors. The present work presents a convincing demonstration of the complementary multi-switching states modulated by remnant ferroelectric polarization, making the FTJ structure good potentials for high-performance CRS memristors.

  12. Underdetermination in evidence-based medicine.

    PubMed

    Chin-Yee, Benjamin H

    2014-12-01

    This article explores the philosophical implications of evidence-based medicine's (EBM's) epistemology in terms of the problem of underdetermination of theory by evidence as expounded by the Duhem-Quine thesis. EBM hierarchies of evidence privilege clinical research over basic science, exacerbating the problem of underdetermination. Because of severe underdetermination, EBM is unable to meaningfully test core medical beliefs that form the basis of our understanding of disease and therapeutics. As a result, EBM adopts an epistemic attitude that is sceptical of explanations from the basic biological sciences, and is relegated to a view of disease at a population level. EBM's epistemic attitude provides a limited research heuristic by preventing the development of a theoretical framework required for understanding disease mechanism and integrating knowledge to develop new therapies. Medical epistemology should remain pluralistic and include complementary approaches of basic science and clinical research, thus avoiding the limited epistemic attitude entailed by EBM hierarchies. PMID:25406418

  13. Evidence-based management.

    PubMed

    Cohen, Frank

    2012-01-01

    It's OK to be lucky when you're lucky, but it's not OK when the issues are critical. Too often, we manage by anecdote, which is OK when you can afford to be wrong, but when finances are tight, or the market is overregulated, or a lot is at stake, making mistakes is not an option. Evidence-based management depends on attention to three components: analytics, decision making, and problem solving. These are skills that should be required of everyone who assumes a management position, no matter how high or low one is on the totem pole. Understanding basic analytical techniques, knowing how to apply these techniques to making good decisions, and learning how to become a skilled problem solver ensure that, when we manage our businesses, we minimize the risk of mistakes and maximize the potential for positive outcomes. PMID:22594062

  14. High-gain inverters based on WSe2 complementary field-effect transistors.

    PubMed

    Tosun, Mahmut; Chuang, Steven; Fang, Hui; Sachid, Angada B; Hettick, Mark; Lin, Yongjing; Zeng, Yuping; Javey, Ali

    2014-05-27

    In this work, the operation of n- and p-type field-effect transistors (FETs) on the same WSe2 flake is realized,and a complementary logic inverter is demonstrated. The p-FET is fabricated by contacting WSe2 with a high work function metal, Pt, which facilities hole injection at the source contact. The n-FET is realized by utilizing selective surface charge transfer doping with potassium to form degenerately doped n+ contacts for electron injection. An ON/OFF current ratio of >10(4) is achieved for both n- and p-FETs with similar ON current densities. A dc voltage gain of >12 is measured for the complementary WSe2 inverter. This work presents an important advance toward realization of complementary logic devices based on layered chalcogenide semiconductors for electronic applications. PMID:24684575

  15. Complementary and Alternative Medicine in the Treatment of Chronic Pelvic Pain in Women: What Is the Evidence?

    PubMed Central

    Paiva, Sara; Carneiro, Márcia Mendonça

    2013-01-01

    Chronic pelvic pain (CPP) is defined as pain of at least 6 months' duration that occurs in the lower abdomen or below the umbilicus and has resulted in functional or psychological disability or required intervention and treatment. Therapeutic interventions center around the treatment of CPP as a diagnosis in and of itself, and treatment of specific disorders that may be related to CPP. A multidisciplinary approach for diagnosis and treatment seems to be most effective for symptomatic relief. This paper reviews the evidence for such interventions as psychological treatments including the use of complementary and alternative medicine techniques for CPP in women. Unfortunately, finding the best evidence in this setting is difficult as only very few randomized controlled trials are available. A combination of treatments is usually required over time for the treatment of refractory CPP. The multifactorial nature of CPP needs to be discussed with the patient and a good rapport as well as a partnership needs to be developed to plan a management program with regular followup. Promotion of a multidisciplinary approach which includes complementary and alternative medicine techniques in managing CPP in women seems to yield the best results. PMID:27335875

  16. The transformer genes in the fig wasp Ceratosolen solmsi provide new evidence for duplications independent of complementary sex determination.

    PubMed

    Jia, L-Y; Xiao, J-H; Xiong, T-L; Niu, L-M; Huang, D-W

    2016-06-01

    Transformer (tra) is the key gene that turns on the sex-determination cascade in Drosophila melanogaster and in some other insects. The honeybee Apis mellifera has two duplicates of tra, one of which (complementary sex determiner, csd) is the primary signal for complementary sex-determination (CSD), regulating the other duplicate (feminizer). Two tra duplicates have been found in some other hymenopteran species, resulting in the assumption that a single ancestral duplication of tra took place in the Hymenoptera. Here, we searched for tra homologues and pseudogenes in the Hymenoptera, focusing on five newly published hymenopteran genomes. We found three tra copies in the fig wasp Ceratosolen solmsi. Further evolutionary and expression analyses also showed that the two duplicates (Csoltra-B and Csoltra-C) are under positive selection, and have female-specific expression, suggesting possible sex-related functions. Moreover, Aculeata species exhibit many pseudogenes generated by lineage-specific duplications. We conclude that phylogenetic reconstruction and pseudogene screening provide novel evidence supporting the hypothesis of independent duplications rather an ancestral origin of multiple tra paralogues in the Hymenoptera. The case of C. solmsi is the first example of a non-CSD species with duplicated tra, contrary to the previous assumption that derived tra paralogues function as the CSD locus. PMID:26748889

  17. Hybridization-based aptamer labeling using complementary oligonucleotide platform for PET and optical imaging.

    PubMed

    Park, Jun Young; Lee, Tae Sup; Song, In Ho; Cho, Ye Lim; Chae, Ju Ri; Yun, Mijin; Kang, Hyungu; Lee, Jung Hwan; Lim, Jong Hoon; Cho, Won Gil; Kang, Won Jun

    2016-09-01

    Aptamers are promising next-generation ligands used in molecular imaging and theragnosis. Aptamers are synthetic nucleic acids that can be held together with complementary sequences by base-pair hybridization. In this study, the complementary oligonucleotide (cODN) hybridization-based aptamer conjugation platform was developed to use aptamers as the molecular imaging agent. The cODN was pre-labeled with fluorescent dye or radioisotope and hybridized with a matched sequence containing aptamers in aqueous conditions. The cODN platform-hybridized aptamers exhibited good serum stability and specific binding affinity towards target cancer cells both in vitro and in vivo. These results suggest that the newly designed aptamer conjugation platform offers great potential for the versatile application of aptamers as molecular imaging agents. PMID:27258484

  18. Rapid switching in electrochromic devices based on complementary conducting polymer films

    SciTech Connect

    Sapp, S.A.; Sotzing, G.A.; Reddinger, J.L.; Reynolds, J.R.

    1996-10-01

    The search for stable, rapid switching electrochromic materials that are easy and inexpensive to process has become the focus of a great deal of research in the past few years. Conducting and electroactive polymers are one class of electrochromic materials which may offer a low cost alternative to the traditional metal oxide materials that have been studied in depth. These materials also offer the advantages of having rapid switching rates and a well defined chemical structure. Recently, there have been many new conducting polymer systems developed which exhibit complementary electrochromic behavior and undergo reversible redox chemistry. This presentation will focus on the design, fabrication, and characterization of electrochromic devices based on complementary conducting polymers as cathodic and anodic electrochromic materials. Spectroelectrochemistry results and switching rate determinations will be discussed for two of these polymer based electrochromic devices.

  19. Retinal Stimulation on Rabbit Using Complementary Metal Oxide Semiconductor Based Multichip Flexible Stimulator toward Retinal Prosthesis

    NASA Astrophysics Data System (ADS)

    Tokuda, Takashi; Asano, Ryosuke; Sugitani, Sachie; Taniyama, Mari; Terasawa, Yasuo; Nunoshita, Masahiro; Nakauchi, Kazuaki; Fujikado, Takashi; Tano, Yasuo; Ohta, Jun

    2008-04-01

    The Functionality of a complementary metal oxide semiconductor (CMOS) LSI-based, multichip flexible retinal stimulator was demonstrated in retinal stimulation experiments on rabbits. A 1×4-configured multichip stimulator was fabricated for application to experiments on animals. An experimental procedure including surgical operations was developed, and retinal stimulation was performed with the fabricated multichip stimulator. Neural responses on the visual cortex were successfully evoked by the fabricated stimulator. The stimulator is confirmed to be applicable to acute animal experiments.

  20. Complementary and Alternative Medicine

    MedlinePlus

    ... Help a Friend Who Cuts? Complementary and Alternative Medicine KidsHealth > For Teens > Complementary and Alternative Medicine Print ... replacement. continue How Is CAM Different From Conventional Medicine? Conventional medicine is based on scientific knowledge of ...

  1. Fluorescent profiling of modular biosynthetic enzymes by complementary metabolic and activity based probes.

    PubMed

    Meier, Jordan L; Mercer, Andrew C; Burkart, Michael D

    2008-04-23

    The study of the enzymes responsible for natural product biosynthesis has proven a valuable source of new enzymatic activities and been applied to a number of biotechnology applications. Protein profiling could prove highly complementary to genetics based approaches by allowing us to understand the activity, transcriptional control, and post-translational modification of these enzymes in their native and dynamic proteomic environments. Here we present a method for the fluorescent profiling of PKS, NRPS, and FAS multidomain modular synthases in their whole proteomes using complementary metabolic and activity based probes. After first examining the reactivity of these activity based probes with a variety of purified recombinant PKS, NRPS, and FAS enzymes in vitro, we apply this duel labeling strategy to the analysis of modular synthases in a human breast cancer cell line and two strains of the natural product producer Bacillus subtilis. Collectively, these studies demonstrate that complementary protein profiling approaches can prove highly useful in the identification and assignment of inhibitor specificity and domain structure of these modular biosynthetic enzymes. PMID:18376827

  2. A high-performance complementary inverter based on transition metal dichalcogenide field-effect transistors.

    PubMed

    Cho, Ah-Jin; Park, Kee Chan; Kwon, Jang-Yeon

    2015-01-01

    For several years, graphene has been the focus of much attention due to its peculiar characteristics, and it is now considered to be a representative 2-dimensional (2D) material. Even though many research groups have studied on the graphene, its intrinsic nature of a zero band-gap, limits its use in practical applications, particularly in logic circuits. Recently, transition metal dichalcogenides (TMDs), which are another type of 2D material, have drawn attention due to the advantage of having a sizable band-gap and a high mobility. Here, we report on the design of a complementary inverter, one of the most basic logic elements, which is based on a MoS2 n-type transistor and a WSe2 p-type transistor. The advantages provided by the complementary metal-oxide-semiconductor (CMOS) configuration and the high-performance TMD channels allow us to fabricate a TMD complementary inverter that has a high-gain of 13.7. This work demonstrates the operation of the MoS2 n-FET and WSe2 p-FET on the same substrate, and the electrical performance of the CMOS inverter, which is based on a different driving current, is also measured. PMID:25852410

  3. A high-performance complementary inverter based on transition metal dichalcogenide field-effect transistors

    NASA Astrophysics Data System (ADS)

    Cho, Ah-Jin; Park, Kee Chan; Kwon, Jang-Yeon

    2015-03-01

    For several years, graphene has been the focus of much attention due to its peculiar characteristics, and it is now considered to be a representative 2-dimensional (2D) material. Even though many research groups have studied on the graphene, its intrinsic nature of a zero band-gap, limits its use in practical applications, particularly in logic circuits. Recently, transition metal dichalcogenides (TMDs), which are another type of 2D material, have drawn attention due to the advantage of having a sizable band-gap and a high mobility. Here, we report on the design of a complementary inverter, one of the most basic logic elements, which is based on a MoS2 n-type transistor and a WSe2 p-type transistor. The advantages provided by the complementary metal-oxide-semiconductor (CMOS) configuration and the high-performance TMD channels allow us to fabricate a TMD complementary inverter that has a high-gain of 13.7. This work demonstrates the operation of the MoS2 n-FET and WSe2 p-FET on the same substrate, and the electrical performance of the CMOS inverter, which is based on a different driving current, is also measured.

  4. Evidence-Based Language Practice

    ERIC Educational Resources Information Center

    Pollock, Eric J.

    2005-01-01

    The purpose of this paper was to examine evidence-based procedures in medicine and to demonstrate that the same protocols can be used in English language instruction. In the evidence-based methodology, studies are divided into those that address specific language problems. Integrated studies are presented as a systematic overview, meta-analysis,…

  5. CAMbase – A XML-based bibliographical database on Complementary and Alternative Medicine (CAM)

    PubMed Central

    Ostermann, Thomas; Zillmann, Hartmut; Raak, Christa K; Buessing, Arndt; Matthiessen, Peter F

    2007-01-01

    The term "Complementary and Alternative Medicine (CAM)" covers a variety of approaches to medical theory and practice, which are not commonly accepted by representatives of conventional medicine. In the past two decades, these approaches have been studied in various areas of medicine. Although there appears to be a growing number of scientific publications on CAM, the complete spectrum of complementary therapies still requires more information about published evidence. A majority of these research publications are still not listed in electronic bibliographical databases such as MEDLINE. However, with a growing demand by patients for such therapies, physicians increasingly need an overview of scientific publications on CAM. Bearing this in mind, CAMbase, a bibliographical database on CAM was launched in order to close this gap. It can be accessed online free of charge or additional costs. The user can peruse more than 80,000 records from over 30 journals and periodicals on CAM, which are stored in CAMbase. A special search engine performing syntactical and semantical analysis of textual phrases allows the user quickly to find relevant bibliographical information on CAM. Between August 2003 and July 2006, 43,299 search queries, an average of 38 search queries per day, were registered focussing on CAM topics such as acupuncture, cancer or general safety aspects. Analysis of the requests led to the conclusion that CAMbase is not only used by scientists and researchers but also by physicians and patients who want to find out more about CAM. Closely related to this effort is our aim to establish a modern library center on Complementary Medicine which offers the complete spectrum of a modern digital library including a document delivery-service for physicians, therapists, scientists and researchers. PMID:17407592

  6. Risk Assessment: Evidence Base

    NASA Technical Reports Server (NTRS)

    Johnson-Throop, Kathy A.

    2007-01-01

    Human systems PRA (Probabilistic Risk Assessment: a) Provides quantitative measures of probability, consequence, and uncertainty; and b) Communicates risk and informs decision-making. Human health risks rated highest in ISS PRA are based on 1997 assessment of clinical events in analog operational settings. Much work remains to analyze remaining human health risks identified in Bioastronautics Roadmap.

  7. Advancing complementary and alternative medicine through social network analysis and agent-based modeling.

    PubMed

    Frantz, Terrill L

    2012-01-01

    This paper introduces the contemporary perspectives and techniques of social network analysis (SNA) and agent-based modeling (ABM) and advocates applying them to advance various aspects of complementary and alternative medicine (CAM). SNA and ABM are invaluable methods for representing, analyzing and projecting complex, relational, social phenomena; they provide both an insightful vantage point and a set of analytic tools that can be useful in a wide range of contexts. Applying these methods in the CAM context can aid the ongoing advances in the CAM field, in both its scientific aspects and in developing broader acceptance in associated stakeholder communities. PMID:22327550

  8. Complementary fMRI and EEG evidence for more efficient neural processing of rhythmic vs. unpredictably timed sounds

    PubMed Central

    van Atteveldt, Nienke; Musacchia, Gabriella; Zion-Golumbic, Elana; Sehatpour, Pejman; Javitt, Daniel C.; Schroeder, Charles

    2015-01-01

    The brain’s fascinating ability to adapt its internal neural dynamics to the temporal structure of the sensory environment is becoming increasingly clear. It is thought to be metabolically beneficial to align ongoing oscillatory activity to the relevant inputs in a predictable stream, so that they will enter at optimal processing phases of the spontaneously occurring rhythmic excitability fluctuations. However, some contexts have a more predictable temporal structure than others. Here, we tested the hypothesis that the processing of rhythmic sounds is more efficient than the processing of irregularly timed sounds. To do this, we simultaneously measured functional magnetic resonance imaging (fMRI) and electro-encephalograms (EEG) while participants detected oddball target sounds in alternating blocks of rhythmic (e.g., with equal inter-stimulus intervals) or random (e.g., with randomly varied inter-stimulus intervals) tone sequences. Behaviorally, participants detected target sounds faster and more accurately when embedded in rhythmic streams. The fMRI response in the auditory cortex was stronger during random compared to random tone sequence processing. Simultaneously recorded N1 responses showed larger peak amplitudes and longer latencies for tones in the random (vs. the rhythmic) streams. These results reveal complementary evidence for more efficient neural and perceptual processing during temporally predictable sensory contexts. PMID:26579044

  9. Retail Location Choice with Complementary Goods: An Agent-Based Model

    NASA Astrophysics Data System (ADS)

    Huang, Arthur; Levinson, David

    This paper models the emergence of retail clusters on a supply chain network comprised of suppliers, retailers, and consumers. Firstly, an agent-based model is proposed to investigate retail location distribution in a market of two complementary goods. The methodology controls for supplier locales and unit sales prices of retailers and suppliers, and a consumer’s willingness to patronize a retailer depends on the total travel distance of buying both goods. On a circle comprised of discrete locations, retailers play a non-cooperative game of location choice to maximize individual profits. Our findings suggest that the probability distribution of the number of clusters in equilibrium follows power law and that hierarchical distribution patterns are much more likely to occur than the spread-out ones. In addition, retailers of complementary goods tend to co-locate at supplier locales. Sensitivity tests on the number of retailers are also performed. Secondly, based on the County Business Patterns (CBP) data of Minneapolis-St. Paul from US Census 2000 database, we find that the number of clothing stores and the distribution of food stores at the zip code level follows power-law distribution.

  10. A Red Cy3-Based Biarsenical Fluorescent Probe Targeted to a Complementary Binding Peptide

    SciTech Connect

    Cao, Haishi; Xiong, Yijia; Wang, Ting; Chen, Baowei; Squier, Thomas C.; Mayer, M. Uljana

    2007-06-22

    Small-molecule biarsenical multiuse affinity probes (MAPs) FlAsH and ReAsH,1,2 in conjunction with complementary protein tags, are important new tools for analyzing cellular function through live-cell imaging,3,4 targeted protein inactivation,5 and the measurement of protein dynamics and binding.6 In addition, MAPs serve as affinity reagents for isolating intact protein complexes for complementary structural measurements.7 These first-generation MAPs bind to a tetracoordinate arsenic group (TAG) binding motif (i.e., CCXXCC or FlAsHTAG) genetically engineered onto a protein of interest. They are superior to other targeted labeling strategies (such as the Halo-tag, the SNAP tag, and fluorescent proteins) in that the small peptide tag does not disrupt protein protein interactions nor perturb the correct trafficking of tagged proteins.8,9 The conserved interatomic distance (*6 Å) between the two arsenic moieties in FlAsH and ReAsH complicates the selective labeling of multiple proteins with different reporters. To overcome these limitations, we have synthesized a new biarsenical MAP (i.e., AsCy3) based on Cy3, a member of the cyanine dye family, whose well-recognized brightness and photostability facilitate their utility in single-molecule measurements. The large interatomic distance between the two arsenics in AsCy3 (*14.5 Å) coupled with the identification of a complementary high-affinity binding sequence CCKAEAACC (Cy3TAG) permits the simultaneous application of both AsCy3 and FlAsH to selectively label their respective binding TAGs in different proteins. In addition, the fluorescence of FlAsH overlaps with the absorption of AsCy3, which can act as an acceptor of fluorescence resonance energy transfer (FRET) to allow ratiometric measurements of protein association.

  11. Insufficient Evidence: The Problems of Evidence-Based Nursing.

    ERIC Educational Resources Information Center

    Rolfe, Gary

    1999-01-01

    Challenges the wisdom of basing nursing practice on the findings of statistical research and offers objections to the philosophy of evidence-based nursing. Proposes rethinking what counts as evidence, suggesting a model based on reflection after the event. (SK)

  12. A novel circuit design for complementary resistive switch-based stateful logic operations

    NASA Astrophysics Data System (ADS)

    Xiao-Ping, Wang; Lin, Chen; Yi, Shen; Bo-Wen, Xu

    2016-05-01

    Recently, it has been demonstrated that memristors can be utilized as logic operations and memory elements. In this paper, we present a novel circuit design for complementary resistive switch (CRS)-based stateful logic operations. The proposed circuit can automatically write the destructive CRS cells back to the original states. In addition, the circuit can be used in massive passive crossbar arrays which can reduce sneak path current greatly. Moreover, the steps for CRS logic operations using our proposed circuit are reduced compared with previous circuit designs. We validate the effectiveness of our scheme through Hspice simulations on the logic circuits. Project supported by the National Natural Science Foundation of China (Grant Nos. 61374150 and 11271146), the State Key Program of the National Natural Science Foundation of China (Grant No. 61134012), the Doctoral Fund of Ministry of Education of China (Grant No. 20130142130012), and the Science and Technology Program of Shenzhen City, China (Grant No. JCYJ20140509162710496).

  13. [Philosophical background of evidence-based medicine].

    PubMed

    Kwon, Sang-Ok

    2004-12-01

    Through the whole history of medicine, there runs a long struggle between two principal tendencies - empiricism and rationalism. The empirical trend lays its emphasis on "experience" for the cure of the sick. The rationalistic trend lays its main emphasis on "mechanism" for the causes of diseases. The term "evidence-based (EBM)", defined as "the conscious, explicit and judicious use of the best current evidence in making decisions about the individual patients", was introduced about ten years ago. The proponents has been described EBM as a "paradigm shift" that will change medical practice in the years ahead. But there has been considerable debate about the value of EBM. The modern medicine, following philosophy of modern science such as the 'realism controlled by empiricism', has developed biomedical model. But the EBM wrapped with clinical epidemiology and statistics, represents response of empiricism to the rationalism (realism). The roots of EBM extend back at least as far as the Paris clinical school, and the work of Pierre Louis in Paris in the early 19th century.Is EBM a paradigm shift? To answer this question, we have to specify the alternative with which we are comparing EBM. The alternative to EBM is the basic science approach: studying the pathophysiological mechanism of the body. But EBM is so clearly intertwined with and complementary to the basic science that it would make little sense to see EBM as a paradigm shift away from basic science. In a sense, evidence-based medicine shows only methodological contribution aimed at improving the gathering and sorting of the best information published by biomedical scientists and clinical epidemiologists for use in clinical practice. Although EBM and the traditional medicine embody different approaches, this does not mean that they are competitors. In fact, the two approach need each; neither can stand alone for the development of clinical practice. PMID:15726761

  14. School Centered Evidence Based Accountability

    ERIC Educational Resources Information Center

    Milligan, Charles

    2015-01-01

    Achievement scores drive much of the effort in today's accountability system, however, there is much more that occurs in every school, every day. School Centered Evidence Based Accountability can be used from micro to macro giving School Boards and Administration a process for monitoring the results of the entire school operation effectively and…

  15. Complementary Constrains on Component based Multiphase Flow Problems, Should It Be Implemented Locally or Globally?

    NASA Astrophysics Data System (ADS)

    Shao, H.; Huang, Y.; Kolditz, O.

    2015-12-01

    Multiphase flow problems are numerically difficult to solve, as it often contains nonlinear Phase transition phenomena A conventional technique is to introduce the complementarity constraints where fluid properties such as liquid saturations are confined within a physically reasonable range. Based on such constraints, the mathematical model can be reformulated into a system of nonlinear partial differential equations coupled with variational inequalities. They can be then numerically handled by optimization algorithms. In this work, two different approaches utilizing the complementarity constraints based on persistent primary variables formulation[4] are implemented and investigated. The first approach proposed by Marchand et.al[1] is using "local complementary constraints", i.e. coupling the constraints with the local constitutive equations. The second approach[2],[3] , namely the "global complementary constrains", applies the constraints globally with the mass conservation equation. We will discuss how these two approaches are applied to solve non-isothermal componential multiphase flow problem with the phase change phenomenon. Several benchmarks will be presented for investigating the overall numerical performance of different approaches. The advantages and disadvantages of different models will also be concluded. References[1] E.Marchand, T.Mueller and P.Knabner. Fully coupled generalized hybrid-mixed finite element approximation of two-phase two-component flow in porous media. Part I: formulation and properties of the mathematical model, Computational Geosciences 17(2): 431-442, (2013). [2] A. Lauser, C. Hager, R. Helmig, B. Wohlmuth. A new approach for phase transitions in miscible multi-phase flow in porous media. Water Resour., 34,(2011), 957-966. [3] J. Jaffré, and A. Sboui. Henry's Law and Gas Phase Disappearance. Transp. Porous Media. 82, (2010), 521-526. [4] A. Bourgeat, M. Jurak and F. Smaï. Two-phase partially miscible flow and transport modeling in

  16. PSRna: Prediction of small RNA secondary structures based on reverse complementary folding method.

    PubMed

    Li, Jin; Xu, Chengzhen; Wang, Lei; Liang, Hong; Feng, Weixing; Cai, Zhongxi; Wang, Ying; Cong, Wang; Liu, Yunlong

    2016-08-01

    Prediction of RNA secondary structures is an important problem in computational biology and bioinformatics, since RNA secondary structures are fundamental for functional analysis of RNA molecules. However, small RNA secondary structures are scarce and few algorithms have been specifically designed for predicting the secondary structures of small RNAs. Here we propose an algorithm named "PSRna" for predicting small-RNA secondary structures using reverse complementary folding and characteristic hairpin loops of small RNAs. Unlike traditional algorithms that usually generate multi-branch loops and 5[Formula: see text] end self-folding, PSRna first estimated the maximum number of base pairs of RNA secondary structures based on the dynamic programming algorithm and a path matrix is constructed at the same time. Second, the backtracking paths are extracted from the path matrix based on backtracking algorithm, and each backtracking path represents a secondary structure. To improve accuracy, the predicted RNA secondary structures are filtered based on their free energy, where only the secondary structure with the minimum free energy was identified as the candidate secondary structure. Our experiments on real data show that the proposed algorithm is superior to two popular methods, RNAfold and RNAstructure, in terms of sensitivity, specificity and Matthews correlation coefficient (MCC). PMID:27045556

  17. Design and implementation of dual-band antennas based on a complementary split ring resonators

    NASA Astrophysics Data System (ADS)

    Ortiz, Noelia; Iriarte, Juan Carlos; Crespo, Gonzalo; Falcone, Francisco

    2015-07-01

    A simple dual-band antenna design and implementation method is proposed in this work, based on the equivalent media properties inspired by resonant metamaterial elements. The equivalent circuit model of dual-band patch antennas based on a complementary split ring resonator (CSRR) is presented and validated. The dual-band patch antenna is designed etching a CSRR in the patch of a conventional rectangular microstrip patch antenna. The first resonance is governed by the quasi-static resonance of the CSRR while the second resonance is originated by the rectangular patch. The fact of etching a CSRR on a rectangular patch antenna also produces a miniaturization of a conventional patch antenna. The equivalent circuit model proposed in this letter is sound in order to understand the functionality of dual-band patch antennas based on a CSRR. Good agreement between simulation, equivalent circuit model and experimental results is shown and discussed. These results lead the equivalent circuit model to become a simple and straightforward tool for the design of this type of multiband antennas, of low cost and versatile operation for a broad range of wireless communication systems.

  18. Complementary Treatment

    MedlinePlus

    ... someone living with PD, this section focuses on herbs, vitamins and supplements. If you are considering complementary ... product recommendations regarding such products. Key Points Most herbs and supplements have not been rigorously studied as ...

  19. Evidence-Based Practice and School Nursing

    ERIC Educational Resources Information Center

    Adams, Susan; McCarthy, Ann Marie

    2005-01-01

    School nurses need to demonstrate that their practice is based on the best evidence available, which is usually data obtained from research. Evidence-based practice involves combining the best evidence available with nursing expertise and patient and family preferences to determine optimum care. Evidence-based practice guidelines are developed by…

  20. Complementary cell-based high-throughput screens identify novel modulators of the unfolded protein response.

    PubMed

    Fribley, Andrew M; Cruz, Patricia G; Miller, Justin R; Callaghan, Michael U; Cai, Peter; Narula, Neha; Neubig, Richard R; Showalter, Hollis D; Larsen, Scott D; Kirchhoff, Paul D; Larsen, Martha J; Burr, Douglas A; Schultz, Pamela J; Jacobs, Renju R; Tamayo-Castillo, Giselle; Ron, David; Sherman, David H; Kaufman, Randal J

    2011-09-01

    Despite advances toward understanding the prevention and treatment of many cancers, patients who suffer from oral squamous cell carcinoma (OSCC) confront a survival rate that has remained unimproved for more than 2 decades, indicating our ability to treat them pharmacologically has reached a plateau. In an ongoing effort to improve the clinical outlook for this disease, we previously reported that an essential component of the mechanism by which the proteasome inhibitor bortezomib (PS-341, Velcade) induced apoptosis in OSCC required the activation of a terminal unfolded protein response (UPR). Predicated on these studies, the authors hypothesized that high-throughput screening (HTS) of large diverse chemical libraries might identify more potent or selective small-molecule activators of the apoptotic arm of the UPR to control or kill OSCC. They have developed complementary cell-based assays using stably transfected CHO-K1 cell lines that individually assess the PERK/eIF2α/CHOP (apoptotic) or the IRE1/XBP1 (adaptive) UPR subpathways. An 66 K compound collection was screened at the University of Michigan Center for Chemical Genomics that included a unique library of prefractionated natural product extracts. The mycotoxin methoxycitrinin was isolated from a natural extract and found to selectively activate the CHOP-luciferase reporter at 80 µM. A series of citrinin derivatives was isolated from these extracts, including a unique congener that has not been previously described. In an effort to identify more potent compounds, the authors examined the ability of citrinin and the structurally related mycotoxins ochratoxin A and patulin to activate the UPR. Strikingly, it was found that patulin at 2.5 to 10 µM induced a terminal UPR in a panel of OSCC cells that was characterized by an increase in CHOP, GADD34, and ATF3 gene expression and XBP1 splicing. A luminescent caspase assay and the induction of several BH3-only genes indicated that patulin could induce apoptosis

  1. An associative capacitive network based on nanoscale complementary resistive switches for memory-intensive computing

    NASA Astrophysics Data System (ADS)

    Kavehei, Omid; Linn, Eike; Nielen, Lutz; Tappertzhofen, Stefan; Skafidas, Efstratios; Valov, Ilia; Waser, Rainer

    2013-05-01

    We report on the implementation of an Associative Capacitive Network (ACN) based on the nondestructive capacitive readout of two Complementary Resistive Switches (2-CRSs). ACNs are capable of performing a fully parallel search for Hamming distances (i.e. similarity) between input and stored templates. Unlike conventional associative memories where charge retention is a key function and hence, they require frequent refresh cycles, in ACNs, information is retained in a nonvolatile resistive state and normal tasks are carried out through capacitive coupling between input and output nodes. Each device consists of two CRS cells and no selective element is needed, therefore, CMOS circuitry is only required in the periphery, for addressing and read-out. Highly parallel processing, nonvolatility, wide interconnectivity and low-energy consumption are significant advantages of ACNs over conventional and emerging associative memories. These characteristics make ACNs one of the promising candidates for applications in memory-intensive and cognitive computing, switches and routers as binary and ternary Content Addressable Memories (CAMs) and intelligent data processing.

  2. Miniaturized sharp band-pass filter based on complementary electric-LC resonator

    NASA Astrophysics Data System (ADS)

    Torabi, Yalda; Dadashzadeh, Golamreza; Oraizi, Homayoon

    2016-04-01

    In this paper, a novel application of complementary electric-LC (CELC) resonator as a basic element to synthesize miniaturized sharp band-pass filters is introduced. The proposed metamaterial band-pass filter is a three-stage CELC-based device, where two shunt short-circuited stubs are employed in the input and output stages and a series gap is etched in the middle stage. By these means, a high-selectivity prototype band-pass filter with 2 % fractional bandwidth in S band is designed and fabricated. The out-of-band attenuation is better than 40 dB, and the upper and lower transition bands are also quite sharp due to the presence of two transmission zeros (nearly 60 and 30 dB fall in 0.2 GHz at lower and upper edges, respectively). Moreover, the filter is substantially miniaturized with a size of effective region of 1.3 cm × 1 cm at 2.9 GHz, which is quite smaller relative to conventional designs with the same performance. The fabrication and measurement of the proposed filter configuration attest to its expected desirable features. Therefore, the application of CELC resonator is proposed for super-compact sharp band-pass filters.

  3. Fully Automated Complementary DNA Microarray Segmentation using a Novel Fuzzy-based Algorithm

    PubMed Central

    Saberkari, Hamidreza; Bahrami, Sheyda; Shamsi, Mousa; Amoshahy, Mohammad Javad; Ghavifekr, Habib Badri; Sedaaghi, Mohammad Hossein

    2015-01-01

    DNA microarray is a powerful approach to study simultaneously, the expression of 1000 of genes in a single experiment. The average value of the fluorescent intensity could be calculated in a microarray experiment. The calculated intensity values are very close in amount to the levels of expression of a particular gene. However, determining the appropriate position of every spot in microarray images is a main challenge, which leads to the accurate classification of normal and abnormal (cancer) cells. In this paper, first a preprocessing approach is performed to eliminate the noise and artifacts available in microarray cells using the nonlinear anisotropic diffusion filtering method. Then, the coordinate center of each spot is positioned utilizing the mathematical morphology operations. Finally, the position of each spot is exactly determined through applying a novel hybrid model based on the principle component analysis and the spatial fuzzy c-means clustering (SFCM) algorithm. Using a Gaussian kernel in SFCM algorithm will lead to improving the quality in complementary DNA microarray segmentation. The performance of the proposed algorithm has been evaluated on the real microarray images, which is available in Stanford Microarray Databases. Results illustrate that the accuracy of microarray cells segmentation in the proposed algorithm reaches to 100% and 98% for noiseless/noisy cells, respectively. PMID:26284175

  4. Segmentation of complementary DNA microarray images by wavelet-based Markov random field model.

    PubMed

    Athanasiadis, Emmanouil I; Cavouras, Dionisis A; Glotsos, Dimitris Th; Georgiadis, Pantelis V; Kalatzis, Ioannis K; Nikiforidis, George C

    2009-11-01

    A wavelet-based modification of the Markov random field (WMRF) model is proposed for segmenting complementary DNA (cDNA) microarray images. For evaluation purposes, five simulated and a set of five real microarray images were used. The one-level stationary wavelet transform (SWT) of each microarray image was used to form two images, a denoised image, using hard thresholding filter, and a magnitude image, from the amplitudes of the horizontal and vertical components of SWT. Elements from these two images were suitably combined to form the WMRF model for segmenting spots from their background. The WMRF was compared against the conventional MRF and the Fuzzy C means (FCM) algorithms on simulated and real microarray images and their performances were evaluated by means of the segmentation matching factor (SMF) and the coefficient of determination (r2). Additionally, the WMRF was compared against the SPOT and SCANALYZE, and performances were evaluated by the mean absolute error (MAE) and the coefficient of variation (CV). The WMRF performed more accurately than the MRF and FCM (SMF: 92.66, 92.15, and 89.22, r2 : 0.92, 0.90, and 0.84, respectively) and achieved higher reproducibility than the MRF, SPOT, and SCANALYZE (MAE: 497, 1215, 1180, and 503, CV: 0.88, 1.15, 0.93, and 0.90, respectively). PMID:19783509

  5. Efficient Image-Vector-Generation Processor for Edge-Based Complementary Feature Representations

    NASA Astrophysics Data System (ADS)

    Yamashita, Naoya; Shibata, Tadashi

    2012-02-01

    A digital processor dedicated to edge-based image vector generation has been developed aiming at real-time image recognition. The processor consists of an on-chip memory and 16 single instruction multiple data (SIMD) processing elements. The capacity of the on-chip memory as well as the overhead for starting the processing have been minimized by introducing a seamless data transferring scheme from memory to processing elements. The 16 SIMD processing elements work together either as accumulators or as shift registers, thus achieving a very efficient generation of two different kinds of feature vector: projected principal-edge distribution (PPED)[3,4] and averaged principal-edge distribution (APED).[5] Concurrent use of these two vectors is shown to be very important for robust image recognition.[5] The chip was fabricated using 0.18-µm complementary metal oxide semiconductor (CMOS) technology and the generation of 64-dimension PPED and APED vectors at 84.7 and 83.9 fps, respectively, from video graphics array (VGA) size images was demonstrated at 62.5 MHz.

  6. Complementary and alternative asthma treatments and their association with asthma control: a population-based study

    PubMed Central

    Chen, Wenjia; FitzGerald, J Mark; Rousseau, Roxanne; Lynd, Larry D; Tan, Wan C; Sadatsafavi, Mohsen

    2013-01-01

    Objectives Many patients with asthma spend time and resources consuming complementary and alternative medicines (CAMs). This study explores whether CAM utilisation is associated with asthma control and the intake of asthma controller medications. Design Population-based, prospective cross-sectional study. Setting General population residing in two census areas in the province of British Columbia, Canada. Recruitment was based on random-digit dialling of both landlines and cell phones. Participants 486 patients with self-reported physician diagnosis of asthma (mean age 52 years; 67.3% woman). Primary and secondary outcome measures We assessed CAM use over the previous 12 months, level of asthma control as defined by the Global Initiative for Asthma and the self-reported intake of controller medications. Multivariate logistic regression was performed to study the relationship between any usage of CAMs (outcome), asthma control and controller medication usage, adjusted for potential confounders. Results A total of 179 (36.8%) of the sample reported CAM usage in the past 12 months. Breathing exercises (17.7%), herbal medicines (10.1%) and vitamins (9.7%) were the most popular CAMs reported. After adjustment, female sex (OR 1.66; 95% CI 1.09 to 2.52) and uncontrolled asthma (vs controlled asthma, OR 2.25, 95% CI 1.30 to 3.89) were associated with a higher likelihood of using any CAMs in the past 12 months. Controller medication use was not associated with CAM usage in general and in the subgroups defined by asthma control. Conclusions Clinicians and policy makers need to be aware of the high prevalence of CAM use in patients with asthma and its association with lack of asthma control. PMID:24005131

  7. Evidence-based integrative medicine in clinical veterinary oncology.

    PubMed

    Raditic, Donna M; Bartges, Joseph W

    2014-09-01

    Integrative medicine is the combined use of complementary and alternative medicine with conventional or traditional Western medicine systems. The demand for integrative veterinary medicine is growing, but evidence-based research on its efficacy is limited. In veterinary clinical oncology, such research could be translated to human medicine, because veterinary patients with spontaneous tumors are valuable translational models for human cancers. An overview of specific herbs, botanics, dietary supplements, and acupuncture evaluated in dogs, in vitro canine cells, and other relevant species both in vivo and in vitro is presented for their potential use as integrative therapies in veterinary clinical oncology. PMID:25174902

  8. Probing complementary memristive characteristics in oxide based memory device via non-conventional chronoamperometry approach

    NASA Astrophysics Data System (ADS)

    Younis, Adnan; Zhang, Lepeng; Chu, Dewei; Li, Sean

    2016-01-01

    In this letter, the resistive switching characteristics of CeO2 based memristor are investigated by utilizing an unusual, non-conventional, and a unique approach of "chronoamperometry." This methodology provides useful insights into memristive characterization for achieving configurable device functionalities such as categorization of minimum threshold potential to prompt switching behaviour, tuneable on/off ratios with accessible multi-level data storage states, etc. Moreover, the analytical studies on carrier drift/diffusion controlled-memristor response and the estimation of time constants at various applied fixed potentials provide tangible evidence to support valence change mechanism in CeO2 based memristors.

  9. Evidence-based Science Communication

    NASA Astrophysics Data System (ADS)

    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.

  10. The evidence-based paradox.

    PubMed

    Hinojosa, Jim

    2013-01-01

    Many occupational therapy practitioners consider evidence-based practice (EBP) to be the means by which occupational therapy can prove the validity of its services and thus support the legitimacy of our profession. The unquestioned acceptance of EBP as the way to establish credibility concerns me; unchallenged acceptance of any idea concerns me. Do practitioners accept EBP as the paradigm for guiding occupational therapy practice and research solely because it is presented as what we must do? I believe that practitioners must examine the implications for our profession of accepting EBP without question. In this article, I review EBP, present criticisms and concerns voiced by other professions and, finally, examine the implications of adopting an EBP perspective that replaces theory-directed practice. PMID:23433283

  11. Complementary health approach to quality of life in menopausal women: a community-based interventional study

    PubMed Central

    Jayabharathi, Baskaran; Judie, Arulappan

    2014-01-01

    Background Menopause is the stage when the menstrual period permanently stops, and is a part of every woman’s life. It usually occurs between the ages of 40 and 60 years, and is associated with hormonal, physical, and psychological changes. Estrogen and progesterone levels play the biggest part in menopause. In this stage, the ovaries make less estrogen and progesterone. When the body produces less of these hormones, the parts of the body that depend on estrogen to keep them healthy will react and this often causes discomfort for women. This study tested the impact of a complementary health approach to quality of life in menopausal women. Methods A community-based interventional study was conducted in selected areas in Kattankulathur Block, Kanchipuram District, Tamil Nadu, India. A simple random sampling technique was used to select menopausal women for the study. Of 260 menopausal women identified, 130 were allocated to a study group and 130 to a control group. The study group underwent yoga training for 1.5 hours per day on 5 consecutive days. After the 5-day intensive yoga training program, the menopausal women practiced yoga daily at home for 35–40 minutes a day. Along with daily yoga practice, they underwent group yoga practice for 2 days a week under the supervision of one of the investigators until 18 weeks. The yoga training program consisted of Yogasanas, Pranayama (breathing exercises), and meditation. The standardized World Health Organization QoL BREF scale was used to assess the women’s quality of life. We distributed an instruction manual on steps of selected yoga practice for the women’s self-reference at home after the 5 days of continuous yoga practice. A yoga practice diary was used to confirm regular performance of yoga. The women in the control group did not participate in the yoga program; however, on completion of the study, these women received intensive yoga training for 5 days. Results There was an extremely high statistically

  12. Complementary Hemispheric Asymmetries in Object Naming and Recognition: A Voxel-Based Correlational Study

    ERIC Educational Resources Information Center

    Acres, K.; Taylor, K. I.; Moss, H. E.; Stamatakis, E. A.; Tyler, L. K.

    2009-01-01

    Cognitive neuroscientific research proposes complementary hemispheric asymmetries in naming and recognising visual objects, with a left temporal lobe advantage for object naming and a right temporal lobe advantage for object recognition. Specifically, it has been proposed that the left inferior temporal lobe plays a mediational role linking…

  13. Outcome Prediction of Consciousness Disorders in the Acute Stage Based on a Complementary Motor Behavioural Tool

    PubMed Central

    Jöhr, Jane; Gilart de Keranflec'h, Charlotte; Van De Ville, Dimitri; Preti, Maria Giulia; Meskaldji, Djalel E.; Hömberg, Volker; Laureys, Steven; Draganski, Bogdan; Frackowiak, Richard; Diserens, Karin

    2016-01-01

    Introduction Attaining an accurate diagnosis in the acute phase for severely brain-damaged patients presenting Disorders of Consciousness (DOC) is crucial for prognostic validity; such a diagnosis determines further medical management, in terms of therapeutic choices and end-of-life decisions. However, DOC evaluation based on validated scales, such as the Revised Coma Recovery Scale (CRS-R), can lead to an underestimation of consciousness and to frequent misdiagnoses particularly in cases of cognitive motor dissociation due to other aetiologies. The purpose of this study is to determine the clinical signs that lead to a more accurate consciousness assessment allowing more reliable outcome prediction. Methods From the Unit of Acute Neurorehabilitation (University Hospital, Lausanne, Switzerland) between 2011 and 2014, we enrolled 33 DOC patients with a DOC diagnosis according to the CRS-R that had been established within 28 days of brain damage. The first CRS-R assessment established the initial diagnosis of Unresponsive Wakefulness Syndrome (UWS) in 20 patients and a Minimally Consciousness State (MCS) in the remaining13 patients. We clinically evaluated the patients over time using the CRS-R scale and concurrently from the beginning with complementary clinical items of a new observational Motor Behaviour Tool (MBT). Primary endpoint was outcome at unit discharge distinguishing two main classes of patients (DOC patients having emerged from DOC and those remaining in DOC) and 6 subclasses detailing the outcome of UWS and MCS patients, respectively. Based on CRS-R and MBT scores assessed separately and jointly, statistical testing was performed in the acute phase using a non-parametric Mann-Whitney U test; longitudinal CRS-R data were modelled with a Generalized Linear Model. Results Fifty-five per cent of the UWS patients and 77% of the MCS patients had emerged from DOC. First, statistical prediction of the first CRS-R scores did not permit outcome differentiation

  14. Complementary and Alternative Medicine.

    PubMed

    Quezada, Sandra M; Briscoe, Jessica; Cross, Raymond K

    2016-06-01

    Inflammatory bowel disease is a complex, chronic, multifactorial inflammatory disorder of the digestive tract. Standard therapies include immunosuppressive and biological treatments, but there is increasing interest in the potential benefit of complementary and alternative medicine for the treatment of inflammatory bowel disease. Given the high prevalence of use of complementary and alternative medicine among inflammatory bowel disease patients, gastroenterologists must remain knowledgeable regarding the risks and benefits of these treatment options. This article reviews the updated scientific data on the use of biologically based complementary and alternative therapies for the treatment of inflammatory bowel disease. PMID:27057686

  15. Synthesizing Quantitative Evidence for Evidence-based Nursing: Systematic Review.

    PubMed

    Oh, Eui Geum

    2016-06-01

    As evidence-based practice has become an important issue in healthcare settings, the educational needs for knowledge and skills for the generation and utilization of healthcare evidence are increasing. Systematic review (SR), a way of evidence generation, is a synthesis of primary scientific evidence, which summarizes the best evidence on a specific clinical question using a transparent, a priori protocol driven approach. SR methodology requires a critical appraisal of primary studies, data extraction in a reliable and repeatable way, and examination for validity of the results. SRs are considered hierarchically as the highest form of evidence as they are a systematic search, identification, and summarization of the available evidence to answer a focused clinical question with particular attention to the methodological quality of studies or the credibility of opinion and text. The purpose of this paper is to introduce an overview of the fundamental knowledge, principals and processes in SR. The focus of this paper is on SR especially for the synthesis of quantitative data from primary research studies that examines the effectiveness of healthcare interventions. To activate evidence-based nursing care in various healthcare settings, the best and available scientific evidence are essential components. This paper will include some examples to promote understandings. PMID:27349664

  16. Ab initio analysis of frequency selective surfaces based on conventional and complementary split ring resonators

    NASA Astrophysics Data System (ADS)

    Marqués, R.; Baena, J. D.; Beruete, M.; Falcone, F.; Lopetegi, T.; Sorolla, M.; Martín, F.; Garcia, J.

    2005-02-01

    Frequency selective surfaces (FSSs) made up of periodic arrays of split ring resonators (SRRs) are analysed. This analysis includes complementary screens, or complementary SRR-FSSs (CSRR-FSSs). It is shown that these FSSs show a dual behaviour, with a stop/pass band behaviour at the frequency of resonance of the SRRs/CSRRs. Cross-polarization effects in the SRR and the CSRR are considered, and it is shown that they permit resonance to occur for normally incident plane wave excitation. This latter property of SRRs and CSRRs also implies that the FSSs considered may act as polarizers and polarization converters as well. An analytical theory, valid for perfectly conducting and infinitely thin screens, is proposed for the SRR-FSSs and CSRR-FSSs. These approximations are valid in the microwave and millimetre-wave range, and up to the terahertz range.

  17. Evidence-based periodontal therapy: An overview

    PubMed Central

    Vijayalakshmi, R.; Anitha, V.; Ramakrishnan, T.; Sudhakar, Uma

    2008-01-01

    Dentists need to make clinical decisions based on limited scientific evidence. In clinical practice, a clinician must weigh a myriad of evidences every day. The goal of evidence-based dentistry is to help practitioners provide their patients with optimal care. This is achieved by integrating sound research evidence with personal clinical expertise and patient values to determine the best course of treatment. Periodontology has a rich background of research and scholarship. Therefore, efficient use of this wealth of research data needs to be a part of periodontal practice. Evidence-based periodontology aims to facilitate such an approach and it offers a bridge from science to clinical practice. The clinician must integrate the evidence with patient preference, scientific knowledge, and personal experience. Most important, it allows us to care for our patients. Therefore, evidence-based periodontology is a tool to support decision-making and integrating the best evidence available with clinical practice. PMID:20142947

  18. Decisions to use complementary and alternative medicine (CAM) by male cancer patients: information-seeking roles and types of evidence used

    PubMed Central

    Evans, Maggie; Shaw, Alison; Thompson, Elizabeth A; Falk, Stephen; Turton, Pat; Thompson, Trevor; Sharp, Deborah

    2007-01-01

    therapies to use and sceptical about others, basing their choices on forms of 'evidence' that were personally meaningful: personal stories of individuals who had been helped by CAM; the long history and enduring popularity of some therapies; the plausibility of the mechanism of action; a belief or trust in individual therapies or their providers; scientific evidence. Scientific evidence ranked low in the men's personal decision-making about CAM, while it was recognised as important for NHS support for CAM. Conclusion These male cancer patients valued the support and guidance of 'trusted individuals' in making choices about CAM. Trusted health professionals could also play a significant role in helping patients to make informed choices. Any such dialogue must, however, acknowledge the different standards of evidence used by patients and clinicians to evaluate the benefits or otherwise of CAM therapies. Such open communication could help to foster an environment of mutual trust where patients are encouraged to discuss their interest in CAM, rather than perpetuate covert, undisclosed use of CAM with its attendant potential hazards. PMID:17683580

  19. Ag/GeSx/Pt-based complementary resistive switches for hybrid CMOS/Nanoelectronic logic and memory architectures

    PubMed Central

    van den Hurk, Jan; Havel, Viktor; Linn, Eike; Waser, Rainer; Valov, Ilia

    2013-01-01

    Complementary resistive switches based on two anti-serially connected Ag/GeSx/Pt devices were studied. The main focus was placed on the pulse mode properties as typically required in memory and logic applications. A self-designed measurement setup was applied to access each CRS part-cell individually. Our findings reveal the existence of two distinct read voltage regimes enabling both spike read as well as level read approaches. Furthermore, we experimentally verified the theoretically predicted kinetic properties in terms of pulse height vs. switching time relationship. The results obtained by this alternative approach allow a significant improvement of the basic understanding of the interplay between the two part-cells in a complementary resistive switch configuration. Furthermore, from these observations we can deduce a simplified write voltage scheme which is applicable for the considered type of memory cell. PMID:24091355

  20. Intelligent complementary sliding-mode control for LUSMS-based X-Y-theta motion control stage.

    PubMed

    Lin, Faa-Jeng; Chen, Syuan-Yi; Shyu, Kuo-Kai; Liu, Yen-Hung

    2010-07-01

    An intelligent complementary sliding-mode control (ICSMC) system using a recurrent wavelet-based Elman neural network (RWENN) estimator is proposed in this study to control the mover position of a linear ultrasonic motors (LUSMs)-based X-Y-theta motion control stage for the tracking of various contours. By the addition of a complementary generalized error transformation, the complementary sliding-mode control (CSMC) can efficiently reduce the guaranteed ultimate bound of the tracking error by half compared with the slidingmode control (SMC) while using the saturation function. To estimate a lumped uncertainty on-line and replace the hitting control of the CSMC directly, the RWENN estimator is adopted in the proposed ICSMC system. In the RWENN, each hidden neuron employs a different wavelet function as an activation function to improve both the convergent precision and the convergent time compared with the conventional Elman neural network (ENN). The estimation laws of the RWENN are derived using the Lyapunov stability theorem to train the network parameters on-line. A robust compensator is also proposed to confront the uncertainties including approximation error, optimal parameter vectors, and higher-order terms in Taylor series. Finally, some experimental results of various contours tracking show that the tracking performance of the ICSMC system is significantly improved compared with the SMC and CSMC systems. PMID:20639156

  1. Printed dose-recording tag based on organic complementary circuits and ferroelectric nonvolatile memories

    PubMed Central

    Nga Ng, Tse; Schwartz, David E.; Mei, Ping; Krusor, Brent; Kor, Sivkheng; Veres, Janos; Bröms, Per; Eriksson, Torbjörn; Wang, Yong; Hagel, Olle; Karlsson, Christer

    2015-01-01

    We have demonstrated a printed electronic tag that monitors time-integrated sensor signals and writes to nonvolatile memories for later readout. The tag is additively fabricated on flexible plastic foil and comprises a thermistor divider, complementary organic circuits, and two nonvolatile memory cells. With a supply voltage below 30 V, the threshold temperatures can be tuned between 0 °C and 80 °C. The time-temperature dose measurement is calibrated for minute-scale integration. The two memory bits are sequentially written in a thermometer code to provide an accumulated dose record. PMID:26307438

  2. [Alternative medicines and "Evidence-Based Medicine" a possible reconciliation?].

    PubMed

    Vanherweghem, J-L

    2015-09-01

    The contrast between the efficiency of Evidence-Based Medicine (EBM), a scientific fact, and the popularity of Complementary and Alternative Medicines (CAM) is a paradox of the art of healing. EBM is based on the paradigm of positivism and materialism while CAM are based on those of relativism and vitalism. These paradigms are diametrically opposed and the aim of an integrative medicine is aporetic. However, EBM is today in a dead end. The objective proof of a disease according to the rules of EBM is often lacking face to the expectations of patients demanding their illness to be taken into account. EBM and CAM have thus to coexist. Lessons can be drawn from CAM : patient expectations should be given a meaning and be integrated in his or her psychosocial context. PMID:26591330

  3. Implementation of evidence-based practice: A naturopath perspective.

    PubMed

    Ooi, Soo Liang; Rae, John; Pak, Sok Cheon

    2016-02-01

    Evidence-based practice (EBP), an approach to clinical practice that places emphasis on the use of best available research evidence for decision-making, has been adopted broadly in clinical practice. As a patient-focused approach, EBP promotes the spirit of inquiry. It can also facilitate consistency of care across professional boundaries, and clarify the directions of research. However, over-emphasis on systematic reviews and randomised control trials as the "gold standard" for evidence is a major limitation of EBP as it is being practised today. There are also objections to EBP based on epistemological grounds. Complementary and alternative medicine (CAM) therapies often fare unfavourably under the scrutiny of EBP due to the lack of research and inherent differences in healing ideology. Naturopathy is a unique form of CAM, based on both traditional and scientific knowledge. We argue that there is no conflict between naturopathy and EBP. EBP can be adopted as a useful approach to assimilate scientific evidence in naturopathic practices. However, naturopaths need to reconcile tensions between traditional and scientific knowledge in their choice of treatment remedies, while adhering to the naturopathic principles of healing, to benefit the patients. They must also maintain their emphasis on clinical expertise, and also patient preferences and values, in clinical decision-making. PMID:26850801

  4. Implementing Evidence-Based Social Work Practice

    ERIC Educational Resources Information Center

    Mullen, Edward J.; Bledsoe, Sarah E.; Bellamy, Jennifer L.

    2008-01-01

    Recently, social work has been influenced by new forms of practice that hold promise for bringing practice and research together to strengthen the scientific knowledge base supporting social work intervention. The most recent new practice framework is evidence-based practice. However, although evidence-based practice has many qualities that might…

  5. Evidence-Based Research in Education.

    ERIC Educational Resources Information Center

    Research Exchange, 2003

    2003-01-01

    This educational newsletter highlights a lead article, "Evidence-Based Research in Education." The article explains that evidence-based research emerged in the field of medicine over 50 years ago, resulting in major advances in the treatment and prevention of disease. It adds that clinical guidelines and protocols are based on the results of…

  6. Sicily statement on evidence-based practice

    PubMed Central

    Dawes, Martin; Summerskill, William; Glasziou, Paul; Cartabellotta, Antonino; Martin, Janet; Hopayian, Kevork; Porzsolt, Franz; Burls, Amanda; Osborne, James

    2005-01-01

    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'. PMID:15634359

  7. DNA-decorated carbon-nanotube-based chemical sensors on complementary metal oxide semiconductor circuitry

    NASA Astrophysics Data System (ADS)

    Chen, Chia-Ling; Yang, Chih-Feng; Agarwal, Vinay; Kim, Taehoon; Sonkusale, Sameer; Busnaina, Ahmed; Chen, Michelle; Dokmeci, Mehmet R.

    2010-03-01

    We present integration of single-stranded DNA (ss-DNA)-decorated single-walled carbon nanotubes (SWNTs) onto complementary metal oxide semiconductor (CMOS) circuitry as nanoscale chemical sensors. SWNTs were assembled onto CMOS circuitry via a low voltage dielectrophoretic (DEP) process. Besides, bare SWNTs are reported to be sensitive to various chemicals, and functionalization of SWNTs with biomolecular complexes further enhances the sensing specificity and sensitivity. After decorating ss-DNA on SWNTs, we have found that the sensing response of the gas sensor was enhanced (up to ~ 300% and ~ 250% for methanol vapor and isopropanol alcohol vapor, respectively) compared with bare SWNTs. The SWNTs coupled with ss-DNA and their integration on CMOS circuitry demonstrates a step towards realizing ultra-sensitive electronic nose applications.

  8. DNA-decorated carbon-nanotube-based chemical sensors on complementary metal oxide semiconductor circuitry.

    PubMed

    Chen, Chia-Ling; Yang, Chih-Feng; Agarwal, Vinay; Kim, Taehoon; Sonkusale, Sameer; Busnaina, Ahmed; Chen, Michelle; Dokmeci, Mehmet R

    2010-03-01

    We present integration of single-stranded DNA (ss-DNA)-decorated single-walled carbon nanotubes (SWNTs) onto complementary metal oxide semiconductor (CMOS) circuitry as nanoscale chemical sensors. SWNTs were assembled onto CMOS circuitry via a low voltage dielectrophoretic (DEP) process. Besides, bare SWNTs are reported to be sensitive to various chemicals, and functionalization of SWNTs with biomolecular complexes further enhances the sensing specificity and sensitivity. After decorating ss-DNA on SWNTs, we have found that the sensing response of the gas sensor was enhanced (up to approximately 300% and approximately 250% for methanol vapor and isopropanol alcohol vapor, respectively) compared with bare SWNTs. The SWNTs coupled with ss-DNA and their integration on CMOS circuitry demonstrates a step towards realizing ultra-sensitive electronic nose applications. PMID:20139486

  9. Electrically tunable terahertz wave modulator based on complementary metamaterial and graphene

    SciTech Connect

    He, Xun-jun Li, Teng-yue; Wang, Lei; Wang, Jian-min; Jiang, Jiu-xing; Yang, Guo-hui; Meng, Fan-yi; Wu, Qun

    2014-05-07

    In this paper, we design and numerically demonstrate an electrically controllable light-matter interaction in a hybrid material/metamaterial system consisting of an artificially constructed cross cut-wire complementary metamaterial and an atomically thin graphene layer to realize terahertz (THz) wave modulator. By applying a bias voltage between the metamaterial and the graphene layer, this modulator can dynamically control the amplitude and phase of the transmitted wave near 1.43 THz. Moreover, the distributions of current density show that this large modulation depth can be attributed to the resonant electric field parallel to the graphene sheet. Therefore, the modulator performance indicates the enormous potential of graphene for developing sophisticated THz communication systems.

  10. Dual-band microwave duplexer based on spiral resonators (SR) and complementary split ring resonators (CSRR)

    NASA Astrophysics Data System (ADS)

    Vélez, A.; Sisó, G.; Campo, A.; Durán-Sindreu, M.; Bonache, J.; Martín, F.

    2011-06-01

    In this work, a microstrip dual-band microwave duplexer implemented by means of a pair of dual-band branch-line hybrid couplers and a pair of dual-band band-stop filters is presented. The hybrid couplers are implemented by using complementary split ring resonators (CSRRs), etched in the ground plane, while the band-stop filters are made of spiral resonators (SRs) coupled to the host line. The measured duplexer characteristics are good and the device is compact by virtue of the small electrical size of the employed resonant elements. From this paper, it is clear that CSRRs and SRs are useful particles for the design of dual-band microwave systems requiring various microwave components.

  11. Dual matrix-based immobilized trypsin for complementary proteolytic digestion and fast proteomics analysis with higher protein sequence coverage.

    PubMed

    Fan, Chao; Shi, Zhaomei; Pan, Yiting; Song, Zifeng; Zhang, Wanjun; Zhao, Xinyuan; Tian, Fang; Peng, Bo; Qin, Weijie; Cai, Yun; Qian, Xiaohong

    2014-02-01

    In an age of whole-genome analysis, the mass spectrometry-based bottom-up strategy is now considered to be the most powerful method for in-depth proteomics analysis. As part of this strategy, highly efficient and complete proteolytic digestion of proteins into peptides is crucial for successful proteome profiling with deep coverage. To achieve this goal, prolonged digestion time and the use of multiple proteases have been adopted. The long digestion time required and tedious sample treatment steps severely limit the sample processing throughput. Though utilization of immobilized protease greatly reduces the digestion time, highly efficient proteolysis of extremely complex proteomic samples remains a challenging task. Here, we propose a dual matrix-based complementary digestion method using two types of immobilized trypsin with opposite matrix hydrophobicity prepared by attaching trypsin on hydrophobic or hydrophilic polymer-brush-modified nanoparticles. The polymer brushes on the nanoparticles serve as three-dimensional supports for a large amount of trypsin immobilization and lead to ultrafast and highly efficient protein digestion. More importantly, the two types of immobilized trypsin show high complementarity in protein digestion with only ∼60% overlap in peptide identification for yeast and membrane protein of mouse liver. Complementary digestion by applying these two types of immobilized trypsin together leads to obviously enhanced protein and peptide identification. Furthermore, the dual matrix-based complementary digestion shows particular advantage in the digestion of membrane proteins, as twice the number of identified peptides is obtained compared with solution digestion using free proteases, demonstrating its potential as a promising alternative to promote proteomics analysis with higher protein sequence coverage. PMID:24447065

  12. Making Evidence-based Practice Educational.

    ERIC Educational Resources Information Center

    Elliott, John

    2001-01-01

    Examines David Hargreaves' ideas about the nature of evidence-based practice and the future direction for educational research. States that one major theme is that current discourse about evidence-based teaching is uninformed by an articulate educational theory, therefore excluding thoughtful consideration of implications of such a theory for…

  13. Evidence-Based Clearinghouses in Social Work

    ERIC Educational Resources Information Center

    Soydan, Haluk; Mullen, Edward J.; Alexandra, Laine; Rehnman, Jenny; Li, You-Ping

    2010-01-01

    Objectives: The purpose of this article is to describe several evidence-based clearinghouses focused on social work and related intervention outcomes, placing them in the context of how such clearinghouses can contribute to research dissemination to foster effective, evidence-based practice. Method: The study employed an analysis of data provided…

  14. What's New about Evidence-Based Assessment?

    ERIC Educational Resources Information Center

    Barlow, David H.

    2005-01-01

    A clear consensus has emerged around the world concerning the desirability and even the urgency of basing health care delivery systems on evidence. Among behavioral health care providers such as psychologists, evidence-based practice (EBP) has been focused largely on interventions. Psychologists have long emphasized a scientifically based…

  15. Evidence-based medicine and levels of evidence.

    PubMed

    Wallace, David K

    2010-01-01

    Evidence-based medicine is the practice of making medical decisions based on evidence gained from applying the scientific method. Published studies are evaluated using three key questions: "Are the results valid?"; "What are the results?"; and "Can the results be applied to my patients?" The hierarchy of study methods for obtaining evidence is, in order from least to most useful: laboratory research, editorials, case reports and series, case-control studies, cohort studies, and randomized clinical trials. Retrospective case series can suffer from problems such as selection of a biased sample, mixing of treatment effects, and lack of control group. Randomized clinical trials (and meta-analyses of multiple trials) provide the highest level of evidence because randomization limits confounding and prevents bias of treatment assignment. In addition, randomized trials have standardization of interventions, prospective data collection, and masked outcome measures. Although every question cannot be addressed by a randomized clinical trial, the best available evidence should be sought and used to guide treatments. PMID:21061876

  16. Modeling the Behavior of an Underwater Acoustic Relative Positioning System Based on Complementary Set of Sequences

    PubMed Central

    Aparicio, Joaquín; Jiménez, Ana; Álvarez, Fernando J.; Ureña, Jesús; De Marziani, Carlos; Diego, Cristina

    2011-01-01

    The great variability usually found in underwater media makes modeling a challenging task, but helpful for better understanding or predicting the performance of future deployed systems. In this work, an underwater acoustic propagation model is presented. This model obtains the multipath structure by means of the ray tracing technique. Using this model, the behavior of a relative positioning system is presented. One of the main advantages of relative positioning systems is that only the distances between all the buoys are needed to obtain their positions. In order to obtain the distances, the propagation times of acoustic signals coded by Complementary Set of Sequences (CSS) are used. In this case, the arrival instants are obtained by means of correlation processes. The distances are then used to obtain the position of the buoys by means of the Multidimensional Scaling Technique (MDS). As an early example of an application using this relative positioning system, a tracking of the position of the buoys at different times is performed. With this tracking, the surface current of a particular region could be studied. The performance of the system is evaluated in terms of the distance from the real position to the estimated one. PMID:22247661

  17. Evaluation of the nutritional characteristics of a finger millet based complementary food.

    PubMed

    Mbithi-Mwikya, Stephen; Van Camp, John; Mamiro, Peter R S; Ooghe, Wilfried; Kolsteren, Patrick; Huyghebaert, Andre

    2002-05-01

    Finger millet (Eleusine coracana), kidney beans (Phaseolus vulgaris), peanuts (Arachis hypogoea), and mango (Mangifera indica) were processed separately and then combined, on the basis of their amino acid scores and energy content, into a complementary food for children of weaning age. The finger millet and kidney beans were processed by germination, autoclaving, and lactic acid fermentation. A mixture containing, on a dry matter basis, 65.2, 19.1, 8.0, and 7.7% of the processed finger millet, kidney beans, peanuts, and mango, respectively, gave a composite protein with an in vitro protein digestibility of 90.2% and an amino acid chemical score of 0.84. This mixture had an energy density of 16.3 kJ.g(-1) of dry matter and a decreased antinutrient content and showed a measurable improvement in the in vitro extractability for calcium, iron, and zinc. A 33% (w/v) pap made from a mix of the processed ingredients had an energy density of 5.4 kJ.g(-1) of pap, which is sufficient to meet the energy requirements of well-nourished children of 6-24 months of age at three servings a day and at the FAO average breast-feeding frequency. PMID:11982437

  18. Modeling the behavior of an underwater acoustic relative positioning system based on complementary set of sequences.

    PubMed

    Aparicio, Joaquín; Jiménez, Ana; Alvarez, Fernando J; Ureña, Jesús; De Marziani, Carlos; Diego, Cristina

    2011-01-01

    The great variability usually found in underwater media makes modeling a challenging task, but helpful for better understanding or predicting the performance of future deployed systems. In this work, an underwater acoustic propagation model is presented. This model obtains the multipath structure by means of the ray tracing technique. Using this model, the behavior of a relative positioning system is presented. One of the main advantages of relative positioning systems is that only the distances between all the buoys are needed to obtain their positions. In order to obtain the distances, the propagation times of acoustic signals coded by Complementary Set of Sequences (CSS) are used. In this case, the arrival instants are obtained by means of correlation processes. The distances are then used to obtain the position of the buoys by means of the Multidimensional Scaling Technique (MDS). As an early example of an application using this relative positioning system, a tracking of the position of the buoys at different times is performed. With this tracking, the surface current of a particular region could be studied. The performance of the system is evaluated in terms of the distance from the real position to the estimated one. PMID:22247661

  19. Moral injury: A new challenge for complementary and alternative medicine.

    PubMed

    Kopacz, Marek S; Connery, April L; Bishop, Todd M; Bryan, Craig J; Drescher, Kent D; Currier, Joseph M; Pigeon, Wilfred R

    2016-02-01

    Moral injury represents an emerging clinical construct recognized as a source of morbidity in current and former military personnel. Finding effective ways to support those affected by moral injury remains a challenge for both biomedical and complementary and alternative medicine. This paper introduces the concept of moral injury and suggests two complementary and alternative medicine, pastoral care and mindfulness, which may prove useful in supporting military personnel thought to be dealing with moral injury. Research strategies for developing an evidence-base for applying these, and other, complementary and alternative medicine modalities to moral injury are discussed. PMID:26860798

  20. Reconciling evidence-based medicine and patient-centred care: defining evidence-based inputs to patient-centred decisions.

    PubMed

    Weaver, Robert R

    2015-12-01

    Evidence-based and patient-centred health care movements have each enhanced the discussion of how health care might best be delivered, yet the two have evolved separately and, in some views, remain at odds with each other. No clear model has emerged to enable practitioners to capitalize on the advantages of each so actual practice often becomes, to varying degrees, an undefined mishmash of each. When faced with clinical uncertainty, it becomes easy for practitioners to rely on formulas for care developed explicitly by expert panels, or on the tacit ones developed from experience or habit. Either way, these tendencies towards 'cookbook' medicine undermine the view of patients as unique particulars, and diminish what might be considered patient-centred care. The sequence in which evidence is applied in the care process, however, is critical for developing a model of care that is both evidence based and patient centred. This notion derives from a paradigm for knowledge delivery and patient care developed over decades by Dr. Lawrence Weed. Weed's vision enables us to view evidence-based and person-centred medicine as wholly complementary, using computer tools to more fully and reliably exploit the vast body of collective knowledge available to define patients' uniqueness and identify the options to guide patients. The transparency of the approach to knowledge delivery facilitates meaningful practitioner-patient dialogue in determining the appropriate course of action. Such a model for knowledge delivery and care is essential for integrating evidence-based and patient-centred approaches. PMID:26456314

  1. Evidence-based policymaking: a critique.

    PubMed

    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. PMID:19395827

  2. Complementary monoclonal antibody-based dot ELISA for universal detection of H5 avian influenza virus

    PubMed Central

    2010-01-01

    Background Rapid diagnosis and surveillance for H5 subtype viruses are critical for the control of H5N1 infection. Results In this study, H5 Dot ELISA, a rapid test for the detection of avian H5N1 influenza virus, was developed with two complementary H5 monoclonal antibodies. HA sequencing of escape mutants followed by epitope mapping revealed that the two Mabs target the epitope component (189th amino acid) on the HA protein but are specific for different amino acids (189Lys or 189Arg). Gene alignment indicated that these two amino acids are the most frequent types on this position among all of the H5 AIV reported in GeneBank. These two H5 Mabs were used together in a dot ELISA to detect H5 viral antigen. The detection limit of the developed test for multiple clades of H5N1 viruses, including clades 0, 1, 2.1, 2.2, 2.3, 4, 7, and 8, was less than 0.5 hemagglutinin units. The specificity of the optimized dot ELISA was examined by using 100 H5 strains, including H5N1 HPAI strains from multiple clades, 36 non-H5N1 viruses, and 4 influenza B viruses. No cross-reactivity was observed for any of the non-H5N1 viruses tested. Among 200 random poultry samples, the test gave 100% positive results for all of the twelve RT-PCR-positive samples. Conclusions Considering that the test is convenient for field use, this H5 Dot ELISA can be used for on-site detection of H5N1 infection in clinical or environmental specimens and facilitate the investigation of H5N1 influenza outbreaks and surveillance in poultry. PMID:21192824

  3. Complementary and alternative medicines and childhood eczema: a US population-based study.

    PubMed

    Silverberg, Jonathan I; Lee-Wong, Mary; Silverberg, Nanette B

    2014-01-01

    The prevalence of complementary and alternative medicine (CAM) use in US children with eczema is unknown. Furthermore, it is unknown whether CAM use in the United States is associated with higher eczema prevalence. We sought to determine the eczema prevalence in association with CAM usage. We analyzed data from the 2007 National Health Interview Survey that included a nationally representative sample of 9417 children ages 0 to 17 years. Overall, 46.9% (95% confidence interval, 45.6%-48.2%) of children in the United States used 1 or more CAM, of which 0.99% (0.28%-1.71%) used CAM specifically to treat their eczema, including herbal therapy (0.46%), vitamins (0.33%), Ayurveda (0.28%), naturopathy (0.24%), homeopathy (0.20%), and traditional healing (0.12%). Several CAMs used for other purposes were associated with increased eczema prevalence, including herbal therapy (survey logistic regression; adjusted odds ratio [95% confidence interval], 2.07 [1.40-3.06]), vitamins (1.45 [1.21-1.74]), homeopathic therapy (2.94 [1.43-6.00]), movement techniques (3.66 [1.62-8.30]), and diet (2.24 [1.10-4.58]), particularly vegan diet (2.53 [1.17-5.51]). In conclusion, multiple CAMs are commonly used for the treatment of eczema in US children. However, some CAMs may actually be harmful to the skin and be associated with higher eczema prevalence in the United States. PMID:25207686

  4. Evidence-Based Teaching: Rhetoric and Reality

    ERIC Educational Resources Information Center

    Wrigley, Terry

    2015-01-01

    This essay connects a number of recent books relating, in different ways, to the contentious issue of how teaching might be better guided by research evidence. In order to shed light on this problematic area, Terry Wrigley begins by pointing out that raising awkward questions about terms such as "evidence- based teaching" is not the same…

  5. Highly sensitive sensors for alkali metal ions based on complementary-metal-oxide-semiconductor-compatible silicon nanowires

    NASA Astrophysics Data System (ADS)

    Zhang, Guo-Jun; Agarwal, Ajay; Buddharaju, Kavitha D.; Singh, Navab; Gao, Zhiqiang

    2007-06-01

    Highly sensitive sensors for alkali metal ions based on complementary-metal-oxide- semiconductor-compatible silicon nanowires (SiNWs) with crown ethers covalently immobilized on their surface are presented. A densely packed organic monolayer terminated with amine groups is introduced to the SiNW surface via hydrosilylation. Amine-modified crown ethers, acting as sensing elements, are then immobilized onto the SiNWs through a cross-linking reaction with the monolayer. The crown ether-functionalized SiNWs recognize Na+ and K+ according to their complexation ability to the crown ethers. The SiNW sensors are highly selective and capable of achieving an ultralow detection limit down to 50nM, over three orders of magnitude lower than that of conventional crown ether-based ion-selective electrodes.

  6. Clinical Trial Adaptation by Matching Evidence in Complementary Patient Sub-groups of Auxiliary Blinding Questionnaire Responses

    PubMed Central

    Arandjelović, Ognjen

    2015-01-01

    Clinical trial adaptation refers to any adjustment of the trial protocol after the onset of the trial. Such adjustment may take on various forms, including the change in the dose of administered medicines, the frequency of administering an intervention, the number of trial participants, or the duration of the trial, to name just some possibilities. The main goal is to make the process of introducing new medical interventions to patients more efficient, either by reducing the cost or the time associated with evaluating their safety and efficacy. The principal challenge, which is an outstanding research problem, is to be found in the question of how adaptation should be performed so as to minimize the chance of distorting the outcome of the trial. In this paper we propose a novel method for achieving this. Unlike most of the previously published work, our approach focuses on trial adaptation by sample size adjustment i.e. by reducing the number of trial participants in a statistically informed manner. We adopt a stratification framework recently proposed for the analysis of trial outcomes in the presence of imperfect blinding and based on the administration of a generic auxiliary questionnaire that allows the participants to express their belief concerning the assigned intervention (treatment or control). We show that this data, together with the primary measured variables, can be used to make the probabilistically optimal choice of the particular sub-group a participant should be removed from if trial size reduction is desired. Extensive experiments on a series of simulated trials are used to illustrate the effectiveness of our method. PMID:26161797

  7. Practice-Based Evidence: Delivering What Works

    ERIC Educational Resources Information Center

    Brendtro, Larry K.; Mitchell, Martin L.

    2012-01-01

    Many methods claim to be Evidence-Based Practices. Yet success comes not from a particular practice, but principles that underlie all effective helping. This article uses the principle of consilience to tap knowledge from science, values, and practical experience.

  8. Evidence-based librarianship: an overview

    PubMed Central

    Eldredge, Jonathan D.

    2000-01-01

    Objective: To demonstrate how the core characteristics of both evidence-based medicine (EBM) and evidence-based health care (EBHC) can be adapted to health sciences librarianship. Method: Narrative review essay involving development of a conceptual framework. The author describes the central features of EBM and EBHC. Following each description of a central feature, the author then suggests ways that this feature applies to health sciences librarianship. Results: First, the decision-making processes of EBM and EBHC are compatible with health sciences librarianship. Second, the EBM and EBHC values of favoring rigorously produced scientific evidence in decision making are congruent with the core values of librarianship. Third, the hierarchical levels of evidence can be applied to librarianship with some modifications. Library researchers currently favor descriptive-survey and case-study methods over systematic reviews, randomized controlled trials, or other higher levels of evidence. The library literature nevertheless contains diverse examples of randomized controlled trials, controlled-comparison studies, and cohort studies conducted by health sciences librarians. Conclusions: Health sciences librarians are confronted with making many practical decisions. Evidence-based librarianship offers a decision-making framework, which integrates the best available research evidence. By employing this framework and the higher levels of research evidence it promotes, health sciences librarians can lay the foundation for more collaborative and scientific endeavors. PMID:11055296

  9. [Looking for evidence-based medical informatics].

    PubMed

    Coiera, Enrico

    2016-03-01

    e-Health is experiencing a difficult time. On the one side, the forecast is for a bright digital health future created by precision medicine and smart devices. On the other hand, most large scale e-health projects struggle to make a difference and are often controversial. Both futures fail because they are not evidence-based. Medical informatics should follow the example of evidence-based medicine, i.e. conduct rigorous research that gives us evidence to solve real world problems, synthesise that evidence and then apply it strictly. We already have the tools for creating a different universe. What we need is evidence, will, a culture of learning, and hard work. PMID:27030221

  10. Complementary medicine for depression.

    PubMed

    Pilkington, Karen; Rampes, Hagen; Richardson, Janet

    2006-11-01

    Surveys have demonstrated that complementary medicine use for depression is widespread, although patterns of use vary. A series of systematic reviews provide a summary of the current evidence for acupuncture, aromatherapy and massage, homeopathy, meditation, reflexology, herbal medicine, yoga, and several dietary supplements and relaxation techniques. The quantity and quality of individual studies vary widely, but research interest in complementary therapies is increasing, particularly in herbal and nutritional products. Major questions are still to be answered with respect to the effectiveness and appropriate role of these therapies in the management of depression. Areas for further research and some of the potential challenges to research design are discussed. Finally, several ongoing developments in information provision on this topic are highlighted. PMID:17144787

  11. Evidence-based complementary and alternative medicine in inpatient care: take a look at Europe.

    PubMed

    Romeyke, Tobias; Stummer, Harald

    2015-04-01

    The aim of this report is to provide the reader an overview of the complex therapy currently used within the German health system. Complex therapies in inpatient care in Germany establish the basis for an integrative and interdisciplinary provision of services. They define minimal criteria for the organization of a hospital, enable the integration of different therapeutic approaches, and therefore, lead to an intensive and holistic treatment by a specially trained team. The German model can be viewed as a pilot program for the introduction of integrative patient-centered care in other hospitals around the world. PMID:25404750

  12. Evidence-based equine dentistry: preventive medicine.

    PubMed

    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. PMID:17616326

  13. Complementary and Alternative Medicine: Core Competencies for Family Nurse Practitioners.

    ERIC Educational Resources Information Center

    Burman, Mary E.

    2003-01-01

    Directors of family nurse practitioner education programs (n=141) reported inclusion of some complementary/alternative medicine content (CAM), most commonly interviewing patients about CAM, critical thinking, evidence-based medicine, laws, ethics, and spiritual/cultural beliefs. Definition of CAM was medically, not holistically based. More faculty…

  14. Complementary characterization data in support of uniaxially aligned electrospun nanocomposites based on a model PVOH-epoxy system

    PubMed Central

    Karimi, Samaneh; Staiger, Mark P.; Buunk, Neil; Fessard, Alison; Tucker, Nick

    2016-01-01

    This paper presents complementary data corresponding to characterization tests done for our research article entitled “Uniaxially aligned electrospun fibers for advanced nanocomposites based on a model PVOH-epoxy system” (Karimi et al., 2016) [1]. Poly(vinyl alcohol) and epoxy resin were selected as a model system and the effect of electrospun fiber loading on polymer properties was examined in conjunction with two manufacturing methods. A novel electrospinning technology for production of uniaxially aligned nanofiber arrays was used. A conventional wet lay-up fabrication method is compared against a novel, hybrid electrospinning–electrospraying approach. The structure and thermomechanical properties of resulting composite materials were examined using scanning electron microscopy, dynamic mechanical analysis, thermogravimetric analysis, differential scanning calorimetry, Fourier transform infrared spectroscopy, and tensile testing. For discussion of obtained results please refer to the research paper (Karimi et al., 2016) [1]. PMID:26977430

  15. Complementary characterization data in support of uniaxially aligned electrospun nanocomposites based on a model PVOH-epoxy system.

    PubMed

    Karimi, Samaneh; Staiger, Mark P; Buunk, Neil; Fessard, Alison; Tucker, Nick

    2016-06-01

    This paper presents complementary data corresponding to characterization tests done for our research article entitled "Uniaxially aligned electrospun fibers for advanced nanocomposites based on a model PVOH-epoxy system" (Karimi et al., 2016) [1]. Poly(vinyl alcohol) and epoxy resin were selected as a model system and the effect of electrospun fiber loading on polymer properties was examined in conjunction with two manufacturing methods. A novel electrospinning technology for production of uniaxially aligned nanofiber arrays was used. A conventional wet lay-up fabrication method is compared against a novel, hybrid electrospinning-electrospraying approach. The structure and thermomechanical properties of resulting composite materials were examined using scanning electron microscopy, dynamic mechanical analysis, thermogravimetric analysis, differential scanning calorimetry, Fourier transform infrared spectroscopy, and tensile testing. For discussion of obtained results please refer to the research paper (Karimi et al., 2016) [1]. PMID:26977430

  16. Plasmonic-resonance-based ternary composite complementary enhancement of the performance of dye-sensitized solar cells.

    PubMed

    Bai, Lihua; Li, Meiya; Liu, Xiaolian; Luoshan, Mengdai; Zhang, Feng; Guo, Kaimo; Zhu, Yongdan; Sun, Beilei; Zhao, Xingzhong

    2016-10-14

    Graphene (G), TiO2 fusiform nanorods (TiO2NRs) adsorbed with Au nanoparticles (AuNPs) are prepared and blended as multifunctional materials into TiO2 nanocrystalline film to form a novel ternary (G-TiO2NRs-Au) composite photoanode in dye-sensitized solar cells (DSSCs). The effects of G-TiO2NRs-Au on the properties of the photoanode and DSSC are investigated. Results show that, by blending G-TiO2NRs-Au, the light absorption and scattering of the photoanode are obviously improved, and the charge transfer resistance R2 and electron recombination are decreased, resulting in a significant enhancement in the short-circuit current density (J sc) and the photoelectric conversion efficiency (PCE) of the DSSCs. The maximum J sc of 17.66 mA cm(-2) and PCE of 8.56% are obtained in the optimal G-TiO2NRs-Au-based DSSC, about 33.6% and 35.0% higher than that obtained in the conventional TiO2-based DSSC. This significant improvement in the performance of the DSSC can be attributed to the ternary composite complementary effects of multi-functions from the surface plasmon resonance of AuNPs, light scattering of TiO2NRs, and the improved dye loading and fast electron transmission channel from graphene. This study provides an effective way of ternary composite complementary enhancement of the J sc and PCE of the DSSCs. PMID:27595326

  17. Timely initiation of complementary feeding and associated factors among children aged 6 to 12 months in Northern Ethiopia: an institution-based cross-sectional study

    PubMed Central

    2013-01-01

    Background Exclusive breastfeeding (EBF) for the first six months of life is critical for the wellbeing of the child. In the mean while, timely initiation and starting nutritionally-adequate, safe, age-appropriate complementary feeding at six months is recommended for the better health and development of infants. According to the Ethiopian Demographic and Health Survey 2011, timely initiation of complementary feeding in Ethiopia at the 6th month was only 51%. The purpose of this study is to determine the magnitude of timely initiation of complementary feeding and associated factors in Mekelle town, Northern Ethiopia. Methods An institutional based cross-sectional study design was conducted among 422 mothers of infants aged from six months to one year selected from six public health facilities. Sample size proportional to the patient flow rate of each institution was allocated and systematic random sampling method was used to get the study participant. An exit interview using structured questionnaire was conducted about their experience on complementary feeding and related experience. The questionnaire was pretested among 21 mothers. Data were entered with EPI info version 3.5.1 and cleaning and analysis was done by using SPSS version 16. Frequencies distribution, binary and multiple logistic regressions were done. OR and 95% confidence interval was computed. Result The prevalence of timely initiation of complementary feeding at sixth month was 62.8% (265/422, 95% C.I: 58.1, 67.31%). Educational level, occupation of mother, parity, having ANC follow up, and birth preparedness were found to be independent predictor of timely initiation of complementary feeding. Conclusions Almost two-third of mothers initiated complementary feeding at six month of child’ age as recommended. This was relatively higher prevalence than most developing countries. However, significant proportion of mothers still did not initiate complementary feeding timely. Mothers who are illiterate

  18. Evidence-Based Practices and Autism

    ERIC Educational Resources Information Center

    Mesibov, Gary B.; Shea, Victoria

    2011-01-01

    Interventions for autism are increasing being held to standards such as "evidence-based practice" in psychology and "scientifically-based research" in education. When these concepts emerged in the context of adult psychotherapy and regular education, they caused considerable controversy. Application of the concepts to autism treatments and special…

  19. Need for Evidence-Based Teaching

    ERIC Educational Resources Information Center

    Groccia, James E.; Buskist, William

    2011-01-01

    Educators believe that rather than being a mere possibility to improve as teachers, it is always "necessary" to improve. One way of improving teaching is to adopt teaching methods that are based on or supported by evidence of success in enhancing student learning. Most teachers base their instructional practices on tradition, the opinion of…

  20. Complementary and Other Interventions

    MedlinePlus

    ... Treatment of ADHD Complementary and Other Interventions Coaching Neurofeedback (EEG Biofeedback) Fish Oil Supplements and ADHD Carrying Your ... and Other Interventions Complementary and Other Interventions Coaching Neurofeedback (EEG Biofeedback) Fish Oil Supplements and ADHD Complementary and ...

  1. Evidence-based Practice of Radiology.

    PubMed

    Lavelle, Lisa P; Dunne, Ruth M; Carroll, Anne G; Malone, Dermot E

    2015-10-01

    Current health care reform in the United States is producing a shift in radiology practice from the traditional volume-based role of performing and interpreting a large number of examinations to providing a more affordable and higher-quality service centered on patient outcomes, which is described as a value-based approach to the provision of health care services. In the 1990 s, evidence-based medicine was defined as the integration of current best evidence with clinical expertise and patient values. When these methods are applied outside internal medicine, the process is called evidence-based practice (EBP). EBP facilitates understanding, interpretation, and application of the best current evidence into radiology practice, which optimizes patient care. It has been incorporated into "Practice-based Learning and Improvement" and "Systems-based Practice," which are two of the six core resident competencies of the Accreditation Council for Graduate Medical Education and two of the 12 American Board of Radiology milestones for diagnostic radiology. Noninterpretive skills, such as systems-based practice, are also formally assessed in the "Quality and Safety" section of the American Board of Radiology Core and Certifying examinations. This article describes (a) the EBP framework, with particular focus on its relevance to the American Board of Radiology certification and maintenance of certification curricula; (b) how EBP can be integrated into a residency program; and (c) the current value and likely place of EBP in the radiology information technology infrastructure. Online supplemental material is available for this article. PMID:26466187

  2. The Complementary Roles of the School Nurse and School Based Health Centers. Position Statement

    ERIC Educational Resources Information Center

    Ondeck, Lynnette; Combe, Laurie; Baszler, Rita; Wright, Janet

    2015-01-01

    It is the position of the National Association of School Nurses (NASN) that the unique combination of school nursing services and school-based health centers (SBHCs) facilitate positive health outcomes for students. The registered professional school nurse (hereinafter referred to as school nurse) is responsible for management of the daily health…

  3. Queer challenges to evidence-based practice.

    PubMed

    Zeeman, Laetitia; Aranda, Kay; Grant, Alec

    2014-06-01

    This paper aims to queer evidence-based practice by troubling the concepts of evidence, knowledge and mental illness. The evidence-based narrative that emerged within biomedicine has dominated health care. The biomedical notion of 'evidence' has been critiqued extensively and is seen as exclusive and limiting, and even though the social constructionist paradigm attempts to challenge the authority of biomedicine to legitimate what constitutes acceptable evidence or knowledge for those experiencing mental illness, biomedical notions of evidence appear to remain relatively intact. Queer theory offers theoretical tools to disrupt biomedical norms and challenges biomedical normativity to indicate how marginalisation occurs when normative truths about mental health classify those who differ from the norm as 'ill' or 'disordered'. Queer theory's emphasis on normativity serves the political aim to subvert marginalisation and bring about radical social and material change. Reference will be made to mental health subjects within each discourse by indicating how the body acts as a vehicle for knowing. Deleuzian notions of the rhizome are used as metaphor to suggest a relational approach to knowledge that does away with either/or positions in either biomedical, or queer knowledge to arrive at a both/and position where the biomedical, constructionist and queer are interrelated and entangled in needing the other for their own evolution. However, queer does not ask for assimilation but celebrates difference by remaining outside to disrupt that which is easily overlooked, assumed to be natural or represented as the norm. The task of queer knowledge is to do justice to the lives lived in the name of evidence-based practice and demands that we consider the relations of power where knowledge is produced. This pursuit creates different knowledge spaces where we identify new intersections that allow for socially just understandings of knowing or evidence to emerge. PMID:23738815

  4. Large scale meta-analysis of fragment-based screening campaigns: privileged fragments and complementary technologies.

    PubMed

    Kutchukian, Peter S; Wassermann, Anne Mai; Lindvall, Mika K; Wright, S Kirk; Ottl, Johannes; Jacob, Jaison; Scheufler, Clemens; Marzinzik, Andreas; Brooijmans, Natasja; Glick, Meir

    2015-06-01

    A first step in fragment-based drug discovery (FBDD) often entails a fragment-based screen (FBS) to identify fragment "hits." However, the integration of conflicting results from orthogonal screens remains a challenge. Here we present a meta-analysis of 35 fragment-based campaigns at Novartis, which employed a generic 1400-fragment library against diverse target families using various biophysical and biochemical techniques. By statistically interrogating the multidimensional FBS data, we sought to investigate three questions: (1) What makes a fragment amenable for FBS? (2) How do hits from different fragment screening technologies and target classes compare with each other? (3) What is the best way to pair FBS assay technologies? In doing so, we identified substructures that were privileged for specific target classes, as well as fragments that were privileged for authentic activity against many targets. We also revealed some of the discrepancies between technologies. Finally, we uncovered a simple rule of thumb in screening strategy: when choosing two technologies for a campaign, pairing a biochemical and biophysical screen tends to yield the greatest coverage of authentic hits. PMID:25550355

  5. Self-complementary quadruply hydrogen-bonded duplexes based on imide and urea units.

    PubMed

    Li, Xianghui; Fang, Yuyu; Deng, Pengchi; Hu, Jinchuan; Li, Tian; Feng, Wen; Yuan, Lihua

    2011-09-01

    The quadruply hydrogen-bonded duplexes based on an imide-urea structure preorganized by three-center hydrogen bonds were found to associate via bifurcated hydrogen bonds. (1)H NMR dilution experiments revealed the high stability of the homodimer in apolar solvent (K(dim) > 10(5) M(-1) in CDCl(3)) and enhancement of association ability due to electron-withdrawing substituent effects. The ready synthetic availability and adjustable association affinity via electronic effects may render these association units potentially applicable in constructing supramolecular architectures. PMID:21819056

  6. Interferometer-based structured-illumination microscopy utilizing complementary phase relationship through constructive and destructive image detection by two cameras.

    PubMed

    Shao, L; Winoto, L; Agard, D A; Gustafsson, M G L; Sedat, J W

    2012-06-01

    In an interferometer-based fluorescence microscope, a beam splitter is often used to combine two emission wavefronts interferometrically. There are two perpendicular paths along which the interference fringes can propagate and normally only one is used for imaging. However, the other path also contains useful information. Here we introduced a second camera to our interferometer-based three-dimensional structured-illumination microscope (I(5)S) to capture the fringes along the normally unused path, which are out of phase by π relative to the fringes along the other path. Based on this complementary phase relationship and the well-defined phase interrelationships among the I(5)S data components, we can deduce and then computationally eliminate the path length errors within the interferometer loop using the simultaneously recorded fringes along the two imaging paths. This self-correction capability can greatly relax the requirement for eliminating the path length differences before and maintaining that status during each imaging session, which are practically challenging tasks. Experimental data is shown to support the theory. PMID:22472010

  7. How Can Primary Health Care System and Community-Based Participatory Research Be Complementary?

    PubMed Central

    Sheikhattari, Payam; Kamangar, Farin

    2010-01-01

    Health statistics leave little doubt that the current health system in Iran, which is mainly based on primary health care (PHC), is a functioning one, and that health in Iran has improved far beyond where it was 40 years ago. However, this system has its limitations too. While PHC is very effective in reducing morbidity and mortality from infectious diseases and other acute conditions, it is far less effective in addressing chronic and multifactorial conditions which are now emerging in Iran. In this article, we review some of the salient features of the current health system in Iran, its strengths and limitations, and then introduce community-based participatory research (CBPR) as a method that could potentially fill some of the gaps in the system. We will discuss the definition and steps needed to implement CBPR, provide some important references, and discuss how this approach may not only improve the health system but it could also lead to improvement in other fields in the society too. PMID:21677760

  8. Value Based Care and Patient-Centered Care: Divergent or Complementary?

    PubMed

    Tseng, Eric K; Hicks, Lisa K

    2016-08-01

    Two distinct but overlapping care philosophies have emerged in cancer care: patient-centered care (PCC) and value-based care (VBC). Value in healthcare has been defined as the quality of care (measured typically by healthcare outcomes) modified by cost. In this conception of value, patient-centeredness is one important but not necessarily dominant quality measure. In contrast, PCC includes multiple domains of patient-centeredness and places the patient and family central to all decisions and evaluations of quality. The alignment of PCC and VBC is complicated by several tensions, including a relative lack of patient experience and preference measures, and conceptions of cost that are payer-focused instead of patient-focused. Several strategies may help to align these two philosophies, including the use of patient-reported outcomes in clinical trials and value determinations, and the purposeful integration of patient preference in clinical decisions and guidelines. Innovative models of care, including accountable care organizations and oncology patient-centered medical homes, may also facilitate alignment through improved care coordination and quality-based payment incentives. Ultimately, VBC and PCC will only be aligned if patient-centered outcomes, perspectives, and preferences are explicitly incorporated into the definitions and metrics of quality, cost, and value that will increasingly influence the delivery of cancer care. PMID:27262855

  9. An ultrahigh vacuum complementary metal oxide silicon compatible nonlithographic system to fabricate nanoparticle-based devices.

    PubMed

    Banerjee, Arghya; Das, Biswajit

    2008-03-01

    Nanoparticles of metals and semiconductors are promising for the implementation of a variety of photonic and electronic devices with superior performances and new functionalities. However, their successful implementation has been limited due to the lack of appropriate fabrication processes that are suitable for volume manufacturing. The current techniques for the fabrication of nanoparticles either are solution based, thus requiring complex surface passivation, or have severe constraints over the choice of particle size and material. We have developed an ultrahigh vacuum system for the implementation of a complex nanosystem that is flexible and compatible with the silicon integrated circuit process, thus making it suitable for volume manufacturing. The system also allows the fabrication of Ohmic contacts and isolation dielectrics in an integrated manner, which is a requirement for most electronic and photonic devices. We have demonstrated the power and the flexibility of this new system for the manufacturing of nanoscale devices by implementing a variety of structures incorporating nanoparticles. Descriptions of this new fabrication system together with experimental results are presented in this article. The system explains the method of size-selected deposition of nanoparticles of any metallic, semiconducting, and (or) insulating materials on any substrate, which is very important in fabricating useful nanoparticle-based devices. It has also been shown that at elevated substrate temperature, a selective deposition of the nanoparticles is observed near the grain-boundary regions. However, in these natural systems, there will always be low and favorable energy states present away from the grain-boundary regions, leading to the undesirable deposition of nanoparticles in the far-grain-boundary regions, too. PMID:18377028

  10. Evidence-Based Practice: Promoting Evidence-Based Interventions in School Psychology

    ERIC Educational Resources Information Center

    Kratochwill, Thomas R.; Steele Shernoff, Elisa

    2004-01-01

    We present an overview of issues related to evidence-based practice and the role that the school psychology profession can play in developing and disseminating evidence based interventions (EBIs). Historical problems relating to and the recurring debate about the integration of research into practice are presented as a context for the current…

  11. Evidence-Based Practice: Promoting Evidence-Based Interventions in School Psychology

    ERIC Educational Resources Information Center

    Kratochwill, Thomas R.; Shernoff, Elisa Steele

    2003-01-01

    We present an overview of issues related to evidence-based practice and the role that the school psychology profession can play in developing and disseminating evidence-based interventions (EBIs). Historical problems relating to and the recurring debate about the integration of research into practice are presented as a context for the current…

  12. Evidence-Based Special Education in the Context of Scarce Evidence-Based Practices

    ERIC Educational Resources Information Center

    TEACHING Exceptional Children, 2014

    2014-01-01

    Evidence-based practices (EBPs) are supported as generally effective for populations of learners by bodies of high-quality and experimental research and, when aligned with stakeholder values and practical needs, should be prioritized for implementation. However, evidence-based practices are not currently available for all learner types in all…

  13. Oncology Nursing Is Evidence-Based Care.

    PubMed

    Kennedy Sheldon, Lisa; Brown, Carlton G

    2016-06-01

    This issue of the Clinical Journal of Oncology Nursing (CJON) will be the final time that you will see the Evidence-Based Practice (EBP) feature column. Why? Because we have seen oncology nursing evolve in the past 20 years and EBP is everywhere! We use it in our clinics and hospital units, incorporate it into decisions about symptom management, and use evidence to develop survivorship guidelines. We discuss EBP in journal clubs and use applications on mobile devices to find the best interventions for our patients. We have oncology nurses sitting on committees to develop guidelines based on the best evidence and expert opinion. We have come a long way and it is our belief that EBP is included in almost every article in CJON and, therefore, a need no longer exists for an individual column about EBP. 
. PMID:27206287

  14. Animal-Based Remedies as Complementary Medicines in the Semi-Arid Region of Northeastern Brazil

    PubMed Central

    Alves, Rômulo R. N.; Barbosa, José A. A.; Santos, Silene L. D. X.; Souto, Wedson M. S.; Barboza, Raynner R. D.

    2011-01-01

    Animals (and their derived products) are essential ingredients in the preparation of many traditional remedies. Despite its prevalence in traditional medical practices worldwide, research on medicinal animals has often been neglected in comparison to medicinal plant research. This work documents the medicinal animals used by a rural community in the semi-arid region, inserted in Caatinga Biome, where 66 respondents provided information on animal species used as medicine, body parts used to prepare the remedies and illnesses to which the remedies were prescribed. We calculated the informant consensus factor to determine the consensus over which species are effective for particular ailments, as well as the species use value to determine the extent of utilization of each species. We recorded the use of 51 animal species as medicines, whose products were recommended for the treatment of 68 illnesses. The informant consensus in the use of many specific remedies is fairly high, giving an additional validity to this folk medicine. Eight species not previously reported as having medicinal use were recorded. The local medicinal fauna is largely based on wild animals, including some endangered species. Given a high proportion of medicinal animals observed in the study area, it is logical to conclude that any conservation strategy should include access to modern health care. PMID:19729490

  15. Evidence Based Education Request Desk. EBE #741

    ERIC Educational Resources Information Center

    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…

  16. Evidence-Based Practice Goes beyond Google

    ERIC Educational Resources Information Center

    Klitzing, Sandra

    2012-01-01

    Evidence-based practice (EBP) is applying research to assist in the selection of interventions that result in increased client quality care. Recently the Commission on Accreditation of Allied Health Education Programs (2010), a new accreditation body for recreational therapy education, included standards that state students should obtain knowledge…

  17. Evidence-Based Classroom Behaviour Management Strategies

    ERIC Educational Resources Information Center

    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…

  18. Statewide Implementation of Evidence-Based Programs

    ERIC Educational Resources Information Center

    Fixsen, Dean; Blase, Karen; Metz, Allison; van Dyke, Melissa

    2013-01-01

    Evidence-based programs will be useful to the extent they produce benefits to individuals on a socially significant scale. It appears the combination of effective programs and effective implementation methods is required to assure consistent uses of programs and reliable benefits to children and families. To date, focus has been placed primarily…

  19. Evidence Based Education Request Desk. EBE #555

    ERIC Educational Resources Information Center

    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. Time for evidence-based cytology

    PubMed Central

    Dey, Pranab

    2007-01-01

    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. PMID:17210074

  1. Finding Evidence-Based Practice Information

    ERIC Educational Resources Information Center

    Childs, Gary M.

    2009-01-01

    Locating sources that are rich in evidence-based practice information can be more difficult for physical as well as occupational therapists in practice settings in which there is not direct access to a health sciences library. In addition, once information has been found, there may not be an easy way to access the data. This commentary will…

  2. The Evidence Base for Positive Peer Culture

    ERIC Educational Resources Information Center

    Laursen, Erik K.

    2010-01-01

    This article explores the evidence base for Positive Peer Culture (PPC) which is a total system for developing positive youth cultures in youth serving organizations. It challenges a popular belief among some researchers that group programs which bring together troubled youth are inherently negative.

  3. Implementing Evidence-Based Treatments in Organizations

    ERIC Educational Resources Information Center

    Woolston, Joseph L.

    2005-01-01

    Several case studies in implementing evidence-based treatments (EBTs) in organizations are presented. Two erroneous presuppositions about treatments with proven efficacy (henceforth called EBTs) frequently lead to major problems (Hoagwood et al., 2001). The first is that the development of an EBT has taken into account the fit between the…

  4. A Three-Stage Inverter-Based Stacked Power Amplifier in 65 nm Complementary Metal Oxide Semiconductor Process

    NASA Astrophysics Data System (ADS)

    Kiumarsi, Hamid; Mizuochi, Yutaka; Ito, Hiroyuki; Ishihara, Noboru; Masu, Kazuya

    2012-02-01

    A three-stage inverter-based stacked power amplifier (PA) in complementary metal oxide semiconductor (CMOS) process is proposed to overcome low breakdown voltage problem of scaled CMOS technologies. Unlike previous reported stacked PAs which radio frequency choke (RFC) was inevitable, we proposed stacked nMOS and pMOS transistors which effectively eliminates use of RFC. By properly setting self-biased circuits' and transistors' parameters, output impedance could reach up to 50 Ω which together with not employing the RFC makes this topology very appealing for the scalable PA realization. As a proof of concept, a three-stage PA using 65 nm CMOS technology is implemented. With a 6 V power supply for the third stage, the fabricated PA shows a small-signal gain of 36 dB, a saturated output power of 16 dBm and a maximum power added efficiency of 10% at 1 GHz. Using a 7.5 V of power supply, saturated output power reaches 18 dBm. To the best of our knowledge, this is the first reported inverter-based stacked PA.

  5. The Evidence-Based Manifesto for School Librarians

    ERIC Educational Resources Information Center

    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…

  6. Animal-based remedies as complementary medicines in Santa Cruz do Capibaribe, Brazil

    PubMed Central

    Alves, Rômulo RN; Lima, Helenice N; Tavares, Marília C; Souto, Wedson MS; Barboza, Raynner RD; Vasconcellos, Alexandre

    2008-01-01

    Background The use of animal products in healing is an ancient and widespread cross-cultural practice. In northeastern Brazil, especially in the semi-arid region, animals and plants are widely used in traditional medicine and play significant roles in healing practices. Zootherapies form an integral part of these cultures, and information about animals is passed from generation to generation through oral folklore. Nevertheless, studies on medicinal animals are still scarce in northeastern Brazil, especially when compared to those focusing on medicinal plants. This paper examines the use and commercialization of animals for medicinal purposes in Brazil's semi-arid caatinga region. Methods Data was obtained through field surveys conducted in the public markets in the city of Santa Cruz do Capibaribe, Pernambuco State, Brazil. We interviewed 16 merchants (9 men and 7 women) who provided information regarding folk remedies based on animal products. Results A total of 37 animal species (29 families), distributed among 7 taxonomic categories were found to be used to treat 51 different ailments. The most frequently cited treatments focused on the respiratory system, and were mainly related to problems with asthma. Zootherapeutic products are prescribed as single drugs or are mixed with other ingredients. Mixtures may include several to many more valuable medicinal animals added to other larger doses of more common medicinal animals and plants. The uses of certain medicinal animals are associated with popular local beliefs known as 'simpatias'. We identified 2 medicinal species (Struthio camelus and Nasutitermes macrocephalus) not previously documented for Brazil. The use of animals as remedies in the area surveyed is associated with socio economic and cultural factors. Some of the medicinal animal species encountered in this study are included in lists of endangered species. Conclusion Our results demonstrate that a large variety of animals are used in traditional

  7. Empirically Supported Treatments in Psychotherapy: Towards an Evidence-Based or Evidence-Biased Psychology in Clinical Settings?

    PubMed Central

    Castelnuovo, Gianluca

    2010-01-01

    The field of research and practice in psychotherapy has been deeply influenced by two different approaches: the empirically supported treatments (ESTs) movement, linked with the evidence-based medicine (EBM) perspective and the “Common Factors” approach, typically connected with the “Dodo Bird Verdict”. About the first perspective, since 1998 a list of ESTs has been established in mental health field. Criterions for “well-established” and “probably efficacious” treatments have arisen. The development of these kinds of paradigms was motivated by the emergence of a “managerial” approach and related systems for remuneration also for mental health providers and for insurance companies. In this article ESTs will be presented underlining also some possible criticisms. Finally complementary approaches, that could add different evidence in the psychotherapy research in comparison with traditional EBM approach, are presented. PMID:21833197

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

    PubMed

    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. PMID:14509997

  9. [Evidence-based medicine: an epistemological approach].

    PubMed

    Henao, Daniel Eduardo; Jaimes, Fabián Alberto

    2009-03-01

    Evidence-based medicine gathers physician's experience and the best scientific evidence to make medical decisions. This proposal has been widely promulgated by medical opinion leaders. Despite a large literature supporting this practice, a formal discussion has not been established regarding its epistemological consequences in daily medical work. The main proposal of evidence-based medicine consists of choosing the best medical decision according to the best available results from scientific studies. Herein, the goal was to highlight inappropriate application of the scientific method used by physics to clinical science. The inaccuracy resides in describing health and disease in strictly numeric equivalents that can be homogenized on a continuous scale. Finally, the authors consider each diseased human being as a complex system, unique and particular, and that this being is defined by an historical background as well as current actual context. Therefore, evidence-based medicine possesses certain limitations that must be recognized in order to to provide better health care to patients. PMID:19753837

  10. What is evidence-based behavior analysis?

    PubMed

    Smith, Tristram

    2013-01-01

    Although applied behavior analysts often say they engage in evidence-based practice, they express differing views on what constitutes "evidence" and "practice." This article describes a practice as a service offered by a provider to help solve a problem presented by a consumer. Solving most problems (e.g., increasing or decreasing a behavior and maintaining this change) requires multiple intervention procedures (i.e., a package). Single-subject studies are invaluable in investigating individual procedures, but researchers still need to integrate the procedures into a package. The package must be standardized enough for independent providers to replicate yet flexible enough to allow individualization; intervention manuals are the primary technology for achieving this balance. To test whether the package is effective in solving consumers' problems, researchers must evaluate outcomes of the package as a whole, usually in group studies such as randomized controlled trials. From this perspective, establishing an evidence-based practice involves more than analyzing the effects of discrete intervention procedures on behavior; it requires synthesizing information so as to offer thorough solutions to problems. Recognizing the need for synthesis offers behavior analysts many promising opportunities to build on their existing research to increase the quality and quantity of evidence-based practices. PMID:25729130

  11. Performance analysis of multiple interference suppression over asynchronous/synchronous optical code-division multiple-access system based on complementary/prime/shifted coding scheme

    NASA Astrophysics Data System (ADS)

    Nieh, Ta-Chun; Yang, Chao-Chin; Huang, Jen-Fa

    2011-08-01

    A complete complementary/prime/shifted prime (CPS) code family for the optical code-division multiple-access (OCDMA) system is proposed. Based on the ability of complete complementary (CC) code, the multiple-access interference (MAI) can be suppressed and eliminated via spectral amplitude coding (SAC) OCDMA system under asynchronous/synchronous transmission. By utilizing the shifted prime (SP) code in the SAC scheme, the hardware implementation of encoder/decoder can be simplified with a reduced number of optical components, such as arrayed waveguide grating (AWG) and fiber Bragg grating (FBG). This system has a superior performance as compared to previous bipolar-bipolar coding OCDMA systems.

  12. Evaluation of drug-induced neurotoxicity based on metabolomics, proteomics and electrical activity measurements in complementary CNS in vitro models.

    PubMed

    Schultz, Luise; Zurich, Marie-Gabrielle; Culot, Maxime; da Costa, Anaelle; Landry, Christophe; Bellwon, Patricia; Kristl, Theresa; Hörmann, Katrin; Ruzek, Silke; Aiche, Stephan; Reinert, Knut; Bielow, Chris; Gosselet, Fabien; Cecchelli, Romeo; Huber, Christian G; Schroeder, Olaf H-U; Gramowski-Voss, Alexandra; Weiss, Dieter G; Bal-Price, Anna

    2015-12-25

    The present study was performed in an attempt to develop an in vitro integrated testing strategy (ITS) to evaluate drug-induced neurotoxicity. A number of endpoints were analyzed using two complementary brain cell culture models and an in vitro blood-brain barrier (BBB) model after single and repeated exposure treatments with selected drugs that covered the major biological, pharmacological and neuro-toxicological responses. Furthermore, four drugs (diazepam, cyclosporine A, chlorpromazine and amiodarone) were tested more in depth as representatives of different classes of neurotoxicants, inducing toxicity through different pathways of toxicity. The developed in vitro BBB model allowed detection of toxic effects at the level of BBB and evaluation of drug transport through the barrier for predicting free brain concentrations of the studied drugs. The measurement of neuronal electrical activity was found to be a sensitive tool to predict the neuroactivity and neurotoxicity of drugs after acute exposure. The histotypic 3D re-aggregating brain cell cultures, containing all brain cell types, were found to be well suited for OMICs analyses after both acute and long term treatment. The obtained data suggest that an in vitro ITS based on the information obtained from BBB studies and combined with metabolomics, proteomics and neuronal electrical activity measurements performed in stable in vitro neuronal cell culture systems, has high potential to improve current in vitro drug-induced neurotoxicity evaluation. PMID:26026931

  13. Developmental outcomes among 18-month-old Malawians after a year of complementary feeding with lipid-based nutrient supplements or corn-soy flour

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The major aim of this trial was to compare the development of 18-month-old infants who received complementary feeding for 1 year with either lipid-based nutrient supplements or micronutrient-fortified corn-soy porridge. Our secondary aim was to determine the socio-economic factors associated with de...

  14. Evidence-Based Chinese Medicine for Hypertension

    PubMed Central

    Wang, Jie; Xiong, Xingjiang

    2013-01-01

    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. PMID:23861720

  15. Evidence-based chinese medicine for hypertension.

    PubMed

    Wang, Jie; Xiong, Xingjiang

    2013-01-01

    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. PMID:23861720

  16. [The philosophical foundations of evidence-based nursing].

    PubMed

    Wang, Linton; Ma, Wei-Fen

    2013-10-01

    As a branch of evidence-based practice, evidence-based nursing emphasizes the integration of patient needs, the evidence for practical problem solving, and the application of nursing expertise. The criteria of evidence and the application of evidence in practice are the central theoretical foundations of evidence-based practice and evidence-based nursing. Therefore, the main philosophical considerations of evidence-based nursing shall focus on the criteria by which evidence supports propositions and how evidence should be applied in practice. In this paper, we explain the criteria of evidence from an epistemological perspective and explain the application of evidence in practice from the perspective of rational decision-making. Finally, we use these philosophical considerations to propose practical guidelines for evidence-based nursing and explain the philosophical significance of nursing practice. PMID:24096459

  17. Complementary and alternative medicine therapies for perinatal depression.

    PubMed

    Deligiannidis, Kristina M; Freeman, Marlene P

    2014-01-01

    Complementary and alternative medicine therapies are increasingly sought out by people with psychiatric disorders. In this chapter, we review the evidence for several commonly used CAM therapies (i.e. omega-3 fatty acids, folate, S-adenosyl-methionine, St John's Wort, bright light therapy, exercise, massage, and acupuncture) in the treatment of perinatal depression. A number of these treatments may be reasonable to consider for women during pregnancy or postpartum, but the safety and efficacy of these relative to standard treatments must still be systematically determined. Evidence-based use of complementary and alternative medicine therapies treatments for perinatal depression is discussed. Adequately powered systematic studies are necessary to determine the role of complementary and alternative medicine therapies in the treatment of perinatal depression. PMID:24041861

  18. Integrating Science and Engineering to Implement Evidence-Based Practices in Health Care Settings.

    PubMed

    Wu, Shinyi; Duan, Naihua; Wisdom, Jennifer P; Kravitz, Richard L; Owen, Richard R; Sullivan, J Greer; Wu, Albert W; Di Capua, Paul; Hoagwood, Kimberly Eaton

    2015-09-01

    Integrating two distinct and complementary paradigms, science and engineering, may produce more effective outcomes for the implementation of evidence-based practices in health care settings. Science formalizes and tests innovations, whereas engineering customizes and optimizes how the innovation is applied tailoring to accommodate local conditions. Together they may accelerate the creation of an evidence-based healthcare system that works effectively in specific health care settings. We give examples of applying engineering methods for better quality, more efficient, and safer implementation of clinical practices, medical devices, and health services systems. A specific example was applying systems engineering design that orchestrated people, process, data, decision-making, and communication through a technology application to implement evidence-based depression care among low-income patients with diabetes. We recommend that leading journals recognize the fundamental role of engineering in implementation research, to improve understanding of design elements that create a better fit between program elements and local context. PMID:25217100

  19. Integrating Science and Engineering to Implement Evidence-Based Practices in Health Care Settings

    PubMed Central

    Wu, Shinyi; Duan, Naihua; Wisdom, Jennifer P.; Kravitz, Richard L.; Owen, Richard R.; Sullivan, Greer; Wu, Albert W.; Di Capua, Paul; Hoagwood, Kimberly Eaton

    2015-01-01

    Integrating two distinct and complementary paradigms, science and engineering, may produce more effective outcomes for the implementation of evidence-based practices in health care settings. Science formalizes and tests innovations, whereas engineering customizes and optimizes how the innovation is applied tailoring to accommodate local conditions. Together they may accelerate the creation of an evidence-based healthcare system that works effectively in specific health care settings. We give examples of applying engineering methods for better quality, more efficient, and safer implementation of clinical practices, medical devices, and health services systems. A specific example was applying systems engineering design that orchestrated people, process, data, decision-making, and communication through a technology application to implement evidence-based depression care among low-income patients with diabetes. We recommend that leading journals recognize the fundamental role of engineering in implementation research, to improve understanding of design elements that create a better fit between program elements and local context. PMID:25217100

  20. What's Wrong with Evidence-Based Medicine?

    PubMed

    Fins, Joseph J

    2016-01-01

    Medicine in the last decades of the twentieth century was ripe for a data sweep that would bring systematic analysis to treatment strategies that seemingly had stood the test of time but were actually unvalidated. Coalescing under the banner of evidence-based medicine, this process has helped to standardize care, minimize error, and promote patient safety. But with this advancement, something of the art of medicine has been lost. PMID:26786040

  1. A one-step colorimetric acid-base titration sensor using a complementary color changing coordination system.

    PubMed

    Cho, Hui Hun; Kim, Si Hyun; Heo, Jun Hyuk; Moon, Young Eel; Choi, Young Hun; Lim, Dong Cheol; Han, Kwon-Hoon; Lee, Jung Heon

    2016-06-21

    We report the development of a colorimetric sensor that allows for the quantitative measurement of the acid content via acid-base titration in a single-step. In order to create the sensor, we used a cobalt coordination system (Co-complex sensor) that changes from greenish blue colored Co(H2O)4(OH)2 to pink colored Co(H2O)6(2+) after neutralization. Greenish blue and pink are two complementary colors with a strong contrast. As a certain amount of acid is introduced to the Co-complex sensor, a portion of greenish blue colored Co(H2O)4(OH)2 changes to pink colored Co(H2O)6(2+), producing a different color. As the ratio of greenish blue and pink in the Co-complex sensor is determined by the amount of neutralization reaction occurring between Co(H2O)4(OH)2 and an acid, the sensor produced a spectrum of green, yellow green, brown, orange, and pink colors depending on the acid content. In contrast, the color change appeared only beyond the end point for normal acid-base titration. When we mixed this Co-complex sensor with different concentrations of citric acid, tartaric acid, and malic acid, three representative organic acids in fruits, we observed distinct color changes for each sample. This color change could also be observed in real fruit juice. When we treated the Co-complex sensor with real tangerine juice, it generated diverse colors depending on the concentration of citric acid in each sample. These results provide a new angle on simple but quantitative measurements of analytes for on-site usage in various applications, such as in food, farms, and the drug industry. PMID:27143645

  2. Evidence-Based Practice for Outpatient Clinical Teams

    ERIC Educational Resources Information Center

    Hamilton, John D.

    2006-01-01

    This column focuses on evidence-based practice (EBP) within multidisciplinary outpatient settings, but first provides some definitions. Besides EBP (Burns and Hoagwood, 2005; Guyatt and Rennie, 2002), there are also evidence-based medicine (EBM; March et al., 2005), evidence-based service (EBS; Chorpita et al., 2002), and evidence-based treatment…

  3. What Is Evidence-Based Behavior Analysis?

    PubMed Central

    Smith, Tristram

    2013-01-01

    Although applied behavior analysts often say they engage in evidence-based practice, they express differing views on what constitutes “evidence” and “practice.” This article describes a practice as a service offered by a provider to help solve a problem presented by a consumer. Solving most problems (e.g., increasing or decreasing a behavior and maintaining this change) requires multiple intervention procedures (i.e., a package). Single-subject studies are invaluable in investigating individual procedures, but researchers still need to integrate the procedures into a package. The package must be standardized enough for independent providers to replicate yet flexible enough to allow individualization; intervention manuals are the primary technology for achieving this balance. To test whether the package is effective in solving consumers' problems, researchers must evaluate outcomes of the package as a whole, usually in group studies such as randomized controlled trials. From this perspective, establishing an evidence-based practice involves more than analyzing the effects of discrete intervention procedures on behavior; it requires synthesizing information so as to offer thorough solutions to problems. Recognizing the need for synthesis offers behavior analysts many promising opportunities to build on their existing research to increase the quality and quantity of evidence-based practices. PMID:25729130

  4. Evidence-based medicine and tort law.

    PubMed

    Foucar, Elliott; Wick, Mark R

    2005-05-01

    Recent statutes and legal decisions have been aimed at bettering the quality of tort-law decisions by substantively improving "expert" testimony. However, in analogy to the experience of physicians attempting to upgrade medical practice using the principles of evidence-based medicine, lawyers and the courts have found it much easier to describe ideal science than to actualize it. This is particularly so in a system (the Law) that has traditionally not been very discerning about scientific rigor, and which has established procedural priorities that are often incompatible with strict scientific standards. This overview will examine the American tort system from an evidence-based perspective. We include a discussion of standards that could be used for "outcomes analysis" in the Law; recognition and classification of errors made by the courts themselves; the relationship between medical errors, "negligence," and standard of care; and the problem of reconciling the rights of plaintiffs with medical-scientific facts. We also consider selected impediments to developing a legal system that is capable of consistently reaching evidence-based decisions concerning complex scientific information, including pathologic interpretation of tissue specimens. PMID:16639995

  5. Evidence-based ethics? On evidence-based practice and the "empirical turn" from normative bioethics

    PubMed Central

    Goldenberg, Maya J

    2005-01-01

    Background The increase in empirical methods of research in bioethics over the last two decades is typically perceived as a welcomed broadening of the discipline, with increased integration of social and life scientists into the field and ethics consultants into the clinical setting, however it also represents a loss of confidence in the typical normative and analytic methods of bioethics. Discussion The recent incipiency of "Evidence-Based Ethics" attests to this phenomenon and should be rejected as a solution to the current ambivalence toward the normative resolution of moral problems in a pluralistic society. While "evidence-based" is typically read in medicine and other life and social sciences as the empirically-adequate standard of reasonable practice and a means for increasing certainty, I propose that the evidence-based movement in fact gains consensus by displacing normative discourse with aggregate or statistically-derived empirical evidence as the "bottom line". Therefore, along with wavering on the fact/value distinction, evidence-based ethics threatens bioethics' normative mandate. The appeal of the evidence-based approach is that it offers a means of negotiating the demands of moral pluralism. Rather than appealing to explicit values that are likely not shared by all, "the evidence" is proposed to adjudicate between competing claims. Quantified measures are notably more "neutral" and democratic than liberal markers like "species normal functioning". Yet the positivist notion that claims stand or fall in light of the evidence is untenable; furthermore, the legacy of positivism entails the quieting of empirically non-verifiable (or at least non-falsifiable) considerations like moral claims and judgments. As a result, evidence-based ethics proposes to operate with the implicit normativity that accompanies the production and presentation of all biomedical and scientific facts unchecked. Summary The "empirical turn" in bioethics signals a need for

  6. [Acupressure and Evidence-Based Nursing].

    PubMed

    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. PMID:26645442

  7. Complementary and Integrative Medicine

    MedlinePlus

    ... medical treatments that are not part of mainstream medicine. When you are using these types of care, it may be called complementary, integrative, or alternative medicine. Complementary medicine is used together with mainstream medical ...

  8. Complementary and Integrative Medicine

    MedlinePlus

    ... care, it may be called complementary, integrative, or alternative medicine. Complementary medicine is used together with mainstream medical ... types of care, it is called integrative medicine. Alternative medicine is used instead of mainstream medical care. The ...

  9. Determinants of complementary feeding practices among mothers of 6–24 months failure to thrive children based on behavioral analysis phase of PRECEDE model, Tehran

    PubMed Central

    Shams, Nasibeh; Mostafavi, Firoozeh; Hassanzadeh, Akbar

    2016-01-01

    Background: This study intended to clarify the determining factors of complementary feeding practices among Tehran 6–24 months failure to thrive children in order to use the results for planning the interventions to reduce the possible adverse effects. Materials and Methods: In this study, 132 mothers of three medical and health centers were chosen by random sampling among those centers operating under the supervision of south of Tehran District Health Center and study data were collected from them. A valid and reliable questionnaire as a data collection instrument developed based on behavioral analysis phase of PRECEDE model. Spearman and Pearson's correlation coefficient test were used to determine the statistical relationship between factors associated with complementary feeding practices among mothers. Results: The mothers’ knowledge was as follows: 0.8%, 20.4%, and 78.8% of them were good, medium, and poor, respectively. Mean scores for the mothers’ performance in terms of supplementary feeding was 66.8. Pearson correlation indicated a positive and significant correlation between the mothers’ performance with enabling and reinforcing factors, but there wasn’t any significant relationship between the mothers’ performance and knowledge about complementary feeding. Conclusions: According to the obtained results, reinforcing factors, and enabling factors are associated with the mothers’ performance in terms of complementary feeding. Hence, attention to these issues is essential for better health interventions planning. PMID:27500177

  10. Considerations for complementary and alternative interventions for pain.

    PubMed

    Schulenburg, Julia

    2015-03-01

    Nurses play an important role in pain management. When considering strategies for effective pain management, nurses must consider and be able to provide information about complementary and alternative therapies. Awareness of alternative interventions for pain extends across herbal therapies, energy medicine, and mind-body exercises. Treatment regimens that integrate conventional therapies with alternative therapies based on the medical systems of non-Western cultures may affect outcomes positively through medical interactions. Nurses should question patients and families about complementary health practices to determine whether they may affect postsurgical recovery and also to determine the level of openness to alternative practices that have evidence of success or equivalency in managing pain. PMID:25707724

  11. Who needs evidence-based health care?

    PubMed Central

    Tsafrir, J; Grinberg, M

    1998-01-01

    The vast amount of published material in clinical and biomedical sciences, and conflicting results on diagnostic and therapeutic procedures may introduce doubts in decision-making for patient care. Information retrieving skills and the critical appraisal of published literature, together with elaboration of practice guidelines based on epidemiological methodology, form the basis of the trend towards evidence-based health care, which aims to overcome these problems. A survey conducted by questionnaire at the Chaim Sheba Medical Center analyzed which types of information sources are considered most relevant and useful for patient care by a cross-section of physicians with varying degrees of experience. They considered review articles and meta-analyses extremely reliable for information purposes, while for practical patient-care purposes they tended to rely more on the opinions of peers and experts. As the requirements of evidence-based health care may influence the attitudes of clinicians to the published literature and its evaluation, they have implications for medical libraries and information centers. Specifically, information specialists will be called upon more and more to impart information-retrieval and critical appraisal skills to clinicians. The involvement of information specialists in information gathering and selection will provide added value to the expertise and knowledge of in-house experts for decision-making. PMID:9549011

  12. [Evidence based medicine for the gastroenterologist].

    PubMed

    Curioso, Walter H; Montori, Víctor M; Curioso, Walter I

    2004-01-01

    Evidence-based medicine (EBM) integrates the best available external evidence in the care of individual patients with the individual clinical expertise and the patient preferences. This method has been designed for use in daily clinical practice. We describe the rationale for EBM and its principles and application in this article. EBM enables gastroenterologists to update the knowledge required to provide patients with high quality medical care. EBM requires four steps: a) formulating a clinical question arising from a doubt concerning a patient; b) conducting an efficient literature search to answer this question; c) critically appraising this evidence using explicit methods to selected articles to determine the validity of their design and the clinical relevance of their results; and d) applying these results to the patient (taking into account their values and preferences and personal and social circumstances). In this paper, we explain the principles and basic concepts of EBM and their application to gastroenterology and we provide an extensive compilation of internet databases of valid information relevant to gastroenterologists. We also provide a selection of useful tools for self-directed learning of critical appraisal skills. Link updates can be accessed at the following URL: http://www.enlacesmedicos.com/e.htm PMID:15098043

  13. Evidence-Based Management of Anticoagulant Therapy

    PubMed Central

    Schulman, Sam; Witt, Daniel M.; Vandvik, Per Olav; Fish, Jason; Kovacs, Michael J.; Svensson, Peter J.; Veenstra, David L.; Crowther, Mark; Guyatt, Gordon H.

    2012-01-01

    Background: High-quality anticoagulation management is required to keep these narrow therapeutic index medications as effective and safe as possible. This article focuses on the common important management questions for which, at a minimum, low-quality published evidence is available to guide best practices. Methods: The methods of this guideline follow those described in Methodology for the Development of Antithrombotic Therapy and Prevention of Thrombosis Guidelines: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines in this supplement. Results: Most practical clinical questions regarding the management of anticoagulation, both oral and parenteral, have not been adequately addressed by randomized trials. We found sufficient evidence for summaries of recommendations for 23 questions, of which only two are strong rather than weak recommendations. Strong recommendations include targeting an international normalized ratio of 2.0 to 3.0 for patients on vitamin K antagonist therapy (Grade 1B) and not routinely using pharmacogenetic testing for guiding doses of vitamin K antagonist (Grade 1B). Weak recommendations deal with such issues as loading doses, initiation overlap, monitoring frequency, vitamin K supplementation, patient self-management, weight and renal function adjustment of doses, dosing decision support, drug interactions to avoid, and prevention and management of bleeding complications. We also address anticoagulation management services and intensive patient education. Conclusions: We offer guidance for many common anticoagulation-related management problems. Most anticoagulation management questions have not been adequately studied. PMID:22315259

  14. Progress in evidence based reproductive surgery

    PubMed Central

    Bosteels, J.; Weyers, S.; Siristatidis, C.; Bhattacharya, S.; D’Hooghe, T.

    2011-01-01

    The Consolidated Standards of Reporting Trials (CONSORT) was introduced in 1996 to improve the methodological quality of published reports of randomised controlled trials. By doing a systematic review of randomised controlled trials on reproductive surgery, our group can demonstrate that the overall quality of the published reports of randomised studies on reproductive surgical interventions has improved after CONSORT. Nevertheless, some problems still remain. By discussing the benefits and pitfalls of randomised trials in reproductive surgery, our opinion paper aims to stimulate the reader’s further interest in evidence-based practice in reproductive surgery. PMID:24753872

  15. Managing and reviewing evidence-based changes.

    PubMed

    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. PMID:27089753

  16. Colposcopy: an evidence-based update.

    PubMed

    Dresang, Lee T

    2005-01-01

    Colposcopy is a diagnostic procedure, most commonly used in the diagnosis of cervical intraepithelial neoplasia and lower genital tract carcinoma. In this article, evidence-based management strategies are updated with discussion of the 2001 American Society for Colposcopy and Cervical Pathology Consensus Guidelines. Practice management issues include methods to improve cervical cancer screening rates, coding and billing, and telemedicine. Textbooks, CD-ROMs, and courses are listed for new learners and experienced providers who want to update and sharpen their skills. PMID:16148248

  17. Comparative effectiveness research: decision-based evidence.

    PubMed

    Kowalski, Charles Joseph; Mrdjenovich, Adam Joel

    2014-01-01

    In the clinical research context, comparative effectiveness research (CER) refers to the comparison of several health-care interventions administered under real-world conditions to individuals representative of the day-to-day clinical practice target population. We provide a brief history of CER and argue that CER can be used to deliver useful, but currently lacking information. Three study designs that can accomplish this are discussed, and incorporating CER into cost-benefit analyses is examined. The relationships between CER and evidence-based and personalized medicine are also considered, as is the challenge of implementing CER results into routine clinical practice. PMID:25544326

  18. Cost Evaluation of Evidence-Based Treatments

    PubMed Central

    Sindelar, Jody L.; Ball, Samuel A.

    2010-01-01

    Many treatment programs have adopted or are considering adopting evidence-based treatments (EBTs). When a program evaluates whether to adopt a new intervention, it must consider program objectives, operational goals, and costs. This article examines cost concepts, cost estimation, and use of cost information to make the final decision on whether to adopt an EBT. Cost categories, including variable and fixed, accounting and opportunity, and costs borne by patients and others, are defined and illustrated using the example of expenditures for contingency management. Ultimately, cost is one consideration in the overall determination of whether implementing an EBT is the best use of a program’s resources. PMID:22002453

  19. Normal childbirth and evidence based practice.

    PubMed

    Waldenström, Ulla

    2007-12-01

    This paper was presented at a Health Conference in March 2007, celebrating the 150th birthday of the Royal Women's Hospital in Melbourne. It discusses the definition of "normal childbirth", and the pros and cons of three medical technologies: caesarean section, epidural analgesia during labour and routine ultrasound screening during pregnancy, and whether clinical practices, in Australia and Sweden (author is Swedish), in relation to these methods are evidence based. It also discusses the impact of non-scientific reasons, such as anxiety, on clinical decision making. PMID:17913612

  20. Complementary and Alternative Treatment for Allergic Conditions.

    PubMed

    Qiu, Juan; Grine, Kristen

    2016-09-01

    This article explains the proposed pathophysiology, evidence of efficacy, and adverse effects of several complementary and alternative medicine modalities, for the treatment of allergic conditions, such as traditional Chinese medicine formula, herbal treatments, acupuncture, and homeopathy. PMID:27545740

  1. Evidence-based medicine: medical librarians providing evidence at the point of care.

    PubMed

    Yaeger, Lauren H; Kelly, Betsy

    2014-01-01

    Evidence-based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. .. by best available external clinical evidence we mean clinically relevant research.' Health care reform authorized by the Affordable Care Act is based on the belief that evidence-based practice (EBP) generates cost savings due to the delivery of more effective care.2 Medical librarians, skilled in identifying appropriate resources and working with multiple complex interfaces, can support clinicians' efforts to practice evidence based medicine by providing time and expertise in articulating the clinical question and identifying the best evidence. PMID:25438362

  2. Evidence-based medicine: medical librarians providing evidence at the point of care.

    PubMed

    Yaeger, Lauren H; Kelly, Betsy

    2014-01-01

    Evidence-based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. .. by best available external clinical evidence we mean clinically relevant research.' Health care reform authorized by the Affordable Care Act is based on the belief that evidence-based practice (EBP) generates cost savings due to the delivery of more effective care.2 Medical librarians, skilled in identifying appropriate resources and working with multiple complex interfaces, can support clinicians' efforts to practice evidence based medicine by providing time and expertise in articulating the clinical question and identifying the best evidence. PMID:25507879

  3. Reconstructing data: evidence-based medicine and evidence-based public health in context.

    PubMed

    Nadav, Davidovitch; Dani, Filc

    2006-01-01

    The emergence of Evidence-Based Medicine (EBM) as the gold-standard practice in biomedicine and public health practices represents a significant epistemological turn in modern medicine. The development of Evidence-Based Public Health (EBPH) followed the emergence of Evidence-Based Medicine, as an attempt to ground health policies and interventions on "sound facts". The present paper analyzes the historical and sociological roots of this turn. We evaluate the ethical and social consequences of this transformation, both within the medical profession (the polarization between a medical elite which strengthened its professional status, and a rank and file which experienced a process of "de-professionalization") and in its relationship to the welfare state (the link between the medical elite, EBM, EBPH and the commodification of health care and public health). PMID:17214142

  4. Evidence-Based Practice Guidelines and School Nursing

    ERIC Educational Resources Information Center

    Adams, Susan; McCarthy, Ann Marie

    2007-01-01

    The use of evidence-based practice (EBP) has become the standard of health care practice. Nurses are expected to use best evidence on a wide range of topics, yet most nurses have limited time, resources, and/or skills to access and evaluate the quality of research and evidence needed to practice evidence-based nursing. EBP guidelines allow nurses…

  5. An Examination of the Bases of Evidence-Based Interventions.

    ERIC Educational Resources Information Center

    Wampold, Bruce E.

    2002-01-01

    School psychology has proposed a system to aid in the identification of evidence-based interventions (Kratochwill & Stoiber, this issue; Lewis-Snyder, Stoiber, & Kratochwill, this issue; Shernoff, Kratochwill, & Stoiber, this issue). In this commentary, issues related to the politics of exclusion, design and theory, methods, and multiculturalism…

  6. Complementary study based on DFT to describe the structure and properties relationship of diblock copolymer based on PVK and PPV

    NASA Astrophysics Data System (ADS)

    Mbarek, M.; Abbassi, F.; Alimi, K.

    2016-09-01

    The structure-properties relationships of copolymer involving N-vinylcarbazole (PVK) and poly (p-phenylene-vinylene) (PPV) blocks, denoted PVK-PPV, was investigated by calculations based on density functional theory (DFT) and completed by experimental analyses. Thus, vibrational, optical and emission spectra of model compound have been simulated and compared to the experiments observations published recently. Ionization potentials (IPs), electron affinities (EAs) and energy gaps were determined. Furthermore, quantum yields, radiative and nonradiative exciton lifetime was highlighted.

  7. Complementary and alternative medicine for treatment of irritable bowel syndrome

    PubMed Central

    Shen, Yi-Hao A.; Nahas, Richard

    2009-01-01

    Abstract OBJECTIVE To review the evidence supporting selected complementary and alternative medicine approaches used in the treatment of irritable bowel syndrome (IBS). QUALITY OF EVIDENCE MEDLINE (from January 1966), EMBASE (from January 1980), and the Cochrane Database of Systematic Reviews were searched until March 2008, combining the terms irritable bowel syndrome or irritable colon with complementary therapies, alternative medicine, acupuncture, fiber, peppermint oil, herbal, traditional, yoga, massage, meditation, mind, relaxation, probiotic, hypnotherapy, psychotherapy, cognitive therapy, or behavior therapy. Results were screened to include only clinical trials, systematic reviews, and meta-analyses. Level I evidence was available for most interventions. MAIN MESSAGE Soluble fibre improves constipation and global IBS symptoms. Peppermint oil alleviates IBS symptoms, including abdominal pain. Probiotic trials show overall benefit for IBS but there is little evidence supporting the use of any specific strain. Hypnotherapy and cognitive-behavioural therapy are also effective therapeutic options for appropriate patients. Certain herbal formulas are supported by limited evidence, but safety is a potential concern. All interventions are supported by systematic reviews or meta-analyses. CONCLUSION Several complementary and alternative therapies can be recommended as part of an evidence-based approach to the treatment of IBS; these might provide patients with satisfactory relief and improve the therapeutic alliance. PMID:19221071

  8. Evaluating the Quality of Evidence from Correlational Research for Evidence-Based Practice

    ERIC Educational Resources Information Center

    Thompson, Bruce; Diamond, Karen E.; McWilliam, Robin; Snyder, Patricia; Snyder, Scott W.

    2005-01-01

    Only true experiments offer definitive evidence for causal inferences, but not all educational interventions are readily amenable to experiments. Correlational evidence can at least tentatively inform evidence-based practice when sophisticated causal modeling or exclusion methods are employed. Correlational evidence is most informative when…

  9. Control of crystallinity and porosity of covalent organic frameworks by managing interlayer interactions based on self-complementary π-electronic force.

    PubMed

    Chen, Xiong; Addicoat, Matthew; Irle, Stephan; Nagai, Atsushi; Jiang, Donglin

    2013-01-16

    Crystallinity and porosity are crucial for crystalline porous covalent organic frameworks (COFs). Here we report synthetic control over the crystallinity and porosity of COFs by managing interlayer interactions based on self-complementary π-electronic forces. Fluoro-substituted and nonsubstituted aromatic units at different molar ratios were integrated into the edge units that stack to trigger self-complementary π-electronic interactions in the COFs. The interactions improve the crystallinity and enhance the porosity by maximizing the total crystal stacking energy and minimizing the unit cell size. Consequently, the COF consisting of equimolar amounts of fluoro-substituted and nonsubstituted units showed the largest effect. These results suggest a new approach to the design of COFs by managing the interlayer interactions. PMID:23270524

  10. Reducing Emergency Department Crowding: Evidence Based Strategies.

    PubMed

    Khalifa, Mohamed; Zabani, Ibrahim

    2016-01-01

    Emergency department (ED) crowding has become a major barrier to receiving timely care. King Faisal Specialist Hospital & Research Center, Saudi Arabia worked on identifying evidence based strategies for reducing the ED crowding by improving the intake. In addition to a review of literature, qualitative survey methods were used to identify strategies, which were classified into 10 suggested procedures categorized into three types of changes. Physical improvements include using physician cubicles, creating a team triage area and an internal waiting area for less acute patients instead of occupying beds. Technology improvements; include using informatics to update the electronic emergency record with information, using palmar scanning to instantly identify patients and using radio communication devices. Process improvements; include a scribe program to decrease clerical documentation tasks, switching between low flow and high flow processes, placing a physician in triage and using patient segmentation methods. PMID:27350468

  11. Sepsis management: An evidence-based approach.

    PubMed

    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. PMID:26968289

  12. Complementary and alternative medicine for autism spectrum disorders: rationale, safety and efficacy.

    PubMed

    Whitehouse, Andrew J O

    2013-09-01

    Complementary and alternative medicine is widely used for children with autism spectrum disorder, despite uncertainty regarding efficacy. This review describes complementary and alternative practices commonly used among this population, the rationale for the use of each practice, as well as the side-effect profile and evidence for efficacy. The existing evidence base indicates that melatonin can be recommended as a treatment for sleeping disturbances associated with autism spectrum disorder, while secretin can be rejected as an efficacious treatment for broader autistic symptoms. There is insufficient evidence to draw conclusions on the efficacy of modified diets, hyperbaric oxygen therapy, immune therapy, and vitamin and fatty acid supplementation. There is a clear need for methodologically rigorous studies to provide evidence-based guidance to families and clinicians regarding complementary and alternative practices for individuals with autism spectrum disorders. PMID:23682728

  13. Evidence Base Update for Autism Spectrum Disorder.

    PubMed

    Smith, Tristram; Iadarola, Suzannah

    2015-01-01

    This evidence base update examines the level of empirical support for interventions for children with autism spectrum disorder (ASD) younger than 5 years old. It focuses on research published since a previous review in this journal (Rogers & Vismara, 2008 ). We identified psychological or behavioral interventions that had been manualized and evaluated in either (a) experimental or quasi-experimental group studies or (b) systematic reviews of single-subject studies. We extracted data from all studies that met these criteria and were published after the previous review. Interventions were categorized across two dimensions. First, primary theoretical principles included applied behavior analysis (ABA), developmental social-pragmatic (DSP), or both. Second, practice elements included scope (comprehensive or focused), modality (individual intervention with the child, parent training, or classrooms), and intervention targets (e.g., spoken language or alternative and augmentative communication). We classified two interventions as well-established (individual, comprehensive ABA and teacher-implemented, focused ABA + DSP), 3 as probably efficacious (individual, focused ABA for augmentative and alternative communication; individual, focused ABA + DSP; and focused DSP parent training), and 5 as possibly efficacious (individual, comprehensive ABA + DSP; comprehensive ABA classrooms; focused ABA for spoken communication; focused ABA parent training; and teacher-implemented, focused DSP). The evidence base for ASD interventions has grown substantially since 2008. An increasing number of interventions have some empirical support; others are emerging as potentially efficacious. Priorities for future research include improving outcome measures, developing interventions for understudied ASD symptoms (e.g., repetitive behaviors), pinpointing mechanisms of action in interventions, and adapting interventions for implementation with fidelity by community providers. PMID:26430947

  14. Toward Evidence-Based Transport of Evidence-Based Treatments: MST as an Example

    ERIC Educational Resources Information Center

    Schoenwald, Sonja K.

    2008-01-01

    This article describes the journey toward evidence-based transport and implementation in usual care settings of Multisystemic Therapy (MST) for youth with drug abuse and behavioral problems (Henggeler, Schoenwald, Borduin, Rowland, & Cunningham, 1998). Research and experience informing the design of the MST transport strategy, progress in…

  15. Evidence-Based Medicine in the Education of Psychiatrists

    ERIC Educational Resources Information Center

    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…

  16. The ABCs of Evidence-Based Practice for Teachers

    ERIC Educational Resources Information Center

    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…

  17. Evidence-Based Health Policy: A Preliminary Systematic Review

    ERIC Educational Resources Information Center

    Morgan, Gareth

    2010-01-01

    Objective: The development of evidence-based health policy is challenging. This study has attempted to identify some of the underpinning factors that promote the development of evidence based health policy. Methods: A preliminary systematic literature review of published reviews with "evidence based health policy" in their title was conducted…

  18. 75 FR 79455 - OPEN GOVERNMENT AND EVIDENCE-BASED REGULATION

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-12-20

    ... From the Federal Register Online via the Government Publishing Office ] OPEN GOVERNMENT AND EVIDENCE-BASED REGULATION There is a close connection, even an inextricable relationship, between open government and evidence- based regulation. If regulatory choices are based on careful analysis of the evidence, and if opportunities are provided...

  19. Compact ultra wide band microstrip bandpass filter based on multiple-mode resonator and modified complementary split ring resonator.

    PubMed

    Marcotegui, J Antonio; Illescas, Jesús Miguel; Estevez, Aritz; Falcone, Francisco

    2013-01-01

    A new class of broadband microstrip filters for Ultra Wide Band (UWB) applications is proposed. In the design, different stages of parallel-coupled microstrip line and other stages with a Modified Complementary Split Ring Resonator (MCSRR)-a concept proposed here for the first time-are adjusted to obtain the desired response with broadband, sharp rejection, low insertion loss, and low return loss. Full wave simulation results as well as measurement results from fabricated prototypes are presented, showing good agreement. The proposed technique offers a new alternative to implement low-cost high-performance filter devices, applicable to a wide range of communication systems. PMID:24319366

  20. Compact Ultra Wide Band Microstrip Bandpass Filter Based on Multiple-Mode Resonator and Modified Complementary Split Ring Resonator

    PubMed Central

    Marcotegui, J. Antonio; Illescas, Jesús Miguel; Estevez, Aritz

    2013-01-01

    A new class of broadband microstrip filters for Ultra Wide Band (UWB) applications is proposed. In the design, different stages of parallel-coupled microstrip line and other stages with a Modified Complementary Split Ring Resonator (MCSRR)—a concept proposed here for the first time—are adjusted to obtain the desired response with broadband, sharp rejection, low insertion loss, and low return loss. Full wave simulation results as well as measurement results from fabricated prototypes are presented, showing good agreement. The proposed technique offers a new alternative to implement low-cost high-performance filter devices, applicable to a wide range of communication systems. PMID:24319366

  1. Chip-scale fluorescence microscope based on a silo-filter complementary metal-oxide semiconductor image sensor.

    PubMed

    Ah Lee, Seung; Ou, Xiaoze; Lee, J Eugene; Yang, Changhuei

    2013-06-01

    We demonstrate a silo-filter (SF) complementary metal-oxide semiconductor (CMOS) image sensor for a chip-scale fluorescence microscope. The extruded pixel design with metal walls between neighboring pixels guides fluorescence emission through the thick absorptive filter to the photodiode of a pixel. Our prototype device achieves 13 μm resolution over a wide field of view (4.8 mm × 4.4 mm). We demonstrate bright-field and fluorescence longitudinal imaging of living cells in a compact, low-cost configuration. PMID:23722754

  2. [Complementary treatment methods for depression in children and adolescents].

    PubMed

    Dolle, Kathrin; Schulte-Körne, Gerd

    2014-01-01

    Depressive disorders are among the more common mental illnesses around the world, about 1- 3% of prepubertal children and 6% of postpubertal children and adolescents are affected. They markedly impair psychosocial development and are associated with higher rate of morbidity and mortality throughout life. Many physicians are unsure about which treatment approaches are effective and how the treatment should be planned. A systematic literature search was carried out in electronic databases and study registries and as a manual search. More than 450 studies (mostly randomized controlled trials = RCTs) were identified and summarized in evidence tables. The ensuing recommendations were agreed upon in a consensus conference. The review summarizes the evidence of complementary treatment methods. The evidence for complementary treatment methods (art and music therapy, sleep deprivation, exercise, electroconvulsive therapy, massage, transcranial magnetic stimulation, relaxation, bibliotherapy, computer based therapy, light therapy, omega-3 treatment) is low or there is no evidence due to missing studies or studies of poor quality. For some methods, i. e. light therapy, relaxation and stress reduction and sleep deprivation there is limited indication for effectiveness without sufficient evidence for a practical guidance. There is an urgent need for adequately informative comparative studies on treatment of depression in children and adolescents considering also complementary methods. PMID:24707770

  3. Non-randomized studies as a source of complementary, sequential or replacement evidence for randomized controlled trials in systematic reviews on the effects of interventions.

    PubMed

    Schünemann, Holger J; Tugwell, Peter; Reeves, Barnaby C; Akl, Elie A; Santesso, Nancy; Spencer, Frederick A; Shea, Beverley; Wells, George; Helfand, Mark

    2013-03-01

    The terms applicability, generalizability, external validity and transferability are related, sometimes used interchangeably and have in common that they lack a clear and consistent definition in the classic epidemiological literature. However, all of these terms generally describe one overarching theme: whether or not available research evidence can be directly utilized to answer the healthcare questions at hand, ideally supported by a judgment about the degree of confidence for this utilization. This concept has been called directness. The objectives of this paper were to delineate how non-randomized studies (NRS) inform judgments in relation to directness and the concepts that it encompasses in the context of systematic reviews. We will briefly review what is known and describe the theoretical and practical issues as well as offer guidance to those tackling the challenges of judging directness and using research evidence to answer healthcare questions with evidence from NRS. In particular, we suggest a framework in which authors can use NRS as a complement, sequence or replacement for randomized controlled trials (RCTs) by focusing on judgments about the population, intervention, comparison and outcomes. Authors of systematic reviews will use NRS to complement judgments about the inconsistencies, the rationale and credibility of subgroup analysis, the baseline risk estimates for the determination of absolute benefits and downsides, and the directness of surrogate outcomes. This evidence includes contextual or supplementary evidence. Authors of systematic review and other summaries of the evidence use NRS as sequential evidence to provide evidence when insufficient evidence is available for an outcome from RCTs, but NRS evidence is available (e.g., long-term harms). Use of evidence from NRS may also serve to replace RCT evidence when NRS provide equivalent (or potentially higher) confidence in the evidence (i.e. quality) compared to indirect evidence from RCTs

  4. Inkjet-printed all solid-state electrochromic devices based on NiO/WO3 nanoparticle complementary electrodes.

    PubMed

    Cai, Guofa; Darmawan, Peter; Cui, Mengqi; Chen, Jingwei; Wang, Xu; Eh, Alice Lee-Sie; Magdassi, Shlomo; Lee, Pooi See

    2016-01-01

    Nanostructured thin films are important in the fields of energy conversion and storage. In particular, multi-layered nanostructured films play an important role as a part of the energy system for energy saving applications in buildings. Inkjet printing is a low-cost and attractive technology for patterning and deposition of multi-layered nanostructured materials on various substrates. However, it requires the development of a suitable ink formulation with optimum viscosity, surface tension and evaporation rate for various materials. In this study, a versatile ink formulation was successfully developed to prepare NiO and WO3 nanostructured films with strong adhesion to ITO coated glass using inkjet printing for energy saving electrochromic applications. We achieved a high performance electrochromic electrode, producing porous and continuous electrochromic films without aggregation. The NiO film with 9 printed layers exhibits an optical modulation of 64.2% at 550 nm and a coloration efficiency (CE) of 136.7 cm(2) C(-1). An inkjet-printed complementary all solid-state device was assembled, delivering a larger optical modulation of 75.4% at 633 nm and a higher CE of 131.9 cm(2) C(-1) among all solid-state devices. The enhanced contrast is due to the printed NiO film that not only performs as an ion storage layer, but also as a complementary electrochromic layer. PMID:26610811

  5. Information literacy for evidence-based practice in perianesthesia nurses: readiness for evidence-based practice.

    PubMed

    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. PMID:20359640

  6. Creating Evidence-Based Research in Adapted Physical Activity

    ERIC Educational Resources Information Center

    Reid, Greg; Bouffard, Marcel; MacDonald, Catherine

    2012-01-01

    Professional practice guided by the best research evidence is a usually referred to as evidence-based practice. The aim of the present paper is to describe five fundamental beliefs of adapted physical activity practices that should be considered in an 8-step research model to create evidence-based research in adapted physical activity. The five…

  7. Evidence-based guidelines: Improving AGREEment on consistence evaluation

    PubMed Central

    Vincenzi, Bruno; Napolitano, Andrea; Santini, Daniele; Maiello, Evaristo; Torri, Valter; Tonini, Giuseppe

    2012-01-01

    Modern clinical practice relies on evidence-based medicine (EBM) and evidence-based guidelines (EBGs). The critical evaluation of EBGs value is therefore an essential step to further improve clinical practice. In our opinion, correlating levels of evidence and grades of recommendation can be an easy tool to quickly display internal consistence of EBGs. PMID:26909252

  8. Evidence-Based Practice in Rehabilitation Counseling: Perceptions and Practices

    ERIC Educational Resources Information Center

    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…

  9. Controlling biofilm with evidence-based dentifrices.

    PubMed

    Ciancio, Sebastian G

    2011-01-01

    This review summarizes research that has assessed the effectiveness of various antimicrobial-containing dentifrices in preventing and/or reducing a number of oral health problems facing our patients today. The results of these studies indicate that, when compared with a conventional fluoride dentifrice, the triclosan/copolymer/fluoride dentifrice is the one with the most evidence to support its ability to deliver significant oral health benefits with no adverse effects. The benefits maybe summarized as follows: improved levels ofsupragingival plaque control; improved gingival health; reducedlikelihood of gingivitis progressing to periodontitis; arrest progression of periodontitis; prevention of supragingival calculus; and reduction in oral malodor. With increased interest in the association of oral health with systemic health, this dentifrice is well-positioned to help reduce the likelihood of gingivitis establishing itself and possibly developing into periodontitis (Figure 1). It also has the potential to have beneficial effects on general health because of its anti-inflammatory properties. Based on the results presented in this article, it is clear that the general population can derive significant clinical benefits from the daily use of a triclosan/copolymer/fluoride dentifrice. The dental profession should feel confident to recommend its use to patients to improve oral health and maintain or promote overall health. PMID:21462625

  10. Subjective evidence based ethnography: method and applications.

    PubMed

    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. PMID:25579747

  11. Inkjet-printed all solid-state electrochromic devices based on NiO/WO3 nanoparticle complementary electrodes

    NASA Astrophysics Data System (ADS)

    Cai, Guofa; Darmawan, Peter; Cui, Mengqi; Chen, Jingwei; Wang, Xu; Eh, Alice Lee-Sie; Magdassi, Shlomo; Lee, Pooi See

    2015-12-01

    Nanostructured thin films are important in the fields of energy conversion and storage. In particular, multi-layered nanostructured films play an important role as a part of the energy system for energy saving applications in buildings. Inkjet printing is a low-cost and attractive technology for patterning and deposition of multi-layered nanostructured materials on various substrates. However, it requires the development of a suitable ink formulation with optimum viscosity, surface tension and evaporation rate for various materials. In this study, a versatile ink formulation was successfully developed to prepare NiO and WO3 nanostructured films with strong adhesion to ITO coated glass using inkjet printing for energy saving electrochromic applications. We achieved a high performance electrochromic electrode, producing porous and continuous electrochromic films without aggregation. The NiO film with 9 printed layers exhibits an optical modulation of 64.2% at 550 nm and a coloration efficiency (CE) of 136.7 cm2 C-1. An inkjet-printed complementary all solid-state device was assembled, delivering a larger optical modulation of 75.4% at 633 nm and a higher CE of 131.9 cm2 C-1 among all solid-state devices. The enhanced contrast is due to the printed NiO film that not only performs as an ion storage layer, but also as a complementary electrochromic layer.Nanostructured thin films are important in the fields of energy conversion and storage. In particular, multi-layered nanostructured films play an important role as a part of the energy system for energy saving applications in buildings. Inkjet printing is a low-cost and attractive technology for patterning and deposition of multi-layered nanostructured materials on various substrates. However, it requires the development of a suitable ink formulation with optimum viscosity, surface tension and evaporation rate for various materials. In this study, a versatile ink formulation was successfully developed to prepare NiO and

  12. Ratiometric, filter-free optical sensor based on a complementary metal oxide semiconductor buried double junction photodiode.

    PubMed

    Yung, Ka Yi; Zhan, Zhiyong; Titus, Albert H; Baker, Gary A; Bright, Frank V

    2015-07-16

    We report a complementary metal oxide semiconductor integrated circuit (CMOS IC) with a buried double junction (BDJ) photodiode that (i) provides a real-time output signal that is related to the intensity ratio at two emission wavelengths and (ii) simultaneously eliminates the need for an optical filter to block Rayleigh scatter. We demonstrate the BDJ platform performance for gaseous NH3 and aqueous pH detection. We also compare the BDJ performance to parallel results obtained by using a slew scanned fluorimeter (SSF). The BDJ results are functionally equivalent to the SSF results without the need for any wavelength filtering or monochromators and the BDJ platform is not prone to errors associated with source intensity fluctuations or sensor signal drift. PMID:26073812

  13. Complementary Metal Oxide Semiconductor Based Multimodal Sensor for In vivo Brain Function Imaging with a Function for Simultaneous Cell Stimulation

    NASA Astrophysics Data System (ADS)

    Tagawa, Ayato; Mitani, Masahiro; Minami, Hiroki; Noda, Toshihiko; Sasagawa, Kiyotaka; Tokuda, Takashi; Ohta, Jun

    2010-04-01

    We have developed a multimodal complementary metal oxide semiconductor (CMOS) sensor device embedded with Au electrodes for fluorescent imaging and cell stimulation in the deep brain of mice. The Au electrodes were placed on the pixel array of the image sensor. Windows over the photodiodes were opened in the electrode area for simultaneous fluorescent imaging and cell stimulation in the same area of the brain tissue. The sensor chip was shaped like a shank and was packaged by two packaging methods for high strength or minimal invasion. The experimental results showed that the 90 ×90 µm2 Au electrodes with windows were capable of injecting theta burst stimulation (TBS)-like current pulses at 0.2-1 mA in a saline solution. We successfully demonstrated that fluorescent imaging and TBS-like current injection can be simultaneously performed in the electrode area of a brain phantom.

  14. Complementary Metal Oxide Semiconductor Based Multimodal Sensor for In vivo Brain Function Imaging with a Function for Simultaneous Cell Stimulation

    NASA Astrophysics Data System (ADS)

    Ayato Tagawa,; Masahiro Mitani,; Hiroki Minami,; Toshihiko Noda,; Kiyotaka Sasagawa,; Takashi Tokuda,; Jun Ohta,

    2010-04-01

    We have developed a multimodal complementary metal oxide semiconductor (CMOS) sensor device embedded with Au electrodes for fluorescent imaging and cell stimulation in the deep brain of mice. The Au electrodes were placed on the pixel array of the image sensor. Windows over the photodiodes were opened in the electrode area for simultaneous fluorescent imaging and cell stimulation in the same area of the brain tissue. The sensor chip was shaped like a shank and was packaged by two packaging methods for high strength or minimal invasion. The experimental results showed that the 90 × 90 μm2 Au electrodes with windows were capable of injecting theta burst stimulation (TBS)-like current pulses at 0.2-1 mA in a saline solution. We successfully demonstrated that fluorescent imaging and TBS-like current injection can be simultaneously performed in the electrode area of a brain phantom.

  15. High-performance carbon-nanotube-based complementary field-effect-transistors and integrated circuits with yttrium oxide

    SciTech Connect

    Liang, Shibo; Zhang, Zhiyong Si, Jia; Zhong, Donglai; Peng, Lian-Mao

    2014-08-11

    High-performance p-type carbon nanotube (CNT) transistors utilizing yttrium oxide as gate dielectric are presented by optimizing oxidization and annealing processes. Complementary metal-oxide-semiconductor (CMOS) field-effect-transistors (FETs) are then fabricated on CNTs, and the p- and n-type devices exhibit symmetrical high performances, especially with low threshold voltage near to zero. The corresponding CMOS CNT inverter is demonstrated to operate at an ultra-low supply voltage down to 0.2 V, while displaying sufficient voltage gain, high noise margin, and low power consumption. Yttrium oxide is proven to be a competitive gate dielectric for constructing high-performance CNT CMOS FETs and integrated circuits.

  16. 'We hold these truths to be self-evident': deconstructing 'evidence-based' medical practice.

    PubMed

    Devisch, Ignaas; Murray, Stuart J

    2009-12-01

    Rationale, aims and objectives Evidence-based medicine (EBM) claims to be based on 'evidence', rather than 'intuition'. However, EBM's fundamental distinction between quantitative 'evidence' and qualitative 'intuition' is not self-evident. The meaning of 'evidence' is unclear and no studies of quality exist to demonstrate the superiority of EBM in health care settings. This paper argues that, despite itself, EBM holds out only the illusion of conclusive scientific rigour for clinical decision making, and that EBM ultimately is unable to fulfil its own structural criteria for 'evidence'. Methods Our deconstructive analysis of EBM draws on the work of the French philosopher, Jacques Derrida. Deconstruction works in the name of justice to lay bare, to expose what has been hidden from view. In plain language, we deconstruct EBM's paradigm of 'evidence', the randomized controlled trial (RCT), to demonstrate that there cannot be incontrovertible evidence for EBM as such. We argue that EBM therefore 'auto-deconstructs' its own paradigm, and that medical practitioners, policymakers and patients alike ought to be aware of this failure within EBM itself. Results EBM's strict distinction between admissible evidence (based on RCTs) and other supposedly inadmissible evidence is not itself based on evidence, but rather, on intuition. In other words, according to EBM's own logic, there can be no 'evidentiary' basis for its distinction between admissible and inadmissible evidence. Ultimately, to uphold this fundamental distinction, EBM must seek recourse in (bio)political ideology and an epistemology akin to faith. PMID:20367689

  17. Complementary therapies for depression: an overview.

    PubMed

    Ernst, E; Rand, J I; Stevinson, C

    1998-11-01

    Depression is one of the most common reasons for using complementary and alternative therapies. The aim of this article is to provide an overview of the evidence available on the treatment of depression with complementary therapies. Systematic literature searches were performed using several databases, reference list searching, and inquiry to colleagues. Data extraction followed a predefined protocol. The amount of rigorous scientific data to support the efficacy of complementary therapies in the treatment of depression is extremely limited. The areas with the most evidence for beneficial effects are exercise, herbal therapy (Hypericum perforatum), and, to a lesser extent, acupuncture and relaxation therapies. There is a need for further research involving randomized controlled trials into the efficacy of complementary and alternative therapies in the treatment of depression. PMID:9819072

  18. Evidence base in guideline generation in diabetes.

    PubMed

    Mühlhauser, I; Meyer, G

    2013-06-01

    During recent years much emphasis has been on the validity, reliability, reproducibility, clinical applicability, clarity, multidisciplinary process, scheduled review and documentation of clinical practice guidelines (CPGs). Still, CPGs show substantial variance in methodological quality. The present paper mainly focuses on two aspects that are particularly critical and contemporary from the perspective of evidence-based medicine: patient centredness and shared decision making, and conflict of interest. Sophisticated patient and consumer involvement at all stages of CPG development could be judged as being the gold standard. However, co-opting patients or consumer representatives and using other techniques of active patient involvement does not replace individual patient preferences in clinical decision-making processes. Current CPGs do not meet patient needs, since they do not provide concise, easy-to-read summaries of the benefits and risks of medicines together with more comprehensive scientific data as a prerequisite for informed or shared decision making. The vast majority of CPG panels have a financial conflict of interest (COI) and under-reporting is common. Not all organisations producing CPGs have set up COI policies, and existing policies vary widely. To solve the problem, CPG experts have recommended that methodologists without any important COI should lead the development process and have primary responsibility. There is a lot of room for other improvements through network transnational activities in the field of CPG development. Waste of time and resources should be avoided through sharing published and unpublished data identified, appraised and extracted for guideline development. The EASD could provide such a clearing house. PMID:23475367

  19. Complementary Barrier Infrared Detector

    NASA Technical Reports Server (NTRS)

    Ting, David Z.; Bandara, Sumith V.; Hill, Cory J.; Gunapala, Sarath D.

    2009-01-01

    The complementary barrier infrared detector (CBIRD) is designed to eliminate the major dark current sources in the superlattice infrared detector. The concept can also be applied to bulk semiconductor- based infrared detectors. CBIRD uses two different types of specially designed barriers: an electron barrier that blocks electrons but not holes, and a hole barrier that blocks holes but not electrons. The CBIRD structure consists of an n-contact, a hole barrier, an absorber, an electron barrier, and a p-contact. The barriers are placed at the contact-absorber junctions where, in a conventional p-i-n detector structure, there normally are depletion regions that produce generation-recombination (GR) dark currents due to Shockley-Read- Hall (SRH) processes. The wider-bandgap complementary barriers suppress G-R dark current. The barriers also block diffusion dark currents generated in the diffusion wings in the neutral regions. In addition, the wider gap barriers serve to reduce tunneling dark currents. In the case of a superlattice-based absorber, the superlattice itself can be designed to suppress dark currents due to Auger processes. At the same time, the barriers actually help to enhance the collection of photo-generated carriers by deflecting the photo-carriers that are diffusing in the wrong direction (i.e., away from collectors) and redirecting them toward the collecting contacts. The contact layers are made from materials with narrower bandgaps than the barriers. This allows good ohmic contacts to be made, resulting in lower contact resistances. Previously, THALES Research and Technology (France) demonstrated detectors with bulk InAsSb (specifically InAs0.91Sb0.09) absorber lattice-matched to GaSb substrates. The absorber is surrounded by two wider bandgap layers designed to minimize impedance to photocurrent flow. The wide bandgap materials also serve as contacts. The cutoff wavelength of the InAsSb absorber is fixed. CBIRD may be considered as a modified

  20. Teachers' Characteristics and Ratings for Evidence-Based Behavioral Interventions

    ERIC Educational Resources Information Center

    Stormont, Melissa; Reinke, Wendy; Herman, Keith

    2011-01-01

    The vast majority of schools today are not prepared to support children's social behavior needs. One challenge is that teachers may not be knowledgeable of evidence-based practices that can be utilized with children. This study explored teachers' agreement ratings for evidence-based and nonevidence-based behavior management practices for children…

  1. Evidence-Based Practice: Integrating Classroom Curriculum and Field Education

    ERIC Educational Resources Information Center

    Tuchman, Ellen; Lalane, Monique

    2011-01-01

    This article describes the use of problem-based learning to teach the scope and consequences of evidence-based practices in mental health through an innovative assignment that integrates classroom and field learning. The authors illustrate the planning and implementation of the Evidence-Based Practice: Integrating Classroom Curriculum and Field…

  2. Complementary and Integrative Therapies

    MedlinePlus

    ... correctly • Supplement is free of harmful contents like pesticides and heavy metals (such as lead, arsenic or ... 1-888-644-6226 http://nccam.nih.gov Natural Medicines Information on complementary therapies http://naturaldatabase.therapeuticresearch. ...

  3. Why the Evidence-Based Paradigm in Early Childhood Education and Care Is Anything but Evident

    ERIC Educational Resources Information Center

    Vandenbroeck, Michel; Roets, Griet; Roose, Rudi

    2012-01-01

    Praxeological research is a necessary contribution to the research field in early childhood education and care, which is currently dominated by an evidence-based paradigm that tends to consider the measurement of predefined outcomes as the most valid form of research. We analyse the history of the evidence-based paradigm in the field of medicine…

  4. Complementary and Alternative Medicine Use among Physicians in Oriental Medicine Hospitals in Vietnam: A Hospital-Based Survey.

    PubMed

    Pham, Duong Duc; Yoo, Jong Hyang; Tran, Binh Quoc; Ta, Thuy Thu

    2013-01-01

    Interest in complementary and alternative medicine (CAM) is growing worldwide, even in Vietnam where traditional medicine is considered mainstream. We conducted a survey of the knowledge, attitudes, and practices of CAM therapies among physicians in oriental medicine (OM) hospitals in Vietnam. A two-stage random selection process selected 337 physicians who were interviewed using a face-to-face method with a standardized structured questionnaire. Data from 312 physicians who completed the questionnaire suggested that oriental herbal medicine and acupuncture (Vietnamese OM version) were the more commonly used CAM modalities compared with Vietnamese folk medicine and other forms of CAM. A broad range of CAM modalities, particularly chiropractice, diet supplements, and dietary therapy, and an excessive proportion of western medication were employed in conjunction with OM in the physicians' daily practice. Their daily practice was influenced by the source of knowledge, education level, medical specialty, and working environment. These findings suggest that physicians in OM hospitals in Vietnam have interests in various forms of CAM therapies besides traditional modes. PMID:23634168

  5. High gain, low noise, fully complementary logic inverter based on bi-layer WSe2 field effect transistors

    NASA Astrophysics Data System (ADS)

    Das, Saptarshi; Dubey, Madan; Roelofs, Andreas

    2014-08-01

    In this article, first, we show that by contact work function engineering, electrostatic doping and proper scaling of both the oxide thickness and the flake thickness, high performance p- and n-type WSe2 field effect transistors (FETs) can be realized. We report record high drive current of 98 μA/μm for the electron conduction and 110 μA/μm for the hole conduction in Schottky barrier WSe2 FETs. Then, we combine high performance WSe2 PFET with WSe2 NFET in double gated transistor geometry to demonstrate a fully complementary logic inverter. We also show that by adjusting the threshold voltages for the NFET and the PFET, the gain and the noise margin of the inverter can be significantly enhanced. The maximum gain of our chemical doping free WSe2 inverter was found to be ˜25 and the noise margin was close to its ideal value of ˜2.5 V for a supply voltage of VDD = 5.0 V.

  6. A Preference Based Measure of Complementary Feeding Quality: Application to the Avon Longitudinal Study of Parents and Children

    PubMed Central

    Mittinty, Murthy N.; Golley, Rebecca K.; Smithers, Lisa G.; Brazionis, Laima; Lynch, John W.

    2013-01-01

    This paper presents the development of the Complementary Feeding Utility Index (CFUI), a composite index aimed to measure adherence to infant feeding guidelines. Through an axiomatic characterization this paper shows the advantages in using the CFUI are the following: it avoids the use of arbitrary cut-offs, and by converting observed diet preferences into utilities, summing the score is meaningful. In addition, as the CFUI is designed to be scored continuously, it allows the transition from intake of beneficial foods (in low quantities) and intake of detrimental foods (in high quantities) to be more subtle. The paper first describes the rationale being the development of the CFUI and then elaborates on the methodology used to develop the CFUI, including the process of selecting the components. The methodology is applied to data collected from the Avon Longitudinal Study of Parents and Children to show the advantages of the CFUI over traditional diet index approaches. Unlike traditional approaches, the distribution of the CFUI does not peak towards mean value but distributes evenly towards the tails of the distribution. PMID:24155886

  7. Multiband one-way polarization conversion in complementary split-ring resonator based structures by combining chirality and tunneling.

    PubMed

    Serebryannikov, Andriy E; Beruete, Miguel; Mutlu, Mehmet; Ozbay, Ekmel

    2015-05-18

    Multiband one-way polarization conversion and strong asymmetry in transmission inspired by it are demonstrated in ultrathin sandwiched structures that comprise two twisted aperture-type arrays of complementary split-ring resonators (CSRRs), metallic mesh, and dielectric layers. The basic features of the resulting mechanism originate from the common effect of chirality and tunneling. The emphasis is put on the (nearly) perfect polarization conversion of linear incident polarization into the orthogonal one and related diodelike asymmetric transmission within multiple narrow bands. Desired polarization conversion can be obtained at several resonances for one of the two opposite incidence directions, whereas transmission is fully blocked for the other one. The resonances, at which the (nearly) perfect conversion takes place, are expected to be inherited from similar structures with parallel, i.e., not rotated CSRR arrays that do not enable chirality and, thus, polarization conversion. It is found that the basic transmission and polarization conversion features and, thus, the dominant physics are rather general, enabling efficient engineering of such structures. The lowest-frequency resonance can be obtained in structures made of conventional materials with total thickness less than λ/50 and up to ten such resonances can correspond to thickness less than λ/20. PMID:26074599

  8. Discovering hidden biodiversity: the use of complementary monitoring of fish diet based on DNA barcoding in freshwater ecosystems.

    PubMed

    Jo, Hyunbin; Ventura, Marc; Vidal, Nicolas; Gim, Jeong-Soo; Buchaca, Teresa; Barmuta, Leon A; Jeppesen, Erik; Joo, Gea-Jae

    2016-01-01

    Ecological monitoring contributes to the understanding of complex ecosystem functions. The diets of fish reflect the surrounding environment and habitats and may, therefore, act as useful integrating indicators of environmental status. It is, however, often difficult to visually identify items in gut contents to species level due to digestion of soft-bodied prey beyond visual recognition, but new tools rendering this possible are now becoming available. We used a molecular approach to determine the species identities of consumed diet items of an introduced generalist feeder, brown trout (Salmo trutta), in 10 Tasmanian lakes and compared the results with those obtained from visual quantification of stomach contents. We obtained 44 unique taxa (OTUs) belonging to five phyla, including seven classes, using the barcode of life approach from cytochrome oxidase I (COI). Compared with visual quantification, DNA analysis showed greater accuracy, yielding a 1.4-fold higher number of OTUs. Rarefaction curve analysis showed saturation of visually inspected taxa, while the curves from the DNA barcode did not saturate. The OTUs with the highest proportions of haplotypes were the families of terrestrial insects Formicidae, Chrysomelidae, and Torbidae and the freshwater Chironomidae. Haplotype occurrence per lake was negatively correlated with lake depth and transparency. Nearly all haplotypes were only found in one fish gut from a single lake. Our results indicate that DNA barcoding of fish diets is a useful and complementary method for discovering hidden biodiversity. PMID:26811787

  9. High gain, low noise, fully complementary logic inverter based on bi-layer WSe{sub 2} field effect transistors

    SciTech Connect

    Das, Saptarshi; Roelofs, Andreas; Dubey, Madan

    2014-08-25

    In this article, first, we show that by contact work function engineering, electrostatic doping and proper scaling of both the oxide thickness and the flake thickness, high performance p- and n-type WSe{sub 2} field effect transistors (FETs) can be realized. We report record high drive current of 98 μA/μm for the electron conduction and 110 μA/μm for the hole conduction in Schottky barrier WSe{sub 2} FETs. Then, we combine high performance WSe{sub 2} PFET with WSe{sub 2} NFET in double gated transistor geometry to demonstrate a fully complementary logic inverter. We also show that by adjusting the threshold voltages for the NFET and the PFET, the gain and the noise margin of the inverter can be significantly enhanced. The maximum gain of our chemical doping free WSe{sub 2} inverter was found to be ∼25 and the noise margin was close to its ideal value of ∼2.5 V for a supply voltage of V{sub DD} = 5.0 V.

  10. Evidence Based Practice of Chronic Pain

    PubMed Central

    Garg, Rakesh; Joshi, Saurabh; Mishra, Seema; Bhatnagar, Sushma

    2012-01-01

    The patients with chronic pain are increasingly reporting to the physicians for its management. Chronic pain are associated with head, neck and shoulder pain, spinal pain, pain in the joints and extremities, complex regional pain syndrome and phantom pain. The chronic pain is being managed worldwide. The different specialty of medicine is producing a lot of evidence through the published literature but the same is not being published in the field of chronic pain management. Though some evidence is being reported as to different aspects of pain management from different parts of the world but same is lacking from Indian subcontinent. This is in contrast to much done clinical work in this field as well. We present here the available evidence in relation to chronic pain management. PMID:23439674

  11. Evidence-based practice: developing mentors to support students.

    PubMed

    Barry, Debbie; Houghton, Trish; Warburton, Tyler

    2016-08-17

    This article, the ninth in a series of 11, provides guidance for new and established mentors and practice teachers on evidence-based practice, the seventh domain of the Nursing and Midwifery Council's Standards to Support Learning and Assessment in Practice (SSLAP). Evidence-based practice is an important aspect of contemporary healthcare and is central to student preparation programmes for nursing, midwifery and specialist community public health nursing (SCPHN). The article describes evidence-based practice, discussing the importance and implementation of an evidence-based approach in the context of role development for mentors and practice teachers in the preparation of nursing, midwifery and SCPHN students. PMID:27533414

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

    PubMed

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

    2013-10-01

    Evidence-based practice has been demonstrated to improve quality of care, increase patients' satisfaction, and reduce the costs of medical care. Therefore, evidence-based practice is now central to the clinical decision-making process and to achieving better quality of care. Today, it is one of the important indicators of core competences for healthcare providers and accreditation for healthcare and educational systems. Further, evidence-based practice encourages in-school and continuous education programs to integrate evidence-based elements and concepts into curricula. Healthcare facilities and professional organizations proactively host campaigns and encourage healthcare providers to participate in evidence-based related training courses. However, the clinical evidence-based practice progress is slow. The general lack of a model for organizational follow-up may be a key factor associated with the slow adoption phenomenon. The authors provide a brief introduction to the evidence-based practice model, then described how it may be successfully translated through a staged process into the evidence-based practices of organizational cultures. This article may be used as a reference by healthcare facilities to promote evidence-based nursing practice. PMID:24096462

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

    PubMed

    Yang, Hai

    2009-03-01

    Evidence-based management of medical disposable materials pays attention to collect evidence comprehensively and systematically, accumulate and create evidence through its own work and also evaluate evidence strictly. This can be used as a function to guide out job. Medical disposable materials evidence system contains product register qualification, product quality certification, supplier's behavior, internal and external communication evidence. Managers can find different ways in creating and using evidence referring to specific inside and outside condition. Evidence-based management can help accelerating the development of management of medical disposable materials from traditional experience pattern to a systematic and scientific pattern. It also has the very important meaning to improve medical quality, control the unreasonable growth of medical expense and make purchase and supply chain be more efficient. PMID:19565800

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

    PubMed

    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. PMID:17312899

  15. Integrating Evidence-Based Perfusion Into Practices: The International Consortium for Evidence-Based Perfusion

    PubMed Central

    Likosky, Donald S.

    2006-01-01

    Abstract: 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 PMID:17312899

  16. Investigating the Evidence Base of Social Stories

    ERIC Educational Resources Information Center

    Ali, Shama; Frederickson, Norah

    2006-01-01

    Social stories were developed in order to support individuals with autism to better cope with social situations, an area of particular difficulty for this population. Despite its growing popularity, there is limited research evidence on the effectiveness of this approach. A review of research on social stories undertaken between 1994 and 2004 was…

  17. Justifying Physical Education Based on Neuroscience Evidence

    ERIC Educational Resources Information Center

    Berg, Kris

    2010-01-01

    Research has shown that exercise improves cognitive function and psychological traits that influence behavior (e.g., mood, level of motivation). The evidence in the literature also shows that physical education may enhance learning or that academic performance is at least maintained despite a reduction in classroom time in order to increase time…

  18. Pedagogic Research and Evidence-Based Management

    ERIC Educational Resources Information Center

    Lindsay, Roger; Breen, Rosanna; Paton-Saltzberg, Renee

    2002-01-01

    The introduction of modular schemes and a semesterised academic year are amongst the most fundamental changes ever to occur in UK higher education. There is, however, a notable lack of pedagogic research evidence on the effects upon student learning of course frameworks and the temporal structure of large-scale learning units. In the absence of…

  19. Complementary and Alternative Medicine Treatments for Children with Autism Spectrum Disorders”

    PubMed Central

    Levy, Susan E.

    2008-01-01

    SYNOPSIS Complementary and alternative medical treatments are commonly used for children with autism spectrum disorders. This review discusses the evidence supporting the most frequently used treatments, including categories of mind-body medicine, energy medicine, biologically based, manipulative and body-based practices, with the latter two the most commonly selected by families. It is important for clinical providers to understand the evidence for efficacy (or lack thereof) and potential side effects. Some CAM practices have evidence to reject their use, such as secretin, others have emerging evidence to support their use, like melatonin. Most treatments, however, have not been adequately studied and do not have evidence to support their use. PMID:18775371

  20. Static and Dynamic Performance of Complementary Inverters Based on Nanosheet α-MoTe2 p-Channel and MoS2 n-Channel Transistors.

    PubMed

    Pezeshki, Atiye; Hosseini Shokouh, Seyed Hossein; Jeon, Pyo Jin; Shackery, Iman; Kim, Jin Sung; Oh, Il-Kwon; Jun, Seong Chan; Kim, Hyungjun; Im, Seongil

    2016-01-26

    Molybdenum ditelluride (α-MoTe2) is an emerging transition-metal dichalcogenide (TMD) semiconductor that has been attracting attention due to its favorable optical and electronic properties. Field-effect transistors (FETs) based on few-layer α-MoTe2 nanosheets have previously shown ambipolar behavior with strong p-type and weak n-type conduction. We have employed a direct imprinting technique following mechanical nanosheet exfoliation to fabricate high-performance complementary inverters using α-MoTe2 as the semiconductor for the p-channel FETs and MoS2 as the semiconductor for the n-channel FETs. To avoid ambipolar behavior and produce α-MoTe2 FETs with clean p-channel characteristics, we have employed the high-workfunction metal platinum for the source and drain contacts. As a result, our α-MoTe2 nanosheet p-channel FETs show hole mobilities up to 20 cm(2)/(V s), on/off ratios up to 10(5), and a subthreshold slope of 255 mV/decade. For our complementary inverters composed of few-layer α-MoTe2 p-channel FETs and MoS2 n-channel FETs we have obtained voltage gains as high as 33, noise margins as high as 0.38 VDD, a switching delay of 25 μs, and a static power consumption of a few nanowatts. PMID:26631357

  1. Evidence-based treatments for cluster headache

    PubMed Central

    Gooriah, Rubesh; Buture, Alina; Ahmed, Fayyaz

    2015-01-01

    Cluster headache (CH), one of the most painful syndromes known to man, is managed with acute and preventive medications. The brief duration and severity of the attacks command the use of rapid-acting pain relievers. Inhalation of oxygen and subcutaneous sumatriptan are the two most effective acute therapeutic options for sufferers of CH. Several preventive medications are available, the most effective of which is verapamil. However, most of these agents are not backed by strong clinical evidence. In some patients, these options can be ineffective, especially in those who develop chronic CH. Surgical procedures for the chronic refractory form of the disorder should then be contemplated, the most promising of which is hypothalamic deep brain stimulation. We hereby review the pathogenesis of CH and the evidence behind the treatment options for this debilitating condition. PMID:26635477

  2. Evidence Based Medicine in Pediatric Practice: Brief Review

    PubMed Central

    Kianifar, Hamid-Reza; Akhondian, Javad; Najafi-Sani, Mehri; Sadeghi, Ramin

    2010-01-01

    Practicing medicine according to the best evidence is gaining popularity in the medical societies. Although this concept, which is usually called Evidence Based Medicine (EBM) has been explained in many resources, it has not been addressed enough in pediatrics. In this review, we briefly explained Evidence Based Medicine approach and its applications in pediatrics in order to help the pediatricians to efficiently integrate EBM into their daily practice. PMID:23056715

  3. Complementary Therapies and Medicines and Reproductive Medicine.

    PubMed

    Smith, Caroline A; Armour, Mike; Ee, Carolyn

    2016-03-01

    Complementary therapies and medicines are a broad and diverse range of treatments, and are frequently used by women and their partners during the preconception period to assist with infertility, and to address pregnancy-related conditions. Despite frequent use, the evidence examining the efficacy, effectiveness, and safety for many modalities is lacking, with variable study quality. In this article, we provide an overview of research evidence with the aim of examining the evidence to inform clinical practice. During the preconception period, there is mixed evidence for acupuncture to improve ovulation, or increase pregnancy rates. Acupuncture may improve sperm quality, but there is insufficient evidence to determine whether this results in improved pregnancy and live birth rates. Acupuncture can be described as a low-risk intervention. Chinese and Western herbal medicines may increase pregnancy rates; however, study quality is low. The evaluation of efficacy, effectiveness, and safety during the first trimester of pregnancy has most commonly reported on herbs, supplements, and practices such as acupuncture. There is high-quality evidence reporting the benefits of herbal medicines and acupuncture to treat nausea in pregnancy. The benefit from ginger to manage symptoms of nausea in early pregnancy is incorporated in national clinical guidelines, and vitamin B6 is recommended as a first-line treatment for nausea and vomiting in pregnancy. The safety of ginger and vitamin B6 is considered to be well established, and is based on epidemiological studies. Acupuncture has been shown to reduce back pain and improve function for women in early pregnancy. There is little evidence to support the use of cranberries in pregnancy for prevention of urinary tract infections, and chiropractic treatment for back pain. Overall the numbers of studies are small and of low quality, although the modalities appear to be low risk of harm. PMID:26866600

  4. Back to basics: implementing evidence-based practice.

    PubMed

    Spruce, Lisa

    2015-01-01

    As health care transitions from volume-based care to value-based care, it is imperative that perioperative nurses implement evidence-based practices that support effective care. Implementing evidence-based practice is a challenge but improves patient outcomes, standardizes care, and decreases patient care costs. Understanding how care interventions work and how to implement them is important to compete in today's health care market. This "Back to Basics" article discusses how to identify, review, and appraise research; make recommendations to implement new practices; evaluate the outcomes of the implementations; and make necessary changes to facilitate evidence-based practice. PMID:25537331

  5. Report on Evidence-Based Interventions: Recommended Next Steps.

    ERIC Educational Resources Information Center

    Nelson, J. Ron; Epstein, Michael H.

    2002-01-01

    Comments on the work of the Task Force on Evidence-Based Interventions in School Psychology. Discusses the significant advances and errors of commission and omission made by the Task Force in their efforts to develop a framework for the identification of evidence-based interventions (EBIs). This discussion is followed by description of a…

  6. Evidence-Based Treatment and Stuttering--Historical Perspective

    ERIC Educational Resources Information Center

    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…

  7. Towards an Understanding of Evidence-Based Practice

    ERIC Educational Resources Information Center

    Digennaro Reed, Florence D.; Reed, Derek D.

    2008-01-01

    The past two decades have seen a rise in the use of the term "evidence-based practice" and a simultaneous increase in the variations in its definition and evaluation. Subsequently, this rise in interest for evidence-based practices has become a double-edged sword for practitioners--that is, while there are a number of interpretations on the…

  8. Evidence-based Nursing Practice: To Infinity and Beyond.

    ERIC Educational Resources Information Center

    Pape, Tess M.

    2003-01-01

    Provides an historical background for evidence-based practice and methods for assimilating research into practice. Information searching, systematic reviews, and other decision-making models are discussed using specific questions for establishing policy guidelines. Stresses the need for evidence-based practice implementing the best-known practices…

  9. Behavioral Activation Is an Evidence-Based Treatment for Depression

    ERIC Educational Resources Information Center

    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…

  10. Evidence-based gene predictions in plant genomes

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Automated evidence-based gene building is a rapid and cost-effective way to provide reliable gene annotations on newly sequenced genomes. One of the limitations of evidence-based gene builders, however, is their requirement for gene expression evidence—known proteins, full-length cDNAs, or expressed...

  11. Barriers and Enablers to Evidence-Based Practices

    ERIC Educational Resources Information Center

    Foster, Robyn

    2014-01-01

    The importance of educational practices based on evidence is well-supported in the literature, however barriers to their implementation in classrooms still exist. This paper examines the phenomenon of evidence-based practice in education highlighting enablers and barriers to their implementation with particular reference to RTLB practice.

  12. Personalizing Research: Special Educators' Awareness of Evidence-Based Practice

    ERIC Educational Resources Information Center

    Guckert, Mary; Mastropieri, Margo A.; Scruggs, Thomas E.

    2016-01-01

    Although evidence-based practices are considered critical to student success, a research-to-practice gap exists. This qualitative study examined practicing special education teachers' perceptions of their use of evidence-based practices. Special education teachers were interviewed and their classroom practices examined. Major themes emerged and…

  13. Teaching Evidence-based Medical Care: Description and Evaluation.

    ERIC Educational Resources Information Center

    Grad, Roland; Macaulay, Ann C.; Warner, Michelle

    2001-01-01

    Describes and evaluates a teaching initiative in evidence-based medical care in McGill University's family practice residency program. Discusses results of pre- and post-course self-assessments by students, which indicated significant increases in skill at formulating clinical questions and searching for evidence-based answers, appraising reviews,…

  14. [Forensic evidence-based medicine in computer communication networks].

    PubMed

    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. PMID:24665620

  15. Evidence-based medicine: applications in dietetic practice.

    PubMed

    Gray, Gregory E; Gray, Lorraine K

    2002-09-01

    Evidence-based medicine has been defined as "the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients." Evidence-based practice requires the ability to apply knowledge of medical informatics (eg, efficiently searching the medical literature) and clinical epidemiology (eg, being able to critically appraise the literature) to the treatment of individual patients. Being able to apply the principles of evidence-based medicine in the dietetic practice adds to the credibility and value of dietetics professionals, is consistent with the dietetic code of ethics, and is empowering. This article provides an introduction to the history, philosophy, and methods of evidence-based medicine as applied to the dietetic practice. This article focuses on a 5-step process to finding the best evidence to answer clinical questions: (a) formulate the question, (b) search for answers, (c) appraise the evidence, (d) apply the results, and (e) assess the outcome. We describe the 4S methodology-a systematic approach to efficiently finding the best evidence to answer clinical questions involving the use of systems (comprehensive, evidence-based resources), synopses (compilations of structured abstracts of high-quality studies), syntheses (systematic reviews), and studies (original research articles). Particular emphasis is given to a method for critically appraising papers that emphasizes validity, importance, and clinical applicability. Resources (including Web sites) for further learning are provided. J Am Diet Assoc. 2002;102:1263-1272. PMID:12792624

  16. Molecular evidence-based medicine: evolution and integration of information in the genomic era.

    PubMed

    Ioannidis, J P A

    2007-05-01

    Evidence-based medicine and molecular medicine have both been influential in biomedical research in the last 15 years. Despite following largely parallel routes to date, the goals and principles of evidence-based and molecular medicine are complementary and they should be converging. I define molecular evidence-based medicine as the study of medical information that makes sense of the advances of molecular biological disciplines and where errors and biases are properly appreciated and placed in context. Biomedical measurement capacity improves very rapidly. The exponentially growing mass of hypotheses being tested requires a new approach to both statistical and biological inference. Multidimensional biology requires careful exact replication of research findings, but indirect corroboration is often all that is achieved at best. Besides random error, bias remains a major threat. It is often difficult to separate bias from the spirit of scientific inquiry to force data into coherent and 'significant' biological stories. Transparency and public availability of protocols, data, analyses and results may be crucial to make sense of the complex biology of human disease and avoid being flooded by spurious research findings. Research efforts should be integrated across teams in an open, sharing environment. Most research in the future may be designed, performed, and integrated in the public cyberspace. PMID:17461979

  17. IBD and Complementary and Alternative Medicine (CAM)

    MedlinePlus

    ... Alternative Medicine (CAM) Go Back Complementary and Alternative Medicine (CAM) Email Print + Share Crohn’s disease and ulcerative ... Energy Medicine, and Biologically-Based Practices. Mind-Body Medicine Mind-body medicine is a set of interventions ...

  18. National Center for Complementary and Integrative Health

    MedlinePlus

    ... About NCCIH NCCIH At a Glance Mission and Vision Organizational Structure Director's ... Integrative Health Health All Health Topics from A-Z Research-based info from acupuncture to zinc. Complementary, Alternative, ...

  19. NCLEX-RN success: evidence-based strategies.

    PubMed

    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. PMID:22024676

  20. Evidence synthesis and its role in evidence-based health care.

    PubMed

    Pearson, Alan

    2014-12-01

    The central role of evidence synthesis (or the systematic review of evidence) in evidence-based health care is often poorly understood. There are numerous examples in the literature of poorly conceived and/or executed systematic reviews and of a lack of awareness of the international standards developed by the international leaders in systematic reviews. The Cochrane Collaboration has played a critical global role in developing and refining systematic review methods in relation to evidence of effects and of diagnostic accuracy. PMID:25458130

  1. Evidence based dental care: integrating clinical expertise with systematic research.

    PubMed

    Kishore, Mallika; Panat, Sunil R; Aggarwal, Ashish; Agarwal, Nupur; Upadhyay, Nitin; Alok, Abhijeet

    2014-02-01

    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 21(st) century, more and more practitioners are joining the train, more education on the subject is being provided to elucidate the knotty areas and there is increasing advocacy for the emergence of the field into a specialty discipline. Evidence-Based Dentistry (EBD), if endorsed by the dental profession, including the research community, may well- influence the extent to which society values dental research. Hence, dental researchers should understand the precepts of EBD, and should also recognize the challenges it presents to the research community to strengthen the available evidence and improve the processes of summarizing the evidence and translating it into practice This paper examines the concept of evidence-based dentistry (EBD), including some of the barriers and will discuss about clinical practice guidelines. PMID:24701551

  2. Evidence-based programs registry: blueprints for Healthy Youth Development.

    PubMed

    Mihalic, Sharon F; Elliott, Delbert S

    2015-02-01

    There is a growing demand for evidence-based programs to promote healthy youth development, but this growth has been accompanied by confusion related to varying definitions of evidence-based and mixed messages regarding which programs can claim this designation. The registries that identify evidence-based programs, while intended to help users sift through the findings and claims regarding programs, has oftentimes led to more confusion with their differing standards and program ratings. The advantages of using evidence-based programs and the importance of adopting a high standard of evidence, especially when taking programs to scale,are described. One evidence-based registry is highlighted--Blueprints for Healthy Youth Development hosted at the University of Colorado Boulder. Unlike any previous initiative of its kind, Blueprints established unmatched standards for identifying evidence-based programs and has acted in a way similar to the FDA--evaluating evidence, data and research to determine which programs meet their high standard of proven efficacy. PMID:25193177

  3. Evidence-based medicine in health care reform.

    PubMed

    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. PMID:21860057

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

    PubMed

    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. PMID:24571523

  5. Evidence-Based Laboratory Medicine: Is It Working in Practice?

    PubMed Central

    Price, Christopher P

    2012-01-01

    The principles of Evidence-Based Medicine have been established for about two decades, with the need for evidence-based clinical practice now being accepted in most health systems around the world. These principles can be employed in laboratory medicine. The key steps in evidence-based practice, namely (i) formulating the question; (ii) searching for evidence; (iii) appraising evidence; (iv) applying evidence; and (v) assessing the experience are all accepted but, as yet, translation into daily clinical and laboratory practice has been slow. Furthermore, the demand for evidence-based laboratory medicine (EBLM) has been slow to develop. There are many contrasting observations about laboratory medicine, for example (i) there is too much testing vs insufficient testing; (ii) testing is expensive vs laboratories are expected to generate income; and (iii) test results have little impact on outcomes vs test results are crucial to clinical decision making. However, there is little evidence to support any of these observations. Integrating the principles of EBLM into routine practice will help to resolve some of these issues by identifying (a) where laboratory medicine fits into the care pathway; (b) where testing is appropriate; (c) the nature and quality of evidence required to demonstrate the clinical utility of a test; (d) how the test result impacts on clinical actions; (e) where changes in the care pathway will occur; and (f) where benefit/value can be achieved. These answers will help to establish the culture of EBLM in clinical and laboratory practice. PMID:22363094

  6. The influence of salinity on Mg/Ca in planktic foraminifers - Evidence from cultures, core-top sediments and complementary δ18O

    NASA Astrophysics Data System (ADS)

    Hönisch, Bärbel; Allen, Katherine A.; Lea, David W.; Spero, Howard J.; Eggins, Stephen M.; Arbuszewski, Jennifer; deMenocal, Peter; Rosenthal, Yair; Russell, Ann D.; Elderfield, Henry

    2013-11-01

    The Mg/Ca ratio in foraminiferal calcite is one of the principal proxies used for paleoceanographic temperature reconstructions, but recent core-top sediment observations suggest that salinity may exert a significant secondary control on planktic foraminifers. This study compiles new and published laboratory culture experiment data from the planktic foraminifers Orbulina universa, Globigerinoides sacculifer and Globigerinoides ruber, in which salinity was varied but temperature, pH and light were held constant. Combining new data with results from previous culture studies yields a Mg/Ca-sensitivity to salinity of 4.4 ± 2.3%, 4.7 ± 1.2%, and 3.3 ± 1.7% per salinity unit (95% confidence), respectively, for the three foraminifer species studied here. Comparison of these sensitivities with core-top data suggests that the much larger sensitivity (27 ± 4% per salinity unit) derived from Atlantic core-top sediments in previous studies is not a direct effect of salinity. Rather, we suggest that the dissolution correction often applied to Mg/Ca data can lead to significant overestimation of temperatures. We are able to reconcile culture calibrations with core-top observations by combining evidence for seasonal occurrence and latitude-specific habitat depth preferences with corresponding variations in physico-chemical environmental parameters. Although both Mg/Ca and δ18O yield temperature estimates that fall within the bounds of hydrographic observations, discrepancies between the two proxies highlight unresolved challenges with the use of paired Mg/Ca and δ18O analyses to reconstruct paleo-salinity patterns across ocean basins. The first step towards resolving these challenges requires a better spatially and seasonally resolved δ18Osw archive than is currently available. Nonetheless, site-specific reconstructions of salinity change through time may be valid.

  7. Dissemination of Evidence-Based Standards of Care

    PubMed Central

    Barkhordarian, Andre; Hacker, Brett; Chiappelli, Francesco

    2011-01-01

    Standards of care pertain to crafting and implementing patient-centered treatment interventions. Standards of care must take into consideration the patient's gender, ethnicity, medical and dental history, insurance coverage (or socioeconomic level, if a private patient), and the timeliness of the targeted scientific evidence. This resolves into a process by which clinical decision-making about the optimal patient-centered treatment relies on the best available research evidence, and all other necessary inputs and factors to provide the best possible treatment. Standards of care must be evidence-based, and not merely based on the evidence – the dichotomy being critical in contemporary health services research and practice. Evidence-based standards of care must rest on the best available evidence that emerges from a concerted hypothesis-driven process of research synthesis and meta-analysis. Health information technology needs to become an every-day reality in health services research and practice to ensure evidence-based standards of care. Current trends indicate that user-friendly methodologies, for the dissemination of evidence-based standards of care, must be developed, tested and distributed. They should include approaches for the quantification and analysis of the textual content of systematic reviews and of their summaries in the form of critical reviews and lay-language summaries. PMID:22355229

  8. Integrating Multiple Evidence Sources to Predict Adverse Drug Reactions Based on a Systems Pharmacology Model

    PubMed Central

    Cao, D-S; Xiao, N; Li, Y-J; Zeng, W-B; Liang, Y-Z; Lu, A-P; Xu, Q-S; Chen, AF

    2015-01-01

    Identifying potential adverse drug reactions (ADRs) is critically important for drug discovery and public health. Here we developed a multiple evidence fusion (MEF) method for the large-scale prediction of drug ADRs that can handle both approved drugs and novel molecules. MEF is based on the similarity reference by collaborative filtering, and integrates multiple similarity measures from various data types, taking advantage of the complementarity in the data. We used MEF to integrate drug-related and ADR-related data from multiple levels, including the network structural data formed by known drug–ADR relationships for predicting likely unknown ADRs. On cross-validation, it obtains high sensitivity and specificity, substantially outperforming existing methods that utilize single or a few data types. We validated our prediction by their overlap with drug–ADR associations that are known in databases. The proposed computational method could be used for complementary hypothesis generation and rapid analysis of potential drug–ADR interactions. PMID:26451329

  9. A Third-Generation Evidence Base for Human Spaceflight Risks

    NASA Technical Reports Server (NTRS)

    Kundrot, Craig E.; Lumpkins, Sarah; Steil, Jennifer; Pellis, Neal; Charles, John

    2014-01-01

    NASA's Human Research Program seeks to understand and mitigate risks to crew health and performance in exploration missions center dot HRP's evidence base consists of an Evidence Report for each HRP risk center dot Three generations of Evidence Reports 1) Review articles + Good content - Limited authorship, infrequent updates 2) Wikipedia articles + Viewed often, very open to contributions - Summary of reviews, very few contributions 3) HRP-controlled wiki articles + Incremental additions to review articles with editorial control

  10. On evidence and evidence-based medicine: lessons from the philosophy of science.

    PubMed

    Goldenberg, Maya J

    2006-06-01

    The evidence-based medicine (EBM) movement is touted as a new paradigm in medical education and practice, a description that carries with it an enthusiasm for science that has not been seen since logical positivism flourished (circa 1920-1950). At the same time, the term "evidence-based medicine" has a ring of obviousness to it, as few physicians, one suspects, would claim that they do not attempt to base their clinical decision-making on available evidence. However, the apparent obviousness of EBM can and should be challenged on the grounds of how 'evidence' has been problematised in the philosophy of science. EBM enthusiasm, it follows, ought to be tempered. The post-positivist, feminist, and phenomenological philosophies of science that are examined in this paper contest the seemingly unproblematic nature of evidence that underlies EBM by emphasizing different features of the social nature of science. The appeal to the authority of evidence that characterizes evidence-based practices does not increase objectivity but rather obscures the subjective elements that inescapably enter all forms of human inquiry. The seeming common sense of EBM only occurs because of its assumed removal from the social context of medical practice. In the current age where the institutional power of medicine is suspect, a model that represents biomedicine as politically disinterested or merely scientific should give pause. PMID:16384628

  11. Mutually Exclusive, Complementary, or . . .

    ERIC Educational Resources Information Center

    Schloemer, Cathy G.

    2016-01-01

    Whether students are beginning their study of probability or are well into it, distinctions between complementary sets and mutually exclusive sets can be confusing. Cathy Schloemer writes in this article that for years she used typical classroom examples but was not happy with the student engagement or the level of understanding they produced.…

  12. Complementary Coffee Cups

    ERIC Educational Resources Information Center

    Banchoff, Thomas

    2006-01-01

    What may have been the birth of a new calculus problem took place when the author noticed that two coffee cups, one convex and one concave, fit nicely together, and he wondered which held more coffee. The fact that their volumes were about equal led to the topic of this article: complementary surfaces of revolution with equal volumes.

  13. Evidence-Based Practice: Separating Science From Pseudoscience

    PubMed Central

    Lee, Catherine M; Hunsley, John

    2015-01-01

    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. PMID:26720821

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

    PubMed

    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. PMID:26720821

  15. The Outcomes Movement and Evidence Based Medicine in Plastic Surgery

    PubMed Central

    Kowalski, Evan.; Chung, Kevin C.

    2012-01-01

    Synopsis Evidence based medicine is analyzed from its inception. The authors take the reader through the early formation of ‘scientific medicine’ that has evolved into the multi-purpose tool it has become today. Early proponents and their intentions that sparked evidence base and outcomes are presented: the work of David Sackett, Brian Haynes, Peter Tugwell, and Victor Neufeld is discussed - how they perceived the need for better clinical outcomes that led to a more formalized evidence based practice. The fundamentals are discussed objectively in detail and potential flaws are presented that guide the reader to deeper comprehension. PMID:23506764

  16. Organizational change tactics: the evidence base in the literature.

    PubMed

    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. PMID:25491004

  17. Using continuous quality improvement to implement evidence-based medicine.

    PubMed

    Quick, Barbara; Nordstrom, Sue; Johnson, Kevin

    2006-01-01

    The importance of implementing evidence-based medicine is being driven by public reporting of outcome data and linking these measures to reimbursement. Most hospitals are faced with many challenges in gaining sponsorship, staffing, creating tools, and reporting of evidence-based outcome measures. This article describes the use of the SSM Health Care (SSMHC) Continuous Quality Improvement model in implementing evidence-based practices at SSM DePaul Health Center, a community hospital member of SSMHC, including successes, opportunities for improvement, and lessons learned. Specifically, the article includes two different processes for data collection and interventions with staff, process requirements for each, and outcome data associated with each model. PMID:17135874

  18. Evidence-Based Management of Phonological Impairment in Children

    ERIC Educational Resources Information Center

    Baker, Elise; McLeod, Sharynne

    2004-01-01

    Evidence-based management of phonological impairment in children is a dynamic process. Speech and language therapists need to evaluate published evidence and use their professional judgement to decide on an intervention plan, evaluate the efficacy of their intervention and re-evaluate decisions. Two case studies are presented to illustrate this…

  19. Need to Address Evidence-Based Practice in Educational Administration

    ERIC Educational Resources Information Center

    Kowalski, Theodore

    2009-01-01

    Purpose: This article presents a case for addressing evidence-based practice (EBP) in educational administration. Content is arranged around four objectives: (a) summarizing the status of educational administration as a profession, (b) defining evidence and the model, (c) explaining EBP's social and professional merit, and (d) identifying barriers…

  20. Practice-Based Evidence--Overcoming Insecure Attachments

    ERIC Educational Resources Information Center

    Fox, Mark

    2011-01-01

    This article examines educational psychologists' (EPs') engagement with evidence-based practice (EBP). In particular it considers the limitations of randomised controlled trials and the difficulties of obtaining sufficient evidence about the effectiveness of interventions. This means that there is a possibility that EPs continue to use…

  1. Evidence-Based Clinical Voice Assessment: A Systematic Review

    ERIC Educational Resources Information Center

    Roy, Nelson; Barkmeier-Kraemer, Julie; Eadie, Tanya; Sivasankar, M. Preeti; Mehta, Daryush; Paul, Diane; Hillman, Robert

    2013-01-01

    Purpose: To determine what research evidence exists to support the use of voice measures in the clinical assessment of patients with voice disorders. Method: The American Speech-Language-Hearing Association (ASHA) National Center for Evidence-Based Practice in Communication Disorders staff searched 29 databases for peer-reviewed English-language…

  2. Integrating Evidence-based Decision Making into Allied Health Curricula.

    ERIC Educational Resources Information Center

    Forrest, Jane L.; Miller, Syrene A.

    2001-01-01

    Evidence-based decision making (EBDM) was incorporated into an institute for 42 dental hygiene, occupational therapy, and physical therapy faculty. The 4-day sessions addressed active teaching techniques, formulation of good questions, critical appraisal of evidence, and application, feedback, and evaluation. Most participants felt prepared to…

  3. What Works? Evidence-Based Practice in Education Is Complex

    ERIC Educational Resources Information Center

    Hempenstall, Kerry

    2014-01-01

    There is a nascent movement towards evidence-based practice in education in Australia, evident in Federal and State education documents, if not in classrooms. Such a classroom-level outcome would require a number of conditions to be met. One of the critical requirements is that teachers be provided with knowledge and training in practices that…

  4. What Is "Evidence-Based Practice" in Geography Education?

    ERIC Educational Resources Information Center

    Roberts, Margaret

    2010-01-01

    Educationalists developed the concept of "evidence-based practice" during the 1990s because of concern about the relevance of educational research to practitioners and about its impact on their practice. This article outlines the different kinds of research evidence related to geographical education, which might inform practice. It then discusses…

  5. Evidence Based Education Request Desk. EBE #652

    ERIC Educational Resources Information Center

    Regional Educational Laboratory Southeast, 2010

    2010-01-01

    Which states are using which turnaround models, as represented in the recent U.S. Department of Education's "Blueprint for Reform: The Reauthorization of the Elementary and Secondary Education Act?" A search for state-level policies on turnaround models was completed based on the targeted states list provided. According to US Department of…

  6. Evidence Based Education Request Desk. EBE #791

    ERIC Educational Resources Information Center

    Regional Educational Laboratory Southeast, 2011

    2011-01-01

    Would anyone in your network be aware of any states that might provide differentiated funding for virtual programs based on the model used--for example, curriculum-in-a-box vs. one with high student-teacher interaction? Are you aware of any research that examines what factors to consider when developing this type of differentiated funding? This…

  7. [Evidence-based medicine: a critical analysis of the concept of evidence in medicine].

    PubMed

    Federspil, G; Vettor, R

    2001-06-01

    There is currently a lively debate involving scholars from diverse cultural background on the subject of evidence-based medicine. In order to set out the grounds of discussion this paper deals with the problem of "evidence", both the concept and meaning of this term. After a brief history of the idea of "evidence" from antiquity to the present day, it will be underlined how modern day thinking recognizes the existence of two types of "evidence": rational evidence supported first by René Descartes, and perceptible evidence, defended by Francis Bacon. In contemporary epistemology the idea of "evidence" has been conceived above all as perceptible and is closely linked to the idea of fact. The concept of "scientific fact" will therefore be analyzed and will reveal how in science, contrary to prevailing opinion, "pure facts" practically do not exist and how the "facts" which scientists talk about in their research are always "facts depending on theory". Subsequently the capacity of "facts" to prove scientific hypothesis will be examined. In the light of more recent epistemological reflection the thesis will be maintained according to which facts are not capable of definitively proving the truth of a theory. Such reflection leads to the conclusion that in medicine "evidence" is always dependent on the theoretical and practical context in which researchers work. In the final part of the paper the epistemological presumptions and ambitions of evidence-based medicine will be examined. This analysis concludes that the epistemology on which evidence-based medicine relies upon does not grasp the true complexity of the scientific methodology and can weaken in doctors the beneficial stimulus that is doubt. PMID:11460834

  8. Reciprocal immune benefit based on complementary production of antibiotics by the leech Hirudo verbana and its gut symbiont Aeromonas veronii

    PubMed Central

    Tasiemski, Aurélie; Massol, François; Cuvillier-Hot, Virginie; Boidin-Wichlacz, Céline; Roger, Emmanuel; Rodet, Franck; Fournier, Isabelle; Thomas, Frédéric; Salzet, Michel

    2015-01-01

    The medicinal leech has established a long-term mutualistic association with Aeromonas veronii, a versatile bacterium which can also display free-living waterborne and fish- or human-pathogenic lifestyles. Here, we investigated the role of antibiotics in the dynamics of interaction between the leech and its gut symbiont Aeromonas. By combining biochemical and molecular approaches, we isolated and identified for the first time the antimicrobial peptides (AMPs) produced by the leech digestive tract and by its symbiont Aeromonas. Immunohistochemistry data and PCR analyses evidenced that leech AMP genes are induced in the gut epithelial cells when Aeromonas load is low (starved animals), while repressed when Aeromonas abundance is the highest (post blood feeding). The asynchronous production of AMPs by both partners suggests that these antibiotic substances (i) provide them with reciprocal protection against invasive bacteria and (ii) contribute to the unusual simplicity of the gut microflora of the leech. This immune benefit substantially reinforces the evidence of an evolutionarily stable association between H. verbana and A. veronii. Altogether these data may provide insights into the processes making the association with an Aeromonas species in the digestive tract either deleterious or beneficial. PMID:26635240

  9. [Evidence-based treatment of atrial fibrillation].

    PubMed

    Máquez, Manlio F; Gómez Flores, Jorge

    2006-01-01

    Radiofrequency catheter ablation has emerged as a curative therapy for paroxysmal atrial fibrillation based on studies demonstrating the role of triggering foci in the pulmonary veins for the initiation of atrial fibrillation. Catheter ablation is performed by a trans-septal approach using radiofrequency energy at the ostium of each pulmonary vein. Mapping is guided by special catheters. Sequential radiofrequency applications eliminates or dissociates pulmonary vein muscle activity. Although complications exists, this procedure can be curative for these patients. PMID:17017102

  10. Complementary feeding patterns in India.

    PubMed

    Kuriyan, R; Kurpad, A V

    2012-10-01

    There are far too many children in the world who suffer from under-nutrition and growth faltering, with life time consequences such as reduced work capacity, increased infections, impaired intellectual performance and an increased risk of non communicable diseases later in life. These changes occur early in life, and consequently, complementary feeding has been receiving increased attention in the international nutrition community. In India, common problems relate not only to insufficient breastfeeding, but also to detrimental feeding practices. Only about 20% of children aged 6-23 months were fed according to the three recommended Infant and Child Feeding practices. The most common types of solid or semi-solid foods fed to both breastfeeding and non-breastfeeding children under 3 years of age were foods made from grains and roots. These complementary feeding practices were found to be significantly associated with poor socioeconomic status, undesirable socio-cultural beliefs, maternal illiteracy, and ignorance. Although many initiatives have been carried out in India to promote Infant and Young Child Feeding, the progress in reducing the number of undernourished children in India over the last decade has been slow and modest. Equally, with the growing evidence and interest in the role of infant nutrition in the development of over nutrition and non-communicable disease, it is important to plan appropriate complementary feeding interventions that result in optimal growth. Contact opportunities with parents, specifically mothers, must be used for counseling through multiple communication channels such as local media, in order to constantly educate the population with consistent and simple messages on child feeding. PMID:22748607

  11. From Opinion-Based to Evidence-Based Social Work: The Swedish Case

    ERIC Educational Resources Information Center

    Sundell, Knut; Soydan, Haluk; Tengvald, Karin; Anttila, Sten

    2010-01-01

    This article presents an account of Sweden's Institute for Evidence-Based Social Work Practice (IMS), located in Stockholm, Sweden. The article places IMS in the context of making Swedish social care services less opinion-based and more evidence-based. The institute is an example of how policy-driven processes promote the use of evidence-based…

  12. CDMBE: A Case Description Model Based on Evidence.

    PubMed

    Zhu, Jianlin; Yang, Xiaoping; Zhou, Jing

    2015-01-01

    By combining the advantages of argument map and Bayesian network, a case description model based on evidence (CDMBE), which is suitable to continental law system, is proposed to describe the criminal cases. The logic of the model adopts the credibility logical reason and gets evidence-based reasoning quantitatively based on evidences. In order to consist with practical inference rules, five types of relationship and a set of rules are defined to calculate the credibility of assumptions based on the credibility and supportability of the related evidences. Experiments show that the model can get users' ideas into a figure and the results calculated from CDMBE are in line with those from Bayesian model. PMID:26421006

  13. CDMBE: A Case Description Model Based on Evidence

    PubMed Central

    Zhu, Jianlin; Yang, Xiaoping; Zhou, Jing

    2015-01-01

    By combining the advantages of argument map and Bayesian network, a case description model based on evidence (CDMBE), which is suitable to continental law system, is proposed to describe the criminal cases. The logic of the model adopts the credibility logical reason and gets evidence-based reasoning quantitatively based on evidences. In order to consist with practical inference rules, five types of relationship and a set of rules are defined to calculate the credibility of assumptions based on the credibility and supportability of the related evidences. Experiments show that the model can get users' ideas into a figure and the results calculated from CDMBE are in line with those from Bayesian model. PMID:26421006

  14. An evidence-based assessment of prescribed grazing practices

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Synthesis findings regarding the evidence-based assessment of prescribed grazing practices include: 1) stocking rate, in conjunction with appropriate temporal and spatial animal distribution, is a key management variable that influences numerous conservation outcomes, 2) assumptions regarding livest...

  15. Development and evaluation of online evidence based guideline bank system.

    PubMed

    Park, Myonghwa

    2006-01-01

    The purpose of this study was to develop and evaluate the online evidence-based nursing practice guideline bank system to support the best evidence-based decision in the clinical and community practice settings. The main homepage consisted of seven modules for introduction of site, EBN, guideline bank, guideline development, guideline review, related sites, and community. The major contents in the guidelines were purpose, developer, intended audience, method of development, target population, testing, knowledge components, and evaluation. Electronic versions of the guidelines were displayed by XML, PDF, and PDA versions. The system usability were evaluated by general users, guideline developers, and guideline reviewers on the web and the results showed high scores of satisfaction. This online evidence-based guideline bank system could support nurses' best and cost-effective clinical decision using the sharable standardized guidelines with education module of evidence based nursing. PMID:17102227

  16. Dynamic DNA devices and assemblies formed by shape-complementary, non-base pairing 3D components

    NASA Astrophysics Data System (ADS)

    Gerling, Thomas; Wagenbauer, Klaus F.; Neuner, Andrea M.; Dietz, Hendrik

    2015-03-01

    We demonstrate that discrete three-dimensional (3D) DNA components can specifically self-assemble in solution on the basis of shape-complementarity and without base pairing. Using this principle, we produced homo- and heteromultimeric objects, including micrometer-scale one- and two-stranded filaments and lattices, as well as reconfigurable devices, including an actuator, a switchable gear, an unfoldable nanobook, and a nanorobot. These multidomain assemblies were stabilized via short-ranged nucleobase stacking bonds that compete against electrostatic repulsion between the components’ interfaces. Using imaging by electron microscopy, ensemble and single-molecule fluorescence resonance energy transfer spectroscopy, and electrophoretic mobility analysis, we show that the balance between attractive and repulsive interactions, and thus the conformation of the assemblies, may be finely controlled by global parameters such as cation concentration or temperature and by an allosteric mechanism based on strand-displacement reactions.

  17. Dynamic DNA devices and assemblies formed by shape-complementary, non-base pairing 3D components.

    PubMed

    Gerling, Thomas; Wagenbauer, Klaus F; Neuner, Andrea M; Dietz, Hendrik

    2015-03-27

    We demonstrate that discrete three-dimensional (3D) DNA components can specifically self-assemble in solution on the basis of shape-complementarity and without base pairing. Using this principle, we produced homo- and heteromultimeric objects, including micrometer-scale one- and two-stranded filaments and lattices, as well as reconfigurable devices, including an actuator, a switchable gear, an unfoldable nanobook, and a nanorobot. These multidomain assemblies were stabilized via short-ranged nucleobase stacking bonds that compete against electrostatic repulsion between the components' interfaces. Using imaging by electron microscopy, ensemble and single-molecule fluorescence resonance energy transfer spectroscopy, and electrophoretic mobility analysis, we show that the balance between attractive and repulsive interactions, and thus the conformation of the assemblies, may be finely controlled by global parameters such as cation concentration or temperature and by an allosteric mechanism based on strand-displacement reactions. PMID:25814577

  18. A regional evidence-based practice fellowship: collaborating competitors.

    PubMed

    Weeks, Susan Mace; Moore, Penny; Allender, Marinda

    2011-01-01

    The authors describe the development of an effort by 21 hospitals and 2 academic institutions in a metropolitan area to strengthen the diffusion of evidence-based practice in their organizations. This has been accomplished by providing collaborative training, mentoring, and support for direct-care RNs through an evidence-based fellowship. The participating direct-care nurses are prepared to take the new knowledge, skills, and abilities they have gained back to the bedside care environment. PMID:21157238

  19. Teaching evidence-based practice: implications for psychology.

    PubMed

    Collins, Frank L; Leffingwell, Thad R; Belar, Cynthia D

    2007-07-01

    A movement advocating the use of evidence-based practice (EBP) is increasingly influencing health care and the practice of psychology. Thus, teaching evidence-based practice in psychology (EBPP) is critical to the preparation of future health service psychologists. In this article, the authors address common myths associated with EBP, propose core components involved in teaching EBPP, and describe an example of how such training can be incorporated into a professional psychology education and training curriculum. PMID:17551942

  20. Overcoming Challenges to Using Evidence-Based Interventions in Schools.

    ERIC Educational Resources Information Center

    Schaeffer, Cindy M.; Bruns, Eric; Weist, Mark; Stephan, Sharon Hoover; Goldstein, Julie; Simpson, Yolanda

    2005-01-01

    The Center for School Mental Health Assistance at the University of Maryland recently completed a review of evidence-based prevention and treatment programs that can be used by school mental health clinicians. Based on the review, a school-based program operating in 22 Baltimore City schools has purchased and trained clinicians in a number of…

  1. A constructivist model for teaching evidence-based practice.

    PubMed

    Rolloff, Mary

    2010-01-01

    The Institute of Medicine has reported that it takes roughly 17 years for evidence generated through research to move into clinical practice. Bridging that gap is an urgent need and will require educators to rethink how nurses are prepared for evidence-based practice. The constructivist theory for learning--in which it is assumed that students construct knowledge and meaning for themselves as they learn--may provide a framework for a redesigned baccalaureate curriculum, one that supports evidence-based practice throughout a nursing student's education. PMID:21086866

  2. [Iatrogenesis. From Iatromancy to Evidence-Based Medicine, to Iatromancy…].

    PubMed

    Campos, Alberto

    2016-01-01

    The qualities of what is considered evidence change and evolve according to theoretical tools of analysis, but also with what the physician perceives and processes cognitively. This includes models and tools such as statistics and evidence-based medicine. Under the term 'iatromancy' are included here different ways of making inductive inferences to establish diagnoses, be it the divinatory art, heuristics, statistics, Evidence-based Medicine (EBM), or the "clinical eye". The interrelationships of different kinds of experience are discussed as justifications for the beliefs of physicians to form judgments in the decision-making processes. PMID:27160625

  3. Towards Trustable Digital Evidence with PKIDEV: PKI Based Digital Evidence Verification Model

    NASA Astrophysics Data System (ADS)

    Uzunay, Yusuf; Incebacak, Davut; Bicakci, Kemal

    How to Capture and Preserve Digital Evidence Securely? For the investigation and prosecution of criminal activities that involve computers, digital evidence collected in the crime scene has a vital importance. On one side, it is a very challenging task for forensics professionals to collect them without any loss or damage. On the other, there is the second problem of providing the integrity and authenticity in order to achieve legal acceptance in a court of law. By conceiving digital evidence simply as one instance of digital data, it is evident that modern cryptography offers elegant solutions for this second problem. However, to our knowledge, there is not any previous work proposing a systematic model having a holistic view to address all the related security problems in this particular case of digital evidence verification. In this paper, we present PKIDEV (Public Key Infrastructure based Digital Evidence Verification model) as an integrated solution to provide security for the process of capturing and preserving digital evidence. PKIDEV employs, inter alia, cryptographic techniques like digital signatures and secure time-stamping as well as latest technologies such as GPS and EDGE. In our study, we also identify the problems public-key cryptography brings when it is applied to the verification of digital evidence.

  4. Complementary and alternative medicine.

    PubMed

    Filshie, Jacqueline; Rubens, Carolyn N J

    2006-03-01

    Thirty years ago, the integration of complementary medicine into cancer care almost was dismissed as quackery. Today, a whole range of complementary and alternative medicine (CAM) techniques have been integrated into the management of cancer, which are often of benefit to patients, when conventional treatment is deemed to have failed or caused intolerable side effects. Health care workers need to inquire about the use of CAM in their patients routinely in a sensitive and nonjudgmental way, and may need to advise patients to stop certain therapies. Yet in advanced cancer, a sensible balance needs to be struck between fear about adverse effects and interactions and the importance of making the remaining weeks/days/months as comfortable and enjoyable as possible. PMID:16487897

  5. Evidence-based management of patients with osteoporosis.

    PubMed

    Guyatt, G H

    1998-01-01

    Evidence-based medicine (EBM) offers an approach to solving clinical problems that places a high value on systematic clinical investigation. Evidence-based clinicians look to the highest rung on a hierarchy of evidence to guide their patient management. When considering therapeutic decisions, randomized control trials examining impact on outcomes that patients feel are important are at the top of the hierarchy of individual studies. Systematic reviews of such trials provide the best evidence for patient care decisions. Systematic reviews include explicit eligibility criteria for studies they include, a comprehensive search, an explicit rating of the methodological quality of the individual trials, and explicit strategies for pooling data. Inferences are weakened if study design is weak (trials are not blinded or we have only observational studies on which to rely), if results are inconsistent across studies, or if studies rely on substitute end points (bone density rather than long-bone fractures). Evidence-based clinicians consider not only the strength of evidence, but the patients' risk of adverse target outcomes and the magnitude of treatment effects in making their therapeutic decisions. EBM encourages quantitative approaches to trading off benefits and risks. For example, in deciding whether to recommend hormone replacement therapy to a 50-yr-old, an evidence-based clinician would consider that the woman has a 15% lifetime risk of fracturing her hip and the median age of the fracture is 79. Observational studies suggest that long-term estrogen therapy will reduce this risk by 25%, and we must therefore treat 25 women for 30 yr to prevent a single fracture. Evidence-based clinicians are also aware that evidence never provides an adequate guide for treatment decisions when considered on its own. Each therapeutic decision involves a trade-off between benefits and risks, and value judgments are invariably involved in making that trade-off. PMID:15304887

  6. Alternative/complementary therapies.

    PubMed

    Freeman, J W; Landis, J

    1997-02-01

    The national trends and our regional experience of the utilization of complementary therapies suggest that a significant number of our patients will continue to employ remedies that are outside the mainstream of what has been defined as conventional Western medicine. The data obtained from our survey is very consistent with the national survey published in 1993. Indeed the national interest in alternative/complementary therapies seems to be growing. A recent newspaper article from Minneapolis noted that Allina, one of Minnesota's largest hospital and HMO systems, found, in a 1995 survey, that two-thirds of surveyed households had a least one member who had used some type of alternative or holistic care over the prior two year period. Certainly continued study of the safety and efficacy of alternative/complementary therapies is warranted. This work is being done on many fronts, including the Office of Alternative Medicine at the National Institutes of Health. A most important aspect of such investigations is to improve the understanding of why patients choose these unconventional remedies. For many patients, the answer is simple. They believe these alternative treatments work. For such patients, alternative therapies may constitute a practical way to move from the sterile "high tech" realm of traditional medicine to a more intimate, "high touch" intervention offered by non-physicians. In the end, physicians' most pressing mandate is "to be of use" to patients in their struggles with illness, disability, and impending death. None of us have all the answers, and the studies alluded to in this essay suggest that a significant segment of the population yearns for interventions that have been traditionally outside the practice of most physicians and nurses. The data from our survey corroborates the high utilization rate of alternative/complementary therapies, regionally and is consistent with national data. Our challenge, as caregivers, is to appropriately respond to the

  7. [Complementary medicine--Jewish medical ethics].

    PubMed

    Katz, Yisrae; Schiff, Elad

    2011-08-01

    In Israel, as in the Western world, the use of different methods of complementary and alternative medicine ICAM) is spreading. CAM raises ethical questions of concern to healthcare providers and to the public: Can physicians recommend a treatment that has no scientific evidence? Should the government include such therapies in the health budget? Can complementary therapists receive protection against lawsuits if their treatment is recognized? The purpose of this article is to present a Jewish perspective on these issues. The fundamental sources that deal with the subject are based on the approach of rabbinic authorities toward unproven medicine, as expressed in the "Mishnah" and "Talmud" (200-500 C.E). The great Jewish scholar who discusses the subject in detail is Maimonides (1135-1204), who defines what "medicine" is and claims that medicine has to rely on reason or experience. Contemporary Jewish commentators present their position based on the interpretation of Maimonides' texts. In this article we claim that treatments can be divided into four groups, each group having a different halachic status: (1) Treatment that might be dangerous--should not be used. (2) Treatment that is safe--can be used, but has no other special status. (3) Treatment recognized by alternative therapists--has consequences for the observant Jew, such as laws of Kashrut and Shabbat. (4) Treatment that was tested and proven using modern medical methods has public significance--the therapist is entitled to legal defense if he made a reasonable mistake; the government can consider funding such treatment using public money. This article presents the Jewish halachic sources upon which we propose an ethical-practical approach to CAM. PMID:21939123

  8. E-commerce application study and complementary services in the sector of laboratory diagnostics based on consumers' opinion.

    PubMed

    Kontis, Alexios-Patapios; Siassiakos, Konstantinos; Kaimakamis, Georgios; Lazakidou, Athina

    2010-01-01

    The field of the Laboratory Diagnostics (in vitro), a sector of the field of health services, constitutes an industrial market that includes activities of research, development, production and products distribution that are designated for laboratory use. These products are defined as techno-medical products including various categories of products such as simple medicines, advanced technological systems, etc. Despite the high performance, the enlargement and the increasing trends of the field, it is not recorded the expected progress in the methods and the ways of promotion, trading and supporting of these products in the market. The present paper aims at the investigation of the consumers' opinion and the specification of those services that are possible to be implemented in electronic services and commerce for a strongly competitive advantage for the enterprises of the sector. The analysis of the findings from the Consumer Purchase Decision Centres (CPDC) shows how important it is to implement web-based applications in the proposed services. PMID:21041180

  9. The use of complementary and alternative medicine (CAM) in children: a telephone-based survey in Korea

    PubMed Central

    2012-01-01

    Background The purpose of this study was to estimate the prevalence and patterns of CAM use in Korean children via a telephone based survey. We also investigated parent satisfaction, a proxy for their child, with CAM therapy and determined the factors affecting satisfaction with CAM use. Methods This study used a landline telephone-based survey to examine a random sample representative of Korean children, aged 0 to 18 years. We assigned and surveyed 2,000 subjects according to age group, gender, and geographical distributions by proportionate quota and systematic sampling of children throughout Korea in 2010. A household of 1,184 with a 18.6% response rate was projected to yield 2,077 completed data. We performed statistical analyses using sampling weight. Results The prevalence of CAM use was 65.3% for the Korean children in our sample population. The most commonly used CAM category was natural products (89.3%). More than half of CAM user’s parents reported satisfaction with their therapies (52.7%), but only 29.1% among them had consulted a Western trained doctor regarding the CAM therapies used. Doctor visits were associated with lower satisfaction with CAM use but not with consultation rate with a doctor. Conclusions Our study suggests that CAM is widely used among children in Korea. Medical doctors should actively discuss the use of CAM therapies with their patients and provide information on the safety and efficacy of diverse CAM modalities to guide the choices of CAM users. PMID:22515558

  10. Physiology versus evidence-based guidance for critical care practice

    PubMed Central

    2015-01-01

    Evidence based medicine is an attempt to optimize the medical decision process through methods primarily based on evidence coming from meta-analyses, systematic reviews, and randomized controlled trials ("evidence-based medicine"), rather than on "clinical judgment" alone. The randomized trials are the cornerstones of this process. However, the randomized trials are just a method to prove or disprove a given hypothesis, which, in turn, derives from a general observation of the reality (premises or theories). In this paper we will examine some of the most recent randomized trials performed in Intensive Care, analyzing their premises, hypothesis and outcome. It is quite evident that when the premises are wrong or too vague the unavoidable consequences will be a negative outcome. We should pay when designing the trial an equal attention in defining premises and hypothesis that we pay for the trial conduction. PMID:26729063

  11. Evidence-based practice: a retrograde step? The importance of pluralism in evidence generation for the practice of health care.

    PubMed

    Clarke, J B

    1999-01-01

    The origin of evidence-based medicine is explored and its connection to evidence-based practice examined. Widespread acceptance of the dominant scientific paradigm supporting evidence-based practice is challenged. Knowledge classifications and their relevance for nursing practice are considered, with the need for a critical balance to be pursued. Recommendations are made, regarding the future of evidence for practice, and a brief example of emerging evidence concerning values of professional caring is offered in redressing the balance. PMID:10214174

  12. An evidence-based vector control strategy for military deployments: the British Army experience.

    PubMed

    Croft, A M; Baker, D; von Bertele, M J

    2001-01-01

    We describe the British Army's current strategy for controlling arthropod vectors of disease during overseas deployments. Military commanders and medical officers have different, but complementary responsibilities in achieving vector control. In this paper we define a hierarchy of evidence-based vector control guidelines. Field guidelines must be based on the best available research evidence, preferably that derived from pragmatic randomised controlled trials (RCTs), and from systematic reviews of trials. Assessing the effectiveness of different vector control measures involves a trade-off between the relative benefits and harm of different technology options. There is compelling scientific evidence that bed nets and screens treated with a pyrethroid insecticide are highly effective in protecting against nocturnally active, anthropophilic arthropods (including ectoparasites), and will reduce the incidence of malaria, leishmaniasis, lymphatic filariasis and Chagas' disease. Etofenprox and deltamethrin are the safest pyrethroids, and permethrin the least safe. Vector control strategies of probable effectiveness are the use of insecticide-treated clothing, the wearing of protective clothing, and the correct use of DEET-based topical insect repellents. Aerosol insecticides are of debatable effectiveness. Other effective vector control measures, of limited usefulness during deployments, include electric fans, mosquito coils/vaporising mats, and smoke. "Biological" vector control measures, and insect buzzers/electrocuters are ineffective. Practical insect avoidance measures, based on an understanding of vector biology, complete the military vector-control arsenal. We conclude that practical insect avoidance measures, combined with pyrethroid-treated nets and clothing, and DEET-based topical repellents, can achieve almost 100% protection against biting arthropods. PMID:11584666

  13. A novel fluorescent aptasensor based on hairpin structure of complementary strand of aptamer and nanoparticles as a signal amplification approach for ultrasensitive detection of cocaine.

    PubMed

    Emrani, Ahmad Sarreshtehdar; Danesh, Noor Mohammad; Ramezani, Mohammad; Taghdisi, Seyed Mohammad; Abnous, Khalil

    2016-05-15

    Cocaine is one of the most commonly misused stimulant which could influence the central nervous system. In this study, a fluorescent aptamer-based sensor (aptasensor) was designed for sensitive and selective detection of cocaine, based on hairpin structure of complementary strand of aptamer (CS), target-induced release of aptamer (Apt) from CS and two kinds of nanoparticles, including silica nanoparticles (SNPs) coated with streptavidin and gold nanoparticles (AuNPs). The designed aptasensor acquires characteristics of AuNPs such as unique optical properties and large surface area, SNPs as amplifiers of fluorescence intensity, higher affinity of Apt toward its target relative to its CS, and finally the hairpin structure of CS that brings the fluorophore (FAM) to close proximity to the surface of SNPs. In the absence of cocaine, FAM is in close proximity to the surface of AuNPs, resulting in a weak fluorescence emission. In the presence of target, FAM comes to close proximity to the surface of SNPs because of the formation of hairpin structure of CS, leading to a very strong fluorescence emission. The fabricated fluorescent aptasensor exhibited a good selectivity toward cocaine with a limit of detection (LOD) as low as 209 pM. Moreover, the designed aptasensor was successfully utilized to detect cocaine in serum with a LOD as low as 293 pM. PMID:26716422

  14. Children and Complementary Health Approaches

    MedlinePlus

    ... Ewsichek What’s the Bottom Line? How much do we know about complementary health approaches for children? We ... about their effects and safety. 1 What do we know about the effectiveness of complementary health approaches ...

  15. A Note on Complementary Medicines

    MedlinePlus

    ... manipulation, and acupuncture are types of complementary and alternative medicine (CAM) currently being used by millions of Americans. ... conventional care. The National Center for Complementary and Alternative Medicine (NCCAM), part of NIH since 1999, funds and ...

  16. Cancer and Complementary Health Approaches

    MedlinePlus

    ... Legislation Advisory Council Job Opportunities All About NCCIH Health Topics A-Z # A B C D E ... from NCI at www.cancer.gov . About Complementary Health Approaches Complementary health approaches are a group of ...

  17. Evidence-Based Practice: The Psychology of EBP Implementation.

    PubMed

    Rousseau, Denise M; Gunia, Brian C

    2016-01-01

    Evidence-based practice (EBP) is an approach used in numerous professions that focuses attention on evidence quality in decision making and action. We review research on EBP implementation, identifying critical underlying psychological factors facilitating and impeding its use. In describing EBP and the forms of evidence it employs, we highlight the challenges individuals face in appraising evidence quality, particularly that of their personal experience. We next describe critical EBP competencies and the challenges underlying their acquisition: foundational competencies of critical thinking and domain knowledge, and functional competencies such as question formulation, evidence search and appraisal, and outcome evaluation. We then review research on EBP implementation across diverse fields from medicine to management and organize findings around three key contributors to EBP: practitioner ability, motivation, and opportunity to practice (AMO). Throughout, important links between psychology and EBP are highlighted, along with the contributions psychological research can make to further EBP development and implementation. PMID:26361048

  18. Shared Decision Making in Complementary and Alternative Medicine Therapies

    PubMed Central

    Jansons, Lauren L.; Lynch, Rachel L.; LeBlanc, Annie; Tilburt, Jon C.

    2013-01-01

    Objective This paper provides a structured approach for pediatricians responding to requests from patients and their families about the complementary medicine treatment options. Methods Using a case-based narrative review approach, the authors outline practical strategies for addressing conflict, uncertainty, and challenges in explaining alternative health paradigms in routine pediatric care. Reflections are drawn from the clinical experience of the authors, the literature, and recent high-profile cases in the United States. Results The discussion of common case-based scenarios illustrates a general guide for approaching conversations about complementary medicine in the care of the pediatric patient that is responsive to evidence and informed by patient and family values. Conclusions The principles of shared decision making can guide constructive conversations in this area in an effort to facilitate improved satisfaction for patient, family, and provider. Practice Implications Discussions of complementary and alternative medicine in pediatrics pose a specific challenge with regard to patient and/or family preferences and the duty of the provider to advocate for the safety of the child. The proposed structured approach is useful in navigating these important conversations. PMID:23205655

  19. Complementary or alternative therapies for osteoarthritis.

    PubMed

    Ernst, Edzard

    2006-02-01

    Complementary or alternative therapies for osteoarthritis are commonly used and therefore it is important that health-care providers and patients are aware of the evidence for or against these approaches. In this article, the best available evidence is reviewed. The results suggest that, for several treatments, the risk-benefit profile is encouraging: acupuncture, several herbal medicines and capsaicin cream. For other therapies the evidence is weak or contradictory: homeopathy, magnet therapy, tai chi, leech therapy, music therapy, yoga, imagery and therapeutic touch. Many other treatments have not been scientifically tested. It is concluded that some complementary or alternative therapies have generated sufficiently promising results to warrant further investigation in large-scale, definitive, randomized clinical trials. PMID:16932660

  20. Evidence-based management of common chronic lower extremity ulcers.

    PubMed

    Richmond, Nicholas A; Maderal, Andrea D; Vivas, Alejandra C

    2013-01-01

    Chronic lower extremity ulcers are a significant burden on patients and health care systems worldwide. Although relatively common, these wounds can be difficult to treat and present a challenge to physicians. Treatment has often been based on anecdotal accounts; however, there is a growing emphasis on using evidence-based conclusions to guide clinical decisions. In this review article, the standard of care and adjuvant therapies of venous leg ulcers and diabetic foot ulcers are presented from an evidence-based perspective. PMID:23742279

  1. How to proceed when evidence-based practice is required but very little evidence available?

    PubMed Central

    2013-01-01

    Background All clinicians of today know that scientific evidence is the base on which clinical practice should rest. However, this is not always easy, in particular in those disciplines, where the evidence is scarce. Although the last decades have brought an impressive production of research that is of interest to chiropractors, there are still many areas such as diagnosis, prognosis, choice of treatment, and management that have not been subjected to extensive scrutiny. Discussion In this paper we argue that a simple system consisting of three questions will help clinicians deal with some of the complexities of clinical practice, in particular what to do when clear clinical evidence is lacking. Question 1 asks: are there objectively tested facts to support the concept? Question 2: are the concepts that form the basis for this clinical act or decision based on scientifically acceptable concepts? And question three; is the concept based on long-term and widely accepted experience? This method that we call the “Traffic Light System” can be applied to most clinical processes. Summary We explain how the Traffic Light System can be used as a simple framework to help chiropractors make clinical decisions in a simple and lucid manner. We do this by explaining the roles of biological plausibility and clinical experience and how they should be weighted in relation to scientific evidence in the clinical decision making process, and in particular how to proceed, when evidence is missing. PMID:23837495

  2. Evidence-Based Practice: A Framework for Making Effective Decisions

    ERIC Educational Resources Information Center

    Spencer, Trina D.; Detrich, Ronnie; Slocum, Timothy A.

    2012-01-01

    The research to practice gap in education has been a long-standing concern. The enactment of No Child Left Behind brought increased emphasis on the value of using scientifically based instructional practices to improve educational outcomes. It also brought education into the broader evidence-based practice movement that started in medicine and has…

  3. Construct Definition Using Cognitively Based Evidence: A Framework for Practice

    ERIC Educational Resources Information Center

    Ketterlin-Geller, Leanne R.; Yovanoff, Paul; Jung, EunJu; Liu, Kimy; Geller, Josh

    2013-01-01

    In this article, we highlight the need for a precisely defined construct in score-based validation and discuss the contribution of cognitive theories to accurately and comprehensively defining the construct. We propose a framework for integrating cognitively based theoretical and empirical evidence to specify and evaluate the construct. We apply…

  4. Evidence-Based Psychosocial Treatments for Child and Adolescent Depression

    ERIC Educational Resources Information Center

    David-Ferdon, Corinne; Kaslow, Nadine J.

    2008-01-01

    The evidence-base of psychosocial treatment outcome studies for depressed youth conducted since 1998 is examined. All studies for depressed children meet Nathan and Gorman's (2002) criteria for Type 2 studies whereas the adolescent protocols meet criteria for both Type 1 and Type 2 studies. Based on the Task Force on the Promotion and…

  5. [Interpretation and judgment formation influence evidence based guidelines].

    PubMed

    Brand, Paul L P

    2012-01-01

    A critical step in the development of evidence based guidelines is the interpretation and weighing-up of the epidemiological evidence. According to the model of human dynamic judgement formation, the personal views, convictions, and choices of the experts developing the guidelines play a part in determining this process. If such views, convictions, and choices are stated explicitly (as is recommended in the GRADE methodology for developing guidelines), physicians are more likely to really follow the guidelines. PMID:22748363

  6. Intramuscular injection technique: an evidence-based approach.

    PubMed

    Ogston-Tuck, Sherri

    2014-09-30

    Intramuscular injections require a thorough and meticulous approach to patient assessment and injection technique. This article, the second in a series of two, reviews the evidence base to inform safer practice and to consider the evidence for nursing practice in this area. A framework for safe practice is included, identifying important points for safe technique, patient care and clinical decision making. It also highlights the ongoing debate in selection of intramuscular injection sites, predominately the ventrogluteal and dorsogluteal muscles. PMID:25249123

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

    PubMed

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

    2015-08-01

    It is important to ensure that cancer pain management is based on the best evidence. Nursing evidence-based pain management can be examined through an evaluation of pain documentation. The aim of this study was to modify and test an evaluation tool for nursing cancer pain documentation, and describe the frequency and quality of nursing pain documentation in one oncology unit via the electronic medical system. A descriptive cross-sectional design was used for this study at an oncology unit of an academic medical center in the Pacific Northwest. Medical records were examined for 37 adults hospitalized during April and May 2013. Nursing pain documentations (N = 230) were reviewed using an evaluation tool modified from the Cancer Pain Practice Index to consist of 13 evidence-based pain management indicators, including pain assessment, care plan, pharmacologic and nonpharmacologic interventions, monitoring and treatment of analgesic side effects, communication with physicians, and patient education. Individual nursing documentation was assigned a score ranging from 0 (worst possible) to 13 (best possible), to reflect the delivery of evidence-based pain management. The participating nurses documented 90% of the recommended evidence-based pain management indicators. Documentation was suboptimal for pain reassessment, pharmacologic interventions, and bowel regimen. The study results provide implications for enhancing electronic medical record design and highlight a need for future research to understand the reasons for suboptimal nursing documentation of cancer pain management. For the future use of the data evaluation tool, we recommend additional modifications according to study settings. PMID:26256215

  8. From evidence-based medicine to genomic medicine

    PubMed Central

    2007-01-01

    The concept of ‘evidence-based medicine’ dates back to mid-19th century or even earlier. It remains pivotal in planning, funding and in delivering the health care. Clinicians, public health practitioners, health commissioners/purchasers, health planners, politicians and public seek formal ‘evidence’ in approving any form of health care provision. Essentially ‘evidence-based medicine’ aims at the conscientious, explicit and judicious use of the current best evidence in making decisions about the care of individual patients. It is in fact the ‘personalised medicine’ in practice. Since the completion of the human genome project and the rapid accumulation of huge amount of data, scientists and physicians alike are excited on the prospect of ‘personalised health care’ based on individual’s genotype and phenotype. The first decade of the new millennium now witnesses the transition from ‘evidence-based medicine’ to the ‘genomic medicine’. The practice of medicine, including health promotion and prevention of disease, stands now at a wide-open road as the scientific and medical community embraces itself with the rapidly expanding and revolutionising field of genomic medicine. This article reviews the rapid transformation of modern medicine from the ‘evidence-based medicine’ to ‘genomic medicine’. PMID:18923934

  9. Critical evaluation of a simple retention time predictor based on LogKow as a complementary tool in the identification of emerging contaminants in water.

    PubMed

    Bade, Richard; Bijlsma, Lubertus; Sancho, Juan V; Hernández, Felix

    2015-07-01

    There has been great interest in environmental analytical chemistry in developing screening methods based on liquid chromatography-high resolution mass spectrometry (LC-HRMS) for emerging contaminants. Using HRMS, compound identification relies on the high mass resolving power and mass accuracy attainable by these analyzers. When dealing with wide-scope screening, retention time prediction can be a complementary tool for the identification of compounds, and can also reduce tedious data processing when several peaks appear in the extracted ion chromatograms. There are many in silico, Quantitative Structure-Retention Relationship methods available for the prediction of retention time for LC. However, most of these methods use commercial software to predict retention time based on various molecular descriptors. This paper explores the applicability and makes a critical discussion on a far simpler and cheaper approach to predict retention times by using LogKow. The predictor was based on a database of 595 compounds, their respective LogKow values and a chromatographic run time of 18min. Approximately 95% of the compounds were found within 4.0min of their actual retention times, and 70% within 2.0min. A predictor based purely on pesticides was also made, enabling 80% of these compounds to be found within 2.0min of their actual retention times. To demonstrate the utility of the predictors, they were successfully used as an additional tool in the identification of 30 commonly found emerging contaminants in water. Furthermore, a comparison was made by using different mass extraction windows to minimize the number of false positives obtained. PMID:25882420

  10. Complementary LC-MS/MS-Based N-Glycan, N-Glycopeptide, and Intact N-Glycoprotein Profiling Reveals Unconventional Asn71-Glycosylation of Human Neutrophil Cathepsin G

    PubMed Central

    Loke, Ian; Packer, Nicolle H.; Thaysen-Andersen, Morten

    2015-01-01

    Neutrophil cathepsin G (nCG) is a central serine protease in the human innate immune system, but the importance of its N-glycosylation remains largely undescribed. To facilitate such investigations, we here use complementary LC-MS/MS-based N-glycan, N-glycopeptide, and intact glycoprotein profiling to accurately establish the micro- and macro-heterogeneity of nCG from healthy individuals. The fully occupied Asn71 carried unconventional N-glycosylation consisting of truncated chitobiose core (GlcNAcβ: 55.2%; Fucα1,6GlcNAcβ: 22.7%), paucimannosidic N-glycans (Manβ1,4GlcNAcβ1,4GlcNAcβ: 10.6%; Manβ1,4GlcNAcβ1,4(Fucα1,6)GlcNAcβ: 7.9%; Manα1,6Manβ1,4GlcNAcβ1,4GlcNAcβ: 3.7%, trace level of Manα1,6Manβ1,4GlcNAcβ1,4(Fucα1,6)GlcNAcβ), and trace levels of monoantennary α2,6- and α2,3-sialylated complex N-glycans. High-resolution/mass accuracy LC-MS profiling of intact nCG confirmed the Asn71-glycoprofile and identified two C-terminal truncation variants at Arg243 (57.8%) and Ser244 (42.2%), both displaying oxidation of solvent-accessible Met152. Asn71 appeared proximal (~19 Å) to the active site of nCG, but due to the truncated nature of Asn71-glycans (~5–17 Å) we questioned their direct modulation of the proteolytic activity of the protein. This work highlights the continued requirement of using complementary technologies to accurately profile even relatively simple glycoproteins and illustrates important challenges associated with the analysis of unconventional protein N-glycosylation. Importantly, this study now facilitates investigation of the functional role of nCG Asn71-glycosylation. PMID:26274980

  11. Evidence-based practice: reflections from five European case studies.

    PubMed

    Baeza, Juan I; Fraser, Alec; Boaz, Annette

    2014-01-01

    Background Evidence-based practice (EBP) is now the accepted orthodoxy in clinical practice and developed from evidence-based medicine. EBP is based on a specific type of evidence that is derived from studies based on randomised controlled trials (RCT). This type of evidence is suited to acute medical care and is more problematic for other clinicians such as nurses and therapists, particularly when they are situated within community or primary care settings. Setting Five stroke care services in England (2), Sweden (2) and Poland (1). Aims To reflect on the evidence gained from these case studies to shed light on various aspects of EBP. This paper focuses on three key issues: (1) the importance of context for evidence, (2) the nature of knowledge, and (3) professional hierarchies. Methods Five qualitative case studies into stroke care were carried out in England, Sweden and Poland. One hundred and twenty semi-structured interviews were carried out with a range of healthcare staff who provided specialised and non-specialised stroke care in acute, community and primary care between October 2010 and September 2011. Medical doctors, nurses and different therapists were included in the samples in all five case studies. For this paper, we reflect on some aspects of this work to illuminate the different interprofessional perspectives relating to EBP in stroke care. Results The lack of RCT-based evidence in the community and primary care sectors can lead to the clinicians working in these sectors being perceived as having a lower status. Clinicians use both tacit and encoded knowledge to guide their practice and there existed both intraand interprofessional tensions in these two types of knowledge. The professional hierarchy of stroke teams varies with national context and the role of the non-specialists is less valued in stroke care. PMID:25949726

  12. Note: A disposable x-ray camera based on mass produced complementary metal-oxide-semiconductor sensors and single-board computers

    NASA Astrophysics Data System (ADS)

    Hoidn, Oliver R.; Seidler, Gerald T.

    2015-08-01

    We have integrated mass-produced commercial complementary metal-oxide-semiconductor (CMOS) image sensors and off-the-shelf single-board computers into an x-ray camera platform optimized for acquisition of x-ray spectra and radiographs at energies of 2-6 keV. The CMOS sensor and single-board computer are complemented by custom mounting and interface hardware that can be easily acquired from rapid prototyping services. For single-pixel detection events, i.e., events where the deposited energy from one photon is substantially localized in a single pixel, we establish ˜20% quantum efficiency at 2.6 keV with ˜190 eV resolution and a 100 kHz maximum detection rate. The detector platform's useful intrinsic energy resolution, 5-μm pixel size, ease of use, and obvious potential for parallelization make it a promising candidate for many applications at synchrotron facilities, in laser-heating plasma physics studies, and in laboratory-based x-ray spectrometry.

  13. Note: A disposable x-ray camera based on mass produced complementary metal-oxide-semiconductor sensors and single-board computers.

    PubMed

    Hoidn, Oliver R; Seidler, Gerald T

    2015-08-01

    We have integrated mass-produced commercial complementary metal-oxide-semiconductor (CMOS) image sensors and off-the-shelf single-board computers into an x-ray camera platform optimized for acquisition of x-ray spectra and radiographs at energies of 2-6 keV. The CMOS sensor and single-board computer are complemented by custom mounting and interface hardware that can be easily acquired from rapid prototyping services. For single-pixel detection events, i.e., events where the deposited energy from one photon is substantially localized in a single pixel, we establish ∼20% quantum efficiency at 2.6 keV with ∼190 eV resolution and a 100 kHz maximum detection rate. The detector platform's useful intrinsic energy resolution, 5-μm pixel size, ease of use, and obvious potential for parallelization make it a promising candidate for many applications at synchrotron facilities, in laser-heating plasma physics studies, and in laboratory-based x-ray spectrometry. PMID:26329247

  14. Three-Dimensional Flexible Complementary Metal-Oxide-Semiconductor Logic Circuits Based On Two-Layer Stacks of Single-Walled Carbon Nanotube Networks.

    PubMed

    Zhao, Yudan; Li, Qunqing; Xiao, Xiaoyang; Li, Guanhong; Jin, Yuanhao; Jiang, Kaili; Wang, Jiaping; Fan, Shoushan

    2016-02-23

    We have proposed and fabricated stable and repeatable, flexible, single-walled carbon nanotube (SWCNT) thin film transistor (TFT) complementary metal-oxide-semiconductor (CMOS) integrated circuits based on a three-dimensional (3D) structure. Two layers of SWCNT-TFT devices were stacked, where one layer served as n-type devices and the other one served as p-type devices. On the basis of this method, it is able to save at least half of the area required to construct an inverter and make large-scale and high-density integrated CMOS circuits easier to design and manufacture. The 3D flexible CMOS inverter gain can be as high as 40, and the total noise margin is more than 95%. Moreover, the input and output voltage of the inverter are exactly matched for cascading. 3D flexible CMOS NOR, NAND logic gates, and 15-stage ring oscillators were fabricated on PI substrates with high performance as well. Stable electrical properties of these circuits can be obtained with bending radii as small as 3.16 mm, which shows that such a 3D structure is a reliable architecture and suitable for carbon nanotube electrical applications in complex flexible and wearable electronic devices. PMID:26768020

  15. A novel electrochemical aptasensor based on Y-shape structure of dual-aptamer-complementary strand conjugate for ultrasensitive detection of myoglobin.

    PubMed

    Taghdisi, Seyed Mohammad; Danesh, Noor Mohammad; Ramezani, Mohammad; Emrani, Ahmad Sarreshtehdar; Abnous, Khalil

    2016-06-15

    Monitoring of myoglobin (Mb) in human blood serum is highly in demand for early diagnosis of acute myocardial infarction (AMI). Here, a novel electrochemical aptasensor was developed for ultrasensitive and selective detection of Mb, based on Y-shape structure of dual-aptamer (DApt)-complementary strand of aptamer (CS) conjugate, gold electrode and exonuclease I (Exo I). The designed aptasensor obtains features of gold, such as high electrochemical conductivity and large surface area, property of Y-shape structure of DApt-CS conjugate to function as a gate and obstacle for the access of redox probe to the surface of electrode, as well as high specificity and sensitivity of aptamer toward its target and Exo I as an enzyme which specifically degrades the 3'-end of single-stranded DNA (ssDNA). In the absence of Mb, the Y-shape structure remains intact. So, a weak electrochemical signal is observed. Upon addition of target, the DApt leave the CS and bind to Mb, leading to disassembly of Y-shape structure and following the addition of Exo I, a strong electrochemical signal could be recorded. The fabricated aptasensor showed high selectivity toward Mb with a limit of detection (LOD) as low as 27 pM. Besides, the developed aptasensor was effectively applied to detect Mb in human serum. PMID:26894983

  16. Note: A disposable x-ray camera based on mass produced complementary metal-oxide-semiconductor sensors and single-board computers

    SciTech Connect

    Hoidn, Oliver R.; Seidler, Gerald T.

    2015-08-15

    We have integrated mass-produced commercial complementary metal-oxide-semiconductor (CMOS) image sensors and off-the-shelf single-board computers into an x-ray camera platform optimized for acquisition of x-ray spectra and radiographs at energies of 2–6 keV. The CMOS sensor and single-board computer are complemented by custom mounting and interface hardware that can be easily acquired from rapid prototyping services. For single-pixel detection events, i.e., events where the deposited energy from one photon is substantially localized in a single pixel, we establish ∼20% quantum efficiency at 2.6 keV with ∼190 eV resolution and a 100 kHz maximum detection rate. The detector platform’s useful intrinsic energy resolution, 5-μm pixel size, ease of use, and obvious potential for parallelization make it a promising candidate for many applications at synchrotron facilities, in laser-heating plasma physics studies, and in laboratory-based x-ray spectrometry.

  17. Evidence-Based Practice and School Libraries: Interconnections of Evidence, Advocacy, and Actions

    ERIC Educational Resources Information Center

    Todd, Ross J.

    2015-01-01

    This author states that a professional focus on evidence based practice (EBP) for school libraries emerged from the International Association of School Librarianship conference when he presented the concept. He challenged the school library profession to actively engage in professional and reflective practices that chart, measure, document, and…

  18. Pediatric Depression: Is There Evidence to Improve Evidence-Based Treatments?

    ERIC Educational Resources Information Center

    Brent, David A.; Maalouf, Fadi T.

    2009-01-01

    Although there have been advances in our ability to treat child and adolescent depression, use of evidence-based treatments still results in many patients with residual symptoms. Advances in our understanding of cognitive, emotional, and ecological aspects of early-onset depression have the potential to lead to improvements in the assessment and…

  19. Evidence and Rigor: Scrutinizing the Rhetorical Embrace of Evidence-Based Decision Making

    ERIC Educational Resources Information Center

    Baker, Bruce; Welner, Kevin G.

    2012-01-01

    The nation's lawmakers have frequently voiced the basic principle that important policy decisions should be evidence based. In this commentary, the authors describe the approach the U.S. Department of Education has taken in its Increasing Educational Productivity project. The authors argue that the department's actual practice in this instance has…

  20. Untangling the Evidence: Introducing an Empirical Model for Evidence-Based Library and Information Practice

    ERIC Educational Resources Information Center

    Gillespie, Ann

    2014-01-01

    Introduction: This research is the first to investigate the experiences of teacher-librarians as evidence-based practice. An empirically derived model is presented in this paper. Method: This qualitative study utilised the expanded critical incident approach, and investigated the real-life experiences of fifteen Australian teacher-librarians,…

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

    PubMed Central

    Fung, Foon Yin; Linn, Yeh Ching

    2015-01-01

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

  2. [Evidence-based clinical practice. Part II--Searching evidence databases].

    PubMed

    Bernardo, Wanderley Marques; Nobre, Moacyr Roberto Cuce; Jatene, Fábio Biscegli

    2004-01-01

    The inadequacy of most of traditional sources for medical information, like textbook and review article, do not sustained the clinical decision based on the best evidence current available, exposing the patient to a unnecessary risk. Although not integrated around clinical problem areas in the convenient way of textbooks, current best evidence from specific studies of clinical problems can be found in an increasing number of Internet and electronic databases. The sources that have already undergone rigorous critical appraisal are classified as secondary information sources, others that provide access to original article or abstract, as primary information source, where the quality assessment of the article rely on the clinician oneself . The most useful primary information source are SciELO, the online collection of Brazilian scientific journals, and Medline, the most comprehensive database of the USA National Library of Medicine, where the search may start with use of keywords, that were obtained at the structured answer construction (P.I.C.O.), with the addition of boolean operators "AND", "OR", "NOT". Between the secondary information sources, some of them provide critically appraised articles, like ACP Journal Club, Evidence Based Medicine and InfoPOEMs, others provide evidences organized as online texts, such as "Clinical Evidence" and "UpToDate", and finally, Cochrane Library are composed by systematic reviews of randomized controlled trials. To get studies that could answer the clinical question is part of a mindful practice, that is, becoming quicker and quicker and dynamic with the use of PDAs, Palmtops and Notebooks. PMID:15253037

  3. Using evidence-based management in a medical practice.

    PubMed

    Solomon, Robert J

    2010-01-01

    Evidence-based management (EBMa) is the application of the evidence-based medicine process to making management decisions. EBMa has been described in a number of publications, which note the advantages of utilizing EBMa and offer generic guidance on the nature of EBMa evidence. This paper provides a specific EBMa pathway for physician practice and health system mangers to use to conduct EBMa database searches. It provides an example of conducting an EBMa search for a practice-based management problem. It describes how to do database searches using Advance Google Scholar, PubMed, and other data sources. It discusses challenges to conducting quality searches, including access to paid subscription databases, and offers suggestions to improve searches. Finally, the paper discusses the importance of establishing a culture of inquiry and using rapid cycle improvement methods to develop organizational EBMa support so health systems will devote adequate resources to information acquisition. PMID:20222263

  4. Use of complementary and alternative therapies in children.

    PubMed

    Woolf, A D; Gardiner, P

    2010-02-01

    The use of complementary and alternative therapies in children has recently shown explosive growth, despite little scientific evidence of benefit, a need for better regulatory oversight, and continuing gaps in the knowledge and attitudes of pediatric health professionals. PMID:20107449

  5. Evidence-based uncertainty in mental health nursing.

    PubMed

    Franks, V

    2004-02-01

    The drive towards evidence-based practice is part of a modern reflective and caring service. However there is a paradox at the heart of the notion of evidence-based care. In order to perform any systemized examination of treatment there has to be a conscious acknowledgement of uncertainty about that treatment. This is uncomfortable and when research does find evidence in favour of a treatment, there is a relief and a return to conviction about what is the best. The paradox is that it seems the most valued research practices are predicated on generalizations about patient treatments and categories. However, nursing care is based on the notion of the uniqueness of the patient and the nurse-patient relationship. Sometimes it is necessary to address the particular and not to rush to generalizations and certainty. The psychoanalytic framework promotes a capacity to tolerate uncertainty and provides a model for understanding conflicting feelings, which can occur within the nurse-patient relationship. The author proposes the psychoanalytic observational method as an adjunct to other research methods. This method places certain kinds of evidence within the rubric of evidence-based nursing practice. The evidence collected in this method is the evidence of the conscious and unconscious experience within the nurse-patient relationship. The author will describe and argue for the place of this research method within the canon of other more widely practised methods within mental health practice. She will propose that for safe practice it is necessary to value and examine the veracity of the feelings and tacit understanding of the nurse. She contends that the current climate of excessive bureaucracy and persecutory risk management is having a damaging effect on both the research process and effective nursing care. PMID:14723645

  6. Evidence-based Nursing Education - a Systematic Review of Empirical Research

    PubMed Central

    Reiber, Karin

    2011-01-01

    The project „Evidence-based Nursing Education – Preparatory Stage“, funded by the Landesstiftung Baden-Württemberg within the programme Impulsfinanzierung Forschung (Funding to Stimulate Research), aims to collect information on current research concerned with nursing education and to process existing data. The results of empirical research which has already been carried out were systematically evaluated with aim of identifying further topics, fields and matters of interest for empirical research in nursing education. In the course of the project, the available empirical studies on nursing education were scientifically analysed and systematised. The over-arching aim of the evidence-based training approach – which extends beyond the aims of this project - is the conception, organisation and evaluation of vocational training and educational processes in the caring professions on the basis of empirical data. The following contribution first provides a systematic, theoretical link to the over-arching reference framework, as the evidence-based approach is adapted from thematically related specialist fields. The research design of the project is oriented towards criteria introduced from a selection of studies and carries out a two-stage systematic review of the selected studies. As a result, the current status of research in nursing education, as well as its organisation and structure, and questions relating to specialist training and comparative education are introduced and discussed. Finally, the empirical research on nursing training is critically appraised as a complementary element in educational theory/psychology of learning and in the ethical tradition of research. This contribution aims, on the one hand, to derive and describe the methods used, and to introduce the steps followed in gathering and evaluating the data. On the other hand, it is intended to give a systematic overview of empirical research work in nursing education. In order to preserve a

  7. A prototype system to support evidence-based practice.

    PubMed

    Demner-Fushman, Dina; Seckman, Charlotte; Fisher, Cheryl; Hauser, Susan E; Clayton, Jennifer; Thoma, George R

    2008-01-01

    Translating evidence into clinical practice is a complex process that depends on the availability of evidence, the environment into which the research evidence is translated, and the system that facilitates the translation. This paper presents InfoBot, a system designed for automatic delivery of patient-specific information from evidence-based resources. A prototype system has been implemented to support development of individualized patient care plans. The prototype explores possibilities to automatically extract patients problems from the interdisciplinary team notes and query evidence-based resources using the extracted terms. Using 4,335 de-identified interdisciplinary team notes for 525 patients, the system automatically extracted biomedical terminology from 4,219 notes and linked resources to 260 patient records. Sixty of those records (15 each for Pediatrics, Oncology & Hematology, Medical & Surgical, and Behavioral Health units) have been selected for an ongoing evaluation of the quality of automatically proactively delivered evidence and its usefulness in development of care plans. PMID:18998835

  8. Evidence-based orthopaedics or 'superstition in the pigeon'.

    PubMed

    Evans, R

    2009-01-01

    Pigeon behavioural conditioning methods are similar to the processes that orthopaedic surgeons use to evaluate new surgical procedures. Alternatively, evidence-based orthopaedics is a tool for surgeons to evaluate procedures in a systematic, patient-centred way that is less instinctive than pigeon behaviour. The objective of this article is to describe evidence-based orthopaedics, and then propose changes to surgical culture with the aim of refining the interpretation of the current literature and improving the quality of future research. The proposals are 'institutional' changes rather than calls for increased funding and more randomised controlled trials. PMID:19750292

  9. Psychosocial factors and diabetes mellitus: evidence-based treatment guidelines.

    PubMed

    Petrak, Frank; Herpertz, Stephan; Albus, Christian; Hirsch, Axel; Kulzer, Bernhard; Kruse, Johannes

    2005-08-01

    The aim of this project was to develop evidence-based guidelines regarding psychosocial aspects of diabetes mellitus in an effort to help the clinician bridge the gap between research and practice. Recommendations address the following topics: patient education, behavioural medicine, and psychiatric disorders of particular relevance to diabetes: depression, anxiety disorders, eating disorders, and dependence on alcohol and nicotine. The present guidelines were developed through an interdisciplinary process of consensus according to the specifications of evidence-based medicine and are recognized by the German Diabetes Association and the German College for Psychosomatic Medicine as their official guidelines. PMID:18220602

  10. Mental Health Clinicians’ Experiences of Implementing Evidence-Based Treatments

    PubMed Central

    Powell, Byron J.; Hausmann-Stabile, Carolina; McMillen, J. Curtis

    2013-01-01

    Implementation research has tremendous potential to bridge the research-practice gap; however, we know more about barriers to evidence-based care than the factors that contribute to the adoption and sustainability of evidence-based treatments (EBTs). This qualitative study explores the experiences of clinicians (N = 11) who were implementing EBTs, highlighting the factors that they perceived to be most critical to successful implementation. The clinicians’ narratives reveal many leverage points that can inform administrators, clinical supervisors, and clinicians who wish to implement EBTs, as well as other stakeholders who wish to develop and test strategies for moving EBTs into routine care. PMID:24066630

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

    PubMed

    Lindoerfer, Doris; Mansmann, Ulrich

    2016-01-01

    This paper discusses an evidence-based approach to software requirements engineering. The approach is called evidence-based, since it uses publications on the specific problem as a surrogate for stakeholder interests, to formulate risks and testing experiences. This complements the idea that agile software development models are more relevant, in which requirements and solutions evolve through collaboration between self-organizing cross-functional teams. The strategy is exemplified and applied to the development of a Software Requirements list used to develop software systems for patient registries. PMID:27577464

  12. Evidence-Based Practice and Quality Improvement in Nursing Education.

    PubMed

    Balakas, Karen; Smith, Joan R

    2016-01-01

    For more than a decade, nursing education has experienced several significant changes in response to challenges faced by healthcare organizations. Accrediting organizations have called for improved quality and safety in care, and the Institute of Medicine has identified evidence-based practice and quality improvement as 2 core competencies to include in the curricula for all healthcare professionals. However, the application of these competencies reaches far beyond the classroom setting. For nurses to possess the knowledge, skills, and attitudes to apply evidence-based practice and quality improvement to the real-world setting, academic-clinical institution partnerships are vital. PMID:27465447

  13. Strategies for searching and managing evidence-based practice resources.

    PubMed

    Robb, Meigan; Shellenbarger, Teresa

    2014-10-01

    Evidence-based nursing practice requires the use of effective search strategies to locate relevant resources to guide practice change. Continuing education and staff development professionals can assist nurses to conduct effective literature searches. This article provides suggestions for strategies to aid in identifying search terms. Strategies also are recommended for refining searches by using controlled vocabulary, truncation, Boolean operators, PICOT (Population/Patient Problem, Intervention, Comparison, Outcome, Time) searching, and search limits. Suggestions for methods of managing resources also are identified. Using these approaches will assist in more effective literature searches and may help evidence-based practice decisions. PMID:25221988

  14. Achievements and Limitations of Evidence-Based Medicine.

    PubMed

    Sheridan, Desmond J; Julian, Desmond G

    2016-07-12

    Evidence-based medicine (EBM) has a long history, but was revived in the early 1990s by a campaign mounted by a movement that took its name. The EBM movement focused attention on the need for greater objectivity in medical decision-making and led to the Cochrane Collaboration, which provides reviews of evidence on the basis of comparative research. Important limitations of EBM's effect on medicine have also emerged. Failure to acknowledge the limitations of clinical trials and systematic reviews has limited their applicability to individual patients' circumstances. An almost exclusive focus on drugs and devices has left vast areas of health care in an evidence vacuum. An overdependence on commissions for its research may have limited its independence in selecting what it investigates. EBM needs to widen its scope beyond drugs and devices to address many areas that often lack evidence at present, notably, health policy, management, and reforms. PMID:27386775

  15. Evidence integration in model-based tree search

    PubMed Central

    Solway, Alec; Botvinick, Matthew M.

    2015-01-01

    Research on the dynamics of reward-based, goal-directed decision making has largely focused on simple choice, where participants decide among a set of unitary, mutually exclusive options. Recent work suggests that the deliberation process underlying simple choice can be understood in terms of evidence integration: Noisy evidence in favor of each option accrues over time, until the evidence in favor of one option is significantly greater than the rest. However, real-life decisions often involve not one, but several steps of action, requiring a consideration of cumulative rewards and a sensitivity to recursive decision structure. We present results from two experiments that leveraged techniques previously applied to simple choice to shed light on the deliberation process underlying multistep choice. We interpret the results from these experiments in terms of a new computational model, which extends the evidence accumulation perspective to multiple steps of action. PMID:26324932

  16. Foundations for evidence-based intraoperative neurophysiological monitoring.

    PubMed

    Howick, Jeremy; Cohen, Bernard Allan; McCulloch, Peter; Thompson, Matthew; Skinner, Stanley A

    2016-01-01

    In this review, we recommend means to enhance the evidence-base for intraoperative neurophysiological monitoring (IONM). We address two preliminary issues: (1) whether IONM should be evaluated as a diagnostic test or an intervention, and (2) the state of the evidence for IONM (as presented in systematic reviews, for example). Three reasons may be suggested to evaluate at least some IONM applications as interventions (or as part of an "interventional cascade"). First, practical barriers limit our ability to measure IONM diagnostic accuracy. Second, IONM results are designed to be correlated with interventions during surgery. Third, IONM should improve patient outcomes when IONM-directed intervention alters the course of surgery. Observational evidence for IONM is growing yet more is required to understand the conditions under which IONM, in its variety of settings, can benefit patients. A multi-center observational cohort study would represent an important initial compromise between the pragmatic difficulties with conducting controlled trials in IONM and the Evidence-Based Medicine (EBM) view that large scale randomized trials are required. Such a cohort study would improve the evidence base and (if justified) provide the rationale for controlled trials. PMID:26268581

  17. EVIDENCEBASED MEDICINE/PRACTICE IN SPORTS PHYSICAL THERAPY

    PubMed Central

    Lehecka, B.J.

    2012-01-01

    A push for the use of evidence‐based medicine and evidence‐based practice patterns has permeated most health care disciplines. The use of evidence‐based practice in sports physical therapy may improve health care quality, reduce medical errors, help balance known benefits and risks, challenge views based on beliefs rather than evidence, and help to integrate patient preferences into decision‐making. In this era of health care utilization sports physical therapists are expected to integrate clinical experience with conscientious, explicit, and judicious use of research evidence in order to make clearly informed decisions in order to help maximize and optimize patient well‐being. One of the more common reasons for not using evidence in clinical practice is the perceived lack of skills and knowledge when searching for or appraising research. This clinical commentary was developed to educate the readership on what constitutes evidence‐based practice, and strategies used to seek evidence in the daily clinical practice of sports physical therapy. PMID:23091778

  18. Evidence for extended age dependent maternal immunity in infected children: mother to child transmission of HIV infection and potential interventions including sulfatides of the human fetal adnexa and complementary or alternative medicines.

    PubMed

    Bhargav, Hemant; Huilgol, Vidya; Metri, Kashinath; Sundell, I Birgitta; Tripathi, Satyam; Ramagouda, Nagaratna; Jadhav, Mahesh; Raghuram, Nagarathna; Ramarao, Nagendra Hongasandra; Koka, Prasad S

    2012-01-01

    The two neighboring southwestern states of India, Karnataka and Maharashtra, have high incidence of HIV/AIDS and are among the six most high prevalence HIV infected states. In Karnataka state, the northern districts of Bagalkot, Belgaum and Bijapur (the three Bs) and in Maharashtra state, the southern districts of Sangli, Satara, and Solapur (the three Ss) are the areas with the highest incidence of HIV/AIDS. We have evaluated the incidence of maternal to child transmission (MTCT) of HIV-1 infection in Belgaum District which is more than 500 kilometers distance by road from the campus in greater Bangalore (Karnataka State). We have obtained the prenatal CD4 counts of HIV infected pregnant mothers. We have also screened the HIV infected children in two orphanages (rehabilitation centres for HIV infected children) in Belgaum District. The clinical conditions of these infected children were assessed for their CD4 counts, anti-retroviral therapy (ART) intake status, outpatient illnesses and body composition. We have observed that there is an influence of the age factor on the CD4 counts of the HIV infected children. Further, in view of the role of our recently found involvement of sulfatide, 3-O- galactosylceramide, in inhibition of HIV-1 replication and enhancement of hematopoiesis which is otherwise inhibited due to such infection, we have discussed the possible role of sulfatides that biologically occur in the fetal adnexa (placentatrophoblasts /amnion/chorion-umbilical cord), in containing HIV infection as a potential safer alternative to the ART regimens currently approved to be clinically practiced. Lastly, we have discussed the complementary and alternative medicine (CAM) therapies such as evidence based yoga and ayurveda as add-on to ART in potential elimination of MTCT of HIV infection. Out of a total of 150 children delivered by HIV infected mothers, 13 children were found to be positive as determined by the dried blood smear (DBS) for virological testing

  19. Creating evidence-based research in adapted physical activity.

    PubMed

    Reid, Greg; Bouffard, Marcel; MacDonald, Catherine

    2012-04-01

    Professional practice guided by the best research evidence is a usually referred to as evidence-based practice. The aim of the present paper is to describe five fundamental beliefs of adapted physical activity practices that should be considered in an 8-step research model to create evidence-based research in adapted physical activity. The five beliefs are individualization, critical thinking, self-determination, program effectiveness, and multifactor complexity. The research model includes conceptualize the problem, conduct research on the process of the problem, conceptualize and specify the intervention, evaluate intervention outcomes, evaluate intervention processes, determine person-by-treatment interactions, determine context-dependent limitations, and investigate factors related to intervention adoption maintenance. The eight steps are explained with reference to two research programs that used a randomized control group design. PMID:22467832

  20. Feedback informed treatment: evidence-based practice meets social construction.

    PubMed

    Tilsen, Julie; McNamee, Sheila

    2015-03-01

    This article explores the challenges presented by the mandate for evidence-based practice for family therapists who identify with the philosophical stance of social construction. The history of psychotherapy outcome research is reviewed, as are current findings that provide empirical evidence for an engaged, dialogic practice. The authors suggest that the binary between empiricism and social construction may be unhinged by understanding empiricism as a particular discursive frame (i.e., a particular way of talking, acting, and being in the world), one of many available as a way of understanding and talking about our work. Through a case vignette, the authors introduce the evidence-based practice of Feedback Informed Treatment as an elaboration of social construction, and as an example of bridging the gap between the discursive frames of empiricism and social construction. PMID:25394600

  1. A framework for disseminating evidence-based health promotion practices.

    PubMed

    Harris, Jeffrey R; Cheadle, Allen; Hannon, Peggy A; Forehand, Mark; Lichiello, Patricia; Mahoney, Eustacia; Snyder, Susan; Yarrow, Judith

    2012-01-01

    Wider adoption of evidence-based, health promotion practices depends on developing and testing effective dissemination approaches. To assist in developing these approaches, we created a practical framework drawn from the literature on dissemination and our experiences disseminating evidence-based practices. The main elements of our framework are 1) a close partnership between researchers and a disseminating organization that takes ownership of the dissemination process and 2) use of social marketing principles to work closely with potential user organizations. We present 2 examples illustrating the framework: EnhanceFitness, for physical activity among older adults, and American Cancer Society Workplace Solutions, for chronic disease prevention among workers. We also discuss 7 practical roles that researchers play in dissemination and related research: sorting through the evidence, conducting formative research, assessing readiness of user organizations, balancing fidelity and reinvention, monitoring and evaluating, influencing the outer context, and testing dissemination approaches. PMID:22172189

  2. Evidence, discovery and justification: the case of evidence-based medicine.

    PubMed

    Gaeta, Rodolfo; Gentile, Nelida

    2016-08-01

    The purpose of this paper is to develop some thoughts on philosophical issues surrounding evidence-based medicine (EBM), especially related to its epistemological dimensions. After considering the scope of several philosophical concepts that are relevant to the discussion, and drawing some distinctions among different aspects of EBM, we evaluate the status of EBM and suggest that EBM is mainly a meta-methodology. Then, we outline an evaluation of the thesis that EBM is a 'new paradigm' in the practice of medicine. We argue that EBM does not seem to have arisen in the way Kuhn imagined paradigms to arise but as a conscious, deliberate proposal, more as programme than as a reality. Furthermore, there is something paradoxical about appealing to evidence or to the best evidence as a way of promoting a new paradigm. For the proposal seems to assume that there is something that by its own virtue is the best evidence for a given time. But this idea would have been rejected by Kuhn. If EBM involves a genuine new alternative in the field of medicine and shows a way in which the discipline will endure henceforth, this indicates that it is not what Kuhn once called a 'paradigm' and even, paradoxically, it is good evidence that scientific paradigms do not exist, at least in medicine. PMID:26200433

  3. Thinking about Complementary and Alternative Medicine

    MedlinePlus

    ... Free Copy This booklet covers: What complementary and alternative medicine is (CAM) is and why people use it The different types of CAM (mind-body methods, biologically based practices, body-based practices, energy medicine, and whole medical systems. How to talk ...

  4. Using Family Paradigms to Improve Evidence-Based Practice

    ERIC Educational Resources Information Center

    Hidecker, Mary Jo Cooley; Jones, Rebecca S.; Imig, David R.; Villarruel, Francisco A.

    2009-01-01

    Purpose: Evidence-based practice (EBP) describes clinical decision making using research, clinical experience, and client values. For family-centered practices, the client's family is integral to this process. This article proposes that using family paradigms, a family science framework, may help elicit and understand client/family values within…

  5. Evidence-Based Library Management: The Leadership Challenge

    ERIC Educational Resources Information Center

    Lakos, Amos

    2007-01-01

    This paper is an extension of the author's earlier work on developing management information services and creating a culture of assessment in libraries. The author will focus observations on the use of data in decision-making in libraries, specifically on the role of leadership in making evidence-based decision a reality, and will review new…

  6. Evidence-Based Practice in Communication Disorders: Progress Not Perfection

    ERIC Educational Resources Information Center

    Kent, Ray D.

    2006-01-01

    Purpose: This commentary is written in response to a companion paper by Nan Bernstein Ratner ("Evidence-Based Practice: An Examination of its Ramifications for the Practice of Speech-Language Pathology"). Method: The comments reflect my experience as Vice President for Research and Technology of the American Speech-Language-Hearing Association…

  7. Evidence-Based Psychotherapy Practice in College Mental Health

    ERIC Educational Resources Information Center

    Cooper, Stewart E.

    2005-01-01

    This lead off article to the special volume on evidence-based psychotherapy (EBP) in college and university counseling and mental health centers presents an overview of the topic and outlines the structure of this publication. A focus on EBP research and practice generally, and in institutions of higher education specifically, is provided for…

  8. Evidence-Based Practice for Treatment of Eating Disorders

    ERIC Educational Resources Information Center

    Resnick, Jaquelyn Liss

    2005-01-01

    The purpose of this chapter is to review the status of evidence-based practice (EBP) for the treatment of students with eating disorders in university and college counseling centers. Several issues affecting the application of the research findings to service delivery for eating disordered students will be addressed. These include discussion of…

  9. The Evidence-Based Reasoning Framework: Assessing Scientific Reasoning

    ERIC Educational Resources Information Center

    Brown, Nathaniel J. S.; Furtak, Erin Marie; Timms, Michael; Nagashima, Sam O.; Wilson, Mark

    2010-01-01

    Recent science education reforms have emphasized the importance of students engaging with and reasoning from evidence to develop scientific explanations. A number of studies have created frameworks based on Toulmin's (1958/2003) argument pattern, whereas others have developed systems for assessing the quality of students' reasoning to support…

  10. Implementing Evidence-Based Programs: Lessons Learned from the Field

    ERIC Educational Resources Information Center

    Powers, Jane; Maley, Mary; Purington, Amanda; Schantz, Karen; Dotterweich, Jutta

    2015-01-01

    Evidence-based programs (EBPs) are used in many health promotion efforts to ensure that the intended positive behavioral and health outcomes will be achieved. However, because EBPs are developed and tested in research settings, the contextual elements of real world implementation play an important role in their successful delivery in communities.…

  11. An Evidence Based Approach to Sepsis: Educational Program

    ERIC Educational Resources Information Center

    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…

  12. Evidence Based Order Sets as a Nursing Care Planning System

    PubMed Central

    LaCrosse, Lisa M.; Heermann, Judith; Azevedo, Karen; Sorrentino, Catherine; Straub, Dawn; O'Dowd, Gloria

    2002-01-01

    The process for developing the nursing care planning (NCP) function for integration into a clinical information system (CIS) will be described. This NCP system uses evidence based order sets or interventions that are specific to a problem with associated patient focused goals or outcomes. The problem, order set, goal framework will eventually be used by all disciplines in the patient focused record.

  13. Fostering Evidence-Based Practice in Nursing Education.

    ERIC Educational Resources Information Center

    Rambur, Betty

    1999-01-01

    Evidence-based nursing practice is impeded by low numbers of baccalaureate nurses, lack of critical perspectives toward research, the volume of information, and conflicting worldviews. Teaching strategies to address the challenge include fostering the ability to question and initiating teacher/student dialog. (SK)

  14. Marketing evidence-based practice: what a CROC™!

    PubMed

    Boyington, Alice R; Ferrall, Sheila M; Sylvanus, Terry

    2010-10-01

    Nurses should be engaged in evidence-based practice (EBP) to ensure that nursing care is efficient and effective. This article describes one cancer center's use of the Marketing Mix framework to educate staff nurses with the CROC™: Clinging Rigidly to Outdated Care campaign. As a result of the campaign, five EBP projects have been initiated in the cancer center. PMID:20880823

  15. Evidence-Based Practices in Outpatient Treatment for Eating Disorders

    ERIC Educational Resources Information Center

    Schaffner, Angela D.; Buchanan, Linda Paulk

    2010-01-01

    This study examined the current issues relevant to implementing evidence-based practices in the context of outpatient treatment for eating disorders. The study also examined the effectiveness of an outpatient treatment program for eating disorders among a group of 196 patients presenting with anorexia nervosa, bulimia nervosa, or eating disorder…

  16. Evidence-Based Practices and Implementation Science in Special Education

    ERIC Educational Resources Information Center

    Cook, Bryan G.; Odom, Samuel L.

    2013-01-01

    Establishing a process for identifying evidence-based practices (EBPs) in special education has been a significant advance for the field because it has the potential for generating more effective educational programs and producing more positive outcomes for students with disabilities. However, the potential benefit of EBPs is bounded by the…

  17. Evidence-Based Kernels: Fundamental Units of Behavioral Influence

    ERIC Educational Resources Information Center

    Embry, Dennis D.; Biglan, Anthony

    2008-01-01

    This paper describes evidence-based kernels, fundamental units of behavioral influence that appear to underlie effective prevention and treatment for children, adults, and families. A kernel is a behavior-influence procedure shown through experimental analysis to affect a specific behavior and that is indivisible in the sense that removing any of…

  18. Evidence-Based Practice Empowers Practitioners: A Response to Epstein

    ERIC Educational Resources Information Center

    Rubin, Allen

    2015-01-01

    Epstein makes a strong argument for the value of clinical data mining (CDM), although he minimizes some of the potential limitations in that methodology, such as attrition. Epstein's portrayal of evidence-based practice (EBP) as practitioner-bashing and treasuring intervention manuals overlooks the emphasis in the EBP process on the need for…

  19. Evidence-Based Rehabilitation Counseling Practice: A Pedagogical Imperative

    ERIC Educational Resources Information Center

    Kosciulek, John F.

    2010-01-01

    This article describes how rehabilitation educators can aid students and practitioners in learning about and engaging in evidence-based rehabilitation counseling practice (EBRCP). Information describing (a) the definition and rationale for EBRCP, (b) controversies surrounding EBRCP, (c) facilitating rehabilitation counselor enthusiasm for EBRCP,…

  20. Implementing evidence-based practice during an economic downturn.

    PubMed

    Beck, Mary S; Staffileno, Beth A

    2012-01-01

    Building a sustainable evidence-based practice (EBP) infrastructure during times of financial constraints poses challenges for nurse leaders. To be successful, plans need to be creative and adaptive, while mindful of limited resources. This commentary describes change management strategies used to implement an EBP infrastructure at a hospital after organizational restructuring occurred. PMID:22832408

  1. Evidence-Based Youth Psychotherapy in the Mental Health Ecosystem

    ERIC Educational Resources Information Center

    Weisz, John R.; Ugueto, Ana M.; Cheron, Daniel M.; Herren, Jenny

    2013-01-01

    Five decades of randomized trials research have produced dozens of evidence-based psychotherapies (EBPs) for youths. The EBPs produce respectable effects in traditional efficacy trials, but the effects shrink markedly when EBPs are tested in practice contexts with clinically referred youths and compared to usual clinical care. We considered why…

  2. Critical Thinking: Knowledge and Skills for Evidence-Based Practice

    ERIC Educational Resources Information Center

    Finn, Patrick

    2011-01-01

    Purpose: I respond to Kamhi's (2011) conclusion in his article "Balancing Certainty and Uncertainty in Clinical Practice" that rational or critical thinking is an essential complement to evidence-based practice (EBP). Method: I expand on Kamhi's conclusion and briefly describe what clinicians might need to know to think critically within an EBP…

  3. Evidence-Based Interprofessional Practice: Learning and Behaviour

    ERIC Educational Resources Information Center

    Littek, Celeste

    2013-01-01

    The purpose of this journal article is to investigate evidence-based practice (EBP) or He Ritenga Whaimohio, as one of the seven principles outlined in the "Resource Teacher: Learning and Behaviour (RTLB) Toolkit" (2011) that guides RTLB practice; and to critique the principle of EBP through practical reflection. (Contains 2 tables and 2…

  4. Disseminating Evidence-Based Practices in Secondary Transition

    ERIC Educational Resources Information Center

    Mustian, April; Mazzotti, Valerie L.; Test, David W.

    2013-01-01

    As educators move into a new era of educational reform, it becomes imperative that teachers use evidence-based instructional practices shown to be effective for students with disabilities. One area that plays a role in this process is secondary transition. The National Secondary Transition Technical Assistance Center has identified 63…

  5. Organizing for Evidence-Based Decision Making and Improvement

    ERIC Educational Resources Information Center

    Leimer, Christina

    2012-01-01

    In today's accountability climate, regional accrediting bodies are requiring colleges and universities to develop and sustain a culture of evidence-based decision making and improvement. But two-thirds of college presidents in a 2011 "Inside Higher Ed" survey said their institutions are not particularly strong at using data for making decisions.…

  6. Evidence-Based Practices in Special Education: Some Practical Considerations

    ERIC Educational Resources Information Center

    Cook, Bryan G.; Tankersley, Melody; Cook, Lysandra; Landrum, Timothy J.

    2008-01-01

    A major tenet of both the Individuals with Disabilities Education Act and the No Child Left Behind Act is the identification and use of evidence-based practices, or those instructional techniques shown by research as most likely to improve student outcomes meaningfully. However, much confusion exists regarding the meaning and potential…

  7. Unraveling Evidence-Based Practices in Special Education

    ERIC Educational Resources Information Center

    Cook, Bryan G.; Cook, Sara Cothren

    2013-01-01

    Evidence-based practices (EBPs) are instructional techniques that meet prescribed criteria related to the research design, quality, quantity, and effect size of supporting research, which have the potential to help bridge the research-to-practice gap and improve student outcomes. In this article, the authors (a) discuss the importance of clear…

  8. Urticaria: an evidence-based update. Conference report.

    PubMed

    Alexandroff, A B; Harman, K E

    2010-08-01

    Summary Evidence-based update meetings are held annually by the Centre of Evidence Based Dermatology, University of Nottingham. Topics are chosen by delegates at the previous year's conference and in the past have included blistering disorders, psoriasis, hair disorders and skin cancers. Once the topic is identified, a trials database search is undertaken with the aim of including speakers who are actively involved in trials that address the subject in question. This year, the eighth Evidence Based Update meeting focused on urticaria and took place in Loughborough University on 14 May 2009. The latest data on the diagnosis and management of acute and chronic urticaria, including cold and solar urticaria, and the impact of food intolerance on chronic urticaria, were presented by an international panel of renowned speakers, who sometimes expressed different viewpoints. The highlights of the meeting included an informal atmosphere, an international perspective, and a practical question and answer session. Over 70% of the delegates stated that they would be changing their clinical practice following on from the meeting. The evidence-based update meeting in 2010 will be devoted to eczema. PMID:20666769

  9. Single-Subject Experimental Design for Evidence-Based Practice

    ERIC Educational Resources Information Center

    Byiers, Breanne J.; Reichle, Joe; Symons, Frank J.

    2012-01-01

    Purpose: Single-subject experimental designs (SSEDs) represent an important tool in the development and implementation of evidence-based practice in communication sciences and disorders. The purpose of this article is to review the strategies and tactics of SSEDs and their application in speech-language pathology research. Method: The authors…

  10. Interteaching: An Evidence-Based Approach to Instruction

    ERIC Educational Resources Information Center

    Brown, Thomas Wade; Killingsworth, Kenneth; Alavosius, Mark P.

    2014-01-01

    This paper describes "interteaching" as an evidence-based method of instruction. Instructors often rely on more traditional approaches, such as lectures, as means to deliver instruction. Despite high usage, these methods are ineffective at achieving desirable academic outcomes. We discuss an innovative approach to delivering instruction…

  11. Evidence-Based Practice in Adapted Physical Education

    ERIC Educational Resources Information Center

    Jin, Jooyeon; Yun, Joonkoo

    2010-01-01

    Although implementation of evidence-based practice (EBP) has been strongly advocated by federal legislation as well as school districts in recent years, the concept has not been well accepted in adapted physical education (APE), perhaps due to a lack of understanding of the central notion of EBP. The purpose of this article is to discuss how APE…

  12. Validation of the Evidence-Based Practice Process Assessment Scale

    ERIC Educational Resources Information Center

    Rubin, Allen; Parrish, Danielle E.

    2011-01-01

    Objective: This report describes the reliability, validity, and sensitivity of a scale that assesses practitioners' perceived familiarity with, attitudes of, and implementation of the evidence-based practice (EBP) process. Method: Social work practitioners and second-year master of social works (MSW) students (N = 511) were surveyed in four sites…

  13. Evidence-Based Practices Project for Suicide Prevention

    ERIC Educational Resources Information Center

    Rodgers, Philip L.; Sudak, Howard S.; Silverman, Morton M.; Litts, David A.

    2007-01-01

    Suicide continues to be a serious public health problem. In response to this problem, a myriad of suicide prevention programs have been developed and employed across the United States. Unfortunately, the effectiveness of many of these programs is unknown because they have not been evaluated using rigorous methods. The Evidence-Based Practices…

  14. Toward an Evidence-Based Assessment of Pediatric Bipolar Disorder

    ERIC Educational Resources Information Center

    Youngstrom, Eric A.; Findling, Robert L.; Kogos Youngstrom, Jen; Calabrese, Joseph R.

    2005-01-01

    This article outlines a provisional evidence-based approach to the assessment of pediatric bipolar disorder (PBD). Public attention to PBD and the rate of diagnosis have both increased substantially in the past decade. Accurate diagnosis is crucial to avoid harm due to mislabeling or unnecessary medication exposure. Because there are no proven…

  15. Evidence-Based Psychosocial Treatments for Ethnic Minority Youth

    ERIC Educational Resources Information Center

    Huey, Stanley J., Jr.; Polo, Antonio J.

    2008-01-01

    This article reviews research on evidence-based treatments (EBTs) for ethnic minority youth using criteria from Chambless et al. (1998), Chambless et al. (1996), and Chambless and Hollon (1998). Although no "well-established" treatments were identified, "probably efficacious" or "possibly efficacious" treatments were found for ethnic minority…

  16. Evidence Based Education Request Desk. EBE #833A

    ERIC Educational Resources Information Center

    Regional Educational Laboratory Southeast, 2011

    2011-01-01

    Over the past decade, research on dropout prevention has become focused on using evidence-based practice, and data-driven decisions, to mitigate students' dropping out of high school and instead, support and prepare students for career and college. Early warning systems or on-track indicators, in which readily available student-level data are used…

  17. Modeling Sensor Reliability in Fault Diagnosis Based on Evidence Theory

    PubMed Central

    Yuan, Kaijuan; Xiao, Fuyuan; Fei, Liguo; Kang, Bingyi; Deng, Yong

    2016-01-01

    Sensor data fusion plays an important role in fault diagnosis. Dempster–Shafer (D-R) evidence theory is widely used in fault diagnosis, since it is efficient to combine evidence from different sensors. However, under the situation where the evidence highly conflicts, it may obtain a counterintuitive result. To address the issue, a new method is proposed in this paper. Not only the statistic sensor reliability, but also the dynamic sensor reliability are taken into consideration. The evidence distance function and the belief entropy are combined to obtain the dynamic reliability of each sensor report. A weighted averaging method is adopted to modify the conflict evidence by assigning different weights to evidence according to sensor reliability. The proposed method has better performance in conflict management and fault diagnosis due to the fact that the information volume of each sensor report is taken into consideration. An application in fault diagnosis based on sensor fusion is illustrated to show the efficiency of the proposed method. The results show that the proposed method improves the accuracy of fault diagnosis from 81.19% to 89.48% compared to the existing methods. PMID:26797611

  18. Modeling Sensor Reliability in Fault Diagnosis Based on Evidence Theory.

    PubMed

    Yuan, Kaijuan; Xiao, Fuyuan; Fei, Liguo; Kang, Bingyi; Deng, Yong

    2016-01-01

    Sensor data fusion plays an important role in fault diagnosis. Dempster-Shafer (D-R) evidence theory is widely used in fault diagnosis, since it is efficient to combine evidence from different sensors. However, under the situation where the evidence highly conflicts, it may obtain a counterintuitive result. To address the issue, a new method is proposed in this paper. Not only the statistic sensor reliability, but also the dynamic sensor reliability are taken into consideration. The evidence distance function and the belief entropy are combined to obtain the dynamic reliability of each sensor report. A weighted averaging method is adopted to modify the conflict evidence by assigning different weights to evidence according to sensor reliability. The proposed method has better performance in conflict management and fault diagnosis due to the fact that the information volume of each sensor report is taken into consideration. An application in fault diagnosis based on sensor fusion is illustrated to show the efficiency of the proposed method. The results show that the proposed method improves the accuracy of fault diagnosis from 81.19% to 89.48% compared to the existing methods. PMID:26797611

  19. Evidence-based medicine and the reconfiguration of medical knowledge.

    PubMed

    Timmermans, Stefan; Kolker, Emily S

    2004-01-01

    Over the past decade, different parties in the health care field have developed and disseminated clinical practice guidelines as part of evidence-based medicine. These formal tools based on a scientific evaluation of the research literature purport to tell health care professionals how to practice medicine. Because clinical practice guidelines shift the knowledge base in the health care field through standardization, they remain controversial within and outside medicine. In this paper, we evaluate the predictive accuracy of four medical professionalization theories--functionalism, Freidson's theory of professional dominance, deprofessionalization theory, and the theory of countervailing powers--to account for (1) the shift from pathophysiology to epidemiology with guidelines, (2) the creation of practice guidelines, and (3) the effects of clinical practice guidelines on the autonomy of health professionals. In light of the mixed predictive record of professionalization theories, we conclude with a need for "evidence-based sociology" and a recalibration of basic premises underlying professionalization theories. PMID:15779473

  20. An Evidence-Based Combining Classifier for Brain Signal Analysis

    PubMed Central

    Kheradpisheh, Saeed Reza; Nowzari-Dalini, Abbas; Ebrahimpour, Reza; Ganjtabesh, Mohammad

    2014-01-01

    Nowadays, brain signals are employed in various scientific and practical fields such as Medical Science, Cognitive Science, Neuroscience, and Brain Computer Interfaces. Hence, the need for robust signal analysis methods with adequate accuracy and generalizability is inevitable. The brain signal analysis is faced with complex challenges including small sample size, high dimensionality and noisy signals. Moreover, because of the non-stationarity of brain signals and the impacts of mental states on brain function, the brain signals are associated with an inherent uncertainty. In this paper, an evidence-based combining classifiers method is proposed for brain signal analysis. This method exploits the power of combining classifiers for solving complex problems and the ability of evidence theory to model as well as to reduce the existing uncertainty. The proposed method models the uncertainty in the labels of training samples in each feature space by assigning soft and crisp labels to them. Then, some classifiers are employed to approximate the belief function corresponding to each feature space. By combining the evidence raised from each classifier through the evidence theory, more confident decisions about testing samples can be made. The obtained results by the proposed method compared to some other evidence-based and fixed rule combining methods on artificial and real datasets exhibit the ability of the proposed method in dealing with complex and uncertain classification problems. PMID:24392125

  1. [QuEChERS-based extraction procedure and rapid resolution liquid chromatography coupled to triple quadrupole mass spectrometry for the determination of nine mycotoxins in cereal-based complementary foods for infants and young children].

    PubMed

    Hu, Wenyan; Xu, Lei; Yang, Jun; Ling, Rui

    2014-02-01

    A rapid method has been developed for the determination of aflatoxins B1, B2, G1 and G2, ochratoxin A, zearalenone, T-2 toxin, deoxynivalenol and fumonisin B1 in cereal-based complementary foods for infants and young children. The mycotoxins were extracted from the samples using a modified QuEChERS-based extraction procedure without any further clean-up step. The separation of the analytes was carried out on an Agilent XDB C18 column (50 mm x 2.1 mm, 1.8 microm) using the mobile phases of acetonitrile and 5 mmol/L ammonium acetate-0.1% (volume percentage) formic acid aqueous solution with gradient elution. The extract was determined by rapid resolution liquid chromatography-tandem mass spectrometry. Matrix-matched calibration was used for the quantification. The proposed method showed good linear correlation with the correlation coefficients all above 0.98. The blank samples were fortified at three levels, and the recoveries ranged from 77.6% to 105.7% with the RSDs from 2.5% to 13.7%. The limits of detection ranged from 0.1 microg/kg to 15.8 microg/kg. The developed method was successfully applied for mycotoxin analysis in 41 samples bought from markets. The method shows advantages in both accuracy and sensitivity, and is suitable for the rapid multi-aflatoxin screening in cereal-based complementary foods for infants and young children. PMID:24822446

  2. An Evidence Base for Human Spaceflight Risks in Wikipedia

    NASA Technical Reports Server (NTRS)

    Kundrot, Craig; Steil, Jennifer; Lumpkins, Sarah; Pellis, Neal

    2013-01-01

    NASA's Human Research Program (HRP) is focused on understanding and mitigating thirty two risks to crew health and performance in exploration missions beyond low Earth orbit. The HRP has developed an evidence report for each of the risks. Most evidence reports are a brief review article describing the evidence related to a specified risk, written at a level appropriate for the scientifically educated, non-specialist reader. Each evidence report captured the current state of knowledge from both research and operations. Two limitations of the evidence reports have become apparent: 1) they are updated infrequently and 2) they do not take full advantage of the expertise available in other space agencies and in related fields of terrestrial research. Therefore, the HRP is experimenting with the use of Wikipedia articles as a repository for evidence. Wikipedia's accessibility to the international space flight community and researchers in related terrestrial fields creates the opportunity to generate a more timely and comprehensive evidence base. Initial Wikipedia articles were populated for seven risks using a subset of the information in the HRP-approved evidence reports: Fatigue and Sleep Loss, Treating An Ill or Injured Crew Member, Radiation Carcinogenesis, Visual Impairment and Intracranial Pressure, Renal Stone Formation, Team Cohesion, and Intervertebral Disc Damage. Since the initial articles were created, there have been additions to these Wikipedia articles, including content from sources outside the HRP, and editorial changes to the pages. We will report on the nature of the contributions made after the initial articles were created, the comprehensiveness of the resulting Wikipedia articles, and the effort required to maintain quality control of the content. The Wikipedia approach will also be compared to wiki efforts that exert more traditional editorial control of content prior to posting.

  3. Global health: the importance of evidence-based medicine

    PubMed Central

    2013-01-01

    Global health is a varied field that comprises research, evaluation and policy that, by its definition, also occurs in disparate locations across the world. This forum article is introduced by our guest editor of the Medicine for Global Health article collection, Gretchen Birbeck. Here, experts based across different settings describe their personal experiences of global health, discussing how evidence-based medicine in resource-limited settings can be translated into improved health outcomes. PMID:24228722

  4. Use of complementary and alternative medicine by those with a chronic disease and the general population - results of a national population based survey

    PubMed Central

    2010-01-01

    Background The use of complementary and alternative medicine (CAM) is becoming more common, but population-based descriptions of its patterns of use are lacking. This study aimed to determine the prevalence of CAM use in the general population and for those with asthma, diabetes, epilepsy and migraine. Methods Data from cycles 1.1, 2.1 and 3.1 of the Canadian Community Health Survey (CCHS) were used for the study. The CCHS is a national cross-sectional survey administered to 400,055 Canadians aged ≥12 between 2001-2005. Self-reported information about professionally diagnosed health conditions was elicited. CCHS surveys use a multistage stratified cluster design to randomly select a representative sample of Canadian household residents. Descriptive data on the utilization of CAM services was calculated and logistic regression was used to determine what sociodemographic factors predict CAM use. Results Weighted estimates show that 12.4% (95% Confidence Interval (CI): 12.2-12.5) of Canadians visited a CAM practitioner in the year they were surveyed; this rate was significantly higher for those with asthma 15.1% (95% CI: 14.5-15.7) and migraine 19.0% (95% CI: 18.4-19.6), and significantly lower for those with diabetes 8.0% (95% CI: 7.4-8.6) while the rate in those with epilepsy (10.3%, 95% CI: 8.4-12.2) was not significantly different from the general population. Conclusion A large proportion of Canadians use CAM services. Physicians should be aware that their patients may be accessing other services and should be prepared to ask and answer questions about the risks and benefits of CAM services in conjunction with standard medical care. PMID:20955609

  5. Utilization Patterns of Conventional and Complementary/Alternative Treatments in Children with Autism Spectrum Disorders and Developmental Disabilities in a Population-Based Study

    PubMed Central

    Akins, CDR Roger Scott; Krakowiak, Paula; Angkustsiri, Kathleen; Hertz-Picciotto, Irva; Hansen, Robin L.

    2014-01-01

    Objective This study compared the utilization of conventional treatments to utilization of complementary and alternative medicine (CAM) in preschoolers with autism spectrum disorders (ASD) and other developmental disabilities (DD). Methods Participants were 578 children who were part of an ongoing population-based, case-control study of 2 to 5 year-olds with ASD, DD, and the general population. Parents completed an interview on past and current services. Results Four hundred fifty-three children with ASD and 125 DD children were included. ASD families received more hours of conventional services compared to DD (17.8 vs. 11; p<0.001). The use of psychotropic medications was low in both groups (~3%). CAM use overall was not significantly different in ASD (39%) versus DD (30%). Hispanic families in both groups used CAM less often than non-Hispanics. Variables such as level of function, immunization status, and presence of an identified neurogenetic disorder were not predictive of CAM use. A higher level of parental education was associated with increased CAM use in ASD and DD. Families who utilized >20 hours per week of conventional services were more likely to use CAM, including potentially unsafe or disproven CAM. Under-immunized children were marginally more likely to use CAM, but not more likely to have received potentially unsafe or disproven CAM. Conclusion CAM use is common in families of young children with neurodevelopmental disorders and is predicted by higher parental education and non-Hispanic ethnicity but not developmental characteristics. Further research should address how healthcare providers can support families in making decisions about CAM use. PMID:24399100

  6. Evaluation of Evidence-Based Nursing Pain Management Practice

    PubMed Central

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

    2014-01-01

    Background It is important to ensure that cancer pain management is based on the best evidence. Nursing evidence-based pain management can be examined through an evaluation of pain documentation. Aims This study aimed to (a) modify and test an evaluation tool for nursing cancer pain documentation, and (b) describe the frequency and quality of nursing pain documentation in one oncology unit via electronic medical system. Design and Setting A descriptive cross-sectional design was used for this study at an oncology unit of an academic medical center in the Pacific Northwest. Methods Medical records were examined for 37 adults hospitalized during April and May of 2013. Nursing pain documentations (N = 230) were reviewed using an evaluation tool modified from the Cancer Pain Practice Index to consist of 13 evidence-based pain management indicators, including pain assessment, care plan, pharmacologic and nonpharmacologic interventions, monitoring and treatment of analgesic side effects, communication with physicians, and patient education. Individual nursing documentation was assigned a score from 0 (worst possible) to 13 (best possible), to reflect the delivery of evidence-based pain management. Results The participating nurses documented 90% of the recommended evidence-based pain management indicators. Documentation was suboptimal for pain reassessment, pharmacologic interventions, and bowel regimen. Conclusions The study results provide implications for enhancing electronic medical record design and highlight a need for future research to understand the reasons for suboptimal nursing documentation of cancer pain management. For the future use of the data evaluation tool, we recommend additional modifications according to study settings. PMID:26256215

  7. Music therapy with disorders of consciousness: current evidence and emergent evidence-based practice.

    PubMed

    Magee, Wendy L; O'Kelly, Julian

    2015-03-01

    Patients with prolonged disorders of consciousness (PDOC) stemming from acquired brain injury present one of the most challenging clinical populations in neurological rehabilitation. Because of the complex clinical presentation of PDOC patients, treatment teams are confronted with many medicolegal, ethical, philosophical, moral, and religious issues in day-to-day care. Accurate diagnosis is of central concern, relying on creative approaches from skilled clinical professionals using combined behavioral and neurophysiological measures. This paper presents the latest evidence for using music as a diagnostic tool with PDOC, including recent developments in music therapy interventions and measurement. We outline standardized clinical protocols and behavioral measures to produce diagnostic outcomes and examine recent research illustrating a range of benefits of music-based methods at behavioral, cardiorespiratory, and cortical levels using video, electrocardiography, and electroencephalography methods. These latest developments are discussed in the context of evidence-based practice in rehabilitation with clinical populations. PMID:25773642

  8. Assessing spatiotemporal variation in actual evapotranspiration for semi-arid watersheds in northwest China: Evaluation of two complementary-based methods

    NASA Astrophysics Data System (ADS)

    Matin, Mir A.; Bourque, Charles P.-A.

    2013-04-01

    SummaryWater vapor generated locally by actual evapotranspiration (AET) is important both to the recycling of water regionally and to the long term sustainability of desert-oases in the semi-arid-to-arid region of northwest (NW) China. An accurate assessment of AET is central to describing the hydrologic status of watersheds. Conventional methods of estimating AET from meteorological point data are generally not appropriate for regions with high spatial variability, particularly with respect to landcover and topography. Insufficient monitoring stations make it particularly difficult to estimate AET that is spatially representative of large areas. The objective of this study was to estimate spatially-distributed monthly AET for a complex landscape, consisting of deserts, oases, and mountains, with climate and landcover data generated primarily from remote sensing (RS) data. In this study, we used two complementary relationship (CR)-based methods to estimate monthly reference evapotranspiration (ETo) and AET over a 10-year period (2000-2009) for two large watersheds in NW China. In evaluating the performance of CR-based methods, we compared point-estimates of ETo and AET generated with the two methods (generated either by using climate-station data or by extracting point-estimates from end products produced from RS-data) against (i) climate-station-based estimates of ETo calculated with the FAO Penman-Monteith (P-M) equation and from pan-evaporation data, and (ii) geographically-corresponding point-estimates of AET extracted from the MODIS global product of AET (MOD16) recently developed by Mu et al. (2011, Remote Sensing of Environment, 115, 1781-1800). Point-extractions of AET from MOD16-products were the least representative, when compared to ETo and AET calculated with the other methods. Between CR-based methods, the Venturini et al. (2008, Remote Sensing of Environment, 112, 132-141) method provided the best comparison with ETo calculated with the P-M equation

  9. eEvidence: Information Seeking Support for Evidence-based Practice: An Implementation Case Study

    PubMed Central

    Zhao, Jin; Kan, Min-Yen; Procter, Paula M.; Zubaidah, Siti; Yip, Wai Kin; Li, Goh Mien

    2010-01-01

    We propose to collect freely available articles from the web to build an evidence-based practice resource collection with up-to-date coverage, and then apply automated classification and key information extraction on the collected articles to provide means for sounder relevance judgments. We implement these features into a dual-interface system that allows users to choose between an active or passive information seeking process depending on the amount of time available. PMID:21347115

  10. Evidence-based medicine meets goal-directed health care.

    PubMed

    Mold, James W; Hamm, Robert; Scheid, Dewey

    2003-05-01

    Evidence-based medicine and goal-directed, patient-centered health care seem, at times, like parallel universes, though, at a conceptual level, they are perfectly compatible. Part of the problem is that many of the kinds of information required for decision making in primary care are often unavailable or difficult to find. Several case examples are used to illustrate this problem, and reasons and solutions are suggested. The goal-directed health care model could be helpful for directing the search for evidence that is relevant to the decisions that patients and their primary care physicians must make on a regular basis. PMID:12772939

  11. Evidence-based clinical practice for the neurointerventionalist.

    PubMed

    Hirsch, Joshua A; Turk, Aquilla S; Mocco, J; Fiorella, David J; Jayaraman, Mahesh V; Meyers, Phillip M; Yoo, Albert J; Manchikanti, Laxmaiah

    2015-03-01

    The field of neurointerventional (NI) surgery has developed in the context of technologic innovation. Many treatments readily provided in 2014 would have been hard to imagine as recently as 10 years ago. The reality of present day NI care is that, while providers, payors, policy makers and patients rely on evidence to guide NI decision-making, the available data are often less robust than participants might desire. In this paper we will explore the fundamentals of evidence-based clinical practice. PMID:24578482

  12. Evidence-based management of developmental dysplasia of the hip.

    PubMed

    Cooper, Anthony Philip; Doddabasappa, Siddesh Nandi; Mulpuri, Kishore

    2014-07-01

    Developmental Dysplasia of the Hip (DDH) refers to a spectrum of abnormalities involving the developing hip. These abnormalities range from mild instability to frank dislocation of the joint. It is important to treat the condition effectively in order to encourage the hip to develop normally and produce good long-term results. This article reviews the evidence related to the treatment of DDH. The quality of evidence for DDH management remains low, with little uniformity in terminology and most studies being retrospective in nature. Given this, it is not possible to recommend or reject most treatment modalities based on existing studies. PMID:24975762

  13. Evidence-based Medicine Search: a customizable federated search engine

    PubMed Central

    Bracke, Paul J.; Howse, David K.; Keim, Samuel M.

    2008-01-01

    Purpose: This paper reports on the development of a tool by the Arizona Health Sciences Library (AHSL) for searching clinical evidence that can be customized for different user groups. Brief Description: The AHSL provides services to the University of Arizona's (UA's) health sciences programs and to the University Medical Center. Librarians at AHSL collaborated with UA College of Medicine faculty to create an innovative search engine, Evidence-based Medicine (EBM) Search, that provides users with a simple search interface to EBM resources and presents results organized according to an evidence pyramid. EBM Search was developed with a web-based configuration component that allows the tool to be customized for different specialties. Outcomes/Conclusion: Informal and anecdotal feedback from physicians indicates that EBM Search is a useful tool with potential in teaching evidence-based decision making. While formal evaluation is still being planned, a tool such as EBM Search, which can be configured for specific user populations, may help lower barriers to information resources in an academic health sciences center. PMID:18379665

  14. How Quality Improvement Practice Evidence Can Advance the Knowledge Base.

    PubMed

    OʼRourke, Hannah M; Fraser, Kimberly D

    2016-01-01

    Recommendations for the evaluation of quality improvement interventions have been made in order to improve the evidence base of whether, to what extent, and why quality improvement interventions affect chosen outcomes. The purpose of this article is to articulate why these recommendations are appropriate to improve the rigor of quality improvement intervention evaluation as a research endeavor, but inappropriate for the purposes of everyday quality improvement practice. To support our claim, we describe the differences between quality improvement interventions that occur for the purpose of practice as compared to research. We then carefully consider how feasibility, ethics, and the aims of evaluation each impact how quality improvement interventions that occur in practice, as opposed to research, can or should be evaluated. Recommendations that fit the evaluative goals of practice-based quality improvement interventions are needed to support fair appraisal of the distinct evidence they produce. We describe a current debate on the nature of evidence to assist in reenvisioning how quality improvement evidence generated from practice might complement that generated from research, and contribute in a value-added way to the knowledge base. PMID:27584696

  15. Evidence-based treatment of patients with rectal cancer

    PubMed Central

    ZHANG, QIANG; YANG, JIE; QIAN, QUN

    2016-01-01

    Rectal cancer is a worldwide disease whose incidence has increased significantly. Evidence-based medicine is a category of medicine that optimizes decision making by using evidence from well-designed and conducted research. Evidence-based medicine can be used to formulate a reasonable treatment plan for newly diagnosed rectal cancer patients. The current review focuses on the application of evidence-based treatment on patients with rectal cancer. The relationship between perioperative blood transfusion and recurrence of rectal cancer after surgery, the selection between minimally invasive laparoscopic surgery and traditional laparotomy, choice of chemotherapy for patients with rectal cancer prior to surgery, selection between stapled and hand-sewn methods for colorectal anastomosis during rectal cancer resection, and selection between temporary ileostomy and colostomy during the surgery were addressed. Laparoscopy is considered to have more advantages but is time-consuming and has high medical costs. In addition, laparoscopic rectal cancer radical resection is preferred to open surgery. In radical resection surgery, use of a stapling device for anastomosis can reduce postoperative anastomotic fistula, although patients should be informed of possible anastomotic stenosis. PMID:26998054

  16. The Notion of Evidence in Evidence-Based Practice by the Nursing Philosophy Working Group.

    ERIC Educational Resources Information Center

    Romyn, Donna M.; Allen, Marion N.; Boschma, Geertje; Duncan, Susan M.; Edgecombe, Nancy; Jensen, Louise A.; Ross-Kerr, Janet C.; Marck, Patricia; Salsali, Mahvash; Tourangeau, Ann E.; Warnock, Fay

    2003-01-01

    Addresses these questions: To what end is evidence sought? What is the nature of evidence? What kinds of evidence are valued by the nursing profession? and What kinds of evidence should underlie clinical decision making? (Contains 28 references.) (SK)

  17. Developing evidence-based immunization recommendations and GRADE.

    PubMed

    Duclos, P; Durrheim, D N; Reingold, A L; Bhutta, Z A; Vannice, K; Rees, H

    2012-12-17

    The Strategic Group of Advisory Experts (SAGE) on immunization is an independent advisory committee with a mandate to advise the World Health Organization (WHO) on the development of vaccine and immunization related policies. SAGE working groups are established on a time-limited basis to review and provide evidence-based recommendations, together with their implications, for open deliberation and decision-making by SAGE. In making its recommendations, SAGE takes into consideration: the epidemiologic and clinical characteristics of the disease; vaccine and immunization characteristics; economic analysis; health system considerations; the existence of and interaction with other intervention and control strategies; costing and social impacts; and legal and ethical concerns. Since 1998, WHO has produced evidence-based vaccine position papers for use primarily by national public health officials and immunization programme managers. Since April 2006 all new or updated position papers have been based on SAGE recommendations. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach has been adopted by WHO and, since 2008, GRADE tables that rate the quality of evidence have been produced in support of key recommendations. SAGE previously expressed concern that GRADE was not ideally suited to many immunization-specific issues such as the vaccine population level effect and the inclusion of surveillance system data, particularly for vaccine safety. Extensive productive interactions with various advisory groups including the US Advisory Committee on Immunization Practices, the European Centres for Disease Control, the German Standing Committee on Vaccination (STIKO), WHO's Global Advisory Committee on Vaccine Safety and the GRADE working group resulted in key enhancements to accommodate vaccine-relevant evidence. This facilitated integration and acceptability of the GRADE approach in the development of immunization related SAGE and WHO

  18. An evidence-based review of dental matrix systems.

    PubMed

    Owens, Barry M; Phebus, Jeffrey G

    2016-01-01

    The restoration of proximal surface cavities, originating from Class II carious lesions, to "normal" anatomical specifications is a fundamental objective for the dental practitioner. Cognitive interpretation of tooth morphology attained from evidence-based resources, together with the necessary psychomotor skills for correct design and completion, are considered essential strategies for restoration success. Also, the visualization of the original tooth structure, if present, should substantially benefit the dentist in the creation of a clinically satisfactory restoration. The purpose of this evidence-based review is to define the cause and effect of decisions based on optimum treatment standards of care for the patient. The concepts of form and function, as related to the oral environment, and the consequences of unsatisfactory dental restorative care will be scrutinized. This article will identify and explain the different challenges and solutions for restoration of dental proximal lesions and provide an overview of past, present, and future procedures. PMID:27599285

  19. Evidence-Based Assessment of Obsessive-Compulsive Disorder.

    PubMed

    Rapp, Amy M; Bergman, R Lindsay; Piacentini, John; McGuire, Joseph F

    2016-01-01

    Obsessive-compulsive disorder (OCD) is a neuropsychiatric illness that often develops in childhood, affects 1%-2% of the population, and causes significant impairment across the lifespan. The first step in identifying and treating OCD is a thorough evidence-based assessment. This paper reviews the administration pragmatics, psychometric properties, and limitations of commonly used assessment measures for adults and youths with OCD. This includes diagnostic interviews, clinician-administered symptom severity scales, self-report measures, and parent/child measures. Additionally, adjunctive measures that assess important related factors (ie, impairment, family accommodation, and insight) are also discussed. This paper concludes with recommendations for an evidence-based assessment based on individualized assessment goals that include generating an OCD diagnosis, determining symptom severity, and monitoring treatment progress. PMID:27594793

  20. Evidence-Based Assessment of Obsessive–Compulsive Disorder

    PubMed Central

    Rapp, Amy M.; Bergman, R. Lindsay; Piacentini, John; McGuire, Joseph F.

    2016-01-01

    Obsessive–compulsive disorder (OCD) is a neuropsychiatric illness that often develops in childhood, affects 1%–2% of the population, and causes significant impairment across the lifespan. The first step in identifying and treating OCD is a thorough evidence-based assessment. This paper reviews the administration pragmatics, psychometric properties, and limitations of commonly used assessment measures for adults and youths with OCD. This includes diagnostic interviews, clinician-administered symptom severity scales, self-report measures, and parent/child measures. Additionally, adjunctive measures that assess important related factors (ie, impairment, family accommodation, and insight) are also discussed. This paper concludes with recommendations for an evidence-based assessment based on individualized assessment goals that include generating an OCD diagnosis, determining symptom severity, and monitoring treatment progress. PMID:27594793

  1. Evidence-based orthopedic surgery: is it possible?

    PubMed

    Suk, Michael; Hanson, Beate; Helfet, David L

    2010-04-01

    The promise of evidence-based medicine is to integrate the highest levels of clinical data with patient outcomes. After framing the question and identifying appropriate studies, evaluating their relevance to clinical practice is highly dependent on the instruments and measures selected to demonstrate outcomes. Currently, there are hundreds of outcomes measures available in the orthopedic literature evaluating these treatments, and it is not uncommon for different measures to produce conflicting results. Consequently, the ability to evaluate an outcomes measure is critical in determining the value of a specific treatment intervention. Similarly, selecting the appropriate outcomes measure for research or clinical purposes is an important decision that may have far reaching implications on reimbursement, surgeon reputation, and patient treatment success. Evidence-based orthopedic surgery is indeed possible, but demands a detailed understanding of why appropriate outcomes selection is important, the difference between clinician-based and patient-reported outcomes (PROs), and potential future directions in orthopedics outcomes research. PMID:20399353

  2. Evidence-based health information and risk competence

    PubMed Central

    Mühlhauser, Ingrid; Albrecht, Martina; Steckelberg, Anke

    2015-01-01

    Consumers and patients want to be included in decisions regarding their own health and have an ethically justified claim on informed decisions. Therefore, sound information is required, but health information is often misleading and based on different interests. The risks of disease and the benefits of medical interventions tend to be overestimated, whereas harm is often underestimated. Evidence-based health information has to fulfil certain criteria, for instance, it should be evidence-based, independent, complete, true as well as understandable. The aim of a medical intervention has to be explained. The different therapeutic options including the option not to intervene have to be delineated. The probabilities for success, lack of success and unwanted side effects have to be communicated in a numerical and understandable manner. Patients have the right to reject medical interventions without any sanctions. PMID:26195924

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

    PubMed Central

    Häuser, Winfried; Arnold, Bernhard; Eich, Wolfgang; Felde, Eva; Flügge, Christl; Henningsen, Peter; Herrmann, Markus; Köllner, Volker; Kühn, Edeltraud; Nutzinger, Detlev; Offenbächer, Martin; Schiltenwolf, Marcus; Sommer, Claudia; Thieme, Kati; Kopp, Ina

    2008-01-01

    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 behavioural therapy

  4. [Computer work and De Quervain's tenosynovitis: an evidence based approach].

    PubMed

    Gigante, M R; Martinotti, I; Cirla, P E

    2012-01-01

    The debate around the role of the work at personal computer as cause of De Quervain's Tenosynovitis was developed partially, without considering multidisciplinary available data. A systematic review of the literature, using an evidence-based approach, was performed. In disorders associated with the use of VDU, we must distinguish those at the upper limbs and among them those related to an overload. Experimental studies on the occurrence of De Quervain's Tenosynovitis are quite limited, as well as clinically are quite difficult to prove the professional etiology, considering the interference due to other activities of daily living or to the biological susceptibility (i.e. anatomical variability, sex, age, exercise). At present there is no evidence of any connection between De Quervain syndrome and time of use of the personal computer or keyboard, limited evidence of correlation is found with time using a mouse. No data are available regarding the use exclusively or predominantly for personal laptops or mobile "smart phone". PMID:23405595

  5. Strengths and limitations of evidence-based dermatology.

    PubMed

    Williams, Hywel C

    2014-03-01

    The need for understanding and reflecting on evidence-based dermatology (EBD) has never been greater given the exponential growth of new external evidence to inform clinical practice. Like any other branch of medicine, dermatologists need to acquire new skills in constructing answerable questions, efficiently searching electronic bibliographic databases, and critically appraising different types of studies. Secondary summaries of evidence in the form of systematic reviews (SR), that is, reviews that are conducted in a systematic, unbiased and explicit manner, reside at the top of the evidence hierarchy, because they are less prone to bias than traditional expert reviews. In addition to providing summaries of the best external evidence, systematic reviews and randomized controlled trials (RCTs) are also powerful ways of identifying research gaps and ultimately setting the agenda of future clinical research in dermatology. But like any paradigm, EBD can have its limitations. Wrong application, misuse and overuse of EBD can have serious consequences. For example, mindless pooling together of data from dissimilar studies in a meta-analysis may render it a form of reductionism that does not make any sense. Similarly, even highly protocolised study designs such as SRs and RCTs are still susceptible to some degree of dishonesty and bias. Over-reliance on randomized controlled trials (RCT) may be inappropriate, as RCTs are not a good source for picking up rare but important adverse effects such as lupus syndrome with minocycline. A common criticism leveled against SRs is that these frequently conclude that there is lack of sufficient evidence to inform current clinical practice, but arguably, such a perception is grounded more on the interpretation of the SRs than anything else. The apparent absence of evidence should not paralyze the dermatologist to adopt a state of therapeutic nihilism. Poor primary data and an SR based on evidence that is not up-to-date are also

  6. Complementary and alternative medical therapies for attention-deficit/hyperactivity disorder and autism.

    PubMed

    Weber, Wendy; Newmark, Sanford

    2007-12-01

    Complementary and alternative medical (CAM) therapies are commonly used by parents for their children who have attention deficit hyperactivity disorder (ADHD) or autism spectrum disorders. The use of these therapies is well documented, yet the evidence of the safety and efficacy of these treatments in children is limited. This article describes the current evidence-based CAM therapies for ADHD and autism, focusing on nutritional interventions; natural health products, including essential fatty acids, vitamins, minerals, and other health supplements; biofeedback; and reducing environmental toxins. The CAM evidence in ADHD is addressed, as is the CAM literature in autism. PMID:18061787

  7. Evidence-based volcanology: application to eruption crises

    NASA Astrophysics Data System (ADS)

    Aspinall, W. P.; Woo, G.; Voight, B.; Baxter, P. J.

    2003-11-01

    The way in which strands of uncertain volcanological evidence can be used for decision-making, and the weight that should be given them, is a problem requiring formulation in terms of the logical principles of Evidence Science. The basic ideas are outlined using the explosion at Galeras volcano in Colombia in January 1993 as an example. Our retrospective analysis suggests that if a robust precautionary appraisal had been made of the circumstances in which distinctive tornillo signals were detected at Galeras, those events might have been construed as stronger precursory evidence for imminent explosive activity than were the indications for quiescence, given by the absence of other warning traits. However, whilst visits to the crater might have been recognised as involving elevated risk if this form of analysis had been applied to the situation in January 1993, a traditional scientific consideration of the available information was likely to have provided a neutral assessment of short-term risk levels. We use these inferences not to criticise interpretations or decisions made at the time, but to illustrate how a structured, evidence-based analysis procedure might have provided a different perspective to that derived from the conventional scientific standpoint. We advocate a formalism that may aid such decision-making in future: graphical Bayesian Belief Networks are introduced as a tool for performing the necessary numerical procedures. With this approach, Evidence Science concepts can be incorporated rationally, efficiently and reliably into decision support during volcanic crises.

  8. Complementary and Alternative Medicine Therapies for Perinatal Depression

    PubMed Central

    Deligiannidis, Kristina M.; Freeman, Marlene P.

    2014-01-01

    Complementary and Alternative Medicine (CAM) therapies are increasingly sought out by patients with psychiatric disorders. This article provides a review of the evidence for several commonly utilized CAM therapies (i.e. omega-3 fatty acids, folate, S-adenosyl-methionine (SAMe), St. John’s Wort, bright light therapy, exercise, massage, and acupuncture) in the treatment of perinatal depression. A number of these treatments may be reasonable to consider for women during pregnancy or the postpartum, but the safety and efficacy of these relative to standard treatments must still be systematically determined. Evidence based use of CAM treatments for perinatal depression is discussed. Adequately powered systematic studies are necessary to determine the role of CAM in the treatment of perinatal depression. PMID:24041861

  9. Evidence-based surgery – evidence from survey and citation analysis in orthopaedic surgery

    PubMed Central

    Kumar, Malhar; Gopalakrishna, Chethan; Swaminath, Pazhayannur V; Mysore, Sanjay S

    2010-01-01

    INTRODUCTION The results of a survey on evidence-based surgery (EBS) among members of the American Academy of Orthopedic Surgeons (AAOS) and the British Orthopaedic Association (BOA) are presented. The study also analyzes the citations earned by articles with different levels of evidence (LOE) to see if LOE have any bearing on the importance attached to the articles by authors and contributors to the journals. SUBJECTS AND METHODS The questionnaire was e-mailed to 1000 randomly chosen consultant orthopaedic surgeons who were members of either the AAOS or the BOA. Participants were provided with the option of responding through web-based entry. For citation analysis, citation data were gathered from the Journal of Bone and Joint Surgery (American volume) between the years 2003 and 2007 (5-year period). RESULTS The survey showed that awareness and access to EBS have improved greatly over the years. At the present time, these factors are not important barriers to the implementation of EBS in clinical practice in developed countries. There was a statistically significant difference in those with and without additional qualifications with regard to the approach to EBS. However, an equal percentage of surgeons with and without additional qualifications felt that it was difficult to adhere to EBS guidelines in daily clinical practice. Citation analysis showed that readers of professional journals attach importance to LOE category of the article and tend to cite level-I evidence articles more than other articles. PMID:21073824

  10. Evidence-based health care management: what is the research evidence available for health care managers?

    PubMed

    Jaana, Mirou; Vartak, Smruti; Ward, Marcia M

    2014-09-01

    In light of increasing interest in evidence-based management, we conducted a scoping review of systematic reviews (SRs) and meta-analyses (MAs) to determine the availability and accessibility of evidence for health care managers; 14 MAs and 61 SRs met the inclusion criteria. Most reviews appeared in medical journals (53%), originated in the United States (29%) or United Kingdom (22%), were hospital-based (55%), and targeted clinical providers (55%). Topics included health services organization (34%), quality/patient safety (17%), information technology (15%), organization/workplace management (13%), and health care workforce (12%). Most reviews addressed clinical topics of relevance to managers; management-related interventions were rare. The management issues were mostly classified as operational (65%). Surprisingly, 96.5% of search results were not on target. A better classification within PubMed is needed to increase the accessibility of meaningful resources and facilitate evidence retrieval. Health care journals should take initiatives encouraging the publication of reviews in relevant management areas. PMID:24296471

  11. Therapeutic management of anal eczema: an evidence-based review

    PubMed Central

    Havlickova, B; Weyandt, G H

    2014-01-01

    Aim To conduct a systematic review of treatments for anal eczema (AE). Methods We conducted a Medline search for clinical trial data for the treatment of perianal diseases including AE, including papers not published in the English language. We assessed the study reports using the system recommended by the Oxford Centre for Evidence-based Medicine. No meta-analysis was attempted. Results The evidence base for topical treatments used to treat AE is very poor: there are very few studies and many of those that exist are of poor quality. The best evidence was found for medications that are yet to be licensed for AE. Among products with existing licences for the treatment of eczema, our assessment found some evidence to support the continued use of mild-to-moderate corticosteroids first line in most patients. Discussion Features of the perianal region, and the fact that it is almost always occluded, mean that not all medications recommended in the general treatment guidelines for eczema are appropriate for AE. However, there are no specific treatment guidelines for these patients. This may in part be because of the lack of high-quality evidence-based medicine in this therapy area. Many frequently prescribed medications were developed and licensed many years ago, in an era when clinical trial design was not expected to be as rigorous as it is today. Conclusion This review highlights the need to conduct more high-quality clinical trials in patients with AE in order that specific guidelines for the management of this difficult proctological condition can be prepared. PMID:24898365

  12. Evidence-based guideline update: Plasmapheresis in neurologic disorders

    PubMed Central

    Cortese, I.; Chaudhry, V.; So, Y.T.; Cantor, F.; Cornblath, D.R.; Rae-Grant, A.

    2011-01-01

    Objective: To reassess the role of plasmapheresis in the treatment of neurologic disorders. Methods: We evaluated the available evidence based on a structured literature review for relevant articles from 1995 through September 2009. In addition, due to revision of the definitions of classification of evidence since the publication of the previous American Academy of Neurology assessment in 1996, the evidence cited in that manuscript was reviewed and reclassified. Results and Recommendations: Plasmapheresis is established as effective and should be offered in severe acute inflammatory demyelinating polyneuropathy (AIDP)/Guillain-Barré syndrome (GBS) and in the short-term management of chronic inflammatory demyelinating polyneuropathy (Class I studies, Level A). Plasmapheresis is established as ineffective and should not be offered for chronic or secondary progressive multiple sclerosis (MS) (Class I studies, Level A). Plasmapheresis is probably effective and should be considered for mild AIDP/GBS, as second-line treatment of steroid-resistant exacerbations in relapsing forms of MS, and for neuropathy associated with immunoglobulin A or immunoglobulin G gammopathy, based on at least one Class I or 2 Class II studies (Level B). Plasmapheresis is probably not effective and should not be considered for neuropathy associated with immunoglobulin M gammopathy, based on one Class I study (Level B). Plasmapheresis is possibly effective and may be considered for acute fulminant demyelinating CNS disease (Level C). There is insufficient evidence to support or refute the use of plasmapheresis for myasthenia gravis, pediatric autoimmune neuropsychiatric disorders associated with streptococcus infection, and Sydenham chorea (Class III evidence, Level U). PMID:21242498

  13. Paving the way for evidence-based medicine in Pakistan.

    PubMed

    Zaidi, Zareen; Hashim, Jawad; Iqbal, Mobeen; Quadri, K Mujtaba

    2007-11-01

    Evidence-based Medicine (EBM) is the process of systematically reviewing, appraising and using clinical research findings to aid the delivery of optimal clinical care to patients. EBM has become popular due to: the need for valid information about diagnosis, prognosis, therapy and prevention during patient care; traditional sources such as textbooks and expert opinion being frequently out-of-date; and knowledge of current best evidence declining with time from graduation from medical college. EBM has become feasible for practicing clinicians due to: new strategies for appraising studies; availability of systematic reviews (summaries) of current best evidence; and information technology (computers with Internet access). In a resource-limited country such as Pakistan, an evidence-based approach can be cost-effective by reducing clinical practices that have no proven benefit. Commonly perceived obstacles to EBM include limited access to computers, the Internet and online resources. Reliable resources of EBM are available (such as The Cochrane Database of Systematic Reviews http://www.cochrane.org) although many of these require paid subscriptions. Another difficulty is the issue of applicability of data from other countries to patients in our setting with different socio-economic factors. Other barriers to EBM in developing countries include: inexperience in small-group learning, limited time to attend workshops, and the lack of role models for practicing EBM. We have also tried to address the common fallacies related to EBM in the hope of greater use of these skills by busy clinicians as well as academic researchers. PMID:18062522

  14. Bowel anastomoses: The theory, the practice and the evidence base

    PubMed Central

    Goulder, Frances

    2012-01-01

    Since the introduction of stapling instruments in the 1970s various studies have compared the results of sutured and stapled bowel anastomoses. A literature search was performed from 1960 to 2010 and articles relating to small bowel, colonic and colorectal anastomotic techniques were reviewed. References from these articles were also reviewed, and relevant articles obtained. Either a stapled or sutured gastrointestinal tract anastomosis is acceptable in most situations. The available evidence suggests that in the following situations, however, particular anastomotic techniques may result in fewer complications: A stapled side-to-side ileocolic anastomosis is preferable following a right hemicolectomy for cancer. A stapled side-to-side anastomosis is likely also preferable after an ileocolic resection for Crohn’s disease. Colorectal anastomoses can be sutured or stapled with similar results, although the incidence of strictures is higher following stapled anastomoses. Following reversal of loop ileostomy there is some evidence to suggest that a stapled side-to-side anastomosis or sutured enterotomy closure (rather than spout resection and sutured anastomosis) results in fewer complications. Non-randomised data has indicated that small bowel anastomoses are best sutured in the trauma patient. This article reviews the theory, practice and evidence base behind the various gastrointestinal anastomoses to help the practising general surgeon make evidence based operative decisions. PMID:23293735

  15. Sequence-based typing of Legionella pneumophila strains isolated from hospital water distribution systems as a complementary element of risk assessment of legionellosis in Poland.

    PubMed

    Pancer, Katarzyna

    2013-01-01

    Many factors affect the risk of Legionella infection, such as the design, construction and maintenance of water distribution systems, the presence of individuals who may be exposed and their vulnerability to infection, and the degree of water system colonization and properties of Legionella strains. For epidemiological investigations, two properties of the Legionella strains are usually determined: serotyping and genotyping (sequence-based typing, SBT). In Poland, data regarding legionellosis are fragmentary, despite the fact that this has been a notifiable disease since 2002. The number of reported cases is very low; moreover, the main method of diagnosis is serological examination (delayed diagnosis and cheaper methods), and only single cases of LD were confirmed by culture of bacteria. Therefore, after 10 years of mandatory reporting of the Legionella spp. infection in Poland, the real epidemiological situation is still unknown; however, risk assessment should be carried out, especially in hospitals. In the presented study, comparison of the sequence types of 111 isolated L. pneumophila strains (from hospital water systems) with those present in the EWGLI SBT data was undertaken for complex risk analysis as a complementary element. In total, strains of L. pneumophila belonging to 12 out of 19 STs determined in the presented study were previously reported to the EWGLI SBT database (ST1, ST42, ST59, ST81, ST87, ST114, ST152, ST191, ST371, ST421, ST461, ST520). Among these strains, only 7 STs were previously reported in the amount of ≥10 (mainly ST1, ST42, ST81). Analysis of EWGLI data were carried out and, proportionally, the highest percentage of hospital-acquired strains (clinical and environmental) was found for ST 81, ST421 and ST152, but the largest number was for ST1. Based on the EWGLI data and the presented results, it was found that persistent colonization of HWS of 3 hospitals by strains belonging to ST42, ST1, ST87 indicated an increased risk of

  16. Teaching of evidence-based medicine to medical undergraduates.

    PubMed

    Atiya, A S

    2002-12-01

    Medical practice is changing, and the foundations of the paradigm shift lie in the development in research over the last four decades. Today, it is no longer adequate to treat a patient purely on clinical experience alone without a clear demonstration of evidence based on research, particularly the use of randomised controlled clinical trials. What is thought to be an effective mode of treatment currently may not necessarily hold true by the time medical students begin his/her medical practice. As a consequence, many medical schools worldwide are increasingly promoting evidence-based medicine (EBM) teaching in their medical curriculum along with problem-based learning (PBL). Teaching of EBM requires a paradigm shift in itself, as students must possess additional skills that are not traditionally part of medical training. These include the ability to acquire the skills in 'means of answering questions' than just 'knowing the answer to questions'. This paper aims to describe what EBM is and to highlight the formative experience of the teaching of EBM at the medical undergraduate level in the University of Malaya. Challenges and opportunities towards successful adoption of evidence-based practice are discussed. PMID:12733204

  17. Continuing to challenge practice to be evidence based.

    PubMed

    Makic, Mary Beth Flynn; Rauen, Carol; Jones, Kimmith; Fisk, Anna C

    2015-04-01

    Practice habits continue in clinical practice despite the availability of research and other forms of evidence that should be used to guide critical care practice interventions. This article is based on a presentation at the 2014 National Teaching Institute of the American Association of Critical-Care Nurses. The article is part of a series of articles that challenge critical care nurses to examine the evidence guiding nursing practice interventions. Four common practice interventions are reviewed: (1) weight-based medication administration, (2) chest tube patency maintenance, (3) daily interruption of sedation, and (4) use of chest physiotherapy in children. For weight-based administration of medication, the patient's actual weight should be measured, rather than using an estimate. The therapeutic effectiveness and dosages of medications used in obese patients must be critically evaluated. Maintaining patency of chest tubes does not require stripping and milking, which probably do more harm than good. Daily interruption of sedation and judicious use of sedatives are appropriate in most patients receiving mechanical ventilation. Traditional chest physiotherapy does not help children with pneumonia, bronchiolitis, or asthma and does not prevent atelectasis after extubation. Critical care nurses are challenged to evaluate their individual practice and to adopt current evidence-based practice interventions into their daily practice. PMID:25834007

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

    PubMed Central

    Devnani, Preeti; Fernandes, Racheal

    2015-01-01

    Rapid eye movement (REM) sleep behavior disorder (RBD) is characterized by dream enactment behavior resulting from a loss of REM skeletal muscle atonia. The neurobiology of REM sleep and the characteristic features of REM atonia have an important basis for understanding the aggravating etiologies the proposed pharmacological interventions in its management. This review outlines the evidence for behavioral and therapeutic measures along with evidence-based guidelines for their implementation, impact on falls, and effect on polysomnography (PSG) while highlighting the non-motor, autonomic, and cognitive impact of this entity. PubMed databases were reviewed upto May 2013 in peer-reviewed scientific literature regarding the pathophysiology and management of RBD in adults. The literature was graded according to the Oxford centre of evidence-based Medicine Levels. An early intervention that helps prevent consequences such as falls and provides a base for intervention with neuroprotective mechanisms and allocates a unique platform that RBD portrays with its high risk of disease conversion with a sufficiently long latency. RBD provides a unique platform with its high risk of disease conversion with a sufficiently long latency, providing an opportunity for early intervention both to prevent consequences such as falls and provide a base for intervention with neuroprotective mechanisms. PMID:25745301

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

    PubMed

    Devnani, Preeti; Fernandes, Racheal

    2015-01-01

    Rapid eye movement (REM) sleep behavior disorder (RBD) is characterized by dream enactment behavior resulting from a loss of REM skeletal muscle atonia. The neurobiology of REM sleep and the characteristic features of REM atonia have an important basis for understanding the aggravating etiologies the proposed pharmacological interventions in its management. This review outlines the evidence for behavioral and therapeutic measures along with evidence-based guidelines for their implementation, impact on falls, and effect on polysomnography (PSG) while highlighting the non-motor, autonomic, and cognitive impact of this entity. PubMed databases were reviewed upto May 2013 in peer-reviewed scientific literature regarding the pathophysiology and management of RBD in adults. The literature was graded according to the Oxford centre of evidence-based Medicine Levels. An early intervention that helps prevent consequences such as falls and provides a base for intervention with neuroprotective mechanisms and allocates a unique platform that RBD portrays with its high risk of disease conversion with a sufficiently long latency. RBD provides a unique platform with its high risk of disease conversion with a sufficiently long latency, providing an opportunity for early intervention both to prevent consequences such as falls and provide a base for intervention with neuroprotective mechanisms. PMID:25745301

  20. Diagnosis and complementary examinations.

    PubMed

    Menghini, Moreno; Duncan, Jacque L

    2014-01-01

    Development of neuroprotective therapies requires an understanding of the mechanisms of retinal degeneration and a way to monitor response to treatment. With the increasing availability of genetic testing, precise characterization of the retinal degeneration phenotype is essential. This chapter covers standard and innovative diagnostic techniques and complementary examinations needed for the evaluation and treatment of retinal degenerative diseases. It aims to provide an overview of functional and structural diagnostic tools for the evaluation of retinal degenerative diseases, but is not intended as a comprehensive reference. Subjective assessment of visual function includes psychophysical tests, such as perimetry and microperimetry. Electrophysiology tests, such as the electroretinogram and electro-oculogram, are crucial in the assessment of retinal degenerative diseases and provide an objective assessment of global photoreceptor and retinal pigment epithelial cell function. Retinal structural measures are correlated with measures of retinal function to characterize the disease phenotype, including fundus photography using color, near-infrared, and autofluorescence imaging. Ocular perfusion can be assessed using fluorescein, indocyanine green, and noninvasive angiography. Optical coherence tomography provides information about retinal structure. Resolution of all images of retinal structure can be improved using adaptive optics, which permits visualization of individual photoreceptors and retinal pigment epithelial cells in the macula. PMID:24732761

  1. Evidence-based medicine: what is the evidence that it has made a difference?

    PubMed

    McQuay, Henry

    2011-07-01

    Evidence-based medicine (EBM) has, over the past 20 years, made us all more critical in our thinking about the efficacy and safety of interventions. This is evident in the higher standards of our spoken and written work, formal and informal, and in our approach to the subject. The downside has been the coincidence of the squeeze on healthcare funding with the emergence of the EBM ideas - it has been all too easy to misuse the tools of EBM to deny patients access to treatment, and this, together with the off-putting political correctness of the EBM approach in some quarters, has made clinicians uneasy. Clinicians have to make decisions about therapy for the individual patient. Ideally this is guided by the best available evidence and their experience. EBM can guide one as to the population efficacy and safety of a particular intervention, but as we all know few patients are average. That guidance can only be given if there is adequate evidence, and the difficulty with guidance about symptom control is often the paucity of evidence of sufficient quality to yield credible guidance. Palliative care is often a 'complex intervention', and here EBM struggles to untangle which components, if any, of the complex interventions are important. The trial and review methodologies for complex intervention are wanting. Tom Chalmers, a grandfather of the EBM movement, argued late in his career that the most important function of the EBM approach was to frame the research agenda. This we think is correct. The process of systematic review of a topic throws up the deficits in trial methods and the lacunae in the data, and this then can show the way forward. PMID:21708846

  2. Standardized Nursing Documentation Supports Evidence-Based Nursing Management.

    PubMed

    Mykkänen, Minna; Miettinen, Merja; Saranto, Kaija

    2016-01-01

    Nursing documentation is crucial to high quality, effective and safe nursing care. According to earlier studies nursing documentation practices vary and nursing classifications used in electronic patient records (EPR) are not yet standardized internationally nor nationally. A unified national model for documenting patient care improves information flow in nursing practice, management, research and development toward evidence-based nursing care. Nursing documentation quality, accuracy and development requires follow-up and evaluation. An audit instrument is used in the Kuopio University Hospital (KUH) when evaluating nursing documentation. The results of the auditing process suggest that the national nursing documentation model fulfills nurses' expectations of electronic tools, facilitating their important documentation duty. This paper discusses the importance of using information about nursing documentation and how we can take advantage of structural information in evidence-based nursing management. PMID:27332244

  3. Using motivational interviewing: through evidence-based health coaching.

    PubMed

    Huffman, Melinda

    2014-10-01

    To enhance compliance and achieve better outcomes, providers must actively engage their patients and caregivers in different ways than in the past. One strategy that has gained national attention is motivational interviewing through evidence-based health coaching. A closer look at this exciting new clinical skill reveals what it is, how it works, why it is so successful, and why our traditional patient approach has fallen short. PMID:25268529

  4. Meniere's disease: an evidence based approach to assessment and management.

    PubMed

    Syed, I; Aldren, C

    2012-02-01

    Menière's disease (MD) is frequently over-diagnosed in both primary and secondary care. This is unfortunate given the significant medical and social implications of such a diagnosis. Difficulties may arise in differentiating the patient with true MD from those individuals with less clearly defined disorders of cochleo-vestibular function. In this review, we suggest a practical evidence based approach to assessment and management of the patient with MD. PMID:22257041

  5. [Integrating complementary medicines into care].

    PubMed

    Graz, Bertrand

    2016-04-01

    More and more research is being carried out into complementary medicines. It is no longer possible to say that these treatments have no scientific basis, as for some, their efficacy has been proven by clinical studies. Health services must move beyond ideological arguments and integrate safe and cost-effective complementary medicines. PMID:27063880

  6. The Four Cornerstones of Evidence-Based Practice in Social Work

    ERIC Educational Resources Information Center

    Gilgun, Jane F.

    2005-01-01

    The purpose of this article is to place evidence-based practice within its wider scholarly contexts and draw lessons from the experiences of other professions that are engaged in implementing it. The analysis is based primarily on evidence-based medicine, the parent discipline of evidence-based practice, but the author also draws on evidence-based…

  7. Evidence-Based Special Education and Professional Wisdom: Putting It All Together

    ERIC Educational Resources Information Center

    Cook, Bryan G.; Tankersley, Melody; Harjusola-Webb, Sanna

    2008-01-01

    There has been an increasing focus on evidence-based practices in special education with efforts underway to authoritatively identify those practices that are evidence based. However, the identification of evidence-based practices is only the beginning of the process of implementing evidence-based special education. The professional wisdom of…

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

    PubMed

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

    2016-01-01

    This review updates and consolidates evidence on the safety of transcranial Direct Current Stimulation (tDCS). Safety is here operationally defined by, and limited to, the absence of evidence for a Serious Adverse Effect, the criteria for which are rigorously defined. This review adopts an evidence-based approach, based on an aggregation of experience from human trials, taking care not to confuse speculation on potential hazards or lack of data to refute such speculation with evidence for risk. Safety data from animal tests for tissue damage are reviewed with systematic consideration of translation to humans. Arbitrary safety considerations are avoided. Computational models are used to relate dose to brain exposure in humans and animals. We review relevant dose-response curves and dose metrics (e.g. current, duration, current density, charge, charge density) for meaningful safety standards. Special consideration is given to theoretically vulnerable populations including children and the elderly, subjects with mood disorders, epilepsy, stroke, implants, and home users. Evidence from relevant animal models indicates that brain injury by Direct Current Stimulation (DCS) occurs at predicted brain current densities (6.3-13 A/m(2)) that are over an order of magnitude above those produced by conventional tDCS. To date, the use of conventional tDCS protocols in human trials (≤40 min, ≤4 milliamperes, ≤7.2 Coulombs) has not produced any reports of a Serious Adverse Effect or irreversible injury across over 33,200 sessions and 1000 subjects with repeated sessions. This includes a wide variety of subjects, including persons from potentially vulnerable populations. PMID:27372845

  9. Social construction and the evidence-based drug policy endeavour.

    PubMed

    Lancaster, Kari

    2014-09-01

    'Evidence-based policy' has become the catch-cry of the drug policy field. A growing literature has been dedicated to better realising the goal of evidence-based drug policy: to maximise the use of the best quality research to inform policy decision-making and help answer the question of 'what works'. Alternative accounts in the policy processes literature conceptualise policy activity as an ambiguous and contested process, and the role of evidence as being only marginally influential. Multiple participants jostle for influence and seek to define what may be regarded as a policy problem, how it may be appropriately addressed, which participants may speak authoritatively, and what knowledge(s) may be brought to bear. The question posited in this article is whether the conceptual shift offered by thinking about policy activity as a process of social construction may be valuable for beginning to explore different perspectives of the evidence-based drug policy endeavour. Within a constructionist account of policy, what counts as valid 'evidence' will always be a constructed notion within a dynamic system, based on the privileging and silencing of participants and discourse, and the contestation of those many positions and perspectives. The social construction account shifts our focus from the inherent value of 'evidence' for addressing 'problems' to the ways in which policy knowledge is made valid, by whom and in what contexts. As such, social construction provides a framework for critically analysing the ways in which 'policy-relevant knowledge' may not be a stable concept but rather one which is constructed through the policy process, and, through a process of validation, is rendered useful. We have limited knowledge in the drug policy field about how this happens; how ambiguity about the problems to be addressed, which voices should be heard, and what activities may be appropriate is contested and managed. By unpicking the values and assumptions which underlie drug

  10. Evidence-based Assessment in Pediatric Psychology: Family Measures

    PubMed Central

    Fiese, Barbara H.; Gold, Jeffrey I.; Cutuli, J. J.; Holmbeck, Grayson N.; Goldbeck, Lutz; Chambers, Christine T.; Abad, Mona; Spetter, Dante; Patterson, Joän

    2008-01-01

    Objective To provide a review of the evidence base of family measures relevant to pediatric psychology. Method Twenty-nine family measures were selected based upon endorsement by Division 54 listserv members, expert judgment, and literature review. Spanning observational and self-report methods, the measures fell into three broad assessment categories: Family functioning, Dyadic family relationships, and Family functioning in the context of childhood chronic health conditions. Measures were categorized as: “Well-established”, “Approaching well-established”, or “Promising.” Results Nineteen measures met “well-established” criteria and the remaining ten were “approaching well-established.” “Well-established” measures were documented for each of the broad assessment categories named above. Conclusions Many measures deemed “well-established” in the general population are proving to be reliable and useful in pediatric samples. More evidence of the validity of family measures is needed in this context. This review should prove helpful to clinicians and researchers as they strive to make evidence-based decisions regarding family measures. PMID:17905801

  11. Effect of Home-Based Complementary Food Fortification on Prevalence of Anemia Among Infants and Young Children Aged 6 to 23 Months in Poor Rural Regions of China.

    PubMed

    Huo, Junsheng; Sun, Jing; Fang, Zheng; Chang, Suying; Zhao, Liyun; Fu, Ping; Wang, Jie; Huang, Jian; Wang, Lijuan; Begin, France; Hipgrave, David B; Ma, Guansheng

    2015-12-01

    Following the 2008 Wenchuan earthquake, the Chinese government instituted an infant and young and child nutrition program that included promotion of in-home fortification of complementary food with ying yang bao (YYB), a soy-based powder containing iron, 2.5 mg as iron-EDTA and 5 mg as ferrous fumarate, and other micronutrients. Ying yang bao was provided to participating families in 8 poor rural counties in Sichuan, Shaanxi, and Gansu provinces by the Ministry of Health. We assessed hemoglobin levels among infants and young children (IYC) aged 6 to 23 months at baseline in May 2010 (n = 1290) and during follow-up in November 2010 (n = 1142), May 2011 (n = 1118), and November 2011 (n = 1040), using the Hemocue method. Interviewers collected basic demographic information and child feeding practices from the children's caretakers. Altitude-adjusted hemoglobin level averaged 10.8 g/dL, and total anemia prevalence was 49.5% at baseline. Average hemoglobin was 11.3 g/dL at 6 months, 11.6 g/dL at 12 months, and 11.7 g/dL at 18 months after introduction of YYB. Moderate anemia (hemoglobin: 70-99 g/dL) decreased from 20.3% at baseline to 7.5%, 5.8%, and 7.3% after 6, 12, and 18 months of home fortification, respectively (P < .001), whereas mild anemia (hemoglobin: 100-110 g/dL) decreased from 29.0% to 16.7%, 18.1%, and 15.4%, respectively (P < .001). Among infants aged 6 to 23 months, 95% had regularly been fed YYB during the observation period. Regression analysis showed that the duration of YYB consumption and number of sachets consumed per week correlated positively with hemoglobin levels and negatively with anemia rates. Home food fortification with YYB is feasible and effective for nutrition promotion among IYC in high-risk regions of China. PMID:26612420

  12. Stepwise expansion of evidence-based care is needed for mental health reform.

    PubMed

    McGorry, Patrick D; Hamilton, Matthew P

    2016-05-16

    Mortality from mental illnesses is increasing and, because they frequently occur early in the life cycle, they are the largest source of disability and reduced economic productivity of all non-communicable diseases. Successful mental health reform can reduce the mortality, morbidity, growing welfare costs and losses in economic productivity caused by mental illness. The government has largely adopted the recommendations of the National Mental Health Commission focusing on early intervention and stepwise care and will implement a reform plan that involves devolving commissioning of federally funded mental health services to primary health networks, along with a greater emphasis on e-mental health. Stepwise expanded investment in and structural support (data collection, evaluation, model fidelity, workforce training) for evidence-based care that rectifies high levels of undertreatment are essential for these reforms to succeed. However, the reforms are currently constrained by a cost-containment policy framework that envisages no additional funding. The early intervention reform aim requires financing for the next stage of development of Australia's youth mental health system, rather than redirecting funds from existing evidence-based programs. People with complex, enduring mental disorders need more comprehensive care. In the context of the National Disability Insurance Scheme, there is a risk that these already seriously underserved patients may paradoxically receive a reduction in coverage. E-health has a key role to play at all stages of illness but must be integrated in a complementary way, rather than as a barrier to access. Research and evaluation are the keys to cost-effective, sustainable reform. PMID:27169969

  13. Cochrane Lecture 1997. What evidence do we need for evidence based medicine?

    PubMed Central

    Hart, J T

    1997-01-01

    As presently understood, evidence based medicine aims to advance practice from its traditional unverifiable mix of art and science to rational use of measurable inputs and outputs. In practice, however, its advocates accept uncritically a desocialised definition of science, assume that major clinical decisions are taken at the level of secondary specialist rather than primary generalist care, and ignore the multiple nature of most clinical problems, as well as the complexity of social problems within which clinical problems arise and have to be solved. These reductionist assumptions derive from the use of evidence based medicine as a tool for managed care in a transactional model for consultations. If these assumptions persist, they will strengthen reification of disease and promote the episodic output of process regardless of health outcome. We need to work within a different paradigm based on development of patients as co-producers rather than consumers, promoting continuing output of health gain through shared decisions using all relevant evidence, within a broader, socialised definition of science. Adoption of this model would require a major social and cultural shift for health professionals. This shift has already begun, promoted by changes in public attitudes to professional authority, changes in the relation of professionals to managers, and pressures for improved effectiveness and efficiency which, contrary to received wisdom, seem more likely to endorse cooperative than transactional clinical production. Progress on these lines is resisted by rapidly growing and extremely powerful economic and political interests. Health professionals and strategists have yet to recognise and admit the existence of this choice. PMID:9519124

  14. Tactics for teaching evidence-based practice: improving self-efficacy in finding and appraising evidence in a master's evidence-based practice unit.

    PubMed

    Chang, Anne; Levin, Rona F

    2014-08-01

    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. PMID:25131896

  15. An Evidence-Based Videotaped Running Biomechanics Analysis.

    PubMed

    Souza, Richard B

    2016-02-01

    Running biomechanics play an important role in the development of injuries. Performing a running biomechanics analysis on injured runners can help to develop treatment strategies. This article provides a framework for a systematic video-based running biomechanics analysis plan based on the current evidence on running injuries, using 2-dimensional (2D) video and readily available tools. Fourteen measurements are proposed in this analysis plan from lateral and posterior video. Identifying simple 2D surrogates for 3D biomechanic variables of interest allows for widespread translation of best practices, and have the best opportunity to impact the highly prevalent problem of the injured runner. PMID:26616185

  16. Neuropsychology 3.0: Evidence-Based Science and Practice

    PubMed Central

    Bilder, Robert M.

    2011-01-01

    Neuropsychology is poised for transformations of its concepts and methods, leveraging advances in neuroimaging, the human genome project, psychometric theory, and information technologies. It is argued that a paradigm shift towards evidence-based science and practice can be enabled by innovations, including: (1) formal definition of neuropsychological concepts and tasks in cognitive ontologies; (2) creation of collaborative neuropsychological knowledgebases; and (3) design of web-based assessment methods that permit free development, large-sample implementation, and dynamic refinement of neuropsychological tests and the constructs these aim to assess. This article considers these opportunities, highlights selected obstacles, and offers suggestions for stepwise progress towards these goals. PMID:21092355

  17. Utilization of evidence-based practice by registered occupational therapists.

    PubMed

    Cameron, Karen Ann V; Ballantyne, Scott; Kulbitsky, Autumnrose; Margolis-Gal, Michelle; Daugherty, Timothy; Ludwig, Ferol

    2005-01-01

    Although the use of evidence-based practice (EBP) is presently on the rise, there have been limited studies examining its use by occupational therapists within the US. The purpose of this study was to examine the use of EBP among registered occupational therapists in the occupational therapy intervention planning process. This descriptive study surveyed 500 members of the American Occupational Therapy Association (AOTA), of which 131 participants responded (26%). The results of the study supported the hypothesis that, within the sample studied, a minority of registered occupational therapists in the US utilize EBP in the intervention planning process. Other results included: (1) As level of academic education increased, the view of the importance of research to occupational therapy decreased. (2) As the years of practice increased, the use of research evidence in making clinical decisions decreased. As the occupational therapy profession moves towards utilization of EBP as a professional standard, it is imperative that the profession examines specific strategies to promote the adoption of such practice by its members, including the promotion of competency in evidence utilization, and the valuing of the established clinical reasoning skills of the practitioner while integrating research evidence into intervention planning to support professional practice. PMID:16398202

  18. Acute Stroke: Current Evidence-based Recommendations for Prehospital Care

    PubMed Central

    Glober, Nancy K.; Sporer, Karl A.; Guluma, Kama Z.; Serra, John P.; Barger, Joe A.; Brown, John F.; Gilbert, Gregory H.; Koenig, Kristi L.; Rudnick, Eric M.; Salvucci, Angelo A.

    2016-01-01

    Introduction In the United States, emergency medical services (EMS) protocols vary widely across jurisdictions. We sought to develop evidence-based recommendations for the prehospital evaluation and treatment of a patient with a suspected stroke and to compare these recommendations against the current protocols used by the 33 EMS agencies in the state of California. Methods We performed a literature review of the current evidence in the prehospital treatment of a patient with a suspected stroke and augmented this review with guidelines from various national and international societies to create our evidence-based recommendations. We then compared the stroke protocols of each of the 33 EMS agencies for consistency with these recommendations. The specific protocol components that we analyzed were the use of a stroke scale, blood glucose evaluation, use of supplemental oxygen, patient positioning, 12-lead electrocardiogram (ECG) and cardiac monitoring, fluid assessment and intravenous access, and stroke regionalization. Results Protocols across EMS agencies in California varied widely. Most used some sort of stroke scale with the majority using the Cincinnati Prehospital Stroke Scale (CPSS). All recommended the evaluation of blood glucose with the level for action ranging from 60 to 80mg/dL. Cardiac monitoring was recommended in 58% and 33% recommended an ECG. More than half required the direct transport to a primary stroke center and 88% recommended hospital notification. Conclusion Protocols for a patient with a suspected stroke vary widely across the state of California. The evidence-based recommendations that we present for the prehospital diagnosis and treatment of this condition may be useful for EMS medical directors tasked with creating and revising these protocols. PMID:26973735

  19. Integration of Evidence Base into a Probabilistic Risk Assessment

    NASA Technical Reports Server (NTRS)

    Saile, Lyn; Lopez, Vilma; Bickham, Grandin; Kerstman, Eric; FreiredeCarvalho, Mary; Byrne, Vicky; Butler, Douglas; Myers, Jerry; Walton, Marlei

    2011-01-01

    INTRODUCTION: A probabilistic decision support model such as the Integrated Medical Model (IMM) utilizes an immense amount of input data that necessitates a systematic, integrated approach for data collection, and management. As a result of this approach, IMM is able to forecasts medical events, resource utilization and crew health during space flight. METHODS: Inflight data is the most desirable input for the Integrated Medical Model. Non-attributable inflight data is collected from the Lifetime Surveillance for Astronaut Health study as well as the engineers, flight surgeons, and astronauts themselves. When inflight data is unavailable cohort studies, other models and Bayesian analyses are used, in addition to subject matters experts input on occasion. To determine the quality of evidence of a medical condition, the data source is categorized and assigned a level of evidence from 1-5; the highest level is one. The collected data reside and are managed in a relational SQL database with a web-based interface for data entry and review. The database is also capable of interfacing with outside applications which expands capabilities within the database itself. Via the public interface, customers can access a formatted Clinical Findings Form (CLiFF) that outlines the model input and evidence base for each medical condition. Changes to the database are tracked using a documented Configuration Management process. DISSCUSSION: This strategic approach provides a comprehensive data management plan for IMM. The IMM Database s structure and architecture has proven to support additional usages. As seen by the resources utilization across medical conditions analysis. In addition, the IMM Database s web-based interface provides a user-friendly format for customers to browse and download the clinical information for medical conditions. It is this type of functionality that will provide Exploratory Medicine Capabilities the evidence base for their medical condition list

  20. Practice-Based Evidence to Evidence-Based Practice: Building the National Radiation Oncology Registry

    PubMed Central

    Efstathiou, Jason A.; Nassif, Deborah S.; McNutt, Todd R.; Bogardus, C. Bob; Bosch, Walter; Carlin, Jeffrey; Chen, Ronald C.; Chou, Henry; Eggert, Dave; Fraass, Benedick A.; Goldwein, Joel; Hoffman, Karen E.; Hotz, Ken; Hunt, Margie; Kessler, Marc; Lawton, Colleen A.F.; Mayo, Charles; Michalski, Jeff M.; Mutic, Sasa; Potters, Louis; Rose, Christopher M.; Sandler, Howard M.; Sharp, Gregory; Tomé, Wolfgang; Tran, Phuoc T.; Wall, Terry; Zietman, Anthony L.; Gabriel, Peter E.; Bekelman, Justin E.

    2013-01-01

    The National Radiation Oncology Registry (NROR), sponsored by the Radiation Oncology Institute and the American Society for Radiation Oncology, is designed to collect standardized information on cancer care delivery among patients treated with radiotherapy in the United States and will focus on patients with prostate cancer. Stakeholders were engaged through a forum that emphasized the need for patient-centered outcomes, minimal data burden, and maximal connectivity to existing registries and databases. An electronic infrastructure is under development to provide connectivity across radiation oncology and hospital information systems. The NROR Gateway features automatic abstraction as well as aggregation of treatment and outcome data. The prostate cancer data dictionary provides standardized elements in four domains: facility, physician, patient, and treatment. The pilot phase will consist of clinical centers chosen to provide a representative mix of radiation treatment modalities, facility types, population-based settings, and regional locations. The initial set of radiation practice metrics includes physician board certification and maintenance, ordering of staging scans, active surveillance discussion, dose prescriptions for low-risk/high-risk disease, radiation fields for low-risk/high-risk disease, image-guided radiation therapy use, androgen deprivation therapy use, post-brachytherapy implant computed tomography dosimetry, collection of toxicity assessments, and longitudinal patient follow-up. The NROR pilot study will provide the framework for expansion to a nationwide electronic registry for radiation oncology. PMID:23942508

  1. Information systems: the key to evidence-based health practice.

    PubMed Central

    Rodrigues, R. J.

    2000-01-01

    Increasing prominence is being given to the use of best current evidence in clinical practice and health services and programme management decision-making. The role of information in evidence-based practice (EBP) is discussed, together with questions of how advanced information systems and technology (IS&T) can contribute to the establishment of a broader perspective for EBP. The author examines the development, validation and use of a variety of sources of evidence and knowledge that go beyond the well-established paradigm of research, clinical trials, and systematic literature review. Opportunities and challenges in the implementation and use of IS&T and knowledge management tools are examined for six application areas: reference databases, contextual data, clinical data repositories, administrative data repositories, decision support software, and Internet-based interactive health information and communication. Computerized and telecommunications applications that support EBP follow a hierarchy in which systems, tasks and complexity range from reference retrieval and the processing of relatively routine transactions, to complex "data mining" and rule-driven decision support systems. PMID:11143195

  2. Telemedicine framework using case-based reasoning with evidences.

    PubMed

    Sene, A; Kamsu-Foguem, B; Rumeau, P

    2015-08-01

    Telemedicine is the medical practice of information exchanged from one location to another through electronic communications to improve the delivery of health care services. This research article describes a telemedicine framework with knowledge engineering using taxonomic reasoning of ontology modeling and semantic similarity. In addition to being a precious support in the procedure of medical decision-making, this framework can be used to strengthen significant collaborations and traceability that are important for the development of official deployment of telemedicine applications. Adequate mechanisms for information management with traceability of the reasoning process are also essential in the fields of epidemiology and public health. In this paper we enrich the case-based reasoning process by taking into account former evidence-based knowledge. We use the regular four steps approach and implement an additional (iii) step: (i) establish diagnosis, (ii) retrieve treatment, (iii) apply evidence, (iv) adaptation, (v) retain. Each step is performed using tools from knowledge engineering and information processing (natural language processing, ontology, indexation, algorithm, etc.). The case representation is done by the taxonomy component of a medical ontology model. The proposed approach is illustrated with an example from the oncology domain. Medical ontology allows a good and efficient modeling of the patient and his treatment. We are pointing up the role of evidences and specialist's opinions in effectiveness and safety of care. PMID:26001421

  3. Evidence-based patient education: knowledge transfer to endodontic patients.

    PubMed

    Sorrell, John T; McNeil, Daniel W; Gochenour, Lori L; Jackson, C Russell

    2009-11-01

    Evidence-based treatment is emphasized in oral health care, but there has been less focus on empirically demonstrating the effects of patient education. Attempts to educate patients must be empirically demonstrated in order to provide evidence-based guidance to practitioners and educators. We conducted two studies that assessed information acquisition during five-minute audiovisual films on oral hygiene procedures, endodontic procedures, and fear about pain during root canal therapy. A fifteen-item Dental Knowledge Questionnaire (DKQ), with three subscales each focusing on the content of one of the films, was developed and psychometrically evaluated. Study 1 included 268 undergraduates; study 2 involved 104 endodontic patients. Participants completed the DKQ, viewed one of the three films, and repeated the questionnaire. The effects of information on knowledge were assessed using 3 (film group) X 3 (subscale of the DKQ) X 2 (time) repeated measures ANOVAs. Scores improved in a content-specific fashion relevant to the film viewed among undergraduates, F(4, 263)=211.33, p<.001, partial eta(2)=.62 and endodontic patients, F(4, 99)=87.22, p<.001, partial eta(2)=.63. The results provide evidence for using brief informational film as an efficacious method to increase patient knowledge, at least in the short term. The DKQ is proposed as a tool to assess patient knowledge in the arenas of oral hygiene and endodontics. PMID:19910479

  4. Epilepsy, Antiepileptic Drugs, and Aggression: An Evidence-Based Review.

    PubMed

    Brodie, Martin J; Besag, Frank; Ettinger, Alan B; Mula, Marco; Gobbi, Gabriella; Comai, Stefano; Aldenkamp, Albert P; Steinhoff, Bernhard J

    2016-07-01

    Antiepileptic drugs (AEDs) have many benefits but also many side effects, including aggression, agitation, and irritability, in some patients with epilepsy. This article offers a comprehensive summary of current understanding of aggressive behaviors in patients with epilepsy, including an evidence-based review of aggression during AED treatment. Aggression is seen in a minority of people with epilepsy. It is rarely seizure related but is interictal, sometimes occurring as part of complex psychiatric and behavioral comorbidities, and it is sometimes associated with AED treatment. We review the common neurotransmitter systems and brain regions implicated in both epilepsy and aggression, including the GABA, glutamate, serotonin, dopamine, and noradrenaline systems and the hippocampus, amygdala, prefrontal cortex, anterior cingulate cortex, and temporal lobes. Few controlled clinical studies have used behavioral measures to specifically examine aggression with AEDs, and most evidence comes from adverse event reporting from clinical and observational studies. A systematic approach was used to identify relevant publications, and we present a comprehensive, evidence-based summary of available data surrounding aggression-related behaviors with each of the currently available AEDs in both adults and in children/adolescents with epilepsy. A psychiatric history and history of a propensity toward aggression/anger should routinely be sought from patients, family members, and carers; its presence does not preclude the use of any specific AEDs, but those most likely to be implicated in these behaviors should be used with caution in such cases. PMID:27255267

  5. Epilepsy, Antiepileptic Drugs, and Aggression: An Evidence-Based Review

    PubMed Central

    Besag, Frank; Ettinger, Alan B.; Mula, Marco; Gobbi, Gabriella; Comai, Stefano; Aldenkamp, Albert P.; Steinhoff, Bernhard J.

    2016-01-01

    Antiepileptic drugs (AEDs) have many benefits but also many side effects, including aggression, agitation, and irritability, in some patients with epilepsy. This article offers a comprehensive summary of current understanding of aggressive behaviors in patients with epilepsy, including an evidence-based review of aggression during AED treatment. Aggression is seen in a minority of people with epilepsy. It is rarely seizure related but is interictal, sometimes occurring as part of complex psychiatric and behavioral comorbidities, and it is sometimes associated with AED treatment. We review the common neurotransmitter systems and brain regions implicated in both epilepsy and aggression, including the GABA, glutamate, serotonin, dopamine, and noradrenaline systems and the hippocampus, amygdala, prefrontal cortex, anterior cingulate cortex, and temporal lobes. Few controlled clinical studies have used behavioral measures to specifically examine aggression with AEDs, and most evidence comes from adverse event reporting from clinical and observational studies. A systematic approach was used to identify relevant publications, and we present a comprehensive, evidence-based summary of available data surrounding aggression-related behaviors with each of the currently available AEDs in both adults and in children/adolescents with epilepsy. A psychiatric history and history of a propensity toward aggression/anger should routinely be sought from patients, family members, and carers; its presence does not preclude the use of any specific AEDs, but those most likely to be implicated in these behaviors should be used with caution in such cases. PMID:27255267

  6. The Care and Feeding of Evidence Based Medicine

    PubMed Central

    2012-01-01

    Wide interest in evidence based medicine (EBM) and its value in patient care, insurance payment decisions, and public health planning has triggered intense medical journal and media coverage that merits review, explanation, and comment. Published EBM data vary in quality for reasons that have been the subject of many perceptive literature reviews. Study design can be faulted, and conflicts of interest, personal and economic, can potentially bias study results and their publication. Practical guides for data evaluation are presented here, with discussion of technical and sociological issues that affect information quality and its clinical application. Clinical practice often appears to resist good evidence in making clinical choices. Personal views of some practicing physicians about EBM are presented that underlie the occasional difficulties in applying valid research information in patient care. Improvements in study design and publication standards may enhance the clinical application of evidence-based information. EBM guided practice holds promise to improve outcomes and expense, to standardize and streamline process in ways that make for much safer patient care. PMID:22532934

  7. Evidence-based Kernels: Fundamental Units of Behavioral Influence

    PubMed Central

    Biglan, Anthony

    2008-01-01

    This paper describes evidence-based kernels, fundamental units of behavioral influence that appear to underlie effective prevention and treatment for children, adults, and families. A kernel is a behavior–influence procedure shown through experimental analysis to affect a specific behavior and that is indivisible in the sense that removing any of its components would render it inert. Existing evidence shows that a variety of kernels can influence behavior in context, and some evidence suggests that frequent use or sufficient use of some kernels may produce longer lasting behavioral shifts. The analysis of kernels could contribute to an empirically based theory of behavioral influence, augment existing prevention or treatment efforts, facilitate the dissemination of effective prevention and treatment practices, clarify the active ingredients in existing interventions, and contribute to efficiently developing interventions that are more effective. Kernels involve one or more of the following mechanisms of behavior influence: reinforcement, altering antecedents, changing verbal relational responding, or changing physiological states directly. The paper describes 52 of these kernels, and details practical, theoretical, and research implications, including calling for a national database of kernels that influence human behavior. PMID:18712600

  8. Review complementary and integrative interventions for cancer-related cognitive changes

    PubMed Central

    Myers, Jamie S.

    2015-01-01

    Cognitive sequelae from a diagnosis of cancer and the subsequent treatment impact survivors’ quality of life and can interfere with both social relationships and employment. The search for evidence-based prevention and intervention strategies continues for both central nervous system (CNS) and non-CNS cancer-related cognitive changes. Complementary therapies in conjunction with conventional medicine are being included in integrative programs designed to maximize symptom management in cancer treatment centers providing survivorship care. The purpose of this article is to review the existing evidence for the use of complementary and integrative interventions to prevent or treat cancer-related cognitive changes and to discuss the rationale for current and future research. Search terminology included: Complementary, alternative, and integrative medicine, cognition, cognitive function, and cancer, and yielded 20 studies that met criteria for inclusion. Preliminary results published to date indicate that some complementary therapies may be beneficial to cancer survivors experiencing cognitive concerns. A number of gaps in the literature remain primarily due to preliminary study designs, small sample sizes, lack of objective cognitive testing, and cognitive function not being a primary endpoint for much of the published work. PMID:26719850

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

    ERIC Educational Resources Information Center

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

    2015-01-01

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

  10. Evidence-based practice: a practical approach to implementation.

    PubMed

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

    2005-01-01

    Organizations often do not have processes in place to support nurses through a systematic approach for developing and evaluating nursing interventions, protocols, critical pathways, and policies that are derived from scientific evidence. The development of a framework to guide inquiry will have a positive impact on patients. This process may foster a higher level of professional engagement by nurses that may, in the long-term, help improve nurse retention and recruitment. The authors discuss a nursing evidence-based practice model and guidelines that were developed by a team of hospital and academic nurse leaders and is practical and easy to use. This model has been successfully implemented across the department of nursing as a strategic initiative. Results of the implementation have shown that staff nurses can effectively use this model with the help of knowledgeable mentors. PMID:15647668

  11. [Evidence-based therapy of polycystic ovarian syndrome].

    PubMed

    Gődény, Sándor; Csenteri, Orsolya Karola

    2015-11-01

    Polycystic ovary syndrome is recognized as the most common hormonal and metabolic disorder likely to affect women. The heterogeneous endocrinopathy is characterized by clinical and/or biochemical hyperandrogenism, oligo- or amenorrhoea, anovulatory infertility, and polycystic ovarian morphology. The syndrome is often associated with obesity, hyperinsulinemia and adversely affects endocrine, metabolic, and cardiovascular health. The symptoms and complaint of the patients vary with age. To maximise health gain of the syndrome, adequate, evidence based effective, efficient and safe treatment is necessary. This article summarises the highest available evidence provided by studies, meta-analysis and systematic reviews about the therapeutical possibilities for treating obesity, hyperandrogenism, menstrual abnormalities, infertility and psychological problems related to polycystic ovary syndrome. PMID:26551444

  12. Knowledge sources for evidence-based practice in rheumatology nursing.

    PubMed

    Neher, Margit; Ståhl, Christian; Ellström, Per-Erik; Nilsen, Per

    2015-12-01

    As rheumatology nursing develops and extends, knowledge about current use of knowledge in rheumatology nursing practice may guide discussions about future knowledge needs. To explore what perceptions rheumatology nurses have about their knowledge sources and about what knowledge they use in their practice, 12 nurses working in specialist rheumatology were interviewed using a semi-structured interview guide. The data were analyzed using conventional qualitative content analysis. The analysis yielded four types of knowledge sources in clinical practice: interaction with others in the workplace, contacts outside the workplace, written materials, and previous knowledge and experience. Colleagues, and physicians in particular, were important for informal learning in daily rheumatology practice. Evidence from the medical arena was accessed through medical specialists, while nursing research was used less. Facilitating informal learning and continuing formal education is proposed as a way toward a more evidence-based practice in extended roles. PMID:25059719

  13. The deconstructing angel: nursing, reflection and evidence-based practice.

    PubMed

    Rolfe, Gary

    2005-06-01

    This paper explores Jacques Derrida's strategy of deconstruction as a way of understanding and critiquing nursing theory and practice. Deconstruction has its origins in philosophy, but I argue that it is useful and relevant as a way of challenging the dominant paradigm of any discipline, including nursing. Because deconstruction is notoriously difficult to define, I offer a number of examples of deconstruction in action. In particular, I focus on three critiques of reflective practice by the meta-narrative of evidence-based practice (EBP) and attempt to show how those critiques can be directed back at EBP itself. I conclude with the observation that EBP is open to many of the criticisms that it directs at other discourses, including problems of a lack of empirical evidence, of distortions due to memory, and of falsification of the 'facts'. PMID:15892723

  14. Strengthening the evidence base for health programming in humanitarian crises.

    PubMed

    Ager, A; Burnham, G; Checchi, F; Gayer, M; Grais, R F; Henkens, M; Massaquoi, M B F; Nandy, R; Navarro-Colorado, C; Spiegel, P

    2014-09-12

    Given the growing scale and complexity of responses to humanitarian crises, it is important to develop a stronger evidence base for health interventions in such contexts. Humanitarian crises present unique challenges to rigorous and effective research, but there are substantial opportunities for scientific advance. Studies need to focus where the translation of evidence from noncrisis scenarios is not viable and on ethical ways of determining what happens in the absence of an intervention. Robust methodologies suited to crisis settings have to be developed and used to assess interventions with potential for delivery at scale. Strengthening research capacity in the low- to middle-income countries that are vulnerable to crises is also crucial. PMID:25214616

  15. Health technology assessment: an evidence-based medicine perspective.

    PubMed

    Glasziou, Paul

    2012-01-01

    A challenge of health technology assessment is integrating the information from different disciplines. This talk focuses on the evidence-based medicine perspective and challenges 3 assumptions of health technology assessment: assumptions about effectiveness, assumptions about coverage by health technology assessment, and assumptions about costs being immutable. Challenging these assumptions has several implications. First is the need for better evidence on effects: both low-volume, high-cost technologies and low-cost, high-volume technologies that are ineffective drains on health care systems' resources. Second, cheap but effective technologies should be better promoted, as they can displace high-cost technologies. Finally, for effective but expensive technologies, we should work to lower the price and/or costs. PMID:22040831

  16. Evidence-Based Parenting Interventions to Promote Secure Attachment

    PubMed Central

    Wright, Barry; Edginton, Elizabeth

    2016-01-01

    Various interventions are used in clinical practice to address insecure or disorganized attachment patterns and attachment disorders. The most common of these are parenting interventions, but not all have a robust empirical evidence base. We undertook a systematic review of randomized trials comparing a parenting intervention with a control, where these used a validated attachment instrument, in order to evaluate the clinical and cost-effectiveness of interventions aiming to improve attachment in children with severe attachment problems (mean age <13 years). This article aims to inform clinicians about the parenting interventions included in our systematic review that were clinically effective in promoting secure attachment. For completeness, we also briefly discuss other interventions without randomized controlled trial evidence, identified in Patient Public Involvement workshops and expert groups at the point our review was completed as being used or recommended. We outline the key implications of our findings for clinical practice and future research. PMID:27583298

  17. Identifying Educational Practices Supported by Rigorous Evidence: A Guide to the Selection of Evidence-Based Practices

    ERIC Educational Resources Information Center

    Regional Resource Center Program, 2014

    2014-01-01

    One component of the recently required State Systemic Improvement Plan (SSIP) for State Departments of Education calls for the selection and implementation of evidence-based practices (EBPs). This report provides six steps to guide the process of selecting evidence based practices (EBP): (1) Begin with the End in Mind--Determine Targeted Outcomes;…

  18. Evidence-Based Practice in Mental Health Care to Ethnic Minority Communities: Has Its Practice Fallen Short of Its Evidence?

    ERIC Educational Resources Information Center

    Aisenberg, Eugene

    2008-01-01

    Evidence-based practice (EBP) has contributed substantially to the advancement of knowledge in the treatment and prevention of adult mental health disorders. A fundamental assumption, based on documented evidence of effectiveness with certain populations, is that EBP is equally effective and applicable to all populations. However, small sample…

  19. Opportunities and Challenges in Evidence-Based Social Policy. Social Policy Report. Volume 28, Number 4

    ERIC Educational Resources Information Center

    Supplee, Lauren H.; Metz, Allison

    2014-01-01

    Despite a robust body of evidence of effectiveness of social programs, few evidence-based programs have been scaled for population-level improvement in social problems. Since 2010 the federal government has invested in evidence-based social policy by supporting a number of new evidence-based programs and grant initiatives. These initiatives…

  20. Alternative and Complementary Cancer Treatments.

    PubMed

    Cassileth

    1996-01-01

    Alternative and complementary therapies differ importantly, and the distinction between the two is crucial for clinical oncologists. "Alternative" or unproven therapies are treatments used independent of surgery, radiation and chemotherapy. They can be dangerous directly and also by delaying patients' receipt of mainstream care. In contrast, complementary therapies typically are adjuncts to mainstream medicine. They can provide symptom control and noninvasive palliation with minimal side effects, improve patients' well-being and enhance cancer medicine. Complementary therapies represent a desired addition and balance to technologically sophisticated cancer care. PMID:10387984