Sample records for evidence-based infection control

  1. Evidence-based protocol for infection control in immediate implant-based breast reconstruction.

    PubMed

    Craft, Randall O; Damjanovic, Branimir; Colwell, Amy S

    2012-10-01

    Immediate breast implant reconstruction has among the highest incidence of infections in plastic surgery. A literature search returned key articles that showed a significant decrease in surgical-site infections by performing nasal swab evaluation to treat methicillin-sensitive and methicillin-resistant Staphylococcus aureus before surgery with mupirocin nasal ointment and 5 days of chlorhexidine scrub to the surgical area. Additional Level 1 data supported the use of chlorhexidine-alcohol over povidone-iodine solutions for skin preparation. Intraoperative data on breast pocket irrigation showed the benefits of povidone-iodine as well as a triple antibiotic solution. Nasal swabs from 120 patients showed no methicillin-resistant S. aureus but did identify 10 patients with methicillin-sensitive S. aureus, 1 with streptococcus, and 3 with gram-negative rods, which changed perioperative antibiotic management. On the basis of the previously mentioned data, an evidence-based protocol for infection control was developed to potentially decrease infection rates. Further cost and efficacy data are warranted. PMID:22964685

  2. The treatment of herpes simplex infections: an evidence-based review.

    PubMed

    Cernik, Christina; Gallina, Kelly; Brodell, Robert T

    2008-06-01

    Genital and labial herpes simplex virus infections are frequently encountered by primary care physicians in the United States. Whereas the diagnosis of this condition is often straightforward, choosing an appropriate drug (eg, acyclovir, valacyclovir hydrochloride, or famciclovir) and dosing regimen can be confusing in view of (1) competing clinical approaches to therapy; (2) evolving dosing schedules based on new research; (3) approved regimens of the Food and Drug Administration that may not match recommendations of the Centers for Disease Control and Prevention or of other experts; and (4) dissimilar regimens for oral and genital infections. The physician must first choose an approach to treatment (ie, intermittent episodic therapy, intermittent suppressive therapy, or chronic suppressive therapy) based on defined clinical characteristics and patient preference. Then, an evidence-based dosing regimen must be selected. In this review, data from all sources are tabulated to provide a handy clinical reference. PMID:18541820

  3. An Evidence-Based Approach to the Diagnosis and Management of Acute Respiratory Infections

    Microsoft Academic Search

    Ann Marie Hart

    2007-01-01

    Acute respiratory infections (ARIs) are commonly experienced in primary care. Although most ARIs are viral in nature and resolve without treatment, nurse practitioners and other clinicians prescribe antibiotics for them 40% to 50% of the time. Thus, the purpose of this article is to review current evidence-based recommendations about the diagnosis and management of ARIs in adults.

  4. Infection control: beyond the horizon.

    PubMed

    Gray, J

    2015-04-01

    This article will consider possible future directions for innovation and research in infection prevention and control, and will make the case for the importance of including clinical and cost-effectiveness evaluation in such research. Opportunities for studies in a number of broad subject areas will be considered, including prevention and control of existing and emerging infection hazards, the challenges posed by changes in the way that medical care is being delivered, technological developments that could be harnessed for infection prevention and control, how new laboratory diagnostic technologies might benefit infection prevention and control, cleaning and decontamination, and the infection control aspects of hospital design. The need for robust economic data to support the wide and timely implementation of evidence-based practice is emphasized. PMID:25586986

  5. Building the evidence base for global tobacco control.

    PubMed Central

    Corrao, M. A.; Guindon, G. E.; Cokkinides, V.; Sharma, N.

    2000-01-01

    The tobacco control movement needs a global information system permitting routine monitoring of the tobacco trade, tobacco farming, the tobacco industry, the prevalence of tobacco use, associated mortality, and national resources for combating tobacco. The Tobacco Control Country Profiles database, a data collection initiative led by the American Cancer Society in collaboration with WHO and the Centers for Disease Control and Prevention, represents the first step in the development of such a system. Baseline data on several indicators of tobacco use were obtained from 191 Member States of WHO, two Associate Members, Hong Kong Special Administrative Region of China (Hong Kong SAR), China (Province of Taiwan) and the West Bank and Gaza Strip. The methods used to compile the data are described in the present paper. Selected indicators from the database were analysed in order to demonstrate the potential utility and value of data derived from an information system devoted to tobacco control. The analyses covered gender-specific smoking prevalence by WHO Region, per capita cigarette consumption by Human Development Index (HDI) category, and average real annual percentage changes in cigarette prices between 1990 and 1999 for selected countries in each category. In 1998, men were almost four times more likely than women to be smokers. The prevalence of smoking among men was highest in the Western Pacific Region. The differential in gender-specific smoking prevalence was narrowest in the Region of the Americas and the European Region. It was wider in the South-East Asia Region and the Western Pacific Region. The lowest and highest per capita consumption of manufactured cigarettes occurred in the lowest and highest HDI categories respectively. In the medium HDI category, China's growing cigarette consumption after 1975 had a major bearing on the rise in per capita consumption. Cigarette price trends suggest that there is considerable scope for increasing taxes on tobacco products, particularly in low or medium HDI countries. The implications of the findings for future tobacco control efforts are discussed, as are issues surrounding the quality of available data, priorities for future data collection and the need to maintain and improve the information system in order to support such efforts. PMID:10994261

  6. Network influences on dissemination of evidence-based guidelines in state tobacco control programs.

    PubMed

    Luke, Douglas A; Wald, Lana M; Carothers, Bobbi J; Bach, Laura E; Harris, Jenine K

    2013-10-01

    Little is known regarding the social network relationships that influence dissemination of evidence-based public health practices and policies. In public health, it is critical that evidence-based guidelines, such as the Centers for Disease Control and Prevention's Best Practices for Comprehensive Tobacco Control Programs, are effectively and efficiently disseminated to intended stakeholders. To determine the organizational and network predictors of dissemination among state tobacco control programs, interviews with members of tobacco control networks across eight states were conducted between August 2009 and September 2010. Measures included partner attributes (e.g., agency type) and relationships among network members (frequency of contact, extent of collaboration, and dissemination of Best Practices). Exponential random graph modeling was used to examine attribute and structural predictors of collaboration and dissemination among partners in each network. Although density and centralization of dissemination ties varied across states, network analyses revealed a consistent prediction pattern across all eight states. State tobacco control dissemination networks were less dense but more centralized compared with organizational contact and collaboration networks. Tobacco control partners in each state were more likely to disseminate the Best Practices guidelines if they also had existing contact and collaboration relationships with one another. Evidence-based guidelines in public health need to be efficiently and broadly disseminated if we hope to translate science into practice. This study suggests that funders, advocacy groups, and public health agencies can take advantage of existing public health organizational relationships to support the communication and dissemination of evidence-based practices and policies. PMID:24084398

  7. A restatement of the natural science evidence base relevant to the control of bovine tuberculosis in Great Britain†

    PubMed Central

    Godfray, H. Charles J.; Donnelly, Christl A.; Kao, Rowland R.; Macdonald, David W.; McDonald, Robbie A.; Petrokofsky, Gillian; Wood, James L. N.; Woodroffe, Rosie; Young, Douglas B.; McLean, Angela R.

    2013-01-01

    Bovine tuberculosis (bTB) is a very important disease of cattle in Great Britain, where it has been increasing in incidence and geographical distribution. In addition to cattle, it infects other species of domestic and wild animals, in particular the European badger (Meles meles). Policy to control bTB is vigorously debated and contentious because of its implications for the livestock industry and because some policy options involve culling badgers, the most important wildlife reservoir. This paper describes a project to provide a succinct summary of the natural science evidence base relevant to the control of bTB, couched in terms that are as policy-neutral as possible. Each evidence statement is placed into one of four categories describing the nature of the underlying information. The evidence summary forms the appendix to this paper and an annotated bibliography is provided in the electronic supplementary material. PMID:23926157

  8. Optimizing care for HIV-infected people who use drugs: evidence-based approaches to overcoming healthcare disparities.

    PubMed

    Meyer, Jaimie P; Althoff, Amy L; Altice, Frederick L

    2013-11-01

    Substance use disorders (SUDs) and human immunodeficiency virus (HIV) are pervasive epidemics that synergize, resulting in negative outcomes for HIV-infected people who use drugs (PWUDs). The expanding epidemiology of substance use demands a parallel evolution of the HIV specialist-beyond HIV to diagnosis and management of comorbid SUDs. The purpose of this paper is to describe healthcare disparities for HIV-infected PWUDs along each point of a continuum of care, and to suggest evidence-based strategies for overcoming these healthcare disparities. Despite extensive dedicated resources and availability of antiretroviral therapy (ART) in the United States, PWUDs continue to experience delayed HIV diagnosis, reduced entry into and retention in HIV care, delayed initiation of ART, and inferior HIV treatment outcomes. Overcoming these healthcare disparities requires integrated packages of clinical, pharmacological, behavioral, and social services, delivered in ways that are cost-effective and convenient and include, at a minimum, screening for and treatment of underlying SUDs. PMID:23797288

  9. An Evidence-Based Medicine Approach to the Treatment of Endometriosis-Associated Chronic Pelvic Pain: Placebo-Controlled Studies

    Microsoft Academic Search

    Fred M. Howard

    2000-01-01

    ObjectiveUse an evidence-based medicine (EBM) approach to evaluate the evidence regarding efficacy of treatment of endometriosis-associated chronic pelvic pain (CPP) in placebo-controlled randomized clinical trials (RCT)

  10. The role of evidence-based media advocacy in the promotion of tobacco control policies.

    PubMed

    Lane, Ch'uyasonqo H; Carter, Marina I

    2012-06-01

    This article discusses the role of evidence-based media advocacy in the promotion of tobacco control policies. Evidence is a driving force for campaigns seeking to implement a tobacco control policy. An effective campaign is based in evidence that demonstrates why a policy should be implemented, and what the potential benefits are. Media advocacy is the process of disseminating information through the communications media where the aim is to effect action, such as a change of policy, or to alter the public's view of an issue. Discussion focuses on: 1) the importance of, and methods for, collecting and communicating evidence and information to make it clear and usable for legislators, the media, and the public; and 2) the role of earned and paid media in advancing tobacco control issues. The discussion is made within the context of a specific advocacy example; in this case the 2010 campaign to increase the tobacco tax in Mexico. PMID:22689166

  11. Cancer Control Planners’ Perceptions and Use of Evidence-Based Programs

    PubMed Central

    Hannon, Peggy A.; Fernandez, Maria E.; Williams, Rebecca; Mullen, Patricia Dolan; Escoffery, Cam; Kreuter, Matthew W.; Pfeiffer, Debra; Kegler, Michelle C.; Reese, LeRoy; Mistry, Ritesh; Bowen, Deborah J.

    2010-01-01

    The Cancer Prevention and Control Research Network (CPCRN) surveyed 282 cancer control planners to inform its efforts to increase the use of evidence-based cancer control programs (EBPs; programs that have been scientifically tested and successfully changed behavior). Respondents included planners from organizations in state Comprehensive Cancer Control coalitions as well as other governmental and non-governmental organizations, and community-based coalitions. Respondents provided information about personal and organizational characteristics, their cancer control programs, their attitudes toward EBPs, and their awareness and use of Web-based resources for EBPs. Although findings showed strong preferences for cancer control programs that have been shown to work, less than half of respondents (48%) had ever used EBP resources. Regardless of whether they had used EBP resources, almost all respondents (97%) indicated that further training would help them and their organization adopt and adapt EBPs for use in their communities. The most frequently endorsed training needs were finding and securing additional resources (such as funding and technical assistance), followed by adapting EBPs for cultural appropriateness. The CPCRN consortium is using these findings to develop a Web-based interactive training and decision support tool that is responsive to the needs identified by the survey respondents. PMID:20357600

  12. Adapting an Evidence-Based Intervention Targeting HIV-Infected Prisoners in Malaysia.

    PubMed

    Copenhaver, Michael M; Tunku, Noor; Ezeabogu, Ifeoma; Potrepka, Jessica; Zahari, Muhammad Muhsin A; Kamarulzaman, Adeeba; Altice, Frederick L

    2011-01-01

    HIV-infected prisoners in Malaysia represent a critical target population for secondary HIV risk reduction interventions and care. We report on the process and outcome of our formative research aimed at systematically selecting and adapting an EBI designed to reduce secondary HIV risk and improve adherence to antiretroviral therapy among soon-to-be-released HIV-infected prisoners. Our formative work involved a critical examination of established EBIs and associated published reports complemented by data elicited through structured interviews and focus groups with key stakeholders, members of the target population, and their family members. Based on all information, we adapted the Holistic Health Recovery Program targeting people living with HIV (HHRP+), an EBI, to consist of eight 2-hour sessions that cover a range of specified topics so that participants may individually apply intervention content as needed to accommodate their particular substance abuse, HIV risk, and antiretroviral adherence issues. This study provides a complete example of the process of selecting and adapting an EBI-taking into account both empirical evidence and input from target organization stakeholders and target population members and their families-for use in real world prison settings where high-risk populations are concentrated. PMID:21860786

  13. A randomized controlled trial comparing two ways of providing evidence-based drug information to GPs

    PubMed Central

    2013-01-01

    Abstract Objective To investigate whether tailored evidence-based drug information (EBDI) to general practitioners (GPs) can change the proportion of ACE inhibitor prescriptions more effectively than EBDI provided as usual three and six months after the intervention. Design Randomized controlled trial. Setting GPs in southern Sweden working at primary health care centres (PHCCs) in seven drug and therapeutic committee areas. Intervention EBDI tailored to motivational interviewing (MI) technique and focused on the benefit aspect was compared with EBDI provided as usual. Subjects There were 408 GPs in the intervention group and 583 GPs in the control group. Main outcome measures Change in proportion of ACE inhibitor prescriptions relative to the sum of ACE inhibitors and angiotensin receptor blockers, three and six months after the intervention. Results The GPs’ average proportions of prescribed ACE inhibitors increased in both groups. No statistically significant differences in the change of proportions were found between intervention and control groups. Information was provided to 29% of GPs in both groups. Conclusion This study could not prove that specially tailored EBDI using MI implements guidelines more effectively than EBDI provided as usual. PMID:23465039

  14. Luliconazole for the treatment of fungal infections: an evidence-based review

    PubMed Central

    Khanna, Deepshikha; Bharti, Subhash

    2014-01-01

    Luliconazole is an imidazole antifungal agent with a unique structure, as the imidazole moiety is incorporated into the ketene dithioacetate structure. Luliconazole is the R-enantiomer, and has more potent antifungal activity than lanoconazole, which is a racemic mixture. In this review, we summarize the in vitro data, animal studies, and clinical trial data relating to the use of topical luliconazole. Preclinical studies have demonstrated excellent activity against dermatophytes. Further, in vitro/in vivo studies have also shown favorable activity against Candida albicans, Malassezia spp., and Aspergillus fumigatus. Luliconazole, although belonging to the azole group, has strong fungicidal activity against Trichophyton spp., similar to that of terbinafine. The strong clinical antifungal activity of luliconazole is possibly attributable to a combination of strong in vitro antifungal activity and favorable pharmacokinetic properties in the skin. Clinical trials have demonstrated its superiority over placebo in dermatophytosis, and its antifungal activity to be at par or even better than that of terbinafine. Application of luliconazole 1% cream once daily is effective even in short-term use (one week for tinea corporis/cruris and 2 weeks for tinea pedis). A Phase I/IIa study has shown excellent local tolerability and a lack of systemic side effects with use of topical luliconazole solution for onychomycosis. Further studies to evaluate its efficacy in onychomycosis are underway. Luliconazole 1% cream was approved in Japan in 2005 for the treatment of tinea infections. It has recently been approved by US Food and Drug Administration for the treatment of interdigital tinea pedis, tinea cruris, and tinea corporis. Topical luliconazole has a favorable safety profile, with only mild application site reactions reported occasionally. PMID:25285056

  15. Comprehensive Cancer Control Partners’ Use of and Attitudes About Evidence-Based Practices

    PubMed Central

    Rose, John M.; Townsend, Julie S.; Fonseka, Jamila; Richardson, Lisa C.; Chovnick, Gary

    2015-01-01

    Introduction National Comprehensive Cancer Control Program (NCCCP) awardees are encouraged to work with partners (eg, nonprofit organizations) to develop and implement plans to reduce the cancer burden in their jurisdictions using evidence-based practices (EBPs). However, the extent of EBP use among awardees and their partners is not well understood. Methods From March through July 2012, we conducted a web-based survey of program partners referred by NCCCP program directors who were involved in implementation of cancer control plans. Results Approximately 53% of referred partners (n = 83) completed surveys, 91.6% of whom represented organizations. Most partners reported involvement in helping to identify (80.5%), adapt (81.7%), implement (90.4%), and evaluate (81.9%) EBPs. The factors rated most frequently as very important when selecting EBPs were “consistent with our organization’s mission” (89.2%) and “cost-effective” (81.9%). Although most respondents said that their organizations understood the importance of using EBPs (84.3%) and had adequate access to cancer registry data (74.7%), few reported having sufficient financial resources to develop new EBPs (7.9%). The most frequently mentioned benefit of using EBPs was that they are proven to work. Resource limitations and difficulty adapting EBPs for specific populations and settings were challenges. Conclusions Our findings help indicate how NCCCP partners are involved in using EBPs and can guide ongoing efforts to encourage the use of EBPs for cancer control. The challenges of using EBPs that partners identified highlight the need to improve strategies to translate cancer prevention and control research into practice in real-world settings and for diverse populations. PMID:26182148

  16. ICNA regional workshops — using national evidence-based guidelines to reduce the risk of catheter-related urinary tract infections: report of post-workshop activities and outcomes

    Microsoft Academic Search

    C. M. Pellowe; R. J. Pratt

    2004-01-01

    ollowing the publication in 2001 of national evidence-based guidelines for preventing healthcare-associated infections, a series of one-day workshops were conducted throughout ICNA regions. These aimed to support key healthcare professionals to use the guidelines as a catalyst to develop local strategies to promote clinical effectiveness and reduce the incidence of catheter-associated urinary tract infections in acute care settings. Almost 600

  17. Building the Palliative Care Evidence Base: Lessons from a Randomized Controlled Trial of Oxygen vs. Room Air for Refractory Dyspnea

    PubMed Central

    LeBlanc, Thomas W.; Abernethy, Amy P.

    2014-01-01

    Palliative Care is increasingly seen as a standard component of high-quality comprehensive cancer care. However, there remain several challenges to its widespread integration into clinical oncology practice, including workforce problems, reimbursement concerns, and a fledgling evidence base. Here we discuss issues around evidence base development in palliative cancer care, using the example of a recently-published randomized controlled trial of oxygen vs. room air. The Oxygen Trial randomized patients with refractory dyspnea and adequate PaO2 to oxygen or room air, administered via nasal cannula. Both groups experienced improvements in self-rated dyspnea scores, but there were no statistical differences between intervention arms. These results suggest that supplementary oxygen is often unnecessary in the palliative setting, and that room air is similarly efficacious. This example highlights the importance and need for ongoing development of the evidence base in palliative medicine. The Palliative Care Research Cooperative Group (PCRC) is a novel National Institute of Nursing Research-funded research infrastructure that seeks to expand the palliative care evidence base. Its first multi-site trial was recently completed, assessing the pragmatic question of whether statin medications can be safely discontinued in end-of-life settings. The PCRC will be a vehicle through which a high-quality evidence base will continue to expand and develop. Such ongoing research efforts are needed to inform and improve palliative care practice. PMID:24994919

  18. Tobacco Control: Using evidence-based research to prevent, treat, and control tobacco use.

    Cancer.gov

    Increasing Smoking Cessation in Low Income Adult Populations Erik Augustson, PhD, MPH Tobacco Control Research Branch Behavioral Research Program Division of Cancer Control and Population Sciences RFA Purpose • To promote innovative research

  19. The implementation road: engaging community partnerships in evidence-based cancer control interventions.

    PubMed

    Breslau, Erica S; Weiss, Elisa S; Williams, Abigail; Burness, Allison; Kepka, Deanna

    2015-01-01

    Southern rural and underserved counties have high proportions of individuals with increased mortality for cervical and breast cancers. To improve the integration of behavioral research into practice, the dissemination and implementation of efficacious interventions to encourage the use of screening have increased in recent years. This study addressed gaps in the dissemination and implementation of evidence-based interventions with a pilot called Team Up. Qualitative interviews with 24 key individuals in six state-level partnerships explored partnership characteristics that influenced selection and use of evidence-based interventions among low-income, rarely or never screened women. Guided by diffusion of innovations theory and the Lasker and Weiss partnership functioning model, interviews about the intervention centered on (a) knowledge surrounding evidence base; (b) identification, selection, and adoption; (c) planning and adaptation; (d) implementation; and (e) partnership reflections and impact. Using grounded theory and content analysis, data revealed that lack of communication and high partner turnover hindered adoption and adaptation, whereas failure of partnership leaders to engage local stakeholders and lack of sufficient funds hampered implementation. Delivery of evidence-based interventions was more effective when partnerships included local partners in early decision making and when coaches were introduced to facilitate strategic thinking about translating evidence-based interventions into practice. A challenge for public health partnerships was the translation of interventions into successful programs, such that underserved communities benefited from early detection intervention research. PMID:24700166

  20. Implementation of evidence-based antenatal care in Mozambique: a cluster randomized controlled trial: study protocol

    PubMed Central

    2014-01-01

    Background Antenatal care (ANC) reduces maternal and perinatal morbidity and mortality directly through the detection and treatment of pregnancy-related illnesses, and indirectly through the detection of women at increased risk of delivery complications. The potential benefits of quality antenatal care services are most significant in low-resource countries where morbidity and mortality levels among women of reproductive age and neonates are higher. WHO developed an ANC model that recommended the delivery of services scientifically proven to improve maternal, perinatal and neonatal outcomes. The aim of this study is to determine the effect of an intervention designed to increase the use of the package of evidence-based services included in the WHO ANC model in Mozambique. The primary hypothesis is that the intervention will increase the use of evidence-based practices during ANC visits in comparison to the standard dissemination channels currently used in the country. Methods This is a demonstration project to be developed through a facility-based cluster randomized controlled trial with a stepped wedge design. The intervention was tailored, based on formative research findings, to be readily applicable to local prenatal care services and acceptable to local pregnant women and health providers. The intervention includes four components: the provision of kits with all necessary medicines and laboratory supplies for ANC (medical and non-medical equipment), a storage system, a tracking system, and training sessions for health care providers. Ten clinics were selected and will start receiving the intervention in a random order. Outcomes will be computed at each time point when a new clinic starts the intervention. The primary outcomes are the delivery of selected health care practices to women attending the first ANC visit, and secondary outcomes are the delivery of selected health care practices to women attending second and higher ANC visits as well as the attitude of midwives in relation to adopting the practices. This demonstration project is pragmatic in orientation and will be conducted under routine conditions. Discussion There is an urgent need for effective and sustainable scaling-up approaches of health interventions in low-resource countries. This can only be accomplished by the engagement of the country’s health stakeholders at all levels. This project aims to achieve improvement in the quality of antenatal care in Mozambique through the implementation of a multifaceted intervention on three levels: policy, organizational and health care delivery levels. The implementation of the trial will probably require a change in accountability and behaviour of health care providers and we expect this change in ‘habits’ will contribute to obtaining reliable health indicators, not only related to research issues, but also to health care outcomes derived from the new health care model. At policy level, the results of this study may suggest a need for revision of the supply chain management system. Given that supply chain management is a major challenge for many low-resource countries, we envisage that important lessons on how to improve the supply chain in Mozambique and other similar settings, will be drawn from this study. Trial registration Pan African Clinical Trial Registry database. Identification number: PACTR201306000550192. PMID:24886392

  1. Evidence based community mobilization for dengue prevention in Nicaragua and Mexico (Camino Verde, the Green Way): cluster randomized controlled trial

    PubMed Central

    Nava-Aguilera, Elizabeth; Arosteguí, Jorge; Morales-Perez, Arcadio; Suazo-Laguna, Harold; Legorreta-Soberanis, José; Hernandez-Alvarez, Carlos; Fernandez-Salas, Ildefonso; Paredes-Solís, Sergio; Balmaseda, Angel; Cortés-Guzmán, Antonio Juan; Serrano de los Santos, René; Coloma, Josefina; Ledogar, Robert J; Harris, Eva

    2015-01-01

    Objective To test whether community mobilization adds effectiveness to conventional dengue control. Design Pragmatic open label parallel group cluster randomized controlled trial. Those assessing the outcomes and analyzing the data were blinded to group assignment. Centralized computerized randomization after the baseline study allocated half the sites to intervention, stratified by country, evidence of recent dengue virus infection in children aged 3-9, and vector indices. Setting Random sample of communities in Managua, capital of Nicaragua, and three coastal regions in Guerrero State in the south of Mexico. Participants Residents in a random sample of census enumeration areas across both countries: 75 intervention and 75 control clusters (about 140 households each) were randomized and analyzed (60 clusters in Nicaragua and 90 in Mexico), including 85?182 residents in 18?838 households. Interventions A community mobilization protocol began with community discussion of baseline results. Each intervention cluster adapted the basic intervention—chemical-free prevention of mosquito reproduction—to its own circumstances. All clusters continued the government run dengue control program. Main outcome measures Primary outcomes per protocol were self reported cases of dengue, serological evidence of recent dengue virus infection, and conventional entomological indices (house index: households with larvae or pupae/households examined; container index: containers with larvae or pupae/containers examined; Breteau index: containers with larvae or pupae/households examined; and pupae per person: pupae found/number of residents). Per protocol secondary analysis examined the effect of Camino Verde in the context of temephos use. Results With cluster as the unit of analysis, serological evidence from intervention sites showed a lower risk of infection with dengue virus in children (relative risk reduction 29.5%, 95% confidence interval 3.8% to 55.3%), fewer reports of dengue illness (24.7%, 1.8% to 51.2%), fewer houses with larvae or pupae among houses visited (house index) (44.1%, 13.6% to 74.7%), fewer containers with larvae or pupae among containers examined (container index) (36.7%, 24.5% to 44.8%), fewer containers with larvae or pupae among houses visited (Breteau index) (35.1%, 16.7% to 55.5%), and fewer pupae per person (51.7%, 36.2% to 76.1%). The numbers needed to treat were 30 (95% confidence interval 20 to 59) for a lower risk of infection in children, 71 (48 to 143) for fewer reports of dengue illness, 17 (14 to 20) for the house index, 37 (35 to 67) for the container index, 10 (6 to 29) for the Breteau index, and 12 (7 to 31) for fewer pupae per person. Secondary per protocol analysis showed no serological evidence of a protective effect of temephos. Conclusions Evidence based community mobilization can add effectiveness to dengue vector control. Each site implementing the intervention in its own way has the advantage of local customization and strong community engagement. Trial registration ISRCTN27581154 PMID:26156323

  2. An ontology of randomized controlled trials for evidence-based practice: content specification and evaluation using the competency decomposition method

    Microsoft Academic Search

    Ida Sim; Ben Olasov; Simona Carini

    2004-01-01

    Abstract Randomized controlled trials (RCTs) are one of the least biased sources of clinical research evidence, and are therefore a critical resource for the practice of evidence-based medicine. With over 10,000 new RCTs indexed in Medline each year, knowledge systems are needed,to help clinicians translate evidence into practice. Common,ontologies for RCTs and other domains,would,facilitate the development of these knowledge systems.

  3. Infection Control and Prevention

    Microsoft Academic Search

    Kerri Thom; Mary-Claire Roghmann

    \\u000a Cancer center patients are frequently immune suppressed and are, therefore, at risk for a wide range of opportunistic pathogens\\u000a in addition to common nosocomial pathogens that are a problem for patients throughout the hospital. A good infection control\\u000a program is extremely important in this setting to reduce the risks of community- and hospital-acquired infections among patients.\\u000a In addition to protecting

  4. An evidence-based prehospital guideline for external hemorrhage control: American College of Surgeons Committee on Trauma.

    PubMed

    Bulger, Eileen M; Snyder, David; Schoelles, Karen; Gotschall, Cathy; Dawson, Drew; Lang, Eddy; Sanddal, Nels D; Butler, Frank K; Fallat, Mary; Taillac, Peter; White, Lynn; Salomone, Jeffrey P; Seifarth, William; Betzner, Michael J; Johannigman, Jay; McSwain, Norman

    2014-01-01

    This report describes the development of an evidence-based guideline for external hemorrhage control in the prehospital setting. This project included a systematic review of the literature regarding the use of tourniquets and hemostatic agents for management of life-threatening extremity and junctional hemorrhage. Using the GRADE methodology to define the key clinical questions, an expert panel then reviewed the results of the literature review, established the quality of the evidence and made recommendations for EMS care. A clinical care guideline is proposed for adoption by EMS systems. Key words: tourniquet; hemostatic agents; external hemorrhage. PMID:24641269

  5. [Infection prevention and control for foodborne infections].

    PubMed

    Mitsuda, Toshihiro

    2012-08-01

    Patients' care for foodborne infections is sometimes very critical, since these patients exerting high copy numbers of contagious pathogens. Recently, Norovirus infection became the most frequent pathogen for large outbreaks in the community and the hospital around the world. Norovirus is alcohol-resistant and highly contagious. For preventing outbreaks of foodborne infections, standard precaution(and contact precaution for diaper changing patients) is required by the CDC's isolation precaution guideline revised at 2007. We need to provide for infection prevention and control in the epidemic winter period not only in healthcare facilities but also for communities. PMID:22894082

  6. Are Bracken Control Methods Effective? An Evidence-Based Approach. Gavin. B. Stewart & Andrew. S. Pullin

    E-print Network

    Miall, Chris

    ) Primary Secondary Tertiary Lowland heath, Upland heath, Lowland acidic grassland, Upland acidic grassland control on nightjar, whinchat, and invertebrates. Table 1. Subject, intervention and outcomes of relevance

  7. Randomised Controlled Trials for Evidence-based Education: Some Problems in Judging "What Works."

    ERIC Educational Resources Information Center

    Morrison, Keith

    2001-01-01

    Makes the case that faith in randomized controlled trials (RCTs) to determine "what works" in education may be misplaced. Identifies eight possible problems with relying on RCTs and notes that the rigor required for RCTs may not be practicable. (SLD)

  8. Evidence-based control of canine rabies: a critical review of population density reduction.

    PubMed

    Morters, Michelle K; Restif, Olivier; Hampson, Katie; Cleaveland, Sarah; Wood, James L N; Conlan, Andrew J K

    2013-01-01

    Control measures for canine rabies include vaccination and reducing population density through culling or sterilization. Despite the evidence that culling fails to control canine rabies, efforts to reduce canine population density continue in many parts of the world. The rationale for reducing population density is that rabies transmission is density-dependent, with disease incidence increasing directly with host density. This may be based, in part, on an incomplete interpretation of historical field data for wildlife, with important implications for disease control in dog populations. Here, we examine historical and more recent field data, in the context of host ecology and epidemic theory, to understand better the role of density in rabies transmission and the reasons why culling fails to control rabies. We conclude that the relationship between host density, disease incidence and other factors is complex and may differ between species. This highlights the difficulties of interpreting field data and the constraints of extrapolations between species, particularly in terms of control policies. We also propose that the complex interactions between dogs and people may render culling of free-roaming dogs ineffective irrespective of the relationship between host density and disease incidence. We conclude that vaccination is the most effective means to control rabies in all species. PMID:23004351

  9. Evidence-based control of canine rabies: a critical review of population density reduction

    PubMed Central

    Morters, Michelle K; Restif, Olivier; Hampson, Katie; Cleaveland, Sarah; Wood, James L N; Conlan, Andrew J K

    2013-01-01

    Control measures for canine rabies include vaccination and reducing population density through culling or sterilization. Despite the evidence that culling fails to control canine rabies, efforts to reduce canine population density continue in many parts of the world. The rationale for reducing population density is that rabies transmission is density-dependent, with disease incidence increasing directly with host density. This may be based, in part, on an incomplete interpretation of historical field data for wildlife, with important implications for disease control in dog populations. Here, we examine historical and more recent field data, in the context of host ecology and epidemic theory, to understand better the role of density in rabies transmission and the reasons why culling fails to control rabies. We conclude that the relationship between host density, disease incidence and other factors is complex and may differ between species. This highlights the difficulties of interpreting field data and the constraints of extrapolations between species, particularly in terms of control policies. We also propose that the complex interactions between dogs and people may render culling of free-roaming dogs ineffective irrespective of the relationship between host density and disease incidence. We conclude that vaccination is the most effective means to control rabies in all species. PMID:23004351

  10. Infection control and prevention considerations.

    PubMed

    Daniels, Titus L; Talbot, Thomas R

    2014-01-01

    Due to the nature of their underlying illness and treatment regimens, cancer patients are at increased risk of infection. Though the advent and widespread use of anti-infective agents has allowed for the application of ever-greater immune-suppressing therapies with successful treatment of infectious complications, prevention of infection remains the primary goal. The evolutionary changes of microorganisms, whereby resistance to anti-infective therapy is increasingly common, have facilitated a paradigm shift in the field of healthcare epidemiology. No longer is the focus on "control" of infection once established in a healthcare environment. Rather, the emphasis is on prevention of infection before it occurs. The most basic tenet of infection prevention, and the cornerstone of all well-designed infection prevention and control programs, is hand hygiene. The hands of healthcare workers provide a common potential source for transmission of infectious agents, and effective decontamination of the hands reduces the risk of transmission of infectious material to other patients. Once infection is suspected or established; however, implementation of effective control strategies is important to limit the spread of infection within a healthcare environment. This chapter outlines the basic tenets of infection prevention, principles of isolation precautions and control measures, and elements for a successful infection control and prevention program. PMID:24706234

  11. A framework for developing an evidence-based, comprehensive tobacco control program

    Microsoft Academic Search

    Laura Rosen; Elliot Rosenberg; Martin McKee; Shosh Gan-Noy; Diane Levin; Elana Mayshar; Galia Shacham; John Borowski; Gabi Bin Nun; Boaz Lev

    2010-01-01

    BACKGROUND: Tobacco control is an area where the translation of evidence into policy would seem to be straightforward, given the wealth of epidemiological, behavioural and other types of research available. Yet, even here challenges exist. These include information overload, concealment of key (industry-funded) evidence, contextualization, assessment of population impact, and the changing nature of the threat. METHODS: In the context

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

    PubMed

    Davis, Leslie Louise

    2015-06-11

    Approximately one in three adults in the United States has hypertension. This article provides an update on the latest JNC-8 guideline for treating hypertension in adults. Emphasis is placed on new and updated information and implications for primary care clinicians to help patients achieve and maintain better blood pressure control. PMID:25922904

  13. Communicating Program Outcomes to Encourage Policymaker Support for Evidence-Based State Tobacco Control

    PubMed Central

    Schmidt, Allison M.; Ranney, Leah M.; Goldstein, Adam O.

    2014-01-01

    Tobacco use, the leading cause of preventable death in the U.S., can be reduced through state-level tobacco prevention and cessation programs. In the absence of research about how to communicate the need for these programs to policymakers, this qualitative study aimed to understand the motivations and priorities of policymakers in North Carolina, a state that enacted a strong tobacco control program from 2003–2011, but drastically reduced funding in recent years. Six former legislators (three Democrats, three Republicans) and three lobbyists for health organizations were interviewed about their attitudes towards tobacco use, support of state-funded programs, and reactions to two policy briefs. Five themes emerged: (1) high awareness of tobacco-related health concerns but limited awareness of program impacts and funding, (2) the primacy of economic concerns in making policy decisions, (3) ideological differences in views of the state’s role in tobacco control, (4) the impact of lobbyist and constituent in-person appeals, and (5) the utility of concise, contextualized data. These findings suggest that building relationships with policymakers to communicate ongoing program outcomes, emphasizing economic data, and developing a constituent advocacy group would be valuable to encourage continued support of state tobacco control programs. PMID:25485977

  14. Evidence-Based Practice in the Use of Antibiotics for Respiratory Tract Infections in Primary Health Centers in Kuwait

    Microsoft Academic Search

    Salem Ayyad; Abdullah Al-Owaisheer; Faisal Al-Banwan; Abdullah Al-Mejalli; Mumtaz Shukkur; Lukman Thalib

    2010-01-01

    Objectives: The objective of this study was to evaluate the use of antibiotics in treating upper respiratory tract infections (URTIs) in primary health centers in Kuwait and investigate the extent to which antibiotic use follows international guidelines. SubjectsandMethods: A nationwide cross-sectional study was conducted with a sample size of 615 patients selected by using a multi-stage cluster sampling method. Of

  15. An outreach intervention to implement evidence based practice in residential care: a randomized controlled trial [ISRCTN67855475

    PubMed Central

    Crotty, Maria; Whitehead, Craig; Rowett, Debra; Halbert, Julie; Weller, David; Finucane, Paul; Esterman, Adrian

    2004-01-01

    Background The aim of this project was to assess whether outreach visits would improve the implementation of evidence based clinical practice in the area of falls reduction and stroke prevention in a residential care setting. Methods Twenty facilities took part in a randomized controlled trial with a seven month follow-up period. Two outreach visits were delivered by a pharmacist. At the first a summary of the relevant evidence was provided and at the second detailed audit information was provided about fall rates, psychotropic drug prescribing and stroke risk reduction practices (BP monitoring, aspirin and warfarin use) for the facility relevant to the physician. The effect of the interventions was determined via pre- and post-intervention case note audit. Outcomes included change in percentage patients at risk of falling who fell in a three month period prior to follow-up and changes in use of psychotropic medications. Chi-square tests, independent samples t-test, and logistic regression were used in the analysis. Results Data were available from case notes at baseline (n = 897) and seven months follow-up (n = 902), 452 residential care staff were surveyed and 121 physicians were involved with 61 receiving outreach visits. Pre-and post-intervention data were available for 715 participants. There were no differences between the intervention and control groups for the three month fall rate. We were unable to detect statistically significant differences between groups for the psychotropic drug use of the patients before or after the intervention. The exception was significantly greater use of "as required" antipsychotics in the intervention group compared with the control group after the pharmacy intervention (RR = 4.95; 95%CI 1.69–14.50). There was no statistically significant difference between groups for the numbers of patients "at risk of stroke" on aspirin at follow-up. Conclusions While the strategy was well received by the physicians involved, there was no change in prescribing patterns. Patient care in residential settings is complex and involves contributions from the patient's physician, family and residential care staff. The project highlights challenges of delivering evidence based care in a setting in which there is a paucity of well controlled trial evidence but where significant health outcomes can be attained. PMID:15066200

  16. Hospital Infection Control in Sweden

    Microsoft Academic Search

    Bertil Nyström

    1988-01-01

    In Sweden the 23 counties are responsible for the medical care of their inhabitants. They own and run virtually all hospitals. This system facilitates a county-based hospital infection control system. The infection control team is based in the county hospital department of clinical bacteriology. It is headed by an MD clinical bacteriologist or, in some counties, by an infectious disease

  17. [Prions, infections and confusions in the "transmissible" spongiform encephalopathies. The other evidence-based science. III. Review].

    PubMed

    León-S, F E; Rodriguez, C I; Prada, D G

    2000-09-01

    There are some neurological disorders with a pathological hallmark called spongiosis which include Creutzfeld-Jakob disease and its new variant, the Gertsmann-Straussler-Scheinker Syndrome and the Fatal Familial Insomnia in humans; and Scrapie and Bovine Spongiform Encephalopathy, among others, in animals. The etiological agent has been considered either transmissible or hereditary or both. Curiously, this agent has no nucleic acids, is impossible to filter, is resistant to inactivation by chemical means, has not been cultured and is unobservable at electron microscopy. All of these facts have led to some researches to claim that these agents are similar to viruses appearing in computers. However, after almost fifty years of research, is still not possible to explain why and how such elements produce the diseases commented about. On the contrary, during these years have been possible to know that these entities called slow viral infections, transmissible amyloidosis, transmissible dementia, transmissible spongiform encephalopathies or prion diseases appear in individuals with genetical predispositions exposed to several worldwide immunological stressors. The possibility that prions are the consequence and not the cause of these diseases in animals and man is day by day more reliable, and supports the suggestion that a systematic intoxication due to pesticides as well as mycotoxin ingestion, produced mainly by different molds such as Aspergillus, Penicillium or Fusarium, seem to be the true etiology of these neurodegenerative disorders. PMID:11029835

  18. Randomised controlled trial of the effect of evidence based information on women's willingness to participate in cervical cancer screening

    PubMed Central

    Adab, P; Marshall, T; Rouse, A; Randhawa, B; Sangha, H; Bhangoo, N

    2003-01-01

    Study objectives: To assess whether providing women with additional information on the pros and cons of screening, compared with information currently offered by the NHS, affects their intention to attend for screening. Design: Randomised controlled trial. Participants were randomly assigned to receive either the control, (based on an NHS Cervical Screening Programme leaflet currently used), or the intervention leaflet (containing additional information on risks and uncertainties). Setting: Three general practices in Birmingham. Participants: 300 women aged 20 to 64 attending the practices during a one month period. Main outcome measures: Intention to attend for screening. Main results: 283 women (94.3%) completed the study. Fewer women in the intervention (79%) than the control group (88%) expressed intention to have screening after reading the information leaflet (difference between groups 9.2%, 95% confidence intervals (CI) 3.2% to 21.7%). The crude odds ratio (OR) and 95% CI was 0.50 (0.26 to 0.97). After adjusting for other factors, the trend persisted (OR 0.60, 95% CI 0.28 to 1.29). Having a previous Pap smear was the only significant predictor of intention to have screening (adjusted OR 2.54, 95% CI 1.03 to 6.21). Subgroup analysis showed no intervention effect in intended uptake between women at higher and lower risk of cervical cancer (p=0.59). Conclusions: Providing women with evidence based information on the risks, uncertainties, and the benefits of screening, is likely to deter some, but not differentially those at higher risk. PMID:12883063

  19. A Randomized Control Trial Examining the Effect of Acceptance and Commitment Training on Clinician Willingness to Use Evidence-Based Pharmacotherapy

    ERIC Educational Resources Information Center

    Varra, Alethea A.; Hayes, Steven C.; Roget, Nancy; Fisher, Gary

    2008-01-01

    This study evaluated the effectiveness of acceptance and commitment training (ACT) for increasing drug and alcohol counselors' willingness to use evidence-based agonist and antagonist pharmacotherapy. Fifty-nine drug and alcohol counselors were randomly assigned to either a 1-day ACT workshop or a 1-day educational control workshop. Both groups…

  20. Day Care Infection Control Protocol.

    ERIC Educational Resources Information Center

    Seattle-King County Dept. of Public Health, Seattle, WA.

    This day care infection control manual was assembled to provide technical guidance for the prevention and control of communicable diseases to child day care facilities in Seattle and King County, Washington. For each disease, the manual provides background information, public health control recommendations, and letters that can be used to…

  1. Enterobiasis (Pinworm Infection): Prevention and Control

    MedlinePLUS

    ... Holidays Contact CDC-INFO Pinworm Infection General Information Pinworm Infection FAQs Epidemiology & Risk Factors Biology Disease Diagnosis Treatment Prevention & Control Resources for Health Professionals Publications Information ...

  2. Environmental infection control of tuberculosis.

    PubMed

    Nardell, Edward A

    2003-12-01

    Current infection control guidelines for tuberculosis focus first on administrative interventions to promptly identify and isolate a known or suspected infectious case. Environmental control measures come next, and finally personal respiratory protection is recommended as a final strategy to prevent transmission. However, both environmental controls and the use of personal respiratory protection are also focused on known or suspected cases, and certain high-risk procedures. There is little focus on general medical areas where unsuspected cases are believed to transmit their infection before they become suspected cases. This review makes the case for increased attention to such areas as general medical wards, clinics, and waiting areas. Administrative controls are needed to improve detection and to reduce the possibility of transmission to high-risk groups. Improved air disinfection through general ventilation, filtration, and ultraviolet germicidal irradiation are needed as ways to address this overlooked source of transmission. PMID:14679478

  3. General principles of infection control.

    PubMed

    Alqurashi, Abdelrahman Mohammad

    2012-12-01

    The nosocomial infection is a significant problem worldwide. Thus, hospitals should be aware of it. The hand-washing at a sink is impractical, unachievable and the hospital subjects always do not comply with it. The infection control practitioners, consensually, claimed that waterless alcohol-based hand rubs should be available at the bedside and their use should be promoted over hand-washing with soap and water. In this review, the detailed CDC guidelines of antimicrobial ingredients designed for hand-washing as well as by concerned authorities are presented. PMID:23469643

  4. 42 CFR 460.74 - Infection control.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... Infection control. (a) Standard procedures. The PACE organization...must follow accepted policies and standard procedures with respect to infection...control, including at least the standard precautions developed by the Centers...

  5. 42 CFR 460.74 - Infection control.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... Infection control. (a) Standard procedures. The PACE organization...must follow accepted policies and standard procedures with respect to infection...control, including at least the standard precautions developed by the Centers...

  6. 42 CFR 460.74 - Infection control.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... Infection control. (a) Standard procedures. The PACE organization...must follow accepted policies and standard procedures with respect to infection...control, including at least the standard precautions developed by the Centers...

  7. 42 CFR 460.74 - Infection control.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... Infection control. (a) Standard procedures. The PACE organization...must follow accepted policies and standard procedures with respect to infection...control, including at least the standard precautions developed by the Centers...

  8. 42 CFR 460.74 - Infection control.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... Infection control. (a) Standard procedures. The PACE organization...must follow accepted policies and standard procedures with respect to infection...control, including at least the standard precautions developed by the Centers...

  9. [Evidence-based medicine].

    PubMed

    Saad, E D; Grunspun, H

    1996-01-01

    Evidence-based medicine has been described as a new approach to teaching and practicing clinical medicine. Although the search for evidence is an established practice among physicians, what is being proposed is the systematic gathering and critical interpretation of data, which can then be used in the appropriate context. The main objective is to provide better care for patients. This is accomplished by transforming clinical problems in specific questions to be answered by searching the literature for the levels of evidence favoring the possible interventions for one particular case. This has to be done in a systematic and conscientious fashion. Through its method, evidence-based medicine places less value on clinical experience, the study understanding of pathophysiology, and common sense; instead, it emphasizes observation, levels of evidence, and critical interpretation of original literature. In this manner, evidence-based medicine may be seen by the authoritarian physician as a threat. Other obstacles to the acceptance of the method include lack of time and lack of familiarity with computers. One important limitation of evidence-based medicine is the incomplete or contradictory evidence available in many areas of clinical medicine, or the so-called "grey zones". We outline the main aspects of evidence-based medicine, expecting a growing interest among brazilian physicians for this useful clinical tool. PMID:8762653

  10. 42 CFR 483.65 - Infection control.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...CERTIFICATION REQUIREMENTS FOR STATES AND LONG TERM CARE FACILITIES Requirements for Long Term Care Facilities § 483.65 Infection control...employees with a communicable disease or infected skin lesions from direct contact with residents...

  11. 42 CFR 483.65 - Infection control.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ...CERTIFICATION REQUIREMENTS FOR STATES AND LONG TERM CARE FACILITIES Requirements for Long Term Care Facilities § 483.65 Infection control...employees with a communicable disease or infected skin lesions from direct contact with residents...

  12. 42 CFR 483.65 - Infection control.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...CERTIFICATION REQUIREMENTS FOR STATES AND LONG TERM CARE FACILITIES Requirements for Long Term Care Facilities § 483.65 Infection control...employees with a communicable disease or infected skin lesions from direct contact with residents...

  13. 42 CFR 483.65 - Infection control.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ...CERTIFICATION REQUIREMENTS FOR STATES AND LONG TERM CARE FACILITIES Requirements for Long Term Care Facilities § 483.65 Infection control...employees with a communicable disease or infected skin lesions from direct contact with residents...

  14. Management of Hospital Infection Control in Iran: A Need for Implementation of Multidisciplinary Approach

    PubMed Central

    Mamishi, Setareh; Pourakbari, Babak; Teymuri, Mostafa; Babamahmoodi, Abdolreza; Mahmoudi, Shima

    2014-01-01

    Nosocomial, or hospital-acquired, infections are considered the most common complications affecting hospitalized patients. According to results obtained from studies conducted in the Children Medical Center Hospital, a teaching children's hospital and a tertiary care referral unit in Tehran, Iran, improvements in infection control practices in our hospital seem necessary. The aim of this study was to identify risk management and review potential hospital hazards that may pose a threat to the health as well as safety and welfare of patients in an Iranian referral hospital. Barriers to compliance and poor design of facilities, impractical guidelines and policies, lack of a framework for risk management, failure to apply behavioral-change theory, and insufficient obligation and enforcement by infection control personnel highlight the need of management systems in infection control in our hospital. In addition, surveillance and early reporting of infections, evaluation of risk-based interventions, and production of evidence-based guidelines in our country are recommended. PMID:25379367

  15. Evidence-based medicine.

    PubMed Central

    MacPherson, D W

    1995-01-01

    Clinical practice guidelines are an important product of the National Committee to Advise on Tropical Medicine and Travel (CATMAT). Recent guidelines have been published on the guiding principles for clinical practice guidelines. The ninth principle states: "Clinical practice guidelines should: (a) cite the specific evidence bearing upon the conclusion, (b) indicate the strength of the evidence [and] (c) specify the date of the most recent evidence considered." The following is CATMAT's statement on evidence-based medicine and the scales used to grade its recommendations. PMID:7820803

  16. Feasibility and impact of an evidence-based electronic decision support system for diabetes care in family medicine: protocol for a cluster randomized controlled trial

    PubMed Central

    2013-01-01

    Background In Belgium, the construction of the national electronic point-of-care information service, EBMPracticeNet, was initiated in 2011 to optimize quality of care by promoting evidence-based decision-making. The collaboration of the government, healthcare providers, Evidence-Based Medicine (EBM) partners, and vendors of Electronic Health Records (EHR) is unique to this project. All Belgian healthcare professionals get free access to an up-to-date database of validated Belgian and nearly 1,000 international guidelines, incorporated in a portal that also provides EBM information from sources other than guidelines, including computerized clinical decision support that is integrated in the EHRs. The EBMeDS system is the electronic evidence-based decision support system of EBMPracticeNet. The EBMeDS system covers all clinical areas of diseases and could play a crucial role in response to the emerging challenge posed by chronic conditions. Diabetes was chosen as the analysis topic of interest. The objective of this study is to assess the effectiveness of EBMeDS use in improving diabetes care. This objective will be enhanced by a formal process evaluation to provide crucial information on the feasibility of using the system in daily Belgian family medicine. Methods The study is a cluster-randomized trial with before/after measurements conducted in Belgian family medicine. Physicians’ practices will be randomly assigned to the intervention or control group in a 1:1 ratio, to receive either the EBMeDS reminders or to follow the usual care process. Randomization will be performed by a statistical consultant with an electronic random list generator, anonymously for the researchers. The follow-up period of the study will be 12 months with interim analysis points at 3, 6 and 9 months. Primary outcome is the one-year pre- to post-implementation change in HbA1c. Patients will not be informed about the intervention. Data analysts will be kept blinded to the allocation. Discussion The knowledge obtained in this study will be useful for further integration in other Belgian software packages. Users’ perceptions and process evaluation will provide information for improving the feasibility of the system. Trial registration The trial is registered with the ClinicalTrials.gov registry: NCT01830569. PMID:23915250

  17. Effectiveness of the tailored Evidence Based Practice training program for Filipino physical therapists: a randomized controlled trial

    PubMed Central

    2014-01-01

    Background This study evaluated the effectiveness of the contextualized EBP training program for Filipino physical therapists in terms of knowledge, skills, attitudes and behavior. Methods A randomized controlled trial was designed to assess the effectiveness of the EBP training program. Fifty four physical therapists were randomly allocated to the EBP group (intervention) and waitlist (control) group. The EBP group had a one day face-to-face training with an online support, whilst the control was waitlisted. There were three measurement points which were pre, post, and three months post intervention for knowledge, skills and attitudes. Activity diaries were used to measure behavior. The diaries were collected after three months. Data analysis was by intention to treat in EBP domains of knowledge, skills and attitudes. Results Fifty-four physical therapists were included in the study. Fifty two (52) completed the post training assessment and 26 completed the 3 months post training assessment for EBP knowledge, skills and attitudes. There were significant improvements in these domains in the EBP group from pre to post training and over a period of three months (p?control group. Thirty seven (37) physical therapists completed their activity diaries over three months. Behavior significantly improved in the EBP group in terms of EBP behaviors (formulating PICO, searching, appraising and applying the evidence) when faced with both new/unique and usual case scenarios (p?control group significantly performed non-EBP behaviors (asking doctors and reading textbooks) when faced with new/unique cases compared with the EBP group (p?controlled trials ISRCTN74485061 (Registration date: February 9, 2011). PMID:25034409

  18. Evidence-Based Anatomy

    PubMed Central

    Yammine, Kaissar

    2014-01-01

    Anatomy is a descriptive basic medical science that is no longer considered a research-led discipline. Many publications in clinical anatomy are prevalence studies treating clinically relevant anatomical variations and reporting their frequencies and/or associations with variables such as age, sex, side, laterality, and ancestry. This article discusses the need to make sense of the available literature. A new concept, evidence-based anatomy (EBA), is proposed to find, appraise, and synthetize the results reported in such publications. It consists in applying evidence-based principles to the field of epidemiological anatomy research through evidence synthesis using systematic reviews and meta-analyses to generate weighted pooled results. Pooled frequencies and associations based on large pooled sample size are likely to be more accurate and to reflect true population statistics and associations more closely. A checklist of a typical systematic review in anatomy is suggested and the implications of EBA for practice and future research, along with its scope, are discussed. The EBA approach would have positive implications for the future preservation of anatomy as a keystone basic science, for sound knowledge of anatomical variants, and for the safety of medical practice. Clin. Anat. 27:847–852, 2014. PMID:24797314

  19. Are treatment targets for hypercholesterolemia evidence based? Systematic review and meta-analysis of randomised controlled trials

    Microsoft Academic Search

    Y. Lebenthal; A. Horvath; P. Dziechciarz; H. Szajewska; R. Shamir

    2010-01-01

    ObjectiveSearch for evidence supporting target age, level of intervention and target values for low-density lipoprotein (LDL) cholesterol levels in children with familial hypercholesterolemia.DesignSystematic review and meta-analysis. PubMed, Medline, CINAHL and Cochrane Reviews databases from 1966 to 2007 were searched for articles reporting statin therapy in children and adolescents aged 8–18 years. Retrieved articles were screened for double-blind randomised controlled trials

  20. Influence network linkages across implementation strategy conditions in a randomized controlled trial of two strategies for scaling up evidence-based practices in public youth-serving systems

    PubMed Central

    2013-01-01

    Background Given the importance of influence networks in the implementation of evidence-based practices and interventions, it is unclear whether such networks continue to operate as sources of information and advice when they are segmented and disrupted by randomization to different implementation strategy conditions. The present study examines the linkages across implementation strategy conditions of social influence networks of leaders of youth-serving systems in 12 California counties participating in a randomized controlled trial of community development teams (CDTs) to scale up use of an evidence-based practice. Methods Semi-structured interviews were conducted with 38 directors, assistant directors, and program managers of county probation, mental health, and child welfare departments. A web-based survey collected additional quantitative data on information and advice networks of study participants. A mixed-methods approach to data analysis was used to create a sociometric data set (n?=?176) to examine linkages between treatment and standard conditions. Results Of those network members who were affiliated with a county (n?=?137), only 6 (4.4%) were directly connected to a member of the opposite implementation strategy condition; 19 (13.9%) were connected by two steps or fewer to a member of the opposite implementation strategy condition; 64 (46.7%) were connected by three or fewer steps to a member of the opposite implementation strategy condition. Most of the indirect steps between individuals who were in different implementation strategy conditions were connections involving a third non-county organizational entity that had an important role in the trial in keeping the implementation strategy conditions separate. When these entities were excluded, the CDT network exhibited fewer components and significantly higher betweenness centralization than did the standard condition network. Conclusion Although the integrity of the RCT in this instance was not compromised by study participant influence networks, RCT designs should consider how influence networks may extend beyond boundaries established by the randomization process in implementation studies. Trial registration NCT00880126 PMID:24229373

  1. Integrated care pathways (ICPs) and infection control

    Microsoft Academic Search

    Ted Nyatanga; Rick Holliman

    2005-01-01

    Purpose – The article aims to globally illuminate and inform the healthcare delivery systems of the potential value of integrated care pathways (ICPs) application to the management and control of infection in the hospital setting Design\\/methodology\\/approach – An analysis of recent pertinent literature (1993-2004) is given, preceded by a broad overview of both the subjects of infection control and ICPs.

  2. Translating an evidence-based diabetes education approach into rural african-american communities: the "wisdom, power, control" program.

    PubMed

    Peña-Purcell, Ninfa C; Jiang, Luohua; Ory, Marcia G; Hollingsworth, Ryan

    2015-05-01

    Purpose. The aim of this exploratory study was to assess the efficacy of the "Wisdom, Power, Control" diabetes self-management education (DSME) program with regard to diabetes knowledge, self-efficacy, self-care, distress level, and A1C in an African-American population. Methods. A prospective, quasi-experimental, repeated-measure design was employed to measure these outcomes. Study participants were assessed at baseline, 6 weeks post-intervention, and at a 3-month A1C follow-up. Results. A total of 103 participants were recruited from the intervention counties, and 14 were identified from the control counties. At the post-test, participants in the intervention group reported a significantly higher level of diabetes knowledge (? = 9.2%, P <0.0001), higher self-efficacy (? = 0.60, P <0.0001), more self-care behaviors (? = 0.48, P <0.0001), lower distress level (? = -0.15, P = 0.05), and higher health status (? = 0.49, P = <0.0001). About 56% of the intervention group completed all six classes, and 25% attended five classes. Conclusions. Findings from this study demonstrate the initial success of translating a culturally adapted DSME program into rural African-American communities. The study highlights important lessons learned in the process of implementing this type of program in a real-world setting with a minority population. PMID:25987809

  3. Vaccines are not associated with autism: an evidence-based meta-analysis of case-control and cohort studies.

    PubMed

    Taylor, Luke E; Swerdfeger, Amy L; Eslick, Guy D

    2014-06-17

    There has been enormous debate regarding the possibility of a link between childhood vaccinations and the subsequent development of autism. This has in recent times become a major public health issue with vaccine preventable diseases increasing in the community due to the fear of a 'link' between vaccinations and autism. We performed a meta-analysis to summarise available evidence from case-control and cohort studies on this topic (MEDLINE, PubMed, EMBASE, Google Scholar up to April, 2014). Eligible studies assessed the relationship between vaccine administration and the subsequent development of autism or autism spectrum disorders (ASD). Two reviewers extracted data on study characteristics, methods, and outcomes. Disagreement was resolved by consensus with another author. Five cohort studies involving 1,256,407 children, and five case-control studies involving 9,920 children were included in this analysis. The cohort data revealed no relationship between vaccination and autism (OR: 0.99; 95% CI: 0.92 to 1.06) or ASD (OR: 0.91; 95% CI: 0.68 to 1.20), nor was there a relationship between autism and MMR (OR: 0.84; 95% CI: 0.70 to 1.01), or thimerosal (OR: 1.00; 95% CI: 0.77 to 1.31), or mercury (Hg) (OR: 1.00; 95% CI: 0.93 to 1.07). Similarly the case-control data found no evidence for increased risk of developing autism or ASD following MMR, Hg, or thimerosal exposure when grouped by condition (OR: 0.90, 95% CI: 0.83 to 0.98; p=0.02) or grouped by exposure type (OR: 0.85, 95% CI: 0.76 to 0.95; p=0.01). Findings of this meta-analysis suggest that vaccinations are not associated with the development of autism or autism spectrum disorder. Furthermore, the components of the vaccines (thimerosal or mercury) or multiple vaccines (MMR) are not associated with the development of autism or autism spectrum disorder. PMID:24814559

  4. Delivery of Evidence-Based Treatment for Multiple Anxiety Disorders in Primary Care: A Randomized Controlled Trial

    PubMed Central

    Roy-Byrne, Peter; Craske, Michelle G.; Sullivan, Greer; Rose, Raphael D.; Edlund, Mark J.; Lang, Ariel J.; Bystritsky, Alexander; Welch, Stacy Shaw; Chavira, Denise A.; Golinelli, Daniela; Campbell-Sills, Laura; Sherbourne, Cathy D.; Stein, Murray B.

    2010-01-01

    Context Improving the quality of mental health care requires moving clinical interventions from controlled research settings into “real world” practice settings. While such advances have been made for depression, little work has been done for anxiety disorders. Objective To determine whether a flexible treatment-delivery model for multiple primary care anxiety disorders (panic, generalized anxiety, social anxiety, and/or posttraumatic stress disorders) would be superior to usual care. Design, Setting, and Participants Randomized controlled effectiveness trial of CALM (“Coordinated Anxiety Learning and Management”) compared to usual care (UC) in 17 primary care clinics in 4 US cities. Between June 2006 and April 2008, 1004 patients with anxiety disorders (with or without major depression), age 18–75, English- or Spanish-speaking, enrolled and subsequently received treatment for 3–12 months. Blinded follow-up assessments at 6, 12, and 18 months after baseline were completed in October 2009. Intervention(s) CALM allowed choice of cognitive behavioral therapy (CBT), medication, or both; included real-time web-based outcomes monitoring to optimize treatment decisions and a computer-assisted program to optimize delivery of CBT by non-expert care managers who also assisted primary care providers in promoting adherence and optimizing medications. Main Outcome Measure(s) 12-item Brief Symptom Inventory (anxiety and somatic symptoms) score. Secondary outcomes: Proportion of responders (? 50% reduction from pre-treatment BSI-12 score) and remitters (total BSI-12 score < 6). Results Significantly greater improvement for CALM than UC in global anxiety symptoms: BSI-12 group differences of ?2.49 (95% CI, ?3.59 to ?1.40), ?2.63 (95% CI, ?3.73 to ?1.54), and ?1.63 (95% CI, ?2.73 to ?0.53) at 6, 12, and 18 months, respectively. At 12 months, response and remission rates (CALM vs. UC) were 63.66% (58.95–68.37) vs. 44.68% (39.76–49.59), and 51.49% (46.60–56.38) vs. 33.28% (28.62–37.93), with a number needed to treat (NNT) of 5.27 (4.18–7.13) for response and 5.5 (4.32–7.55) for remission. Conclusions For patients with anxiety disorders treated in primary care clinics, a collaborative care intervention, compared to usual care, resulted in greater improvement in anxiety symptoms, functional disability, and quality of care over 18 months. PMID:20483968

  5. Infection control in paediatric office settings

    PubMed Central

    2008-01-01

    Transmission of infection in the paediatric office is of increasing concern. The present document discusses routes of transmission of infection and the principles of current infection control measures. Prevention includes appropriate office design and administrative policies, triage, routine practices for the care of all patients (eg, hand hygiene; use of gloves, masks, eye protection and gowns for specific procedures; adequate cleaning, disinfection and sterilization of surfaces and equipment including toys, and aseptic technique for invasive procedures), and additional precautions for specific infections. Personnel should be adequately immunized, and those infected should follow work-restriction policies. PMID:19412374

  6. Perioperative pain control after total knee arthroplasty: An evidence based review of the role of peripheral nerve blocks

    PubMed Central

    Danninger, Thomas; Opperer, Mathias; Memtsoudis, Stavros G

    2014-01-01

    Over the last decades, the number of total knee arthroplasty procedures performed in the United States has been increasing dramatically. This very successful intervention, however, is associated with significant postoperative pain, and adequate postoperative analgesia is mandatory in order to allow for successful rehabilitation and recovery. The use of regional anesthesia and peripheral nerve blocks has facilitated and improved this goal. Many different approaches and techniques for peripheral nerve blockades, either landmark or, more recently, ultrasound guided have been described over the last decades. This includes but is not restricted to techniques discussed in this review. The introduction of ultrasound has improved many approaches to peripheral nerves either in success rate and/or time to block. Moreover, ultrasound has enhanced the safety of peripheral nerve blocks due to immediate needle visualization and as consequence needle guidance during the block. In contrast to patient controlled analgesia using opioids, patients with a regional anesthetic technique suffer from fewer adverse events and show higher patient satisfaction; this is important as hospital rankings and advertisement have become more common worldwide and many patients use these factors in order to choose a certain institution for a specific procedure. This review provides a short overview of currently used regional anesthetic and analgesic techniques focusing on related implications, considerations and outcomes. PMID:25035824

  7. Ceftazidime–avibactam: an evidence-based review of its pharmacology and potential use in the treatment of Gram-negative bacterial infections

    PubMed Central

    Lagacé-Wiens, Philippe; Walkty, Andrew; Karlowsky, James A

    2014-01-01

    Avibactam (NXL104, AVE1330A) is a semi-synthetic, non-?-lactam, ?-lactamase inhibitor that is active against Ambler class A, class C, and some class D serine ?-lactamases. In this review, we summarize the in vitro data, pharmacology, mechanisms of action and resistance, and clinical trial data relating to the use of this agent combined with ceftazidime for the treatment of Gram-negative bacterial infections. The addition of avibactam to ceftazidime improves its in vitro activity against Enterobacteriaceae and Pseudomonas aeruginosa. Avibactam does not improve the activity of ceftazidime against Acinetobacter spp., Burkholderia spp., or most anaerobic Gram-negative rods. Pharmacodynamic data indicate that ceftazidime—avibactam is bactericidal at concentrations achievable in human serum. Animal studies demonstrate that ceftazidime–avibactam is effective in ceftazidime-resistant Gram-negative septicemia, meningitis, pyelonephritis, and pneumonia. Limited clinical trials published to date have reported that ceftazidime–avibactam is as effective as therapy with a carbapenem in complicated urinary tract infection and complicated intra-abdominal infection (combined with metronidazole) including infection caused by cephalosporin-resistant Gram-negative isolates. Safety and tolerability of ceftazidime–avibactam in clinical trials has been excellent, with few serious drug-related adverse events reported. Given the abundant clinical experience with ceftazidime and the significant improvement that avibactam provides in its activity against contemporary ?-lactamase-producing Gram-negative pathogens, it is likely this new combination agent will play a role in the empiric treatment of complicated urinary tract infections (monotherapy) and complicated intra-abdominal infections (in combination with metronidazole) caused or suspected to be caused by antimicrobial-resistant pathogens (eg, extended spectrum beta-lactamase-, AmpC-, or Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae and multidrug-resistant P. aeruginosa). Potential future uses also include hospital-acquired pneumonia (in combination with antistaphylococcal and antipneumococcal agents) or treatment of skin and soft tissue infections caused by antimicrobial-resistant Gram-negative pathogens (eg, diabetic foot infections), but further clinical trials are required. PMID:24493994

  8. Diffusion of an evidence-based smoking cessation intervention through Facebook: a randomised controlled trial study protocol

    PubMed Central

    Cobb, Nathan K; Jacobs, Megan A; Saul, Jessie; Wileyto, E Paul; Graham, Amanda L

    2014-01-01

    Introduction Online social networks represent a potential mechanism for the dissemination of health interventions including smoking cessation; however, which elements of an intervention determine diffusion between participants is unclear. Diffusion is frequently measured using R, the reproductive rate, which is determined by the duration of use (t), the ‘contagiousness’ of an intervention (?) and a participant's total contacts (z). We have developed a Facebook ‘app’ that allows us to enable or disable various components designed to impact the duration of use (expanded content, proactive contact), contagiousness (active and passive sharing) and number of contacts (use by non-smoker supporters). We hypothesised that these elements would be synergistic in their impact on R, while including non-smokers would induce a ‘carrier’ state allowing the app to bridge clusters of smokers. Methods and analysis This study is a fractional factorial, randomised control trial of the diffusion of a Facebook application for smoking cessation. Participants recruited through online advertising are randomised to 1 of 12 cells and serve as ‘seed’ users. All user interactions are tracked, including social interactions with friends. Individuals installing the application that can be traced back to a seed participant are deemed ‘descendants’ and form the outcome of interest. Analysis will be conducted using Poisson regression, with event count as the outcome and the number of seeds in the cell as the exposure. Results The results will be reported as a baseline R0 for the reference group, and incidence rate ratio for the remainder of predictors. Ethics and Dissemination This study uses an abbreviated consent process designed to minimise barriers to adoption and was deemed to be minimal risk by the Institutional Review Board (IRB). Results will be disseminated through traditional academic literature as well as social media. If feasible, anonymised data and underlying source code are intended to be made available under an open source license. ClinicalTrials.gov registration number NCT01746472. PMID:24448847

  9. A KT intervention including the evidence alert system to improve clinician’s evidence-based practice behavior—a cluster randomized controlled trial

    PubMed Central

    2013-01-01

    Background It is difficult to foster research utilization among allied health professionals (AHPs). Tailored, multifaceted knowledge translation (KT) strategies are now recommended but are resource intensive to implement. Employers need effective KT solutions but little is known about; the impact and viability of multifaceted KT strategies using an online KT tool, their effectiveness with AHPs and their effect on evidence-based practice (EBP) decision-making behavior. The study aim was to measure the effectiveness of a multifaceted KT intervention including a customized KT tool, to change EBP behavior, knowledge, and attitudes of AHPs. Methods This is an evaluator-blinded, cluster randomized controlled trial conducted in an Australian community-based cerebral palsy service. 135 AHPs (physiotherapists, occupational therapists, speech pathologists, psychologists and social workers) from four regions were cluster randomized (n?=?4), to either the KT intervention group (n?=?73 AHPs) or the control group (n?=?62 AHPs), using computer-generated random numbers, concealed in opaque envelopes, by an independent officer. The KT intervention included three-day skills training workshop and multifaceted workplace supports to redress barriers (paid EBP time, mentoring, system changes and access to an online research synthesis tool). Primary outcome (self- and peer-rated EBP behavior) was measured using the Goal Attainment Scale (individual level). Secondary outcomes (knowledge and attitudes) were measured using exams and the Evidence Based Practice Attitude Scale. Results The intervention group’s primary outcome scores improved relative to the control group, however when clustering was taken into account, the findings were non-significant: self-rated EBP behavior [effect size 4.97 (95% CI -10.47, 20.41) (p?=?0.52)]; peer-rated EBP behavior [effect size 5.86 (95% CI -17.77, 29.50) (p?=?0.62)]. Statistically significant improvements in EBP knowledge were detected [effect size 2.97 (95% CI 1.97, 3.97 (p?

  10. Colistimethate sodium for the treatment of chronic pulmonary infection in cystic fibrosis: an evidence-based review of its place in therapy

    PubMed Central

    Koerner-Rettberg, Cordula; Ballmann, Manfred

    2014-01-01

    Chronic bacterial respiratory-tract infections are a major driving force in the pathogenesis of cystic fibrosis (CF) lung disease and promote chronic lung-function decline, destruction, and progression to respiratory failure at a premature age. Gram-negative bacteria colonizing the airways in CF are a major problem in CF therapy due to their tendency to develop a high degree of resistance to antibiotic agents over time. Pseudomonas aeruginosa is the dominating bacterial strain infecting the CF lung from early childhood on, and multiresistant strains frequently develop after years of therapy. Colistin has been used for treating pulmonary bacterial infections in CF for decades due to its very good Gram-negative activity. However, drawbacks include concerns regarding toxicity when being applied systemically, and the lack of approval for application by inhalation in the USA for many years. Other antibiotic substances for systemic use are available with good to excellent Gram-negative and anti-Pseudomonas activity, while there are only three substances approved for inhalation use in the treatment of chronic pulmonary infection with proven benefit in CF. The emergence of multiresistant strains leaving nearly no antibiotic substance as a treatment option, the limited number of antibiotics with high activity against P. aeruginosa, the concerns about increasing the risk of antibiotic resistance by continuous antibiotic therapy, the development of new drug formulations and drug-delivery devices, and, finally, the differing treatment strategies used in CF centers call for defining the place of this “old” drug, colistimethate, in today’s CF therapy. This article reviews the available evidence to reflect on the place of colistimethate sodium in the therapy of chronic pulmonary infection in CF. PMID:25278817

  11. Infection Control During Filoviral Hemorrhagic Fever Outbreaks

    PubMed Central

    Vanessa, N Raabe; Matthias, Borchert

    2012-01-01

    Breaking the human-to-human transmission cycle remains the cornerstone of infection control during filoviral (Ebola and Marburg) hemorrhagic fever outbreaks. This requires effective identification and isolation of cases, timely contact tracing and monitoring, proper usage of barrier personal protection gear by health workers, and safely conducted burials. Solely implementing these measures is insufficient for infection control; control efforts must be culturally sensitive and conducted in a transparent manner to promote the necessary trust between the community and infection control team in order to succeed. This article provides a review of the literature on infection control during filoviral hemorrhagic fever outbreaks focusing on outbreaks in a developing setting and lessons learned from previous outbreaks. The primary search database used to review the literature was PUBMED, the National Library of Medicine website. PMID:22529631

  12. INFECTION CONTROL IN ALTERNATIVE HEALTHCARE SETTINGS

    PubMed Central

    Flanagan, Elaine; Chopra, Teena; Mody, Lona

    2011-01-01

    SYNOPSIS With the changing healthcare delivery, patients receive care at various settings including acute care hospitals, skilled nursing facilities, outpatient primary care and specialty clinics, as well as at home, exposing them to pathogens in various settings. Various healthcare settings face unique challenges requiring individualized infection control programs. Infection control programs in skilled nursing facilities should address: surveillance for infections and antimicrobial resistance, outbreak investigation and control plan for epidemics, isolation precautions, hand hygiene, staff education, and employee and resident health programs. Infection control programs in ambulatory clinics should address: Triage and standard – transmission based precautions, cleaning, disinfection and sterilization principles, surveillance in surgical clinics, safe injection practices, and bioterrorism and disaster planning for ambulatory clinics. PMID:21316005

  13. Evidence-Based Practice

    PubMed Central

    Ammouri, Ali A.; Raddaha, Ahmad A.; Dsouza, Preethy; Geethakrishnan, Renu; Noronha, Judith A.; Obeidat, Arwa A.; Shakman, Lina

    2014-01-01

    Objectives: The aim of this study was to describe nurses’ practices, attitudes, knowledge/skills and perceived barriers in relation to evidence-based practice (EBP) in Oman. Methods: This descriptive cross-sectional study was conducted between February and November 2012. A self-reported 24-item questionnaire was used to measure EBP practices, attitudes and knowledge/skills among a convenience sample of 600 nurses working in four governmental hospitals in Muscat, Oman. Responses were scored on a one to seven rating scale. Barriers to EBP were measured on a five-point Likert scale using two subscales. Descriptive statistics and general linear regression were used to analyse the data. Results: A total of 414 nurses were included in the study. The greatest barriers to developing EBP among nurses were insufficient time for research (3.51 ± 0.97) and insufficient resources to change practices (3.64 ± 0.99). Nurses with more years of experience reported increased use of EBP (P <0.01), more positive attitudes towards EBP (P <0.001) and fewer barriers to research (P <0.01). Significant positive correlations were found between years of experience and practice (r = 0.16) and attitudes (r = 0.20). Nurses with a baccalaureate degree reported fewer barriers to research than those qualified at a diploma level (P <0.001). Nurses who perceived more barriers to research reported less use of EBP (P <0.001), less positive attitudes towards EBP (P <0.001) and limited EBP knowledge/skills (P <0.001). Conclusion: These findings provide a basis for enhancing nursing practices, knowledge and skills. Continuing education for nurses and minimising barriers is crucial to increasing the use of EBP in Oman. PMID:25364558

  14. 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 choose to wait for collective professional standards to reveal acceptable practice or follow a strategy of punctuated equilibrium, only switching out established practice habits when very conspicuous advantages are identified. Integration in medicine appears to follow the statistically sophisticated practice of updating estimates of clinical parameters (probabilities) for diagnoses, treatments, prognoses, and side-effects. This approach is likely beyond the skill or interest of clinical dentists and it fails to incorporate values in the integration. The use of decision trees to integrate both research and experiential parameters and values is illustrated and it is shown that such a technique identifies why there are very few cases in dentistry where evidence needs to be consulted and indicates what such cases are. PMID:21485345

  15. Best infection control practices for intradermal, subcutaneous, and intramuscular needle injections.

    PubMed Central

    Hutin, Yvan; Hauri, Anja; Chiarello, Linda; Catlin, Mary; Stilwell, Barbara; Ghebrehiwet, Tesfamicael; Garner, Julia

    2003-01-01

    OBJECTIVE: To draw up evidence-based guidelines to make injections safer. METHODS: A development group summarized evidence-based best practices for preventing injection-associated infections in resource-limited settings. The development process included a breakdown of the WHO reference definition of a safe injection into a list of potentially critical steps, a review of the literature for each of these steps, the formulation of best practices, and the submission of the draft document to peer review. FINDINGS: Eliminating unnecessary injections is the highest priority in preventing injection-associated infections. However, when intradermal, subcutaneous, or intramuscular injections are medically indicated, best infection control practices include the use of sterile injection equipment, the prevention of contamination of injection equipment and medication, the prevention of needle-stick injuries to the provider, and the prevention of access to used needles. CONCLUSION: The availability of best infection control practices for intradermal, subcutaneous, and intramuscular injections will provide a reference for global efforts to achieve the goal of safe and appropriate use of injections. WHO will revise the best practices five years after initial development, i.e. in 2005. PMID:12973641

  16. 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

  17. Psychiatric Mental Health Evidence-Based Practice

    Microsoft Academic Search

    Michael J. Rice

    2008-01-01

    This article is the first in a new column focusing on evidence-based practice (EBP) in psychiatric mental health nursing. The EBP movement was strongly influenced by a British epidemiologist, Dr. Cochrane, who advocated care based on randomized clinical controlled trials in the late 1900s. Although the majority of the EBP movement is directed toward developing clinical guidelines, the critical element

  18. Updated Diagnoses and Evidence-based Treatments

    E-print Network

    Hofmann, Hans A.

    . It is a brain disease over which the individual has no control. It is causedUpdated Diagnoses and Evidence-based Treatments for Addiction Carlton Erickson, Ph by brain dysregulaon iniated by drug use. #12;The main symptom of chemical

  19. Evaluation of a tailored, multi-component intervention for implementation of evidence-based clinical practice guidelines in primary care physical therapy: a non-randomized controlled trial

    PubMed Central

    2014-01-01

    Background Clinical practice guidelines are important for transmitting research findings into practice and facilitating the application of evidence-based practice (EBP). There is a paucity of knowledge about the impact of guideline implementation strategies in primary care physical therapy. The aim of this study was to evaluate the effect of a guideline implementation intervention in primary care physical therapy in western Sweden. Methods An implementation strategy based on theory and current evidence was developed. A tailored, multi-component implementation intervention, addressing earlier identified determinants, was carried out in three areas comprising 28 physical therapy practices including 277 physical therapists (PTs) (intervention group). In two adjacent areas, 171 PTs at 32 practices received no intervention (control group). The core component of the intervention was an implementation seminar with group discussions. Among other components were a website and email reminders. Data were collected at baseline and follow-up with a web-based questionnaire. Primary outcomes were the self-reported awareness of, knowledge of, access to, and use of guidelines. Secondary outcomes were self-reported attitudes toward EBP and guidelines. Analyses were performed using Pearson’s ?2 test and approximative z-test. Results 168 PTs (60.6%) in the intervention group and 88 PTs (51.5%) in the control group responded to the follow-up questionnaire. 186/277 PTs (67.1%) participated in the implementation seminars, of which 97 (52.2%) responded. The proportions of PTs reporting awareness of (absolute difference in change 20.6%, p?=?0.023), knowledge where to find (20.4%, p?=?0.007), access to (21.7%, p?control group. The proportion of PTs reporting frequent guideline use after participation in the implementation seminar was 15.2% (p?=?0.043) higher than the proportion in the control group. A higher proportion considered EBP helpful in decision making (p?=?0.018). There were no other significant differences in secondary outcomes. Conclusions A tailored, theory- and evidence-informed, multi-component intervention for the implementation of clinical practice guidelines had a modest, positive effect on awareness of, knowledge of, access to, and use of guidelines, among PTs in primary care in western Sweden. In general, attitudes to EBP and guidelines were not affected. PMID:24589291

  20. Modelling respiratory infection control measure effects

    PubMed Central

    LIAO, C. M.; CHEN, S. C.; CHANG, C. F.

    2008-01-01

    SUMMARY One of the most pressing issues in facing emerging and re-emerging respiratory infections is how to bring them under control with current public health measures. Approaches such as the Wells–Riley equation, competing-risks model, and Von Foerster equation are used to prioritize control-measure efforts. Here we formulate how to integrate those three different types of functional relationship to construct easy-to-use and easy-to-interpret critical-control lines that help determine optimally the intervention strategies for containing airborne infections. We show that a combination of assigned effective public health interventions and enhanced engineering control measures would have a high probability for containing airborne infection. We suggest that integrated analysis to enhance modelling the impact of potential control measures against airborne infections presents an opportunity to assess risks and benefits. We demonstrate the approach with examples of optimal control measures to prioritize respiratory infections of severe acute respiratory syndrome (SARS), influenza, measles, and chickenpox. PMID:17475088

  1. [The technology of apical infection control].

    PubMed

    Qing, Yu; Yang, Yang; Bei, Chang

    2014-10-01

    Root canal therapy is the most efficient way to treat pulptitis and periapical inflammation, which can clear infections of root canal systems, fill the root canal firmly, and avoid reinfection. However, the variations in root canal morphology and complexity of infection confer difficulty in thoroughly eliminating microorganisms and their by-products in the root canal system, especially in the root apex area (including the top one-third of the root canal and periapical tissue), which is described as the hardest area to clean during endodontic treatment. Infection is difficult to remove entirely because the apex area is hard to approach using dental instruments and because of the existence of special morphological structures, such as apical ramification, intercanal anastomoses, and lateral branch of root canal. This review gives a brief introduction of the characteristics and difficulties of apical infection and knowledge on how to control such infections, including root apex preparation, irrigation and disinfection, and root canal filling. PMID:25509016

  2. [The technology of apical infection control].

    PubMed

    Qing, Yu; Yang, Yang; Bei, Chang

    2014-10-01

    Root canal therapy is the most efficient way to treat pulptitis and periapical inflammation, which can clear infections of root canal systems, fill the root canal firmly, and avoid reinfection. However, the variations in root canal morphology and complexity of infection confer difficulty in thoroughly eliminating microorganisms and their by-products in the root canal system, especially in the root apex area (including the top one-third of the root canal and periapical tissue), which is described as the hardest area to clean during endodontic treatment. Infection is difficult to remove entirely because the apex area is hard to approach using dental instruments and because of the existence of special morphological structures, such as apical ramification, intercanal anastomoses, and lateral branch of root canal. This review gives a brief introduction of the characteristics and difficulties of apical infection and knowledge on how to control such infections, including root apex preparation, irrigation and disinfection, and root canal filling. PMID:25490815

  3. The control of hookworm infection in China

    PubMed Central

    Zheng, Qi; Chen, Ying; Zhang, Hao-Bing; Chen, Jia-Xu; Zhou, Xiao-Nong

    2009-01-01

    Background Hookworm is still one of the three main soil-transmitted helminths prevalent in China, and 39 million cases infected with hookworm were estimated in China in 2006. Results The main approach to the control of hookworm infections in China consists of large-scale deworming, rebuilding sanitation systems in rural areas and health education. The availability of low-cost, safe and single-dose albendazole make large-scale deworming programs possible in China. Currently, sanitary latrines with three-cells are recommended by government for the control of soil-transmitted helminths, since 35% of helminth infections and 83% of worm eggs could be reduced after using this kind of sanitary latrine. In addition, economic prosperity contributes greatly to the reduction of hookworm prevalence, but the inequity of economic and social development among different regions of China provides a scenario that the worst threat of hookworm infection is located in the poorest areas of southern and central China. Therefore, it is necessary to put more investments into prophylaxis and treatment of hookworm in these poor regions. Conclusion Although the prevalence of hookworm infection has fallen significantly in the last 15 years in China, the current strategy for controlling hookworm infections still needs to be strengthened along with the three-pronged approach, e.g. distributing anthelmintic drugs in schools and undertaking large-scale of hookworm deworming, improving water supplies and sanitation, and proper health education. PMID:19775473

  4. [Control of Haemophilus influenzae infections].

    PubMed

    Guérin, N

    1994-01-01

    The results of all clinical trials and mass immunization programmes carried out over the past few years are extremely encouraging and should be the prelude to systematic immunization. Three vaccines that are immunogenic in infants over 6 weeks old, are now available: HbOC linked to diphtheria toxin, PRP-OMP linked to a meningococcus protein, and PRP-T linked to tetanus toxoid. Their safety has been demonstrated particularly when administration at a very early age before the period of risk. Efficacy has been demonstrated, even in population groups who do not respond well to non-conjugate vaccines. Immunogenicity persists even in unfavourable contexts such as individuals with sickle-cell anaemia or leukosis or a previous history of vaccine failure. The duration of immunity amply covers the period of risk and probably a longer because of the booster effect of natural infections. The possibility of combining Hib vaccine with other routine immunizations in infancy will reduce the cost of this additional immunization. Thus it is possible to envisage its integration into immunization programmes in developing countries. Cost/benefit studies show advantages. What is needed now is to achieve high immunization coverage, guaranteeing efficacy of immunization at national level, by ensuring that health personnel as well as families are fully informed about the seriousness of Hib infections and the good tolerance and efficacy of the conjugate vaccines. PMID:7921693

  5. Bilingual Language Control and General Purpose Cognitive Control among Individuals with Bilingual Aphasia: Evidence Based on Negative Priming and Flanker Tasks

    PubMed Central

    Dash, Tanya; Kar, Bhoomika R.

    2014-01-01

    Background. Bilingualism results in an added advantage with respect to cognitive control. The interaction between bilingual language control and general purpose cognitive control systems can also be understood by studying executive control among individuals with bilingual aphasia. Objectives. The current study examined the subcomponents of cognitive control in bilingual aphasia. A case study approach was used to investigate whether cognitive control and language control are two separate systems and how factors related to bilingualism interact with control processes. Methods. Four individuals with bilingual aphasia performed a language background questionnaire, picture description task, and two experimental tasks (nonlinguistic negative priming task and linguistic and nonlinguistic versions of flanker task). Results. A descriptive approach was used to analyse the data using reaction time and accuracy measures. The cumulative distribution function plots were used to visualize the variations in performance across conditions. The results highlight the distinction between general purpose cognitive control and bilingual language control mechanisms. Conclusion. All participants showed predominant use of the reactive control mechanism to compensate for the limited resources system. Independent yet interactive systems for bilingual language control and general purpose cognitive control were postulated based on the experimental data derived from individuals with bilingual aphasia. PMID:24982591

  6. RCN introduce new guidelines in infection control.

    PubMed

    Sims-Williams, F

    1987-08-01

    The RCN Safety Representatives Conference Co-ordinating Committee urge all nurses, not only to be vaccinated against hepatitis B, but also to ensure that they understand, and appreciate, infection control guidelines, and to ensure that, in their local working environment, they are followed closely. This statement is contained in the preface of the Royal College of Nursing's Introduction to Hepatitis B and Nursing Guidelines for Infection Control, launched in London on 30th June 1987, as part of the RCN's active campaign on hepatitis B. It is anticipated that these guidelines will have an enormous impact on the NHS. PMID:10284270

  7. Infection control issues in patients with haematological malignancies in the era of multidrug-resistant bacteria.

    PubMed

    Ruhnke, Markus; Arnold, Renate; Gastmeier, Petra

    2014-12-01

    Drug-resistant Gram-negative and Gram-positive bacteria are now increasingly identified as a cause of infections in immunocompromised hosts. Bacteria identified include the multidrug-resistant (MDR) and even pandrug-resistant Acinetobacter baumannii and Pseudomonas aeruginosa, as well as carbapenem-resistant Enterobacteriaceae spp. The threat from MDR pathogens has been well-documented in the past decade with warnings about the consequences of inappropriate use of antimicrobial drugs. Resistant bacteria can substantially complicate the treatment of infections in critically ill patients and can have a substantial effect on mortality. Inappropriate antimicrobial treatment can affect morbidity, mortality, and overall health-care costs. Evidence-based data for prevention and control of MDR pathogen infections in haematology are scarce. Although not yet established a bundle of infection control and prevention measures with an anti-infective stewardship programme is an important strategy in infection control, diagnosis, and antibiotic selection with optimum regimens to ensure a successful outcome for patients. PMID:25456379

  8. 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…

  9. Teaching evidence based medicine literature searching skills to medical students during the clinical years - a protocol for a randomised controlled trial

    Microsoft Academic Search

    Dragan Ilic; Katrina Tepper; Marie Misso

    2011-01-01

    Background  Two of the key steps in evidence based medicine (EBM) are being able to construct a clinical question and effectively search\\u000a the literature to source relevant information. No evidence currently exists that informs whether such skills should be taught\\u000a to medical students during their pre-clinical years, or delivered to include both the pre-clinical and clinical years of study.\\u000a This is

  10. Can psychological models bridge the gap between clinical guidelines and clinicians' behaviour? A randomised controlled trial of an intervention to influence dentists' intention to implement evidence-based practice

    Microsoft Academic Search

    M Johnston; N B Pitts; C Deery; I Ricketts; M Bahrami; C Ramsay; J Johnston; D Bonetti

    2003-01-01

    Objective The lag between publication of evidence for clinical practice and implementation by clinicians may be decades. Research using psychological models demonstrates that changing intention is very important in changing behaviour. This study examined an intervention (rehearsing alternative actions) to change dentists' intention to implement evidence-based practice (EBP) for third molar (TM) management.Design Randomised controlled trial \\/ postal.Setting Primary care.Subjects

  11. Infections Control in North American Dental Schools.

    ERIC Educational Resources Information Center

    Sampson, Elise; Dhuru, Virendra B.

    1989-01-01

    Results from 1982 and 1987 surveys of dental schools concerning infection control issues found greater recent emphasis on instrument sterilization and barrier use, but some inconsistency and confusion concerning hepatitis B and HIV virus carrier patients and personnel. The information was used to develop guidelines for school policy formation.…

  12. Challenges to evidence-based medicine

    Microsoft Academic Search

    Deborah A. Zarin; Julia L. Young; Joyce C. West

    2005-01-01

    Background The practice of evidence-based medicine depends on the availability of clinically relevant research, yet questions have been raised about the generalizability of findings from randomized controlled trials (RCTs). Objectives The aim of this study was to quantify differences between RCT patients and treatments and those in day-to-day clinical practice. Research Design Data from published reports of two key RCTs

  13. Overview of Evidence-based Medicine: Challenges for Evidence-based Laboratory Medicine

    Microsoft Academic Search

    Matthew J. McQueen

    2001-01-01

    Evidence-based medicine (EBM) has been driven by the need to cope with information overload, by cost-control, and by a public impatient for the best in diagnostics and treatment. Clinical guidelines, care maps, and outcome measures are quality improvement tools for the appro- priateness, efficiency, and effectiveness of health ser- vices. Although they are imperfect, their value increases with the quality

  14. [Hospital infection and our policy to control].

    PubMed

    Aiba, S; Shiozaki, H; Matsumoto, H; Ikeya, T

    1992-09-01

    Since we organized the committee to control hospital infection in April 1980, we have adopted various investigations and strategies. When wide spread of infection caused by Escherichia coli, Staphylococcus aureus and Pseudomonas aeruginosa was recognized in 1981 our strategies were set up of water faucets with footpedal, frequent to wash of hands and use of disposable paper towels. Investigation of HBV markers revealed that the positive rate of HBV antibody was 21% in scrub and ward nurse group. Vaccination was performed to our HVB antibody negative members to protect them from the infection of HBV antigen. After HBV antigen positive patients were operated, we sterilized the operating room using our ultraviolet ray irradiation apparatus. In 1990, 50 cases infected with MRSA were detected bacteriologically, which occupied 68.5% of all those infected with Staphylococcus aureus. Therefore, we cultured MRSA from nose swabs and investigated numbers of bacteria in the air which were gathered with air sampler in the operating rooms and wards. PMID:1470157

  15. 42 CFR 485.725 - Condition of participation: Infection control.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ...and Public Health Agencies as Providers of Outpatient Physical Therapy and Speech-Language Pathology Services § 485.725...Infection control. The organization that provides outpatient physical therapy services establishes an infection-control...

  16. Queering evidence-based practice

    Microsoft Academic Search

    Damien W. Riggs

    2011-01-01

    That which is currently understood as evidence-based practice within the discipline of psychology primarily relies upon a positivist interpretation of the world around us. Although such an interpretation may be argued by some to be useful, others argue that it fails to recognise the impact of social contexts and the role they play in producing particular negative mental health outcomes

  17. (Three core Evidence-Based

    E-print Network

    MSc Masters One system (Three core ideas) {01} Evidence-Based Management {02} Entrepreneurship & Innovation {03} Engaged Social Value Depth of knowledge Open mind Future answers and opportunities MASTER OF SCIENCE IN FINANCE AND BANKING Teaching staff trained in the best and most respected universities

  18. Module: Evidence Based Practice Module Specification

    E-print Network

    Weyde, Tillman

    Module: Evidence Based Practice Module Specification KEY FACTS Module Code: RCM005 Department: Evidence Based Practice Summary Description Evidence based practice is an approach to clinical problem solving and health care provision based on "good evidence". The purpose of evidence based practice

  19. Sicily statement on evidence-based practice

    Microsoft Academic Search

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

    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

  20. 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

  1. Variation in Infection Prevention Practices in Dialysis Facilities: Results From the National Opportunity to Improve Infection Control in ESRD (End-Stage Renal Disease) Project.

    PubMed

    Chenoweth, Carol E; Hines, Stephen C; Hall, Kendall K; Saran, Rajiv; Kalbfleisch, John D; Spencer, Teri; Frank, Kelly M; Carlson, Diane; Deane, Jan; Roys, Erik; Scholz, Natalie; Parrotte, Casey; Messana, Joseph M

    2015-07-01

    OBJECTIVE To observe patient care across hemodialysis facilities enrolled in the National Opportunity to Improve Infection Control in ESRD (end-stage renal disease) (NOTICE) project in order to evaluate adherence to evidence-based practices aimed at prevention of infection. SETTING AND PARTICIPANTS Thirty-four hemodialysis facilities were randomly selected from among 772 facilities in 4 end-stage renal disease participating networks. Facility selection was stratified on dialysis organization affiliation, size, socioeconomic status, and urban/rural status. MEASUREMENTS Trained infection control evaluators used an infection control worksheet to observe 73 distinct infection control practices at the hemodialysis facilities, from October 1, 2011, through January 31, 2012. RESULTS There was considerable variation in infection control practices across enrolled facilities. Overall adherence to recommended practices was 68% (range, 45%-92%) across all facilities. Overall adherence to expected hand hygiene practice was 72% (range, 10%-100%). Compliance to hand hygiene before and after procedures was high; however, during procedures hand hygiene compliance averaged 58%. Use of chlorhexidine as the specific agent for exit site care was 19% overall but varied from 0% to 35% by facility type. The 8 checklists varied in the frequency of perfect performance from 0% for meeting every item on the checklist for disinfection practices to 22% on the arteriovenous access practices at initiation. CONCLUSIONS Our findings suggest that there are many areas for improvement in hand hygiene and other infection prevention practices in end-stage renal disease. These NOTICE project findings will help inform the development of a larger quality improvement initiative at dialysis facilities. Infect Control Hosp Epidemiol 2015;36(7):802-806. PMID:25773538

  2. Evidence-based guideline recommendations.

    PubMed

    Burkhart, Mary C; Wade, John; Lesperance, Virginia

    2013-10-01

    Cancer survivorship is expected to increase in coming years. Survivors include recipients of hematopoietic stem cell transplantations, signaling the necessity for evidence-based guidelines that focus on long-term follow-up needs. Studies have shown that evidence-based care can improve cancer survivors' quality of life and long-term outcomes. The implication is that early identification and intervention in chronic health problems such as graft-versus-host disease result in improved outcomes and a higher quality of survivorship. These discoveries signal a need to provide specific care management with appropriate and timely screening and preventive services. Recommendations for long-term follow-up post-hematopoietic stem cell transplantation are an important guide to direct clinical practice with this patient population and optimize their outcomes. PMID:24080061

  3. Evidence-based diagnostic radiology.

    PubMed

    Dixon, A K

    1997-08-16

    The radiological community has a long track record of self-examination, starting well before evidence-based medicine came of age. It had to produce such evidence to prove the need for and win funds for its expensive gadgets. The assessment of new tests is easier than proving the value of well-established ones, and in scrutinising the evidence base for an imaging technique a balance must be struck between apparent (eg, diagnostic) benefit and real benefit to the patient. And even when there is a wealth of good evidence healthy debate continues. So radiology may be ahead of some other disciplines in considering the evidence for its daily practice. For example, where is the evidence for the routine clinical examination-and might the radiologist with a chest X-ray and abdominal ultrasound do better? PMID:9274596

  4. Infection Control Procedures in Commercial Dental Laboratories in Jordan

    Microsoft Academic Search

    Ziad Nawaf Al-Dwairi

    The risk of cross-infection in dental clinics and laboratories has attracted the attention of practitioners for the past few years, yet several medical centers have discarded compliance with infection control guidelines, resulting in a non-safe environ- ment for research and medical care. In Jordan, there is lack of known standard infection control programs that are conducted by the Jordanian Dental

  5. A randomized controlled dismantling trial of post-workshop consultation strategies to increase effectiveness and fidelity to an evidence-based psychotherapy for Posttraumatic stress disorder

    PubMed Central

    2013-01-01

    Background Posttraumatic Stress Disorder (PTSD) is a serious mental health condition with substantial costs to individuals and society. Among military veterans, the lifetime prevalence of PTSD has been estimated to be as high as 20%. Numerous research studies have demonstrated that short-term cognitive-behavioral psychotherapies, such as Cognitive Processing Therapy (CPT), lead to substantial and sustained improvements in PTSD symptoms. Despite known benefits, only a minority of clinicians provide these therapies. Transferring this research knowledge into clinical settings remains one of the largest hurdles to improving the health of veterans with PTSD. Attending a workshop alone is insufficient to promote adequate knowledge transfer and sustained skill; however, relatively little research has been conducted to identify effective post-training support strategies. Methods The current study investigates whether clinicians receiving post-workshop support (six-month duration) will deliver CPT with greater fidelity (i.e., psychotherapy adherence and competence) and have improved patient outcomes compared with clinicians receiving no formal post-workshop support. The study conditions are: technology-enhanced group tele-consultation; standard group tele-consultation; and fidelity assessment with no consultation. The primary outcome is independent assessment (via audio-recordings) of the clinicians’ adherence and competence in delivering CPT. The secondary outcome is observed changes in patient symptoms during and following treatment as a function of clinician fidelity. Post-consultation interviews with clinicians will help identify facilitators and barriers to psychotherapy skill acquisition. The study results will inform how best to implement and transfer evidence-based psychotherapy (e.g., CPT) to clinical settings to attain comparable outcomes to those observed in research settings. Discussion Findings will deepen our understanding of how much and what type of support is needed following a workshop to help clinicians become proficient in delivering a new protocol. Several influences on clinician learning and patient outcomes will be discussed. An evidence-based model of clinical consultation will be developed, with the ultimate goal of informing policy and influencing best practice in clinical consultation. Trial registration ClinicalTrials.gov: NCT01861769 PMID:23902798

  6. Evaluation of Nosocomial Infection Control Programs in health services 1

    PubMed Central

    Menegueti, Mayra Gonçalves; Canini, Silvia Rita Marin da Silva; Bellissimo-Rodrigues, Fernando; Laus, Ana Maria

    2015-01-01

    OBJECTIVES: to evaluate the Nosocomial Infection Control Programs in hospital institutions regarding structure and process indicators. METHOD: this is a descriptive, exploratory and quantitative study conducted in 2013. The study population comprised 13 Nosocomial Infection Control Programs of health services in a Brazilian city of the state of São Paulo. Public domain instruments available in the Manual of Evaluation Indicators of Nosocomial Infection Control Practices were used. RESULTS: The indicators with the highest average compliance were "Evaluation of the Structure of the Nosocomial Infection Control Programs" (75%) and "Evaluation of the Epidemiological Surveillance System of Nosocomial Infection" (82%) and those with the lowest mean compliance scores were "Evaluation of Operational Guidelines" (58.97%) and "Evaluation of Activities of Control and Prevention of Nosocomial Infection" (60.29%). CONCLUSION: The use of indicators identified that, despite having produced knowledge about prevention and control of nosocomial infections, there is still a large gap between the practice and the recommendations. PMID:25806637

  7. Photodynamic Antimicrobial Polymers for Infection Control

    PubMed Central

    McCoy, Colin P.; O’Neil, Edward J.; Cowley, John F.; Carson, Louise; De Baróid, Áine T.; Gdowski, Greg T.; Gorman, Sean P.; Jones, David S.

    2014-01-01

    Hospital-acquired infections pose both a major risk to patient wellbeing and an economic burden on global healthcare systems, with the problem compounded by the emergence of multidrug resistant and biocide tolerant bacterial pathogens. Many inanimate surfaces can act as a reservoir for infection, and adequate disinfection is difficult to achieve and requires direct intervention. In this study we demonstrate the preparation and performance of materials with inherent photodynamic, surface-active, persistent antimicrobial properties through the incorporation of photosensitizers into high density poly(ethylene) (HDPE) using hot-melt extrusion, which require no external intervention except a source of visible light. Our aim is to prevent bacterial adherence to these surfaces and eliminate them as reservoirs of nosocomial pathogens, thus presenting a valuable advance in infection control. A two-layer system with one layer comprising photosensitizer-incorporated HDPE, and one layer comprising HDPE alone is also described to demonstrate the versatility of our approach. The photosensitizer-incorporated materials are capable of reducing the adherence of viable bacteria by up to 3.62 Log colony forming units (CFU) per square centimeter of material surface for methicillin resistant Staphylococcus aureus (MRSA), and by up to 1.51 Log CFU/cm2 for Escherichia coli. Potential applications for the technology are in antimicrobial coatings for, or materials comprising objects, such as tubing, collection bags, handrails, finger-plates on hospital doors, or medical equipment found in the healthcare setting. PMID:25250740

  8. 76 FR 63622 - Healthcare Infection Control Practices Advisory Committee, (HICPAC)

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-13

    ...strategies for surveillance, prevention, and control of infections (e.g., nosocomial infections), antimicrobial resistance, and related events in settings where healthcare is provided; and (3) periodic updating of guidelines...

  9. 77 FR 4820 - Healthcare Infection Control Practices Advisory Committee (HICPAC)

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-01-31

    ...strategies for surveillance, prevention, and control of infections (e.g., nosocomial infections), antimicrobial resistance, and related events in settings where healthcare is provided; and (3) periodic updating of guidelines...

  10. 76 FR 29756 - Healthcare Infection Control Practices Advisory Committee (HICPAC)

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-05-23

    ...strategies for surveillance, prevention, and control of infections (e.g., nosocomial infections), antimicrobial resistance, and related events in settings where healthcare is provided; and (3) periodic updating of guidelines...

  11. 42 CFR 483.65 - Infection control.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...development and transmission of disease and infection. (a) Infection...employees with a communicable disease or infected skin lesions from direct contact with...direct contact will transmit the disease. (3) The facility...

  12. 38 CFR 51.190 - Infection control.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ...development and transmission of disease and infection. (a) Infection...employees with a communicable disease or infected skin lesions from engaging in any...environment that would transmit the disease. (3) The facility...

  13. Evidence-Based Practice and Organizational Development in Libraries

    E-print Network

    Russell, Keith

    2008-01-01

    to information, and to data-driven decision making, anticipated the current movement toward evidence-based practice (EBP) in libraries. He suggests that libraries embrace the premises, philosophy, values, and practices of organizational development (OD... control over an ever-growing body of intellectual content and bibliographic information. Lancaster is one Evidence-Based Practice and Organizational Development in Libraries Keith Russell LIBRARY TRENDS, Vol. 56, No. 4, Spring 2008 (“The Evaluation...

  14. Control of immunopathology during chikungunya virus infection.

    PubMed

    Petitdemange, Caroline; Wauquier, Nadia; Vieillard, Vincent

    2015-04-01

    After several decades of epidemiologic silence, chikungunya virus (CHIKV) has recently re-emerged, causing explosive outbreaks and reaching the 5 continents. Transmitted through the bite of Aedes species mosquitoes, CHIKV is responsible for an acute febrile illness accompanied by several characteristic symptoms, including cutaneous rash, myalgia, and arthralgia, with the latter sometimes persisting for months or years. Although CHIKV has previously been known as a relatively benign disease, more recent epidemic events have brought waves of increased morbidity and fatality, leading it to become a serious public health problem. The host's immune response plays a crucial role in controlling the infection, but it might also contribute to the promotion of viral spread and immunopathology. This review focuses on the immune responses to CHIKV in human subjects with an emphasis on early antiviral immune responses. We assess recent developments in the understanding of their possible Janus-faced effects in the control of viral infection and pathogenesis. Although preventive vaccination and specific therapies are yet to be developed, exploring this interesting model of virus-host interactions might have a strong effect on the design of novel therapeutic options to minimize immunopathology without impairing beneficial host defenses. PMID:25843597

  15. An expert system for culture-based infection control surveillance.

    PubMed Central

    Kahn, M. G.; Steib, S. A.; Fraser, V. J.; Dunagan, W. C.

    1993-01-01

    Hospital-acquired infections represent a significant cause of prolonged inpatient days and additional hospital charges. We describe an expert system, called GERMWATCHER, which applies the Centers for Disease Control's National Nosocomial Infection Surveillance culture-based criteria for detecting nosocomial infections. GERMWATCHER has been deployed at Barnes Hospital, a large tertiary-care teaching hospital, since February 1993. We describe the Barnes Hospital infection control environment, the expert system design, and a predeployment performance evaluation. We then compare our system to other efforts in computer-based infection control. PMID:8130456

  16. Historical perspectives on evidence-based nursing.

    PubMed

    Beyea, Suzanne C; Slattery, Mary Jo

    2013-04-01

    The authors of this article offer a review and historical perspective on research utilization and evidence-based practice in nursing. They present the evolution of research utilization to the more contemporary framework of evidence-based nursing practice. The authors address the role of qualitative research in the context of evidence-based practice. Finally, some approaches and resources for learning more about the fundamentals of evidence-based healthcare are provided. PMID:23575492

  17. 42 CFR 416.51 - Conditions for coverage-Infection control.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...ASC must maintain an infection control program that seeks to minimize infections and communicable diseases...acceptable standards of practice. (b) Standard: Infection control program...infection control and prevention program must...

  18. 42 CFR 416.51 - Conditions for coverage-Infection control.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...ASC must maintain an infection control program that seeks to minimize infections and communicable diseases...acceptable standards of practice. (b) Standard: Infection control program...infection control and prevention program must...

  19. 42 CFR 416.51 - Conditions for coverage-Infection control.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ...ASC must maintain an infection control program that seeks to minimize infections and communicable diseases...acceptable standards of practice. (b) Standard: Infection control program...infection control and prevention program must...

  20. 42 CFR 416.51 - Conditions for coverage-Infection control.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ...ASC must maintain an infection control program that seeks to minimize infections and communicable diseases...acceptable standards of practice. (b) Standard: Infection control program...infection control and prevention program must...

  1. 42 CFR 416.51 - Conditions for coverage-Infection control.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...ASC must maintain an infection control program that seeks to minimize infections and communicable diseases...acceptable standards of practice. (b) Standard: Infection control program...infection control and prevention program must...

  2. Evidence-Based Practices for Designing Public

    E-print Network

    Minnesota, University of

    Evidence-Based Practices for Designing Public Engagement in Transportation Kathryn Quick Assistant Questions for Evidence-Based Design 1. What are the purposes of this public engagement effort? 2. Can we for Evidence-Based Design 1. What are the purposes of this public engagement effort? 2. Can we move beyond

  3. An Evidence-Based Systematic Review of

    E-print Network

    Connor, Ed

    (Kang et al., 2012). The main objective of this Evidence-Based Practice (EBP) project was to compare and the highest quality of care. Methods Utilizing the Johns Hopkins Nursing Evidence-Based Practice (EBP) modelAn Evidence-Based Systematic Review of Efficacious Interventions for the Management of Delirium

  4. Evidence-based prevention, management, and monitoring of dental caries.

    PubMed

    Barber, Lois Rigmont; Wilkins, Esther M

    2002-01-01

    Dental caries, not unlike periodontal diseases, is now recognized as an infectious, transmissible, multifactorial disease of bacterial origin. Current evidence-based emphasis is on the need to recognize a carious lesion in its earliest stage before demineralization has produced a cavitated lesion that requires restoration by a dentist. As a result of current understanding of caries control, the dental hygienist's role as a prevention specialist is to determine the dental caries risk factors for patients of all ages and to introduce remineralization strategies into the patient's dental hygiene care plan. Conservative strategies of a concentrated program include initial infection control with a chlorhexidine rinse; extra daily fluoride exposures; placement of pit and fissure sealants where indicated; control of sucrose exposures; use of sugar substitutes, particularly xylitol-containing sugar-free chewing gum; and an emphasis on a daily bacterial plaque removal routine. Evidence supports the management and monitoring of dental caries. Caries risk level must be reevaluated at each maintenance appointment. Appropriate in-office strategies to preserve tooth structure should be carried out and followed by applicable home regimens that are based on need, not age. PMID:12592918

  5. Evolution of equine infection control programs.

    PubMed

    Smith, Bradford P

    2004-12-01

    The science of control of infectious diseases in hospitals was born in 1847 when Semmelweis, a physician, ordered his medical students to scrub their hands in chlorinated lime water between patients and demonstrated that this simple procedure resulted ina dramatic decline in patient morbidity and mortality. In the late nineteenth century came huge breakthroughs in the understanding that microorganisms cause many disorders, and methods to eliminate and control these microorganisms were attempted. By 1910, sterile instruments, gowns, masks, and gloves had become standard for surgical procedures in large university human hospitals, and isolation of human and veterinary patients with contagious diseases became standard. With the advent of vaccines, many epidemic viral diseases could be controlled, and antimicrobial drugs allowed many previously devastating bacterial diseases to be treated effectively. Before long, however, bacterial resistance became an important issue and remains so today, particularly for Salmonella and Staphylococcus aureus in horses. Vaccination has decreased the number of animals susceptible to equine influenza and equine herpesvirus 1, yet these contagious diseases still pose a serious issue in large equine veterinary hospitals. The development of equine isolation facilities and improved methods of barn cleaning; mandatory application of procedures, such as handwashing or use of disinfectant hand wipes, to prevent the spread of infectious diseases; and monitoring of antimicrobial resistance and use of restricted antimicrobial drugs were driven by recognition and necessity and have given rise to current equine infection control programs. PMID:15519815

  6. Hospital Epidemiology and Infection Control in Acute-Care Settings

    PubMed Central

    Sydnor, Emily R. M.; Perl, Trish M.

    2011-01-01

    Summary: Health care-associated infections (HAIs) have become more common as medical care has grown more complex and patients have become more complicated. HAIs are associated with significant morbidity, mortality, and cost. Growing rates of HAIs alongside evidence suggesting that active surveillance and infection control practices can prevent HAIs led to the development of hospital epidemiology and infection control programs. The role for infection control programs has grown and continues to grow as rates of antimicrobial resistance rise and HAIs lead to increasing risks to patients and expanding health care costs. In this review, we summarize the history of the development of hospital epidemiology and infection control, common HAIs and the pathogens causing them, and the structure and role of a hospital epidemiology and infection control program. PMID:21233510

  7. [Current guideline for hospital infection control in Japan].

    PubMed

    Sakakibara, Yoko; Takezawa, Jun

    2002-11-01

    The Committee for Prevention of Nosocomial Infection organized by national university hospitals has developed guideline for preventing hospital acquired infections. This was developed after intensive and systematic reviews of the existing scientific papers, followed by a consensus meeting with presence of the infection control specialists. The guideline consisted of following categories: standard precaution, causality organism, urinary tract infection, ventilator associated pneumonia, surgical site infection, catheter related bloodstream infection, and accidental contamination by needles. We also plan to evaluate the effectiveness of this guideline, and continue to update it by our consistent review of scientific papers. PMID:12440111

  8. 38 CFR 51.190 - Infection control.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ...OF VETERANS AFFAIRS (CONTINUED) PER DIEM FOR NURSING HOME CARE OF VETERANS IN STATE HOMES Standards § 51.190 Infection...must prohibit employees with a communicable disease or infected skin lesions from engaging in any contact with residents or...

  9. 38 CFR 51.190 - Infection control.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ...OF VETERANS AFFAIRS (CONTINUED) PER DIEM FOR NURSING HOME CARE OF VETERANS IN STATE HOMES Standards § 51.190 Infection...must prohibit employees with a communicable disease or infected skin lesions from engaging in any contact with residents or...

  10. 38 CFR 51.190 - Infection control.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ...OF VETERANS AFFAIRS (CONTINUED) PER DIEM FOR NURSING HOME CARE OF VETERANS IN STATE HOMES Standards § 51.190 Infection...must prohibit employees with a communicable disease or infected skin lesions from engaging in any contact with residents or...

  11. 38 CFR 51.190 - Infection control.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ...OF VETERANS AFFAIRS (CONTINUED) PER DIEM FOR NURSING HOME CARE OF VETERANS IN STATE HOMES Standards § 51.190 Infection...must prohibit employees with a communicable disease or infected skin lesions from engaging in any contact with residents or...

  12. Postoperative adjuvant chemotherapy of gastric cancer: scrutiny into the clinical evidence based on quality assessment of medical literature of randomized controlled trials

    Microsoft Academic Search

    Hei-Cheul Jeung; Sun Young Rha; Sang Joon Shin; Joong Bae Ahn; Jae Kyung Roh; Chan Hee Park; Sung Hoon Noh; Hyun Cheol Chung

    2009-01-01

    The aim of this study was to scrutinize the evidence of adjuvant chemotherapy of gastric cancer by assessing the quality of\\u000a the medical literature of randomized controlled trials (RCTs). A quality assessment (QA) scoring system was devised with the\\u000a three parameters—control of bias, quality of report, and quality of design—which consisted 19 items. We searched for all the\\u000a publications of

  13. 42 CFR 485.725 - Condition of participation: Infection control.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...Public Health Agencies as Providers of Outpatient Physical Therapy and Speech-Language Pathology Services § 485...control. The organization that provides outpatient physical therapy services establishes an infection-control...

  14. 42 CFR 485.725 - Condition of participation: Infection control.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...Public Health Agencies as Providers of Outpatient Physical Therapy and Speech-Language Pathology Services § 485...control. The organization that provides outpatient physical therapy services establishes an infection-control...

  15. Modern trends in infection control practices in intensive care units.

    PubMed

    Gandra, Sumanth; Ellison, Richard T

    2014-01-01

    Hospital-acquired infections (HAIs) are common in intensive care unit (ICU) patients and are associated with increased morbidity and mortality. There has been an increasing effort to prevent HAIs, and infection control practices are paramount in avoiding these complications. In the last several years, numerous developments have been seen in the infection prevention strategies in various health care settings. This article reviews the modern trends in infection control practices to prevent HAIs in ICUs with a focus on methods for monitoring hand hygiene, updates in isolation precautions, new methods for environmental cleaning, antimicrobial bathing, prevention of ventilator-associated pneumonia, central line-associated bloodstream infections, catheter-associated urinary tract infections, and Clostridium difficile infection. PMID:23753240

  16. Evidence-Based Practice in Psychology

    Microsoft Academic Search

    2006-01-01

    The evidence-based practice movement has become an important feature of health care systems and health care policy. Within this context, the APA 2005 Presidential Task Force on Evidence-Based Practice defines and discusses evidence-based practice in psychology (EBPP). In an integration of science and practice, the Task Force’s report describes psychology’s fundamental commitment to sophisticated EBPP and takes into account the

  17. A focus on intra-abdominal infections

    Microsoft Academic Search

    Massimo Sartelli

    2010-01-01

    Complicated intra-abdominal infections are an important cause of morbidity and are frequently associated with poor prognosis, particularly in higher risk patients. Well defined evidence-based recommendations for intra-abdominal infections treatment are partially lacking because of the limited number of randomized-controlled trials. Factors consistently associated with poor outcomes in patients with intra-abdominal infections include increased illness severity, failed source control, inadequate empiric

  18. The national database of hospital-based cancer registries: a nationwide infrastructure to support evidence-based cancer care and cancer control policy in Japan.

    PubMed

    Higashi, Takahiro; Nakamura, Fumiaki; Shibata, Akiko; Emori, Yoshiko; Nishimoto, Hiroshi

    2014-01-01

    Monitoring the current status of cancer care is essential for effective cancer control and high-quality cancer care. To address the information needs of patients and physicians in Japan, hospital-based cancer registries are operated in 397 hospitals designated as cancer care hospitals by the national government. These hospitals collect information on all cancer cases encountered in each hospital according to precisely defined coding rules. The Center for Cancer Control and Information Services at the National Cancer Center supports the management of the hospital-based cancer registry by providing training for tumor registrars and by developing and maintaining the standard software and continuing communication, which includes mailing lists, a customizable web site and site visits. Data from the cancer care hospitals are submitted annually to the Center, compiled, and distributed as the National Cancer Statistics Report. The report reveals the national profiles of patient characteristics, route to discovery, stage distribution, and first-course treatments of the five major cancers in Japan. A system designed to follow up on patient survival will soon be established. Findings from the analyses will reveal characteristics of designated cancer care hospitals nationwide and will show how characteristics of patients with cancer in Japan differ from those of patients with cancer in other countries. The database will provide an infrastructure for future clinical and health services research and will support quality measurement and improvement of cancer care. Researchers and policy-makers in Japan are encouraged to take advantage of this powerful tool to enhance cancer control and their clinical practice. PMID:23448800

  19. Infections and cancer: debate about using vaccines as a cancer control tool

    PubMed Central

    2013-01-01

    In 2012, Infectious Agents and Cancer commissioned a thematic series collection of articles on Prevention of HPV related cancer. The articles have attracted wide interest and stimulated debate, including about the utility of vaccines in cancer control. The application of vaccines to cancer control fulfills a promise envisioned at the turn of the 20th century when remarkable experiments showed that some cancers were caused by infections. This suggested the possibility of applying infection-control strategies to cancer control. Vaccines represent the most practical cost-effective technology to prevent wide human suffering and death from many acute infectious diseases, such as small pox or polio. Hitherto applied to control of acute fatal infections, vaccines, if developed, might provide a potent way to control cancer. The articles in the HPV thematic series show success in developing and applying a vaccine against human papilloma virus (HPV). A vaccine is also available against hepatitis B virus (HBV), which causes liver cancer. These vaccines augment the tools available to control the associated cancers. Scientific endeavor continues for six other cancer-associated infections, mostly viruses. Not surprisingly, debate about the safety of vaccines targeting cancer has been triggered in the scientific community. Questions about safety have been raised for those populations where other means to control these cancers may be available. Although it is difficult to quantify risk from vaccines in individuals where other cancer control services exist, it is likely to be low. Vaccines are much safer today than before. Technological advancement in vaccine development and manufacture and improved regulatory review and efficient distribution have minimized substantially the risk for harm from vaccines. Formal and informal debate about the pros and cons of applying vaccines as a cancer control tools is ongoing in scientific journals and on the web. Infectious Agents and Cancer encourages evidence-based discussion to clarify understanding of the role of vaccines in cancer control. In a similar vein, the journal will not consider anecdotal reports and rhetorical arguments because they are unlikely to inform policy, regulation, or the public. PMID:23642130

  20. Treating PTSD in patients with psychosis: a within-group controlled feasibility study examining the efficacy and safety of evidence-based PE and EMDR protocols.

    PubMed

    de Bont, Paul A J M; van Minnen, Agnes; de Jongh, Ad

    2013-12-01

    The present study uses a within-group controlled design to examine the efficacy and safety of two psychological approaches to posttraumatic stress disorder (PTSD) in 10 patients with a concurrent psychotic disorder. Patients were randomly assigned either to prolonged exposure (PE; N=5) or eye movement desensitization and reprocessing (EMDR; N=5). Before, during, and after treatment, a total of 20 weekly assessments of PTSD symptoms, hallucinations, and delusions were carried out. Twelve weekly assessments of adverse events took place during the treatment phase. PTSD diagnosis, level of social functioning, psychosis-prone thinking, and general psychopathology were assessed pretreatment, posttreatment, and at three-month follow-up. Throughout the treatment, adverse events were monitored at each session. An intention-to-treat analysis of the 10 patients starting treatment showed that the PTSD treatment protocols of PE and EMDR significantly reduced PTSD symptom severity; PE and EMDR were equally effective and safe. Eight of the 10 patients completed the full intervention period. Seven of the 10 patients (70%) no longer met the diagnostic criteria for PTSD at follow-up. No serious adverse events occurred, nor did patients show any worsening of hallucinations, delusions, psychosis proneness, general psychopathology, or social functioning. The results of this feasibility trial suggest that PTSD patients with comorbid psychotic disorders benefit from trauma-focused treatment approaches such as PE and EMDR. PMID:24094795

  1. Human natural killer cells control Plasmodium falciparum infection by eliminating infected

    E-print Network

    Dao, Ming

    Human natural killer cells control Plasmodium falciparum infection by eliminating infected red, Singapore 138602; b Humanized Mouse Unit, Institute of Molecular and Cell Biology, Agency for Science blood cells Qingfeng Chena,b , Anburaj Amaladossa , Weijian Yea,c , Min Liua , Sara Dummlera , Fang

  2. Control of Murine Cytomegalovirus Infection by ?? T Cells

    PubMed Central

    Sell, Sabrina; Dietz, Monika; Schneider, Andrea; Holtappels, Rafaela; Mach, Michael; Winkler, Thomas H.

    2015-01-01

    Infections with cytomegalovirus (CMV) can cause severe disease in immunosuppressed patients and infected newborns. Innate as well as cellular and humoral adaptive immune effector functions contribute to the control of CMV in immunocompetent individuals. None of the innate or adaptive immune functions are essential for virus control, however. Expansion of ?? T cells has been observed during human CMV (HCMV) infection in the fetus and in transplant patients with HCMV reactivation but the protective function of ?? T cells under these conditions remains unclear. Here we show for murine CMV (MCMV) infections that mice that lack CD8 and CD4 ??-T cells as well as B lymphocytes can control a MCMV infection that is lethal in RAG-1-/- mice lacking any T- and B-cells. ?? T cells, isolated from infected mice can kill MCMV infected target cells in vitro and, importantly, provide long-term protection in infected RAG-1-/- mice after adoptive transfer. ?? T cells in MCMV infected hosts undergo a prominent and long-lasting phenotypic change most compatible with the view that the majority of the ?? T cell population persists in an effector/memory state even after resolution of the acute phase of the infection. A clonotypically focused V?1 and V?2 repertoire was observed at later stages of the infection in the organs where MCMV persists. These findings add ?? T cells as yet another protective component to the anti-CMV immune response. Our data provide clear evidence that ?? T cells can provide an effective control mechanism of acute CMV infections, particularly when conventional adaptive immune mechanisms are insufficient or absent, like in transplant patient or in the developing immune system in utero. The findings have implications in the stem cell transplant setting, as antigen recognition by ?? T cells is not MHC-restricted and dual reactivity against CMV and tumors has been described. PMID:25658831

  3. Infection control in the pulmonary function test laboratory

    PubMed Central

    Rasam, Shweta Amol; Apte, Komalkirti Keshavkiran; Salvi, Sundeep Santosh

    2015-01-01

    Pulmonary function testing plays a crucial role in the diagnostic evaluation of patients with lung diseases. Cases of cross infection acquired from the pulmonary function laboratory, although rare, have been reported from various countries. It is therefore imperative to identify the risks and potential organisms implicated in cross infections in a pulmonary function test (PFT) laboratory and implement better and more effective infection control procedures, which will help in preventing cross infections. The infrastructure, the daily patient flow, and the prevalent disinfection techniques used in a PFT laboratory, all play a significant role in transmission of infections. Simple measures to tackle the cross infection potential in a PFT laboratory can help reduce this risk to a bare minimum. Use of specialized techniques and equipment can also be of much use in a set up that has a high turnover of patients. This review aims at creating awareness about the possible pathogens and situations commonly encountered in a PFT laboratory. We have attempted to suggest some relevant and useful infection control measures with regard to disinfection, sterilization, and patient planning and segregation to help minimize the risk of cross infections in a PFT laboratory. The review also highlights the lacuna in the current scenario of PFT laboratories in India and the need to develop newer and better methods of infection control, which will be more user-friendly and cost effective. Further studies to study the possible pathogens in a PFT laboratory and evaluate the prevalent infection control strategies will be needed to enable us to draw more precious conclusions, which can lead to more relevant, contextual recommendations for cross infections control in PFT lab in India.

  4. Evidence-Based Practice in Psychology

    Microsoft Academic Search

    Ronald F. Levant; Nadia T. Hasan

    2008-01-01

    This article focuses on the 2005 American Psychological Association Presidential Task Force on Evidence-Based Practice in Psychology. After describing the rationale and results of this task force, the authors review the literature that has appeared following the approval of the Policy Statement on Evidence-Based Practice in Psychology by the American Psychological Association Council of Representatives, with reference to the implications

  5. Human Givens Therapy: The Evidence Base

    Microsoft Academic Search

    Nadia Corp; Anna Tsaroucha; Paul Kingston

    2008-01-01

    This paper reviews the current evidence base for human givens therapy in the context of mental health. A systematic literature search was conducted from which it is concluded that the evidence base for human givens therapy is currently limited: most evidence proffered is expert opinion supported with brief case studies or anecdotal evidence, with the exception of two descriptive studies

  6. The need for evidence-based conservation

    E-print Network

    Kark, Salit

    to which medical practice was based on research evidence of effectiveness and led to the conclusionThe need for evidence-based conservation William J. Sutherland1 , Andrew S. Pullin2 , Paul M Sciences, University of East Anglia, Norwich, UK. NR4 7TJ 2 Centre for Evidence-Based Conservation, School

  7. 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…

  8. Translating Research and Building the Evidence Base

    E-print Network

    Keinan, Alon

    promoting evidence-based, rigorously-tested programs and practices throughout all program areas, including Discovery Practice-based Evidence DIFFUSION #12;What's New About Translational Research? Hasn't CCE beenTranslating Research and Building the Evidence Base John Eckenrode Professor of Human Development

  9. 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…

  10. Evidence-Based Practices in Secondary Transition

    ERIC Educational Resources Information Center

    Test, David W.; Fowler, Catherine H.; Richter, Sharon M.; White, James; Mazzotti, Valerie; Walker, Allison R.; Kohler, Paula; Kortering, Larry

    2009-01-01

    A literature review was conducted to identify evidence-based practices in secondary transition using quality indicator checklists for experimental research. Practices were categorized by the Taxonomy for Transition Programming. Overall, 32 secondary transition evidence-based practices were identified. Two practices had a strong level of evidence,…

  11. Multicultural Issues in Evidence-Based Interventions

    ERIC Educational Resources Information Center

    Ingraham, Colette L.; Oka, Evelyn R.

    2006-01-01

    School psychologists involved in the delivery of psychological and educational interventions face the challenge of identifying interventions that will work within their schools. The evidence-based intervention (EBI) approach has received attention as a promising way to identify effective interventions. The national Task Force on Evidence Based

  12. 38 CFR 52.190 - Infection control.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ...CONTINUED) PER DIEM FOR ADULT DAY HEALTH CARE OF VETERANS IN STATE HOMES Standards § 52...staff with a communicable disease or infected skin lesions from attending the adult day health care program if direct contact will transmit...

  13. 38 CFR 52.190 - Infection control.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ...CONTINUED) PER DIEM FOR ADULT DAY HEALTH CARE OF VETERANS IN STATE HOMES Standards § 52...staff with a communicable disease or infected skin lesions from attending the adult day health care program if direct contact will transmit...

  14. 38 CFR 52.190 - Infection control.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ...CONTINUED) PER DIEM FOR ADULT DAY HEALTH CARE OF VETERANS IN STATE HOMES Standards § 52...staff with a communicable disease or infected skin lesions from attending the adult day health care program if direct contact will transmit...

  15. 38 CFR 52.190 - Infection control.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ...CONTINUED) PER DIEM FOR ADULT DAY HEALTH CARE OF VETERANS IN STATE HOMES Standards § 52...staff with a communicable disease or infected skin lesions from attending the adult day health care program if direct contact will transmit...

  16. 38 CFR 52.190 - Infection control.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ...AFFAIRS (CONTINUED) PER DIEM FOR ADULT DAY HEALTH CARE OF VETERANS IN STATE HOMES Standards...staff with a communicable disease or infected skin lesions from attending the adult day health care program if direct contact will...

  17. Harmonizing and supporting infection control training in Europe.

    PubMed

    Brusaferro, S; Arnoldo, L; Cattani, G; Fabbro, E; Cookson, B; Gallagher, R; Hartemann, P; Holt, J; Kalenic, S; Popp, W; Privitera, G; Prikazsky, V; Velasco, C; Suetens, C; Varela Santos, C

    2015-04-01

    Healthcare-associated infection (HCAI), patient safety, and the harmonization of related policies and programmes are the focus of increasing attention and activity in Europe. Infection control training for healthcare workers (HCWs) is a cornerstone of all patient safety and HCAI prevention and control programmes. In 2009 the European Centre for Disease Prevention and Control (ECDC) commissioned an assessment of needs for training in infection control in Europe (TRICE), which showed a substantial increase in commitment to HCAI prevention. On the other hand, it also identified obstacles to the harmonization and promotion of training in infection control and hospital hygiene (IC/HH), mostly due to differences between countries in: (i) the required qualifications of HCWs, particularly nurses; (ii) the available resources; and (iii) the sustainability of IC/HH programmes. In 2013, ECDC published core competencies for infection control and hospital hygiene professionals in the European Union and a new project was launched ['Implementation of a training strategy for infection control in the European Union' (TRICE-IS)] that aimed to: define an agreed methodology and standards for the evaluation of IC/HH courses and training programmes; develop a flexible IC/HH taxonomy; and implement an easily accessible web tool in 'Wiki' format for IC/HH professionals. This paper reviews several aspects of the TRICE and the TRICE-IS projects. PMID:25777079

  18. 42 CFR 418.60 - Condition of participation: Infection control.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...Prevention. The hospice must follow accepted standards of practice to prevent the transmission of infections...and communicable diseases, including the use of standard precautions. (b) Standard: Control. The hospice must maintain a...

  19. 42 CFR 418.60 - Condition of participation: Infection control.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...Prevention. The hospice must follow accepted standards of practice to prevent the transmission of infections...and communicable diseases, including the use of standard precautions. (b) Standard: Control. The hospice must maintain a...

  20. 42 CFR 418.60 - Condition of participation: Infection control.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ...Prevention. The hospice must follow accepted standards of practice to prevent the transmission of infections...and communicable diseases, including the use of standard precautions. (b) Standard: Control. The hospice must maintain a...

  1. 42 CFR 418.60 - Condition of participation: Infection control.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...Prevention. The hospice must follow accepted standards of practice to prevent the transmission of infections...and communicable diseases, including the use of standard precautions. (b) Standard: Control. The hospice must maintain a...

  2. 42 CFR 418.60 - Condition of participation: Infection control.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ...Prevention. The hospice must follow accepted standards of practice to prevent the transmission of infections...and communicable diseases, including the use of standard precautions. (b) Standard: Control. The hospice must maintain a...

  3. 42 CFR 485.725 - Condition of participation: Infection control.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ...Clinics, Rehabilitation Agencies, and Public Health Agencies as Providers of Outpatient Physical Therapy and Speech-Language Pathology Services § 485.725 Condition of participation: Infection control. The organization that provides...

  4. Infection Control: The Use and Handling of Toothbrushes

    MedlinePLUS

    ... Guidelines Safety Infant Formula and Fluorosis Scientific Reviews Fluoride in Drinking Water Health Effects and Environmental Impact ... Growth Reference Statistics Engineering & Operations Training Programs Other Fluoride Products Links to Other Organizations Materials Infection Control ...

  5. Healthcare workers and prevention of hepatitis C virus transmission: exploring knowledge, attitudes and evidence-based practices in hemodialysis units in Italy

    PubMed Central

    2013-01-01

    Background Evidence exists regarding the full prevention of HCV transmission to hemodialysis patients by implementing universal precaution. However, little information is available regarding the frequency with which hospitals have adopted evidence-based practices for preventing HCV infection among hemodialysis patients. A cross-sectional survey has been conducted among nurses in Calabria region (Italy) in order to acquire information about the level of knowledge, the attitudes and the frequencies of evidence-based practices that prevent hospital transmission of HCV. Methods All 37 hemodialysis units (HDU) of Calabria were included in the study and all nurses were invited to participate in the study and to fill in a self-administered questionnaire. Results 90% of the nurses working in HDU participated in the study. Correct answers about HCV pattern of transmission ranged from 73.7% to 99.3% and were significantly higher in respondents who knew that isolation of HCV-infected patients is not recommended and among those who knew that previous bloodstream infections should be included in medical record and among nurses with fewer years of practice. Most correctly thought that evidence-based infection control measures provide adequate protection against transmission of bloodborne pathogens among healthcare workers. Positive attitude was significantly higher among more knowledgeable nurses. Self-reporting of appropriate handwashing procedures were significantly more likely in nurses who were aware that transmission of bloodborne pathogens among healthcare workers may be prevented through adoption of evidence-based practices and with a correct knowledge about HCV transmission patterns. Conclusions Behavior changes should be aimed at abandoning outdated practices and adopting and maintaining evidence-based practices. Initiatives focused at enabling and reinforcing adherence to effective prevention practices among nurses in HDU are strongly needed. PMID:23391009

  6. History of evidence-based medicine

    PubMed Central

    Sur, Roger L.; Dahm, Philipp

    2011-01-01

    This essay reviews the historical circumstances surrounding the introduction and evolution of evidence-based medicine. Criticisms of the approach are also considered. Weaknesses of existing standards of clinical practice and efforts to bring more certainty to clinical decision making were the foundation for evidence-based medicine, which integrates epidemiology and medical research. Because of its utility in designing randomized clinical trials, assessing the quality of the literature, and applying medical research at the bedside, evidence-based medicine will continue to have a strong influence on everyday clinical practice. PMID:22279315

  7. 75 FR 34146 - Draft Guideline for the Prevention and Control of Norovirus Gastroenteritis Outbreaks in...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-06-16

    ...for developing, implementing, and evaluating infection prevention and control programs for healthcare settings across the continuum of care. This guideline provides evidence-based recommendations for prevention and control of norovirus outbreaks in...

  8. Dengue Infection and Miscarriage: A Prospective Case Control Study

    PubMed Central

    Tan, Peng Chiong; Soe, May Zaw; Si Lay, Khaing; Wang, Seok Mui; Sekaran, Shamala Devi; Omar, Siti Zawiah

    2012-01-01

    Background Dengue is the most prevalent mosquito borne infection worldwide. Vertical transmissions after maternal dengue infection to the fetus and pregnancy losses in relation to dengue illness have been reported. The relationship of dengue to miscarriage is not known. Method We aimed to establish the relationship of recent dengue infection and miscarriage. Women who presented with miscarriage (up to 22 weeks gestation) to our hospital were approached to participate in the study. For each case of miscarriage, we recruited 3 controls with viable pregnancies at a similar gestation. A brief questionnaire on recent febrile illness and prior dengue infection was answered. Blood was drawn from participants, processed and the frozen serum was stored. Stored sera were thawed and then tested in batches with dengue specific IgM capture ELISA, dengue non-structural protein 1 (NS1) antigen and dengue specific IgG ELISA tests. Controls remained in the analysis if their pregnancies continued beyond 22 weeks gestation. Tests were run on 116 case and 341 control sera. One case (a misdiagnosed viable early pregnancy) plus 45 controls (39 lost to follow up and six subsequent late miscarriages) were excluded from analysis. Findings Dengue specific IgM or dengue NS1 antigen (indicating recent dengue infection) was positive in 6/115 (5·2%) cases and 5/296 (1·7%) controls RR 3·1 (95% CI 1·0–10) P?=?0·047. Maternal age, gestational age, parity and ethnicity were dissimilar between cases and controls. After adjustments for these factors, recent dengue infection remained significantly more frequently detected in cases than controls (AOR 4·2 95% CI 1·2–14 P?=?0·023). Interpretation Recent dengue infections were more frequently detected in women presenting with miscarriage than in controls whose pregnancies were viable. After adjustments for confounders, the positive association remained. PMID:22590658

  9. The Prescription Project promotes evidence-based

    E-print Network

    Chapman, Michael S.

    The Prescription Project promotes evidence-based prescribing and works to eliminate conflicts of interest in medicine due to pharmaceutical marketing to physicians. It is promoting policy change practicing physicians in the wider community. Where pharmaceutical industry marketing conflicts

  10. The Art of Evidence-Based Practice

    Microsoft Academic Search

    David E. Pollio

    2006-01-01

    The purpose of this article is to discuss evidence-based practice (EBP) from the perspective of a self-identified evidence-based practitioner. Discussion of EBP includes choosing an initial intervention and evaluation procedures, the iterative process of rechoosing and refining an intervention over the treatment life span, and the importance of evi- dence within the specific clinical situation. Two illustrative case studies are

  11. Psychiatric mental health evidence-based practice.

    PubMed

    Rice, Michael J

    2008-05-01

    This article is the first in a new column focusing on evidence-based practice (EBP) in psychiatric mental health nursing. The EBP movement was strongly influenced by a British epidemiologist, Dr. Cochrane, who advocated care based on randomized clinical controlled trials in the late 1900s. Although the majority of the EBP movement is directed toward developing clinical guidelines, the critical element focuses on the therapeutic relationship and clinical judgment associated with providing care. This column will address a clinical problem, define PICO questions, report knowledge base searches, and present existing evidence. Recommendations will be offered for potential interventions and suggestions for evaluating clinical outcomes. Nurses can no longer view clinical studies as academic exercises discarded on graduation and not applied to the clinical setting. Conscientiously applying what is known about treatments and interventions of ethical, if not legal, value is consistent with the professional definition of care. J Am Psychiatr Nurses Assoc, 2008; 14(2), 107-111. DOI: 10.1177/1078390308315798. PMID:21665759

  12. Pyrimidinergic Receptor Activation Controls Toxoplasma gondii Infection in Macrophages

    PubMed Central

    Moreira-Souza, Aline Cristina Abreu; Marinho, Ygor; Correa, Gladys; Santoro, Giani França; Coutinho, Claudia Mara Lara Melo; Vommaro, Rossiane Claudia; Coutinho-Silva, Robson

    2015-01-01

    Infection by the protozoan parasite Toxoplasma gondii is highly prevalent worldwide and may have serious clinical manifestations in immunocompromised patients. T. gondii is an obligate intracellular parasite that infects almost any cell type in mammalian hosts, including immune cells. The immune cells express purinergic P2 receptors in their membrane – subdivided into P2Y and P2X subfamilies - whose activation is important for infection control. Here, we examined the effect of treatment with UTP and UDP in mouse peritoneal macrophages infected with T. gondii tachyzoites. Treatment with these nucleotides reduced parasitic load by 90%, but did not increase the levels of the inflammatory mediators NO and ROS, nor did it modulate host cell death by apoptosis or necrosis. On the other hand, UTP and UDP treatments induced early egress of tachyzoites from infected macrophages, in a Ca2+-dependent manner, as shown by scanning electron microscopy analysis, and videomicroscopy. In subsequent infections, prematurely egressed parasites had reduced infectivity, and could neither replicate nor inhibit the fusion of lysosomes to the parasitophorous vacuole. The use of selective agonists and antagonists of the receptor subtypes P2Y2 and P2Y4 and P2Y6 showed that premature parasite egress may be mediated by the activation of these receptor subtypes. Our results suggest that the activity of P2Y host cell receptors controls T. gondii infection in macrophages, highlighting the importance of pyrimidinergic signaling for innate immune system response against infection. Finally the P2Y receptors should be considered as new target for the development of drugs against T. gondii infection. PMID:26192447

  13. Evidence-Based Assessment in Case Management to Improve Abnormal Cancer Screen Follow-Up

    ERIC Educational Resources Information Center

    Vourlekis, Betsy; Ell, Kathleen; Padgett, Deborah

    2005-01-01

    The authors describe an evidence-based assessment protocol for intensive case management to improve screening diagnostic follow-up developed through a research project in breast and cervical cancer early detection funded by the Centers for Disease Control and Prevention. Three components of an evidence-based approach to assessment are presented…

  14. Promoting Evidence-Based Practice in Child Protection

    Microsoft Academic Search

    Geraldine Macdonald

    1998-01-01

    This article argues for the adoption of an evidence-based approach to decision-making in child protection. Such a change hinges upon the availability of good quality, up-to-date evidence that is readily accessible to practitioners and policy-makers. Following a resume' of the arguments for recognizing controlled trials as methodologically superior to other forms of methodology in evaluating professional interventions, the article presents

  15. Towards an evidence based health care management.

    PubMed

    Axelsson, R

    1998-01-01

    Inspired by the development of Evidence Based Medicine, this article introduces a new approach for health care management called Evidence Based Management. This approach promises to improve the practice of health care management, at the same time as it may stimulate research on the organization and management of health care. Evidence Based Management means that health care managers should learn to search for and critically appraise evidence from management research as a basis for their practice. This will require some new managerial skills that should be included in the education and training of health care managers. It will also require a new orientation for research on health care management. There will be a demand for more applied research, and also for research with a more positivist orientation. PMID:10346052

  16. Crime prevention: more evidence-based analysis.

    PubMed

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

    2008-02-01

    This paper introduces a new section of Psicothema dedicated to the evidence-based approach to crime prevention. Along with an original sexual-offender-treatment programme implemented in Spain, this section presents four systematic reviews of important subjects in the criminological arena, such as sexual offender treatment, the well-known programme, the effectiveness of custodial versus non-custodial sanctions in reoffending and the fight against terrorism. We also highlight some of the focal points that scientists, practitioners and governments should take into account in order to support this evidence-based viewpoint of crime prevention. PMID:18206058

  17. Evidence-based practice in rehabilitation nursing.

    PubMed

    Pierce, Linda L

    2007-01-01

    How to use research is a learned skill. With this skill rehabilitation nurses can help ensure that their practice is based on the best evidence available. Evidence-based practice is a balance of using external research-based clinical evidence and clinical expertise. The purpose of this article is to show rehabilitation nurses how to build the skills for using evidence, rather than just doing research. This involves asking questions, finding and appraising relevant data, and putting that information into everyday practice. When evidence-based practice is merged into a clinician's daily routine, the result is a more analytical and, ultimately, effective clinical practice. PMID:17899991

  18. Evidence-based fitness promotion in an afterschool setting: implementation fidelity and its policy implications.

    PubMed

    Thaw, Jean M; Villa, Manuela; Reitman, David; DeLucia, Christian; Gonzalez, Vanessa; Hanson, K Lori

    2014-01-01

    Little is known about how the adoption of evidence-based physical activity (PA) curricula by out-of-school time (OST) programs affects children's physical fitness, and there are no clear guidelines of what constitutes reasonable gains given the types of PA instruction currently offered in these programs. Using a three-wave, quasi-experimental, naturalistic observation design, this study evaluated the implementation of an evidence-based PA instruction curriculum (Sports, Play, and Active Recreation for Kids [SPARK]) and examined whether the potential health benefits of evidence-based PA instruction can be replicated in this context when compared to OST programs that do not use evidence-based PA curricula. Quality of PA instruction and SPARK implementation fidelity were also assessed. Results indicated that children in the non-evidence-based/standard PA instruction programs engaged in higher levels of moderate-to-vigorous PA (MVPA) and showed greater improvements in fitness levels over time. The findings from this chapter suggest that while it is generally accepted that evidence-based approaches yield higher levels of PA when implemented by researchers under controlled conditions, findings are inconsistent when evidence-based PA instruction is implemented in the field, under presumably less controlled conditions. It appears that when it comes to PA instruction in afterschool, either less structured activities or well-implemented evidence-based practices could be the key to promoting higher PA levels and greater health and fitness for school-aged children. PMID:25530243

  19. 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…

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

    Microsoft Academic Search

    Thomas R. Kratochwill; Elisa Steele Shernoff

    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 challenges faced by those engaged in the EBI movement in

  1. Implementing evidence-based recommended practices for the management of patients with mild traumatic brain injuries in Australian emergency care departments: study protocol for a cluster randomised controlled trial

    PubMed Central

    2014-01-01

    Background Mild head injuries commonly present to emergency departments. The challenges facing clinicians in emergency departments include identifying which patients have traumatic brain injury, and which patients can safely be sent home. Traumatic brain injuries may exist with subtle symptoms or signs, but can still lead to adverse outcomes. Despite the existence of several high quality clinical practice guidelines, internationally and in Australia, research shows inconsistent implementation of these recommendations. The aim of this trial is to test the effectiveness of a targeted, theory- and evidence-informed implementation intervention to increase the uptake of three key clinical recommendations regarding the emergency department management of adult patients (18 years of age or older) who present following mild head injuries (concussion), compared with passive dissemination of these recommendations. The primary objective is to establish whether the intervention is effective in increasing the percentage of patients for which appropriate post-traumatic amnesia screening is performed. Methods/design The design of this study is a cluster randomised trial. We aim to include 34 Australian 24-hour emergency departments, which will be randomised to an intervention or control group. Control group departments will receive a copy of the most recent Australian evidence-based clinical practice guideline on the acute management of patients with mild head injuries. The intervention group will receive an implementation intervention based on an analysis of influencing factors, which include local stakeholder meetings, identification of nursing and medical opinion leaders in each site, a train-the-trainer day and standardised education and interactive workshops delivered by the opinion leaders during a 3 month period of time. Clinical practice outcomes will be collected retrospectively from medical records by independent chart auditors over the 2 month period following intervention delivery (patient level outcomes). In consenting hospitals, eligible patients will be recruited for a follow-up telephone interview conducted by trained researchers. A cost-effectiveness analysis and process evaluation using mixed-methods will be conducted. Sample size calculations are based on including 30 patients on average per department. Outcome assessors will be blinded to group allocation. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12612001286831 (date registered 12 December 2012). PMID:25012235

  2. Controlling healthcare-associated infections in the NHS.

    PubMed

    Duerden, Brian

    2008-04-01

    The prevention and control of healthcare-associated infection (HCAI) is a priority for the NHS. The delivery of national targets for reducing methicillin resistant Staphylococcus aureus bacteraemias and Clostridium difficile infection are supported by enhanced mandatory surveillance through the Health Protection Agency and a Department of Health improvement programme that promotes policies and protocols for enhancing clinical procedures and places infection prevention and control at the centre of clinical and corporate governance. The Health Act 2006 Code of Practice makes such policies and protocols a legal requirement and compliance will be assessed by the Healthcare Commission. Clinicians must recognise their responsibilities for patient safety and take a lead role in ensuring good practice to reduce HCAI. PMID:18478854

  3. Infection Prevention and Control 2010 ISOLATION PRECAUTIONS EDUCATIONAL SHEET FOR

    E-print Network

    Kim, Duck O.

    Infection Prevention and Control 2010 ISOLATION PRECAUTIONS EDUCATIONAL SHEET FOR PATIENTS with your visit, remove the PPE carefully and discard it in the trash provided Perform hand hygiene Hospital: Contact Precautions requires gloves and gown for entering the patient's room. Enteric

  4. Controversies in isolation and general infection control practices in pediatrics

    Microsoft Academic Search

    Jane D Siegel

    2002-01-01

    Current controversies in pediatric isolation and infection control include correct application of standard precautions, importance of providing adequate staffing levels in intensive care units to prevent transmission of infectious agents, use of rapid diagnostic testing and best precautions to prevent transmission of respiratory syncytial virus, best methods to prevent transmission of multidrug-resistant organisms in acute care settings, and preventing transmission

  5. Infection control: Knowledge and compliance among Saudi undergraduate dental students

    PubMed Central

    Al-Maweri, Sadeq Ali; Tarakji, Bassel; Shugaa-Addin, Bassam; Al-Shamiri, Hashem M.; Alaizari, Nader Ahmed; AlMasri, Ousamah

    2015-01-01

    Objective: This study aimed to assess the level of knowledge, attitudes, and practices regarding infection control procedures among undergraduate dental students. Methods: This was a questionnaire-based cross-sectional survey. A self-administered questionnaire consisting of questions on students’ vaccination status as well as knowledge and attitudes regarding infection control was sent to 600 undergraduate dental students in the fourth, fifth, and sixth year of the Al-Farabi College for Dentistry and Nursing, Riyadh, Saudi Arabia. The collected data were analyzed using SPSS software. The significance level was set at P<0.05. Results: The response rate was 85% (512 out of 600). While the vast majority of students (90%) had been vaccinated against hepatitis, only 37.4% have been assessed for anti-HBs. A total of 98.8% and 90.8% reported always wearing gloves and masks, respectively, during dental procedures. The use of protective eyewear was reported by only 29.2%. A significantly higher proportion of sixth-year students showed a positive attitude toward the treatment of patients with infectious diseases than other students of lower academic years. Approximately one-third of students reported having one or more occupational injuries while treating their patients. Conclusion: Although the students had good knowledge and attitudes regarding infection control, the compliance and practice levels regarding the same were low. Such findings highlight the necessity of continued infection-control education of Saudi dental students. PMID:26199855

  6. Evidence-based pain guidelines in HIV care.

    PubMed

    Newshan, Gayle; Staats, Jo Anne

    2013-01-01

    Despite advances in HIV treatment, pain continues to be a prevalent symptom experienced by persons living with HIV (PLWH) and is associated with sleep disturbance and lower quality of life. Ongoing assessments guide effective pain management. Substance abuse issues and concerns about diversion complicate pain treatment. We reviewed the evidence of current research related to pharmacological and nonpharmacological interventions for pain. A comprehensive review of the literature was conducted, including randomized controlled trials, meta-analyses, evidence-based clinical practice guidelines, and expert opinion; studies of HIV neuropathy and pediatric populations were excluded. We limited the search to English language and human studies. While pharmacology-based interventions are widespread, their efficacy over the long term is questionable. Nonpharmacological therapies are promising and require further study. Aberrant behaviors related to opiates are common in PLWH; expert guidelines to address them are presented. A case study is included to illustrate an application of evidence-based clinical practice. PMID:23290371

  7. Evidence-based medicine for occupational health

    Microsoft Academic Search

    J. H. A. M. Verbeek; Dijk van F. J. H; A. Malmivaara; C. T. J. Hulshof; K. Rasanen; E. Kankaanpaa; K. Mukala

    2002-01-01

    inusing medical subject headings, and unreliable search strategies. With the use of the abstracts only, most clinical questions could be answered satisfactorily, but concrete risk estimates were often lacking. The lack of availability of full text journals decreased the reliability of the critical appraisal and risk estimation. Conclusions Evidence-based medicine is a feasible and useful method for occupational medicine. Instruction

  8. Evidence Based Education Request Desk. EBE #798

    ERIC Educational Resources Information Center

    Regional Educational Laboratory Southeast, 2011

    2011-01-01

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

  9. 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…

  10. 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…

  11. 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…

  12. 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…

  13. Evidence Based Research: Implications for Counselor Educators.

    ERIC Educational Resources Information Center

    Bartley, Amy E.; Biles, Kathy E.; Low, Lori L.; Nakazawa-Hewitt, M.; Windish, Bonnie L.

    For the past decade, the practice of evidence based research (EBR) in treatment decisions has been a standard in the medical field, and is quickly becoming a standard of practice in other human service fields. Counselor educators are faced with the necessity to begin to implement EBR into their teaching and scholarship, but have limited knowledge…

  14. Training Psychologists for Evidence-Based Practice

    Microsoft Academic Search

    John Hunsley

    2007-01-01

    Evidence-base practice (EBP) is now commonplace in many health care services and, in recent years, there has been a healthy debate about the role of EBP in psychology. In this article, I provide information on the nature of EBP and how it is consistent with professional training models and standards in psychology. In discussing some of the concerns that have

  15. Evidence-based practice: friend or foe?

    Microsoft Academic Search

    Alan Breen

    1997-01-01

    Chiropractic is an increasingly-recognised health profession and systematic reviews of the effectiveness of manipulation for back pain are responsible for much of that recognition. Establishement on this basis, however demands that the profession learns to operate in the new clinical culture of evidence based practice if it is to progress. This calls for changes in emphases in education for self-monitoring

  16. Evidence-Based Practice Implementation in Kansas

    Microsoft Academic Search

    Charles A. RappRichard; Richard J. Goscha; Linda S. Carlson

    2010-01-01

    Over the last 8 years, Kansas has been successful in the implementation of evidence-based practices. This paper describes\\u000a the strategies used at multiple levels of the mental health system including: state policy, provider agency management, fidelity\\u000a and outcome monitoring, supervisor training and support, and practitioner training. The challenges going forth are described.

  17. 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…

  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. Evidence-Based Practice and Social Work

    Microsoft Academic Search

    C. Aaron McNeece; Bruce A. Thyer

    2004-01-01

    The essential features of contemporary evidence-based practice (EBP) are outlined, with specific reference to the applications of this model to various areas of social work, micro through macro. EBP is seen as a welcome addition to our field, representing a fuller and more comprehensive development of earlier and related positions such as empirical clinical practice within social work, and the

  20. 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…

  1. Evidence Based Education Request Desk. EBE #510

    ERIC Educational Resources Information Center

    Regional Educational Laboratory Southeast, 2009

    2009-01-01

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

  2. Evidence-Based mini-manual

    E-print Network

    MacMillan, Andrew

    . Scott Health Sciences Library University of Alberta Bruce Fisher Department of Medicine Duncan Saunders School of Public Health Sciences July, 2009 #12;2 #12;3 What is Evidence-Based Medicine? Evidence. Ask a focused clinical question 3. Access the clinical research literature (i.e., the evidence) 4

  3. Geographical Representativeness of Published and Ongoing Randomized Controlled Trials. The Example of: Tobacco Consumption and HIV Infection

    PubMed Central

    Ahmad, Nizar; Boutron, Isabelle; Dechartres, Agnes; Durieux, Pierre; Ravaud, Philippe

    2011-01-01

    Background The challenge for evidence-based healthcare is to reduce mortality and the burden of diseases. This study aimed to compare where research is conducted to where research is needed for 2 public health priorities: tobacco consumption and HIV infection. Methods We identified randomized controlled trials (RCTs) included in Cochrane systematic reviews published between 1997 and 2007 and registered ongoing RCTs identified in January 2009 through the World Health Organization's International Clinical Trials Registry Platform (WHO-ICTRP) evaluating interventions aimed at reducing or stopping tobacco use and treating or preventing HIV infection. We used the WHO and World Bank reports to classify the countries by income level, as well as map the global burden of disease and mortality attributable to tobacco use and HIV infection to the countries where the trials performed. Results We evaluated 740 RCTs included in systematic reviews and 346 ongoing RCTs. For tobacco use, 4% of RCTs included in systematic reviews and 2% of ongoing trials were performed in low- and middle-income countries, even though these countries represented 70% of the mortality related to tobacco use. For HIV infection, 31% of RCTs included in systematic reviews and 33% of ongoing trials were performed in low- and middle-income countries, even though these countries represented 99% of the mortality related to HIV infection. Conclusions Our results highlight an important underrepresentation of low- and middle-income countries in currently available evidence (RCTs included in systematic reviews) and awaiting evidence (registered ongoing RCTs) for reducing or stopping tobacco use and treating or preventing HIV infection. PMID:21347383

  4. Evidence-Based Medicine, the Essential Role of Systematic Reviews,

    E-print Network

    Meng, Weiyi

    available, most appropriate evidence in the care of each patient, a practice known as Evidence-based Storage and Retrieval, Text-Mining, Evidence-Based Medicine. 1. Introduction The practice of Evidence-Based of these reviews including the Cochrane Collaboration (e.g., Adams, et al., 2008) and the Evidence-based Practice

  5. Evidence-based consensus on the diagnosis, prevention and management of hepatitis C virus disease

    PubMed Central

    Shaheen, Mahrukh Akbar; Idrees, Muhammad

    2015-01-01

    Hepatitis C virus (HCV) is a potent human pathogen and is one of the main causes of chronic hepatitis round the world. The present review describes the evidence-based consensus on the diagnosis, prevention and management of HCV disease. Various techniques, for the detection of anti-HCV immunoglobulin G immunoassays, detection of HCV RNA by identifying virus-specific molecules nucleic acid testings, recognition of core antigen for diagnosis of HCV, quantitative antigen assay, have been used to detect HCV RNA and core antigen. Advanced technologies such as nanoparticle-based diagnostic assays, loop-mediated isothermal amplification and aptamers and Ortho trak-C assay have also come to the front that provides best detection results with greater ease and specificity for detection of HCV. It is of immense importance to prevent this infection especially among the sexual partners, injecting drug users, mother-to-infant transmission of HCV, household contact, healthcare workers and people who get tattoos and piercing on their skin. Management of this infection is intended to eradicate it out of the body of patients. Management includes examining the treatment (efficacy and protection), assessment of hepatic condition before commencing therapy, controlling the parameters upon which dual and triple therapies work, monitoring the body after treatment and adjusting the co-factors. Examining the treatment in some special groups of people (HIV/HCV co-infected, hemodialysis patients, renal transplanted patients). PMID:25848486

  6. Evidence-based consensus on the diagnosis, prevention and management of hepatitis C virus disease.

    PubMed

    Shaheen, Mahrukh Akbar; Idrees, Muhammad

    2015-03-27

    Hepatitis C virus (HCV) is a potent human pathogen and is one of the main causes of chronic hepatitis round the world. The present review describes the evidence-based consensus on the diagnosis, prevention and management of HCV disease. Various techniques, for the detection of anti-HCV immunoglobulin G immunoassays, detection of HCV RNA by identifying virus-specific molecules nucleic acid testings, recognition of core antigen for diagnosis of HCV, quantitative antigen assay, have been used to detect HCV RNA and core antigen. Advanced technologies such as nanoparticle-based diagnostic assays, loop-mediated isothermal amplification and aptamers and Ortho trak-C assay have also come to the front that provides best detection results with greater ease and specificity for detection of HCV. It is of immense importance to prevent this infection especially among the sexual partners, injecting drug users, mother-to-infant transmission of HCV, household contact, healthcare workers and people who get tattoos and piercing on their skin. Management of this infection is intended to eradicate it out of the body of patients. Management includes examining the treatment (efficacy and protection), assessment of hepatic condition before commencing therapy, controlling the parameters upon which dual and triple therapies work, monitoring the body after treatment and adjusting the co-factors. Examining the treatment in some special groups of people (HIV/HCV co-infected, hemodialysis patients, renal transplanted patients). PMID:25848486

  7. [Norwegian infection control in the new Europe].

    PubMed

    Dobloug, J H

    1994-08-10

    Infectious diseases are still a major health problem world wide. In Europe, however, and in Norway in particular, infectious diseases have not been a threat to public health for several years. In this paper, some of the major events in the European region which could have an impact on public health are discussed. These events include the extensive migration of people in the European region, military conflicts in former Yugoslavia, serious economic and social problems in the former Soviet-Union, and the expansion of the European Union (EU). Increased passage across borders of people and food may, in the worst case, represent a threat to public health. The paper also deals with the status of the different elements of the Norwegian health care system involved with infectious disease control, and with the parts of this system that should be improved, in order to adjust to the new epidemiologic situation that may be encountered in the European region. PMID:7992275

  8. Slaving and release in co-infection control

    PubMed Central

    2013-01-01

    Background Animal and human infection with multiple parasite species is the norm rather than the exception, and empirical studies and animal models have provided evidence for a diverse range of interactions among parasites. We demonstrate how an optimal control strategy should be tailored to the pathogen community and tempered by species-level knowledge of drug sensitivity with use of a simple epidemiological model of gastro-intestinal nematodes. Methods We construct a fully mechanistic model of macroparasite co-infection and use it to explore a range of control scenarios involving chemotherapy as well as improvements to sanitation. Results Scenarios are presented whereby control not only releases a more resistant parasite from antagonistic interactions, but risks increasing co-infection rates, exacerbating the burden of disease. In contrast, synergisms between species result in their becoming epidemiologically slaved within hosts, presenting a novel opportunity for controlling drug resistant parasites by targeting co-circulating species. Conclusions Understanding the effects on control of multi-parasite species interactions, and vice versa, is of increasing urgency in the advent of integrated mass intervention programmes. PMID:23721567

  9. T Cell Responses during Influenza Infection: Getting and Keeping Control

    PubMed Central

    Kim, Taeg S.; Sun, Jie; Braciale, Thomas J.

    2011-01-01

    The 2009 influenza pandemic highlights the threat that type A influenza poses to human health. Thus there is an urgency to understand the pathobiology of influenza infection and the contribution of the host immune response to both virus elimination and the development of lung injury. This review focuses on the T cell arm of the adaptive host immune response to influenza and assesses recent developments in our understanding of the induction of primary influenza virus-specific T cell responses by antigen-presenting cells, the interaction of activated effector T cells with antigen-bearing cells in the infected lungs, and the contribution of influenza-specific effector T cells to the development and control of lung injury and inflammation during infection. PMID:21435950

  10. Evidence-based policy: rhetoric and reality.

    PubMed

    Raine, R

    1998-10-01

    Evidence-based policy has been hailed as the current zeitgeist in health care. Its intuitive appeal is clear but its implementation is problematic. This case study demonstrates the practical difficulties of using this approach for purchasing health care. New technologies suffer from limited knowledge about both their long-term benefits and their adverse effects. This undermines attempts to assess effectiveness and efficiency in local populations. Furthermore, the use of evidence should not be assumed to eliminate the need to apply value judgements, which has repercussions for the attainment of equity of access to health care. It is therefore unrealistic to view this approach as a panacea. Rather, evidence-based medicine should contribute to the decision-making process, in conjunction with other considerations such as equity and patient preference. PMID:10187206

  11. Evidence-based practice: pediatric tonsillectomy.

    PubMed

    Oomen, Karin P Q; Modi, Vikash K; Stewart, Michael G

    2012-10-01

    Tonsillectomy is one of the most common surgical procedures performed in children in the United States. Indications and recommendations for perioperative management are multiple and may vary among clinicians. Although tonsillectomy is a safe procedure, it can be associated with morbidity. Several techniques have been developed to reduce perioperative complications, but evidence of this reduction is lacking. This article provides clinicians with evidence-based guidance on perioperative clinical decision making and surgical technique for tonsillectomy. PMID:22980686

  12. Modernism, Postmodernism and (Evidence-Based) Practice

    Microsoft Academic Search

    Heather L. Ramey; Sarah Grubb

    2009-01-01

    One dominant discourse in the mental health arena revolves around evidence-based practice (EBP). Although there is ongoing\\u000a debate about the implementation of EBP in the mental health field, most of these discussions have been limited to modernist\\u000a ideas. While discussions about EBP have occurred from alternate perspectives, particularly postmodernism, a lack of open dialogue\\u000a has resulted in these two groups

  13. Evidence-based medicine in otolaryngology journals

    Microsoft Academic Search

    Boris L. Bentsianov; Marina Boruk; Richard M. Rosenfeld

    2002-01-01

    Objective: We set out to assess, within the context of evidence-based medicine, the levels of supporting evidence for therapeutic recommendations made in leading otolaryngology journals. Design: We used a cross-sectional survey of clinical research articles published in 1999 in 4 high-circulation otolaryngology journals. Outcome Measures: We used study design methodology and level of evidence for clinical research articles with therapeutic

  14. Evidence-based practice in action.

    PubMed

    MacPhee, Maura

    2002-08-01

    As Associate Editor for Journal of Pediatric Nursing (JPN), I will be assisting with evidence-based practice (EBP) submissions or other clinically based articles. I welcome questions, works-in-progress for constructive criticism, and finished submissions for review. This article comprises an overview of the EBP process, an EBP submission format for JPN, and 4 examples of EBP in a variety of pediatric clinical settings. PMID:12219333

  15. Evidence Based Psychosocial Interventions in Substance Use

    PubMed Central

    Jhanjee, Sonali

    2014-01-01

    In recent years, there has been significant progress and expansion in the development of evidence-based psychosocial treatments for substance abuse and dependence. A literature review was undertaken using the several electronic databases (PubMed, Cochrane Database of systemic reviews and specific journals, which pertain to psychosocial issues in addictive disorders and guidelines on this topic). Overall psychosocial interventions have been found to be effective. Some interventions, such as cognitive behavior therapy, motivational interviewing and relapse prevention, appear to be effective across many drugs of abuse. Psychological treatment is more effective when prescribed with substitute prescribing than when medication or psychological treatment is used alone, particularly for opiate users. The evidence base for psychological treatment needs to be expanded and should also include research on optimal combinations of psychological therapies and any particular matching effects, if any. Psychological interventions are an essential part of the treatment regimen and efforts should be made to integrate evidence-based interventions in all substance use disorder treatment programs. PMID:24860208

  16. Perioperative Glucose Control and Infection Risk in Older Surgical Patients.

    PubMed

    Lee, Pearl; Min, Lillian; Mody, Lona

    2014-03-01

    The aging of the U.S. population is leading to an increasing number of surgical procedures performed on older adults. At the same time, the quality of medical care is being more closely scrutinized. Surgical site infection is a widely-assessed outcome. Evidence suggests that strict perioperative serum glucose control among patients with or without diabetes can lower the risk of these infections, but it is unclear whether this control should be applied to older surgical patients. In this clinical review, we discuss current research on perioperative serum glucose management for cardiothoracic, orthopedic, and general/colorectal surgery. In addition, we summarize clinical recommendations and quality-of-care process indicators provided by surgical, diabetes, and geriatric medical organizations. PMID:25431751

  17. Clinical governance and infection control in the United Kingdom.

    PubMed

    Masterson, R G; Teare, E L

    2001-01-01

    The recent organizational changes in the NHS have at their core the concept of clinical governance. Although initially poorly defined and understood this term has now taken on a clear identity, placing quality alongside fiscal probity and corporate governance at the top of NHS priorities. Integral to clinical governance are the basic elements of clear national standards for services and treatments that are to be locally delivered through assured, monitored, high quality healthcare. It is within this framework that workers in infection control must develop their own methods of applying clinical governance. This review explores the implications that the strategy of clinical governance holds for the speciality of infection control, emphasizing the benefits its active adoption can bring and highlighting the key relevance of clinical risk management in this setting. It illustrates clinical governance as a tool to engage colleagues on a multi-disciplinary front, most particularly the crucial link to senior Trust management. PMID:11281117

  18. Effectiveness of Infection Control Barriers for Construction in Healthcare 

    E-print Network

    Huo, Jinyun

    2014-08-12

    the earlier research work by (Bassett, 2013): • AIA American Institute of Architects • APIC Association for Professionals in Infection Control • Aspergillus: Aspergillus spp. and in particular Aspergillus fumigatus are fungi that play an essential role.... Environmental surveys indicate that all humans will inhale at least several hundred Aspergillus spores per day. (Latge, 1999) • Aspergillosis: Aspergillosis is a disease caused by the inhalation of the fungus Aspergillus, and usually this inhalation results...

  19. Bovine viral diarrhea virus infections: manifestations of infection and recent advances in understanding pathogenesis and control.

    PubMed

    Brodersen, B W

    2014-03-01

    Bovine viral diarrhea virus (BVDV) continues to be of economic significance to the livestock industry in terms of acute disease and fetal loss. Many of the lesions relating to BVDV infection have been well described previously. The virus is perpetuated in herds through the presence of calves that are persistently infected. Relationships between various species and biotypes of BVDV and host defenses are increasingly understood. Understanding of the host defense mechanisms of innate immunity and adaptive immunity continues to improve, and the effects of the virus on these immune mechanisms are being used to explain how persistent infection develops. The noncytopathic biotype of BVDV plays the major role in its effects on the host defenses by inhibiting various aspects of the innate immune system and creation of immunotolerance in the fetus during early gestation. Recent advances have allowed for development of affordable test strategies to identify and remove persistently infected animals. With these improved tests and removal strategies, the livestock industry can begin more widespread effective control programs. PMID:24476940

  20. Vitamin E and wound healing: an evidence-based review.

    PubMed

    Hobson, Rachel

    2014-08-14

    Vitamin E has been demonstrated to modulate cellular signalling, gene expression and affect wounds infected with methicillin-resistant Staphylococcus aureus (MRSA), thus influencing wound healing. This evidence-based review aimed to identify and evaluate current research assessing the properties of vitamin E in relation to wound healing, through its role as an antioxidant and its influence on connective tissue growth factor (CTGF), MRSA and gene transcription. Literature dated from 1996 to 2012, published in English, involving either animals or adult humans with an acute or chronic wound were included. The databases that contained relevant articles were narrowed down to four, and a total of 33 identified studies were included. The literature review revealed that there is a significant dearth of robust studies establishing the effects of vitamin E on wound healing, and further research is clearly warranted. PMID:25124164

  1. Evidence based abreactive ego state therapy for PTSD.

    PubMed

    Barabasz, Arreed

    2013-07-01

    A single 5-6 hours manualized abreactive ego state therapy session has recently been subjected to two placebo-controlled investigations meeting evidence-based criteria. Ego state therapy was found to be a highly effective and durable treatment for posttraumatic stress disorder. Apparently, ego state therapy works because it is emotion focused, activates sub-cortical structures, and because the supportive, interpretive therapist reconstructs the patient's personality to be resilient and adaptive. In this article the author reviews the treatment procedures and presents the findings of both studies. PMID:24660339

  2. Gelsolin activity controls efficient early HIV-1 infection

    PubMed Central

    2013-01-01

    Background HIV-1 entry into target lymphocytes requires the activity of actin adaptors that stabilize and reorganize cortical F-actin, like moesin and filamin-A. These alterations are necessary for the redistribution of CD4-CXCR4/CCR5 to one pole of the cell, a process that increases the probability of HIV-1 Envelope (Env)-CD4/co-receptor interactions and that generates the tension at the plasma membrane necessary to potentiate fusion pore formation, thereby favouring early HIV-1 infection. However, it remains unclear whether the dynamic processing of F-actin and the amount of cortical actin available during the initial virus-cell contact are required to such events. Results Here we show that gelsolin restructures cortical F-actin during HIV-1 Env-gp120-mediated signalling, without affecting cell-surface expression of receptors or viral co-receptor signalling. Remarkably, efficient HIV-1 Env-mediated membrane fusion and infection of permissive lymphocytes were impaired when gelsolin was either overexpressed or silenced, which led to a loss or gain of cortical actin, respectively. Indeed, HIV-1 Env-gp120-induced F-actin reorganization and viral receptor capping were impaired under these experimental conditions. Moreover, gelsolin knockdown promoted HIV-1 Env-gp120-mediated aberrant pseudopodia formation. These perturbed-actin events are responsible for the inhibition of early HIV-1 infection. Conclusions For the first time we provide evidence that through its severing of cortical actin, and by controlling the amount of actin available for reorganization during HIV-1 Env-mediated viral fusion, entry and infection, gelsolin can constitute a barrier that restricts HIV-1 infection of CD4+ lymphocytes in a pre-fusion step. These findings provide important insights into the complex molecular and actin-associated dynamics events that underlie early viral infection. Thus, we propose that gelsolin is a new factor that can limit HIV-1 infection acting at a pre-fusion step, and accordingly, cell-signals that regulate gelsolin expression and/or its actin-severing activity may be crucial to combat HIV-1 infection. PMID:23575248

  3. Mincle is not essential for controlling Mycobacterium tuberculosis infection.

    PubMed

    Heitmann, Lisa; Schoenen, Hanne; Ehlers, Stefan; Lang, Roland; Hölscher, Christoph

    2013-04-01

    Individually and combined, Toll-like receptors (TLR)-2, -4, -9, nucleotide oligomerization domain (NOD) 2 and NALP3 contribute to the Mycobacterium tuberculosis (Mtb)-induced innate immune response only to a limited extent, particularly in terms of inducing antibacterial protection and granuloma formation in vivo. A singular essential sensory component of this initial response has not been discovered yet. Trehalose-6,6'-dimycolate (TDM), a well known mycobacterial cell wall glycolipid, is believed to be involved in these early inflammatory processes after Mtb infection. Only recently the macrophage inducible C-type lectin (Mincle) was demonstrated as an essential receptor for TDM. However, not much is known about the sensing capacity of Mincle during infection with live mycobacteria. To determine the significance of Mincle during tuberculosis (TB), we analyzed the outcome of Mtb infection in Mincle-deficient mice. Whereas in the absence of Mincle macrophages did not respond to TDM, Mincle-deficient mice were capable of mounting an efficient granulomatous and protective immune response after low and high dose infections with Mtb. Mutant mice generated a normal T helper (TH) 1 and TH17 immune response followed by the induction of efficient macrophage effector mechanisms and control of mycobacterial growth identical to wildtype mice. From our results we conclude that absence of the innate receptor Mincle can be fully compensated for in vivo in terms of sensing Mtb and mounting a protective inflammatory immune response. PMID:22784441

  4. The Oral Bacterial Communities of Children with Well-Controlled HIV Infection and without HIV Infection

    PubMed Central

    Goldberg, Brittany E.; Mongodin, Emmanuel F.; Jones, Cheron E.; Chung, Michelle; Fraser, Claire M.; Tate, Anupama; Zeichner, Steven L.

    2015-01-01

    The oral microbial community (microbiota) plays a critical role in human health and disease. Alterations in the oral microbiota may be associated with disorders such as gingivitis, periodontitis, childhood caries, alveolar osteitis, oral candidiasis and endodontic infections. In the immunosuppressed population, the spectrum of potential oral disease is even broader, encompassing candidiasis, necrotizing gingivitis, parotid gland enlargement, Kaposi’s sarcoma, oral warts and other diseases. Here, we used 454 pyrosequencing of bacterial 16S rRNA genes to examine the oral microbiome of saliva, mucosal and tooth samples from HIV-positive and negative children. Patient demographics and clinical characteristics were collected from a cross-section of patients undergoing routine dental care. Multiple specimens from different sampling sites in the mouth were collected for each patient. The goal of the study was to observe the potential diversity of the oral microbiota among individual patients, sample locations, HIV status and various dental characteristics. We found that there were significant differences in the microbiome among the enrolled patients, and between sampling locations. The analysis was complicated by uneven enrollment in the patient cohorts, with only five HIV-negative patients enrolled in the study and by the rapid improvement in the health of HIV-infected children between the time the study was conceived and completed. The generally good oral health of the HIV-negative patients limited the number of dental plaque samples that could be collected. We did not identify significant differences between well-controlled HIV-positive patients and HIV-negative controls, suggesting that well-controlled HIV-positive patients essentially harbor similar oral flora compared to patients without HIV. Nor were significant differences in the oral microbiota identified between different teeth or with different dental characteristics. Additional studies are needed to better characterize the oral microbiome in children and those with poorly-controlled HIV infections. PMID:26146997

  5. Cost evaluation of evidence-based treatments.

    PubMed

    Sindelar, Jody L; Ball, Samuel A

    2010-12-01

    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

  6. Hawaii's statewide evidence-based practice program.

    PubMed

    Mark, Debra D; Latimer, Rene'e W; White, Joan P; Bransford, Deborah; Johnson, Katherine G; Song, Valerie L

    2014-09-01

    Hawaii's innovative statewide evidence-based practice program facilitates practice change across multiple health care systems. The innovation eliminated duplicative efforts and provided resources, was compatible with the values of health care organizations, and had experience with a pilot program. Interpersonal and mass media communication promoted and embedded the practice change. Users included nurse champions with multidisciplinary team members. The rate of adoption varied across projects and, although resources seemed to be a major determinant of successful institutionalization, there does not seem to be a predictable pattern of successful project implementation. PMID:25155528

  7. Multidisciplinary and evidence-based management of fistulizing perianal Crohn's disease.

    PubMed

    Sordo-Mejia, Ricardo; Gaertner, Wolfgang B

    2014-08-15

    Perianal symptoms are common in patients with Crohn's disease and cause considerable morbidity. The etiology of these symptoms include skin tags, ulcers, fissures, abscesses, fistulas or stenoses. Fistula is the most common perianal manifestation. Multiple treatment options exist although very few are evidence-based. The phases of treatment include: drainage of infection, assessment of Crohn's disease status and fistula tracts, medical therapy, and selective operative management. The impact of biological therapy on perianal Crohn's disease is uncertain given that outcomes are conflicting. Operative treatment to eradicate the fistula tract can be attempted once infection has resolved and Crohn's disease activity is controlled. The operative approach should be tailored according to the anatomy of the fistula tract. Definitive treatment is challenging with medical and operative treatment rarely leading to true healing with frequent complications and recurrence. Treatment success must be weighed against the risk of complications, specially anal sphincter injury. A full understanding of the etiology and all potential therapeutic options is critical for success. Multidisciplinary management of fistulizing perianal Crohn's disease is crucial to improve outcomes. PMID:25133026

  8. Multidisciplinary and evidence-based management of fistulizing perianal Crohn’s disease

    PubMed Central

    Sordo-Mejia, Ricardo; Gaertner, Wolfgang B

    2014-01-01

    Perianal symptoms are common in patients with Crohn’s disease and cause considerable morbidity. The etiology of these symptoms include skin tags, ulcers, fissures, abscesses, fistulas or stenoses. Fistula is the most common perianal manifestation. Multiple treatment options exist although very few are evidence-based. The phases of treatment include: drainage of infection, assessment of Crohn’s disease status and fistula tracts, medical therapy, and selective operative management. The impact of biological therapy on perianal Crohn’s disease is uncertain given that outcomes are conflicting. Operative treatment to eradicate the fistula tract can be attempted once infection has resolved and Crohn’s disease activity is controlled. The operative approach should be tailored according to the anatomy of the fistula tract. Definitive treatment is challenging with medical and operative treatment rarely leading to true healing with frequent complications and recurrence. Treatment success must be weighed against the risk of complications, specially anal sphincter injury. A full understanding of the etiology and all potential therapeutic options is critical for success. Multidisciplinary management of fistulizing perianal Crohn’s disease is crucial to improve outcomes. PMID:25133026

  9. Evidence-based practice: A challenge for European developmental psychology

    Microsoft Academic Search

    Christiane Spiel

    2009-01-01

    In recent years the evidence-based practice movement has been seeing great gains in impact. Standards for research leading to evidence-based practice have been defined. So far, however, in the area of education standards of evidence are not extensively implemented and in most federal European policies an evidence-based reform has not been attained. The present paper advocates investing effort in evidence-based

  10. The Coalition for Evidence-Based Policy

    NSDL National Science Digital Library

    The Coalition for Evidence-Based Policy's aim is to increase government effectiveness by using evidence of what works based on rigorous policy analysis. On the "Mission & Activities" tab near the top of any page, visitors can read of the ineffective policies the Coalition targets. For example, the site details government-funded social programs that have failed to make progress in the areas they are supposed to help, such as "poverty reduction", "K-12 education", and "economic mobility." Further down the page is a list of programs that have been deemed effective by the Coalition - "Nurse-Family Partnership," "Career Academies," and "Success for All in Grades K-2." The "Publications" tab lists the five types of publications of the Coalition, including "Rigorous Evidence," their monthly e-newsletter that can be subscribed to for free for anyone interested in evidence-based policy. Some of the other publications include "Published Op-Eds/Letters to the Editor" and "Coalition Policy Proposals," which have covered, among other things, "Technology Development," "Crime/Substance Abuse," and "Health Care."

  11. Implementation of infection control best practice in intensive care units throughout Europe: a mixed-method evaluation study

    PubMed Central

    2013-01-01

    Background The implementation of evidence-based infection control practices is essential, yet challenging for healthcare institutions worldwide. Although acknowledged that implementation success varies with contextual factors, little is known regarding the most critical specific conditions within the complex cultural milieu of varying economic, political, and healthcare systems. Given the increasing reliance on unified global schemes to improve patient safety and healthcare effectiveness, research on this topic is needed and timely. The ‘InDepth’ work package of the European FP7 Prevention of Hospital Infections by Intervention and Training (PROHIBIT) consortium aims to assess barriers and facilitators to the successful implementation of catheter-related bloodstream infection (CRBSI) prevention in intensive care units (ICU) across several European countries. Methods We use a qualitative case study approach in the ICUs of six purposefully selected acute care hospitals among the 15 participants in the PROHIBIT CRBSI intervention study. For sensitizing schemes we apply the theory of diffusion of innovation, published implementation frameworks, sensemaking, and new institutionalism. We conduct interviews with hospital health providers/agents at different organizational levels and ethnographic observations, and conduct rich artifact collection, and photography during two rounds of on-site visits, once before and once one year into the intervention. Data analysis is based on grounded theory. Given the challenge of different languages and cultures, we enlist the help of local interpreters, allot two days for site visits, and perform triangulation across multiple data sources. Qualitative measures of implementation success will consider the longitudinal interaction between the initiative and the institutional context. Quantitative outcomes on catheter-related bloodstream infections and performance indicators from another work package of the consortium will produce a final mixed-methods report. Conclusion A mixed-methods study of this scale with longitudinal follow-up is unique in the field of infection control. It highlights the ‘Why’ and ‘How’ of best practice implementation, revealing key factors that determine success of a uniform intervention in the context of several varying cultural, economic, political, and medical systems across Europe. These new insights will guide future implementation of more tailored and hence more successful infection control programs. Trial registration Trial number: PROHIBIT-241928 (FP7 reference number) PMID:23421909

  12. Evaluating Baccalaureate Occupational Therapy Education in Evidence-based Practice

    Microsoft Academic Search

    Lynette Isted; Jeannine Millsteed

    2004-01-01

    Purpose: This study investigated whether graduates had implemented the evidence-based practice skills learnt in their baccalaureate course in their workplace. It clarifies our understanding of factors that influence delivering evidence-based practice in the workplace and the efficacy of evidence based practice courses introduced in higher education. It indicates whether education by itself solves the implementation riddle or if workplace factors

  13. 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…

  14. 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…

  15. Evaluation of Evidence-Based Practices in Online Learning

    E-print Network

    Alpay, S. Pamir

    Evaluation of Evidence-Based Practices in Online Learning A Meta-Analysis and Review of Online Learning Studies #12;#12;Evaluation of Evidence-Based Practices in Online Learning: A Meta.S. Department of Education, Office of Planning, Evaluation, and Policy Development, Evaluation of Evidence-Based

  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. Clustering of Medical Publications for Evidence Based Medicine Summarisation

    E-print Network

    Aliod, Diego Mollá

    practitioners to improve their effective practice of EBM. 2 Clustering for Evidence Based Medicine The ultimate and evidence- based summaries obtained from the "Clinical Inquiries" section of the Journal of Family PracticeClustering of Medical Publications for Evidence Based Medicine Summarisation Sara Faisal Shash

  18. Using infection prevention data for improvement: the infection prevention control team as a clinical support micro-system

    Microsoft Academic Search

    Evonne Teresa Curran

    2011-01-01

    Process and outcome data are essential to evaluate the effectiveness of infection prevention and control teams (IPCT). Data are used for: the identification of possible outbreaks, surveillance of healthcare associated infections, monitoring the epidemiology of alert organisms, monitoring IPC practices, creating arguments for the need to change practices, and demonstrating whether the changes in practices have been effective in improving

  19. Optimisation of infection prevention and control in acute health care by use of behaviour change: a systematic review.

    PubMed

    Edwards, Rachel; Charani, Esmita; Sevdalis, Nick; Alexandrou, Banos; Sibley, Eleanor; Mullett, David; Loveday, Heather P; Drumright, Lydia N; Holmes, Alison

    2012-04-01

    Changes in the behaviour of health-care workers (HCWs) are required to improve adherence to infection prevention and control (IPC) guidelines. Despite heavy investment in strategies to change behaviour, effectiveness has not been adequately assessed. We did a systematic review to assess the effectiveness and sustainability of interventions to change IPC behaviour and assessed exploratory literature for barriers to and facilitators of behaviour change. 21 studies published from 1999 to 2011 met our inclusion criteria: seven intervention studies and 14 exploratory studies. Of the intervention studies none explicitly incorporated psychological theory and only two contained elements of social marketing in the design, although five addressed sustainability. All elicited behaviour change, reduction in infection risk, or both. The exploratory studies identified social and cultural factors that affect the IPC behaviour of HCWs. To improve the standard of research and broaden the evidence base, we recommend that quality criteria are added to existing systematic review guidelines to enable the inclusion of qualitative research and to ensure robust design, implementation, and reporting of interventions. PMID:22342325

  20. Applying Evidence-Based Medicine Principles to Hip Fracture Management

    PubMed Central

    Bernstein, Joseph; Morshed, Saam; Helfet, David L.; Bhandari, Mohit; Ahn, Jaimo

    2014-01-01

    Bone has the capacity to regenerate and not scar after injury – sometimes leaving behind no evidence at all of a prior fracture. As surgeons capable of facilitating such healing, it becomes our responsibility to help choose a treatment that minimizes functional deficits and residual symptoms. And in the case of the geriatric hip fracture, we have seen the accumulation of a vast amount of evidence to help guide us. The best method we currently have for selecting treatment plans is by the practice of evidence-based medicine. According to the now accepted hierarchy, the best is called Level I evidence (e.g., well performed randomized controlled trials) – but this evidence is best only if it is available and appropriate. Lower forms of accepted evidence include cohort studies, case control studies, case series, and case reports, and last, expert opinion – all of which can be potentially instructive. The hallmark of evidence-based treatment is not so much the reliance on evidence in general, but to use the best available evidence relative to the particular patient, the clinical setting and surgeon experience. Correctly applied, varying forms of evidence each have a role in aiding surgeons offer appropriate care for their patients – to help them best fix the fracture. PMID:25593964

  1. Applying evidence-based medicine principles to hip fracture management.

    PubMed

    Bernstein, Joseph; Morshed, Saam; Helfet, David L; Bhandari, Mohit; Ahn, Jaimo

    2014-01-01

    Bone has the capacity to regenerate and not scar after injury - sometimes leaving behind no evidence at all of a prior fracture. As surgeons capable of facilitating such healing, it becomes our responsibility to help choose a treatment that minimizes functional deficits and residual symptoms. And in the case of the geriatric hip fracture, we have seen the accumulation of a vast amount of evidence to help guide us. The best method we currently have for selecting treatment plans is by the practice of evidence-based medicine. According to the now accepted hierarchy, the best is called Level I evidence (e.g., well performed randomized controlled trials) - but this evidence is best only if it is available and appropriate. Lower forms of accepted evidence include cohort studies, case control studies, case series, and case reports, and last, expert opinion - all of which can be potentially instructive. The hallmark of evidence-based treatment is not so much the reliance on evidence in general, but to use the best available evidence relative to the particular patient, the clinical setting and surgeon experience. Correctly applied, varying forms of evidence each have a role in aiding surgeons offer appropriate care for their patients - to help them best fix the fracture. PMID:25593964

  2. 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…

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

    Microsoft Academic Search

    Sonja K. Schoenwald

    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 evaluating its viability and validity, and implications for future research are described. Findings from

  4. Evidence-based management of recurrent miscarriages

    PubMed Central

    Jeve, Yadava B.; Davies, William

    2014-01-01

    Recurrent miscarriages are postimplantation failures in natural conception; they are also termed as habitual abortions or recurrent pregnancy losses. Recurrent pregnancy loss is disheartening to the couple and to the treating clinician. There has been a wide range of research from aetiology to management of recurrent pregnancy loss. It is one of the most debated topic among clinicians and academics. The ideal management is unanswered. This review is aimed to produce an evidence-based guidance on clinical management of recurrent miscarriage. The review is structured to be clinically relevant. We have searched electronic databases (PubMed and Embase) using different key words. We have combined the searches and arranged them with the hierarchy of evidences. We have critically appraised the evidence to produce a concise answer for clinical practice. We have graded the evidence from level I to V on which these recommendations are based. PMID:25395740

  5. Infection control preparedness for human infection with influenza A H7N9 in Hong Kong.

    PubMed

    Cheng, Vincent C C; Tai, Josepha W M; Lee, W M; Chan, W M; Wong, Sally C Y; Chen, Jonathan H K; Poon, Rosana W S; To, Kelvin K W; Chan, Jasper F W; Ho, P L; Chan, K H; Yuen, K Y

    2015-01-01

    OBJECTIVE To assess the effectiveness of infection control preparedness for human infection with influenza A H7N9 in Hong Kong. DESIGN A descriptive study of responses to the emergence of influenza A H7N9. SETTING A university-affiliated teaching hospital. PARTICIPANTS Healthcare workers (HCWs) with unprotected exposure (not wearing N95 respirator during aerosol-generating procedure) to a patient with influenza A H7N9. METHODS A bundle approach including active and enhanced surveillance, early airborne infection isolation, rapid molecular diagnostic testing, and extensive contact tracing for HCWs with unprotected exposure was implemented. Seventy HCWs with unprotected exposure to an index case were interviewed especially regarding their patient care activities. RESULTS From April 1, 2013, through May 31, 2014, a total of 126 (0.08%) of 163,456 admitted patients were tested for the H7 gene by reverse transcription-polymerase chain reaction per protocol. Two confirmed cases were identified. Seventy (53.8%) of 130 HCWs had unprotected exposure to an index case, whereas 41 (58.6%) and 58 (82.9%) of 70 HCWs wore surgical masks and practiced hand hygiene after patient care, respectively. Sixteen (22.9%) of 70 HCWs were involved in high-risk patient contacts. More HCWs with high-risk patient contacts received oseltamivir prophylaxis (P=0.088) and significantly more had paired sera collected for H7 antibody testing (P<0.001). Ten (14.3%) of 70 HCWs developed influenza-like illness during medical surveillance, but none had positive results by reverse transcription-polymerase chain reaction. Paired sera was available from 33 of 70 HCWs with unprotected exposure, and none showed seroconversion against H7N9. CONCLUSIONS Despite the delay in airborne precautions implementation, no patient-to-HCW transmission of influenza A H7N9 was demonstrated. PMID:25627766

  6. Bloodstream infections and central line-associated bloodstream infections.

    PubMed

    Watson, Christopher M; Al-Hasan, Majdi N

    2014-12-01

    It is estimated that more than 575,000 individuals develop bloodstream infections (BSI) annually in North America, accounting for nearly 80,000 deaths. Central line-associated BSI (CLABSI) is a major contributor to the cost of health care. Although primary BSI may be seen by the surgeon, a secondary BSI is more likely to be encountered, especially CLABSI. Prompt identification of the source of infection in patients with secondary BSI is paramount. This practice allows early source control and initiation of appropriate antimicrobial therapy, with subsequent improvement in outcomes. An understanding of evidence-based preventative measures and bundles is important. PMID:25440121

  7. Infection control and prevention strategies in the ICU

    Microsoft Academic Search

    A. F. Widmer

    1994-01-01

    Although only 5–10% of all hospitalized patients are treated in ICUs, they account for approximately 25% of all nosocomial infections, and the incidence of nosocomial infections in ICUs is 5–10 times higher than that observed in general hospital wards. Systemic and respiratory infections are far more common than in general wards, and most epidemics originate, in ICUs. Nosocomial infections are

  8. Adaptation Guidance for Evidence-Based Teen Pregnancy and STI/HIV Prevention Curricula: From Development to Practice

    PubMed Central

    ROLLERI, LORI A.; FULLER, TALERIA R.; FIRPO-TRIPLETT, REGINA; LESESNE, CATHERINE A.; MOORE, CLAIRE; LEEKS, KIMBERLY D.

    2014-01-01

    Evidence-based interventions (EBIs) are effective in preventing ado-lescent pregnancy and sexually transmitted infections; however, prevention practitioners are challenged when selecting and adapting the most appropriate programs. While there are existing adaptation frameworks, there is little practical guidance in applying research in the field. To address this need, the Centers for Disease Control and Prevention (CDC) Division of Reproductive Health initiated the Adaptation Guidance Project. The project included the development of a comprehensive adaptation guidance framework and adaptation kits for select evidence-based teen pregnancy and HIV prevention programs. In addition, three innovative concepts emerged that have application to other adaptation program and evaluation efforts, including moving research into practice. First, the authors defined the core components of an EBI in three distinct ways: core content, core pedagogy, and core implementation. Second, they piloted a practitioner-friendly adaptation guidance-messaging schema—Green, Yellow, and Red Light Adaptations, and last they included fidelity/adaptation monitoring logs. This article will describe the process used to develop the adaptation guidance kits, including the main features and tools. PMID:25844074

  9. Control and mitigation of healthcare-acquired infections: designing clinical trials to evaluate new materials and technologies.

    PubMed

    Sharpe, Peter A; Schmidt, Michael G

    2011-01-01

    Hospitals clean environmental surfaces to lower microbial contamination and reduce the likelihood of transmitting infections. Despite current cleaning and hand hygiene protocols, hospital-acquired infections (HAIs) continue to result in a significant loss of life and cost the U.S. healthcare system an estimated $45 billion annually. Stainless steel and chrome are often selected for hospital touch surfaces for their "clean appearance," comparatively smooth finish, resistance to standard cleaners, and relative effectiveness for removing visible dirt during normal cleaning. Designers use wood surfaces for aesthetics; plastic surfaces have become increasingly endemic for their relative lower initial cost; and "antimicrobial agents" are being incorporated into a variety of surface finishes.This paper concentrates on environmental surface materials with a history of bactericidal control of infectious agents and focuses on the methods necessary to validate their effectiveness in healthcare situations. Research shows copper-based metals to have innate abilities to kill bacteria in laboratory settings, but their effectiveness in patient care environments has not been adequately investigated. This article presents a research methodology to expand the evidence base from the laboratory to the built environment. For such research to have a meaningful impact on the design/specifying community, it should assess typical levels of environmental pathogens (i.e., surface "cleanliness") as measured by microbial burden (MB); evaluate the extent to which an intervention with copper-based materials in a randomized clinical trial affects the level of contamination; and correlate how the levels of MB affect the incidence of infections acquired during hospital stays. PMID:22322640

  10. Controlled release of gentamicin from polyelectrolyte multilayers to treat implant-related infection

    E-print Network

    Moskowitz, Joshua Seth

    2012-01-01

    Polyelectrolyte multilayered (PEM) coatings were fabricated to incorporate and release the small, hydrophilic antibiotic gentamicin from implant surfaces for infection control. The use of a cationic hydrolytically cleavable ...

  11. Viral infections as controlling factors for the deep biosphere? (Invited)

    NASA Astrophysics Data System (ADS)

    Engelen, B.; Engelhardt, T.; Sahlberg, M.; Cypionka, H.

    2009-12-01

    The marine deep biosphere represents the largest biotope on Earth. Throughout the last years, we have obtained interesting insights into its microbial community composition. However, one component that was completely overlooked so far is the viral inventory of deep-subsurface sediments. While viral infections were identified to have a major impact on the benthic microflora of deep-sea surface sediments (Danavaro et al. 2008), no studies were performed on deep-biosphere samples, so far. As grazers probably play only a minor role in anoxic and highly compressed deep sediments, viruses might be the main “predators” for indigenous microorganisms. Furthermore, the release of cell components, called “the viral shunt”, could have a major impact on the deep biosphere in providing labile organic compounds to non-infected microorganisms in these generally nutrient depleted sediments. However, direct counting of viruses in sediments is highly challenging due to the small size of viruses and the high background of small particles. Even molecular surveys using “universal” PCR primers that target phage-specific genes fail due to the vast phage diversity. One solution for this problem is the lysogenic viral life cycle as many bacteriophages integrate their DNA into the host genome. It is estimated that up to 70% of cultivated bacteria contain prophages within their genome. Therefore, culture collections (Batzke et al. 2007) represent an archive of the viral composition within the respective habitat. These prophages can be induced to become free phage particles in stimulation experiments in which the host cells are set under certain stress situations such as a treatment with UV exposure or DNA-damaging antibiotics. The study of the viral component within the deep biosphere offers to answer the following questions: To which extent are deep-biosphere populations controlled by viral infections? What is the inter- and intra-specific diversity and the host-specific viral biogeography? Can viral infections tell us something about the physiological state of indigenous microorganisms? Finally, we will obtain estimates for the viral shunt as an important factor for sustaining the deep biosphere. References: Batzke A, Engelen B, Sass H, Cypionka H (2007) Phylogenetic and physiological diversity of cultured deep-biosphere bacteria from Equatorial Pacific Ocean and Peru Margin sediments. Geomicrobiology J 24:261-273 Danovaro R, Dell'Anno A, Corinaldesi C, Magagnini M, Noble R, Tamburini C, Weinbauer M (2008) Major viral impact on the functioning of benthic deep-sea ecosystems. Nature 454: 1084-U1027.

  12. Fundamental shortcomings of evidence-based medicine.

    PubMed

    Valkenburg, Govert; Achterhuis, Hans; Nijhof, André

    2003-01-01

    The development of any scientific theory has a certain logic. Bruno Latour formulated a theory, describing the development of science and technology. Outcomes of science are not guided by nature or "the truth", but by a complex negotiation. It starts with ideas, which follow paths of publications and assessment. Then they are either rejected or accepted. Analysing the development of evidence-based medicine with Latour's theory, we find two fundamental problems. First, EBM tends to standardise moral considerations. Second, EBM standardises the patient, since test populations are usually composed homogeneously. Presumptions concerning methods and morals are slid into the EBM-methodology during its development. With Latour we should say, that the conceptions of the standard patient and standard morals have been delegated to this methodology. They are carried out strictly, and this causes the discomfort with practitioners and scientists within EBM. A solution should be sought for in redesigning trials, in a less morally charged fashion, and concerning less standardised patients. PMID:14730800

  13. Recovery of evidence-based practice.

    PubMed

    Gordon, Sarah E; Ellis, Pete M

    2013-02-01

    Consumer recovery is now enshrined in the national mental health policy of many countries. If this construct, which stems from the consumer/user/survivor movement, is truly to be the official and formal goal of mental health services, then it must be the yardstick against which evidence-based practice (EBP) is judged. From a consumer-recovery perspective, this paper re-examines aspects of services chosen for study, methodologies, outcomes measures, and standards of evidence associated with EBP, those previously having been identified as deficient and in need of expansion. One of the significant differences between previous investigations and the present study is that the work, writing, perspectives, and advocacy of the consumer movement has developed to such a degree that we now have a much more extensive body of material upon which to critique EBP and inform and support the expansion of EBP. Our examination reinforces previous findings and the ongoing need for expansion. The consumer recovery-focused direction, resources, frameworks, and approaches identified through the present paper should be used to expand the aspects of services chosen for study, methodologies, outcomes measures, and standards of evidence. This expansion will ultimately enable services to practice in a manner consistent with the key characteristics of supporting personal recovery. PMID:22830603

  14. 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

  15. Merging Evidence-Based Psychosocial Interventions in Schizophrenia

    PubMed Central

    Lecomte, Tania; Corbière, Marc; Simard, Stéphanie; Leclerc, Claude

    2014-01-01

    Psychosocial interventions are an essential part of the treatment for people with severe mental illness such as schizophrenia. The criteria regarding what makes an intervention “evidence-based” along with a current list of evidence-based interventions are presented. Although many evidence-based interventions exist, implementation studies reveal that few, if any, are ever implemented in a given setting. Various theories and approaches have been developed to better understand and overcome implementation obstacles. Among these, merging two evidence-based interventions, or offering an evidence-based intervention within an evidence-based service, are increasingly being reported and studied in the literature. Five such merges are presented, along with their empirical support: cognitive behavior therapy (CBT) with skills training; CBT and family psychoeducation; supported employment (SE) and skills training; SE and cognitive remediation; and SE and CBT. PMID:25431447

  16. Outbreak of hepatitis C virus infections at an outpatient hemodialysis facility: the importance of infection control competencies.

    PubMed

    Rao, Agam K; Luckman, Emily; Wise, Matthew E; MacCannell, Taranisia; Blythe, David; Lin, Yulin; Xia, Guoliang; Drobeniuc, Jan; Noble-Wang, Judith; Arduino, Matthew J; Thompson, Nicola D; Patel, Priti R; Wilson, Lucy E

    2013-01-01

    In the United States, the prevalence of hepatitis C virus infection among patients treated in hemodialysis facilities is five times higher than among the general population. This study investigated eight new hepatitis C virus infections among patients treated at an outpatient hemodialysis facility. Epidemiologic investigation and viral sequencing demonstrated that transmission likely occurred between patients typically treated during the same or consecutive shifts at the same or a nearby station. Several infection control breaches were observed including lapses involving the preparation, handling, and administration of parenteral medications. Improved infection control education and training for all hemodialysis facility staff is an important component of assuring adherence to appropriate procedures and preventing future outbreaks. PMID:23785746

  17. Establishing CASA as an evidence-based practice.

    PubMed

    Lawson, Jennifer; Berrick, Jill Duerr

    2013-01-01

    In this article the authors examine the evidentiary status of the Court Appointed Special Advocates (CASA) program through a review of current research findings and a critical analysis of the study methodologies used to produce those findings. Due to the equivocal research findings and widespread methodological weaknesses (most notably selection bias) in the literature base, it is determined that there is not currently enough evidence to establish CASA as an evidence-based practice. In spite of the challenges to the feasibility of such research, a future research agenda is suggested that calls for the execution of large randomized controlled trials in order to produce findings that will inform a deeper understanding of CASA effectiveness in improving child outcomes. PMID:23879356

  18. APA Presidential Task Force on Evidence-Based Practice

    Microsoft Academic Search

    Alvin R. Mahrer; Frederick L. Newman; John C. Norcross; Doris K. Silverman; Brian D. Smedley; Bruce E. Wampold; Drew I. Westen; Brian T. Yates; Nolan W. Zane; Geoffrey M. Reed; Lynn F. Bufka; Paul D. Nelson; Cynthia D. Belar; Merry Bullock

    The evidence-based practice movement has become an important feature of health care systems and health care policy. Within this context, the APA 2005 Presidential Task Force on Evidence-Based Practice defines and discusses evidence-based practice in psychology (EBPP). In an in- tegration of science and practice, the Task Force's report describes psychology's fundamental commitment to sophis- ticated EBPP and takes into

  19. 75 FR 3912 - Healthcare Infection Control Practices Advisory Committee (HICPAC)

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-01-25

    ...healthcare-associated infections Recovery Act efforts; discussion on the draft guideline for prevention of intravascular catheter-related bloodstream infections; and the draft guideline for the prevention and management of norovirus gastroenteritis...

  20. 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, multicomponent treatment and amitriptyline. Based on expert opinion, a stepwise FMS-management was proposed. Step 1 comprises confirming the diagnosis and patient education and treatment of physical or mental comorbidities or aerobic exercise or cognitive behavioural therapy or amitriptyline. Step 2 includes multicomponent treatment. Step 3 comprises no further treatment or self-management (aerobic exercise, stress management) and/or booster multicomponent therapy and/or pharmacological therapy (duloxetine or fluoxetine or paroxetine or pregabalin or tramadol/aminoacetophen) and/or psychotherapy (hypnotherapy or written emotional disclosure) and/or physical therapy (balneotherapy or whole body heat therapy) and/or complementary therapies (homoeopathy or vegetarian diet). The choice of treatment options should be based on informed decision-making and respect of the patients’ preferences. PMID:19675740

  1. Effectiveness of an evidence-based chiropractic continuing education workshop on participant knowledge of evidence-based health care

    Microsoft Academic Search

    Ronald J Feise; Jaroslaw P Grod; Anne Taylor-Vaisey

    2006-01-01

    BACKGROUND: Chiropractors must continue to learn, develop themselves professionally throughout their careers, and become self-directed and lifelong learners. Using an evidence-based approach increases the probability of optimal patient outcomes. But most chiropractors lack knowledge and interest in evidence-based approaches. The purpose of this study was to develop and measure the effectiveness of evidence-based training for chiropractic practitioners in a continuing

  2. [A survey on elements of an effective hospital infection control program for Korea].

    PubMed

    Yoon, H S

    1989-08-01

    The main purpose of this survey was to identify for elements of an effective hospital infection control program for Korea. Nurses and doctors who had participated in an education program for infection control or were responsible for hospital infection control were selected as data informers. The data were collected from 51 subjects by employing a Delphi technique in a series of three rounds from September 1, 1987, to March 31, 1988. In each round the responses to questionnaires were analyzed and the results were communicated back to the individuals. Finally 32 elements of effective hospital infection control program were reduced to 10 elements. 10 elements are as follows; 1) Hospital administrator's knowledge of importance and necessity for HIC (hospital infection control) 2) Supporting HIC administratively 3) Constituting infection control committee and role of ICC 4) Developing an educational program and providing a work manual for the hospital infection control staff 5) Educating and informing medical staff about hospital infection 6) Surveillance for hospital infection 7) Developing patient care technique 8) Controlling the hospital environment 9) Executing regular health examinations of all medical staff 10) Recruiting the medical staff sufficiently Three rankings of response rate about 32 elements are as follows: 1) Hiring a full time staff member for the HIC (66%) 2) Establishing a hospital policy and standards for the HIC (66%) 3) Activating the infection control committee and taking administrative action to support the ICC (63%) In addition the rankings of importance score by Likert 5 scale are as follows: 1) Washing hands scrupulously (4.88) 2) Nurses participation as key members of the ICC (4.75) 3) Reviewing and evaluating all ongoing aseptic techniques (4.69) In conclusion, first of all, administrative support must be given to hiring a full time staff member and to organization of infection control committee for the HIC in Korea. PMID:2681916

  3. Effectiveness of short-term, enhanced, infection control support in improving compliance with infection control guidelines and practice in nursing homes: a cluster randomized trial.

    PubMed

    Gopal Rao, G; Jeanes, A; Russell, H; Wilson, D; Atere-Roberts, E; O'Sullivan, D; Donaldson, N

    2009-10-01

    In this prospective cluster randomized controlled trial we evaluated the impact of short-term provision of enhanced infection control support on infection control practice in nursing homes in South London. Twelve nursing homes were recruited, six each in intervention (300 residents) and control (265 residents) groups. Baseline observations of hand hygiene facilities, environmental cleanliness and safe disposal of clinical waste showed poor compliance in both groups. Post-intervention observations showed improvement in both groups. There was no statistical difference between the two groups in the compliance for hand hygiene facilities (P=0.69); environmental cleanliness (P=0.43) and safe disposal of clinical waste (P=0.96). In both groups, greatest improvement was in compliance with safe disposal of clinical waste and the least improvement was in hand hygiene facilities. Since infection control practice improved in intervention and control groups, we could not demonstrate that provision of short-term, enhanced, infection control support in nursing homes had a significant impact in infection control practice. PMID:19257913

  4. Control of HPV infection and related cancer through vaccination.

    PubMed

    Tran, Nam Phuong; Hung, Chien-Fu; Roden, Richard; Wu, T-C

    2014-01-01

    Human papillomavirus (HPV), the most common sexually transmitted virus, and its associated diseases continue to cause significant morbidity and mortality in over 600 million infected individuals. Major progress has been made with preventative vaccines, and clinical data have emerged regarding the efficacy and cross-reactivity of the two FDA approved L1 virus like particle (VLP)-based vaccines. However, the cost of the approved vaccines currently limits their widespread use in developing countries which carry the greatest burden of HPV-associated diseases. Furthermore, the licensed preventive HPV vaccines only contain two high-risk types of HPV (HPV-16 and HPV-18) which can protect only up to 75 % of all cervical cancers. Thus, second generation preventative vaccine candidates hope to address the issues of cost and broaden protection through the use of more multivalent L1-VLPs, vaccine formulations, or alternative antigens such as L1 capsomers, L2 capsid proteins, and chimeric VLPs. Preventative vaccines are crucial to controlling the transmission of HPV, but there are already hundreds of millions of infected individuals who have HPV-associated lesions that are silently progressing toward malignancy. This raises the need for therapeutic HPV vaccines that can trigger T cell killing of established HPV lesions, including HPV-transformed tumor cells. In order to stimulate such antitumor immune responses, therapeutic vaccine candidates deliver HPV antigens in vivo by employing various bacterial, viral, protein, peptide, dendritic cell, and DNA-based vectors. This book chapter will review the commercially available preventive vaccines, present second generation candidates, and discuss the progress of developing therapeutic HPV vaccines. PMID:24008298

  5. Exit site infections: systematic microbiologic and quality control are needed.

    PubMed

    Freitas, Cristina; Rodrigues, Anabela; Carvalho, Maria João; Cabrita, António

    2009-01-01

    For the period January 2005 to June 2008, we reviewed the rates, causes, and outcomes of exit-site infection (ESI) among 137 consecutive patients [mean age: 51 +/- 16 years; 17 (12.4%) with diabetes; 76 (55%) on automated PD; time at risk: 240.41 dialysis years; mean follow-up: 20.4 +/- 13.8 months]. Treatment protocol included mini-laparotomy and Popovich-Moncrief placement method, with presurgical cefazolin prophylaxis and routine prescription of topical mupirocin for the exit site. Oral cotrimoxazole was the initial empirical ESI treatment. A total of 49 patients (36%) experienced 76 episodes of ESI, for a global incidence of 0.31 episodes per year at risk. Gram-positive organisms occurred in 56% of the cases, and gram-negative organisms in 27%. Staphylococcus aureus caused 15 ESIs (0.06 episodes/patient-year), and only 15% of gram-positive organisms were methicillin resistant. Methicillin-resistant S. aureus were all sensitive to cotrimoxazole. Pseudomonas species caused 11 ESIs (0.04 episodes/patient-year). Other Enterobacteriaceae occurred at a rate of 0.03 episodes/patient-year. Fungal ESLs occurred at a rate of 0.004 episodes/patient-year The ESI cure rate was 96%. In 3 patients, the catheter was removed, but only 2 patients (2.6%) experienced ESI-related peritonitis. Our unit's treatment policy and prophylactic use of exit-site mupirocin resulted in a low S. aureus ESI rate without an alarming incidence of gram-negative or Pseudomonas infections. Routine microbiologic and quality control is mandatory for strategies individualized to the dialysis center. PMID:19886313

  6. The future for infection prevention and control in English primary care trusts

    Microsoft Academic Search

    H. Pickles; B. Nunkoo; K. Sadler

    2008-01-01

    Although less well developed than in the hospital sector, the infection prevention and control function is important to primary and community care. In each reorganisation in the NHS, any specialist workforce needs to align with that part of the system that holds the relevant responsibilities and duties. This paper describes how infection control nursing has shifted its focus over the

  7. Control of immune response of HIV infection model by gradual reduction of drug dose

    Microsoft Academic Search

    H. J. Chang; H. Shim; J. H. Seo

    2004-01-01

    It is known that HIV (human immunodeficiency virus) infection that causes AIDS is a dynamic process that can be modeled mathematically. By changing the drug effect in the model, which can be regarded as the control input, the control goal of this paper is to drive any initial state into an equilibrium called the 'non-progressor,' where the symptom of infected

  8. Efficacy of Infection Control Interventions in Reducing the Spread of Multidrug-Resistant Organisms in the

    E-print Network

    Ruan, Shigui

    Efficacy of Infection Control Interventions in Reducing the Spread of Multidrug-Resistant Organisms, Coral Gables, Florida, United States of America, 5 Department of Math and Computer Science, University: D'Agata EMC, Horn MA, Ruan S, Webb GF, Wares JR (2012) Efficacy of Infection Control Interventions

  9. The habitus of hygiene: Discourses of cleanliness and infection control in nursing workq

    Microsoft Academic Search

    Brian Brown; Paul Crawford; Brigitte Nerlich; Nelya Koteyko

    This paper reports upon a qualitative interview study of 22 matrons, infection control staff and operating theatre staff who were questioned about their working lives and the role they played in the control of healthcare acquired infections such as MRSA virus in the UK. A theoretical framework drawing upon the work of Bourdieu is deployed as his notion of habitus

  10. 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…

  11. 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…

  12. 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…

  13. 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...

  14. 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…

  15. Addressing Key Challenges in Evidence-Based Practice in Psychology

    Microsoft Academic Search

    John Hunsley

    2007-01-01

    With its promise of enhancing the effectiveness of services, evidence-based practice in psychology (EBPP) appears to offer much to psychologists, patients, and policymakers. The purpose of this article is to examine some of the key challenges facing psychologists who wish to provide evidence-based treatment services, including how research evidence is used in EBPP, whether the results of the treatment research

  16. Ms Siti ZUBAIDAH, Assistant Director of Nursing (Evidence Based-

    E-print Network

    Kan, Min-Yen

    Ms Siti ZUBAIDAH, Assistant Director of Nursing (Evidence Based- Nursing Unit) Dr Emily Ang Deputy Quanzhen, RN Lin Qianqian (Front row) eEvidence: Evidence based care supported by Technology Paula M is determined by the nurses in clinical and community practice · Evidence available immediately at the point

  17. Counting what counts: performance measurement and evidence-based practice

    Microsoft Academic Search

    Andrew Booth

    2006-01-01

    Purpose – The purpose of this paper is to explore conceptual and practical links between performance measurement and evidence-based library and information practice (EBLIP) and to identify lessons to be learned from evidence-based healthcare. Design\\/methodology\\/approach – The paper presents a selective review of key writings in EBLIP for reference to performance measurement. Findings – The paper finds that performance measurement

  18. 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…

  19. 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…

  20. Opening Pandora's Box: Evidence-based practice for educational psychologists

    Microsoft Academic Search

    Mark Fox

    2003-01-01

    Over the past few years evidence-based practice has become of central concern to health and social services in this country. The fundamental tenant is that there must be a clear link between professional practice and its research base. This paper outlines the concept of evidence-based practice and how it rests on the concept of good quality research -- defined as

  1. 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…

  2. Joanna Briggs Institute: an evidence-based practice database.

    PubMed

    Vardell, Emily; Malloy, Michele

    2013-01-01

    The Joanna Briggs Institute Evidence-Based Practice Database offers systematic reviews, practice recommendations, and consumer information designed to support evidence-based practice. A sample search was conducted within the Ovid platform to demonstrate functionality and available tools. PMID:24180651

  3. 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…

  4. Overview of the Evidence Base for Family Interventions in Child Psychiatry.

    PubMed

    Sharma, Neha; Sargent, John

    2015-07-01

    This article provides updated information about evidence-based family interventions for child and adolescent mental health issues. The article reviews randomized controlled trials for family-based interventions carried out over the last 15 years. The studies were selected from an evidence-based clearinghouse search for family therapy, and specific child and adolescent psychiatric disorders. It is hoped this review guides clinical treatment and encourages clinicians to consider family involvement in treatment. This is specifically necessary when there is a limited response to psychopharmacologic and individual or group psychotherapy treatment. PMID:26092734

  5. IRB decision-making with imperfect knowledge: a framework for evidence-based research ethics review.

    PubMed

    Anderson, Emily E; DuBois, James M

    2012-01-01

    Here we describe the five steps of evidence-based practice as applied to research ethics review and apply these steps to three exemplar dilemmas: incentive payments in substance abuse research; informed consent for biobanking; and placebo-controlled trials involving pregnant women in order to demonstrate the potential of empirical data to inform and improve IRB decision-making. PMID:23289698

  6. The Conceptualization, Integration, and Support of Evidence-Based Interventions in the Schools

    ERIC Educational Resources Information Center

    Becker, Kimberly D.; Domitrovich, Celene E.

    2011-01-01

    The studies in this issue break the mold of the traditional stage model of the development and testing of evidence-based interventions (EBIs) within the confines of highly controlled studies (Onken, Blaine, & Battjes, 1997). Although this approach has merits, the need for EBIs in school settings has outpaced their deployment. The authors of these…

  7. Examining the Sustainability of an Evidence-Based Preschool Curriculum: The REDI Program

    ERIC Educational Resources Information Center

    Sanford DeRousie, Rebecca M.; Bierman, Karen L.

    2012-01-01

    This study examined the extent to which an evidence-based preschool curriculum (Head Start REDI) was sustained by 20 teachers during the year following a randomized controlled efficacy trial, when teachers were no longer required by the research project to implement the curriculum. Two quantitative measures of sustainability (teacher ratings, REDI…

  8. Developing Evidence-Based Practice: The Role of Case-Based Research

    Microsoft Academic Search

    David J. A. Edwards; Frank M. Dattilio; Dennis B. Bromley

    2004-01-01

    How can practitioners engage in evidence-based practice when the evidence for effectiveness of psychological treatments comes from randomized controlled trials using patient populations different from those encountered in everyday settings and treatment manuals that seem oversimplified and inflexible? The authors argue that important evidence about best practice comes from case-based research, which builds knowledge in a clinically useful manner and

  9. Improving Dissemination of Evidence-Based Programs through Researcher-Practitioner Collaboration

    ERIC Educational Resources Information Center

    Özdemir, Metin; Giannotta, Fabrizia

    2014-01-01

    Prevention field has achieved major advances in developing, implementing, and testing the efficacy of preventive interventions in controlled settings. Nevertheless, there is still a gap in translating the success of programs in efficacy trials into real-life settings. Dissemination of evidence-based programs is a major challenge. The authors argue…

  10. [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

  11. Investigating Nosocomial Infections as Sentinel Events—Algorithm by the C4QI Infection Control Group

    Microsoft Academic Search

    C. Perego; B. Tegtmeier

    2004-01-01

    ISSUE: Healthcare organizations are required by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) to “manage as sentinel events all identified cases of unanticipated death or major loss of function due to nosocomial infections.” Because patients at cancer centers are generally at high risk for serious infections, these institutions face unusual difficulty when they must determine whether a morbid

  12. Adaptation Guidance for Evidence-Based Teen Pregnancy and STI/HIV Prevention Curricula: From Development to Practice

    ERIC Educational Resources Information Center

    Rolleri, Lori A.; Fuller, Taleria R.; Firpo-Triplett, Regina; Lesesne, Catherine A.; Moore, Claire; Leeks, Kimberly D.

    2014-01-01

    Evidence-based interventions (EBIs) are effective in preventing adolescent pregnancy and sexually transmitted infections; however, prevention practitioners are challenged when selecting and adapting the most appropriate programs. While there are existing adaptation frameworks, there is little practical guidance in applying research in the field.…

  13. Controlling nosocomial infection based on structure of hospital social networks

    Microsoft Academic Search

    Taro Ueno; Naoki Masuda

    2008-01-01

    Nosocomial infection raises a serious public health problem, as implied by the existence of pathogens characteristic to healthcare and hospital-mediated outbreaks of influenza and SARS. We simulate stochastic SIR dynamics on social networks, which are based on observations in a hospital in Tokyo, to explore effective containment strategies against nosocomial infection. The observed networks have hierarchical and modular structure. We

  14. Mathematical models of immune effector responses to viral infections: Virus control versus the development of pathology

    NASA Astrophysics Data System (ADS)

    Wodarz, Dominik

    2005-12-01

    This article reviews mathematical models which have investigated the importance of lytic and non-lytic immune responses for the control of viral infections. Lytic immune responses fight the virus by killing infected cells, while non-lytic immune responses fight the virus by inhibiting viral replication while leaving the infected cell alive. The models suggest which types or combinations of immune responses are required to resolve infections which vary in their characteristics, such as the rate of viral replication and the rate of virus-induced target cell death. This framework is then applied to persistent infections and viral evolution. It is investigated how viral evolution and antigenic escape can influence the relative balance of lytic and non-lytic responses over time, and how this might correlate with the transition from an asymptomatic infection to pathology. This is discussed in the specific context of hepatitis C virus infection.

  15. Education and training in evidence-based urology

    Microsoft Academic Search

    Charles D. Scales Jr

    2011-01-01

    Objectives  Urologists believe evidence-based clinical practice improves patient care. Competence in critical appraisal skills is necessary\\u000a to successfully implement evidence-based practice. However, practicing urologists, urology program training directors, and\\u000a residents have identified the need for urology-specific resources to promote competence in evidence-based practice. The objective\\u000a of this review is to identify urology-specific educational resources for critical appraisal skills.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  The PubMed® database

  16. 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

  17. 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

  18. [Advances in research on harm and control of Enterobius vermicularis infection in children].

    PubMed

    An, Yao-Wu; Pang, Xin-Li; Liu, Jie-Bing; Huang, Shao-Yu

    2012-10-01

    In China, the infection rate of Enterobius vermicularis in children is still relatively high. Because the development and spread of worm eggs is fast, it is easy to treat but difficult to control the disease, and the control effect is also difficult to be consolidated. The long-term repeated Enterobius vermicularis infection may cause the damage on children's body and mind in different degrees. This paper offers an overview on the current status, harm and prevention and control of Enterobius vermicularis infection. PMID:23373277

  19. Casualties of war: the infection control assessment of civilians transferred from conflict zones to specialist units overseas for treatment.

    PubMed

    Morton, H; Gray, J

    2015-08-01

    The casualties of global conflict attract media attention and sympathy in public, governmental, and non-governmental circles. Hospitals in developed countries offering specialist reconstructive or tertiary services are not infrequently asked to accept civilian patients from overseas conflict for complex surgical procedures or rehabilitation. Concern about the infection prevention and control risks posed by these patients, and the lack of a good evidence base on which to base measured precautions, means that the precautionary principle of accepting zero risk is usually followed. The aim of this article is to highlight infection control considerations that may be required when treating casualties from overseas conflict, based partly on our own experience. Currently there is a lack of published evidence and national consensus on how to manage these patients. The precautionary principle requires that there is an ongoing search for evidence and knowledge that can be used to move towards more traditional risk management. We propose that only by gathering the experiences of the many individual hospitals that have each cared for small numbers of such patients can such evidence and knowledge be assimilated. PMID:26002183

  20. Comparison of four teaching methods on Evidence-based Practice skills of postgraduate nursing students.

    PubMed

    Fernandez, Ritin S; Tran, Duong Thuy; Ramjan, Lucie; Ho, Carey; Gill, Betty

    2014-01-01

    The aim of this study was to compare four teaching methods on the evidence-based practice knowledge and skills of postgraduate nursing students. Students enrolled in the Evidence-based Nursing (EBN) unit in Australia and Hong Kong in 2010 and 2011 received education via either the standard distance teaching method, computer laboratory teaching method, Evidence-based Practice-Digital Video Disc (EBP-DVD) teaching method or the didactic classroom teaching method. Evidence-based Practice (EBP) knowledge and skills were evaluated using student assignments that comprised validated instruments. One-way analysis of covariance was implemented to assess group differences on outcomes after controlling for the effects of age and grade point average (GPA). Data were obtained from 187 students. The crude mean score among students receiving the standard+DVD method of instruction was higher for developing a precise clinical question (8.1±0.8) and identifying the level of evidence (4.6±0.7) compared to those receiving other teaching methods. These differences were statistically significant after controlling for age and grade point average. Significant improvement in cognitive and technical EBP skills can be achieved for postgraduate nursing students by integrating a DVD as part of the EBP teaching resources. The EBP-DVD is an easy teaching method to improve student learning outcomes and ensure that external students receive equivalent and quality learning experiences. PMID:23107585

  1. Infection Control Practice in the Operating Room: Staff Adherence to Existing Policies in a Developing Country

    PubMed Central

    Cawich, Shamir O; Tennant, Ingrid A; McGaw, Clarence D; Harding, Hyacinth; Walters, Christine A; Crandon, Ivor W

    2013-01-01

    Context: Infection control interventions are important for containing surgery-related infections. For this reason, the modern operating room (OR) should have well-developed infection control policies. The efficacy of these policies depends on how well the OR staff adhere to them. There is a lack of available data documenting adherence to infection control policies. Objective: To evaluate OR staff adherence to existing infection control policies in Jamaica. Methods: We administered a questionnaire to all OR staff to assess their training, knowledge of local infection control protocols, and practice with regard to 8 randomly selected guidelines. Adherence to each guideline was rated with fixed-choice items on a 4-point Likert scale. The sum of points determined the adherence score. Two respondent groups were defined: adherent (score > 26) and nonadherent (score ? 26). We evaluated the relationship between respondent group and age, sex, occupational rank, and time since completion of basic medical training. We used ?2 and Fisher exact tests to assess associations and t tests to compare means between variables of interest. Results: The sample comprised 132 participants (90 physicians and 42 nurses) with a mean age of 36 (standard deviation ± 9.5) years. Overall, 40.1% were adherent to existing protocols. There was no significant association between the distribution of adherence scores and sex (p = 0.319), time since completion of basic training (p = 0.595), occupational rank (p = 0.461), or age (p = 0.949). Overall, 19% felt their knowledge of infection control practices was inadequate. Those with working knowledge of infection control practices attained it mostly through informal communication (80.4%) and self-directed research (62.6%). Conclusion: New approaches to the problem of nonadherence to infection control guidelines are needed in the Caribbean. Several unique cultural, financial, and environmental factors influence adherence in this region, in contrast to conditions in developed countries. PMID:24355900

  2. Association for Professionals in Infection Control and Epidemiology

    MedlinePLUS

    ... About About APIC Vision and mission History Leadership Awards Staff directory Chapters Committees Bylaws Membership sections Work ... expert Sanjay Saint receives the 2015 Distinguished Scientist Award from APIC The Association for Professionals in Infection ...

  3. Nosocomial infections in burn patients: etiology, antimicrobial resistance, means to control.

    PubMed

    Leseva, M; Arguirova, M; Nashev, D; Zamfirova, E; Hadzhyiski, O

    2013-03-31

    The aim of our study was to determine the etiology of nosocomial infections, their changes over a period of five years (2007-2011), and the measures for control of infections and antimicrobial resistance in the Burns Clinic of the N.I. Pirogov University Multi-Profile Hospital for Active Treatment and Emergency Medicine, Sofia, Bulgaria. The medical records for all the patients and the database of the "Clinical Microbiology and Surveillance of Infections" National Information System were reviewed and analyzed to identify the microbial pathogens isolated in our burns Clinic. The three most frequent nosocomial pathogens were S. aureus, A. baumannii and P. aeruginosa. In order to control effectively nosocomial infections, a system of anti-infective and anti- microbial resistance measures has been developed and routinely implemented in our Clinic since 2008. Since 2009, thanks to this system, there has been a significant decrease in the rates of multi-resistant Staphylococcus aureus strains. Although at present the incidence of the nosocomial infections in our burns clinic is lower than in neighboring countries, several important infection control issues still need to be solved. We mainly rely on updating and strengthening the existing anti-infective system in order to control the spread of multi-drug resistant organisms, such as A. baumannii, extended spectrum beta-lactamase-producing Enterobacteriaceae, and carbapenem-resistant P. aeruginosa. PMID:23966892

  4. Vitiligo: an evidence-based update. Report of the 13th Evidence Based Update Meeting, 23 May 2013, Loughborough, U.K.

    PubMed

    Meredith, F; Abbott, R

    2014-03-01

    The Evidence Based Update (EBU) meetings are annual one-day meetings held by the Centre of Evidence Based Dermatology at the University of Nottingham. The aim of the meeting is to discuss high-quality evidence, mainly in the form of systematic reviews and randomized controlled trials, on a different topic each year. The meetings are designed to be interactive with a panel discussion between international experts and delegates forming a key part of the meeting. The 13th EBU meeting was on vitiligo and took place on 23 May 2013 in Loughborough, U.K. The most recent research including new and unpublished studies was presented on the classification of vitiligo, the evidence behind different treatment options and current guidelines for vitiligo. PMID:24131286

  5. Controlling nosocomial infection based on structure of hospital social networks

    Microsoft Academic Search

    Taro Ueno; Naoki Masuda

    2008-01-01

    Nosocomial infection (i.e. infection in healthcare facilities) raises a serious public health problem, as implied by the existence of pathogens characteristic to healthcare facilities such as methicillin-resistant Staphylococcus aureus and hospital-mediated outbreaks of influenza and severe acute respiratory syndrome. For general communities, epidemic modeling based on social networks is being recognized as a useful tool. However, disease propagation may occur

  6. Evidence-based practice in splinting the injured hand.

    PubMed

    Li-Tsang, Cecilia W P; Chu, Mary M L

    2002-12-01

    Evidence-based medicine has been practised in the early 1990s in the Western countries and its model has aroused interests in the Asian countries including Hong Kong in the late 1990s. The need for evidence-based practice was called upon by Sackett and his colleagues 14-16 mainly because of the exponential growth of new evidence of treatment effectiveness. There is a great demand for clinicians to search for the best evidence and to incorporate into the daily practice so as to ensure the best quality and standard of treatment. This paper is to review the development and process of evidence-based practice in the area of hand splinting for our local clinicians. Some major problems were identified in the delivery of clinical evidence-based practice, and suggestions have been made to overcome these problems with a view in supporting its model in the local clinical field. PMID:12596283

  7. 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)

  8. Evidence-Based African First Aid Guidelines and Training Materials

    Microsoft Academic Search

    Stijn Van de Velde; Emmy De Buck; Philippe Vandekerckhove; Jimmy Volmink

    2011-01-01

    Stijn Van de Velde and colleagues describe the African First Aid Materials project, which developed evidence-based guidelines on administering first aid in the African context as well as training materials to support the implementation of the guidelines.

  9. 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

  10. Using Evidence-Based Principles in Clinical Practice

    E-print Network

    Storkel, Holly Lynn

    2004-01-01

    To help students better understand how to use evidence-based principles in clinical practice, Prof. Storkel is revising her SPLH 880 course so that students can access evidence from clinical research and apply it to specific patients....

  11. Evidence based practice profiles: Differences among allied health professions

    Microsoft Academic Search

    Maureen P McEvoy; Marie T Williams; Timothy S Olds

    2010-01-01

    BACKGROUND: Most previous studies of allied health professionals' evidence based practice (EBP) attitudes, knowledge and behaviours have been conducted with profession specific questionnaires of variable psychometric strength. This study compared the self-report EBP profiles of allied health professionals\\/trainees in an Australian university. METHODS: The Evidence-Based Practice Profile (EBP2) questionnaire assessed five domains (Relevance, Terminology, Practice, Confidence, Sympathy) in 918 subjects

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

    Microsoft Academic Search

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

    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 protocols for evidence-based interventions. We present findings

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

    Microsoft Academic Search

    Ellen Tuchman; Monique Lalane

    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 Education Assignment designed to promote a deeper, more comprehensive and critical understanding of the

  14. Evidence-Based Practice Knowledge and Utilization among Social Workers

    Microsoft Academic Search

    Natalie D. Pope; Latrice Rollins; Josphine Chaumba; Ed Risler

    2011-01-01

    In this study the researchers examined the knowledge, skills, and use of Evidence-Based Practice in a sample of social workers from different practice settings. Using an electronic survey, data were collected from a group of social work practitioners (N = 200). Participants in their 30s and 40s demonstrated the most knowledge and use of Evidence-Based Practice. In addition, a high

  15. Evidence based practice: a survey of physiotherapists' current practice

    Microsoft Academic Search

    Ross Iles; Megan Davidson

    2006-01-01

    Backgound and Purpose. Evidence-based practice is the explicit use of current best evidence in making decisions about the care of individual patients and is a concept of growing importance for physiotherapy. The aim of the present study was to investigate Australian physiotherapists' self-reported practice, skills and knowledge of evidence-based practice and to examine differences between recent and experienced grad- uates,

  16. Embracing change: evidence-based management in action

    Microsoft Academic Search

    Helen Greenwood; Marigold Cleeve

    2008-01-01

    Purpose – In recent years public libraries have increasingly been required to collect data for the assessment of their performance and to inform service developments. The purpose of this paper is to describe an initiative to promote an evidence-based approach to library management in a UK county library service. Design\\/methodology\\/approach – The paper gives a definition of evidence-based librarianship and

  17. Evidence-Based Resources for Public Health Project

    Microsoft Academic Search

    E. Hatheway Simpson; Elaine Russo Martin; Sharon Telleen; Roger S. Luckmann

    2003-01-01

    Introduction\\u000aEvidence-Based Medicine (EBM) for clinical medicine involves using the best evidence to care for individual patients. Evidence-based public health (EBPH) involves using the best evidence to develop public health policies and intervention programs. There are various EBM resources available to help clinicians sort through the vast amount of medical literature to find the best evidence for their practice needs,

  18. History and Development of Evidence-based Medicine

    Microsoft Academic Search

    Jeffrey A. Claridge; Timothy C. Fabian

    2005-01-01

    This article illustrates the timeline of the development of evidence-based medicine (EBM). The term “evidence-based medicine” is relatively new. In fact, as far as we can tell, investigators from McMaster’s University began using the term during the 1990s. EBM was defined as “a systemic approach to analyze published research as the basis of clinical decision making.” Then in 1996, the

  19. Evidence-based cognitive rehabilitation: Recommendations for clinical practice

    Microsoft Academic Search

    Keith D. Cicerone; Cynthia Dahlberg; Kathleen Kalmar; Donna M. Langenbahn; James F. Malec; Thomas F. Bergquist; Thomas Felicetti; Joseph T. Giacino; J. Preston Harley; Douglas E. Harrington; Jean Herzog; Sally Kneipp; Linda Laatsch; Philip A. Morse

    2000-01-01

    Cicerone KD, Dahlberg C, Kalmar K, Langenbahn DM, Malec JF, Bergquist TF, Felicetti T, Giacino JT, Harley JP, Harrington DE, Herzog J, Kneipp S, Laatsch L, Morse PA. Evidence-based cognitive rehabilitation: recommendations for clinical practice. Arch Phys Med Rehabil 2000;81:1596-615. Objective: To establish evidence-based recommendations for the clinical practice of cognitive rehabilitation, derived from a methodical review of the scientific

  20. 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

  1. Parasite infection and tuberculosis disease among children: a case-control study.

    PubMed

    Franke, Molly F; Del Castillo, Hernán; Pereda, Ynés; Lecca, Leonid; Fuertes, Jhoelma; Cárdenas, Luz; Becerra, Mercedes C; Bayona, Jaime; Murray, Megan

    2014-02-01

    We conducted a case-control study to examine associations between parasite infection, including protozoa infection, and tuberculosis (TB) in children in Lima, Peru. We enrolled 189 matched-pairs. In multivariable conditional logistic regression analyses, Blastocystis hominis infection (rate ratio = 0.30, 95% confidence interval = 0.14-0.64, P = 0.002) was strongly associated with a lower risk of TB. We observed a statistically significant inverse linear dose-response relationship between Blastocystis hominis infection and TB. These findings should be confirmed in future prospective studies. PMID:24379242

  2. Parasite Infection and Tuberculosis Disease among Children: A Case–Control Study

    PubMed Central

    Franke, Molly F.; del Castillo, Hernán; Pereda, Ynés; Lecca, Leonid; Fuertes, Jhoelma; Cárdenas, Luz; Becerra, Mercedes C.; Bayona, Jaime; Murray, Megan

    2014-01-01

    We conducted a case–control study to examine associations between parasite infection, including protozoa infection, and tuberculosis (TB) in children in Lima, Peru. We enrolled 189 matched-pairs. In multivariable conditional logistic regression analyses, Blastocystis hominis infection (rate ratio = 0.30, 95% confidence interval = 0.14–0.64, P = 0.002) was strongly associated with a lower risk of TB. We observed a statistically significant inverse linear dose-response relationship between Blastocystis hominis infection and TB. These findings should be confirmed in future prospective studies. PMID:24379242

  3. 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

  4. The role of evidence based medicine in neurotrauma.

    PubMed

    Honeybul, S; Ho, K M

    2015-04-01

    The introduction of evidence based medicine de-emphasised clinical experience and so-called "background information" and stressed the importance of evidence gained from clinical research when making clinical decisions. For many years randomised controlled trials have been seen to be the only way to advance clinical practice, however, applying this methodology in the context of severe trauma can be problematic. In addition, it is increasingly recognised that considerable clinical experience is required in order to critically evaluate the quality of the evidence and the validity of the conclusions as presented. A contemporary example is seen when considering the role of decompressive craniectomy in the management of neurotrauma. Although there is a considerable amount of evidence available attesting to the efficacy of the procedure, considerable clinical expertise is required in order to properly interpret the results of these studies and the implications for clinical practice. Given these limitations the time may have come for a redesign of the traditional pyramid of evidence, to a model that re-emphasises the importance of "background information" such as pathophysiology and acknowledges the role of clinical experience such that the evidence can be critically evaluated in its appropriate context and the subsequent implications for clinical practice be clearly and objectively defined. PMID:25595956

  5. Preventing catheter-related UTIs: a series of workshops for infection control nurses

    Microsoft Academic Search

    Stephen Pinn

    2003-01-01

    This is a report from a workshop for infection control nurses sponsored by the ICNA in conjunction with Thames Valley University, and supported by an educational grant from BARD Ltd. It was held in London on 7 October 2002.

  6. How-to-Do-It: Infection Control Guidelines for Blood Typing & Blood Smear Labs.

    ERIC Educational Resources Information Center

    Vetter, Edwin A.

    1989-01-01

    Provides a set of guidelines for infection control of the Acquired Immune Deficiency Syndrome and the serum hepatitis viruses during blood typing procedures. Emphasizes that disposal of blood contaminated materials should comply with local health department recommendations. (RT)

  7. Genetic Control of Resistance to Trypanosoma brucei brucei Infection in Mice

    Microsoft Academic Search

    Matyáš Šíma; Helena Havelková; Lei Quan; Milena Svobodová; Ta?ána Jarošíková; Jarmila Vojtíšková; Alphons P. M. Stassen; Peter Demant; Marie Lipoldová

    2011-01-01

    BackgroundTrypanosoma brucei brucei infects livestock, with severe effects in horses and dogs. Mouse strains differ greatly in susceptibility to this parasite. However, no genes controlling these differences were mapped.MethodsWe studied the genetic control of survival after T. b. brucei infection using recombinant congenic (RC) strains, which have a high mapping power. Each RC strain of BALB\\/c-c-STS\\/A (CcS\\/Dem) series contains a

  8. Toxoplasma gondii infection and liver disease: a case-control study in a Northern Mexican population

    Microsoft Academic Search

    Cosme Alvarado-Esquivel; José Luis Torres-Berumen; Sergio Estrada-Martínez; Oliver Liesenfeld; Miguel Francisco Mercado-Suarez

    2011-01-01

    Background  Infection with the protozoan parasite Toxoplasma gondii may cause liver disease. However, the impact of the infection in patients suffering from liver disease is unknown. Therefore,\\u000a through a case-control study design, 75 adult liver disease patients attending a public hospital in Durango City, Mexico,\\u000a and 150 controls from the general population of the same region matched by gender, age, and

  9. Information Technology and Evidence-based Practices: A Commentary on “Evidence-Based Implementation Strategies: Results of a Qualitative Study”

    Microsoft Academic Search

    Robert E. Drake; Gary R. Bond

    2008-01-01

    Congratulations to Rapp and his colleagues (2008) for a helpful explication of important factors in the implementation of evidence-based practices in Kansas. This article is the latest to appear from the National Evidence-based Practices Project (http:\\/\\/www.mentalhealthpractices.com). The steady flow of articles from that project will significantly expand the field’s empirical knowledge regarding the implementation of effective psychosocial interventions in mental

  10. Innate Immune Control of West Nile Virus Infection

    PubMed Central

    Arjona, Alvaro; Wang, Penghua; Montgomery, Ruth R.; Fikrig, Erol

    2011-01-01

    West Nile virus (WNV), from the Flaviviridae family, is a re-emerging zoonotic pathogen of medical importance. In humans, WNV infection may cause life-threatening meningoencephalitis or long-term neurologic sequelae. WNV is transmitted by Culex spp mosquitoes and both the arthropod vector and the mammalian host are equipped with antiviral innate immune mechanisms sharing a common phylogeny. As far as the current evidence is able to demonstrate, mosquitoes primarily rely on RNA interference, Toll, Imd and JAK-STAT signaling pathways for limiting viral infection, while mammals are provided with these and other more complex antiviral mechanisms involving antiviral effectors, inflammatory mediators, and cellular responses triggered by highly specialized pathogen detection mechanisms that often resemble their invertebrate ancestry. This mini-review summarizes our current understanding of how the innate immune systems of the vector and the mammalian host react to WNV infection and shape its pathogenesis. PMID:21790942

  11. Trends in the use of evidence-based therapy for resectable gastric cancer

    PubMed Central

    Snyder, Rebecca A.; Penson, David F.; Ni, Shenghua; Koyama, Tatsuki; Merchant, Nipun B.

    2014-01-01

    Background and Objectives Two pivotal randomized controlled trials (RCTs), the Intergroup (INT-0116) and Medical Research Council Adjuvant Gastric Infusional Chemotherapy (MAGIC) trials, demonstrated a survival benefit of multimodality therapy in patients with resectable gastric cancer. The purpose of this study was to determine utilization rates of these treatment regimens in the U.S. and to identify factors associated with receipt of evidence-based care. Methods We performed a retrospective cohort study of patients with Stage IB-Stage IV (M0) gastric adenocarcinoma who underwent resection from 1991–2009 using the linked SEER-Medicare database. Results Only 19.1% of patients received post-operative chemoradiation therapy (CRT), and 1.9% received peri-operative chemotherapy; most patients underwent surgery alone (60.9%). Patients with more advanced stage, younger age, and fewer comorbidities were more likely to receive evidence-based care. We found no association between National Cancer Institute (NCI) designation and delivery of multimodality therapy. However, patients who underwent medical oncology consultation were much more likely to receive evidence-based treatment (OR 3.10, 95% CI 2.35–4.09). Conclusions Rates of peri-operative chemotherapy and post-operative CRT in patients with resected gastric cancer remain remarkably low, despite high-quality RCT evidence demonstrating their benefit. Furthermore, NCI designation does not appear to be associated with administration of evidence-based treatment. PMID:24891231

  12. Translating evidence-based interventions for implementation: Experiences from Project HEAL in African American churches

    PubMed Central

    2014-01-01

    Background Community-based approaches have been increasing in the effort to raise awareness and early detection for cancer and other chronic disease. However, many times, such interventions are tested in randomized trials, become evidence-based, and then fail to reach further use in the community. Project HEAL (Health through Early Awareness and Learning) is an implementation trial that aims to compare two strategies of implementing evidence-based cancer communication interventions in African American faith-based organizations. Method This article describes the community-engaged process of transforming three evidence-based cancer communication interventions into a coherent, branded strategy for training community health advisors with two delivery mechanisms. Peer community health advisors receive training through either a traditional classroom approach (with high technical assistance/support) or a web-based training portal (with low technical assistance/support). Results We describe the process, outline the intervention components, report on the pilot test, and conclude with lessons learned from each of these phases. Though the pilot phase showed feasibility, it resulted in modifications to data collection protocols and team and community member roles and expectations. Conclusions Project HEAL offers a promising strategy to implement evidence-based interventions in community settings through the use of technology. There could be wider implications for chronic disease prevention and control. PMID:24885069

  13. Indwelling catheter management: from habit-based to evidence-based practice.

    PubMed

    Smith, JoAnn Mercer

    2003-12-01

    Indwelling urinary catheters are used in the care of more than five million patients per year. Prevalence rates range from 4% in home care to 25% in acute care. Catheter-associated urinary tract infections account for more than 40% of all nosocomial infections and can be associated with significant complications. Clinical practices in catheter management vary widely and frequently are not evidence-based. Effective nursing measures include: identifying patients who no longer need indwelling catheters, discussing appropriate catheter alternatives, and providing patient and caregiver education. Many catheter-associated problems can be avoided by selecting a closed catheter system with a small size catheter (14 to 18 French with a 5-cc balloon), following manufacturer's recommendations for inflation/deflation, maintaining a closed system, securing the catheter, and properly positioning the drainage bag. Practices such as routine catheter irrigation should be avoided. Current recommendations related to the management of encrustation and blockage also are discussed. Providing evidence-based catheter management strategies may reduce the rate of catheter-associated urinary tract infection, catheter encrustation, and leakage as well as the discomfort and costs associated with these complications. PMID:14712009

  14. Fluoxetine: a review on evidence based medicine

    PubMed Central

    Rossi, Andrea; Barraco, Alessandra; Donda, Pietro

    2004-01-01

    Background Fluoxetine was the first molecule of a new generation of antidepressants, the Selective Serotonin Re-uptake Inhibitors (SSRIs). It is recurrently the paradigm for the development of any new therapy in the treatment of depression. Many controlled studies and meta-analyses were performed on Fluoxetine, to improve the understanding of its real impact in the psychiatric area. The main objective of this review is to assess the quality and the results reported in the meta-analyses published on Fluoxetine. Methods Published articles on Medline, Embase and Cochrane databases reporting meta-analyses were used as data sources for this review. Articles found in the searches were reviewed by 2 independent authors, to assess if these were original meta-analyses. Only data belonging to the most recent and comprehensive meta-analytic studies were included in this review. Results Data, based on a group of 9087 patients, who were included in 87 different randomized clinical trials, confirms that fluoxetine is safe and effective in the treatment of depression from the first week of therapy. Fluoxetine's main advantage over previously available antidepressants (TCAs) was its favorable safety profile, that reduced the incidence of early drop-outs and improved patient's compliance, associated with a comparable efficacy on depressive symptoms. In these patients, Fluoxetine has proven to be more effective than placebo from the first week of therapy. Fluoxetine has shown to be safe and effective in the elderly population, as well as during pregnancy. Furthermore, it was not associated with an increased risk of suicide in the overall evaluation of controlled clinical trials. The meta-analysis available on the use of Fluoxetine in the treatment of bulimia nervosa shows that the drug is as effective as other agents with fewer patients dropping out of treatment. Fluoxetine has demonstrated to be as effective as chlomipramine in the treatment of Obsessive-Compulsive-Disorder (OCD). Conclusion Fluoxetine can be considered a drug successfully used in several diseases for its favorable safety/efficacy ratio. As the response rate of mentally ill patients is strictly related to each patient's personal characteristics, any new drug in this area, will have to be developed under these considerations. PMID:14962351

  15. Perioperative Nursing Leaders Implement Clinical Practice Guidelines Using the Iowa Model of Evidence-Based Practice.

    PubMed

    White, Shawna; Spruce, Lisa

    2015-07-01

    Many health care organizations, nursing leaders, and individual clinicians are not providing care consistently based on evidence and many are not aware of the evidence that is available. Preventable complications have an adverse effect on hospital reimbursement and the burden is placed on hospital personnel and nursing leaders to use current evidence to improve care and prevent complications, such as surgical site infections. Using AORN resources, leadership involvement and ownership, and implementing a theoretical model will contribute to implementing daily evidence-based practice and help to decrease the chasm between research and practice. PMID:26119609

  16. Novel Evidence-Based Systemic Lupus Erythematosus Responder Index

    PubMed Central

    Furie, Richard A.; Petri, Michelle A.; Wallace, Daniel J.; Ginzler, Ellen M.; Merrill, Joan T.; Stohl, William; Chatham, W. Winn; Strand, Vibeke; Weinstein, Arthur; Chevrier, Marc R.; Zhong, John; Freimuth, William W.

    2009-01-01

    Objective To describe a new systemic lupus erythematosus (SLE) Responder Index (SRI) based on the belimumab phase II SLE trial and demonstrate its potential utility in SLE clinical trials. Methods Data from a 449-patient randomized, double-blind, placebo-controlled study of 3 doses of belimumab (1, 4, 10 mg/kg) or placebo plus standard of care therapy (SOC) over a 56-week period were analyzed. SELENA-SLEDAI and BILAG SLE disease activity instruments, SF-36 Health Survey, and biomarker analyses were used to create a novel SRI. Response to treatment in a subset of SLE patients (n=321) who were serologically active (ANA ?1:80 and/or anti-dsDNA antibody ?30 IU) at baseline was retrospectively evaluated using the SRI. Results SRI response is defined as: 1) ?4-point reduction in SELENA-SLEDAI score; 2) no new BILAG A or no more than 1 new BILAG B domain score; and 3) no deterioration from baseline in the Physician’s Global Assessment (PGA) by ?0.3 points. In serologically active patients, addition of belimumab to SOC resulted in a response in 46% of patients at week 52 compared with 29% for the placebo patients (P=0.006). SRI responses were independent of baseline autoantibody subtype. Conclusion Evidence-based evaluation of a large randomized, placebo-controlled trial in SLE resulted in the ability to define a robust responder index based on improvement in disease activity without worsening of the overall condition or the development of significant disease activity in new organ systems. PMID:19714615

  17. Effectiveness of bundled behavioural interventions to control healthcare-associated infections: a systematic review of the literature

    Microsoft Academic Search

    S. W. Aboelela; P. W. Stone; E. L. Larson

    2007-01-01

    Summary Attempts to address the growing problem of healthcare- associated infections (HAIs) and their impact on healthcare systems have historically relied on infection control policies that recommend good hygiene through standard and enhanced precautions (e.g. barrier precau- tions and patient isolation). In order for infection control strategies to be effective, however, healthcare workers' behaviour must be congruent with these policies.

  18. An Infective Factor Controlling Sex Compatibility in Bacterium coli

    Microsoft Academic Search

    L. L. CAVALLI; J. LEDERBERG; ESTHER M. LEDERBERG

    1953-01-01

    SUMMARY: Incompatibility may occur in Bacterium coli strains which were previously considered homothallic. A cross between two incompatible strains is completely sterile. Such strains are termed F - . Strains which are self-compatible are termed F+ and are productive when crossed either with other F+ strains or with F- strains. The F+ state is transmissible by infection due to a

  19. The Aedes aegypti Toll Pathway Controls Dengue Virus Infection

    PubMed Central

    Xi, Zhiyong; Ramirez, Jose L.; Dimopoulos, George

    2008-01-01

    Aedes aegypti, the mosquito vector of dengue viruses, utilizes its innate immune system to ward off a variety of pathogens, some of which can cause disease in humans. To date, the features of insects' innate immune defenses against viruses have mainly been studied in the fruit fly Drosophila melanogaster, which appears to utilize different immune pathways against different types of viruses, in addition to an RNA interference–based defense system. We have used the recently released whole-genome sequence of the Ae. aegypti mosquito, in combination with high-throughput gene expression and RNA interference (RNAi)-based reverse genetic analyses, to characterize its response to dengue virus infection in different body compartments. We have further addressed the impact of the mosquito's endogenous microbial flora on virus infection. Our findings indicate a significant role for the Toll pathway in regulating resistance to dengue virus, as indicated by an infection-responsive regulation and functional assessment of several Toll pathway–associated genes. We have also shown that the mosquito's natural microbiota play a role in modulating the dengue virus infection, possibly through basal-level stimulation of the Toll immune pathway. PMID:18604274

  20. Infection Control in the Long Term Care Facility.

    ERIC Educational Resources Information Center

    Morris, Sara

    This booklet is intended to increase the awareness of persons working in long-term care facilities regarding the danger of infectious disease and the ways in which it can be spread. Materials in this booklet include: (1) a brief discussion of historical events in the study of microorganisms; (2) information about how microorganisms cause infection

  1. Detection and control of rotavirus infections in zoo animals.

    PubMed

    Baumeister, B M; Castro, A E; McGuire-Rodgers, S J; Ramsay, E C

    1983-12-01

    Fecal specimens from 15 exotic animal species, with and without diarrhea, were examined for the presence of rotavirus, bacterial enteropathogens, and intestinal parasites. A commercial enzyme-linked immunosorbent assay was used to detect antigens of rotavirus. Rotavirus was detected in the feces of 20 (57%) of 35 of the animals, which included addax (Addax nasomaculatus), nyala (Tragelaphus angasi), saiga (Saiga tatarica), white-tailed gnu (Connochaetus gnou), greater kudu (Tragelaphus strepsiceros), sitatunga (Tragelaphus spekei), Grant's gazelle (Gazella granti roosevelti), sable antelope (Hippotragus niger niger), kob (Kobus kob leucotis), pygmy marmoset (Callithrix pygmaea), bush dog (Speothos venaticus), grizzly bear (Ursus arctos horribilis), and red kangaroo (Megaleia rufa). Bacterial pathogens were found in 8 animals, 5 of which had concurrent rotavirus infections. Most (60%) of the animals with rotavirus infection were less than 2 weeks old; however, rotavirus also was detected in feces from adult animals. Although most of the cases of rotavirus infection were detected in nursery-reared animals, exhibit-reared animals also were infected with rotavirus. PMID:6315660

  2. Updating the guideline development methodology of the Healthcare Infection Control Practices Advisory Committee (HICPAC).

    PubMed

    Umscheid, Craig A; Agarwal, Rajender K; Brennan, Patrick J

    2010-05-01

    This article describes the recent update to the guideline development methodology of the Healthcare Infection Control Practices Advisory Committee (HICPAC). These methods are being used to develop future HICPAC guidelines, beginning with the guideline on preventing catheter-associated urinary tract infections released in 2009. The article includes a background on HICPAC, the strengths and limitations of the methods it's used over the last two decades, and the rationale behind these recent updates. In addition, we describe the new infrastructure used to develop guidelines at HICPAC, key changes in methodology, and new elements of HICPAC guidelines, like the implementation and audit section. We also describe current challenges to the development of infection control guidelines. The current update builds on past strengths and current advances in guideline development and implementation, and enables HICPAC to improve the validity and usability of its guidelines while also addressing emerging challenges in guideline development in the area of infection prevention and control. PMID:20116133

  3. Survey on AIDS, fear and infection control: attitudes affecting management decisions.

    PubMed

    Horowitz, L G; Lipkowitz, R D

    1992-01-01

    As a result of increased public concern about AIDS and dental treatment, dental professionals need to cope with legislative reactions, increased infection control costs, patient anxiety and vigilance on the part of law enforcement agencies regarding compliance with "universal precautions." Recommendations abound for educating patients about dental office infection control to allay irrational fears and market dental office asepsis, but few studies quantitatively measure these needs or address the behavioral concerns patients have about AIDS infection related to dental care. In this investigation, dental patients were surveyed to determine their beliefs, attitudes and behaviors regarding AIDS and dental office infection control. Several important educational caveats were identified. This paper considers these challenges and provides patient education and practice management recommendations consistent with a preventive focus on allaying dental patients' fears while building more successful dental practices. PMID:1298576

  4. [Evidence based of chemoradiotherapy in cervix carcinoma].

    PubMed

    Joly-Lobbedez, F

    2009-10-01

    Since 10 years, the combination of chemoradiotherapy has become a standard of treatment of the advanced localized cervical cancer. Two systematic reviews of the literature (including the results of the different clinical trials) have already been published. The aim of this article is to present the results of the recent meta-analysis based on individual patient data and to discuss the perspectives. This meta-analysis was rigorously designed: trials selected had the same control arm with the same radiotherapy without concomitant chemotherapy, the definition of the primary outcome (overall survival) was homogeneous and analysis was made in intent to treat. The results confirm the advantage in overall survival in favor of the chemoradiotherapy with an absolute 5-year overall survival benefit of 6% (60-66%) and 8% of 5-year disease-free survival (50-58%). Interestingly, even if cisplatin seems to be the most active drug, a significant advantage is also observed with no platinum chemotherapy. A polychemotherapy is not more active than a monochemotherapy and there was a suggestion of a difference in the size of the survival benefit with tumor stage. Larger benefits were seen for the few trials in which additional chemotherapy was administered after chemoradiotherapy, but results have to be confirmed by other clinical trials. Late toxicity was not well evaluated and a long-term follow-up of the patients is important to assess the real incidence of long-term side effects of the chemoradiotherapy and the impact on quality of life. New strategies combining new chemotherapy protocols or targeted therapy with radiation are promising but have to be evaluated in comparative clinical trials before use in routine. PMID:19695934

  5. Biofilms and persistent wound infections in United States military trauma patients: a case–control analysis

    PubMed Central

    2014-01-01

    Background Complex traumatic injuries sustained by military personnel, particularly when involving extremities, often result in infectious complications and substantial morbidity. One factor that may further impair patient recovery is the persistence of infections. Surface-attached microbial communities, known as biofilms, may play a role in hindering the management of infections; however, clinical data associating biofilm formation with persistent or chronic infections are lacking. Therefore, we evaluated the production of bacterial biofilms as a potential risk factor for persistent infections among wounded military personnel. Methods Bacterial isolates and clinical data from military personnel with deployment-related injuries were collected through the Trauma Infectious Disease Outcomes Study. The study population consisted of patients with diagnosed skin and soft-tissue infections. Cases (wounds with bacterial isolates of the same organism collected 14 days apart) were compared to controls (wounds with non-recurrent bacterial isolates), which were matched by organism and infectious disease syndrome. Potential risk factors for persistent infections, including biofilm formation, were examined in a univariate analysis. Data are expressed as odds ratios (OR; 95% confidence interval [CI]). Results On a per infected wound basis, 35 cases (representing 25 patients) and 69 controls (representing 60 patients) were identified. Eight patients with multiple wounds were utilized as both cases and controls. Overall, 235 bacterial isolates were tested for biofilm formation in the case–control analysis. Biofilm formation was significantly associated with infection persistence (OR: 29.49; CI: 6.24-infinity) in a univariate analysis. Multidrug resistance (OR: 5.62; CI: 1.02-56.92), packed red blood cell transfusion requirements within the first 24 hours (OR: 1.02; CI: 1.01-1.04), operating room visits prior to and on the date of infection diagnosis (OR: 2.05; CI: 1.09-4.28), anatomical location of infected wound (OR: 5.47; CI: 1.65-23.39), and occurrence of polymicrobial infections (OR: 69.71; CI: 15.39-infinity) were also significant risk factors for persistent infections. Conclusions We found that biofilm production by clinical strains is significantly associated with the persistence of wound infections. However, the statistical power of the analysis was limited due to the small sample size, precluding a multivariate analysis. Further data are needed to confirm biofilm formation as a risk factor for persistent wound infections. PMID:24712544

  6. 77 FR 40634 - Solicitation for a Cooperative Agreement: Pretrial Technical Assistance for Evidence-Based...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-07-10

    ...organizational change principles (evidence-based practices) in achieving measurable...of a system informed by evidence-based practice. It defines a vision of...the capacity to implement evidence-based practices; Establish...

  7. 76 FR 57742 - National Registry of Evidence-Based Programs and Practices

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-16

    ...National Registry of Evidence-Based Programs and Practices AGENCY: Substance...National Registry of Evidence-based Programs and Practices (NREPP): Open...National Registry of Evidence-based Programs and Practices (NREPP) is a...

  8. Optimal control of a two-strain tuberculosis-HIV/AIDS co-infection model.

    PubMed

    Agusto, F B; Adekunle, A I

    2014-05-01

    Tuberculosis is a bacterial disease caused by Mycobacterium tuberculosis (TB). The risk for TB infection greatly increases with HIV infection; TB disease occurs in 7-10% of patients with HIV infection each year, increasing the potential for transmission of drug-resistant Mycobacterium tuberculosis strains. In this paper a deterministic model is presented and studied for the transmission of TB-HIV/AIDS co-infection. Optimal control theory is then applied to investigate optimal strategies for controlling the spread of the disease using treatment of infected individuals with TB as the system control variables. Various combination strategies were examined so as to investigate the impact of the controls on the spread of the disease. And incremental cost-effectiveness ratio (ICER) was used to investigate the cost effectiveness of all the control strategies. Our results show that the implementation of the combination strategy involving the prevention of treatment failure in drug-sensitive TB infectious individuals and the treatment of individuals with drug-resistant TB is the most cost-effective control strategy. Similar results were obtained with different objective functionals involving the minimization of the number of individuals with drug-sensitive TB-only and drug-resistant TB-only with the efforts involved in applying the control. PMID:24704209

  9. Common infections in the history of cancer patients and controls

    Microsoft Academic Search

    U. Abel; N. Becker; R. Angerer; R. Frentzel-Beyme; M. Kaufmann; P. Schlag; S. Wysocki; J. Wahrendorf; G. Schulz

    1991-01-01

    Summary The association between the frequency of manifest infectious diseases and cancer risk was investigated in a case-control study at Heidelberg, FRG. A total of 255 cases with carcinomas of the stomach, colon, rectum, breast, and ovary, as well as 255 population controls and 230 hospital controls were interviewed using a standard questionnaire. Controls were matched to the cases for

  10. Reduction in Central Line-Associated Bloodstream Infection Rates After Implementations of Infection Control Measures at a Level 3 Neonatal Intensive Care Unit.

    PubMed

    Dumpa, Vikramaditya; Adler, Bonny; Allen, Delena; Bowman, Deborah; Gram, Amy; Ford, Pat; Sannoh, Sulaiman

    2014-11-01

    Advances in neonatology led to survival of micro-preemies, who need central lines. Central line-associated bloodstream infection (CLABSI) causes prolonged hospitalization, morbidities, and mortality. Health care team education decreases CLABSIs. The objective was to decrease CLABSIs using evidence-based measures. The retrospective review compared CLABSI incidence during and after changes in catheter care. In April 2011, intravenous (IV) tubing changed from Interlink to Clearlink; IV tubing changing interval increased from 24 to 72 hours. CLABSIs increased. The following measures were implemented: July 2011, reeducation of neonatal intensive care staff on Clearlink; August 2011, IV tubing changing interval returned to 24 hours; September 2011, changed from Clearlink back to Interlink; November 2011, review of entire IV process and in-service on hand hygiene; December 2011, competencies on IV access for all nurses. CLABSIs were compared during and after interventions. Means were compared using the t test and ratios using the ?(2) test; P <.05. CLABSIs decreased from 4.4/1000 to 0/1000 catheter-days; P < .05. Evidence-based interventions reduced CLABSIs. PMID:25372275

  11. A Legume Genetic Framework Controls Infection of Nodules by Symbiotic and Endophytic Bacteria

    PubMed Central

    Zgadzaj, Rafal; James, Euan K.; Kelly, Simon; Kawaharada, Yasuyuki; de Jonge, Nadieh; Jensen, Dorthe B.; Madsen, Lene H.; Radutoiu, Simona

    2015-01-01

    Legumes have an intrinsic capacity to accommodate both symbiotic and endophytic bacteria within root nodules. For the symbionts, a complex genetic mechanism that allows mutual recognition and plant infection has emerged from genetic studies under axenic conditions. In contrast, little is known about the mechanisms controlling the endophytic infection. Here we investigate the contribution of both the host and the symbiotic microbe to endophyte infection and development of mixed colonised nodules in Lotus japonicus. We found that infection threads initiated by Mesorhizobium loti, the natural symbiont of Lotus, can selectively guide endophytic bacteria towards nodule primordia, where competent strains multiply and colonise the nodule together with the nitrogen-fixing symbiotic partner. Further co-inoculation studies with the competent coloniser, Rhizobium mesosinicum strain KAW12, show that endophytic nodule infection depends on functional and efficient M. loti-driven Nod factor signalling. KAW12 exopolysaccharide (EPS) enabled endophyte nodule infection whilst compatible M. loti EPS restricted it. Analysis of plant mutants that control different stages of the symbiotic infection showed that both symbiont and endophyte accommodation within nodules is under host genetic control. This demonstrates that when legume plants are exposed to complex communities they selectively regulate access and accommodation of bacteria occupying this specialized environmental niche, the root nodule. PMID:26042417

  12. A legume genetic framework controls infection of nodules by symbiotic and endophytic bacteria.

    PubMed

    Zgadzaj, Rafal; James, Euan K; Kelly, Simon; Kawaharada, Yasuyuki; de Jonge, Nadieh; Jensen, Dorthe B; Madsen, Lene H; Radutoiu, Simona

    2015-06-01

    Legumes have an intrinsic capacity to accommodate both symbiotic and endophytic bacteria within root nodules. For the symbionts, a complex genetic mechanism that allows mutual recognition and plant infection has emerged from genetic studies under axenic conditions. In contrast, little is known about the mechanisms controlling the endophytic infection. Here we investigate the contribution of both the host and the symbiotic microbe to endophyte infection and development of mixed colonised nodules in Lotus japonicus. We found that infection threads initiated by Mesorhizobium loti, the natural symbiont of Lotus, can selectively guide endophytic bacteria towards nodule primordia, where competent strains multiply and colonise the nodule together with the nitrogen-fixing symbiotic partner. Further co-inoculation studies with the competent coloniser, Rhizobium mesosinicum strain KAW12, show that endophytic nodule infection depends on functional and efficient M. loti-driven Nod factor signalling. KAW12 exopolysaccharide (EPS) enabled endophyte nodule infection whilst compatible M. loti EPS restricted it. Analysis of plant mutants that control different stages of the symbiotic infection showed that both symbiont and endophyte accommodation within nodules is under host genetic control. This demonstrates that when legume plants are exposed to complex communities they selectively regulate access and accommodation of bacteria occupying this specialized environmental niche, the root nodule. PMID:26042417

  13. A policy to control the spread of HIV infection.

    PubMed Central

    Kuller, L. H.

    1988-01-01

    Prevention of transmission of HIV infection is the most important public health concern of the AIDS epidemic. To date, unfortunately, we have failed to contain the epidemic. The increasingly rapid spread of HIV into the IV drug-abusing population and subsequent heterosexual transmission represent a further failure of the public health system. Current organization of the public health programs, especially the lack of independence and adequate financial and personnel support, is an extremely serious problem. More funding may not be the answer, unless there is better organization. Identification of infected individuals and a vigorous education program must be implemented. HIV antibody-positive individuals should be followed carefully in order to evaluate the risk factors for AIDS and efficacy of specific interventions. PMID:3051701

  14. Catheter associated mycobacteremia: Opening new fronts in infection control

    PubMed Central

    Rathor, Neha; Khillan, Vikas; Panda, Dipanjan

    2015-01-01

    Mycobacterium fortuitum is a rapidly growing Mycobacterium ubiquitous in nature, known to form biofilms. This property increases its propensity to colonize the in situ central line and makes it a prospective threat for nosocomial infection. We report a case of 48-year-old female with carcinoma cecum who reported to us with clinical illness and neutropenia while on chemotherapy via totally implanted central venous device, postlaparoscopic-assisted right hemicolectomy. PMID:26195861

  15. Evidence-Based Review of Subjective Pediatric Sleep Measures

    PubMed Central

    Toliver-Sokol, Marisol; Palermo, Tonya M.

    2011-01-01

    Objective?This manuscript provides an evidence-based psychometric review of parent and child-report pediatric sleep measures using criteria developed by the American Psychological Association (APA) Division 54 Evidence-Based Assessment (EBA) Task Force.?Methods?Twenty-one measures were reviewed: four measures of daytime sleepiness, four measures of sleep habits/hygiene, two measures assessing sleep-related attitudes/cognitions, five measures of sleep initiation/maintenance, and six multidimensional sleep measures.?Results?Six of the 21 measures met “well-established” evidence-based assessment criteria. An additional eight measures were rated as “approaching well-established” and seven were rated as “promising.”?Conclusions?Overall, the multidimensional sleep measures received the highest ratings. Strengths and weaknesses of the measures are described. Recommendations for future pediatric sleep assessment are presented including further validation of measures, use of multiple informants, and stability of sleep measures over time. PMID:21227912

  16. Gender inequities in sexually transmitted infections: implications for HIV infection and control in Lagos State, Nigeria

    PubMed Central

    Adeyemi, Ezekiel Oluwagbemiga

    2011-01-01

    Beyond the statistics of sex-based differences in infection rates, there are profound differences in the underlying causes and consequences of HIV infections in male and female which need to be examined. The study therefore examines; the gender differences in the STI knowledge and gender-related potential risks of HIV heterosexual transmission. Quantitative and qualitative data were collected. A multistage random sampling procedure was employed in administration of 1358 questionnaires. For qualitative data, four focus group discussions (FGD) were conducted to collect information from stakeholders within the study population, while In-depth interview was employed to collect information from 188 people living with HIV/AIDS through support groups in the State. The data collected were subjected to basic demographic analytical techniques. Combination of univariate, bivariate, and multivariate analysis were employed. Information from focus group discussions and in-depth interviews were transcribed and organized under broad headings that depict different aspects of the discussions. Majority of the respondents interviewed did not inform their partners about their infection in the study area. It was also discovered that stigmatization did not allow some women to disclose their status to their sexual partners. Some of the HIV-positive patients interviewed agreed that they did not attend the health facilities to treat the STI’s before they were finally confirmed positive. The study hypothesis revealed that communication between partners about STI’s was associated with an increase in risk reduction behaviour. The paper concluded that there is need for more information and education on communication about STI’s between the sexual partners; to reduce the spread of sexually transmitted diseases within the nation. PMID:24470905

  17. Evidence-based youth psychotherapy in the mental health ecosystem.

    PubMed

    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 this might be the case. We examined relevant research literature and drew examples from our own research in practice settings. One reason for the falloff in EBP effects may be that so little youth treatment research has been done in the context of everyday practice. Researchers may have missed opportunities to learn how to make EBPs work well in the actual youth mental health ecosystem, in which so many real-world factors are at play that cannot be controlled experimentally. We sketch components and characteristics of that ecosystem, including clinically referred youths, their caregivers and families, the practitioners who provide their care, the organizations within which care is provided, the network of youth service systems (e.g., child welfare, education), and the policy context (e.g., reimbursement regulations and incentives). We suggest six strategies for future research on EBPs within the youth mental health ecosystem, including reliance on the deployment-focused model of development and testing, testing the mettle of current EBPs in everyday practice contexts, using the heuristic potential of usual care, testing restructured and integrative adaptations of EBPs, studying the use of treatment response feedback to guide clinical care, and testing models of the relation between policy change and EBP implementation. PMID:23402704

  18. Successful Human Infection with P. falciparum Using Three Aseptic Anopheles stephensi Mosquitoes: A New Model for Controlled Human Malaria Infection

    PubMed Central

    Laurens, Matthew B.; Billingsley, Peter; Richman, Adam; Eappen, Abraham G.; Adams, Matthew; Li, Tao; Chakravarty, Sumana; Gunasekera, Anusha; Jacob, Christopher G.; Sim, B. Kim Lee; Edelman, Robert; Plowe, Christopher V.; Hoffman, Stephen L.; Lyke, Kirsten E.

    2013-01-01

    Controlled human malaria infection (CHMI) is a powerful method for assessing the efficacy of anti-malaria vaccines and drugs targeting pre-erythrocytic and erythrocytic stages of the parasite. CHMI has heretofore required the bites of 5 Plasmodium falciparum (Pf) sporozoite (SPZ)-infected mosquitoes to reliably induce Pf malaria. We reported that CHMI using the bites of 3 PfSPZ-infected mosquitoes reared aseptically in compliance with current good manufacturing practices (cGMP) was successful in 6 participants. Here, we report results from a subsequent CHMI study using 3 PfSPZ-infected mosquitoes reared aseptically to validate the initial clinical trial. We also compare results of safety, tolerability, and transmission dynamics in participants undergoing CHMI using 3 PfSPZ-infected mosquitoes reared aseptically to published studies of CHMI using 5 mosquitoes. Nineteen adults aged 18–40 years were bitten by 3 Anopheles stephensi mosquitoes infected with the chloroquine-sensitive NF54 strain of Pf. All 19 participants developed malaria (100%); 12 of 19 (63%) on Day 11. The mean pre-patent period was 258.3 hours (range 210.5–333.8). The geometric mean parasitemia at first diagnosis by microscopy was 9.5 parasites/µL (range 2–44). Quantitative polymerase chain reaction (qPCR) detected parasites an average of 79.8 hours (range 43.8–116.7) before microscopy. The mosquitoes had a geometric mean of 37,894 PfSPZ/mosquito (range 3,500–152,200). Exposure to the bites of 3 aseptically-raised, PfSPZ-infected mosquitoes is a safe, effective procedure for CHMI in malaria-naïve adults. The aseptic model should be considered as a new standard for CHMI trials in non-endemic areas. Microscopy is the gold standard used for the diagnosis of Pf malaria after CHMI, but qPCR identifies parasites earlier. If qPCR continues to be shown to be highly specific, and can be made to be practical, rapid, and standardized, it should be considered as an alternative for diagnosis. Trial Registration ClinicalTrials.gov NCT00744133 NCT00744133 PMID:23874828

  19. Application of meta-analysis in evidence-based oncology

    Microsoft Academic Search

    Xiaoping Lin; Qingsheng Wang

    2008-01-01

    The Cochrane Collaboration is an international not-for-profit and independent organization, dedicated to providing up-to-date\\u000a evidence-based information about the effects of healthcare in the form of systematic reviews. Meta-analysis is a statistical\\u000a tool to prepare the systematic reviews. This paper briefly introduces the above terms and how to apply evidence-based oncology.\\u000a Recent findings by using meta-analysis for cancers of the breast,

  20. Archie Cochrane and his vision for evidence-based medicine

    PubMed Central

    Shah, Hriday M.; Chung, Kevin C.

    2009-01-01

    Archibald (Archie) Cochrane's most influential mark on healthcare was his 1971 publication, “Effectiveness and Efficiency.” This book strongly criticized the lack of reliable evidence behind many of the commonly accepted healthcare interventions at the time. His criticisms spurred rigorous evaluations of healthcare interventions and highlighted the need for evidence in medicine. His call for a collection of systematic reviews led to the creation of The Cochrane Collaboration. Archie Cochrane was a visionary person who helped lay down much of the foundation for evidence-based medicine. This paper will introduce evidence-based medicine to Plastic Surgery by tracing its history to the seminal efforts by Archie Cochrane. PMID:19730323

  1. Double-blind peer reviewed paper Problem-based learning — a case for infection control

    Microsoft Academic Search

    M. Cole

    2005-01-01

    odern health care requires a workforce that is capable of exploring complex issues, articulate,Mand has the capacity to develop problem-solving strategies based on reflective decision-making. The importance of education in the prevention of health care-associated infection is well documented, however measuring the effectiveness of infection control educational programmes has been problematic with insufficient programmes and unsatisfactory levels of compliance being

  2. Focused ethnographic studies in the WHO programme for the control of acute respiratory infections

    Microsoft Academic Search

    Sandy Cove; Gretel H. Pelto

    1993-01-01

    Focused Ethnographic Studies (FESs), developed and sponsored by the World Health Organization (WHO) Programme for the Control of Acute Respiratory Infections (ARI), have facilitated ethnographic research dedicated to determining key household behaviors and understandings surrounding respiratory infections—particularly pneumonia—in children. The FES design emphasizes anthropological theory and methods while limiting the scope and duration of fieldwork to a specific “program?relevant” research

  3. From Baghdad to Bethesda: Infection Control Considerations for Iraqi-War Related Injuries

    Microsoft Academic Search

    E. Vasquez; M. J. Duncan; K. Petersen; J. English; S. Tasker

    2004-01-01

    ISSUE: Literature from the Vietnam War, Iran-Iraq War, and field reports from Landsthul Regional Medical Center and USNS Comfort, identified multidrug-resistant acinetobacter (MDRA) and other gram-negative rods (GNR) as war-zone community-acquired pathogens both colonizing and infecting war casualties.PROJECT: Infection control professionals (ICPs) formed a multidisciplinary team to design a surveillance protocol for patients admitted with injuries from the Iraqi War

  4. Caspase12 controls West Nile virus infection via the viral RNA receptor RIG-I

    Microsoft Academic Search

    Penghua Wang; Alvaro Arjona; Yue Zhang; Hameeda Sultana; Jianfeng Dai; Long Yang; Philippe M LeBlanc; Karine Doiron; Maya Saleh; Erol Fikrig

    2010-01-01

    Caspase-12 has been shown to negatively modulate inflammasome signaling during bacterial infection. Its function in viral immunity, however, has not been characterized. We now report an important role for caspase-12 in controlling viral infection via the pattern-recognition receptor RIG-I. After challenge with West Nile virus (WNV), caspase-12-deficient mice had greater mortality, higher viral burden and defective type I interferon response

  5. When staff handle staph : user-driven versus expert-driven communication of infection control guidelines

    Microsoft Academic Search

    Fenne Verhoeven

    2009-01-01

    Health care-associated infections cause thousands of preventable deaths each year. Therefore, it is crucial that health care workers (HCWs) adhere to infection control guidelines. Although most HCWs are aware of the rationale for guidelines, adherence is generally poor, which might be caused by the guidelines’ expert-driven character. Whereas traditional, paper-based guidelines have a strong focus on scientific validation, regulation, and

  6. Claudin-1 gene variants and susceptibility to hepatitis C infection in HIV-1 infected intravenous drug users (an ANRS case-control study).

    PubMed

    Ghosn, Jade; Fouquet, Baptiste; Quertainmont, Yann; Salmon, Dominique; Sahali, Sabrinel; Rioux, Christophe; Duvivier, Claudine; Mole, Martine; Delfraissy, Jean-François; Misrahi, Micheline

    2015-04-01

    Hepatitis C virus (HCV) seroprevalence is highly diverse among human immunodeficiency virus-1 (HIV-1) infected patients, ranging between 10% of HIV-1 infected homo-bisexuel men, to >92% in patients infected with HIV-1 who acquired HIV-1 through intravenous drug use. Thus, being HCV-free while having acquired HIV-1 via intravenous drug use is a rare situation. Claudin-1 is a protein involved in intracellular tight-junctions and has been identified as a major cellular co-receptor for HCV infection. Our objective was to determine whether Claudin-1 gene (CLDN1) mutations might be involved in natural resistance to HCV infection. We conducted a case-control study. All recruited patients acquired HIV-1 infection via intravenous drug use route before 1995. The case study patients remained free from HCV infection (negative anti-HCV antibodies and HCV-RNA). The control study patients was co-infected with HCV (positive anti-HCV antibodies). Direct genomic sequencing of the CLDN1 gene coding region and adjacent intron/exons junctions was performed from peripheral blood mononuclear cells. A total of 138 Caucasian patients were enrolled. Twenty-two patients (cases) were free from HCV infection and 116 (controls) were co-infected with HCV. We found single nucleotide polymorphisms (SNPs) described previously with no significant differences in allele frequencies between cases and controls. In conclusion, despite being a major cellular co-receptor for HCV entry in vitro, we did not identify any specific substitution in CLDN1 gene coding region in our study patients highly exposed but resistant to HCV infection in vivo. Other cellular co-factors involved in HCV infection should be investigated in this highly-exposed intravenous drug users patients. PMID:25611191

  7. Modelling nematode infections in sheep and parasite control strategies 

    E-print Network

    Laurenson, Yan Christian Stephen Mountfort

    2012-11-30

    Gastrointestinal parasitism in grazing lambs adversely affects animal performance and welfare, causing significant production losses for the sheep industry. Control of gastrointestinal parasitism using chemotherapeutic ...

  8. Compliance with infection control practices in an university hospital dental clinic

    PubMed Central

    Mutters, Nico T.; Hägele, Ulrike; Hagenfeld, Daniel; Hellwig, Elmar; Frank, Uwe

    2014-01-01

    Aim: Compliance with infection control practices is the key to quality care and excellence in dentistry. Infection control remains one of the most cost-beneficial interventions available. However, implementing control procedures requires full compliance of the whole dental team. The aim of our study was to measure the compliance in daily clinical practice. Methods: The compliance with infection control practices in dentistry by dental health care personnel (DHCP) in a German university dental clinic was observed during clinical work. In addition, a survey was conducted to assess the individual knowledge about infection control procedures. Contamination of the workplace during invasive dental procedures was tested, as well. Results: A total of 58 invasive dental treatments implying close contacts between HCWs and patients were scrutinized. All HCWs (100%) wore gloves during dental work, but in some cases (female dentists: 14.3%; dental assistants: 28.6%) gloves were neither changed nor hands were disinfected between different activities or patient contacts (female dentists: 68.6%; male dentists: 60.9%; dental assistants: 93%). Only 31.4% of female and 39.1% of male dentists carried out adequate hygienic hand disinfection after removing gloves. Male dentists wore significantly more often (100%) protective eyewear compared to 77.1% of female dentists (p<0.05). In addition, most of female dentists (62.9%) and dental assistants (80.7%) wore jewelry during dental procedures. Conclusion: Despite the knowledge of distinct hygiene procedures only a small percentage of dental staff performs hygiene practices according to recommended guidelines. Strict audit is clearly needed in the dental setting to ensure compliance with infection control guidelines to prevent transmission of pathogens. Our results provide insights for the development of a targeted education and training strategy to enhance compliance of dental staff especially of dental assistants with infection control procedures. PMID:25285262

  9. Effectiveness of Hospital-Wide Methicillin-Resistant Staphylococcus aureus (MRSA) Infection Control Policies Differs by Ward Specialty

    PubMed Central

    Sadsad, Rosemarie; Sintchenko, Vitali; McDonnell, Geoff D.; Gilbert, Gwendolyn L.

    2013-01-01

    Methicillin-resistant Staphylococcus aureus (MRSA) is a major cause of preventable nosocomial infections and is endemic in hospitals worldwide. The effectiveness of infection control policies varies significantly across hospital settings. The impact of the hospital context towards the rate of nosocomial MRSA infections and the success of infection control is understudied. We conducted a modelling study to evaluate several infection control policies in surgical, intensive care, and medical ward specialties, each with distinct ward conditions and policies, of a tertiary public hospital in Sydney, Australia. We reconfirm hand hygiene as the most successful policy and find it to be necessary for the success of other policies. Active screening for MRSA, patient isolation in single-bed rooms, and additional staffing were found to be less effective. Across these ward specialties, MRSA transmission risk varied by 13% and reductions in the prevalence and nosocomial incidence rate of MRSA due to infection control policies varied by up to 45%. Different levels of infection control were required to reduce and control nosocomial MRSA infections for each ward specialty. Infection control policies and policy targets should be specific for the ward and context of the hospital. The model we developed is generic and can be calibrated to represent different ward settings and pathogens transmitted between patients indirectly through health care workers. This can aid the timely and cost effective design of synergistic and context specific infection control policies. PMID:24340085

  10. A focus on intra-abdominal infections

    PubMed Central

    2010-01-01

    Complicated intra-abdominal infections are an important cause of morbidity and are frequently associated with poor prognosis, particularly in higher risk patients. Well defined evidence-based recommendations for intra-abdominal infections treatment are partially lacking because of the limited number of randomized-controlled trials. Factors consistently associated with poor outcomes in patients with intra-abdominal infections include increased illness severity, failed source control, inadequate empiric antimicrobial therapy and healthcare-acquired infection. Early prognostic evaluation of complicated intra-abdominal infections is important to select high-risk patients for more aggressive therapeutic procedures. The cornerstones in the management of complicated intra-abdominal infections are both source control and antibiotic therapy. The timing and the adequacy of source control are the most important issues in the management of intra-abdominal infections, because inadequate and late control of septic source may have a negative effect on the outcomes. Recent advances in interventional and more aggressive techniques could significantly decrease the morbidity and mortality of physiologically severe complicated intra-abdominal infections, even if these are still being debated and are yet not validated by limited prospective trials. Empiric antimicrobial therapy is nevertheless important in the overall management of intra-abdominal infections. Inappropriate antibiotic therapy may result in poor patient outcomes and in the appearance of bacterial resistance. Antimicrobial management is generally standardised and many regimens, either with monotherapy or combination therapy, have proven their efficacy. Routine coverage especially against Enterococci and candida spp is not always recommended, but can be useful in particular clinical conditions. A de escalation approach may be recommended in patients with specific risk factors for multidrug resistant infections such as immunodeficiency and prolonged antibacterial exposure. Therapy should focus on the obtainment of adequate source control and adequate use of antimicrobial therapy dictated by individual patient risk factors. Other critical issues remain debated and more controversies are still open mainly because of the limited number of randomized controlled trials. PMID:20302628

  11. Evidence-Based Assessment of Depression in Adults

    ERIC Educational Resources Information Center

    Joiner, Thomas E.; Walker, Rheeda L.; Pettit, Jeremy W.; Perez, Marisol; Cukrowicz, Kelly C.

    2005-01-01

    From diverse perspectives, there is little doubt that depressive symptoms cohere to form a valid and distinct syndrome. Research indicates that an evidence-based assessment of depression would include (a) measures with adequate psychometric properties; (b) adequate coverage of symptoms; (c) adequate coverage of depressed mood, anhedonia, and…

  12. Developing the Skills Required for Evidence-Based Practice.

    ERIC Educational Resources Information Center

    French, Beverley

    1998-01-01

    Evidence-based practice, the ability to find and apply research evidence in health care practice, requires the ability to define the question, access information, make comparative analyses, and aggregate knowledge. Systematic research review should be part of nursing education. (SK)

  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. Orchidopexy for undescended testis in England: is it evidence based?

    Microsoft Academic Search

    John E. McCabe; Simon E. Kenny

    2008-01-01

    BackgroundCurrent evidence-based recommendations are that orchidopexy for undescended testis should be performed before 18 months of age. We examined hospital episode statistics data for all orchidopexies performed in England over a 9-year period to see how well this guideline was implemented in current practice and examine trends.

  15. 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.…

  16. Evidence-Based Therapies for Oppositional Behavior in Young Children

    Microsoft Academic Search

    Robert J. McMahon; Julie S. Kotler

    The primary purpose of this chapter is to present and critically evaluate current evidence-based interventions for oppositional behavior (OB) in young children. Children with OB are typically described by parents and teachers as argumentative, disobedient, disruptive, demanding, and defiant. We have operationalized “young children” as including children between the ages of 3 and 8, thus encompassing the preschool and early

  17. Evidence-Based Diagnosis: Incorporating Diagnostic Instruments into Clinical Practice

    ERIC Educational Resources Information Center

    Doss, Amanda Jensen

    2005-01-01

    This article is intended to serve as a practical guide for practitioners interested in incorporating evidence-based diagnosis (EBD) instruments into their clinical practices to refine the diagnostic process. Three measures are used to illustrate this process, the DISC-IV (Shaffer et al., 2000), the Schedule for Affective Disorders and…

  18. Evidence-Based Secondary Transition Practices for Enhancing School Completion

    ERIC Educational Resources Information Center

    Test, David W.; Fowler, Catherine H.; White, James; Richter, Sharon; Walker, Allison

    2009-01-01

    Approximately 28% of students with disabilities do not complete high school (National Longitudinal Transition Study-2, 2005). This increases the likelihood that these students will experience low wages, high rates of incarceration, and limited access to postsecondary education. This article reviews evidence-based secondary transition practices…

  19. 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

  20. 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

  1. Hindawi Publishing Corporation Evidence-Based Complementary and Alternative Medicine

    E-print Network

    Richner, Heinz

    Hindawi Publishing Corporation Evidence-Based Complementary and Alternative Medicine Volume 2012 of Medicinal Plant Knowledge in the Andean Highlands: A Case Study from Peru and Bolivia Sarah-Lan Mathez a study of patterns in the distribution and transmission of medicinal plant knowledge in rural Andean

  2. 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…

  3. 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…

  4. 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…

  5. 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…

  6. 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…

  7. Evidence-based psychiatric nursing practice: Rhetoric or reality

    Microsoft Academic Search

    Gail W. Stuart

    2001-01-01

    The most desirable basis to substantiate clinical practice is the evidence of well-established research findings. Developing evidence-based care involves defining the clinical question, finding the evidence, analyzing the evidence, using the evidence, and evaluating the outcome. Practice guidelines and clinical algorithms are useful tools for applying research findings in a practical way. Other mental health professionals are actively incorporating an

  8. Desired Attributes of Evidence Assessments for Evidence-based Practices

    Microsoft Academic Search

    H. Stephen Leff; Jeremy A. Conley

    2006-01-01

    In this paper we describe three approaches to assessing evidence for stakeholders interested in evidence-based practices: narrative reviews, systematic reviews (including meta-analyses), and registries. We then compare the approaches in terms of the degree to which they posses desired attributes of evidence assessments. Our review suggests that hybrid approaches that combined the best features of all three should be pursued

  9. The Complexity of Evidence-Based Practice: A Case Study

    Microsoft Academic Search

    Beverly M. Simmons

    2011-01-01

    In this article, the author addresses areas of complexity within evidence-based social work practice that she has encountered in her work with clients. The author offers an in-depth case study from her practice that involves the assessment and treatment of a client with a complicated diagnostic presentation. Clinical choices are discussed using a biopsychosocial framework that highlights the importance of

  10. 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…

  11. Evaluating Evidence-Based Interventions in School Psychology.

    ERIC Educational Resources Information Center

    Durlak, Joseph A.

    2002-01-01

    The tactics adopted by the Task Force on Evidence-Based Interventions in School Psychology have advantages in terms of literature coverage and providing data on multiple dimensions. Two suggestions to improve Task Force efforts are offered in terms of the specification of key outcomes and the use of effect sizes to gauge the impact and value of…

  12. An Informatics Infrastructure Is Essential for Evidence-based Practice

    Microsoft Academic Search

    Suzanne Bakken

    2001-01-01

    The contention of the author is that an informatics infrastructure is essential for evidenced-based practice. Five building blocks of an informatics infrastructure for evidence-based practice are proposed: 1) standardized terminologies and structures, 2) digital sources of evidence, 3) standards that facilitate health care data exchange among heterogeneous systems, 4) informatics processes that support the acquisition and application of evidence to

  13. Incorporating Evidence-Based Practice into the Macro Practice Curriculum

    Microsoft Academic Search

    Ramon M. Salcido

    2008-01-01

    Considerable attention has been directed in preparing social work students to understand the paradigm of evidence-based practice (EBP). The infusion of EBP through training, course instruction, and assignments has the potential to enhance EBP knowledge acquisition in the macro practice curriculum. This article examines an approach to integrating EBP into the curriculum through a training model that is linked with

  14. Effect Size in Psychiatric Evidence-Based Practice Care

    Microsoft Academic Search

    Michael J. Rice

    2009-01-01

    Developing evidence-based practice skills requires a familiarity with the language and terminology of clinical research. Few articles discuss concepts, such as effect size, that must be understood to determine if the findings of studies are clinically meaningful. Clinically meaningful results of studies are determined by the effect size of an intervention. The effect size of an intervention, such as cognitive—behavioral

  15. Can Evidence-Based Dental Health Care Assure Quality?

    ERIC Educational Resources Information Center

    McCulloch, Christopher A. G.

    1994-01-01

    It is suggested that evidence-based health care is appropriate in dental care delivery, and dental educators can play an important role in overcoming barriers to teaching and practice of this approach. Obstacles include misinterpretations, insufficient evidence, undeveloped critical appraisal skills, skepticism, inadequate time, and poor access to…

  16. Evidence-Based Teaching: Now and in the Future

    ERIC Educational Resources Information Center

    Buskist, William; Groccia, James E.

    2011-01-01

    The purpose of assembling this "New Directions in Teaching and Learning" volume was to introduce college and university teachers to a broad range of approaches that reflect evidence-based teaching (EBT). As each of the preceding chapters has shown, EBT not only can increase student learning across a variety of measures, it also can increase…

  17. 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

  18. Evidence-based Laboratory Medicine: Supporting Decision-Making

    Microsoft Academic Search

    Christopher P. Price

    2000-01-01

    There is an implicit acceptance that an evidence-based culture underpins the practice of laboratory medicine, in part because it is perceived as the scientific foundation of medicine. However, several reviews of specific test procedures or technologies have shown that the evi- dence base is limited and in many cases flawed. One of the key deficiencies in the scientific literature on

  19. Evidence based practices are critical care nurses ready for it?

    Microsoft Academic Search

    Tracey Bucknall; Beverley Copnell; Kathleen Shannon; Dianne McKinley

    2001-01-01

    In the emergence of the evidence based practice movement, critical care nurses have struggled to identify scientific evidence on which to base their clinical practice. While the lack of critical care nursing research is a major concern, other important issues have significantly stalled the implementation of evidence even when it is available. A descriptive study of 274 critical care nurses

  20. 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…

  1. 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…

  2. Implementation of Evidence-Based Mental Health Practice in England

    Microsoft Academic Search

    Richard H. Beinecke

    2004-01-01

    Evidence-based practice (EBP) in mental health is generating much interest throughout the world. England is the world leader in EBPs. Key issues in implementing EBPs are summarized. Based on extensive interviews, EBPs and sources of information in the United Kingdom are reviewed, development of EBPs in the United States and the United Kingdom are compared, and the challenges of translating

  3. 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…

  4. 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…

  5. 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…

  6. Developing the skills required for evidence-based practice

    Microsoft Academic Search

    Beverley French

    1998-01-01

    The current health care environment requires practitioners with the skills to find and apply the best currently available evidence for effective health care, to contribute to the development of evidence-based practice protocols, and to evaluate the impact of utilizing validated research findings in practice. Current approaches to teaching research are based mainly on gaining skills by participation in the research

  7. 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…

  8. Need for evidence-based practice in prosthodontics

    Microsoft Academic Search

    James D. Anderson

    2000-01-01

    Statement Of Problem. Patients, their insurers, the courts, and the scientific community are demanding more evidence to support the effectiveness of health care strategies. Purpose. This article describes evidence-based practice, its origins, and value as a way of addressing the demand for evidence of treatment effectiveness in maxillofacial prosthetics. Material And Methods. A limited review of maxillofacial prosthetics literature was

  9. 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…

  10. Evidence-Based Practice in the Early Childhood Field

    ERIC Educational Resources Information Center

    Buysse, Virginia, Ed.; Wesley, Patricia W., Ed.

    2006-01-01

    Evidence-based practice is a decision-making process that integrates the best available scientific research evidence with family and professional wisdom and values. The editors argue that it has the potential to transform the services provided to children and families because it incorporates the "different ways of knowing" that characterize early…

  11. Evidence-Based Practice and Policy: Choices Ahead

    Microsoft Academic Search

    Eileen Gambrill

    2006-01-01

    Choices about how to view evidence-based practice (EBP) are being made by educators, practitioners, agency administrators, and staff in a variety of organizations designed to promote integration of research and practice such as clearinghouses on EBP. Choices range from narrow views of EBP such as use of empirically based guidelines and treatment manuals to the broad philosophy and evolving process

  12. 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…

  13. Is there an evidence-based practice for burns?

    Microsoft Academic Search

    Charmaine Childs

    1998-01-01

    Doublts and questions about clinical decision making need to be answered. Evidence-based medicine aims to provide answers by systematically finding information from the vast assortmment of research papers in the literature and bringing it together to use in everyday practice and in the best interests of the patient. Although clinical (and experimental) studies have a variety of methodologics, ranging from

  14. Integration of Evidence-Based Practice into the University Clinic

    ERIC Educational Resources Information Center

    Goldstein, Brian A.

    2008-01-01

    The author explains different principles, which can be used for the integration of evidence-based practice into the university clinic. Research literature, systematic reviews and practice guidelines are shown to work as the evidence for the teachers, as well as the students.

  15. 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…

  16. Developing Research Competence to Support Evidence-Based Practice

    Microsoft Academic Search

    Lora E. Burke; Elizabeth A. Schlenk; Susan M. Sereika; Susan M. Cohen; Mary Beth Happ; Janice S. Dorman

    2005-01-01

    This article describes one step in the process that was undertaken to prepare for the introduction of evidence-based practice (EBP) into the curriculum across the Bachelor of Science in Nursing, Master of Science in Nursing, and Doctor of Philosophy pro- grams, as well as the programs that were under development, Clinical Nurse Leader and Doctor of Nursing Practice, at the

  17. INTEGRATING EVIDENCE-BASED PRACTICE AND SOCIAL WORK FIELD EDUCATION

    Microsoft Academic Search

    Tonya Edmond; Deborah Megivern; Cynthia Williams; Estelle Rochman; Matthew Howard

    2006-01-01

    The social work academic community is currently considering and critiquing the idea of evidence-based practice (EBP). Given the vital part that practicum education plays in the social work profession, understanding the views of field instructors on this subject is essential. The George Warren Brown School of Social Work at Washington University surveyed 283 field instructors within 180 agencies and found

  18. Evidence-Based Practice: Beyond Empirically Supported Treatments

    Microsoft Academic Search

    Stanley B. Messer

    2004-01-01

    Must the clinician choose between a practice that is strictly objective and data based and one that is purely subjective and experience based? Optimally, practitioners need to follow a model of evidence-based psychotherapy practice, such as the disciplined inquiry or local clinical scientist model, that encompasses a theoretical formulation, empirically supported treatments (ESTs), empirically supported therapy relationships, clinicians' accumulated practical

  19. 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…

  20. The Concept of Evidence in Evidence-Based Practice

    ERIC Educational Resources Information Center

    Kvernbekk, Tone

    2011-01-01

    There exists a vast literature on evidence-based practice (EBP) in education. The debate branches out in several directions, for example, what EBP entails for the nature of educational practice, what it entails for the teaching profession, what counts as use and abuse of evidence, and what educational research could or should contribute to a what…

  1. 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…

  2. How Evidence-Based Practices Contribute to Community Integration

    Microsoft Academic Search

    Gary R. Bond; Michelle P. Salyers; Angela L. Rollins; Charles A. Rapp; Anthony M. Zipple

    2004-01-01

    Since the groundbreaking work of the Robert Wood Johnson Conference in 1998 identifying six evidence-based practices (EBPs) for people with severe mental illness (SMI), the mental health field has moved in the direction of re-examination and redesign of service systems. Surprisingly, one area that has not been fully explicated is the role that EBPs play in promoting community integration. In

  3. 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.

  4. Evidence-Based Practice in the Social Services

    Microsoft Academic Search

    Michelle Johnson; Michael J. Austin

    2008-01-01

    Evidence-based practice integrates individual practitioner expertise with the best available evidence while also considering the values and expectations of clients. Research can be categorized into two broad areas: primary (experiments, clinical trials, and surveys) and secondary research (overviews of major studies, practice guidelines, and decision and economic analyses). One of the major challenges to incorporating research evidence into organizational life

  5. Qualitative research in evidence-based practice: a valuable partnership

    Microsoft Academic Search

    Lisa Given

    2006-01-01

    Purpose – The purpose of this paper is to discuss the nature of the qualitative research paradigm, with a particular emphasis on the marginalization of qualitative approaches within the current discourse of evidence-based librarianship. Design\\/methodology\\/approach – The paper presents examples of qualitative research in the field of library and information studies, reviews the discourse of EBL as it relates to

  6. Determining Evidence-Based Practices in Special Education

    ERIC Educational Resources Information Center

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

    2009-01-01

    Determining evidence-based practices is a complicated enterprise that requires analyzing the methodological quality and magnitude of the available research supporting specific practices. This article reviews criteria and procedures for identifying what works in the fields of clinical psychology, school psychology, and general education; and it…

  7. An introduction to evidence-based practice for hand therapists

    Microsoft Academic Search

    Joy C. MacDermid

    2004-01-01

    Evidence-based practice (EBP) is a methodologic approach to clinical practice in which evidence is used to reach an informed decision when making a diagnosis, selecting a diagnostic test, picking an intervention, or determining a prognosis. Finding the best evidence through searching and critical appraisal of the methodologic quality of clinical evidence are essential steps. Matching clinical recommendations to the level

  8. Teaching Evidence-Based Medicine: A Regional Dissemination Model.

    ERIC Educational Resources Information Center

    Leipzig, Rosanne M.; Wallace, Eleanor Z.; Smith, Lawrence G.; Sullivant, Jean; Dunn, Kathel; McGinn, Thomas

    2003-01-01

    Described and evaluated an interactive course designed to create a cadre of medical school faculty in New York who could integrate evidence-based medicine into their training programs. Findings for representatives of 30 internal medicine residency programs show the usefulness of the regional dissemination model used. (SLD)

  9. 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…

  10. Evidence-Based Practice: A Potential Approach for Effective Coaching

    Microsoft Academic Search

    Dianne R. Stober; David Drake

    As coaching develops as an emerging profession, it is vital for coaches to begin integrating evidence from both coaching-specific research and related disciplines, their own expertise, and an understanding of the uniqueness of each client. Evidence-based practice (EBP) encompasses these three endeavors in designing interventions aimed at positive growth and change for their recipients. While coaching does not have an

  11. 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.…

  12. Specific dermatoses of pregnancy: An evidence-based systematic review

    Microsoft Academic Search

    George Kroumpouzos; Lisa M. Cohen

    2003-01-01

    Objective: We conducted an evidence-based systematic analysis of the literature on specific dermatoses of pregnancy. Study Design: The bibliographic databases MEDLINE and EMBASE were screened for studies and reports in all languages about herpes gestationis, pruritic urticarial papules and plaques of pregnancy, pruritic folliculitis of pregnancy, and prurigo of pregnancy from January 1962 to January 2002. As main index terms,

  13. Green Cities | Cheap Change Evidence-Based | Math Sleuth

    E-print Network

    Papautsky, Ian

    ResearchUC june 2011 Green Cities | Cheap Change Evidence-Based | Math Sleuth #12;CV UCResea, Kim Burdett, Katy Cosse, Dawn Fuller, Amanda Harper, Keith Herrell, Angela Koenig, Katie Pence, M on the system, not the patient 6 Metal Smith Quicker reactions from cheaper metals 10 Growing Green Cities

  14. 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,…

  15. Teaching Evidence-based Medicine: Caveats and Challenges.

    ERIC Educational Resources Information Center

    Welch, H. Gilbert; Lurie, Jon D.

    2000-01-01

    Discusses three caveats to the evidence-based paradigm in medical education: (1) detection of abnormalities that may not ever be overtly expressed inflates apparent diagnostic test performance; (2) probability revision is valuable primarily as an exercise to gain qualitative insights; and (3) patients are likely to be interested in more than just…

  16. Arbitrary Metrics: Implications for Identifying Evidence-Based Treatments

    ERIC Educational Resources Information Center

    Kazdin, Alan E.

    2006-01-01

    Research designed to establish the empirical underpinnings of psychotherapy relies heavily on arbitrary metrics, and researchers often do not know if clients receiving an evidence-based treatment have improved in everyday life or changed in a way that makes a difference, apart from the changes the arbitrary metrics may have shown. In other words,…

  17. Device-Associated Infections Rates and Mortality in Intensive Care Units of Peruvian Hospitals. International Nosocomial Infection Control Consortium (INICC) Findings

    Microsoft Academic Search

    Luis Cuellar; Eduardo Fernández Maldonado; Victor D Rosenthal; Alex Castañeda Sabogal; Rosa Rosales; Manuel Jesús Mayorga Espichan; Luis Camacho Cosavalente; Luis Isidro Castillo Bravo; Yudy Gamio Cárdenas; Mirtha Arroyo Lezma; María Linares Cáceres; Teodoro Rodríguez; Iliana Paredes Goicochea

    Objective: We sought to measure Device-associated infection (DAI) rates, microbiological profile, bacterial resistance, and attributable mortality in intensive care units (ICUs) in hospitals members of the International Nosocomial Infection Control Consortium (INICC) in Peru. Methods: Prospective cohort surveillance of DAIs was done in four ICUs in four hospitals applying the definitions of the CDC-NNIS System. Results: From September 2003 to

  18. A Case-Control Study of Risk Factors Associated with Scrub Typhus Infection in Beijing, China

    PubMed Central

    Zhang, Liqin; Dou, Xiangfeng; Wang, Xiaomei; Li, Weihong; Zhang, Xiuchun; Sun, Yulan; Guan, Zengzhi; Li, Xinyu; Wang, Quanyi

    2013-01-01

    To investigate the risk factors of scrub typhus infection in Beijing, China, a case-control study was carried out. Cases (n?=?56) were defined as persons who were diagnosed by PCR and serological method within three years. Three neighborhood control subjects were selected by matching for age and occupation. Living at the edge of the village, living in the houses near grassland, vegetable field or ditch, house yard without cement floor, piling weeds in the house or yard, all of these were risk factors for scrub typhus infection. Working in vegetable fields and hilly areas, and harvesting in autumn posed the highest risks, with odds ratios (ORs) and 95% confidence intervals (CIs) of 3.7 (1.1–11.9), 8.2 (1.4–49.5), and 17.2 (5.1–57.9), respectively. These results would be useful for the establishment of a detail control strategy for scrub typhus infection in Beijing, China. PMID:23691083

  19. A case-control study of risk factors associated with scrub typhus infection in Beijing, China.

    PubMed

    Lyu, Yanning; Tian, Lili; Zhang, Liqin; Dou, Xiangfeng; Wang, Xiaomei; Li, Weihong; Zhang, Xiuchun; Sun, Yulan; Guan, Zengzhi; Li, Xinyu; Wang, Quanyi

    2013-01-01

    To investigate the risk factors of scrub typhus infection in Beijing, China, a case-control study was carried out. Cases (n?=?56) were defined as persons who were diagnosed by PCR and serological method within three years. Three neighborhood control subjects were selected by matching for age and occupation. Living at the edge of the village, living in the houses near grassland, vegetable field or ditch, house yard without cement floor, piling weeds in the house or yard, all of these were risk factors for scrub typhus infection. Working in vegetable fields and hilly areas, and harvesting in autumn posed the highest risks, with odds ratios (ORs) and 95% confidence intervals (CIs) of 3.7 (1.1-11.9), 8.2 (1.4-49.5), and 17.2 (5.1-57.9), respectively. These results would be useful for the establishment of a detail control strategy for scrub typhus infection in Beijing, China. PMID:23691083

  20. Herbal traditional Chinese medicine and its evidence base in gastrointestinal disorders

    PubMed Central

    Teschke, Rolf; Wolff, Albrecht; Frenzel, Christian; Eickhoff, Axel; Schulze, Johannes

    2015-01-01

    Herbal traditional Chinese medicine (TCM) is used to treat several ailments, but its efficiency is poorly documented and hence debated, as opposed to modern medicine commonly providing effective therapies. The aim of this review article is to present a practical reference guide on the role of herbal TCM in managing gastrointestinal disorders, supported by systematic reviews and evidence based trials. A literature search using herbal TCM combined with terms for gastrointestinal disorders in PubMed and the Cochrane database identified publications of herbal TCM trials. Results were analyzed for study type, inclusion criteria, and outcome parameters. Quality of placebo controlled, randomized, double-blind clinical trials was poor, mostly neglecting stringent evidence based diagnostic and therapeutic criteria. Accordingly, appropriate Cochrane reviews and meta-analyses were limited and failed to support valid, clinically relevant evidence based efficiency of herbal TCM in gastrointestinal diseases, including gastroesophageal reflux disease, gastric or duodenal ulcer, dyspepsia, irritable bowel syndrome, ulcerative colitis, and Crohn’s disease. In conclusion, the use of herbal TCM to treat various diseases has an interesting philosophical background with a long history, but it received increasing skepticism due to the lack of evidence based efficiency as shown by high quality trials; this has now been summarized for gastrointestinal disorders, with TCM not recommended for most gastrointestinal diseases. Future studies should focus on placebo controlled, randomized, double-blind clinical trials, herbal product quality and standard criteria for diagnosis, treatment, outcome, and assessment of adverse herb reactions. This approach will provide figures of risk/benefit profiles that hopefully are positive for at least some treatment modalities of herbal TCM. Proponents of modern herbal TCM best face these promising challenges of pragmatic modern medicine by bridging the gap between the two medicinal cultures. PMID:25914456

  1. Evaluation of Copper Supplementation to Control Haemonchus contortus Infections of Sheep in Sweden

    PubMed Central

    Waller, PJ; Bernes, G; Rudby-Martin, L; Ljungström, B-L; Rydzik, A

    2004-01-01

    A pen study was conducted to assess the effect of providing daily copper mineral supplement, or copper wire particle (COWP) capsules, on established or incoming mixed nematode infections in young sheep. For lambs with established (6 week old) infections, COWP resulted in 97% and 56% reduction of the adult and early L4 stages of H. contortus, respectively, compared with controls (p < 0.001). Additionally there was a 74% reduction in Teladorsagia circumcincta infections in the COWP lambs compared with controls (p < 0.01). However, no effect was observed when COWP were given at the commencement of a larval dosing period of 6 weeks. There was no significant effect of copper mineral supplement (given at the recommended rate to prevent Cu deficiency) on either established, or developing parasite infections. In addition, a field trial was conducted on a commercial farm to assess the effects of COWP in the management of recurrent H. contortus infections, but lack of parasites during the grazing season prevented an adequate assessment from being made. These results indicate that there is little, if any, benefit from a parasite control standpoint in recommending copper therapy, specifically to control parasites in Swedish sheep flocks. PMID:15663075

  2. Advancing the evidence base in cancer: psychosocial multicenter trials

    PubMed Central

    2012-01-01

    Background The diagnosis and treatment of cancer is associated with significant distress and psychosocial morbidity. Although psychosocial interventions have been developed in an attempt to improve psychosocial outcomes in cancer patients and survivors, there is continued debate about whether there is adequate high-level evidence to establish the effectiveness of these interventions. The evidence base is limited as a result of numerous challenges faced by those attempting to conduct psychosocial intervention trials within the health system. Barriers include insufficient participant recruitment, difficulty generalizing from single-trial studies, difficulty in building and managing research teams with multidisciplinary expertise, lack of research design expertise and a lack of incentives for researchers conducting intervention research. To strengthen the evidence base, more intervention studies employing methodologically rigorous research designs are necessary. Methods In order to advance the evidence base of interventions designed to improve psychosocial outcomes for cancer patients and survivors, we propose the formation of a collaborative trials group that conducts multicenter trials to test the effectiveness of such interventions. Results Establishment of such a group would improve the quality of the evidence base in psychosocial research in cancer patients, by increasing support for conducting intervention research and providing intervention research training opportunities. A multidisciplinary collaborative group conducting multicenter trials would have the capacity to overcome many of the barriers that currently exist. Conclusions A stronger evidence base is necessary to identify effective psychosocial interventions for cancer patients. The proposed formation of a psycho-oncology collaborative trials group that conducts multicenter trials to test the effectiveness of psychosocial interventions would assist in achieving this outcome. PMID:22992443

  3. 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

  4. 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…

  5. 78 FR 62636 - Healthcare Infection Control Practices Advisory Committee (HICPAC)

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-10-22

    ...meetings and other committee management activities, for both the Centers for Disease Control and Prevention and the Agency for Toxic Substances and Disease Registry. Elaine L. Baker, Director, Management Analysis and Services Office, Centers for...

  6. New technologies for the control of human hookworm infection.

    PubMed

    Hotez, Peter J; Bethony, Jeff; Bottazzi, Maria Elena; Brooker, Simon; Diemert, David; Loukas, Alex

    2006-07-01

    Since the 1990s, the major approach to hookworm control has been morbidity reduction in school-aged children by periodic deworming with benzimidazoles. Now, efforts are underway to determine the feasibility of integrating deworming with control programs that target other neglected tropical diseases. However, the sustainability of benzimidazole deworming for hookworm is of concern because of the variable efficacy of mebendazole, high rates of post-treatment reinfection and possible development of drug resistance. This requires parallel efforts to develop new and complementary hookworm control tools, such as new anthelmintic drugs (e.g. tribendimidine) and a recombinant hookworm vaccine. It is hoped that, ultimately, anthelmintic vaccination will be linked to deworming as part of an expanded control package. PMID:16709466

  7. Predictive models of control strategies involved in containing indoor airborne infections.

    PubMed

    Chen, S-C; Chang, C-F; Liao, C-M

    2006-12-01

    Recently developed control measure modeling approaches for containing airborne infections, including engineering controls with respiratory protection and public health interventions, are readily amenable to an integrated-scale analysis. Here we show that such models can be derived from an integrated-scale analysis generated from three different types of functional relationship: Wells-Riley mathematical model, competing-risks model, and Von Foerster equation, both of the key epidemiological determinants involved and of the functional connections between them. We examine mathematically the impact of engineering control measures such as enhanced air exchange and air filtration rates with personal masking combined with public health interventions such as vaccination, isolation, and contact tracing in containing the spread of indoor airborne infections including influenza, chickenpox, measles, and severe acute respiratory syndrome (SARS). If enhanced engineering controls could reduce the basic reproductive number (R0) below 1.60 for chickenpox and 3 for measles, our simulations show that in such a prepared response with public health interventions would have a high probability of containing the indoor airborne infections. Combinations of engineering control measures and public health interventions could moderately contain influenza strains with an R0 as high as 4. Our analysis indicates that effective isolation of symptomatic patients with low-efficacy contact tracing is sufficient to control a SARS outbreak. We suggest that a valuable added dimension to public health inventions could be provided by systematically quantifying transmissibility and proportion of asymptomatic infection of indoor airborne infection. Practical Implications We have developed a flexible mathematical model that can help determine the best intervention strategies for containing indoor airborne infections. The approach presented here is scalable and can be extended to include additional control efficacies. If a newly emergent airborne infection should appear, the model could be quickly calibrated to data and intervention options at the early stage of the outbreak. Data could be provided from the field to estimate value of R0, the serial interval between cases, the distributions of the latent, incubation, and infectious periods, case fatality rates, and secondary spread within important mixing groups. The combination of enhanced engineering control measures and assigned effective public health interventions would have a high probability for containing airborne infection. PMID:17100668

  8. Global epidemiology, ecology and control of soil-transmitted helminth infections

    PubMed Central

    Brooker, Simon; Clements, Archie CA; Bundy, Don AP

    2007-01-01

    Soil-transmitted helminth (STH) infections are among the most prevalent of chronic human infections worldwide. Based on the demonstrable impact on child development, there is a global commitment to finance and implement control strategies with a focus on school-based chemotherapy programmes. The major obstacle to the implementation of cost-effective control is the lack of accurate descriptions of the geographical distribution of infection. In recent years considerable progress has been made in the use of geographical information systems (GIS) and remote sensing (RS) to better understand helminth ecology and epidemiology, and to develop low cost ways to identify target populations for treatment. This chapter explores how this information has been used practically to guide large-scale control programmes. The use of satellite-derived environmental data has yielded new insights into the ecology of infection at a geographical scale that has proven impossible to address using more traditional approaches, and has in turn allowed spatial distributions of infection prevalence to be predicted robustly by statistical approaches. GIS/RS have increasingly been used in the context of large-scale helminth control programmes, including not only STH infections but also those focusing on schistosomiasis, filariasis and onchocerciasis. The experience indicates that GIS/RS provides a cost-effective approach to designing and monitoring programs at realistic scale. Importantly, the use of this approach has begun to transition from being a specialist approach of international vertical programs to become a routine tool in developing public sector control programs. GIS/RS is used here to describe the global distribution of STH infections and to estimate the number of infections in school age children in sub-Saharan Africa (89.9 million) and the annual cost of providing a single anthelmintic treatment using a school-based approach (US$5.0-7.6 million). These are the first estimates at a continental scale to explicitly include the fine spatial distribution of infection prevalence and population, and suggest that traditional methods have overestimated the situation. The results suggest that continent-wide control of parasites is, from a financial perspective, an attainable goal. PMID:16647972

  9. Thermal injury induces impaired function in polymorphonuclear neutrophil granulocytes and reduced control of burn wound infection

    PubMed Central

    Calum, H; Moser, C; Jensen, P Ø; Christophersen, L; Maling, D S; van Gennip, M; Bjarnsholt, T; Hougen, H P; Givskov, M; Jacobsen, G K; Høiby, N

    2009-01-01

    Severe thermal injury induces immunosuppression, involving all parts of the immune system, especially when large fractions of the total body surface area are affected. An animal model was established to characterize the burn-induced immunosuppression. In our novel mouse model a 6% third-degree burn injury was induced in mice with a hot-air blower. The third-degree burn was confirmed histologically. The mice were allocated into five groups: control, shave, burn, infection and burn infection group. At 48 h, a decline in the concentration of peripheral blood leucocytes was observed in the group of mice with burn wound. The reduction was ascribed to the decline in concentration of polymorphonuclear neutrophil leucocytes and monocytes. When infecting the skin with Pseudomonas aeruginosa, a dissemination of bacteria was observed only in the burn wound group. Histological characterization of the skin showed a more polymorphonuclear neutrophil granulocytes (PMNs)-dominated inflammation in the group of mice with infected burn wound compared with the with burn wound group. In contrast, a higher degree of inflammation was observed in the burn wound group compared with the group of mice with infected burn wound. Furthermore, the oxidative burst and the phagocytic capacity of the PMNs were reduced in the group of mice with burn wound. Using this novel mouse model of thermal injury a decline of peripheral leucocytes was observed, whereas the increased local inflammatory response at the site of infection showed reduced capacity to contain and eliminate the infection. PMID:19210518

  10. Mental Health Provider Attitudes Toward Adoption of Evidence-Based Practice: The Evidence-Based Practice Attitude Scale (EBPAS)

    Microsoft Academic Search

    Gregory A. Aarons

    2004-01-01

    Mental health provider attitudes toward organizational change have not been well studied. Dissemination and implementation of evidence-based practices (EBPs) into real-world settings represent organizational change that may be limited or facilitated by provider attitudes toward adoption of new treatments, interventions, and practices. A brief measure of mental health provider attitudes toward adoption of EBPs was developed and attitudes were examined

  11. Finding Evidence-Based Answers to Clinical Questions Quickly and Effectively See also the Biomedical Libraries' Evidence-Based Medicine Research Guide

    E-print Network

    for the treatment of Alzheimer's? Clinical Pharmacology Online Micromedex Epocrates Online evidenceFinding Evidence-Based Answers to Clinical Questions ­ Quickly and Effectively See also the Biomedical Libraries' Evidence-Based Medicine Research Guide Finding Evidence-Based Answers to Clinical

  12. Kinetics of Myeloid Dendritic Cell Trafficking and Activation: Impact on Progressive, Nonprogressive and Controlled SIV Infections

    PubMed Central

    Wijewardana, Viskam; Kristoff, Jan; Xu, Cuiling; Ma, Dongzhu; Haret-Richter, George; Stock, Jennifer L.; Policicchio, Benjamin B.; Mobley, Adam D.; Nusbaum, Rebecca; Aamer, Hadega; Trichel, Anita; Ribeiro, Ruy M.; Apetrei, Cristian; Pandrea, Ivona

    2013-01-01

    We assessed the role of myeloid dendritic cells (mDCs) in the outcome of SIV infection by comparing and contrasting their frequency, mobilization, phenotype, cytokine production and apoptosis in pathogenic (pigtailed macaques, PTMs), nonpathogenic (African green monkeys, AGMs) and controlled (rhesus macaques, RMs) SIVagmSab infection. Through the identification of recently replicating cells, we demonstrated that mDC mobilization from the bone marrow occurred in all species postinfection, being most prominent in RMs. Circulating mDCs were depleted with disease progression in PTMs, recovered to baseline values after the viral peak in AGMs, and significantly increased at the time of virus control in RMs. Rapid disease progression in PTMs was associated with low baseline levels and incomplete recovery of circulating mDCs during chronic infection. mDC recruitment to the intestine occurred in all pathogenic scenarios, but loss of mucosal mDCs was associated only with progressive infection. Sustained mDC immune activation occurred throughout infection in PTMs and was associated with increased bystander apoptosis in blood and intestine. Conversely, mDC activation occurred only during acute infection in nonprogressive and controlled infections. Postinfection, circulating mDCs rapidly became unresponsive to TLR7/8 stimulation in all species. Yet, stimulation with LPS, a bacterial product translocated in circulation only in SIV-infected PTMs, induced mDC hyperactivation, apoptosis and excessive production of proinflammatory cytokines. After infection, spontaneous production of proinflammatory cytokines by mucosal mDCs increased only in progressor PTMs. We thus propose that mDCs promote tolerance to SIV in the biological systems that lack intestinal dysfunction. In progressive infections, mDC loss and excessive activation of residual mDCs by SIV and additional stimuli, such as translocated microbial products, enhance generalized immune activation and inflammation. Our results thus provide a mechanistic basis for the role of mDCs in the pathogenesis of AIDS and elucidate the causes of mDC loss during progressive HIV/SIV infections. PMID:24098110

  13. Effectiveness of an evidence-based chiropractic continuing education workshop on participant knowledge of evidence-based health care

    PubMed Central

    Feise, Ronald J; Grod, Jaroslaw P; Taylor-Vaisey, Anne

    2006-01-01

    Background Chiropractors must continue to learn, develop themselves professionally throughout their careers, and become self-directed and lifelong learners. Using an evidence-based approach increases the probability of optimal patient outcomes. But most chiropractors lack knowledge and interest in evidence-based approaches. The purpose of this study was to develop and measure the effectiveness of evidence-based training for chiropractic practitioners in a continuing education setting. Methods We developed and evaluated a continuing education workshop on evidence-based principles and methods for chiropractic practitioners. Forty-seven chiropractors participated in the training and testing. The course consisted of 12.5 hours of training in which practitioners learned to develop focused questions, search electronic data bases, critically review articles and apply information from the literature to specific clinical questions. Following the workshop, we assessed the program performance through the use of knowledge testing and anonymous presentation quality surveys. Results Eighty-five percent of the participants completed all of the test, survey and data collection items. Pretest knowledge scores (15-item test) were low (47%). Post intervention scores (15-item test) improved with an effect size of 2.0. A 59-item knowledge posttest yielded very good results (mean score 88%). The quality of presentation was rated very good, and most participants (90%) would "definitely recommend" or "recommend" the workshop to a colleague. Conclusion The results of the study suggest that the continuing education course was effective in enhancing knowledge in the evidence-based approach and that the presentation was well accepted. PMID:16930482

  14. International Nosocomial Infection Control Consortium (INICC) report, data summary for 2003-2008, issued June 2009.

    PubMed

    Rosenthal, Victor D; Maki, Dennis G; Jamulitrat, Silom; Medeiros, Eduardo A; Todi, Subhash Kumar; Gomez, David Yepes; Leblebicioglu, Hakan; Abu Khader, Ilham; Miranda Novales, María Guadalupe; Berba, Regina; Ramírez Wong, Fernando Martín; Barkat, Amina; Pino, Osiel Requejo; Dueñas, Lourdes; Mitrev, Zan; Bijie, Hu; Gurskis, Vaidotas; Kanj, S S; Mapp, Trudell; Hidalgo, Rosalía Fernández; Ben Jaballah, Nejla; Raka, Lul; Gikas, Achilleas; Ahmed, Altaf; Thu, Le Thi Anh; Guzmán Siritt, María Eugenia

    2010-03-01

    We report the results of the International Infection Control Consortium (INICC) surveillance study from January 2003 through December 2008 in 173 intensive care units (ICUs) in Latin America, Asia, Africa, and Europe. During the 6-year study, using Centers for Disease Control and Prevention (CDC) US National Healthcare Safety Network (NHSN; formerly the National Nosocomial Infection Surveillance system [NNIS]) definitions for device-associated health care-associated infection, we collected prospective data from 155,358 patients hospitalized in the consortium's hospital ICUs for an aggregate of 923,624 days. Although device utilization in the developing countries' ICUs was remarkably similar to that reported from US ICUs in the CDC's NHSN, rates of device-associated nosocomial infection were markedly higher in the ICUs of the INICC hospitals: the pooled rate of central venous catheter (CVC)-associated bloodstream infections (BSI) in the INICC ICUs, 7.6 per 1000 CVC-days, is nearly 3-fold higher than the 2.0 per 1000 CVC-days reported from comparable US ICUs, and the overall rate of ventilator-associated pneumonia (VAP) was also far higher, 13.6 versus 3.3 per 1000 ventilator-days, respectively, as was the rate of catheter-associated urinary tract infection (CAUTI), 6.3 versus 3.3 per 1000 catheter-days, respectively. Most strikingly, the frequencies of resistance of Staphylococcus aureus isolates to methicillin (MRSA) (84.1% vs 56.8%, respectively), Klebsiella pneumoniae to ceftazidime or ceftriaxone (76.1% vs 27.1%, respectively), Acinetobacter baumannii to imipenem (46.3% vs 29.2%, respectively), and Pseudomonas aeruginosa to piperacillin (78.0% vs 20.2%, respectively) were also far higher in the consortium's ICUs, and the crude unadjusted excess mortalities of device-related infections ranged from 23.6% (CVC-associated bloodstream infections) to 29.3% (VAP). PMID:20176284

  15. Control of Ditylenchus dipsaci in Infected Garlic Seed Cloves by Nonfumigant Nematicides

    PubMed Central

    Roberts, P. A.; Greathead, A. S.

    1986-01-01

    Different rates of granular formulations ofaldicarb, carbofuran, ethoprop, fensulfothion, and phenamiphos were applied directly onto garlic seed cloves in the seed furrow in sandy clay loam, clay loam, and loam soils at planting to assess efficacy for control of Ditylenchus dipsaci in infected seed cloves. All treatments were compared to hotwater-formalin clove dip disinfection treatment and to nontreated infected controls. Aldicarb and phenamiphos at 2.52 and 5.04 kg a.i./ ha, but not at lower rates, effectively suppressed infection by D. dipsaci and increased yields. Although both nematicides slightly slowed the rate of plant emergence, normal stands were established. Trace levels of infection occurred in all treatments, including the hotwater-formalin dip. Carbofuran at 5.04 kg a.i./ha controlled the nematode but was phytotoxic. Ethoprop was phytotoxic. Fensulfothion did not control D. dipsaci even at the highest application rate, 8.90 kg a.i./ha. Single and multiple applications of oxamyl at 1.12-8.96 kg a.i./ha, applied as a surface spray or in furrow irrigation water, slowed the early progression of disease symptoms but failed to provide season-long nematode control. PMID:19294142

  16. A limited role of iNKT cells in controlling systemic Candida albicans infections.

    PubMed

    Tarumoto, Norihito; Kinjo, Yuki; Ueno, Keigo; Okawara, Akiko; Watarai, Hiroshi; Taniguchi, Masaru; Maesaki, Shigefumi; Miyazaki, Yoshitsugu

    2012-01-01

    Candida albicans is a major cause of invasive fungal infections. Mortality attributable to candidemia is very high, even when patients are treated with adequate antifungal agents. Therefore, it is important to investigate the mechanisms of immune response to C. albicans. Invariant natural killer T (iNKT) cells, innate lymphocytes that express an invariant T cell receptor ? chain, participate in the response to various microbes, including two fungal pathogens, Aspergillus fumigatus and Cryptococcus neoformans. However, it is unknown whether iNKT cells play a role in the immune response to C. albicans. In this study, we have investigated the role of iNKT cells in the host defense against systemic C. albicans infection in mice. We compared the survival and fungal clearance between control mice and J?18KO mice, which specifically lack iNKT cells, after intravenous C. albicans infection. There was no difference in the survival and fungal burden in the kidneys of the control and J?18KO mice. Furthermore, production of inflammatory cytokines in several organs during C. albicans infection did not significantly differ between these two groups. These results suggest that iNKT cells play a minor role in controlling systemic C. albicans infections in mice. PMID:23183205

  17. Evidence-Based Special Education and Professional Wisdom: Putting It All Together

    Microsoft Academic Search

    Bryan G. Cook; Melody Tankersley; Sanna Harjusola-Webb

    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 special educators will be necessary for evidence-based practices to be implemented effectively and result

  18. The barriers to achieving an evidence base for bitemark analysis.

    PubMed

    Pretty, Iain A

    2006-05-15

    Forensic dentistry is the union of two scientific disciplines, both of which are undergoing a renewed scientific rigor. In forensic science the advent of the Daubert ruling has required that judges assess the forensic value of 'expert testimony' ensuring that techniques, methodologies and practices are not only commonly accepted (as was the previous hurdle during the Frye era) but that error rates, assessment of reliability and validation studies are published to support their use. This new degree of judicial scrutiny has been mirrored in the field of dentistry itself, where organisations search and summarise randomised controlled trials in order to recommend best practice and devise clinical care pathways that are firmly grounded in proven scientific research. Despite the obvious drive from both of these professions, forensic dentistry, and in particular the sub-discipline of bitemark analysis, has been remarkably slow to address the obvious deficiencies in the evidence base that underpins this element of forensic science. Reviews of the literature reveal that the vast majority of published works are case reports, and very little primary literature exists. This paper reviews those studies that have assessed aspects of bitemark analysis including the crucial issue of the uniqueness of the human dentition; the application of transparent overlays and the application of statistical probabilities in bitemark conclusions. There are numerous barriers to undertaking high quality research in the field of bitemark analysis, the most important of which is the use of a gold-standard that is acceptable both in terms of diagnostic research but is also forensically relevant. If bitemark analysis is to continue to play a role in the judicial process then there is an urgent need for high quality studies that meet the levels of forensic and scientific scrutiny applied to other disciplines within the criminal justice system. Studies are required to determine not that the human dentition is unique, but how this asserted uniqueness is represented on human skin and other substrates. The error rates associated with the analysis of bitemarks are required on a procedural level as well as an individual practitioner basis and scales and interpretative indices of bitemark severity and forensic significance should be validated and introduced into common use. PMID:16540273

  19. Repurposing drugs for the treatment and control of helminth infections

    PubMed Central

    Panic, Gordana; Duthaler, Urs; Speich, Benjamin; Keiser, Jennifer

    2014-01-01

    Helminth infections are responsible for a considerable public health burden, yet the current drug armamentarium is small. Given the high cost of drug discovery and development, the high failure rates and the long duration to develop novel treatments, drug repurposing circumvents these obstacles by finding new uses for compounds other than those they were initially intended to treat. In the present review, we summarize in vivo and clinical trial findings testing clinical candidates and marketed drugs against schistosomes, food-borne trematodes, soil-transmitted helminths, Strongyloides stercoralis, the major human filariases lymphatic filariasis and onchocerciasis, taeniasis, neurocysticercosis and echinococcosis. While expanding the applications of broad-spectrum or veterinary anthelmintics continues to fuel alternative treatment options, antimalarials, antibiotics, antiprotozoals and anticancer agents appear to be producing fruitful results as well. The trematodes and nematodes continue to be most investigated, while cestodal drug discovery will need to be accelerated. The most clinically advanced drug candidates include the artemisinins and mefloquine against schistosomiasis, tribendimidine against liver flukes, oxantel pamoate against trichuriasis, and doxycycline against filariasis. Preclinical studies indicate a handful of promising future candidates, and are beginning to elucidate the broad-spectrum activity of some currently used anthelmintics. Challenges and opportunities are further discussed. PMID:25516827

  20. Assessment of oral mucositis in adult and pediatric oncology patients: an evidence-based approach.

    PubMed

    Farrington, Michele; Cullen, Laura; Dawson, Cindy

    2010-01-01

    Oral mucositis is a frequent side effect of cancer treatment and can lead to delayed treatment, reduced treatment dosage, altered nutrition, dehydration, infections, xerostomia, pain, and higher healthcare costs. Mucositis is defined as "inflammatory lesions of the oral and/or gastrointestinal tract caused by high-dose cancer therapies. Alimentary tract mucositis refers to the expression of mucosal injury across the continuum of oral and gastrointestinal mucosa, from the mouth to the anus" (Peterson, Bensadoun, & Roila, 2008, p. ii122). Evidence demonstrates that oral mucositis is quite distressing for patients. In addition, the majority of oncology nurses are unaware of available guidelines related to the care of oral mucositis. A multidisciplinary Oral Mucositis Committee was formed by the University of Iowa Hospitals and Clinics to develop evidence-based prevention and treatment strategies for adult and pediatric oncology patients experiencing oral mucositis. The first step was implementing an evidence-based nursing oral assessment. The Iowa Model was used to guide this evidence-based practice initiative. The Oral Assessment Guide (OAG) is reliable and valid, feasible, and sensitive to changing conditions. The OAG was piloted on an Adult Leukemia and Bone Marrow Transplant Unit leading to modification and adaptation. The pilot evaluation found 87% of patients had an abnormal oral assessment involving all categories in the tool. Nursing questionnaires showed that staff (8/23; 35% response) felt they were able to identify at risk patients using the OAG (3.3; 1-4 scale), and the tool accurately identifies mucosal changes (2.9; 1-4 scale). A knowledge assessment found nurses correctly identified OAG components 63% of the time. Unlike results from a national survey, most University of Iowa Hospitals and Clinics nurses (63%) were aware of national guidelines for prevention and treatment of oral mucositis. Developing an evidence-based nursing policy and updating documentation systems was done before implementation occurred. Computer-based and printed educational materials were developed for nursing staff caring for oncology patients. Team members were responsible for facilitating adoption in clinical areas. After organizational roll out, the nursing assessment was documented in all patients 87% of the time, and 99% for inpatients. The highest risk population, head and neck cancer patients receiving radiation, had documentation in 88% of audited visits. Other clinics required further work. Changing the system to the electronic medical record created an additional need for integration of the evidence-based practice with housewide documentation of oral assessment being completed 60.9% of the time. Use of an evidence-based assessment is the first step in a comprehensive program to reduce a common and highly distressing side effect of cancer treatment. Nursing documentation of oral assessment is well integrated on inpatient units. Opportunities for improvement remain in ambulatory care. Multidisciplinary team collaborations to expand evidence-based assessment and research questions generated from this work will be shared. PMID:20863028

  1. Use of Evidence-Based Primary and Secondary Cardiac Prevention Therapy Among Outpatients with Atrial Fibrillation

    PubMed Central

    Hess, Paul L.; Kim, Sunghee; Piccini, Jonathan P; Allen, Larry A.; Ansell, Jack E.; Chang, Paul; Freeman, James V.; Gersh, Bernard J.; Kowey, Peter R.; Mahaffey, Kenneth W.; Thomas, Laine; Peterson, Eric D.; Fonarow, Gregg C.

    2013-01-01

    Background Patients with atrial fibrillation often have cardiovascular risk factors or known comorbid disease, yet the use of evidence-based primary and secondary prevention cardiac therapy among atrial fibrillation outpatients is unknown. Methods Using baseline data collected between June 2010 and August 2011 from 174 sites participating in ORBIT-AF, a US national registry of patients with atrial fibrillation coordinated from Durham, NC, USA, we examined professional guideline -recommended evidence-based therapy use for cardiovascular comorbid conditions and risk factors. Multivariable logistic regression was used to identify factors associated with receipt of all indicated evidence-based therapy. Results Among 10096 enrolled patients, 93.5% were eligible for one or more evidence-based therapy. Among those eligible, 46.6% received all indicated therapies: 62.3% received an antiplatelet agent, 72.3% received a ?-blocker, 59.5% received an angiotensin converting enzyme or angiotensin receptor blocker, 15.3% received an aldosterone antagonist, 65.7% received a statin, and 58.8% received implantable cardioverter-defibrillator. A minority of patients with coronary artery disease, diabetes mellitus, heart failure, and peripheral vascular disease received all indicated therapies (25.1%, 43.2%, 42.5%, and 43.4%, respectively). A total of 52.4% of patients had controlled hypertension and 74.6% of patients with hyperlipidemia received a statin. Factors associated with non-receipt of all indicated therapies included frailty, comorbid illness, geographic region, and antiarrhythmic drug therapy. Conclusions The majority of eligible atrial fibrillation outpatients did not receive all guideline-recommended therapies for cardiovascular comorbid conditions and risk factors. This represents a potential opportunity to improve atrial fibrillation patients’ quality of care and outcomes. PMID:23787195

  2. Measurement of perceptions of educational environment in evidence-based medicine.

    PubMed

    Bergh, Anne-Marie; Grimbeek, Jackie; May, Win; Gülmezoglu, A Metin; Khan, Khalid S; Kulier, Regina; Pattinson, Robert C

    2014-08-01

    In recent years, there has been a renewed interest in measuring perceptions regarding different aspects of the medical educational environment. A reliable tool was developed for measuring perceptions of the educational environment as it relates to evidence-based medicine as part of a multicountry randomised controlled trial to evaluate the effectiveness of a clinically integrated evidence-based medicine course. Participants from 10 specialties completed the questionnaire. A working dataset of 518 observations was available. Two independent subsets of data were created for conducting an exploratory factor analysis (n=244) and a confirmatory factor analysis (n=274), respectively. The exploratory factor analysis yielded five 67-item definitive instruments, with five to nine dimensions; all resulted in acceptable explanations of the total variance (range 56.6-65.9%). In the confirmatory factor analysis phase, all goodness of-fit measures were acceptable for all models (root mean square error of approximation ? 0.047; comparative fit index ? 0.980; normed ?(2) ? 1.647; Bentler-Bonett normed fit index ? 0.951). The authors selected the factorisation with seven dimensions (factor-7 instrument) as the most useful on pragmatic grounds and named it Evidence-Based Medicine Educational Environment Measure 67 (EBMEEM-67). Cronbach's ? for subscales ranged between 0.81 and 0.93. The subscales are: 'Knowledge and learning materials'; 'Learner support'; 'General relationships and support'; 'Institutional focus on EBM'; 'Education, training and supervision'; 'EBM application opportunities'; and 'Affirmation of EBM environment'. The EBMEEM-67 can be a useful diagnostic and benchmarking tool for evaluating the perceptions of residents of the environment in which evidence-based medicine education takes place. PMID:24688088

  3. An evidence-based approach to the management of uninvestigated dyspepsia in the era of Helicobacter pylori

    PubMed Central

    Veldhuyzen van Zanten, S J; Flook, N; Chiba, N; Armstrong, D; Barkun, A; Bradette, M; Thomson, A; Bursey, F; Blackshaw, P; Frail, D; Sinclair, P

    2000-01-01

    OBJECTIVES: To provide Canadian primary care physicians with an evidence-based clinical management tool, including diagnostic and treatment recommendations, for patients who present with uninvestigated dyspepsia. RECOMMENDATIONS: The management tool has 5 key decision steps addressing the following: (1) evidence that symptoms originate in the upper gastrointestinal tract, (2) presence of alarm features, (3) use of nonsteroidal anti-inflammatory drugs (NSAIDs), (4) dominant reflux symptoms and (5) evidence of Helicobacter pylori infection. All patients over 50 years of age who present with new-onset dyspepsia and patients who present with alarm features should receive prompt investigation, preferably by endoscopy. The management options for patients with uninvestigated dyspepsia who use NSAIDs regularly are: (1) to stop NSAID therapy and assess symptomatic response, (2) to treat with NSAID prophylaxis if NSAID therapy cannot be stopped or (3) to refer for investigation. Gastroesophageal reflux disease can be diagnosed clinically if the patient's dominant symptoms are heartburn or acid regurgitation, or both; these patients should be treated with acid suppressive therapy. The remaining patients should be tested for H. pylori infection, and those with a positive result should be treated with H. pylori-eradication therapy. Those with a negative result should have their symptoms treated with optimal antisecretory therapy or a prokinetic agent. VALIDATION AND EVIDENCE: Evidence for resolution of the dyspepsia symptoms was the main outcome measure. Supporting evidence for the 5 steps in the management tool and the recommendations for treatment were graded according to the strength of the evidence and were endorsed by consensus of committee members. If no randomized controlled clinical trials were available, the recommendations were based on the best available evidence. LITERATURE REVIEW: Evidence was obtained from MEDLINE searches for pertinent articles published from 1966 to October 1999. The searches focused on dyspepsia, diagnosis and treatment. Additional articles were retrieved through a manual search of bibliographies and abstracts from international gastroenterology conferences. PMID:10870511

  4. Comparison Test for Infection Control Barriers for Construction in Healthcare 

    E-print Network

    Bassett, Aimee

    2013-05-06

    . This experimental work is the first stage in a research program to develop better dust controls for construction at existing medical facilities to reduce the incidence of dust borne fungi, such as Aspergillus spp. To better protect at-risk patients from exposure...

  5. Chicken Industry Strategies for Control of Tumor Virus Infections

    Microsoft Academic Search

    KENTON S. KREAGER

    Marek's disease (MD) and lymphoid leukosis (LL) are two distinct viral diseases that cause tumor mortality in chickens. Marek's disease, being horizontally transmitted, is controlled through biosecu- rity measures and vaccination. Prevention of early exposure before vaccine immunity is established is most important. Some multi-house growing farms have converted to all single-age placements to break the ongoing cycle of transmission.

  6. Comparison Test for Infection Control Barriers for Construction in Healthcare

    E-print Network

    Bassett, Aimee

    2013-05-06

    . This experimental work is the first stage in a research program to develop better dust controls for construction at existing medical facilities to reduce the incidence of dust borne fungi, such as Aspergillus spp. To better protect at-risk patients from exposure...

  7. THE CONTROL OF BOVINE VIRAL DIARRHOEA VIRUS INFECTION HARKNESS JW

    E-print Network

    Paris-Sud XI, Université de

    diverses stratégies de contrôle possibles sont passées en revue et les problèmes liés à la vaccination sont and to debate significant advances in the context of control. In this paper, current ideas concerning policy will be examined, and finally the potential for vaccine use and the scope for development

  8. Control of food-borne infections and intoxications

    Microsoft Academic Search

    Hans-Jürgen Sinell

    1995-01-01

    Most food-borne diseases are caused by microorganisms that initially contaminate the living plant or animal or recontaminate the food during handling or processing. Control measures are intended to (1) prevent microorganisms from contaminating food and involve all hygienic production measures (raw material, premises, equipment, cleaning and disinfection, personnel); (2) prevent microorganisms both from growing or forming toxins, e.g. through chilling,

  9. Factors that influence effective evidence-based medicine instruction.

    PubMed

    Mi, Misa

    2013-01-01

    Evidence-based medicine (EBM) as a health care practice is being incorporated into education programs across the spectrum of medical education to develop lifelong learning skills and to enhance the practice of evidence-based health care. Since improving the quality of patient care is the ultimate goal of EBM, EBM learning must be integrated with clinical application, and resulted outcomes must be reflected in learning transfer (or EBM practice) within the context of solving patient problems. Different factors may constitute the context or environment in which EBM is learned, practiced, and sustained. However, these contextual factors are seldom considered and examined in the development, implementation, and evaluation of EBM instruction for learners at different levels. This article will introduce several contextual factors as tips and strategies that affect EBM learning and transfer. Also included in the article are recommended practices for designing effective EBM instruction that would contribute to a sustainable change in learner behavior. PMID:24180650

  10. Developing the evidence base for hygiene and emollient practices.

    PubMed

    Cowdell, Fiona

    2015-04-01

    Maintaining skin integrity is an essential part of ensuring health and wellbeing in older people, and personal hygiene and emollient practices are central in achieving this aim. As nurses we are expected to deliver evidence-based care. However, there is a significant lack of evidence about how best we should provide day-to-day care that promotes skin health for older people. This article briefly examines the concept of evidence-based practice, reveals the gap in knowledge on skin hygiene and emollient practices for older people and justifies the need for a systematic review in this area. Finally it introduces a Cochrane protocol for a review that will collate and review existing knowledge and identify areas for future research. The application to practice of the new evidence generated either by the Cochrane review or by subsequent research is examined. PMID:25924756

  11. 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

  12. 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

  13. Multicultural competence and evidence-based practice in group therapy.

    PubMed

    Chen, Eric C; Kakkad, Dhruvi; Balzano, Julie

    2008-11-01

    The multicultural competence (MC) and evidence-based practice (EBP) initiatives have each generated healthy debates in the mental health field, with ample implications for clinical training and practice. Using two case illustrations, we highlight practical challenges and prospects in the intersection of MC and EBP. To facilitate complementary practice of MC and EBP, we offer strategies for the group therapist as a "local clinical scientist" to deliver culturally responsive treatments. We stress the importance of cultural adaptation of EBP models, namely, modifying evidence-based interventions that involve changes in service delivery, in the nature of the therapeutic relationship, or in components of the treatment itself to accommodate the cultural beliefs and behaviors of racial-cultural minority clients. Cultural adaptation of EBP in group therapy needs to be grounded in developmental contextualism and social justice. We discuss the two cases with an eye toward advancing multicultural competence in group therapy. PMID:18802951

  14. Attacks on Science: The Risks to Evidence-Based Policy

    PubMed Central

    Rosenstock, Linda; Lee, Lore Jackson

    2002-01-01

    As government agencies, academic centers, and researchers affiliated with them provide an increasing share of the science base for policy decisions, they are also subject to efforts to politicize or silence objective scientific research. Such actions increasingly use sophisticated and complex strategies that put evidence-based policy making at risk. To assure the appropriate use of scientific evidence and the protection of the scientists who provide it, institutions and individuals must grow more vigilant against these tactics. Maintaining the capacity for evidence-based policy requires differentiating between honest scientific challenge and evident vested interest and responding accordingly, building and diversifying partnerships, assuring the transparency of funding sources, agreeing on rules for publication, and distinguishing the point where science ends and policy begins. PMID:11772749

  15. EditorialEvidence based library and information practice.

    PubMed

    Grant, Maria J

    2011-06-01

    Whilst many of us engage in supporting clinicians in identifying, appraising and using evidence, how many of us adopt the same approach to our own work? A recent survey by the UK LIS Research Coalition indicated that 60% of respondents use research reports as a source of information whilst a similar proportion of health library respondents use professional events such as conferences as a source of information. This summer sees the 6(th) International Evidence Based Library and Information Practice (EBLIP6) being held at the University of Salford, UK between 27(th) -30(th) June which will go some way to satisfying this latter information need whilst the Health Information and Libraries Journal can help satisfy the need for research reports. Whatever you're doing this summer, let's make it evidence based. PMID:21564491

  16. An Evidence-based Elective on Dietary Supplements

    PubMed Central

    Caron, Whitney; Zeolla, Mario

    2009-01-01

    Objective To implement and evaluate the effectiveness of a pharmacy elective on dietary supplements that emphasized evidence-based care. Design A 3-credit elective that employed both traditional lectures and a variety of active-learning exercises was implemented. The course introduction provided a background in dietary supplement use and evidence-based medicine principles before addressing dietary supplements by primary indication. Assessment Student learning was assessed through quizzes, case assignments, discussion board participation, and completion of a longitudinal group project. Precourse and postcourse surveys were conducted to assess students' opinions, knowledge, and skills related to course objectives. Conclusion The course was an effective way to increase students' knowledge of dietary supplements and skills and confidence in providing patient care in this area. PMID:19777095

  17. Evidence-based behavioral interventions for repetitive behaviors in autism.

    PubMed

    Boyd, Brian A; McDonough, Stephen G; Bodfish, James W

    2012-06-01

    Restricted and repetitive behaviors (RRBs) are a core symptom of autism spectrum disorders (ASD). There has been an increased research emphasis on repetitive behaviors; however, this research primarily has focused on phenomenology and mechanisms. Thus, the knowledge base on interventions is lagging behind other areas of research. The literature suggests there are evidence-based practices to treat "lower order" RRBs in ASD (e.g., stereotypies); yet, there is a lack of a focused program of intervention research for "higher order" behaviors (e.g., insistence on sameness). This paper will (a) discuss barriers to intervention development for RRBs; (b) review evidence-based interventions to treat RRBs in ASD, with a focus on higher order behaviors; and (c) conclude with recommendations for practice and research. PMID:21584849

  18. Evidence-Based Ethics for Neurology and Psychiatry Research

    PubMed Central

    Kim, Scott Y. H.

    2004-01-01

    Summary: American bioethics, historically arising out of theology and philosophy, has been dominated by the method of normative analysis. Ethics as policy, however, requires in addition a solid evidence base. This paper discusses the background conditions that make neurotherapeutics research particularly challenging. Three key ethical issues are discussed within an evidence-based ethics framework: the ethical challenges arising from changes in the financial incentive structures for academic researchers and their institutions, the challenges of risk-benefit analysis for neurotherapeutics protocols testing innovative interventions, and the evolving issues surrounding impaired decision-making capacity and surrogate consent for research. For each of these issues, selected empirical data are reviewed, areas for further inquiry are noted, and the need for development of novel methods for bioethics policy research is discussed. PMID:15717040

  19. Burn center journal club promotes clinical research, continuing education, and evidence-based practice.

    PubMed

    Fowler, Laura; Gottschlich, Michele M; Kagan, Richard J

    2013-01-01

    The purpose of this study was to characterize the structure, policy, implementation, and outcome measures of a burn team journal club to assess its effectiveness in promoting multidisciplinary education relative to research competency, clinical knowledge, and evidence-based practice. After 2 years of a new multidisciplinary format, an anonymous quality assurance survey was distributed to staff members of a regional pediatric burn center to evaluate the impact of the journal club on clinical and research indicators. The 24 journal club meetings evaluated in this study included a variety of topics, among which were wound healing, infection, nutrition, metabolism, sleep, medications, alternative medicine, research compliance, and child abuse. The speakers included a variety of hospital personnel: 26% researchers, 23% physicians, 20% registered nurses, and 31% other disciplines and attendance mean was 29 participants per session (range 17-50). Survey results from 30 respondents indicated that 100% judged the program to be valuable to personal educational needs and 83% indicated that format did not warrant change. According to self-report data, the journal club enhanced medical knowledge (90%), patient care (73%), research competency (70%), critical thinking (63%), and evidence-based practice (63%). Results indicate that the journal club program was well received by participants, and promoted enhanced knowledge and improved patient care. In the future, barriers to research initiatives and integration of research findings into practice warrant follow-up study. Journal club should be incorporated into the learning curriculum of burn practitioners as a means to promote critical thinking, research competency, and evidence-based clinical practice. PMID:23519068

  20. Single-subject designs as a tool for evidence-based clinical practice: Are they unrecognised and undervalued?

    PubMed

    Perdices, Michael; Tate, Robyn L

    2009-12-01

    One could be forgiven for thinking that the only road to evidence-based clinical practice is the application of results from randomised controlled trials (or systematic reviews of such). By contrast, single-subject designs in the context of evidence-based clinical practice are believed by many to be strange bedfellows. In this paper, we argue that single-subject designs play an important role in evidence-based clinical practice. We survey the contents of Neuropsychological Rehabilitation in relation to single-subject designs and tackle the main criticisms that have been levelled against them. We offer practical guidance for rating the methodological quality of single-subject designs and applying statistical techniques to measure treatment efficacy. These guides are equally applicable to research studies and everyday clinical practice with individual patients. PMID:19657974

  1. Community Coalitions as a System: Effects of Network Change on Adoption of Evidence-Based Substance Abuse Prevention

    Microsoft Academic Search

    Thomas W. Valente; Chich Ping Chou; Mary Ann Pentz

    2007-01-01

    Objectives. We examined the effect of community coalition network structure on the effectiveness of an intervention designed to accelerate the adoption of evidence-based substance abuse prevention programs. Methods. At baseline, 24 cities were matched and randomly assigned to 3 con- ditions (control, satellite TV training, and training plus technical assistance). We surveyed 415 community leaders at baseline and 406 at

  2. The Treatment of Depression in Older Adults in the Primary Care Setting: An Evidence-Based Review

    Microsoft Academic Search

    Karyn M. Skultety; Antonette Zeiss

    2006-01-01

    The objective of this study was to conduct an evidence-based review of treatments for depression in older adults in the primary care setting. A literature search was conducted using PsycINFO and Medline to identify relevant, English language studies published from January 1994 to April 2004 with samples aged 55 and older. Studies were required to be randomized controlled trials that

  3. Ethics and Evidence-Based Medicine: Is There a Conflict?

    PubMed Central

    Loewy, Erich H.

    2007-01-01

    This article addresses the advantages, disadvantages, and traps to which evidence-based medicine (EBM) may lead and suggests that, to be ethically valid, EBM must be aimed at the patient's best interests and not at the financial interests of others. While financial considerations are by no means trivial, it is hypocritical – if not dangerous – to hide them behind words like “evidence” or “quality.” PMID:18092036

  4. Clinical practice guidelines to inform evidence-based clinical practice

    Microsoft Academic Search

    J. Stuart Wolf; Heddy Hubbard; Martha M. Faraday; John B. Forrest

    2011-01-01

    Background  With the volume of medical research currently published, any one practitioner cannot independently review the literature to\\u000a determine best evidence-based medical care. Additionally, non-specialists usually do not have the experience to know best\\u000a practice for all of the frequent clinical circumstances for which there is no good evidence. Clinical practice guidelines\\u000a (CPGs) help clinicians to address these problems because they

  5. [Vegetarian diets and cardiovascular health: evidence-based and pondering].

    PubMed

    Chen, Keji; Liu, Yue

    2014-06-01

    The correlation between vegetarian diets and cardiovascular health is always one of the hotspots. Many scholars have performed so many clinical researches all over the world, providing evidence-based medicine (EBM) reference for clarifying their correlation. In this paper, we raise ideas and expectation on the basis of a Meta-analysis about vegetarian diets and blood pressure (published on JAMA Internal Medicine in Feb 2014) in combination of main clinical research literature in this field in recent 20 years. PMID:25046943

  6. Evidence-based practice across the health professions

    Microsoft Academic Search

    Tammy Hoffman; Sally Bennett; Chris Del Mar

    2009-01-01

    Evidence-based practice continues to be a growing influence in health education. It’s a powerful tool which can lead to more effective practice, promote communication and interdisciplinary healthcare, and improve the clinician’s knowledge and clinical reasoning skills. It’s the integration of clinical expertise and practice, with the best available research and evidence for the improvement of patient outcomes. The volume, diversity

  7. Implementation of Evidence-Based Practice and Organizational Performance

    Microsoft Academic Search

    Peter S. Hovmand; David F. Gillespie

    2010-01-01

    Administrators of mental health services may expect evidence-based practice (EBP) to offer strategic benefits. Existing theory\\u000a suggests that the benefits of implementing EBP vary by organizational characteristics. This paper presents a conceptual framework\\u000a for considering how implementation impacts organizational performance. The framework is developed as a system dynamics simulation\\u000a model based on existing literature, organizational theory, and key informant interviews

  8. Practitioner Attitudes Toward Evidence-based Practice: Themes and Challenges

    Microsoft Academic Search

    Timothy D. Nelson; Ric G. Steele; Jennifer A. Mize

    2006-01-01

     Abstract  The widespread successful implementation of evidence-based practices (EBPs) into community mental health settings will require\\u000a a thorough understanding of practitioner attitudes toward these approaches. This study reports on the results of two community\\u000a mental health practitioner focus groups investigating attitudes toward EBPs, perceived challenges to implementing EBPs, and\\u000a recommendations for researchers interested in facilitating EBP use in community settings. The

  9. Evidence-based emergency medicine at the 'coal face'.

    PubMed

    Than, Martin; Bidwell, Susan; Davison, Carol; Phibbs, Rebecca; Walker, Marg

    2005-08-01

    While evidence-based medicine may be trumpeted by zealots, managers and politicians, incorporating it into clinical practice is easier said than done. The present article aims to show that it can be achieved and gives some clinical examples to illustrate this. An appendix contains a summary of useful databases and websites for accessing good medical information and evidence, quickly and reliably near the bedside. PMID:16091095

  10. Evidence-based Treatment of Chronic Heart Failure

    Microsoft Academic Search

    David Rosen; Matthew V. Decaro; Mark G. Graham

    2007-01-01

    The past two decades have seen a knowledge explosion in the field of cardiovascular diseases, in general, and in the understanding\\u000a of chronic heart failure (HF) as a complex neurohumoral syndrome in particular. A new staging system for chronic HF has been\\u000a developed within the last decade to facilitate the evidence-based prescription of medications and medical devices for each\\u000a of

  11. Patients and the Internet: guidance for evidence-based choices.

    PubMed

    Gregory-Head, B

    1999-01-01

    This paper discusses the uses of the Internet by the public to gather healthcare information. It reviews the types of information available and the pitfalls of random searches. It provides guidance for directed searches and advice for patients and practitioners seeking evidence-based sources. It discusses future directions and the growing responsibilities of professions to stay educated with regard to Internet technology. PMID:10506807

  12. Evidence-Based Behavioral Interventions for Repetitive Behaviors in Autism

    Microsoft Academic Search

    Brian A. BoydStephen; Stephen G. McDonough; James W. Bodfish

    Restricted and repetitive behaviors (RRBs) are a core symptom of autism spectrum disorders (ASD). There has been an increased\\u000a research emphasis on repetitive behaviors; however, this research primarily has focused on phenomenology and mechanisms. Thus,\\u000a the knowledge base on interventions is lagging behind other areas of research. The literature suggests there are evidence-based\\u000a practices to treat “lower order” RRBs in

  13. Basic Elements for Conducting Evidence-Based Occupational Therapy

    Microsoft Academic Search

    Ingrid Söderback

    \\u000a This chapter reports on methodology for evaluating the effectiveness of the interventions discussed in this handbook. The\\u000a content and the four steps that compose evidence-based interventions are described as well as the various methods for conducting\\u000a quality assurance. Assessment instruments represent the prerequisites for conducting evaluations of intervention effectiveness.\\u000a Therefore, their possible aims, psychometric functions, and the process of collecting

  14. Legacy of Avicenna and evidence-based medicine

    Microsoft Academic Search

    Mohammadali M. Shoja; Mohammad Reza Rashidi; R. Shane Tubbs; Jalal Etemadi; Feridoon Abbasnejad; Paul S. Agutter

    2011-01-01

    Although the term ‘evidence-based medicine’ (EBM) is of recent origin, its roots are generally agreed to lie in earlier times. Several writers have suggested that the 11th century CE physician and philosopher Avicenna (Ibn Sina) formulated an approach to EBM that broadly resembles modern-day principles and practice. The aim of this paper is to explore the origins and influence of

  15. Effectiveness of In-Room Air Filtration and Dilution Ventilation for Tuberculosis Infection Control

    Microsoft Academic Search

    S. Miller-Leiden; C. Lohascio; W. W. Nazaroff; J. M. Macher

    1996-01-01

    Tuberculosis (TB) is a public health problem that may pose substantial risks to health care workers and others. TB infection occurs by inhalation of airborne bacteria emitted by persons with active disease. We experimentally evaluated the effectiveness of in-room air filtration systems, specifically portable air filters (PAFs) and ceiling-mounted air filters (CMAFs), in conjunction with dilution ventilation, for controlling TB

  16. Education of the adult learner: a practical approach for the infection control practitioner.

    PubMed

    Jackson, M M; Lynch, P

    1986-12-01

    Infection control practitioners (ICPs) are expected to be educators in their role, yet few have had formal training in preparing, presenting, and evaluating education programs for personnel from different disciplines. This article presents guidance from several sources specific to "andragogy"--the art and science of helping adults learn--to assist the ICP in the role of educator. PMID:3642995

  17. LABORATORY EFFICACY OF AMOXICILLIN FOR THE CONTROL OF STREPTOCOCCUS INIAE INFECTION IN BLUE TILAPIA

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Experimental trials were performed to evaluate the efficacy of amoxicillin (AMX) in controlling Streptococcus iniae infection in blue tilapia, Tilapia aurea. The dose levels of AMX tested were 5, 10, 30 and 80 mg active ingredient per kilogram of fish body weight per day. Administration of medicat...

  18. Innovative infection prevention and control teaching for nursing students: a personal reflection

    Microsoft Academic Search

    E. Burnett

    2009-01-01

    A crucial part of our role as Infection Prevention and Control Practitioners is to develop, facilitate and evaluate the teaching and learning of students and healthcare workers. However, creating an environment for participation, interaction and socialisation whilst effectively stimulating reflective and critical thinking in order to promote good practice can be challenging. This paper is a critical reflection, based on

  19. Healthcare governance and the modernisation of the NHS: infection prevention and control

    Microsoft Academic Search

    R Pratt; S Morgan; J Hughes; A Mulhall; C Fry; C Perry; L Tew

    2002-01-01

    Quality is central to the government's programme for modernising the NHS and clinical quality is at the heart of this agenda. The recent introduction of corporate governance with controls assurance and clinical governance in the NHS has established a framework for providing such excellence in clinical care.Governance applies to all healthcare activities and provides an ideal opportunity for infection prevention

  20. Saving Lives audits: do they improve infection prevention and control practice?

    Microsoft Academic Search

    H Slyne; C Phillips; J Parkes

    2012-01-01

    Aretrospective audit evaluation was conducted to determine whether the introduction of two clinical skills trainers for four months in a district general hospital improved compliance with infection prevention and control practices. Saving Lives (Department of Health, 2010) peripheral venous cannula and urinary catheter high impact intervention audit data were analysed for six months before, four months during and six months