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Sample records for evidence-based infection control

  1. AANA introduces an evidence-based infection control guide.

    PubMed

    Griffis, Charles A

    2013-06-01

    The American Association of Nurse Anesthetists Infection Control Task Force applied a rigorous evidence-based process to the revision of the Infection Control Guide for Certified Registered Nurse Anesthetists. This article details the necessity of a current Professional Practice infection control document, including an expansion of infection control and prevention literature since the last revision of this document; a multitude of infectious outbreaks; and an overwhelming lack of adherence to principles of effective hand hygiene, asepsis, and safe injection practices. Specific areas discussed include preventive measures used by Certified Registered Nurse Anesthetists during patient care activities; infection control measures aimed at procedures involving the anesthesia delivery system; and infection control practices for cleaning, disinfecting, and terminal cleaning of the environment. PMID:23923666

  2. 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

  3. Evidence-Based Update to the U.S. Centers for Disease Control and Prevention and Healthcare Infection Control Practices Advisory Committee Guideline for the Prevention of Surgical Site Infection: Developmental Process.

    PubMed

    Berríos-Torres, Sandra I

    2016-04-01

    Recommendations in the "Guideline for Prevention of Surgical Site Infection, 1999" were based on experts' selective interpretation of the scientific evidence. Effective 2009, the U.S. Centers for Disease Control and Prevention (CDC) and its Healthcare Infection Control Practices Advisory Committee (HICPAC) updated their guideline development process. This is a narrative summary of the updated process focusing on key changes and challenges specific to the Guideline for Prevention of Surgical Site Infection. The guideline development process now incorporates evidence-based methodology and provides explicit links between the evidence and the recommendations using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method. There is also participation by professional surgical societies, an updated guideline structure (core and procedure-specific sections), additional planned related manuscripts (introductions to the guideline and research opportunities), and new proposed venues for publication. The new CDC and HICPAC "Guideline for the Prevention of Surgical Site Infection" represents a substantial advancement from recommendations for infection control practices based on expert opinion to evidence-based practices. The new structure is meant to facilitate future updates, in particular, those addressing specialty or procedure-specific surgical site infection prevention questions. Increased presence by the surgical community through the professional surgical societies' engagement in the guideline development process, lead authorship of related manuscripts, and proposed publication in the surgical literature not only increase adherence by the surgical community, but also promote an ongoing collaboration with public health and other partners in a multidisciplinary approach to SSI prevention. PMID:26891203

  4. Implementing Evidence-Based Practice to Reduce Infections Following Arthroplasty.

    PubMed

    Mori, Candy

    2015-01-01

    Surgical site infections can have a devastating effect on a patient's morbidity impacting their quality of life and productivity in society. Financial burdens are placed on healthcare organizations because of surgical site infections as well. Evidence has shown that it is a worthwhile endeavor to implement a practice to screen and treat patients who are nasal carriers of Staphylococcus aureus and methicillin-resistant Staphylococcus aureus. Implementing evidence-based practices to combat surgical site infections can help ensure quality healthcare, while producing best possible patient outcomes; however, getting evidence to the bedside can be a challenge. The Johns Hopkins nursing evidence-based practice model is designed to help nurses translate evidence into practice. This article describes the steps one community hospital took to implement an evidence-based practice using the Johns Hopkins model to decrease the likelihood of methicillin-resistant Staphylococcus aureus surgical site infections in patients undergoing total knee arthroplasty and total hip arthroplasty. PMID:26213870

  5. Evidence Base for Quality Control Activities in Cardiovascular Imaging.

    PubMed

    Eskandari, Mehdi; Kramer, Christopher M; Hecht, Harvey S; Jaber, Wael A; Marwick, Thomas H

    2016-03-01

    Quality control is pervasive in most modern business, but, surprisingly, is in its infancy in medicine in general-and cardiovascular imaging in particular. The increasing awareness of the cost of cardiovascular imaging, matched by a desire to show benefits from imaging to patient outcome, suggests that this deficiency should be reassessed. Demonstration of improved quality has been proposed to require a focus on several domains: laboratory organization, patient selection, image acquisition, image interpretation, and results communication. Improvement in these steps will require adoption of a variety of interventions, including laboratory accreditation, appropriate use criteria, and continuous quality control and enhancements in reporting, but the evidence base for the benefit of interventions on these steps has been sparse. The purpose of this review is to evaluate the current status and future goals of developing the evidence base for these processes in cardiovascular imaging. PMID:26965731

  6. Central Line-Associated Bloodstream Infection Prevention: Standardizing Practice Focused on Evidence-Based Guidelines.

    PubMed

    Conley, Susanne B

    2016-02-01

    Central venous access devices (CVADs) are integral to the treatment and provision of supportive care for many patients with cancer. Central venous catheters are the most frequent cause of healthcare-associated bloodstream infections. Healthcare-associated bloodstream infections can be prevented when evidence-based practices are followed consistently over time. Establishing nursing best practice with CVADs in the ambulatory setting presents additional challenges because of multiple providers, caregivers, and policies. This article identifies evidence-based practice strategies implemented at a comprehensive ambulatory cancer center to standardize best nursing practice for central lines.?. PMID:26800401

  7. Infection Control

    MedlinePLUS

    ... lives are lost because of the spread of infections in hospitals. Health care workers can take steps ... of infectious diseases. These steps are part of infection control. Proper hand washing is the most effective ...

  8. Network Influences on Dissemination of Evidence-Based Guidelines in State Tobacco Control Programs

    ERIC Educational Resources Information Center

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

    2013-01-01

    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…

  9. Network Influences on Dissemination of Evidence-Based Guidelines in State Tobacco Control Programs

    ERIC Educational Resources Information Center

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

    2013-01-01

    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

  10. When to start antiretroviral therapy: the need for an evidence base during early HIV infection

    PubMed Central

    2013-01-01

    Background Strategies for use of antiretroviral therapy (ART) have traditionally focused on providing treatment to persons who stand to benefit immediately from initiating the therapy. There is global consensus that any HIV+ person with CD4 counts less than 350 cells/μl should initiate ART. However, it remains controversial whether ART is indicated in asymptomatic HIV-infected persons with CD4 counts above 350 cells/μl, or whether it is more advisable to defer initiation until the CD4 count has dropped to 350 cells/μl. The question of when the best time is to initiate ART during early HIV infection has always been vigorously debated. The lack of an evidence base from randomized trials, in conjunction with varying degrees of therapeutic aggressiveness and optimism tempered by the risks of drug resistance and side effects, has resulted in divided expert opinion and inconsistencies among treatment guidelines. Discussion On the basis of recent data showing that early ART initiation reduces heterosexual HIV transmission, some countries are considering adopting a strategy of universal treatment of all HIV+ persons irrespective of their CD4 count and whether ART is of benefit to the individual or not, in order to reduce onward HIV transmission. Since ART has been found to be associated with both short-term and long-term toxicity, defining the benefit:risk ratio is the critical missing link in the discussion on earlier use of ART. For early ART initiation to be justified, this ratio must favor benefit over risk. An unfavorable ratio would argue against using early ART. Summary There is currently no evidence from randomized controlled trials to suggest that a strategy of initiating ART when the CD4 count is above 350 cells/μl (versus deferring initiation to around 350 cells/μl) results in benefit to the HIV+ person and data from observational studies are inconsistent. Large, clinical endpoint-driven randomized studies to determine the individual health benefits versus risks of earlier ART initiation are sorely needed. The counter-argument to this debate topic can be freely accessed here: http://www.biomedcentral.com/1741-7015/11/147. PMID:23767777

  11. 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

  12. Effective Evidence-Based Programs For Preventing Sexually-Transmitted Infections: A Meta-Analysis.

    PubMed

    Petrova, Dafina; Garcia-Retamero, Rocio

    2015-01-01

    Educational programs for preventing sexually transmitted infections (STIs) have often been implemented in different settings and populations. Mathematica Policy Research and Child Trends conducted a systematic review of 289 evidence-based interventions aiming to reduce STIs and sexual risk behavior in adolescents in the United States. These interventions were published between 1989 and 2012. We conducted a meta-analysis of the interventions that assessed incidence of STIs at follow up, and we identified key characteristics of successful interventions. Results showed that on average interventions reduced incidence roughly from 7 to 6 out of 100 people (17% relative risk reduction (RRR)). Interventions focused on abstinence had no effect, while comprehensive education programs aiming to improve skills and promote safe sexual practices reduced risk by 4 percent (23% RRR). In particular, interventions teaching condom use skills or communication and negotiation skills reduced incidence of STIs by 3 to 4 percent (30% RRR). Finally, interventions decreasing frequency of intercourse or number of sexual partners and interventions increasing condom use also reduced incidence of STIs by 5 to 7 percent (28-36% RRR). Overall properly designed interventions with the above-mentioned characteristics can achieve a 30% reduction of STI incidence. Implications for designing successful interventions to prevent STIs in adolescents are discussed. PMID:26149164

  13. Use of Mini-Grant to Disseminate Evidence-Based Interventions for Cancer Prevention and Control.

    PubMed

    Kegler, Michelle C; Carvalho, Michelle L; Ory, Marcia; Kellstedt, Deb; Friedman, Daniela B; McCracken, James Lyndon; Dawson, Glenna; Fernandez, Maria

    2015-01-01

    Mini-grants are an increasingly common tool for engaging communities in evidence-based interventions for promoting public health. This article describes efforts by 4 Centers for Disease Control and Prevention/National Cancer Institute-funded Cancer Prevention and Control Research Network centers to design and implement mini-grant programs to disseminate evidence-based interventions for cancer prevention and control. This article also describes source of evidence-based interventions, funding levels, selection criteria, time frame, number and size of grants, types of organizations funded, selected accomplishments, training and technical assistance, and evaluation topics/methods. Grant size ranged from $1000 to $10 000 (median = $6250). This mini-grant opportunity was characterized by its emphasis on training and technical assistance for evidence-based programming and dissemination of interventions from National Cancer Institute's Research-Tested Intervention Programs and Centers for Disease Control and Prevention's Guide to Community Preventive Services. All projects had an evaluation component, although they varied in scope. Mini-grant processes described can serve as a model for organizations such as state health departments working to bridge the gap between research and practice. PMID:25734652

  14. A Review of Evidence-Based Care of Symptomatic Trichomoniasis and Asymptomatic Trichomonas vaginalis Infections.

    PubMed

    Meites, Elissa; Gaydos, Charlotte A; Hobbs, Marcia M; Kissinger, Patricia; Nyirjesy, Paul; Schwebke, Jane R; Secor, W Evan; Sobel, Jack D; Workowski, Kimberly A

    2015-12-15

    Trichomonas vaginalis is the most prevalent nonviral sexually transmitted infection, affecting an estimated 3.7 million women and men in the United States. Health disparities are prominent in the epidemiology of this infection, which affects 11% of women aged ≥40 years and a disproportionately high percentage of black women. Particularly high prevalences have been identified among sexually transmitted disease (STD) clinic patients and incarcerated individuals. This article reviews and updates scientific evidence in key topic areas used for the development of the 2015 STD Treatment Guidelines published by the Centers for Disease Control and Prevention. Current evidence is presented regarding conditions associated with Trichomonas vaginalis infection, including human immunodeficiency virus (HIV) and pregnancy complications such as preterm birth. Nucleic acid amplification tests and point-of-care tests are newly available diagnostic methods that can be conducted on a variety of specimens, potentially allowing highly sensitive testing and screening of both women and men at risk for infection. Usually, trichomoniasis can be cured with single-dose therapy of an appropriate nitroimidazole antibiotic, but women who are also infected with HIV should receive therapy for 7 days. Antimicrobial resistance is an emerging concern. PMID:26602621

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

    PubMed

    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

    2013-10-01

    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

  16. 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

  17. Assessing awareness and use of evidence-based programs for cancer control in Puerto Rico.

    PubMed

    Calo, William A; Fernndez, Mara E; Rivera, Mirza; Daz, Elba C; Correa-Fernndez, Virmarie; Pattatucci, Angela; Wetter, David W

    2012-06-01

    The Community Cancer Control Outreach Program (CCCOP) is a community-academic partnership aimed at developing and implementing a cancer control outreach, research, and training program in Puerto Rico. The CCCOP surveyed 56 partners to assess their awareness, training needs, and use of resources related to evidence-based programs (EBPs). Despite relatively high levels (70 %) of confidence in adopting EBPs, there were low levels of awareness (37 %) and use (25 %) of existing EBPs resources. Respondents' who had used EBPs resources were more likely to have positive beliefs about EBPs than nonusers (p<0.05). Training needs were high among respondents and no significant differences were found between those who had and had not used existing EBPs resources. These findings can guide the development of training tools and technical assistance to increase the use of EBPs for Latino audiences. PMID:22528632

  18. Evidence-based medicine concerning efficacy of vaccination against Clostridium chauvoei infection in cattle.

    PubMed

    Uzal, Francisco A

    2012-03-01

    Clostridium chauvoei infections occur frequently in cattle and produce disease end lethality. Vaccination is frequently used to prevent occurrence of these infections. Although the literature on blackleg is voluminous, scientific evidence on the efficacy of vaccination against C chauvoei to prevent diseases and lethality in cattle is scant. This study demonstrates that the evidence of efficacy of C chauvoei vaccines to prevent infection by this microorganism in cattle is poor to moderate. A greater participation of practitioners in clinical research and greater access to informational tools such as systematic reviews must be part of the objectives of veterinary medicine. PMID:22374118

  19. Optimizing Care for HIV-Infected People Who Use Drugs: Evidence-Based Approaches to Overcoming Healthcare Disparities

    PubMed Central

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

    2013-01-01

    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 specialistbeyond 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

  20. Evidence-based prevent catheter-associated urinary tract infections guidelines and burn-injured patients: a pilot study.

    PubMed

    Christ-Libertin, Cheryl; Black, Sharon; Latacki, Theresa; Bair, Tina

    2015-01-01

    The objective of this pilot study was to describe effectiveness of an evidence-based guideline designed to prevent catheter-associated urinary tract infection (CA-UTI) in reducing CA-UTI in the burn-injured patient population. The study used a pre- and post-bundle implementation comparison design. Inclusion criteria included burn-injured patients of all ages with an indwelling urinary catheter. Patient demographic data were collected by medical record review when informed of a CA-UTI. The Rosswurm-Larrabee Model six-step process model guided implementation of practice change. The sample included eight burn-injured patients (7-88 years). Catheter day range was 1 to 27 days. Each patient had a clear indication for an indwelling urinary catheter; the need for accurate urinary output measurement in a critically injured patient. Four patients had a catheter placed twice during the stay. Nurses reported using a bladder scanner to assess bladder volume for post-operative patients with urinary retention avoiding use of an indwelling urinary catheter in some cases. Integration of evidence-based guidelines in practice resulted in a reduced CA-UTI rate, reduced catheter days, increased days between CA-UTI, and outperformance of the national benchmark statistic. In 2013, the burn unit reduced catheter days by about 75% and reduced infection incidence by >90% in three quarters after implementation of the practice changes. The unit was able to sustain a CA-UTI rate of zero for 248 days. PMID:25501781

  1. Acute Phase Reactants in Infections: Evidence-Based Review and a Guide for Clinicians

    PubMed Central

    Markanday, Anurag

    2015-01-01

    Acute-phase reactants such as erythrocyte sedimentation rate and C-reactive protein have traditionally been used as markers for inflammation and as a measure of sickness index in infectious and noninfectious conditions. In the last decade, more data have become available on the wider and more specific role for these markers in the management of complex infections. This includes the potential role in early diagnosis, in differentiating infectious from noninfectious causes, as a prognostic marker, and in antibiotic guidance strategies. A better defined role for biological markers as a supplement to clinical assessment may lead to more judicious antibiotic prescriptions, and it has the potential for a long-term favorable impact on antimicrobial stewardship and antibiotic resistance. Procalcitonin as a biological marker has been of particular interest in this regard. This review examines the current published evidence and summarizes the role of various acute-phase markers in infections. A MEDLINE search of English-language articles on acute-phase reactants and infections published between 1986 and March 2015 was conducted. Additional articles were also identified through a search of references from the retrieved articles, published guidelines, systematic reviews, and meta-analyses. PMID:26258155

  2. 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

  3. 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 organizations 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

  4. An Evidence-Based Practice Educational Intervention for Athletic Trainers: A Randomized Controlled Trial

    PubMed Central

    Welch, Cailee E.; Van Lunen, Bonnie L.; Hankemeier, Dorice A.

    2014-01-01

    Context: As evidence-based practice (EBP) becomes a necessity in athletic training, Web-based modules have been developed and made available to the National Athletic Trainers' Association membership as a mechanism to educate athletic trainers (ATs) on concepts of EBP. Objective: To assess the effect of an educational intervention on enhancing knowledge of EBP among ATs. Design: Randomized controlled trial. Setting: Web-based modules and knowledge assessment. Patients or Other Participants: A total of 164 of 473 ATs (34.7% response rate), including professional athletic training students, graduate students, clinical preceptors, educators, and clinicians, were randomized into a control group (40 men, 42 women) or experimental group (33 men, 49 women). Intervention(s): Ten Web-based modules were developed that covered concepts involved in the EBP process. Both groups completed the Evidence-Based Practice Knowledge Assessment before and after the intervention phase. During the intervention phase, the experimental group had access to the Web-based modules for 4 weeks, whereas the control group had no direct responsibilities for the investigation. The knowledge assessment consisted of 60 multiple choice questions pertaining to concepts presented in the 10 modules. Test-retest reliability was determined to be good (intraclass correlation coefficient [2,1] = 0.726, 95% confidence interval = 0.605, 0.814). Main Outcome Measure(s): Independent variables consisted of group (control, experimental) and time (preassessment, postassessment). Knowledge scores were tabulated by awarding 1 point for each correct answer (maximum = 60). Between-group and within-group differences were calculated using a 2 2 repeated-measures analysis of variance (P ? .05), post hoc t tests, and Hedges g effect size with 95% confidence intervals. Results: We found a group time interaction (F1,162 = 26.29, P < .001). No differences were identified between the control (30.12 5.73) and experimental (30.65 5.93) groups during the preassessment (t162 = 0.58, P = .84). The experimental group (36.35 8.58) obtained higher scores on the postassessment than the control group (30.99 6.33; t162 = 4.55, P = .01). No differences were identified among time instances within the control group (t81 = 1.77, P = .08); however, the experimental group obtained higher scores on the postassessment than the preassessment (t81 = 7.07, P < .001). Conclusions: An educational intervention consisting of 10 Web-based modules was an effective mechanism to increase knowledge of foundational EBP concepts among ATs. However, it is not known whether ATs are integrating EBP into daily clinical practice. Researchers should determine whether increased knowledge of EBP affects the daily clinical decision making of ATs. PMID:24568228

  5. 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

  6. Teaching of evidence-based medicine to medical students in Mexico: a randomized controlled trial

    PubMed Central

    2012-01-01

    Background Evidence-Based Medicine (EBM) is an important competency for the healthcare professional. Experimental evidence of EBM educational interventions from rigorous research studies is limited. The main objective of this study was to assess EBM learning (knowledge, attitudes and self-reported skills) in undergraduate medical students with a randomized controlled trial. Methods The educational intervention was a one-semester EBM course in the 5th year of a public medical school in Mexico. The study design was an experimental parallel group randomized controlled trial for the main outcome measures in the 5th year class (M5 EBM vs. M5 non-EBM groups), and quasi-experimental with static-groups comparisons for the 4th year (M4, not yet exposed) and 6th year (M6, exposed 6 months to a year earlier) groups. EBM attitudes, knowledge and self-reported skills were measured using Taylor’s questionnaire and a summative exam which comprised of a 100-item multiple-choice question (MCQ) test. Results 289 Medical students were assessed: M5 EBM=48, M5 non-EBM=47, M4=87, and M6=107. There was a higher reported use of the Cochrane Library and secondary journals in the intervention group (M5 vs. M5 non-EBM). Critical appraisal skills and attitude scores were higher in the intervention group (M5) and in the group of students exposed to EBM instruction during the previous year (M6). The knowledge level was higher after the intervention in the M5 EBM group compared to the M5 non-EBM group (p<0.001, Cohen's d=0.88 with Taylor's instrument and 3.54 with the 100-item MCQ test). M6 Students that received the intervention in the previous year had a knowledge score higher than the M4 and M5 non-EBM groups, but lower than the M5 EBM group. Conclusions Formal medical student training in EBM produced higher scores in attitudes, knowledge and self-reported critical appraisal skills compared with a randomized control group. Data from the concurrent groups add validity evidence to the study, but rigorous follow-up needs to be done to document retention of EBM abilities. PMID:23131115

  7. 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 countrys 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

  8. Controlling Legionella in hospital drinking water: an evidence-based review of disinfection methods.

    PubMed

    Lin, Yusen E; Stout, Janet E; Yu, Victor L

    2011-02-01

    Hospital-acquired Legionnaires' disease is directly linked to the presence of Legionella in hospital drinking water. Disinfecting the drinking water system is an effective preventive measure. The efficacy of any disinfection measures should be validated in a stepwise fashion from laboratory assessment to a controlled multiple-hospital evaluation over a prolonged period of time. In this review, we evaluate systemic disinfection methods (copper-silver ionization, chlorine dioxide, monochloramine, ultraviolet light, and hyperchlorination), a focal disinfection method (point-of-use filtration), and short-term disinfection methods in outbreak situations (superheat-and-flush with or without hyperchlorination). The infection control practitioner should take the lead in selection of the disinfection system and the vendor. Formal appraisals by other hospitals with experience of the system under consideration is indicated. Routine performance of surveillance cultures of drinking water to detect Legionella and monitoring of disinfectant concentrations are necessary to ensure long-term efficacy. PMID:21460472

  9. 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; Arostegu, Jorge; Morales-Perez, Arcadio; Suazo-Laguna, Harold; Legorreta-Soberanis, Jos; Hernandez-Alvarez, Carlos; Fernandez-Salas, Ildefonso; Paredes-Sols, Sergio; Balmaseda, Angel; Corts-Guzmn, Antonio Juan; Serrano de los Santos, Ren; 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 interventionchemical-free prevention of mosquito reproductionto 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

  10. Systematic Review of Evidence-Based Guidelines on Medication Therapy for Upper Respiratory Tract Infection in Children with AGREE Instrument

    PubMed Central

    Zeng, Linan; Zhang, Lingli; Hu, Zhiqiang; Ehle, Emily A.; Chen, Yuan; Liu, Lili; Chen, Min

    2014-01-01

    Objectives To summarize recommendations of existing guidelines on the treatment of upper respiratory tract infections (URTIs) in children, and to assess the methodological quality of these guidelines. Methods We searched seven databases and web sites of relevant academic agencies. Evidence-based guidelines on pediatric URTIs were included. AGREE II was used to assess the quality of these guidelines. Two researchers selected guidelines independently and extracted information on publication years, institutions, target populations, recommendations, quality of evidence, and strength of recommendations. We compared the similarities and differences of recommendations and their strength. We also analyzed the reasons for variation. Results Thirteen guidelines meeting our inclusion criteria were included. Huge differences existed among these 13 guidelines concerning the categorization of evidence and recommendations. Nearly all of these guidelines lacked the sufficient involvement of stake holders. Further, the applicability of these guidelines still needs to be improved. In terms of recommendations, penicillin and amoxicillin were suggested for group A streptococcal pharyngitis. Amoxicillin and amoxicillin-clavulanate were recommended for acute bacterial rhinosinusitis (ABRS). An observation of 2–3 days prior to antibiotic therapy initiation for mild acute otitis media (AOM) was recommended with amoxicillin as the suggested first choice agent. Direct evidence to support strong recommendations on the therapy for influenza is still lacking. In addition, the antimicrobial durations for pharyngitis and ABRS were still controversial. No consensus was reached for the onset of antibiotics for ABRS in children. Conclusions Future guidelines should use a consistent grading system for the quality of evidence and strength of recommendations. More effort needs to be paid to seek the preference of stake holders and to improve the applicability of guidelines. Further, there are still areas in pediatric URTIs that need more research. PMID:24586287

  11. Impact of an Evidence-Based Medicine Curriculum on Resident Use of Electronic Resources: A Randomized Controlled Study

    PubMed Central

    Willett, Laura R.; Murphy, David J.; ORourke, Kerry; Sharma, Ranita; Shea, Judy A.

    2008-01-01

    Background Evidence-based medicine (EBM) is widely taught in residency, but evidence for effectiveness of EBM teaching on changing residents behavior is limited. Objective To investigate the impact of an EBM curriculum on residents use of evidence-based resources in a simulated clinical experience. Design/Participants Fifty medicine residents randomized to an EBM teaching or control group. Measurements A validated test of EBM knowledge (Fresno test) was administered before and after intervention. Post intervention, residents twice completed a Web-based, multiple-choice instrument (15 items) comprised of clinical vignettes, first without then with access to electronic resources. Use of electronic resources was tracked using ProxyPlus software. Within group prepost differences and between group post-test differences were examined. Results There was more improvement in EBM knowledge (100-point scale) for the intervention group compared to the control group (mean score increase 22 vs. 12, ?=?0.012). In the simulated clinical experience, the most commonly accessed resources were Ovid (71% of residents accessed) and InfoPOEMs (62%) for the EBM group and UptoDate (67%) and MDConsult (58%) for the control group. Residents in the EBM group were more likely to use evidence-based resources than the control group. Performance on clinical vignettes was similar between the groups both at baseline (?=?0.19) and with access to information resources (?=?0.89). Conclusions EBM teaching improved EBM knowledge and increased use of evidence-based resources by residents, but did not improve performance on Web-based clinical vignettes. Future studies will need to examine impact of EBM teaching on clinical outcomes. PMID:18769979

  12. Evidence-based modeling of network discharge dynamics during periodic pacing to control epileptiform activity.

    PubMed

    Bush, Keith; Panuccio, Gabriella; Avoli, Massimo; Pineau, Joelle

    2012-03-15

    Deep brain stimulation (DBS) is a promising therapeutic approach for epilepsy treatment. Recently, research has focused on the implementation of stimulation protocols that would adapt to the patients need (adaptive stimulation) and deliver electrical stimuli only when it is most useful. A formal mathematical description of the effects of electrical stimulation on neuronal networks is a prerequisite for the development of adaptive DBS algorithms. Using tools from non-linear dynamic analysis, we describe an evidence-based, mathematical modeling approach that (1) accurately simulates epileptiform activity at time-scales of single and multiple ictal discharges, (2) simulates modulation of neural dynamics during epileptiform activity in response to fixed, low-frequency electrical stimulation, (3) defines a mapping from real-world observations to model state, and (4) defines a mapping from model state to real-world observations. We validate the real-world utility of the model's properties by statistical comparison between the number, duration, and interval of ictal-like discharges observed in vitro and those simulated in silica under conditions of repeated stimuli at fixed-frequency. These validation results confirm that the evidence-based modeling approach captures robust, informative features of neural network dynamics of in vitro epileptiform activity under periodic pacing and support its use for further implementation of adaptive DBS protocols for epilepsy treatment. PMID:22172917

  13. Infection prevention and control.

    PubMed

    Pegram, Anne; Bloomfield, Jacqueline

    2015-03-18

    All newly registered graduate nurses are required to have the appropriate knowledge and understanding to perform the skills required for patient care, specifically the competencies identified in the Nursing and Midwifery Council's essential skills clusters. This article focuses on the third essential skills cluster - infection prevention and control. It provides an overview and discussion of the key skills and behaviours that must be demonstrated to meet the standards set by the Nursing and Midwifery Council. In doing so, it considers the key principles of infection prevention and control, including local and national policies, standard infection control precautions, risk assessment, standard isolation measures and asepsis. PMID:25783280

  14. Infection control for norovirus

    PubMed Central

    Barclay, L.; Park, G. W.; Vega, E.; Hall, A.; Parashar, U.; Vinjé, J.; Lopman, B.

    2015-01-01

    Norovirus infections are notoriously difficult to prevent and control, owing to their low infectious dose, high shedding titre, and environmental stability. The virus can spread through multiple transmission routes, of which person-to-person and foodborne are the most important. Recent advances in molecular diagnostics have helped to establish norovirus as the most common cause of sporadic gastroenteritis and the most common cause of outbreaks of acute gastroenteritis across all ages. In this article, we review the epidemiology and virology of noroviruses, and prevention and control guidelines, with a focus on the principles of disinfection and decontamination. Outbreak management relies on sound infection control principles, including hand hygiene, limiting exposure to infectious individuals, and thorough environmental decontamination. Ideally, all infection control recommendations would rely on empirical evidence, but a number of challenges, including the inability to culture noroviruses in the laboratory and the challenges of outbreak management in complex environments, has made it difficult to garner clear evidence of efficacy in certain areas of infection control. New experimental data on cultivable surrogates for human norovirus and on environmental survivability and relative resistance to commonly used disinfectants are providing new insights for further refinining disinfection practices. Finally, clinical trials are underway to evaluate the efficacy of vaccines, which may shift the current infection control principles to more targeted interventions. PMID:24813073

  15. Evidence-based practice protocol to improve glucose control in individuals with type 2 diabetes mellitus.

    PubMed

    Evans, Michael M

    2010-01-01

    Type 2 diabetes mellitus is a major public health problem in the United States. In adult patients with type 2 DM, what is the effect of adding a follow-up telephone intervention by an APRN on blood glucose control as compared to standard treatment alone? Findings from one systematic review and five randomized control trials were used to support a protocol to elicit improvement in glycemic control. PMID:21337987

  16. Study design in evidence-based surgery: What is the role of case-control studies?

    PubMed Central

    Cao, Amy M; Cox, Michael R; Eslick, Guy D

    2016-01-01

    Randomized controlled trials (RCTs) are the gold standard in terms of study design, however, in the surgical setting conducting RCTs can often be unethical or logistically impossible. Case-control studies should become the major study design used in surgical research when RCTs are unable to be conducted and definitely replacing case series which offer little insight into surgical outcomes and disease processes.

  17. Study design in evidence-based surgery: What is the role of case-control studies?

    PubMed

    Cao, Amy M; Cox, Michael R; Eslick, Guy D

    2016-03-26

    Randomized controlled trials (RCTs) are the gold standard in terms of study design, however, in the surgical setting conducting RCTs can often be unethical or logistically impossible. Case-control studies should become the major study design used in surgical research when RCTs are unable to be conducted and definitely replacing case series which offer little insight into surgical outcomes and disease processes. PMID:27019801

  18. 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

  19. 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 20032011, 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 states 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

  20. Action observation for upper limb function after stroke: evidence-based review of randomized controlled trials

    PubMed Central

    Kim, KyeongMi

    2015-01-01

    [Purpose] The purpose of this study was to suggest evidenced information about action observation to improve upper limb function after stroke. [Methods] A systematic review of randomized controlled trials involving adults aged 18?years or over and including descriptions of action observation for improving upper limb function was undertaken. Electronic databases were searched, including MEDLINE, CINAHL, and PEDro (the Physiotherapy Evidence Database), for articles published between 2000 to 2014. Following completion of the searches, two reviewers independently assessed the trials and extracted data using a data extraction form. The same two reviewers independently documented the methodological quality of the trials by using the PEDro scale. [Results] Five randomized controlled trials were ultimately included in this review, and four of them (80%) reported statistically significant effects for motor recovery of upper limb using action observation intervention in between groups. [Conclusion] This review of the literature presents evidence attesting to the benefits conferred on stroke patints resulting from participation in an action observation intervention. The body of literature in this field is growing steadily. Further work needs to be done to evaluate the evidence for different conditions after stroke and different duration of intervention. PMID:26644700

  1. Developing the evidence-base for Safe Communities: a multi-level, partly randomised, controlled trial.

    PubMed

    Seedat, M; McClure, R; Suffla, S; van Niekerk, A

    2012-01-01

    Safe Communities, representing a global activation of the public health logic, may be strengthened through theoretical, methodological and empirical support. In the spirit of this Special Issue that aims to analyse the achievements and challenges inherent to Safe Communities, we offer our contribution in the form of a methodology of a multi-country child safety, peace and health promotion study. The study, situated within an African-centred initiative called Ukuphepha - an isiZulu word meaning demonstrating African safety - is underpinned by four theoretical claims that frame injury and violence prevention as a multi-disciplinary issue to be addressed through a suite of interventions to family and extended social systems. The interventions, sensitive to the priorities of each participating country, have been informed by the literature on effective interventions and the authors' joint experiences of community development. The study is designed as a population-based, multi-level, multi-intervention partly randomised controlled trial, and there are potentially 24 participant communities representing South Africa, Mozambique, Egypt, Zambia, Uganda, Bangladesh, Malaysia and Australia - over three commencement phases. Whereas process evaluation will focus on community engagement, impact evaluation will consider risk and protective factors, and outcome evaluation will examine the overall effectiveness of the interventions. Notwithstanding the many challenges, the study will provide insights into the methodology and mechanisms of ecologically-oriented interventions that locate injury and violence prevention as an activity arising from safety, peace and health promotion. PMID:22873717

  2. Voices of decision makers on evidence-based policy: A case of evolving TB/HIV co-infection policy in India.

    PubMed

    Reddy, K Srikanth; Sahay, Seema

    2016-03-01

    This study explores decision makers' perspectives on evidence-based policy (EBP) development using the case of TB/HIV co-infection in India. Twelve in-depth interviews were conducted with purposively selected key national and international policy decision makers in India. Verbatim transcripts were processed and analysed thematically using QSR (NUD*IST 6). The decision makers were unequivocal in recognizing the TB/HIV co-infection as an important public health issue in India and stated the problem to be different than Africa. The need of having a "third programme" for co-infection was not felt. According to them, the public health management of this co-infection must be within the realm of these two programmes. The study also emphasized on decision makers' perspectives on evidence and the process of utilization of evidence for decision-making for co-infection. Study findings showed global evidence was not always accepted by the decision makers and study shows several examples of decision makers demanding local evidence for policy decisions. Decision makers did make interim policies based on global evidence but most of the time their mandate was to get local evidence. Thus, operations research/implementation science especially multi-centric studies emerge as important strategy for EBP development. Researcher-policy maker interface was a gap where role of researcher as aggressive communicator of research findings was expected. PMID:26462134

  3. [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

  4. Infection Control in Dental Settings

    MedlinePLUS

    ... Although the principles of infection control remain unchanged, new technologies, materials, equipment, and data require continuous evaluation of current infection control practices. The unique nature of many dental procedures, ... Care – A new resource for those needing information about basic infection ...

  5. Insights in public health: Building support for an evidence-based teen pregnancy and sexually transmitted infection prevention program adapted for foster youth.

    PubMed

    Smith, Tamara; Clark, Judith F; Nigg, Claudio R

    2015-01-01

    Hawai'i Youth Services Network (HYSN) was founded in 1980 and is incorporated as a 501(c) (3) organization. HYSN plays a key role in the planning, creation, and funding of local youth services. One of HYSN's focuses is teen pregnancy and sexually transmitted infections (STI) prevention among foster youth. Foster youth are at a greater risk for teen pregnancy and STI due to a variety of complex factors including instability, trauma, and emancipation from the foster care system. This article highlights how HYSN is leveraging both federal and local funding, as well as other resources, in order to implement an evidence-based teen pregnancy and STI prevention program adapted for foster youth. PMID:25628980

  6. Cost-Effectiveness Analysis of Brief and Expanded Evidence-Based Risk Reduction Interventions for HIV-Infected People Who Inject Drugs in the United States

    PubMed Central

    Song, Dahye L.; Altice, Frederick L.; Copenhaver, Michael M.; Long, Elisa F.

    2015-01-01

    Aims Two behavioral HIV prevention interventions for people who inject drugs (PWID) infected with HIV include the Holistic Health Recovery Program for HIV+ (HHRP+), a comprehensive evidence-based CDC-supported program, and an abbreviated Holistic Health for HIV (3H+) Program, an adapted HHRP+ version in treatment settings. We compared the projected health benefits and cost-effectiveness of both programs, in addition to opioid substitution therapy (OST), to the status quo in the U.S. Methods A dynamic HIV transmission model calibrated to epidemic data of current US populations was created. Projected outcomes include future HIV incidence, HIV prevalence, and quality-adjusted life years (QALYs) gained under alternative strategies. Total medical costs were estimated to compare the cost-effectiveness of each strategy. Results Over 10 years, expanding HHRP+ access to 80% of PWID could avert up to 29,000 HIV infections, or 6% of the projected total, at a cost of $7,777/QALY gained. Alternatively, 3H+ could avert 19,000 infections, but is slightly more cost-effective ($7,707/QALY), and remains so under widely varying effectiveness and cost assumptions. Nearly two-thirds of infections averted with either program are among non-PWIDs, due to reduced sexual transmission from PWID to their partners. Expanding these programs with broader OST coverage could avert up to 74,000 HIV infections over 10 years and reduce HIV prevalence from 16.5% to 14.1%, but is substantially more expensive than HHRP+ or 3H+ alone. Conclusions Both behavioral interventions were effective and cost-effective at reducing HIV incidence among both PWID and the general adult population; however, 3H+, the economical HHRP+ version, was slightly more cost-effective than HHRP+. PMID:25658949

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

    PubMed

    Len-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

  8. 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…

  9. 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

  10. Medical Students' and Tutors' Experiences of Directed and Self-Directed Learning Programs in Evidence-Based Medicine: A Qualitative Evaluation Accompanying a Randomized Controlled Trial

    ERIC Educational Resources Information Center

    Bradley, Peter; Oterholt, Christina; Nordheim, Lena; Bjorndal, Arild

    2005-01-01

    This qualitative study aims to interpret the results of a randomized controlled trial comparing two educational programs (directed learning and self-directed learning) in evidence-based medicine (EBM) for medical students at the University of Oslo from 2002 to 2003. There is currently very little comparative educational research in this field. In

  11. A cluster randomized controlled trial to evaluate the effectiveness of the clinically integrated RHL evidence -based medicine course

    PubMed Central

    2010-01-01

    Background and objectives Evidence-based health care requires clinicians to engage with use of evidence in decision-making at the workplace. A learner-centred, problem-based course that integrates e-learning in the clinical setting has been developed for application in obstetrics and gynaecology units. The course content uses the WHO reproductive health library (RHL) as the resource for systematic reviews. This project aims to evaluate a clinically integrated teaching programme for incorporation of evidence provided through the WHO RHL. The hypothesis is that the RHL-EBM (clinically integrated e-learning) course will improve participants' knowledge, skills and attitudes, as well as institutional practice and educational environment, as compared to the use of standard postgraduate educational resources for EBM teaching that are not clinically integrated. Methods The study will be a multicentre, cluster randomized controlled trial, carried out in seven countries (Argentina, Brazil, Democratic Republic of Congo, India, Philippines, South Africa, Thailand), involving 50-60 obstetrics and gynaecology teaching units. The trial will be carried out on postgraduate trainees in the first two years of their training. In the intervention group, trainees will receive the RHL-EBM course. The course consists of five modules, each comprising self-directed e-learning components and clinically related activities, assignments and assessments, coordinated between the facilitator and the postgraduate trainee. The course will take about 12 weeks, with assessments taking place pre-course and 4 weeks post-course. In the control group, trainees will receive electronic, self-directed EBM-teaching materials. All data collection will be online. The primary outcome measures are gain in EBM knowledge, change in attitudes towards EBM and competencies in EBM measured by multiple choice questions (MCQs) and a skills-assessing questionniare administered eletronically. These questions have been developed by using questions from validated questionnaires and adapting them to the current course. Secondary outcome measure will be educational environment towards EBM which will be assessed by a specifically developed questionnaire. Expected outcomes The trial will determine whether the RHL EBM (clinically integrated e-leraning) course will increase knowledge, skills and attitudes towards EBM and improve the educational environment as compared to standard teaching that is not clinically integrated. If effective, the RHL-EBM course can be implemented in teaching institutions worldwide in both, low-and middle income countries as well as industrialized settings. The results will have a broader impact than just EBM training because if the approach is successful then the same educational strategy can be used to target other priority clinical and methodological areas. Trial Registration ACTRN12609000198224 PMID:20470382

  12. Essentials of paediatric infection control

    PubMed Central

    Moore, Dorothy L

    2001-01-01

    Young children readily transmit and acquire nosocomial infections. Children are also vulnerable to endogenous infections as a result of the breakdown of their normal defences by disease, invasive procedures or therapy. The increasing acuity of illness in hospitalized children and therapeutic advances have resulted in a patient population that is increasingly at higher risk for nosocomial infections. Antibiotic resistance has emerged as a problem in some paediatric hospitals, usually in intensive care and oncology units. Infection rates are the highest in neonatal and paediatric intensive care units (where bloodstream infections are the most frequent), and are usually associated with intravascular devices. On general paediatric wards, respiratory and gastrointestinal infections predominate, reflecting the occurrence in the community. The surveillance of nosocomial infections identifies priorities for infection control activities and permits evaluation of interventions. The prevention of transmission between patients and to personnel requires that certain measures be taken with all patients, and that additional precautions be taken with some infections, based on the route of transmission. The prevention of transmission from personnel involves ensuring that personnel are appropriately immunized and counselled about working with infections. The prevention of nosocomial infection also involves control of visitors, appropriate management of invasive procedures and devices, sterilization and disinfection of equipment, provision of a clean environment and adequate staffing. Severely immunocompromised children require extra protection, including ventilation systems that reduce the risk of exposure to filamentous fungi. Infection control in paediatrics is an evolving field that must adapt to changes in the paediatric patient population and in health care technology. PMID:20084127

  13. 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

  14. 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…

  15. Evidence-Based Practice

    ERIC Educational Resources Information Center

    Haycock, Ken

    2004-01-01

    Much has been written recently about the importance of "evidence based practice" for teacher librarians. Principals value most collaboration by teacher librarians. Collaboration affects achievement. This article discusses how principals can play a part in teacher-librarian collaboration.

  16. Barriers and opportunities for evidence-based health service planning: the example of developing a Decision Analytic Model to plan services for sexually transmitted infections in the UK

    PubMed Central

    2012-01-01

    Background Decision Analytic Models (DAMs) are established means of evidence-synthesis to differentiate between health interventions. They have mainly been used to inform clinical decisions and health technology assessment at the national level, yet could also inform local health service planning. For this, a DAM must take into account the needs of the local population, but also the needs of those planning its services. Drawing on our experiences from stakeholder consultations, where we presented the potential utility of a DAM for planning local health services for sexually transmitted infections (STIs) in the UK, and the evidence it could use to inform decisions regarding different combinations of service provision, in terms of their costs, cost-effectiveness, and public health outcomes, we discuss the barriers perceived by stakeholders to the use of DAMs to inform service planning for local populations, including (1) a tension between individual and population perspectives; (2) reductionism; and (3) a lack of transparency regarding models, their assumptions, and the motivations of those generating models. Discussion Technological advances, including improvements in computing capability, are facilitating the development and use of models such as DAMs for health service planning. However, given the current scepticism among many stakeholders, encouraging informed critique and promoting trust in models to aid health service planning is vital, for example by making available and explicit the methods and assumptions underlying each model, associated limitations, and the process of validation. This can be achieved by consultation and training with the intended users, and by allowing access to the workings of the models, and their underlying assumptions (e.g. via the internet), to show how they actually work. Summary Constructive discussion and education will help build a consensus on the purposes of STI services, the need for service planning to be evidence-based, and the potential for mathematical tools like DAMs to facilitate this. PMID:22805183

  17. [Evidence-based prevention].

    PubMed

    Valsecchi, Massimo

    2008-01-01

    The purpose of this contribution is to indicate the situation of the initiatives ongoing in the nation to abolish preventative action lacking evident and solid foundations of efficacy from our health legislation. The status of the proposal for the bill, "Measures for the simplification of administrative duties related to the protection of health and other health-related actions", is illustrated, as well as the ongoing work of the "EBP (Evidence Based Prevention) subcommittee" instituted within the permanent scientific committee of the CCM. The national situation regarding two of the first interventions of rationalization activated is presented: the abolition of health controls for food workers and health controls on minors with low-risk jobs. The first data are presented of the latest monitoring of the administrative and health effects in the Veneto Region following the abolition of LISA, which occurred in 2004. A troubling evaluation is expressed on the state of the attempt to renew prevention in the nation especially regarding the sectors of veterinary medicine and job-related medicine. Further effort on the part of scientific societies is hoped for and the necessity of a strong initiative by the coordinating inter-regional prevention round-table is demonstrated. The round-table should take the initiative to discuss with the CCM a work program that involves evaluation interventions in all areas of prevention, including those relative to work-places and veterinary services. In this way, an attempt to reconstruct, from the bottom-up, a unitary vision of intervention will be possible, one that is now strongly fragmented at the level of the central government. PMID:18773600

  18. Infection Control in Cystic Fibrosis

    PubMed Central

    Saiman, Lisa; Siegel, Jane

    2004-01-01

    Over the past 20 years there has been a greater interest in infection control in cystic fibrosis (CF) as patient-to-patient transmission of pathogens has been increasingly demonstrated in this unique patient population. The CF Foundation sponsored a consensus conference to craft recommendations for infection control practices for CF care providers. This review provides a summary of the literature addressing infection control in CF. Burkholderia cepacia complex, Pseudomonas aeruginosa, and Staphylococcus aureus have all been shown to spread between patients with CF. Standard precautions, transmission-based precautions including contact and droplet precautions, appropriate hand hygiene for health care workers, patients, and their families, and care of respiratory tract equipment to prevent the transmission of infectious agents serve as the foundations of infection control and prevent the acquisition of potential pathogens by patients with CF. The respiratory secretions of all CF patients potentially harbor clinically and epidemiologically important microorganisms, even if they have not yet been detected in cultures from the respiratory tract. CF patients should be educated to contain their secretions and maintain a distance of >3 ft from other CF patients to avoid the transmission of potential pathogens, even if culture results are unavailable or negative. To prevent the acquisition of pathogens from respiratory therapy equipment used in health care settings as well as in the home, such equipment should be cleaned and disinfected. It will be critical to measure the dissemination, implementation, and potential impact of these guidelines to monitor changes in practice and reduction in infections. PMID:14726455

  19. Enterobiasis (Pinworm Infection): Prevention and Control

    MedlinePLUS

    ... 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 For: Travelers ...

  20. Clinician-led improvement in cancer care (CLICC) - testing a multifaceted implementation strategy to increase evidence-based prostate cancer care: phased randomised controlled trial - study protocol

    PubMed Central

    2014-01-01

    Background Clinical practice guidelines have been widely developed and disseminated with the aim of improving healthcare processes and patient outcomes but the uptake of evidence-based practice remains haphazard. There is a need to develop effective implementation methods to achieve large-scale adoption of proven innovations and recommended care. Clinical networks are increasingly being viewed as a vehicle through which evidence-based care can be embedded into healthcare systems using a collegial approach to agree on and implement a range of strategies within hospitals. In Australia, the provision of evidence-based care for men with prostate cancer has been identified as a high priority. Clinical audits have shown that fewer than 10% of patients in New South Wales (NSW) Australia at high risk of recurrence after radical prostatectomy receive guideline recommended radiation treatment following surgery. This trial will test a clinical network-based intervention to improve uptake of guideline recommended care for men with high-risk prostate cancer. Methods/Design In Phase I, a phased randomised cluster trial will test a multifaceted intervention that harnesses the NSW Agency for Clinical Innovation (ACI) Urology Clinical Network to increase evidence-based care for men with high-risk prostate cancer following surgery. The intervention will be introduced in nine NSW hospitals over 10 months using a stepped wedge design. Outcome data (referral to radiation oncology for discussion of adjuvant radiotherapy in line with guideline recommended care or referral to a clinical trial of adjuvant versus salvage radiotherapy) will be collected through review of patient medical records. In Phase II, mixed methods will be used to identify mechanisms of provider and organisational change. Clinicians knowledge and attitudes will be assessed through surveys. Process outcome measures will be assessed through document review. Semi-structured interviews will be conducted to elucidate mechanisms of change. Discussion The study will be one of the first randomised controlled trials to test the effectiveness of clinical networks to lead changes in clinical practice in hospitals treating patients with high-risk cancer. It will additionally provide direction regarding implementation strategies that can be effectively employed to encourage widespread adoption of clinical practice guidelines. Trial registration Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12611001251910. PMID:24884877

  1. Towards Evidence-Based, Quality-Controlled Health Promotion: The Dutch Recognition System for Health Promotion Interventions

    ERIC Educational Resources Information Center

    Brug, Johannes; van Dale, Djoeke; Lanting, Loes; Kremers, Stef; Veenhof, Cindy; Leurs, Mariken; van Yperen, Tom; Kok, Gerjo

    2010-01-01

    Registration or recognition systems for best-practice health promotion interventions may contribute to better quality assurance and control in health promotion practice. In the Netherlands, such a system has been developed and is being implemented aiming to provide policy makers and professionals with more information on the quality and…

  2. Towards Evidence-Based, Quality-Controlled Health Promotion: The Dutch Recognition System for Health Promotion Interventions

    ERIC Educational Resources Information Center

    Brug, Johannes; van Dale, Djoeke; Lanting, Loes; Kremers, Stef; Veenhof, Cindy; Leurs, Mariken; van Yperen, Tom; Kok, Gerjo

    2010-01-01

    Registration or recognition systems for best-practice health promotion interventions may contribute to better quality assurance and control in health promotion practice. In the Netherlands, such a system has been developed and is being implemented aiming to provide policy makers and professionals with more information on the quality and

  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. Homeopathic remedy for arsenic toxicity?: Evidence-based findings from a randomized placebo-controlled double blind human trial.

    PubMed

    Belon, Philippe; Banerjee, Antara; Karmakar, Susanta Roy; Biswas, Surjyo Jyoti; Choudhury, Sandipan Chaki; Banerjee, Pathikrit; Das, Jayanta Kumar; Pathak, Surajit; Guha, Bibhas; Paul, Saili; Bhattacharjee, Nandini; Khuda-Bukhsh, Anisur Rahman

    2007-10-01

    Millions of people are at risk of groundwater arsenic contamination, but supply of arsenic-free drinking water is grossly inadequate. The present study was intended to examine if a potentized homeopathic remedy reportedly showing ameliorating potentials in people inhabiting high-risk arsenic-contaminated areas but drinking arsenic-free water, can also ameliorate arsenic toxicity in subjects living in high-risk arsenic-contaminated areas, and drinking arsenic-contaminated water. This pilot study was conducted on 20 males and 19 females of village Dasdiya (arsenic contaminated) who initially agreed to act as volunteers; but as many as 14, mostly placebo-fed subjects, later dropped out. 18 volunteers, 14 males and 4 females, from a distant village, Padumbasan (arsenic-free), served as negative controls. In a double blind placebo-controlled study, a potentized remedy of homeopathic Arsenicum Album-30 and its placebo (Succussed Alcohol-30) were given randomly to volunteers. Arsenic contents in urine and blood and several widely accepted toxicity biomarkers and pathological parameters in blood were analyzed before and after 2 months of administration of either verum or placebo. Elevated levels of ESR, creatinine and eosinophils and increased activities of AST, ALT, LPO and GGT were recorded in arsenic exposed subjects. Decreased levels of hemoglobin, PCV, neutrophil percentages, and GSH content and low G-6-PD activity were also observed in the arsenic exposed people. The administration of "verum" appeared to make positive modulations of these parameters, suggestive of its ameliorative potentials. Most of the subjects reported better appetite and improvement in general health, thereby indicating possibility of its use in remote arsenic-contaminated areas as an interim health support measure to a large population at risk. PMID:17628642

  5. 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

  6. Randomized controlled trials in evidence-based mental health care: getting the right answer to the right question.

    PubMed

    Essock, Susan M; Drake, Robert E; Frank, Richard G; McGuire, Thomas G

    2003-01-01

    The purpose of clinical research is to answer this question: Would a new treatment, when added to the existing range of treatment options available in practice, help patients? Randomized controlled trials (RCTs)--in particular, double-blind RCTs--have important methodological advantages over observational studies for addressing this question. These advantages, however, come at a price. RCTs compare treatments using a particular allocation rule for assigning patients to treatments (random assignment) that does not mimic real-world practice. "Favorable" results from an RCT indicating that a new treatment is superior to existing treatments are neither necessary nor sufficient for establishing a "yes" answer to the question posed above. Modeled on an experimental design, RCTs are expensive in time and money and must compare simple differences in treatments. Findings have a high internal validity but may not address the needs of the field, particularly where treatment is complex and rapidly evolving. Design of clinical research needs to take account of the way treatments are allocated in actual practice and include flexible designs to answer important questions most effectively. PMID:12908666

  7. 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. 27:847852, 2014. PMID:24797314

  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 (β) 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. 42 CFR 460.74 - Infection control.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 4 2013-10-01 2013-10-01 false Infection control. 460.74 Section 460.74 Public...) PACE Administrative Requirements 460.74 Infection control. (a) Standard procedures. The PACE organization must follow accepted policies and standard procedures with respect to infection control,...

  10. 38 CFR 52.190 - Infection control.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 2 2013-07-01 2013-07-01 false Infection control. 52.190... FOR ADULT DAY HEALTH CARE OF VETERANS IN STATE HOMES Standards 52.190 Infection control. The program management must establish and maintain an infection control program designed to prevent the development...

  11. 42 CFR 460.74 - Infection control.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 4 2014-10-01 2014-10-01 false Infection control. 460.74 Section 460.74 Public...) PACE Administrative Requirements 460.74 Infection control. (a) Standard procedures. The PACE organization must follow accepted policies and standard procedures with respect to infection control,...

  12. 42 CFR 460.74 - Infection control.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 4 2012-10-01 2012-10-01 false Infection control. 460.74 Section 460.74 Public...) PACE Administrative Requirements 460.74 Infection control. (a) Standard procedures. The PACE organization must follow accepted policies and standard procedures with respect to infection control,...

  13. 38 CFR 52.190 - Infection control.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 2 2014-07-01 2014-07-01 false Infection control. 52.190... FOR ADULT DAY HEALTH CARE OF VETERANS IN STATE HOMES Standards 52.190 Infection control. The program management must establish and maintain an infection control program designed to prevent the development...

  14. 42 CFR 460.74 - Infection control.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 4 2011-10-01 2011-10-01 false Infection control. 460.74 Section 460.74 Public...) PACE Administrative Requirements 460.74 Infection control. (a) Standard procedures. The PACE organization must follow accepted policies and standard procedures with respect to infection control,...

  15. 38 CFR 52.190 - Infection control.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 2 2011-07-01 2011-07-01 false Infection control. 52.190... FOR ADULT DAY HEALTH CARE OF VETERANS IN STATE HOMES Standards 52.190 Infection control. The program management must establish and maintain an infection control program designed to prevent the development...

  16. Effectiveness of evidence-based medicine training for undergraduate students at a Chinese Military Medical University: a self-controlled trial

    PubMed Central

    2014-01-01

    Background To evaluate the effect of the integration of evidence-based medicine (EBM) into medical curriculum by measuring undergraduate medical students EBM knowledge, attitudes, personal application, and anticipated future use. Methods A self-controlled trial was conducted with 251 undergraduate students at a Chinese Military Medical University, using a validated questionnaire regarding the students evidence-based practice (EBP) about knowledge (EBP-K), attitude (EBP-A), personal application (EBP-P), and future anticipated use (EBP-F). The educational intervention was a 20-hour EBM course formally included in the universitys medical curriculum, combining lectures with small group discussion and student-teacher exchange sessions. Data were analyzed using paired t-tests to test the significance of the difference between a before and after comparison. Results The difference between the pre- and post-training scores were statistically significant for EBP-K, EBP-A, EBP-P, and EBP-F. The scores for EBP-P showed the most pronounced percentage change after EBM training (48.97??8.6%), followed by EBP-A (20.83??2.1%), EBP-K (19.21??3.2%), and EBP-F (17.82??5.7%). Stratified analyses by gender, and program subtypes did not result in any significant changes to the results. Conclusions The integration of EBM into the medical curriculum improved undergraduate medical students EBM knowledge, attitudes, personal application, and anticipated future use. A well-designed EBM training course and objective outcome measurements are necessary to ensure the optimum learning opportunity for students. PMID:24996537

  17. Expanding primary care capacity to treat hepatitis C virus infection through an evidence-based care model--Arizona and Utah, 2012-2014.

    PubMed

    Mitruka, Kiren; Thornton, Karla; Cusick, Susanne; Orme, Christina; Moore, Ann; Manch, Richard A; Box, Terry; Carroll, Christie; Holtzman, Deborah; Ward, John W

    2014-05-01

    Hepatitis C virus (HCV) infection is the leading reason for liver transplantation and a common cause of hepatocellular carcinoma, the most rapidly increasing cause of cancer-related deaths in the United States. Of the approximately 3 million persons living with HCV infection in the United States, an estimated 38% are linked to care, 11% are treated, and 6% achieve cure. Recent development of highly effective and well-tolerated medications, such as sofosbuvir and simeprevir, to treat chronic HCV infection shows promise in curbing rising HCV-related morbidity and mortality, with the potential to cure >90% of patients. To fully benefit from these new treatments, improvement in linkage to care and treatment is urgently needed.* Lack of provider expertise in HCV treatment and limited access to specialists are well-documented barriers to HCV treatment. In September 2012, CDC funded programs in Utah and Arizona to improve access to primary care providers with the capacity to manage and treat HCV infection. Both programs were modeled on the Extension for Community Healthcare Outcomes (Project ECHO), developed by the University of New Mexico's Health Sciences Center in 2003 to build primary care capacity to treat diseases among rural, underserved populations through videoconferencing and case-based learning in "teleECHO" clinics. To assess the effectiveness of these programs in improving primary care provider capacity and increasing the number of patients initiating treatment, process and patient outcome data for each state program were analyzed. In both states, Project ECHO was successfully implemented, training 66 primary care clinicians, predominantly from rural settings. Nearly all (93%) of the clinicians had no prior experience in care and treatment of HCV infection. In both states combined, 129 (46%) of HCV-infected patients seen in teleECHO clinics received antiviral treatment, more than doubling the proportion of patients expected to receive treatment. These findings demonstrate Project ECHO's ability to expand primary care capacity to treat HCV infection, notably among underserved populations. PMID:24807237

  18. Methods for developing evidence-based recommendations by the Advisory Committee on Immunization Practices (ACIP) of the U.S. Centers for Disease Control and Prevention (CDC).

    PubMed

    Ahmed, Faruque; Temte, Jonathan L; Campos-Outcalt, Doug; Schnemann, Holger J

    2011-11-15

    The Advisory Committee on Immunization Practices (ACIP) provides expert external advice and guidance to the Director of the Centers for Disease Control and Prevention and the Secretary of the U.S. Department of Health and Human Services on use of vaccines and related agents for control of vaccine-preventable disease in the United States. During the October 2010 ACIP meeting, the ACIP voted to adopt a new framework for developing evidence-based recommendations that is based on the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. Key factors considered in the development of recommendations include the balance of benefits and harms, type of evidence, values and preferences of the people affected, and health economic analyses. Category A recommendations will be made for all persons in an age- or risk-factor-based group. Category B recommendations will be made for individual clinical decision making; category B recommendations do not apply to all members of an age- or risk-factor-based group, but in the context of a clinician-patient interaction, vaccination may be found to be appropriate for a person. Evidence tables will be used to summarize the benefits and harms and the strengths and limitations of the body of evidence. The new evidence framework will enhance the ACIP's decision-making process by making it more transparent, consistent and systematic. PMID:21839794

  19. Reduction of Catheter-Associated Urinary Tract Infections Through the Use of an Evidence-Based Nursing Algorithm and the Implementation of Shift Nursing Rounds: A Quality Improvement Project.

    PubMed

    Thomas, Kamishia L

    2016-01-01

    Catheter-associated urinary tract infections (CAUTIs) are the most common hospital-acquired infections. The purpose of this quality improvement (QI) project was to successfully implement a nurse-led evidence-based practice change designed to reduce CAUTIs in a cardiac intensive care and step-down unit. The QI project was implemented using a convenience sample of patients admitted to the cardiac intensive care and step-down unit.Evaluation data were collected 3 months preimplementation and 9 months postimplementation. We used Wick's Check-Plan-Do-Check-Act model of continuous QI to guide the project. A statistically significant change in the number of CAUTIs (P = .009) and CAUTI occurrences (P = .005) was observed following the intervention. The number of indwelling catheter days and indwelling catheter utilization did not significantly differ following implementation of the intervention. Nurse compliance with the intervention was computed for each month; the average compliance rate was 91%. Findings from this project indicate that a nurse-led evidence-based practice project exerted a positive influence on CAUTI occurrences. PMID:26808302

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

    PubMed

    Lagac-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

  1. Effect of evidence-based drug therapy on long-term outcomes in patients discharged after myocardial infarction: a nested casecontrol study in Italy

    PubMed Central

    Kirchmayer, Ursula; Di Martino, Mirko; Agabiti, Nera; Bauleo, Lisa; Fusco, Danilo; Belleudi, Valeria; Arc, Massimo; Pinnarelli, Luigi; Perucci, Carlo Alberto; Davoli, Marina

    2013-01-01

    Purpose There are some methodological concerns regarding results from observational studies about the effectiveness of evidence-based (EB) drug therapy in secondary prevention after myocardial infarction. The present study used a nested casecontrol approach to address these major methodological limitations. Methods A cohort of 6880 patients discharged from hospital after acute myocardial infarction (AMI) in 20062007 was enrolled and followed-up throughout 2009. Exposure was defined as adherence to each drug in terms of the proportion of days covered (cutoff ? 75%). Composite treatment groups, that is, groups with no EB therapy or therapy with one, two, three, or four EB drugs), were analyzed. Outcomes were overall mortality and reinfarction. Nested casecontrol studies were performed for both outcomes, matching four controls to every case (841 deaths, 778 reinfarctions) by gender, age, and individual follow-up. The association between exposure to EB drug therapy and outcomes was analyzed using conditional logistic regression, adjusting for revascularization procedures, comorbidities, duration of index admission, and use of the study drugs prior to admission. Results Mortality and reinfarction risk decreased with the use of an increasing number of EB drugs. Combinations of two or more EB drugs were associated with a significant protective effect (p < 0.001) versus no EB drugs (mortality: 4 EB drugs: ORadj = 0.35; 95%CI: 0.210.59; reinfarction: 4 EB drugs: ORadj = 0.23; 95%CI: 0.150.37). Conclusions These findings of the beneficial effects of EB polytherapy on mortality and morbidity in a population-based setting using a nested casecontrol approach strengthen existing evidence from observational studies. Copyright 2013 John Wiley & Sons, Ltd. PMID:23529919

  2. 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

  3. Methicillin-resistant Staphylococcus aureus. A continuing infection control challenge.

    PubMed

    Molinari, John A

    2012-04-01

    The ability of MRSA and other staphylococci to colonize, persist, and adapt to multiple environmental and tissue conditions has allowed for these bacteria to be virtually ubiquitous in their distribution. The effectiveness of commonly used antibiotics, such as penicillin, has continued to decline against infections caused by MRSA and increasingly resistant strains. The challenge for both dental and medical health professionals is to routinely apply proven, evidence-based infection control precautions. As mentioned earlier in this discussion, when compliance with effective aseptic technique practices improves, the patients and environments. Ensure that reusable equipment is not used for the care of another patient until it has been appropriately cleaned and reprocessed and that single-use items are properly discarded. Clean and disinfect clinical contact surfaces that are not barrier-protected by using an environmental protection agency-registered hospital disinfectant with a low- (ie, HIV and HBV label claims) to intermediate-level (ie, tuberculocidal claim) activity after each patient. When the surface is visibly contaminated with blood, an intermediate-incidence of detectable infections can be reduced. Microorganisms will continue to evolve and adapt in order to survive and thrive, sometimes at the expense of susceptible human hosts. The struggle is to constantly remain aware of impending infectious threats which may challenge current precautions, and maintain and improve the quality of infection control to minimize the potential for disease. PMID:22612032

  4. The Spatial Distribution of Hepatitis C Virus Infections and Associated Determinants—An Application of a Geographically Weighted Poisson Regression for Evidence-Based Screening Interventions in Hotspots

    PubMed Central

    Kauhl, Boris; Heil, Jeanne; Hoebe, Christian J. P. A.; Schweikart, Jürgen; Krafft, Thomas; Dukers-Muijrers, Nicole H. T. M.

    2015-01-01

    Background Hepatitis C Virus (HCV) infections are a major cause for liver diseases. A large proportion of these infections remain hidden to care due to its mostly asymptomatic nature. Population-based screening and screening targeted on behavioural risk groups had not proven to be effective in revealing these hidden infections. Therefore, more practically applicable approaches to target screenings are necessary. Geographic Information Systems (GIS) and spatial epidemiological methods may provide a more feasible basis for screening interventions through the identification of hotspots as well as demographic and socio-economic determinants. Methods Analysed data included all HCV tests (n = 23,800) performed in the southern area of the Netherlands between 2002–2008. HCV positivity was defined as a positive immunoblot or polymerase chain reaction test. Population data were matched to the geocoded HCV test data. The spatial scan statistic was applied to detect areas with elevated HCV risk. We applied global regression models to determine associations between population-based determinants and HCV risk. Geographically weighted Poisson regression models were then constructed to determine local differences of the association between HCV risk and population-based determinants. Results HCV prevalence varied geographically and clustered in urban areas. The main population at risk were middle-aged males, non-western immigrants and divorced persons. Socio-economic determinants consisted of one-person households, persons with low income and mean property value. However, the association between HCV risk and demographic as well as socio-economic determinants displayed strong regional and intra-urban differences. Discussion The detection of local hotspots in our study may serve as a basis for prioritization of areas for future targeted interventions. Demographic and socio-economic determinants associated with HCV risk show regional differences underlining that a one-size-fits-all approach even within small geographic areas may not be appropriate. Future screening interventions need to consider the spatially varying association between HCV risk and associated demographic and socio-economic determinants. PMID:26352611

  5. 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

  6. Indoor environmental control of tuberculosis and other airborne infections.

    PubMed

    Nardell, E A

    2016-02-01

    Tuberculosis (TB) remains the airborne infection of global importance, although many environmental interventions to control TB apply to influenza and other infections with airborne potential. This review focuses on the global problem and the current state of available environmental interventions. TB transmission is facilitated in overcrowded, poorly ventilated congregate settings, such as hospitals, clinics, prisons, jails, and refugee camps. The best means of TB transmission control is source control- to identify unsuspected infectious cases and to promptly begin effective therapy. However, even with active case finding and rapid diagnostics, not every unsuspected case will be identified, and environmental control measures remain the next intervention of choice. Natural ventilation is the main means of air disinfection and has the advantage of wide availability, low cost, and high efficacy-under optimal conditions. It is usually not applicable all year in colder climates and may not be effective when windows are closed on cold nights in warm climates, for security, and for pest control. In warm climates, windows may be closed when air conditioning is installed for thermal comfort. Although mechanical ventilation, if properly installed and maintained, can provide adequate air disinfection, it is expensive to install, maintain, and operate. The most cost-effective way to achieve high levels of air disinfection is upper room germicidal irradiation. The safe and effective application of this poorly defined intervention is now well understood, and recently published evidence-based application guidelines will make implementation easier. PMID:26178270

  7. Evidence-Based Language Practice

    ERIC Educational Resources Information Center

    Pollock, Eric J.

    2005-01-01

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

  8. 38 CFR 52.190 - Infection control.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 2 2010-07-01 2010-07-01 false Infection control. 52.190 Section 52.190 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS (CONTINUED) PER DIEM FOR ADULT DAY HEALTH CARE OF VETERANS IN STATE HOMES Standards § 52.190 Infection control. The program management must establish and...

  9. 38 CFR 51.190 - Infection control.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 2 2010-07-01 2010-07-01 false Infection control. 51.190 Section 51.190 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS (CONTINUED) PER DIEM FOR NURSING HOME CARE OF VETERANS IN STATE HOMES Standards § 51.190 Infection control. The facility management must establish and maintain...

  10. 38 CFR 51.190 - Infection control.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 2 2011-07-01 2011-07-01 false Infection control. 51.190 Section 51.190 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS (CONTINUED) PER DIEM FOR NURSING HOME CARE OF VETERANS IN STATE HOMES Standards § 51.190 Infection control. The...

  11. 38 CFR 51.190 - Infection control.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 2 2013-07-01 2013-07-01 false Infection control. 51.190 Section 51.190 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS (CONTINUED) PER DIEM FOR NURSING HOME CARE OF VETERANS IN STATE HOMES Standards § 51.190 Infection control. The...

  12. 38 CFR 51.190 - Infection control.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 2 2014-07-01 2014-07-01 false Infection control. 51.190 Section 51.190 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS (CONTINUED) PER DIEM FOR NURSING HOME CARE OF VETERANS IN STATE HOMES Standards § 51.190 Infection control. The...

  13. 38 CFR 51.190 - Infection control.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 2 2012-07-01 2012-07-01 false Infection control. 51.190 Section 51.190 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS (CONTINUED) PER DIEM FOR NURSING HOME CARE OF VETERANS IN STATE HOMES Standards § 51.190 Infection control. The...

  14. 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

  15. 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

  16. Infection control in cardiac surgery.

    PubMed

    Clark, R E; Amos, W C; Higgins, V; Bemberg, K F; Weldon, C S

    1976-01-01

    This report relates the results of a multifaceted, 4 year program directed toward reduction of infection in patients undergoing cardiac operations and extracorporeal circulation in a large teaching hospital. Retrospective analysis of all superficial and deep wound infections and prosthetic valve infections for the period of 1966 to 1970 and a prospective study of the period of 1970 to 1974 were made. The multifaceted program begun in 1970 consisted of (1) renovation of a cardiac operating room with incorporation of a high flow, vertical unidirectional ventilation system, (2) change in the gown and draping material for improvement of barriers to bacteriologic shedding, (3) frequent steam sterilization of prosthetic valves, (4) routine use of an antistaphylococcal agent in patients receiving valve replacement, and (5) an unannounced bacteriologic monitoring program of the cardiac operating room personnel. Studies of airborne particulates and bacteria and adequacy of skin preparation and hair removal also were conducted. The studies showed that (1) a high-flow HEPA filtered vertical ventilation system and altered operating room clothing reduced the concentration of airborne particles and the concentration of bacteria at the wound by a factor of 10 compared to conventional operating rooms, (2) the incidence of markedly contaminated scrubbed and unscrubbed hands decreased, (3) shedders and carriers were identified, and (4) current patient skin preparation and hair removal practices were satisfactory. The results of the program were a reduction of the deep wound infection rate from 2.9 to 0.6 percent (p less than 0.01) and a concomitant total wound infection decrease from 6.6 to 3.3 percent. Prosthetic valve infection rates decreased fourfold, from 5.6 to 1.4 percent. It is concluded that careful attention to possible endogenous sources of infection from the patient and a multifaceted program directed to exogenous sources of infection can lower infection rates in cardiac surgical patients. PMID:1246694

  17. Infection control in severely burned patients

    PubMed Central

    Coban, Yusuf Kenan

    2012-01-01

    In the last two decades, much progress has been made in the control of burn wound infection and nasocomial infections (NI) in severely burned patients. The continiually changing epidemiology is partially related to greater understanding of and improved techniques for burn patient management as well as effective hospital infection control measures. With the advent of antimicrobial chemotherapeutic agents, infection of the wound site is now not as common as, for example, urinary and blood stream infections. Universal application of early excision of burned tissues has made a substantial improvement in the control of wound-related infections in burns. Additionally, the development of new technologies in wound care have helped to decrease morbidity and mortality in severe burn victims. Many examples can be given of the successful control of wound infection, such as the application of an appropriate antibiotic solution to invasive wound infection sites with simultaneous vacuum-assisted closure, optimal preservation of viable tissues with waterjet debridement systems, edema and exudate controlling dressings impregnated with Ag (Silvercel, Aquacell-Ag). The burned patient is at high risk for NI. Invasive interventions including intravenous and urinary chateterization, and entubation pose a further risk of NIs. The use of newly designed antimicrobial impregnated chateters or silicone devices may help the control of infection in these immunocomprimised patients. Strict infection control practices (physical isolation in a private room, use of gloves and gowns during patient contact) and appropriate empirical antimicrobial therapy guided by laboratory surveillance culture as well as routine microbial burn wound culture are essential to help reduce the incidance of infections due to antibiotic resistant microorganisms. PMID:24701406

  18. Engineering infection control through facility design.

    PubMed Central

    Noskin, G. A.; Peterson, L. R.

    2001-01-01

    Many medical centers have modified their facility design to provide a safer environment for patients. From an infection control perspective, the primary objective of hospital design is to place the patient at no risk for infection while hospitalized. We describe historical landmarks about hospital design, modern facility design, and specific designs to prevent acquisition and spread of infections such as tuberculosis and aspergillosis. PMID:11294739

  19. Infection control update: beware of the ragwheel.

    PubMed

    Noraian, K W

    1989-01-01

    Previously, concern about infection control in dentistry emphasized the handpiece, operator safety, barrier technique, and patient protection in the dental operatory. As current knowledge of infection control increases an expanded understanding of other sources of disease transmission is indicated. Often overlooked is the dental laboratory of which particular interest focuses on the lathes used in preparing prosthetic appliances, castings, orthodontic appliances, and surgical stents. Specifically, the potential threat of the ragwheel to the patient and operator is significant. Ragwheels and pumice samples were collected and cultured, the results of which mandate the need for infection control guidelines for the dental laboratory. PMID:2489210

  20. 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

  1. 42 CFR 483.65 - Infection control.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 5 2010-10-01 2010-10-01 false Infection control. 483.65 Section 483.65 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STANDARDS AND CERTIFICATION REQUIREMENTS FOR STATES AND LONG TERM CARE FACILITIES Requirements for Long Term Care Facilities § 483.65 Infection...

  2. Compliance with infection prevention and control in oral health-care facilities: a global perspective.

    PubMed

    Oosthuysen, Jeann; Potgieter, Elsa; Fossey, Annabel

    2014-12-01

    Many publications are available on the topic of compliance with infection prevention and control in oral health-care facilities all over the world. The approaches of developing and developed countries show wide variation, but the principles of infection prevention and control are the same globally. This study is a systematic review and global perspective of the available literature on infection prevention and control in oral health-care facilities. Nine focus areas on compliance with infection-control measures were investigated: knowledge of infectious occupational hazards; personal hygiene and care of hands; correct application of personal protective equipment; use of environmental barriers and disposable items; sterilisation (recirculation) of instruments and handpieces; disinfection (surfaces) and housekeeping; management of waste disposal; quality control of dental unit waterlines, biofilms and water; and some special considerations. Various international studies from developed countries have reported highly scientific evidence-based information. In developed countries, the resources for infection prevention and control are freely available, which is not the case in developing countries. The studies in developing countries also indicate serious shortcomings with regard to infection prevention and control knowledge and education in oral health-care facilities. This review highlights the fact that availability of resources will always be a challenge, but more so in developing countries. This presents unique challenges and the opportunity for innovative thinking to promote infection prevention and control. PMID:25244364

  3. 42 CFR 483.65 - Infection control.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ...) STANDARDS AND CERTIFICATION REQUIREMENTS FOR STATES AND LONG TERM CARE FACILITIES Requirements for Long Term Care Facilities § 483.65 Infection control. The facility must establish and maintain an...

  4. 42 CFR 483.65 - Infection control.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ...) STANDARDS AND CERTIFICATION REQUIREMENTS FOR STATES AND LONG TERM CARE FACILITIES Requirements for Long Term Care Facilities § 483.65 Infection control. The facility must establish and maintain an...

  5. 42 CFR 483.65 - Infection control.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...) STANDARDS AND CERTIFICATION REQUIREMENTS FOR STATES AND LONG TERM CARE FACILITIES Requirements for Long Term Care Facilities § 483.65 Infection control. The facility must establish and maintain an...

  6. 42 CFR 483.65 - Infection control.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...) STANDARDS AND CERTIFICATION REQUIREMENTS FOR STATES AND LONG TERM CARE FACILITIES Requirements for Long Term Care Facilities § 483.65 Infection control. The facility must establish and maintain an...

  7. 77 FR 58397 - Healthcare Infection Control Practices Advisory Committee (HICPAC)

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-09-20

    ... HUMAN SERVICES Centers for Disease Control and Prevention Healthcare Infection Control Practices... surveillance, prevention, and control of healthcare-associated infections (e.g., nosocomial infections) antimicrobial resistance and related events in settings where healthcare is provided, including...

  8. 75 FR 22816 - Healthcare Infection Control Practices Advisory Committee (HICPAC)

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-04-30

    ... HUMAN SERVICES Centers for Disease Control and Prevention Healthcare Infection Control Practices... control of healthcare-associated infections (e.g., nosocomial infections), antimicrobial resistance, and related events in settings where healthcare is provided, including hospitals, ambulatory and...

  9. Reduction of central line-associated bloodstream infection rates in a neonatal intensive care unit after implementation of a multidisciplinary evidence-based quality improvement collaborative: A four-year surveillance

    PubMed Central

    Ting, Joseph Y; Goh, Vicki SK; Osiovich, Horacio

    2013-01-01

    BACKGROUND: The use of central venous catheters has permitted lifesaving treatment for critically ill neonates; however, the attributable mortality rate for central line-associated bloodstream infections (CLABSIs) has been estimated to be between 4% and 20%. In 2006/2007, the authors’ neonatal intensive care unit (NICU) had a CLABSI rate that was nearly twofold higher than that reported by other Canadian NICUs. OBJECTIVE: To implement a quality improvement collaborative to reduce the incidence of neonatal CLABSI. METHODS: A retrospective observational study was performed to compare CLABSI in neonates admitted to the authors’ level III NICU between August 2007 and March 2011. The entire study period was divided into four time periods to evaluate secular trends. A comprehensive catheter-related bloodstream infection prevention initiative was implemented in August 2007. The initiatives included staff education, standardization of skin preparation protocol, introduction of new antiseptic agents, implementation of central catheter insertion and maintenance checklists, reinforcement of the use of maximal sterile barrier precautions, and revision of the central catheter configuration and maintenance protocols. RESULTS: The median CLABSI rate of 7.9 per 1000 catheter days at the beginning of the study (period 1 [August 2007 to June 2008]) gradually decreased over the entire study period (P=0.034): period 2 (July 2008 to May 2009), 3.3 per 1000 catheter days; period 3 (June 2009 to April 2010), 2.6 per 1000 catheter days; and period 4 (May 2010 to March 2011), 2.2 per 1000 catheter days. CONCLUSION: A multidisciplinary evidence-based quality improvement collaborative resulted in a significant reduction in the CLABSI rate. Continuous quality improvement measures are required to reduce catheter-related bloodstream infections among low-birth-weight infants. PMID:24489559

  10. Post-treatment control of HIV infection

    SciTech Connect

    Conway, Jessica M.; Perelson, Alan S.

    2015-04-13

    Antiretroviral therapy (ART) for HIV is not a cure. However, recent studies suggest that ART, initiated early during primary infection, may induce post-treatment control (PTC) of HIV infection with HIV RNA maintained at <50 copies per mL. We investigate the hypothesis that ART initiated early during primary infection permits PTC by limiting the size of the latent reservoir, which, if small enough at treatment termination, may allow the adaptive immune response to prevent viral rebound (VR) and control infection. We use a mathematical model of within host HIV dynamics to capture interactions among target cells, productively infected cells, latently infected cells, virus, and cytotoxic T lymphocytes (CTLs). Analysis of our model reveals a range in CTL response strengths where a patient may show either VR or PTC, depending on the size of the latent reservoir at treatment termination. Below this range, patients will always rebound, whereas above this range, patients are predicted to behave like elite controllers. As a result, using data on latent reservoir sizes in patients treated during primary infection, we also predict population-level VR times for non-controllers consistent with observations.

  11. Updating the evidence base on the operational costs of supplementary immunization activities for current and future accelerated disease control, elimination and eradication efforts

    PubMed Central

    2014-01-01

    Background To achieve globally or regionally defined accelerated disease control, elimination and eradication (ADC/E/E) goals against vaccine-preventable diseases requires complementing national routine immunization programs with intensive, time-limited, and targeted Supplementary Immunization Activities (SIAs). Many global and country-level SIA costing efforts have historically relied on what are now outdated benchmark figures. Mobilizing adequate resources for successful implementation of SIAs requires updated estimates of non-vaccine costs per target population. Methods This assessment updates the evidence base on the SIA operational costs through a review of literature between 1992 and 2012, and an analysis of actual expenditures from 142 SIAs conducted between 2004 and 2011 and documented in country immunization plans. These are complemented with an analysis of budgets from 31 SIAs conducted between 2006 and 2011 in order to assess the proportion of total SIA costs per person associated with various cost components. All results are presented in 2010 US dollars. Results Existing evidence indicate that average SIA operational costs were usually less than US$0.50 per person in 2010 dollars. However, the evidence is sparse, non-standardized, and largely out of date. Average operational costs per person generated from our analysis of country immunization plans are consistently higher than published estimates, approaching US$1.00 for injectable vaccines. The results illustrate that the benchmarks often used to project needs underestimate the true costs of SIAs and the analysis suggests that SIA operational costs have been increasing over time in real terms. Our assessment also illustrates that operational costs vary across several dimensions. Variations in the actual costs of SIAs likely to reflect the extents to which economies of scale associated with campaign-based delivery can be attained, the underlying strength of the immunization program, sensitivities to the relative ease of vaccine administration (i.e. orally, or by injection), and differences in disease-specific programmatic approaches. The assessment of SIA budgets by cost component illustrates that four cost drivers make up the largest proportion of costs across all vaccines: human resources, program management, social mobilization, and vehicles and transportation. These findings suggest that SIAs leverage existing health system infrastructure, reinforcing the fact that strong routine immunization programs are an important pre-requisite for achieving ADC/E/E goals. Conclusions The results presented here will be useful for national and global-level actors involved in planning, budgeting, resource mobilization, and financing of SIAs in order to create more realistic assessments of resource requirements for both existing ADC/E/E efforts as well as for new vaccines that may deploy a catch-up campaign-based delivery component. However, limitations of our analysis suggest a need to conduct further research into operational costs of SIAs. Understanding the changing face of delivery costs and cost structures for SIAs will continue to be critical to avoid funding gaps and in order to improve vaccination coverage, reduce health inequities, and achieve the ADC/E/E goals many of which have been endorsed by the World Health Assembly and are included in the Decade of Vaccines Global Vaccine Action Plan. PMID:24450832

  12. Post-treatment control of HIV infection

    PubMed Central

    Conway, Jessica M.; Perelson, Alan S.

    2015-01-01

    Antiretroviral therapy (ART) for HIV is not a cure. However, recent studies suggest that ART, initiated early during primary infection, may induce post-treatment control (PTC) of HIV infection with HIV RNA maintained at <50 copies per mL. We investigate the hypothesis that ART initiated early during primary infection permits PTC by limiting the size of the latent reservoir, which, if small enough at treatment termination, may allow the adaptive immune response to prevent viral rebound (VR) and control infection. We use a mathematical model of within host HIV dynamics to capture interactions among target cells, productively infected cells, latently infected cells, virus, and cytotoxic T lymphocytes (CTLs). Analysis of our model reveals a range in CTL response strengths where a patient may show either VR or PTC, depending on the size of the latent reservoir at treatment termination. Below this range, patients will always rebound, whereas above this range, patients are predicted to behave like elite controllers. Using data on latent reservoir sizes in patients treated during primary infection, we also predict population-level VR times for noncontrollers consistent with observations. PMID:25870266

  13. Post-treatment control of HIV infection

    DOE PAGESBeta

    Conway, Jessica M.; Perelson, Alan S.

    2015-04-13

    Antiretroviral therapy (ART) for HIV is not a cure. However, recent studies suggest that ART, initiated early during primary infection, may induce post-treatment control (PTC) of HIV infection with HIV RNA maintained at <50 copies per mL. We investigate the hypothesis that ART initiated early during primary infection permits PTC by limiting the size of the latent reservoir, which, if small enough at treatment termination, may allow the adaptive immune response to prevent viral rebound (VR) and control infection. We use a mathematical model of within host HIV dynamics to capture interactions among target cells, productively infected cells, latently infectedmore » cells, virus, and cytotoxic T lymphocytes (CTLs). Analysis of our model reveals a range in CTL response strengths where a patient may show either VR or PTC, depending on the size of the latent reservoir at treatment termination. Below this range, patients will always rebound, whereas above this range, patients are predicted to behave like elite controllers. As a result, using data on latent reservoir sizes in patients treated during primary infection, we also predict population-level VR times for non-controllers consistent with observations.« less

  14. Surgical smoke and infection control.

    PubMed

    Alp, E; Bijl, D; Bleichrodt, R P; Hansson, B; Voss, A

    2006-01-01

    Gaseous byproducts produced during electrocautery, laser surgery or the use of ultrasonic scalpels are usually referred to as 'surgical smoke'. This smoke, produced with or without a heating process, contains bio-aerosols with viable and non-viable cellular material that subsequently poses a risk of infection (human immunodeficiency virus, hepatitis B virus, human papillomavirus) and causes irritation to the lungs leading to acute and chronic inflammatory changes. Furthermore, cytotoxic, genotoxic and mutagenic effects have been demonstrated. The American Occupational Safety and Health Administration have estimated that 500000 workers are exposed to laser and electrosurgical smoke each year. The use of standard surgical masks alone does not provide adequate protection from surgical smoke. While higher quality filter masks and/or double masking may increase the filtration capability, a smoke evacuation device or filter placed near (2-5 cm) the electrocautery blade or on endoscope valves offers additional (and necessary) safety for operating personnel and patients. PMID:16002179

  15. Giardia Infection Prevention and Control

    MedlinePLUS

    ... page you requested has moved to Prevention & Control. File Formats Help: How do I view different file formats (PDF, DOC, PPT, MPEG) on this site? Adobe PDF file Microsoft PowerPoint file Microsoft Word file Microsoft Excel ...

  16. The ethics of infection control: philosophical frameworks.

    PubMed

    Bryan, Charles S; Call, Theresa J; Elliott, Kevin C

    2007-09-01

    Recent developments that are relevant to the ethics of infection control include the patient safety movement, the appearance of new diseases (notably, severe acute respiratory syndrome) that pose threats to healthcare workers, data confirming the suspicion that infection control measures such as isolation may compromise patient care, and, in philosophy, renewed interest in virtue ethics and communitarianism. We review general ethical frameworks and relevant vocabulary for infection control practitioners and hospital epidemiologists. Frameworks for the ethics of infection control resemble those of public health more than those of clinical medicine but embrace elements of both. The optimum framework, we suggest, takes into account a virtue-based communitarianism. The virtue ethics movement stresses the need to consider not only rules and outcomes but also the character of the individual(s) involved. Communitarianism emphasizes the well-being and values of local communities, best determined by shared, democratic decision making among stakeholders. Brief discussions of 15 consecutive cases illustrate the extent to which the daily practice of infection control poses problems heavily freighted with ethical overtones. PMID:17932830

  17. School Centered Evidence Based Accountability

    ERIC Educational Resources Information Center

    Milligan, Charles

    2015-01-01

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

  18. 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

  19. 77 FR 4820 - Healthcare Infection Control Practices Advisory Committee (HICPAC)

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-01-31

    ... HUMAN SERVICES Centers for Disease Control and Prevention Healthcare Infection Control Practices... Director, Division of Healthcare Quality Promotion regarding (1) the practice of healthcare infection... infections), antimicrobial resistance, and related events in settings where healthcare is provided; and...

  20. 77 FR 28392 - Healthcare Infection Control Practices Advisory Committee (HICPAC)

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-05-14

    ... HUMAN SERVICES Centers for Disease Control and Prevention Healthcare Infection Control Practices... Director, Division of Healthcare Quality Promotion regarding 1) the practice of healthcare infection... infections), antimicrobial resistance, and related events in settings where healthcare is provided; and...

  1. 78 FR 62636 - Healthcare Infection Control Practices Advisory Committee (HICPAC)

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-10-22

    ... HUMAN SERVICES Centers for Disease Control and Prevention Healthcare Infection Control Practices... Healthcare Quality Promotion, the Director, National Center for Emerging and Zoonotic Infectious Diseases... healthcare infection prevention and control; (2) strategies for surveillance, prevention, and control...

  2. 75 FR 63844 - Healthcare Infection Control Practices Advisory Committee (HICPAC)

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-10-18

    ... HUMAN SERVICES Centers for Disease Control and Prevention Healthcare Infection Control Practices... healthcare infection control and strategies for surveillance, prevention, and control of healthcare... where healthcare is provided, including hospitals, ambulatory and long-term care facilities, and...

  3. 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…

  4. 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

  5. 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

  6. Snapshots: Chromatin Control of Viral Infection

    PubMed Central

    Knipe, David M.; Lieberman, Paul M.; Jung, Jae U.; McBride, Alison A.; Morris, Kevin V.; Ott, Melanie; Margolis, David; Nieto, Amelia; Nevels, Michael; Parks, Robin J.; Kristie, Thomas M.

    2012-01-01

    Like their cellular host counterparts, many invading viral pathogens must contend with, modulate, and utilize the host cells chromatin machinery to promote efficient lytic infection or control persistent-latent states. While not intended to be comprehensive, this review represents a compilation of conceptual snapshots of the dynamic interplay of viruses with the chromatin environment. Contributions focus on chromatin dynamics during infection, viral circumvention of cellular chromatin repression, chromatin organization of large DNA viruses, tethering and persistence, viral interactions with cellular chromatin modulation machinery, and control of viral latency-reactivation cycles. PMID:23217624

  7. 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

  8. Control of viruses infecting grapevine.

    PubMed

    Maliogka, Varvara I; Martelli, Giovanni P; Fuchs, Marc; Katis, Nikolaos I

    2015-01-01

    Grapevine is a high value vegetatively propagated fruit crop that suffers from numerous viruses, including some that seriously affect the profitability of vineyards. Nowadays, 64 viruses belonging to different genera and families have been reported in grapevines and new virus species will likely be described in the future. Three viral diseases namely leafroll, rugose wood, and infectious degeneration are of major economic importance worldwide. The viruses associated with these diseases are transmitted by mealybugs, scale and soft scale insects, or dagger nematodes. Here, we review control measures of the major grapevine viral diseases. More specifically, emphasis is laid on (i) approaches for the production of clean stocks and propagative material through effective sanitation, robust diagnosis, as well as local and regional certification efforts, (ii) the management of vectors of viruses using cultural, biological, and chemical methods, and (iii) the production of resistant grapevines mainly through the application of genetic engineering. The benefits and limitations of the different control measures are discussed with regard to accomplishments and future research directions. PMID:25591880

  9. 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

  10. Performance improvement in the long-term-care setting: building on the foundation of infection control.

    PubMed

    Stevenson, Kurt B; Loeb, Mark

    2004-01-01

    Infection control programs were among the first organized efforts to improve the quality of healthcare delivered to patients and are an excellent model for the development of other healthcare performance improvement activities. Whether labeled as infection control, quality improvement, or patient safety, performance improvement initiatives share similar methods and principles. The quality of care in long-term-care facilities (LTCFs) has been scrutinized for years and has received renewed attention with the recent initiation of public reporting of quality measures by Medicare. This article reviews the principles of performance improvement, discusses the importance of employing evidence-based interventions, and emphasizes the value of local performance improvement in LTCFs. Residents of LTCFs remain at high risk for the development of nosocomial infections, and among performance improvement initiatives, infection control is recommended as a high priority for all LTCFs. Fortunately, infection control contains the essential elements for performance improvement, and a successful infection control program can provide the foundation for expanding performance improvement throughout the LTCF. There is still much that needs to be done to determine the best clinical practices for LTCFs, and this should remain a priority for future research. Furthermore, efforts should continue to apply these principles at the local level to ensure that all residents of LTCFs receive the best care possible. PMID:14756224

  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. 42 CFR 460.74 - Infection control.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Infection control. 460.74 Section 460.74 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PACE Administrative Requirements §...

  13. 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.…

  14. Assessing infection control measures for pandemic influenza.

    PubMed

    Wein, Lawrence M; Atkinson, Michael P

    2009-07-01

    We construct a mathematical model of aerosol (i.e., droplet-nuclei) transmission of influenza within a household containing one infected and embed it into an epidemic households model in which infecteds occasionally infect someone from another household; in a companion paper, we argue that the contribution from contact transmission is trivial for influenza and the contribution from droplet transmission is likely to be small. Our model predicts that the key infection control measure is the use of N95 respirators, and that the combination of respirators, humidifiers, and ventilation reduces the threshold parameter (which dictates whether or not an epidemic breaks out) by approximately 20% if 70% of households comply, and by approximately 40% if 70% of households and workplaces comply (approximately 28% reduction would have been required to control the 1918 pandemic). However, only approximately 30% of the benefits in the household are achieved if these interventions are used only after the infected develops symptoms. It is also important for people to sleep in separate bedrooms throughout the pandemic, space permitting. Surgical masks with a device (e.g., nylon hosiery) to reduce face-seal leakage are a reasonable alternative to N95 respirators if the latter are in short supply. PMID:19392673

  15. 76 FR 29756 - Healthcare Infection Control Practices Advisory Committee (HICPAC)

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-05-23

    ... HUMAN SERVICES Centers for Disease Control and Prevention Healthcare Infection Control Practices... Healthcare Quality Promotion regarding (1) The practice of healthcare infection control; (2) strategies for..., and related events in settings where healthcare is provided; and (3) periodic updating of...

  16. 78 FR 6329 - Healthcare Infection Control Practices Advisory Committee (HICPAC)

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-01-30

    ... HUMAN SERVICES Centers for Disease Control and Prevention Healthcare Infection Control Practices... advice and guidance to the Director, Division of Healthcare Quality Promotion, the Director, National... of healthcare infection prevention and control; (2) strategies for surveillance, prevention,...

  17. 76 FR 63622 - Healthcare Infection Control Practices Advisory Committee, (HICPAC)

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-13

    ... HUMAN SERVICES Centers for Disease Control and Prevention Healthcare Infection Control Practices... Healthcare Quality Promotion regarding (1) The practice of healthcare infection control; (2) strategies for..., and related events in settings where healthcare is provided; and (3) periodic updating of...

  18. 75 FR 29772 - Healthcare Infection Control Practices Advisory Committee, (HICPAC)

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-05-27

    ... HUMAN SERVICES Centers for Disease Control and Prevention Healthcare Infection Control Practices... Zoonotic Infectious Diseases (NCEZID) regarding (1) The practice of healthcare infection control; (2...), antimicrobial resistance, and related events in settings where healthcare is provided; and (3) periodic...

  19. From evidence based bioethics to evidence based social policies.

    PubMed

    Bonneux, Luc

    2007-01-01

    In this issue, Norwegian authors demonstrate that causes of early expulsion out the workforce are rooted in childhood. They reconstruct individual biographies in administrative databases linked by an unique national identification number, looking forward 15 years in early adulthood and looking back 20 years till birth with close to negligible loss to follow up. Evidence based bioethics suggest that it is better to live in a country that allows reconstructing biographies in administrative databases then in countries that forbid access by restrictive legislation based on privacy considerations. The benefits of gained knowledge from existing and accessible information are tangible, particularly for the weak and the poor, while the harms of theoretical privacy invasion have not yet materialised. The study shows once again that disadvantage runs in families. Low parental education, parental disability and unstable marital unions predict early disability pensions and premature expulsion out gainful employment. The effect of low parental education is mediated by low education of the index person. However, in a feast of descriptive studies of socio-economic causes of ill health we still face a famine of evaluative intervention studies. An evidence based social policy should be based on effective interventions that are able to break the vicious circles of disability handed down from generation to generation. PMID:17657572

  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. Healthcare-associated infections in Intensive Care Units: epidemiology and infection control in low-to-middle income countries.

    PubMed

    Alp, Emine; Damani, Nizam

    2015-01-01

    Healthcare-associated infections (HAIs) are major patient safety problems in hospitals, especially in intensive care units (ICUs). Patients in ICUs are prone to HAIs due to reduced host defense mechanisms, low compliance with infection prevention and control (IPC) measures due to lack of education and training, and heavy workload and low staffing levels, leading to cross-transmission of microorganisms from patient to patient. Patients with HAIs have prolonged hospital stays, and have high morbidity and mortality, thus adding economic burden on the healthcare system. For various reasons, in low-to-middle income countries (LMICs), the scale of the problem is huge; each year, many people die from HAIs. In this review, epidemiology of HAIs and infection prevention and control measures in ICUs is discussed, with especial emphasis on LMICs. High rates of HAIs caused by multidrug-resistant organisms (MDROs) are serious problems in ICUs in LMICs. In view of increasing prevalence of MDROs, LMICs should establish effective IPC infrastructure, appoint IPC teams, and provide adequate training and resources. These resources to establish and appoint IPC teams can be released by avoiding ritualistic, wasteful, and unsafe IPC practices, and by diverting resources to implement basic IPC measures, including early detection of infection, isolation of patients, application of appropriate IPC precautions, adherence to hand hygiene, and implementation of HAIs care bundles and basic evidence-based practices. PMID:26517477

  2. [Sexually transmitted infections: epidemiology and control].

    PubMed

    Díez, M; Díaz, A

    2011-01-01

    Sexually transmitted infections (STI) include a group of diseases of diverse infectious etiology in which sexual transmission is relevant. The burden of disease that STI represent globally is unknown for several reasons. Firstly, asymptomatic infections are common in many STI; secondly, diagnostic techniques are not available in some of the most affected countries; finally, surveillance systems are inexistent or very deficient in many areas of the world. The Word Health Organization has estimated that in 1999 there were 340 million new cases of syphilis, gonorrhoea, chlamydia infection and trichomoniasis. An increasing trend in the incidence of gonorrhoea and syphilis has been noticed in the last years in the European Union, including Spain. Co-infection with other STI, especially HIV, should be ruled out in all STI patients. Chlamydia screening is also of particular importance since this is the most common STI in Europe and frequently goes unnoticed. STI prevention and control should be based on health education, early diagnosis and treatment, screening for asymptomatic infections, contact investigation and vaccination for those diseases for which a vaccine is available. PMID:21750856

  3. Effects of evidence-based strategies to reduce the socioeconomic gradient of uptake in the English NHS Bowel Cancer Screening Programme (ASCEND): four cluster-randomised controlled trials

    PubMed Central

    Wardle, Jane; von Wagner, Christian; Kralj-Hans, Ines; Halloran, Stephen P; Smith, Samuel G; McGregor, Lesley M; Vart, Gemma; Howe, Rosemary; Snowball, Julia; Handley, Graham; Logan, Richard F; Rainbow, Sandra; Smith, Steve; Thomas, Mary C; Counsell, Nicholas; Morris, Steve; Duffy, Stephen W; Hackshaw, Allan; Moss, Sue; Atkin, Wendy; Raine, Rosalind

    2016-01-01

    Summary Background Uptake in the national colorectal cancer screening programme in England varies by socioeconomic status. We assessed four interventions aimed at reducing this gradient, with the intention of improving the health benefits of screening. Methods All people eligible for screening (men and women aged 60–74 years) across England were included in four cluster-randomised trials. Randomisation was based on day of invitation. Each trial compared the standard information with the standard information plus the following supplementary interventions: trial 1 (November, 2012), a supplementary leaflet summarising the gist of the key information; trial 2 (March, 2012), a supplementary narrative leaflet describing people's stories; trial 3 (June, 2013), general practice endorsement of the programme on the invitation letter; and trial 4 (July–August, 2013) an enhanced reminder letter with a banner that reiterated the screening offer. Socioeconomic status was defined by the Index of Multiple Deprivation score for each home address. The primary outcome was the socioeconomic status gradient in uptake across deprivation quintiles. This study is registered, number ISRCTN74121020. Findings As all four trials were embedded in the screening programme, loss to follow-up was minimal (less than 0·5%). Trials 1 (n=163 525) and 2 (n=150 417) showed no effects on the socioeconomic gradient of uptake or overall uptake. Trial 3 (n=265 434) showed no effect on the socioeconomic gradient but was associated with increased overall uptake (adjusted odds ratio [OR] 1·07, 95% CI 1·04–1·10, p<0·0001). In trial 4 (n=168 480) a significant interaction was seen with socioeconomic status gradient (p=0·005), with a stronger effect in the most deprived quintile (adjusted OR 1·11, 95% CI 1·04–1·20, p=0·003) than in the least deprived (1·00, 0·94–1·06, p=0·98). Overall uptake was also increased (1·07, 1·03–1·11, p=0·001). Interpretation Of four evidence-based interventions, the enhanced reminder letter reduced the socioeconomic gradient in screening uptake, but further reducing inequalities in screening uptake through written materials alone will be challenging. Funding National Institute for Health Research. PMID:26680217

  4. Control of infection in hospital wards

    PubMed Central

    Blowers, Robert

    1961-01-01

    Some of the problems of ward management are reviewed. Methods suggested for dealing with them are probably not the ideals that should ultimately be attained but minimum standards to serve as immediate objectives. They concern indications for and methods of isolation, control of infection from staff, environmental contamination, and a few technical procedures. A new type of dressing towel for wounds is described. Images PMID:16810967

  5. Evidence-based Science Communication

    NASA Astrophysics Data System (ADS)

    Kahan, D.

    2012-12-01

    This presentation will describe a concrete strategy for bridging the gap between the *science* of science communication and the practice of it. In recent years, social scientists have made substantial progress in identifying the psychological influences that shape public receptivity to scientific information relating to climate change and other public policy issues. That work, however, has consisted nearly entirely of laboratory experiments and public opinion surveys; these methods identify general mechanisms of information processing but do not yield concrete prescriptions for communication in field settings. In order to integrate the findings of the science of science communication with the practice of it, field communication must now be made into a meaningful site of science communication research. "Evidence-based science communication" will involve collaborative work between social scientists and practitioners aimed at formulating and testing scientifically informed communication strategies in real-world contexts.

  6. 42 CFR 418.60 - Condition of participation: Infection control.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) HOSPICE CARE Conditions of Participation: Patient Care § 418.60 Condition of participation: Infection control. The hospice must maintain and document an effective infection control program that protects patients, families, visitors, and...

  7. 42 CFR 418.60 - Condition of participation: Infection control.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) HOSPICE CARE Conditions of Participation: Patient Care § 418.60 Condition of participation: Infection control. The hospice must maintain and document an effective infection control program that protects patients, families, visitors, and...

  8. 42 CFR 418.60 - Condition of participation: Infection control.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) HOSPICE CARE Conditions of Participation: Patient Care § 418.60 Condition of participation: Infection control. The hospice must maintain and document an effective infection control program that protects patients, families, visitors, and...

  9. 75 FR 50770 - Healthcare Infection Control Practices Advisory Committee (HICPAC)

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-08-17

    ... HUMAN SERVICES Centers for Disease Control and Prevention Healthcare Infection Control Practices..., and related events in settings where healthcare is provided; and (3) periodic updating of guidelines and other policy statements regarding prevention of healthcare- associated infections and...

  10. Cross-infection control in dental laboratories.

    PubMed

    Jagger, D C; Huggett, R; Harrison, A

    1995-08-01

    The attitudes to cross-infection control of 800 dental laboratories registered with the Dental Laboratories Association have been surveyed. Considering the topicality of the subject material and the need for careful cross-infection control within and beyond the dental surgery, the response rate of 22% (175) was disappointingly low. As a result of the low response rate, the results should be seen as a guide only. Forty-nine percent of respondents had a cross-infection policy and of those with no policy 64% intended to implement one in the future. Thirty percent of laboratories receive known undisinfected work from the dental surgery. Of those items disinfected on arrival at the laboratory, those most frequently disinfected are dental impressions (77%) and dentures (51%). The most popular chemicals used for disinfection are household bleach, chlorhexidine and glutaraldehyde. Forty-four percent of the respondents generally (90% or more of the time) wear gloves when handling dental work received and opened in the laboratory. Seventy-four percent wear protective eye spectacles when trimming or polishing prostheses. Sixty-one percent used no disinfectant in the pumice and 93% did not disinfect the polishing instruments, eg wheels and mops. Forty-six percent had a policy for immunisation of staff against Hepatitis B. PMID:7546949

  11. Evidence-Based Practice in Psychology

    ERIC Educational Resources Information Center

    American Psychologist, 2006

    2006-01-01

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

  12. The MTHFR C677T polymorphism contributes to increased risk of Alzheimer's disease: evidence based on 40 case-control studies.

    PubMed

    Peng, Qiliu; Lao, Xianjun; Huang, Xiuli; Qin, Xue; Li, Shan; Zeng, Zhiyu

    2015-01-23

    The association between methylenetetrahydrofolate reductase (MTHFR) gene C677T polymorphism and Alzheimer's Disease (AD) risk has been widely reported with inconsistent results. We performed an updated meta-analysis of all available studies to clarify this situation. We conducted a comprehensive literature search in PubMed Alzgene, Embase, and Chinese Biomedical Literature database (CBM) for the period up to June 2014. Finally, a total of 40 case-control studies with 4503 AD cases and 5767 controls were included. Overall, significant increased AD risk was found, when all studies were pooled into the meta-analysis. In subgroup analyses stratified by ethnicity, age of onset, and APOE ?4 status, significant increased AD risk was found in Asians, late-onset AD, and APOE ?4 carriers, but not in Caucasians, early-onset AD, and non-APOE ?4 carriers. The present meta-analysis suggested that the MTHFR is a candidate gene for AD susceptibility. The MTHFR C677T polymorphism may be a risk factor for AD in Asians, APOE ?4 carriers, and late-onset AD. Further, investigations taking the potential gene-gene and gene-environmental interactions into consideration for the MTHFR C677T polymorphism should be conducted. PMID:25486592

  13. 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

  14. Photodynamic antimicrobial polymers for infection control.

    PubMed

    McCoy, Colin P; O'Neil, Edward J; Cowley, John F; Carson, Louise; De Barid, ine 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/cm(2) 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

  15. Epistemology of evidence based medicine.

    PubMed

    Michel, Luc

    2006-01-01

    Clinically relevant attitudes and guidelines issued by a rational evidence based medicine (EBM) approach integrate individual clinical expertise with the best available external clinical evidence from systematic research. However, many physicians, while considering the ultraliberal world they are practising in and fearing that the primary goal of managed care in a market environment is reducing cost in order to make profit or decrease spending, remain suspicious of this kind of tentative protocol driven medicine when applied to medical and surgical practice. If physicians want to develop a health policy agenda that emphasises patient care issues above providers' or payers' interests, they should share a common semantics (i.e. understand the words and the numbers), enhance education programmes, improve continuing objective assessment of the way medicine and surgery are performed, face moral issues raised by innovation, and assume an increased leadership role in sound critical evaluation of non-validated new techniques. They should no longer consider EBM as a weapon turned against the medical profession, but rather see it as a tool that may provide some answers to chronically unresolved questions in the evolving art of Medicine and Surgery. PMID:16929624

  16. Enhancing Father Engagement and Interparental Teamwork in an Evidence-Based Parenting Intervention: A Randomized-Controlled Trial of Outcomes and Processes.

    PubMed

    Frank, Tenille J; Keown, Louise J; Sanders, Matthew R

    2015-11-01

    This study examined the outcomes and process in a positive parenting program adapted to enhance father engagement and teamwork. A randomized control trial of the Group Triple P Program with additional father-relevant content was conducted with 42 families of children with conduct problems aged between 3 to 8years. Families were allocated to either the intervention or waitlist condition. Assessments of child behavior, self- and partner-reported parenting, and the interparental relationship were conducted at T1 (pre), T2 (post), and T3 (6-month follow-up). Observations were used to examine fathers' and mothers' unique and shared contributions to group process during participation in parenting group sessions. Following program completion (T2) intervention group fathers and mothers reported significantly fewer child behavior problems, dysfunctional parenting practices, and interparental conflict about child-rearing than waitlist parents. Intervention group mothers also reported increased parenting confidence and rated their partners as showing significantly fewer dysfunctional parenting practices. Intervention effects were maintained at 6-month follow-up. Observational data showed that fathers and mothers made similar contributions during the group sessions. The most frequent types of contributions were asking questions and sharing information with other parents about implementing parenting strategies. The key differences between parents were fathers' more frequent use of humor and mothers' more frequent sharing of personal stories and reporting co-parenting cooperation. The levels of session attendance and program satisfaction were high for both fathers and mothers. Findings highlight the potential benefits of efforts to engage both fathers and mothers for program adherence, satisfaction, and effectiveness. PMID:26520218

  17. Impact of an Infection Control Program in a Specialized Preschool.

    ERIC Educational Resources Information Center

    Krilov, Leonard R.; And Others

    1996-01-01

    Evaluated effects of infection control interventions--including infection control lectures and attention to environmental hygiene--on the number and types of infection illnesses occurring in a specialized preschool. Subjects were infants and preschoolers with Down Syndrome. Found that total illnesses decreased significantly, particularly for…

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

    PubMed Central

    Menegueti, Mayra Gonalves; 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 So 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

  19. Infection control in a developing world.

    PubMed

    Elston, James; Hinitt, Ian; Batson, Steve; Noakes, Cath; Wright, John; Walley, John; Humphreys, Clare

    2013-11-01

    The global HIV and tuberculosis (TB) epidemics have placed enormous burdens upon already overstretched healthcare workers and poorly resourced healthcare facilities in sub-Saharan Africa. The rapid emergence of multi-drug resistant TB, and its association with hospital-based outbreaks, have highlighted the role that healthcare facilities inadvertently may play in maintaining TB transmission, and the vital importance of attaining good TB infection control. James Elston, a specialist physician in infectious diseases and general internal medicine, who recently returned from a second stint in Swaziland, says many of the region's healthcare facilities are outdated, poorly ventilated, and were not designed for their current purpose. Here he describes how U.K.-based architects and healthcare engineers responded to an urgent call for assistance and, via close collaboration, and using novel design software, empowered healthcare workers to dramatically and rapidly improve their TB inpatient facilities, and protect the health of patients and staff. PMID:24397225

  20. 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

  1. Control of Salmonella infections in animals and prevention of human foodborne Salmonella infections. WHO Consultation.

    PubMed Central

    1994-01-01

    In many countries the incidence of human salmonella infections has markedly increased in recent years. To discuss recent developments and current understanding on the control of salmonella infections in animals, WHO organized a Consultation on the Control of Salmonella Infections in Animals: Prevention of Foodborne Salmonella Infections in Humans, held in Jena, Germany, on 21-26 November 1993. The present article summarizes the recommendations made by the participants on the pathoimmunogenesis, diagnosis, epidemiology, and control of salmonella infections and contaminations in animal production. PMID:7867127

  2. 42 CFR 485.725 - Condition of participation: Infection control.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... Providers of Outpatient Physical Therapy and Speech-Language Pathology Services § 485.725 Condition of participation: Infection control. The organization that provides outpatient physical therapy...

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

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... Providers of Outpatient Physical Therapy and Speech-Language Pathology Services § 485.725 Condition of participation: Infection control. The organization that provides outpatient physical therapy...

  4. 42 CFR 485.725 - Condition of participation: Infection control.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... Providers of Outpatient Physical Therapy and Speech-Language Pathology Services § 485.725 Condition of participation: Infection control. The organization that provides outpatient physical therapy...

  5. 42 CFR 485.725 - Condition of participation: Infection control.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... Providers of Outpatient Physical Therapy and Speech-Language Pathology Services § 485.725 Condition of participation: Infection control. The organization that provides outpatient physical therapy...

  6. Evidence-Based Research in Education.

    ERIC Educational Resources Information Center

    Research Exchange, 2003

    2003-01-01

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

  7. The Art of Evidence-Based Practice

    ERIC Educational Resources Information Center

    Pollio, David E.

    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…

  8. An evidence-based business planning process.

    PubMed

    Brandt, Julie A; Reed Edwards, Donna; Cox Sullivan, Sheila; Zehler, Jean K; Grinder, Sandra; Scott, Karen J; Cook, Judy H; Roper, Debra; Dickey, Aurora; Maddox, Kathleen L

    2009-12-01

    Using a systematic, evidence-based approach for developing a business plan allows nurse executives to forecast the needs of the organization, involve nursing staff at all levels, evaluate the direction of the profession, and present a plan with clear, concise goals. The authors describe 4 steps necessary in developing an effective evidence-based business plan. PMID:19955962

  9. 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,

  10. 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

  11. 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

  12. 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

  13. Towards Evidence Based Usability in Health Informatics?

    PubMed

    Marcilly, Romaric; Peute, Linda W; Beuscart-Zephir, Marie-Catherine; Jaspers, Monique W

    2015-01-01

    In a Health Information Technology (HIT) regulatory context in which the usability of this technology is more and more a critical issue, there is an increasing need for evidence based usability practice. However, a clear definition of evidence based usability practice and how to achieve it is still lacking. This paper underlines the need for evidence based HIT design and provides a definition of evidence based usability practice as the conscientious, explicit and judicious use of current best evidence in making decisions in design of interactive systems in health by applying usability engineering and usability design principles that have proven their value in practice. Current issues that hamper evidence based usability practice are highlighted and steps needed to achieve evidence are presented. PMID:26262527

  14. World Wide Web resources on control of nosocomial infections.

    PubMed

    Siempos, Ilias I; Fragoulis, Konstantinos N; Falagas, Matthew E

    2007-01-01

    Nosocomial infections are a major worldwide cause of death and disability, infection control programs are effective in limiting these infections, especially those acquired in the intensive care unit. The development of the world wide web has provided health care professionals with immediate access to continuously updated information in the field of infection control. We sought to identify websites that contain information on nosocomial infection control by using popular internet search engines, such as Google, Yahoo and AltaVista, and by reviewing relevant publications identified in the PubMed and Current Contents databases. Only those sites that were English language, open access, and developed by a government, academic institution, or national or international scientific association were eligible for inclusion. From a vast number of internet sites initially identified, we selected 49 that provide information on infection control for inclusion in our list of practical and relevant internet resources. Several sites provide general information on infection control practices, whereas others focus on one or a few specific infection(s). We provide health care professionals with a timely and succinct list of open access internet resources that contain information regarding the prevention and control of nosocomial infections in order to help in the dissemination of relevant information and so contribute to the limitation of such hazards. PMID:17254319

  15. Impact of a Multifaceted and Clinically Integrated Training Program in Evidence-Based Practice on Knowledge, Skills, Beliefs and Behaviour among Clinical Instructors in Physiotherapy: A Non-Randomized Controlled Study

    PubMed Central

    Olsen, Nina Rydland; Bradley, Peter; Espehaug, Birgitte; Nortvedt, Monica Wammen; Lygren, Hildegunn; Frisk, Bente; Bjordal, Jan Magnus

    2015-01-01

    Background and Purpose Physiotherapists practicing at clinical placement sites assigned the role as clinical instructors (CIs), are responsible for supervising physiotherapy students. For CIs to role model evidence-based practice (EBP) they need EBP competence. The aim of this study was to assess the short and long term impact of a six-month multifaceted and clinically integrated training program in EBP on the knowledge, skills, beliefs and behaviour of CIs supervising physiotherapy students. Methods We invited 37 CIs to participate in this non-randomized controlled study. Three self-administered questionnaires were used pre- and post-intervention, and at six-month follow-up: 1) The Adapted Fresno test (AFT), 2) the EBP Belief Scale and 3) the EBP Implementation Scale. The analysis approach was linear regression modeling using Generalized Estimating Equations. Results In total, 29 CIs agreed to participate in the study: 14 were invited to participate in the intervention group and 15 were invited to participate in the control group. One in the intervention group and five in the control group were lost to follow-up. At follow-up, the group difference was statistically significant for the AFT (mean difference = 37, 95% CI (15.9 -58.1), p<0.001) and the EBP Beliefs scale (mean difference = 8.1, 95% CI (3.1 -13.2), p = 0.002), but not for the EBP Implementation scale (mean difference = 1.8. 95% CI (-4.5-8.1), p = 0.574). Comparing measurements over time, we found a statistically significant increase in mean scores related to all outcome measures for the intervention group only. Conclusions A multifaceted and clinically integrated training program in EBP was successful in improving EBP knowledge, skills and beliefs among CIs. Future studies need to ensure long-term EBP behaviour change, in addition to assessing CIs’ abilities to apply EBP knowledge and skills when supervising students. PMID:25894559

  16. 75 FR 3912 - Healthcare Infection Control Practices Advisory Committee (HICPAC)

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-01-25

    ... HUMAN SERVICES Centers for Disease Control and Prevention Healthcare Infection Control Practices...), antimicrobial resistance, and related events in settings where healthcare is provided; and (3) periodic updating of guidelines and other policy statements regarding prevention of healthcare-associated...

  17. Infection Control: The Use and Handling of Toothbrushes

    MedlinePLUS

    ... Control in Dental Settings FAQs for Infection Control File Formats Help: How do I view different file formats (PDF, DOC, PPT, MPEG) on this site? Adobe PDF file Microsoft PowerPoint file Microsoft Word file Microsoft Excel ...

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

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM HOSPICE CARE Conditions of Participation: Patient Care § 418.60 Condition of participation: Infection control. The hospice must maintain and document an effective infection control program that protects patients, families, visitors, and hospice personnel by...

  19. 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

  20. A brief history of infection control - past and present.

    PubMed

    Forder, A A

    2007-11-01

    The scientific study of hospital or nosocomial cross-infection began during the first half of the 18th century, and from that time until the start of the 'Bacteriological Era' many of the most notable contributions originated in Scotland. However it was only 100 years later in 1858 that Florence Nightingale promoted the case for hospital reform. The real understanding of hospital infection followed upon the discoveries of Pasteur, Koch and Lister and the beginning of the 'Bacteriological Era'. The close of the 19th century saw the triumphs of hospital reform and asepsis and seemed to herald the final victory over hospital cross-infection. However, the victory was short-lived. It was soon realised that infections occurred not only in obstetric and surgical patients, but in medical patients as well, and that air could also be a source of infection. Streptococcal, staphylococcal and then Gram-negative bacilli as a cause of hospital infection became a focus of attention, as did antibiotic-resistant organisms. This paper looks briefly at the establishment of the control of infection doctor, infection control committee and infection control nurse as well as summarising the changes, problems and advances in infection control up to the present time. PMID:18250929

  1. Expanding the infection control team: development of the infection control liaison position for the neonatal intensive care unit.

    PubMed

    Wright, Judy; Stover, Beth H; Wilkerson, Shirley; Bratcher, Denise

    2002-05-01

    Neonatal survival has risen progressively during the past 30 years. As the limits of viability continue to decline, the challenges of providing care to infants at the lowest extremes of gestational age and birth weight continually increase. Nosocomial infections in this very fragile population can be devastating. The complexity of care of these premature infants requires specialized knowledge of the neonate, infectious disease processes, and methods to reduce infection risks in the neonatal intensive care unit. The role of infection control liaison has been established in our institution as an adjunct to meeting this challenge by providing a line of communication between staff, neonatologists, and the infection control team. This article describes the role of the infection control liaison and its overall impact on the infection control program in an 87-bed level II, III, and IV neonatal intensive care unit from 1995 to 1999. PMID:11988713

  2. Infantile spasms--evidence based medical management.

    PubMed

    Sahu, Jitendra Kumar

    2014-10-01

    Infantile spasms constitute significant burden of refractory epilepsy in children. The first line treatment choice varies at different centres. The author presents concise evidence based update on medical management of infantile spasms. PMID:24986193

  3. Infection control and dental practice: frequently asked questions.

    PubMed

    DePaola, Louis G

    2004-01-01

    The principles of infection control are constantly evolving to meet the challenges presented by newly emerging diseases. The Centers for Disease Control and Prevention (CDC) Guideline for Infection Control in Dental Health-Care Settings, 2003, is an important update of current infection control practices that will help the dental profession be better prepared to reduce the transmission of infectious disease(s) in the foreseeable future. However, basic questions still abound. This article reviews frequently asked questions and formats their answers according to recommendations from the 2003 CDC document. PMID:15641333

  4. Staff compliance with infection control practices: application of behavioural sciences.

    PubMed

    Seto, W H

    1995-06-01

    Microbiology and epidemiology have made significant contributions to the field of Infection Control. Most nosocomial infections which can be prevented are related to inappropriate patient care practices. However, it is extremely difficult to implement new infection control policies. To achieve staff compliance, infection control should learn from the behavioural sciences. Three related fields have been shown to be helpful in this respect: social psychology, consumer behaviour and organizational behaviour. Basic concepts from all three fields can be applied to the work of infection control for achieving staff compliance; the use of social power and the reasoned action model from the field of social psychology; the use of participatory decision-making from organizational behaviour; and the opinion leaders from consumer behaviour. PMID:7560941

  5. Current standards for infection control: audit assures compliance.

    PubMed

    Flanagan, Pauline

    Having robust policies and procedures in place for infection control is fundamentally important. However, each organization has to go a step beyond this; evidence has to be provided that these policies and procedures are followed. As of 1 April 2009, with the introduction of the Care Quality Commission and The Health and Social Care Act 2008 Code of Practice for the NHS on the Prevention and Control of Healthcare-Associated Infections and Related Guidance, the assurance of robust infection control measures within any UK provider of health care became an even higher priority. Also, the commissioning of any service by the NHS must provide evidence that the provider has in place robust procedures for infection control. This article demonstrates how the clinical audit team at the Douglas Macmillan Hospice in North Staffordshire, UK, have used audit to assure high rates of compliance with the current national standards for infection control. Prior to the audit, hospice staff had assumed that the rates of compliance for infection control approached 100%. This article shows that a good quality audit tool can be used to identify areas of shortfall in infection control and the effectiveness of putting in place an action plan followed by re-audit. PMID:19773687

  6. Designing an acupuncture study to meet evidence-based medical criteria: methodological considerations for logistic design and development of treatment interventions arising from the German randomized controlled acupuncture trial on chronic shoulder pain (GRASP).

    PubMed

    Molsberger, Albrecht F; Mau, J; Gotthardt, H; Schneider, T; Drabik, A

    2004-08-31

    The results from studies on potential treatment effects of acupuncture are often limited due to serious difficulties in methodology. Randomized controlled trials on acupuncture should test a widely accepted treatment strategy of verum and sham acupuncture. However, in clinical practice various patterns of acupuncture techniques are employed, and up to now no generally accepted guidelines on how to perform a reliable verum or sham treatment have been established. Another limitation is that in most studies the study populations are too small to obtain reliable data and to detect subtle differences between the unspecific needling of sham acupuncture and specific needling of verum acupuncture with sufficient statistical power. Moreover, only a multicenter trial in an outpatient setting would guarantee a naturalistic environment in which acupuncture is used in clinical practice. In the present report we discuss such methodological aspects in detail and summarize some practical considerations for planning an acupuncture trial that fulfills evidence-based medical criteria. The largest German study on the treatment effects of acupuncture in patients with chronic shoulder pain (recruited patients n = 452), might serve as an example for such a well-designed study. Before we could conduct our study, clear definitions and protocols for the verum and sham acupuncture treatments as well as adequate endpoints had to be developed. For this we used a combination of a comprehensive study of the literature and structured interviews with experienced physicians followed by an expert panel. A total of 41 physicians had to be trained to achieve a homogeneously high quality of acupuncture treatment. The latter represents a prerequisite for reproducibility, constituting a critical component of rigorous efficacy trials in scientific acupuncture research. PMID:15337631

  7. 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

  8. 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. PMID:26180386

  9. TNFRs and Control of Chronic LCMV Infection: Implications for Therapy.

    PubMed

    Clouthier, Derek L; Watts, Tania H

    2015-11-01

    The control of persistent viral infections requires the immune system to limit the spread of the virus while avoiding immunopathology. Recent studies have revealed that members of the tumor necrosis factor receptor (TNFR) superfamily play unique and pivotal roles in control of chronic lymphocytic choriomeningitis virus (LCMV) infection and in some settings can tip the balance between immune control and immune pathology. We review these findings and discuss how our understanding of the role of TNFRs in the immune response to chronic LCMV infection may shed light on what happens during HIV infection in humans. We discuss preclinical models of TNF/TNFR family-targeted immunotherapy of chronic LCMV infection and evaluate which TNFRs present the most promising targets for immune intervention. PMID:26481667

  10. Building new hospitals: a UK infection control perspective.

    PubMed

    Stockley, J M; Constantine, C E; Orr, K E

    2006-03-01

    Infection control input is vital throughout the planning, design and building stages of a new hospital project, and must continue through the commissioning (and decommissioning) process, evaluation and putting the facility into full clinical service. Many hospitals continue to experience problems months or years after occupying the new premises; some of these could have been avoided by infection control involvement earlier in the project. The importance of infection control must be recognized by the chief executive of the hospital trust and project teams overseeing the development. Clinical user groups and contractors must also be made aware of infection control issues. It is vital that good working relationships are built up between the infection control team (ICT) and all these parties. ICTs need the authority to influence the process. This may require their specific recognition by the Private Finance Initiative National Unit, the Department of Health or other relevant authorities. ICTs need training in how to read design plans, how to write effective specifications, and in other areas with which they may be unfamiliar. The importance of documentation and record keeping is paramount. External or independent validation of processes should be available, particularly in commissioning processes. Building design in relation to infection control needs stricter national regulations, allowing ICTs to focus on more local usage issues. Further research is needed to provide evidence regarding the relationship between building design and the prevalence of infection. PMID:16337712

  11. ICMR programme on Antibiotic Stewardship, Prevention of Infection & Control (ASPIC).

    PubMed

    Chandy, Sujith J; Michael, Joy Sarojini; Veeraraghavan, Balaji; Abraham, O C; Bachhav, Sagar S; Kshirsagar, Nilima A

    2014-02-01

    Antimicrobial resistance and hospital infections have increased alarmingly in India. Antibiotic stewardship and hospital infection control are two broad strategies which have been employed globally to contain the problems of resistance and infections. For this to succeed, it is important to bring on board the various stakeholders in hospitals, especially the clinical pharmacologists. The discipline of clinical pharmacology needs to be involved in themes such as antimicrobial resistance and hospital infection which truly impact patient care. Clinical pharmacologists need to collaborate with faculty in other disciplines such as microbiology to achieve good outcomes for optimal patient care in the hospital setting. The ASPIC programme was initiated by the Indian Council of Medical Research (ICMR) in response to the above need and was designed to bring together faculty from clinical pharmacology, microbiology and other disciplines to collaborate on initiating and improving antibiotic stewardship and concurrently curbing hospital infections through feasible infection control practices. This programme involves the participation of 20 centres per year throughout the country which come together for a training workshop. Topics pertaining to the above areas are discussed in addition to planning a project which helps to improve antibiotic stewardship and infection control practices in the various centres. It is hoped that this programme would empower hospitals and institutions throughout the country to improve antibiotic stewardship and infection control and ultimately contain antimicrobial resistance. PMID:24718396

  12. ICMR programme on Antibiotic Stewardship, Prevention of Infection & Control (ASPIC)

    PubMed Central

    Chandy, Sujith J.; Michael, Joy Sarojini; Veeraraghavan, Balaji; Abraham, O.C.; Bachhav, Sagar S.; Kshirsagar, Nilima A.

    2014-01-01

    Antimicrobial resistance and hospital infections have increased alarmingly in India. Antibiotic stewardship and hospital infection control are two broad strategies which have been employed globally to contain the problems of resistance and infections. For this to succeed, it is important to bring on board the various stakeholders in hospitals, especially the clinical pharmacologists. The discipline of clinical pharmacology needs to be involved in themes such as antimicrobial resistance and hospital infection which truly impact patient care. Clinical pharmacologists need to collaborate with faculty in other disciplines such as microbiology to achieve good outcomes for optimal patient care in the hospital setting. The ASPIC programme was initiated by the Indian Council of Medical Research (ICMR) in response to the above need and was designed to bring together faculty from clinical pharmacology, microbiology and other disciplines to collaborate on initiating and improving antibiotic stewardship and concurrently curbing hospital infections through feasible infection control practices. This programme involves the participation of 20 centres per year throughout the country which come together for a training workshop. Topics pertaining to the above areas are discussed in addition to planning a project which helps to improve antibiotic stewardship and infection control practices in the various centres. It is hoped that this programme would empower hospitals and institutions throughout the country to improve antibiotic stewardship and infection control and ultimately contain antimicrobial resistance. PMID:24718396

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

    NASA Technical Reports Server (NTRS)

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

    2014-01-01

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

  14. Evidence-based policymaking: a critique.

    PubMed

    Greenhalgh, Trisha; Russell, Jill

    2009-01-01

    The idea that policy should be based on best research evidence might appear to be self-evident. But a closer analysis reveals a number of problems and paradoxes inherent in the concept of "evidence-based policymaking." The current conflict over evidence-based policymaking parallels a long-standing "paradigm war" in social research between positivist, interpretivist, and critical approaches. This article draws from this debate in order to inform the discussions over the appropriateness of evidence- based policymaking and the related question of what is the nature of policymaking. The positivist, empiricist worldview that underpins the theory and practice of evidence-based medicine (EBM) fails to address key elements of the policymaking process. In particular, a narrowly "evidence-based" framing of policymaking is inherently unable to explore the complex, context-dependent, and value-laden way in which competing options are negotiated by individuals and interest groups. Sociolinguistic tools such as argumentation theory offer opportunities for developing richer theories about how policymaking happens. Such tools also have potential practical application in the policymaking process: by enhancing participants' awareness of their own values and those of others, the quality of the collective deliberation that lies at the heart of policymaking may itself improve. PMID:19395827

  15. 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

  16. 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

  17. Comparison of an interactive with a didactic educational intervention for improving the evidence-based practice knowledge of occupational therapists in the public health sector in South Africa: a randomised controlled trial

    PubMed Central

    2014-01-01

    Background Despite efforts to identify effective interventions to implement evidence-based practice (EBP), uncertainty remains. Few existing studies involve occupational therapists or resource-constrained contexts. This study aimed to determine whether an interactive educational intervention (IE) was more effective than a didactic educational intervention (DE) in improving EBP knowledge, attitudes and behaviour at 12 weeks. Methods A matched pairs design, randomised controlled trial was conducted in the Western Cape of South Africa. Occupational therapists employed by the Department of Health were randomised using matched-pair stratification by type (clinician or manager) and knowledge score. Allocation to an IE or a DE was by coin-tossing. A self-report questionnaire (measuring objective knowledge and subjective attitudes) and audit checklist (measuring objective behaviour) were completed at baseline and 12 weeks. The primary outcome was EBP knowledge at 12 weeks while secondary outcomes were attitudes and behaviour at 12 weeks. Data collection occurred at participants places of employment. Audit raters were blinded, but participants and the provider could not be blinded. Results Twenty-one of 28 pairs reported outcomes, but due to incomplete data for two participants, 19 pairs were included in the analysis. There was a median increase of 1.0 points (95% CI?=?-4.0, 1.0) in the IE for the primary outcome (knowledge) compared with the DE, but this difference was not significant (P?=?0.098). There were no significant differences on any of the attitude subscale scores. The median 12-week audit score was 8.6 points higher in the IE (95% CI?=?-7.7, 27.0) but this was not significant (P?=?0.196). Within-group analyses showed significant increases in knowledge in both groups (IE: T?=?4.0, P <0.001; DE: T?=?12.0, P?=?0.002) but no significant differences in attitudes or behaviour. Conclusions The results suggest that the interventions had similar outcomes at 12 weeks and that the interactive component had little additional effect. Trial registration Pan African Controlled Trials Register PACTR201201000346141, registered 31 January 2012. Clinical Trials NCT01512823, registered 1 February 2012. South African National Clinical Trial Register DOH2710093067, registered 27 October 2009. The first participants were randomly assigned on 16 July 2008. PMID:24916176

  18. 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

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

    PubMed

    Mbulaiteye, Sam M; Buonaguro, Franco M

    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. Understanding Evidence-Based Public Health Policy

    PubMed Central

    Chriqui, Jamie F.; Stamatakis, Katherine A.

    2009-01-01

    Public health policy has a profound impact on health status. Missing from the literature is a clear articulation of the definition of evidence-based policy and approaches to move the field forward. Policy-relevant evidence includes both quantitative (e.g., epidemiological) and qualitative information (e.g., narrative accounts). We describe 3 key domains of evidence-based policy: (1) process, to understand approaches to enhance the likelihood of policy adoption; (2) content, to identify specific policy elements that are likely to be effective; and (3) outcomes, to document the potential impact of policy. Actions to further evidence-based policy include preparing and communicating data more effectively, using existing analytic tools more effectively, conducting policy surveillance, and tracking outcomes with different types of evidence. PMID:19608941

  1. [Infection control and hygiene management in equine hospitals].

    PubMed

    Walther, Birgit; Janssen, Traute; Gehlen, Heidrun; Vincze, Szilvia; Borchers, Kerstin; Wieler, Lothar H; Barton, Ann Kristin; Lbke-Becker, Antina

    2014-01-01

    With the rising importance of nosocomial infections in equine hospitals, increased efforts with regard to biosecurity and infection control are necessary. This even more since nosocomial infections are often associated with multi-drug resistant pathogens. Consequently, the implementation of targeted prevention programs is essential. Since nosocomial infections are usually multifactorial events, realization of only a single measure is rarely effective to overcome nosocomial spread in clinical practice. Equine patients may be colonized at admission with multi-drug resistant pathogens such as methicillin resistant Staphylococcus aureus (MRSA) and/or extended spectrum beta lactamase-producing (ESBL-) Enterobacteriaceae. Regardless of their individual resistance properties, these bacteria are common and usually unnoticed colonizers of either the nasopharynx or the intestinal tract. Also viral diseases caused by equine herpesvirus 1 (EHV-1) and EHV-4 may reach a clinic by patients which are latently infected or in the incubation period. To prevent nosocomal outbreaks, achieve an interruption in the infection chain and to eradicate infectious agents from the hospital environment, a professional hospital management is necessary. This should be adapted to both the wide range of pathogens causing nosocomial infections and the individual needs of equine patients. Amongst others, this approach includes a risk classification of equine patients at admission and information/enlightenment of the animal owners at discharge. An efficient management of inpatients, a targeted hygiene management and clear responsibilities with respect to biosecurity together with a surveillance of nosocomial infections form the cornerstone of infection control in equine hospitals. PMID:25872258

  2. Lessons to be Learned from Evidence-based Medicine: Practice and Promise of Evidence-based Medicine and Evidence-based Education.

    ERIC Educational Resources Information Center

    Wolf, Fredric M.

    2000-01-01

    Presents statistics of deaths caused by medical errors and argues the effects of misconceptions in diagnosis and treatment. Suggests evidence-based medicine to enhance the quality of practice and minimize error rates. Presents 10 evidence-based lessons and discusses the possible benefits of evidence-based medicine to evidence-based education and

  3. Implementing GermWatcher, an enterprise infection control application.

    PubMed

    Doherty, Joshua; Noirot, Laura A; Mayfield, Jennie; Ramiah, Sridhar; Huang, Christine; Dunagan, Wm Claiborne; Bailey, Thomas C

    2006-01-01

    Automated surveillance tools can provide significant advantages to infection control practitioners. When stored in a relational database, the data collected can also be used to support numerous research and quality improvement opportunities. A previously described electronic infection control surveillance system was remodeled to provide multi-hospital support, an XML based rule set, and interoperability with an enterprise terminology server. This paper describes the new architecture being used at hospitals across BJC HealthCare. PMID:17238333

  4. Implementing GermWatcher, an Enterprise Infection Control Application

    PubMed Central

    Doherty, Joshua; Noirot, Laura A.; Mayfield, Jennie; Ramiah, Sridhar; Huang, Christine; Dunagan, Wm. Claiborne; Bailey, Thomas C.

    2006-01-01

    Automated surveillance tools can provide significant advantages to infection control practitioners. When stored in a relational database, the data collected can also be used to support numerous research and quality improvement opportunities. A previously described electronic infection control surveillance system was remodeled to provide multi-hospital support, an XML based rule set, and interoperability with an enterprise terminology server. This paper describes the new architecture being used at hospitals across BJC HealthCare. PMID:17238333

  5. Evidence-based healthcare in developing countries.

    PubMed

    Pearson, Alan; Jordan, Zoe

    2010-06-01

    Developing countries have limited resources, so it is particularly important to invest in healthcare that works. The case for evidence-based practice has long been made in the West. However, poor access to information makes this endeavour near impossible for health professionals working with vulnerable communities in low-income economies. This paper provides a call to action to create an evidence base for health professionals in developing countries and identify appropriate strategies for the dissemination of this information in realistic and meaningful ways. PMID:21077397

  6. Recommended infection-control policies for patients with human immunodeficiency virus infection. An update.

    PubMed

    Gerberding, J L

    1986-12-11

    HIV is not readily transmitted to health care workers, even after accidental parenteral exposure to infected blood. Existing guidelines for reducing exposure to blood and other body fluids will protect workers who care for patients infected with this pathogen. New infection-control guidelines for patients with AIDS are therefore not required. Awareness of the potential for nosocomial transmission of HIV has resulted in a renewed respect for the principles and practice of infection control. The procedures that the task force recommended to prevent contact with body fluids will reduce exposure not only to HIV but also to other potentially contagious pathogens in the health care environment. Implementation and enforcement of these guidelines for all patients could greatly reduce the incidence of nosocomial and occupationally acquired infections. PMID:3466033

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

    ERIC Educational Resources Information Center

    Kratochwill, Thomas R.; Steele Shernoff, Elisa

    2004-01-01

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

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

    ERIC Educational Resources Information Center

    Kratochwill, Thomas R.; Shernoff, Elisa Steele

    2003-01-01

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

  9. 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

  10. 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…

  11. Evidence-Based Teaching: Rhetoric and Reality

    ERIC Educational Resources Information Center

    Wrigley, Terry

    2015-01-01

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

  12. The Evidence Base for Positive Peer Culture

    ERIC Educational Resources Information Center

    Laursen, Erik K.

    2010-01-01

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

  13. Evidence Based Education Request Desk. EBE #741

    ERIC Educational Resources Information Center

    Regional Educational Laboratory Southeast, 2010

    2010-01-01

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

  14. 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

  15. 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…

  16. 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…

  17. 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

  18. Statewide Implementation of Evidence-Based Programs

    ERIC Educational Resources Information Center

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

    2013-01-01

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

  19. Evidence Based Education Request Desk. EBE #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…

  20. 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…

  1. 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

  2. Exploring the evidence base for national and regional policy interventions to combat resistance.

    PubMed

    Dar, Osman A; Hasan, Rumina; Schlundt, Jrgen; Harbarth, Stephan; Caleo, Grazia; Dar, Fazal K; Littmann, Jasper; Rweyemamu, Mark; Buckley, Emmeline J; Shahid, Mohammed; Kock, Richard; Li, Henry Lishi; Giha, Haydar; Khan, Mishal; So, Anthony D; Bindayna, Khalid M; Kessel, Anthony; Pedersen, Hanne Bak; Permanand, Govin; Zumla, Alimuddin; Rttingen, John-Arne; Heymann, David L

    2016-01-16

    The effectiveness of existing policies to control antimicrobial resistance is not yet fully understood. A strengthened evidence base is needed to inform effective policy interventions across countries with different income levels and the human health and animal sectors. We examine three policy domains-responsible use, surveillance, and infection prevention and control-and consider which will be the most effective at national and regional levels. Many complexities exist in the implementation of such policies across sectors and in varying political and regulatory environments. Therefore, we make recommendations for policy action, calling for comprehensive policy assessments, using standardised frameworks, of cost-effectiveness and generalisability. Such assessments are especially important in low-income and middle-income countries, and in the animal and environmental sectors. We also advocate a One Health approach that will enable the development of sensitive policies, accommodating the needs of each sector involved, and addressing concerns of specific countries and regions. PMID:26603921

  3. 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

  4. 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

  5. Pyrimidinergic Receptor Activation Controls Toxoplasma gondii Infection in Macrophages

    PubMed Central

    Moreira-Souza, Aline Cristina Abreu; Marinho, Ygor; Correa, Gladys; Santoro, Giani Frana; 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

  6. 78 FR 28221 - Healthcare Infection Control Practices Advisory Committee (HICPAC)

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-14

    ... HUMAN SERVICES Centers for Disease Control and Prevention Healthcare Infection Control Practices... Committee is charged with providing advice and guidance to the Director, Division of Healthcare Quality... Director, CDC, the Secretary, Health and Human Services regarding (1) the practice of healthcare...

  7. What's new about evidence-based assessment?

    PubMed

    Barlow, David H

    2005-09-01

    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 psychometric approach to the development of assessment procedures. Nevertheless, the era of evidence-based assessment highlights 2 somewhat different issues. First, sophisticated assessment is closely integrated with our emerging conceptions of psychopathology, rather than standing separate from these conceptions. Second, broad-based ongoing outcomes assessment systems are increasingly required for EBP on the part of governments and health care policymakers. This article summarizes these developments and looks to the future. PMID:16262456

  8. Transmission and Institutional Infection Control of Tuberculosis.

    PubMed

    Nardell, Edward A

    2015-01-01

    Tuberculosis (TB) transmission control in institutions is evolving with increased awareness of the rapid impact of treatment on transmission, the importance of the unsuspected, untreated case of transmission, and the advent of rapid molecular diagnostics. With active case finding based on cough surveillance and rapid drug susceptibility testing, in theory, it is possible to be reasonably sure that no patient enters a facility with undiagnosed TB or drug resistance. Droplet nuclei transmission of TB is reviewed with an emphasis on risk factors relevant to control. Among environmental controls, natural ventilation and upper-room ultraviolet germicidal ultraviolet air disinfection are the most cost-effective choices, although high-volume mechanical ventilation can also be used. Room air cleaners are generally not recommended. Maintenance is required for all engineering solutions. Finally, personal protection with fit-tested respirators is used in many situations where administrative and engineering methods cannot assure protection. PMID:26292985

  9. Evidence-based practices and autism.

    PubMed

    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 education has raised additional concerns. An analysis of the benefits and limitations of current approaches to empiricism in autism interventions is presented, and suggestions for future research are made. PMID:20876165

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

    PubMed

    Fins, Joseph J

    2016-01-01

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

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

    PubMed Central

    2015-01-01

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

  12. The vanishing mother: Cesarean section and "evidence-based obstetrics".

    PubMed

    Wendland, Claire L

    2007-06-01

    The philosophy of "evidence-based medicine"--basing medical decisions on evidence from randomized controlled trials and other forms of aggregate data rather than on clinical experience or expert opinion--has swept U.S. medical practice in recent years. Obstetricians justify recent increases in the use of cesarean section, and dramatic decreases in vaginal birth following previous cesarean, as evidence-based obstetrical practice. Analysis of pivotal "evidence" supporting cesarean demonstrates that the data are a product of its social milieu: The mother's body disappears from analytical view; images of fetal safety are marketing tools; technology magically wards off the unpredictability and danger of birth. These changes in practice have profound implications for maternal and child health. A feminist project within obstetrics is both feasible and urgently needed as one locus of resistance. PMID:17601085

  13. Foundations for evidence-based intraoperative neurophysiological monitoring.

    PubMed

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

    2016-01-01

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

  14. 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

  15. Bioengineered probiotics, a strategic approach to control enteric infections.

    PubMed

    Amalaradjou, Mary Anne Roshni; Bhunia, Arun K

    2013-01-01

    Enteric infections account for high morbidity and mortality and are considered to be the fifth leading cause of death at all ages worldwide. Seventy percent of all enteric infections are foodborne. Thus significant efforts have been directed toward the detection, control and prevention of foodborne diseases. Many antimicrobials including antibiotics have been used for their control and prevention. However, probiotics offer a potential alternative intervention strategy owing to their general health beneficial properties and inhibitory effects against foodborne pathogens. Often, antimicrobial probiotic action is non-specific and non-discriminatory or may be ineffective. In such cases, bioengineered probiotics expressing foreign gene products to achieve specific function is highly desirable. In this review we summarize the strategic development of recombinant bioengineered probiotics to control enteric infections, and to examine how scientific advancements in the human microbiome and their immunomodulatory effects help develop such novel and safe bioengineered probiotics. PMID:23327986

  16. Bioengineered probiotics, a strategic approach to control enteric infections

    PubMed Central

    Amalaradjou, Mary Anne Roshni; Bhunia, Arun K

    2013-01-01

    Enteric infections account for high morbidity and mortality and are considered to be the fifth leading cause of death at all ages worldwide. Seventy percent of all enteric infections are foodborne. Thus significant efforts have been directed toward the detection, control and prevention of foodborne diseases. Many antimicrobials including antibiotics have been used for their control and prevention. However, probiotics offer a potential alternative intervention strategy owing to their general health beneficial properties and inhibitory effects against foodborne pathogens. Often, antimicrobial probiotic action is non-specific and non-discriminatory or may be ineffective. In such cases, bioengineered probiotics expressing foreign gene products to achieve specific function is highly desirable. In this review we summarize the strategic development of recombinant bioengineered probiotics to control enteric infections, and to examine how scientific advancements in the human microbiome and their immunomodulatory effects help develop such novel and safe bioengineered probiotics. PMID:23327986

  17. Glycerin-Based Hydrogel for Infection Control

    PubMed Central

    Stout, Edward I.; McKessor, Angie

    2012-01-01

    Problem Infection is a major problem in the health and wellbeing of patients in hospitals, nursing homes, and other medical facilities as well as the homecare patients and the general public. According to Scientia Advisors, wound care costs the healthcare system over $7 billion in 2009. After adding the cost associated with potential complications such as infections, extended physician care, and lengthy hospital stays, the annual wound care expenditures well exceeded over $20 billion.1 There are 20 million reported cases of diabetes per year and more every day. Because of the fact that leg ulcers are the number one health problem of men coupled with the rise in drug resistance of infections, the importance of providing the professional and the public with relatively simple and affordable wound care is of extreme importance. Often the wounds can become chronic wounds, which then result in long-term nursing expense in time and supplies or, worse yet, can result in expensive amputations ranging from $5000 to $40,000 per patient. Solution There are many dressing options now available for treating wounds with components such as glycerin, honey, salt, and many other natural products, with some dressings being more appropriate than others. In 1988, a patented glycerin-based dressing was introduced to the market, called Elasto-Gel™.2 New Technology Elasto-Gel™ is a glycerin-based gel sheet (65%) combined with a hydrophilic polymer that causes the sheet to absorb the exudate from the wound and simultaneously release the glycerin from the gel, which adds many benefits to the wound for excellent healing outcomes. The gel sheet is 1/8th of an inch thick with a four-way stretch backing. It has the ability to absorb 3–4 times its own weight of fluids. The dressing will not dry out or allow the exudate to dry out, thus keeping the dressing from becoming bonded to the wound or the surrounding tissue. It does not have adhesive properties and, therefore, will not cause damage to the wound bed or periwound area upon dressing removal. Because of the thickness, the product provides excellent cushion and padding support. It has been also proven to be bacteriostatic/fungistatic. (Bacteriostatic is the ability to restrain the development or reproduction of bacteria.3) Product Technology Glycerin is a huamectant by definition and has been recognized by the U.S. Food and Drug Administration (FDA). Humectants attract, bind, and hold moisture to the site of application. The actual concentration of glycerin in a wound dressing is indicative of the ability to absorb excess moisture. Exudate management is an important function of topical treatment. The ability to absorb drainage and prevent pooling of exudate in the wound or on the surrounding skin are attributes specific to high glycerin content. Perhaps, the most significant advantage of the glycerin-based hydrogel sheet is its impact on wound bioburden and pathogenic organisms.4 Glycerin is a simple three-carbon tri-alcohol and is a natural humectant. It is used as a carrier in many medicines and as plasticizer in gelatin gel capsules. Glycerin is a component of cosmetics, conditioners, soaps, foods, and other common products. It is a component of mono-, di-, and triglycerides naturally occurring in the body. These glycerides and glycerin are constantly reacted with each other by the natural enzymes and reversed with the natural metabolic processes already present in the body. Any glycerin that may be absorbed into the body fluid is rapidly diluted in these fluids and is no longer toxic but is metabolized as another component of the food chain. It is well known that glycerin in high concentration will exhibit dehydrating effect on many systems including living cells by the commonly known process of osmosis. (Osmosis: the flow or diffusion that takes place through a semipermable membrane, as of living cell, typically separating a solvent such as water, thus bringing about equilibrium conditions.5) It has been shown that glycerin at high concentration will be cytotoxic to all cells that have been tested if they are exposed long enough. These properties of glycerin have been recognized by the European Skin Bank, where they use 85% glycerin solutions to store cadaver skin at ∼42F, and can be used for potential wound coverings. The cadaver skin that has been prepared by this method has been available since 1994.6 The concern for safety resulted in a three-day international synmposium7 with emphasis on glycerin-preserved cadaver skin providing healthy environment for the preserved skin to be successfully accepted without rejection, having no complications of infection and providing excellent healing outcomes and minimal scaring. Additional research by Dr. David P. Mackie of the Red Cross Hospital, The Netherlands, reported that using 85% glycerin solutions had slow bactericidal effects and also showed virocidal activity on several types of viruses.8 Dr. Hoekstra has observed that within 2 hours after application of Elasto-Gel™, the inflammatory reaction is reduced.9 Vandeputte, Belgium, showed that wounds covered with Elasto-Gel™ had fewer myofibroblasts than those covered with hydrocolloid.10 It has been proposed that myofibroblasts in high concentrations contribute to the formation of hypertrophic and keloid scars. As noted earlier, there is less scar formation when glycerin-based gel sheets are used. The data sited here have shown that glycerin and glycerin-based products are effective antimicrobial agents with less side effects. Many verbal reports along with personal communications have indicated that applying glycerin-based gel sheets to stalled wounds, some 15–20-year-old chronic wounds, resulted in healing in 1–20 weeks (data/case studies on file). Indications for Use Elasto-Gel™ has been approved for all types of wounds, that is, pressure ulcers, acute and chronic wounds, diabetic wounds, traumatic wounds, dermatology wounds, cancer tumors, and first- and second-degree burns, to name a few. Because of the product's features and benefits, it may be used on a variety of wounds. Because of its padding properties, it may be also used as a preventative product over bony prominence areas so that wounds do not occur. The glycerin properties act as a skin substitute and may also be used for scar reduction. Caution Elasto-Gel™ is not approved for third-degree burns as no dressing has been approved by the FDA for this type of wound. PMID:24527279

  18. Evidence-Based Practice for Outpatient Clinical Teams

    ERIC Educational Resources Information Center

    Hamilton, John D.

    2006-01-01

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

  19. Evidence-Based Practice for Outpatient Clinical Teams

    ERIC Educational Resources Information Center

    Hamilton, John D.

    2006-01-01

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

  20. Evidence that hepatitis C virus genome partly controls infection outcome

    PubMed Central

    Hartfield, Matthew; Bull, Rowena; White, Peter A; Lloyd, Andrew; Luciani, Fabio; Alizon, Samuel

    2014-01-01

    Infection by hepatitis C virus (HCV) leads to one of two outcomes; either the infection resolves within approximately 6 months or the virus can persist indefinitely. Host genetics are known to affect the likelihood of clearance or persistence. By contrast, the importance of the virus genotype in determining infection outcome is unknown, as quantifying this effect traditionally requires well-characterized transmission networks, which are rare. Extending phylogenetic approaches previously developed to estimate the virus control over set-point viral load in HIV-1 infections, we simulate inheritance of a binary trait along a phylogenetic tree, use this data to quantify how infection outcomes cluster and ascertain the effect of virus genotype on these. We apply our method to the Hepatitis C Incidence and Transmission Study in prisons (HITS-p) data set from Australia, as this cohort prospectively identified incident cases including viraemic subjects who ultimately clear the virus, thus providing us with a unique collection of sequences from clearing infections. We detect significant correlations between infection outcome and virus distance in the phylogeny for viruses of Genotype 1, with estimates lying at around 67%. No statistically significant estimates were obtained for viruses of Genotype 3a. PMID:24944567

  1. Pasteurisation and the control of milkborne infection in Britain.

    PubMed Central

    Sharp, J C; Paterson, G M; Barrett, N J

    1985-01-01

    Infections carried in milk, particularly salmonellosis and campylobacter enteritis, have continued to feature in Great Britain in recent years. Less commonly reported infections included an outbreak in 1984 in England due to Streptococcus zooepidemicus, in which 12 people, eight of whom died, were admitted to hospital. The implementation of legislation in 1983 requiring heat treatment of cows' milk for sale to the public reduced the incidence of milkborne infection in Scotland compared with previous years and compared with England and Wales, where, without legislative control, outbreaks continue to occur. Until compulsory pasteurisation is introduced throughout Britain and dairy farming communities can be persuaded to drink only heat treated milk outbreaks of milkborne infection will continue. PMID:3926238

  2. [The community health team: roles and responsibilities in infection control].

    PubMed

    Fu, Yu-Chen; Chen, Mei-Yen; Feng, Huang-Chih

    2011-08-01

    Over the past three decades, chronic disease has replaced communicable disease as the leading collective cause of death in Taiwan. As a result, medical and public healthcare manpower and budgets dedicated to communicable diseases have been reduced. The 2003 outbreak of Severe Acute Respiratory Syndrome (SARS) changed government epidemic prevention policies and marked a renewed focus on preventing and controlling communicable diseases. This study introduces Taiwan's communicable disease control system and reforms, the domestic status of communicable diseases, the infection control policies of Japanese colonial authorities in the early 20th century, and national / community-level communicable disease control mechanisms in place before and after 2003. This paper further examines the actual health management conditions in a county in southern Taiwan to show how the public health system is rooted in communities, how infection control strategies are promoted, and how social organizations influence community life and mores. PMID:21809284

  3. The rectal microbiota of cats infected with feline immunodeficiency virus infection and uninfected controls.

    PubMed

    Weese, J S; Nichols, J; Jalali, M; Litster, A

    2015-10-22

    Rectal swabs were collected from 31 cats, 16 with FIV infection and 15 uninfected controls, to evaluate and compare the rectal bacterial microbiota in cats with feline immunodeficiency virus (FIV) infection and uninfected controls. The rectal microbiota was characterized via next generation sequencing of 16S rRNA gene (V4 region) polymerase chain reaction products. Eighteen different phyla were identified. Firmicutes dominated in both groups, followed by Proteobacteria and Actinobacteria, but there were no significant differences between groups. When predominant orders are compared, FIV-infected cats had significant higher median relative abundances of Bifidobacteriales (P=0.022), Lactobacillales (P=0.022) and Aeromonadales (P=0.043). No differences were identified in the 50 most common genera when adjusted for false discovery rate. There were significant differences in community membership (Jaccard index, unifrac P=0.008, AMOVA P<0.001) and community structure (Yue&Clayton index, unifrac P=0.03, AMOVA P=0.005) between groups. However, only one metacommunity (enterotype) was identified. The rectal microbiota differed between cats with FIV infection and uninfected controls. Some of the changes that were noted have been associated with 'dysbiosis' and proinflammatory states in other species, so it is possible that subclinical alteration in the intestinal microbiota could influence the health of FIV-infected cats. Evaluation of the reasons for microbiota alteration and the potential impact on cat health is required. PMID:26315773

  4. [Norwegian infection control in modern Europe].

    PubMed

    Dobloug, J H

    1994-01-01

    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 Sovjet-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:7937019

  5. [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

  6. 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

  7. The impact of economic recession on infection prevention and control.

    PubMed

    O'Riordan, M; Fitzpatrick, F

    2015-04-01

    The economic recession that began in 2007 led to austerity measures and public sector cutbacks in many European countries. Reduced resource allocation to infection prevention and control (IPC) programmes is impeding prevention and control of tuberculosis, HIV and vaccine-preventable infections. In addition, higher rates of infectious disease in the community have a significant impact on hospital services, although the extent of this has not been studied. With a focus on quick deficit reduction, preventive services such IPC may be regarded as non-essential. Where a prevention programme succeeds in reducing disease burden to a low level, its very success can undermine the perceived need for the programme. To mitigate the negative effects of recession, we need to: educate our political leaders about the economic benefits of IPC; better quantify the costs of healthcare-associated infection; and evaluate the effects of budget cuts on healthcare outcomes and IPC activities. PMID:25639208

  8. Evidence based update: open versus closed reduction.

    PubMed

    Ghayoumi, Pouriya; Kandemir, Utku; Morshed, Saam

    2015-03-01

    Outcomes after operative treatment of displaced femoral neck fractures in young adults are fraught with high complications rates including non-union and avascular necrosis. Among the therapeutic controversies that persist is the role of open reduction, which would allow surgeons a direct means to improve the quality of reduction, a predictor of successful treatment. We performed a systematic review of the literature to compare the outcomes (nonunion, avascular necrosis, and deep infection) after open reduction with internal fixation (ORIF) to closed reduction with internal fixation (CRIF) of acute (surgery performed less than 6 weeks from injury) femoral neck fractures in young adults (average age of 50 or younger) followed for at least one year. Despite the large literature investigating outcomes after operative treatment of femoral neck fracture, relatively few studies aimed to determine the relative risk of complications associated with method of reduction. Therefore, both observational and randomised studies as well as case series with clear descriptions of surgical approach and outcomes were included. We identified 21 studies that matched our inclusion criteria. The incidence of nonunion was 11.6% in closed reduction and 14.9% in the open reduction group (P=0.25). The incidence of avascular necrosis for CRIF and ORIF were 17.2% and 17.7% respectively (P=0.91). The incidence of deep wound infection was 0.49% in the closed reduction group and 3.9% in the open reduction group (P=0.0019). Meta-analysis of risk ratios estimated from six of the studies with comparative data revealed no significant difference in the incidence of nonunion, avascular necrosis or total complications between the two reduction techniques. In summary, systematic review of the literature reveals a lack of evidence in support of ORIF versus CRIF as a means of treating displaced femoral neck fractures in young patients with respect to union and avascular necrosis; however, the incidence of surgical site infections may be lower with CRIF. Firm conclusions cannot be drawn given the lack of high quality prospective studies and patient reported outcomes. In the future, randomised controlled trials will be required to test the effect of reduction method. PMID:25554424

  9. Queer challenges to evidence-based practice.

    PubMed

    Zeeman, Laetitia; Aranda, Kay; Grant, Alec

    2014-06-01

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

  10. Evidence-based psychosocial treatment for schizophrenia.

    PubMed

    Fenton, W S; Schooler, N R

    2000-01-01

    Current recommendations for evidence-based schizophrenia treatment support a comprehensive, individualized approach that integrates advances in psychopharmacology with psychosocial strategies for disease management. In this issue of the Schizophrenia Bulletin, we invited clinician investigators to summarize new empirical data concerning the efficacy of psychosocial interventions that target common and particularly problematic aspects of schizophrenia. A rich formulary of psychosocial interventions with demonstrated efficacy is now available. With new neuroleptic medications, these interventions should define the current standard of care for schizophrenia. PMID:10755666

  11. [Evidence-based medicine: methods and critics].

    PubMed

    Bizouarn, P

    2007-04-01

    The evaluation of professional practices is now obligatory. Evidence-Based Medicine, defined as the use of current best evidence in making well-informed decisions, could play a major role for that purpose, as it allows an objective evaluation of the clinical practices by the use of there commendations it gives rise to. The aim of that study was to describe the EBM decision procedure with examples in anaesthesia, and to present its limits, particularly due to the problems of hierarchies of evidence. PMID:17276026

  12. Microdermabrasion: an evidence-based review.

    PubMed

    Karimipour, Darius J; Karimipour, Gholamreza; Orringer, Jeffrey S

    2010-01-01

    Microdermabrasion is a popular technique used in the treatment of several skin problems, including acne, acne scarring, striae distensae, and photoaging. This article will review the relevant literature and use an evidence-based approach to evaluate the clinical efficacy of microdermabrasion in skin care. In summary, microdermabrasion appears to be a procedure that can produce changes in dermal matrix constituents and result in improvement in skin contour irregularities. It may also be beneficial in improving transepidermal delivery of certain medications. Its role in the treatment of dyschromias and acne vulgaris is limited. PMID:20048628

  13. Cost Evaluation of Evidence-Based Treatments

    PubMed Central

    Sindelar, Jody L.; Ball, Samuel A.

    2010-01-01

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

  14. PREVENTION AND CONTROL OF RETICULOENDOTHELIOSIS VIRUS INFECTION: RATIONALE AND STRATEGIES

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Reticuloendotheliosis virus (REV) is a common retroviral infection of poultry that only rarely causes significant disease problems. Typically, the issue of control is dismissed as unnecessary for and not practiced in commercial flocks. Prevention is a more relevant issue and preventive measures ar...

  15. 42 CFR 482.42 - Condition of participation: Infection control.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... services must— (1) Ensure that the hospital-wide quality assurance program and training programs address... HUMAN SERVICES (CONTINUED) STANDARDS AND CERTIFICATION CONDITIONS OF PARTICIPATION FOR HOSPITALS Basic Hospital Functions § 482.42 Condition of participation: Infection control. The hospital must provide...

  16. 42 CFR 494.30 - Condition: Infection control.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... adjacent hospital or other public areas. (a) Standard: Procedures for infection control. The facility must....C. 552(a) and 1 CFR Part 51. This publication is available for inspection at the CMS Information...) and 1 CFR part 51. This publication is available for inspection at the CMS Information Resource...

  17. 42 CFR 482.42 - Condition of participation: Infection control.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...) Ensure that the hospital-wide quality assessment and performance improvement (QAPI) program and training... HUMAN SERVICES (CONTINUED) STANDARDS AND CERTIFICATION CONDITIONS OF PARTICIPATION FOR HOSPITALS Basic Hospital Functions § 482.42 Condition of participation: Infection control. The hospital must provide...

  18. 42 CFR 482.42 - Condition of participation: Infection control.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... the hospital-wide quality assessment and performance improvement (QAPI) program and training programs... HUMAN SERVICES (CONTINUED) STANDARDS AND CERTIFICATION CONDITIONS OF PARTICIPATION FOR HOSPITALS Basic Hospital Functions § 482.42 Condition of participation: Infection control. The hospital must provide...

  19. 42 CFR 482.42 - Condition of participation: Infection control.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... services must— (1) Ensure that the hospital-wide quality assurance program and training programs address... HUMAN SERVICES (CONTINUED) STANDARDS AND CERTIFICATION CONDITIONS OF PARTICIPATION FOR HOSPITALS Basic Hospital Functions § 482.42 Condition of participation: Infection control. The hospital must provide...

  20. 42 CFR 482.42 - Condition of participation: Infection control.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ...) Ensure that the hospital-wide quality assessment and performance improvement (QAPI) program and training... HUMAN SERVICES (CONTINUED) STANDARDS AND CERTIFICATION CONDITIONS OF PARTICIPATION FOR HOSPITALS Basic Hospital Functions § 482.42 Condition of participation: Infection control. The hospital must provide...

  1. 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

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

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Condition of participation: Infection control. 418.60 Section 418.60 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM HOSPICE CARE Conditions of Participation: Patient Care § 418.60 Condition of participation:...

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

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 5 2010-10-01 2010-10-01 false Condition of participation: Infection control. 485.725 Section 485.725 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STANDARDS AND CERTIFICATION CONDITIONS OF PARTICIPATION: SPECIALIZED PROVIDERS Conditions of Participation for...

  4. Education in infection control: A need for European certification.

    PubMed

    Zingg, W; Mutters, N T; Harbarth, S; Friedrich, A W

    2015-12-01

    Healthcare-associated infections are common adverse events in acute-care medicine, causing significant morbidity and mortality. There has been a significant increase in the commitment to infection prevention and control (IPC) among European countries in recent years. However, there is still heterogeneity in training opportunities and IPC qualifications. The European Union promotes the harmonization of IPC strategies among member states. The European Centre for Disease Prevention and Control (ECDC)-commissioned Training in Infection Control in Europe project sets the stage for harmonization of IPC activities in Europe by issuing a list of core competencies for IPC professionals. European certification of IPC training and professionals would be the next logical step, which must be achieved by close collaboration between different stakeholders in Europe such as the ECDC, the European Society of Clinical Microbiology and Infectious Diseases (ESCMID), the European Union of Medical Specialities, and the national IPC societies. Therefore, the ESCMID has launched the new European Committee on Infection Control to take the lead in the implementation of a European (board) certificate for IPC professionals. PMID:26363403

  5. Control of acute dengue virus infection by natural killer cells.

    PubMed

    Petitdemange, Caroline; Wauquier, Nadia; Rey, Juliana; Hervier, Baptiste; Leroy, Eric; Vieillard, Vincent

    2014-01-01

    Dengue fever is the most important arthropod-borne viral disease worldwide, affecting 50-100 million individuals annually. The clinical picture associated with acute dengue virus (DENV) infections ranges from classical febrile illness to life-threatening disease. The innate immunity is the first line of defense in the control of viral replication. This review will examine the particular role of natural killer (NK) cells in DENV infection. Over recent years, our understanding of the interplay between NK cells and viral pathogenesis has improved significantly. NK cells express an array of inhibitory and activating receptors that enable them to detect infected targets while sparing normal cells, and to recruit adaptive immune cells. To date, the exact mechanism by which NK cells may contribute to the control of DENV infection remains elusive. Importantly, DENV has acquired mechanisms to evade NK cell responses, further underlining the relevance of these cells in pathophysiology. Hence, understanding how NK cells affect the outcome of DENV infection could benefit the management of this acute disease. PMID:24860571

  6. Evidence-based health promotion programs for schools and communities.

    PubMed

    Inman, Dianna D; van Bakergem, Karen M; Larosa, Angela C; Garr, David R

    2011-02-01

    Healthy People 2020 includes an objective to increase the proportion of elementary, middle, and senior high schools that provide comprehensive school health education to prevent health problems in the following areas: unintentional injury; violence; suicide; tobacco use and addiction; alcohol or other drug use; unintended pregnancy, HIV/AIDS, and sexually transmitted infections (STI); unhealthy dietary patterns; and inadequate physical activity. These specific goals are part of the efforts of Healthy People 2020 to increase the proportion of elementary, middle, and senior high schools that have health education goals or objectives that address the knowledge and skills articulated in the National Health Education Standards. A focus on Pre-K through 12 health education is a prerequisite for the implementation of a coordinated, seamless approach to health education as advocated by the Healthy People Curriculum Task Force and incorporated into the Education for Health framework. To help accomplish these goals, this article views the role of education as part of the broader socioecologic model of health. A comprehensive literature review was undertaken to identify evidence-based, peer-reviewed programs, strategies, and resources. The results of this review are presented organized as sexual health, mental and emotional health, injury prevention, tobacco and substance abuse, and exercise and healthy eating. Evidence-based implementation strategies, often considered the missing link, are recommended to help achieve the Healthy People 2020 objective of increasing the prevalence of comprehensive school health education programs designed to reduce health risks for children. PMID:21238871

  7. 42 CFR 416.51 - Conditions for coverage-Infection control.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 3 2011-10-01 2011-10-01 false Conditions for coverage-Infection control. 416.51....51 Conditions for coverageInfection control. The ASC must maintain an infection control program that seeks to minimize infections and communicable diseases. (a) Standard: Sanitary environment. The ASC...

  8. [Acupressure and Evidence-Based Nursing].

    PubMed

    Chen, Li-Li; Lin, Jun-Dai

    2015-12-01

    Acupressure is a traditional Chinese medicine approach to disease prevention and treatment that may be operated by nurses independently. Therefore, acupressure is being increasingly applied in clinical nursing practice and research. Recently, the implementation of evidence-based nursing (EBN) in clinical practice has been encouraged to promote nursing quality. Evidence-based nursing is a method-ology and process of implementation that applies the best-available evidence to clinical practice, which is acquired through the use of empirical nursing research. Therefore, in this paper, we address the topic of acupressure within the context of empirical nursing practice. We first introduce the current status of acupressure research and provide the locations of common acupoints in order to guide future empirical nursing research and to help nurses use these acupoints in clinical practice. Finally, we describe the steps that are necessary to apply the current empirical information on acupressure as well as provide suggestions to promote safety and efficacy in order to guide nurses in the accurate application of acupressure in nursing practice. PMID:26645442

  9. Evidence-Based Chinese Medicine for Hypertension

    PubMed Central

    Wang, Jie; Xiong, Xingjiang

    2013-01-01

    Hypertension is an important worldwide public -health challenge with high mortality and disability. Due to the limitations and concerns with current available hypertension treatments, many hypertensive patients, especially in Asia, have turned to Chinese medicine (CM). Although hypertension is not a CM term, physicians who practice CM in China attempt to treat the disease using CM principles. A variety of approaches for treating hypertension have been taken in CM. For seeking the best evidence of CM in making decisions for hypertensive patients, a number of clinical studies have been conducted in China, which has paved the evidence-based way. After literature searching and analyzing, it appeared that CM was effective for hypertension in clinical use, such as Chinese herbal medicine, acupuncture, moxibustion, cupping, qigong, and Tai Chi. However, due to the poor quality of primary studies, clinical evidence is still weak. The potential benefits and safety of CM for hypertension still need to be confirmed in the future with well-designed RCTs of more persuasive primary endpoints and high-quality SRs. Evidence-based Chinese medicine for hypertension still has a long way to go. PMID:23861720

  10. Evidence-based medical education -quo vadis?

    PubMed

    Leung, Gabriel M; Johnston, Janice M

    2006-06-01

    The evidence base for most educational initiatives, at least until very recently, is largely composed of low-level evidence. Four major barriers underlie this historical observation, namely: (1) perceived ethical and acceptability problems arising from the unequal treatment of learners in experimental designs; (2) limited choice of outcome measures and validated instruments; (3) time and resource constraints; and (4) methodological issues concerning contextual confounding and small sample sizes. We advocate the adoption of a 'balanced scorecard' approach in the evaluation of education interventions that brings together a comprehensive panel of outcomes under one framework. We require a diversity of rigorously applied methods to generate these outcomes, drawing from the quantitative and qualitative disciplines of epidemiology, psychology and economics. We further suggest that the research community discuss and agree on a standardized set of common metrics or benchmarks. We conclude with a case study examining whether a hand-held computer clinical decision support tool improves clerkship learning of evidence-based medicine. The era of Brownian motion in health education research is over. What we demand in terms of burden of proof for educational effectiveness should be no less rigorous than our call for an ever escalating threshold concerning evidence of clinical care. PMID:16722922

  11. Evidence-based Practice of Radiology.

    PubMed

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

    2015-10-01

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

  12. Time for evidence-based cytology

    PubMed Central

    Dey, Pranab

    2007-01-01

    Evidence-based medicine (EBM) is a fashionable and an extremely hot topic for clinicians, patients and the health service planners. Evidence-based cytology (EBC) is an offshoot of EBM. The EBC is concerned with generating a reproducible, high quality and clinically relevant test result in the field of cytology. This is a rapidly evolving area with high practical importance. EBC is based entirely on research data. The various professional bodies on cytology design and recommend guidelines on the basis of evidences. Once the guideline is implemented and practiced then the experiences of the practicing cytopathologists may be used as a feed back to alter the existing guideline. The various facets of EBC are sampling and specimen adequacy, morphological identification and computer based expert system, integrated reporting, identification of the controversial areas and high quality researches for evidences. It is the duty of the individuals and institutions to practice EBC for better diagnosis and management of the patients. In this present paper, the various aspects of EBC have been discussed. PMID:17210074

  13. 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

  14. Infection control. 1: A practical guide to glove usage.

    PubMed

    Parker, L J

    With increased demands from the general public for healthcare professionals to be accountable for their actions, many are becoming familiar with clinical governance and other initiatives to improve clinical practice. Good infection control is central to nursing practice. To achieve higher standards of clinical practice, especially when thinking about how to reduce the risk of cross-infection, it is necessary to not only do the right thing, but also do the thing right. Safe practice should be uppermost in the minds of healthcare professionals when caring for patients. This new series of articles attempts to look at the practical aspects of infection control, highlighting the requirements for risk assessment and applying the principles of infection control to a variety of patient care situations. This article investigates the use of protective clothing and gloves. It looks at the types of gloves available for use, the importance of choosing the correct glove for the task to be undertaken, and the modern day problems of allergies to latex. PMID:10531821

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

    PubMed Central

    Goldenberg, Maya J

    2005-01-01

    Background The increase in empirical methods of research in bioethics over the last two decades is typically perceived as a welcomed broadening of the discipline, with increased integration of social and life scientists into the field and ethics consultants into the clinical setting, however it also represents a loss of confidence in the typical normative and analytic methods of bioethics. Discussion The recent incipiency of "Evidence-Based Ethics" attests to this phenomenon and should be rejected as a solution to the current ambivalence toward the normative resolution of moral problems in a pluralistic society. While "evidence-based" is typically read in medicine and other life and social sciences as the empirically-adequate standard of reasonable practice and a means for increasing certainty, I propose that the evidence-based movement in fact gains consensus by displacing normative discourse with aggregate or statistically-derived empirical evidence as the "bottom line". Therefore, along with wavering on the fact/value distinction, evidence-based ethics threatens bioethics' normative mandate. The appeal of the evidence-based approach is that it offers a means of negotiating the demands of moral pluralism. Rather than appealing to explicit values that are likely not shared by all, "the evidence" is proposed to adjudicate between competing claims. Quantified measures are notably more "neutral" and democratic than liberal markers like "species normal functioning". Yet the positivist notion that claims stand or fall in light of the evidence is untenable; furthermore, the legacy of positivism entails the quieting of empirically non-verifiable (or at least non-falsifiable) considerations like moral claims and judgments. As a result, evidence-based ethics proposes to operate with the implicit normativity that accompanies the production and presentation of all biomedical and scientific facts unchecked. Summary The "empirical turn" in bioethics signals a need for reconsideration of the methods used for moral evaluation and resolution, however the options should not include obscuring normative content by seemingly neutral technical measure. PMID:16277663

  16. 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

  17. Human gastrointestinal nematode infections: are new control methods required?

    PubMed Central

    Stepek, Gillian; Buttle, David J; Duce, Ian R; Behnke, Jerzy M

    2006-01-01

    Gastrointestinal (GI) nematode infections affect 50% of the human population worldwide, and cause great morbidity as well as hundreds of thousands of deaths. Despite modern medical practices, the proportion of the population infected with GI nematodes is not falling. This is due to a number of factors, the most important being the lack of good healthcare, sanitation and health education in many developing countries. A relatively new problem is the development of resistance to the small number of drugs available to treat GI nematode infections. Here we review the most important parasitic GI nematodes and the methods available to control them. In addition, we discuss the current status of new anthelmintic treatments, particularly the plant cysteine proteinases from various sources of latex-bearing plants and fruits. PMID:16965561

  18. Therapeutic Depletion of Natural Killer Cells Controls Persistent Infection

    PubMed Central

    Daniels, Keith A.; Welsh, Raymond M.

    2014-01-01

    ABSTRACT Persistent viral infections are associated with host and viral factors that impair effective antiviral immunity. Natural killer (NK) cells contribute to establishment of persistent lymphocytic choriomeningitis virus (LCMV) infection in mice through suppression of virus-specific T cell responses during the first few days of infection, but NK cell depletion during those early time points can enable severe T cell-mediated immune pathology and death of the host. Here we show that long after their peak in cytolytic activation, NK cells continue to support viral persistence at later times of infection. Delayed depletion of NK cells, 2 to 3 weeks after infection, enhanced virus-specific T cell responses and viral control. This enhancing effect of delayed NK cell depletion on antiviral immunity, in contrast to early NK cell depletion, was not associated with increased morbidity and mortality, and mice quickly regained weight after treatment. The efficacy of the depletion depended in part upon the size of the original virus inoculum, the viral load at the time of depletion, and the presence of CD4 T cells. Each of these factors is an important contributor to the degree of CD8 T cell dysfunction during viral persistence. Thus, NK cells may continuously contribute to exhaustion of virus-specific T cells during chronic infection, possibly by depleting CD4 T cells. Targeting of NK cells could thus be considered in combination with blockade of other immunosuppressive pathways, such as the interleukin-10 (IL-10) and programmed death 1 (PD-1) pathways, as a therapy to cure chronic human infections, including those with HIV or hepatitis C virus. IMPORTANCE PMID:24284324

  19. Training the Evidence-Based Practitioner

    PubMed Central

    LeFebvre, Ronald P.; Peterson, David H.; Haas, Mitchell; Gillette, Richard G.; Novak, Charles W.; Tapper, Janet; Muench, John P.

    2011-01-01

    An important goal of chiropractic clinical education should be to teach specific evidence-based practice (EBP) skills to chiropractic students, interns, and doctors. Using a nominal group process, the authors produced a document similar to the Council of Chiropractic Education standards for clinical competencies that can be used to drive an EBP curriculum. Standard texts and journal articles were consulted to create the standards for this program and each standard and corresponding learning objective was discussed in detail and was then graded by the committee in terms of importance and the level of competency that should be attained. Six standards and 31 learning objectives were generated with the learning objectives being further divided into lists of specific competencies. It is the hope of these authors that by sharing this document it can serve as a comprehensive and detailed seed document for other institutions. PMID:21677870

  20. Evidence-Based Education in Plastic Surgery.

    PubMed

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

    2015-08-01

    Educational reforms in resident training have historically been driven by reports from medical societies and organizations. Although educational initiatives are well intended, they are rarely supported by robust evidence. The Accreditation Council for Graduate Medical Education recently introduced competency-based training, a form of outcomes-based education that has been used successfully in nonmedical professional vocations. This initiative has promise to advance the quality of resident education, but questions remain regarding implementation within plastic surgery. In particular, how will competency-based training impact patient outcomes, and will the methodologies used to assess competencies (i.e., milestones) be accurate and validated by literature? This report investigates resident educational reform and the need for more evidence-based educational initiatives in plastic surgery training. PMID:26218400

  1. 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

  2. How to Practice Evidence-Based Medicine

    PubMed Central

    Swanson, Jennifer A.; Schmitz, DeLaine; Chung, Kevin C.

    2015-01-01

    Evidence-based medicine (EBM) is defined as the conscientious, explicit and judicious use of current best evidence, combined with individual clinical expertise and patient preferences and values, in making decisions about the care of individual patients. In an effort to emphasize the importance of EBM in plastic surgery, ASPS and PRS have launched an initiative to improve the understanding of EBM concepts and provide tools for implementing EBM in practice. Through a series of special articles aimed at educating plastic surgeons, our hope is that readers will be compelled to learn more about EBM and incorporate its principles into their own practices. As the first of the series, this article provides a brief overview of the evolution, current application, and practice of EBM. PMID:20224459

  3. Nanotheranostics in evidence based personalized medicine.

    PubMed

    Sharma, Sushil

    2014-01-01

    Efficient drug delivery systems are exceedingly important for novel drug discovery. The evidence-based personalized medicine (EBPM) promises to deliver the right drug at the right time to a right patient as it covers clinicallysignificant genetic predisposition and chronopharmacological aspects of nanotheranostics. Recently nanotechnology has provided clinically-significant information at the cellular, molecular, and genetic level to facilitate evidence-based personalized treatment. Particularly drug encapsulation in pegylated liposomes has improved pharmacodynamics of cancer, cardiovascular diseases, and neurodegenerative diseases. Long-circulating liposomes and block copolymers concentrate slowly via enhanced permeability and retention (EPR) effect in the solid tumors and are highly significant for the drug delivery in cancer chemotherapeutics. Selective targeting of siRNA and oligonucleotides to tumor cells with a potential to inhibit multi-drug resistant (MDR) malignancies has also shown promise. In addition, implantable drug delivery devices have improved the treatment of several chronic diseases. Recently, microRNA, metallothioneins (MTs), ?-synuclein index, and Charnoly body (CB) have emerged as novel drug discovery biomarkers. Hence CB antagonists-loaded ROSscavenging targeted nanoparticles (NPs) may be developed for the treatment of neurodegenerative and cardiovascular diseases. Nonspecific induction of CBs in the hyper-proliferative cells may cause alopecia, gastrointestinal tract (GIT) symptoms, myelosuppression, neurotoxicity, and infertility. Therefore selective CB agonists may be developed to augment cancer stem cell specific CB formation to eradicate MDR malignancies with minimum or no adverse effects. This review highlights recent advances on safe, economical, and effective treatment of neurodegenerative diseases, cardiovascular diseases, and cancer by adopting emerging nanotheranostic strategies to accomplish EBPM. PMID:25174340

  4. Compliance with infection-control procedures among Illinois orthodontists.

    PubMed

    Davis, D; BeGole, E A

    1998-06-01

    The authors of previous studies have reported an increasing percentage of orthodontists complying with infection-control procedures in their offices, yet compliance was found to be less than ideal. In this study we surveyed Illinois orthodontists to evaluate their compliance with the infection-control guidelines established by the American Dental Association and the Centers for Disease Control and Prevention. This study is an addition to a small number of studies in the field of orthodontics on infection-control procedures. The study population was taken from the World Directory of Orthodontists, which contains 374 listings for the state of Illinois. Responses were received from 140 orthodontists, for a response rate of 37%. Thirty-two percent of the responding orthodontists stated that they always wear masks; 13% said they never do. Almost 97% of the orthodontists said they always wear gloves, and no orthodontist reported never wearing gloves. Nearly 64% of the orthodontists reported always using eyewear, and 34% said they wear gowns, whereas only 5% do not wear eye protection and 35% never wear gowns. With regard to instruments and pliers, most of the orthodontists reported using dry-heat ovens (72% and 80%, respectively), whereas nearly 58% said they use chemical disinfection to some extent on instruments and 39% said they use chemical disinfection on pliers. Only 51% of the orthodontists surveyed in our study reported using a steam autoclave to sterilize handpieces, whereas 27% said they use dry-heat ovens, 11% reported using chemical vapor, and 37% said they use chemical disinfection. In conclusion, compliance with infection control procedures among orthodontists has improved from recent studies but is still less than full compliance. PMID:9637568

  5. 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

  6. 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…

  7. Infection prevention and control strategies in the era of limited resources and quality improvement: a perspective paper.

    PubMed

    Vandijck, Dominique; Cleemput, Irina; Hellings, Johan; Vogelaers, Dirk

    2013-11-01

    This paper aims to describe, using an evidence-based approach, the importance of and the resources necessary for implementing effective infection prevention and control (IPC) programmes. The intrinsic and explicit values of such strategies are presented from a clinical, health-economic and patient safety perspective. Policy makers and hospital managers are committed to providing comprehensive, accessible, and affordable healthcare of high quality. Changes in the healthcare system over time accompanied with variations in demographics and case-mix have considerably affected the availability, quality and ultimately the safety of healthcare. The main goal of an IPC programme is to prevent and control healthcare-associated infections (HAI). Many patient-, healthcare provider-, and organizational factors are associated with an increased risk for acquiring HAIs and may impact both the quality and outcome of patient care. Evidence has been published in support of having an effective IPC programme. It has been estimated that about one-third of HAIs could be prevented if key elements of the evidence-based recommendations for IPC are adequately introduced and followed. However, several healthcare agencies from over the world have reported deficits in the essential resources and components of current IPC programmes. To meet its main goal, staffing, training, and infrastructure requirements are needed. Nevertheless, and given the economic crisis, policy makers and hospital managers may be tempted to not increase or even to reduce the budget as it consumes resources and does not generate sufficient visible revenue. IPC is a critical issue in patient safety, as HAIs are by far the most common complication affecting admitted patients. The significant clinical and health-economic burden HAIs place on the healthcare system speak to the importance of getting introduced effective IPC programmes. PMID:23969192

  8. 76 FR 9577 - Healthcare Infection Control Practices Advisory Committee: Notice of Charter Renewal

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-02-18

    ... HUMAN SERVICES Centers for Disease Control and Prevention Healthcare Infection Control Practices... (Pub. L. 92-463) of October 6, 1972, that the Healthcare Infection Control Practices Advisory Committee... information, contact Jeffrey Hageman, M.H.S., Executive Secretary, Healthcare Infection Control...

  9. 78 FR 6328 - Healthcare Infection Control Practices Advisory Committee: Notice of Charter Renewal

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-01-30

    ... HUMAN SERVICES Centers for Disease Control and Prevention Healthcare Infection Control Practices... (Pub. L. 92-463) of October 6, 1972, that the Healthcare Infection Control Practices Advisory Committee... information, contact Jeffrey Hageman, M.H.S., Executive Secretary, Healthcare Infection Control...

  10. 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

  11. Vaccine to control the viral infection of fish

    DOEpatents

    Leong, Jo-Ann C.

    1994-10-11

    Subunit vaccines and their use for immunizing fish against infection by viruses are disclosed. In particular, plasmid pG8 is constructed by joining, with the plasmid pUC8, DNA which encodes the glycoprotein of infectious hematopoietic necrosis virus (IHNV). E. coli cells are transformed by pG8, whereby pure viral antigen is produced to provide a vaccine for the control of IHNV in fish.

  12. Vaccine to Control the Viral Infection of Fish.

    DOEpatents

    Leong, JoAnn Ching

    1994-10-11

    Subunit vaccines and their use for immunizing fish against infection by viruses are disclosed. In particular, plasmid pG8 is constructed by joining, with the plasmid pUC8, DNA which encodes the glycoprotein of infectious hematopoietic necrosis virus (IHNV). E. coli cells are transformed by pG8, whereby pure viral antigen is produced to provide a vaccine for the control of IHNV in fish. 10 figs.

  13. Information Retrieval for Evidence-Based Decision Making.

    ERIC Educational Resources Information Center

    Ford, Nigel; Miller, Dave; Booth, Andrew; O'Rourke, Alan; Ralph, Jane; Turnock, Edward

    1999-01-01

    Discusses evidence-based decision making; describes techniques to support evidence-based retrieval in the field of medicine which emphasize the retrieval and application of high quality knowledge to solve real-world problems; and considers the transferability of evidence-based information seeking to other fields. (Contains 69 references.) (LRW)

  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. The Evidence Missing from Evidence-Based Practice

    ERIC Educational Resources Information Center

    Stuart, Richard B.; Lilienfeld, Scott O.

    2007-01-01

    Comments on the report by the APA Presidential Task Force on Evidence-Based Practice (see record 2006-05893-001) entitled Evidence-based practice in psychology. Regrettably, the task force report was largely silent on three critical issues. As a consequence, it omitted much of the evidence necessary for a complete picture of evidence-based

  16. 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

  17. 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…

  18. 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

  19. 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…

  20. Cutaneous fungal infection following renal transplantation: a case control study.

    PubMed

    Shuttleworth, D; Philpot, C M; Salaman, J R

    1987-11-01

    The prevalence of cutaneous fungal infection was studied in 72 patients who had undergone renal transplantation and compared with a group of age and sex matched controls. Samples were obtained from toe nails, toe webs, and the upper back; clinically suspicious lesions from other areas were also examined. A total of 576 sites were sampled (288 in each group). Pathogenic fungi were identified from 44 sites (15%) in the renal transplant (RT) group compared with 26 sites (9%) in the control group, (P less than 0.05). However, site-specific differences were less marked; no difference was found between the RT group and controls when the results from the toe nails and toe webs were analysed separately. Trichophyton mentagrophytes was the most common species isolated from both groups. Colonization of the back with Pityrosporum yeasts was significantly more common in the RT group, but few patients in either group had tinea versicolor. 'Mixed infections', with more than one species of fungus isolated in an individual, were only found in the RT group. We also examined the relationship between the presence of fungal infection and the presence or absence of cutaneous malignancy in the renal transplant group. No increase in the prevalence of fungal colonization was found in those patients who had developed cutaneous malignancy compared with those who had not. PMID:3318908

  1. 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

  2. Viral Immune Evasion in Dengue: Toward Evidence-Based Revisions of Clinical Practice Guidelines

    PubMed Central

    Chiappelli, Francesco; Santos, Silvana Maria Eloi; Caldeira Brant, Xenia Maria; Bakhordarian, Andre; Thames, April D; Maida, Carl A; Du, Angela M; Jan, Allison L; Nahcivan, Melissa; Nguyen, Mia T; Sama, Nateli

    2014-01-01

    Dengue, a leading cause of illness and death in the tropics and subtropics since the 1950׳s, is fast spreading in the Western hemisphere. Over 30% of the world׳s population is at risk for the mosquitoes that transmit any one of four related Dengue viruses (DENV). Infection induces lifetime protection to a particular serotype, but successive exposure to a different DENV increases the likelihood of severe form of dengue fever (DF), dengue hemorrhagic fever (DHF), or dengue shock syndrome (DSS). Prompt supportive treatment lowers the risk of developing the severe spectrum of Dengue-associated physiopathology. Vaccines are not available, and the most effective protective measure is to prevent mosquito bites. Here, we discuss selected aspects of the syndemic nature of Dengue, including its potential for pathologies of the central nervous system (CNS). We examine the fundamental mechanisms of cell-mediated and humoral immunity to viral infection in general, and the specific implications of these processes in the regulatory control of DENV infection, including DENV evasion from immune surveillance. In line with the emerging model of translational science in health care, which integrates translational research (viz., going from the patient to the bench and back to the patient) and translational effectiveness (viz., integrating and utilizing the best available evidence in clinical settings), we examine novel and timely evidence-based revisions of clinical practice guidelines critical in optimizing the management of DENV infection and Dengue pathologies. We examine the role of tele-medicine and stakeholder engagement in the contemporary model of patient centered, effectiveness-focused and evidence-based health care. Abbreviations BBB - blood-brain barrier, CNS - central nervous system, DAMP - damage-associated molecular patterns, DENV - dengue virus, DF - dengue fever, DHF - dengue hemorrhagic fever, DSS - dengue shock syndrome, DALYs - isability adjusted life years, IFN-g - interferon-gamma, ILX - interleukinX, JAK/STAT - janus kinase (JAK) / Signal transducer and activator of transcription (STAT), LT - Escherichia coli heat-labile enterotoxin formulations deficient in GM1 binding by mutation (LT[G33D]), MCP-1 - monocyte chemotactic protein 1, M-CSF - macrophage colony-stimulating fact, MHC - major histocompatibility complex, MIF - macrophage migration inhibitory factor, [MIP-1]-α / -β - macrophage inflammatory protein-1 alpha and beta, mAb - monoclonal antibody, NS1 - non-structural protein 1 of dengue virus, NK - natural killer cells, PAMP - pathogen-associated molecular patterns, PBMC - peripheral blood mononuclear cells, TBF-b - transforming growth factor-beta, TNF-α - tumor necrosis-alpha, VHFs - virus hemorrhagic fevers, WHO - World Health Organization. PMID:25670874

  3. "They just know": the epistemological politics of "evidence-based" non-formal education.

    PubMed

    Archibald, Thomas

    2015-02-01

    Community education and outreach programs should be evidence-based. This dictum seems at once warranted, welcome, and slightly platitudinous. However, the "evidence-based" movement's more narrow definition of evidence--privileging randomized controlled trials as the "gold standard"--has fomented much debate. Such debate, though insightful, often lacks grounding in actual practice. To address that lack, the purpose of the study presented in this paper was to examine what actually happens, in practice, when people support the implementation of evidence-based programs (EBPs) or engage in related efforts to make non-formal education more "evidence-based." Focusing on three cases--two adolescent sexual health projects (one in the United States and one in Kenya) and one more general youth development organization--I used qualitative methods to address the questions: (1) How is evidence-based program and evidence-based practice work actually practiced? (2) What perspectives and assumptions about what non-formal education is are manifested through that work? and (3) What conflicts and tensions emerge through that work related to those perspectives and assumptions? Informed by theoretical perspectives on the intersection of science, expertise, and democracy, I conclude that the current dominant approach to making non-formal education more evidence-based by way of EBPs is seriously flawed. PMID:25204228

  4. Transformational and Transactional Leadership: Association With Attitudes Toward Evidence-Based Practice

    PubMed Central

    Aarons, Gregory A.

    2006-01-01

    Objective Leadership in organizations is important in shaping workers perceptions, responses to organizational change, and acceptance of innovations, such as evidence-based practices. Transformational leadership inspires and motivates followers, whereas transactional leadership is based more on reinforcement and exchanges. Studies have shown that in youth and family service organizations, mental health providers attitudes toward adopting an evidence-based practice are associated with organizational context and individual provider differences. The purpose of this study was to expand these findings by examining the association between leadership and mental health providers attitudes toward adopting evidence-based practice. Methods Participants were 303 public-sector mental health service clinicians and case managers from 49 programs who were providing mental health services to children, adolescents, and their families. Data were gathered on providers characteristics, attitudes toward evidence-based practices, and perceptions of their supervisors leadership behaviors. Zero-order correlations and multilevel regression analyses were conducted that controlled for effects of service providers characteristics. Results Both transformational and transactional leadership were positively associated with providers having more positive attitudes toward adoption of evidence-based practice, and transformational leadership was negatively associated with providers perception of difference between the providers current practice and evidence-based practice. Conclusions Mental health service organizations may benefit from improving transformational and transactional supervisory leadership skills in preparation for implementing evidence-based practices. PMID:16870968

  5. 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

  6. Promoting best practices for control of respiratory infections

    PubMed Central

    Hogg, William; Huston, Patricia; Martin, Carmel; Saginur, Raphael; Newbury, Adriana; Vilis, Eileen; Soto, Enrique

    2006-01-01

    OBJECTIVE To determine the effectiveness of a short-term intervention to promote best practices for control of respiratory infections in primary care physicians offices. DESIGN Before-after observational study. SETTING Family physicians offices in Ottawa, Ont. PARTICIPANTS General practitioners and office staff. INTERVENTIONS Four infection-control practices (use of masks, alcohol-based hand gel, and signs, and asking patients to sit at least 1 m apart in the waiting room) were observed, and 2 reported infection-control practices (disinfecting surfaces and use of hand-gel dispensers in examining rooms) were audited before the intervention and 6 weeks after the intervention. MAIN OUTCOME MEASURES Percentage of patients asked to use masks and alcohol-based hand gel, number of relevant signs, and percentage of patients asked to sit at least 1 m away from other patients. Percentage of surfaces disinfected and percentage of physicians using hand-gel dispensers in examining rooms. RESULTS Of 242 practices invited, 53 agreed to participate (22% response rate), and within those practices, 143/151 (95%) physicians participated. Signs regarding respiratory infection control measures increased from 15.4% to 81.1% following the intervention (P?control of respiratory infections in primary care offices. Collaboration between public health services and primary care can promote best practices and warrants further study and development in areas of common interest. PMID:17279223

  7. Is Helicobacter pylori infection associated with glycemic control in diabetics?

    PubMed Central

    Dai, Yi-Ning; Yu, Wei-Lai; Zhu, Hua-Tuo; Ding, Jie-Xia; Yu, Chao-Hui; Li, You-Ming

    2015-01-01

    AIM: To investigate whether Helicobacter pylori (H. pylori) infection is associated with glycemic control and whether hyperglycemia is modified by eradication therapy. METHODS: The databases of PubMed, Cochrane Library, Chinese BioMedicine Web Base and Chinese Science and Technology Journals were searched from inception to June 2014. Studies examining the association between H. pylori infection and glycemic control and?or the effect of eradication treatment on glycemic control in diabetic humans were eligible for inclusion. Meta-analyses were conducted using the Review Manager software version 5.2. The outcome measures are presented as weighed mean differences (WMDs) with 95% confidence intervals (CIs). Statistical heterogeneity was assessed by the Cochran Q test and the I2 statistic. RESULTS: A total of 21 relevant publications were identified. A meta-analysis of 11 studies with 513 patients with diabetes mellitus (DM) showed significantly lower glycosylated hemoglobin (HbA1c) levels in the H. pylori-negative than H. pylori-positive DM participants (WMD = 0.43, 95%CI: 0.07-0.79; P = 0.02). In children and adolescents with type 1 DM (T1DM), there was a positive association between H. pylori infection and HbA1c level (WMD = 0.35, 95%CI: 0.05-0.64; P = 0.02), but there was no difference in those with type 2 DM (T2DM, WMD = 0.51, 95%CI: -0.63-1.65; P = 0.38). A meta-analysis of six studies with 325 T2DM participants showed a significant difference in the fasting plasma glucose levels between H. pylori-positive and H. pylori-negative participants (WMD = 1.20, 95%CI: 0.17-2.23; P = 0.02). Eradication of H. pylori did not improve glycemic control in the T2DM participants in a three-month follow-up period (HbA1c decrease: WMD = -0.03, 95%CI = -0.14-0.08; P = 0.57; fasting plasma glucose decrease: WMD = -0.06, 95%CI: -0.36-0.23; P = 0.68). Glycemic control was significantly better in T1DM participants who were not reinfected than in those who were reinfected (HbA1c: WMD = 0.72, 95%CI: 0.32-1.13: P = 0.00). CONCLUSION: H. pylori infection is associated with poorer glycemic control in T1DM patients, but eradication may not improve glycemic control in DM in a short-term follow-up period. PMID:25954115

  8. [Patient-oriented prevention and control of hospital-acquired infections (author's transl)].

    PubMed

    Daschner, F

    1979-11-15

    The incidence of hospital-acquired infections varies between 2 and 15% (on average 5 to 8%). Most common nosocomial infections are urinary tract infections, wound infections, respiratory tract infections, septicemia and infections of the skin and subcutaneous tissue. Nosocomial infections arise essentially via two routes: endogenously from the bodies own flora or exogenously via direct or indirect contact with the patient. Bacteria are most commonly transmitted from patient to patient by hands. Air as a vehicle, by which bacteria are transmitted, plays a relatively minor role. Priorities in hospital infection control are: hand washing and hand desinfection, improvement of certain nursing techniques, isolation of infected or susceptible patients, an infection control team with a nurse epidemiologist, surveillance and control of antibiotic therapy regimens, especially of antibiotic prophylaxis. Routine floor desinfection could not be shown to significantly reduce the hospital infection rate. PMID:522423

  9. [THE FOUNDATIONS OF EVIDENCE-BASED MEDICINE].

    PubMed

    Pasleau, F

    2015-01-01

    The fundamentals of Evidence-Based Medicine (EBM) are the clinical experience, the application of best evidences from research and the consideration of patient expectations. It enabled significant progresses in the management of diseases with a low or multifactorial causality. But it has also led to unintended negative consequences, partly related to conflicts of interest. The objective of this article is to bring the attention back to the scientific rigor that must sustain the medical practice, namely in the occurrence : 1) formulating a question that addresses all the elements of an individual clinical situation; 2) exploring the literature systematically; 3) estimating the degree of confidence in the conclusions of clinical trials. EBM provides intuitive tools to address some uncomfortable concepts of biostatistics and to identify the biases and the embellished data that invalidate many studies. However, it is difficult to decide of the care of a single patient from observations issued from the comparison of'heterogeneous groups. Personalized medicine should help to overcome this difficulty and should facilitate clinical decision making by targeting the patients who are most likely to benefit from an intervention without much inconvenience. PMID:26285443

  10. Evidence-Based Management of Anticoagulant Therapy

    PubMed Central

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

    2012-01-01

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

  11. Knee surgery and its evidence base.

    PubMed

    Sharma, A; Hasan, K; Carter, A; Zaidi, R; Cro, S; Briggs, T; Goldberg, A

    2016-03-01

    Introduction Evidence driven orthopaedics is gaining prominence. It enables better management decisions and therefore better patient care. The aim of our study was to review a selection of the leading publications pertaining to knee surgery to assess changes in levels of evidence over a decade. Methods Articles from the years 2000 and 2010 in The Knee, the Journal of Arthroplasty, Knee Surgery, Sports Traumatology, Arthroscopy, the Journal of Bone and Joint Surgery (American Volume) and the Bone and Joint Journal were analysed and ranked according to guidelines from the Centre for Evidence-Based Medicine. The intervening years (2003, 2005 and 2007) were also analysed to further define the trend. Results The percentage of high level evidence (level I and II) studies increased albeit without reaching statistical significance. Following a significant downward trend, the latter part of the decade saw a major rise in levels of published evidence. The most frequent type of study was therapeutic. Conclusions Although the rise in levels of evidence across the decade was not statistically significant, there was a significant drop and then rise in these levels in the interim. It is therefore important that a further study is performed to assess longer-term trends. Recent developments have made clear that high quality evidence will be having an ever increasing influence on future orthopaedic practice. We suggest that journals implement compulsory declaration of a published study's level of evidence and that authors consider their study designs carefully to enhance the quality of available evidence. PMID:26890835

  12. Fundamental shortcomings of evidence-based medicine.

    PubMed

    Valkenburg, Govert; Achterhuis, Hans; Nijhof, Andr

    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. 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

  14. A Unique Approach to Dissemination of Evidence-Based Protocols: A Successful CAUTI Reduction Pilot.

    PubMed

    Dols, Jean Dowling; White, Sondra K; Timmons, Amy L; Bush, Michelle; Tripp, Joanne; Childers, Amanda Kay; Mathers, Nicholas; Tobias, Maria M

    2016-01-01

    A unique approach to disseminate an evidence-based protocol for urinary catheter management was led by a staff-driven catheter-associated urinary tract infection (CAUTI) reduction team in one hospital. The nurseeducators, faculty from a local university, and the facility's clinical nurse leader mentored the team. As an approachto reduce CAUTIs in the transplant care and intensive care units, the team developed an interdisciplinary CAUTIEducation Fair, which provided a safe, nonthreateningenvironment to unlearn prior behaviors and showcompetency in new evidence-based ones. PMID:26797307

  15. Multidisciplinary and evidence-based management of fistulizing perianal Crohns disease

    PubMed Central

    Sordo-Mejia, Ricardo; Gaertner, Wolfgang B

    2014-01-01

    Perianal symptoms are common in patients with Crohns 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 Crohns disease status and fistula tracts, medical therapy, and selective operative management. The impact of biological therapy on perianal Crohns disease is uncertain given that outcomes are conflicting. Operative treatment to eradicate the fistula tract can be attempted once infection has resolved and Crohns 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 Crohns disease is crucial to improve outcomes. PMID:25133026

  16. Controlling bacterial infections by inhibiting proton-dependent processes.

    PubMed

    Kaneti, Galoz; Meir, Ohad; Mor, Amram

    2016-05-01

    Bacterial resistance to antibiotics is recognized as one of the greatest threats in modern healthcare, taking a staggering toll worldwide. New approaches for controlling bacterial infections must be designed, eventually combining multiple strategies for complimentary therapies. This review explores an old/new paradigm for multi-targeted antibacterial therapy, focused at disturbing bacterial cytoplasmic membrane functions at sub minimal inhibitory concentrations, namely through superficial physical alterations of the bilayer, thereby perturbing transmembrane signals transduction. Such a paradigm may have the advantage of fighting the infection while avoiding many of the known resistance mechanisms. This article is part of a Special Issue entitled: Antimicrobial peptides edited by Karl Lohner and Kai Hilpert. PMID:26522076

  17. The potential for a controlled human infection platform in Singapore

    PubMed Central

    Balasingam, Shobana; Horby, Peter; Wilder-Smith, Annelies

    2014-01-01

    For over 100 years, controlled human infection (CHI) studies have been performed to advance the understanding of the pathogenesis, treatment and prevention of infectious diseases. This methodology has seen a resurgence, as it offers an efficient model for selecting the most promising agents for further development from available candidates. CHI studies are utilised to bridge safety and immunogenicity testing and phase II/III efficacy studies. However, as this platform is not currently utilised in Asia, opportunities to study therapeutics and vaccines for infections that are important in Asia are missed. This review examines the regulatory differences for CHI studies between countries and summarises other regulatory differences in clinical trials as a whole. We found that the regulations that would apply to CHI studies in Singapore closely mirror those in the United Kingdom, and conclude that the regulatory and ethical guidelines in Singapore are compatible with the conduct of CHI studies. PMID:25273928

  18. The potential for a controlled human infection platform in Singapore.

    PubMed

    Balasingam, Shobana; Horby, Peter; Wilder-Smith, Annelies

    2014-09-01

    For over 100 years, controlled human infection (CHI) studies have been performed to advance the understanding of the pathogenesis, treatment and prevention of infectious diseases. This methodology has seen a resurgence, as it offers an efficient model for selecting the most promising agents for further development from available candidates. CHI studies are utilised to bridge safety and immunogenicity testing and phase II/III efficacy studies. However, as this platform is not currently utilised in Asia, opportunities to study therapeutics and vaccines for infections that are important in Asia are missed. This review examines the regulatory differences for CHI studies between countries and summarises other regulatory differences in clinical trials as a whole. We found that the regulations that would apply to CHI studies in Singapore closely mirror those in the United Kingdom, and conclude that the regulatory and ethical guidelines in Singapore are compatible with the conduct of CHI studies. PMID:25273928

  19. Reality of evidence-based practice in palliative care.

    PubMed

    Visser, Claire; Hadley, Gina; Wee, Bee

    2015-09-01

    There has been a paradigm shift in medicine away from tradition, anecdote and theoretical reasoning from the basic sciences towards evidence-based medicine (EBM). In palliative care however, statistically significant benefits may be marginal and may not be related to clinical meaningfulness. The typical treatment vs. placebo comparison necessitated by 'gold standard' randomised controlled trials (RCTs) is not necessarily applicable. The complex multimorbidity of end of life care involves considerations of the patient's physical, psychological, social and spiritual needs. In addition, the field of palliative care covers a heterogeneous group of chronic and incurable diseases no longer limited to cancer. Adequate sample sizes can be difficult to achieve, reducing the power of studies and high attrition rates can result in inadequate follow up periods. This review uses examples of the management of cancer-related fatigue and death rattle (noisy breathing) to demonstrate the current state of EBM in palliative care. The future of EBM in palliative care needs to be as diverse as the patients who ultimately derive benefit. Non-RCT methodologies of equivalent quality, validity and size conducted by collaborative research networks using a 'mixed methods approach' are likely to pose the correct clinical questions and derive evidence-based yet clinically relevant outcomes. PMID:26487964

  20. Reality of evidence-based practice in palliative care

    PubMed Central

    Visser, Claire; Hadley, Gina; Wee, Bee

    2015-01-01

    There has been a paradigm shift in medicine away from tradition, anecdote and theoretical reasoning from the basic sciences towards evidence-based medicine (EBM). In palliative care however, statistically significant benefits may be marginal and may not be related to clinical meaningfulness. The typical treatment vs. placebo comparison necessitated by gold standard randomised controlled trials (RCTs) is not necessarily applicable. The complex multimorbidity of end of life care involves considerations of the patients physical, psychological, social and spiritual needs. In addition, the field of palliative care covers a heterogeneous group of chronic and incurable diseases no longer limited to cancer. Adequate sample sizes can be difficult to achieve, reducing the power of studies and high attrition rates can result in inadequate follow up periods. This review uses examples of the management of cancer-related fatigue and death rattle (noisy breathing) to demonstrate the current state of EBM in palliative care. The future of EBM in palliative care needs to be as diverse as the patients who ultimately derive benefit. Non-RCT methodologies of equivalent quality, validity and size conducted by collaborative research networks using a mixed methods approach are likely to pose the correct clinical questions and derive evidence-based yet clinically relevant outcomes. PMID:26487964

  1. Continuing Progress in Infection Control in U.S. Dental Schools.

    ERIC Educational Resources Information Center

    Merchant, Virginia A.; Molinari, John A.

    1990-01-01

    Results of a 1988 survey of dental school deans concerning infection control instruction and protocols found increased attention to infection control and application of recommended protocols. Findings are contrasted with those of earlier studies, and remaining obstacles to implementation of infection control programs are discussed. (Author/MSE)

  2. Comprehensive control of human papillomavirus infections and related diseases.

    PubMed

    Bosch, F Xavier; Broker, Thomas R; Forman, David; Moscicki, Anna-Barbara; Gillison, Maura L; Doorbar, John; Stern, Peter L; Stanley, Margaret; Arbyn, Marc; Poljak, Mario; Cuzick, Jack; Castle, Philip E; Schiller, John T; Markowitz, Lauri E; Fisher, William A; Canfell, Karen; Denny, Lynette A; Franco, Eduardo L; Steben, Marc; Kane, Mark A; Schiffman, Mark; Meijer, Chris J L M; Sankaranarayanan, Rengaswamy; Castellsagu, Xavier; Kim, Jane J; Brotons, Maria; Alemany, Laia; Albero, Ginesa; Diaz, Mireia; de Sanjos, Silvia

    2013-12-29

    Infection with human papillomavirus (HPV) is recognized as one of the major causes of infection-related cancer worldwide, as well as the causal factor in other diseases. Strong evidence for a causal etiology with HPV has been stated by the International Agency for Research on Cancer for cancers of the cervix uteri, penis, vulva, vagina, anus and oropharynx (including base of the tongue and tonsils). Of the estimated 12.7 million new cancers occurring in 2008 worldwide, 4.8% were attributable to HPV infection, with substantially higher incidence and mortality rates seen in developing versus developed countries. In recent years, we have gained tremendous knowledge about HPVs and their interactions with host cells, tissues and the immune system; have validated and implemented strategies for safe and efficacious prophylactic vaccination against HPV infections; have developed increasingly sensitive and specific molecular diagnostic tools for HPV detection for use in cervical cancer screening; and have substantially increased global awareness of HPV and its many associated diseases in women, men, and children. While these achievements exemplify the success of biomedical research in generating important public health interventions, they also generate new and daunting challenges: costs of HPV prevention and medical care, the implementation of what is technically possible, socio-political resistance to prevention opportunities, and the very wide ranges of national economic capabilities and health care systems. Gains and challenges faced in the quest for comprehensive control of HPV infection and HPV-related cancers and other disease are summarized in this review. The information presented may be viewed in terms of a reframed paradigm of prevention of cervical cancer and other HPV-related diseases that will include strategic combinations of at least four major components: 1) routine introduction of HPV vaccines to women in all countries, 2) extension and simplification of existing screening programs using HPV-based technology, 3) extension of adapted screening programs to developing populations, and 4) consideration of the broader spectrum of cancers and other diseases preventable by HPV vaccination in women, as well as in men. Despite the huge advances already achieved, there must be ongoing efforts including international advocacy to achieve widespread-optimally universal-implementation of HPV prevention strategies in both developed and developing countries. This article summarizes information from the chapters presented in a special ICO Monograph 'Comprehensive Control of HPV Infections and Related Diseases' Vaccine Volume 30, Supplement 5, 2012. Additional details on each subtopic and full information regarding the supporting literature references may be found in the original chapters. PMID:24331745

  3. Comprehensive control of human papillomavirus infections and related diseases.

    PubMed

    Bosch, F Xavier; Broker, Thomas R; Forman, David; Moscicki, Anna-Barbara; Gillison, Maura L; Doorbar, John; Stern, Peter L; Stanley, Margaret; Arbyn, Marc; Poljak, Mario; Cuzick, Jack; Castle, Philip E; Schiller, John T; Markowitz, Lauri E; Fisher, William A; Canfell, Karen; Denny, Lynette A; Franco, Eduardo L; Steben, Marc; Kane, Mark A; Schiffman, Mark; Meijer, Chris J L M; Sankaranarayanan, Rengaswamy; Castellsagu, Xavier; Kim, Jane J; Brotons, Maria; Alemany, Laia; Albero, Ginesa; Diaz, Mireia; de Sanjos, Silvia

    2013-12-31

    Infection with human papillomavirus (HPV) is recognized as one of the major causes of infection-related cancer worldwide, as well as the causal factor in other diseases. Strong evidence for a causal etiology with HPV has been stated by the International Agency for Research on Cancer for cancers of the cervix uteri, penis, vulva, vagina, anus and oropharynx (including base of the tongue and tonsils). Of the estimated 12.7 million new cancers occurring in 2008 worldwide, 4.8% were attributable to HPV infection, with substantially higher incidence and mortality rates seen in developing versus developed countries. In recent years, we have gained tremendous knowledge about HPVs and their interactions with host cells, tissues and the immune system; have validated and implemented strategies for safe and efficacious prophylactic vaccination against HPV infections; have developed increasingly sensitive and specific molecular diagnostic tools for HPV detection for use in cervical cancer screening; and have substantially increased global awareness of HPV and its many associated diseases in women, men, and children. While these achievements exemplify the success of biomedical research in generating important public health interventions, they also generate new and daunting challenges: costs of HPV prevention and medical care, the implementation of what is technically possible, socio-political resistance to prevention opportunities, and the very wide ranges of national economic capabilities and health care systems. Gains and challenges faced in the quest for comprehensive control of HPV infection and HPV-related cancers and other disease are summarized in this review. The information presented may be viewed in terms of a reframed paradigm of prevention of cervical cancer and other HPV-related diseases that will include strategic combinations of at least four major components: 1) routine introduction of HPV vaccines to women in all countries, 2) extension and simplification of existing screening programs using HPV-based technology, 3) extension of adapted screening programs to developing populations, and 4) consideration of the broader spectrum of cancers and other diseases preventable by HPV vaccination in women, as well as in men. Despite the huge advances already achieved, there must be ongoing efforts including international advocacy to achieve widespread-optimally universal-implementation of HPV prevention strategies in both developed and developing countries. This article summarizes information from the chapters presented in a special ICO Monograph 'Comprehensive Control of HPV Infections and Related Diseases' Vaccine Volume 30, Supplement 5, 2012. Additional details on each subtopic and full information regarding the supporting literature references may be found in the original chapters. PMID:24332295

  4. Comprehensive control of human papillomavirus infections and related diseases.

    PubMed

    Bosch, F Xavier; Broker, Thomas R; Forman, David; Moscicki, Anna-Barbara; Gillison, Maura L; Doorbar, John; Stern, Peter L; Stanley, Margaret; Arbyn, Marc; Poljak, Mario; Cuzick, Jack; Castle, Philip E; Schiller, John T; Markowitz, Lauri E; Fisher, William A; Canfell, Karen; Denny, Lynette A; Franco, Eduardo L; Steben, Marc; Kane, Mark A; Schiffman, Mark; Meijer, Chris J L M; Sankaranarayanan, Rengaswamy; Castellsagu, Xavier; Kim, Jane J; Brotons, Maria; Alemany, Laia; Albero, Ginesa; Diaz, Mireia; de Sanjos, Silvia

    2013-12-30

    Infection with human papillomavirus (HPV) is recognized as one of the major causes of infection-related cancer worldwide, as well as the causal factor in other diseases. Strong evidence for a causal etiology with HPV has been stated by the International Agency for Research on Cancer for cancers of the cervix uteri, penis, vulva, vagina, anus and oropharynx (including base of the tongue and tonsils). Of the estimated 12.7 million new cancers occurring in 2008 worldwide, 4.8% were attributable to HPV infection, with substantially higher incidence and mortality rates seen in developing versus developed countries. In recent years, we have gained tremendous knowledge about HPVs and their interactions with host cells, tissues and the immune system; have validated and implemented strategies for safe and efficacious prophylactic vaccination against HPV infections; have developed increasingly sensitive and specific molecular diagnostic tools for HPV detection for use in cervical cancer screening; and have substantially increased global awareness of HPV and its many associated diseases in women, men, and children. While these achievements exemplify the success of biomedical research in generating important public health interventions, they also generate new and daunting challenges: costs of HPV prevention and medical care, the implementation of what is technically possible, socio-political resistance to prevention opportunities, and the very wide ranges of national economic capabilities and health care systems. Gains and challenges faced in the quest for comprehensive control of HPV infection and HPV-related cancers and other disease are summarized in this review. The information presented may be viewed in terms of a reframed paradigm of prevention of cervical cancer and other HPV-related diseases that will include strategic combinations of at least four major components: 1) routine introduction of HPV vaccines to women in all countries, 2) extension and simplification of existing screening programs using HPV-based technology, 3) extension of adapted screening programs to developing populations, and 4) consideration of the broader spectrum of cancers and other diseases preventable by HPV vaccination in women, as well as in men. Despite the huge advances already achieved, there must be ongoing efforts including international advocacy to achieve widespread-optimally universal-implementation of HPV prevention strategies in both developed and developing countries. This article summarizes information from the chapters presented in a special ICO Monograph 'Comprehensive Control of HPV Infections and Related Diseases' Vaccine Volume 30, Supplement 5, 2012. Additional details on each subtopic and full information regarding the supporting literature references may be found in the original chapters. PMID:24331817

  5. Comprehensive control of human papillomavirus infections and related diseases.

    PubMed

    Bosch, F Xavier; Broker, Thomas R; Forman, David; Moscicki, Anna-Barbara; Gillison, Maura L; Doorbar, John; Stern, Peter L; Stanley, Margaret; Arbyn, Marc; Poljak, Mario; Cuzick, Jack; Castle, Philip E; Schiller, John T; Markowitz, Lauri E; Fisher, William A; Canfell, Karen; Denny, Lynette A; Franco, Eduardo L; Steben, Marc; Kane, Mark A; Schiffman, Mark; Meijer, Chris J L M; Sankaranarayanan, Rengaswamy; Castellsagu, Xavier; Kim, Jane J; Brotons, Maria; Alemany, Laia; Albero, Ginesa; Diaz, Mireia; de Sanjos, Silvia

    2013-11-22

    Infection with human papillomavirus (HPV) is recognized as one of the major causes of infection-related cancer worldwide, as well as the causal factor in other diseases. Strong evidence for a causal etiology with HPV has been stated by the International Agency for Research on Cancer for cancers of the cervix uteri, penis, vulva, vagina, anus and oropharynx (including base of the tongue and tonsils). Of the estimated 12.7 million new cancers occurring in 2008 worldwide, 4.8% were attributable to HPV infection, with substantially higher incidence and mortality rates seen in developing versus developed countries. In recent years, we have gained tremendous knowledge about HPVs and their interactions with host cells, tissues and the immune system; have validated and implemented strategies for safe and efficacious prophylactic vaccination against HPV infections; have developed increasingly sensitive and specific molecular diagnostic tools for HPV detection for use in cervical cancer screening; and have substantially increased global awareness of HPV and its many associated diseases in women, men, and children. While these achievements exemplify the success of biomedical research in generating important public health interventions, they also generate new and daunting challenges: costs of HPV prevention and medical care, the implementation of what is technically possible, socio-political resistance to prevention opportunities, and the very wide ranges of national economic capabilities and health care systems. Gains and challenges faced in the quest for comprehensive control of HPV infection and HPV-related cancers and other disease are summarized in this review. The information presented may be viewed in terms of a reframed paradigm of prevention of cervical cancer and other HPV-related diseases that will include strategic combinations of at least four major components: 1) routine introduction of HPV vaccines to women in all countries, 2) extension and simplification of existing screening programs using HPV-based technology, 3) extension of adapted screening programs to developing populations, and 4) consideration of the broader spectrum of cancers and other diseases preventable by HPV vaccination in women, as well as in men. Despite the huge advances already achieved, there must be ongoing efforts including international advocacy to achieve widespread-optimally universal-implementation of HPV prevention strategies in both developed and developing countries. This article summarizes information from the chapters presented in a special ICO Monograph 'Comprehensive Control of HPV Infections and Related Diseases' Vaccine Volume 30, Supplement 5, 2012. Additional details on each subtopic and full information regarding the supporting literature references may be found in the original chapters. PMID:24229716

  6. Comprehensive Control of Human Papillomavirus Infections and Related Diseases

    PubMed Central

    Bosch, F. Xavier; Broker, Thomas R.; Forman, David; Moscicki, Anna-Barbara; Gillison, Maura L.; Doorbar, John; Stern, Peter L.; Stanley, Margaret; Arbyn, Marc; Poljak, Mario; Cuzick, Jack; Castle, Philip E.; Schiller, John T.; Markowitz, Lauri E.; Fisher, William A.; Canfell, Karen; Denny, Lynette A.; Franco, Eduardo L.; Steben, Marc; Kane, Mark A.; Schiffman, Mark; Meijer, Chris J.L.M.; Sankaranarayanan, Rengaswamy; Castellsagué, Xavier; Kim, Jane J.; Brotons, Maria; Alemany, Laia; Albero, Ginesa; Diaz, Mireia; de Sanjosé, Silvia

    2014-01-01

    Infection with human papillomavirus (HPV) is recognized as one of the major causes of infection-related cancer worldwide, as well as the causal factor in other diseases. Strong evidence for a causal etiology with HPV has been stated by the International Agency for Research on Cancer for cancers of the cervix uteri, penis, vulva, vagina, anus and oropharynx (including base of the tongue and tonsils). Of the estimated 12.7 million new cancers occurring in 2008 worldwide, 4.8% were attributable to HPV infection, with substantially higher incidence and mortality rates seen in developing versus developed countries. In recent years, we have gained tremendous knowledge about HPVs and their interactions with host cells, tissues and the immune system; have validated and implemented strategies for safe and efficacious prophylactic vaccination against HPV infections; have developed increasingly sensitive and specific molecular diagnostic tools for HPV detection for use in cervical cancer screening; and have substantially increased global awareness of HPV and its many associated diseases in women, men, and children. While these achievements exemplify the success of biomedical research in generating important public health interventions, they also generate new and daunting challenges: costs of HPV prevention and medical care, the implementation of what is technically possible, socio-political resistance to prevention opportunities, and the very wide ranges of national economic capabilities and health care systems. Gains and challenges faced in the quest for comprehensive control of HPV infection and HPV-related cancers and other disease are summarized in this review. The information presented may be viewed in terms of a reframed paradigm of prevention of cervical cancer and other HPV-related diseases that will include strategic combinations of at least four major components: 1) routine introduction of HPV vaccines to women in all countries, 2) extension and simplification of existing screening programs using HPV-based technology, 3) extension of adapted screening programs to developing populations, and 4) consideration of the broader spectrum of cancers and other diseases preventable by HPV vaccination in women, as well as in men. Despite the huge advances already achieved, there must be ongoing efforts including international advocacy to achieve widespread—optimally universal—implementation of HPV prevention strategies in both developed and developing countries. This article summarizes information from the chapters presented in a special ICO Monograph ‘Comprehensive Control of HPV Infections and Related Diseases’ Vaccine Volume 30, Supplement 5, 2012. Additional details on each subtopic and full information regarding the supporting literature references may be found in the original chapters. PMID:24229716

  7. Epidemiology, surveillance and control of Nipah virus infections in Malaysia.

    PubMed

    Chua, K B

    2010-12-01

    The outbreak of Nipah virus, affecting pigs and pig-farm workers, was first noted in September 1998 in the north-western part of peninsular Malaysia. By March 1999, the outbreak had spread to other pig-farming areas of the country, inclusive of the neighbouring country, Singapore. A total of 283 human cases of viral encephalitis with 109 deaths were recorded in Malaysia from 29 September 1998 to December 1999. During the outbreak period, a number of surveillances under three broad groups; Surveillance in Human Health Sector, Surveillance in Animal Health Sector, and Surveillance for the Reservoir Hosts, were carried out to determine the prevalence, risk of virus infections and transmission in human and swine populations as well as the source and reservoir hosts of Nipah virus. Surveillance data showed that the virus spread rapidly among pigs within infected farms and transmission was attributed to direct contact with infective excretions and secretions. The spread of the virus among pig farms within and between states of peninsular Malaysia was due to movement of pigs. The transmission of the virus to humans was through close contact with infected pigs. Human to human transmission was considered a rare event though the Nipah virus could be isolated from saliva, urine, nasal and pharyngeal secretions of patients. Field investigations identified fruitbats of the Pteropid species as the natural reservoir hosts of the viruses. The outbreak was effectively brought under control following the discovery of the virus and institution of correct control measures through a combined effort of multi-ministerial and multidisciplinary teams working in close co-operation and collaboration with other international agencies. PMID:21329176

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

    PubMed

    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

  9. 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

  10. Infection Control Programs and Antibiotic Control Programs to Limit Transmission of Multi-Drug Resistant Acinetobacter baumannii Infections: Evolution of Old Problems and New Challenges for Institutes

    PubMed Central

    Chen, Chang-Hua; Lin, Li-Chen; Chang, Yu-Jun; Chen, Yu-Min; Chang, Chin-Yen; Huang, Chieh-Chen

    2015-01-01

    Background: Acinetobacter baumannii complex (A. baumannii) has been isolated worldwide. The rapid spread of multidrug-resistant A. baumannii complex (MDRAB) in clinical settings has made choosing an appropriate antibiotic to treat these infections and executing contact precautions difficult for clinicians. Although controlling the transmission of MDRAB is a high priority for institutions, there is little information about MDRAB control. Therefore, this study evaluated infection control measures for A. baumannii infections, clusters and outbreaks in the literature. Methods: We performed a review of OVID Medline (from 1980 to 2015), and analyzed the literature. Results: We propose that both infection control programs and antibiotic control programs are essential for control of MDRAB. The first, effective control of MDRAB infections, requires compliance with a series of infection control methods including strict environmental cleaning, effective sterilization of reusable medical equipment, concentration on proper hand hygiene practices, and use of contact precautions, together with appropriate administrative guidance. The second strategy, effective antibiotic control programs to decrease A. baumannii, is also of paramount importance. Conclusion: We believe that both infection control programs and antibiotics stewardship programs are essential for control of MDRAB infections. PMID:26264006

  11. Healthcare Associated Infections of Methicillin-Resistant Staphylococcus aureus: A Case-Control-Control Study

    PubMed Central

    Yao, Zhenjiang; Peng, Yang; Chen, Xiaofeng; Bi, Jiaqi; Li, Ying; Ye, Xiaohua; Shi, Jing

    2015-01-01

    Background Methicillin-resistant Staphylococcus aureus (MRSA) is one of the most widespread and dangerous pathogens in healthcare settings. We carried out this case-control-control study at a tertiary care hospital in Guangzhou, China, to examine the antimicrobial susceptibility patterns, risk factors and clinical outcomes of MRSA infections. Methods A total of 57 MRSA patients, 116 methicillin-susceptible Staphylococcus aureus (MSSA) patients and 102 S. aureus negative patients were included in this study. We applied the disk diffusion method to compare the antimicrobial susceptibilities of 18 antibiotics between MRSA and MSSA isolates. Risk factors of MRSA infections were evaluated using univariate and multivariate logistic regression models. We used Cox proportional hazards models and logistic regression analysis to assess the hospital stay duration and fatality for patients with MRSA infections. Results The MRSA group had significantly higher resistance rates for most drugs tested compared with the MSSA group. Using MSSA patients as controls, the following independent risk factors of MRSA infections were identified: 3 or more prior hospitalizations (OR 2.8, 95% CI 1.35.8, P = 0.007), chronic obstructive pulmonary disease (OR 5.9, 95% CI 1.720.7, P = 0.006), and use of a respirator (OR 3.6, 95% CI 1.012.9, P = 0.046). With the S. aureus negative patients as controls, use of a respirator (OR 3.8, 95% CI 1.013.9, P = 0.047) and tracheal intubation (OR 8.2, 95% CI 1.545.1, P = 0.016) were significant risk factors for MRSA infections. MRSA patients had a longer hospital stay duration and higher fatality in comparison with those in the two control groups. Conclusions MRSA infections substantially increase hospital stay duration and fatality. Thus, MRSA infections are serious issues in this healthcare setting and should receive more attention from clinicians. PMID:26470023

  12. Could Our Pretest Probabilities Become Evidence Based?

    PubMed Central

    Richardson, W Scott; Polashenski, Walter A; Robbins, Brett W

    2003-01-01

    OBJECTIVE We sought to measure the proportion of patients on our clinical service who presented with clinical problems for which research evidence was available to inform estimates of pretest probability. We also aimed to discern whether any of this evidence was of sufficient quality that we would want to use it for clinical decision making. DESIGN Prospective, consecutive case series and literature survey. SETTING Inpatient medical service of a university-affiliated Veterans' Affairs hospital in south Texas. PATIENTS Patients admitted during the 3 study months for diagnostic evaluation. MEASUREMENTS Patients' active clinical problems were identified prospectively and recorded at the time of discharge, transfer, or death. We electronically searched medline and hand-searched bibliographies to find citations that reported research evidence about the frequency of underlying diseases that cause these clinical problems. We critically appraised selected citations and ranked them on a hierarchy of evidence. RESULTS We admitted 122 patients for diagnostic evaluation, in whom we identified 45 different principal clinical problems. For 35 of the 45 problems (78%; 95% confidence interval [95% CI], 66% to 90%), we found citations that qualified as disease probability evidence. Thus, 111 of our 122 patients (91%; 95% CI, 86% to 96%) had clinical problems for which evidence was available in the medical literature. CONCLUSIONS During 3 months on our hospital medicine service, almost all of the patients admitted for diagnostic evaluation had clinical problems for which evidence is available to guide our estimates of pretest probability. If confirmed by others, these data suggest that clinicians' pretest probabilities could become evidence based. PMID:12648252

  13. Evidence base in guideline generation in diabetes.

    PubMed

    Mhlhauser, I; Meyer, G

    2013-06-01

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

  14. Integrated control of Fascioloides magna infection in northern Italy.

    PubMed

    Balbo, T; Rossi, L; Meneguz, P G

    1989-01-01

    The following study records ten years' experience in the control of Fascioloides magna infection in a fenced area grazed by an overdense red deer population together with free-ranging cattle. During the winter 1977/78 mortality due to a "fascioloidosis-malnutrition syndrome" reduced the deer stock almost by half. Control measures were aimed at combatting the fluke in the wild definitive host by the administration of medicated pellets. Four flukicides were used over the years: rafoxanide, diamphenetide, oxyclozanide and triclabendazole. Efforts were also made to control the number of deer and to improve their condition by artificial feeding during the winter months. Intervention on the habitat of the intermediate hosts of F. magna were purposely avoided. The efficacy of this programme was evaluated by both copromicroscopic examinations and fluke counts from the livers of the wild and domestic macromammals living in the study area. Some yield parameters of the deer population were also taken into account. Results demonstrate that F. magna infection, though a hazard for cattle productivity, remained a deer problem when pharmacological prophylaxis was regularly applied. PMID:2486993

  15. IFN? and perforin cooperate to control infection and prevent fatal pathology during persistent gammaherpesvirus infection in mice.

    PubMed

    Bartholdy, C; Hgh-Petersen, M; Storm, P; Holst, P J; Orskov, C; Christensen, J P; Thomsen, A R

    2014-06-01

    Infection with murine gammaherpesvirus 68 has become an accepted model for studying the virus/host interactions with regard to gammaherpesvirus infections. Previous studies using gene-deficient mice have revealed that neither IFN? nor perforin is essential in controlling the outcome of infection or the virus load during chronic infection in C57BL/6 mice. However, pronounced multiorgan fibrosis and splenic atrophy are observed in mice lacking IFN? or the IFN? receptor. To study the interplay between perforin and IFN? in controlling the virus-induced pathology and the viral load during chronic gammaherpesvirus infection, we infected IFN?/perforin double-deficient C57BL/6 mice and followed the course of infection. While absence of perforin prevented the splenic atrophy in IFN?-deficient mice, fibrosis did not disappear. Moreover, double-deficient mice developed extreme splenomegaly, were unable to control the viral load and displayed chronic immune activation. Thus, IFN? and perforin act in concert to minimize pathology and control the viral load in mice chronically infected with MHV68. Furthermore, while certain aspect of the virus-induced pathology in IFN?-deficient mice may be alleviated in double-deficient mice, other aspects are exaggerated, and the normal architecture of the spleen is completely destroyed. We believe that these findings add to the understanding of the virus/host interaction during chronic gammaherpes virus infection. PMID:24684620

  16. Merging Evidence-Based Psychosocial Interventions in Schizophrenia

    PubMed Central

    Lecomte, Tania; Corbire, Marc; Simard, Stphanie; 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

  17. An advanced educational program promoting evidence-based practice.

    PubMed

    Cullen, Laura; Titler, Marita G; Rempel, Grace

    2011-04-01

    Evidence-based practice has led to improved health care quality and safety; greater patient, family, and staff satisfaction; and reduced costs. Despite these promising outcomes, use of evidence-based practice is inconsistent. The purpose of this article is to describe an advanced educational program for nurses in leadership roles responsible for guiding teams and mentoring colleagues through the challenges inherent in the evidence-based practice process. The Advanced Practice Institute: Promoting Adoption of Evidence-Based Practice is an innovative program designed to develop advanced skills essential for completing evidence-based practice projects and building organizational capacity for evidence-based practice programs. Learning is facilitated through group discussion, facilitated work time, networking, and consultation. Content includes finding and synthesizing evidence, learning effective strategies for implementation and evaluation, and discussing techniques for building an EBP program in the nurses' organization. Program evaluations are extremely positive, and the long-term impact is described. PMID:20705775

  18. The oil crisis, risk and evidence-based practice.

    PubMed

    Traynor, Michael

    2002-09-01

    Evidence-based practice has risen to prominence over the last 20 years. Different professions have taken it up in different ways and for different purposes. It has been seen as holding both threats and advantages to professionalising endeavours and professional identity. It has engendered controversy but some criticisms of it have been unconvincing. It is possible to account for its rise as a response to tightening financial constraints on state spending in the west, as a sign of a culture increasingly concerned with risk, distrust of professionals and experts, as well as a way for professionals themselves to maintain control over their activity in the face of growing managerialism. This paper reviews the literature of some of the movement's proponents as well as criticism from various professional groups. It concludes that more useful than either arguing for or against it, is to understand the policy background and sociological reasons for its emergence and spread. PMID:12199880

  19. Directing the public to evidence-based online content.

    PubMed

    Cooper, Crystale Purvis; Gelb, Cynthia A; Vaughn, Alexandra N; Smuland, Jenny; Hughes, Alexandra G; Hawkins, Nikki A

    2015-04-01

    To direct online users searching for gynecologic cancer information to accurate content, the Centers for Disease Control and Prevention's (CDC) 'Inside Knowledge: Get the Facts About Gynecologic Cancer' campaign sponsored search engine advertisements in English and Spanish. From June 2012 to August 2013, advertisements appeared when US Google users entered search terms related to gynecologic cancer. Users who clicked on the advertisements were directed to relevant content on the CDC website. Compared with the 3 months before the initiative (March-May 2012), visits to the CDC web pages linked to the advertisements were 26 times higher after the initiative began (June-August 2012) (p<0.01), and 65 times higher when the search engine advertisements were supplemented with promotion on television and additional websites (September 2012-August 2013) (p<0.01). Search engine advertisements can direct users to evidence-based content at a highly teachable moment--when they are seeking relevant information. PMID:25053580

  20. Why "What Works" Won't Work: Evidence-Based Practice and the Democratic Deficit in Educational Research

    ERIC Educational Resources Information Center

    Biesta, Gert

    2007-01-01

    In this essay, Gert Biesta provides a critical analysis of the idea of evidence-based practice and the ways in which it has been promoted and implemented in the field of education, focusing on the tension between scientific and democratic control over educational practice and research. Biesta examines three key assumptions of evidence-based

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

    PubMed

    Likosky, Donald S

    2006-12-01

    There is surmounting pressure for clinicians domestically and abroad not only to practice evidence-based perfusion, but also to supplement practice with documentation thereof. In this editorial, I shall describe an international initiative aimed at embracing this dictum from patients, regulatory bodies, and payers. "Research is the only hope that the future will be different than the past"- Daniel Mintz, MD "Practical men who believe themselves to be quite exempt from any intellectual influences are usually the slaves of some defunct economist.... It is ideas not vested interests which are dangerous for good or evil."-John Maynard Keynes. PMID:17312899

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

    PubMed Central

    Likosky, Donald S.

    2006-01-01

    Abstract: There is surmounting pressure for clinicians domestically and abroad not only to practice evidence-based perfusion, but also to supplement practice with documentation thereof. In this editorial, I shall describe an international initiative aimed at embracing this dictum from patients, regulatory bodies, and payers. Research is the only hope that the future will be different than the pastDaniel Mintz, MD Practical men who believe themselves to be quite exempt from any intellectual influences are usually the slaves of some defunct economist. It is ideas not vested interests which are dangerous for good or evil.John Maynard Keynes PMID:17312899

  3. Infections

    MedlinePLUS

    ... Externa) Eye Infections Pinkeye (Conjunctivitis) Styes Fungal Infections (Ringworm, Yeast, etc.) Diaper Rash Infections That Pets Carry Pneumocystis Pneumonia Tinea (Ringworm, Jock Itch, Athlete's Foot) Immunizations Flu Center ...

  4. Updating the evidence base for suctioning adult patients: A systematic review

    PubMed Central

    Overend, Tom J; Anderson, Cathy M; Brooks, Dina; Cicutto, Lisa; Keim, Michael; McAuslan, Debra; Nonoyama, Mika

    2009-01-01

    OBJECTIVES: To update a previous clinical practice guideline on suctioning in adult patients, published in the Canadian Respiratory Journal in 2001. METHODS: A primary search of the MEDLINE (from 1998), CINAHL, EMBASE and The Cochrane Library (all from 1996) databases up to November 2007, was conducted. These dates reflect the search limits reached in the previous clinical practice guideline. A secondary search of the reference lists of retrieved articles was also performed. Two reviewers independently appraised each study before meeting to reach consensus. Study quality was evaluated using the Jadad and PEDro scales. When sufficient data were available, a meta-analysis was conducted using a random effects model. Data are reported as ORs, weighted mean differences and 95% CIs. When no comparisons were possible, qualitative analyses of the data were completed. RESULTS: Eighty-one studies were critically appraised from a pool of 123. A total of 28 randomized controlled trials or randomized crossover studies were accepted for inclusion. Meta-analysis was possible for open versus closed suctioning only. Recommendations from 2001 with respect to hyperoxygenation, hyperinflation, use of a ventilator circuit adaptor and subglottic suctioning were confirmed. New evidence was identified with respect to indications for suctioning, open suction versus closed suction systems, use of medications and infection control. CONCLUSIONS: While new evidence continues to be varied in strength, and is still lacking in some areas of suctioning practice, the evidence base has improved since 2001. Members of the health care team should incorporate this evidence into their practice. PMID:19557211

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

    PubMed

    Ross, Jacqueline

    2010-04-01

    Information literacy, the recognition of information required, and the development of skills for locating, evaluating, and effectively using relevant evidence is needed for evidence-based practice (EBP). The purpose of this study was to examine perianesthesia nurses' perception of searching skills and access to evidence sources. The design was a descriptive, exploratory survey. The sample consisted of ASPAN members (n = 64) and nonmembers (n = 64). The Information Literacy for Evidence-Based Nursing Practice instrument was used. Findings were that ASPAN members read more journal articles, were more proficient with computers, and used Cumulative Index to Nursing and Allied Health Literature (CINAHL) more frequently than nonmembers. The three top barriers to use of research were: lack of understanding of organization or structure of electronic databases, lack of skills to critique and/or synthesize the literature, and difficulty in accessing research materials. In conclusion, education is needed for critiquing literature and understanding electronic databases and research articles to promote EBP in perianesthesia areas. PMID:20359640

  6. Middle East Respiratory Syndrome Infection Control and Prevention Guideline for Healthcare Facilities.

    PubMed

    Kim, Jin Yong; Song, Joon Young; Yoon, Young Kyung; Choi, Seong-Ho; Song, Young Goo; Kim, Sung-Ran; Son, Hee-Jung; Jeong, Sun-Young; Choi, Jung-Hwa; Kim, Kyung Mi; Yoon, Hee Jung; Choi, Jun Yong; Kim, Tae Hyong; Choi, Young Hwa; Kim, Hong Bin; Yoon, Ji Hyun; Lee, Jacob; Eom, Joong Sik; Lee, Sang-Oh; Oh, Won Sup; Choi, Jung-Hyun; Yoo, Jin-Hong; Kim, Woo Joo; Cheong, Hee Jin

    2015-12-01

    Middle East Respiratory Syndrome (MERS) is an acute viral respiratory illness with high mortality caused by a new strain of betacoronavirus (MERS-CoV). Since the report of the first patient in Saudi Arabia in 2012, large-scale outbreaks through hospital-acquired infection and inter-hospital transmission have been reported. Most of the patients reported in South Korea were also infected in hospital settings. Therefore, to eliminate the spread of MERS-CoV, infection prevention and control measures should be implemented with rigor. The present guideline has been drafted on the basis of the experiences of infection control in the South Korean hospitals involved in the recent MERS outbreak and on domestic and international infection prevention and control guidelines. To ensure efficient MERS-CoV infection prevention and control, care should be taken to provide comprehensive infection control measures including contact control, hand hygiene, personal protective equipment, disinfection, and environmental cleaning. PMID:26788414

  7. Middle East Respiratory Syndrome Infection Control and Prevention Guideline for Healthcare Facilities

    PubMed Central

    Kim, Jin Yong; Song, Joon Young; Yoon, Young Kyung; Choi, Seong-Ho; Song, Young Goo; Kim, Sung-Ran; Son, Hee-Jung; Jeong, Sun-Young; Choi, Jung-Hwa; Kim, Kyung Mi; Yoon, Hee Jung; Choi, Jun Yong; Kim, Tae Hyong; Choi, Young Hwa; Kim, Hong Bin; Yoon, Ji Hyun; Lee, Jacob; Eom, Joong Sik; Lee, Sang-Oh; Oh, Won Sup; Choi, Jung-Hyun; Yoo, Jin-Hong; Kim, Woo Joo

    2015-01-01

    Middle East Respiratory Syndrome (MERS) is an acute viral respiratory illness with high mortality caused by a new strain of betacoronavirus (MERS-CoV). Since the report of the first patient in Saudi Arabia in 2012, large-scale outbreaks through hospital-acquired infection and inter-hospital transmission have been reported. Most of the patients reported in South Korea were also infected in hospital settings. Therefore, to eliminate the spread of MERS-CoV, infection prevention and control measures should be implemented with rigor. The present guideline has been drafted on the basis of the experiences of infection control in the South Korean hospitals involved in the recent MERS outbreak and on domestic and international infection prevention and control guidelines. To ensure efficient MERS-CoV infection prevention and control, care should be taken to provide comprehensive infection control measures including contact control, hand hygiene, personal protective equipment, disinfection, and environmental cleaning. PMID:26788414

  8. [Outcomes of Infection Control Team Inspections at the Dental Hospital, Tokyo Medical and Dental University].

    PubMed

    Mitsuhiro, Sunakawa; Hiroyuki, Matsumoto; Rie, Okihata; Hiromi, Tsuruoka; Yuichi, Yamada; Toshiko, Adachi; Yuichi, Izumi

    2015-07-01

    In the Dental Hospital, Tokyo Medical and Dental University, an infection control team (ICT) has been formed to inspect each diagnosis department of clinics and wards in order to identify problems regarding nosocomial infection control. In this study, we analyzed the inspection reports and highlighted the following serious problems: 1) inadequate hygienic hand-washing for out- and in-patient treatment, 2) incomplete wearing of personal protective equipment (PPE) by dental health care workers, 3) necessity of environmental improvement in the clinics, and 4) cross-infection risk induced by. the continuous use of treatment devices without appropriate disinfection. The ICT provided feedback to the inspected departments, suggesting solutions to problems regarding nosocomial infection control. In order to enhance infection control in our hospital, dental healthcare practitioners must make further efforts on nosocomial infection control and prevention, and act according to their position by continuously educating students and enlightening hospital staff about the importance of infection control. PMID:26502663

  9. Adapting an evidence-based intervention for HIV to avail access to testing and risk-reduction counseling for female victims of sexual violence in post-earthquake Haiti.

    PubMed

    Rahill, Guitele J; Joshi, Manisha; Hernandez, Anthony

    2016-02-01

    Haiti has the highest prevalence of HIV/AIDS in the Caribbean. Before the 2010 earthquake, Haitian women bore a disproportionate burden of HIV/AIDS, had lower HIV knowledge, less capacity to negotiate for safer sex, and limited access to HIV testing and risk-reduction (RR) counseling. Since 2010, there has been an increase in sexual violence against women, characterized by deliberate vaginal injuries by non-intimate partners, increasing victims' risk of sexually transmitted infections including HIV/AIDS. Needed is an adaptation of evidence-based interventions for HIV that include HIV testing and counseling for this stigmatized population. We reviewed several features of Centers for Disease Control and Prevention's 103 evidence-based interventions for HIV (e.g., measures used, participant risk characteristics, theoretical framework, outcome variables, and evidence tier) in an attempt to seek a feasibly adaptable evidence-based intervention for HIV that could be used for victims of sexual violence (VOSV). RESPECT, one of the reviewed evidence-based HIV interventions, comprises of one-on-one, client-focused HIV prevention/RR counseling, and RAPID HIV testing. Adapting RESPECT can enhance access to testing for Haitian VOSV and can influence their perceptions of HIV risk, and establishment of RR goals for future consensual intimate relations. Adapting and implementing RESPECT can increase uptake of evidence-based HIV interventions among Haitians and positively affect a region with high HIV prevalence and increased rates of sexual violence. PMID:26278002

  10. 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

  11. Infection Control and Bloodstream Infection Prevention: The Perspective of Patients Receiving Hemodialysis

    PubMed Central

    See, Isaac; Shugart, Alicia; Lamb, Carrie; Kallen, Alexander J.; Patel, Priti R.; Sinkowitz-Cochran, Ronda L.

    2015-01-01

    Patients on hemodialysis, particularly those dialyzed through central lines, are at risk of acquiring bloodstream infections. Strategies to prevent bloodstream infections in patients on dialysis include educating patients about infection prevention, although patients perspectives on this topic are not known. During focus groups conducted to explore these issues, patients reported that education on infection prevention should begin early in the process of dialysis, and that patients should be actively engaged as partners in infection prevention. PMID:24689263

  12. Need for more targeted measures - only less severe hospital-associated infections declined after introduction of an infection control program.

    PubMed

    Koch, Anne M; Nilsen, Roy M; Dalheim, Anne; Cox, Rebecca J; Harthug, Stig

    2015-01-01

    A systematic infection control program is found to be an important tool to reduce hospital-associated infections (HAIs) and surveillance of infection is a significant part of it. The aim of this paper was to present the result from 17 years continuous prevalence studies after implementation of a systematic infection control program, to examine trends of hospital-associated infections and to study possible risk factors for different sites of infection. Data from 61399 in-patients at Haukeland University Hospital, Norway, from 1994 to 2010 was included in the study. Overall prevalence of HAIs was 7.6%. There was a reduction in HAIs from 8.3% in 1994 to 7.1% in 2010 (relative decrease 14.4%), mostly attributable to a significant reduction in the prevalence of urinary tract infections (UTI). For surgical site infections (SSI) we found a borderline significant increase (p=0.05). Male gender (except for UTI), urinary tract catheter and surgical operation were all strong predictors for HAIs. Higher age was a risk factor for all infection types, except for BSI. In conclusion, repeated prevalence surveys demonstrated a significant reduction in HAIs but no decrease in hospital-associated BSI, LRTI and SSI. There was, however, a rapid decline of UTI and other less severe HAIs. PMID:25488823

  13. Evidence-based Value of Prophylactic Drainage in Gastrointestinal Surgery

    PubMed Central

    Petrowsky, Henrik; Demartines, Nicolas; Rousson, Valentin; Clavien, Pierre-Alain

    2004-01-01

    Objective: To determine the evidence-based value of prophylactic drainage in gastrointestinal (GI) surgery. Methods: An electronic search of the Medline database from 1966 to 2004 was performed to identify articles comparing prophylactic drainage with no drainage in GI surgery. The studies were reviewed and classified according to their quality of evidence using the grading system proposed by the Oxford Centre for Evidence-based Medicine. Seventeen randomized controlled trials (RCTs) were found for hepato-pancreatico-biliary surgery, none for upper GI tract, and 13 for lower GI tract surgery. If sufficient RCTs were identified, we performed a meta-analysis to characterize the drain effect using the random-effects model. Results: There is evidence of level 1a that drains do not reduce complications after hepatic, colonic, or rectal resection with primary anastomosis and appendectomy for any stage of appendicitis. Drains were even harmful after hepatic resection in chronic liver disease and appendectomy. In the absence of RCTs, there is a consensus (evidence level 5) about the necessity of prophylactic drainage after esophageal resection and total gastrectomy due to the potential fatal outcome in case of anastomotic and gastric leakage. Conclusion: Many GI operations can be performed safely without prophylactic drainage. Drains should be omitted after hepatic, colonic, or rectal resection with primary anastomosis and appendectomy for any stage of appendicitis (recommendation grade A), whereas prophylactic drainage remains indicated after esophageal resection and total gastrectomy (recommendation grade D). For many other GI procedures, especially involving the upper GI tract, there is a further demand for well-designed RCTs to clarify the value of prophylactic drainage. PMID:15570212

  14. Extending the Reach of an Evidence Based Theatrical Intervention

    PubMed Central

    Noice, Helga; Noice, Tony

    2013-01-01

    Background/Study Context In Experiment 1, the authors investigated whether they could train retirement home activity directors with no previous experience in theatre to successfully execute an evidence-based four week theatre-arts intervention. In Experiment 2, they investigated whether an outside professional acting teacher who received only minimal training via email and telephone could successfully execute the same intervention heretofore only carried out by the actor/director/professor who devised it. Methods A total of 115 participants (ages 68–94) in four different retirement homes were taught theatre-arts either by their in-house activity director who had no formal training in theatre or a professional acting teacher recruited through a local community college. The intervention consisted of twice-weekly 70-minute lessons for four weeks. After random assignment to experimental or waiting-list control groups, participants were given pre- and post-tests on both functional and cognitive measures. Results Experiment 1 showed that activity directors were able to run this intervention and achieve significant results on the 28-item functional measure (OTDL-R) as measured by a mixed design ANOVA and paired sample t-tests (p<.001), and on one cognitive measure, Means—End Problem Solving (MEPS), as measured by a MANCOVA and follow-up univariate ANOVAs. Experiment 2 (outside acting teacher) used the identical measures and revealed significant results on the OTDL-R (p = .002), Word Recall, MEPS, and Verbal Fluency (ηp2 ranging from .28 to .59). Conclusions This study addressed the feasibility of training multiple instructors of varying experience to administer this theatre arts intervention. Previous iterations had all been administered by the professional actor/director/theatre-professor who devised the program. These current results demonstrate that widespread administration of this short-term (four-week) evidence-based intervention is feasible. PMID:23875838

  15. Using a Novel Lysin To Help Control Clostridium difficile Infections.

    PubMed

    Wang, Qiong; Euler, Chad W; Delaune, Aurelia; Fischetti, Vincent A

    2015-12-01

    As a consequence of excessive antibiotic therapies in hospitalized patients, Clostridium difficile, a Gram-positive anaerobic spore-forming intestinal pathogen, is the leading cause of hospital-acquired diarrhea and colitis. Drug treatments for these diseases are often complicated by antibiotic-resistant strains and a high frequency of treatment failures and relapse; therefore, novel nonantibiotic approaches may prove to be more effective. In this study, we recombinantly expressed a prophage lysin identified from a C. difficile strain, CD630, which we named PlyCD. PlyCD was found to have lytic activity against specific C. difficile strains. However, the recombinantly expressed catalytic domain of this protein, PlyCD1-174, displayed significantly greater lytic activity (>4-log kill) and a broader lytic spectrum against C. difficile strains while still retaining a high degree of specificity toward C. difficile versus commensal clostridia and other bacterial species. Our data also indicated that noneffective doses of vancomycin and PlyCD1-174 when combined in vitro could be significantly more bactericidal against C. difficile. In an ex vivo treatment model of mouse colon infection, we found that PlyCD1-174 functioned in the presence of intestinal contents, significantly decreasing colonizing C. difficile compared to controls. Together, these data suggest that PlyCD1-174 has potential as a novel therapeutic for clinical application against C. difficile infection, either alone or in combination with other preexisting treatments to improve their efficacy. PMID:26392484

  16. 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...

  17. 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…

  18. Evidence-Based Practice in Education. Conducting Educational Research

    ERIC Educational Resources Information Center

    Pring, Richard; Thomas, Gary

    2004-01-01

    The book begins with an explication of evidence-based practice. Some of the ideas of its proponents are discussed, including the Campbell Collaboration, and the application to education of Cochrane-style reviews and meta-analyses. The thinking behind evidence-based practice has been the subject of much criticism, particularly in education, and

  19. Evidence-Based Assessment of Anxiety Disorders in Adults

    ERIC Educational Resources Information Center

    Antony, Martin M.; Rowa, Karen

    2005-01-01

    This article discusses issues related to the development and dissemination of evidence-based assessment strategies for anxiety disorders and associated problems. It begins with a review of the criteria that should be considered when determining whether particular assessment procedures are evidence-based. These include such factors as reliability,

  20. Evidence-Based Reform in Education: What Will It Take?

    ERIC Educational Resources Information Center

    Slavin, Robert E.

    2008-01-01

    If education is to make significant progress in the twenty-first century, it must embrace evidence-based reforms. Perhaps the most important requirement for evidence-based reform is the development of a substantial set of replicable programs and practices with strong evidence of effectiveness. Educators and policy makers must have a variety of…

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

    ERIC Educational Resources Information Center

    Tuchman, Ellen; Lalane, Monique

    2011-01-01

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

  2. 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

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

    PubMed Central

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

    2012-01-01

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

  4. 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…

  5. 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

  6. 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

  7. 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

  8. 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

  9. 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

  10. Toxocara Infection in Psychiatric Inpatients: A Case Control Seroprevalence Study

    PubMed Central

    Alvarado-Esquivel, Cosme

    2013-01-01

    Background There is poor knowledge about the epidemiology of toxocariasis in psychiatric patients. Aims Determine the seroepidemiology of Toxocara infection in psychiatric patients. Methods Through a case-control seroprevalence study, 128 psychiatric inpatients and 276 control subjects were compared for the presence of anti-Toxocara IgG antibodies in Durango, Mexico. Socio-demographic, clinical, and behavioral characteristics of inpatients associated with toxocariasis were also investigated. Results Six of the 128 (4.7%) psychiatric inpatients, and 3 (1.1%) of the 276 controls were positive for anti-Toxocara IgG antibodies (P = 0.03). Stratification by age showed that Toxocara seroprevalence was significantly (P = 0.02) higher in patients aged ≤50 years old (6/90∶6.7%) than controls of the same age (2/163∶1.2%). While Toxocara seroprevalence was similar in patients and controls aged >50 years old. Stratification by gender showed that Toxocara seroprevalence was significantly (P = 0.03) higher in female patients (2/37∶5.4%) than in female controls (0/166∶0%). No statistically significant associations between Toxocara seropositivity and clinical characteristics were found. In contrast, Toxocara seropositivity was associated with consumption of goat meat and raw sea snail. Conclusions This is the first report of toxocariasis in psychiatric inpatients in Mexico. Further studies with larger sample sizes are needed to elucidate the association of toxocariasis with psychiatric diseases. The role of the consumption of goat meat and raw sea snail in the transmission of Toxocara deserve further investigation. PMID:23626838

  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. [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

  13. Airborne infection control in India: Baseline assessment of health facilities

    PubMed Central

    Parmar, Malik M.; Sachdeva, K.S.; Rade, Kiran; Ghedia, Mayank; Bansal, Avi; Nagaraja, Sharath Burugina; Willis, Matthew D.; Misquitta, Dyson P.; Nair, Sreenivas A.; Moonan, Patrick K.; Dewan, Puneet K.

    2016-01-01

    Background Tuberculosis transmission in health care settings represents a major public health problem. In 2010, national airborne infection control (AIC) guidelines were adopted in India. These guidelines included specific policies for TB prevention and control in health care settings. However, the feasibility and effectiveness of these guidelines have not been assessed in routine practice. This study aimed to conduct baseline assessments of AIC policies and practices within a convenience sample of 35 health care settings across 3 states in India and to assess the level of implementation at each facility after one year. Method A multi-agency, multidisciplinary panel of experts performed site visits using a standardized risk assessment tool to document current practices and review resource capacity. At the conclusion of each assessment, facility-specific recommendations were provided to improve AIC performance to align with national guidelines. Result Upon initial assessment, AIC systems were found to be poorly developed and implemented. Administrative controls were not commonly practiced and many departments needed renovation to achieve minimum environmental standards. One year after the baseline assessments, there were substantial improvements in both policy and practice. Conclusion A package of capacity building and systems development that followed national guidelines substantially improved implementation of AIC policies and practice. PMID:26970461

  14. Measuring the quality of infection control in Dutch nursing homes using a standardized method; the Infection prevention RIsk Scan (IRIS)

    PubMed Central

    2014-01-01

    Background We developed a standardised method to assess the quality of infection control in Dutch Nursing Home (NH), based on a cross-sectional survey that visualises the results. The method was called the Infection control RIsk Infection Scan (IRIS). We tested the applicability of this new tool in a multicentre surveillance executed June and July 2012. Methods The IRIS includes two patient outcome-variables, i.e. the prevalence of healthcare associated infections (HAI) and rectal carriage of Extended-Spectrum Beta-Lactamase (ESBL) producing Enterobacteriaceae (ESBL-E); two patient-related risk factors, i.e. use of medical devices, and antimicrobial therapy; and three ward-related risk factors, i.e. environmental contamination, availability of local guidelines, and shortcomings in infection prevention preconditions. Results were categorised as low-, intermediate- and high risk, presented in an easy-to-read graphic risk spider-plot. This plot was given as feedback to management and healthcare workers of the NH. Results Large differences were found among most the variables in the different NH. Common shortcomings were the availability of infection control guidelines and the level of environmental cleaning. Most striking differences were observed in the prevalence of ESBL carriage, ranged from zero to 20.6% (p?infection control situation of the participating NH. The results can be used to improve the quality of infection control based on the specific needs of a NH but needs further validation in future studies. Repeated measurement can determine the effectiveness of the interventions. This makes the IRIS a useful tool for quality systems. PMID:25243067

  15. Knowledge and Practice of Nursing Staff towards Infection Control Measures in the Palestinian Hospitals

    ERIC Educational Resources Information Center

    Fashafsheh, Imad; Ayed, Ahmad; Eqtait, Faeda; Harazneh, Lubna

    2015-01-01

    Health care professionals are constantly exposed to microorganisms. Many of which can cause serious or even lethal infections. Nurses in particular are often exposed to various infections during the course of carrying out their nursing activities. Therefore nurses should have sound knowledge and strict adherence to infection control practice. Aim…

  16. NF-kappaB and virus infection: who controls whom.

    PubMed

    Santoro, M Gabriella; Rossi, Antonio; Amici, Carla

    2003-06-01

    Among the different definitions of viruses, 'pirates of the cell' is one of the most picturesque, but also one of the most appropriate. Viruses have been known for a long time to utilize a variety of strategies to penetrate cells and, once inside, to take over the host nucleic acid and protein synthesis machinery to build up their own components and produce large amounts of viral progeny. As their genomes carry a minimal amount of information, encoding only a few structural and regulatory proteins, viruses are largely dependent on their hosts for survival; however, despite their apparent simplicity, viruses have evolved different replicative strategies that are regulated in a sophisticated manner. During the last years, the study of the elaborate relationship between viruses and their hosts has led to the understanding of how viral pathogens not only are able to alter the host metabolism via their signaling proteins, but are also able to hijack cellular signaling pathways and transcription factors, and control them to their own advantage. In particular, the nuclear factor-kappaB (NF-kappaB) pathway appears to be an attractive target for common human viral pathogens. This review summarizes what is known about the control of NF-kappaB by viruses, and discusses the possible outcome of NF-kappaB activation during viral infection, which may benefit either the host or the pathogen. PMID:12773372

  17. Evidence-based Diagnostics: Adult Septic Arthritis

    PubMed Central

    Carpenter, Christopher R.; Schuur, Jeremiah D.; Everett, Worth W.; Pines, Jesse M.

    2011-01-01

    Background Acutely swollen or painful joints are common complaints in the emergency department (ED). Septic arthritis in adults is a challenging diagnosis, but prompt differentiation of a bacterial etiology is crucial to minimize morbidity and mortality. Objectives The objective was to perform a systematic review describing the diagnostic characteristics of history, physical examination, and bedside laboratory tests for nongonococcal septic arthritis. A secondary objective was to quantify test and treatment thresholds using derived estimates of sensitivity and specificity, as well as best-evidence diagnostic and treatment risks and anticipated benefits from appropriate therapy. Methods Two electronic search engines (PUBMED and EMBASE) were used in conjunction with a selected bibliography and scientific abstract hand search. Inclusion criteria included adult trials of patients presenting with monoarticular complaints if they reported sufficient detail to reconstruct partial or complete 2 2 contingency tables for experimental diagnostic test characteristics using an acceptable criterion standard. Evidence was rated by two investigators using the Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS). When more than one similarly designed trial existed for a diagnostic test, meta-analysis was conducted using a random effects model. Interval likelihood ratios (LRs) were computed when possible. To illustrate one method to quantify theoretical points in the probability of disease whereby clinicians might cease testing altogether and either withhold treatment (test threshold) or initiate definitive therapy in lieu of further diagnostics (treatment threshold), an interactive spreadsheet was designed and sample calculations were provided based on research estimates of diagnostic accuracy, diagnostic risk, and therapeutic risk/benefits. Results The prevalence of nongonococcal septic arthritis in ED patients with a single acutely painful joint is approximately 27% (95% confidence interval [CI] = 17% to 38%). With the exception of joint surgery (positive likelihood ratio [+LR] = 6.9) or skin infection overlying a prosthetic joint (+LR = 15.0), history, physical examination, and serum tests do not significantly alter posttest probability. Serum inflammatory markers such as white blood cell (WBC) counts, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) are not useful acutely. The interval LR for synovial white blood cell (sWBC) counts of 0 10925 109/ L was 0.33; for 25 10950 109/L, 1.06; for 50 109100 109/L, 3.59; and exceeding 100 109/L, infinity. Synovial lactate may be useful to rule in or rule out the diagnosis of septic arthritis with a +LR ranging from 2.4 to infinity, and negative likelihood ratio (?LR) ranging from 0 to 0.46. Rapid polymerase chain reaction (PCR) of synovial fluid may identify the causative organism within 3 hours. Based on 56% sensitivity and 90% specificity for sWBC counts of >50 109/L in conjunction with best-evidence estimates for diagnosis-related risk and treatment-related risk/benefit, the arthrocentesis test threshold is 5%, with a treatment threshold of 39%. Conclusions Recent joint surgery or cellulitis overlying a prosthetic hip or knee were the only findings on history or physical examination that significantly alter the probability of nongonococcal septic arthritis. Extreme values of sWBC (>50 109/L) can increase, but not decrease, the probability of septic arthritis. Future ED-based diagnostic trials are needed to evaluate the role of clinical gestalt and the efficacy of nontraditional synovial markers such as lactate. PMID:21843213

  18. Evidence-based pharmacotherapy of eating disorders.

    PubMed

    Flament, Martine F; Bissada, Hany; Spettigue, Wendy

    2012-03-01

    The objective was to review scientific evidence for efficacy and safety of pharmacotherapy in adults or children with an eating disorder (ED). We conducted a computer search for all randomized controlled trials (RCTs) published between 1960 and May 2010 for treatment of anorexia nervosa (AN), bulimia nervosa (BN) or binge-eating disorder (BED). For drugs for which no RCT was found, open trials or case reports were retrieved. Clinically relevant RCTs in the treatment of AN have used atypical antipsychotics, selective serotonin reuptake inhibitors (SSRIs), and zinc supplementation. Olanzapine demonstrated an adjunctive effect for in-patient treatment of underweight AN patients, and fluoxetine helped prevent relapse in weight-restored AN patients in 1/2 studies. For treatment of BN, controlled studies have used SSRIs, other antidepressants, and mood stabilizers. In 9/11 studies, pharmacotherapy yielded a statistically significant although moderate reduction in binge/purge frequency, and some additional benefits. For BED, RCTs have been conducted using SSRIs and one serotonin norepinephrine reuptake inhibitor (SNRI), mood stabilizers, and anti-obesity medications. In 11/12 studies, there was a statistically significant albeit limited effect of medication. Meta-analyses on efficacy of pharmacotherapy for BN and BED support moderate effect sizes for medication, but generally low recovery rates. Treatment resistance is an inherent feature of AN, where treatment should focus on renourishment plus psychotherapy. For BN and BED, combined treatment with pharmacotherapy and cognitive behaviour therapy has been more effective than either alone. Data on the long-term efficacy of pharmacotherapy for EDs are scarce. Short- and long-term pharmacotherapy of EDs still remains a challenge for the clinician. PMID:21414249

  19. Evidence-based Comprehensive Approach to Forearm Arterial Laceration

    PubMed Central

    Thai, Janice N.; Pacheco, Jose A.; Margolis, David S.; Swartz, Tianyi; Massey, Brandon Z.; Guisto, John A.; Smith, Jordan L.; Sheppard, Joseph E.

    2015-01-01

    Introduction Penetrating injury to the forearm may cause an isolated radial or ulnar artery injury, or a complex injury involving other structures including veins, tendons and nerves. The management of forearm laceration with arterial injury involves both operative and nonoperative strategies. An evolution in management has emerged especially at urban trauma centers, where the multidisciplinary resource of trauma and hand subspecialties may invoke controversy pertaining to the optimal management of such injuries. The objective of this review was to provide an evidence-based, systematic, operative and nonoperative approach to the management of isolated and complex forearm lacerations. A comprehensive search of MedLine, Cochrane Library, Embase and the National Guideline Clearinghouse did not yield evidence-based management guidelines for forearm arterial laceration injury. No professional or societal consensus guidelines or best practice guidelines exist to our knowledge. Discussion The optimal methods for achieving hemostasis are by a combination approach utilizing direct digital pressure, temporary tourniquet pressure, compressive dressings followed by wound closure. While surgical hemostasis may provide an expedited route for control of hemorrhage, this aggressive approach is often not needed (with a few exceptions) to achieve hemostasis for most forearm lacerations. Conservative methods mentioned above will attain the same result. Further, routine emergent or urgent operative exploration of forearm laceration injuries are not warranted and not cost-beneficial. It has been widely accepted with ample evidence in the literature that neither injury to forearm artery, nerve or tendon requires immediate surgical repair. Attention should be directed instead to control of bleeding, and perform a complete physical examination of the hand to document the presence or absence of other associated injuries. Critical ischemia will require expeditious surgical restoration of arterial perfusion. In a well-perfused hand, however, the presence of one intact artery is adequate to sustain viability without long-term functional disability, provided the palmar arch circulation is intact. Early consultation with a hand specialist should be pursued, and follow-up arrangement made for delayed primary repair in cases of complex injury. Conclusion Management in accordance with well-established clinical principles will maximize treatment efficacy and functional outcome while minimizing the cost of medical care. PMID:26759666

  20. Efficacy of an Adapted HIV and Sexually Transmitted Infection Prevention Intervention for Incarcerated Women: A Randomized Controlled Trial

    PubMed Central

    Fogel, Catherine I.; Crandell, Jamie L.; Neevel, A. M.; Parker, Sharon D.; Carry, Monique; White, Becky L.; Fasula, Amy M.; Herbst, Jeffrey H.; Gelaude, Deborah J.

    2014-01-01

    Objectives We tested the efficacy of an adapted evidence-based HIV–sexually transmitted infection (STI) behavioral intervention (Providing Opportunities for Women′s Empowerment, Risk-Reduction, and Relationships, or POWER) among incarcerated women. Methods We conducted a randomized trial with 521 women aged 18 to 60 years in 2 correctional facilities in North Carolina in 2010 and 2011. Intervention participants attended 8 POWER sessions; control participants received a single standard-of-care STI prevention session. We followed up at 3 and 6 months after release. We examined intervention efficacy with mixed-effects models. Results POWER participants reported fewer male sexual partners than did control participants at 3 months, although this finding did not reach statistical significance; at 6 months they reported significantly less vaginal intercourse without a condom outside of a monogamous relationship and more condom use with a main male partner. POWER participants also reported significantly fewer condom barriers, and greater HIV knowledge, health-protective communication, and tangible social support. The intervention had no significant effects on incident STIs. Conclusions POWER is a behavioral intervention with potential to reduce risk of acquiring or transmitting HIV and STIs among incarcerated women returning to their communities. PMID:25211714

  1. 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-Barr 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

  2. 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

  3. Fluoxetine: a review on evidence based medicine.

    PubMed

    Rossi, Andrea; Barraco, Alessandra; Donda, Pietro

    2004-02-12

    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

  4. The WORD (Wholeness, Oneness, Righteousness, Deliverance): Design of a randomized controlled trial testing the effectiveness of an evidence-based weight loss and maintenance intervention translated for a faith-based, rural, African American population using a community-based participatory approach

    PubMed Central

    Yeary, Karen Hye-cheon Kim; Cornell, Carol E.; Prewitt, Elaine; Bursac, Zoran; Tilford, J. Mick; Turner, Jerome; Eddings, Kenya; Love, ShaRhonda; Whittington, Emily; Harris, Kimberly

    2014-01-01

    Background The positive effects of weight loss on obesity-related risk factors diminish unless weight loss is maintained. Yet little work has focused on the translation of evidence-based weight loss interventions with the aim of sustaining weight loss in underserved populations. Using a community-based participatory approach (CBPR) that engages the strong faith-based social infrastructure characteristic of rural African American communities is a promising way to sustain weight loss in African Americans, who bear a disproportionate burden of the obesity epidemic. Objectives Led by a collaborative community-academic partnership, The WORD aims to change dietary and physical activity behaviors to produce and maintain weight loss in rural, African American adults of faith. Design The WORD is a randomized controlled trial with 450 participants nested within 30 churches. All churches will receive a 16-session core weight loss intervention. Half of the churches will be randomized to receive an additional 12-session maintenance component. Methods The WORD is a cultural adaptation of the Diabetes Prevention Program, whereby small groups will be led by trained church members. Participants will be assessed at baseline, 6, 12, and 18 months. A detailed cost-effectiveness and process evaluation will be included. Summary The WORD aims to sustain weight loss in rural African Americans. The utilization of a CBPR approach and the engagement of the faith-based social infrastructure of African American communities will maximize the intervention's sustainability. Unique aspects of this trial include the focus on weight loss maintenance and the use of a faith-based CBPR approach in translating evidence-based obesity interventions. PMID:25461496

  5. Evidence-based recommendation on toothpaste use.

    PubMed

    Cury, Jaime Aparecido; Tenuta, Livia Maria Andalo

    2014-01-01

    Toothpaste can be used as a vehicle for substances to improve the oral health of individuals and populations. Therefore, it should be recommended based on the best scientific evidence available, and not on the opinion of authorities or specialists. Fluoride is the most important therapeutic substance used in toothpastes, adding to the effect of mechanical toothbrushing on dental caries control. The use of fluoride toothpaste to reduce caries in children and adults is strongly based on evidence, and is dependent on the concentration (minimum of 1000 ppm F) and frequency of fluoride toothpaste use (2'/day or higher). The risk of dental fluorosis due to toothpaste ingestion by children has been overestimated, since there is no evidence that: 1) fluoride toothpaste use should be postponed until the age of 3-4 or older, 2) low-fluoride toothpaste avoids fluorosis and 3) fluorosis has a detrimental effect on the quality of life of individuals exposed to fluoridated water and toothpaste. Among other therapeutic substances used in toothpastes, there is evidence that triclosan/copolymer reduce dental biofilm, gingivitis, periodontitis, calculus and halitosis, and that toothpastes containing stannous fluoride reduce biofilm and gingivitis. PMID:24554097

  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. Towards Evidence-Based Practice in Language Intervention for Bilingual Children

    ERIC Educational Resources Information Center

    Thordardottir, Elin

    2010-01-01

    Evidence-based practice requires that clinical decisions be based on evidence from rigorously controlled research studies. At this time, very few studies have directly examined the efficacy of clinical intervention methods for bilingual children. Clinical decisions for this population cannot, therefore, be based on the strongest forms of research

  9. 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…

  10. [Building an evidence-based practice culture: incorporating evidence-based nursing in the clinical ladder system].

    PubMed

    Kuo, Hsueh-Ming; Lin, Chen-Hsiu; Lee, Hsiu-Hsien; Chang, Mei-Jen; Fan, Sheng-Hsin; Chang, Ying-Ju

    2011-04-01

    Evidence-based practice has become a dominant trend in the healthcare with the objective of providing efficient, high quality health care, and policy making. Traditional problem-solving methods may not adequately address consumer needs in the rapidly changing modern healthcare system. In order to make correct decisions, a systematic and scientific approach to the collection, assessment, and interpretation of clinical information is essential for the health care provider. Creating an evidence-based practice nursing culture is the most fundamental way for nurses to recognize the importance of evidence-based nursing and, subsequently, adapt to solving clinical problems. This paper elaborates the strategy for incorporating evidence-based nursing into the clinical ladder system used at the authors' affiliated medical center. Three strategies are introduced. These are: (1) including the EBN concept in newcomer in-service training; (2) adopting evidence-based nursing practice competence as a criterion in the clinical ladder system, with various evidence-based, ladder-related reports required for promotion; and (3) providing support to nurses through centralized and decentralized education as well as individual consultation. The proposed strategy is provided as a practical reference for educators and policy makers working to foster evidence-based practice nursing cultures. PMID:21455895

  11. An evidence-based assessment of prescribed grazing practices

    Technology Transfer Automated Retrieval System (TEKTRAN)

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

  12. Evidence-based medicine in health care reform.

    PubMed

    Hughes, Gordon B

    2011-10-01

    The Patient Protection and Affordable Care Act of 2010 mandates a national comparative outcomes research project agenda. Comparative effectiveness research includes both clinical trials and observational studies and is facilitated by electronic health records. A national network of electronic health records will create a vast electronic data "warehouse" with exponential growth of observational data. High-quality associations will identify research topics for pragmatic clinical trials, and systematic reviews of clinical trials will provide optimal evidence-based medicine. Evidence-based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. Thus, health care reform will provide a robust environment for comparative effectiveness research, systematic reviews, and evidence-based medicine, and implementation of evidence-based medicine should lead to improved quality of care. PMID:21860057

  13. Evidence-based research and practice in clinical neuropsychology.

    PubMed

    Chelune, Gordon J

    2010-04-01

    While a definition for evidence-based clinical neuropsychological practice (EBCNP) has yet to emerge, it is likely to integrate the same core features as evidence-based medicine; namely, best research evidence, clinical expertise, and individual patient needs. Given the nascent stage of EBCNP, suggestions are made to advance evidence-based approaches in both research and practice. The common elements are: recognition that clinical outcomes are recorded at the level of the individual; and to be useful, outcomes research must be presented in a way that can be directly applied on a case-by-case basis. Tracking the outcomes of our clinical services in an evidence-based manner that is publicly verifiable will demonstrate the value of neuropsychological services to our patients, our referral sources, and ultimately to payers. PMID:18821179

  14. 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)

  15. Evidence-Based Appraisal of Antireflux Fundoplication

    PubMed Central

    Catarci, Marco; Gentileschi, Paolo; Papi, Claudio; Carrara, Alessandro; Marrese, Renato; Gaspari, Achille Lucio; Grassi, Giovanni Battista

    2004-01-01

    Objective: To highlight the current available evidence in antireflux surgery through a systematic review of randomized controlled trials (RCTs). Summary Background Data: Laparoscopic fundoplication is currently suggested as the gold standard for the surgical treatment of gastroesophageal reflux disease, but many controversies are still open concerning the influence of some technical details on its results. Methods: Papers related to RCTs identified via a systematic literature search were evaluated according to standard criteria. Data regarding the patient sample, study methods, and outcomes were abstracted and summarized across studies. Defined outcomes were examined for 41 papers published from 1974 to 2002 related to 25 RCTs. A meta-analysis was performed pooling the results as odds ratios (OR), rate differences (RD), and number needed to treat (NNT). Data given as mean and/or median values were pooled as a mean SD (SD). Results: No perioperative deaths were found in any of the RCTs. Immediate results showed a significantly lower operative morbidity rate (10.3% versus 26.7%, OR 0.33, RD ?12%, NNT 8), shorter postoperative stay (3.1 versus 5.2 days, P = 0.03), and shorter sick leave (20.1 versus 35.8 days, P = 0.03) for laparoscopic versus open fundoplication. No significant differences were found regarding the incidence of recurrence, dysphagia, bloating, and reoperation for failure at midterm follow-up. No significant differences in operative morbidity (13.1% versus 9.4%) and in operative time (90.2 versus 84.2 minutes) were found in partial versus total fundoplication. A significantly lower incidence of reoperation for failure (1.6% versus 9.6%, OR 0.21, RD ?7%, NNT 14) was found after partial fundoplication, with no significant differences regarding the incidence of recurrence and/or dysphagia. Routine division of short gastric vessels during total fundoplication showed no significant advantages regarding the incidence of postoperative dysphagia and recurrence when compared with no division. The use of ultrasonic scalpel compared with clips or bipolar cautery for the division of short gastric vessels showed no significant effect on operative time, postoperative complications, and costs. Conclusions: Laparoscopic antireflux surgery is at least as safe and as effective as its open counterpart, with reduced morbidity, shortened postoperative stay, and sick leave. Partial fundoplication significantly reduces the risk of reoperations for failure over total fundoplication. Routine versus no division of short gastric vessels showed no significant advantages. A word of caution is needed when implementing these results derived from RCTs performed in specialized centers into everyday clinical practice, where experience and skills may be suboptimal. PMID:15075649

  16. Clarification and Elaboration on Evidence-Based Practice in Psychology

    ERIC Educational Resources Information Center

    Wampold, Bruce E.; Goodheart, Carol D.; Levant, Ronald F.

    2007-01-01

    Responds to comments by D. C. Wendt and B. D. Slife (see record 2007-13085-019), P. H. Hunsberger (see record 2007-13085-020), and R. B. Stuart and S. O. Lilienfeld (see record 2007-13085-021) regarding the report by the APA Presidential Task Force on Evidence-Based Practice (see record 2006-05893-001) entitled Evidence-based practice in…

  17. Clarification and Elaboration on Evidence-Based Practice in Psychology

    ERIC Educational Resources Information Center

    Wampold, Bruce E.; Goodheart, Carol D.; Levant, Ronald F.

    2007-01-01

    Responds to comments by D. C. Wendt and B. D. Slife (see record 2007-13085-019), P. H. Hunsberger (see record 2007-13085-020), and R. B. Stuart and S. O. Lilienfeld (see record 2007-13085-021) regarding the report by the APA Presidential Task Force on Evidence-Based Practice (see record 2006-05893-001) entitled Evidence-based practice in

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

    PubMed

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

    2011-01-01

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

  19. 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

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

    PubMed

    Mihalic, Sharon F; Elliott, Delbert S

    2015-02-01

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

  1. Specialized Community-Based Care: An Evidence-Based Analysis

    PubMed Central

    2012-01-01

    Background Specialized community-based care (SCBC) refers to services that manage chronic illness through formalized links between primary and specialized care. Objectives The objectives of this evidence-based analysis (EBA) were as follows: to summarize the literature on SCBC, also known as intermediate care to synthesize the evidence from previous Medical Advisory Secretariat (now Health Quality Ontario) EBAs on SCBC for heart failure, diabetes, chronic obstructive pulmonary disease (COPD), and chronic wounds to examine the role of SCBC in family practice Results Part 1: Systematic Review of Intermediate Care Seven systematic reviews on intermediate care since 2008 were identified. The literature base is complex and difficult to define. There is evidence to suggest that intermediate care is effective in improving outcomes; however, the effective interventions are still uncertain. Part 2: Synthesis of Evidence in Intermediate Care Mortality Heart failure Significant reduction in patients receiving SCBC COPD Nonsignificant reduction in patients receiving SCBC Hospitalization Heart failure Nonsignificant reduction in patients receiving SCBC COPD Significant reduction in patients receiving SCBC Emergency Department Visits Heart failure Nonsignificant reduction in patients receiving SCBC COPD Significant reduction in patients receiving SCBC Disease-Specific Patient Outcomes COPD Nonsignificant improvement in lung function in patients receiving SCBC Diabetes Significant reduction in hemoglobin A1c (HbA1c) and systolic blood pressure in patients receiving SCBC Chronic wounds Significant increase in the proportion of healed wounds in patients receiving SCBC Quality of Life Heart failure Trend toward improvement in patients receiving SCBC COPD Significant improvement in patients receiving SCBC Part 3: Intermediate Care in Family PracticeEvidence-Based Analysis Five randomized controlled trials were identified comparing SCBC to usual care in family practice. Inclusion criteria were 1) the presence of multiple chronic conditions, and 2) interventions that included 2 or more health care professions. The GRADE quality of the evidence was assessed as low for all outcomes due to the inconsistency and indirectness of the results. Limitations This review did not look at disease-specific studies on intermediate care in family practice. Conclusions Specialized community-based care effectively improves outcomes in patients with heart failure, COPD, and diabetes. The effectiveness of SCBC in family practice is unclear. PMID:23226812

  2. Overcoming the obstacles of implementing infection prevention and control guidelines.

    PubMed

    Birgand, G; Johansson, A; Szilagyi, E; Lucet, J-C

    2015-12-01

    Reasons for a successful or unsuccessful implementation of infection prevention and control (IPC) guidelines are often multiple and interconnected. This article reviews key elements from the national to the individual level that contribute to the success of the implementation of IPC measures and gives perspectives for improvement. Governance approaches, modes of communication and formats of guidelines are discussed with a view to improve collaboration and transparency among actors. The culture of IPC influences practices and varies according to countries, specialties and healthcare providers. We describe important contextual aspects, such as relationships between actors and resources and behavioural features including professional background or experience. Behaviour change techniques providing goal-setting, feedback and action planning have proved effective in mobilizing participants and may be key to trigger social movements of implementation. The leadership of international societies in coordinating actions at international, national and institutional levels using multidisciplinary approaches and fostering collaboration among clinical microbiology, infectious diseases and IPC will be essential for success. PMID:26369604

  3. Spatial Targeting for Bovine Tuberculosis Control: Can the Locations of Infected Cattle Be Used to Find Infected Badgers?

    PubMed Central

    Smith, Catherine M.; Downs, Sara H.; Mitchell, Andy; Hayward, Andrew C.; Fry, Hannah; Le Comber, Steven C.

    2015-01-01

    Bovine tuberculosis is a disease of historical importance to human health in the UK that remains a major animal health and economic issue. Control of the disease in cattle is complicated by the presence of a reservoir species, the Eurasian badger. In spite of uncertainty in the degree to which cattle disease results from transmission from badgers, and opposition from environmental groups, culling of badgers has been licenced in two large areas in England. Methods to limit culls to smaller areas that target badgers infected with TB whilst minimising the number of uninfected badgers culled is therefore of considerable interest. Here, we use historical data from a large-scale field trial of badger culling to assess two alternative hypothetical methods of targeting TB-infected badgers based on the distribution of cattle TB incidents: (i) a simple circular ‘ring cull’; and (ii) geographic profiling, a novel technique for spatial targeting of infectious disease control that predicts the locations of sources of infection based on the distribution of linked cases. Our results showed that both methods required coverage of very large areas to ensure a substantial proportion of infected badgers were removed, and would result in many uninfected badgers being culled. Geographic profiling, which accounts for clustering of infections in badger and cattle populations, produced a small but non-significant increase in the proportion of setts with TB-infected compared to uninfected badgers included in a cull. It also provided no overall improvement at targeting setts with infected badgers compared to the ring cull. Cattle TB incidents in this study were therefore insufficiently clustered around TB-infected badger setts to design an efficient spatially targeted cull; and this analysis provided no evidence to support a move towards spatially targeted badger culling policies for bovine TB control. PMID:26565626

  4. Spatial Targeting for Bovine Tuberculosis Control: Can the Locations of Infected Cattle Be Used to Find Infected Badgers?

    PubMed

    Smith, Catherine M; Downs, Sara H; Mitchell, Andy; Hayward, Andrew C; Fry, Hannah; Le Comber, Steven C

    2015-01-01

    Bovine tuberculosis is a disease of historical importance to human health in the UK that remains a major animal health and economic issue. Control of the disease in cattle is complicated by the presence of a reservoir species, the Eurasian badger. In spite of uncertainty in the degree to which cattle disease results from transmission from badgers, and opposition from environmental groups, culling of badgers has been licenced in two large areas in England. Methods to limit culls to smaller areas that target badgers infected with TB whilst minimising the number of uninfected badgers culled is therefore of considerable interest. Here, we use historical data from a large-scale field trial of badger culling to assess two alternative hypothetical methods of targeting TB-infected badgers based on the distribution of cattle TB incidents: (i) a simple circular 'ring cull'; and (ii) geographic profiling, a novel technique for spatial targeting of infectious disease control that predicts the locations of sources of infection based on the distribution of linked cases. Our results showed that both methods required coverage of very large areas to ensure a substantial proportion of infected badgers were removed, and would result in many uninfected badgers being culled. Geographic profiling, which accounts for clustering of infections in badger and cattle populations, produced a small but non-significant increase in the proportion of setts with TB-infected compared to uninfected badgers included in a cull. It also provided no overall improvement at targeting setts with infected badgers compared to the ring cull. Cattle TB incidents in this study were therefore insufficiently clustered around TB-infected badger setts to design an efficient spatially targeted cull; and this analysis provided no evidence to support a move towards spatially targeted badger culling policies for bovine TB control. PMID:26565626

  5. Evidence-based medicine: an overview of key concepts.

    PubMed

    Carter, Marissa J

    2010-04-01

    Since Sackett et al established the defining principles almost 20 years ago, the concept evidence-based medicine (EBM) has grown and is reflected in the current US healthcare reform debate. To determine the relevancy of EBM elements to wound care, a review of the literature was conducted using several electronic databases. English-language literature was searched for articles published between 1985 and 2009 with regard to EBM principles, study design, systematic reviews, meta-analysis, safety, and clinical practice guidelines to find insightful and balanced studies and commentary. Current literature shows general agreement on the hierarchy of clinical trial design and the value of systematic reviews and meta-analysis but a divergence of opinions about optimal EBM rating schemes remains. Randomized controlled trials will continue to be the gold standard of trial design to evaluate treatment efficacy, but they often are poorly executed. The value of comparative observational trials is frequently underrated and although systematic reviews and meta-analysis are valuable for summarizing the evidence, care needs to be taken to avoid pitfalls. Research also suggests that clinical practice guideline implementation studies are needed if their content is to be fully appreciated by practicing clinicians. Thus, while EBM has advanced considerably in the last 20 years, tradition-based care is still evident in wound care. The challenge is to ensure EBM continues to integrate individual clinical expertise with the best available external clinical evidence from high quality research. PMID:20424294

  6. Disruptive Innovations for Designing and Diffusing Evidence-based Interventions

    PubMed Central

    Rotheram-Borus, Mary Jane; Swendeman, Dallas; Chorpita, Bruce F.

    2013-01-01

    The numbers of evidence-based interventions (EBIs) have been growing exponentially, both therapeutic and prevention programs. Yet, EBIs have not been broadly adopted in the United States. In order for our EBI science to significantly reduce disease burden, we need to critically re-examine our scientific conventions and norms. Innovation may be spurred by re-examining the biomedical model for validating EBIs and the compartmentalization of EBIs as disease-specific, institutionally-based, counseling programs. The model of Disruptive Innovations suggests that we re-engineer EBIs based on their most robust features in order to reach more people in less time and at lower cost. Four new research agendas will be required to support disruptive innovations in EBI science: synthesize common elements across EBIs; experiment with new delivery formats (e.g., consumer controlled, self-directed, brief, paraprofessional, coaching, and technology and media strategies); adopt market strategies to promote and diffuse EBI science, knowledge, and products; and adopt continuous quality improvement as a research paradigm for systematically improving EBIs, based on ongoing data and feedback. EBI science can have more impact if it can better leverage what we know from existing EBIs in order to inspire, engage, inform, and support families and children to adopt and sustain healthy daily routines and lifestyles. PMID:22545596

  7. A Survey of Infection Prevention and Control Practices among Hematopoietic Stem Cell Transplant Centers.

    PubMed

    Beam, Elena; Keating, Michael R; Razonable, Raymund R

    2016-03-01

    This survey of the American Society of Transplantation Infectious Disease Community of Practice demonstrates variations in clinical practices among hematopoietic stem cell transplant centers on selected infection prevention and control practices. Our findings highlight a need and emphasize an opportunity to optimize patient care through standardization of practices in this vulnerable population. Infect. Control Hosp. Epidemiol. 2016;37(3):348-351. PMID:26639213

  8. Prevention of infections in nursing homes: antibiotic prophylaxis versus infection control and antimicrobial stewardship measures.

    PubMed

    Giannella, Maddalena; Tedeschi, Sara; Bartoletti, Michele; Viale, Pierluigi

    2016-02-01

    Because of the lack of structural and human resources for implementing more effective and safe preventive procedures, antimicrobial prophylaxis is often used to prevent infections in nursing homes. However, if data on the efficacy of antibiotic prophylaxis in nursing homes are null, there is a plenty of evidence that the inappropriate use of antimicrobials in this setting is associated with a high rate of colonization and infection with multi-drug-resistant organisms (MDROs), and of Clostridium difficile infection (CDI). Here, we have reviewed the infection epidemiology, the burden of MDROs and CDI, the antibiotic use and some potential infection preventive measures in nursing homes, pointing up the peculiarities of this setting and the absolute need of a more prudential use of antimicrobials. PMID:26655286

  9. Glycolytic control of vacuolar-type ATPase activity: A mechanism to regulate influenza viral infection

    SciTech Connect

    Kohio, Hinissan P.; Adamson, Amy L.

    2013-09-15

    As new influenza virus strains emerge, finding new mechanisms to control infection is imperative. In this study, we found that we could control influenza infection of mammalian cells by altering the level of glucose given to cells. Higher glucose concentrations induced a dose-specific increase in influenza infection. Linking influenza virus infection with glycolysis, we found that viral replication was significantly reduced after cells were treated with glycolytic inhibitors. Addition of extracellular ATP after glycolytic inhibition restored influenza infection. We also determined that higher levels of glucose promoted the assembly of the vacuolar-type ATPase within cells, and increased vacuolar-type ATPase proton-transport activity. The increase of viral infection via high glucose levels could be reversed by inhibition of the proton pump, linking glucose metabolism, vacuolar-type ATPase activity, and influenza viral infection. Taken together, we propose that altering glucose metabolism may be a potential new approach to inhibit influenza viral infection. - Highlights: • Increased glucose levels increase Influenza A viral infection of MDCK cells. • Inhibition of the glycolytic enzyme hexokinase inhibited Influenza A viral infection. • Inhibition of hexokinase induced disassembly the V-ATPase. • Disassembly of the V-ATPase and Influenza A infection was bypassed with ATP. • The state of V-ATPase assembly correlated with Influenza A infection of cells.

  10. 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.…

  11. 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.

  12. Sustained institutional effects of an evidence-based HIV prevention intervention.

    PubMed

    Wang, Bo; Stanton, Bonita; Knowles, Valerie; Russell-Rolle, Glenda; Deveaux, Lynette; Dinaj-Koci, Veronica; Li, Xiaoming; Brathwaite, Nanika; Lunn, Sonja

    2014-06-01

    Limited data are available as to what happens in institutions involved in behavioral intervention trials after the trial has ended. Specifically, do the trainers continue to administer the behavioral intervention that had been the focus of the trial? To address this question, we examined data in grade six schools before a year-long behavioral intervention had been delivered in some schools (and a year-long control condition in others) and data obtained again 6 and 7 years later in the same two sets of schools. Data were derived from the baseline surveys of two interventions: (1) national implementation of the evidence-based Focus on Youth in the Caribbean (FOYC) intervention in 2011; and (2) the randomized, controlled trial of the FOYC intervention in 2004/2005. Cross-sectional, longitudinal comparisons and random coefficient regression analysis were conducted to evaluate long-term intervention effects. Results indicate that grade six students in 2011 from schools in which the FOYC intervention had been implemented in 2004/2005 had a higher level of HIV/AIDS knowledge, increased reproductive health skills, increased self-efficacy regarding their ability to prevent HIV infection, and greater intention to use protection if they were to have sex compared to their counterparts from schools where no such training took place. We concluded that new cohorts of students benefited from the extensive training and/or experience in teaching the FOYC curriculum received by teachers, guidance counselors and administrators in schools which had delivered the FOYC intervention as part of a randomized trial several years earlier. The findings suggest that teachers who previously were trained to deliver the FOYC intervention may continue to teach at least some portions of the curriculum to subsequent classes of students attending these schools. PMID:23584570

  13. 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

  14. An Evidence Base for Human Spaceflight Risks in Wikipedia

    NASA Technical Reports Server (NTRS)

    Kundrot, Craig; Steil, Jennifer; Lumpkins, Sarah; Pellis, Neal

    2013-01-01

    NASA's Human Research Program (HRP) is focused on understanding and mitigating thirty two risks to crew health and performance in exploration missions beyond low Earth orbit. The HRP has developed an evidence report for each of the risks. Most evidence reports are a brief review article describing the evidence related to a specified risk, written at a level appropriate for the scientifically educated, non-specialist reader. Each evidence report captured the current state of knowledge from both research and operations. Two limitations of the evidence reports have become apparent: 1) they are updated infrequently and 2) they do not take full advantage of the expertise available in other space agencies and in related fields of terrestrial research. Therefore, the HRP is experimenting with the use of Wikipedia articles as a repository for evidence. Wikipedia's accessibility to the international space flight community and researchers in related terrestrial fields creates the opportunity to generate a more timely and comprehensive evidence base. Initial Wikipedia articles were populated for seven risks using a subset of the information in the HRP-approved evidence reports: Fatigue and Sleep Loss, Treating An Ill or Injured Crew Member, Radiation Carcinogenesis, Visual Impairment and Intracranial Pressure, Renal Stone Formation, Team Cohesion, and Intervertebral Disc Damage. Since the initial articles were created, there have been additions to these Wikipedia articles, including content from sources outside the HRP, and editorial changes to the pages. We will report on the nature of the contributions made after the initial articles were created, the comprehensiveness of the resulting Wikipedia articles, and the effort required to maintain quality control of the content. The Wikipedia approach will also be compared to wiki efforts that exert more traditional editorial control of content prior to posting.

  15. Evidence-based dentistry: a model for clinical practice.

    PubMed

    Faggion, Clvis M; Tu, Yu-Kang

    2007-06-01

    Making decisions in dentistry should be based on the best evidence available. The objective of this study was to demonstrate a practical procedure and model that clinicians can use to apply the results of well-conducted studies to patient care by critically appraising the evidence with checklists and letter grade scales. To demonstrate application of this model for critically appraising the quality of research evidence, a hypothetical case involving an adult male with chronic periodontitis is used as an example. To determine the best clinical approach for this patient, a four-step, evidence-based model is demonstrated, consisting of the following: definition of a research question using the PICO format, search and selection of relevant literature, critical appraisal of identified research reports using checklists, and the application of evidence. In this model, the quality of research evidence was assessed quantitatively based on different levels of quality that are assigned letter grades of A, B, and C by evaluating the studies against the QUOROM (Quality of Reporting Meta-Analyses) and CONSORT (Consolidated Standards of Reporting Trials) checklists in a tabular format. For this hypothetical periodontics case, application of the model identified the best available evidence for clinical decision making, i.e., one randomized controlled trial and one systematic review of randomized controlled trials. Both studies showed similar answers for the research question. The use of a letter grade scale allowed an objective analysis of the quality of evidence. A checklist-driven model that assesses and applies evidence to dental practice may substantially improve dentists' decision making skill. PMID:17554100

  16. Combining Biofilm-Controlling Compounds and Antibiotics as a Promising New Way to Control Biofilm Infections

    PubMed Central

    Estrela, Andréia Bergamo; Abraham, Wolf-Rainer

    2010-01-01

    Many bacteria grow on surfaces forming biofilms. In this structure, they are well protected and often high dosages of antibiotics cannot clear infectious biofilms. The formation and stabilization of biofilms are mediated by diffusible autoinducers (e.g. N-acyl homoserine lactones, small peptides, furanosyl borate diester). Metabolites interfering with this process have been identified in plants, animals and microbes, and synthetic analogues are known. Additionally, this seems to be not the only way to control biofilms. Enzymes capable of cleaving essential components of the biofilm matrix, e.g. polysaccharides or extracellular DNA, and thus weakening the biofilm architecture have been identified. Bacteria also have mechanisms to dissolve their biofilms and return to planktonic lifestyle. Only a few compounds responsible for the signalling of these processes are known, but they may open a completely novel line of biofilm control. All these approaches lead to the destruction of the biofilm but not the killing of the pathogens. Therefore, a combination of biofilm-destroying compounds and antibiotics to handle biofilm infections is proposed. In this article, different approaches to combine biofilm-controlling compounds and antibiotics to fight biofilm infections are discussed, as well as the balance between biofilm formation and virulence.

  17. HIV, trauma, and infection control: universal precautions are universally ignored.

    PubMed

    Hammond, J S; Eckes, J M; Gomez, G A; Cunningham, D N

    1990-05-01

    The medical, legal, and ethical problems associated with routine HIV screening have led to the recommendation that all patients should be presumed to be seropositive and thus protective measures should be taken by all health care workers. This philosophy, termed "universal precautions," has been difficult to adhere to or enforce, however. Nevertheless, in some trauma population subsets, the prevalence of HIV seropositivity runs as high as 19%, and thus presents an occupational hazard to the trauma health care worker. The mainstays of universal precautions (UP) are barrier techniques against body fluid contact and protection from inadvertent needlestick. To judge compliance with a strict UP protocol, surgical residents engaged in trauma room resuscitations were observed on a random basis by trauma nurse coordinators. Previously, UP had been discussed in conferences and by memo. Over 2 months, 81 trauma rooms were observed, involving 18 house officers. Overall, there was only 16% compliance with strict UP. The most common protocol variations involved sharps technique. While glove use was nearly universal, protective eye wear, ankle and foot protection, and body protection such as gowns or aprons were commonly ignored. Even in the presence of invasive procedures such as endotracheal intubation or insertion of chest tubes, compliance was less than 40%. The reasons most commonly given by house officers for the lapse in UP were not knowing the protocol, forgetting the protocol, or not having time to implement the protocol. Even for the nine patients residents identified as suspected of being in a high-risk category, UP was strictly adhered to only once. Compliance with universal precautions is difficult to achieve under the best of circumstances. It cannot be assumed that passive informational measures can achieve this goal. Active infection control surveillance and ongoing housestaff inservice are required to minimize the risk of inadvertent injury or contamination. PMID:2342138

  18. Association for Professionals in Infection Control and Epidemiology

    MedlinePLUS

    ... of Prevention Strategist . View Issue American Journal of Infection Control—March 2016 2/29/2016 Highlights: Visitor characteristics and alcohol-based hand sanitizer dispenser locations at the hospital entrance: Effect on visitor use rates Empowering patients ...

  19. Infections

    MedlinePLUS

    ... Flu) Is it a Medical Emergency? Listeria Infections Lyme Disease MRSA Mad Cow Disease Measles Meningitis Middle Ear ... Disease Hives (Urticaria) Impetigo Infections That Pets Carry Lyme Disease Measles Molluscum Contagiosum Oral Thrush Paronychia Pityriasis Rosea ...

  20. TLR signaling controls lethal encephalitis in WNV-infected brain.

    PubMed

    Sabouri, Amir H; Marcondes, Maria Cecilia Garibaldi; Flynn, Claudia; Berger, Michael; Xiao, Nengming; Fox, Howard S; Sarvetnick, Nora E

    2014-07-29

    Toll-like receptors (TLRs) are known to be activated in Central Nervous System (CNS) viral infections and are recognized to be a critical component in innate immunity. Several reports state a role for particular TLRs in various CNS viral infections. However, excessive TLR activation was previously reported by us in correlation with a pathogenic, rather than a protective, outcome, in a model of SIV encephalitis. Here we aimed at understanding the impact of TLR-mediated pathways by evaluating the early course of pathogenesis in the total absence of TLR signaling during CNS viral infections. We utilized a mouse model of sublethal West Nile virus (WNV) infection. WNV is an emerging neurotropic flavivirus, and a significant global cause of viral encephalitis. The virus was peripherally injected into animals that simultaneously lacked two key adapter molecules of TLR signaling, MyD88 and TRIF. On day 2 pi (post infection), MyD88/Trif-/- mice showed an increased susceptibility to WNV infection, and revealed an impairment in innate immune cytokines, when compared to wild type mice (WT). By day 6 pi, there was an increase in viral burden and robust expression of inflammatory cytokines as well as higher cell infiltration into the CNS in MyD88/Trif-/-, when compared to infected WT. A drastic increase in microglia activation, astrogliosis, and inflammatory trafficking were also observed on day 6 pi in MyD88/Trif-/-. Our observations show a protective role for TLR signaling pathways in preventing lethal encephalitis at early stages of WNV infection. PMID:24928618

  1. Pathogenesis of human immunodeficiency virus infection and prospects for control.

    PubMed Central

    Ho, D. D.; Kaplan, J. C.

    1987-01-01

    In just six years after the initial description of the acquired immunodeficiency syndrome, much has been learned about the etiologic agent, the human immunodeficiency virus. The pathogenic mechanisms utilized by this virus to infect selectively and persistently T4+ lymphocytes and monocyte/macrophages, leading to immunodeficiency and neurologic dysfunction, are slowly becoming clear. Better understanding of the pathogenesis of human immunodeficiency virus infection is essential for the rational design of therapeutic and preventive strategies to combat this deadly virus. PMID:3324508

  2. Evidence-based reproductive medicine: a critical appraisal

    PubMed Central

    Dhont, M.

    2013-01-01

    Evidence-based medicine has become the golden standard of good medical practice. I analysed meta-analyses and systematic reviews, the cornerstones of evidence-based medicine, pertaining to two important problems in in vitro fertilization: failed implantation and poor ovarian response to ovarian stimulation. Numerous interventions and procedures have been tried to facilitate implantation and to enhance the ovarian response to stimulation. Notwithstanding the fact that many clinical trials have been performed, very few procedures can as yet stand the critical test of evidence-based medicine. A plea is made for co-ordination between clinicians and reviewers and co-operation between infertility centres to combine their efforts to set up sufficiently powered clinical trials to arrive at more solid evidence for a number of interventions in in vitro fertilization programmes. PMID:24753948

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

    PubMed

    Lee, Catherine M; Hunsley, John

    2015-12-01

    Evidence-based practice (EBP) requires that clinicians be guided by the best available evidence. In this article, we address the impact of science and pseudoscience on psychotherapy in psychiatric practice. We describe the key principles of evidence-based intervention. We describe pseudoscience and provide illustrative examples of popular intervention practices that have not been abandoned, despite evidence that they are not efficacious and may be harmful. We distinguish efficacy from effectiveness, and describe modular approaches to treatment. Reasons for the persistence of practices that are not evidence based are examined at both the individual and the professional system level. Finally, we offer suggestions for the promotion of EBP through clinical practice guidelines, modelling of scientific decision making, and training in core skills. PMID:26720821

  4. Implementing Evidence-Based Practices: Considerations for the Hospice Setting

    PubMed Central

    Sanders, Sara; Mackin, Melissa Lehan; Reyes, Jimmy; Herr, Keela; Titler, Marita; Fine, Perry; Forcucci, Chris

    2015-01-01

    With tighter regulations and greater scrutiny of outcomes, hospice programs are being challenged to consider the implementation of Evidence-Based Practices (EBPs). This study reports the findings from interviews conducted with hospice directors and focus groups with the staff at eight experimental site hospice programs that occurred following the completion of a multifaceted translating research into practice (TRIP) intervention designed to promote the adoption of evidence-based pain management interventions. The purpose of this paper is to provide a background in the use of EBPs, to report the facilitators and barriers to overall implementation of evidence-based pain practices in the hospice setting, and to provide recommendations for hospices interested in improving use of EBPs in this setting. It was determined that hospice programs need to evaluate three main factors prior to the start of an EBP initiative: Community culture, Agency culture, and Staff culture. Recommendations for implementation of EBPs in hospice organizations are provided. PMID:20167834

  5. 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.

  6. Compliance with infection control practices in sputum microscopy centres: a study from Kerala, India

    PubMed Central

    Ubaid, N. P.; Nagaraja, S. B.; Shewade, H. D.; Padmanabhan, K. V.; Naik, B. R.; Satpati, M.; Blesson, S.; Jayasree, A. K.

    2015-01-01

    Background: One of the strategies of the Revised National Tuberculosis Control Programme in India to achieve tuberculosis control is by increasing case detection through a nationwide network of designated microscopy centres (DMC). Practice of standard precautions for infection control in these DMCs is very important to prevent transmission of infection not only to the laboratory personnel, but also to the general population. However, in India this has not been evaluated by an external agency. Method: A cross-sectional study was carried out to assess knowledge, facilities and compliance regarding infection control practices (ICP) in all 38 DMCs in Kannur district, Kerala, India, in 2015. Using observations and interviews, the investigators collected data in a structured format. Results: Overall knowledge about infection control was found to be satisfactory among 29% of laboratory technicians. Overall facilities for infection control were satisfactory in 61% of the DMCs, while adherence to ICP was satisfactory in 45% of the DMCs. Knowledge regarding ICP was better in government DMCs, whereas facilities for ICP and adherence to biomedical waste management guidelines were better in private DMCs. Conclusion: Given the higher risk of infection among laboratory technicians, there is an urgent need to address the shortcomings in infection control practices. PMID:26767180

  7. Towards evidence-based health administration education: the tasks ahead.

    PubMed

    Griffith, J R

    2000-01-01

    The vision of a more objective, patient-oriented and quantitative evaluation of medicine motivates much current activity in health care, and has come to be called "evidence-based" medicine (Atkins, Kamerow and Eisenberg 1998). A similar vision underlies this special issue. It derives from the 1998 AUPHA annual meeting theme of teaching management technology and the work of an AUPHA task force. The task force is seeking support for a collaborative program to develop measures of educational outcomes and use them in the systematic improvement of member programs (Stephen F. Loebs, PhD, Chair. Members include Ray Davis, PhD; Jeptha W. Dalston, PhD; Gary Filerman, PhD; Barry Greene, PhD; the author; and Douglas Wakefield, PhD.) The task force calls this effort "evidence-based health administration education." It intends a systematic, outcomes-oriented, evaluation and improvement of the educational process, as the evidence-based medicine movement does of medical care. Evolution of member programs using measured performance and continuous improvement is implied, rather than dramatic change (Griffith 1998). Just as evidence-based medicine relies on a disease-oriented taxonomy, evidence-based education must rely on an agreed-upon set of specific skills, knowledge, and abilities (SKAs) that can be learned by students and tested in graduates. This paper discusses what lessons can be learned from the papers reported in the issue, identifies the components necessary to implement the vision, and suggests how AUPHA can proceed in the near future to implement evidence-based education. PMID:11183261

  8. Criteria for evidence-based practice in Iranian traditional medicine.

    PubMed

    Soltani Arabshahi, SeyyedKamran; Mohammadi Kenari, Hoorieh; Kordafshari, Gholamreza; Shams-Ardakani, MohammadReza; Bigdeli, Shoaleh

    2015-07-01

    The major difference between Iranian traditional medicine and allopathic medicine is in the application of evidence and documents. In this study, criteria for evidence-based practice in Iranian traditional medicine and its rules of practice were studied. The experts' views were investigated through in- depth, semi-structured interviews and the results were categorized into four main categories including Designing clinical questions/clinical question-based search, critical appraisal, resource search criteria and clinical prescription appraisal. Although the application of evidence in Iranian traditional medicine follows Evidence Based Medicine (EBM) principles but it benefits from its own rules, regulations, and criteria that are compatible with EBM. PMID:26520629

  9. 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

  10. Accreditation and certification for evidence-based design.

    PubMed

    Stichler, Jaynelle F

    2010-04-01

    The Evidence-Based Design Accreditation and Certification (EDAC) is a professional certification that validates that individuals have a core body of knowledge and experience necessary to lead and engage in an evidence-based design process for healthcare facilities. This bimonthly department expands nurse leaders' knowledge and competencies in health facility design and enables them to lead in design efforts. In this article, the vision and mission of EDAC and specific content are shared to increase nurse leaders' awareness of the certification when interviewing prospective architectural firms or for nurse leaders who aspire to have a career in the healthcare design field. PMID:20305460

  11. 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

  12. A constructive Indian country response to the evidence-based program mandate.

    PubMed

    Walker, R Dale; Bigelow, Douglas A

    2011-01-01

    Over the last 20 years governmental mandates for preferentially funding evidence-based "model" practices and programs has become doctrine in some legislative bodies, federal agencies, and state agencies. It was assumed that what works in small sample, controlled settings would work in all community settings, substantially improving safety, effectiveness, and value-for-money. The evidence-based "model" programs mandate has imposed immutable "core components," fidelity testing, alien programming and program developers, loss of familiar programs, and resource capacity requirements upon tribes, while infringing upon their tribal sovereignty and consultation rights. Tribal response in one state (Oregon) went through three phases: shock and rejection; proposing an alternative approach using criteria of cultural appropriateness, aspiring to evaluability; and adopting logic modeling. The state heard and accepted the argument that the tribal way of knowing is different and valid. Currently, a state-authorized tribal logic model and a review panel process are used to approve tribal best practices for state funding. This constructive response to the evidence-based program mandate elevates tribal practices in the funding and regulatory world, facilitates continuing quality improvement and evaluation, while ensuring that practices and programs remain based on local community context and culture. This article provides details of a model that could well serve tribes facing evidence-based model program mandates throughout the country. PMID:22400457

  13. Airway epithelial control of Pseudomonas aeruginosa infection in cystic fibrosis

    PubMed Central

    Campόdonico, Victoria L; Gadjeva, Mihaela; Paradis-Bleau, Catherine; Uluer, Ahmet; Pier, Gerald B

    2013-01-01

    Defective expression or function of the cystic fibrosis transmembrane conductance regulator (CFTR) underlies the hypersusceptibility of cystic fibrosis (CF) patients to chronic airway infections, particularly with Pseudomonas aeruginosa. CFTR is involved in the specific recognition of P. aeruginosa, thereby contributing to effective innate immunity and proper hydration of the airway surface layer (ASL). In CF, the airway epithelium fails to initiate an appropriate innate immune response, allowing the microbe to bind to mucus plugs that are then not properly cleared because of the dehydrated ASL. Recent studies have identified numerous CFTR-dependent factors that are recruited to the epithelial plasma membrane in response to infection and that are needed for bacterial clearance, a process that is defective in CF patients hypersusceptible to infection with this organism. PMID:18262467

  14. 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

  15. Evidence-based medicine and hospital reform: Tracing origins back to Florence Nightingale

    PubMed Central

    Aravind, Maya; Chung, Kevin C.

    2015-01-01

    The use of reliable evidence to evaluate health care interventions has gained strong support within the medical community and in the field of plastic surgery in particular. Evidence-based medicine aims to improve health care and reduce costs through the use of sound clinical evidence in evaluating treatments, procedures and outcomes. The field is hardly new, however, and most trace its origins back to the work of Cochrane in the 1970s and Sackett in the 1990s. Though she wouldn’t know it, Florence Nightingale was applying the concepts of evidence-based reform to the medical profession more than a century before. She used medical statistics to reveal the nature of infection in hospitals and on the battlefield. Moreover, Nightingale marshaled data and evidence to establish guidelines for health care reform. Tracing the origins of evidence-based medicine back to Nightingale underscores how critical this movement is to improving the quality and effectiveness of patient care today. PMID:19910854

  16. Selecting antagonists for control of postharvest brown rot of stone fruits originating from latent infections

    Technology Transfer Automated Retrieval System (TEKTRAN)

    In contrast to biological control of postharvest decays (BCPD) of fruits originating from wound infections after harvest, BCPD originating from latent infections occurring in the orchard has not been developed. This is largely due to the lack of methodology to screen and evaluate microbes for bioco...

  17. Current issues in endoscope reprocessing and infection control during gastrointestinal endoscopy

    PubMed Central

    Nelson, Douglas B; Muscarella, Lawrence F

    2006-01-01

    The purpose of this article is to review the evidence regarding transmission of infection during gastrointestinal endoscopy, factors important in endoscope reprocessing and infection control, areas to focus on to improve compliance, and recent developments and advances in the field. PMID:16810740

  18. 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

  19. Pathogenic bacterial species associated with endodontic infection evade innate immune control by disabling neutrophils.

    PubMed

    Matsui, Aritsune; Jin, Jun-O; Johnston, Christopher D; Yamazaki, Hajime; Houri-Haddad, Yael; Rittling, Susan R

    2014-10-01

    Endodontic infections, in which oral bacteria access the tooth pulp chamber, are common and do not resolve once established. To investigate the effects of these infections on the innate immune response, we established a mouse subcutaneous chamber model, where a mixture of four oral pathogens commonly associated with these infections (endodontic pathogens [EP]), i.e., Fusobacterium nucleatum, Streptococcus intermedius, Parvimonas micra, and Prevotella intermedia, was inoculated into subcutaneously implanted titanium chambers. Cells that infiltrated the chamber after these infections were primarily neutrophils; however, these neutrophils were unable to control the infection. Infection with a nonpathogenic oral bacterial species, Streptococcus mitis, resulted in well-controlled infection, with bacterial numbers reduced by 4 to 5 log units after 7 days. Propidium iodide (PI) staining of the chamber neutrophils identified three distinct populations: neutrophils from EP-infected chambers were intermediate in PI staining, while cells in chambers from mice infected with S. mitis were PI positive (apoptotic) or negative (live). Strikingly, neutrophils from EP-infected chambers were severely impaired in their ability to phagocytose and to generate reactive oxygen species in vitro after removal from the chamber compared to cells from S. mitis-infected chambers. The mechanism of neutrophil impairment was necrotic cell death as determined by morphological analyses. P. intermedia alone could induce a similar neutrophil phenotype. We conclude that the endodontic pathogens, particularly P. intermedia, can efficiently disable and kill infiltrating neutrophils, allowing these infections to become established. These results can help explain the persistence of endodontic infections and demonstrate a new virulence mechanism associated with P. intermedia. PMID:25024367

  20. Pathogenic Bacterial Species Associated with Endodontic Infection Evade Innate Immune Control by Disabling Neutrophils

    PubMed Central

    Matsui, Aritsune; Jin, Jun-O; Johnston, Christopher D.; Yamazaki, Hajime; Houri-Haddad, Yael

    2014-01-01

    Endodontic infections, in which oral bacteria access the tooth pulp chamber, are common and do not resolve once established. To investigate the effects of these infections on the innate immune response, we established a mouse subcutaneous chamber model, where a mixture of four oral pathogens commonly associated with these infections (endodontic pathogens [EP]), i.e., Fusobacterium nucleatum, Streptococcus intermedius, Parvimonas micra, and Prevotella intermedia, was inoculated into subcutaneously implanted titanium chambers. Cells that infiltrated the chamber after these infections were primarily neutrophils; however, these neutrophils were unable to control the infection. Infection with a nonpathogenic oral bacterial species, Streptococcus mitis, resulted in well-controlled infection, with bacterial numbers reduced by 4 to 5 log units after 7 days. Propidium iodide (PI) staining of the chamber neutrophils identified three distinct populations: neutrophils from EP-infected chambers were intermediate in PI staining, while cells in chambers from mice infected with S. mitis were PI positive (apoptotic) or negative (live). Strikingly, neutrophils from EP-infected chambers were severely impaired in their ability to phagocytose and to generate reactive oxygen species in vitro after removal from the chamber compared to cells from S. mitis-infected chambers. The mechanism of neutrophil impairment was necrotic cell death as determined by morphological analyses. P. intermedia alone could induce a similar neutrophil phenotype. We conclude that the endodontic pathogens, particularly P. intermedia, can efficiently disable and kill infiltrating neutrophils, allowing these infections to become established. These results can help explain the persistence of endodontic infections and demonstrate a new virulence mechanism associated with P. intermedia. PMID:25024367

  1. Adopting an Evidence-Based Lifestyle Physical Activity Program: Dissemination Study Design and Methods.

    PubMed

    Dunn, Andrea L; Buller, David B; Dearing, James W; Cutter, Gary; Guerra, Michele; Wilcox, Sara; Bettinghaus, Erwin P

    2012-06-01

    BACKGROUND: There is a scarcity of research studies that have examined academic-commercial partnerships to disseminate evidence-based physical activity programs. Understanding this approach to dissemination is essential because academic-commercial partnerships are increasingly common. Private companies have used dissemination channels and strategies to a degree that academicians have not, and declining resources require academicians to explore these partnerships. PURPOSE: This paper describes a retrospective case-control study design including the methods, demographics, organizational decision-making, implementation rates, and marketing strategy for Active Living Every Day (ALED), an evidence-based lifestyle physical activity program that has been commercially available since 2001. Evidence-based public health promotion programs rely on organizations and targeted sectors to disseminate these programs although relatively little is known about organizational-level and sector-level influences that lead to their adoption and implementation. METHODS: Cases (n=154) were eligible if they had signed an ALED license agreement with Human Kinetics (HK), publisher of the program's textbooks and facilitator manuals, between 2001 and 2008. Two types of controls were matched (2:2:1) and stratified by sector and region. Active controls (Control 1; n=319) were organizations that contacted HK to consider adopting ALED. Passive controls (Control 2; n=328) were organizations that received unsolicited marketing materials and did not initiate contact with HK. We used Diffusion of Innovations Theory (DIT) constructs as the basis for developing the survey of cases and controls. RESULTS: Using the multi-method strategy recommended by Dillman, a total of n=801 cases and controls were surveyed. Most organizations were from the fitness sector followed by medical, nongovernmental, governmental, educational, worksite and other sectors with significantly higher response rates from government, educational and medical sectors compared with fitness and other sectors, (p=0.02). More cases reported being involved in the decision to adopt ALED (p<0.0001). Data indicate that a low percentage of controls had ever heard of ALED despite repeated marketing and offering other types of physical activity programs and services. Finally, slightly over half of the adopters reported they had actually implemented the ALED program. CONCLUSION: Dissemination research requires new perspectives and designs to produce valid insights about the results of dissemination efforts. This study design, survey methods and theoretically-based questions can serve as a useful model for other evidence-based public health interventions that are marketed by commercial publishers to better understand key issues related to adoption and implementation of evidence-based programs. PMID:23181147

  2. 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

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

    ERIC Educational Resources Information Center

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

    2013-01-01

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

  4. Evidence-Based Practice in Adapted Physical Education

    ERIC Educational Resources Information Center

    Jin, Jooyeon; Yun, Joonkoo

    2010-01-01

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

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

    PubMed

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

    2010-10-01

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

  6. Evidence-Based Practice in Stuttering: Some Questions to Consider

    ERIC Educational Resources Information Center

    Ratner, Nan Bernstein

    2005-01-01

    A recent forum in "JFD" (28/3, 2003) evaluated the status of evidence-based practice in fluency disorders, and offered recommendations for improvement. This article re-evaluates the level of support available for some popular approaches to stuttering therapy and questions the relative value placed on some types of programs endorsed by the forum.…

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

    ERIC Educational Resources Information Center

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

    2013-01-01

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

  8. Dissemination of evidence-based standards of care.

    PubMed

    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

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

    PubMed

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

    2015-08-01

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

  10. 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

  11. Situational Analysis: A Framework for Evidence-Based Practice

    ERIC Educational Resources Information Center

    Annan, Jean

    2005-01-01

    Situational analysis is a framework for professional practice and research in educational psychology. The process is guided by a set of practice principles requiring that psychologists' work is evidence-based, ecological, collaborative and constructive. The framework is designed to provide direction for psychologists who wish to tailor their

  12. Teaching Evidence-based Medicine Using Literature for Problem Solving.

    ERIC Educational Resources Information Center

    Mottonen, Merja; Tapanainen, Paivi; Nuutinen, Matti; Rantala, Heikki; Vainionpaa, Leena; Uhari, Matti

    2001-01-01

    Evidence-based medicine--the process of using research findings systematically as the basis for clinical decisions--can be taught using problem-solving teaching methods. Evaluates whether it was possible to motivate students to use the original literature by giving them selected patient problems to solve. (Author/ASK)

  13. 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

  14. 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)

  15. 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

  16. Evidence-Based Practices Project for Suicide Prevention

    ERIC Educational Resources Information Center

    Rodgers, Philip L.; Sudak, Howard S.; Silverman, Morton M.; Litts, David A.

    2007-01-01

    Suicide continues to be a serious public health problem. In response to this problem, a myriad of suicide prevention programs have been developed and employed across the United States. Unfortunately, the effectiveness of many of these programs is unknown because they have not been evaluated using rigorous methods. The Evidence-Based Practices

  17. 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

  18. 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.

  19. 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

  20. 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…

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

    ERIC Educational Resources Information Center

    Forrest, Jane L.; Miller, Syrene A.

    2001-01-01

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

  2. 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

  3. 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

  4. Not Funding the Evidence-Based Model in Ohio

    ERIC Educational Resources Information Center

    Edlefson, Carla

    2010-01-01

    The purpose of this descriptive case study was to describe the implementation of Ohio's version of the Evidence-Based Model (OEBM) state school finance system in 2009. Data sources included state budget documents and analyses as well as interviews with local school officials. The new system was responsive to three policy objectives ordered by the

  5. Evidence-Based Practices Project for Suicide Prevention

    ERIC Educational Resources Information Center

    Rodgers, Philip L.; Sudak, Howard S.; Silverman, Morton M.; Litts, David A.

    2007-01-01

    Suicide continues to be a serious public health problem. In response to this problem, a myriad of suicide prevention programs have been developed and employed across the United States. Unfortunately, the effectiveness of many of these programs is unknown because they have not been evaluated using rigorous methods. The Evidence-Based Practices…

  6. 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.

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

    ERIC Educational Resources Information Center

    Kent, Ray D.

    2006-01-01

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

  8. 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.

  9. 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…

  10. 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

  11. 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

  12. Evidence-Based Practice and Evaluation: From Insight to Impact

    ERIC Educational Resources Information Center

    Dunsmuir, Sandra; Brown, Emma; Iyadurai, Suzi; Monsen, Jeremy

    2009-01-01

    With the growing emphasis on accountability and evidence-based practice, evaluation has become increasingly important in the contexts in which educational psychologists (EPs) practice. This paper describes a Target Monitoring and Evaluation (TME) system, derived from Goal Attainment Scaling (GAS) which was developed to evaluate outcomes of a wide

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

    ERIC Educational Resources Information Center

    Schaffner, Angela D.; Buchanan, Linda Paulk

    2010-01-01

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

  14. An Evidence-Based Protocol for Protecting Newborns From Pertussis.

    PubMed

    Stinson, Cynthia F; Hooper, Gwendolyn; Oliver, JoAnn S

    2015-01-01

    Pertussis, also known as whooping cough, is a vaccine-preventable disease most commonly affecting infants and young children. This article describes a project to develop an evidence-based protocol for implementing prenatal vaccination and cocooning in a major medical center in Georgia. PMID:26460912

  15. 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…

  16. Evidence-Based Practice: The Wave of the Past

    ERIC Educational Resources Information Center

    Stricker, George

    2003-01-01

    Chwalisz (2003) proposed an evidence-based practice model for training in counseling psychology, based on the apparent failures of the scientist-practitioner model and the need for an expanded view of scientific evidence. Although I am sympathetic to the model she developed, and also to a local clinical scientist model that I have written about

  17. 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

  18. 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…

  19. Making the Case for Evidence-Based Practice

    ERIC Educational Resources Information Center

    Bates, Joanne; McClure, Janelle; Spinks, Andy

    2010-01-01

    Evidence-based practice is the collection, interpretation, and use of data, such as collection statistics or assessment results, that measure the effectiveness of a library media program. In this article, the authors will present various forms of evidence and show that any library media specialist can use data to make informed decisions that

  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 Psychosocial Treatments for Child and Adolescent Depression

    ERIC Educational Resources Information Center

    David-Ferdon, Corinne; Kaslow, Nadine J.

    2008-01-01

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

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

    ERIC Educational Resources Information Center

    Finn, Patrick

    2011-01-01

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

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

    ERIC Educational Resources Information Center

    David-Ferdon, Corinne; Kaslow, Nadine J.

    2008-01-01

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

  4. 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…

  5. 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

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

    PubMed

    Munro, Nancy

    2004-01-01

    Evidence-based practice is an important force in healthcare today. Its impact on the practice of the advanced practice nurse (APN) is becoming more apparent with the development of practice guidelines and protocols. The phrase, "That's the way I've always done it," is being replaced by, "This practice is evidence based." The philosophy of supporting practice with scientific evidence is not new but has been revitalized and emphasized as protocols have been developed to "mold" practice to achieve successful outcomes. This revolution is being applied to all areas of healthcare practice. Assessment of the patient is usually the first contact the APN has with the patient. It is an important time to gather information from the patient interview, physical examination, laboratory data, and test interpretation. Scientific evidence, properly interpreted, is applied in this step of assessment. The APN will then use clinical judgment and the knowledge gained from graduate education to assist with the formulation of a diagnosis. The APN has a unique opportunity to promote an evidence-based practice model at the grass roots level and persuade the bedside nurse to integrate this process into his or her practice. Ultimately, patients will receive better care and outcomes will be improved using evidence-based assessment. PMID:15586152

  7. Using Family Paradigms to Improve Evidence-Based Practice

    ERIC Educational Resources Information Center

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

    2009-01-01

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

  8. Integrating Evidence-Based Practices in Middle Science Reading

    ERIC Educational Resources Information Center

    Kroeger, Stephen D.; Burton, Cathy; Preston, Christopher

    2009-01-01

    The purpose of this study was to examine the effectiveness of an evidence-based practice that addresses the learning needs of middle school students who have difficulty comprehending science texts. The teachers used a single-subject reversal design to implement peer-mediated instruction while asking to what degree the use of peer-mediated

  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. 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

  11. 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

  12. 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

  13. 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

  14. 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

  15. 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)

  16. 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)

  17. 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

  18. 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,

  19. 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…

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

    ERIC Educational Resources Information Center

    Kent, Ray D.

    2006-01-01

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