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Abstract Evidence can be obtained from clinical trials and bacteriological studies. The latter consist mainly of measuring reductions in colonization, or reductions in bacterial counts on naturally or artificially contaminated surfaces, following the introduction of the measure to be tested. Controlled clinical trials usually provide the best evidence, but are infrequently carried out due to the large number of subjects
With constant information overflow, it is getting increasingly difficult for healthcare professionals to be aware of the latest guidelines, policies and research and to implement these at local level. The National Resource for InfectionControl (NRIC) project (see: www.nric.org.uk) provides a `single one-stop shop' not only for infectioncontrol teams who may require national policy, guidance and available evidence to
S. Wiseman; P. Kostkova; S. DSouza; J. Mani-Saada; G. Madle
Background: To adopt an evidence-based approach, professionals must be able to access, identify, interpret, and critically appraise best evidence. Critical appraisal requires essential skills, such as computer literacy and an understanding of research principles. These skills also are required for professionals to contribute to evidence.Methods: In 1996, members of the Australian InfectionControl Association were surveyed to establish a profile
he need for evidence-based practice in health care is now well accepted. Best practice is likely to change over time with the emergence of new research evidence and may be influenced by other factors, such as acceptability to the general public.Controlled clinical trials supply the most robust evidence, but in the field of infectioncontrol trials are often difficult to
Tobacco production, distribution, and use are international issues with significant health and economic implications. This paper provides an overview of the effective approaches to tobacco control including decreasing demand for tobacco products through taxation, consumer education, research, bans on advertising and promotion, warning labels, and restrictions on public smoking. The effectiveness of reducing the supply of tobacco products through prohibition, restrictions on youth access, crop substitution, trade restrictions, and control of smuggling, will also be discussed. Decreasing smoking, particularly among young people, by preventing or delaying initiation, preventing regular use, and increasing cessation through behavioural approaches for all ages is reviewed. Cessation methods including pharmacological approaches, 'quitlines', Internet programmes, and the targeting of specific populations are discussed. Internet availability of tobacco products and sustainability of current efforts are presented as continuing challenges to tobacco control. PMID:14725648
This review summarizes research that has assessed the effectiveness of various antimicrobial-containing dentifrices in preventing and/or reducing a number of oral health problems facing our patients today. The results of these studies indicate that, when compared with a conventional fluoride dentifrice, the triclosan/copolymer/fluoride dentifrice is the one with the most evidence to support its ability to deliver significant oral health benefits with no adverse effects. The benefits maybe summarized as follows: improved levels ofsupragingival plaque control; improved gingival health; reducedlikelihood of gingivitis progressing to periodontitis; arrest progression of periodontitis; prevention of supragingival calculus; and reduction in oral malodor. With increased interest in the association of oral health with systemic health, this dentifrice is well-positioned to help reduce the likelihood of gingivitis establishing itself and possibly developing into periodontitis (Figure 1). It also has the potential to have beneficial effects on general health because of its anti-inflammatory properties. Based on the results presented in this article, it is clear that the general population can derive significant clinical benefits from the daily use of a triclosan/copolymer/fluoride dentifrice. The dental profession should feel confident to recommend its use to patients to improve oral health and maintain or promote overall health. PMID:21462625
In addition to proper cleansing, debridement and local wound care, foot infections in diabetic patients require carefully selected antibiotic therapy. Serious infections necessitate hospitalization for initial parenteral broad-spectrum antibiotic therapy. Appropriately selected patients with mild infections can be treated as outpatients with oral (or even topical) therapy. Initial antibiotic selection is usually empirical, but definitive therapy may be modified based
Objective: An evidence-based surgical antimicrobial prophylaxis (AMP) protocol was implemented in multiple facilities to determine if compliance led to a decrease in New York State reportable surgical site infections (SSIs). Implementation focused on changing practitioner behavior. Methods: An evidence-based protocol was developed and approved by participating clinical divisions in the five hospitals involved in the project. Quality assurance (QA) processes
John A. Savino; Jane Smeland; Ellen L. Flink; Angelo Ruperto; Amanda Hines; Thomas Sullivan; Kerri Galvin; Donald A. Risucci
An evidence-based surgical antimicrobial prophylaxis (AMP) protocol was implemented in multiple facilities to determine if compliance led to a decrease in New York State reportable surgical site infections (SSIs). Implementation focused on changing practi...
J. Smeland E. L. Flink A. Ruperto A. Hines T. Sullivan
National evidence-based guidelines for preventing healthcare-associated infections (HCAI) in National Health Service (NHS) hospitals in England were commissioned by the Department of Health (DH) and developed during 1998-2000 by a nurse-led multi-professional team of researchers and specialist clinicians. Following extensive consultation, they were published in January 2001. These guidelines describe the precautions healthcare workers should take in three areas: standard principles for preventing HCAI, which include hospital environmental hygiene, hand hygiene, the use of personal protective equipment, and the safe use and disposal of sharps; preventing infections associated with the use of short-term indwelling urethral catheters; and preventing infections associated with central venous catheters. The evidence for these guidelines was identified by multiple systematic reviews of experimental and non-experimental research and expert opinion as reflected in systematically identified professional, national and international guidelines, which were formally assessed by a validated appraisal process. In 2003, we developed complementary national guidelines for preventing HCAI in primary and community care on behalf of the National Collaborating Centre for Nursing and Supportive Care (National Institute for Healthand Clinical Excellence). A cardinal feature of evidence-based guidelines is that they are subject to timely review in order that new research evidence and technological advances can be identified, appraised and, if shown to be effective in preventing HCAI, incorporated into amended guidelines. Periodically updating the evidencebase and guideline recommendations is essential in order to maintain their validity and authority. Consequently, the DH commissioned a review of new evidence published following the last systematic reviews. We have now updated the evidencebase for making infection prevention and control recommendations. A critical assessment of the updated evidence indicated that the original epic guidelines published in 2001 remain robust, relevant and appropriate but that adjustments need to be made to some guideline recommendations following a synopsis of the evidence underpinning the guidelines. These updated national guidelines (epic2) provide comprehensive recommendations for preventing HCAI in hospitals and other acute care settings based on the best currently available evidence. Because this is not always the best possible evidence, we have included a suggested agenda for further research in each section of the guidelines. National evidence-based guidelines are broad principles of best practice which need to be integrated into local practice guidelines. To monitor implementation, we have suggested key audit criteria for each section of recommendations. Clinically effective infection prevention and control practice is an essential feature of protecting patients. By incorporating these guidelines into routine daily clinical practice, patient safety can be enhanced and the risk of patients acquiring an infection during episodes of healthcare in NHS hospitals in England can be minimised. PMID:17307562
Pratt, R J; Pellowe, C M; Wilson, J A; Loveday, H P; Harper, P J; Jones, S R L J; McDougall, C; Wilcox, M H
What is the effectiveness of cancer control interventions (i.e., smoking cessation, healthy diet, mammography, cervical cancer screening, and control of cancer pain) to promote behavior uptake. What strategies have been evaluated to disseminate cancer con...
Serious policy-relevant research on organized crime has been thwarted by ideological views, the failure to generate systematic data, and a single-minded law enforcement approach to its control. Correspondingly, there has been a failure to generate needed data for analysis and evaluation of anti–organized crime initiatives. This article summarizes the current situation, evaluates emerging work which is challenging past assumptions, and
... 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 infectioncontrol. Proper hand washing is the most effective ...
Despite the lack of evidence of efficacy of antibiotic agents for treating upper respiratory tract infection (URI) symptoms (i.e., acute cough, sore throat, purulent nasal discharge, bronchitis, and the common cold), primary care providers frequently prescribe antibiotic agents for patients presenting with such symptoms. Far from being a harmless practice, prescribing antibiotics for conditions for which there is no proven benefit of such therapy contributes to a number of adverse consequences, including the development of antimicrobial resistance and an unnecessary expense to patients and the healthcare system as a whole. An evidence-based approach to practice can guide nurse practitioners in making the best clinical management decisions for patients presenting with URI symptoms. PMID:11271117
BACKGROUND: Evidence-based medicine (EBM) has been widely integrated into residency curricula, although results of randomized controlled trials and long term outcomes of EBM educational interventions are lacking. We sought to determine if an EBM workshop improved internal medicine residents' EBM knowledge and skills and use of secondary evidence resources. METHODS: This randomized controlled trial included 48 internal medicine residents at
David A Feldstein; Matthew J Maenner; Rachaya Srisurichan; Mary A Roach; Bennett S Vogelman
We introduce a mindful evidence-based practice model to operationalize mindfulness to improve bedside infection prevention practices. Using catheter-associated urinary tract infection prevention as an example, we illustrate how clinicians can be more mindful about appropriate catheter indications and timely catheter removal. PMID:24018928
Kiyoshi-Teo, Hiroko; Krein, Sarah L; Saint, Sanjay
Little is known regarding the social network relationships that influence dissemination of evidence-based public health practices and policies. In public health, it is critical that evidence-based guidelines, such as the Centers for Disease Control and Prevention's Best Practices for Comprehensive Tobacco Control Programs, are effectively and efficiently disseminated to intended stakeholders. To determine the organizational and network predictors of dissemination among state tobacco control programs, interviews with members of tobacco control networks across eight states were conducted between August 2009 and September 2010. Measures included partner attributes (e.g., agency type) and relationships among network members (frequency of contact, extent of collaboration, and dissemination of Best Practices). Exponential random graph modeling was used to examine attribute and structural predictors of collaboration and dissemination among partners in each network. Although density and centralization of dissemination ties varied across states, network analyses revealed a consistent prediction pattern across all eight states. State tobacco control dissemination networks were less dense but more centralized compared with organizational contact and collaboration networks. Tobacco control partners in each state were more likely to disseminate the Best Practices guidelines if they also had existing contact and collaboration relationships with one another. Evidence-based guidelines in public health need to be efficiently and broadly disseminated if we hope to translate science into practice. This study suggests that funders, advocacy groups, and public health agencies can take advantage of existing public health organizational relationships to support the communication and dissemination of evidence-based practices and policies. PMID:24084398
Luke, Douglas A; Wald, Lana M; Carothers, Bobbi J; Bach, Laura E; Harris, Jenine K
Background Urinary tract infections (UTIs, including upper and lower symptomatic) are the most common infections in nursing homes and prevention may reduce patient suffering, antibiotic use and resistance. The spectre of agents used in preventing UTIs in nursing homes is scarcely documented and the aim of this study was to explore which agents are prescribed for this purpose. Methods We conducted a one-day, point-prevalence study in 44 Norwegian nursing homes during April-May 2006. Nursing home residents prescribed any agent for UTI prophylaxis were included. Information recorded was type of agent and dose, patient age and gender, together with nursing home characteristics. Appropriateness of prophylactic prescribing was evaluated with references to evidence in the literature and current national guidelines. Results The study included 1473 residents. 18% (n = 269) of the residents had at least one agent recorded as prophylaxis of UTI, varying between 0-50% among the nursing homes. Methenamine was used by 48% of residents prescribed prophylaxis, vitamin C by 32%, and cranberry products by 10%. Estrogens were used by 30% but only one third was for vaginal administration. Trimethoprim and nitrofurantoin were used as prophylaxis by 5% and 4%, respectively. Conclusions The agents frequently prescribed to prevent UTIs in Norwegian nursing homes lack documented efficacy including methenamine and vitamin C. Recommended agents like trimethoprim, nitrofurantoin and vaginal estrogens are infrequently used. We conclude that prescribing of prophylactic agents for UTIs in nursing homes is not evidence-based.
Evidence-based practice requires flexible systems for information retrieval. Search processes in electronic databases must be based on terms, which are familiar to professionals and describe accurately the problem to be solved. The paper describes the process of evolving a controlled nursing vocabulary for indexing and information retrieval purposes. The vocabulary is based on terms of the Medline thesaurus the medical
Mathematical models have long provided basic insights for malaria control. The recent success of the Onchocerciasis Control Program in west Africa shows that models can make great pragmatic contributions to intervention programs if the modeling is integrated into the overall program, and if the participants are clear about what models can and cannot do. This lesson can be applied to evidence-based malaria control.
Objective To compare the effect of evidencebased information on risk with that of standard information on informed choice in screening for colorectal cancer.Design Randomised controlled trial with 6 months’ follow-up.Setting German statutory health insurance scheme.Participants 1577 insured people who were members of the target group for colorectal cancer screening (age 50-75, no history of colorectal cancer).Interventions Brochure with evidence
Anke Steckelberg; Christian Hülfenhaus; Burkhard Haastert; Ingrid Mühlhauser
Journal Clubs are a well-recognized strategy used by clinicians to critique and keep up to date with relevant literature. This article provides an example of an assessment of an article appearing in this issue of the American Journal of InfectionControl titled, "US School/Academic Institution Disaster and Pandemic Preparedness and Seasonal Influenza Vaccination Among School Nurses." PMID:22938853
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 evidencebase 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.
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.
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 evidencebase 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
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
Acquiring a healthcare associated infection (HCAI) in hospital remains a significant threat to patient safety, and catheter associated urinary tract infections (CAUTI) account for the majority of these infections. This review focuses on the complementary and continuing influence of central policy, evidence for practice, and educational support on strategies to reduce the incidence of CAUTI in the National Health Service
The Cancer Prevention and Control Research Network surveyed 282 cancer control planners to inform its efforts to increase the use of evidence-based cancer control programs (EBPs; programs that have been scientifically tested and have successfully changed behavior). Respondents included planners from organizations in state Comprehensive Cancer Control coalitions as well as other governmental and nongovernmental organizations and community-based coalitions. Respondents provided information about personal and organizational characteristics, their cancer control programs, their attitudes toward EBPs, and their awareness and use of Web-based resources for EBPs. Although findings showed strong preferences for cancer control programs that have been shown to work, less than half of respondents (48%) had ever used EBP resources. Regardless of whether they had used EBP resources, almost all respondents (97%) indicated that further training would help them and their organizations adopt and adapt EBPs for use in their communities. The most frequently endorsed training needs were finding and securing additional resources (such as funding and technical assistance), followed by adapting EBPs for cultural appropriateness. The Cancer Prevention and Control Research Network consortium is using these findings to develop a Web-based interactive training and decision support tool that is responsive to the needs identified by the survey respondents. PMID:20357600
With the explosion of Internet accessibility, online delivery offers potential for significantly greater reach of evidence-based obesity treatment programs for adults. Online behavioral weight control has been shown to produce significant weight loss, with more recent programs demonstrating larger losses and general consumer satisfaction. A growing literature indicates several program parameters that may offer greatest engagement in online obesity interventions and better weight loss outcomes, including interactive, dynamic Web site features and synchronous counselor contact, although this research is in the early stages, and a clear picture of the essential components for the most effective online obesity program remains to be determined. Further research is required to enhance weight loss outcomes, determine cost-effectiveness of Internet-delivered programs, and identify the individuals most likely to benefit from treatment in this format.
Krukowski, Rebecca A.; West, Delia Smith; Harvey-Berino, Jean
With the explosion of Internet accessibility, online delivery offers potential for significantly greater reach of evidence-based obesity treatment programs for adults. Online behavioral weight control has been shown to produce significant weight loss, with more recent programs demonstrating larger losses and general consumer satisfaction. A growing literature indicates several program parameters that may offer greatest engagement in online obesity interventions and better weight loss outcomes, including interactive, dynamic Web site features and synchronous counselor contact, although this research is in the early stages, and a clear picture of the essential components for the most effective online obesity program remains to be determined. Further research is required to enhance weight loss outcomes, determine cost-effectiveness of Internet-delivered programs, and identify the individuals most likely to benefit from treatment in this format. PMID:20046664
Krukowski, Rebecca A; West, Delia Smith; Harvey-Berino, Jean
INTRODUCTION: Academic detailing, typically conducted by impartial advisors, can optimize prescribing behavior. The objective of this prospective controlled trial was to determine if evidence-based detailing conducted by a pharmaceutical manufacturer can also improve physician prescribing habits.MATERIALS AND METHODS: Physicians in eight Ontario regions were randomized to receive manufacturer detailing at least twice over six months using either an evidence-based educational
Lisa Dolovich; Mitchell Levine; Rod Tarajos; Eric Duku
Substance use disorders (SUDs) and human immunodeficiency virus (HIV) are pervasive epidemics that synergize, resulting in negative outcomes for HIV-infected people who use drugs (PWUDs). The expanding epidemiology of substance use demands a parallel evolution of the HIV specialist-beyond HIV to diagnosis and management of comorbid SUDs. The purpose of this paper is to describe healthcare disparities for HIV-infected PWUDs along each point of a continuum of care, and to suggest evidence-based strategies for overcoming these healthcare disparities. Despite extensive dedicated resources and availability of antiretroviral therapy (ART) in the United States, PWUDs continue to experience delayed HIV diagnosis, reduced entry into and retention in HIV care, delayed initiation of ART, and inferior HIV treatment outcomes. Overcoming these healthcare disparities requires integrated packages of clinical, pharmacological, behavioral, and social services, delivered in ways that are cost-effective and convenient and include, at a minimum, screening for and treatment of underlying SUDs. PMID:23797288
Meyer, Jaimie P; Althoff, Amy L; Altice, Frederick L
Infections are among the most common diagnoses in the emergency department (ED), and antibiotics are among the most frequently prescribed drugs. Community-acquired pneumonia (CAP) and healthcare-associated pneumonia (HCAP) are frequently encountered in the ED, and pneumonia is the seventh leading cause of death in the United States. Cystitis, pyelonephritis, and complicated urinary tract infection (UTI) are often treated in the ED, with UTI being one of the most common reasons for healthy young women to require antimicrobial treatment. Intra-abdominal infections have an incidence of 3.5 million cases per year in the United States, and emergency clinicians must make complex decisions regarding appropriate evaluation and management. Skin and soft-tissue infections (SSTIs) are common, their incidence in the ED has been rising, and the emergence of methicillin-resistant Staphylococcus aureus (MRSA) infection has altered their management. Timely diagnosis and management of infectious disease, including proper antimicrobial treatment, is an important goal of emergency care. This issue of Emergency Medicine Practice reviews the available evidence and consensus guidelines for the management of common infectious diseases presenting to the ED and presents recommendations for treatment. PMID:22292348
Objective Translation of evidence-based guidelines into clinical practice has been inconsistent. We performed a randomized, controlled trial of guideline-based care suggestions delivered to physicians when writing orders on computer workstations. Study Setting Inner-city academic general internal medicine practice. Study Design Randomized, controlled trial of 246 physicians (25 percent faculty general internists, 75 percent internal medicine residents) and 20 outpatient pharmacists. We enrolled 706 of their primary care patients with asthma or chronic obstructive pulmonary disease. Care suggestions concerning drugs and monitoring were delivered to a random half of the physicians and pharmacists when writing orders or filling prescriptions using computer workstations. A 2 × 2 factorial randomization of practice sessions and pharmacists resulted in four groups of patients: physician intervention, pharmacist intervention, both interventions, and controls. Data Extraction/Collection Methods Adherence to the guidelines and clinical activity was assessed using patients' electronic medical records. Health-related quality of life, medication adherence, and satisfaction with care were assessed using telephone questionnaires. Principal Findings During their year in the study, patients made an average of five scheduled primary care visits. There were no differences between groups in adherence to the care suggestions, generic or condition-specific quality of life, satisfaction with physicians or pharmacists, medication compliance, emergency department visits, or hospitalizations. Physicians receiving the intervention had significantly higher total health care costs. Physician attitudes toward guidelines were mixed. Conclusions Care suggestions shown to physicians and pharmacists on computer workstations had no effect on the delivery or outcomes of care for patients with reactive airways disease.
Tierney, William M; Overhage, J Marc; Murray, Michael D; Harris, Lisa E; Zhou, Xiao-Hua; Eckert, George J; Smith, Faye E; Nienaber, Nancy; McDonald, Clement J; Wolinsky, Fredric D
Urinary tract infections (UTIs) are common in children, but the routine work-up and treatment recommendations are still controversial.\\u000a Long-term complications, including renal scarring, hypertension, and renal failure, have been the main concern and the reason\\u000a for use of antibiotic prophylaxis and invasive imaging techniques. In the past several years, numerous studies have been published\\u000a comparing different imaging protocols and questioning
Paul A. Merguerian; Einar F. Sverrisson; Daniel B. Herz; Leslie T. McQuiston
From Celsus' first reports of rubor, calor, dolor, tumor, and functio laesa, has come an understanding of inflammation's manifestations at the organ, tissue, vascular, cellular, genetic, and molecular levels. Molecular medicine now raises the opposite question: can local oral infections and their inflammatory mediators increase systemic morbidity or mortality? From these perspectives we examine the clinical evidence relating caries, periodontal disease, and pericoronitis to systemic disease. Widespread affirmation of an oral-systemic linkage remains elusive, raising sobering cautions. PMID:21982600
HIV-infected prisoners in Malaysia represent a critical target population for secondary HIV risk reduction interventions and care. We report on the process and outcome of our formative research aimed at systematically selecting and adapting an EBI designed to reduce secondary HIV risk and improve adherence to antiretroviral therapy among soon-to-be-released HIV-infected prisoners. Our formative work involved a critical examination of established EBIs and associated published reports complemented by data elicited through structured interviews and focus groups with key stakeholders, members of the target population, and their family members. Based on all information, we adapted the Holistic Health Recovery Program targeting people living with HIV (HHRP+), an EBI, to consist of eight 2-hour sessions that cover a range of specified topics so that participants may individually apply intervention content as needed to accommodate their particular substance abuse, HIV risk, and antiretroviral adherence issues. This study provides a complete example of the process of selecting and adapting an EBI—taking into account both empirical evidence and input from target organization stakeholders and target population members and their families—for use in real world prison settings where high-risk populations are concentrated.
Copenhaver, Michael M.; Tunku, Noor; Ezeabogu, Ifeoma; Potrepka, Jessica; Zahari, Muhammad Muhsin A.; Kamarulzaman, Adeeba; Altice, Frederick L.
Health care-associated infections (HAIs) are a major clinical and economic problem in Australian hospitals, and a significant proportion are preventable. HAIs are the result of complex environmental, microbiological, pathological, behavioural and organisational factors, and prevention requires a multifaceted ("bundled") approach, including appropriate policies, educational programs for health care workers, and adequate resources to implement them effectively. Failure to protect patients from avoidable harm, including HAIs, has significant ethical implications; it often reflects both organisational systems failure and non-compliance of health care workers with evidence-based policies, including hand hygiene. If implemented with appropriate safeguards, infectioncontrol "bundles" that include sanctions for poor compliance with hand hygiene and other infectioncontrol policies, will achieve sustained improvements where previous approaches have failed. PMID:19527207
Gilbert, Gwendolyn L; Cheung, Paul Y; Kerridge, Ian B
BACKGROUND: The aim of this project was to assess whether outreach visits would improve the implementation of evidencebased clinical practice in the area of falls reduction and stroke prevention in a residential care setting. METHODS: Twenty facilities took part in a randomized controlled trial with a seven month follow-up period. Two outreach visits were delivered by a pharmacist. At
Maria Crotty; Craig Whitehead; Debra Rowett; Julie Halbert; David Weller; Paul Finucane; Adrian Esterman
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.
As health care moves home, so do infections. By taking active infection surveillance and control measures into the home, the Missouri Alliance Home Care Infection Surveillance and Control Project is improving quality care and patient outcomes. Tracking bladder and central venous catheter infections since 1993, the home health agencies from more than 25 states that participate in this infection project
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 infectioncontrol 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
The Framework Convention on Tobacco Control (FCTC) is a seminal event in tobacco control and in global health. Scientific evidence guided the creation of the FCTC, and as the treaty moves into its implementation phase, scientific evidence can be used to guide the formulation of evidence?based tobacco control policies. The International Tobacco Control Policy Evaluation Project (ITC Project) is a transdisciplinary international collaboration of tobacco control researchers who have created research studies to evaluate and understand the psychosocial and behavioural impact of FCTC policies as they are implemented in participating ITC countries, which together are inhabited by over 45% of the world's smokers. This introduction to the ITC Project supplement of Tobacco Control presents a brief outline of the ITC Project, including a summary of key findings to date. The overall conceptual model and methodology of the ITC Project—involving representative national cohort surveys created from a common conceptual model, with common methods and measures across countries—may hold promise as a useful paradigm in efforts to evaluate and understand the impact of population?based interventions in other important domains of health, such as obesity.
ollowing the publication in 2001 of national evidence-based guidelines for preventing healthcare-associated infections, a series of one-day workshops were conducted throughout ICNA regions. These aimed to support key healthcare professionals to use the guidelines as a catalyst to develop local strategies to promote clinical effectiveness and reduce the incidence of catheter-associated urinary tract infections in acute care settings. Almost 600
Infectioncontrol nurses work to ensure practice is evidence-based, thereby minimising infection risks. There is, however, a gap between theory and practice in infectioncontrol at clinical level. Link nurse groups have been used in an attempt to ensure practice is evidence-based.This article describes a research study that examined the efficacy of an infectioncontrol link nurse programme, which had
Guidelines for Preventing Opportunistic Infections Among Hematopoietic Stem Cell Transplant Recipients contains a section on hospital infectioncontrol including evidence-based recommendations regarding ventilation, construction, equipment, plants, play areas and toys, health-care workers, visitors, patient skin and oral care, catheter-related infections, drug-resistant organisms, and specific nosocomial infections. These guidelines are intended to reduce the number and severity of hospital infections in hematopoietic stem cell transplant recipients.
In 1998, the Department of Health (England) commissioned the first phase of national evidence-based guidelines for preventing healthcare associated infections. These focused on developing a set of standard principles for preventing infections in hospitals together with guidelines for preventing hospital-acquired infections (HAI) associated with the use of short-term indwelling ureteral catheters in acute care and with central venous catheters in acute care. These guidelines are systematically developed broad statements (principles) of good practice that all practitioners can use and which can be incorporated into local protocols. A nurse-led, multi-professional team composed of infection prevention practitioners, clinical microbiologists/retrovirologist, epidemiologists, and researchers developed the guidelines. A rigorous guideline development process was used to inform the systematic reviews, the clinical and critical appraisal of relevant evidence, and linking that evidence to evolving guidelines. Both general and specialist clinical practitioners were involved in all stages of developing these guidelines, as were representatives from relevant Royal Colleges, learned societies, other professional organisations and key stakeholders. The introduction to these guidelines describes a robust and validated guideline development model that can be used by others to develop future guidelines. This model is described in more detail in the associated technical reports that can be found on the project web site http://www.epic.tvu.ac.uk. Locating and appropriately using good quality evidence to inform guideline development in this field is challenging. Evidence from rigorously conducted experimental studies was frequently limited and consequently a range of other types of evidence were systematically retrieved and carefully appraised. The concluding discussion on implementation highlights potential issues for clinical governance and areas for future research and suggests issues that need to be addressed to allow practitioners to successfully incorporate these guidelines into routine clinical practice. PMID:11161888
Pratt, R J; Pellowe, C; Loveday, H P; Robinson, N; Smith, G W; Barrett, S; Davey, P; Harper, P; Loveday, C; McDougall, C; Mulhall, A; Privett, S; Smales, C; Taylor, L; Weller, B; Wilcox, M
Objectives: Constructing an answerable question and effectively searching the medical literature are key steps in practicing evidence-based medicine (EBM). This study aimed to identify the effectiveness of delivering a single workshop in EBM literature searching skills to medical students entering their first clinical years of study. Methods: A randomized controlled trial was conducted with third-year undergraduate medical students. Participants were randomized to participate in a formal workshop in EBM literature searching skills, with EBM literature searching skills and perceived competency in EBM measured at one-week post-intervention via the Fresno tool and Clinical Effectiveness and Evidence-Based Practice Questionnaire. Results: A total of 121 participants were enrolled in the study, with 97 followed-up post-intervention. There was no statistical mean difference in EBM literature searching skills between the 2 groups (mean difference?=?0.007 (P?=?0.99)). Students attending the EBM workshop were significantly more confident in their ability to construct clinical questions and had greater perceived awareness of information resources. Conclusions: A single EBM workshop did not result in statistically significant changes in literature searching skills. Teaching and reinforcing EBM literature searching skills during both preclinical and clinical years may result in increased student confidence, which may facilitate student use of EBM skills as future clinicians.
Background: Representatives of counselling and person-centred organisations indicate many of their members feel their profession and orientation is under threat, with counselling services being decommissioned in NHS settings. Aims: To understand the views of key figures in the psychological therapies field (policy makers, researchers and representatives of the counselling community) towards randomised controlled trials (RCTs), and their present and future
BACKGROUND: Tobacco control is an area where the translation of evidence into policy would seem to be straightforward, given the wealth of epidemiological, behavioural and other types of research available. Yet, even here challenges exist. These include information overload, concealment of key (industry-funded) evidence, contextualization, assessment of population impact, and the changing nature of the threat. METHODS: In the context
Laura Rosen; Elliot Rosenberg; Martin McKee; Shosh Gan-Noy; Diane Levin; Elana Mayshar; Galia Shacham; John Borowski; Gabi Bin Nun; Boaz Lev
Background: In clinical practice, scientific evidence about infectioncontrol is often ignored and hygiene rituals are followed. Methods: Within an evidence-basedinfectioncontrol program, a quarterly rotating surveillance program for nosocomial infections was implemented in 4 intensive care units (ICUs) at the Aachen University Hospital, Germany. Results: For the first time, the unit-specific nosocomial infection situation was made clear to
S. W. Lemmen; D. Zolldann; P. Gastmeier; R. Lütticken
Reports about breast cancer (BC) research in low and middle income countries (LMCs) are difficult to access. A bibliographic database was constituted and is described in the present review. Six databases and cancer conference proceedings were searched. The search included publications focusing on the prevention, early detection, diagnosis, treatment and supportive/palliative care of BC in LMCs (2000-2008). Biological/genetic studies or animal studies were excluded. In all, 44,096 publications were identified of which 4362 met the inclusion criteria, including 210 reports of randomized controlled trials. Only 53% of publications were indexed in Medline. Publications about treatment represented the largest contribution (29%). Mainland China produced the most published research (18%). Only 2.4% of all publications related to palliative care of BC patients. More research is needed in the fields of BC prevention, awareness-raising, early detection, and palliative care in LMCs. Systematic reviews are needed to select those studies that can be safely regarded as "best evidence". PMID:21440846
The publication contains several brochures on the topic of infection-control procedures in the dental office, particularly on prevention of AIDS and Hepatitis B transmission. There are also guidelines on the same subject addressing health care and public ...
Infectioncontrol is a dynamic and ever-changing subject and all dental staff should be kept aware of the most up-to-date procedures required to prevent the transmission of infection and should understand why these procedures are necessary. Regular monitoring and updating of all procedures in the light of new scientific evidence is necessary and all new staff must be trained in infectioncontrol procedures prior to working in the surgery. A practitioner who is routinely following an appropriate infectioncontrol policy, including the use of techniques and products of proven efficacy (perhaps through accreditation), is better placed to refute allegations arising in the course of civil litigation, health and safety at work prosecution, complaints and disciplinary procedures, or investigations by the GDC. PMID:16892574
Sexually transmitted infections (STIs) causing upper genital tract problems after termination of pregnancy (TOP) is well recognized. We undertook this study to assess the local prevalence of Chlamydia trachomatis infection and to estimate the potential benefits of introducing screening. The prevalence rate of C. trachomatis was 6%. Nine sexual contacts of the index cases were identified. They were symptom free, but all had non-specific urethritis (NSU). Four of them were positive for C. trachomatis. We conclude that screening for chlamydial infection is essential and routine prophylactic antibiotic cover may not be beneficial. PMID:10726939
This project studies infectioncontrol practices of Migrant/Community Health Center (M/CHC) dental programs in PHS Region VI. Eighteen dental sites were visited in M/CHCs to determine the level of compliance with the Centers for Disease Control and Preven...
The risk of transmission of infection within the dental workplace is low, but recent data have indicated that human immunodeficiency virus transmission between dentist and patient can occur, and that while nosocomial transmission of hepatitis B virus is now less likely, a small but significant number of staff may be at risk of hepatitis C virus and varicella zoster virus infection during dental treatment. Despite these continued risks, shortcomings remain in cross-infectioncontrol in the dental workplace. Dental clinicians still fail to take adequate steps to minimize nosocomial infection, inconsistently using appropriate methods of sterilization and not providing ancillary staff with suitable protective clothing. Similarly, although vaccinated against hepatitis B virus, a substantial number of clinicians are reluctant to treat hepatitis B virus- or human immunodeficiency virus-infected patients. Cross-infectioncontrol procedures continue to be modified. Of importance, it has been confirmed that protective rubber gloves cannot be reused, as micropunctures develop during rewashing. Sharps injuries are common in dental practice, but there are still no effective measures to prevent postinjury human immunodeficiency virus or hepatitis C virus infection. Instrument sterilization is generally safe and effective, but the contamination of dental unit water supplies remains to be overcome, and while impressions can be placed in disinfectants for up to 1 hour without significant dimensional change, it is not known if infectious agents within the impression material are inactivated by this procedure. PMID:1666310
Study objectives: To assess whether providing women with additional information on the pros and cons of screening, compared with information currently offered by the NHS, affects their intention to attend for screening. Design: Randomised controlled trial. Participants were randomly assigned to receive either the control, (based on an NHS Cervical Screening Programme leaflet currently used), or the intervention leaflet (containing additional information on risks and uncertainties). Setting: Three general practices in Birmingham. Participants: 300 women aged 20 to 64 attending the practices during a one month period. Main outcome measures: Intention to attend for screening. Main results: 283 women (94.3%) completed the study. Fewer women in the intervention (79%) than the control group (88%) expressed intention to have screening after reading the information leaflet (difference between groups 9.2%, 95% confidence intervals (CI) 3.2% to 21.7%). The crude odds ratio (OR) and 95% CI was 0.50 (0.26 to 0.97). After adjusting for other factors, the trend persisted (OR 0.60, 95% CI 0.28 to 1.29). Having a previous Pap smear was the only significant predictor of intention to have screening (adjusted OR 2.54, 95% CI 1.03 to 6.21). Subgroup analysis showed no intervention effect in intended uptake between women at higher and lower risk of cervical cancer (p=0.59). Conclusions: Providing women with evidencebased information on the risks, uncertainties, and the benefits of screening, is likely to deter some, but not differentially those at higher risk.
Objectives: The objective of this study was to evaluate the use of antibiotics in treating upper respiratory tract infections (URTIs) in primary health centers in Kuwait and investigate the extent to which antibiotic use follows international guidelines. SubjectsandMethods: A nationwide cross-sectional study was conducted with a sample size of 615 patients selected by using a multi-stage cluster sampling method. Of
Salem Ayyad; Abdullah Al-Owaisheer; Faisal Al-Banwan; Abdullah Al-Mejalli; Mumtaz Shukkur; Lukman Thalib
In studies from the USA it has been shown that infectioncontrol can lower infection rates by 30%. To achieve this an infectioncontrol programme has to be given a firm structure. Judging from the opinions presented by an educational workshop within the International Federation of InfectionControl (IFIC) and from the literature there is an international consensus on the
|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…
Varra, Alethea A.; Hayes, Steven C.; Roget, Nancy; Fisher, Gary
Objective To evaluate the use of a computerised support system for decision making for implementing evidencebased clinical guidelines for the management of asthma and angina in adults in primary care. Design A before and after pragmatic cluster randomised controlled trial utilising a two by two incomplete block design. Setting 60 general practices in north east England. Participants General practitioners
Martin Eccles; Elaine McColl; Nick Steen; Nikki Rousseau; Jeremy Grimshaw; David Parkin; Ian Purves
Aims: Evidence-based guidelines recommend a range of treatments for falls and injury prevention. We undertook a randomised trial of a falls prevention service to screen for falls risk factors and recommend to GPs an evidenced base prescription for falls prevention. Methods: All patients who presented with a fall to the Emergency Department at Flinders Medical Centre over a 22-week period
Craig Whitehead; Rachel Wundke; Maria Crotty; Paul Finucane
Relaxation therapy for the treatment of hypertension presented a number of challenges, in terms of conducting and using research as well as gaining the wider acceptance of this complementary therapy in common practice in Hong Kong. Two issues were central to the current implementation of complementary therapies: the evidence-based practice movement and the management of risk during the implementation of
BACKGROUND: Previous studies have shown that Norwegian public health physicians do not systematically and explicitly use scientific evidence in their practice. They work in an environment that does not encourage the integration of this information in decision-making. In this study we investigate whether a theoretically grounded tailored intervention to diffuse evidence-based public health practice increases the physicians' use of research
Louise Forsetlund; Peter Bradley; Lisa Forsen; Lena Nordheim; Gro Jamtvedt; Arild Bjørndal
Healthcare is changing as evidence-based medicine (EBM) is incorporated into education and practice. This article considers the hierarchy of evidence, the validation of evidence for decision making and the extent to which this includes aspects of cultural and social constructs of health. We review the influence and the methodology of EBM as it is applied to complementary and alternative medicine
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
Aims. To explore whether Astragalus or its formulations could prevent upper respiratory infection in children with nephrotic syndrome and how best to use it. Methods. We transformed a common clinical question in practice to an answerable question according to the PICO principle. Databases, including the Cochrane Library (Issue 5, 2012), PUBMED (1966–2012.8), CBM (1978–2012.8), VIP (1989–2012.8), and CNKI (1979–2012.8), were searched to identify Cochrane systematic reviews and clinical trials. Then, the quality of and recommendations from the clinical evidence were evaluated using the GRADEpro software. Results. The search yielded 537 papers. Only two studies with high validity were included for synthesis calculations. The results showed that Astragalus granules could effectively reduce URTI in children with nephrotic syndrome compared with prednisone treatment alone (23.9% versus 42.9%; RR = 0.56 and 95% CI = 0.33–0.93). The dose of Astragalus granules was 2.25 gram (equivalent to 15 gram crude Astragalus) twice per day, at least for 3–6 months. The level of evidence quality was low, but we still recommended the evidence to the patient according to GRADEpro with the opinion of the expert. Followup showed the incidence of URTI in this child decreased significantly. Conclusions. Astragalus granules may reduce the incidence of URTI in children with nephrotic syndrome.
It is questionable whether the Evidence-Based Healdi Care model, whereby end users appraise all potentially pertinent information, is sustainable. A shift to an Evidence-Based Practice model, featuring a new medical knowledge base infrastructure facilitating rapid translation of clinical research into practice should be embraced. This shift would offer new opportunities for health sciences librarians. In this article, the authors: (1)
Education and training forms an important part of the role of the infectioncontrol team. It is equally important that the infectioncontrol nurse and doctor have mechanisms in place to monitor staff utilization of the knowledge gained, in their clinical practice. The infectioncontrol audit which I have developed in Southern Derbyshire has been used in various health care
We live in an age of information, innovation and change. Clinical decision making based on good quality evidence should lead to more effective and efficient treatments. Each practitioner has a role in assesing this information. This paper outlines this role, together with the advantages and problems of introducing an evidence-based approach to dentistry.
Evidence-based practice (EBP) has been received with enthusiasm and interest by many nurses. It has, however, raised skepticism and negative reactions from others. This article seeks to address the place of EBP in care of the elderly by outlining EBP and providing some pertinent examples of how it can be used in caring for older people. Finally, it promotes EBP
In Sweden the 23 counties are responsible for the medical care of their inhabitants. They own and run virtually all hospitals. This system facilitates a county-based hospital infectioncontrol system. The infectioncontrol team is based in the county hospital department of clinical bacteriology. It is headed by an MD clinical bacteriologist or, in some counties, by an infectious disease
Evidencebased medicine is a systematic method employed to secure the best scientific available evidence when making clinical decisions. Several steps are taken in these process, describing a clinical scenario, formulating a specific clinical question, searching the literature for the pertinent studies, selecting the relevant articles using rules of evidence, understanding and calculating measures of effect, and finally incorporating the evidence and patients preferences in the clinical decision process. PMID:16281423
Most large acute hospitals have an infectioncontrol team, consisting of the infectioncontrol officier and nurse, which is responsible for day-to-day control of infection. The infectioncontrol officier is usually the medical microbiologist, a physician in charge of the microbiology laboratory, who is responsible to the Health Authority for control of infection. The team responsibilities usually include smaller hospitals,
This paper arises out of two workshop sessions held at the fourth meeting of the Federation of Infection Societies, Manchester, 1997. The aims of the workshops were, first, to identify the factors which impede the process of translating research findings into infectioncontrol practice and second, to suggest how these barriers may be overcome. Key points from the workshops are
Background Two of the key steps in evidencebased medicine (EBM) are being able to construct a clinical question and effectively search the literature to source relevant information. No evidence currently exists that informs whether such skills should be taught to medical students during their pre-clinical years, or delivered to include both the pre-clinical and clinical years of study. This is an important component of curriculum design as the level of clinical maturity of students can affect their perception of the importance and uptake of EBM principles in practice. Methods/Design A randomised controlled trial will be conducted to identify the effectiveness of delivering a formal workshop in EBM literature searching skills to third year medical students entering their clinical years of study. The primary outcome of EBM competency in literature searching skills will be evaluated using the Fresno tool. Discussion This trial will provide novel information on the effectiveness of delivering a formal education workshop in evidencebased medicine literature searching skills during the clinical years of study. The result of this study will also identify the impact of teaching EBM literature searching skills to medical students during the clinical years of study.
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…
Brug, Johannes; van Dale, Djoeke; Lanting, Loes; Kremers, Stef; Veenhof, Cindy; Leurs, Mariken; van Yperen, Tom; Kok, Gerjo
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 effectiveness of available health promotion interventions and to promote use of good-practice
J. Brug; D. van Dale; L. Lanting; S. Kremers; C. Veenhof; M. Leurs; T. van Yperen; G. Kok
This purpose of this article is to contrast the analgesic efficacy of acupuncture following dental surgery with the analgesic effects based on the expectation of benefit in two independently conducted placebo-controlled trials evaluating acupuncture as an adjunctive therapy for dental surgery. Both trials used pain following dental surgery as the outcome variable, and both included a blinding check to ascertain
R. Barker Bausell; Lixing Lao; Stewart Bergman; Wen-Lin Lee; Brian M. Berman
|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…
Brug, Johannes; van Dale, Djoeke; Lanting, Loes; Kremers, Stef; Veenhof, Cindy; Leurs, Mariken; van Yperen, Tom; Kok, Gerjo
This day care infectioncontrol 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…
Seattle-King County Dept. of Public Health, Seattle, WA.
|This day care infectioncontrol 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…
Seattle-King County Dept. of Public Health, Seattle, WA.
...2010-10-01 2010-10-01 false Infectioncontrol. 460.74 Section 460...Requirements Â§ 460.74 Infectioncontrol. (a) Standard procedures...standard procedures with respect to infectioncontrol, including at least the...
...2009-07-01 2009-07-01 false Infectioncontrol. 51.190 Section 51...HOMES Standards Â§ 51.190 Infectioncontrol. The facility management must establish and maintain an infectioncontrol program designed to...
...2013-07-01 2013-07-01 false Infectioncontrol. 52.190 Section 52...HOMES Standards Â§ 52.190 Infectioncontrol. The program management must establish and maintain an infectioncontrol program designed to...
...2010-07-01 2010-07-01 false Infectioncontrol. 51.190 Section 51...HOMES Standards Â§ 51.190 Infectioncontrol. The facility management must establish and maintain an infectioncontrol program designed to...
...2009-10-01 2009-10-01 false Infectioncontrol. 460.74 Section 460...Requirements Â§ 460.74 Infectioncontrol. (a) Standard procedures...standard procedures with respect to infectioncontrol, including at least the...
...2013-07-01 2013-07-01 false Infectioncontrol. 51.190 Section 51...HOMES Standards Â§ 51.190 Infectioncontrol. The facility management must establish and maintain an infectioncontrol program designed to...
...2012-10-01 2012-10-01 false Infectioncontrol. 460.74 Section 460...Requirements Â§ 460.74 Infectioncontrol. (a) Standard procedures...standard procedures with respect to infectioncontrol, including at least the...
Healthcare Providers are having to make quicker, riskier decisions in a competitive and regulated environment. Leaders often make these decisions with the advice of management consultants; however, top management generally lacks adequate internal support to rigorously evaluate strategic interventions or consultant recommendations and to learn from industry-wide best practices. In fact, healthcare providers generally underinvest in management support, both in evaluating best practices within the organization and in learning from past strategic interventions. The creation of evidence-based management cooperatives might be a means to change this trend. PMID:11183283
The accelerating epidemics of noncommunicable diseases (NCDs) in India call for a comprehensive public health response which can effectively combat and control them before they peak and inflict severe damage in terms of unaffordable health, economic, and social costs. To synthesize and present recent evidences regarding the effectiveness of several types of public health interventions to reduce NCD burden. Interventions influencing behavioral risk factors (like unhealthy diet, physical inactivity, tobacco and alcohol consumption) through policy, public education, or a combination of both have been demonstrated to be effective in reducing the NCD risk in populations as well as in individuals. Policy interventions are also effective in reducing the levels of several major biological risk factors linked to NCDs (high blood pressure; overweight and obesity; diabetes and abnormal blood cholesterol). Secondary prevention along the lines of combination pills and ensuring evidenced based clinical care are also critical. Though the evidence for health promotion and primary prevention are weaker, policy interventions and secondary prevention when combined with these are likely to have a greater impact on reducing national NCD burden. A comprehensive and integrated response to NCDs control and prevention needs a "life course approach." Proven cost-effective interventions need to be integrated in a NCD prevention and control policy framework and implemented through coordinated mechanisms of regulation, environment modification, education, and health care responses. PMID:22628907
Singh, Kavita; Reddy, K Srinath; Prabhakaran, Dorairaj
Studies have shown that despite infectioncontrol guidelines recommending that false fingernails, nail varnish, stoned rings and wrist watches not be worn by clinical staff, a large proportion of them continue to do so. The recently updated epic guidelines (Pratt et al, 2007) state that hand jewellery and false finger nails should be kept short, clean and free from nail polish. This article discusses the bacterial carriage, contributions to outbreaks of infection and interference with proper hand hygiene practices, thereby explaining why these recommendations are made in infectioncontrol policies and guidelines. PMID:17577182
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
The operating theatre complex is the heart of any major surgical hospital. Good operating theatre design meets the functional needs of theatre care professionals. Operating theatre design must pay careful consideration to traffic patterns, the number and configuration of nearby operating rooms, the space required for staff, administration and storage, provisions for sterile processing and systems to control airborne contaminants (Wan et al 2011). There have been infectioncontrol issues with private finance initiative built operating theatres (Unison 2003, Ontario Health Coalition 2005). The aim of this article is to address these issues as they relate to infectioncontrol and prevention. PMID:23162994
Background Physical restraints are regularly applied in German nursing homes. Their frequency varies substantially between centres. Beneficial effects of physical restraints have not been proven, however, observational studies and case reports suggest various adverse effects. We developed an evidence-based guidance on this topic. The present study evaluates the clinical efficacy and safety of an intervention programme based on this guidance aimed to reduce physical restraints and minimise centre variations. Methods/Design Cluster-randomised controlled trial with nursing homes randomised either to the intervention group or to the control group with standard information. The intervention comprises a structured information programme for nursing staff, information materials for legal guardians and residents' relatives and a one-day training workshop for nominated nurses. A total of 36 nursing home clusters including approximately 3000 residents will be recruited. Each cluster has to fulfil the inclusion criteria of at least 20% prevalence of physical restraints at baseline. The primary endpoint is the number of residents with at least one physical restraint at six months. Secondary outcome measures are the number of falls and fall-related fractures. Discussion If successful, the intervention should be implemented throughout Germany. In case the intervention does not succeed, a three-month pre-post-study with an optimised intervention programme within the control group will follow the randomised trial. Trial registration ISRCTN34974819
The authors describe the organization of infectioncontrol in Belgium with respect to official regulations, the tasks and the training of the infectioncontrol doctor and of the infectioncontrol nurse, functioning of the infectioncontrol committee, the financing and the availability of guidelines.
G. Reybrouck; M. Vande Putte; M. Zumofen; J. J. Haxhe
The GRASP® nursing workload management system was used over a five-month period by both the infectioncontrol nurses (ICNs) in an infectioncontrol team (ICT) in a 1200-bedded university teaching hospital trust. GRASP data were used to quantify and qualify patient and Trust requirements for infectioncontrol (IC). The results indicated that care was being prioritised as the average daily
C. M. Trundle; M. Farrington; L. Anderson; C. K. Redpath
Many features of the NHS conspire to make workforce planning different and difficult. It is often integrated with other planning processes. There are few available guidelines for workforce configurations of infectioncontrol (IC) teams or evidence that assesses the effectiveness of different staffing configurations. A telephone survey of IC practice in four NHS trusts in England was undertaken to assist
Waterbirths are increasingly being offered as an option, although concerns about associated infection risks have been expressed. We undertook an audit of current practice in our region to help formulate an infectioncontrol policy. Questionnaires were sent to the InfectionControl Nurses at 16 centres, with a request for completion in conjunction with the InfectionControl Doctor.Fourteen (88%) centres responded,
This paper describes the organization of infectioncontrol in Italy with respect to regulatory requirements, the tasks and training of the infectioncontrol physician and nurse, and the function and responsibilities of the infectioncontrol committee. Moreover, the paper reports on incidence and prevalence of hospital-acquired infections (HAI), antibiotic usage and antimicrobial resistance in Italy.
M. Bassetti; J. Topal; A. Di Biagio; P. Salvalaggio; G. P. Basadonna; D. Bassetti
Both panegyric and criticism of evidence-based dentistry tend to be clumsy because the concept is poorly defined. This analysis identifies several contributions to the profession that have been made under the EBD banner. Although the concept of clinicians integrating clinical epidemiology, the wisdom of their practices, and patients' values is powerful, its implementation has been distorted by a too heavy emphasis of computerized searches for research findings that meet the standards of academics. Although EBD advocates enjoy sharing anecdotal accounts of mistakes others have made, faulting others is not proof that one's own position is correct. There is no systematic, high-quality evidence that EBD is effective. The metaphor of a three-legged stool (evidence, experience, values, and integration) is used as an organizing principle. "Best evidence" has become a preoccupation among EBD enthusiasts. That overlong but thinly developed leg of the stool is critiqued from the perspectives of the criteria for evidence, the difference between internal and external validity, the relationship between evidence and decision making, the ambiguous meaning of "best," and the role of reasonable doubt. The strongest leg of the stool is clinical experience. Although bias exists in all observations (including searches for evidence), there are simple procedures that can be employed in practice to increase useful and objective evidence there, and there are dangers in delegating policy regarding allowable treatments to external groups. Patient and practitioner values are the shortest leg of the stool. As they are so little recognized, their integration in EBD is problematic and ethical tensions exist where paternalism privileges science over patient's self-determined best interests. Four potential approaches to integration are suggested, recognizing that there is virtually no literature on how the "seat" of the three-legged stool works or should work. It is likely that most dentists choose to wait for collective professional standards to reveal acceptable practice or follow a strategy of punctuated equilibrium, only switching out established practice habits when very conspicuous advantages are identified. Integration in medicine appears to follow the statistically sophisticated practice of updating estimates of clinical parameters (probabilities) for diagnoses, treatments, prognoses, and side-effects. This approach is likely beyond the skill or interest of clinical dentists and it fails to incorporate values in the integration. The use of decision trees to integrate both research and experiential parameters and values is illustrated and it is shown that such a technique identifies why there are very few cases in dentistry where evidence needs to be consulted and indicates what such cases are. PMID:21485345
In our review published in the previous issue, we noted that contradictory infection prevention and control recommendations have resulted in confusion in practice and inconsistent use of personal respiratory protection when caring for patients with infectious respiratory tuberculosis in hospitals and other healthcare facilities. Recent national evidence-based guidelines in England and Wales have sought to clarify this issue by making
Background Many older people in long-term care do not receive evidence-based diagnosis or management for heart failure; it is not known whether this can be achieved for this population. We initiated an onsite heart failure service, compared with ‘usual care’ with the aim of establishing the feasibility of accurate diagnosis and appropriate management. Methods A pilot randomised controlled trial which randomised residents from 33 care facilities in North-East England with left ventricular systolic dysfunction (LVSD) to usual care or an onsite heart failure service. The primary outcome was the optimum prescription of angiotensin-converting enzyme inhibitors and beta-adrenergic antagonists at 6 months. Results Of 399 echocardiographically-screened residents aged 65–100 years, 30 subjects with LVSD were eligible; 28 (93%) consented and were randomised (HF service: 16; routine care: 12). Groups were similar at baseline; six month follow-up was completed for 25 patients (89%); 3 (11%) patients died. Results for the primary outcome were not statistically significant but there was a consistent pattern of increased drug use and titration to optimum dose in the intervention group (21% compared to 0% receiving routine care, p=0.250). Hospitalisation rates, quality of life and mortality at 6 months were similar between groups. Conclusions This study demonstrated the feasibility of an on-site heart failure service for older long-term care populations. Optimisation of medication appeared possible without adversely affecting quality of life; this questions clinicians’ concerns about adverse effects in this group. This has international implications for managing such patients. These methods should be replicated in a large-scale study to quantify the scale of benefit. Trial registration ISRCTN19781227 http://www.controlled-trials.com/ISRCTN19781227
...Control and Prevention Healthcare InfectionControl Practices Advisory Committee...The practice of hospital infectioncontrol; strategies for surveillance, prevention, and control of infections (e.g., nosocomial...
In this paper we introduce a new type of knowledge operator, called evidence- based knowledge, intended to capture the constructive core of common knowledge. An evidence-based knowledge system is obtained by augmenting a multi-agent logic of knowledge with a system of evidence assertions t:' (\\
Like the practice of evidence-based medicine, evidence-based financial management can be used by providers to improve results. The concept provides a framework that managers and researchers can use to help direct efforts in gathering and using evidence to support management decisions in health care. PMID:14560582
Finkler, Steven A; Henley, Richard J; Ward, David M
Contents: 'If you provide services to dental patients..' (Introduction to the File); Hepatitis B; A Major Health Risk in Dentistry; What About AIDS; Practical InfectionControl; A Workbook for the Dental Team; Reprint: Recommended Infection-Control Practi...
The report is part of the Guidelines for Prevention and Control of Nosocomial Infections. The CDC guidelines were developed to provide a central reference for professionals involved in infectioncontrol that contains CDC recommendations and os easily acce...
This editorial aims to answer the question of whether infectioncontrol is an academic specialty. By considering the consequences of a lack of infectioncontrol in terms of patient morbidity and mortality and hence cost, it is easy to establish the importance of the area. Infectioncontrol embraces not only developing policies for preventing the physical spread of a microorganism
Objective : To study the quality of nosocomial infectioncontrol with respect to structure and process. Material and Method : Data collection by questionnaire and interview administrators and medical personnel in 57 hospitals in Thailand in 2002. Results : Nosocomial infectioncontrol was implemented in all 57 hospitals. In every hospital, there was an infectioncontrol committee (ICC) and at
Suboptimal infection-control practice raises the risk of infection in emergency departments, while time constraints and the presence of large numbers of staff with varying shift patterns can make the delivery of infection training and education difficult. In response to disappointing infectioncontrol audit results, the author carried out a small pilot study to ascertain nursing and medical staff awareness of local policies on infection prevention and control, and their uptake of the relevant training programmes. The results indicate that doctors' knowledge of, and compliance with, infection-control procedures is poorer than those of nurses. This article discusses the results and makes recommendations to improve practice. PMID:23488068
\\u000a In the United States, African American youth are disproportionally affected by human immunodeficiency virus (HIV) and sexually\\u000a transmitted infections (STIs). An estimated 1.2 million people are living with HIV\\/AIDS (Glynn & Rhodes, 2005). Data from\\u000a 33 states in the United States with confidential name-based reporting show that in 2006 African Americans of all ages represented\\u000a 49% of HIV\\/AIDS diagnosis, although
BACKGROUND: Physical restraints are regularly applied in German nursing homes. Their frequency varies substantially between centres. Beneficial effects of physical restraints have not been proven, however, observational studies and case reports suggest various adverse effects. We developed an evidence-based guidance on this topic. The present study evaluates the clinical efficacy and safety of an intervention programme based on this guidance
Evidence-based practice has had a growing impact on chiropractic education and the delivery of chiropractic care. For evidence-based practice to penetrate and transform a profession, the penetration must occur at 2 levels. One level is the degree to which individual practitioners possess the willingness and basic skills to search and assess the literature. Chiropractic education received a significant boost in this realm in 2005 when the National Center for Complementary and Alternative Medicine awarded 4 chiropractic institutions R25 education grants to strengthen their research/evidence-based practice curricula. The second level relates to whether the therapeutic interventions commonly employed by a particular health care discipline are supported by clinical research. A growing body of randomized controlled trials provides evidence of the effectiveness and safety of manual therapies.
The assessment of the optimal treatment option based on best current knowledge is called evidence-based medicine (EBM). Considering the cost explosion in public health systems, EBM should also incorporate proper utilization of the restricted economical resources and should enforce quality assurance in medicine. It is imperative that surgeons realize that randomized controlled trials are applicable to the operative specialties in
Moritz N. Wente; Christoph M. Seiler; Waldemar Uhl; Markus W. Büchler
...Condition of participation: Infectioncontrol. 418.60 Section 418...Condition of participation: Infectioncontrol. The hospice must maintain and document an effective infectioncontrol program that protects...
...and Prevention Healthcare InfectionControl Practices Advisory Committee...The practice of healthcare infection prevention and control; (2) strategies for surveillance, prevention, and control of infections, antimicrobial...
Objective: Our objective is to describe how softwareengineering might benefit from an evidence-basedapproach and to identify the potential difficultiesassociated with the approach.Method: We compared the organisation and technicalinfrastructure supporting evidence-based medicine (EBM)with the situation in software engineering. We consideredthe impact that factors peculiar to software engineering(i.e. the skill factor and the lifecycle factor) would haveon our ability to practice evidence-based
Background Long-standing randomised controlled trial (RCT) evidence indicates that asthma action plans can improve patient outcomes. Internationally, however, these plans are seldom issued by professionals or used by patients/carers. To understand how the benefits of such plans might be realised clinically, we previously investigated barriers and facilitators to their implementation in a systematic review of relevant RCTs and synthesised qualitative studies exploring professional and patient/carer views. Our final step was to integrate these two separate studies. Methods First, a theoretical model of action plan implementation was proposed, derived from our synthesis of 19 qualitative studies, identifying elements which, if incorporated into future interventions, could promote their use. Second, 14 RCTs included in the quantitative synthesis were re-analysed to assess the extent to which these elements were present within their interventions (that is, ‘strong’, ‘weak’ or ‘no’ presence) and with what effect. Matrices charted each element’s presence and strength, facilitating analysis of element presence and action plan implementation. Results Four elements (professional education, patient/carer education, (patient/carer and professional) partnership working and communication) were identified in our model as likely to promote asthma plan use. Thirteen interventions reporting increased action plan implementation contained all four elements, with two or more strongly present. One intervention reporting no effect on action plan implementation contained only weakly present elements. Intervention effectiveness was reported using a narrow range of criteria which did not fully reflect the four elements. For example, no study assessed whether jointly developed action plans increased use. Whilst important from the professional and patient/carer perspectives, the integral role of these elements in intervention delivery and their effect on study outcomes was under-acknowledged in these RCTs. Conclusions Our novel approach provides an evidence-base for future action plan interventions. Such interventions need to ensure all elements in our implementation model (patient/carer and professional education to support development of effective partnership working and communication) are strongly present within them and a wider range of criteria better reflecting the realities of clinical practice and living with asthma are used to measure their effectiveness. We now intend to test such a complex intervention using a cluster trial design.
These guidelines have been developed for practitioners who insert catheters and for persons responsible for surveillance and control of infections in hospital, outpatient, and home health-care settings. This report was prepared by a working group comprising members from professional organizations representing the disciplines of critical care medicine, infectious diseases, health-care infectioncontrol, surgery, anesthesiology, interventional radiology, pulmonary medicine, pediatric medicine, and nursing. The working group was led by the Society of Critical Care Medicine (SCCM), in collaboration with the Infectious Disease Society of America (IDSA), Society for Healthcare Epidemiology of America (SHEA), Surgical Infection Society (SIS), American College of Chest Physicians (ACCP), American Thoracic Society (ATS), American Society of Critical Care Anesthesiologists (ASCCA), Association for Professionals in InfectionControl and Epidemiology (APIC), Infusion Nurses Society (INS), Oncology Nursing Society (ONS), Society of Cardiovascular and Interventional Radiology (SCVIR), American Academy of Pediatrics (AAP), and the Healthcare InfectionControl Practices Advisory Committee (HICPAC) of the Centers for Disease Control and Prevention (CDC) and is intended to replace the Guideline for Prevention of Intravascular Device-Related Infections published in 1996. These guidelines are intended to provide evidence-based recommendations for preventing catheter-related infections. Major areas of emphasis include 1) educating and training health-care providers who insert and maintain catheters; 2) using maximal sterile barrier precautions during central venous catheter insertion; 3) using a 2% chlorhexidine preparation for skin antisepsis; 4) avoiding routine replacement of central venous catheters as a strategy to prevent infection; and 5) using antiseptic/antibiotic impregnated short-term central venous catheters if the rate of infection is high despite adherence to other strategies (ie, education and training, maximal sterile barrier precautions, and 2% chlorhexidine for skin antisepsis). These guidelines also identify performance indicators that can be used locally by health-care institutions or organizations to monitor their success in implementing these evidence-based recommendations. PMID:12415057
O'Grady, Naomi P; Alexander, Mary; Dellinger, E Patchen; Gerberding, Julie L; Heard, Stephen O; Maki, Dennis G; Masur, Henry; McCormick, Rita D; Mermel, Leonard A; Pearson, Michele L; Raad, Issam I; Randolph, Adrienne; Weinstein, Robert A
Standardised training curricula for infectioncontrol nurses (ICNs) and recognition of the specialty exist in many European countries, but infectioncontrol physician (ICP) is not a specialty recognised by the UEMS. To gather information on curricula for ICPs, members of the ESCMID Study Group on Nosocomial Infections received a questionnaire. There is discussion about which 'professions' should be included in
A. Voss; F. Allerberger; E. Bouza; B. Cookson; F. Daschner; M. Dettenkofer; P. Gastmeier; B. Gordts; P. B. Heczko; B. Jovanovic; W. Koller; H. Mittermeyer; E. Nagy; H. Richet; S. Unal; A. F. Widmer
Background Two of the key steps in evidencebased medicine (EBM) are being able to construct a clinical question and effectively search\\u000a the literature to source relevant information. No evidence currently exists that informs whether such skills should be taught\\u000a to medical students during their pre-clinical years, or delivered to include both the pre-clinical and clinical years of study.\\u000a This is
Patterns embedded in large volumes of clinical data may provide important insights into the characteristics of patients or care delivery processes, but may be difficult to identify by traditional means. Data mining offers methods that can recognize patterns in these large data sets and make them actionable. We present an example of this capability in which we successfully applied data mining to hospital infectioncontrol. The Data Mining Surveillance System (DMSS) uses data from the clinical laboratory and hospital information systems to create association rules linking patients, sample types, locations, organisms, and antibiotic susceptibilities. Changes in association strength over time signal epidemiologic patterns potentially appropriate for follow-up, and additional heuristic methods identify the most informative of these patterns for alerting. PMID:18194722
Studies report that students in health care professions do not retain knowledge of infectioncontrol and demonstrate poor hand hygiene compliance. This study describes the effect of a multifaceted approach (education, skills training, and monitoring) on nursing students' knowledge of infectioncontrol principles, opinions, hand hygiene practices, and value of nursing research in evidence-based practice. Students participated in hand hygiene monitoring of health care workers with 900 observations. Students demonstrated strong knowledge of hand hygiene principles: 63% reported that hand hygiene monitoring positively influenced their own compliance. Although posters have been identified as effective prompts, students did not perceive poster reminders as effective in prompting handwashing. Students reported that hand hygiene activities helped them value the role of the nurse in research and evidence-based practice. This study may help educators clarify misconceptions that result in student noncompliance in hand hygiene practices. PMID:21366164
Waltman, Patricia A; Schenk, Laura K; Martin, Tina M; Walker, Jean
Purpose – There is evidence that some strategies for guideline implementation are more successful than others. This paper aims to describe the process of developing an evidence-based guideline implementation strategy for use in rural emergency departments. Design\\/methodology\\/approach – Participation in a nationally funded, research fellowship program involved attendance at workshops run by internationally renowned experts in the field of knowledge
The aim of the Training Evidence-based Practitioners Program was to augment evidence-based practice capacity by training clinical specialists and primary care providers to become evidence-based practitioners (EBP) in their respective areas and organizatio...
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…
|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…
The majority of healthcare-associated infections result from cross-transmission related to inappropriate patient-care practices. Improving practices frequently implies modifying healthcare workers' behaviour, a key challenge of today's infectioncontrol. To improve healthcare workers' compliance with practices, infectioncontrol should learn from the behavioural sciences. Social cognitive models can help to improve our understanding of human behaviour. Cognitive determinants that shape behaviour
We examined differences in approaches to HIV-related infectioncontrol practices in two university teaching hospitals in the United States and Nigeria. Health care workers (n = 202 in Nigeria and 186 in the USA) responded to a previously validated measure of infectioncontrol practices. There were significant differences in the estimated probability of treating a person with HIV disease (higher
The aim of this paper is to discuss the provision and development of infectioncontrol services within primary care during a time of significant change. This will be aided by describing how the use of audit can assist in identifying areas of priority within an under-resourced service.There have been many changes in the provision of infectioncontrol services within primary
Background: Australian infectioncontrol practitioners (ICPs) have not been previously profiled. Knowledge of their practice is limited, making support and evaluation of their programs difficult. To investigate the current role, function, and attributes of this group, we undertook a national survey of members of the Australian InfectionControl Association. Methods: In 1996 a questionnaire was sent to all 1078 nonmedical
This paper takes the perspective of a recently appointed infectioncontrol nurse (ICN) and looks at how the issue of accountability for specialist practitioners is influencing practice. The article may also be relevant to link nurses and those considering a career move into infectioncontrol.
I have been a military infectioncontrol nurse for six years and have been stationed in California, Turkey and now in England. Each of these assignments has afforded unique and wonderful experiences. In this article, I will describe these assignments and the amazing differences among them. I will touch on the educational differences and levels of infectioncontrol practitioners I
West Nile virus (WNV) is a re-emerging pathogen responsible for fatal outbreaks of meningoencephalitis in humans. Recent research using a mouse model of infection has indicated that specific chemokines and chemokine receptors help mediate the host response to WNV acting by at least three mechanisms: control of early neutrophil recruitment to the infection site (Cxcr2), control of monocytosis in blood
The Certification Board in InfectionControl and Epidemiology, Inc, directed its Test and Administrative Subcommittees to compose a Job Analysis Committee in 1995. This 16-member Job Analysis Committee, in collaboration with Applied Measurement Professionals, Inc, conducted a job analysis survey of infectioncontrol professionals in the United States and Canada during 1996. The reassessment of the previous Certification Board in
These guidelines have been developed for practitioners who insert catheters and for persons responsible for surveillance and control of infections in hospital, outpatient, and home health-care settings. This report was prepared by a working group comprising members from professional organizations representing the disciplines of critical care medicine, infectious diseases, health-care infectioncontrol, surgery anesthesiology interventional radiology pulmonary medicine, pediatric medicine, and nursing. The working group was led by the Society of Critical Care Medicine (SCCM), in collaboration with the Infectious Disease Society of America (IDSA), Society for Healthcare Epidemiology ofAmerica (SHEA), Surgical Infection Society (SIS), American College of Chest Physicians (ACCP), American Thoracic Society (ATS), American Society of Critical Care Anesthesiologists (ASCCA), Association for Professionals in InfectionControl and Epidemiology (APIC), Infusion Nurses Society (INS), Oncology Nursing Society (ONS), Society of Cardiovascular and Interventional Radiology (SCVIR), American Academy of Pediatrics (AAP), and the Healthcare InfectionControl Practices Advisory Committee (HICPAC) of the Centers for Disease Control and Prevention (CDC) and is intended to replace the Guideline for Prevention of Intravascular Device-Related Infections published in 1996 These guidelines are intended to provide evidence-based recommendations for preventing catheter-related infections. Major areas of emphasis include 1) educating and training health-care providers who insert and maintain catheters; 2) using maximal sterile barrier precautions during central venous catheter insertion; 3) using a 2% chlorhexidine preparation for skin antisepsis; 4) avoiding routine replacement of central venous catheters as a strategy to prevent infection; and 5) using antiseptic/antibiotic impregnated short-term central venous catheters if the rate of infection is high despite adherence to other strategies (i.e., education and training, maximal sterile barrier precautions, and 2% chlorhexidine for skin antisepsis). These guidelines also identify performance indicators that can be used locally by health-care institutions or organizations to monitor their success in implementing these evidence-based recommendations. PMID:12233868
O'Grady, Naomi P; Alexander, Mary; Dellinger, E Patchen; Gerberding, Julie L; Heard, Stephen O; Maki, Dennis G; Masur, Henry; McCormick, Rita D; Mermel, Leonard A; Pearson, Michele L; Raad, Issam I; Randolph, Adrienne; Weinstein, Robert A
The majority of healthcare-associated infections result from cross-transmission related to inappropriate patient-care practices. Improving practices frequently implies modifying healthcare workers' behaviour, a key challenge of today's infectioncontrol. To improve healthcare workers' compliance with practices, infectioncontrol should learn from the behavioural sciences. Social cognitive models can help to improve our understanding of human behaviour. Cognitive determinants that shape behaviour are acquired through the socialization process and are susceptible to change. Some models have been applied to evaluate predictors of health behaviour but, so far, none have been successfully applied to explain behaviour in the field of infectioncontrol. Successful strategies to improve infectioncontrol practices result from their multidimensional aspect. Similarly, social models that include several levels of cognitive determinants have more chance of success to explain change in behaviour. Concrete examples applied to infectioncontrol issues are presented, including special references to hand hygiene behaviour. The theory of ecological perspective, based on the idea that behaviour is viewed as being affected by and affecting multiple levels of influence, and that it both influences and is influenced by the social environment, seems promising to explain behaviour modification. Studies are needed to assess the key determinants of infectioncontrol practices and behaviour promotion among the different populations of healthcare workers, and to implement and evaluate the impact of the different components of multimodal programmes to promote optimal infectioncontrol practices. PMID:15350707
Evidence-based medicine (EBM) has been driven by the need to cope with information overload, by cost-control, and by a public impatient for the best in diagnostics and treatment. Clinical guidelines, care maps, and outcome measures are quality improvement tools for the appro- priateness, efficiency, and effectiveness of health ser- vices. Although they are imperfect, their value increases with the quality
West Nile virus (WNV) is a re-emerging pathogen responsible for fatal outbreaks of meningoencephalitis in humans. Recent research using a mouse model of infection has indicated that specific chemokines and chemokine receptors help mediate the host response to WNV acting by at least three mechanisms: control of early neutrophil recruitment to the infection site (Cxcr2), control of monocytosis in blood (Ccr2) and control of leukocyte movement from blood to brain (Cxcr4, Cxcr3, Cxcl10 and possibly Ccr5). CCR5 also appears to be important in human infection, since individuals genetically deficient in this receptor have increased risk of symptomatic disease once infected. These findings provide detailed insight into non-redundant chemokine roles in organ-specific leukocyte recruitment during infection, and emphasize the importance of the balance between pathogen control and immunopathology in determining overall clinical outcome. PMID:21376172
...Control and Prevention Healthcare InfectionControl Practices Advisory Committee...The practice of healthcare infectioncontrol; (2) strategies for surveillance...NICU), draft guideline for infectioncontrol in healthcare personnel,...
...Control and Prevention Healthcare InfectionControl Practices Advisory Committee...The practice of healthcare infectioncontrol; (2) strategies for surveillance...the draft guideline for InfectionControl in Healthcare Personnel;...
...Control and Prevention Healthcare InfectionControl Practices Advisory Committee...regarding the practice of healthcare infectioncontrol and strategies for surveillance...NICU); draft guideline for InfectionControl in Healthcare Personnel;...
...Control and Prevention Healthcare InfectionControl Practices Advisory Committee...The practice of healthcare infectioncontrol; (2) strategies for surveillance...NICU); draft guidelines for infectioncontrol in healthcare personnel;...
...Control and Prevention Healthcare InfectionControl Practices Advisory Committee...the practice of healthcare infectioncontrol; 2) strategies for surveillance, prevention, and control of infections (e.g., nosocomial...
...Control and Prevention Healthcare InfectionControl Practices Advisory Committee...the practice of healthcare infectioncontrol; (2) strategies for surveillance...NICU), draft guideline for infectioncontrol in healthcare personnel,...
In December 1990 the Investigation and Prevention Branch, Hospital Infections Program, Centers for Disease Control and Prevention (CDC), developed the Hospital Infections Program infectioncontrol information system (HIP ICIS) to respond more efficiently to more than 200 public inquiries (telephone or written) that HIP receives daily. The HIP ICIS allows anyone with a Touch-Tone telephone, fax machine, or computer to
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. Evidencebased 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 evidencebased social policy should be based on effective interventions that are able to break the vicious circles of disability handed down from generation to generation.
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. Evidencebased 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 evidencebased 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
Infectioncontrol faces radical changes at the beginning of the third millennium. The first part of this review focuses on problems not yet solved, such as 1) surveillance systems, which should be active and extremely flexible; 2) infection outbreaks in hospitals and strategies to avoid them; 3) hand washing and alternatives such as rapid hand antisepsis; 4) water and food
The importance of infectioncontrol in clinical care has long been recognised by healthcare practitioners (Meers et al, 1981), but in the last decade the public have become much more aware of healthcare-associated infections through the media and in particular its attention to MRSA and the increase in rates in the UK (BBC, 2005a). Clostridium difficile has added to the
Background:Control chart methodology has been widely touted for monitoring and improving quality in the health care setting. P charts and U charts are frequently recommended for rate and ratio statistics, but their practical value in infectioncontrol may be limited because they (1) are not risk-adjusted, and (2) perform poorly with small denominators. The Standardized Infection Ratio is a statistic
ExtractIn spite of numerous publications on the salmonellae and their effects on various hosts, few countries can assess accurately the annual toll of human illness or economic losses in. livestock as a result of these infections. Attempts are being made, at both international and national levels, to remedy this deficiency, particularly as food-borne salmonellosis in countries with high standards of
The general setting for the management of many European hospitals has undergone enormous changes during the last five to 10 years, especially with respect to economic, personnel and technical resources. This change has had a serious influence on the practice of infectioncontrol. To get an insight of the problems infectioncontrol practitioners in Europe today have to face, hospital epidemiologists representing nine European countries were asked to answer a questionnaire. In most countries, new laws on communicable disease prevention and infectioncontrol in hospitals have been implemented during the last few years. In conjunction with the widespread introduction of quality assurance and the accreditation of hospitals, organizational aspects of infectioncontrol have gained importance. However, budget restrictions and the growing competition between institutions are major challenges. In general, there has been a remarkable influence of the documented changes on the practice of infectioncontrol in European hospitals. Facing this situation, infectioncontrol practitioners should abandon unproven measures and implement those that are evidence-based, to prevent hospital acquired infection (HAI). Cost reducing initiatives, like the use of well designed multi-use devices and the reuse of disposables should be considered and scientifically assessed. PMID:10658774
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 randomized control trial. Behavioral activation was consistently superior to wait list and treatment as usual
...Condition of participation: Infectioncontrol. 482.42 Section 482...Condition of participation: Infectioncontrol. The hospital must provide...persons must be designated as infectioncontrol officer or officers to...
...Condition of participation: Infectioncontrol. 482.42 Section 482...Condition of participation: Infectioncontrol. The hospital must provide...persons must be designated as infectioncontrol officer or officers to...
Standardised training curricula for infectioncontrol nurses (ICNs) and recognition of the specialty exist in many European countries, but infectioncontrol physician (ICP) is not a specialty recognised by the UEMS. To gather information on curricula for ICPs, members of the ESCMID Study Group on Nosocomial Infections received a questionnaire. There is discussion about which 'professions' should be included in an infectioncontrol team. Within the 12 countries included, the average full-time equivalents (FTEs) for ICPs and ICNs per 1000 beds were 1.2 and 3.4, respectively. In addition to ICNs and ICPs, an infectioncontrol team should also include a data manager, an epidemiologist, secretarial/administrative support, and possibly, surveillance technicians. Overall, the composition of an ideal infectioncontrol team was estimated to be 9.3 FTE per 1000 beds. The background of ICPs can be clinical microbiology or infectious diseases. Among the participants, it was predominantly clinical microbiology. The ideal training curriculum for the ICP should include 6 years of postgraduate training. Of these, at least 2 years should be 'clinical training' (e.g., internal medicine) to acquire experience in the management of high-risk patients. Furthermore, training with regard to infectioncontrol and hospital epidemiology should be offered as a 'common trunk' for those being trained in clinical microbiology or infectious diseases. Important issues that remain are: implementation/standardisation of training curricula for doctors, recognition of ICP as a separate specialty or sub-specialty of clinical microbiology and/or infectious diseases, validation of on-the-job training facilities in terms of the number of doctors and nurses who can give training and the category of patients/problems present, and mandatory postgraduate education/continuing medical education specific for infectioncontrol for doctors and nurses in the field. PMID:15760441
ISSUE: Beth Israel Medical Center (BIMC)—Petrie Division is an 850-bed tertiary-care hospital located in New York City. The InfectionControl Department (IC) has made major efforts to educate all levels of staff on infectioncontrol policies and practices. Because the nursing staff has very complicated work schedules, a self-learning module was developed to improve education on infectioncontrol topics for
B. Koll; B. Raucher; J. Reich; I. Jabara; G. Fraser
Evidencebased medicine (EBM) considered one of the most important developments in the practice of medicine in recent years, has evolved as a tool for improving the quality of health care. Several studies have shown EBM to be safe and cost-effective. Physicians have welcomed EBM and shown a positive attitude toward it and have expressed desire to learn more about it. This is consistent in most studies done in different countries. However, some studies found considerable misunderstanding about terms and websites used in EBM. The major barriers to the practice of EBM perceived by physician in different studies include insufficient time and evidence, patients’ preference and financial constraints. Training has been found to be conducive to the implementation and promotion of EBM. Some Arab countries are already implementing EBM and plan to include it in the undergraduate curriculum. In Saudi Arabia EBM was introduced in the late 90's and a National EBM Advisory Board was formed.
Many occupational therapy practitioners consider evidence-based practice (EBP) to be the means by which occupational therapy can prove the validity of its services and thus support the legitimacy of our profession. The unquestioned acceptance of EBP as the way to establish credibility concerns me; unchallenged acceptance of any idea concerns me. Do practitioners accept EBP as the paradigm for guiding occupational therapy practice and research solely because it is presented as what we must do? I believe that practitioners must examine the implications for our profession of accepting EBP without question. In this article, I review EBP, present criticisms and concerns voiced by other professions and, finally, examine the implications of adopting an EBP perspective that replaces theory-directed practice. PMID:23433283
BACKGROUND: The results of randomised controlled trials can be usefully illuminated by studies of the processes by which they achieve their effects. The Theory of Planned Behaviour (TPB) offers a framework for conducting such studies. This study used TPB to explore the observed effects in a pragmatic cluster randomised controlled trial of a structured recall and prompting intervention to increase
Jillian J Francis; Martin P Eccles; Marie Johnston; Paula Whitty; Jeremy M Grimshaw; Eileen FS Kaner; Liz Smith; Anne Walker
Evidence-based practice (EBP) is the process of using current, best evidence to guide nursing care and improve patient outcomes. This article discusses the differences between research and EBP, reviews the process of EBP, and applies EBP guidelines to central catheter infections, a clinical problem relevant to infusion nursing. PMID:20631583
Information from peer-reviewed articles, guidelines from professional societies and manufacturers' instructions were considered to determine the risk factors in optometric practice and to make recommendations for disinfection, sterilisation and reprocessing of instrumentation and other equipment used in practice and measures for personal protection. Wherever possible, all practitioners should adopt measures to decrease the risk of transmission of infection, such as single use instruments/equipment, appropriate methods of reprocessing where items are reused, routine employment of standard infectioncontrol precautions and application of more rigorous procedures for infected or immuno-suppressed individuals. PMID:17958566
Lakkis, Carol; Lian, Ka-Yee; Napper, Genevieve; Kiely, Patricia M
Health care related infections are expensive untoward events, not only in terms of morbidity and mortality, but also cost. Prevention is essential, as well as limiting dissemination. Specify measures refer usually to hospital hygiene. However, health care tend to be provided more and more outside of the acute care hospital, with increasing complexity and thus risk for health care related infections. This risk varies according to patient's characteristics as well as environmental parameters. Consequently, it is essential to adapt preventive measures to situations such as home health care or nursing homes. We describe a model of regional organization for infectioncontrol in various health care settings. PMID:18078188
Sordet, C; Blanchard, L; Besson, C; Christin, L; Valle, G; Risuleo, M; Regard, C Schmider
ABSTRACT: 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
Sexually transmitted infections other than HIV are important global health issues. They have, however, been neglected as a public-health priority and control efforts continue to fail. Sexually transmitted infections, by their nature, affect individuals, who are part of partnerships and larger sexual networks, and in turn populations. We propose a framework of individual, partnership, and population levels for examining the effects of sexually transmitted infections and interventions to control them. At the individual level we have a range of effective diagnostic tests, treatments, and vaccines. These options are unavailable or inaccessible in many resource-poor settings, where syndromic management remains the core intervention for individual case management. At the partnership level, partner notification and antenatal syphilis screening have the potential to prevent infection and re-infection. Interventions delivered to whole populations, or groups in whom the risks of infection and onward transmission are very high, have the greatest potential effect. Improvements to the infrastructure of treatment services can reduce the incidence of syphilis and gonorrhoea or urethritis. Strong evidence for the effectiveness of most other interventions on population-level outcomes is, however, scarce. Effective action requires a multifaceted approach including better basic epidemiological and surveillance data, high quality evidence about effectiveness of individual interventions and programmes, better methods to get effective interventions onto the policy agenda, and better advocacy and more commitment to get them implemented properly. We must not allow stigma, prejudice, and moral opposition to obstruct the goals of infectious disease control. PMID:17141708
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.
This paper describes findings from the Community Youth Development Study (CYDS), a randomized controlled trial of the Communities That Care (CTC) prevention system, on the adoption and implementation fidelity of science-based prevention programming in 24 communities. Data were collected using the Community Resource Documentation (CRD), which entailed a multi-tiered sampling process and phone and web-based surveys with directors of community-based agencies and coalitions, school principals, service providers, and teachers. Four years after the initiation of the CTC prevention system, the results indicated increased use of tested, effective prevention programs in the 12 CTC intervention communities compared to the 12 control communities, and significant differences favoring the intervention communities in the numbers of children and families participating in these programs. Few significant differences were found regarding implementation quality; respondents from both intervention and control communities reported high rates of implementation fidelity across the services provided. PMID:21667142
Fagan, Abigail A; Arthur, Michael W; Hanson, Koren; Briney, John S; Hawkins, J David
Dust, a Substance Hazardous to Health comes under the Control of Substances Hazardous to Health Regulations (COSHH) 2002. Numerous Health care workers are exposed to human nail dust - e.g. chi- ropodists, podiatrists, podologists, and beauticians. This paper outlines UK guidelines, reducing exposure to adverse health effects of exposure to human nail dust. A microbiological risk assessment method was under-
The practice of evidence-based medicine involves the integration of individual clinical expertise with the best available external clinical evidence from the systematic retrieval of the most current literature. Clinicians need to conduct a critical appraisal of the medical articles they access. However, clinicians in developing countries usually lack access to the best resources for evidence-based practice (EBP). The abstracts of 100 of the most recently published randomised controlled trials were used in the present study. These abstracts were critically appraised using a new questionnaire. Questions 1 to 8 were answerable by 38%, 26%, 52%, 23%, 12%, 53%, 36% and 12%, respectively, of the examined summaries. EBP requires better access to medical resources. Therefore, the summaries of relevant studies should be complete and self-sufficient to support EBP. This means a research summary should adequately report the findings of a clinical trial without needing to access the full text. PMID:22672605
American recognition for medical pluralism arrived in 1991. The National Center for Complementary and Alternative Medicine was established under the National Institutes of Health in 1998. Following this, patients and researchers began exploring use of integrative medicine. Terence Ryan with Gerry Bodeker in Europe, Brian Berman in America, and the Indian council of Medical Research advocated traditional medicine and integrative medicine. The Institute of Applied Dermatology (IAD), Kerala has developed integrated allopathic (biomedical) and ayurvedic therapies to treat Lymphatic Filariasis, Lichen planus, and Vitiligo. Studies conducted at the IAD have created a framework for evidence-based and integrative dermatology (ID). This paper gives an overview of advances in ID with an example of Lichen Planus, which was examined jointly by dermatologists and Ayurveda doctors. The clinical presentation in these patients was listed in a vikruthi table of comparable biomedical terms. A vikruthi table was used for drug selection in ayurvedic dermatology. A total of 19 patients were treated with ayurvedic prescriptions to normalize the vatha-kapha for 3 months. All patients responded and no side effects were recorded. In spite of advancing knowledge on ID, several challenges remain for its use on difficult to treat chronic skin diseases. The formation of new integrative groups and financial support are essential for the growth of ID in India.
Narahari, Saravu R; Prasanna, Kodimoole S; Sushma, Kandathu V
Introduction The tobacco control effort in Turkey has made significant progress in recent years. Turkey initiated its tobacco control effort with the passing of Law 4207 (The Prevention of Harmful Effects of Tobacco Products) in 1996 and ratified the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) in 2004. It is important to base policy decisions on valid and reliable evidence from population-based, representative studies that are periodically repeated to enable policy makers to monitor the results of their interventions and to appropriately tailor anti-tobacco activities towards future needs. Methods The Global Youth Tobacco Survey (GYTS) was developed to track tobacco use among young people and enhance the capacity of countries to design, implement, and evaluate tobacco control and prevention programs. Turkey conducted the GYTS in 2003 and data from this survey can be used as baseline measures for evaluation of the tobacco control programs implemented by the Ministry of Health (MOH) of the Turkish government. Results The GYTS was conducted in 2003 on a representative sample of students aged 13 to 15 years. It indicated that almost 3 in 10 students in Turkey had ever smoked cigarettes, with significantly higher rates among boys. Current cigarette smoking rates were lower, at 9% for boys and 4% for girls. The prevalence of current use of other tobacco products was about half these figures for each gender. About 80% were exposed to secondhand smoke. Exposure to pro-smoking media messages was not rare. Almost half of the smokers 'usually' bought their tobacco from a store, despite the law prohibiting this. Exposure to teaching against smoking in schools was not universal. Conclusion Findings from the GYTS, with periodic repeats of the survey, can be used to monitor the impact of enforcing various provisions of the present law (No: 4207), the progress made in achieving the goals of the WHO FCTC, and the effectiveness of various preventive interventions against smoking. Such data would inform and help in the development of public health strategy.
Background To evaluate the effectiveness of a multifaceted implementation strategy on physicians’ referral rate to and knowledge on the community occupational therapy in dementia program (COTiD program). Methods A cluster randomized controlled trial with 28 experimental and 17 control clusters was conducted. Cluster included a minimum of one physician, one manager, and two occupational therapists. In the control group physicians and managers received no interventions and occupational therapists received a postgraduate course. In the experimental group physicians and managers had access to a website, received newsletters, and were approached by telephone. In addition, physicians were offered one outreach visit. In the experimental group occupational therapists received the postgraduate course, training days, outreach visits, regional meetings, and access to a reporting system. Main outcome measure was the number of COTiD referrals received by each cluster which was assessed at 6 and 12 months after the start of the intervention. Referrals were included from both participating physicians (enrolled in the study and received either the control or experimental intervention) and non-participating physicians (not enrolled but of whom referrals were received by participating occupational therapists). Mixed model analyses were used to analyze the data. All analyses were based on the principle of intention-to-treat. Results At 12 months experimental clusters received significantly more referrals with an average of 5,24 referrals (SD 5,75) to the COTiD program compared to 2,07 referrals in the control group (SD 5,14). The effect size at 12 months was 0.58. Although no difference in referral rate was found for the physicians participating in the study, the number of referrals from non-participating physicians (t ?2,55 / 43 / 0,02) differed significantly at 12 months. Conclusion Passive dissemination strategies are less likely to result in changes in professional behavior. The amount of physicians exposed to active strategies was limited. In spite of this we found a significant difference in the number of referrals which was accounted for by more referrals of non-participating physicians in the experimental clusters. We hypothesize that the increase in referrals was caused by an increase in occupational therapists’ efforts to promote their services within their network. Trial registration NCT01117285
Healthcare delivery has moved from acute care hospitals to multiple settings, including subacute care, long-term care or nursing\\u000a home (NH), rehabilitation, assisted living, home, and outpatient settings.\\u000a \\u000a These transitions provide an opportunity for pathogens to be transferred from one setting to another.\\u000a \\u000a \\u000a Nursing homes should design their infectioncontrol programs based on the population that they serve.\\u000a \\u000a \\u000a Infectioncontrol programs
Monitoring the current status of cancer care is essential for effective cancer control and high-quality cancer care. To address the information needs of patients and physicians in Japan, hospital-based cancer registries are operated in 397 hospitals designated as cancer care hospitals by the national government. These hospitals collect information on all cancer cases encountered in each hospital according to precisely defined coding rules. The Center for Cancer Control and Information Services at the National Cancer Center supports the management of the hospital-based cancer registry by providing training for tumor registrars and by developing and maintaining the standard software and continuing communication, which includes mailing lists, a customizable web site and site visits. Data from the cancer care hospitals are submitted annually to the Center, compiled, and distributed as the National Cancer Statistics Report. The report reveals the national profiles of patient characteristics, route to discovery, stage distribution, and first-course treatments of the five major cancers in Japan. A system designed to follow up on patient survival will soon be established. Findings from the analyses will reveal characteristics of designated cancer care hospitals nationwide and will show how characteristics of patients with cancer in Japan differ from those of patients with cancer in other countries. The database will provide an infrastructure for future clinical and health services research and will support quality measurement and improvement of cancer care. Researchers and policy-makers in Japan are encouraged to take advantage of this powerful tool to enhance cancer control and their clinical practice. PMID:23448800
The present study uses a within-group controlled design to examine the efficacy and safety of two psychological approaches to posttraumatic stress disorder (PTSD) in 10 patients with a concurrent psychotic disorder. Patients were randomly assigned either to prolonged exposure (PE; N=5) or eye movement desensitization and reprocessing (EMDR; N=5). Before, during, and after treatment, a total of 20 weekly assessments of PTSD symptoms, hallucinations, and delusions were carried out. Twelve weekly assessments of adverse events took place during the treatment phase. PTSD diagnosis, level of social functioning, psychosis-prone thinking, and general psychopathology were assessed pretreatment, posttreatment, and at three-month follow-up. Throughout the treatment, adverse events were monitored at each session. An intention-to-treat analysis of the 10 patients starting treatment showed that the PTSD treatment protocols of PE and EMDR significantly reduced PTSD symptom severity; PE and EMDR were equally effective and safe. Eight of the 10 patients completed the full intervention period. Seven of the 10 patients (70%) no longer met the diagnostic criteria for PTSD at follow-up. No serious adverse events occurred, nor did patients show any worsening of hallucinations, delusions, psychosis proneness, general psychopathology, or social functioning. The results of this feasibility trial suggest that PTSD patients with comorbid psychotic disorders benefit from trauma-focused treatment approaches such as PE and EMDR. PMID:24094795
de Bont, Paul A J M; van Minnen, Agnes; de Jongh, Ad
The complexity of surveillance, prevention, and control of nosocomial infections has increased over the last decades, owing to reductions in the length of hospital stay, health care practice outside of the hospital (home care, day hospital care, long-term care facilities, nursing homes), the increase in the number of elderly patients, new and emerging diseases, multidrug-resistant pathogens, and the administrative requirements for accreditation. In this setting, infectioncontrol nurses are progressively assuming new responsibilities in addition to infectioncontrol, such as ensuring the safety of the patient, guaranteeing health care quality, and other tasks. In the light of these changes, professional organizations of infectioncontrol personnel have voiced the opinion that staffing for infectioncontrol work should not be based solely on the number of hospital beds, but also on the complexity of the tasks involved, which should be defined according to standardized criteria and infectioncontrol indicators. In addition, the cost-benefit relationship of infectioncontrol programs should be demonstrated. PMID:19386388
|Results from 1982 and 1987 surveys of dental schools concerning infectioncontrol 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.…
Purpose – The purpose of this research is to explore healthcare workers' infectioncontrol practices from a behavioural viewpoint. Major behavioural theories are explored. Findings from a study which drew heavily from the PRECEDE theoretical framework are presented. The main purpose of this quasi-experimental study was to observe health care workers' behavioural compliance with hand hygiene guidelines during patient care
Background: Studies conducted in the first decade of the AIDS epidemic indicated that, in general, dentists had suboptimal levels of compliance with standard infectioncontrol practices, including work practices designed to reduce exposure to bloodborne pathogens. This study was designed to assess current rates of compliance with these practices in a population of Maryland dentists and to identify correlates of
Robyn R. M. Gershon; Christine Karkashian; David Vlahov; Martha Grimes; Elizabeth Spannhake
Results from 1982 and 1987 surveys of dental schools concerning infectioncontrol 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.…
Outpatient procedures have become more complex, requiring outpatient providers to offer technical procedures in the home, office, and clinic. This shift in health care has brought about the need for staff members to become proficient in a variety of technical procedures that were once done only in the hospital setting. Outpatient i.v. therapy has caused home health care agencies, physicians' offices, and clinics to seek education and training regarding i.v. therapy and to develop basic infection-control guidelines and guidelines related to the insertion and maintenance of i.v. devices. The goals of the outpatient provider are to prevent i.v.-related complications and to provide quality patient care. These can be accomplished by strict adherence to sound infection-control guidelines and routine monitoring of procedure techniques and complications of care. Outpatient providers may wish to seek expertise and guidance from hospital infection-control personnel, infectious diseases specialists, or other infection-control consultants to meet the demands of the complexity of outpatient care. PMID:9888034
The article explores the impact of the `transformational leadership' style in the role of modern matron with regards to infectioncontrol practices. Policy and guidance on the modern matron role suggest that it is distinctive in its combination of management and clinical components, and in its reliance on transformational leadership. Senior nurses are therefore expected to motivate staff by creating
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 infectioncontrol 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
Microbiology and epidemiology have made significant contributions to the field of InfectionControl. Most nosocomial infections which can be prevented are related to inappropriate patient care practices. However, it is extremely difficult to implement new infectioncontrol policies. To achieve staff compliance, infectioncontrol should learn from the behavioural sciences. Three related fields have been shown to be helpful in
Hospital infectioncontrol in Thailand was initiated in 1971, but it was not until 1987 that active infectioncontrol activities actually started. To evaluate the efficacy of the infectioncontrol programme, two national prevalence studies of hospital acquired infection (HAI) were undertaken. The HAI prevalence rate in 1988 was 11·7%; this was reduced to 7·3% four years later. The reduction
S. Danchaivijitr; T. Tangtrakool; S. Waitayapiches; S. Chokloikaew
Home health care infectioncontrol programs are multifaceted and involve every member of a home care agency. The infectioncontrol process involves five key areas: staff education, detailed policy and procedures, documentation of an infection, surveillance of the program, and a quality\\/performance improvement aspect. As home health care agencies move toward outcome measures, a comprehensive infectioncontrol program is key
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
A B S T R A C T Evidence-based dentistry is a discipline that provides best, explicit-based evidence to dentists and their patients in shared decision-making. Currently, dentists are being trained and directed to adopt the role of translational researchers in develop- ing evidence-based dental practices. Practically, evidence-based dentistry is not usable in its current mode for the provision of
The evidence-based practice movement has become an important feature of health care systems and health care policy. Within this context, the APA 2005 Presidential Task Force on Evidence-Based Practice defines and discusses evidence-based practice in psychology (EBPP). In an integration of science and practice, the Task Force’s report describes psychology’s fundamental commitment to sophisticated EBPP and takes into account the
...HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention Healthcare InfectionControl Practices Advisory Committee (HICPAC...CDC, regarding (1) the practice of infectioncontrol; (2) strategies for surveillance,...
The paper examines the possible sources of infection on an international aircraft, including the provision of food, the supply of drinking water, and the removal of waste. It considers aspects of control, and explains some of the steps which have to be taken by a major international carrier to ensure that the high quality expected by the customer is provided in all areas of the world, even those where natural resources and expertise may be limited. The emphasis is on providing a safe product, and removing any possible risk of infection of the passengers. PMID:8495009
The epidemiological situation of tuberculosis (TB) in Germany has improved considerably during the past few years. However, those in unprotected contact with infectious tuberculosis patients frequently and/or over longer periods of time and/or intensively continue to have a higher risk for TB infection. Rapid diagnosis, prompt initiation of effective treatment, and adequate infectioncontrol measures are of particular importance to prevent infection. The present recommendations depict the essentials of infectioncontrol as well as specific measures in the hospital (isolation, criteria for its duration and technical requirements, types of respiratory protection, disinfection measures, waste disposal). The specific requirements for outpatients (medical practice), at home, for ambulance services, and in congregate settings, including prisons, are also addressed. Compared with the previous recommendations the pattern of respiratory protection measures has been simplified. As a rule, hospital staff and those visiting infectious tuberculosis patients are advised to wear respiratory protection that satisfies the criteria of FFP2-masks (DIN EN 149), while patients should wear mouth-nose protectors (surgical masks) in the presence of others and outside the isolation room. A detailed depiction of criteria for isolation and its duration in smear positive and only culturally confirmed pulmonary tuberculosis has been added. PMID:22723258
Synopsis The article focuses on the evidence basis for the management of benign paroxysmal positional vertigo (BPPV), the most common diagnosis of vertigo in both primary care and subspecialty settings. Like all articles in this compilation of evidence-based practice, an overview is presented along with evidencebased clinical assessment, diagnosis, and management. Summaries of differential diagnosis of vertigo and outcomes are presented.
... National Institutes of Health www.nih.gov • The Cochrane Collaboration www.cochrane.org • Centre for Evidence-Based Medicine www.cebm. ... No. 8 Sources: National Institutes of Health, The Cochrane Collaboration, Centre for Evidence-Based Medicine, American Heart ...
|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…
|Objectives: The purpose of this article is to describe several evidence-based clearinghouses focused on social work and related intervention outcomes, placing them in the context of how such clearinghouses can contribute to research dissemination to foster effective, evidence-based practice. Method: The study employed an analysis of data provided…
Evidence-based practice has become part of the language of health care. This article illustrates the professional implications for orthopaedic nurses and the challenges it raises for current and future practice development. The article suggests steps for developing an evidence-based approach to orthopaedic practice, the necessary skills nurses need to develop, and the benefits of a multidisciplinary view in developing practice.
This article focuses on the 2005 American Psychological Association Presidential Task Force on Evidence-Based Practice in Psychology. After describing the rationale and results of this task force, the authors review the literature that has appeared following the approval of the Policy Statement on Evidence-Based Practice in Psychology by the American Psychological Association Council of Representatives, with reference to the implications
|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…
Mullen, Edward J.; Bledsoe, Sarah E.; Bellamy, Jennifer L.
In this column, a reader identifies the importance of accurate, up-to-date information in making informed decisions. She is shocked to find that the Lamaze classes she observes are not evidence-based. Evidence-based practice is described, and examples of the use of best evidence in childbirth classes are discussed. The implications for childbirth education are explored.
The American Association of Nurse Anesthetists Practice Committee applies a standardized evidence-based process to the development and revision of practice-related documents and member resources. This article highlights recent Practice Committee work related to the revision and development of new materials for the Professional Practice Manual for the Certified Registered Nurse Anesthetist. Specific areas discussed include infectioncontrol, Certified Registered Nurse Anesthetists and the interprofessional team, safe practices for needle and syringe use, securing propofol, safe surgery and anesthesia, patient safety and fatigue, and the use of mobile devices. PMID:23513315
With the advent of the Controls Assurance Standards (NHS Executive, 1999), Clinical Governance (1999), The Management and Control of Hospital Acquired Infections in Acute NHS Trusts in England (Department of Health, 2000) and other circulars and directives, the role of the infectioncontrol nurse has never been so challenging, putting infectioncontrol firmly on the government and public agenda.In line
Hospital-acquired infection poses significant clinical and economic burden worldwide. In the Kingdom of Saudi Arabia, infectioncontrol is a young, rapidly growing specialty. An infrastructure to expedite the growth of this important discipline is fast being established. The kingdom faces unique challenges when addressing infectioncontrol, which are the subject of this review. Much of the policy-making in domestic infection
...Agencies, and Public Health Agencies as Providers of Outpatient Physical Therapy and Speech-Language Pathology Services Â§ 485...Infectioncontrol. The organization that provides outpatient physical therapy services establishes an infection-control...
...Agencies, and Public Health Agencies as Providers of Outpatient Physical Therapy and Speech-Language Pathology Services Â§ 485...Infectioncontrol. The organization that provides outpatient physical therapy services establishes an infection-control...
This guideline updates and replaces the previous edition of the Centers for Disease Control and Prevention (CDC) 'Guideline for InfectionControl in Hospital Personnel,' published to provide methods for reducing the transmission of infections from patient...
E. A. Bolyard O. C. Tablan W. W. Williams M. L. Pearson C. N. Shapiro S. D. Deitchman
The attitudes to cross-infectioncontrol 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-infectioncontrol 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
Evidence-based medicine (EBM) is increasingly important for clinical surgery and for promotion of best practices into surgical decision making. Although barriers exist in the current surgical literature, for certain surgical scenarios, formal efforts to promote evidence-based surgery (EBS) into surgical education are helping to equip future surgeons with these important tools for optimizing patient care. As our evidence-base grows and standards of care evolve, incorporating EBM into everyday practice for trainees and staff surgeons remains an ongoing challenge.
...effective infectioncontrol program that...controllinginfections and communicable...Standard: Prevention. The hospice...accepted standards of practice to...transmission of infections and communicable...including the use of standard precautions...Standard: Control. The hospice...identification, prevention,...
...effective infectioncontrol program that...controllinginfections and communicable...Standard: Prevention. The hospice...accepted standards of practice to...transmission of infections and communicable...including the use of standard precautions...Standard: Control. The hospice...identification, prevention,...
Hospital risk management demands the development of broad and inclusive infectioncontrol policies. This is particularly true for anaesthetic equipment where appropriate recommendations on decontamination measures remains a difficult subject for infectioncontrol teams since there are no national guidelines. It is a topic which has perhaps been neglected in hospital infectioncontrol policies despite the widespread use of anaesthetic
Originating in England, infectioncontrol nurse posts have become well established throughout the world over the last 45 years. As health care during this time has changed, so has the role of the infectioncontrol nurse. However, some of the role components and the challenges faced are the same in 2005 as they were in 1959. While infectioncontrol nurses
Link nurses act as a link between their own clinical area and the infectioncontrol team. Their role is to increase awareness of infectioncontrol issues in their ward and motivate staff to improve practice. It is essential that they receive training from the infectioncontrol team to ensure their competence. They have been shown to be of value to
Ideally, practice guidelines for cancer prevention should reflect the available empirical evidence. Although the most persuasive arguments for the efficacy of an intervention come from randomized controlled trials (RCTs), such studies are not always feasible because of ethical or logistical reasons. The advent of evidence-based medicine has underscored the need for consortia of researchers specialized in reviewing the biomedical literature
Eduardo L. Franco; Eliane Duarte-Franco; Thomas E. Rohan
New studies of the treatment of neuropathic pain have increased the need for an updated review of randomized, double-blind, placebo-controlled trials to support an evidencebased algorithm to treat neuropathic pain conditions. Available studies were identified using a MEDLINE and EMBASE search. One hundred and five studies were included. Numbers needed to treat (NNT) and numbers needed to harm (NNH)
N. B. Finnerup; M. Otto; H. J. McQuay; T. S. Jensen; S. H. Sindrup
Currently, professionals in all fields that work with students with disabilities, including education, face a “demand” that their decisions about which interventions to use be guided by evidence-based practices. The “gold standard” for evaluating the effectiveness of interventions is the use of randomized, controlled trials that are well designed and implemented. In this article, the author identifies the challenges in
The present study proposes a fuzzy mathematical model of HIV infection consisting of a linear fuzzy differential equations (FDEs) system describing the ambiguous immune cells level and the viral load which are due to the intrinsic fuzziness of the immune system's strength in HIV-infected patients. The immune cells in question are considered CD4+ T-cells and cytotoxic T-lymphocytes (CTLs). The dynamic behavior of the immune cells level and the viral load within the three groups of patients with weak, moderate, and strong immune systems are analyzed and compared. Moreover, the approximate explicit solutions of the proposed model are derived using a fitting-based method. In particular, a fuzzy control function indicating the drug dosage is incorporated into the proposed model and a fuzzy optimal control problem (FOCP) minimizing both the viral load and the drug costs is constructed. An optimality condition is achieved as a fuzzy boundary value problem (FBVP). In addition, the optimal fuzzy control function is completely characterized and a numerical solution for the optimality system is computed.
Zarei, Hassan; Kamyad, Ali Vahidian; Heydari, Ali Akbar
The vast amount of clinical information available today and the difficulties that clinicians have in applying this information\\u000a have given rise to interest in evidence-based medicine. An additional impetus for the development of the evidencebased medicine\\u000a movement has been the increasing recognition that much of medical practice is not evidence-based. This article presents a\\u000a brief overview of the principles of
AimTo study the overall level of evidence-based practice in an accident and emergency eye unit in the UK and evaluate the extent of evidence-based practice by ophthalmologists and nurse practitioners (NPs).MethodsThe case notes of all new patients attending our accident and emergency department for a period of 1 week were reviewed prospectively. For each case, the diagnosis at presentation and
The purpose of this article is to discuss evidence-based practice (EBP) from the perspective of a self-identified evidence-based practitioner. Discussion of EBP includes choosing an initial intervention and evaluation procedures, the iterative process of rechoosing and refining an intervention over the treatment life span, and the importance of evi- dence within the specific clinical situation. Two illustrative case studies are
This article employs the process of critical reflection to uncover and challenge the hegemonic assumptions of evidence-based practice (EBP). The critical reflection process results in a re-conceptualisation of best practices that, while still honouring empirical research, is less hierarchical and more inclusive of a broad spectrum of interests than traditional EBP. Multidimensional Evidence-Based Practice (MEBP) validates consumer wisdom, professional experience,
Prevention of nosocomial infection is a key part of good neonatal care. In particular, methicillin resistant Staphylococcus aureus (MRSA) is an important pathogen with screening for colonisation now commonplace. There appear wide variations in infectioncontrol practices in UK neonatal units.AimsThe aim of this survey was to determine the impact of infectioncontrol problems, and to evaluate the differences in
The infectioncontrol team can provide education by a variety of methods. One cheap and effective method is by the use of newsletters. In our small survey only one department produced a newsletter, although almost half produced articles for a Trust publication. Maybe with the introduction of managed clinical networks into pathology, newsletters could be produced jointly by departments and
Background: Nosocomial infections (NIs) are a serious patient safety issue. Infectioncontrol personnel are responsible for implementing interventions to reduce this risk. The purpose of this systematic review was to audit the published economic evidence of the attributable cost of NIs and interventions conducted by infectioncontrol professionals and to evaluate the methods used. Economic evaluation methodology and recommendations for
Patricia W. Stone; Elaine Larson; Lina Najib Kawar
Babesia bovis causes an acute and often fatal infection in adult cattle, which if resolved, leads to a state of persistent infection in otherwise clinically healthy cattle. Persistently infected cattle are generally resistant to reinfection with related parasite strains, and this resistance in the face of infection is termed concomitant immunity. Young animals are generally more resistant than adults to
Wendy C. Brown; Junzo Norimine; Donald P. Knowles; Will L. Goff
Many evidence-based interventions fail to translate into routine care for individuals experiencing significant mental health disorders. Moving the evidence-based intervention from the controlled research settings to the broader mental health systems is an ongoing challenge for administrators and practitioners in the mental health delivery network. In the United States, the movement to bring evidence-based mental health interventions into the public
Three decades ago infection-control programmes were created to control antibiotic-resistant nosocomial infections, but numbers of these infections have continued to increase, leading many to question whether control is feasible. Meticillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci were major problems during the 1990s. Many hospitals have tried antibiotic control but with limited efficacy against these pathogens. Studies of antibiotic restriction, substitution, and
Barry M Farr; Cassandra D Salgado; Tobi B Karchmer; Robert J Sherertz
\\u000a After reading this chapter and answering the discussion questions that follow, you should be able to\\u000a \\u000a \\u000a \\u000a • \\u000a \\u000a \\u000a Present a synopsis of the status of evidence-based global maternal and child health practice and policy, with particular emphasis\\u000a on developing countries.\\u000a \\u000a \\u000a \\u000a \\u000a • \\u000a \\u000a \\u000a Discuss the methods, advantages and criticisms of evidence-based practice.\\u000a \\u000a \\u000a \\u000a • \\u000a \\u000a \\u000a Discuss relevant historical milestones in the emergence of the evidence-based
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.
Ventilator associated pneumonia (VAP) is the leading cause of morbidity and mortality in intensive care units. The incidence of VAP varies from 7% to 70% in different studies and the mortality rates are 20–75% according to the study population. Aspiration of colonized pathogenic microorganisms on the oropharynx and gastrointestinal tract is the main route for the development of VAP. On the other hand, the major risk factor for VAP is intubation and the duration of mechanical ventilation. Diagnosis remains difficult, and studies showed the importance of early initiation of appropriate antibiotic for prognosis. VAP causes extra length of stay in hospital and intensive care units and increases hospital cost. Consequently, infectioncontrol policies are more rational and will save money.
...HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention Healthcare InfectionControl Practices Advisory Committee (HICPAC) In...L. 92-463), the Centers for Disease Control and Prevention (CDC) announce the...
The aim of evidence-based medicine is to support clinical decision making by providing tools for systematically locating, appraising, and applying the best information currently available to improve patient outcomes. This article summarizes the basic steps for practicing evidence-based medicine in the management of cutaneous diseases. Special emphasis is placed on the following 4 major steps in the process: asking a clinical question taking into consideration 4 elements; finding the evidence; critically appraising the evidence; and integrating the new information into clinical expertise and judgment, in order to make the best decision in each clinical setting. PMID:19445872
The poor translation of evidence into practice is a well-known problem. Hopes are high that information technology can help make evidence-based practice feasible for mere mortal physicians. In this paper, we draw upon the methods and perspectives of clinical practice, medical informatics, and health services research to analyze the gap between evidence and action, and to argue that computing systems for bridging this gap should incorporate both informatics and health services research expertise. We discuss 2 illustrative systems—trial banks and a web-based system to develop and disseminate evidence-based guidelines (alchemist)— and conclude with a research and training agenda.
The conditions of space travel create a unique challenge to infection prevention. Ground-based and in-flight research has demonstrated multiple alterations in the immune system that likely increase the risk of infection caused by intracellular and extrace...
BACKGROUND: Psychological theories of behaviour may provide a framework to guide the design of interventions to change professional behaviour. Behaviour change interventions, designed using psychological theory and targeting important motivational beliefs, were experimentally evaluated for effects on the behavioural intention and simulated behaviour of GPs in the management of uncomplicated upper respiratory tract infection (URTI). METHODS: The design was a
Susan Hrisos; Martin Eccles; Marie Johnston; Jill Francis; Eileen FS Kaner; Nick Steen; Jeremy Grimshaw
In this article, we review a newly developed evidence-based immersive simulation experience for use with health care personnel and students. The article provides information necessary for infectioncontrol professionals to understand the development process of the training. Evidence supporting the use of such training is provided, and opportunities to integrate this training into the health care setting and classroom are discussed. PMID:21784556
Farley, Jason E; Doughman, Danielle; Jeeva, Rani; Jeffries, Pamela; Stanley, Joan M
Some providers of health care within the European Union (EU)—whether public or private—seem to give little priority to the establishment of quality control and common standards for infectioncontrol. Though uniform practice of infectioncontrol in hospitals was recommended by The Council of Europe no formal declaration about conformity or quality assessment of this important area seems to have been
A symposium was held in June 2009 near Freiburg in Germany. Twenty-nine attendees from several European countries participated, most of whom are actively involved in research and hospital infection prevention and control. The following topics were presented and discussed: isolation and screening for control of multidrug-resistant organisms; impact of the environment on healthcare-associated infection (HAI); new technologies to controlinfection--state
M. Dettenkofer; A. Ammon; P. Astagneau; S. J. Dancer; P. Gastmeier; S. Harbarth; H. Humphreys; W. V. Kern; O. Lyytikäinen; H. Sax; A. Voss; A. F. Widmer
Evidence-based medicine, with its capacity to improve patient outcomes, has grown prominent throughout the medical field. Otolaryngology is at a crucial stage in the expansion of evidence-based medicine, with its impact seen in many arenas. As the evidence continues to shape our field, we hope to serve our otolaryngology community through this invited series, which is dedicated to the exposition of evidence-based medicine and its applications. This first installment examines evidence-based medicine itself and its multiple interpretations, including a purist view, a population-based view, and a view centered on the individual. Strengths and weaknesses of each are discussed, as well the potential for unification and evolution of these concepts. We also place evidence-based medicine in the context of the mindset of traditional medicine and anticipate future developments. PMID:20416448
Shin, Jennifer J; Randolph, Gregory W; Rauch, Steven D
Introduction: Evidence-based medicine is often misunderstood as ‘cookbook medicine with standard recipes’ that does not take clinical experience into account. It is, however, supposed to be a basis for decision making in caring for individual patients under consideration of patients’ preferences. This seems to be very important, since diabetic retinopathy continues to be the most frequent cause of vision loss
An evidence-based (EB) approach has been a significant driver in reforming healthcare over the past two decades. This change has extended across a broad range of health professions, including oral healthcare. A key element in achieving an EB approach to oral healthcare is educating our practitioners, both current and future. This involves providing opportunities integrated within simulated and actual clinical
T. Winning; I. Needleman; M. Rohlin; A. Carrassi; B. Chadwick; K. Eaton; K. Hardwick; R. Ivancakova; R. L. Jallaludin; D. Johnsen; J.-G. Kim; D. Lekkas; D. Li; D. Onisei; A. Pissiotis; P. Reynolds; I. Tonni; J. Vanobbergen; R. Vassileva; J. Virtanen; P. Wesselink; N. Wilson
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…
Evidence-based practice (EBP) is a process in which scientific evidence is evaluated to determine underlying trends and principles of health\\/health care. This information is then translated into information about best clinical practices. EBP affords a systematic way to improve healthcare, improve patient outcomes, and evaluate resources needed. The Star Model of EBP provides a mechanism to transform large collections of
Evidence-based practice (EBP) has emerged as a marker for health care quality. However, several barriers prevent the transition of nursing research to practice, such as lack of knowledge, lack of time, and little perceived value. The purpose of this descriptive study was to examine the extent of current understanding of EBP, knowledge\\/skills, and attitudes among registered nurses in an urban
Many evidence-based trust models require the ad- justment of parameters such as aging- or exploration-factors. What the literature often does not address is the systematic choice of these parameters. In our work, we propose a generic procedure for finding trust model parameters that maximize the expected utility to the trust model user. The procedure is based on game- theoretic considerations
Patients with personality disorders are prescribed psychotropic medications with greater frequency than almost any other diagnostic group. Prescribing practices in these populations are often based on anecdotal evidence rather than rigorous data. Although evidence-based psychotherapy remains an integral part of treatment, Axis II psychopathology is increasingly conceptualized according to neurobiological substrates that correspond to specific psychopharmacological strategies. We summarize the best available evidence regarding medication treatment of personality disordered patients and provide optimal strategies for evidence-based practice. Most available evidence is concentrated around borderline and schizotypal personality disorders, with some additional evidence concerning the treatment of avoidant and antisocial personality disorders. Although maladaptive personality symptoms respond to antidepressants, antipsychotics, mood stabilizers, and other medications, evidence-based pharmacotherapy is most useful in treating circumscribed symptom domains and induces only partial improvement. Most available evidence supports use of medication in reducing impulsivity and aggression, characteristic of borderline and antisocial psychopathology. Efforts have also begun to reduce psychotic-like symptoms and improve cognitive deficits characteristic of schizotypy. Indirect evidence is also provided for psychopharmacological reduction of social anxiety central to avoidant personality disorder. Evidence-based practice requires attention to domains of expected clinical improvement associated with a medication, relative to the potential risks. The development of future rational pharmacotherapy will require increased understanding of the neurobiological underpinnings of personality disorders and their component dimensions. Increasing efforts to translate personality theory and social cognitive neuroscience into increasingly specific neurobiological substrates may provide more effective targets for pharmacotherapy. PMID:21320390
Ripoll, Luis H; Triebwasser, Joseph; Siever, Larry J
|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…
|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…
|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…
Evidence-base practice (EBP) is now commonplace in many health care services and, in recent years, there has been a healthy debate about the role of EBP in psychology. In this article, I provide information on the nature of EBP and how it is consistent with professional training models and standards in psychology. In discussing some of the concerns that have
This article explores the evidencebase 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.
The 2007 guidelines from the Infectious Diseases Society of America/American Thoracic Society are a blend of level-of-evidence strength and consensus opinion--a unified, evidence-based document. These new recommendations address prior discrepancies between the 2 specialties. We developed a CAP treatment algorithm based on the new advisory. PMID:17764643
Bernheisel, Christopher R; Schlaudecker, Jeffrey D
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…
|This article explores the evidencebase 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.|
|Wellness conceptualized as "the" paradigm for counseling provides strength-based strategies for assessing clients, conceptualizing issues developmentally, and planning interventions to remediate dysfunction and optimize growth. Wellness counseling models have stimulated significant research that helps to form the evidencebase for practice in the…
Evidence-based medicine was recently noted as one of the top 15 most important medical discoveries over the past 160 years. Since the term was coined in 1990, EBM has seen unparalleled adoption in medicine and surgery. We discuss the early origins of EBM and its dissemination in medicine, especially orthopaedic surgery.
Objective: One aim of this study will focus on determining what are evidence-based studies in asthma control. A second aim focuses on determining which asthma interventions, selfmonitoring tools and asthma management programs have shown to be the most significant in improving outcomes in patients with asthma. Recommendations will be made to future asthma self-management programs based on the findings.\\u000aMethodology:
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…
|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…
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-basedinfectioncontrol 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.
Nosocomial infections and their control are a world-wide challenge. The prevalence of nosocomial infections is generally higher in developing countries with limited resources than industrialized countries. In this paper we aimed to further explain the differences with regard to infectioncontrol challenges between Turkey, a country with "limited" resources, and the Netherlands, a country with "reasonable" resources. Infrastructure of hospitals, low compliance of hand hygiene, understaffing, overcrowding, heavy workload, misuse of personal protective equipments, late establishment of infectioncontrol programme are major problems in limited-resources countries. These problems cause high infection rates and spread of multi-drug resistant pathogens. To improve the control and prevention of infections in countries with limited resources, a multi-facet approach is needed.
The manual is intended for use by hospital personnel who are responsible for infection, surveillance and control. The guidelines have been derived from a variety of sources, including studies conducted by the Centers for Disease Control and by others and ...
This manual is intended for use by hospital personnel who are responsible for infection surveillance and control. The guidelines have been derived from a variety of sources, including studies conducted by the Centers for Disease Control and by others and ...
Objectives: The purpose of this study was to determine the knowledge and attitudes of dental health care workers (DHCWs) towards infectioncontrol procedures, to examine DHCWs’ practising behaviour in respect of infectioncontrol, and to determine whether a relationship exists between knowledge, attitudes and behaviour.Methods:Within this systematic review, study quality was assessed in line with selection criteria relating to study
B. L Gordon; F. J. T Burke; J Bagg; H. S Marlborough; E. S McHugh
A study was undertaken to determine the resources available in Italian hospitals for the control of nosocomial infections and the factors favouring a successful approach. During January–May 2000 a questionnaire about infectioncontrol was sent to the hospital health director of all Italian National Health System hospitals treating acute patients and with more than 3500 admissions in 1999. An active
S. Brusaferro; R. Quattrin; F. Barbone; D. D'Alessandro; G. F. Finzi
Objective: This study describes the organization of infectioncontrol committees in a Brazilian multihospital system, identifying their major problems. Our goal is to discuss the main deficiencies in infectioncontrol and to target some interventions that can improve the efficiency of these actions in Brazilian hospitals. Design and setting: We used a descriptive epidemiologic design. We interviewed the chairs and
Tania Cristina de Oliveira; Maria Luiza Moretti Branchini
Background Irrigation and débridement with retention of prosthesis is commonly performed for periprosthetic joint infection. Infection\\u000a control is reportedly dependent on timing of irrigation and débridement relative to the index procedure.\\u000a \\u000a \\u000a \\u000a \\u000a Questions\\/purposes We therefore (1) compared the ability of irrigation and débridement to control acute postoperative, acute delayed, and chronic\\u000a infections and (2) determined whether any patient-related factors influenced infectioncontrol.\\u000a \\u000a \\u000a \\u000a \\u000a Patients
Loukas Koyonos; Benjamin Zmistowski; Craig J. Della Valle; Javad Parvizi
Our objective was to provide evidence-based guidance for management decisions during labor and delivery. We performed MEDLINE, PubMed, and COCHRANE searches with the terms labor, delivery, pregnancy, randomized trials, plus each management aspect of labor and delivery (eg, early admission). Each management step of labor and delivery was reviewed separately. Evidence-based good quality data favor hospital births, delayed admission, support by doula, training birth assistants in developing countries, and upright position in the second stage. Home-like births, enema, shaving, routine vaginal irrigation, early amniotomy, "hands-on" method, fundal pressure, and episiotomy can be associated with complications without sufficient benefits and should probably be avoided. We conclude that labor and delivery interventions supported by good quality data as just described should be routinely performed. All aspects with lower data quality should be researched with adequately powered and designed trials. PMID:18984077
Berghella, Vincenzo; Baxter, Jason K; Chauhan, Suneet P
Objective To conduct an evidence-based review of pediatric pain measures. Methods Seventeen measures were examined, spanning pain intensity self-report, questionnaires and diaries, and behavioral observations. Measures were classified as ''Well-established,'' ''Approaching well-established,'' or ''Promising'' according to established criteria. Information was highlighted to help professionals evaluate the instruments for particular purposes (e.g., research, clinical work). Results Eleven measures met criteria for
Lindsey L. Cohen; Kathleen Lemanek; L. Blount; Lynnda M. Dahlquist; Crystal S. Lim; Tonya M. Palermo; Kristine D. McKenna; Karen E. Weiss
People with schizophrenia can be helped greatly with pharmacologic and psychosocial interventions that are known to be effective.\\u000a Several interventions are now supported by research: use of medications following specific guidelines, training in illness\\u000a self-management, case management based on principles of assertive community treatment, family psychoeducation, supported employment,\\u000a and integrated substance abuse treatment. However, few patients actually receive these evidence-based
Robert E. Drake; Kim T. Mueser; William C. Torrey; Alexander L. Miller; Anthony F. Lehman; Gary R. Bond; Howard H. Goldman; H. Steven Leff
One dominant discourse in the mental health arena revolves around evidence-based practice (EBP). Although there is ongoing\\u000a debate about the implementation of EBP in the mental health field, most of these discussions have been limited to modernist\\u000a ideas. While discussions about EBP have occurred from alternate perspectives, particularly postmodernism, a lack of open dialogue\\u000a has resulted in these two groups
Recent statutes and legal decisions have been aimed at bettering the quality of tort-law decisions by substantively improving "expert" testimony. However, in analogy to the experience of physicians attempting to upgrade medical practice using the principles of evidence-based medicine, lawyers and the courts have found it much easier to describe ideal science than to actualize it. This is particularly so in a system (the Law) that has traditionally not been very discerning about scientific rigor, and which has established procedural priorities that are often incompatible with strict scientific standards. This overview will examine the American tort system from an evidence-based perspective. We include a discussion of standards that could be used for "outcomes analysis" in the Law; recognition and classification of errors made by the courts themselves; the relationship between medical errors, "negligence," and standard of care; and the problem of reconciling the rights of plaintiffs with medical-scientific facts. We also consider selected impediments to developing a legal system that is capable of consistently reaching evidence-based decisions concerning complex scientific information, including pathologic interpretation of tissue specimens. PMID:16639995
As the field of social work moves toward the implementation of evidence-based practice, agencies require training, mentoring, and peer networking to ensure successful adoption. This article defines successful adoption as knowledge and competence in the process of evidence-based practice. Successful adoption is best accomplished through the education and training of organization teams comprising key leaders—executive staff and board members. The
This document prescribes responsibilities and methods of sterilizing or disinfecting dental items in Air Force dental facilities to prevent or reduce the chance of cross-infection of patients and staff. The importance of preparing dental items for sterili...
B. A. Matis A. G. Christen J. M. Young W. R. Sellers
The objective of our systematic review was to provide updated evidence-based guidance for surgical decisions during cesarean delivery (CD). We performed an English-language MEDLINE, PubMed, and COCHRANE search with the terms, cesarean section, cesarean delivery, cesarean, pregnancy, and randomized trials, plus each technical aspect of CD. Randomized control trials (RCTs) involving any aspect of CD technique from Jan. 1, 2005, to Sept. 1, 2012, were evaluated to update a previous systematic review. We also summarized Cochrane reviews, systematic reviews, and metaanalyses if they included additional RCTs since this review. We identified 73 RCTs, 10 metaanalyses and/or systematic reviews, and 12 Cochrane reviews during this time frame. Recommendations with high levels of certainty as defined by the US Preventive Services Task Force favor pre-skin incision prophylactic antibiotics, cephalad-caudad blunt uterine extension, spontaneous placental removal, surgeon preference on uterine exteriorization, single-layer uterine closure when future fertility is undesired, and suture closure of the subcutaneous tissue when thickness is 2 cm or greater and do not favor manual cervical dilation, subcutaneous drains, or supplemental oxygen for the reduction of morbidity from infection. The technical aspect of CD with high-quality, evidence-based recommendations should be adopted. Although 73 RCTs over the past 8 years is encouraging, additional well-designed, adequately powered trials on the specific technical aspects of CD are warranted. PMID:23467047
Dahlke, Joshua D; Mendez-Figueroa, Hector; Rouse, Dwight J; Berghella, Vincenzo; Baxter, Jason K; Chauhan, Suneet P
The Centers for Disease Control and Prevention estimates that 2 million patients suffer from hospital-acquired infections every year and nearly 100,000 of them die. Most of these medical errors are preventable. Hospital-acquired infections result in up to $4.5 billion in additional healthcare expenses annually. The U.S. government has responded to this financial loss by focusing on healthcare quality report cards and by taking strong action to curb healthcare spending. The Medicare Program has proposed changes to the Hospital Inpatient Prospective Payment System and Fiscal Year Rates: Proposed Rule CMS 1488-P-Healthcare-associated infection. Payment will be linked to performance. Under the new rule, payment will be withheld from hospitals for care associated with treating certain catheter-associated urinary tract infections, vascular catheter-associated infections, and mediastinitis after coronary artery bypass graft surgery. Infection-prevention strategies are essential. In the healthcare setting, the infectioncontrol department is categorized as non-revenue-producing. Funds dedicated to resources such as staff, educational programs, and prevention measures are vastly limited. Hospital leaders will need to balance the upfront cost needed to prevent hospital-related infections with the non-reimbursed expense accrued secondary to potentially preventable infections. The purpose of this paper is to present case studies and cost analysis of hospital-acquired infections and present strategies that reduce infections and cost.
BACKGROUND: Evidence-based practice (EBP) models provide a framework to guide organizations and their clinicians to implement evidence-based policies, protocols, and guidelines. A historical review of evidence-based models is presented. The revised Colorado Patient-Centered Interprofessional EBP Model supports use of research evidence and nonresearch evidence and adopts a patient-centered approach to EBP. AIM: The purpose of this article is to present a framework that can be used to transform an organization and foster the use of evidence by interdisciplinary team members. APPROACH: An evidence-based intervention to decrease catheter associated urinary tract infections (CAUTI) is presented to show how the model is operationalized. The EBP model is supported by the five steps that clinicians should use as they identify a clinical problem, gather the evidence, and move the evidence into practice. Ideas for dissemination of new models to clinicians throughout the organization are presented. PMID:21134125
Goode, Colleen J; Fink, Regina M; Krugman, Mary; Oman, Kathleen S; Traditi, Lisa K
Background Co-infection of HIV patients with cytomegalovirus (CMV) is associated with enhanced AIDS progression and CMV end-organ diseases. On the other hand, persistent CMV infection has recently been shown to decrease tumor relapse and protect against lethal bacterial infection. The influence of persistent CMV on the outcome of an acute retroviral superinfection is still unknown. Results Here we show that a persistent murine CMV (mCMV) infection surprisingly confers higher resistance to a primary Friend retrovirus infection (FV) of mice. Decreased FV titers and augmented FV-specific CD8 T-cell responses were found in mCMV infected mice during primary FV superinfection. NK cells produced higher amounts of IFNgamma after FV infection of persistently mCMV infected mice suggesting that these cells were involved in the ‘protective’ effect. Depletion of NK1.1+ cells or neutralization of IFNgamma during FV superinfection abrogated the mCMV-mediated effect. Conclusion Our data demonstrate for the first time that a persistent CMV infection induces long-lasting NK cell responses that can enhance immunity to primary retroviral infections. To our knowledge, studies investigating primary HIV infection have not analyzed the role of the CMV seropositivity in these patients. Our observations suggest that NK cells in CMV seropositive individuals might contribute to the control of primary HIV infection.
Sir Arthur Conan Doyle, the creator of the fictional detective Sherlock Holmes, studied medicine at the University of Edinburgh between 1876 and 1881 under Doctor Joseph Bell who emphasised in his teaching the importance of observation, deduction and evidence. Sherlock Holmes was modelled on Joseph Bell. The modern notions of EvidenceBased Medicine (EBM) are not new. A very brief indication of some of the history of EBM is presented including a discussion of the important and usually overlooked contribution of statisticians to the Popperian philosophy of EBM. PMID:14509997
Many treatment programs have adopted or are considering adopting evidence-based treatments (EBTs). When a program evaluates whether to adopt a new intervention, it must consider program objectives, operational goals, and costs. This article examines cost concepts, cost estimation, and use of cost information to make the final decision on whether to adopt an EBT. Cost categories, including variable and fixed, accounting and opportunity, and costs borne by patients and others, are defined and illustrated using the example of expenditures for contingency management. Ultimately, cost is one consideration in the overall determination of whether implementing an EBT is the best use of a program’s resources.
To be effective, infection prevention and control must be integrated into the complex and multiple interlinking systems within a hospital's management structure. Each of the systems must consider how activity associated with it can be optimised to minimise infection risk to patients. The components of an organisational structure to achieve these quality assurance and patient safety aims are discussed. The use of performance management tools in relation to infectioncontrol metrics is reviewed, and the use of hospital-acquired infection as a proxy indicator for deficiencies of system management is considered. Infection prevention and control cannot be the role and responsibility of a single individual or a small dedicated team; rather it should be a priority at all levels and integrated within all management systems, including the research and educational agendas. PMID:19699008
A historical review of infectioncontrol over the last 4 decades indicates that the field has evolved from being one whose investigative work laid the foundation for understanding the chain of infection to an influential profession whose research on effective prevention methods have revolutionized clinical practice throughout the world. Underlying our successes is the fact that growth in the profession
he importance of high-quality research to address our knowledge deficits in relation to the causes of hospital-acquired infection has been acknowledged by the Department of Health. However, the contribution of nursing research may be restricted by confusion over the use of different paradigms and the discipline's lack of research pedigree. This paper discusses how nursing and infectioncontrol has historically
Our aim was to ascertain the current practice of adjuvant therapy for tonsillectomy and to determine whether it is evidencebased. Anonymized postal questionnaires were sent to all UK otolaryngology consultants registered with the specialty association, and a literature search was performed using relevant search terms in all possible combinations. Among the responders there was little enthusiasm for routine intra-operative local anaesthesia, post-operative topical benzydamine hydrochloride (Difflam) spray or post-operative antibiotics. This is consistent with the lack of robust evidence to support any of these practices. Paracetamol (acetaminophen) is prescribed by almost 90 per cent for post-operative analgesia, and the current literature supports its efficacy and safety. Further, most practitioners combine paracetamol with opioids and/or non-steroidal anti-inflammatory drugs (NSAIDs). Evidence to support the additional use of these agents is, however, non-existent or limited. Some aspects of tonsillectomy care are uniform and evidencebased. Others are heterogeneous and suffer from lack of adequate data in the literature. PMID:16102216
Objective To conduct an evidence-based review of pediatric pain measures. Methods Seventeen measures were examined, spanning pain intensity self-report, questionnaires and diaries, and behavioral observations. Measures were classified as “Well-established,” “Approaching well-established,” or “Promising” according to established criteria. Information was highlighted to help professionals evaluate the instruments for particular purposes (e.g., research, clinical work). Results Eleven measures met criteria for “Well-established,” six “Approaching well-established,” and zero were classified as “Promising.” Conclusions There are a number of strong measures for assessing children's pain, which allows professionals options to meet their particular needs. Future directions in pain assessment are identified, such as highlighting culture and the impact of pain on functioning. This review examines the research and characteristics of some of the commonly used pain tools in hopes that the reader will be able to use this evidence-based approach and the information in future selection of assessment devices for pediatric pain.
Lemanek, Kathleen; Blount, Ronald L.; Dahlquist, Lynnda M.; Lim, Crystal S.; Palermo, Tonya M.; McKenna, Kristine D.; Weiss, Karen E.
The following article is intended to question certain procedures designed to prevent cross-infection. It is the first of a series of occasional articles describing new techniques, research, and new products, which it is hoped, may enable dental practitioners to update their knowledge of this rapidly changing subject. PMID:8461204
This program provides a convenient, self-paced learning experience for all members of the dental health care team. There are three units--each consists of a videotape and accompanying workbook material. Unit 1 - principles and fundamentals of infection co...
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
Inman, Dianna D; van Bakergem, Karen M; Larosa, Angela C; Garr, David R
...policies and procedures for investigating, controlling, and preventing infections in the organization and monitors staff performance to ensure that the policies and procedures are executed. (b) All personnel follow written procedures for...
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.
Vitamin D deficiency is a global health problem. Vitamin D has attracted attention since evidence emerged that it may have functions beyond the control of serum calcium, for example immune system functioning and protection against damage to blood vessels. Gaps in the evidencebase relating to vitamin D are also acknowledged. In this article, the production and functions of vitamin D are described, and the effects of vitamin D deficiency on pregnant women, infants, older people and other at-risk individuals are outlined. The management of vitamin D deficiency and the benefits of vitamin D supplementation are also identified. PMID:23987882
Sphincter of Oddi dysfunction is a painful syndrome that presents as recurrent episodes of right upper quadrant biliary pain, or recurrent idiopathic pancreatitis. It is a disease process that has been a subject of controversy, in part because its natural history, disease course and treatment outcomes have not been clearly defined in large controlled studies with long-term follow-up. This review is aimed at clarifying the state-of-the-art with an evidence-based summary of the current diagnostic and therapeutic approaches and modalities for sphincter of Oddi dysfunction. PMID:24161134
This report summarizes recommendations of the Healthcare InfectionControl Practices Advisory Committee (HICPAC) and the Advisory Committee on Immunization Practices (ACIP) concerning influenza vaccination of health-care personnel (HCP) in the United States. These recommendations apply to HCP in acute care hospitals, nursing homes, skilled nursing facilities, physician's offices, urgent care centers, and outpatient clinics, and to persons who provide home health care and emergency medical services. The recommendations are targeted at health-care facility administrators, infection-control professionals, and occupational health professionals responsible for influenza vaccination programs and influenza infection-control programs in their institutions. HICPAC and ACIP recommend that all HCP be vaccinated annually against influenza. Facilities that employ HCP are strongly encouraged to provide vaccine to their staff by using evidence-based approaches that maximize vaccination rates. PMID:16498385
Pearson, Michele L; Bridges, Carolyn B; Harper, Scott A
A multidisciplinary team approach is a necessity when caring for the wounded warriors, especially in matters of infectioncontrol. Healthcare providers can be very resourceful. The healthcare team at an echelon 5 military treatment facility made changes in their infectioncontrol practices to prevent cross-contamination of a multidrug resistant bacterium. Each member was a vital part in the decision-making process to change behavior and old habits. PMID:19092511
Cilento, Barbara; Culbertson, Colleen L; Gallagher, Alison L
Tuberculosis (TB) infectioncontrol recommendations in healthcare settings were developed to decrease nosocomial transmission from adults. In the absence of pediatric-specific guidelines, these infectioncontrol recommendations have been incorporated, in almost unmodified format, for childhood TB. We will review the evidence concerning the contagiousness of TB in children, scenarios in which transmission is more likely, review United States national recommendations, and consider the family unit, as opposed to the patient, to be the transmission unit for childhood TB. PMID:22079589
...2010-10-01 false Conditions for coverage-Infectioncontrol. 416.51 Section 416.51 Public...416.51 Conditions for coverageâInfectioncontrol. The ASC must maintain an infectioncontrol program that seeks to minimize...
...2009-10-01 false Conditions for coverage-Infectioncontrol. 416.51 Section 416.51 Public...416.51 Conditions for coverageâInfectioncontrol. The ASC must maintain an infectioncontrol program that seeks to minimize...
...2012-10-01 false Conditions for coverage-Infectioncontrol. 416.51 Section 416.51 Public...416.51 Conditions for coverageâInfectioncontrol. The ASC must maintain an infectioncontrol program that seeks to minimize...
Geriatric wards have a higher prevalence of infection than surgical or acute medical wards, and multiresistant organisms contribute a nonnegligeable proportion of infections in elderly inpatients. The measures used to prevent nosocomial infections in geriatric wards are the same as in other types of wards. They include identifying and ensuring the technical and geographic isolation of colonized and infected patients. Health care providers should be informed of the situation, and antimicrobials used with discernment to avoid the selection of multiresistant organisms. Implementation of these measures is made difficult by architectural factors, the fact that many geriatric patients require assistance in all the activities of daily living, and the long duration of stays in geriatric wards. Additional measures are probably essential to achieve long-term control of nosocomial infections. Insufficient attention has been given to health care providers' perceptions of nosocomial infection and to defining the tasks actually performed by these providers. PMID:9769907
Effective solutions to reduce the rate of healthcare-associated infection necessitate direct action at many different levels. One of the many strategies at a large teaching hospital in the UK has been the introduction and development of the infectioncontrol link role. This paper describes the development of this role via the use of a professional portfolio. Monthly seminars were conducted
Nosocomial infections are believed to occur most frequently in intensive care units (ICUs), and they affect the outcome of\\u000a the patients admitted to the ICU. However, this notion was based on CDC\\/NNIS findings on their overall hospital surveillance\\u000a of US hospitals in 1970–1990. This notion is, however, still true as far as the use of medical equipments concerned as an
Introduction: The epidemiology of multidrug-resistant organisms is changing as evidenced by a shift to the community. Hospitalized patients are admitted to home health care with multidrug-resistant organisms. Numerous states have reported an increased incidence of community-acquired infections caused by multidrug-resistant organisms where reportedly no exposure to antibiotics or health care in the 3 months before symptom onset occurred. Method: A
The Diploma in Hospital InfectionControl (DipHIC) was established by the Hospital Infection Society (HIS), the London School of Hygiene and Tropical Medicine (LSHTM) and the Public Health Laboratory Service (PHLS) in 1997 and has now completed two examinations. We outline progress since the announcement of the diploma and changes to the written examination and reflective portfolio. The reflective process is described and guidance provided to active infectioncontrol practitioners wishing to consider application for the diploma by accreditation of prior learning. PMID:11428883
Cookson, B D; Jenner, E A; Roberts, C; Drasar, B; Ridgway, G
Co-infection with mycobacteria and helminths is widespread in developing countries, but how this alters host immunological control of each pathogen is not comprehensively understood. In this study, we demonstrate that acute Nippostrongylus brasiliensis (Nb) murine infection reduce early pulmonary mycobacterial colonization. This Nb-associated reduction in pulmonary Mycobacterium tuberculosis colony-forming units was associated with early and increased activation of pulmonary CD4 T cells and increased T helper type 1 (Th1) and Th2 cytokine secretion. An accelerated and transient augmentation of neutrophils and alveolar macrophages (AMs) was also observed in co-infected animals. AMs displayed markers of both classical and alternative activation. Intranasal transfer of pulmonary macrophages obtained from donor mice 5 days after Nb infection significantly reduced pulmonary Mycobacterium bovis Bacille Calmette-Guérin clearance in recipient mice. These data demonstrate that early stage Nb infection elicits a macrophage response, which is protective during the early stages of subsequent mycobacterial infection. PMID:23250274
du Plessis, N; Kleynhans, L; Thiart, L; van Helden, P D; Brombacher, F; Horsnell, W G C; Walzl, G
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.
LeFebvre, Ronald P.; Peterson, David H.; Haas, Mitchell; Gillette, Richard G.; Novak, Charles W.; Tapper, Janet; Muench, John P.
This article describes the journey toward evidence-based transport and implementation in usual care settings of Multisystemic Therapy (MST) for youth with drug abuse and behavioral problems (Henggeler, Schoenwald, Borduin, Rowland, & Cunningham, 1998). Research and experience informing the design of the MST transport strategy, progress in evaluating its viability and validity, and implications for future research are described. Findings from
|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…
At the heart of evidence-based practice in stuttering treatment are four issues: (1) the collection of data to inform treatment; (2) the long standing concern with maintenance of treatment gains; (3) the need to demonstrate accountability to clients, payers and our profession as service providers; and (4) the desire to advance theoretical knowledge. This article addresses the first three of
Background Dengue is the most prevalent mosquito borne infection worldwide. Vertical transmissions after maternal dengue infection to the fetus and pregnancy losses in relation to dengue illness have been reported. The relationship of dengue to miscarriage is not known. Method We aimed to establish the relationship of recent dengue infection and miscarriage. Women who presented with miscarriage (up to 22 weeks gestation) to our hospital were approached to participate in the study. For each case of miscarriage, we recruited 3 controls with viable pregnancies at a similar gestation. A brief questionnaire on recent febrile illness and prior dengue infection was answered. Blood was drawn from participants, processed and the frozen serum was stored. Stored sera were thawed and then tested in batches with dengue specific IgM capture ELISA, dengue non-structural protein 1 (NS1) antigen and dengue specific IgG ELISA tests. Controls remained in the analysis if their pregnancies continued beyond 22 weeks gestation. Tests were run on 116 case and 341 control sera. One case (a misdiagnosed viable early pregnancy) plus 45 controls (39 lost to follow up and six subsequent late miscarriages) were excluded from analysis. Findings Dengue specific IgM or dengue NS1 antigen (indicating recent dengue infection) was positive in 6/115 (5·2%) cases and 5/296 (1·7%) controls RR 3·1 (95% CI 1·0–10) P?=?0·047. Maternal age, gestational age, parity and ethnicity were dissimilar between cases and controls. After adjustments for these factors, recent dengue infection remained significantly more frequently detected in cases than controls (AOR 4·2 95% CI 1·2–14 P?=?0·023). Interpretation Recent dengue infections were more frequently detected in women presenting with miscarriage than in controls whose pregnancies were viable. After adjustments for confounders, the positive association remained.
Tan, Peng Chiong; Soe, May Zaw; Si Lay, Khaing; Wang, Seok Mui; Sekaran, Shamala Devi; Omar, Siti Zawiah
Probiotics are live micro-organisms administered to provide health benefits. Probiotics are being increasingly used in healthcare contexts both in research studies and routine practice, for example in neonatal intensive care. Currently there is a paucity of guidelines or regulations governing the mitigation of infection risks associated with the use of probiotics in clinical practice. We propose a number of recommendations to mitigate risks. These include the communication of probiotic use to appropriate stakeholders, ensuring that routine laboratories can identify and test the susceptibility of probiotic strains, assuring standards for preparation and administration, and ensuring surveillance designed to capture adverse events. PMID:23414706
|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…
This article briefly describes the mandate for evidence-based practice in social work, the basic principles of evidence-based social work practice, systemic obstacles to evidence-based social work practice in home care, and suggestions for removing these obstacles.
|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…
Evidence-based medicine is the conscientious and judicious use of current best knowledge in making decisions about the care of individual patients, often from well-designed, randomized, controlled trials. Authoritative medicine is the traditional approach to learning and practicing medicine, but no one authority has comprehensive scientific knowledge. Archie Cochrane proposed that every medical specialty should compile a list of all of the randomized, controlled trials within its field to be available for those who wish to know what treatments are effective. This was done first for obstetrics by a group collecting and critically analyzing all of the randomized trials and then indicating procedures every mother should have and those that no mother should have. Support during labor was used as an example. Similar groups are now active in almost all specialties, with information available on the Internet in the Cochrane Database of Systematic Reviews. Developmental-behavioral pediatrics should be part of this movement to evidence-based medicine. PMID:10608375
Evidence-based practice is net als continue kwaliteitsverbetering en klinisch onderzoek een methode om de kwaliteit van zorg te verbeteren. Marja Storm-Versloot concentreerde zich in op evidence-based besluitvorming bij vier verschillende (verpleegkundige) beslissingen. Ze onderzocht triagesystemen op de spoedeisende hulp, de effectiviteit van een programma om te stoppen met roken, de effectiviteit van zilververbanden en de klinische waarde van routinematige controles.
Evidence-based parenting and family interventions are effective in improving parenting skills, positive parent–child relations and children's developmental outcomes. Programmes based on “principles of effective prevention” do not prove that a programme works. Evidence-based programmes (EBPs) are programmes tested in multiple randomized control trials by different researchers and producing large effect sizes. Hence, selecting a family EBP that best matches the
The manual is intended for use by hospital personnel who are responsible for infection surveillance and control. The guidelines have been derived from a variety of sources, including studies conducted by the Centers for Disease Control and by others and h...
The manual is intended for use by hospital personnel who are responsible for infection surveillance and control. The guidelines have been derived from a variety of sources, including studies conducted by the Centers for Disease Control and by others and h...
Background: Many acute care facilities report endemic methicillin-resistant Staphylococcus aureus (MRSA), while others describe the occurrence of sporadic disease outbreaks. The timely implementation of effective infectioncontrol measures is essential to minimise the incidence of MRSA cases and the magnitude of disease outbreaks. Management strategies for the containment and control of MRSA currently vary between facilities and demonstrate varying levels
Elizabeth J Halcomb; Ritin Fernandez; Rhonda Griffiths; PJ Newton; Louise D Hickman
This paper identifies deficiencies in some current practices of causation and risk evaluation by toxicologists and formulates an evidence-based solution. The practice of toxicology focuses on adverse health events caused by physical or chemical agents. Some relations between agents and events are identified risks, meaning unwanted events known to occur at some frequency. However, other relations that are only possibilities--not known to occur (and may never be realized)--also are sometimes called risks and are even expressed quantitatively. The seemingly slight differences in connotation among various uses of the word 'risk' conceal deeply philosophic differences in the epistemology of harm. We label as 'nomological possibilities' (not as risks) all predictions of harm that are known not to be physically or logically impossible. Some of these nomological possibilities are known to be causal. We term them 'epistemic'. Epistemic possibilities are risks. The remaining nomological possibilities are called 'uncertainties'. Distinguishing risks (epistemic relationships) from among all nomological possibilities requires knowledge of causation. Causality becomes knowable when scientific experiments demonstrate, in a strong, consistent (repeatable), specific, dose-dependent, coherent, temporal and predictive manner that a change in a stimulus determines an asymmetric, directional change in the effect. Many believe that a similar set of characteristics, popularly called the 'Hill Criteria', make it possible, if knowledge is robust, to infer causation from only observational (nonexperimental) studies, where allocation of test subjects or items is not under the control of the investigator. Until the 1980s, medical decisions about diagnosis, prevention, treatment or harm were often made authoritatively. Rather than employing a rigorous evaluation of causal relationships and applying these criteria to the published knowledge, the field of medicine was dominated by authority-based opinions, expressed by experts (or consensus groups of experts) relying on their education, training, experience, wisdom, prestige, intuition, skill and improvisation. In response, evidence-based medicine (EBM) was developed, to make a conscientious, explicit and judicious use of current best evidence in deciding about the care of individual patients. Now globally embraced, EBM employs a structured, 'transparent' protocol for carrying out a deliberate, objective, unbiased and systematic review of the evidence about a formally framed question. Not only in medicine, but now in dentistry, engineering and other fields that have adapted the methods of EBM, it is the quality of the evidence and the rigor of the analysis through evidence-based logic (EBL), rather than the professional standing of the reviewer, that leads to evidence-based conclusions about what is known. Recent studies have disclosed that toxicologists (individually or in expert groups), not unlike their medical counterparts prior to EBM, show distressing variations in their biases with regard to data selection, data interpretation and data evaluation when performing reviews for causation analyses. Moreover, toxicologists often fail to acknowledge explicitly (particularly in regulatory and policy-making arenas) when shortcomings in the evidence necessitate reliance upon authority-based opinions, rather than evidence-based conclusions (Guzelian PS, Guzelian CP. Authority-based explanation. Science 2004; 303: 1468-69). Accordingly, for answering questions about general and specific causation, we have constructed a framework for evidence-based toxicology (EBT), derived from the accepted principles of EBM and expressed succinctly as three stages, comprising 12 total steps. These are: 1) collecting and evaluating the relevant data (Source, Exposure, Dose, Diagnosis); 2) collecting and evaluating the relevant knowledge (Frame the question, Assemble the relevant (delimited) literature, Assess and critique the literature); and 3) Joining data with knowledge to arrive at a conclusion (General causation--answ
Guzelian, Philip S; Victoroff, Michael S; Halmes, N Christine; James, Robert C; Guzelian, Christopher P
Despite record resources being directed to infectioncontrol (IC), hospital-acquired infection (HAI) seems to be an ever increasing problem. Most of the high profile organisms are multidrug- resistant (MDR) either with acquired, e.g. methicillin-resistant Staphylococcus aureus (MRSA) and extended-spectrum b-lactamase (ESBL) producers, or natural resistance (Clostridium difficile), and some such as MRSA are not merely replacing methicillin-susceptible S. aureus (MSSA)
In daily practice, it is difficult to find a registered drug for children, because about 70% of the drugs prescribed in children are not studied, off-label or unlicensed in this age group. Clinical trials have usually been performed in adults, and then in daily practice dosages are adjusted for children without proper studies in that age group. In some countries, national formularies are being established to overcome the existing variance in prescribing between physicians. Complicating factors in finding the correct dosage for children include the heterogeneity between different age groups in the developmental stages of the organs influencing the absorption, distribution, metabolism, and excretion as well as differences in body composition during growth. Growth may also influence the effects and adverse effects of a drug used in a child. For oral administration of drugs in children, the bioavailability, the taste, the composition, and the absence of toxic ingredients for that age group are additional important factors. The EU has recently introduced legislation to stimulate the pharmaceutical industry to investigate the pharmacological effect and safety of new medicines in children. In response to this legislation, research networks are being established to provide the optimal infrastructure for pediatric drug investigation. The goals of this paper are to review the current problems in daily practice and to address the needs for evidencebased pharmacotherapy in children. PMID:21199133
Kemper, Elles Marleen; Merkus, Maruschka; Wierenga, Peter C; Van Rijn, Petra C; Van der Werff, Desirée; Lie-A-Huen, Loraine; Offringa, Martin
Migraine headache is a chronic, painful, disabling and potentially progressive, condition primarily occurring in early and middle adulthood. For many patients, daily activities are impaired by the sudden and unpredictable occurrence of migraine attacks. In recent years, significant progress has been made in the field of migraine treatment. For the acute treatment of migraine attacks, 5-hydroxytryptophan(1B/D) agonists (so called triptans), were the most innovative development, successfully aborting attacks in less than 1 h. The search for innovative drugs usable for migraine prevention, however, was less successful, mainly due to the lack of reliable and predictive animal models. Recently, neuromodulators such as valproic acid and topiramate, initially developed as anticonvulsants, have been shown in large clinical trials to be effective in the prevention of migraine. As for the acute treatment of migraine attacks more than 10 years ago, large clinical trial programs are now setting new standards for evidence-based medicine in migraine prevention. This review summarizes the current options in migraine prevention with special emphasis on clinical trial design and new developments such as topiramate. PMID:15938666
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.
Schulman, Sam; Witt, Daniel M.; Vandvik, Per Olav; Fish, Jason; Kovacs, Michael J.; Svensson, Peter J.; Veenstra, David L.; Crowther, Mark; Guyatt, Gordon H.
Evidence-based medicine (EBM) integrates the best available external evidence in the care of individual patients with the individual clinical expertise and the patient preferences. This method has been designed for use in daily clinical practice. We describe the rationale for EBM and its principles and application in this article. EBM enables gastroenterologists to update the knowledge required to provide patients with high quality medical care. EBM requires four steps: a) formulating a clinical question arising from a doubt concerning a patient; b) conducting an efficient literature search to answer this question; c) critically appraising this evidence using explicit methods to selected articles to determine the validity of their design and the clinical relevance of their results; and d) applying these results to the patient (taking into account their values and preferences and personal and social circumstances). In this paper, we explain the principles and basic concepts of EBM and their application to gastroenterology and we provide an extensive compilation of internet databases of valid information relevant to gastroenterologists. We also provide a selection of useful tools for self-directed learning of critical appraisal skills. Link updates can be accessed at the following URL: http://www.enlacesmedicos.com/e.htm PMID:15098043
Curioso, Walter H; Montori, Víctor M; Curioso, Walter I
Background Ethnic minority adolescent women with a history of sexual or physical abuse and sexually transmitted infections represent a vulnerable population at risk for HIV. Community-based interventions for behavior modification and subsequent risk reduction have not been effective among these women. Objectives To evaluate the effects of a theory-based (AIDS Risk Reduction Model) cognitive behavioral intervention model versus enhanced counseling for abused ethnic minority adolescent women on infection with sexually transmitted infection at 6 and 12 months follow-up. Design Controlled randomized trial with longitudinal follow-up Settings Southwestern United States, Metropolitan community-based clinic Participants Mexican-and-African American adolescent women aged 14-18 years with a history of abuse or sexually transmitted infection seeking sexual health care Methods Extensive preliminary study for intervention development was conducted including individual interviews, focus groups, secondary data analysis, pre-testing and feasibility testing for modification of an evidence-based intervention prior to testing in the randomized controlled trial. Following informed consents for participation in the trial, detailed interviews concerning demographics, abuse history, sexual risk behavior, sexual health and physical exams were obtained. Randomization into either control or intervention groups was conducted. Intervention participants received workshop, support group and individual counseling sessions. Control participants received abuse and enhanced clinical counseling. Follow-up including detailed interview and physical exam was conducted at 6 and 12 months following study entry to assess for infection. Intention to treat analysis was conducted to assess intervention effects using chi-square and multiple regression models. Results 409 Mexican-(n=342) and African-(n=67) American adolescent women with abuse and sexually transmitted infection histories were enrolled; 90% intervention group attendance; longitudinal follow-up at 6 (93%) and 12 (94%) months. Intervention (n=199) versus control (n=210) group participants experienced fewer infections at 0-6 (0% vs. 6.6%, p=0.001), 6-12 (3.6% vs. 7.8%, p=0.005, CI 95% lower-upper .001-.386) and 0-12 (4.8% vs. 13.2%, p=0.002, CI 95% lower-upper, .002-.531) month intervals. Conclusions A cognitive behavioral intervention specifically designed for ethnic minority adolescent women with a history of abuse and sexually transmitted infection was effective for prevention of infection. These results provide evidence for development of evidence-based interventions for sexually transmitted infection/HIV. Implications include translation to community-clinic-based settings for prevention of adverse outcomes regarding sexual health of adolescent women.
Since the foundation of the DVO ("Dachverband Osteologie") in 1999, it has been the continuous ambition to implement evidence-based medicine in the clinical course for the effective diagnosis and treatment of osteoporosis. This aim was addressed by the implementation of general guidelines (DVO) in 2003. These guidelines (DVO) offer strategies for diagnosis and treatment of osteoporosis in postmenopausal women, osteoporosis in elderly women and glucocorticoid-induced osteoporosis. Evidence-based treatment of osteoporosis recommends the supplementation with calcium and vitamin D, considering antiresorptive therapy antifracture efficacy is proven for the bisphosphonates alendronate, ibandronate and risedronate on the one hand and the SERM raloxifen on the other hand. On the basis of valid data from randomized, placebo-controlled clinical trials, new therapy regimen like rhPTH1-34 (teriparatide) or strontium ranelate fulfill the recommendation criteria for the guidelines (DVO). Effective treatment of glucocorticoid-induced osteoporosis includes supplemental calcium and vitamin D and antiresorptive agents like the bisphosphonates alendronate, risedronate and etidronate according to the guidelines (DVO). PMID:16802548
Fassbender, Walter Josef; Stumpf, Ulla Cordula; Jockenhövel, Friedrich
Background A classification system with four types of infected TKAs has been commonly used to determine treatment, especially with regard\\u000a to whether the prosthesis should be removed or retained.\\u000a \\u000a \\u000a \\u000a \\u000a Questions\\/purposes We asked whether (1) the classification-dictated treatment of the four types of infection after TKA would controlinfection\\u000a and maintain functional TKA; (2) repeated débridement and two-stage TKA would further improve the
Neonatal nosocomial infections are public health threats in the developing world, and successful interventions are rarely reported. A before-and-after study was conducted in the neonatal unit of the Hôpital Principal de Dakar, Senegal to assess the efficacy of a multi-faceted hospital infectioncontrol programme implemented from March to May 2005. The interventions included clustering of nursing care, a simple algorithm for empirical therapy of suspected early-onset sepsis, minimal invasive care and promotion of early discharge of neonates. Data on nosocomial bloodstream infections, mortality, bacterial resistance and antibiotic use were collected before and after implementation of the infectioncontrol programme. One hundred and twenty-five infants were admitted immediately before the programme (Period 1, January-February 2005) and 148 infants were admitted immediately after the programme (Period 2, June-July 2005). The two groups of infants were comparable in terms of reason for admission and birth weight. After implementation of the infectioncontrol programme, the overall rate of nosocomial bloodstream infections decreased from 8.8% to 2.0% (P=0.01), and the rate of nosocomial bloodstream infections/patient-day decreased from 10.9 to 2.9/1000 patient-days (P=0.03). Overall mortality rates did not differ significantly. The proportion of neonates who received antimicrobial therapy for suspected early-onset sepsis decreased significantly from 100% to 51% of at-risk infants (P<0.001). The incidence of drug-resistant bacteria was significantly lower after implementation of the programme (79% vs 12%; P<0.001), and remained low one year later. In this neonatal unit, simple, low-cost and sustainable interventions led to the control of a high incidence of bacterial nosocomial bloodstream infections, and the efficacy of these interventions was long-lasting. Such interventions could be extended to other low-income countries. PMID:21820760
Landre-Peigne, C; Ka, A S; Peigne, V; Bougere, J; Seye, M N; Imbert, P
Graduates of a 2-day basic training course in infectioncontrol were surveyed. Respondents were generally from Midwestern long-term care facilities and small hospitals. These infectioncontrol practitioners had multiple roles in addition to infectioncontrol, most notably employee health and quality assurance. Infectioncontrol practitioners demonstrated significant job stability. The vast majority of institutions where survey respondents were employed followed
Infectioncontrol is everyone's business and it is important that all members of staff observe good infectioncontrol practice. An effective infectioncontrol link nurse system has been shown to support and develop this approach. The strength of ward-based infectioncontrol link nurses depends upon their effectiveness as role models and their ability to influence practice on their wards and
E. L. Teare; A. J. Peacock; H. Dakin; L. Bates; J. Grant-Casey
ISSUE: Many community hospitals struggle to meet infectioncontrol (IC) standards without the guidance of an infectious disease physician or an experienced infectioncontrol practitioner (ICP). In many community hospitals, nurses assume the role of ICP without proper training and physician support, and\\/or infectioncontrol is an assigned duty for personnel with other responsibilities.PROJECT: Duke InfectionControl Outreach (DICON) was
The objective of this study was to assess current infectioncontrol practice in Europe and its structure, future research priorities, and how infectioncontrol should be organised. A questionnaire was sent to 223 hospital infectioncontrol physicians throughout Europe, of whom 54 in 18 countries responded. With respect to future research priorities in infectioncontrol in Europe, the largest proportion
F. D. Daschner; R. Cauda; H. Grundmann; A. Voss; A. F. Widmer
External anogenital warts, or condylomata acuminata, are caused by the proliferation of squamous epithelial cells secondary to human papillomavirus infection. In sexually active adults and adolescents, anogenital warts are a common sexually transmitted disease, but in children they may be a sign of sexual abuse. There are several treatment options available for anogenital warts, but no treatment has been proven to be the most efficacious, and recurrence after clinical clearance is common. Evidence-based treatment of genital warts is challenging because of the lack of controlled trials comparing treatments, especially in pediatric and adolescent populations. This paper discusses various treatment modalities such as physical destruction, cytotoxic agents, and immunomodulating therapies. Many variables influence the selection of a treatment, such as the size, quantity, and location of the warts; and the patient and provider preference, and its availability and cost. All treatments can cause local side effects, and patient tolerability must also be factored into treatment selection. Many treatments have similar clearance and recurrence rates, and none of the treatments completely eliminates the virus. With the numerous challenges surrounding the treatment of anogenital warts, the primary prevention of HPV infection through vaccination is a key component in decreasing the incidence of the disease. PMID:22530225
Background Unlike most acute viral infectionscontrolled with the appearance of virus-specific neutralizing antibodies (NAbs), primary HIV infections are not met with such potent and early antibody responses. This brings into question if or how the presence of potent antibodies can contribute to primary HIV control, but protective efficacies of antiviral antibodies in primary HIV infections have remained elusive; and, it has been speculated that even NAb induction could have only a limited suppressive effect on primary HIV replication once infection is established. Here, in an attempt to answer this question, we examined the effect of passive NAb immunization post-infection on primary viral replication in a macaque AIDS model. Methods and Findings The inoculums for passive immunization with simian immunodeficiency virus mac239 (SIVmac239)-specific neutralizing activity were prepared by purifying polyclonal immunoglobulin G from pooled plasma of six SIVmac239-infected rhesus macaques with NAb induction in the chronic phase. Passive immunization of rhesus macaques with the NAbs at day 7 after SIVmac239 challenge resulted in significant reduction of set-point plasma viral loads and preservation of central memory CD4 T lymphocyte counts, despite the limited detection period of the administered NAb responses. Peripheral lymph node dendritic cell (DC)-associated viral RNA loads showed a remarkable peak with the NAb administration, and DCs stimulated in vitro with NAb-preincubated SIV activated virus-specific CD4 T lymphocytes in an Fc-dependent manner, implying antibody-mediated virion uptake by DCs and enhanced T cell priming. Conclusions Our results present evidence indicating that potent antibody induction post-infection can result in primary immunodeficiency virus control and suggest direct and indirect contribution of its absence to initial control failure in HIV infections. Although difficulty in achieving requisite neutralizing titers for sterile HIV protection by prophylactic vaccination has been suggested, this study points out a possibility of non-sterile HIV control by prophylactic vaccine-induced, sub-sterile titers of NAbs post-infection, providing a rationale of vaccine-based NAb induction for primary HIV control.
During acute viral infections, clearance of the pathogen is followed by the contraction of the anti-viral T cell compartment. In contrast, T cell responses need to be maintained over a longer period of time during chronic viral infections in order to control viral replication and to avoid viral spreading. Much is known about inhibitory signals such as through PD-1 that limit T cell activity during chronic viral infection, but little is known about the stimulatory signals that allow maintenance of anti-viral T cells. Here, we show that the co-stimulatory molecule OX40 (CD134) is critically required in the context of persistent LCMV clone 13 infection. Anti-viral T cells express high levels of OX40 in the presence of their cognate antigen and T cells lacking the OX40 receptor fail to accumulate sufficiently. Moreover, the emergence of T cell dependent germinal center responses and LCMV-specific antibodies are severely impaired. Consequently, OX40-deficient mice fail to control LCMV clone 13 infection over time, highlighting the importance of this signaling pathway during persistent viral infection.
Cheng, Yang; Heeg, Maximilian; Salek-Ardakani, Shahram; Crotty, Shane; Croft, Michael; von Herrath, Matthias G.
Background: Lower respiratory tract infections like acute bronchitis, exacerbated chronic obstructive pulmonary disease and community-acquired pneumonia are often unnecessarily treated with antibiotics, mainly because of physicians' difficulties to distinguish viral from bacterial cause and to estimate disease-severity. The goal of this trial is to compare medical outcomes, use of antibiotics and hospital resources in a strategy based on enforced evidence-based guidelines versus procalcitonin guided antibiotic therapy in patients with lower respiratory tract infections. Methods and design: We describe a prospective randomized controlled non-inferiority trial with an open intervention. We aim to randomize over a fixed recruitment period of 18 months a minimal number of 1002 patients from 6 hospitals in Switzerland. Patients must be >18 years of age with a lower respiratory tract infections <28 days of duration. Patients with no informed consent, not fluent in German, a previous hospital stay within 14 days, severe immunosuppression or chronic infection, intravenous drug use or a terminal condition are excluded. Randomization to either guidelines-enforced management or procalcitonin-guided antibiotic therapy is stratified by centre and type of lower respiratory tract infections. During hospitalization, all patients are reassessed at days 3, 5, 7 and at the day of discharge. After 30 and 180 days, structured phone interviews by blinded medical students are conducted. Depending on the randomization allocation, initiation and discontinuation of antibiotics is encouraged or discouraged based on evidence-based guidelines or procalcitonin cut off ranges, respectively. The primary endpoint is the risk of combined disease-specific failure after 30 days. Secondary outcomes are antibiotic exposure, side effects from antibiotics, rate and duration of hospitalization, time to clinical stability, disease activity scores and cost effectiveness. The study hypothesis is that procalcitonin-guidance is non-inferior (i.e., at worst a 7.5% higher combined failure rate) to the management with enforced guidelines, but is associated with a reduced total antibiotic use and length of hospital stay. Discussion: Use of and prolonged exposure to antibiotics in lower respiratory tract infections is high. The proposed trial investigates whether procalcitonin-guidance may safely reduce antibiotic consumption along with reductions in hospitalization costs and antibiotic resistance. It will additionally generate insights for improved prognostic assessment of patients with lower respiratory tract infections. Trial registration: ISRCTN95122877
Gammaherpesviruses, such as Epstein-Barr virus (EBV), are ubiquitous cancer-associated pathogens that interact with DNA damage response, a tumor suppressor network. Chronic gammaherpesvirus infection and pathogenesis in a DNA damage response-insufficient host are poorly understood. Ataxia-telangiectasia (A-T) is associated with insufficiency of ataxia-telangiectasia mutated (ATM), a critical DNA damage response kinase. A-T patients display a pattern of anti-EBV antibodies suggestive of poorly controlled EBV replication; however, parameters of chronic EBV infection and pathogenesis in the A-T population remain unclear. Here we demonstrate that chronic gammaherpesvirus infection is poorly controlled in an animal model of A-T. Intriguingly, in spite of a global increase in T cell activation and numbers in wild-type (wt) and ATM-deficient mice in response to mouse gammaherpesvirus 68 (MHV68) infection, the generation of an MHV68-specific immune response was altered in the absence of ATM. Our finding that ATM expression is necessary for an optimal adaptive immune response against gammaherpesvirus unveils an important connection between DNA damage response and immune control of chronic gammaherpesvirus infection, a connection that is likely to impact viral pathogenesis in an ATM-insufficient host.
Kulinski, Joseph M.; Leonardo, Steven M.; Mounce, Bryan C.; Malherbe, Laurent; Gauld, Stephen B.
Background: Control of infection within the long-term care facility is a daunting problem. Elderly patients are at high risk for contracting infection because of reduced innate immunity, malnutrition, and the presence of chronic medical conditions. This small study tested the effect of developing and implementing a comprehensive preventive infectioncontrol program in the long-term care setting and examined the resultant
Alex T. Makris; Louise Morgan; Donna J. Gaber; Alan Richter; Joseph R. Rubino
As a branch of evidence-based practice, evidence-based nursing emphasizes the integration of patient needs, the evidence for practical problem solving, and the application of nursing expertise. The criteria of evidence and the application of evidence in practice are the central theoretical foundations of evidence-based practice and evidence-based nursing. Therefore, the main philosophical considerations of evidence-based nursing shall focus on the criteria by which evidence supports propositions and how evidence should be applied in practice. In this paper, we explain the criteria of evidence from an epistemological perspective and explain the application of evidence in practice from the perspective of rational decision-making. Finally, we use these philosophical considerations to propose practical guidelines for evidence-based nursing and explain the philosophical significance of nursing practice. PMID:24096459
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
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
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
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 evidencebased health policy.Methods: A preliminary systematic literature review of published reviews with ‘evidencebased health policy’ in their title was conducted using PubMed as a search engine. The identified papers were critically analysed using
The evidence-based practice movement has become an important feature of health care systems and health care policy. Within this context, the APA 2005 Presidential Task Force on Evidence-Based Practice defines and discusses evidence-based practice in psychology (EBPP). In an in- tegration of science and practice, the Task Force's report describes psychology's fundamental commitment to sophis- ticated EBPP and takes into
Alvin R. Mahrer; Frederick L. Newman; John C. Norcross; Doris K. Silverman; Brian D. Smedley; Bruce E. Wampold; Drew I. Westen; Brian T. Yates; Nolan W. Zane; Geoffrey M. Reed; Lynn F. Bufka; Paul D. Nelson; Cynthia D. Belar; Merry Bullock
Perioperative hyperglycemia in critically ill surgery patients increases the risk of postoperative infection (POI), which is a common, and often costly, surgical complication. Hyperglycemia is associated with abnormalities in leukocyte function, including granulocyte adherence, impaired phagocytosis, delayed chemotaxis, and depressed bactericidal capacity. These leukocyte deficiencies are the cause of infection and improve with tight glycemic control, which leads to fewer POIs in critically ill surgical patients. Tight glycemic control, such as intensive insulin therapy, has a risk of hypoglycemia. In addition, the optimal targeted blood glucose range to reduce POI remains unknown. Since 2006, we have investigated tight perioperative blood glucose control using a closed-loop artificial endocrine pancreas system, to reduce POI and to avoid hypoglycemia. In this Topic Highlight, we review the relationship between perioperative glycemic control and POI, including the use of the artificial pancreas. PMID:19725144
Surgical site infections (SSIs) represent a major source of morbidity and mortality among surgical patients (Swenson et al 2009). The most common source of SSls is the patient's own skin flora (Zinn et al 2010). A literature review was performed on the impact of the different intraoperative skin preparation solutions in reducing the risk of SSIs, concluding that 2% chlorhexidine in spirit is the most effective. PMID:23691885
Background: The purpose of this study was to design and implement a comprehensive infectioncontrol program and measure its effects on the number and types of infectious illnesses experienced by children attending a specialized preschool program.Methods: Participants in the study were children with Down syndrome enrolled in a school-based early intervention program. The ages of the children ranged from 6
Leonard R. Krilov; Stephen R. Barone; Francine S. Mandel; Timothy M. Cusack; Donna J. Gaber; Joseph R. Rubino
Study objective: To determine the frequency with which patients with suspected tuberculosis (TB) or TB risk factors present to US emergency departments and to describe current ED TB infection-control facilities and practices. Design: Mailed survey of a sample of EDs in US acute care facilities. Participants: A random sample (n=446) of subjects who responded to a 1992 survey of all
Gregory J Moran; Mary Anne Fuchs; William R Jarvis; David A Talan
We conducted a survey of a random sample of California orthodontists and of general dentists to compare their infectioncontrol procedures. Questionnaires were returned by 124 orthodontists (56% response rate) and 126 general dentists (61% response rate). Eighteen questions were asked covering practice profile, perception of risk from hepatitis B virus (HBV) and human immunodeficiency virus (HIV), exposure to blood, barrier protection used, and sterilization and disinfection procedures. Gloves always were worn by 80% of the orthodontists sampled, 63% always wore glasses, and 59% changed gloves between patients. Orthodontists sterilized their instruments 66% of the time and pliers 49% of the time. Compared with general dentists, orthodontists' perception of risk, use of barrier protection, and sterilization and disinfection procedures were lower in all areas. Our data suggest that poorer performance may be because orthodontists: (1) perceive their younger population of patients at less risk for HBV and HIV; (2) treat 2.5 times as many patients, which increases the costs of infectioncontrol; (3) do not use invasive procedures; and (4) perceive that glove use decreases dexterity. Orthodontists should follow the American Dental Association/Council on Dental Therapeutics infectioncontrol guidelines for universal precautions. To meet these guidelines, orthodontists still need improvement in all aspects of their infectioncontrol procedures. PMID:1626533
ISSUE: Toys are utilized throughout most inpatient and outpatient areas. Our previous policy addressed toy cleaning in the inpatient setting, but did not address issues in the outpatient setting. A more comprehensive policy was needed.PROJECT: The InfectionControl Unit formed a multidisciplinary team to revise the policy, including staff from Nursing, Child Life, and Central Service. An algorithm was created
This is the second in a series of articles describing a research study that examined the efficacy of an infectioncontrol link nurse programme, which had an educational programme based upon adult learning theory, delivered using an action research approach. This article describes the results of a quantitative study that aimed to identify if the utilisation of this programme led
The purpose of this prospective study was to investigate whether a risk control programme based on risk assessment, new treatment modalities and the presence of a surveillance programme reduces the incidence of surgical, site infections (SSI). Between January 2001 and December 2003, 167 patients were treated for a total of 183 SSIs. Data were collected on pre-operative risk factors, intra-operative
P. Segers; A. P. de Jong; J. J. Kloek; L. Spanjaard
What is the impact of infectioncontrol regulations, standards, and recommendations on the home care practice setting? This article discusses regulations, such as the OSHA bloodborne pathogen rules, and other standards and recommendations that mandate or influence the practice of home health. In a health care environment where more care, particularly more complex care, is delivered in the home setting,
A home health care agency's infectioncontrol program is at the heart of every aspect of its operations, from the human resources\\/application process to the actual provision of patient care, including the working environment for all of the employees of the agency. Each employee has a part in making the program successful.
Background: To ensure quality patient care and enhance career development, competency levels of infectioncontrol professionals (ICPs) need to be identified and strengthened so that high standards of practice are established and maintained. Objective: The purpose of this study was to apply a modified version of Benner's (1984) “Novice to Expert” model of skill acquisition to levels of competency and
ISSUE: It has been reported that the methicillin-resistant rate of S. aureus and the MRSA isolation rate in ENT outpatient departments are higher than in any other medical services, which means that there is a high risk of transmission of MRSA among patients. For this reason, we have carried an infectioncontrol program in order to reduce the MRSA isolation
Objectives: To evaluate the roles of infectioncontrol nurses (ICNs) and to detect problems, obstacles during work and needs for support in community hospitals. Material and Method: A descriptive study, data from interview and questionnaire survey of 2 ICN from HA awarded hospitals and 146 IC nurses from hospitals applied for HA. Results: From April to May 2002, questionnaires were
The aim of this study was to investigate compliance of dental students in a Saudi dental school with recommended infectioncontrol protocols. A pilot-tested questionnaire concerning various aspects of infectioncontrol practices was distributed to 330 dental students. The response rate was 93.9% (n = 311). About 99% of students recorded the medical history of their patients and 80% were vaccinated against hepatitis B. The highest compliance (100%) with recommended guidelines was reported for wearing gloves and use of a new saliva ejector for each patient. Over 90% of the respondents changed gloves between patients, wore face masks, changed hand instruments, burs and handpieces between patients, used a rubber dam in restorative procedures and discarded sharp objects in special containers. A lower usage rate was reported for changing face masks between patients (81%), disinfecting impression materials (87%) and dental prosthesis (74%) and wearing gowns (57%). Eye glasses and face shield were used by less than one-third of the sample. The majority of students were found to be in compliance with most of the investigated infectioncontrol measures. Nevertheless, further education is needed to improve some infectioncontrol measures including vaccination for Hepatitis B virus (HBV), wearing eye glasses, gowns and face shields and disinfecting impression materials and dental prostheses. PMID:23879255
Ahmad, Ibrahim Ali; Rehan, Elaf Ali; Pani, Sharat Chandra
Evidence-based practice has been demonstrated to improve quality of care, increase patients' satisfaction, and reduce the costs of medical care. Therefore, evidence-based practice is now central to the clinical decision-making process and to achieving better quality of care. Today, it is one of the important indicators of core competences for healthcare providers and accreditation for healthcare and educational systems. Further, evidence-based practice encourages in-school and continuous education programs to integrate evidence-based elements and concepts into curricula. Healthcare facilities and professional organizations proactively host campaigns and encourage healthcare providers to participate in evidence-based related training courses. However, the clinical evidence-based practice progress is slow. The general lack of a model for organizational follow-up may be a key factor associated with the slow adoption phenomenon. The authors provide a brief introduction to the evidence-based practice model, then described how it may be successfully translated through a staged process into the evidence-based practices of organizational cultures. This article may be used as a reference by healthcare facilities to promote evidence-based nursing practice. PMID:24096462
OBJECTIVE:The skin is a potential source for invasive infections in neonates from developing countries such as Bangladesh, where the level of environmental contamination is exceedingly high. A randomized controlled trial was conducted from 1998 to 2003 in the Special Care Nursery of a tertiary hospital in Bangladesh to test the effectiveness of topical emollient therapy in enhancing the skin barrier
Gary L Darmstadt; A S M Nawshad Uddin Ahmed; Samir K Saha; M A K Azad Chowdhury; Muhammad Asif Alam; Mahamuda Khatun; Robert E Black; Mathuram Santosham
BACKGROUND: Chiropractors must continue to learn, develop themselves professionally throughout their careers, and become self-directed and lifelong learners. Using an evidence-based approach increases the probability of optimal patient outcomes. But most chiropractors lack knowledge and interest in evidence-based approaches. The purpose of this study was to develop and measure the effectiveness of evidence-based training for chiropractic practitioners in a continuing
Ronald J Feise; Jaroslaw P Grod; Anne Taylor-Vaisey
Evidence exists that pain is inadequately controlled in most patients. This is caused, in part, by the fact that doctors and nurses have based clinical practice on myths and misconceptions about pain medications, rather than by using evidence-based research. Evidence also exists that when pain is adequately controlled, there is greater patient satisfaction with care. The purpose of Part 3
The prevalence of fibromyalgia syndrome (FMS) of 1–2% in the general population associated with high disease-related costs and the conflicting data on treatment effectiveness had led to the development of evidence-based guidelines designed to provide patients and physicians guidance in selecting among the alternatives. Until now no evidence-based interdisciplinary (including patients) guideline for the management of FMS was available in Europe. Therefore a guideline for the management of fibromyalgia syndrome (FMS) was developed by 13 German medical and psychological associations and two patient self-help organisations. The task was coordinated by two German scientific umbrella organisations, the Association of the Scientific Medical Societies in Germany AWMF and the German Interdisciplinary Association of Pain Therapy DIVS. A systematic search of the literature including all controlled studies, systematic reviews and meta-analyses of pharmacological and non-pharmacological treatments of FMS was performed in the Cochrane Library (1993–12/2006), Medline (1980–12/2006), PsychInfo (1966–12/2006) and Scopus (1980–12/ 2006). Levels of evidence were assigned according to the classification system of the Oxford-Centre for EvidenceBased Medicine. Grading of the strengths of recommendations was done according to the German program for disease management guidelines. Standardized procedures were used to reach a consensus on recommendations. The guideline was reviewed and finally approved by the boards of the societies involved and published online by the AWMF on april 25, 2008: http://www.uni-duesseldorf.de/AWMF/ll/041-004.htm. A short version of the guideline for patients is available as well: http://www.uni-duesseldorf.de/AWMF/ll/041-004p.htm. The following procedures in the management of FMS were strongly recommended: information on diagnosis and therapeutic options and patient-centered communication, aerobic exercise, cognitive and operant behavioural therapy, multicomponent treatment and amitriptyline. Based on expert opinion, a stepwise FMS-management was proposed. Step 1 comprises confirming the diagnosis and patient education and treatment of physical or mental comorbidities or aerobic exercise or cognitive behavioural therapy or amitriptyline. Step 2 includes multicomponent treatment. Step 3 comprises no further treatment or self-management (aerobic exercise, stress management) and/or booster multicomponent therapy and/or pharmacological therapy (duloxetine or fluoxetine or paroxetine or pregabalin or tramadol/aminoacetophen) and/or psychotherapy (hypnotherapy or written emotional disclosure) and/or physical therapy (balneotherapy or whole body heat therapy) and/or complementary therapies (homoeopathy or vegetarian diet). The choice of treatment options should be based on informed decision-making and respect of the patients’ preferences.
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
We surveyed a random sample of South Carolina physicians and infectioncontrol practitioners about the reporting of human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) cases. Of physicians surveyed, 79% indicated that HIV infection as well as AIDS should be reported by name. The following characteristics were associated with those physicians who do not report AIDS cases: not feeling responsible for reporting, not reporting a case perceived to have been reported in another state, believing that information required for reporting is not on the chart, and residing in an urban setting. Targeted education can address these underreporting factors.
We surveyed a random sample of South Carolina physicians and infectioncontrol practitioners about the reporting of human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) cases. Of physicians surveyed, 79% indicated that HIV infection as well as AIDS should be reported by name. The following characteristics were associated with those physicians who do not report AIDS cases: not feeling responsible for reporting, not reporting a case perceived to have been reported in another state, believing that information required for reporting is not on the chart, and residing in an urban setting. Targeted education can address these underreporting factors. PMID:1585971
ISSUE: Construction-related infectioncontrol guidelines for healthcare facilities are primarily directed toward preventing healthcare-associated fungal infection (e.g., Aspergillus species) in occupied buildings. There are, however, no generally accepted standards for infectioncontrol commissioning of a newly constructed ambulatory surgery center. A model infectioncontrol program for commissioning such a building is presented.PROJECT: To develop an infectioncontrol-commissioning program for a
L. Lee; N. Whittington; D. Villaflor-Camagong; L. Bui; A. Streifel; B. Cookson; E. Whimbey
Epidemic theory predicts that the vaccination threshold required to interrupt local transmission of an immunizing infection like measles depends only on the basic reproductive number and hence transmission rates. When the search for optimal strategies is expanded to incorporate economic constraints, the optimum for disease control in a single population is determined by relative costs of infection and control, rather than transmission rates. Adding a spatial dimension, which precludes local elimination unless it can be achieved globally, can reduce or increase optimal vaccination levels depending on the balance of costs and benefits. For weakly coupled populations, local optimal strategies agree with the global cost-effective strategy; however, asymmetries in costs can lead to divergent control optima in more strongly coupled systems--in particular, strong regional differences in costs of vaccination can preclude local elimination even when elimination is locally optimal. Under certain conditions, it is locally optimal to share vaccination resources with other populations. PMID:21825129
Klepac, Petra; Laxminarayan, Ramanan; Grenfell, Bryan T
Proton pump inhibitors (PPI) are very effective in inhibiting acid secretion and are extensively used in many acid related diseases. They are also often used in patients with cirrhosis sometimes in the absence of a specific acid related disease, with the aim of preventing peptic complications in patients with variceal or hypertensive gastropathic bleeding receiving multidrug treatment. Contradicting reports support their use in cirrhosis and evidence of their efficacy in this condition is poor. Moreover there are convincing papers suggesting that acid secretion is reduced in patients with liver cirrhosis. With regard to Helicobacter pylori (H pylori) infection, its prevalence in patients with cirrhosis is largely variable among different studies, and it seems that H pylori eradication does not prevent gastro-duodenal ulcer formation and bleeding. With regard to the prevention and treatment of oesophageal complications after banding or sclerotherapy of oesophageal varices, there is little evidence for a protective role of PPI. Moreover, due to liver metabolism of PPI, the dose of most available PPIs should be reduced in cirrhotics. In conclusion, the use of this class of drugs seems more habit related than evidence-based eventually leading to an increase in health costs. PMID:18494046
Lodato, Francesca; Azzaroli, Francesco; Di Girolamo, Maria; Feletti, Valentina; Cecinato, Paolo; Lisotti, Andrea; Festi, Davide; Roda, Enrico; Mazzella, Giuseppe
The outbreak of severe acute respiratory syndrome (SARS) in 2003 alerted the world to the new face of pandemic disease: highly contagious and fatal infections for which no vaccines are available and current drugs are largely ineffective. As a practitioner providing primary care, the optometrist must be familiar with new and evolving infections present in today's society. Though they may be viewed as extreme events, scenarios such as the re-emergence of SARS, the affliction posed by the H5N1 strain of avian influenza and the threat of a bioterrorist attack have all been described. In the event that such events occur, there is the potential for the spread of some highly virulent, transmissible disease. This paper highlights these public health threats and discusses several areas that the optometrist may want to consider regarding infectioncontrol in an era in which a highly transmissible disease is being spread from person to person. PMID:17177663
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.
Stepek, Gillian; Buttle, David J; Duce, Ian R; Behnke, Jerzy M
Over the last 20 years some magic words have delighted the neuroscientific community such as ‘‘plasticity’’ or ‘‘network’’. When it comes to medical services another magic word is ‘‘evidencebased medicine’’. Evidencebased medicine (EBM) means to use well organized knowledge to shape decisions. This is of course a good idea. Historically the first roots of using knowledge to shape
Purpose – Drawing on recent research related to hospital facilities, this paper aims to discuss the role of evidence-based design in facility planning and design as a key element in helping the field of facility planning and management continue to strengthen professional practice. Design\\/methodology\\/approach – The discussion draws on relevant literature and recent research. Findings – Evidence-based design is having
|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…
Purpose: To illustrate the way in which both fluency shaping (FS) and stuttering management (SM) treatments for developmental stuttering in adults are evidencebased. 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…
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…
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…
With increased regulation and scrutiny of outcomes, hospice programs are being challenged to consider the implementation of evidence-based practices (EBPs). This study reports findings from hospice director interviews and staff focus groups, which occurred following the completion of a multifaceted translating research into practice (TRIP) intervention designed to promote evidence-based pain management practices. The purpose of this article is to
Sara Sanders; Melissa Lehan Mackin; Jimmy Reyes; Keela Herr; Marita Titler; Perry Fine; Chris Forcucci
Evidence-based practice (EBP) involves the integration of the expertise of individual practitioners with the best available evidence within the context of values and expectations of clients. Little is known about the implementation of evidence-based practice in the human services. This article is based on a comprehensive search of the literature related to the organizational factors needed to introduce EBP into
|School Library Journal's 2007 Leadership Summit, "Where's the Evidence? Understanding the Impact of School Libraries," focused on the topic of evidence-based practice. Evidence-based school librarianship is a systematic approach that engages research-derived evidence, school librarian-observed evidence, and user-reported evidence in the processes…
|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…
This article examines what has been learnt about practice-academic partnership from two Research in Practice projects aimed at supporting the development of evidence-based practice in social care. Tangible support from organisations is needed to support both the partnership approach and the development of evidence-based practice.
With its promise of enhancing the effectiveness of services, evidence-based practice in psychology (EBPP) appears to offer much to psychologists, patients, and policymakers. The purpose of this article is to examine some of the key challenges facing psychologists who wish to provide evidence-based treatment services, including how research evidence is used in EBPP, whether the results of the treatment research
This paper explores how the evidence-based practice and quality improvement movements are informing our understanding of what counts as quality patient care. Implicit in the debate is that we have understood and can manage the concept of patient safety. Using a true case study, the paper will illustrate how a clearer, more integrated understanding of safety, evidence-based practice and quality
Objective To review the evidencebase for measures of cognitive functioning frequently used within the field of pediatric psychology. Methods From a list of 47 measures identified by the Society of Pediatric Psychology (Division 54) Evidence-Based Assessment Task Force Workgroup, 27 measures were included in the review. Measures were organized, reviewed, and evaluated according to general domains of functioning (e.g.,
Jonathan M. Campbell; Ronald T. Brown; Sarah E. Cavanagh; Sarah F. Vess; Mathew J. Segall
A clinical practicum was successfully implemented for RN to BSN students to apply evidence-based practice to actual clinical problems affecting nursing practice. The author describes how this practicum was implemented and the requisite resources and support systems. This senior-level capstone course enabled students to understand and value a lifelong learning approach to evidence-based practice. PMID:16980821
|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…
There is mounting concern about the impact of health care restructuring on the provision of infection prevention services across the health care continuum. In response to this, Health Canada hosted two meetings of Canadian infectioncontrol experts to develop a model upon which the resources required to support an effective, integrated infection prevention and control program across the health care
Viruses account for the majority of the acute respiratory tract infections (ARIs) globally with a mortality exceeding 4 million deaths per year. The most commonly encountered viruses, in order of frequency, include influenza, respiratory syncytial virus, parainfluenza and adenovirus. Current evidence suggests that the major mode of transmission of ARls is through large droplets, but transmission through contact (including hand contamination with subsequent self-inoculation) and infectious respiratory aerosols of various sizes and at short range (coined as "opportunistic" airborne transmission) may also occur for some pathogens. Opportunistic airborne transmission may occur when conducting highrisk aerosol generating procedures and airborne precautions will be required in this setting. General infectioncontrol measures effective for all respiratory viral infections are reviewed and followed by discussion on some of the common viruses, including severe acute respiratory syndrome (SARS) coronavirus and the recently discovered novel coronavirus. PMID:23888794
Seto, W H; Conly, J M; Pessoa-Silva, C L; Malik, M; Eremin, S
Despite much research on immunological responses to helminth parasites, knowledge of the dynamic interplay between levels of herd immunity in humans and the rates of exposure, establishment and mortality of parasites remains limited. We describe here a simple mathematical model for the population dynamics of helminth infections which mirrors the development of a degree of acquired immunity within populations which are genetically heterogeneous with respect to immunological responsiveness. We interpret observed patterns in the age-specific intensity of infection and attempt to understand the possible effects of control measures based on chemotherapy and vaccination. Mass chemotherapy can, in some circumstances, reduce the level of herd immunity such that average worm burdens in the adult age classes rise above their precontrol levels. When certain individuals or groups are predisposed to heavy infection, selective or targeted drug treatment can have significantly greater impact than mass or random application. Conversely, model predictions suggest that effective parasite control by vaccination (if and when vaccines become available) is difficult to achieve in communities that are genetically heterogeneous in their ability to mount protective responses to infection. PMID:4000277
The epidemiological situation of tuberculosis (TB) in Germany has improved considerably during the past few years. However, those in unprotected contact with infectious tuberculosis patients frequently and/or over longer periods of time and/or intensively continue to have a higher risk for TB infection. Rapid diagnosis, prompt initiation of effective treatment, and adequate infectioncontrol measures are of particular importance to prevent infection. The present recommendations depict the essentials of infectioncontrol as well as specific measures in the hospital (isolation, criteria for its duration and technical requirements, types of respiratory protection, disinfection measures, waste disposal). The specific requirements for outpatients (medical practice), at home, for ambulance services, and in congregate settings, including prisons, are also addressed. Compared with the previous recommendations the pattern of respiratory protection measures has been simplified. As a rule, hospital staff and those visiting infectious tuberculosis patients are advised to wear respiratory protection that satisfies the criteria of FFP2-masks (DIN EN 149), while patients should wear mouth-nose protectors (surgical masks) in the presence of others and outside the isolation room. A detailed depiction of criteria for isolation and its duration in smear positive and only culturally confirmed pulmonary tuberculosis has been added. PMID:22294284
This review sets out to explore how education and training provisions for members of the InfectionControl Team (ICT) have developed alongside their roles and in response to changes in the British National Health Service. It focuses on the Consultant in Communicable Disease Control, the InfectionControl Doctor and the InfectionControl Nurse in the United Kingdom, but also briefly
In spite of continuing concerns about disproportionate representation of African Americans, American Indians, and selected other groups in foster care, development of the practice and policy evidencebase has paid scant attention to incorporating the specific concerns of these communities in intervention research. The authors review the current foundation of evidence-based practice and identify gaps in the knowledge base with
In this paper we have attempted to describe the manner of spread of an endemic, native, respiratory infection and a method for its control. The essential factor determining the prevalence of such an endemic disease is, we believe, host susceptibility, which is controlled by hereditary and environmental influences. Furthermore, it seems probable that the amount of this population susceptibility determines the dosage of specific microbes available to the population. An increase in dosage in the herd is followed by an increase in the spread and severity of the infection, and a decrease by a corresponding alleviation. Hence, two methods for the prevention of epidemics are available: (1) an enhancement of population resistance, and (2) the reduction to a minimum of available dosage. These procedures have proved successful for 3 years in maintaining a population of breeding rabbits, in the midst of a badly infected community, entirely free from Bact. lepisepticum infection. Confirmation of the above conclusions has been gained from other studies in the field of experimental epidemiology. Dr. D. T. Smith (2), at Saranac, New York, found that changes in population susceptibility were responsible for a severe outbreak of Bact. lepisepticum infection and septicemia. Freund (3), at Berlin, has just published an interesting account of respiratory epidemics of rabbits and guinea pigs, apparently brought about by sudden changes in temperature and housing conditions. Pneumonia and Pasteurella infection, endemic in the population, increased suddenly in extent and severity. Nevertheless, neither endemic nor epidemic strains of the microorganisms were found to be especially virulent. Dr. Theobald Smith (4), in a study of paratyphoid epidemics of guinea pigs, has made similar observations. He noted that pregnant females acted as the foci of infection, and that from these individuals, presumably of lessened resistance, the bacteria were given off and infection was spread. The studies in experimental epidemiology are rapidly reaching a stage where they may be applied to the problems of human disease. Indeed, more recent observations of the mode of spread of pneumonia (5-7), scarlet fever (8), typhoid (9, 10), plague (11), diphtheria (12-14), measles (15), and tuberculosis (16-18) increasingly show a tendency to discard the theory of fluctuating microbic virulence and to emphasize the importance of the host factors. PMID:19869298
Dental hospital staff and students were observed during clinical work for their compliance with infectioncontrol procedures, as recommended by the British Dental Association. A total of 183 contacts between health care worker and patient were scrutinised during December 1990. Nearly all health care workers (96%) wore gloves to carry out dental treatment, but in some cases gloves were neither changed nor hands washed between patients. Only one half wore protective eyewear and about one third (38%) wore no mask. Some dental surgery assistants used heavy duty gloves and some even scrubbed dirty dental instruments without wearing any gloves. Strict audit is clearly needed in every clinical setting in order to ensure compliance with infectioncontrol. PMID:1622678
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 infectioncontrol 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 infectioncontrol, 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
The devastating clinical and economic implications of floods exemplify the need for effective global infection prevention and control (IPC) strategies for natural disasters. Reopening of hospitals after excessive flooding requires a balance between meeting the medical needs of the surrounding communities and restoration of a safe hospital environment. Postflood hospital preparedness plans are a key issue for infectioncontrol epidemiologists, healthcare providers, patients, and hospital administrators. We provide recent IPC experiences related to reopening of a hospital after extensive black-water floods necessitated hospital closures in Thailand and the United States. These experiences provide a foundation for the future design, execution, and analysis of black-water flood preparedness plans by IPC stakeholders. PMID:23295568
Apisarnthanarak, Anucha; Mundy, Linda M; Khawcharoenporn, Thana; Glen Mayhall, C
This article reviews the comprehensive data on the safety and tolerability from over 6,300 patients who have taken artemether/lumefantrine (Coartem) as part of Novartis-sponsored or independently-sponsored clinical trials. The majority of the reported adverse events seen in these studies are mild or moderate in severity and tend to affect the gastrointestinal or nervous systems. These adverse events, which are common in both adults and children, are also typical of symptoms of malaria or concomitant infections present in these patients. The wealth of safety data on artemether/lumefantrine has not identified any neurological, cardiac or haematological safety concerns. In addition, repeated administration is not associated with an increased risk of adverse drug reactions including neurological adverse events. This finding is especially relevant for children from regions with high malaria transmission rates who often receive many courses of anti-malarial medications during their lifetime. Data are also available to show that there were no clinically relevant differences in pregnancy outcomes in women exposed to artemether/lumefantrine compared with sulphadoxine-pyrimethamine during pregnancy. The six-dose regimen of artemether/lumefantrine is therefore well tolerated in a wide range of patient populations. In addition, post-marketing experience, based on the delivery of 250 million treatments as of July 2009, has not identified any new safety concerns for artemether/lumefantrine apart from hypersensitivity and allergies, known class effects of artemisinin derivatives. PMID:19818173
This article reviews the comprehensive data on the safety and tolerability from over 6,300 patients who have taken artemether/lumefantrine (Coartem®) as part of Novartis-sponsored or independently-sponsored clinical trials. The majority of the reported adverse events seen in these studies are mild or moderate in severity and tend to affect the gastrointestinal or nervous systems. These adverse events, which are common in both adults and children, are also typical of symptoms of malaria or concomitant infections present in these patients. The wealth of safety data on artemether/lumefantrine has not identified any neurological, cardiac or haematological safety concerns. In addition, repeated administration is not associated with an increased risk of adverse drug reactions including neurological adverse events. This finding is especially relevant for children from regions with high malaria transmission rates who often receive many courses of anti-malarial medications during their lifetime. Data are also available to show that there were no clinically relevant differences in pregnancy outcomes in women exposed to artemether/lumefantrine compared with sulphadoxine-pyrimethamine during pregnancy. The six-dose regimen of artemether/lumefantrine is therefore well tolerated in a wide range of patient populations. In addition, post-marketing experience, based on the delivery of 250 million treatments as of July 2009, has not identified any new safety concerns for artemether/lumefantrine apart from hypersensitivity and allergies, known class effects of artemisinin derivatives.
ISSUE: In January 2003, the Maryland State Department of Health and Mental Hygiene (DHMH) surveyed, for the first time, all acute-care facilities (ACFs) and long-term-care facilities (LTCFs) in the state to determine the current state of infectioncontrol resources and practices in Maryland.PROJECT: A self-administered questionnaire was sent to all 48 ACFs and 248 LTCFs. The questions asked about 1)
ISSUE: Beijing United Family Hospital (BJU) is a for-profit 50-bed hospital in Beijing, China, with the goal of being the first hospital in China to receive Joint Commission International Accreditation (JCIA). This abstract describes the lessons learned from the first international infectioncontrol (IC) internship between BJU and The Johns Hopkins University School of Nursing (JHUSON).PROJECT: To improve IC and
S. Borwein; P. Wang; A. Nevin; X. Shen; C. Bekedam; V. Mock; M. Hill
Infection of mice with pneumonia virus of mice (PVM) is used as a natural host experimental model for studying the pathogenesis of infection with the closely related human respiratory syncytial virus. We analyzed the contribution of T cells to virus control and pathology after PVM infection. Control of a sublethal infection with PVM strain 15 in C57BL\\/6 mice was accompanied
Stefanie Frey; Christine D. Krempl; Annette Schmitt-Graff; Stephan Ehl
Individual differences in response to pharmacologic treatment limits the usefulness of mean data obtained from randomized controlled trials. These individual differences exist even in genetically uniform inbred mouse strains. While stratification can be of value in large studies, the individual patient history is the most effective currently available guide for personalized medicine in psychopharmacology.
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
The general fear, superstition and alarm surrounding HIV/AIDS warrant that the highest standards of care be available to our patients. A survey on infectioncontrol was undertaken in Durban to assess the current state of infectioncontrol procedures among dentists in private practice. A self-administered 44-item questionnaire was hand-delivered to a random sample of 75 dentists (31.3%)--see comments in Methods--in private practice. The response rate was 90.7% (68 dentists). The routine use of gloves, masks, and protective eyewear was reported by 97.1%, 82.4% and 52.9% of dentists respectively. Although 89.7% of dentists had autoclaves in their practices, only 45.2% autoclaved their high speed handpieces and 39.7% their slow handpieces. Almost 60% of dentists did not use rubber dam at all whilst 46.3% did not disinfect impressions before sending them to the laboratory. Approximately 6% of respondents reported re-using local anaesthetic cartridges and 1.5% re-used needles. Needlestick injuries in the previous six months were reported by 13.8% of dentists but two thirds of them did not follow any specific protocol after injury. Almost 90 per cent of dentists were immunised against Hepatitis B but more than 60% of their staff were not. The results of the study showed that adherence to universally accepted guidelines for infectioncontrol remain low amid a climate of an ever-increasing HIV pandemic. PMID:11887441
In this department, Drs Newhouse and Wilson highlight hot topics in nursing outcomes, research, and evidence-based practice relevant to the nurse administrator. Content includes evidence-based projects and decision making, locating measurement tools for quality improvement and safety projects, using outcome measures to evaluate quality, practice implications of administrative research, and exemplars of projects that demonstrate innovative approaches to organizational problems. In this article, the authors describe the implications of meaningful use implementation to evidence-based practice and outcome measurement and discuss issues facing nurse executives in planning for these changes. PMID:22922746
Over the last decade, a consensus has emerged regarding a set of evidence-based practices for schizophrenia that address symptom management and psychosocial functioning. Yet, surveys suggest that the great majority of the population of individuals with schizophrenia do not receive evidence-based care. In this article, we review the empirical literature on implementation of evidence-based practices for schizophrenia patients. We first examine lessons learned from implementation studies in general medicine. We then summarize the implementation literature specific to schizophrenia, including medication practices, psychosocial interventions, information technology, and state- and federal-level interventions. We conclude with recommendations for future directions.
Evidence-based nursing requires that students think reflectively and use clinical inquiry to develop clinical reasoning and decision-making skills. Likewise, nursing students need a strategy to be successful in passing the NCLEX-RN. The authors identify strategies based on nursing research to facilitate student success. While learning the evidence-based nursing process, the student must begin to think like a nurse while answering clinical practice questions. Using the skills taught for evidence-based nursing can be a powerful tool to approach the NCLEX-RN and succeed. PMID:22024676
Tropical bovine theileriosis caused by Theileria annulata and transmitted by ticks of the genus Hyalomma may be controlled by one or more of the following methods: i) management, with particular emphasis on movement control; ii) vector control by application of acaricides, preventing transmission of disease; iii) treatment of clinical disease using specific chemotherapeutics; iv) immunization with live vaccines; and v) the use of cattle resistant to ticks or the disease. Of these the most important and effective control method is the use of a live cell culture vaccine attenuated by prolonged culture in vitro of mononuclear cells persistently infected with macroschizonts of T. annulata. This vaccine, used chiefly in susceptible taurine dairy cattle, can now be complemented by using novel chemotherapeutic naphthoquinones--parvaquone and buparvaquone--which are very effective in treatment of the clinical disease in these valuable cattle. PMID:2126619
The daily responsibilities of medical communications professionals require the application of evidence-based medicine (EBM) principles. Decision making based on personal experience alone, without knowledge from well-designed, controlled, randomized trials with adequate sample size, often overestimates the efficacy and underestimates the safety risks associated with drug therapy. The practice of EBM involves integrating clinical expertise with the best available evidence from
Patrick J. Bryant; Michael J. Steinberg; Christopher M. Marrone
Objective To test a multifaceted collaborative quality improvement intervention designed to promote evidencebased surfactant treatment for preterm infants of 23-29 weeks' gestation. Design Cluster randomised controlled trial Setting and participants 114 neonatal intensive care units (which treated 6039 infants of 23-29 weeks gestation born in 2001).
Jeffrey D Horbar; Joseph H Carpenter; Jeffrey Buzas; Roger F Soll; Gautham Suresh; Michael B Bracken; Laura C Leviton; Paul E Plsek; John C Sinclair; Vermont Oxford
Only in the last three decades, the restless legs syndrome (RLS) has been examined in randomized controlled trials. The Movement Disorder Society (MDS) commissioned a task force to perform an evidence-based review of the med- ical literature on treatment modalities used to manage patients with RLS. The task force performed a search of the published literature using electronic databases. The
Claudia Trenkwalder; Wayne A. Hening; Pasquale Montagna; Wolfgang H. Oertel; Richard P. Allen; Arthur S. Walters; Joao Costa; Karin Stiasny-Kolster; Cristina Sampaio
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…
Electrical stimulation is frequently recommended for the treatment of urinary incontinence in men. However, few randomized, controlled trials allow practitioners to evaluate the evidencebase for this practice. The purpose of this article is to determine, based on a review of the literature, whether adequate evidence exists to support the use of electrical stimulation as a treatment of male urinary
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 coach ratings) and a qualitative measure (teacher interview) were collected
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…
|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,…
BackgroundChildren of mothers infected with soil-transmitted helminths (STH) may have an increased susceptibility to STH infection.Methods and FindingsWe did a case-control study nested in a birth cohort in Ecuador. Data from 1,004 children aged 7 months to 3 years were analyzed. Cases were defined as children with Ascaris lumbricoides and\\/or Trichuris trichiura, controls without. Exposure was defined as maternal infection
Raaj S. Mehta; Alejandro Rodriguez; Martha Chico; Irene Guadalupe; Nely Broncano; Carlos Sandoval; Fernanda Tupiza; Edward Mitre; Philip J. Cooper
Introduction Following trauma, patients may suffer an overwhelming pro-inflammatory response and immune paralysis resulting in infection and multiple organ failure (MOF). Various potentially immunomodulative interventions have been tested. The objective of this study is to systematically review the randomized controlled trials (RCTs) that investigate the effect of potentially immunomodulative interventions in comparison to a placebo or standard therapy on infection, MOF, and mortality in trauma patients. Methods A computerized search of MEDLINE, the Cochrane CENTRAL Register of Controlled Trials, and EMBASE yielded 502 studies, of which 18 unique RCTs were deemed relevant for this study. The methodological quality of these RCTs was assessed using a critical appraisal checklist for therapy articles from the Centre for EvidenceBased Medicine. The effects of the test interventions on infection, MOF, and mortality rates and inflammatory parameters relative to the controls were recorded. Results In most studies, the inflammatory parameters differed significantly between the test and control groups. However, significant changes in infection, MOF, and mortality rates were only measured in studies testing immunoglobulin, IFN-?, and glucan. Conclusions Based on level 1b and 2b studies, administration of immunoglobulin, IFN-?, or glucan have shown the most promising results to improve the outcome of trauma patients.
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
Human adenovirus type 5 and temperature-sensitive mutants ts36, ts37, and ts125 induced cellular DNA synthesis in quiescent rodent cells at both permissive and nonpermissive temperatures. Cellular DNA synthesis induced by adenovirus type 5 or by serum required protein synthesis for both initiation and continuation, whereas viral DNA synthesis was not dependent upon continued protein synthesis once it was initiated. Both cellular and viral DNA replication was induced in adenovirus type 5-infected cells in the presence of dibutyryl cyclic AMP at concentrations which inhibited induction by serum which suggested that some of the controls of DNA synthesis in serum-treated and virus-infected cells are different. After adenovirus infection of quiescent cells, there was a decrease in the number of cells with G1 DNA content and an increase in cells with G2 diploid and greater DNA contents. Thus, adenovirus type 5 induces a complete round of cellular DNA replication, but in some cells, it induces a second round without completion of a normal mitosis. These results suggest that adenovirus type 5 is able to alter cell growth cycle controls in a way which may be related to its ability to transform cells.
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 × 109–25 × 109/ L was 0.33; for 25 × 109–50 × 109/L, 1.06; for 50 × 109–100 × 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.
Carpenter, Christopher R.; Schuur, Jeremiah D.; Everett, Worth W.; Pines, Jesse M.
The aim of this article is to review the principles of infectioncontrol relating to intravenous (IV) therapy. IV therapy and peripheral IV cannulation are common procedures. Zingg and Pittet (2009) noted that as many as 80% of hospitalized patients will have a cannula in situ, and Hart (2008) suggested that patients who require IV therapy are often seriously ill and immunocompromised, thus are more susceptible to infection. The Department of Health (DH) (2007a) estimated that 6000 patients acquire a catheter-related bloodstream infection every year in the UK. Robust standards of practice are therefore paramount to ensure safe and competent practice, both in peripheral IV cannulation and IV care. Using the chain of infection as a framework to review practice will enable practitioners to ensure thorough standards of practice, and the Royal College of Nursing (RCN) (2005) stated that only trained and competent staff using strict aseptic techniques should be involved in IV or cannulae care. Furthermore, the Code (Nursing and Midwifery Council (NMC), (2008) stipulates all practitioners must deliver care based on the best available evidence and/or best practice, and that knowledge and skills for safe and effective practice must be kept up-to-date throughout each health professional's working life. PMID:21042241
OBJECTIVE To provide family physicians with an overview of the evidence for managing superficial cutaneous abscesses. SOURCES OF INFORMATION PubMed (from 1950), EMBASE (from 1974), The Cochrane Library (from 1966), and Google (from 1998) were searched as were reference lists of identified articles. Summary sites, such as ACP Journal Club and InfoPOEMs, and background resources were also reviewed. MAIN MESSAGE There are many areas of debate regarding abscess management, including pain control, necessity of culture and sensitivity testing, empiric treatment with antibiotics, and open versus primary closure of wounds. Usefulness of cultures and empiric antibiotic treatment has risen to the forefront with the increasing incidence of community-acquired, methicillin-resistant Staphylococcus aureus. CONCLUSION In immunocompetent patients with no confounding risk factors, incision and drainage under local anesthetic is generally sufficient for abscess management. There is no compelling evidence for routine cultures or empiric treatment with antibiotics. Further research is required.
Professor Alan Glasper discusses the Royal College of Nursing's recently announced information literacy competences, which set out skills required by nurses to deliver safe and effective evidence-based care. PMID:21378643
Stijn Van de Velde and colleagues describe the African First Aid Materials project, which developed evidence-based guidelines on administering first aid in the African context as well as training materials to support the implementation of the guidelines.
Stijn Van de Velde; Emmy De Buck; Philippe Vandekerckhove; Jimmy Volmink
Certification in infectioncontrol has been available since 1983. In this, the 15th anniversary of the Certified in InfectionControl examination, it seems appropriate to examine how the program was developed, how it has evolved, and future opportunities for Certification in InfectionControl and Epidemiology. This article was written to provide a brief history and an update on the current
In 1994 health services in the Edmonton region were consolidated into an integrated network called Capital Health. Infectioncontrol professionals in the region met to develop a vision for the future of infectioncontrol; the tasks were to prepare a proposal for a regional program, develop indicators for outcome measurements, and standardize guidelines and products. Although regionalization of infectioncontrol
Rhoda M. Wiens; F. Lee Hanna; Maureen J. Miller; Anita C. Hanrahan; Geoffrey D. Taylor
Healthcare-acquired infections (HAIs) are a serious concern, costing the NHS 1 billion pounds a year and causing 5000 deaths annually despite increased funding. A contributing factor is the variety of aseptic techniques in use in different hospitals and even within a single hospital. These cause problems for healthcare workers as well as increasing the risk of HAI. This article examines a number of traditional approaches to aseptic technique, highlighting their differences and the implications for infectioncontrol. It concludes that improvement in aseptic technique could be achieved by implementation of a single unified approach to aseptic technique that can be standardized and audited annually, such as the aseptic non-touch technique (ANTT), which has been recommended for adoption throughout the UK. It ends with suggestions for measures that could be introduced and strengthened to improve aseptic technique, and ultimately reduce the rate of HAI. PMID:19127228
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
Backgound and Purpose. Evidence-based practice is the explicit use of current best evidence in making decisions about the care of individual patients and is a concept of growing importance for physiotherapy. The aim of the present study was to investigate Australian physiotherapists' self-reported practice, skills and knowledge of evidence-based practice and to examine differences between recent and experienced grad- uates,
\\u000a Evidence-based Head and Neck Oncology is the implementation of, or the move toward, Evidence-based medicine (EBM) in the care\\u000a of individual patients with head and neck squamous cell carcinoma. While the general principles and pitfalls of EBM apply\\u000a in this subfield as well as in medicine in general, this chapter maintains a head and neck focus. A number of recent
The term evidence-based medicine originated at McMaster University in Canada in 1981 when staff in the Department of Clinical Epidemiology and Biostatistics began publishing a series of papers designed to teach physicians how to critically review medical research literature (Guyatt & Rennie, 2002). This slowly developed into an approach to using research evidence in routine patient care. Evidence-based medicine has
In this study the researchers examined the knowledge, skills, and use of Evidence-Based Practice in a sample of social workers from different practice settings. Using an electronic survey, data were collected from a group of social work practitioners (N = 200). Participants in their 30s and 40s demonstrated the most knowledge and use of Evidence-Based Practice. In addition, a high
Natalie D. Pope; Latrice Rollins; Josphine Chaumba; Ed Risler
This article describes the use of problem-based learning to teach the scope and consequences of evidence-based practices in mental health through an innovative assignment that integrates classroom and field learning. The authors illustrate the planning and implementation of the Evidence-Based Practice: Integrating Classroom Curriculum and Field Education Assignment designed to promote a deeper, more comprehensive and critical understanding of the
In several nations, shifts in federal policy, consumer attitudes, and pay-for-services systems have placed a stronger emphasis on evidence-based practice than at any time previously. This emphasis, while generally compatible with the behavior-analytic focus on evidence above all, does not always benefit behavior analysis. For example, in the larger movement of evidence-based practice, most evaluators do not place great weight
\\u000a This chapter presents the origins and assumptions of evidence-based medicine as rooted in the philosophy of science called\\u000a positivism. The basic principles of the positivist approach to science, empiricism, exclusivity, universality, and autonomy\\u000a are explained and identified in reproductive and perinatal health outcomes related studies from the systematic reviews of\\u000a the Cochrane Library, the premier database on evidence-based medicine. A
There is much to recommend an increased emphasis on evidence-based medicine (EBM) training in medical education. Evidence-based\\u000a practice has emerged as a national priority in efforts to improve health care quality (1). Physicians are encouraged to identify, appraise, and apply the best evidence in their decision making for individual patients.\\u000a However, this ideal remains far from realization. Physicians leave the
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 the problematic nature of the concept of “evidence-based” in relation to the
This article explores the implementation of evidence-based design elements in the renovation of 1 patient room on a budget of $3500. The functional mock-up was evaluated through survey and focus groups by staff, visitors, and physicians to identify problematic features. Overall, participants perceived that design elements were effective with only minor modification needed before replication. Suggestions are provided for ways to implement evidence-based design with limited funds. PMID:21900861
Turner, Shelly E; Anderson, E Faye; Frith, Karen H; Couch, Bobby
Practicing medicine according to the best evidence is gaining popularity in the medical societies. Although this concept, which is usually called EvidenceBased Medicine (EBM) has been explained in many resources, it has not been addressed enough in pediatrics. In this review, we briefly explained EvidenceBased Medicine approach and its applications in pediatrics in order to help the pediatricians to efficiently integrate EBM into their daily practice.
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. Evidence-based practice is discussed within the context of emerging
The current paper describes three models of research-practice collaboration to scale-up evidence-based practices (EBP): (1)\\u000a the Rolling Cohort model in England, (2) the Cascading Dissemination model in San Diego County, and (3) the Community Development\\u000a Team model in 53 California and Ohio counties. Multidimensional Treatment Foster Care (MTFC) and KEEP are the focal evidence-based\\u000a practices that are designed to improve
Patricia Chamberlain; Rosemarie Roberts; Helen Jones; Lynne Marsenich; Todd Sosna; Joseph M. Price
Introduction\\u000aEvidence-Based Medicine (EBM) for clinical medicine involves using the best evidence to care for individual patients. Evidence-based public health (EBPH) involves using the best evidence to develop public health policies and intervention programs. There are various EBM resources available to help clinicians sort through the vast amount of medical literature to find the best evidence for their practice needs,
E. Hatheway Simpson; Elaine Russo Martin; Sharon Telleen; Roger S. Luckmann
The Center for School Mental Health Assistance at the University of Maryland recently completed a review of evidence-based prevention and treatment programs that can be used by school mental health clinicians. Based on the review, a school-based program operating in 22 Baltimore City schools has purchased and trained clinicians in a number of protocols for evidence-based interventions. We present findings
Cindy M. Schaeffer; Eric Bruns; Mark Weist; Sharon Hoover Stephan; Julie Goldstein; Yolanda Simpson
A movement advocating the use of evidence-based practice (EBP) is increasingly influencing health care and the practice of psychology. Thus, teaching evidence-based practice in psychology (EBPP) is critical to the preparation of future health service psychologists. In this article, the authors address common myths associated with EBP, propose core components involved in teaching EBPP, and describe an example of how such training can be incorporated into a professional psychology education and training curriculum. PMID:17551942
Collins, Frank L; Leffingwell, Thad R; Belar, Cynthia D
Acute respiratory infections of viral or bacterial origin represent 1 of the 3 main causes of morbidity and mortality in children of developing countries, where they typically are responsible for 15-20% of deaths in children under 5. Mortality rates are higher in children under 1 year and decline with age. Fewer than 2% of children with pneumonia in developed countries die, vs. an estimated 10-20% in developing countries. Operational studies indicate that children dying of acute respiratory infections are those who do not receive health services or receive them too late, and those whose moderate infections are inadequately treated. Determining factors include inaccessibility of health services, socioeconomic problems, cultural factors limiting the frequency and acceptance of formal health services, and inadequate management of acute respiratory infections by the general health services. Immunizations, better case management and health education are 3 interventions for control of respirator infections that offer immediate potential benefits for primary health care in developing countries. Vaccinations against whooping cough, measles, and diphtheria are part of the Expanded Program of Immunization. Anti-pneumococcal vaccines and flu shots are not appropriate for use in children in developing countries. Health personnel should be trained to use antibiotics more rationally and efficiently and to make referrals to higher levels of care when needed. Oxygen treatment should be available in secondary and tertiary care centers. Health personnel should be trained to administer simple treatments for other possible complications of respiratory infections. Such measures have been applied sporadically in developing countries and data on their efficacy remain sparse. But mortality rates declined greatly in 1 rural community of India after introduction of the measures, and more proofs of their efficacy will become available as programs develop. It will be necessary to train health agents in differentiation of cases according to gravity, to recommend and apply treatment, to administer antimicrobial drugs, and to refer cases to hospitals. The main decision of the health agent concerns the gravity of the case and not the diagnosis of pneumonia or bronchitis. A classification based on the few most important signs and symptoms will facilitate the 2 principal decisions about treatment; whether to administer antimicrobial and whether to treat at home or refer to a higher level of care. A 3-part classification of acute respiratory infections if suggested for all outpatient care and community health agents: serious cases requiring hospitalization 2) moderate cases requiring antimicrobial but not hospitalization and 3) mild cases not requiring antimicrobial. PMID:3187734
Nationally, 9–10% of hospital in-patients acquire an infection during their admission. These infections are a major source of avoidable morbidity, mortality and additional resource use. Many could be prevented by use of effective infectioncontrol practi ces. However, the theory-practice gap affects compliance with infectioncontrol procedures in the same way that it affects other areas of nursing practice. Infection
Evidence-based practice has shown that open visitation in the intensive care setting positively impacts patient outcomes. However, many intensive care units continue to strictly limit visitation hours. One concern for nurses is that open visitation will expose their vulnerable patients to an increased risk of infection. This fear is unfounded in professional literature as well as in the experience of a busy intensive care unit in San Antonio, Texas. Keeping our patients safe from hospital-acquired infections requires vigilant attention to infection prevention procedures. Meanwhile, what may actually be bugging our patients is a health care culture that is based on tradition and is blind to the many benefits provided by a more liberal visitation policy rooted in patient-centered care. PMID:21160294
Objective: To develop a scientifically sound and clinically relevant evidence-based guideline for the treatment of painful diabetic neuropathy (PDN). Methods: We performed a systematic review of the literature from 1960 to August 2008 and classified the studies according to the American Academy of Neurology classification of evidence scheme for a therapeutic article, and recommendations were linked to the strength of the evidence. The basic question asked was: “What is the efficacy of a given treatment (pharmacologic: anticonvulsants, antidepressants, opioids, others; and nonpharmacologic: electrical stimulation, magnetic field treatment, low-intensity laser treatment, Reiki massage, others) to reduce pain and improve physical function and quality of life (QOL) in patients with PDN?” Results and Recommendations: Pregabalin is established as effective and should be offered for relief of PDN (Level A). Venlafaxine, duloxetine, amitriptyline, gabapentin, valproate, opioids (morphine sulfate, tramadol, and oxycodone controlled-release), and capsaicin are probably effective and should be considered for treatment of PDN (Level B). Other treatments have less robust evidence or the evidence is negative. Effective treatments for PDN are available, but many have side effects that limit their usefulness, and few studies have sufficient information on treatment effects on function and QOL.
Bril, V.; England, J.; Franklin, G.M.; Backonja, M.; Cohen, J.; Del Toro, D.; Feldman, E.; Iverson, D.J.; Perkins, B.; Russell, J.W.; Zochodne, D.
Evidence-based librarianship (EBL) is a relatively new concept for librarians. This paper lays out a practical framework for the implementation of EBL. A new way of thinking about research in librarianship is introduced using the well-built question process and the assignment of librarian research questions to one of six domains specific to librarianship. As a profession, librarianship tends to reflect more qualitative, social sciences/humanities in its research methods and study types which tend to be less rigorous and more prone to bias. Randomised controlled trials (RCT) do not have to be placed at the top of an evidence 'hierarchy' for librarianship. Instead, a more encompassing model reflecting librarianship as a whole and the kind of research likely to be done by librarians is proposed. 'Evidence' from a number of disciplines including health sciences, business and education can be utilized by librarians and applied to their practice. However, access to and availability of librarianship literature needs to be further studied. While using other disciplines (e.g. EBHC) as a model for EBL has been explored in the literature, the authors develop models unique to librarianship. While research has always been a minor focus in the profession, moving research into practice is becoming more important and librarians need to consider the issues surrounding research in order to move EBL forward. PMID:12389602
Legionella pneumophila is an intracellular pathogen that replicates within alveolar macrophages. Through its ability to activate multiple host innate immune components, L. pneumophila has emerged as a useful tool to dissect inflammatory signaling pathways in macrophages. However the resolution of L. pneumophila infection in the lung requires multiple cell types and abundant cross talk between immune cells. Few studies have examined the coordination of events that lead to effective immune control of the pathogen. Here we discuss L. pneumophila interactions with macrophages and dendritic cell subsets and highlight the paucity of knowledge around how these interactions recruit and activate other immune effector cells in the lung. PMID:21687433
Schuelein, Ralf; Ang, Desmond K Y; van Driel, Ian R; Hartland, Elizabeth L
Legionella pneumophila is an intracellular pathogen that replicates within alveolar macrophages. Through its ability to activate multiple host innate immune components, L. pneumophila has emerged as a useful tool to dissect inflammatory signaling pathways in macrophages. However the resolution of L. pneumophila infection in the lung requires multiple cell types and abundant cross talk between immune cells. Few studies have examined the coordination of events that lead to effective immune control of the pathogen. Here we discuss L. pneumophila interactions with macrophages and dendritic cell subsets and highlight the paucity of knowledge around how these interactions recruit and activate other immune effector cells in the lung.
Schuelein, Ralf; Ang, Desmond K. Y.; van Driel, Ian R.; Hartland, Elizabeth L.
Although renowned as a lethal pathogen, Neisseria meningitidis has adapted to be a commensal of the human nasopharynx. It shares extensive genetic and antigenic similarities with the urogenital pathogen Neisseria gonorrhoeae but displays a distinct lifestyle and niche preference. Together, they pose a considerable challenge for vaccine development as they modulate their surface structures with remarkable speed. Nonetheless, their host-cell attachment and invasion capacity is maintained, a property that could be exploited to combat tissue infiltration. With the primary focus on N. meningitidis, this Review examines the known mechanisms used by these pathogens for niche establishment and the challenges such mechanisms pose for infectioncontrol. PMID:19287450
Congratulations to Rapp and his colleagues (2008) for a helpful explication of important factors in the implementation of evidence-based practices in Kansas. This article is the latest to appear from the National Evidence-based Practices Project (http:\\/\\/www.mentalhealthpractices.com). The steady flow of articles from that project will significantly expand the field’s empirical knowledge regarding the implementation of effective psychosocial interventions in mental
Mental health and social service provider attitudes toward evidence-based practice have been measured through the development\\u000a and validation of the Evidence-Based Practice Attitude Scale (EBPAS; Aarons, Ment Health Serv Res 6(2):61–74, 2004). Scores on the EBPAS scales are related to provider demographic characteristics, organizational characteristics, and leadership.\\u000a However, the EBPAS assesses only four domains of attitudes toward EBP. The current
Gregory A. AaronsGuy; Guy Cafri; Lindsay Lugo; Angelina Sawitzky
HIV infects and propagates into CD4+ T lymphocytes and macrophages, although many other cell types play an important role in virus spreading and pathogenesis. In addition to regulatory viral proteins, the cytokine network has early been implicated as a major controller of the plastic capacity of HIV to spread productively or rather remain silently integrated in the chromosomes of infected cells. The recent discovery of CCR5 and CXCR4 as essential entry co-receptors together with CD4 has highlighted a novel and potentially important step in the pharmacological hunt for more effective antiviral agents. In addition to regulate HIV expression and replication, several cytokines have demonstrated the capacity of up- or down-modulating chemokine receptors including CCR5 and CXCR4 with the consequence of influencing the susceptibility of T cells and macrophages to HIV infection. Pharmacological agents such as pertussis toxin B-oligomer have demonstrated HIV suppressive effects via non competitive binding of CCR5, whereas interferons or interleukin-16 (IL-16) can prevent post-entry steps in HIV expression. At the clinical level, several cytokines or their receptors are useful markers for monitoring disease progression and its consequence on the immune system. Cytokine-based therapy represents a realistic complementary approach to traditional antiretroviral therapy potentially capable of restoring important adaptive or innate immune functions ultimately curtailing HIV spreading and its consequences on the immune system, as exemplified by the experimental clinical use of IL-2. PMID:11472251
The study of HIV-infected “controllers” who are able to maintain low levels of plasma HIV RNA in the absence of antiretroviral therapy (ART) may provide insights for HIV cure and vaccine strategies. Despite maintaining very low levels of plasma viremia, controllers have elevated immune activation and accelerated atherosclerosis. However, the degree to which low-level replication contributes to these phenomena is not known. Sixteen asymptomatic controllers were prospectively treated with ART for 24 weeks. Controllers had a statistically significant decrease in ultrasensitive plasma and rectal HIV RNA levels with ART. Markers of T cell activation/dysfunction in blood and gut mucosa also decreased substantially with ART. Similar reductions were observed in the subset of “elite” controllers with pre-ART plasma HIV RNA levels below conventional assays (<40 copies/mL). These data confirm that HIV replication persists in controllers and contributes to a chronic inflammatory state. ART should be considered for these individuals (ClinicalTrials.gov NCT01025427).
Hatano, Hiroyu; Yukl, Steven A.; Ferre, April L.; Graf, Erin H.; Somsouk, Ma; Sinclair, Elizabeth; Abdel-Mohsen, Mohamed; Liegler, Teri; Harvill, Kara; Hoh, Rebecca; Palmer, Sarah; Bacchetti, Peter; Hunt, Peter W.; Martin, Jeffrey N.; McCune, Joseph M.; Tracy, Russell P.; Busch, Michael P.; O'Doherty, Una; Shacklett, Barbara L.; Wong, Joseph K.; Deeks, Steven G.
The aim of this study was to compare four teaching methods on the evidence-based practice knowledge and skills of postgraduate nursing students. Students enrolled in the Evidence-based Nursing (EBN) unit in Australia and Hong Kong in 2010 and 2011 received education via either the standard distance teaching method, computer laboratory teaching method, Evidence-based Practice-Digital Video Disc (EBP-DVD) teaching method or the didactic classroom teaching method. Evidence-based Practice (EBP) knowledge and skills were evaluated using student assignments that comprised validated instruments. One-way analysis of covariance was implemented to assess group differences on outcomes after controlling for the effects of age and grade point average (GPA). Data were obtained from 187 students. The crude mean score among students receiving the standard+DVD method of instruction was higher for developing a precise clinical question (8.1±0.8) and identifying the level of evidence (4.6±0.7) compared to those receiving other teaching methods. These differences were statistically significant after controlling for age and grade point average. Significant improvement in cognitive and technical EBP skills can be achieved for postgraduate nursing students by integrating a DVD as part of the EBP teaching resources. The EBP-DVD is an easy teaching method to improve student learning outcomes and ensure that external students receive equivalent and quality learning experiences. PMID:23107585
OBJECTIVES Several studies have evaluated whether evidence-based medicine (EBM) training courses can improve skills such as literature searching and critical appraisal but to date, few data exist on whether teaching EBM skills and providing evidence-based resources result in change in behavior or clinical outcomes. This study was conducted to evaluate whether a multifaceted EBM intervention consisting of teaching EBM skills and provision of electronic evidence resources changed clinical practice. DESIGN Before/after study. SETTING The medical inpatient units at a district general hospital. PARTICIPANTS Thirty-five attending physicians and 12 medicine residents. INTERVENTION A multicomponent EBM intervention was provided including an EBM training course of seven 1-hour sessions, an EBM syllabus and textbook, and provision of evidence-based resources on the hospital network. MEASUREMENTS AND MAIN RESULTS The primary outcome of the study was the quality of evidence in support of therapies initiated for the primary diagnoses in 483 consecutive patients admitted during the month before and the month after the intervention. Patients admitted after implementation of the EBM intervention were significantly more likely to receive therapies proven to be beneficial in randomized controlled trials (62% vs 49%; P = .016). Of these trial-proven therapies, those offered after the EBM intervention were significantly more likely to be based on high-quality randomized controlled trials (95% vs 87%; P = .023). CONCLUSIONS A multifaceted intervention designed to teach and support EBM significantly improved evidence-based practice patterns in a district general hospital.
...END-STAGE RENAL DISEASE FACILITIES Patient Safety Â§ 494.30 Condition: Infection...Infections Among Chronic Hemodialysis Patients,â developed by the...section header âHBV-Infected Patientsâ, found on pages 27 and 28...
...END-STAGE RENAL DISEASE FACILITIES Patient Safety Â§ 494.30 Condition: Infection...Infections Among Chronic Hemodialysis Patients,â developed by the...section header âHBV-Infected Patientsâ, found on pages 27 and 28...
One could be forgiven for thinking that the only road to evidence-based clinical practice is the application of results from randomised controlled trials (or systematic reviews of such). By contrast, single-subject designs in the context of evidence-based clinical practice are believed by many to be strange bedfellows. In this paper, we argue that single-subject designs play an important role in
Summary Quorum sensing (QS) is the process through which bacteria communicate utilizing small diffusible molecules termed autoinducers. It has been demonstrated that QS controls a plethora of microbial processes including the expression of virulence factors. Here, we report an immunopharmacotherapeutic approach for the attenuation of QS in the Gram-positive human pathogen Staphylococcus aureus. An anti-autoinducer monoclonal antibody, AP4-24 H11, was elicited against a rationally-designed hapten, and efficiently inhibited QS in vitro through the sequestration of the autoinducing peptide (AIP)-4 produced by S. aureus RN4850. Importantly, AP4-24H11 suppressed S. aureus pathogenicity in an abscess formation mouse model in vivo and provided complete protection against a lethal S. aureus challenge. These findings provide a strong foundation for further investigations of using immunopharmacotherapy for the treatment of bacterial infections in which QS controls the expression of virulence factors.
Park, Junguk; Jagasia, Reshma; Kaufmann, Gunnar F.; Mathison, John C.; Ruiz, Diana I.; Moss, Jason A.; Meijler, Michael M.; Ulevitch, Richard J.; Janda, Kim D.
The numerous controlled clinical trials performed recently in pulmonary arterial hypertension (PAH) can allow us to abandon a clinical-based treatment strategy and adopt an evidence-based therapy. Both uncontrolled and controlled clinical trials with different compounds and procedures are reviewed and compared in order to define the efficacy-to-side-effect ratio of each treatment. A grading system for the level of evidence of
Nazzareno Galiè; Werner Seeger; Robert Naeije; Gerald Simonneau; Lewis J. Rubin