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1

epic2: National evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England.  

PubMed

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 evidence base 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 evidence base 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

2007-02-01

2

Infection Control  

MedlinePLUS

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

3

Evidence-based screening for low bone mineral density in HIV-infected men.  

PubMed

Low bone mineral density, which leads to osteoporosis and fracture risk, is an emerging clinical problem in HIV-infected patients. Our evidence-based practice project screened a convenience sample of 225 HIV-infected men for low bone mineral density using the Osteoporosis Self-Assessment Tool, and of those men, 173 were also screened by quantitative ultrasound of the calcaneus. One hundred twelve men had low bone mineral density by either or both screening methods. Seventy-one of these 112 men were tested by dual-energy x-ray absorptiometry and 73% had low bone mineral density. The positive protective value of the Osteoporosis Self-Assessment Tool was 73% and for quantitative ultrasound was 88%. These results suggest that routine low bone mineral density screening should be included as standard practice for all HIV-infected patients. PMID:24823286

Albright, Patsi; Du, Ping; Haas, Richard E; Pugh, Linda C

2014-01-01

4

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

PubMed Central

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

2013-01-01

5

Evidence-based management of deep wound infection after spinal instrumentation.  

PubMed

In this study, evidence-based medicine is used to assess optimal surgical and medical management of patients with post-operative deep wound infection following spinal instrumentation. A computerized literature search of the PubMed database was performed. Twenty pertinent studies were identified. Studies were separated into publications addressing instrumentation retention versus removal and publications addressing antibiotic therapy regimen. The findings were classified based on level of evidence (I-III) and findings were summarized into evidentiary tables. No level I or II evidence was identified. With regards to surgical management, five studies support instrumentation retention in the setting of early deep infection. In contrast, for delayed infection, the evidence favors removal of instrumentation at the time of initial debridement. Surgeons should be aware that for deformity patients, even if solid fusion is observed, removal of instrumentation may be associated with significant loss of correction. A course of intravenous antibiotics followed by long-term oral suppressive therapy should be pursued if instrumentation is retained. A shorter treatment course may be appropriate if hardware is removed. PMID:25308619

Lall, Rishi R; Wong, Albert P; Lall, Rohan R; Lawton, Cort D; Smith, Zachary A; Dahdaleh, Nader S

2014-10-01

6

Building the evidence base for global tobacco control.  

PubMed Central

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

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

2000-01-01

7

Infection control.  

PubMed

From an infectious disease point of view, dentistry has never been safer than it is today for both patients and the dental team. This state of affairs has resulted from the establishment and practice of strict infection control in the office using the concept of universal precautions. Infection control consists of a series of procedures directed at reducing the number of microbes shared among people. An approach to the management of infection control involves identification of an office safety coordinator and total involvement of everyone in the office. The procedures of infection control can be grouped into six major areas. 1. Handwashing and gloving provides protection to both patients and the dental team. 2. Protection against aerosols and spatter involves the use of a preprocedure mouthrinse, HVE, rubber dam, saliva ejection, mask, protective eyewear, and protective clothing. 3. Instrument processing provides instruments that are safe for patient use. 4. Surface asepsis eliminates the involvement of environmental surfaces in the spread of disease agents. 5. Management of sharps and other regulated waste reduces the chances for sharps injuries and contact with potentially infectious material. 6. Aseptic techniques include aseptic retrieval of supplies, reducing contamination from dental unit water, aseptic radiographic procedures, proper use of disposables, and preventing contamination of the dental laboratory. PMID:8641531

Miller, C H

1996-04-01

8

Prevention of urinary tract infections in nursing homes: lack of evidence-based prescription?  

PubMed Central

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. PMID:22040144

2011-01-01

9

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

PubMed Central

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

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

2013-01-01

10

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

PubMed

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

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

2015-01-01

11

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

PubMed Central

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.

2013-01-01

12

Cancer control planners' perceptions and use of evidence-based programs.  

PubMed

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

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

2010-01-01

13

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

PubMed Central

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 of Israel's health targeting initiative, Healthy Israel 2020, we describe the steps taken to develop a comprehensive tobacco control strategy. We elaborate on the following: a) scientific issues influencing the choice of tobacco control strategies; b) organization of existing evidence of effectiveness of interventions into a manageable form, and c) consideration of relevant philosophical and political issues. We propose a framework for developing a plan and illustrate this process with a case study in Israel. Results Broad consensus exists regarding the effectiveness of most interventions, but current recommendations differ in the emphasis they place on different strategies. Scientific challenges include integration of complex and sometimes conflicting information from authoritative sources, and lack of estimates of population impact of interventions. Philosophical and political challenges include the use of evidence-based versus innovative policymaking, the importance of individual versus governmental responsibility, and whether and how interventions should be prioritized. The proposed framework includes: 1) compilation of a list of potential interventions 2) modification of that list based on local needs and political constraints; 3) streamlining the list by categorizing interventions into broad groupings of related interventions; together these groupings form the basis of a comprehensive plan; and 4) refinement of the plan by comparing it to existing comprehensive plans. Conclusions Development of a comprehensive tobacco control plan is a complex endeavour, involving crucial decisions regarding intervention components. "Off the shelf" plans, which need to be adapted to local settings, are available from a variety of sources, and a multitude of individual recommendations are available. The proposed framework for adapting existing approaches to the local social and political climate may assist others planning for smoke-free societies. Additionally, this experience has implications for development of evidence-based health plans addressing other risk factors. PMID:20507612

2010-01-01

14

Pediatric herpes simplex virus infections: an evidence-based approach to treatment.  

PubMed

Herpes simplex virus is a common virus that causes a variety of clinical presentations ranging from mild to life-threatening. Orolabial and genital herpes are common disorders that can often be managed in an outpatient setting; however, some patients do present to the emergency department with those conditions, and emergency clinicians should be aware of possible complications in the pediatric population. Neonatal herpes is a rare disorder, but prompt recognition and initiation of antiviral therapy is imperative, as the morbidity and mortality of the disease is high. Herpes encephalitis is an emergency that also requires a high index of suspicion to diagnose. Herpes simplex virus is also responsible for a variety of other clinical presentations, including herpes gladiatorum, herpetic whitlow, eczema herpeticum, and ocular herpes. This issue reviews the common clinical presentations of the herpes simplex virus, the life-threatening infections that require expedient identification and management, and recommended treatment regimens. PMID:24649621

Sanders, Jennifer E; Garcia, Sylvia E

2014-01-01

15

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

PubMed Central

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

Khanna, Deepshikha; Bharti, Subhash

2014-01-01

16

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

PubMed

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

Khanna, Deepshikha; Bharti, Subhash

2014-01-01

17

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

Cancer.gov

Measures and Determinants of Smokeless Tobacco Use Prevention and Cessation Mark Parascandola, PhD, MPH Tobacco Control Research Branch Division of Cancer Control and Population Sciences National Cancer Institute Purpose of the RFA • Understand

18

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

PubMed

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

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

2015-01-01

19

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

PubMed Central

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

2012-01-01

20

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

PubMed Central

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

2014-01-01

21

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

PubMed Central

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

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

2014-01-01

22

Building the evidence base for effective tobacco control policies: the International Tobacco Control Policy Evaluation Project (the ITC Project)  

PubMed Central

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. PMID:16754940

Fong, G T; Cummings, K M

2006-01-01

23

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

Microsoft Academic Search

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

Ida Sim; Ben Olasov; Simona Carini

2004-01-01

24

Evidence-based dermatology.  

PubMed

Evidence-based dermatology (EBD) is the application of the principles of evidence-based medicine to the diagnosis and treatment of skin disorders. EBD does not discount the individual dermatologist's clinical judgment. In fact, EBD is based on the interaction of external evidence, the physician's clinical experience, and the patient's experience. Randomized controlled trials constitute one of the highest levels of evidence and are the gold standard for validating a therapeutic intervention. For the treatment of rosacea, oral tetracycline, topical metronidazole, topical azelaic acid, and topical sulfur/sodium sulfacetamide have been validated by more than one randomized controlled trial. PMID:15810804

Margolis, David J

2005-03-01

25

Teaching evidence-based medicine literature searching skills to medical students during the clinical years: a randomized controlled trial  

PubMed Central

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. PMID:22879808

Tepper, Katrina; Misso, Marie

2012-01-01

26

Randomised controlled trial of a theoretically grounded tailored intervention to diffuse evidence-based public health practice [ISRCTN23257060  

PubMed Central

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 information. Methods 148 self-selected public health physicians were randomised to an intervention group (n = 73) and a control group (n = 75). The intervention group received a multifaceted intervention while the control group received a letter declaring that they had access to library services. Baseline assessments before the intervention and post-testing immediately at the end of a 1.5-year intervention period were conducted. The intervention was theoretically based and consisted of a workshop in evidence-based public health, a newsletter, access to a specially designed information service, to relevant databases, and to an electronic discussion list. The main outcome measure was behaviour as measured by the use of research in different documents. Results The intervention did not demonstrate any evidence of effects on the objective behaviour outcomes. We found, however, a statistical significant difference between the two groups for both knowledge scores: Mean difference of 0.4 (95% CI: 0.2–0.6) in the score for knowledge about EBM-resources and mean difference of 0.2 (95% CI: 0.0–0.3) in the score for conceptual knowledge of importance for critical appraisal. There were no statistical significant differences in attitude-, self-efficacy-, decision-to-adopt- or job-satisfaction scales. There were no significant differences in Cochrane library searching after controlling for baseline values and characteristics. Conclusion Though demonstrating effect on knowledge the study failed to provide support for the hypothesis that a theory-based multifaceted intervention targeted at identified barriers will change professional behaviour. PMID:12694632

Forsetlund, Louise; Bradley, Peter; Forsen, Lisa; Nordheim, Lena; Jamtvedt, Gro; Bjørndal, Arild

2003-01-01

27

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

PubMed Central

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

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

2014-01-01

28

School-based, randomised controlled trial of an evidence-based condom promotion leaflet.  

PubMed

A condom use promotion leaflet was designed for use with older teenagers in schools. The text targeted a series of cognitive and behavioural antecedents of condom use identified in the literature. Given previous evidence that motivational incentives can enhance the effectiveness of health promotion leaflets, the leaflet was presented in conjunction with a quiz and prize draw. Students were randomly assigned to either the intervention condition or a (no leaflet or incentive) control condition. Measures were taken immediately, pre-intervention and 4 weeks later from 404 students. The 20-min intervention successfully promoted six of the eight measured cognitions, namely (1) attitude towards using condoms with a new partner (2) attitude towards using condoms with a steady partner (3) normative beliefs in relation to preparatory actions (4) self-efficacy in relation to both preparatory actions and (5) condom use (6) intention to use condoms, as well as three measured preparatory actions, that is, purchasing condoms, carrying condoms and discussing condom use. The intervention did not increase condom use with steady or new partners but power to test intervention impact on condom use was curtailed. PMID:25159906

Hill, Chloe A; Abraham, Charles

2008-01-01

29

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

Microsoft Academic Search

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

2010-01-01

30

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

PubMed

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

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

2015-01-01

31

Computer-based teaching is as good as face to face lecture-based teaching of evidence based medicine: a randomised controlled trial  

Microsoft Academic Search

BACKGROUND: At postgraduate level evidence based medicine (EBM) is currently taught through tutor based lectures. Computer based sessions fit around doctors' workloads, and standardise the quality of educational provision. There have been no randomized controlled trials comparing computer based sessions with traditional lectures at postgraduate level within medicine. METHODS: This was a randomised controlled trial involving six postgraduate education centres

James Davis; Evi Chryssafidou; Javier Zamora; David Davies; Khalid Khan; Arri Coomarasamy

2007-01-01

32

Real-time, evidence-based medicine instruction: a randomized controlled trial in a neonatal intensive care unit*  

PubMed Central

Purpose: The study assesses potential for improving residents' evidence-based medicine searching skills in MEDLINE through real-time librarian instruction. Subjects: Ten residents on a rotation in a neonatal intensive care unit participated. Methodology: Residents were randomized into an instruction and a non-instruction group. Residents generated questions from rounds and searched MEDLINE for answers. Data were collected through observation, search strategy analysis, and surveys. Librarians observed searches and collected data on questions, searching skills, search problems, and the test group's instruction topics. Participants performed standardized searches before, after, and six-months after intervention and were scored using a search strategy analysis tool (1 representing highest score and 5 representing lowest score). Residents completed pre- and post-intervention surveys to measure opinions about MEDLINE and search satisfaction. Results: Post-intervention, the test group formulated better questions, used limits more effectively, and reported greater confidence in using MEDLINE. The control group expressed less satisfaction with retrieval and demonstrated more errors when limiting. The test and control groups had the following average search scores respectively: 3.0 and 3.5 (pre-intervention), 3.3 and 3.4 (post-intervention), and 2.0 and 3.8 (six-month post-intervention). Conclusion: Data suggest that measurable learning outcomes were achieved. Residents receiving instruction improved and retained searching skills six-months after intervention. PMID:11999177

Bradley, Doreen R.; Rana, Gurpreet Kaur; Martin, Patricia W.; Schumacher, Robert E.

2002-01-01

33

Gastric biopsies: The gap between evidence-based medicine and daily practice in the management of gastric Helicobacter pylori infection  

PubMed Central

BACKGROUND: Many consider histology to be the gold standard for Helicobacter pylori detection. Because the number and distribution of H pylori organisms vary, particularly in patients taking proton pump inhibitors (PPIs), the American Gastroenterological Association recommends discontinuing PPIs two weeks before endoscopy, and taking biopsies from both the body and antrum. OBJECTIVE: To assess the influence of clinical practice on the histopathological detection of H pylori infection. METHODS: Electronic patient records were evaluated for the sites of gastric sampling and PPI use at endoscopy. One hundred fifty cases with biopsies taken from both antrum and body were randomly selected for pathological re-review with special stains. The gastric regions sampled, H pylori distribution and influence of clinical factors on pathological interpretation were assessed. RESULTS: Between 2005 and 2010, 10,268 biopsies were taken to detect H pylori. Only one region was sampled in 60% of patients (antrum 47%, body 13%). Re-review of biopsies taken from both antrum and body indicated that the correct regions were sampled in only 85 (57%) patients. Of these, 54 were H pylori positive and 96 were H pylori negative. H pylori was present in the antrum in only 15% of the patients and body only in 21%. Of 96 H pylori-negative patients, two were reinterpreted as positive. Forty-seven per cent of patients were taking PPIs at endoscopy, contributing to both false-negative and false-positive diagnoses. CONCLUSION: Despite national and international guidelines for managing H pylori infection, the American Gastroenterological Association guidelines are infrequently adhered to, with PPIs frequently contributing to false diagnosis; sampling one region only increases the likelihood of missing active infection by at least 15%. PMID:24106732

El-Zimaity, Hala; Serra, Stefano; Szentgyorgyi, Eva; Vajpeyi, Rajkumar; Samani, Amir

2013-01-01

34

Canadian Helicobacter Study Group Consensus Conference: Update on the approach to Helicobacter pylori infection in children and adolescents--an evidence-based evaluation.  

PubMed

As an update to previously published recommendations for the management of Helicobacter pylori infection, an evidence-based appraisal of 14 topics was undertaken in a consensus conference sponsored by the Canadian Helicobacter Study Group. The goal was to update guidelines based on the best available evidence using an established and uniform methodology to address and formulate recommendations for each topic. The degree of consensus for each recommendation is also presented. The clinical issues addressed and recommendations made were: population-based screening for H. pylori in asymptomatic children to prevent gastric cancer is not warranted; testing for H. pylori in children should be considered if there is a family history of gastric cancer; the goal of diagnostic interventions should be to determine the cause of presenting gastrointestinal symptoms and not the presence of H. pylori infection; recurrent abdominal pain of childhood is not an indication to test for H. pylori infection; H. pylori testing is not required in patients with newly diagnosed gastroesophageal reflux disease; H. pylori testing may be considered before the use of long-term proton pump inhibitor therapy; testing for H. pylori infection should be considered in children with refractory iron deficiency anemia when no other cause has been found; when investigation of pediatric patients with persistent or severe upper abdominal symptoms is indicated, upper endoscopy with biopsy is the investigation of choice; the 13C-urea breath test is currently the best noninvasive diagnostic test for H. pylori infection in children; there is currently insufficient evidence to recommend stool antigen tests as acceptable diagnostic tools for H. pylori infection; serological antibody tests are not recommended as diagnostic tools for H. pylori infection in children; first-line therapy for H. pylori infection in children is a twice-daily, triple-drug regimen comprised of a proton pump inhibitor plus two antibiotics (clarithromycin plus amoxicillin or metronidazole); the optimal treatment period for H. pylori infection in children is 14 days; and H. pylori culture and antibiotic sensitivity testing should be made available to monitor population antibiotic resistance and manage treatment failures. PMID:16010300

Bourke, Billy; Ceponis, Peter; Chiba, Naoki; Czinn, Steve; Ferraro, Richard; Fischbach, Lori; Gold, Ben; Hyunh, Hien; Jacobson, Kevan; Jones, Nicola L; Koletzko, Sibylle; Lebel, Sylvie; Moayyedi, Paul; Ridell, Robert; Sherman, Philip; van Zanten, Sander; Beck, Ivan; Best, Linda; Boland, Margaret; Bursey, Ford; Chaun, Hugh; Cooper, Geraldine; Craig, Brian; Creuzenet, Carole; Critch, Jeffrey; Govender, Krishnasamy; Hassall, Eric; Kaplan, Alan; Keelan, Monica; Noad, Garth; Robertson, Marli; Smith, Lesley; Stein, Markus; Taylor, Diane; Walters, Thomas; Persaud, Robin; Whitaker, Scott; Woodland, Robert

2005-07-01

35

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

PubMed Central

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

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

2015-01-01

36

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

ERIC Educational Resources Information Center

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

2008-01-01

37

Effect of computerised evidence based guidelines on management of asthma and angina in adults in primary care: cluster randomised controlled trial  

Microsoft Academic Search

Objective To evaluate the use of a computerised support system for decision making for implementing evidence based 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

2002-01-01

38

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

ERIC Educational Resources Information Center

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

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

2005-01-01

39

Complementary medicine and evidence-based practice: power and control in healthcare - Questions about an arranged marriage  

Microsoft Academic Search

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

Assunta Hunter; Airdre Grant

2005-01-01

40

Infection Control in Dental Settings  

MedlinePLUS

... CDC.gov . Oral Health home School-Based Dental Sealant Programs Community Water Fluoridation Fluoridation Basics Benefits Guidelines ... Health Engineering & Operations Infection Control School-Based Dental Sealant Programs Community Water Fluoridation FAQs Community Water Fluoridation ...

41

Day Care Infection Control Protocol.  

ERIC Educational Resources Information Center

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

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

42

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

PubMed Central

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

2012-01-01

43

[Evidence-based medicine].  

PubMed

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

Saad, E D; Grunspun, H

1996-01-01

44

Evidence-based dentistry  

Microsoft Academic Search

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.

D Richards; A Lawrence

1998-01-01

45

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

PubMed Central

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

2014-01-01

46

Evidence-Based Medicine  

Microsoft Academic Search

Zum Thema  \\u000a Evidence-Based-Medicine (EMB), die auf klinischer Forschung gegründete wissenschaftliche Medizin, wird beschrieben als „gewissenhafter,\\u000a ausdrücklicher und vernüftiger Gebrauch der gegenwärtig besten externen, wissenschaftlichen Evidenz für Entscheidungen in\\u000a der medizinischen Versorgung individueller Patienten. Die Praxis der EBM bedeutet die Integration individueller klinischer\\u000a Expertise mit der externen Evidenz aus systematischer Forschung”.\\u000a \\u000a \\u000a \\u000a Auf den ärztlichen Entscheidungsprozeß sei also ausdrücklich hingewiesen, auch wenn

G. Antes

1998-01-01

47

Evidence-based medicine.  

PubMed Central

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

MacPherson, D W

1995-01-01

48

Mouthwashes for the control of supragingival biofilm and gingivitis in orthodontic patients: evidence-based recommendations for clinicians.  

PubMed

Properly performed daily mechanical biofilm control is the most important prevention strategy for periodontal diseases. However, proper mechanical biofilm control is not performed effectively by the majority of the population, mainly due to lack of motivation and of manual dexterity. Local biofilm retention factors may aggravate home oral hygiene quality. For this reason, patients wearing fixed orthodontic appliances comprise a group that may benefit from the daily use of mouthwashes. The purpose of this review was to perform a systematic search in the literature on antiseptics used to control supragingival biofilm and gingivitis in orthodontic patients. Six studies investigating the effect of chlorhexidine and 5 studies evaluating the effect of the daily use of antiseptics were found. Chlorhexidine showed better results in reducing plaque and gingivitis. However, because of its adverse effects after continuous use, it should not be indicated for long-term periods. Among the agents considered for daily use, the fixed combination of essential oils was the only one evaluated in a clinical trial, in which a comparative group presented a statistically significant clinical impact. There is no direct evidence supporting the indication of antiseptic agents for orthodontic patients other than chlorhexidine and essential oils. It can be concluded that, for patients undergoing orthodontic treatment, chlorhexidine should be considered for treating acute gingival inflammation, whereas essential oils should be indicated for long-term daily use in controlling supragingival biofilm. PMID:25055220

Haas, Alex Nogueira; Pannuti, Claudio Mendes; Andrade, Ana Karina Pinto de; Escobar, Elaine Cristina; Almeida, Eliete Rodrigues de; Costa, Fernando Oliveira; Cortelli, José Roberto; Cortelli, Sheila Cavalca; Rode, Sigmar de Melo; Pedrazzi, Vinicius; Oppermann, Rui Vicente

2014-07-11

49

What are the Evidence Based Public Health Interventions for Prevention and Control of NCDs in Relation to India?  

PubMed

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

2011-12-01

50

What are the Evidence Based Public Health Interventions for Prevention and Control of NCDs in Relation to India?  

PubMed Central

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

2011-01-01

51

Evidence-Based Anatomy  

PubMed Central

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

Yammine, Kaissar

2014-01-01

52

Diploma in hospital infection control (Dip HIC)  

Microsoft Academic Search

The London School of Hygiene and Tropical Medicine (LSHTM) has established a Diploma in Hospital Infection Control (Dip-HIC). The course for this new Diploma is run under the auspices of the Hospital Infection Society (HIS) and the Public Health Laboratory Service (PHLS) and will commence in October 1997. The aim of this course is to provide infection control staff with

A. M. Emmerson; R. C. Spencer; B. D. Cookson; C. Roberts; B. S. Drasar

1997-01-01

53

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

PubMed

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

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

2014-06-17

54

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

PubMed Central

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

2014-01-01

55

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

PubMed Central

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

2013-01-01

56

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

PubMed Central

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

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

2014-01-01

57

Evidence-based management.  

PubMed

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

Cohen, Frank

2012-01-01

58

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

PubMed Central

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

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

2014-01-01

59

Aztreonam (for inhalation solution) for the treatment of chronic lung infections in patients with cystic fibrosis: an evidence-based review  

PubMed Central

Cystic fibrosis (CF) is a genetic disease caused by abnormal chloride transport across cellular membranes. In the respiratory tract, this molecular defect causes obstruction of the airways by mucus and chronic endobronchial infection. The majority of patients suffer early death from chronic respiratory disease. Pseudomonas aeruginosa is the predominant chronic airway pathogen in older children and adults with CF and is associated with worse outcomes. However, overall survival in CF has been greatly improved in recent decades due in large part to the aggressive treatment of chronic infections such as P. aeruginosa. While intravenous and oral antibiotics are commonly used in the management of CF respiratory infections, inhaled anti-infective therapies offer the benefit of delivering the drug directly to the site of infection and avoiding potential toxicities associated with systemic absorption. Aztreonam lysine (AZLI) has recently been developed as an inhaled antibiotic for chronic use in CF patients with endobronchial P. aeruginosa infection. This paper reviews background data and the clinical studies which contributed to AZLI’s formal FDA approval and growing role in the management of CF pulmonary disease. PMID:22022288

Kirkby, Stephen; Novak, Kimberly; McCoy, Karen

2011-01-01

60

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

PubMed Central

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

2013-01-01

61

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

PubMed

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

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

2014-05-01

62

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

PubMed Central

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

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

2014-01-01

63

Evidence-Based Nursing Resources  

Microsoft Academic Search

Evidence-based medicine and, more generally, evidence-based practice (EBP), is the integration of the best available patient care evidence and clinical expertise—guided by and sensitized to patient values—into a patient-oriented decision-making process. It is increasingly clear that all health professions neither equally value nor draw upon the same pool of evidence. Although there are areas of overlap between evidence-based nursing and

Mark A. Spasser

2005-01-01

64

Evidence-Based Practice  

PubMed Central

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

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

2014-01-01

65

A Systematic Review of Evidence-Based Behavioral Interventions for African American Youth at Risk for HIV\\/STI Infection, 1988–2007  

Microsoft Academic Search

\\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

Khiya Marshall; Nicole Crepaz; Ann O’Leary

66

38 CFR 52.190 - Infection control.  

Code of Federal Regulations, 2010 CFR

...control program designed to prevent the development and...Investigate, control, and prevent infections in the program...program management must prevent participants or staff...health care program if direct contact will transmit the...

2010-07-01

67

Practicing evidence based medicine at the bedside: a randomized controlled pilot study in undergraduate medical students assessing the practicality of tablets, smartphones, and computers in clinical life.  

PubMed

BackgroundPracticing evidence-based medicine is an important aspect of providing good medical care. Accessing external information through literature searches on computer-based systems can effectively achieve integration in clinical care. We conducted a pilot study using smartphones, tablets, and stationary computers as search devices at the bedside. The objective was to determine possible differences between the various devices and assess students¿ internet use habits.MethodsIn a randomized controlled pilot study, 120 students were divided in three groups. One control group solved clinical problems on a computer and two intervention groups used mobile devices at the bedside. In a questionnaire, students were asked to report their internet use habits as well as their satisfaction with their respective search tool using a 5-point Likert scale.ResultsOf 120 surveys, 94 (78.3%) complete data sets were analyzed. The mobility of the tablet (3.90) and the smartphone (4.39) was seen as a significant advantage over the computer (2.38, p¿<¿.001). However, for performing an effective literature search at the bedside, the computer (3.22) was rated superior to both tablet computers (2.13) and smartphones (1.68). No significant differences were detected between tablets and smartphones except satisfaction with screen size (tablet 4.10, smartphone 2.00, p¿<¿.001).ConclusionsUsing a mobile device at the bedside to perform an extensive search is not suitable for students who prefer using computers. However, mobility is regarded as a substantial advantage, and therefore future applications might facilitate quick and simple searches at the bedside. PMID:25477073

Friederichs, Hendrik; Marschall, Bernhard; Weissenstein, Anne

2014-12-01

68

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

PubMed

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

Oosthuysen, Jeanné; Potgieter, Elsa; Fossey, Annabel

2014-12-01

69

Infection control in paediatric office settings  

PubMed Central

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

2008-01-01

70

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

PubMed Central

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

2014-01-01

71

Psychiatric Mental Health Evidence-Based Practice  

Microsoft Academic Search

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

Michael J. Rice

2008-01-01

72

Infection control in cardiac surgery.  

PubMed

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

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

1976-01-01

73

Evidence-based new service package vs. routine service package for smoking cessation to prevent high risk patients from cardiovascular diseases (CVD): study protocol for randomized controlled trial  

PubMed Central

Background Smoking cessation is a high-priority intervention to prevent CVD events and deaths in developing countries. While several interventions to stop smoking have been proved successful, the question of how to increase their effectiveness and practicality in developing countries remains. In this study, a newly devised evidence-based smoking cessation service package will be compared with the existing service in a randomized controlled trial within the community setting of Thailand. Method/Design This randomized control trial will recruit 440 current smokers at CVD risk because of being diabetic and/or hypertensive. Informed, consented participants will be randomly allocated into the new service-package arm and the routine service arm. The study will take place in the non-communicable disease clinics of the Maetha District Hospital, Lampang, northern Thailand. The new smoking-cessation service-package comprises (1) regular patient motivation and coaching from the same primary care nurse over a 3-month period; (2) monthly application of piCO?+?smokerlyzer to sustain motivation of smoker’s quitting attempt and provide positive feedback over a 3-month period; (3) assistance by an assigned family member; (4) nicotine replacement chewing gum to relieve withdrawal symptoms. This new service will be compared with the traditional routine service comprising the 5A approach in a 1-year follow-up. Participants who consent to participate in the study but refuse to attempt quitting smoking will be allocated to the non-randomized arm, where they will be just followed up and monitored. Primary outcome of the study is smoking cessation rate at 1-year follow-up proven by breath analysis measuring carbomonoxide in parts per million in expired air. Secondary outcomes are smoking cessation rate at the 6-month follow-up, blood pressure and heart rate, CVD risk according to the Framingham general cardiovascular risk score, CVD events and deaths at the 12-month follow-up, and the cost-effectiveness of the health service packages. Intention-to-treat analysis will be followed. Factors influencing smoking cessation will be analyzed by the structure equation model. Discussion This multicomponent intervention, accessible at primary healthcare clinics, and focusing on the individual as well as the family and social environment, is unique and expected to work effectively. Trial registration Current Controlled Trials ISRCTN89315117 PMID:24308874

2013-01-01

74

Engineering infection control through facility design.  

PubMed Central

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

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

2001-01-01

75

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

PubMed Central

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

Dash, Tanya; Kar, Bhoomika R.

2014-01-01

76

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

Federal Register 2010, 2011, 2012, 2013

...Control and Prevention Healthcare Infection Control Practices...Place: CDC, Global Communications Center, Building 19...Director, Division of Healthcare Quality Promotion regarding...1) the practice of healthcare infection...

2012-01-31

77

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

Federal Register 2010, 2011, 2012, 2013

...Control and Prevention Healthcare Infection Control Practices...Place: CDC, Global Communications Center, Building 19...Director, Division of Healthcare Quality Promotion regarding...1) The practice of healthcare infection...

2011-05-23

78

The role of the infection control doctor.  

PubMed

The ideal infection control doctor would be a combination of an infectious disease specialist, microbiologist, epidemiologist, social worker, psychologist, teacher, researcher, antibiotic therapy specialist, policeman, priest, supervisor for housekeeping, architect, partner for the infection control nurse, and who should combine the qualities of Mary Poppins, Sherlock Holmes, Francis von Assisi and Margaret Thatcher. A new role is that of a specialist in environmental pollution by detergents, disinfectants and certain disposables. PMID:2896740

Daschner, F D

1988-02-01

79

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

PubMed Central

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

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

2003-01-01

80

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

Microsoft Academic Search

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

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

2003-01-01

81

Behavioral Activation Is an Evidence-Based Treatment for Depression  

ERIC Educational Resources Information Center

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…

Sturmey, Peter

2009-01-01

82

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

PubMed Central

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

2014-01-01

83

Evidence-Based Treatment of Acute Pancreatitis  

PubMed Central

Background: The management of acute pancreatitis (AP) is still based on speculative and unproven paradigms in many centers. Therefore, we performed an evidence-based analysis to assess the best available treatment. Methods: A comprehensive Medline and Cochrane Library search was performed evaluating the indication and timing of interventional and surgical approaches, and the value of aprotinin, lexipafant, gabexate mesylate, and octreotide treatment. Each study was ranked according to the evidence-based methodology of Sackett; whenever feasible, we performed new meta-analyses using the random-effects model. Recommendations were based on the available level of evidence (A = large randomized; B = small randomized; C = prospective trial). Results: None of the evaluated medical treatments is recommended (level A). Patients with AP should receive early enteral nutrition (level B). While mild biliary AP is best treated by primary cholecystectomy (level B), patients with severe biliary AP require emergency endoscopic papillotomy followed by interval cholecystectomy (level A). Patients with necrotizing AP should receive imipenem or meropenem prophylaxis to decrease the risk of infected necrosis and mortality (level A). Sterile necrosis per se is not an indication for surgery (level C), and not all patients with infected necrosis require immediate surgery (level B). In general, early necrosectomy should be avoided (level B), and single necrosectomy with postoperative lavage should be preferred over “open-packing” because of fewer complications with comparable mortality rates (level C). Conclusions: While providing new insights into key aspects of AP management, this evidence-based analysis highlights the need for further clinical trials, particularly regarding the indications for antibiotic prophylaxis and surgery. PMID:16432347

Heinrich, Stefan; Schäfer, Markus; Rousson, Valentin; Clavien, Pierre-Alain

2006-01-01

84

Principles of evidence based medicine  

Microsoft Academic Search

Health care professionals are increasingly required to base clinical decisions on the best available evidence. Evidence based medicine (EBM) is a systematic approach to clinical problem solving which allows the integration of the best available research evidence with clinical expertise and patient values. This paper explains the concept of EBM and introduces the five step EBM model: formulation of answerable

A K Akobeng

2005-01-01

85

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

Microsoft Academic Search

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

Matthew J. McQueen

2001-01-01

86

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

Federal Register 2010, 2011, 2012, 2013

...Disease Control and Prevention Healthcare Infection Control Practices...Control and Prevention, Global Communications Center, Building 19, Auditorium...the Director, Division of Healthcare Quality Promotion, the Director...regarding (1) the practice of healthcare infection prevention...

2013-10-22

87

Module: Evidence Based Practice Module Specification  

E-print Network

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

Weyde, Tillman

88

Infection control practices for dental radiography.  

PubMed

Infection control for dental radiography employs the same materials, processes, and techniques used in the operatory, yet unless proper procedures are established and followed, there is a definite potential for cross-contamination to clinical area surfaces and DHCP. In general, the aseptic practices used are relatively simple and inexpensive, yet they require complete application in every situation. PMID:15218669

Palenik, Charles John

2004-06-01

89

Infections Control in North American Dental Schools.  

ERIC Educational Resources Information Center

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

Sampson, Elise; Dhuru, Virendra B.

1989-01-01

90

Correlates of infection control practices in dentistry  

Microsoft Academic Search

Background: Studies conducted in the first decade of the AIDS epidemic indicated that, in general, dentists had suboptimal levels of compliance with standard infection control 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

1998-01-01

91

Control of viruses infecting grapevine.  

PubMed

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

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

2015-01-01

92

Modelling respiratory infection control measure effects  

Microsoft Academic Search

SUMMARY One of the most pressing issues in facing emerging and re-emerging respiratory infections is how to bring them under control with current public health measures. Approaches such as the Wells-Riley equation, competing-risks model, and Von Foerster equation are used to prioritize control-measure efforts. Here we formulate how to integrate those three different types of functional relationship to construct easy-to-use

C. F. C HA

2008-01-01

93

Sicily statement on evidence-based practice  

Microsoft Academic Search

BACKGROUND: A variety of definitions of evidence-based practice (EBP) exist. However, definitions are in themselves insufficient to explain the underlying processes of EBP and to differentiate between an evidence-based process and evidence-based outcome. There is a need for a clear statement of what Evidence-Based Practice (EBP) means, a description of the skills required to practise in an evidence-based manner and

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

2005-01-01

94

Obstetric infection control in a developing country.  

PubMed

In Ghana, infection has been identified as a major cause of birth-related mortality. Results of a 2-month observation of infection control practices among Ghanaian obstetric nurses and midwives indicated that most personnel did not practice basic rules of asepsis. Problems included frequent breaks in technique, inadequate sterilization and disinfection, and repeated exposure to large amounts of blood and vaginal secretions. Supplies were limited and, even when available, not always used appropriately. The situation in developing countries is different from that in the United States. Therefore, an observational needs assessment is essential to plan relevant and practical measures for change. PMID:8478737

Cronin, W A; Quansah, M G; Larson, E

1993-01-01

95

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

PubMed Central

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

2013-01-01

96

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

Federal Register 2010, 2011, 2012, 2013

...Disease Control and Prevention Healthcare Infection Control Practices...2013. Place: CDC, Global Communications Center, Building 19, Auditorium...the Director, Division of Healthcare Quality Promotion, the Director...regarding: (1) The practice of healthcare infection prevention...

2013-01-30

97

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

Federal Register 2010, 2011, 2012, 2013

...Disease Control and Prevention Healthcare Infection Control Practices...Prevention (CDC), Global Communications Center, Bldg 19, Auditorium...the Director, Division of Healthcare Quality Promotion, the Director...regarding (1) the practice of healthcare infection prevention...

2013-05-14

98

Evidence-Based Practice and Organizational Development in Libraries  

E-print Network

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

Russell, Keith

2008-01-01

99

42 CFR 418.60 - Condition of participation: Infection control.  

Code of Federal Regulations, 2010 CFR

...surveillance, identification, prevention, control, and investigation of infectious and communicable...disease prevention. (c) Standard: Education. The hospice must provide infection control education to employees, contracted providers,...

2010-10-01

100

Evidence-Based Practices for Designing Public  

E-print Network

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

Minnesota, University of

101

An Evidence-Based Systematic Review of  

E-print Network

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

Connor, Ed

102

Evidence-based Science Communication  

NASA Astrophysics Data System (ADS)

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

Kahan, D.

2012-12-01

103

Photodynamic antimicrobial polymers for infection control.  

PubMed

Hospital-acquired infections pose both a major risk to patient wellbeing and an economic burden on global healthcare systems, with the problem compounded by the emergence of multidrug resistant and biocide tolerant bacterial pathogens. Many inanimate surfaces can act as a reservoir for infection, and adequate disinfection is difficult to achieve and requires direct intervention. In this study we demonstrate the preparation and performance of materials with inherent photodynamic, surface-active, persistent antimicrobial properties through the incorporation of photosensitizers into high density poly(ethylene) (HDPE) using hot-melt extrusion, which require no external intervention except a source of visible light. Our aim is to prevent bacterial adherence to these surfaces and eliminate them as reservoirs of nosocomial pathogens, thus presenting a valuable advance in infection control. A two-layer system with one layer comprising photosensitizer-incorporated HDPE, and one layer comprising HDPE alone is also described to demonstrate the versatility of our approach. The photosensitizer-incorporated materials are capable of reducing the adherence of viable bacteria by up to 3.62 Log colony forming units (CFU) per square centimeter of material surface for methicillin resistant Staphylococcus aureus (MRSA), and by up to 1.51 Log CFU/cm(2) for Escherichia coli. Potential applications for the technology are in antimicrobial coatings for, or materials comprising objects, such as tubing, collection bags, handrails, finger-plates on hospital doors, or medical equipment found in the healthcare setting. PMID:25250740

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

2014-01-01

104

Photodynamic Antimicrobial Polymers for Infection Control  

PubMed Central

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

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

2014-01-01

105

Teaching residents evidence-based medicine skills  

Microsoft Academic Search

OBJECTIVES: To measure the effectiveness of an educational intervention designed to teach residents four essential evidence-based medicine\\u000a (EBM) skills: question formulation, literature searching, understanding quantitative outcomes, and critical appraisal.\\u000a \\u000a \\u000a DESIGN: Firm-based, controlled trial.\\u000a \\u000a \\u000a \\u000a \\u000a SETTING: Urban public hospital.\\u000a \\u000a \\u000a \\u000a \\u000a PARTICIPANTS: Fifty-five first-year internal medicine residents: 18 in the experimental group and 37 in the control group.\\u000a \\u000a \\u000a \\u000a \\u000a INTERVENTION: An EBM course, taught 2

Christopher A. Smith; Pamela S. Ganschow; Brendan M. Reilly; Arthur T. Evans; Robert A. McNutt; Albert Osei; Muhammad Saquib; Satish Surabhi; Sunil Yadav

2000-01-01

106

Nanoparticles and the control of oral infections.  

PubMed

The potential of antimicrobial nanoparticles to control oral infections is reviewed. Such particles can be classified as having a size no greater than 100 nm and are produced using traditional or more novel techniques. Exploitation of the toxic properties of nanoparticles to bacteria, fungi and viruses, in particular metals and metal oxides, as well as their incorporation into polymeric materials have increased markedly over the past decade. The potential of nanoparticles to control the formation of biofilms within the oral cavity, as a function of their biocidal, anti-adhesive and delivery capabilities, is now receiving close attention. Latest insights into the application of nanoparticles within this field, including their use in photodynamic therapy, will be reviewed. Possible approaches to alter biocompatibility and desired function will also be covered. PMID:24388116

Allaker, Robert P; Memarzadeh, Kaveh

2014-02-01

107

[Epidemiology and control of hookworm infection in Fujian province].  

PubMed

Fujian province has been known to be endemic for mixed hookworm infection with Ancylostoma duodenale as the predominant species. The infection rate was 50% before 1980. As a result of mass treatment starting from 1980, the infection rate was decreased in most areas. And, infection foci were changed from sweet potato fields to the banana, sweatcane and asparagus fields where the infection rate tended to increase. It is stressed that the current endemic characteristics of hookworm infection should be paid more attention in implementing the control programme of hookworm infection. PMID:7720205

Chen, Z; Yang, F; Zheng, G; Lin, A

1994-01-01

108

An expert system for culture-based infection control surveillance.  

PubMed

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

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

1993-01-01

109

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

PubMed

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

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

2015-01-23

110

Inleiding in evidence-based medicine  

Microsoft Academic Search

Samenvatting  In Capita selecta worden evidence based handelen en de theorievorming daarover verder uitgediept. Belangwekkende publicaties,\\u000a methoden, technieken, definities en discussies zullen in deze rubriek regelmatig aan de orde komen. Evidence based handelen\\u000a wordt op deze wijze voor de paramedici in een breder perspectief geplaatst. In deze tweede aflevering van Capita selecta een\\u000a gedeelte uit `Inleiding in evidence-based medicine’ (Offringa e.a.,

M. Offringa; W. J. J. Assendelft; R. J. P. M. Scholten

2003-01-01

111

Infection control in a developing world.  

PubMed

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

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

2013-11-01

112

Ventilator associated pneumonia and infection control  

PubMed Central

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, infection control policies are more rational and will save money. PMID:16600048

Alp, Emine; Voss, Andreas

2006-01-01

113

Hospital Epidemiology and Infection Control in Acute-Care Settings  

PubMed Central

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

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

2011-01-01

114

The Politics of Evidence-Based Medicine  

Microsoft Academic Search

The impetus for these essays on evidence in medicine and law is commonly called evidence-based medicine: the movement to evaluate the safety, effectiveness, and cost of medical practices using tools from science and social science and to base clinical practice on such knowledge. Evidence-based medicine is portrayed as an alternative to medicine based on authority, tradition, and the physician's personal

Marc A. Rodwin

2001-01-01

115

Evidence-Based Clearinghouses in Social Work  

ERIC Educational Resources Information Center

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…

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

2010-01-01

116

Multicultural Issues in Evidence-Based Interventions  

ERIC Educational Resources Information Center

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

Ingraham, Colette L.; Oka, Evelyn R.

2006-01-01

117

Implementing Evidence-Based Social Work Practice  

ERIC Educational Resources Information Center

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.

2008-01-01

118

Evidence-Based Practice and School Nursing  

ERIC Educational Resources Information Center

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…

Adams, Susan; McCarthy, Ann Marie

2005-01-01

119

The need for evidence-based conservation  

E-print Network

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

Kark, Salit

120

Translating Research and Building the Evidence Base  

E-print Network

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

Keinan, Alon

121

Evidence-Based Practices in Secondary Transition  

ERIC Educational Resources Information Center

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

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

2009-01-01

122

Evidence-Based Research in Education.  

ERIC Educational Resources Information Center

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

Research Exchange, 2003

2003-01-01

123

EVIDENCE-BASED CARE AND THE CURRICULUM  

Microsoft Academic Search

An evidence-based 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 evidence-based approach to oral healthcare is educating our practitioners, both current and future. This involves providing opportunities integrated within simulated and actual clinical settings

Tracey Winning; Ian Needleman; Madeleine Rohlin; Antonio Carrassi

124

Strategies for searching and managing evidence-based practice resources.  

PubMed

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

Robb, Meigan; Shellenbarger, Teresa

2014-10-01

125

Systematic review of adherence to infection control guidelines in dentistry  

Microsoft Academic Search

Objectives: The purpose of this study was to determine the knowledge and attitudes of dental health care workers (DHCWs) towards infection control procedures, to examine DHCWs’ practising behaviour in respect of infection control, 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

2001-01-01

126

Evidence-Based Medicine in Surgical Education  

PubMed Central

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. PMID:23997670

Kwaan, Mary R.; Melton, Genevieve B.

2012-01-01

127

Infection Control and Prevention: A Review of Hospital-Acquired Infections and the Economic Implications  

PubMed Central

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 infection control 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. PMID:21603406

Reed, Deoine; Kemmerly, Sandra A.

2009-01-01

128

Infection control and prevention: a review of hospital-acquired infections and the economic implications.  

PubMed

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 infection control 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. PMID:21603406

Reed, Deoine; Kemmerly, Sandra A

2009-01-01

129

Moving an Evidence-Based Intervention Into Routine Mental Health Care: A Multifaceted Case Example  

Microsoft Academic Search

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

Mary C. Ruffolo; Jeff Capobianco

2012-01-01

130

Evidence-Based Medicine and Medical Authority  

Microsoft Academic Search

Over the last five years evidence-based medicine (EBM) has been promoted in mainstream medical literature in Canada, the United States, and the United Kingdom as a new paradigm in medical education and practice. \\

Keith Denny

1999-01-01

131

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

PubMed Central

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

2013-01-01

132

Evidence-Based Practice: Management of Vertigo  

PubMed Central

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

Nguyen-Huynh, Anh T.

2012-01-01

133

The Art of Evidence-Based Practice  

Microsoft Academic Search

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

David E. Pollio

2006-01-01

134

A Third-Generation Evidence Base for Human Spaceflight Risks  

NASA Technical Reports Server (NTRS)

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

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

2014-01-01

135

Human natural killer cells control Plasmodium falciparum infection by eliminating infected  

E-print Network

Human natural killer cells control Plasmodium falciparum infection by eliminating infected red, Singapore 138602; b Humanized Mouse Unit, Institute of Molecular and Cell Biology, Agency for Science for review October 25, 2013) Immunodeficient mouse­human chimeras provide a powerful approach to study host

Dao, Ming

136

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

PubMed Central

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

2013-01-01

137

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

Federal Register 2010, 2011, 2012, 2013

...infections, update from the HICPAC surveillance working group, and guidance for control of Carbapenem-resistant Enterobacteriaceae. Agenda items are subject to change as priorities dictate. For Further Information Contact: Heidi...

2011-10-13

138

Implementing GermWatcher, an enterprise infection control application.  

PubMed

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

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

2006-01-01

139

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

ERIC Educational Resources Information Center

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…

Vourlekis, Betsy; Ell, Kathleen; Padgett, Deborah

2005-01-01

140

Understanding Evidence-Based Public Health Policy  

PubMed Central

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

Chriqui, Jamie F.; Stamatakis, Katherine A.

2009-01-01

141

The fifth evolutionary era in infection control: interventional epidemiology.  

PubMed

A historical review of infection control 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 revoluntionized clinical practice throughout the world. Underlying our successes is the fact that growth in the profession has brought with it an enormous expansion in responsibilities, which in turn has impacted, in some cases severely, the personnel and time resources of infection control departments. At the same time, the economic pressures brought on by the upheavals in the business of health care have trickled down wherein it now influences the makeup and effectiveness of infection control programs. To continue with our mission of reducing morbidity and mortality, and perhaps to avoid a diminishing of our own professional influence, it will become essential that new approaches to the management of infection control programs be implemented. The approach must start by incorporating a basic mandate for change in the infection control professional. PMID:10679135

Garcia, R; Barnard, B; Kennedy, V

2000-02-01

142

Evidence-based radiology: why and how?  

Microsoft Academic Search

Purpose  To provide an overview of evidence-based medicine (EBM) in relation to radiology and to define a policy for adoption of this\\u000a principle in the European radiological community.\\u000a \\u000a \\u000a \\u000a Results  Starting from Sackett’s definition of EBM we illustrate the top-down and bottom-up approaches to EBM as well as EBM’s limitations.\\u000a Delayed diffusion and peculiar features of evidence-based radiology (EBR) are defined with emphasis

Francesco Sardanelli; Myriam G. Hunink; Fiona J. Gilbert; Giovanni Di Leo; Gabriel P. Krestin

2010-01-01

143

Evidence-based Practice for Mere Mortals  

PubMed Central

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. PMID:11972727

Sim, Ida; Sanders, Gillian D; McDonald, Kathryn M

2002-01-01

144

Promoting Evidence-Based Practice in Child Protection  

Microsoft Academic Search

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

Geraldine Macdonald

1998-01-01

145

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

PubMed Central

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

2014-01-01

146

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

PubMed Central

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

2014-01-01

147

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

Microsoft Academic Search

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

Thomas R. Kratochwill; Elisa Steele Shernoff

2003-01-01

148

CD8+ T Cells Control Ross River Virus Infection in Musculoskeletal Tissues of Infected Mice.  

PubMed

Ross River virus (RRV), chikungunya virus, and related alphaviruses cause debilitating polyarthralgia and myalgia. Mouse models of RRV and chikungunya virus have demonstrated a role for the adaptive immune response in the control of these infections. However, questions remain regarding the role for T cells in viral control, including the magnitude, location, and dynamics of CD8(+) T cell responses. To address these questions, we generated a recombinant RRV expressing the H-2(b)-restricted glycoprotein 33 (gp33) determinant derived from the glycoprotein of lymphocytic choriomeningitis virus. Using tetramers, we tracked gp33-specific CD8(+) T cells during RRV-lymphocytic choriomeningitis virus infection. We found that acute RRV infection induces activation of CD8(+) T cell responses in lymphoid and musculoskeletal tissues that peak from 10-14 d postinoculation, suggesting that CD8(+) T cells contribute to control of acute RRV infection. Mice genetically deficient for CD8(+) T cells or wild-type mice depleted of CD8(+) T cells had elevated RRV loads in skeletal muscle tissue, but not joint-associated tissues, at 14 d postinoculation, suggesting that the ability of CD8(+) T cells to control RRV infection is tissue dependent. Finally, adoptively transferred T cells were capable of reducing RRV loads in skeletal muscle tissue of Rag1(-/-) mice, indicating that T cells can contribute to the control of RRV infection in the absence of B cells and Ab. Collectively, these data demonstrate a role for T cells in the control of RRV infection and suggest that the antiviral capacity of T cells is controlled in a tissue-specific manner. PMID:25488988

Burrack, Kristina S; Montgomery, Stephanie A; Homann, Dirk; Morrison, Thomas E

2015-01-15

149

Staffing and structure of infection prevention and control programs  

PubMed Central

Background The nature of infection prevention and control is changing; however, little is known about current staffing and structure of infection prevention and control programs. Methods Our objectives were to provide a snapshot of the staffing and structure of hospital-based infection prevention and control programs in the United States. A Web-based survey was sent to 441 hospitals that participate in the National Healthcare Safety Network. Results The response rate was 66% (n = 289); data were examined on 821 professionals. Infection preventionist (IP) staffing was significantly negatively related to bed size, with higher staffing in smaller hospitals (P < .001). Median staffing was 1 IP per 167 beds. Forty-seven percent of IPs were certified, and 24 percent had less than 2 years of experience. Most directors or hospital epidemiologists were reported to have authority to close beds for outbreaks always or most of the time (n = 225, 78%). Only 32% (n = 92) reported using an electronic surveillance system to track infections. Conclusion This study is the first to provide a comprehensive description of current infection prevention and control staffing, organization, and support in a select group of hospitals across the nation. Further research is needed to identify effective staffing levels for various hospital types as well as examine how the IP role is changing over time. PMID:19201510

Stone, Patricia W.; Dick, Andrew; Pogorzelska, Monika; Horan, Teresa C.; Furuya, E. Yoko; Larson, Elaine

2009-01-01

150

Evidence-based medicine for occupational health  

Microsoft Academic Search

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

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

2002-01-01

151

The Principles of Evidence-Based Medicine  

Microsoft Academic Search

Evidence-based medicine (EBM) integrates individual clinical expertise with the best available external evidence in the care of individual patients. By enabling clinicians to directly appraise and apply current clinical research, EBM deals with the problems of deterioration in clinical performance, information overload, and lag in application of research findings to clinical practice. Thus, EBM is a useful tool to address

S Wiebe

2000-01-01

152

Metadata for Evidence Based Medicine resources  

Microsoft Academic Search

A new metadata element set based on Dublin Core Metadata Element Set (DC) and Admin- Core: Administrative Container C ore (A-Core) was proposed for Evidence Based Medicine (EBM) sources after reviewing metadata elements and contents of current EBM sources and medical metadata for Internet resources. The metadata schema was designed to provide a common format for existing primary and secondary

Yukiko Sakai

2001-01-01

153

Evidence Based Practice for Library Instruction  

E-print Network

tutorials significantly more effective in teaching first-year students information literacy skills? #12;© M Literacy · Evidence Based Library & Information Practice · Journal of Education for Library & Information-year students information literacy skills? #12;© M. Oakleaf 2011 #12;© M. Oakleaf 2011 #12;© M. Oakleaf 2011

Oakleaf, Megan

154

Exploring the evidence base for museum value  

Microsoft Academic Search

As museums argue their case for sustainable funding in an increasingly challenging economic climate, the requirement to prove their value will be rigorous. But the concept of value is an evolving one and developing an evidence base is a challenging task. This article examines the concept of value as an emerging phenomenon, how we describe the value of museums and

Carol A. Scott

2009-01-01

155

Finding an Evidence-Based Program  

Cancer.gov

Know how to use your needs assessment and program goals and objectives to help you select your program. Be able to find evidence-based program resources. Know how to use search options to narrow your program choices and find out what programs will and will not work with your community.

156

Evidence-Based Classroom Behaviour Management Strategies  

ERIC Educational Resources Information Center

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…

Parsonson, Barry S.

2012-01-01

157

Nurses' Perceptions of Evidence-Based Practice  

Microsoft Academic Search

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

Karen D. Lehman

158

Finding Evidence-Based Practice Information  

ERIC Educational Resources Information Center

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…

Childs, Gary M.

2009-01-01

159

Evidence-Based Practice and Social Work  

Microsoft Academic Search

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

C. Aaron McNeece; Bruce A. Thyer

2004-01-01

160

Evidence-Based Practice Goes beyond Google  

ERIC Educational Resources Information Center

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

Klitzing, Sandra

2012-01-01

161

Evidence-Based Practices and Autism  

ERIC Educational Resources Information Center

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

Mesibov, Gary B.; Shea, Victoria

2011-01-01

162

Evidence Based Education Request Desk. EBE #555  

ERIC Educational Resources Information Center

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

Regional Educational Laboratory Southeast, 2009

2009-01-01

163

Evidence-based orthopaedics: A brief history  

PubMed Central

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. PMID:19826513

Hoppe, Daniel J; Bhandari, Mohit

2008-01-01

164

Evidence-based care and the curriculum  

Microsoft Academic Search

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

2008-01-01

165

Controlling infection potentials when passing surgical instruments.  

PubMed

1. Recent research suggests that percutaneous injury occurs in 6.9% of observed surgical procedures. This finding indicates that percutaneous injuries occur often during surgery, placing OR personnel at risk for infection potential with bloodborne pathogens. 2. One approach to reducing the risk of injury with contaminated sharps is to introduce a change in the normal method of passing sharps. A new method, the "hands-free" technique, focuses on the safety of the OR professional without disrupting the established routine of the operating room. This new technique is designed to reduce the number of "collisions" between sharps and OR professionals. 3. Caution and staff education are important during any attempt to use hands-free instrument passing techniques in an OR setting. The hands-free technique of passing sharps should be practiced until all members of the surgical team have a high degree of comfort using it. PMID:8291075

Kovach, T

1993-01-01

166

Clustering of Medical Publications for Evidence Based Medicine Summarisation  

E-print Network

Clustering of Medical Publications for Evidence Based Medicine Summarisation Sara Faisal Shash properties of medi- cal publications for the aim of Evidence Based Medicine summarisa- tion. Given a dataset of such clustering for natural language processing tasks in Evidence Based Medicine. 1 Introduction Evidence Based

Aliod, Diego Mollá

167

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

E-print Network

Evidence-Based Medicine, the Essential Role of Systematic Reviews, and the Need for Automated Text Storage and Retrieval, Text-Mining, Evidence-Based Medicine. 1. Introduction The practice of Evidence-Based available, most appropriate evidence in the care of each patient, a practice known as Evidence-based

Meng, Weiyi

168

Evidence-based treatment of schizophrenia.  

PubMed

People with schizophrenia can be helped greatly with pharmacologic and psychosocial interventions that are known to be effective. Several interventions are now supported by research: use of medications following specific guidelines, training in illness self-management, case management based on principles of assertive community treatment, family psychoeducation, supported employment, and integrated substance abuse treatment. However, few patients actually receive these evidence-based interventions because they are not provided in routine mental health settings. Therefore, implementing effective treatments in mental health treatment programs is a critical challenge for the field. We review the six areas of evidence-based treatment of schizophrenia, as well as knowledge regarding implementation of mental health programs in routine practice settings. PMID:11122986

Drake, R E; Mueser, K T; Torrey, W C; Miller, A L; Lehman, A F; Bond, G R; Goldman, H H; Leff, H S

2000-10-01

169

Evidence-based medicine in otolaryngology journals  

Microsoft Academic Search

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

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

2002-01-01

170

Evidence-based medicine in de praktijk  

Microsoft Academic Search

Samenvatting  Evidence-based medicine (EBM) heeft de laatste jaren een grote vlucht genomen in veel gebieden van de geneeskunde, maar over\\u000a de toepasbaarheid van deze methode in de bedrijfsgeneeskunde is relatief weinig bekend. Aan de hand van vier verschillende\\u000a vraagstukken uit de dagelijkse praktijk zijn met behulp van de EBM-methode, zoekvragen opgesteld die met de publiek toegankelijke\\u000a database van medische literatuur Medline,

J. H. A. M. Verbeek; Frank van Dijk; Antti Malmivaara; Carel Hulshof; Kimmo Räsänen; Eilo Kankaanpää; Kristiina Mukala

2004-01-01

171

Carboxymethylcellulose film for bacterial wound infection control and healing.  

PubMed

Infection control and wound healing profiles of sodium carboxymethylcellulose (SCMC) films were investigated as a function of their anti-bacterial action, physical structures, polymer molecular weights and carboxymethyl substitution degrees. The films were prepared with in vitro polymer/film and in vivo microbe-colonized wound healing/systemic infection profiles examined. Adhesive high carboxymethyl substituted SCMC films aided healing via attaching to microbes and removing them from wound. Pseudomonas aeruginosa was removed via encapsulating in gelling low molecular weight SCMC film, whereas Staphylococcus aureus was trapped in tight folds of high molecular weight SCMC film. Incomplete microbe removal from wound did not necessary translate to inability to heal as microbe remnant at wound induced fibroblast migration and aided tissue reconstruction. Using no film nonetheless will cause systemic blood infection. SCMC films negate infection and promote wound healing via specific polymer-microbe adhesion, and removal of S. aureus and P. aeruginosa requires films of different polymer characteristics. PMID:25129756

Wong, Tin Wui; Ramli, Nor Amlizan

2014-11-01

172

Evidence-based Medicine in Animal Reproduction.  

PubMed

With new knowledge being generated and published daily, the importance of evidence-based approaches in veterinary medicine is obvious. Clinicians must stay current or risk making poor decisions that clients may challenge. Especially in animal reproduction, several new substances and procedures to diagnose or treat reproductive disorders have been introduced in the last years. On the other hand, a closer look at the quality of published literature on animal reproduction reveals major deficits in methodology and reporting of many clinical trials. We strongly recommend systematically assessing the quality of scientific information when reading journal papers before using the given information in practice. The aim of evidence-based medicine (EBM) is to base the decisions in the practice of medicine on valid, clinically relevant research data. Therefore, we suggest that students should become familiar with the concepts of evidence-based veterinary medicine (EBVM) at the beginning of their veterinary education. Concepts and supporting tools such as checklists for literature assessment have been developed and validated. The purpose of this article is to review and discuss the importance of incorporating EBVM in animal reproduction. The need for further research that produces strong evidence in different fields of animal reproduction and better reporting of relevant study information is obvious. PMID:25220744

Arlt, S P; Heuwieser, W

2014-09-01

173

Controlling healthcare-associated infections in the NHS.  

PubMed

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

Duerden, Brian

2008-04-01

174

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

Federal Register 2010, 2011, 2012, 2013

...HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention Healthcare Infection Control Practices Advisory Committee: Notice of Charter...October 6, 1972, that the Healthcare Infection Control Practices Advisory Committee, Department...

2013-01-30

175

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

Federal Register 2010, 2011, 2012, 2013

...HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention Healthcare Infection Control Practices Advisory Committee: Notice of Charter...October 6, 1972, that the Healthcare Infection Control Practices Advisory Committee, Department...

2011-02-18

176

Surgical Site Infections in Breast Surgery: Case-control Study  

Microsoft Academic Search

The purpose of this study was to estimate the frequency of surgical site infections (SSIs) and identify associated risk factors for each type of breast surgery at a cancer hospital. We used a nested case-control design. Between February 1, 2000 and July 31, 2000, all breast surgeries performed were recorded on a daily basis. After hospital discharge, we evaluated patients

Diana Vilar-Compte; Benedicte Jacquemin; Carlos Robles-Vidal; Patricia Volkow

2004-01-01

177

Risk control of surgical site infection after cardiothoracic surgery  

Microsoft Academic Search

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

2006-01-01

178

Dental dams: the secret tool for infection control.  

PubMed

Dental dams, although in existence for over 100 years, are the most widely underused tool of infection control. This article addresses the many benefits of using dental dams and discusses simplified methods of incorporating dams into the dental practice. PMID:16553008

Costello, Mary R

2006-03-01

179

Tuberculosis Infection-Control Practices in United States Emergency Departments  

Microsoft Academic Search

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

1995-01-01

180

Control of acute dengue virus infection by natural killer cells.  

PubMed

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

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

2014-01-01

181

Hawaii's statewide evidence-based practice program.  

PubMed

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

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

2014-09-01

182

Observation, Sherlock Holmes, and Evidence Based Medicine.  

PubMed

Sir Arthur Conan Doyle, the creator of the fictional detective Sherlock Holmes, studied medicine at the University of Edinburgh between 1876 and 1881 under Doctor Joseph Bell who emphasised in his teaching the importance of observation, deduction and evidence. Sherlock Holmes was modelled on Joseph Bell. The modern notions of Evidence Based Medicine (EBM) are not new. A very brief indication of some of the history of EBM is presented including a discussion of the important and usually overlooked contribution of statisticians to the Popperian philosophy of EBM. PMID:14509997

Osborn, John

2002-01-01

183

Slaving and release in co-infection control  

PubMed Central

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

2013-01-01

184

Human gastrointestinal nematode infections: are new control methods required?  

PubMed Central

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

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

2006-01-01

185

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

PubMed Central

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

Aarons, Gregory A.

2006-01-01

186

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

PubMed Central

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

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

2014-01-01

187

Evidence-Based Chinese Medicine for Hypertension  

PubMed Central

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

Wang, Jie; Xiong, Xingjiang

2013-01-01

188

Evidence-based Assessment of Pediatric Pain  

PubMed Central

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. PMID:18024983

Lemanek, Kathleen; Blount, Ronald L.; Dahlquist, Lynnda M.; Lim, Crystal S.; Palermo, Tonya M.; McKenna, Kristine D.; Weiss, Karen E.

2008-01-01

189

Evidence-based chinese medicine for hypertension.  

PubMed

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

Wang, Jie; Xiong, Xingjiang

2013-01-01

190

The Coalition for Evidence-Based Policy  

NSDL National Science Digital Library

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

191

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

PubMed Central

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

Goldenberg, Maya J

2005-01-01

192

Evidence-based practice: A challenge for European developmental psychology  

Microsoft Academic Search

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

Christiane Spiel

2009-01-01

193

Clustering of Medical Publications for Evidence Based Medicine Summarisation  

E-print Network

Clustering of Medical Publications for Evidence Based Medicine Summarisation Sara Faisal Shash a study of the clustering properties of medical publications for the aim of Evidence Based Medicine-document summarisation system for Evidence Based Medicine that groups (clusters) the input documents according

Aliod, Diego Mollá

194

Evidence-Based Medicine in the Education of Psychiatrists  

ERIC Educational Resources Information Center

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…

Srihari, Vinod

2008-01-01

195

The ABCs of Evidence-Based Practice for Teachers  

ERIC Educational Resources Information Center

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…

Kretlow, Allison G.; Blatz, Sharon L.

2011-01-01

196

Evaluation of Evidence-Based Practices in Online Learning  

E-print Network

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

Alpay, S. Pamir

197

Evidence-Based Health Policy: A Preliminary Systematic Review  

ERIC Educational Resources Information Center

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

Morgan, Gareth

2010-01-01

198

Clinical governance and infection control in the United Kingdom.  

PubMed

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

Masterson, R G; Teare, E L

2001-01-01

199

Perioperative Glucose Control and Infection Risk in Older Surgical Patients.  

PubMed

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

Lee, Pearl; Min, Lillian; Mody, Lona

2014-03-01

200

Applying Evidence-Based Medicine Principles to Hip Fracture Management  

PubMed Central

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

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

2014-01-01

201

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

PubMed Central

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

Sordo-Mejia, Ricardo; Gaertner, Wolfgang B

2014-01-01

202

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

PubMed

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

Sordo-Mejia, Ricardo; Gaertner, Wolfgang B

2014-08-15

203

Vaccine to control the viral infection of fish  

DOEpatents

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

Leong, Jo-Ann C. (Albany, OR)

1994-10-11

204

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

ERIC Educational Resources Information Center

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…

Schoenwald, Sonja K.

2008-01-01

205

Underdetermination in evidence-based medicine.  

PubMed

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

Chin-Yee, Benjamin H

2014-11-19

206

Evidence-based assessment of personality disorders.  

PubMed

The purpose of this article is to provide a foundation for the development of evidence-based guidelines for the assessment of personality disorders, focusing in particular on integrated assessment strategies. The general strategy recommended herein is to first administer a self-report inventory to alert oneself to the potential presence of particular maladaptive personality traits followed by a semistructured interview to verify their presence. This strategy is guided by the existing research that suggests particular strengths of self-report inventories and semistructured interviews relative to unstructured clinical interviews. However, the authors also consider research that suggests that further improvements to the existing instruments can be made. The authors emphasize, in particular, a consideration of age of onset, distortions in self-perception and presentation, gender bias, culture and ethnicity, and personality change. PMID:16262454

Widiger, Thomas A; Samuel, Douglas B

2005-09-01

207

[Communication problems in evidence-based medicine].  

PubMed

From a humanistic, social scientific perspective, the most complex task in evidence-based medicine lies in the communication of specialized medical knowledge to non-professionals. Information is never simply the neutral transmission of facts, not even when dealing with scientific knowledge and research. It is always interpreted and evaluated from a particular perspective in a specific context. That information can be neutral is thus a myth. In all medical consultations the process of communication is not just a matter of transmitting information from one who knows to one who does not. Knowledge created and formulated in a scientific context is thus recontextualised first in a clinical situation and then as an interpreted version in people's real lives. Furthermore there are difficulties when practice must be based on current research, in a situation in which no prior clinical experience exists and in which results are interpreted and used regardless of the relative certainty of current evidence. PMID:11894613

Sachs, Lisbeth

2002-02-21

208

A systematic review of randomized controlled trials exploring the effect of immunomodulative interventions on infection, organ failure, and mortality in trauma patients  

PubMed Central

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 Evidence Based 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. PMID:20687920

2010-01-01

209

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

PubMed

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

Brodersen, B W

2014-03-01

210

Infection Control Quick Reference Guide as a Means of Educating and Assisting Healthcare Workers  

Microsoft Academic Search

ISSUE: Infection control programs generally employ a policy and procedure manual to address certain infection control issues. Our hospital's manual had grown to the point where it was cumbersome and (possibly) intimidating to staff, leading to many calls and pages from staff when the answers to their questions were available in the Infection Control Manual.PROJECT: According to principles of adult

M. Laskowski

2004-01-01

211

Genetic control of weight loss during pneumonic Burkholderia pseudomallei infection.  

PubMed

Burkholderia pseudomallei (Bp) is the causal agent of a high-morbidity/mortality disease syndrome known as melioidosis. This syndrome can range from acute fulminate disease to chronic, local, and disseminated infections that are often difficult to treat because Bp exhibits resistance to many antibiotics. Bp is a prime candidate for use in biologic warfare/terrorism and is classified as a Tier-1 select agent by HHS and APHIS. It is known that inbred mouse strains display a range of susceptibility to Bp and that the murine infection model is ideal for studying acute melioidosis. Here, we exploit a powerful mouse genetics resource that consists of a large family of BXD-type recombinant inbred strains, to perform genome-wide linkage analysis of the weight loss phenotype following pneumonic infection with Bp. We infected parental mice and 32 BXD strains with 50-100 CFU of Bp (strain 1026b) and monitored weight retention each day over an eleven-day time course. Using the computational tools in GeneNetwork, we performed genome-wide linkage analysis to identify an interval on chromosome 12 that appears to control the weight retention trait. We then analyzed and ranked positional candidate genes in this interval, several of which have intriguing connections with innate immunity, calcium homeostasis, lipid transport, host cell growth and development, and autophagy. PMID:24687986

Emery, Felicia D; Parvathareddy, Jyothi; Pandey, Ashutosh K; Cui, Yan; Williams, Robert W; Miller, Mark A

2014-07-01

212

Control of tropical theileriosis (Theileria annulata infection) of cattle.  

PubMed

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

Brown, C G

1990-04-01

213

Controlled silver-releasing polymers and their potential for urinary tract infection control.  

PubMed

Calcium phosphate controlled release glass has been developed as a biocompatible vehicle for the sustained delivery of antibacterial silver ions. The solution rate in the presence of physiological fluids can be made constant over the design life of the product and one application in urinary tract infection control is outlined. PMID:2009349

Gilchrist, T; Healy, D M; Drake, C

1991-01-01

214

Minimally invasive treatment of Peyronie's disease: evidence-based progress.  

PubMed

Peyronie's disease (PD) is often physically and psychologically devastating for patients, and the goal of treatment is to improve symptoms and sexual function without adding treatment-related morbidity. The potential for treatment-related morbidity after more invasive interventions, e.g. surgery, creates a need for effective minimally invasive treatments. We critically examined the available literature using levels of evidence to determine the reported support for each treatment. Most available minimally invasive treatments lack critical support for effectiveness due to the absence of randomised, placebo-controlled trials (RCTs) or non-significant results after RCTs. Iontophoresis, oral therapies (vitamin E, potassium para-aminobenzoate, tamoxifen, carnitine, and colchicine), extracorporeal shockwave therapy, and intralesional injection with verapamil or nicardipine have shown mixed or negative results. Treatments that have decreased penile curvature deformity in Level 1 or Level 2 evidence-based, placebo-controlled studies include intralesional injection with interferon ?-2b or collagenase clostridium histolyticum. PMID:24447536

Jordan, Gerald H; Carson, Culley C; Lipshultz, Larry I

2014-07-01

215

Infection Control Preparedness for Human Infection With Influenza A H7N9 in Hong Kong.  

PubMed

OBJECTIVE To assess the effectiveness of infection control preparedness for human infection with influenza A H7N9 in Hong Kong. DESIGN A descriptive study of responses to the emergence of influenza A H7N9. SETTING A university-affiliated teaching hospital. PARTICIPANTS Healthcare workers (HCWs) with unprotected exposure (not wearing N95 respirator during aerosol-generating procedure) to a patient with influenza A H7N9. METHODS A bundle approach including active and enhanced surveillance, early airborne infection isolation, rapid molecular diagnostic testing, and extensive contact tracing for HCWs with unprotected exposure was implemented. Seventy HCWs with unprotected exposure to an index case were interviewed especially regarding their patient care activities. RESULTS From April 1, 2013, through May 31, 2014, a total of 126 (0.08%) of 163,456 admitted patients were tested for the H7 gene by reverse transcription-polymerase chain reaction per protocol. Two confirmed cases were identified. Seventy (53.8%) of 130 HCWs had unprotected exposure to an index case, whereas 41 (58.6%) and 58 (82.9%) of 70 HCWs wore surgical masks and practiced hand hygiene after patient care, respectively. Sixteen (22.9%) of 70 HCWs were involved in high-risk patient contacts. More HCWs with high-risk patient contacts received oseltamivir prophylaxis (P=0.088) and significantly more had paired sera collected for H7 antibody testing (P<0.001). Ten (14.3%) of 70 HCWs developed influenza-like illness during medical surveillance, but none had positive results by reverse transcription-polymerase chain reaction. Paired sera was available from 33 of 70 HCWs with unprotected exposure, and none showed seroconversion against H7N9. CONCLUSIONS Despite the delay in airborne precautions implementation, no patient-to-HCW transmission of influenza A H7N9 was demonstrated. Infect Control Hosp Epidemiol 2015;36(1): 87-92. PMID:25627766

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

2015-01-01

216

Increasing capacity for evidence-based practice through the evidence-based practice academy.  

PubMed

Although mentoring is an important aspect of implementing evidence-based practice (EBP), few models exist for EBP education. The EBP Academy is an innovative, 6-month educational program designed to develop clinical staff as EBP nurse mentors. Sessions provide protected time for participants to work on their EBP projects with assigned mentors who have EBP expertise and similar clinical or research interests. Participants develop EBP projects focused on improving care in their clinical areas. Evaluation of the EBP Academy is based on a four-level model, including participant feedback about the program, perception of meeting program objectives, ability to apply knowledge to practice through EBP projects, and outcome data measured as a result of implementing the EBP changes. By developing EBP mentors, capacity to move nursing practice to a stronger evidence-based foundation can be enhanced. Positive, professional nursing and patient outcomes have been demonstrated when structured EBP education is provided. PMID:24494661

Green, Angela; Jeffs, Debra; Huett, Amy; Jones, Luann R; Schmid, Barbara; Scott, Angela R; Walker, Liz

2014-02-01

217

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

PubMed Central

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

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

2009-01-01

218

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

PubMed Central

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

2013-01-01

219

Integrated control of Fascioloides magna infection in northern Italy.  

PubMed

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

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

1989-01-01

220

Social marketing: a behavior change technology for infection control.  

PubMed

Changing health care worker behaviors is a core function of infection control programs. The social change technologies of education and institutional policy are limited in their capacity to achieve desired behaviors on a sustained basis because they do not address the importance of opportunity and ability in practice enhancement. Social marketing addresses the health care worker's lack of opportunity and ability by offering a bundle of benefits at low cost with high accessibility and by doing this better than the behavioral status quo. This article introduces some social marketing concepts and explicates them in the context of hand hygiene promotion. PMID:16945693

Mah, Manuel W; Deshpande, Sameer; Rothschild, Michael L

2006-09-01

221

Merging Evidence-Based Psychosocial Interventions in Schizophrenia  

PubMed Central

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

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

2014-01-01

222

42 CFR 494.30 - Condition: Infection control.  

Code of Federal Regulations, 2010 CFR

...END-STAGE RENAL DISEASE FACILITIES Patient Safety § 494.30 Condition: Infection...Infections Among Chronic Hemodialysis Patients,” developed by the...section header “HBV-Infected Patients”, found on pages 27 and 28...

2010-10-01

223

[Phytomedicine in otorhinolaryngology - evidence-based medicine with medicinal plants].  

PubMed

Phytomedicine has become an increasingly important treatment option for patients in the western world. Patients who experienced failure or adverse reactions with conventional western medicine often switch to natural and holistic methods. In eastern countries, with their long history of traditional medicine, patients often resort to herbal preparations as the majority of western medicines are unaffordable. The desire of western physicians for evidence-based medicine also applies in the sector of phytomedicine. A serious perception of natural products in scientific medicine can therefore only be based on data from prospective, controlled, randomized double-blind clinical trials. In order to illuminate the present scientific foundation of effective and reliable phytomedicine, a literature search in PubMed (Medline) was conducted based on inclusion and exclusion criteria. The main focus was on the field of otorhinolaryngology. Besides the presentation of selected, reliable studies and the evaluation of the efficacy of various medicinal plants, shortcomings of selected publications are discussed. PMID:22159338

Sertel, S

2011-12-01

224

Evidence-based practice improvement: merging 2 paradigms.  

PubMed

This article presents a new model, Evidence-Based Practice Improvement, for improving patient care. The model merges 2 extant paradigms currently used for quality improvement initiatives-evidence-based practice and practice or performance improvement. The literature expounds on the virtues of each of these approaches, yet no authors have moved beyond parallel play between them. The merged model, Evidence-Based Practice Improvement, may provide a more effective and practical approach to reach our quality goals. PMID:19680149

Levin, Rona F; Keefer, Jeffrey M; Marren, Joan; Vetter, MaryJo; Lauder, Bonnie; Sobolewski, Sally

2010-01-01

225

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

PubMed

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

Koch, Anne Mette; Nilsen, Roy Miodini; Dalheim, Anne; Cox, Rebecca Jane; Harthug, Stig

2014-12-01

226

Evolution of the evidence-based Papanicolaou smear  

Microsoft Academic Search

Cervical cancer rates have decreased over the past century, but rates have remained relatively constant during the last decade. Evidence-based management of the abnormal Papanicolaou (Pap) smear and the use of additional testing at the time of the Pap smear are discussed in light of the current evidence. Also explored in-depth is the evidence base for Papanicolaou smear collection and

Jane Mashburn

2001-01-01

227

Teachers' Characteristics and Ratings for Evidence-Based Behavioral Interventions  

ERIC Educational Resources Information Center

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

Stormont, Melissa; Reinke, Wendy; Herman, Keith

2011-01-01

228

Evidence-Based Treatment and Stuttering--Historical Perspective  

ERIC Educational Resources Information Center

Purpose: To illustrate the way in which both fluency shaping (FS) and stuttering management (SM) treatments for developmental stuttering in adults are evidence based. Method: A brief review of the history and development of FS and SM is provided. It illustrates that both can be justified as evidence-based treatments, each treatment seeking…

Prins, David; Ingham, Roger J.

2009-01-01

229

Evidence-Based Practice Guidelines and School Nursing  

ERIC Educational Resources Information Center

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…

Adams, Susan; McCarthy, Ann Marie

2007-01-01

230

Evidence-based Nursing Practice: To Infinity and Beyond.  

ERIC Educational Resources Information Center

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

Pape, Tess M.

2003-01-01

231

Evidence-Based Practice in Rehabilitation Counseling: Perceptions and Practices  

ERIC Educational Resources Information Center

This study describes certified rehabilitation counselors' attitudes (n=163) about evidence based practice, knowledge and skills related to obtaining and evaluating evidence, use of literature in practice, availability of information, and perceived barriers to evidence-based practice. Responses related to knowledge and skills were mixed with strong…

Bezyak, Jill L.; Kubota, Coleen; Rosenthal, David

2010-01-01

232

Evidence-Based Practice: Integrating Classroom Curriculum and Field Education  

ERIC Educational Resources Information Center

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…

Tuchman, Ellen; Lalane, Monique

2011-01-01

233

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

E-print Network

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

Kan, Min-Yen

234

Towards an Understanding of Evidence-Based Practice  

ERIC Educational Resources Information Center

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

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

2008-01-01

235

Counting what counts: performance measurement and evidence-based practice  

Microsoft Academic Search

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

Andrew Booth

2006-01-01

236

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

Microsoft Academic Search

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

Mark Fox

2003-01-01

237

Evidence-based gene predictions in plant genomes  

Technology Transfer Automated Retrieval System (TEKTRAN)

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

238

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

PubMed

Objectives. We tested the efficacy of an adapted evidence-based HIV-sexually transmitted infection (STI) behavioral intervention (Providing Opportunities for Women's Empowerment, Risk-Reduction, and Relationships, or POWER) among incarcerated women. Methods. We conducted a randomized trial with 521 women aged 18 to 60 years in 2 correctional facilities in North Carolina in 2010 and 2011. Intervention participants attended 8 POWER sessions; control participants received a single standard-of-care STI prevention session. We followed up at 3 and 6 months after release. We examined intervention efficacy with mixed-effects models. Results. POWER participants reported fewer male sexual partners than did control participants at 3 months, although this finding did not reach statistical significance; at 6 months they reported significantly less vaginal intercourse without a condom outside of a monogamous relationship and more condom use with a main male partner. POWER participants also reported significantly fewer condom barriers, and greater HIV knowledge, health-protective communication, and tangible social support. The intervention had no significant effects on incident STIs. Conclusions. POWER is a behavioral intervention with potential to reduce risk of acquiring or transmitting HIV and STIs among incarcerated women returning to their communities. (Am J Public Health. Published online ahead of print September 11, 2014: e1-e8. doi:10.2105/AJPH.2014.302105). PMID:25211714

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

2014-09-11

239

Toxocara Infection in Psychiatric Inpatients: A Case Control Seroprevalence Study  

PubMed Central

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

Alvarado-Esquivel, Cosme

2013-01-01

240

Interventions to control nosocomial infections: study designs and statistical issues.  

PubMed

There is a wide range of potential study designs for intervention studies to decrease nosocomial infections in hospitals. The analysis is complex due to competing events, clustering, multiple timescales and time-dependent period and intervention variables. This review considers the popular pre-post quasi-experimental design and compares it with randomized designs. Randomization can be done in several ways: randomization of the cluster [intensive care unit (ICU) or hospital] in a parallel design; randomization of the sequence in a cross-over design; and randomization of the time of intervention in a stepped-wedge design. We introduce each design in the context of nosocomial infections and discuss the designs with respect to the following key points: bias, control for non-intervention factors, and generalizability. Statistical issues are discussed. A pre-post-intervention design is often the only choice that will be informative for a retrospective analysis of an outbreak setting. It can be seen as a pilot study with further, more rigorous designs needed to establish causality. To yield internally valid results, randomization is needed. Generally, the first choice in terms of the internal validity should be a parallel cluster randomized trial. However, generalizability might be stronger in a stepped-wedge design because a wider range of ICU clinicians may be convinced to participate, especially if there are pilot studies with promising results. For analysis, the use of extended competing risk models is recommended. PMID:24286854

Wolkewitz, M; Barnett, A G; Palomar Martinez, M; Frank, U; Schumacher, M

2014-02-01

241

Status of infection control policies and organisation in European hospitals, 2001: the ARPAC study  

Microsoft Academic Search

Patient safety in hospital care depends on effective infection control (IC) programmes. The Antimicrobial Resistance Prevention and Control (ARPAC) study assessed the organisation, components and human resources of IC programmes in European hospitals. A questionnaire survey of policies and procedures implemented in 2001 for the surveillance and control of nosocomial infection and antibiotic resistance was completed by 169 acute-care hospitals

M. J. Struelens; D. Wagner; J. Bruce; F. M. MacKenzie; B. D. Cookson; A. Voss; P. J. J. A. van den Broek; I. M. Gould

2006-01-01

242

Infections  

MedlinePLUS

... Ear (Otitis Externa) Syphilis Tetanus Tonsillitis Toxic Shock Syndrome Toxic Synovitis Tuberculosis Urinary Tract Infections Vaginal Yeast Infections Warts West Nile Virus What Is "PANS"? Whooping Cough (Pertussis) ...

243

Evidence-based practice: a deconstruction and postmodern critique: book review article.  

PubMed

This paper discusses the significance of postmodernism for healthcare practice, specifically the discourse known as 'evidence-based practice'. It considers two texts, both of which present postmodern analyses of contemporary issues. One text presents a deconstruction of evidence-based practice in an attempt to reveal its 'true' nature, which is portrayed as one that does not respect research paradigms other than the randomised controlled trial, merely pays lip service to expertise and fails to connect with the real nature of clinical practice. The second text considers the accusation that absolute relativism implied by postmodern approaches may permit an 'anything goes' mentality and provide succour to those advocating unacceptable practices. A 'defence' of postmodernism in relation to the accusation that it encourages holocaust denial is used to consider further the nature and limitations of postmodern critiques of evidence-based practice. This review concludes that postmodernism fundamentally challenges the apparent 'objectivity' of evidence-based practice but it does not challenge the fundamental rules for acquiring and testing evidence. Rather it is the selection of questions to be asked and answered by evidence-based practice/practitioners that is the true limitation. This is the ground upon which fruitful argument can be had about the significance of evidence without undermining the requirement that there be evidence and standards to judge such evidence. PMID:15708022

Griffiths, Peter

2005-03-01

244

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

E-print Network

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

Moskowitz, Joshua Seth

2012-01-01

245

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

PubMed Central

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

2014-01-01

246

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

ERIC Educational Resources Information Center

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

Özdemir, Metin; Giannotta, Fabrizia

2014-01-01

247

Applying Evidence-Based Medicine to Traditional Chinese Medicine: Debate and Strategy  

Microsoft Academic Search

Drawing on recent paper published literature in both English and Chinese, this explores reactions to the eval- uation of Chinese medicine using randomized controlled trials (RCTs) and the standards of evidence-based medicine (EBM). The literature review revealed a few sources which contend that Chinese medicine should not be evaluated on the basis of RCTs, but a far greater number which

Jeanne L. Shea

2006-01-01

248

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

Microsoft Academic Search

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

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

2004-01-01

249

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

ERIC Educational Resources Information Center

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…

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

2012-01-01

250

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

ERIC Educational Resources Information Center

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

Becker, Kimberly D.; Domitrovich, Celene E.

2011-01-01

251

Collaborative quality improvement to promote evidence based surfactant for preterm infants: a cluster randomised trial  

Microsoft Academic Search

Objective To test a multifaceted collaborative quality improvement intervention designed to promote evidence based 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

2004-01-01

252

Evidence-Based Review of the Literature on Intrathecal Delivery of Pain Medication  

Microsoft Academic Search

Evidence-based medicine depends on the existence of controlled clinical trials that establish the safety and efficacy of specific therapeutic techniques. Many interventions in clinical practice have achieved widespread acceptance despite little evidence to support them in the scientific literature; the critical appraisal of these interventions based on accumulating experience is a goal of medicine. To clarify the current state of

Gary Bennett; Mario Serafini; Kim Burchiel; Eric Buchser; Ashley Classen; Tim Deer; Stuart Du Pen; F. Michael Ferrante; Samuel J Hassenbusch; Leland Lou; Jan Maeyaert; Richard Penn; Russell K Portenoy; Richard Rauck; K. Dean Willis; Tony Yaksh

2000-01-01

253

Providers' Perceptions of and Receptivity toward Evidence-Based HIV Prevention Interventions  

ERIC Educational Resources Information Center

Since 1999, the Centers for Disease Control and Prevention have trained over 10,000 service providers from more than 5,000 agencies to implement evidence-based HIV prevention interventions through its Diffusion of Effective Behavioral Interventions DEBI) program. Based on in-depth, semistructured interviews with a convenience sample of 22 HIV…

Owczarzak, Jill; Dickson-Gomez, Julia

2011-01-01

254

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

PubMed

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

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

2013-01-01

255

Procalcitonin guided antibiotic therapy and hospitalization in patients with lower respiratory tract infections: a prospective, multicenter, randomized controlled trial  

Microsoft Academic Search

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

Philipp Schuetz; Mirjam Christ-Crain; Marcel Wolbers; Ursula Schild; Robert Thomann; Claudine Falconnier; Isabelle Widmer; Stefanie Neidert; Claudine A Blum; Ronald Schönenberger; Christoph Henzen; Thomas Bregenzer; Claus Hoess; Martin Krause; Heiner C Bucher; Werner Zimmerli; Beat Müller

2007-01-01

256

Updated Evidence-Based Treatment Algorithm in Pulmonary Arterial Hypertension  

PubMed Central

Uncontrolled and controlled clinical trials with different compounds and procedures are reviewed to define the risk-benefit profiles for therapeutic options in pulmonary arterial hypertension (PAH). A grading system for the level of evidence of treatments based on the controlled clinical trials performed with each compound is used to propose an evidence-based treatment algorithm. The algorithm includes drugs approved by regulatory agencies for the treatment of PAH and/or drugs available for other indications. The different treatments have been evaluated mainly in idiopathic PAH, heritable PAH, and in PAH associated with the scleroderma spectrum of diseases or with anorexigen use. Extrapolation of these recommendations to other PAH subgroups should be done with caution. Oral anticoagulation is proposed for most patients; diuretic treatment and supplemental oxygen are indicated in cases of fluid retention and hypoxemia, respectively. High doses of calcium channel blockers are indicated only in the minority of patients who respond to acute vasoreactivity testing. Nonresponders to acute vasoreactivity testing, or responders who remain in World Health Organization (WHO) functional class III, should be considered candidates for treatment with either an oral phosphodiesterase-5 inhibitor or an oral endothelin-receptor antagonist. Continuous intravenous administration of epoprostenol remains the treatment of choice in WHO functional class IV patients. Combination therapy is recommended for patients treated with PAH monotherapy who remain in New York Heart Association functional class III. Atrial septostomy and lung transplantation are indicated for refractory patients or where medical treatment is unavailable. PMID:19555861

Barst, Robyn J.; Gibbs, J. Simon; Ghofrani, Hossein A.; Hoeper, Marius M.; McLaughlin, Vallerie V.; Rubin, Lewis J.; Sitbon, Olivier; Tapson, Victor; Galiè, Nazzareno

2009-01-01

257

[Evidence-based treatment of canine demodicosis].  

PubMed

This article briefly reviews pathogenesis, clinics and diagnosis of canine demodicosis and summarizes treatment options for this disease based on published evidence. The disease is caused by excessive proliferation of Demodex mites in the hair follicles that may be due to genetic factors or immunosuppressive diseases or treatments. The disease is characterized by alopecia, papules, pustules and crusts. Diagnosis is confirmed by detection of several mites in deep skin scrapings or trichograms. Based on published studies, licensed successful treatments for many patients are weekly amitraz rinses in a concentration of 0.05% and (in dogs with mild to moderate clinical signs) weekly spot-ons containing moxidectin. In severe, treatment-resistant cases, daily oral macrocyclic lactones such as milbemycin oxim (1-2 mg/kg), ivermectin or moxidectin (0.3 mg/kg after daily gradual dose increases from 0.05mg/kg) may be used. Doramectin orally or subcutaneously at 0.6 mg/kg has also been reported as successful therapy. Secondary bacterial skin infections are common and should be treated with antimicrobial shampoos and possibly oral antibiotics. PMID:22167167

Mueller, R S

2011-01-01

258

The Outcomes Movement and Evidence Based Medicine in Plastic Surgery  

PubMed Central

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

Kowalski, Evan.; Chung, Kevin C.

2012-01-01

259

Implementing Evidence-Based Practices for People With Schizophrenia  

PubMed Central

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. PMID:19491315

Drake, Robert E.; Bond, Gary R.; Essock, Susan M.

2009-01-01

260

Back to basics: implementing evidence-based practice.  

PubMed

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

Spruce, Lisa

2015-01-01

261

Evidence Searching for Evidence-based Psychology Practice  

PubMed Central

There is an increased awareness of evidence-based methodology among psychologists, but little exists in the literature about how to access the research. Moreover, the prohibitive cost of this information combined with limited time are barriers to the identification of evidence to answer clinical questions. This article presents an example of a question worked though in an evidence-based way. Methods are highlighted, including distinguishing background and foreground questions, breaking down questions into searchable statements, and adapting statements to suit both the question being asked and the resource being searched. A number of free, evidence-based resources are listed. Knowing how and where to access this information will enable practitioners to more easily use an evidence-based approach to their practice. PMID:21503266

Falzon, Louise; Davidson, Karina W.; Bruns, Daniel

2010-01-01

262

Using Evidence-Based Principles in Clinical Practice  

E-print Network

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

Storkel, Holly Lynn

2004-01-01

263

The Iowa Model of Evidence-Based Practice to Promote Quality Care: an illustrated example in oncology nursing.  

PubMed

Evidence-based practice (EBP) improves the quality of patient care and helps control healthcare costs. Numerous EBP models exist to assist nurses and other healthcare providers to integrate best evidence into clinical practice. The Iowa Model of Evidence-Based Practice to Promote Quality Care is one model that should be considered. Using an actual clinical example, this article describes how the Iowa Model can be used effectively to implement an actual practice change at the unit or organizational level. PMID:24675251

Brown, Carlton G

2014-04-01

264

History and Development of Evidence-based Medicine  

Microsoft Academic Search

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

Jeffrey A. Claridge; Timothy C. Fabian

2005-01-01

265

Evidence based practice: a survey of physiotherapists' current practice  

Microsoft Academic Search

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,

Ross Iles; Megan Davidson

2006-01-01

266

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

PubMed

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

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

2014-01-01

267

Evidence Based Dental Care: Integrating Clinical Expertise with Systematic Research  

PubMed Central

Clinical dentistry is becoming increasingly complex and our patients more knowledgeable. Evidence-based care is now regarded as the “gold standard” in health care delivery worldwide. The basis of evidence based dentistry is the published reports of research projects. They are, brought together and analyzed systematically in meta analysis, the source for evidence based decisions. Activities in the field of evidence-based dentistry has increased tremendously in the 21st century, more and more practitioners are joining the train, more education on the subject is being provided to elucidate the knotty areas and there is increasing advocacy for the emergence of the field into a specialty discipline. Evidence-Based Dentistry (EBD), if endorsed by the dental profession, including the research community, may well- influence the extent to which society values dental research. Hence, dental researchers should understand the precepts of EBD, and should also recognize the challenges it presents to the research community to strengthen the available evidence and improve the processes of summarizing the evidence and translating it into practice This paper examines the concept of evidence-based dentistry (EBD), including some of the barriers and will discuss about clinical practice guidelines. PMID:24701551

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

2014-01-01

268

Evidence-based programs registry: Blueprints for Healthy Youth Development.  

PubMed

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

Mihalic, Sharon F; Elliott, Delbert S

2015-02-01

269

Disruptive Innovations for Designing and Diffusing Evidence-based Interventions  

PubMed Central

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

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

2013-01-01

270

Evidence-based pharmacotherapy of eating disorders.  

PubMed

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

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

2012-03-01

271

Mixed-Strain Mycobacterium tuberculosis Infections and the Implications for Tuberculosis Treatment and Control  

PubMed Central

Summary: Numerous studies have reported that individuals can simultaneously harbor multiple distinct strains of Mycobacterium tuberculosis. To date, there has been limited discussion of the consequences for the individual or the epidemiological importance of mixed infections. Here, we review studies that documented mixed infections, highlight challenges associated with the detection of mixed infections, and discuss possible implications of mixed infections for the diagnosis and treatment of patients and for the community impact of tuberculosis control strategies. We conclude by highlighting questions that should be resolved in order to improve our understanding of the importance of mixed-strain M. tuberculosis infections. PMID:23034327

van Helden, Paul D.; Wilson, Douglas; Colijn, Caroline; McLaughlin, Megan M.; Abubakar, Ibrahim; Warren, Robin M.

2012-01-01

272

A New Look at Old Data: Infection Control Case Study  

Microsoft Academic Search

This case study demonstrates the process one accredited home care organization followed to reduce its infection rate. Ongoing benchmarking of urinary tract infection (UTI) rates was the basis of measuring the performance of the organization. The project culminated in the development of a UTI patient education tool and improved outcomes to care.

Carol M. Arnold

1999-01-01

273

A co-infection model of malaria and cholera diseases with optimal control.  

PubMed

In this paper we formulate a mathematical model for malaria-cholera co-infection in order to investigate their synergistic relationship in the presence of treatments. We first analyze the single infection steady states, calculate the basic reproduction number and then investigate the existence and stability of equilibria. We then analyze the co-infection model, which is found to exhibit backward bifurcation. The impact of malaria and its treatment on the dynamics of cholera is further investigated. Secondly, we incorporate time dependent controls, using Pontryagin's Maximum Principle to derive necessary conditions for the optimal control of the disease. We found that malaria infection may be associated with an increased risk of cholera but however, cholera infection is not associated with an increased risk for malaria. Therefore, to effectively control malaria, the malaria intervention strategies by policy makers must at the same time also include cholera control. PMID:25245609

Okosun, K O; Makinde, O D

2014-12-01

274

[Patient care according to the latest state of the science--implications of evidence-based medicine].  

PubMed

Evidence-based medicine implies that recommendations ideally exist for each clinical question based on a systematic data search in the current literature, a data extraction, a summary and critical appraisal. Over the last fifty years evidence-based medicine has been growing rapidly. Systematic reviews and randomised controlled trials are of high impact in this field. However, the question remains: in which way is daily clinical practice affected? In an era of time- and cost-pressures as well as manpower shortages, the complex process of evidence-based medicine is difficult. Examples from perioperative pain therapy are provided to demonstrate how evidence-based medicine could be feasible and incorporated into daily practice. PMID:20155644

Pöpping, Daniel M; Wenk, Manuel; Bürkle, Hartmut

2010-02-01

275

An Evidence Base for Human Spaceflight Risks in Wikipedia  

NASA Technical Reports Server (NTRS)

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

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

2013-01-01

276

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

PubMed Central

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

2014-01-01

277

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

PubMed Central

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

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

2014-01-01

278

Surgical site infections at the National Cancer Institute in Mexico: A case-control study  

Microsoft Academic Search

Objectives: To quantify the surgical infection rate and to identify risk factors associated with surgical site infection.Methods: We conducted a case-control study of all surgical patients between January 1, 1993, and June 30, 1994. The frequency of surgical site infection per 100 surgeries was calculated. The odds ratio (OR) was estimated by using logistic regression analysis.setting: A 130-bed tertiary-care teaching

Diana Vilar-Compte; Alejandro Mohar; Silvia Sandoval; Margarita de la Rosa; Gordillo Patricia; Patricia Volkow

2000-01-01

279

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

PubMed

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

Aravind, Maya; Chung, Kevin C

2010-01-01

280

Microreview Immune-mediated control of Chlamydia infection  

E-print Network

pregnancy, infertility and blindness. Exposure of the host to C. trachomatis stimulates multiple innate to chronic pain, infertility and ectopic pregnancy. Serovars L1­L3 also establish infection in the urogenital

Starnbach, Michael

281

Plant RNA binding proteins for control of RNA virus infection  

PubMed Central

Plant RNA viruses have effective strategies to infect host plants through either direct or indirect interactions with various host proteins, thus suppressing the host immune system. When plant RNA viruses enter host cells exposed RNAs of viruses are recognized by the host immune system through processes such as siRNA-dependent silencing. Interestingly, some host RNA binding proteins have been involved in the inhibition of RNA virus replication, movement, and translation through RNA-specific binding. Host plants intensively use RNA binding proteins for defense against viral infections in nature. In this mini review, we will summarize the function of some host RNA binding proteins which act in a sequence-specific binding manner to the infecting virus RNA. It is important to understand how plants effectively suppress RNA virus infections via RNA binding proteins, and this defense system can be potentially developed as a synthetic virus defense strategy for use in crop engineering. PMID:24427141

Huh, Sung Un; Paek, Kyung-Hee

2013-01-01

282

Infection control. The therapeutic uses of cranberry juice.  

PubMed

This article considers the treatment of recurrent cystitis. It examines the evidence for drinking cranberry juice to prevent recurrent urinary tract infections and discusses the nursing issues raised, drawing conclusions from the evidence presented. PMID:7612429

Nazarko, L

283

THE CONTROL OF BOVINE VIRAL DIARRHOEA VIRUS INFECTION HARKNESS JW  

E-print Network

to the live- stock industry with accuracy. It is nevertheless clear that BVD is a multifacetted syndrome et al 1985) or facilitate their spread (Edwards et al 1986). Synergistic infections of this type

Paris-Sud XI, Université de

284

An Approach for Query-focused Text Summarisation for Evidence Based Medicine  

E-print Network

An Approach for Query-focused Text Summarisation for Evidence Based Medicine Abeed Sarker1 , Diego Processing, Evidence Based Medicine, Query-focused Summarisation 1 Introduction Evidence Based Medicine (EBM

Aliod, Diego Mollá

285

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

Federal Register 2010, 2011, 2012, 2013

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

2011-09-16

286

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

Federal Register 2010, 2011, 2012, 2013

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

2012-07-10

287

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

Technology Transfer Automated Retrieval System (TEKTRAN)

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

288

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

PubMed Central

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

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

2013-01-01

289

Human natural killer cells control Plasmodium falciparum infection by eliminating infected red blood cells  

PubMed Central

Immunodeficient mouse–human chimeras provide a powerful approach to study host-specific pathogens, such as Plasmodium falciparum that causes human malaria. Supplementation of immunodeficient mice with human RBCs supports infection by human Plasmodium parasites, but these mice lack the human immune system. By combining human RBC supplementation and humanized mice that are optimized for human immune cell reconstitution, we have developed RBC-supplemented, immune cell-optimized humanized (RICH) mice that support multiple cycles of P. falciparum infection. Depletion of human natural killer (NK) cells, but not macrophages, in RICH mice results in a significant increase in parasitemia. Further studies in vitro show that NK cells preferentially interact with infected RBCs (iRBCs), resulting in the activation of NK cells and the elimination of iRBCs in a contact-dependent manner. We show that the adhesion molecule lymphocyte-associated antigen 1 is required for NK cell interaction with and elimination of iRBCs. Development of RICH mice and validation of P. falciparum infection should facilitate the dissection of human immune responses to malaria parasite infection and the evaluation of therapeutics and vaccines. PMID:24474774

Chen, Qingfeng; Amaladoss, Anburaj; Ye, Weijian; Liu, Min; Dummler, Sara; Kong, Fang; Wong, Lan Hiong; Loo, Hooi Linn; Loh, Eva; Tan, Shu Qi; Tan, Thiam Chye; Chang, Kenneth T. E.; Dao, Ming; Suresh, Subra; Preiser, Peter R.; Chen, Jianzhu

2014-01-01

290

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

PubMed

Immunodeficient mouse-human chimeras provide a powerful approach to study host-specific pathogens, such as Plasmodium falciparum that causes human malaria. Supplementation of immunodeficient mice with human RBCs supports infection by human Plasmodium parasites, but these mice lack the human immune system. By combining human RBC supplementation and humanized mice that are optimized for human immune cell reconstitution, we have developed RBC-supplemented, immune cell-optimized humanized (RICH) mice that support multiple cycles of P. falciparum infection. Depletion of human natural killer (NK) cells, but not macrophages, in RICH mice results in a significant increase in parasitemia. Further studies in vitro show that NK cells preferentially interact with infected RBCs (iRBCs), resulting in the activation of NK cells and the elimination of iRBCs in a contact-dependent manner. We show that the adhesion molecule lymphocyte-associated antigen 1 is required for NK cell interaction with and elimination of iRBCs. Development of RICH mice and validation of P. falciparum infection should facilitate the dissection of human immune responses to malaria parasite infection and the evaluation of therapeutics and vaccines. PMID:24474774

Chen, Qingfeng; Amaladoss, Anburaj; Ye, Weijian; Liu, Min; Dummler, Sara; Kong, Fang; Wong, Lan Hiong; Loo, Hooi Linn; Loh, Eva; Tan, Shu Qi; Tan, Thiam Chye; Chang, Kenneth T E; Dao, Ming; Suresh, Subra; Preiser, Peter R; Chen, Jianzhu

2014-01-28

291

Mental Health Clinicians’ Experiences of Implementing Evidence-Based Treatments  

PubMed Central

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

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

2013-01-01

292

Impact of chemo-therapy on optimal control of malaria disease with infected immigrants.  

PubMed

We derived and analyzed rigorously a mathematical model that describes the dynamics of malaria infection with the recruitment of infected immigrants, treatment of infectives and spray of insecticides against mosquitoes in the population. Both qualitative and quantitative analysis of the deterministic model are performed with respect to stability of the disease free and endemic equilibria. It is found that in the absence of infected immigrants disease-free equilibrium is achievable and is locally asymptotically stable. Using Pontryagin's Maximum Principle, the optimal strategies for disease control are established. Finally, numerical simulations are performed to illustrate the analytical results. PMID:21219965

Makinde, O D; Okosun, K O

2011-04-01

293

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

ERIC Educational Resources Information Center

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

Vetter, Edwin A.

1989-01-01

294

Airway epithelial control of Pseudomonas aeruginosa infection in cystic fibrosis  

PubMed Central

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

Camp?donico, Victoria L; Gadjeva, Mihaela; Paradis-Bleau, Catherine; Uluer, Ahmet; Pier, Gerald B

2013-01-01

295

The effect of triclosan coated sutures on rate of Surgical Site Infection after hip and knee replacement: a protocol for a double-blind randomised controlled trial  

PubMed Central

Background 187,000 hip and knee joint replacements are performed every year in the National Health Service (NHS). One of the commonest complications is surgical site infection (SSI), and this represents a significant burden in terms of patient morbidity, mortality and cost to health services around the world. The aim of this randomised controlled trial (RCT) is to determine if the addition of triclosan coated sutures to a standard regimen can reduce the rate of SSI after total knee replacement (TKR) and total hip replacement (THR). Methods 2400 patients due to undergo a total hip or knee replacement are being recruited into this two-centre RCT. Participants are recruited before surgery and randomised to either standard care or intervention group. Participants, outcome assessors and statistician are blind to treatment allocation throughout the study. The intervention consists of triclosan coated sutures vs. standard non-coated sutures. The primary outcome is the Health protection Agency (HPA) defined superficial surgical site infection at 30 days. Secondary outcomes include HPA defined deep surgical site infection at 12 months, length of hospital stay, critical care stay, and payer costs. Discussion To date there are no orthopaedic randomised controlled trials on this scale assessing the effectiveness of a surgical intervention, particularly those that can be translated across the surgical specialities. The results from this trial will inform evidence-based recommendations for suture selection in the management of patients undergoing total hip or knee replacement. If triclosan coated sutures are found to be an effective intervention, implementation into clinical practice could improve long-term outcomes for patients undergoing hip and knee replacement. Trial registration Current Controlled Trials ISRCTN 17807356. PMID:25027459

2014-01-01

296

Evidence-Based Selection of Candidates for the Levonorgestrel Intrauterine Device (IUD)  

PubMed Central

Background Recent evidence-based guidelines expanded the definition of appropriate candidates for the levonorgestrel-releasing intrauterine system (LNG-IUS). We investigated correlates of evidence-based selection of candidates for the LNG-IUS by physicians who offer insertion. Methods We conducted a mixed-mode (online and mail) survey of practicing family physicians and obstetrician-gynecologists in Seattle. Results A total of 269 physicians responded to the survey (44% response rate). Of the 217 respondents who inserted intrauterine devices, half or fewer routinely recommended the LNG-IUS to women who are nulliparous, younger than 20 years old, or have a history of sexually transmitted infections (STIs). In multivariable analyses, training/resident status was positively associated with recommending the LNG-IUS to women <20 years old (adjusted odds ratio [aOR], 3.6; 95% confidence interval [CI], 1.6–8.0) and women with history of STI (aOR, 3.7; 95% CI, 1.6–8.4). Perceived risk of infection or infertility was negatively associated with recommending the LNG-IUS to nulliparous women (aOR, 0.2; 95% CI, 0.1–0.5) and women with a history of STI (aOR, 0.3; 95% CI, 0.1–0.8). Conclusions Many family physicians and obstetrician-gynecologists who insert the LNG-IUS are overly restrictive in selecting candidates, although those who train residents are more likely to follow evidence-based guidelines. Interventions that address negative bias and perceptions of risks, in addition to improving knowledge, are needed to promote wider use of the LNG-IUS. PMID:24390883

Callegari, Lisa S.; Darney, Blair G.; Godfrey, Emily M.; Sementi, Olivia; Dunsmoor-Su, Rebecca; Prager, Sarah W.

2014-01-01

297

Predictors of tuberculosis and human immunodeficiency virus co-infection: a case-control study  

PubMed Central

OBJECTIVES: The human immunodeficiency virus (HIV) and Mycobacterium tuberculosis co-infection is a major global challenge. It is not clear why some HIV-positive people are co-infected with tuberculosis (TB) while others are not. This study addressed that question. METHODS: This case-control study was conducted in Tehran, Iran in June 2004, enrolling 2,388 HIV-positive people. Cases were selected from those who were co-infected with TB and controls from those without TB. Multiple logistic regression analysis was performed to assess the association between M. tuberculosis/HIV co-infection and several predictors. Odds ratios (ORs) and their 95% confidence intervals (CIs) were calculated. RESULTS: In this study, 241 cases were compared with 2,147 controls. Sex, age, marital status, educational level, imprisonment, smoking, narcotic use, route of HIV transmission, previous TB infection, isoniazid preventive therapy (IPT), antiretroviral therapy (ART), and low CD4 count (<350 cells/mm3) were independently associated with M. tuberculosis/HIV co-infection (p<0.001). However, after adjusting for all other variables in the model, only the association between M. tuberculosis/HIV co-infection and the following predictors remained statistically significant: imprisonment (odds ratio [OR], 3.82; 95% confidence interval [CI], 2.11-6.90), previous TB infection (OR, 5.54; 95% CI, 1.99-15.39), IPT (OR, 0.13; 95% CI, 0.06-0.31), ART (OR, 1.81; 95% CI, 1.26-2.61), and CD4 count <350 cells/mm3 (OR, 2.34; 95% CI, 1.36-4.02). CONCLUSIONS: Several predictors are associated with M. tuberculosis/HIV co-infection, but only a few indicators were significantly associated with M. tuberculosis/HIV co-infection. It is estimated that a number of predictors of M. tuberculosis/HIV co-infection remain unknown and require further investigation. PMID:25358465

Molaeipoor, Leila; Poorolajal, Jalal; Mohraz, Minoo; Esmailnasab, Nader

2014-01-01

298

Hindawi Publishing Corporation Evidence-Based Complementary and Alternative Medicine  

E-print Network

Hindawi Publishing Corporation Evidence-Based Complementary and Alternative Medicine Volume 2012 of Medicinal Plant Knowledge in the Andean Highlands: A Case Study from Peru and Bolivia Sarah-Lan Mathez, 3012 Berne, Switzerland 2 Institute of Economic Botany, The New York Botanical Garden, 2900 Southern

Richner, Heinz

299

EVIDENCEBASED MEDICINE/PRACTICE IN SPORTS PHYSICAL THERAPY  

PubMed Central

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

Lehecka, B.J.

2012-01-01

300

Evidence-Based Psychosocial Treatments for Ethnic Minority Youth  

ERIC Educational Resources Information Center

This article reviews research on evidence-based treatments (EBTs) for ethnic minority youth using criteria from Chambless et al. (1998), Chambless et al. (1996), and Chambless and Hollon (1998). Although no "well-established" treatments were identified, "probably efficacious" or "possibly efficacious" treatments were found for ethnic minority…

Huey, Stanley J., Jr.; Polo, Antonio J.

2008-01-01

301

Critical Thinking: Knowledge and Skills for Evidence-Based Practice  

ERIC Educational Resources Information Center

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

Finn, Patrick

2011-01-01

302

Interteaching: An Evidence-Based Approach to Instruction  

ERIC Educational Resources Information Center

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

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

2014-01-01

303

Using Family Paradigms to Improve Evidence-Based Practice  

ERIC Educational Resources Information Center

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

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

2009-01-01

304

Evidence-Based Practices in Outpatient Treatment for Eating Disorders  

ERIC Educational Resources Information Center

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

Schaffner, Angela D.; Buchanan, Linda Paulk

2010-01-01

305

Evidence-Based Youth Psychotherapy in the Mental Health Ecosystem  

ERIC Educational Resources Information Center

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

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

2013-01-01

306

Evidence-Based Practice Problems: Form and Focus  

Microsoft Academic Search

Health care reform poses major challenges for psychiatric mental health care. Foremost among the challenges is a mandate for reimbursement based on performance-based outcomes. Clinicians can increase the efficiency of evidence-based practice searches by using the correct form of PICOT (population, intervention, comparator, outcome, time frame) question to focus the search, based on (a) diagnosis, (b) treatment, (c) prognosis, (d)

Michael J. Rice

2010-01-01

307

Arbitrary Metrics: Implications for Identifying Evidence-Based Treatments  

ERIC Educational Resources Information Center

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

Kazdin, Alan E.

2006-01-01

308

Evidence-Based Psychosocial Treatments for Child and Adolescent Depression  

ERIC Educational Resources Information Center

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

David-Ferdon, Corinne; Kaslow, Nadine J.

2008-01-01

309

Dissemination of Evidence-Based Standards of Care  

PubMed Central

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

Barkhordarian, Andre; Hacker, Brett; Chiappelli, Francesco

2011-01-01

310

Evidence-based medicine (EBM) applied to Parkinson's disease treatment  

Microsoft Academic Search

This paper is a narrative review of the concept of evidence-based medicine (EBM) and its application in the movement disorders field. The paper has three parts:1.Discussion of the generic concept of EBM and of the most commonly voiced criticisms; explanation of how relevant are for the comprehension of EBM procedures the notion of implicit and explicit knowledge; discussion of the

Cristina Sampaio; Joaquim J. Ferreira; João Costa

2002-01-01

311

Evidence-Based Library Management: The Leadership Challenge  

Microsoft Academic Search

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

Amos Lakos

2007-01-01

312

Fostering Evidence-Based Practice in Nursing Education.  

ERIC Educational Resources Information Center

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

Rambur, Betty

1999-01-01

313

Evidence-based psychiatric nursing practice: Rhetoric or reality  

Microsoft Academic Search

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

Gail W. Stuart

2001-01-01

314

Building evidence-based practice with staff nurses through mentoring  

Microsoft Academic Search

Evidence- based practice (EBP) is an effective way for nurses to improve patient outcomes. Although EBP has gained popularity, barriers to implementation exist. This study explored whether mentoring neonatal intensive care unit (NICU) nurses in EBP would increase their participation in EBP. A sample of 20 nurses were mentored in an EBP project. The EBP Beliefs Scale and EBP Implementation

Kathleen DiGaudio Mariano; Linda M. Caley; Linda Eschberger; Ann Woloszyn; Patricia Volker; Michael S. Leonard; Ying Tung

2009-01-01

315

Evidence-Based Teaching: Now and in the Future  

ERIC Educational Resources Information Center

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

Buskist, William; Groccia, James E.

2011-01-01

316

Evidence-Based Interprofessional Practice: Learning and Behaviour  

ERIC Educational Resources Information Center

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

Littek, Celeste

2013-01-01

317

Disseminating Evidence-Based Practices in Secondary Transition  

ERIC Educational Resources Information Center

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

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

2013-01-01

318

How Evidence-Based Practices Contribute to Community Integration  

Microsoft Academic Search

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

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

2004-01-01

319

What Works? Evidence-Based Practice in Education Is Complex  

ERIC Educational Resources Information Center

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

Hempenstall, Kerry

2014-01-01

320

Developing Research Competence to Support Evidence-Based Practice  

Microsoft Academic Search

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

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

2005-01-01

321

Unraveling Evidence-Based Practices in Special Education  

ERIC Educational Resources Information Center

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

Cook, Bryan G.; Cook, Sara Cothren

2013-01-01

322

Evidence-Based Practices and Implementation Science in Special Education  

ERIC Educational Resources Information Center

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

Cook, Bryan G.; Odom, Samuel L.

2013-01-01

323

Need for evidence-based practice in prosthodontics  

Microsoft Academic Search

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

James D. Anderson

2000-01-01

324

Determining Evidence-Based Practices in Special Education  

ERIC Educational Resources Information Center

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

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

2009-01-01

325

Is there an evidence-based practice for burns?  

Microsoft Academic Search

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

Charmaine Childs

1998-01-01

326

INTEGRATING EVIDENCE-BASED PRACTICE AND SOCIAL WORK FIELD EDUCATION  

Microsoft Academic Search

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

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

2006-01-01

327

Evidence-Based Practice and Policy: Choices Ahead  

Microsoft Academic Search

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

Eileen Gambrill

2006-01-01

328

Single-Subject Experimental Design for Evidence-Based Practice  

ERIC Educational Resources Information Center

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

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

2012-01-01

329

Developing the skills required for evidence-based practice  

Microsoft Academic Search

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

Beverley French

1998-01-01

330

Integration of Evidence-Based Practice into the University Clinic  

ERIC Educational Resources Information Center

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

Goldstein, Brian A.

2008-01-01

331

Barriers and Enablers to Evidence-Based Practices  

ERIC Educational Resources Information Center

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

Foster, Robyn

2014-01-01

332

Evidence-Based Practice: A Framework for Making Effective Decisions  

ERIC Educational Resources Information Center

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

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

2012-01-01

333

The Concept of Evidence in Evidence-Based Practice  

ERIC Educational Resources Information Center

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

Kvernbekk, Tone

2011-01-01

334

Making the Case for Evidence-Based Practice  

ERIC Educational Resources Information Center

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

Bates, Joanne; McClure, Janelle; Spinks, Andy

2010-01-01

335

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

ERIC Educational Resources Information Center

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…

Roberts, Margaret

2010-01-01

336

Evidence-Based Practice in the Early Childhood Field  

ERIC Educational Resources Information Center

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

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

2006-01-01

337

An introduction to evidence-based practice for hand therapists  

Microsoft Academic Search

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

Joy C. MacDermid

2004-01-01

338

Evidence-Based Practice: Beyond Empirically Supported Treatments  

Microsoft Academic Search

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

Stanley B. Messer

2004-01-01

339

Qualitative research in evidence-based practice: a valuable partnership  

Microsoft Academic Search

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

Lisa Given

2006-01-01

340

Evidence-Based Practices in Special Education: Some Practical Considerations  

ERIC Educational Resources Information Center

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

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

2008-01-01

341

Evidence-Based Practice in the Social Services  

Microsoft Academic Search

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

Michelle Johnson; Michael J. Austin

2008-01-01

342

Evidence-Based Practice and Evaluation: From Insight to Impact  

ERIC Educational Resources Information Center

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

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

2009-01-01

343

Evidence-Based Recognition of 3-D Objects  

Microsoft Academic Search

An evidence-based recognition technique is defined that identifies 3-D objects by looking for their notable features. This technique makes use of an evidence rule base, which is a set of salient or evidence conditions with corresponding evidence weights for various objects in the database. A measure of similarity between the set of observed features and the set of evidence conditions

Anil K. Jain; Richard Hoffman

1988-01-01

344

Evidence-Based Psychotherapy Practice in College Mental Health  

ERIC Educational Resources Information Center

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

Cooper, Stewart E.

2005-01-01

345

Toward Evidence-Based Practice with Domestic Violence Perpetrators  

Microsoft Academic Search

This review examines the policy and practice of interventions with male perpetrators of domestic violence in light of the widely accepted principles of evidence-based practice. Thus far, these policies and practices have enjoyed immunity from the external, empirical accountability available through implementing the findings from evaluations research and other empirical practice analyses. This immunity is supported by a policy framework

Kenneth Corvo; Donald Dutton; Wan-Yi Chen

2008-01-01

346

Evidence-Based Parent Consultation with School-Related Outcomes  

ERIC Educational Resources Information Center

In this article, 18 studies using parent consultation to effect a change in children's school-related behavior were evaluated according to guidelines set forth by the APA's Task Force on Evidence-Based Interventions in School Psychology. Results indicate that parent consultation is an effective method of intervention delivery for a variety of…

Guli, Laura A.

2005-01-01

347

Organizing for Evidence-Based Decision Making and Improvement  

ERIC Educational Resources Information Center

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

Leimer, Christina

2012-01-01

348

Vitiligo: concise evidence based guidelines on diagnosis and management  

Microsoft Academic Search

Vitiligo is a common disease that causes a great degree of psychological distress. In its classical forms it is easily recognised and diagnosed. This review provides an evidence based outline of the management of vitiligo, particularly with the non-specialist in mind. Treatments for vitiligo are generally unsatisfactory. The initial approach to a patient who is thought to have vitiligo is

David J Gawkrodger; Anthony D Ormerod; Lindsay Shaw; Inma Mauri-Sole; Maxine E Whitton; M Jane Watts; Alex V Anstey; Jane Ingham; Katharine Young

2010-01-01

349

Teaching Evidence-based Medicine: Caveats and Challenges.  

ERIC Educational Resources Information Center

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

Welch, H. Gilbert; Lurie, Jon D.

2000-01-01

350

Multiresistant pathogens in geriatric nursing – infection control in residential facilities for geriatric nursing in Germany  

PubMed Central

Background: The increase of multidrug-resistant organisms (MDROs) causes problems in geriatric nursing homes. Older people are at increased a growing risk of infection due to multimorbidity and frequent stays in hospital. A high proportion of the elderly require residential care in geriatric nursing facilities, where hygiene requirements in nursing homes are similar to those in hospitals. For this reason we examined how well nursing homes are prepared for MDROs and how effectively protect their infection control residents and staff. Methods: A cross-sectional study was performed on infection control in residential geriatric nursing facilities in Germany 2012. The questionnaire recorded important parameters of hygiene, resident and staff protection and actions in case of existing MDROs. Results: The response was 54% in Hamburg and 27% in the rest of Germany. Nursing homes were generally well equipped for dealing with infection control: There were standards for MDROs and regular hygiene training for staff. The facilities provided adequate protective clothing, affected residents are usually isolated and hygienic laundry processing conducted. There are deficits in the communication of information on infected residents with hospitals and general practitioners. 54% of nursing homes performed risk assessments for staff infection precaution. Conclusion: There is a growing interest in MDROs and infection control will be a challenge in for residential geriatric nursing facilities in the future. This issue has also drawn increasing attention. Improvements could be achieved by improving communication between different participants in the health service, together with specific measures for staff protection at work. PMID:25285266

Peters, Claudia; Schablon, Anja; Bollongino, Kirsten; Maaß, Monika; Kaß, Dietmar; Dulon, Madeleine; Diel, Roland; Nienhaus, Albert

2014-01-01

351

An Infective Factor Controlling Sex Compatibility in Bacterium coli  

Microsoft Academic Search

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

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

1953-01-01

352

The Aedes aegypti Toll Pathway Controls Dengue Virus Infection  

PubMed Central

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

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

2008-01-01

353

Infection Control in the Long Term Care Facility.  

ERIC Educational Resources Information Center

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

Morris, Sara

354

Antibiotic-resistant Campylobacter: could efflux pump inhibitors control infection?  

Microsoft Academic Search

Campylobacter is the most common cause of bacterial gastroenteritis in the world. Poultry is the main reservoir of human infections. The widespread use of antibiotics in agriculture and veterinary medicine has resulted in the emergence of an increasing number of antibiotic-resistant Campylobacter strains that can be transmitted to humans through the food chain. Of particular concern to public health is

Teresa Quinn; Jean-Michel Bolla; Jean-Marie Pages; Seamus Fanning

2007-01-01

355

HIV Treatment as Prevention: Models, Data, and Questions—Towards Evidence-Based Decision-Making  

PubMed Central

Antiretroviral therapy (ART) for those infected with HIV can prevent onward transmission of infection, but biological efficacy alone is not enough to guide policy decisions about the role of ART in reducing HIV incidence. Epidemiology, economics, demography, statistics, biology, and mathematical modelling will be central in framing key decisions in the optimal use of ART. PLoS Medicine, with the HIV Modelling Consortium, has commissioned a set of articles that examine different aspects of HIV treatment as prevention with a forward-looking research agenda. Interlocking themes across these articles are discussed in this introduction. We hope that this article, and others in the collection, will provide a foundation upon which greater collaborations between disciplines will be formed, and will afford deeper insights into the key factors involved, to help strengthen the support for evidence-based decision-making in HIV prevention. PMID:22802739

2012-01-01

356

Common infections in the history of cancer patients and controls  

Microsoft Academic Search

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

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

1991-01-01

357

Impact of an evidence-based medicine curriculum based on adult learning theory  

Microsoft Academic Search

Objective  To develop and implement an evidence-based medicine (EBM) curriculum and determine its effectiveness in improving residents’\\u000a EBM behaviors and skills.\\u000a \\u000a \\u000a \\u000a Design  Description of the curriculum and a multifaceted evaluation, including a pretest-posttest controlled trial.\\u000a \\u000a \\u000a \\u000a Setting  University-based primary care internal medicine residency program.\\u000a \\u000a \\u000a \\u000a Participants  Second-and third-year internal medicine residents (N=34).\\u000a \\u000a \\u000a \\u000a Interventions  A 7-week EBM curriculum in which residents work through the steps of evidence-based decisions

Michael L. Green; Peter J. Ellis

1997-01-01

358

MAFF statutory incident reports in surveillance, prevention, and control of human Salmonella typhimurium infection.  

PubMed

We surveyed consultants in communicable disease control (CCDCs) for their views on the current and potential value of Statutory Incident Reports--Salmonella in Animals, Birds and their Products received from the Ministry of Agriculture Fisheries and Food (MAFF), in the surveillance, prevention, and control of Salmonella typhimurium infections in humans. CCDCs from 103 (83%) of 124 district health authorities responded. Most CCDCs in rural areas used the reports either to cross reference information about animal and human isolates or to discuss with environmental health officers. Many believed that the reports' relevance to human infection could be improved if they were sent more quickly. Some CCDCs suggested that it would be useful to cross reference laboratory reports of animal and human infection at regional level and to have personal contact with local veterinary officers of MAFF. Close cooperation between public health doctors and MAFF and a coordinated approach is needed to prevent and control associations between animal and human zoonotic infections. PMID:8935423

Fone, D L; Barker, R M

1996-04-26

359

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

PubMed Central

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

2014-01-01

360

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

Microsoft Academic Search

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

Gregory A. Aarons

2004-01-01

361

[Tuberculosis infection control practice in hospitals from the viewpoint of occupational health].  

PubMed

Several outbreaks of tuberculosis (TB) among health care workers were reported recently in Japan. To assess the current situation of TB infection control practice in hospitals in Japan from the viewpoint of occupational health, we carried out a cross sectional survey by mail-questionnaires. The questionnaires with closed and open-ended questions to ask situation of TB infection control program in hospital were mailed to 542 hospital chiefs in and around Tokyo, Kantoh district. 269 replies were received. We analyzed them especially focussing on the prevention of TB among health care workers. Out of 269 hospitals replied, 39 of them had wards and/or beds designated for tuberculosis patients, 223 did not have, and 7 were unknown. 102 (38.9%) had set written tuberculosis infection control programs or guidelines, only 21 (53.8%) have set them even in hospitals with TB beds. 110 (42.0%) hospitals had triage system for identifying patients with active TB in the outpatient setting. Although, most health care workers underwent annual health check programs including chest X-rays, only 67 (25.6%) of the hospitals provide tuberculin skin test to their new recruits. 165 (63.0%) of hospitals admit that undiagnosed patients with respiratory symptoms may stay with immuno-compromised patients in the same room. Since administrative management, staff education, environmental control in work place, personal infection control and individual health care should be carried out from the viewpoint of occupational health, we showed concrete steps of these in this paper. We recommend that a TB infection control manager in each hospital should be designated, and that TB infection control program and/or guideline should be made. Environmental control in work place to prevent infection should be more prioritized in Japan. PMID:10355228

Suzuki, K; Onozaki, I; Shimura, A

1999-04-01

362

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

PubMed

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

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

2014-11-01

363

Infection prevention and control during prolonged human space travel.  

PubMed

Prolonged human spaceflight to another planet or an asteroid will introduce unique challenges of mitigating the risk of infection. During space travel, exposure to microgravity, radiation, and stress alter human immunoregulatory responses, which can in turn impact an astronaut's ability to prevent acquisition of infectious agents or reactivation of latent infection. In addition, microgravity affects virulence, growth kinetics, and biofilm formation of potential microbial pathogens. These interactions occur in a confined space in microgravity, providing ample opportunity for heavy microbial contamination of the environment. In addition, there is the persistence of aerosolized, microbe-containing particles. Any mission involving prolonged human spaceflight must be carefully planned to minimize vulnerabilities and maximize the likelihood of success. PMID:23051761

Mermel, Leonard A

2013-01-01

364

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

ERIC Educational Resources Information Center

There has been an increasing focus on evidence-based practices in special education with efforts underway to authoritatively identify those practices that are evidence based. However, the identification of evidence-based practices is only the beginning of the process of implementing evidence-based special education. The professional wisdom of…

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

2008-01-01

365

Take 3 Steps Toward Preventing Infections During Cancer Treatment  

MedlinePLUS

... steps they can take to prevent infections during cancer chemotherapy treatment. The campaign aims to reduce infections in cancer patients. PreventCancerInfections.org is an evidence-based, interactive ...

366

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

PubMed Central

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

Adeyemi, Ezekiel Oluwagbemiga

2011-01-01

367

Single-Subject Experimental Design for Evidence-Based Practice  

PubMed Central

Purpose Single-subject experimental designs (SSEDs) represent an important tool in the development and implementation of evidence-based practice in communication sciences and disorders. The purpose of this article is to review the strategies and tactics of SSEDs and their application in speech-language pathology research. Method The authors discuss the requirements of each design, followed by advantages and disadvantages. The logic and methods for evaluating effects in SSED are reviewed as well as contemporary issues regarding data analysis with SSED data sets. Examples of challenges in executing SSEDs are included. Specific exemplars of how SSEDs have been used in speech-language pathology research are provided throughout. Conclusion SSED studies provide a flexible alternative to traditional group designs in the development and identification of evidence-based practice in the field of communication sciences and disorders. PMID:23071200

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

2014-01-01

368

Evidence-Based Behavioral Interventions for Repetitive Behaviors in Autism  

PubMed Central

Restricted and repetitive behaviors (RRBs) are a core symptom of autism spectrum disorders (ASD). There has been an increased research emphasis on repetitive behaviors; however, this research primarily has focused on phenomenology and mechanisms. Thus, the knowledge base on interventions is lagging behind other areas of research. The literature suggests there are evidence-based practices to treat “lower order” RRBs in ASD (e.g., stereotypies); yet, there is a lack of a focused program of intervention research for “higher order” behaviors (e.g., insistence on sameness). This paper will (a) discuss barriers to intervention development for RRBs; (b) review evidence-based interventions to treat RRBs in ASD, with a focus on higher order behaviors; and (c) conclude with recommendations for practice and research. PMID:21584849

McDonough, Stephen G.; Bodfish, James W.

2013-01-01

369

Reuse of medical devices: implications for infection control.  

PubMed

Reuse of both single-use and multiuse medical devices is a common practice and can result in transmission of infection when appropriate sterilization or reprocessing does not occur. Reuse of single-use devices can be problematic because there are no clear standards for reprocessing, although data regarding adverse outcomes are limited. Single-use devices are commonly reused, appropriately or inappropriately, in resource-limited settings because of cost constraints. Reuse of medical devices raises important legal and ethical questions. PMID:22284382

Shuman, Emily K; Chenoweth, Carol E

2012-03-01

370

Review: Phage therapy: A modern tool to control bacterial infections.  

PubMed

The evolution of antibiotic-resistant in bacteria has aggravated curiosity in development of alternative therapy to conventional drugs. One of the emerging drugs that can be used alternative to antibiotics is bacteriophage therapy. The use of living phages in the cure of lethal infectious life threatening diseases caused by Gram positive and Gram negative bacteria has been reported. Another development in the field of bacteriophage therapy is the use of genetically modified and non replicating phages in the treatment of bacterial infection. Genetically engineered bacteriophages can be used as adjuvant along with antibiotic therapy. Phages encoded with lysosomal enzymes are also effectual in the treatment of infectious diseases. PMID:25553704

Qadir, Muhammad Imran

2015-01-01

371

[Strategies for prevention and control of healthcare related infections by Acinetobacter baumannii].  

PubMed

The frequent development of acquired antibiotics resistance in bacteria represents a challenge for Public Health in terms of healthcare associated infections control. Apart from the appropriate use of drugs, in particular the choice of proper antimicrobial therapy, increasing interest is, therefore, given to the non-pharmacological prevention of these infections. Acinetobacter (A.) baumannii is a micoorganism that commonly causes infections for patients hospitalized in critical hospital wards (intensive care units, burn centers, surgery, neonatology, etc) potentially severe and difficult to treat, because A. baumannii is resistant to many or sometimes all, available antibiotics (PDR - pan drug resistant). The aim of the present paper was to review the available measures for preventing and controlling the contamination and the spread of these types of bacterial infections in health care scenarios, with particular attention to two methods that stand out for efficiency and safety: hand hygiene and environmental disinfection. PMID:22509619

Puro, V; Pittalis, S; Agolini, G; Agolini, G; Protano, C; Raitano, A; Ferraro, F; Vitali, M

2011-01-01

372

Whither our art? Clinical wisdom and evidence-based medicine  

Microsoft Academic Search

The relationship between evidence-based medicine (EBM) and clinical judgement is the subject of conceptual and practical dispute.\\u000a For example, EBM and clinical guidelines are seen to increasingly dominate medical decision-making at the expense of other,\\u000a human elements, and to threaten the art of medicine. Clinical wisdom always remains open to question. We want to know why\\u000a particular beliefs are held,

Malcolm Parker

2002-01-01

373

The Promises And Pitfalls Of Evidence-Based Medicine  

Microsoft Academic Search

ABSTRACT: Evidence-based medicine,(EBM) aims to address,the persistent problem,of clinical practice variation with the help of various tools, including standardized practice guidelines. While advocates welcome the stronger scientific foundation of such guidelines, critics fear that they will lead to “cookbook medicine.” Studies show, however, that few guidelines lead to consistent changes in provider behavior. The hopes, fears, and mixed re- cord

Stefan Timmermans; Aaron Mauck

2005-01-01

374

Unterschiede zwischen Evidence-Based Medicine und konventionell bester Medizin  

Microsoft Academic Search

Zusammenfassung  ? Die Umsetzung rationaler Konzepte im Gesundheitssystem wird möglich sein, wenn zwei Bedingungen erfüllt sind: Die gesetzlichen\\u000a Rahmenbedingungen müssen auf dieses Ziel abgestimmt sein, und neue Strategien sind zu etablieren. Die neuen Strategien werden\\u000a benötigt, um aus der Informationsflut die Daten zu finden, welche tatsächlich «Evidenz» zur Begründung des medizinischen Fortschritts\\u000a enthalten.\\u000a \\u000a Evidence-Based Medicine (EBM) bietet diese Strategien an. Um

Franz Porzsolt; Regina Kunz

1997-01-01

375

Global health: the importance of evidence-based medicine  

PubMed Central

Global health is a varied field that comprises research, evaluation and policy that, by its definition, also occurs in disparate locations across the world. This forum article is introduced by our guest editor of the Medicine for Global Health article collection, Gretchen Birbeck. Here, experts based across different settings describe their personal experiences of global health, discussing how evidence-based medicine in resource-limited settings can be translated into improved health outcomes. PMID:24228722

2013-01-01

376

Evidence-based medicine training in internal medicine residency programs  

Microsoft Academic Search

To characterize evidence-based medicine (EBM) curricula in internal medicine residency programs, a written survey was mailed\\u000a to 417 program directors of U.S. internal medicine residency programs. For programs offering a freestanding (dedicated curricular\\u000a time) EBM curriculum, the survey inquired about its objectives, format, curricular time, attendance, faculty development,\\u000a resources, and evaluation. All directors responded to questions regarding integrating EBM teaching

Michael L. Green

2000-01-01

377

Social Media, Evidence-Based Tweeting, and JCEHP.  

PubMed

Medical practice and medical journals must adapt to a constantly changing environment, in which social media plays an ever-increasing role. Social media platforms such as Twitter can provide an opportunity to disseminate information in innovative ways. The concept of evidence-based tweeting is introduced, especially as "tweeting the meeting" continues to expand within medical conferences and other venues important for continuing education for health care providers. Future social media strategies for the journal are outlined. PMID:25530289

Djuricich, Alexander M

2014-10-01

378

Evidence-based Treatment of Chronic Heart Failure  

Microsoft Academic Search

The past two decades have seen a knowledge explosion in the field of cardiovascular diseases, in general, and in the understanding\\u000a of chronic heart failure (HF) as a complex neurohumoral syndrome in particular. A new staging system for chronic HF has been\\u000a developed within the last decade to facilitate the evidence-based prescription of medications and medical devices for each\\u000a of

David Rosen; Matthew V. Decaro; Mark G. Graham

2007-01-01

379

Putting evidence into practice: evidence-based interventions for depression.  

PubMed

Depression is a distressing emotion that occurs during various times of the cancer trajectory. Depression often goes unrecognized and untreated, which can significantly affect cost, quality of life, and treatment adherence. The Oncology Nursing Society's Putting Evidence Into Practice depression project team reviewed current literature to identify evidence-based interventions to reduce depression in people with cancer. Pharmacologic and nonpharmacologic interventions were evaluated, and opportunities for nurses to integrate recommendations into practice are offered in this article. PMID:25427607

Fulcher, Caryl D; Kim, Hee-Ju; Smith, Patsy R; Sherner, Tammie L

2014-12-01

380

Using motivational interviewing: through evidence-based health coaching.  

PubMed

To enhance compliance and achieve better outcomes, providers must actively engage their patients and caregivers in different ways than in the past. One strategy that has gained national attention is motivational interviewing through evidence-based health coaching. A closer look at this exciting new clinical skill reveals what it is, how it works, why it is so successful, and why our traditional patient approach has fallen short. PMID:25268529

Huffman, Melinda

2014-10-01

381

Gained in translation: evidence-based medicine meets pediatric psychopharmacology.  

PubMed

Evidence-based medicine (EBM) represents a powerful model for clinicians to translate everyday clinical tasks of finding and applying scientific literature into explicit and systematic steps. This article uses a question about treating adolescent depression to illustrate this approach in the context of a particular patient and his family. By helping the clinician apply population data to the 'bedside', EBM can supplement information from individual patient narratives and can facilitate informed decisions. PMID:16321734

Srihari, Vinod; Martin, Andrés

2006-01-01

382

Evidence-Based Practice Among Nurses in Italy  

Microsoft Academic Search

A cross-sectional survey was conducted among a random sample of 449 nurses in Italy, using a self-administered questionnaire to assess knowledge, attitudes, and behaviors regarding evidence-based practice (EBP). A significantly higher level of knowledge was observed among nurses who (a) did not work in medical and surgical wards; (b) believed that the evaluation of the efficacy of the health interventions

Alberico Filippini; Alessandra Sessa; Gabriella Di Giuseppe; Italo F. Angelillo

2011-01-01

383

Improving the evidence base of nursing education programs.  

PubMed

The need for evidence-based practice (EBP) has been supported by many professional groups. However, nurses face many barriers to involvement in the EBP process. Continuing nursing education program planners can play a key role in helping to overcome these barriers by working with presenters and content developers to ensure that the content they prepare is rooted in the best available evidence. PMID:25081120

Lubejko, Barbara G

2014-08-01

384

Implementing evidence-based practice: Walking the talk  

Microsoft Academic Search

Russworm and Larrabee’s (1999) six-step model for evidence-based practice (EBP) was used by 10 nursing teams to seek answers to clinical questions. These teams, primarily composed of staff nurses, participated in a health region-wide EBP program over 1 year. Overall, the model served as a useful mechanism for examining practice-derived questions. However, additional strategies needed to be incorporated by the

Norma E. Thurston; Kathryn M. King

2004-01-01

385

Global health: the importance of evidence-based medicine.  

PubMed

Global health is a varied field that comprises research, evaluation and policy that, by its definition, also occurs in disparate locations across the world. This forum article is introduced by our guest editor of the Medicine for Global Health article collection, Gretchen Birbeck. Here, experts based across different settings describe their personal experiences of global health, discussing how evidence-based medicine in resource-limited settings can be translated into improved health outcomes. PMID:24228722

Birbeck, Gretchen L; Wiysonge, Charles S; Mills, Edward J; Frenk, Julio J; Zhou, Xiao-Nong; Jha, Prabhat

2013-01-01

386

Practitioner Attitudes Toward Evidence-based Practice: Themes and Challenges  

Microsoft Academic Search

 Abstract  The widespread successful implementation of evidence-based practices (EBPs) into community mental health settings will require\\u000a a thorough understanding of practitioner attitudes toward these approaches. This study reports on the results of two community\\u000a mental health practitioner focus groups investigating attitudes toward EBPs, perceived challenges to implementing EBPs, and\\u000a recommendations for researchers interested in facilitating EBP use in community settings. The

Timothy D. Nelson; Ric G. Steele; Jennifer A. Mize

2006-01-01

387

American Dental Association evidence-based dentistry website  

Microsoft Academic Search

In March 2009, the American Dental Association (ADA) launched a new evidence-based dentistry (EBD) website (ebd.ada.org). The site has been established to provide the dental profession with access to evidence from high-quality systematic reviews and is supported by a grant from the National Library of Medicine and the National Institute for Dental and Craniofacial Research(Grant Number G08 LM008956).

Derek Richards

2009-01-01

388

The Implementation of Evidence-Based Practices in Public Schools  

Microsoft Academic Search

\\u000a Educators have sometimes been chided for the enthusiasm with which they embrace new trends and concepts. Their enthusiasm\\u000a regarding evidence-based practice (EBP) is crucial, however, as it will be key to the movement of EBP from the laboratory\\u000a to real-world settings, such as public schools. Generalizing from the laboratory to public schools is essential if EBP are\\u000a to ever reach

Peter Doehring; Vincent Winterling

389

Evidence-Based Psychosocial Treatments for Ethnic Minority Youth  

Microsoft Academic Search

This article reviews research on evidence-based treatments (EBTs) for ethnic minority youth using criteria from Chambless et al. (1998), Chambless et al. (1996), and Chambless and Hollon (1998). Although no well-established treatments were identified, probably efficacious or possibly efficacious treatments were found for ethnic minority youth with anxiety-related problems, attention-deficit\\/hyperactivity disorder, depression, conduct problems, substance use problems, trauma-related syndromes, and

Stanley J. Huey Jr; Antonio J. Polo

2008-01-01

390

Ethics and Evidence-Based Medicine: Is There a Conflict?  

PubMed Central

This article addresses the advantages, disadvantages, and traps to which evidence-based medicine (EBM) may lead and suggests that, to be ethically valid, EBM must be aimed at the patient's best interests and not at the financial interests of others. While financial considerations are by no means trivial, it is hypocritical – if not dangerous – to hide them behind words like “evidence” or “quality.” PMID:18092036

Loewy, Erich H.

2007-01-01

391

Route of hysterectomy: an evidence-based approach.  

PubMed

The number of hysterectomies performed has long been a concern; now the appropriateness of the surgical method is under more careful scrutiny. What is the clinically appropriate route and method for hysterectomy in a given patient? To ensure that each patient receives the best possible care at reasonable costs, physicians must closely examine recent data comparing surgical approaches to hysterectomy. So, what is the most evidence-based approach for hysterectomy? PMID:24351441

Kovac, S Robert

2014-03-01

392

Evidence-Based Quality Improvement: The State Of The Science  

Microsoft Academic Search

ABSTRACT: Routine practice fails to incorporate research evidence in a timely and reliable fashion. Many quality improvement,(QI) efforts aim to close these gaps between,clinical re- search and practice. However, in sharp contrast to the paradigm of evidence-based medi- cine, these efforts often proceed on the basis of intuition and anecdotal accounts of suc- cessful strategies for changing,provider behavior or achieving

Kaveh G. Shojania; Jeremy M. Grimshaw

2005-01-01

393

Evidence-based medicine: What has happened in the past 50 years?  

PubMed

Although the phrase 'evidence-based medicine' (EBM) was used for the first time in the medical literature less than 25 years ago, the history of EBM goes back for centuries. What is remarkable is how popular and how globally accepted the EBM movement has become in such a short time. Many famous, past clinicians have played major roles in the disciplines that preceded EBM, particularly 'clinical epidemiology'. It soon became clear to the early EBM champions that 'evidence' was only part of the clinical decision-making process. Consequently, both clinical expertise and the patient's values and preferences were rapidly incorporated into the concept we now know as 'EBM'. The current need for high-quality, easily accessible 'evidence-based summaries' for busy clinicians is now apparent, as traditional EBM requires both considerable time and skill. Consequently, there is a progressive move away from the primary literature (such as randomised controlled trials) to systematic reviews and other 'evidence-based summaries'. The future of EBM will almost certainly involve widespread utilisation of 'clinical (computer)-based decision support systems'. PMID:25536873

Mellis, Craig

2015-01-01

394

Psychodynamic psychotherapies: evidence-based practice and clinical wisdom.  

PubMed

This article is based on an exhaustive review of the psychotherapy outcomes literature, undertaken originally at the instigation of the UK Department of Health by Roth and Fonagy (Department of Health, 1995). We have recently updated this review (Fonagy, Target, Cottrell, Phillips, & Kurtz, 2002; Roth & Fonagy, 2004) and extended it to identify all studies of psychoanalytic psychotherapy. The usual methods for identifying studies were employed (Fonagy, Target, et al., 2002; Roth & Fonagy, in press). The key questions that should be asked of this literature given the current state of research in this area (also see Westen, Morrison, & Thompson-Brenner, 2004) are: Are there any disorders for which short-term psychodynamic psychotherapy (STPP) can be considered evidence-based, Are there any disorders for which STPP is uniquely effective as either the only evidence-based treatment or as a treatment that is more effective than alternatives, and Is there any evidence base for long-term psychodynamic psychotherapy (LTPP) either in terms of achieving effects not normally associated with short-term treatment or addressing problems that have not been addressed by STPP? In this context, short-term therapy is conceived of as a treatment of around 20 sessions delivered usually once weekly. PMID:15899755

Fonagy, Peter; Roth, Anthony; Higgitt, Anna

2005-01-01

395

Evidence-based approach to harmonised reference intervals.  

PubMed

Although we are in the era of evidence-based medicine, there is still a substantial gap between theory and current practice with the application of reference intervals as decision making tools. Different laboratories may have different reference intervals for the same tests using the same analytical methods and platforms. These differences have the potential to confuse physicians making the assessment and monitoring of patients more difficult by providing discordant information. This paper attempts to demonstrate how to use evidence-based approach for harmonising reference intervals. In order to consider harmonisation we must first have an appreciation of the various factors that influence the determination of that reference interval such as the choice of individuals within the population studied, biological variability of the analyte studied, partitioning, sample collection, analytical aspects such as bias and statistical models. An a priori approach for determining reference intervals, whilst recommended, may be beyond the scope of most laboratories and consideration should be given to the use of a validated indirect a posteriori approach. Regardless of method used, the continuing application of an evidence-based approach in harmonised reference intervals to meet the quality expectations of physicians should be pursued. PMID:24183842

Koerbin, Gus; Sikaris, Ken Andrew; Jones, Graham Ross Dallas; Ryan, Julie; Reed, Maxine; Tate, Jill

2014-05-15

396

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

PubMed

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

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

2014-08-01

397

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

PubMed

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

Farrington, Michele; Cullen, Laura; Dawson, Cindy

2010-01-01

398

Surgical site infections after arthroscopy: Outbreak investigation and case control study  

Microsoft Academic Search

Purpose: The goal of this study was to determine the causes of increased post-arthroscopy surgical site infections (SSIs) and to define risk factors for infection. Type of Study: Outbreak investigation and case control study at a university-affiliated community hospital from 1994 to 1996, with surveillance through 1999. Methods: Demographic, clinical, and microbiological data were collected on 27 post-arthrocopy SSIs from

Hilary M. Babcock; Cathy Carroll; Matthew Matava; Paul L’Ecuyer; Victoria Fraser

2003-01-01

399

A programme for controlling acute respiratory infections in children: Memorandum from a WHO Meeting*  

PubMed Central

The unacceptably high mortality related to acute respiratory infections (ARI) in children, recognition of the importance of bacteria in the causation of severe acute lower respiratory infection in developing countries, and the established effectiveness of antimicrobial and supportive treatment in averting death make a strong case for the initiation of an ARI control programme. This should be spearheaded by prototype ARI service activities, delivered through primary health care and backed up by well-coordinated health systems research. PMID:6609020

1984-01-01

400

Distinct Organ-Dependent Mechanisms for the Control of Murine Cytomegalovirus Infection by Natural Killer Cells  

Microsoft Academic Search

Antiviral mechanisms by which natural killer (NK) cells control murine cytomegalovirus (MCMV) infection inthespleensandliversofC57BL\\/6miceweremeasured,revealingdifferentmechanismsofcontrolindifferent organs. Three days postinfection, MCMV titers in the spleens of perforin 0\\/0 mice were higher than in those of perforin 1\\/1 mice, but no elevation of liver titers was found in perforin 0\\/0 mice. NK cell depletion in MCMV-infected perforin 0\\/0 mice resulted only in an

CHIN H. TAY; ANDRAYMOND M. WELSH

1997-01-01

401

Human Papillomavirus Infection and Esophageal Cancer: a Nationwide Seroepidemiologic Case-Control Study in Sweden  

Microsoft Academic Search

Background: Infection with human papillomavirus (HPV) type 16 has been implicated as a risk factor for esophageal squamous cell carcinoma in three seroepidemiologic studies. We conducted a larger, population-based study to verify this association and to investigate possible confounding factors. Methods: We performed a nationwide case-control study in Sweden of HPV16 or HPV18 infection and risk of esophageal squamous cell

Jesper Lagergren; Zhaohui Wang; Reinhold Bergstrom; Joakim Dillner; Olof Nyren

402

Syphilis infection among homosexual men reporting contact with syphilis: a case control study  

PubMed Central

Objective High rates of syphilis have been reported among men who have sex with men (MSM) internationally. Guidelines recommend presumptive treatment of sexual contacts of individuals with syphilis at the point of care. The aim of this study was to determine the proportion who were infected with syphilis and the factors predictive of infection among men reporting contact with a man with syphilis. Design Contacts who were syphilis infected (cases) were compared with those who were uninfected (controls). Setting This study was conducted at the main public sexually transmitted diseases clinic in Victoria, Australia. Participants One hundred and seventy-two MSM presenting as sexual contacts of men with syphilis at a sexual health service in Melbourne, Australia, between July 2007 and October 2011 were assessed for syphilis. Outcome measures Proportion of MSM who are infected with syphilis and factors associated with infection. Results Of the 172 men who presented reporting contact with syphilis, 26 (15%, 95% CI 10 to 20%) had syphilis. One man had primary syphilis, 4 had secondary syphilis, while the remaining 21 had early latent syphilis. Infection was associated with unprotected anal sex over the prior 3?months (adjusted OR 6.1, 95% CI 1.4 to 26.8). Conclusions One in seven men presenting as contacts of syphilis had syphilis infection, most of whom were latently infected. Contacts reporting recent unprotected anal sex were more likely to have syphilis. PMID:22907046

Weerakoon, Ajith P; Fairley, Christopher K; Read, Tim RH; Bradshaw, Catriona; Forrester, Catherine; Bissessor, Melanie; Denham, Ian; Chen, Marcus Y

2012-01-01

403

Burn center journal club promotes clinical research, continuing education, and evidence-based practice.  

PubMed

The purpose of this study was to characterize the structure, policy, implementation, and outcome measures of a burn team journal club to assess its effectiveness in promoting multidisciplinary education relative to research competency, clinical knowledge, and evidence-based practice. After 2 years of a new multidisciplinary format, an anonymous quality assurance survey was distributed to staff members of a regional pediatric burn center to evaluate the impact of the journal club on clinical and research indicators. The 24 journal club meetings evaluated in this study included a variety of topics, among which were wound healing, infection, nutrition, metabolism, sleep, medications, alternative medicine, research compliance, and child abuse. The speakers included a variety of hospital personnel: 26% researchers, 23% physicians, 20% registered nurses, and 31% other disciplines and attendance mean was 29 participants per session (range 17-50). Survey results from 30 respondents indicated that 100% judged the program to be valuable to personal educational needs and 83% indicated that format did not warrant change. According to self-report data, the journal club enhanced medical knowledge (90%), patient care (73%), research competency (70%), critical thinking (63%), and evidence-based practice (63%). Results indicate that the journal club program was well received by participants, and promoted enhanced knowledge and improved patient care. In the future, barriers to research initiatives and integration of research findings into practice warrant follow-up study. Journal club should be incorporated into the learning curriculum of burn practitioners as a means to promote critical thinking, research competency, and evidence-based clinical practice. PMID:23519068

Fowler, Laura; Gottschlich, Michele M; Kagan, Richard J

2013-01-01

404

Cost-effectiveness of a nurse-based intervention (AIMS) to improve adherence among HIV-infected patients: design of a multi-centre randomised controlled trial  

PubMed Central

Background Non-adherence to HIV-treatment can have a negative impact on patients’ treatment success rates, quality of life, infectiousness, and life expectancy. Few adherence interventions have shown positive effects on adherence and/or virologic outcomes. The theory- and evidence-based Adherence Improving self-Management Strategy (AIMS) is an intervention that has been demonstrated to improve adherence and viral suppression rates in a randomised controlled trial. However, evidence of its cost-effectiveness is lacking. Following a recent review suggesting that cost-effectiveness evaluations of adherence interventions for chronic diseases are rare, and that the methodology of such evaluations is poorly described in the literature, this manuscript presents the study protocol for a multi-centre trial evaluating the effectiveness and cost-effectiveness of AIMS among a heterogeneous sample of patients. Methods/design The study uses a multi-centre randomised controlled trial design to compare the AIMS intervention to usual care from a societal perspective. Embedded in this RCT is a trial-based and model-based economic evaluation. A planned number of 230 HIV-infected patients are randomised to receive either AIMS or usual care. The relevant outcomes include changes in adherence, plasma viral load, quality of life, and societal costs. The time horizon for the trial-based economic evaluation is 12–15 months. Costs and effects are extrapolated to a lifetime horizon for the model-based economic evaluation. Discussion The present multicentre RCT is designed to provide sound methodological evidence regarding the effectiveness and cost-effectiveness of a nurse-based counselling intervention (AIMS) to support treatment adherence among a large and heterogeneous sample of HIV-infected patients in the Netherlands. The objective of the current paper is to describe the trial protocol in sufficient detail to allow full evaluation of the quality of the study design. It is anticipated that, if proven cost-effective, AIMS can contribute to improved evidence-based counselling guidelines for HIV-nurses and other health care professionals. Trial registration The study has been registered on clinicaltrials.gov (Identifier: NCT01429142). PMID:24059292

2013-01-01

405

Association between Helicobacter Pylori Infection and Ulcerative Colitis-A Case Control Study from China  

PubMed Central

Aims To investigate the association between H. pylori infection and UC prevalence in China. Materials and Methods Subjects were selected from patients admitted in Department of Gastroenterology for abdominal pain, hematochezia, diarrhea and other GI symptoms during 2009-2012. UC diagnosis was based on both colonoscopy and biopsy. H. pylori detection was based on 14C urea breath test (UBT) and biopsy sample culture. Patients' demographic, anthropometric and serologic data were selected. H. pylori infection rate was compared between UC and control groups, followed by a subgroup analysis on the association between H. pylori infection and extent and severity degree of UC. Results Totally, 153 and 121 patients were selected and divided into UC and control groups. There were no significant differences in age, gender, BMI, hypertension and diabetes. However, smoking history was significantly lower while WBC and CRP levels were significantly higher in UC group. The H. pylori infection rate in UC group was 30.5%, significantly lower than that of 57.0% in control group. The H. pylori infection rate in UC of left colon and whole colon were 33,9% and 24.2% (p<0.05 between them), both significantly lower than that in control group. In addition, the H. pylori infection rates in mild, moderate and severe UC subgroups were 37.8%, 32.3% and 22.2% (p>0.05 among them), all of which were significantly lower than that in control group. Conclusion We reported a significantly lower H. pylori infection rate in UC patients with different extent and severity degree, which provides evidence for bacteria involvement in UC pathogenesis and reminder clinicians to keep cautious in considering H. pylori eradication in UC patients. PMID:24046521

Jin, Xi; Chen, Yi-peng; Chen, Shao-hua; Xiang, Zun

2013-01-01

406

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

PubMed

Hepatitis C virus (HCV) seroprevalence is highly diverse among human immunodeficiency virus-1 (HIV-1) infected patients, ranging between 10% of HIV-1 infected homo-bisexuel men, to >92% in patients infected with HIV-1 who acquired HIV-1 through intravenous drug use. Thus, being HCV-free while having acquired HIV-1 via intravenous drug use is a rare situation. Claudin-1 is a protein involved in intracellular tight-junctions and has been identified as a major cellular co-receptor for HCV infection. Our objective was to determine whether Claudin-1 gene (CLDN1) mutations might be involved in natural resistance to HCV infection. We conducted a case-control study. All recruited patients acquired HIV-1 infection via intravenous drug use route before 1995. The case study patients remained free from HCV infection (negative anti-HCV antibodies and HCV-RNA). The control study patients was co-infected with HCV (positive anti-HCV antibodies). Direct genomic sequencing of the CLDN1 gene coding region and adjacent intron/exons junctions was performed from peripheral blood mononuclear cells. A total of 138 Caucasian patients were enrolled. Twenty-two patients (cases) were free from HCV infection and 116 (controls) were co-infected with HCV. We found single nucleotide polymorphisms (SNPs) described previously with no significant differences in allele frequencies between cases and controls. In conclusion, despite being a major cellular co-receptor for HCV entry in vitro, we did not identify any specific substitution in CLDN1 gene coding region in our study patients highly exposed but resistant to HCV infection in vivo. Other cellular co-factors involved in HCV infection should be investigated in this highly-exposed intravenous drug users patients. J. Med. Virol. 87:619-624, 2015. © 2015 Wiley Periodicals, Inc. PMID:25611191

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

2015-04-01

407

Addiction treatment provider attitudes on staff capacity and evidence-based clinical training: results from a national study.  

PubMed

This national study of addiction-treatment organizations' implementation of evidence-based practices examines: (1) organizational/leadership factors associated with director (n = 212) attitudes regarding staff resistance to organizational change, and (2) organizational/staff factors associated with staff (n = 312) attitudes regarding evidence-based clinical training. Linear regression analyses, controlling for type of treatment unit, leadership/staff characteristics and organizational readiness to change, identified that directors who perceived their organization needed more guidance and had less staff cohesion and autonomy rated staff resistance to organizational change significantly higher. Staff with higher levels of education and greater agreement that their organization supported change had greater preference for evidence-based trainings. Federal addiction treatment policy should both promote education and training of treatment staff and organizational development of treatment CBOs.? PMID:21477056

Lundgren, Lena; Amodeo, Maryann; Krull, Ivy; Chassler, Deborah; Weidenfeld, Rachel; de Saxe Zerden, Lisa; Gowler, Rebekah; Lederer, Jaime; Cohen, Alexander; Beltrame, Clelia

2011-01-01

408

Is there an evidence base for the practice of ENT surgery?  

PubMed

In order to assess the strength of the 'evidence base' for the practice of otolaryngology a review of recent journal articles was undertaken. A review of all articles published during the period 1990-1994 in five major general otolaryngology journals was performed. The articles were classified according to a standardized scheme from the abstract or, if necessary, the full paper. Papers were grouped into observational studies (descriptive or analytical, hypothesis-testing), controlled trials, randomized controlled trials, audits, non-clinical and others. One true meta-analysis was found. Randomized controlled trials comprised 0.7%-4% of articles across the journals studied; other controlled trials comprised 0.8-2%; and other analytical studies 7.6-21.9%. Very few true audits were seen. Descriptive studies were by far the commonest type of paper seen. This literature review suggests there is a poor evidence base for our specialty if one regards randomized controlled trials as the gold standard. PMID:9160930

Maran, A G; Molony, N C; Armstrong, M W; Ah-See, K

1997-04-01

409

Cognitive-Behavioral Psychotherapy for Anxiety and Depressive Disorders in Children and Adolescents: An Evidence-Based Medicine Review  

ERIC Educational Resources Information Center

Objective: To review the literature on the cognitive-behavioral treatment of children and adolescents with anxiety and depressive disorders within the conceptual framework of evidence-based medicine. Method: The psychiatric and psychological literature was systematically searched for controlled trials applying cognitive-behavioral treatment to…

Compton, Scott N.; March, John S.; Brent, David; Albano, Anne Marie; Weersing, V. Robin; Curry, John

2004-01-01

410

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

PubMed Central

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

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

2013-01-01

411

A case-control study of gynecomastia in HIV-1-infected patients receiving HAART.  

PubMed

Gynecomastia has been reported to occur in HIV-infected patients receiving HAART. A retrospective case-control study was conducted to determine risk factors associated with this condition. Two control patients were randomly chosen for each of 23 case patients identified. An efavirenz-containing regimen was strongly associated with the development of gynecomastia (odds ratio, 20; P < .001). Case patients were not more likely to have lipodystrophy, low testosterone levels, chronic infection with hepatitis B or C virus, or liver dysfunction compared with control patients. None of these factors altered the efavirenz-associated risk when analyzed by multiple logistic regression. Efavirenz appears to be strongly associated with gynecomastia in HIV-infected patients receiving HAART. PMID:14959701

Rahim, Sibtain; Ortiz, Olivia; Maslow, Melanie; Holzman, Robert

2004-01-01

412

Summary of guidelines for infection prevention and control for flexible gastrointestinal endoscopy  

PubMed Central

BACKGROUND: High-quality processes to ensure infection prevention and control in the delivery of safe endoscopy services are essential. In 2010, the Public Health Agency of Canada and the Canadian Association of Gastroenterology (CAG) developed a Canadian guideline for the reprocessing of flexible gastrointestinal endoscopy equipment. METHODS: The CAG Endoscopy Committee carefully reviewed the 2010 guidelines and prepared an executive summary. RESULTS: Key elements relevant to infection prevention and control for flexible gastrointestinal endoscopy were highlighted for each of the recommendations included in the 2010 document. The 2010 guidelines consist of seven sections, including administrative recommendations, as well as recommendations for endoscopy and endoscopy decontamination equipment, reprocessing endoscopes and accessories, endoscopy unit design, quality management, outbreak investigation and management, and classic and variant Creutzfeldt-Jakob Disease. DISCUSSION: The recommendations for infection prevention and control for flexible gastrointestinal endoscopy are intended for all individuals with responsibility for endoscopes in all settings where endoscopy is performed. PMID:23781518

Hookey, Lawrence; Armstrong, David; Enns, Rob; Matlow, Anne; Singh, Harminder; Love, Jonathan

2013-01-01

413

Efficiency of controlled topical delivery of silver sulfadiazine in infected burn wounds.  

PubMed

The present study is designed to assess the potential benefits of controlled delivery of silver sulfadiazine from collagen scaffold (SSDM-CS) in infected deep partial thickness burn wounds in which epidermis is lost completely and the entire papillary dermis and most of the recticular layer of the dermis is lost. Infection induced by inoculating 10(7) colony forming units (cfu) of Pseudomonas aeruginosa caused significant increase in wound size (20%) till day 15, which decreased significantly from day 9 by SSDM-CS treatment, showing complete healing by day 27 (control > or = 37 days). Early subsidence of infection (<10(2) cfu, day 9) by SSDM-CS resulted in faster epidermal resurfacing and fibroplasia, whereas heavy microbial load (>10(7) cfu, day 9) in controls caused severe inflammatory cellular infiltration. Persistent infection triggered early expression of proinflammatory cytokines intereukin-6, intereukin 1-beta, and tumor necrosis factor-alpha, lasting until day 9, whereas cytokine level decreased in SSDM-CS-treated group by day 6. Infection exacerbated expression of active matrix metalloproteinases (MMPs)-2 and -9 in controls (day 15), while SSDM-CS positively modulated MMP-2 and -9 with faster decline in their levels (day 12). Inherent nature of the dressing to maintain drug level at equilibrium therapeutic concentration (51.2 microg/mL) for prolonged time (72 h), below systemic toxic limits (20 microg/dL, serum level), accelerated the magnitude and sequence of reparative events. PMID:18431769

Shanmugasundaram, N; Uma, T S; Ramyaa Lakshmi, T S; Babu, Mary

2009-05-01

414

The Purinergic P2X7 Receptor Is Not Required for Control of Pulmonary Mycobacterium tuberculosis Infection  

Microsoft Academic Search

The importance in vivo of P2X7 receptors in control of virulent Mycobacterium tuberculosis was examined in a low-dose aerosol infection mouse model. P2X7\\/ mice controlled infection in lungs as well as wild-type mice, suggesting that the P2X7 receptor is not required for control of pulmonary M. tuberculosis infection. Signaling through the purinergic P2X7 receptor by mM con- centrations of extracellular

Amy J. Myers; Brandon Eilertson; Scott A. Fulton; JoAnne L. Flynn; David H. Canaday

2005-01-01

415

Distribution of haematological indices among subjects with Blastocystis hominis infection compared to controls  

PubMed Central

Introduction Some studies suggest Blastocystis hominis is a potentially pathogenic protozoa. Blastocystis hominis contributed to anaemia in children aged 8–10 years old in one study. Aim To compare haematological indices in cases with blastocystis hominis infection with healthy controls. Material and methods From 2001 to 2012, 97600 stool examinations were done in 4 university hospitals. Parasites were observed in 46,200 specimens. Of these cases, subjects with complete laboratory investigation (complete blood count – CBC, ferritin, total iron binding capacity – TIBC, and serum) and blastocystis hominis infection were included in this study as the case group. Of these cases, 6851 cases had only B. hominis infection. In the control group, 3615 subjects without parasite infestation were included. Age, haemoglobin (Hb), serum iron, TIBC, white blood cell (WBC), platelet (PLT), mean corpuscular volume (MCV), haematocrit (HCT) and erythrocyte sedimentation rate (ESR) were recorded for cases and controls. SPSS software version 13.0 was used for analysis. Independent sample t-test and ?2 tests were used for comparison. Results Erythrocyte sedimentation rate level was significantly higher in cases with B. hominis infection (p < 0.05). C-reactive protein level was positive in 1.46% of cases and 0.5% of controls, which was statistically significant (p < 0.05). Frequency of serum iron < 120 was significantly higher in cases with B. hominis infection compared to controls. Occult blood was positive in 0.93% of cases and in none of the controls (p < 0.05). Conclusions The ESR, CRP and occult blood was significantly higher in cases with B. hominis infection. PMID:24868297

Javaherizadeh, Hazhir; Soltani, Shahrzad; Torabizadeh, Mehdi; Yousefi, Elham

2014-01-01

416

Cardiac Involvement with Parasitic Infections  

PubMed Central

Summary: Parasitic infections previously seen only in developing tropical settings can be currently diagnosed worldwide due to travel and population migration. Some parasites may directly or indirectly affect various anatomical structures of the heart, with infections manifested as myocarditis, pericarditis, pancarditis, or pulmonary hypertension. Thus, it has become quite relevant for clinicians in developed settings to consider parasitic infections in the differential diagnosis of myocardial and pericardial disease anywhere around the globe. Chagas' disease is by far the most important parasitic infection of the heart and one that it is currently considered a global parasitic infection due to the growing migration of populations from areas where these infections are highly endemic to settings where they are not endemic. Current advances in the treatment of African trypanosomiasis offer hope to prevent not only the neurological complications but also the frequently identified cardiac manifestations of this life-threatening parasitic infection. The lack of effective vaccines, optimal chemoprophylaxis, or evidence-based pharmacological therapies to control many of the parasitic diseases of the heart, in particular Chagas' disease, makes this disease one of the most important public health challenges of our time. PMID:20375355

Hidron, Alicia; Vogenthaler, Nicholas; Santos-Preciado, José I.; Rodriguez-Morales, Alfonso J.; Franco-Paredes, Carlos; Rassi, Anis

2010-01-01

417

Risk factors for HIV infection among circumcised men in Uganda: a case-control study  

PubMed Central

Introduction Male circumcision (MC) reduces the risk of HIV infection. However, the risk reduction effect of MC can be modified by type of circumcision (medical, traditional and religious) and sexual risk behaviours post-circumcision. Understanding the risk behaviours associated with HIV infection among circumcised men (regardless of form of circumcision) is critical to the design of comprehensive risk reduction interventions. This study assessed risk factors for HIV infection among men circumcised through various circumcision approaches. Methods This was a case-control study which enrolled 155 cases (HIV-infected) and 155 controls (HIV-uninfected), all of whom were men aged 18–35 years presenting at the AIDS Information Center for HIV testing and care. The outcome variable was HIV sero-status. Using SPSS version 17, multivariable logistic regression was performed to identify factors independently associated with HIV infection. Results Overall, 83.9% among cases and 56.8% among controls were traditionally circumcised; 7.7% of cases and 21.3% of controls were religiously circumcised while 8.4% of cases and 21.9% of controls were medically circumcised. A higher proportion of cases than controls reported resuming sexual intercourse before complete wound healing (36.9% vs. 14.1%; p<0.01). Risk factors for HIV infection prior to circumcision were:being in a polygamous marriage (AOR: 6.6, CI: 2.3–18.8) and belonging to the Bagisu ethnic group (AOR: 6.1, CI: 2.6–14.0). After circumcision, HIV infection was associated with: being circumcised at >18 years (AOR: 5.0, CI: 2.4–10.2); resuming sexual intercourse before wound healing (AOR: 3.4, CI: 1.6–7.3); inconsistent use of condoms (AOR: 2.7, CI: 1.5–5.1); and having sexual intercourse under the influence of peers (AOR: 2.9, CI: 1.5–5.5). Men who had religious circumcision were less likely to have HIV infection (AOR: 0.4, 95% CI: 0.2–0.9) than the traditionally circumcised but there was no statistically significant difference between those who were traditionally circumcised and those who were medically circumcised (AOR: 0.40, 95% CI: 0.1–1.1). Conclusions Being circumcised at adulthood, resumption of sexual intercourse before wound healing, inconsistent condom use and having sex under the influence of peers were significant risk factors for HIV infection. Risk reduction messages should address these risk factors, especially among traditionally circumcised men. PMID:25556374

Ediau, Michael; Matovu, Joseph KB; Byaruhanga, Raymond; Tumwesigye, Nazarius M; Wanyenze, Rhoda K

2015-01-01

418

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

PubMed Central

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

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

2007-01-01

419

Antiviral immunity following smallpox virus infection: a case-control study.  

PubMed

Outbreaks of smallpox (i.e., caused by variola virus) resulted in up to 30% mortality, but those who survived smallpox infection were regarded as immune for life. Early studies described the levels of neutralizing antibodies induced after infection, but smallpox was eradicated before contemporary methods for quantifying T-cell memory were developed. To better understand the levels and duration of immunity after smallpox infection, we performed a case-control study comparing antiviral CD4(+) and CD8(+) T-cell responses and neutralizing antibody levels of 24 smallpox survivors with the antiviral immunity observed in 60 smallpox-vaccinated (i.e., vaccinia virus-immune) control subjects. We found that the duration of immunity following smallpox infection was remarkably similar to that observed after smallpox vaccination, with antiviral T-cell responses that declined slowly over time and antiviral antibody responses that remained stable for decades after recovery from infection. These results indicate that severe, potentially life-threatening disease is not required for the development of sustainable long-term immunity. This study shows that the levels of immunity induced following smallpox vaccination are comparable in magnitude to that achieved through natural variola virus infection, and this may explain the notable success of vaccination in eradicating smallpox, one of the world's most lethal diseases. PMID:20926574

Hammarlund, Erika; Lewis, Matthew W; Hanifin, Jon M; Mori, Motomi; Koudelka, Caroline W; Slifka, Mark K

2010-12-01

420

Active Screening of Multi-Drug Resistant Bacteria Effectively Prevent and Control the Potential Infections.  

PubMed

Our objective is to determine if actively screen the multi-drug resistant bacteria (MDRB) infection in intensive care unit (ICU) to prevent, control, and decrease the infection rate and transmission of MDRB. The patients admitted in ICU of one hospital in 2013 were analyzed. The throat swab, blood, defecation, and urine of patients were actively collected for bacteria cultures to screen Pseudomonas aeruginosa, Klebsiella pneumoniae, Escherichia coli, Staphylococcus aureus, and Acinetobacter baumannii in patients. All patients received screening of MDRB infection and colonization within 2 days and after 2 days of admission, the results showed that there were 418 infectious bacterial strains in total and P. aeruginosa was the main bacterium. The asymptomatic infection rates of P. aeruginosa, K. pneumonia, E. coli, S. aureus, and A. baumannii were 39.02, 24.74, 44.00, 29.17, and 33.33 %, respectively; the symptomatic infection rates were 60.98, 75.26, 56.00, 70.83, and 66.67 %. 59.70 % patients received antibiotics treatment, 27.45 % patients received trachea cannula, 32.95 % patients received mechanism ventilation, 2.27 % patients received arterial cannula or venous cannula and 4.00 % patients received indwelling urinary catheters. The main MDRB in ICU is P. aeruginosa. The active screening of MDRB infection and colonization can provide the opportunity to take the life-saving measure against MDRB and treat patients. This can decrease the infection risk and the nosocomial transmission of MDRB. PMID:25416582

Ren, Yuguo; Ma, Guoliang; Peng, Lin; Ren, Yufeng; Zhang, Fengmei

2014-11-22

421

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

PubMed Central

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

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

2009-01-01

422

Global control of pneumococcal infections by pneumococcal vaccines.  

PubMed

Streptococcus pneumoniae is a major worldwide cause of morbidity and mortality. Pneumococcal carriage is considered to be an important source of horizontal spread of this pathogen within the community. Pneumococcal conjugate vaccine (PCV) is capable of inducing serotype-specific antibodies in sera of infants, and has been suggested to reduce nasopharyngeal carriage of vaccine-type pneumococci in children. PCV is generally immunogenic for pediatric patients with invasive pneumococcal disease, with an exception for the infecting serotypes. Based on evidences from the clinical trials of PCV, the health impact of childhood pneumococcal pneumonia appears to be high in developing countries where most of global childhood pneumonia deaths occur. PCV vaccination may prevent hundreds of deaths per 100,000 children vaccinated in developing countries, while PCV vaccination is expected to prevent less than 10 deaths per 100,000 children vaccinated in the developed countries. Therefore, the WHO has proposed a strategy to reduce the incidence of severe pneumonia by 75% in child less than 5 years of age compared to 2010 levels by 2025. PMID:25425955

Oishi, Kazunori; Tamura, Kazuyo; Akeda, Yukihiro

2014-06-01

423

Repurposing drugs for the treatment and control of helminth infections.  

PubMed

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

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

2014-12-01

424

Exploring Implementation and Fidelity of Evidence-Based Behavioral Interventions for HIV Prevention: Lessons Learned from the Focus on Kids Diffusion Case Study  

ERIC Educational Resources Information Center

Evidence-based interventions (EBIs) are used in public health to prevent HIV infection among youth and other groups. EBIs include core elements, features that are thought to be responsible for the efficacy of interventions. The authors evaluate experiences of organizations that adopted an HIV-prevention EBI, Focus on Kids (FOK), and their fidelity…

Galbraith, Jennifer S.; Stanton, Bonita; Boekeloo, Bradley; King, Winifred; Desmond, Sharon; Howard, Donna; Black, Maureen M.; Carey, James W.

2009-01-01

425

Therapeutic management of anal eczema: an evidence-based review  

PubMed Central

Aim To conduct a systematic review of treatments for anal eczema (AE). Methods We conducted a Medline search for clinical trial data for the treatment of perianal diseases including AE, including papers not published in the English language. We assessed the study reports using the system recommended by the Oxford Centre for Evidence-based Medicine. No meta-analysis was attempted. Results The evidence base for topical treatments used to treat AE is very poor: there are very few studies and many of those that exist are of poor quality. The best evidence was found for medications that are yet to be licensed for AE. Among products with existing licences for the treatment of eczema, our assessment found some evidence to support the continued use of mild-to-moderate corticosteroids first line in most patients. Discussion Features of the perianal region, and the fact that it is almost always occluded, mean that not all medications recommended in the general treatment guidelines for eczema are appropriate for AE. However, there are no specific treatment guidelines for these patients. This may in part be because of the lack of high-quality evidence-based medicine in this therapy area. Many frequently prescribed medications were developed and licensed many years ago, in an era when clinical trial design was not expected to be as rigorous as it is today. Conclusion This review highlights the need to conduct more high-quality clinical trials in patients with AE in order that specific guidelines for the management of this difficult proctological condition can be prepared. PMID:24898365

Havlickova, B; Weyandt, G H

2014-01-01

426

Genetic control of resistance to mouse cytomegalovirus infection  

Microsoft Academic Search

Summary A mouse cytomegalovirus (MCMV) recovered from wild (W) mice proved non-infectious for albino Swiss (S) mice and it could not be propagated in cell cultures derived from S embryos. The analysis of the transmission of this feature suggested that the resistance of S mice to that particular MCMV was under genetic control, and this genetic resistance was a unifactorial

P. Diosi; P. Arcan; Livia Plavo?if

1974-01-01

427

Endoluminal GERD treatments: critical appraisal of current literature with evidence-based medicine instruments  

Microsoft Academic Search

Background  The literature of endoluminal treatment of gastroesophageal reflux disease (GERD) widely varies in the level of evidence presented\\u000a for analysis. Therefore there is a need for a comprehensive evidence-based medicine (EBM) analysis of the current literature\\u000a evidence of the three FDA-approved modalities used for endoluminal treatment of GERD.\\u000a \\u000a \\u000a \\u000a Search strategy  In January 2007, the MEDLINE database was searched for randomized controlled

Alfonso Torquati; William O. Richards

2007-01-01

428

Promoting nurses' knowledge in evidence-based practice: do educational methods matter?  

PubMed

Evidence-based practice (EBP) is a mandate for nursing practice. Education on EBP has occurred in academic settings, but not all nurses have received this training. The authors describe a randomized controlled pretest/posttest design testing the differences in effectiveness of two educational methods to improve nurses' knowledge, attitudes, and practice of EBP. Results indicated both methods improved self-reported practice. On the basis of the study findings, staff development educators can select the teaching method that best complements their organizational environment. PMID:23877287

Toole, Belinda M; Stichler, Jaynelle F; Ecoff, Laurie; Kath, Lisa

2013-01-01

429

Intravenous salbutamol for childhood asthma: evidence-based medicine?  

PubMed

Intravenous salbutamol is commonly used to treat children with severe asthma unresponsive to inhaled ?2-agonist therapy. However, in this setting, there is little clinical trial data demonstrating its effectiveness. Additionally, there are significant concerns that intravenous salbutamol-dosing recommendations for children with acute asthma are excessive, and unnecessarily raise the potential for adverse reactions, such as lactic acidosis and tachycardia which, by increasing respiratory workload, exacerbate respiratory failure. Here, we review salbutamol clinical pharmacology and toxicology, evidence relating to its use in acute asthma and highlight gaps in the evidence base. PMID:24938536

Starkey, E S; Mulla, H; Sammons, H M; Pandya, H C

2014-09-01

430

Lithium Therapy and Hyperparathyroidism: An Evidence-Based Assessment  

Microsoft Academic Search

Background  Prolonged therapeutic exposure to lithium compounds can have adverse consequences on calcium homeostasis. A unique form of\\u000a hyperparathyroidism appears to be causally linked to chronic lithium exposure. We provide a comprehensive review of relevant\\u000a literature using a structured, evidence-based approach.\\u000a \\u000a \\u000a \\u000a Methods  Published data were identified from systematic electronic literature searches. References are assigned a level of evidence\\u000a according to a validated

Brian D. Saunders; Erika F. H. Saunders; Paul G. Gauger

2009-01-01

431

Overview of evidence-based practice and translation science.  

PubMed

Evidence-based practice and translation science are not interchangeable terms; EBP is the application of evidence in practice (the doing of EBP), whereas translation science is the study of implementation interventions, factors, and contextual variables that affect knowledge uptake and use in practices and communities. The use of collaborative networks such as the National Nursing Practice Network maximizes sharing of resources and knowledge about EBPs, an infrastructure for conducting multi-site translation studies, and a venue for large scale-up of EBP projects across multiple healthcare settings. PMID:25155527

Titler, Marita G

2014-09-01

432

Complementary medicine: evidence base, competence to practice and regulation.  

PubMed

This paper describes the current status and evidence base for acupuncture, homeopathy, herbal and manipulative medicine, as well as the regulatory framework within which these therapies are provided. It also explores the present role of the Royal College of Physicians' Subcommittee on Complementary and Alternative Medicine (CAM) in relation to these developments. A number of CAM professions have encouraged the Royal College of Physicians Subcommittee to act as a reference point for their discussions with the conventional medical profession and the subcomittee believes that they are able to fulfil this function. PMID:12848257

Lewith, George T; Breen, Alan; Filshie, Jacqueline; Fisher, Peter; McIntyre, Michael; Mathie, Robert T; Peters, David

2003-01-01

433

Evidence-based macro practice: addressing the challenges and opportunities.  

PubMed

Steps involved in the process of evidence-based practice are reviewed in terms of their applicability to macro-level social work. These steps include (1) posing answerable questions; (2) locating credible research studies, (3) critically evaluating this research and its applicability to a practice situation; 4. selecting an intervention(s) by integrating research evidence with professional expertise, ethical standards, and the situation's unique circumstance; and (5) evaluating outcomes. This process has clear and compelling applications to macro-practice. A substantial body of research applicable to macro-level social work currently exists. Widespread adoption of EBP has great potential to improve social work programs and policies. PMID:19042876

Thyer, Bruce A

2008-01-01

434

Evidence-based practice readiness of ASORN members.  

PubMed

Due to the importance of evidence-based practice and its impact on patient outcomes, a research study was conducted in early 2013 soliciting participation of ASORN members. Findings indicate the collegiality and curiosity of nurses, who identify a gap in practice due to lack of knowledge/skills and organizational barriers. Since nurses value EBP and research, as noted in study findings and ASORN Board of Directors support, efforts to advance the art and science of ophthalmic nursing will continue in the future. PMID:24319821

Fowler, Susan B

2013-01-01

435

Developing evidence-based practice champions in the Maldives.  

PubMed

Evidence-based practice (EBP) is an approach that has gained recognition for facilitating the transfer of evidence into clinical practice. EBP champions is a strategy that can be adopted to encourage the uptake of EBP. This paper describes an action research project that was undertaken in Maldives. EBP champion model has been introduced in the Maldives early 2012 and aims to produce clinical leaders from variety of backgrounds who could implement EBP. This paper provides an extended discussion of the process that was undertaken to prepare EBP champions and their roles in implementing EBP. PMID:24330210

Shifaza, Fathimath; Evans, David; Bradley, Helen; Ullrich, Sandra

2013-12-01

436

Developing an evidence-based list of journals for nursing.  

PubMed

The Nursing and Allied Health Resources Section (NAHRS) of the Medical Library Association created the 2012 NAHRS Selected List of Nursing Journals to assist librarians with collection development and to provide nurses and librarians with data on nursing and interdisciplinary journals to assist their decisions about where to submit articles for publication. This list is a continuation and expansion of a list initially known as the Key Nursing Journals list. It compares database coverage and full-text options for each title and includes an analysis of the number of evidence-based, research, and continuing education articles. PMID:24860267

Sherwill-Navarro, Pamela; Kennedy, Joy C; Allen, Margaret Peg

2014-04-01

437

Hepatocellular carcinoma review: Current treatment, and evidence-based medicine  

PubMed Central

We read with great interest the recent article entitled “Hepatocellular carcinoma review: Current treatment, and evidence-based medicine” by Raza et al, published in World Journal of Gastroenterology. Authors evaluated treatments for early and advanced stage hepatocellular carcinoma based on an extensive review of the relevant literature. They reported that radiofrequency ablation is the most effective local ablative therapy. They concluded that RF ablation is equivalent to surgical resection in well selected patients with early stage hepatocellular carcinoma. In addition, we want to mention microwave ablation besides RF ablation. PMID:25548509

Karaman, Bulent; Battal, Bilal; Sari, Sebahattin; Verim, Samet

2014-01-01

438

[Stress ulcer prophylaxis in septic patients. Evidence-based overview].  

PubMed

In spite of decreasing incidence stress-related gastrointestinal bleeding is still an important problem in intensive care medicine. Especially patients with severe sepsis or septic shock are prone to develop lesions of the upper gastrointestinal tract with consecutive bleeding. In order to prevent gastrointestinal bleeding various pharmacological agents are used to either suppress gastric acid or neutralize its effect. The following article presents an update on important aspects of stress-related mucosal disease. It further reviews current literature to provide evidence-based recommendations for stress ulcer prophylaxis in septic patients. PMID:18464210

Elke, Gunnar; Schädler, Dirk; Zick, Günther; Scholz, Jens; Weiler, Norbert

2008-05-01

439

Leishmania infection in a population of dogs: an epidemiological investigation relating to visceral leishmaniasis control.  

PubMed

Identification of factors associated with Leishmania infection in dogs is essential for targeting visceral leishmaniasis control actions. Thus, the present study analyzed some of these factors in a population of dogs in a Brazilian municipality, along with the limitations of control strategies implemented there. The association between the exposure variables and occurrences of infection was analyzed through logistic regression models. The disease control interventions were treated qualitatively. Out of the 755 animals examined, 13.6% (103/755) were seropositive. Of these, 23.3% (24/103) were asymptomatic and 76.7% (79/103) presented at least one clinical sign possibly associated with visceral leishmaniasis. With weak associations, purebred, shorthaired, over 5 years of age, male and large dogs were more prone to infection. The latter two variables formed the final regression model and the association with dog size was statistically significant. The control strategies developed presented limitations and a great number of seronegative dogs was culled. The data presented contribute towards better understanding of the dynamics of infection in canine visceral leishmaniasis and indicate that actions aimed towards adequate implementation of Visceral Leishmaniasis control program in Brazilian endemic areas should be prioritized. PMID:24473887

Penaforte, Klauber Menezes; Belo, Vinícius Silva; Teixeira-Neto, Rafael Gonçalves; Ribeiro, Renata Aparecida Nascimento; de Oliveira, Robson Bruniera; Schettini, Dante Alighieri; da Silva, Eduardo Sergio

2013-01-01

440

Experimental Tuberculosis in the Wistar Rat: A Model for Protective Immunity and Control of Infection  

PubMed Central

Background Despite the availability of many animal models for tuberculosis (TB) research, there still exists a need for better understanding of the quiescent stage of disease observed in many humans. Here, we explored the use of the Wistar rat model for the study of protective immunity and control of Mycobacterium tuberculosis (Mtb) infection. Methodology/Principal Findings The kinetics of bacillary growth, evaluated by the colony stimulating assay (CFU) and the extent of lung pathology in Mtb infected Wistar rats were dependent on the virulence of the strains and the size of the infecting inoculums. Bacillary growth control was associated with induction of T helper type 1 (Th1) activation, the magnitude of which was also Mtb strain and dose dependent. Histopathology analysis of the infected lungs demonstrated the formation of well organized granulomas comprising epithelioid cells, multinucleated giant cells and foamy macrophages surrounded by large numbers of lymphocytes. The late stage subclinical form of disease was reactivated by immunosuppression leading to increased lung CFU. Conclusion The Wistar rat is a valuable model for better understanding host-pathogen interactions that result in control of Mtb infection and potentially establishment of latent TB. These properties together with the ease of manipulation, relatively low cost and well established use of rats in toxicology and pharmacokinetic analyses make the rat a good animal model for TB drug discovery. PMID:21533270

Singhal, Amit; Aliouat, El Moukhtar; Hervé, Maxime; Mathys, Vanessa; Kiass, Mehdi; Creusy, Colette; Delaire, Baptiste; Tsenova, Liana; Fleurisse, Laurence; Bertout, Julie; Camacho, Luis; Foo, Damian; Tay, Hui Chien; Siew, Jie Yee; Boukhouchi, Warda; Romano, Marta; Mathema, Barun; Dartois, Véronique; Kaplan, Gilla; Bifani, Pablo

2011-01-01

441

Leprosy and infection with the human immunodeficiency virus in Uganda; a case-control study.  

PubMed

Both leprosy and infection with the human immunodeficiency virus (HIV) are endemic in Uganda. Various speculations about a possible interaction between the two infections have been put forward but not confirmed. A case-control study involving 189 new leprosy patients and 481 matched controls, resident in eight Ugandan districts, was carried out to investigate if any relationship exists between leprosy and infection with HIV-1 in Uganda. Serum samples from 23 (12.2%) of the 189 leprosy patients tested positive for HIV-1 antibodies as compared to 88 (18.3%) of the 481 control sera. The two proportions of HIV seropositivity are not different statistically. A stratified analysis of the data by districts was done and showed a negative relationship between leprosy and HIV infection in the case of Rakai District (0.04 < odds ratio < 0.61, p = 0.002). It is recommended that studies seeking to observe the clinical progress of dually infected patients might help to reveal new knowledge about a possible relationship between HIV and leprosy and about the immunology of leprosy in general. PMID:7868948

Kawuma, H J; Bwire, R; Adatu-Engwau, F

1994-12-01

442

Azithromycin and spiramycin induce anti-inflammatory response in human trophoblastic (BeWo) cells infected by Toxoplasma gondii but are able to control infection.  

PubMed

Toxoplasma gondii is an important pathogen which may cause fetal infection if primary infection. Our previous studies have used human choriocarcinoma trophoblastic cells (BeWo cell line) as experimental model of T. gondii infection involving placental microenvironment. This study aimed to examine the effects of azithromycin and spiramycin against T. gondii infection in BeWo cells. Cells were treated with different concentrations of the macrolide antibiotics and analyzed first for cell viability using thiazolyl blue tetrazole (MTT) assay. As cell viability was significantly decreased with drug concentrations higher than 400 ?g/mL, the concentration range used in further experiments was from 50 to 400 ?g/mL. The number of infected cells and intracellular replication of T. gondii decreased after treatment with each drug. The infection induced up-regulation of the macrophage migration inhibitory factor (MIF), which was also enhanced in infected cells after treatment with azithromycin, but not with spiramycin. Analysis of the cytokine profile showed increase TNF-?, IL-10 and IL-4 production, but decreased IFN-? levels, were detected in infected cells and treated with each drug. In conclusion, treatment of human trophoblastic BeWo cells with with azithromycin or spiramycin is able to control the infection and replication of T. gondii. In addition, treatment with these macrolides, especially with azityromycin induces an anti-inflammatory response and high MIF production, which can be important for the establishment and maintenance of a viable pregnancy during T. gondii infection. PMID:21908042

Franco, P S; Gomes, A O; Barbosa, B F; Angeloni, M B; Silva, N M; Teixeira-Carvalho, A; Martins-Filho, O A; Silva, D A O; Mineo, J R; Ferro, E A V

2011-11-01

443

Efficacy and safety of nanohybrids comprising silver nanoparticles and silicate clay for controlling Salmonella infection  

PubMed Central

Developing effective and safe drugs is imperative for replacing antibiotics and controlling multidrug-resistant microbes. Nanoscale silicate platelet (NSP) and its nanohybrid, silver nanoparticle/NSP (AgNP/NSP), have been developed, and the nanohybrids show a strong and general antibacterial activity in vitro. Here, their efficacy for protecting Salmonella-infected chicks from fatality and septicemia was evaluated. Both orally administrated NSP and AgNP/NSP, but not AgNPs alone, effectively reduced the systemic Salmonella infection and mortality. In addition, quantitative Ag analyses demonstrated that Ag deposition from AgNP/NSP in the intestines was less than that from conventional AgNPs, indicating that the presence of NSP for immobilizing AgNPs reduced Ag accumulation in tissue and improved the safety of AgNPs. These in vivo results illustrated that both NSP and AgNP/NSP nanohybrid represent potential agents for controlling enteric bacterial infections. PMID:22654516

Chiao, Shu-Her; Lin, Siou-Hong; Shen, Ching-I; Liao, Jiunn-Wang; Bau, I-Jiuan; Wei, Jiun-Chiou; Tseng, Li-Ping; Hsu, Shan-hui; Lai, Ping-Shan; Lin, Shinn-Zong; Lin, Jiang-Jen; Su, Hong-Lin

2012-01-01

444

Data Needs for Evidence-Based Decisions: A TB Modeler’s “Wish List”  

PubMed Central

Summary Infectious disease models are important tools for understanding epidemiology and supporting policy decisions for disease control. In the case of tuberculosis (TB), such models have informed our understanding and control strategies for over 40 years, but the primary assumptions of these models – and their most urgent data needs – remain obscure to many TB researchers and control officers. The structure and parameter values of TB models are informed by observational studies and experiments, but the evidence base in support of these models remains incomplete. Speaking from the perspective of infectious disease modelers addressing the broader TB research and control communities, we describe the basic structure common to most TB models and present a “wish list” that would improve the evidence foundation upon which these models are built. As a comprehensive TB research agenda is formulated, we argue that the data needs of infectious disease models – our primary long-term decision-making tools – should figure prominently. PMID:23743307

Dowdy, David W.; Dye, Christopher; Cohen, Ted

2014-01-01

445

Three Collaborative Models for Scaling Up Evidence-Based Practices  

PubMed Central

The current paper describes three models of research-practice collaboration to scale-up evidence-based practices (EBP): (1) the Rolling Cohort model in England, (2) the Cascading Dissemination model in San Diego County, and (3) the Community Development Team model in 53 California and Ohio counties. Multidimensional Treatment Foster Care (MTFC) and KEEP are the focal evidence-based practices that are designed to improve outcomes for children and families in the child welfare, juvenile justice, and mental health systems. The three scale-up models each originated from collaboration between community partners and researchers with the shared goal of wide-spread implementation and sustainability of MTFC/KEEP. The three models were implemented in a variety of contexts; Rolling Cohort was implemented nationally, Cascading Dissemination was implemented within one county, and Community Development Team was targeted at the state level. The current paper presents an overview of the development of each model, the policy frameworks in which they are embedded, system challenges encountered during scale-up, and lessons learned. Common elements of successful scale-up efforts, barriers to success, factors relating to enduring practice relationships, and future research directions are discussed. PMID:21484449

Roberts, Rosemarie; Jones, Helen; Marsenich, Lynne; Sosna, Todd; Price, Joseph M.

2015-01-01

446

Integrating evidence-based decision making into allied health curricula.  

PubMed

An evidence-based approach may decrease variations in practice and time delays in adopting new procedures. This report describes the process for incorporating evidence-based decision making (EBDM) into curricula using active teaching techniques. The process centers on a national four-day Faculty Development Institute (FDI) program for dental hygiene, occupational therapy, and physical therapy faculty. Phase I assesses pre-Institute EBDM knowledge, skills, and teaching strategies. Phase II, onsite, involves learning EBDM principles and teaching skills and developing an educational package. Phase III integrates these into the curriculum, with ongoing follow-up. At baseline, faculty were unfamiliar with EBDM but were incorporating related skills. Formulation of questions and evidence gathering for patient-care decisions were weak. Phase II follow-up showed a significant increase in EBDM knowledge, p < 0.001, and 100% agreed or strongly agreed that they were prepared to integrate EBDM into their courses; 93% felt better prepared to use EBDM. Curricula and educational experiences need to include EBDM skills. The three-phase process can support faculty in making needed changes. PMID:11828582

Forrest, J L; Miller, S A

2001-01-01

447

[Evidence-based medicine: a movement in crisis?].  

PubMed

A recent paper published in The BMJ has argued that the evidence-based medicine movement is now facing a serious crisis. In the authors' opinion, the first problem is that the EBM "quality mark" has been misappropriated by vested interests. The second aspect is that the volume of evidence, especially clinical guidelines, has become unmanageable. Moreover, the statistically significant benefits may be marginal in clinical practice. Also, inflexible rules and technology driven prompts may produce care that is management driven rather than patient centred. In the end, evidence-based guidelines often map poorly to complex multimorbidity. To address the above concerns, the authors believe that a campaign for real EBM is needed: patients must demand better evidence, better presented, better explained, and applied in a more personalised way. All the relevant stakeholders (researchers, editors, publishers, etc.) should contribute to return to the movement's founding principles. The article is a detailed summary of issues already known of great interest, but perhaps with an over-emphasis in the title and tone, without focusing on the key aspect: the production and shaping of the evidence. PMID:25229758

Ciccone, Giovannino

2014-09-01

448

The Care and Feeding of Evidence Based Medicine  

PubMed Central

Wide interest in evidence based medicine (EBM) and its value in patient care, insurance payment decisions, and public health planning has triggered intense medical journal and media coverage that merits review, explanation, and comment. Published EBM data vary in quality for reasons that have been the subject of many perceptive literature reviews. Study design can be faulted, and conflicts of interest, personal and economic, can potentially bias study results and their publication. Practical guides for data evaluation are presented here, with discussion of technical and sociological issues that affect information quality and its clinical application. Clinical practice often appears to resist good evidence in making clinical choices. Personal views of some practicing physicians about EBM are presented that underlie the occasional difficulties in applying valid research information in patient care. Improvements in study design and publication standards may enhance the clinical application of evidence-based information. EBM guided practice holds promise to improve outcomes and expense, to standardize and streamline process in ways that make for much safer patient care. PMID:22532934

2012-01-01

449

Evidence Based Conservative Management of Patello-femoral Syndrome  

PubMed Central

Patellofemoral pain syndrome (PFPS) is defined as pain surrounding the patella when sitting with bent knees for prolonged periods of time or when performing activities like ascending or descending stairs, squatting or athletic activities. Patella dislocation is not included in PFPS. This review analyzes the evidence based conservative management of PFPS. A Cochrane Library search related to PFPS was performed until 18 January 2014. The key words were: patellofemoral pain syndrome. Eight papers were found, of which three were reviewed because they were focused on the topic of the article. We also searched the PubMed using the following keywords: evidence based conservative management of patellofemoral pain syndrome. Twelve articles were found, of which seven were reviewed because they were focused on the topic of the article. Overall ten articles were analyzed. Different treatments can be tried for PFPS, including pharmacotherapy, therapeutic ultrasound, exercise therapy, and taping and braces. Non-steroidal anti-inflammatory drugs (NSAIDs) may reduce pain in the short term, but pain does not improve after three months. Therapeutic ultrasound appears not to have a clinically important effect on pain relief for patients with PFPS. The evidence that exercise therapy is more effective in treating PFPS than no exercise is limited with respect to pain reduction, and conflicting with respect to functional improvement. No significant difference has been found between taping and non-taping. The role of knee braces is still controversial. More well-designed studies are needed. PMID:25207305

Rodriguez-Merchan, E. Carlos

2014-01-01

450

Bowel anastomoses: The theory, the practice and the evidence base  

PubMed Central

Since the introduction of stapling instruments in the 1970s various studies have compared the results of sutured and stapled bowel anastomoses. A literature search was performed from 1960 to 2010 and articles relating to small bowel, colonic and colorectal anastomotic techniques were reviewed. References from these articles were also reviewed, and relevant articles obtained. Either a stapled or sutured gastrointestinal tract anastomosis is acceptable in most situations. The available evidence suggests that in the following situations, however, particular anastomotic techniques may result in fewer complications: A stapled side-to-side ileocolic anastomosis is preferable following a right hemicolectomy for cancer. A stapled side-to-side anastomosis is likely also preferable after an ileocolic resection for Crohn’s disease. Colorectal anastomoses can be sutured or stapled with similar results, although the incidence of strictures is higher following stapled anastomoses. Following reversal of loop ileostomy there is some evidence to suggest that a stapled side-to-side anastomosis or sutured enterotomy closure (rather than spout resection and sutured anastomosis) results in fewer complications. Non-randomised data has indicated that small bowel anastomoses are best sutured in the trauma patient. This article reviews the theory, practice and evidence base behind the various gastrointestinal anastomoses to help the practising general surgeon make evidence based operative decisions. PMID:23293735

Goulder, Frances

2012-01-01

451

Causation and evidence-based practice: an ontological review.  

PubMed

This paper explores the nature of causation within the framework of evidence-based practice (EBP) for health care. The aims of the paper were first to define and evaluate how causation is presently accounted for in EBP; second, to present an alternative causal account by which health care can develop in both its clinical application and its scientific research activity. The paper was premised on the idea that causation underlies medical and health care practices and impacts on the way we understand health science research and daily clinical practice. The question of what causation is should therefore be of utmost relevance for all concerned with the science, philosophy and progress of EBP. We propose that the way causation is thought of in contemporaneous health care is exposed by evidential frameworks, which categorize research methods on their epistemological strengths. It is then suggested that the current account of causation is limited in respect of both the functionality of EBP, and its inherent scientific processes. An alternative ontology of causation is provided, which has its roots in dispositionalism. Here, causes are not seen as regular events necessitating an effect, but rather phenomena that are highly complex, context-sensitive and that tend towards an effect. We see this as a better account of causation for evidence-based health care. PMID:22994999

Kerry, Roger; Eriksen, Thor Eirik; Lie, Svein Anders Noer; Mumford, Stephen D; Anjum, Rani Lill

2012-10-01

452

Evidence-based Estimates of the Demand for Radiotherapy.  

PubMed

There are different methods that may be used to estimate the future demand for radiotherapy services in a population ranging from expert opinion through to complex modelling techniques. This manuscript describes the use of evidence-based treatment guidelines to determine indications for radiotherapy. It also uses epidemiological data to estimate the proportion of the population who have attributes that suggest a benefit from radiotherapy in order to calculate the overall proportion of a population of new cases of cancer who appropriately could be recommended to undergo radiotherapy. Evidence-based methods are transparent and adaptable to different populations but require extensive information about the indications for radiotherapy and the proportion of cancer cases with those indications in the population. In 2003 this method produced an estimate that 52.4% of patients with a registered cancer-type had an indication for radiotherapy. The model was updated in 2012 because of changes in cancer incidence, stage distributions and indications for radiotherapy. The new estimate of the optimal radiotherapy utilisation rate was 48.3%. The decrease was due to changes in the relative frequency of cancer types and some changes in indications for radiotherapy. Actual rates of radiotherapy utilisation in most populations still fall well below this benchmark. PMID:25455408

Delaney, G P; Barton, M B

2015-02-01

453

A Systematic Review of the Evidence Base for Telehospice  

PubMed Central

Abstract The use of telehealth technologies to overcome the geographic distances in the delivery of hospice care has been termed telehospice. Although telehospice research has been conducted over the last 10 years, little is known about the comprehensive findings within the field. The purpose of this systematic article was to focus on available research and answer the question, What is the state of the evidence related to telehospice services? The article was limited to studies that had been published in the English language and indexed between January 1, 2000 and March 23, 2010. Indexed databases included PubMed and PsycINFO and contained specified key words. Only research published in peer review journals and reporting empirical data, rather than opinion or editorials, were included. A two-part scoring framework was modified and applied to assess the methodological rigor and pertinence of each study. Scoring criteria allowed the evaluation of both quantitative and qualitative methodologies. Twenty-six studies were identified with the search strategy. Although limited in number and in strength, studies have evaluated the use of a variety of technologies, attitudes toward use by providers and consumers, clinical outcomes, barriers, readiness, and cost. A small evidence base for telehospice has emerged over the last 10 years. Although the evidence is of medium strength, its pertinence is strong. The evidence base could be strengthened with randomized trials and additional clinical-outcome-focused research in larger randomized samples and in qualitative studies with better-described samples. PMID:22085114

Demiris, George; Wittenberg-Lyles, Elaine; Washington, Karla; Day, Tami; Novak, Hannah

2012-01-01

454

Evidence-based Assessment in Pediatric Psychology: Family Measures  

PubMed Central

Objective?To provide a review of the evidence base of family measures relevant to pediatric psychology.?Method?Twenty-nine family measures were selected based upon endorsement by Division 54 listserv members, expert judgment, and literature review. Spanning observational and self-report methods, the measures fell into three broad assessment categories: Family functioning, Dyadic family relationships, and Family functioning in the context of childhood chronic health conditions. Measures were categorized as: “Well-established”, “Approaching well-established”, or “Promising.”?Results?Nineteen measures met “well-established” criteria and the remaining ten were “approaching well-established.” “Well-established” measures were documented for each of the broad assessment categories named above.?Conclusions?Many measures deemed “well-established” in the general population are proving to be reliable and useful in pediatric samples. More evidence of the validity of family measures is needed in this context. This review should prove helpful to clinicians and researchers as they strive to make evidence-based decisions regarding family measures. PMID:17905801

Fiese, Barbara H.; Gold, Jeffrey I.; Cutuli, J. J.; Holmbeck, Grayson N.; Goldbeck, Lutz; Chambers, Christine T.; Abad, Mona; Spetter, Dante; Patterson, Joän

2008-01-01

455

Pregnancy planning guide. Evidence-based information for prospective parents.  

PubMed Central

PROBLEM BEING ADDRESSED: Pregnancy planning is inadequately supported by existing information and materials. OBJECTIVE OF PROGRAM: To design and pilot-test a new way to help women plan their pregnancies and incorporate important evidence-based information directly into their planning. To evaluate the content of the new Pregnancy Planning Guide and women's satisfaction with it. MAIN COMPONENTS OF PROGRAM: The Pregnancy Planning Guide combines a rotating gestational wheel surrounded by information about time-specific events in pregnancy with evidence-based information about common concerns during pregnancy. The guide is designed to be used as a quick reference for women and their partners; it highlights issues to be discussed at greater length with maternity caregivers. The guide was first evaluated for content validity by 27 experienced maternity caregivers and then revised. The revised version was given to 108 women of childbearing age along with a survey to assess their satisfaction with the guide and the extent to which they thought it was useful. CONCLUSION: The Pregnancy Planning Guide is useful for women planning pregnancy. It should promote increased use of folic acid in the periconception period and a greater understanding of when birth is likely to occur. PMID:12166010

Maier, Krista M.; Kirkham, Colleen M.; Lim, Elizabeth; Cheung, Ka Wai; Grzybowski, Stefan

2002-01-01

456

Evidence-based Assessment of Cognitive Functioning in Pediatric Psychology  

PubMed Central

Objective To review the evidence base 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., attention/executive functioning, memory). Results Twenty-two of 27 measures reviewed demonstrated psychometric properties that met “Well-established” criteria as set forth by the Assessment Task Force. Psychometric properties were strongest for measures of general cognitive ability and weakest for measures of visual-motor functioning and attention. Conclusions We report use of “Well-established” measures of overall cognitive functioning, nonverbal intelligence, academic achievement, language, and memory and learning. For several specific tests in the domains of visual-motor functioning and attention, additional psychometric data are needed for measures to meet criteria as “Well established.” PMID:18194973

Brown, Ronald T.; Cavanagh, Sarah E.; Vess, Sarah F.; Segall, Mathew J.

2008-01-01

457

The Evidence Base for the Evaluation and Management of Dizziness  

PubMed Central

Objective Dizziness presentations pose many clinical challenges. The objective of this study is to broadly summarize the evidence base that supports clinical decisions in dizziness presentations. Methods MEDLINE (1966 to September 2007), Web of Science, and The Cochrane Library were searched for articles with clinical relevance on topics concerning dizziness. Additional sources were also searched for clinical practice guidelines. The following information was abstracted from each article: year of publication, journal type, type of article, and the topics of the article. Results Of nearly 3000 articles identified, 1244 articles met the inclusion criteria. The most common article type was a case report or case series, followed by expert opinion or review articles, studies of medical tests, and clinical trials. Meta-analyses and systematic reviews were found on benign paroxysmal positional vertigo and Meniere’s disease, but only a few other topics. No clinical practice guidelines were found that focus specifically on dizziness. Conclusions The evidence base for the evaluation and management of dizziness seems to be weak. Future work to establish or summarize evidence in clinically meaningful ways could contribute to efforts to optimize patient care and healthcare utilization for one of the most common presenting symptoms. PMID:20367831

Kerber, Kevin A.; Fendrick, A. Mark

2009-01-01

458

The care and feeding of evidence based medicine.  

PubMed

Wide interest in evidence based medicine (EBM) and its value in patient care, insurance payment decisions, and public health planning has triggered intense medical journal and media coverage that merits review, explanation, and comment. Published EBM data vary in quality for reasons that have been the subject of many perceptive literature reviews. Study design can be faulted, and conflicts of interest, personal and economic, can potentially bias study results and their publication. Practical guides for data evaluation are presented here, with discussion of technical and sociological issues that affect information quality and its clinical application. Clinical practice often appears to resist good evidence in making clinical choices. Personal views of some practicing physicians about EBM are presented that underlie the occasional difficulties in applying valid research information in patient care. Improvements in study design and publication standards may enhance the clinical application of evidence-based information. EBM guided practice holds promise to improve outcomes and expense, to standardize and streamline process in ways that make for much safer patient care. PMID:22532934

Tabrah, Frank L

2012-04-01

459

Do short courses in evidence based medicine improve knowledge and skills? Validation of Berlin questionnaire and before and after study of courses in evidence based medicine  

PubMed Central

Objective To develop and validate an instrument for measuring knowledge and skills in evidence based medicine and to investigate whether short courses in evidence based medicine lead to a meaningful increase in knowledge and skills. Design Development and validation of an assessment instrument and before and after study. Setting Various postgraduate short courses in evidence based medicine in Germany. Participants The instrument was validated with experts in evidence based medicine, postgraduate doctors, and medical students. The effect of courses was assessed by postgraduate doctors from medical and surgical backgrounds. Intervention Intensive 3 day courses in evidence based medicine delivered through tutor facilitated small groups. Main outcome measure Increase in knowledge and skills. Results The questionnaire distinguished reliably between groups with different expertise in evidence based medicine. Experts attained a threefold higher average score than students. Postgraduates who had not attended a course performed better than students but significantly worse than experts. Knowledge and skills in evidence