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Sample records for accp evidence-based clinical

  1. Medical therapy for pulmonary arterial hypertension: updated ACCP evidence-based clinical practice guidelines.

    PubMed

    Badesch, David B; Abman, Steven H; Simonneau, Gerald; Rubin, Lewis J; McLaughlin, Vallerie V

    2007-06-01

    A consensus panel convened by the American College of Chest Physicians developed guidelines for the treatment of pulmonary arterial hypertension (PAH) that were published in 2004. Subsequently, several important clinical trials have been published, and new treatments have received regulatory approval. In addition, add-on and combination therapy are being explored, which promise to open new therapeutic avenues. This article, taking into consideration studies published prior to September 1, 2006, provides an update to the previously published guidelines. The original guidelines have been summarized, a discussion of new studies has been added, and the treatment algorithm has been revised to take into account recent developments in therapy. This update provides evidence-based treatment recommendations for physicians involved in the care of patients with PAH. Due to the complexity of the diagnostic evaluation required and the treatment options available, referral of patients with PAH to a specialized center continues to be strongly recommended.

  2. Medical therapy for pulmonary arterial hypertension: ACCP evidence-based clinical practice guidelines.

    PubMed

    Badesch, David B; Abman, Steve H; Ahearn, Gregory S; Barst, Robyn J; McCrory, Douglas C; Simonneau, Gerald; McLaughlin, Vallerie V

    2004-07-01

    Pulmonary arterial hypertension (PAH) is often difficult to diagnose and challenging to treat. Untreated, it is characterized by a progressive increase in pulmonary vascular resistance leading to right ventricular failure and death. The past decade has seen remarkable improvements in therapy, driven largely by the conduct of randomized controlled trials. Still, the selection of most appropriate therapy is complex, and requires familiarity with the disease process, evidence from treatment trials, complicated drug delivery systems, dosing regimens, side effects, and complications. This chapter will provide evidence-based treatment recommendations for physicians involved in the care of these complex patients. Due to the complexity of the diagnostic evaluation required, and the treatment options available, it is strongly recommended that consideration be given to referral of patients with PAH to a specialized center.

  3. Preparing clinical pharmacy scientists for careers in clinical/translational research: can we meet the challenge?: ACCP Research Affairs Committee Commentary.

    PubMed

    Parker, Robert B; Ellingrod, Vicki; DiPiro, Joseph T; Bauman, Jerry L; Blouin, Robert A; Welage, Lynda S

    2013-12-01

    Developing clinical pharmacists' research skills and their ability to compete for extramural funding is an important component of the American College of Clinical Pharmacy's (ACCP) vision for pharmacists to play a prominent role in generating the new knowledge used to guide patient pharmacotherapy. Given the recent emphasis on clinical/translational research at the National Institutes of Health (NIH) and the key role of drug therapy in the management of many diseases, there is an unprecedented opportunity for the profession to contribute to this enterprise. A crucial question facing the profession is whether we can generate enough appropriately trained scientists to take advantage of these opportunities to generate the new knowledge to advance drug therapy. Since the 2009 publication of the ACCP Research Affairs Committee editorial recommending the Ph.D. degree (as opposed to fellowship training) as the optimal method for preparing pharmacists as clinical/translational scientists, significant changes have occurred in the economic, professional, political, and research environments. As a result, the 2012 ACCP Research Affairs Committee was charged with reexamining the college's position on training clinical pharmacy scientists in the context of these substantial environmental changes. In this commentary, the potential impact of these changes on opportunities for pharmacists in clinical/translational research are discussed as are strategies for ACCP, colleges of pharmacy, and the profession to increase the number and impact of clinical pharmacy scientists. Failure of our profession to take advantage of these opportunities risks our ability to contribute substantively to the biomedical research enterprise and ultimately improve the pharmacotherapy of our patients.

  4. Evaluating the performance of clinical pharmacy faculty: putting the ACCP template to use.

    PubMed

    Schumock, G T; Crawford, S Y; Giusto, D A; Hutchinson, R A

    1993-01-01

    The responsibilities of clinical faculty members are often multifaceted and may include direct patient care, didactic and experiential teaching, research, and administrative duties. Specialization, poorly defined standards of care, and lack of direct supervision have traditionally made performance evaluation difficult. We implemented a method to evaluate clinical faculty as they carried out patient care activities using a revised template for the evaluation of a clinical pharmacist developed by the American College of Clinical Pharmacy Clinical Practice Affairs Committee. In addition, it allows individuals to report and evaluate their own performance in the areas of patient care, instructional activity, university and public service, research and scholarly activities, and administrative duties. Teaching evaluations from clerkship students and residents are also submitted and assessed during the annual interview. To determine the usefulness of the evaluation, including the template, we surveyed the opinions of clinical faculty (nontenured) at four primary practice sites (response rate 92%). Mean scores for responses suggested agreement with statements as to the merits of the evaluation system; however, there was some variation among practice sites. Incorporating the template into a broad evaluation system was effective in facilitating improved job performance and career development. Adaptation of the template may be practice site dependent and should be coordinated by a participative approach. Additional assessment may be facilitated by physician, nurse, or peer evaluation.

  5. The 2016 ACCP Pharmacotherapy Didactic Curriculum Toolkit.

    PubMed

    Schwinghammer, Terry L; Crannage, Andrew J; Boyce, Eric G; Bradley, Bridget; Christensen, Alyssa; Dunnenberger, Henry M; Fravel, Michelle; Gurgle, Holly; Hammond, Drayton A; Kwon, Jennifer; Slain, Douglas; Wargo, Kurt A

    2016-11-01

    The 2016 American College of Clinical Pharmacy (ACCP) Educational Affairs Committee was charged with updating and contemporizing ACCP's 2009 Pharmacotherapy Didactic Curriculum Toolkit. The toolkit has been designed to guide schools and colleges of pharmacy in developing, maintaining, and modifying their curricula. The 2016 committee reviewed the recent medical literature and other documents to identify disease states that are responsive to drug therapy. Diseases and content topics were organized by organ system, when feasible, and grouped into tiers as defined by practice competency. Tier 1 topics should be taught in a manner that prepares all students to provide collaborative, patient-centered care upon graduation and licensure. Tier 2 topics are generally taught in the professional curriculum, but students may require additional knowledge or skills after graduation (e.g., residency training) to achieve competency in providing direct patient care. Tier 3 topics may not be taught in the professional curriculum; thus, graduates will be required to obtain the necessary knowledge and skills on their own to provide direct patient care, if required in their practice. The 2016 toolkit contains 276 diseases and content topics, of which 87 (32%) are categorized as tier 1, 133 (48%) as tier 2, and 56 (20%) as tier 3. The large number of tier 1 topics will require schools and colleges to use creative pedagogical strategies to achieve the necessary practice competencies. Almost half of the topics (48%) are tier 2, highlighting the importance of postgraduate residency training or equivalent practice experience to competently care for patients with these disorders. The Pharmacotherapy Didactic Curriculum Toolkit will continue to be updated to provide guidance to faculty at schools and colleges of pharmacy as these academic pharmacy institutions regularly evaluate and modify their curricula to keep abreast of scientific advances and associated practice changes. Access the

  6. Hematology/Oncology Pharmacy Association Entry-level Competencies Task Force Response Statement to the 2016 American College of Clinical Pharmacy (ACCP) Pharmacotherapy Didactic Curriculum Toolkit.

    PubMed

    Nightingale, Ginah; Saunders, Ila M; Comeau, Jill M; Fancher, Karen; Miller, Tim; O'Bryant, Cindy; Yeh, Jason

    2017-03-01

    As more disease states have an increasing number of therapeutic options, pharmacy schools are continuously challenged to provide pharmacy students with a comprehensive education in a finite amount of time. It is particularly challenging to determine which diseases and associated therapeutic options should be included in the curriculum. The 2016 ACCP Pharmacotherapy Didactic Curriculum Toolkit seeks to provide clarity and guidance to schools and colleges of pharmacy to assist with curricular development.(1) Oncologic disorders are a vital part of the pharmacy curricula and are taught in the majority of colleges of pharmacy in the United States in the didactic and experiential setting.(2) This article is protected by copyright. All rights reserved.

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

    ERIC Educational Resources Information Center

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

    2013-01-01

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

  8. Deterministic versus evidence-based attitude towards clinical diagnosis.

    PubMed

    Soltani, Akbar; Moayyeri, Alireza

    2007-08-01

    Generally, two basic classes have been proposed for scientific explanation of events. Deductive reasoning emphasizes on reaching conclusions about a hypothesis based on verification of universal laws pertinent to that hypothesis, while inductive or probabilistic reasoning explains an event by calculation of some probabilities for that event to be related to a given hypothesis. Although both types of reasoning are used in clinical practice, evidence-based medicine stresses on the advantages of the second approach for most instances in medical decision making. While 'probabilistic or evidence-based' reasoning seems to involve more mathematical formulas at the first look, this attitude is more dynamic and less imprisoned by the rigidity of mathematics comparing with 'deterministic or mathematical attitude'. In the field of medical diagnosis, appreciation of uncertainty in clinical encounters and utilization of likelihood ratio as measure of accuracy seem to be the most important characteristics of evidence-based doctors. Other characteristics include use of series of tests for refining probability, changing diagnostic thresholds considering external evidences and nature of the disease, and attention to confidence intervals to estimate uncertainty of research-derived parameters.

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

    PubMed

    Raditic, Donna M; Bartges, Joseph W

    2014-09-01

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

  10. Response: Clinical wisdom and evidence-based medicine are complementary.

    PubMed

    De Freitas, Julian; Haque, Omar S; Gopal, Abilash A; Bursztajn, Harold J

    2012-01-01

    A long-debated question in the philosophy of health, and contingent disciplines, is the extent to which wise clinical practice ("clinical wisdom") is, or could be, compatible with empirically validated medicine ("evidence-based medicine"--EBM). Here we respond to Baum-Baicker and Sisti, who not only suggest that these two types of knowledge are divided due to their differing sources, but also that EBM can sometimes even hurt wise clinical practice. We argue that the distinction between EBM and clinical wisdom is poorly defined, unsupported by the methodology employed, and ultimately incorrect; crucial differences exist, we argue, not in the source of a particular piece of clinical knowledge, but in its dependability. In light of this subtle but fundamental revision, we explain how clinical wisdom and EBM are--by necessity--complementary, rather than in conflict. We elaborate on how recognizing this relationship can have far-reaching implications for the domains of clinical practice, medical education, and health policy.

  11. Evidence-based clinical practice guidelines for liver cirrhosis 2015.

    PubMed

    Fukui, Hiroshi; Saito, Hidetsugu; Ueno, Yoshiyuki; Uto, Hirofumi; Obara, Katsutoshi; Sakaida, Isao; Shibuya, Akitaka; Seike, Masataka; Nagoshi, Sumiko; Segawa, Makoto; Tsubouchi, Hirohito; Moriwaki, Hisataka; Kato, Akinobu; Hashimoto, Etsuko; Michitaka, Kojiro; Murawaki, Toshikazu; Sugano, Kentaro; Watanabe, Mamoru; Shimosegawa, Tooru

    2016-07-01

    The Japanese Society of Gastroenterology revised the evidence-based clinical practice guidelines for liver cirrhosis in 2015. Eighty-three clinical questions were selected, and a literature search was performed for the clinical questions with use of the MEDLINE, Cochrane, and Igaku Chuo Zasshi databases for the period between 1983 and June 2012. Manual searching of the latest important literature was added until August 2015. The guidelines were developed with use of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. This digest version in English introduces selected clinical questions and statements related to the management of liver cirrhosis and its complications. Branched-chain amino acids relieve hypoalbuminemia and hepatic encephalopathy and improve quality of life. Nucleoside analogues and peginterferon plus ribavirin combination therapy improve the prognosis of patients with hepatitis B virus related liver cirrhosis and hepatitis C related compensated liver cirrhosis, respectively, although the latter therapy may be replaced by direct-acting antivirals. For liver cirrhosis caused by primary biliary cirrhosis and active autoimmune hepatitis, urosodeoxycholic acid and steroid are recommended, respectively. The most adequate modalities for the management of variceal bleeding are the endoscopic injection sclerotherapy for esophageal varices and the balloon-occluded retrograde transvenous obliteration following endoscopic obturation with cyanoacrylate for gastric varices. Beta-blockers are useful for primary prophylaxis of esophageal variceal bleeding. The V2 receptor antagonist tolvaptan is a useful add-on therapy in careful diuretic therapy for ascites. Albumin infusion is useful for the prevention of paracentesis-induced circulatory disturbance and renal failure. In addition to disaccharides, the nonabsorbable antibiotic rifaximin is useful for the management of encephalopathy. Anticoagulation therapy is proposed for

  12. Evidence-based clinical practice, [corrected] evidence-based medicine and the Cochrane collaboration.

    PubMed

    Gambrill, E

    1999-03-01

    Encouraging professionals in training and later to consider practice-related research findings when making important clinical decisions is an on-going concern. Evidenced-Based Medicine (EBM) and the Cochrane Collaboration (CC) provide a source of tools and ideas for doing so, as well as a roster of colleagues who share this interest. Evidenced-based medicine involves integrating clinical expertise with the best available external evidence from systematic research as well as considering the values and expectations of patients/clients. Advantage can be taken of educational formats developed in EBM, such as problem-based learning and critical-appraisal workshops in which participants learn how to ask key answerable questions related to important clinical practice questions (e.g., regarding effectiveness, accuracy of assessment measures, prediction, prevention, and quality of clinical practice guidelines) and to access and critically appraise related research. The Cochrane Collaboration is a world-wide network of centers that prepare, maintain, and disseminate high-quality systematic reviews on the efficacy of healthcare. These databases allow access to evidence related to clinical practice decisions. Forging reciprocal working relationships with those involved in EBM reciprocal and the CC should contribute to the pursuit of shared goals such as basing clinical decisions on the best-available evidence and involving clients as informed consumers.

  13. Clinical data warehousing for evidence based decision making.

    PubMed

    Narra, Lekha; Sahama, Tony; Stapleton, Peta

    2015-01-01

    Large volumes of heterogeneous health data silos pose a big challenge when exploring for information to allow for evidence based decision making and ensuring quality outcomes. In this paper, we present a proof of concept for adopting data warehousing technology to aggregate and analyse disparate health data in order to understand the impact various lifestyle factors on obesity. We present a practical model for data warehousing with detailed explanation which can be adopted similarly for studying various other health issues.

  14. Toward clinical scholarship: promoting evidence-based practice in the clinical setting.

    PubMed

    Mohide, E Ann; Coker, Esther

    2005-01-01

    Organizational interventions are being suggested to increase the rate of quality research dissemination and uptake. This article describes how one tertiary institution is using an evidence-based nursing (EBN) committee as an organizational strategy to shift its nursing culture toward clinical scholarship. A number of approaches and activities that have stimulated the movement toward evidence-based practice (EBP) are examined: organizational commitment to EBP, strategic positioning of the EBN committee within nursing's administrative structure, articulation of a mission, conceptualization of a model for EBN practice, learning on the job, selection and adoption of an evidence-based model for implementing change, marketing for a change in culture toward clinical scholarship, and other selected examples of projects undertaken by the committee. Action-oriented principles associated with committee experiences are related to the approaches and activities.

  15. Evidence-based review of clinical studies on pulpotomy.

    PubMed

    2009-08-01

    Although pulpotomy procedures have a long history of clinical application, comparatively few dental clinical trials have evaluated this treatment approach. In this section, we provide an analysis of recent clinical studies evaluating pulpotomy procedures in dental patients.

  16. Nurse practitioner clinical decision-making and evidence-based practice.

    PubMed

    Vincent, Deborah; Hastings-Tolsma, Marie; Gephart, Sheila; Alfonzo, Paige M

    2015-05-15

    Evidence-based practice is key to improving patient outcomes but can be challenging for busy nurse practitioners to implement. This article describes the process of critically appraising evidence for use in clinical practice and offers strategies for implementing evidence-based innovations and disseminating the findings.

  17. [The historical background and present development of evidence-based healthcare and clinical nursing].

    PubMed

    Tsai, Jung-Mei

    2014-12-01

    Evidence-based healthcare (EBHC) emphasizes the integration of the best research evidence with patient values, specialist suggestions, and clinical circumstances during the process of clinical decision-making. EBHC is a recognized core competency in modern healthcare. Nursing is a professional discipline of empirical science that thrives in an environment marked by advances in knowledge and technology in medicine as well as in nursing. Clinical nurses must elevate their skills and professional qualifications, provide efficient and quality health services, and promote their proficiency in EBHC. The Institute of Medicine in the United States indicates that evidence-based research results often fail to disseminate efficiently to clinical decision makers. This problem highlights the importance of better promoting the evidence-based healthcare fundamentals and competencies to frontline clinical nurses. This article describes the historical background and present development of evidence-based healthcare from the perspective of modern clinical nursing in light of the importance of evidence-based healthcare in clinical nursing; describes the factors associated with evidence-based healthcare promotion; and suggests strategies and policies that may improve the promotion and application of EBHC in clinical settings. The authors hope that this paper provides a reference for efforts to improve clinical nursing in the realms of EBHC training, promotion, and application.

  18. Clinical use of Skype: a review of the evidence base.

    PubMed

    Armfield, Nigel R; Gray, Leonard C; Smith, Anthony C

    2012-04-01

    Skype is a popular and free software application that allows PCs and mobile devices to be used for video communication over the Internet. We reviewed the literature to determine whether the clinical use of Skype is supported by evidence. One small (n = 7) controlled clinical trial had assessed the effect of nursing communication using Skype on elderly patients with dementia and their carers. However, we were unable to identify any large, well-designed studies which had formally evaluated the safety, clinical effectiveness, security and privacy of Skype for the routine delivery of patient care. While there were many case reports and small studies, no firm evidence either in favour of, or against the use of Skype for clinical telehealth was found. The risks and benefits of using Skype for clinical purposes are not known.

  19. Towards automated calculation of evidence-based clinical scores

    PubMed Central

    Aakre, Christopher A; Dziadzko, Mikhail A; Herasevich, Vitaly

    2017-01-01

    AIM To determine clinical scores important for automated calculation in the inpatient setting. METHODS A modified Delphi methodology was used to create consensus of important clinical scores for inpatient practice. A list of 176 externally validated clinical scores were identified from freely available internet-based services frequently used by clinicians. Scores were categorized based on pertinent specialty and a customized survey was created for each clinician specialty group. Clinicians were asked to rank each score based on importance of automated calculation to their clinical practice in three categories - “not important”, “nice to have”, or “very important”. Surveys were solicited via specialty-group listserv over a 3-mo interval. Respondents must have been practicing physicians with more than 20% clinical time spent in the inpatient setting. Within each specialty, consensus was established for any clinical score with greater than 70% of responses in a single category and a minimum of 10 responses. Logistic regression was performed to determine predictors of automation importance. RESULTS Seventy-nine divided by one hundred and forty-four (54.9%) surveys were completed and 72/144 (50%) surveys were completed by eligible respondents. Only the critical care and internal medicine specialties surpassed the 10-respondent threshold (14 respondents each). For internists, 2/110 (1.8%) of scores were “very important” and 73/110 (66.4%) were “nice to have”. For intensivists, no scores were “very important” and 26/76 (34.2%) were “nice to have”. Only the number of medical history (OR = 2.34; 95%CI: 1.26-4.67; P < 0.05) and vital sign (OR = 1.88; 95%CI: 1.03-3.68; P < 0.05) variables for clinical scores used by internists was predictive of desire for automation. CONCLUSION Few clinical scores were deemed “very important” for automated calculation. Future efforts towards score calculator automation should focus on technically feasible

  20. Evidence-based clinical practice guidelines for chronic pancreatitis 2015.

    PubMed

    Ito, Tetsuhide; Ishiguro, Hiroshi; Ohara, Hirotaka; Kamisawa, Terumi; Sakagami, Junichi; Sata, Naohiro; Takeyama, Yoshifumi; Hirota, Morihisa; Miyakawa, Hiroyuki; Igarashi, Hisato; Lee, Lingaku; Fujiyama, Takashi; Hijioka, Masayuki; Ueda, Keijiro; Tachibana, Yuichi; Sogame, Yoshio; Yasuda, Hiroaki; Kato, Ryusuke; Kataoka, Keisho; Shiratori, Keiko; Sugiyama, Masanori; Okazaki, Kazuichi; Kawa, Shigeyuki; Tando, Yusuke; Kinoshita, Yoshikazu; Watanabe, Mamoru; Shimosegawa, Tooru

    2016-02-01

    Chronic pancreatitis is considered to be an irreversible progressive chronic inflammatory disease. The etiology and pathology of chronic pancreatitis are complex; therefore, it is important to correctly understand the stage and pathology and provide appropriate treatment accordingly. The newly revised Clinical Practice Guidelines of Chronic Pancreatitis 2015 consist of four chapters, i.e., diagnosis, staging, treatment, and prognosis, and includes a total of 65 clinical questions. These guidelines have aimed at providing certain directions and clinically practical contents for the management of chronic pancreatitis, preferentially adopting clinically useful articles. These revised guidelines also refer to early chronic pancreatitis based on the Criteria for the Diagnosis of Chronic Pancreatitis 2009. They include such items as health insurance coverage of high-titer lipase preparations and extracorporeal shock wave lithotripsy, new antidiabetic drugs, and the definition of and treatment approach to pancreatic pseudocyst. The accuracy of these guidelines has been improved by examining and adopting new evidence obtained after the publication of the first edition.

  1. Spirulina in clinical practice: evidence-based human applications.

    PubMed

    Karkos, P D; Leong, S C; Karkos, C D; Sivaji, N; Assimakopoulos, D A

    2011-01-01

    Spirulina or Arthrospira is a blue-green alga that became famous after it was successfully used by NASA as a dietary supplement for astronauts on space missions. It has the ability to modulate immune functions and exhibits anti-inflammatory properties by inhibiting the release of histamine by mast cells. Multiple studies investigating the efficacy and the potential clinical applications of Spirulina in treating several diseases have been performed and a few randomized controlled trials and systematic reviews suggest that this alga may improve several symptoms and may even have an anticancer, antiviral and antiallergic effects. Current and potential clinical applications, issues of safety, indications, side-effects and levels of evidence are addressed in this review. Areas of ongoing and future research are also discussed.

  2. Anemia, Heart Failure and Evidence-Based Clinical management

    PubMed Central

    Pereira, Camila Alves; Roscani, Meliza Goi; Zanati, Silméia Garcia; Matsubara, Beatriz Bojikian

    2013-01-01

    Anemia is a prevalent comorbidity and marker of a poorer prognosis in patients with heart failure (HF). Its clinical relevance, as well as its pathophysiology and the clinical management of these patients are important subjects in the specialized literature. In the present review, we describe the current concepts on the pathophysiology of anemia in HF, its diagnostic criteria, and the recommendations for iron supplementation. Also, we make a critical analysis of the major studies showing evidences on the benefits of this supplementation. The four main components of anemia are addressed: chronic disease, dilutional, "renal" and malabsorption. In patients with HF, the diagnostic criteria are the same as those used in the general population: serum ferritin levels lower than 30 mcg/L in patients without kidney diseases and lower than 100 mcg/L or serum ferritin levels between 100-299 mcg/L with transferring saturation lower than 20% in patients with chronic kidney diseases. Finally, the therapeutic possibilities for anemia in this specific patient population are discussed. PMID:23917508

  3. Evidence-based clinical use of insulin premixtures

    PubMed Central

    2013-01-01

    Brazil is expected to have 19.6 million patients with diabetes by the year 2030. A key concept in the treatment of type 2 diabetes mellitus (T2DM) is establishing individualized glycemic goals based on each patient’s clinical characteristics, which impact the choice of antihyperglycemic therapy. Targets for glycemic control, including fasting blood glucose, postprandial blood glucose, and glycated hemoglobin (A1C), are often not reached solely with antihyperglycemic therapy, and insulin therapy is often required. Basal insulin is considered an initial strategy; however, premixed insulins are convenient and are equally or more effective, especially for patients who require both basal and prandial control but desire a more simplified strategy involving fewer daily injections than a basal-bolus regimen. Most physicians are reluctant to transition patients to insulin treatment due to inappropriate assumptions and insufficient information. We conducted a nonsystematic review in PubMed and identified the most relevant and recently published articles that compared the use of premixed insulin versus basal insulin analogues used alone or in combination with rapid-acting insulin analogues before meals in patients with T2DM. These studies suggest that premixed insulin analogues are equally or more effective in reducing A1C compared to basal insulin analogues alone in spite of the small increase in the risk of nonsevere hypoglycemic events and nonclinically significant weight gain. Premixed insulin analogues can be used in insulin-naïve patients, in patients already on basal insulin therapy, and those using basal-bolus therapy who are noncompliant with blood glucose self-monitoring and titration of multiple insulin doses. We additionally provide practical aspects related to titration for the specific premixed insulin analogue formulations commercially available in Brazil. PMID:24011173

  4. Clinical expert facilitators of evidence-based practice: a community hospital program.

    PubMed

    Rutledge, Dana N; Skelton, Katie

    2011-01-01

    A 1-year program for select clinical nurse experts led to increased comfort in using evidence-based practice strategies. Nurses identified specific barriers and facilitators for evidence-based practice efforts, accomplished individual goals, and saw changes in their practice roles. Results from the program and its evaluation are that staff can benefit from such an effort (4-day course with specific follow-up activities).

  5. [Evidence-Based Knowledge Translation: From Scientific Evidence to Clinical Nursing Practice].

    PubMed

    Chen, Kee-Hsin; Kao, Ching-Chiu; Chen, Chiehfeng

    2016-12-01

    In 1992, Gordon Guyatt coined the term "evidence-based medicine", which has since attracted worldwide attention. In 2007, the Institute of Medicine's Roundtable on Evidence-Based Medicine set the goal that 90% of clinical decisions would be supported by accurate, timely, and up-to-date clinical information and would reflect the best available evidence by 2020. However, the chasm between knowing and doing remains palpable. In 2000, the Canadian Institute of Health Research applied the term "knowledge translation" to describe the bridge that is necessary to cross the gap between research knowledge and clinical practice. The present paper outlines the conceptual framework, barriers, and promotion strategies for evidence-based knowledge translation and shares clinical experience related to overcoming the seven layers of leakage (aware, accepted, applicable, able, acted on, agreed, and adhered to). We hope that this paper can enhance the public well-being and strengthen the future health care system.

  6. Description of a Standardized Treatment Center That Utilizes Evidence-Based Clinic Operations to Facilitate Implementation of an Evidence-Based Treatment

    PubMed Central

    Donohue, Brad; Allen, Daniel N.; Romero, Valerie; Hill, Heather H.; Vasaeli, Kathryn; Lapota, Holly; Tracy, Kendra; Gorney, Suzanne; Abdel-al, Ruweida; Caldas, Diana; Herdzik, Karen; Bradshaw, Kelsey; Valdez, Robby; Van Hasselt, Vincent B.

    2012-01-01

    Developers of evidence-based therapies are enhancing methods of teaching therapists to implement “best practices” with integrity. However, there is a relative dearth of information available as to clinic operations and related contextual factors necessary to sustain successful implementation of these treatments. This article describes various evidence-based administrative strategies and methods utilized by clinic staff to effectively implement a comprehensive evidence-based treatment for substance abuse (i.e., Family Behavior Therapy). The basic structure of the clinic, standardized behavioral methods associated with its day-to-day operations, and maintenance of treatment integrity are delineated. Infrastructural systems are underscored, including clinical record keeping, quality assurance, and staff management. PMID:19535671

  7. Evidence-Based Youth Psychotherapies Versus Usual Clinical Care: A Meta-Analysis of Direct Comparisons

    ERIC Educational Resources Information Center

    Weisz, John R.; Jensen-Doss, Amanda; Hawley, Kristin M.

    2006-01-01

    In the debate over evidence-based treatments (EBTs) for youth, one question is central: Do EBTs produce better outcomes than the usual interventions employed in clinical care? The authors addressed this question through a meta-analysis of 32 randomized trials that directly compared EBTs with usual care. EBTs outperformed usual care. Effects fell…

  8. Evidence-Based Practice for Children with Speech Sound Disorders: Part 2 Application to Clinical Practice

    ERIC Educational Resources Information Center

    Baker, Elise; McLeod, Sharynne

    2011-01-01

    Purpose: This article provides both a tutorial and a clinical example of how speech-language pathologists (SLPs) can conduct evidence-based practice (EBP) when working with children with speech sound disorders (SSDs). It is a companion paper to the narrative review of 134 intervention studies for children who have an SSD (Baker & McLeod, 2011).…

  9. An Evidence-Based Practice Model across the Academic and Clinical Settings

    ERIC Educational Resources Information Center

    Wolter, Julie A.; Corbin-Lewis, Kim; Self, Trisha; Elsweiler, Anne

    2011-01-01

    This tutorial is designed to provide academic communication sciences and disorders (CSD) programs, at both the undergraduate and graduate levels, with a comprehensive instructional model on evidence-based practice (EBP). The model was designed to help students view EBP as an ongoing process needed in all clinical decision making. The three facets…

  10. Clinical Decision Support Systems for the Practice of Evidence-based Medicine

    PubMed Central

    Sim, Ida; Gorman, Paul; Greenes, Robert A.; Haynes, R. Brian; Kaplan, Bonnie; Lehmann, Harold; Tang, Paul C.

    2001-01-01

    Background: The use of clinical decision support systems to facilitate the practice of evidence-based medicine promises to substantially improve health care quality. Objective: To describe, on the basis of the proceedings of the Evidence and Decision Support track at the 2000 AMIA Spring Symposium, the research and policy challenges for capturing research and practice-based evidence in machine-interpretable repositories, and to present recommendations for accelerating the development and adoption of clinical decision support systems for evidence-based medicine. Results: The recommendations fall into five broad areas—capture literature-based and practice-based evidence in machine-interpretable knowledge bases; develop maintainable technical and methodological foundations for computer-based decision support; evaluate the clinical effects and costs of clinical decision support systems and the ways clinical decision support systems affect and are affected by professional and organizational practices; identify and disseminate best practices for work flow–sensitive implementations of clinical decision support systems; and establish public policies that provide incentives for implementing clinical decision support systems to improve health care quality. Conclusions: Although the promise of clinical decision support system–facilitated evidence-based medicine is strong, substantial work remains to be done to realize the potential benefits. PMID:11687560

  11. Development of an evidence-based clinical practice guideline on linear growth measurement of children.

    PubMed

    Foote, Jan M; Brady, Linda H; Burke, Amber L; Cook, Jennifer S; Dutcher, Mary E; Gradoville, Kathleen M; Groos, Jennifer A; Kinkade, Kimberly M; Meeks, Reylon A; Mohr, Pamela J; Schultheis, Debra S; Walker, Brenda S; Phillips, Kirk T

    2011-08-01

    Growth is an important indicator of child health; however, measurements are frequently inaccurate and unreliable. This article reviews the literature on linear growth measurement error and describes methods used to develop and evaluate an evidence-based clinical practice guideline on the measurement of recumbent length and stature of infants, children, and adolescents. Systematic methods were used to identify evidence to answer clinical questions about growth measurement. A multidisciplinary team critically appraised and synthesized the evidence to develop clinical practice recommendations using an evidence-based practice rating scheme. The guideline was prospectively evaluated through internal and external reviews and a pilot study to ensure its validity and reliability. Adoption of the clinical practice guideline can improve the accuracy and reliability of growth measurement data.

  12. Clinical Teachers' Attitudes toward the Efficacy of Evidence-Based Medicine Workshop and Self-Reported Ability in Evidence-Based Practice in Iran

    ERIC Educational Resources Information Center

    Kouhpayehzadeh, Jalil; Baradaran, Hamid; Arabshahi, Kamran Soltani; Knill-Jones, Robin

    2006-01-01

    Introduction: Evidence-based medicine (EBM) has been introduced in medical schools worldwide, but there is little known about effective methods for teaching EBM skills, particularly in developing countries. This study assesses the impact of an EBM workshop on clinical teachers' attitudes and use of EBM skills. Methods: Seventy-two clinical…

  13. Description of a Standardized Treatment Center that Utilizes Evidence-Based Clinic Operations to Facilitate Implementation of an Evidence-Based Treatment

    ERIC Educational Resources Information Center

    Donohue, Brad; Allen, Daniel N.; Romero, Valerie; Hill, Heather H.; Vasaeli, Kathryn; Lapota, Holly; Tracy, Kendra; Gorney, Suzanne; Abdel-al, Ruweida; Caldas, Diana; Herdzik, Karen; Bradshaw, Kelsey; Valdez, Robby; Van Hasselt, Vincent B.

    2009-01-01

    Developers of evidence-based therapies are enhancing methods of teaching therapists to implement "best practices" with integrity. However, there is a relative dearth of information available as to clinic operations and related contextual factors necessary to sustain successful implementation of these treatments. This article describes various…

  14. Evaluating research for clinical significance: using critically appraised topics to enhance evidence-based neuropsychology.

    PubMed

    Bowden, Stephen C; Harrison, Elise J; Loring, David W

    2014-01-01

    Meehl's (1973, Psychodiagnosis: Selected papers. Minneapolis: University of Minnesota Press) distinction between statistical and clinical significance holds special relevance for evidence-based neuropsychological practice. Meehl argued that despite attaining statistical significance, many published findings have limited practical value since they do not inform clinical care. In the context of an ever expanding clinical research literature, accessible methods to evaluate clinical impact are needed. The method of Critically Appraised Topics (Straus, Richardson, Glasziou, & Haynes, 2011, Evidence-based medicine: How to practice and teach EBM (4th ed.). Edinburgh: Elsevier Churchill-Livingstone) was developed to provide clinicians with a "toolkit" to facilitate implementation of evidence-based practice. We illustrate the Critically Appraised Topics method using a dementia screening example. We argue that the skills practiced through critical appraisal provide clinicians with methods to: (1) evaluate the clinical relevance of new or unfamiliar research findings with a focus on patient benefit, (2) help focus of research quality, and (3) incorporate evaluation of clinical impact into educational and professional development activities.

  15. Advancing the Scientific Foundation for Evidence-Based Practice in Clinical Child and Adolescent Psychology.

    PubMed

    Roberts, Michael C; Blossom, Jennifer B; Evans, Spencer C; Amaro, Christina M; Kanine, Rebecca M

    2016-05-24

    Evidence-based practice (EBP) has become a central focus in clinical child and adolescent psychology. As originally defined, EBP in psychology is the integration of the best available research evidence, patient characteristics, and clinical expertise. Although evidence-based perspectives have garnered widespread acceptance in recent years, there has also been some confusion and disagreement about the 3-part definition of EBP, particularly the role of research. In this article, we first provide a brief review of the development of EBP in clinical child and adolescent psychology. Next, we outline the following 4 points to help clarify the understanding of EBP: (a) knowledge should not be confused with epistemic processes, (b) research on clinician and client factors is needed for EBP, (c) research on assessment is needed for EBP, and (d) the 3-part conceptualization of EBP can serve as a useful framework to guide research. Based on these principles, we put forth a slightly revised conceptualization of EBP, in which the role of research is expanded and more clearly operationalized. Finally, based on our review of the literature, we offer illustrative examples of specific directions for future research to advance the evidence base for EBP in clinical child and adolescent psychology.

  16. Improving the Evidence Base for Treating Older Adults With Cancer: American Society of Clinical Oncology Statement.

    PubMed

    Hurria, Arti; Levit, Laura A; Dale, William; Mohile, Supriya G; Muss, Hyman B; Fehrenbacher, Louis; Magnuson, Allison; Lichtman, Stuart M; Bruinooge, Suanna S; Soto-Perez-de-Celis, Enrique; Tew, William P; Postow, Michael A; Cohen, Harvey J

    2015-11-10

    The American Society of Clinical Oncology (ASCO) convened a subcommittee to develop recommendations on improving the evidence base for treating older adults with cancer in response to a critical need identified by the Institute of Medicine. Older adults experience the majority of cancer diagnoses and deaths and make up the majority of cancer survivors. Older adults are also the fastest growing segment of the US population. However, the evidence base for treating this population is sparse, because older adults are underrepresented in clinical trials, and trials designed specifically for older adults are rare. The result is that clinicians have less evidence on how to treat older adults, who represent the majority of patients with cancer. Clinicians and patients are forced to extrapolate from trials conducted in younger, healthier populations when developing treatment plans. This has created a dearth of knowledge regarding the risk of toxicity in the average older patient and about key end points of importance to older adults. ASCO makes five recommendations to improve evidence generation in this population: (1) Use clinical trials to improve the evidence base for treating older adults with cancer, (2) leverage research designs and infrastructure for generating evidence on older adults with cancer, (3) increase US Food and Drug Administration authority to incentivize and require research involving older adults with cancer, (4) increase clinicians' recruitment of older adults with cancer to clinical trials, and (5) use journal policies to improve researchers' reporting on the age distribution and health risk profiles of research participants.

  17. Non-clinical influences on clinical decision-making: a major challenge to evidence-based practice

    PubMed Central

    Hajjaj, FM; Salek, MS; Basra, MKA; Finlay, AY

    2010-01-01

    Summary This article reviews an aspect of daily clinical practice which is of critical importance in virtually every clinical consultation, but which is seldom formally considered. Non-clinical influences on clinical decision-making profoundly affect medical decisions. These influences include patient-related factors such as socioeconomic status, quality of life and patient's expectations and wishes, physician-related factors such as personal characteristics and interaction with their professional community, and features of clinical practice such as private versus public practice as well as local management policies. This review brings together the different strands of knowledge concerning non-clinical influences on clinical decision-making. This aspect of decision-making may be the biggest obstacle to the reality of practising evidence-based medicine. It needs to be understood in order to develop clinical strategies that will facilitate the practice of evidence-based medicine. PMID:20436026

  18. Improving the Implementation of Evidence-Based Clinical Practices in Adolescent Reproductive Health Care Services

    PubMed Central

    Romero, Lisa M.; Middleton, Dawn; Mueller, Trisha; Avellino, Lia; Hallum-Montes, Rachel

    2015-01-01

    Purpose The purposes of the study were to describe baseline data in the implementation of evidence-based clinical practices among health center partners as part of a community-wide teen pregnancy prevention initiative and to identify opportunities for health center improvement. Methods Health center partner baseline data were collected in the first year (2011) and before program implementation of a 5-year community-wide teen pregnancy prevention initiative. A needs assessment on health center capacity and implementation of evidence-based clinical practices was administered with 51 health centers partners in 10 communities in the United States with high rates of teen pregnancy. Results Health centers reported inconsistent implementation of evidence-based clinical practices in providing reproductive health services to adolescents. Approximately 94.1% offered same-day appointments, 91.1% had infrastructure to reduce cost barriers, 90.2% offered after-school appointments, and 80.4% prescribed hormonal contraception without prerequisite examinations or testing. Approximately three quarters provided visual and audio privacy in examination rooms (76.5%) and counseling areas (74.5%). Fewer offered a wide range of contraceptive methods (67.8%) and took a sexual health history at every visit (54.9%). Only 45.1% reported Quick Start initiation of hormonal contraception, emergency contraception (43.1%), or intrauterine devices (12.5%) were “always” available to adolescents. Conclusions The assessment highlighted opportunities for health center improvement. Strategies to build capacity of health center partners to implement evidence-based clinical practices may lead to accessibility and quality of reproductive health services for adolescents in the funded communities. PMID:26381918

  19. Restoration of posterior teeth in clinical practice: evidence base for choosing amalgam versus composite.

    PubMed

    Kovarik, Robert E

    2009-01-01

    This article reviews the current use of amalgam versus resin composite in posterior restorations and the evidence-base for choosing between these two treatment options. While much research has been published on the issue of the clinical use of amalgam versus resin composite, there are several issues that limit the true evidence-base on the subject. Furthermore, while the majority of published studies on posterior composites would seem to indicate equivalent clinical performance of resin composite to amalgam restorations, the studies that should be weighted much more heavily (randomized controlled trials) do not support the slant of the rest of the literature. As part of an evidence-based approach to private practice, clinicians need to be aware of the levels of evidence in the literature and need to properly inform patients of the true clinical outcomes that are associated with the use of amalgam versus resin composite for posterior restorations, so that patients are themselves making informed decisions about their dental care.

  20. Methodology for Developing Evidence-Based Clinical Imaging Guidelines: Joint Recommendations by Korean Society of Radiology and National Evidence-Based Healthcare Collaborating Agency

    PubMed Central

    Choi, Sol Ji; Jeong, Woo Kyoung; Jo, Ae Jeong; Choi, Jin A; Kim, Min-Jeong; Lee, Min; Jung, Seung Eun; Do, Kyung Hyun; Yong, Hwan Seok; Sheen, Seungsoo

    2017-01-01

    This paper is a summary of the methodology including protocol used to develop evidence-based clinical imaging guidelines (CIGs) in Korea, led by the Korean Society of Radiology and the National Evidence-based Healthcare Collaborating Agency. This is the first protocol to reflect the process of developing diagnostic guidelines in Korea. The development protocol is largely divided into the following sections: set-up, process of adaptation, and finalization. The working group is composed of clinical imaging experts, and the developmental committee is composed of multidisciplinary experts to validate the methodology. The Korean CIGs will continue to develop based on this protocol, and these guidelines will act for decision supporting tools for clinicians as well as reduce medical radiation exposure. PMID:28096730

  1. Why many clinical psychologists are resistant to evidence-based practice: root causes and constructive remedies.

    PubMed

    Lilienfeld, Scott O; Ritschel, Lorie A; Lynn, Steven Jay; Cautin, Robin L; Latzman, Robert D

    2013-11-01

    Psychotherapists are taught that when a client expresses resistance repeatedly, they must understand and address its underlying sources. Yet proponents of evidence-based practice (EBP) have routinely ignored the root causes of many clinical psychologists' reservations concerning the use of scientific evidence to inform clinical practice. As a consequence, much of the resistance to EBP persists, potentially widening the already large scientist-practitioner gap. Following a review of survey data on psychologists' attitudes toward EBP, we examine six sources underpinning resistance toward EBP in clinical psychology and allied domains: (a) naïve realism, which can lead clinicians to conclude erroneously that client change is due to an intervention itself rather than to a host of competing explanations; (b) deep-seated misconceptions regarding human nature (e.g., mistaken beliefs regarding the causal primacy of early experiences) that can hinder the adoption of evidence-based treatments; (c) statistical misunderstandings regarding the application of group probabilities to individuals; (d) erroneous apportioning of the burden of proof on skeptics rather than proponents of untested therapies; (e) widespread mischaracterizations of what EBP entails; and (f) pragmatic, educational, and attitudinal obstacles, such as the discomfort of many practitioners with evaluating the increasingly technical psychotherapy outcome literature. We advance educational proposals for articulating the importance of EBP to the forthcoming generation of clinical practitioners and researchers, and constructive remedies for addressing clinical psychologists' objections to EBP.

  2. OrthoEvidence™: A Clinical Resource for Evidence-Based Orthopedics

    PubMed Central

    Sprague, Sheila; Smith, Chris; Bhandari, Mohit

    2015-01-01

    The prevalence of musculoskeletal issues in clinical practice, and the limited focus placed upon musculoskeletal conditions by current electronic summary resources, highlights the need for a resource that provides access to simple and concise summaries of top-quality orthopedic literature for orthopedic surgeons and allied healthcare professionals. OrthoEvidence™ is an online clinical resource that addresses the paucity of adequate evidence-based summary tools in the field of orthopedic surgery. OrthoEvidence™ uses a rigorous, transparent, and unique process to review, evaluate, and summarize high quality research studies and their implications for orthopedic clinical practice. Randomized controlled trials and meta-analyses are identified and reviewed by an expert medical writing team, who prepare Advanced Clinical Evidence (ACETM) reports: one or two detailed pages including critical appraisals and synopses of key research. These timely and targeted reports provide a clear understanding about the quality of evidence associated with each summarized study, and can be organized by users to identify trending information. OrthoEvidence™ allows members to use their time efficiently and to stay current by having access to a breadth of timely, high-quality research output. OrthoEvidence™ is easily accessible through the internet and is available at the point-of-care, which allows treating orthopedic surgeons and allied health professionals to easily practice the principles of evidence-based medicine within their clinical practices.. PMID:26330990

  3. [The Usage of Auricular Acupressure in Clinical Nursing and Evidence-Based Research].

    PubMed

    Cheng, Jui-Fen; Lo, Chyi; Tzeng, Ya-Ling

    2015-12-01

    Auricular acupressure is a non-invasive physiotherapy that was developed based on the traditional Chinese meridian theory. Because it is non-invasive, simple to implement, and easy to learn, and because it presents minimal side effects and may be executed independently, this therapy may be used as an alternative or auxiliary approach to symptom management as well as to self-care. The increasing support for auricular acupressure from evidence-based research in Taiwan and elsewhere offers the opportunity to include auricular acupressure as a treatment option in evidence-based nursing interventions. Because nursing education in Taiwan is guided by Western medical concepts and principles, most nurses are not familiar with auricular acupressure, which is derived from traditional Chinese medicine. Therefore, this article not only systemically introduces the definition and theoretical basis of auricular acupressure but also includes the principles and application-related knowledge. Furthermore, this article analyzes the common problems encountered in auricular acupressure research in order to improve the familiarity of nurses with this therapy, to provide references for clinical application, and to provide a basis for designing new evidence-based nursing research efforts.

  4. Respiratory clinical guidelines inform ward-based nurses’ clinical skills and knowledge required for evidence-based care

    PubMed Central

    Johnson, Alisha M.

    2016-01-01

    Respiratory clinical guidelines provide clinicians with evidence-based guidance for practice. Clinical guidelines also provide an opportunity to identify the knowledge and technical and non-technical skills required by respiratory ward-based registered nurses. The aim of this review was to use a systematic process to establish the core technical and non-technical skills and knowledge identified in evidence-based clinical guidelines that enable the care of hospitalised adult respiratory patients. 17 guidelines were identified in our systematic review. The quality assessment demonstrated variability in these guidelines. Common core knowledge and technical and non-technical skills were identified. These include pathophysiology, understanding of physiological measurements and monitoring, education, counselling, and ward and patient management. The knowledge and skills extracted from respiratory clinical guidelines may inform a curriculum for ward-based respiratory nursing to ensure optimal care of adult patients. PMID:28210299

  5. Respiratory clinical guidelines inform ward-based nurses' clinical skills and knowledge required for evidence-based care.

    PubMed

    Johnson, Alisha M; Smith, Sheree M S

    2016-09-01

    Respiratory clinical guidelines provide clinicians with evidence-based guidance for practice. Clinical guidelines also provide an opportunity to identify the knowledge and technical and non-technical skills required by respiratory ward-based registered nurses. The aim of this review was to use a systematic process to establish the core technical and non-technical skills and knowledge identified in evidence-based clinical guidelines that enable the care of hospitalised adult respiratory patients. 17 guidelines were identified in our systematic review. The quality assessment demonstrated variability in these guidelines. Common core knowledge and technical and non-technical skills were identified. These include pathophysiology, understanding of physiological measurements and monitoring, education, counselling, and ward and patient management. The knowledge and skills extracted from respiratory clinical guidelines may inform a curriculum for ward-based respiratory nursing to ensure optimal care of adult patients.

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

    PubMed

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

    2013-01-01

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

  7. Electronic Clinic Journaling: The Use of Weblogs to Support Evidence-Based Practice in Doctor of Audiology Students

    ERIC Educational Resources Information Center

    Neldon, Gayle B.

    2009-01-01

    Evidence-based practice (EBP) is a strategy for the provision of high quality health care. The use of journals to document clinical experiences and reflection has been used in speech-language pathology as well as nursing and psychology. This study uses qualitative analysis to study what AuD students learn about evidence-based practice from writing…

  8. Clinical postconference pedagogy: exploring evidence-based practice with millennial-inspired "Building Blocks".

    PubMed

    Schams, Kristin A; Kuennen, Jackie K

    2012-01-01

    This article reports an innovative teaching strategy consisting of learning units whereby students come to postconference sessions prepared to share evidence-based practice (EBP) information associated with upcoming laboratory concepts, discover relationships among laboratory concepts and current nursing practice, and associate personal clinical experiences with the practice environment. This strategy, named "Building Blocks," represents one method to transform nursing education into a more active process, and also has the potential to prepare graduates who can function in a dynamic health care environment incorporating EBP.

  9. Acute pain management in morbid obesity - an evidence based clinical update.

    PubMed

    Budiansky, Adele Sandra; Margarson, Michael P; Eipe, Naveen

    2017-03-01

    Increasing numbers of patients with morbid obesity are presenting for surgery and their acute pain management requires an evidence-based clinical update. The objective of this study was to complete a literature review for acute pain management in morbid obesity and provide an evidence-based clinical update with recommendations. Using standardized search terms, in March 2015, we completed a literature search to determine evidence for different acute pain pharmacological modalities in morbid obesity. For each modality the highest level of evidence was ascertained and recommendations for each pharmacological modality are presented. Though overall evidence is limited to few well conducted clinical trials, mostly related to weight loss surgery, multimodal analgesia with step-wise, severity-based, opioid-sparing approach appears to improve acute pain management in morbid obesity. The perioperative use of non-opioid adjuvants appears to offer further improvements in patient safety and outcomes. Further research into standardization of pain assessments and implementation of acute pain management protocols is required.

  10. Development of EBM-CDSS (Evidence-Based Clinical Decision Support System) to AIG Prognostication in Terminally Ill Patients

    DTIC Science & Technology

    2016-03-01

    1 Award Number: W81-XWH-09-2-0175 TITLE: Development of EBM-CDSS (Evidence-Based Clinical Decision Support System) to AIG Prognostication in...From - To) 25Sep2009 - 31Dec2015 4. TITLE AND SUBTITLE Development of EBM-CDSS (Evidence-Based Clinical Decision Support System) to AIG Prognostication...health.usf.edu 4 14. ABSTRACT Goal of the project is to develop an Evidence-based Clinical Decision Support (CDSS-EBM) system and make it available at the point

  11. [Exercise is medicine: development and evidence-based practice in clinical exercise physiology].

    PubMed

    Zhou, Shi

    2014-08-01

    It has been well established that appropriate physical activity and exercise play an important role in promotion of health and fitness, prevention of disease and treatment and rehabilitation of health conditions. However, practice based on scientific evidence, in respect of the role and effectiveness of exercise interventions in prevention and treatment of diseases, has only been promoted and implemented in the fields of clinical exercise physiology, public health and medicine in recent years. This brief review provides an introduction of the concept of "Exercise is Medicine", the development and evidence-based practice in Clinical Exercise Physiology, and the role and training of Clinical Exercise Physiologist in the health care system of some other countries.

  12. What clinical psychologists know about evidence-based practice: familiarity with online resources and research methods.

    PubMed

    Berke, David M; Rozell, Cassandra A; Hogan, Thomas P; Norcross, John C; Karpiak, Christie P

    2011-04-01

    Evidence-based practice (EBP) requires that practitioners routinely access, appraise, and utilize the best available research. We surveyed a representative sample of the Society of Clinical Psychology; 549 psychologists (response rate = 46%) reported their frequency of engaging in EBP when offering psychological services, rated their current knowledge of 12 online research resources, and evaluated their current knowledge of 12 research methods and designs. These psychologists reported, on average, using EBP in 73.1% of their psychological services. With the exception of PsycINFO and MEDLINE, clinical psychologists related low to moderate knowledge of online research resources. By contrast, these psychologists reported considerable knowledge of most research methods and designs, except for odds ratios and structural equation modeling. Psychologists' theoretical orientation, clinical experience, and employment setting predicted knowledge of both online resources and research designs. We discuss the educational and practice ramifications of these results.

  13. Factors associated with medical student clinical reasoning and evidence based medicine practice

    PubMed Central

    Kamei, Robert; Chan, Kenneth; Goh, Sok-Hong; Ngee, Lek

    2015-01-01

    Objectives To identify the factors associated with medical students’ clinical reasoning (CR) use and evidence-based medicine (EBM) use in the clinical setting. Methods Our cross-sectional study surveyed 44 final-year medical students at an emerging academic medical center in Singapore. We queried the students’ EBM and CR value and experiences in the classroom and clinical settings. We compared this to their perceptions of supervisors’ value and experiences using t-tests. We developed measures of teaching culture and practice culture by combining relevant questions into summary scores. Multivariate linear regression models were applied to identify factors associated with the students’ CR and EBM clinical use. Results Eighty-nine percent of students responded (n=39). Students reported valuing CR (p=0.03) and EBM (p=0.001) more than their supervisors, but practiced these skills similarly (p=0.83; p=0.82). Clinical practice culture and classroom CR experience were independently associated with students’ CR clinical use (p=0.05; p=0.04), and classroom EBM experience was independently associated with students’ EBM clinical use (p=0.03). Clinical teaching culture was not associated with students’ CR and EBM clinical use. Conclusions Our study found that medical students’ classroom experience and the clinical practice culture influenced their CR and EBM use. The clinical teaching culture did not. These findings suggest that in order to increase student CR and EBM use, in addition to providing classroom experience, medical educators may need to change the hospital culture by encouraging supervisors to use these skills in their clinical practice. PMID:26547924

  14. Radiologists’ perspectives about evidence-based medicine and their clinical practice: a semistructured interview study

    PubMed Central

    Tong, Allison; Mahady, Suzanne E; Craig, Jonathan C; Lau, Gabes; Peduto, Anthony J; Loy, Clement

    2014-01-01

    Objectives To describe radiologist's attitudes and perspectives on evidence-based medicine (EBM) and their practice. Design Face-to-face semistructured interviews, thematic analysis. Setting 24 institutions across six Australian states and New Zealand. Transcripts were imported into HyperRESEARCH software and thematically analysed. Participants 25 radiologists. Results Six themes were identified: legitimising decisions (validated justification, prioritising patient preferences, reinforcing protocols), optimising outcomes (ensuring patient safety, maximising efficiency), availability of access (requiring immediacy, inadequacy of evidence, time constraints, proximity of peer networks, grasping information dispersion), over-riding pragmatism (perceptibly applicability, preserving the art of medicine, technical demands), limited confidence (conceptual obscurity, reputation-based trust, demands constant practice, suspicion and cynicism), and competing powers (hierarchical conflict, prevailing commercial interests). Conclusions Radiologists believe EBM can support clinical decision-making for optimal patient outcomes and service efficiency but feel limited in their capacities to assimilate and apply EBM in practice. Improving access to evidence, providing ongoing education and training supplemented with practical tools for appraising evidence; and developing evidence-based guidelines and protocols may enhance feasibility and promote the confidence and skills among radiologists in applying EBM in radiology practice for better patient care. PMID:25500161

  15. Evidence-based practice guidelines--one way to enhance clinical practice.

    PubMed

    Bailes, Barbara K

    2002-06-01

    Abdominoplasty and liposuction guidelines are just two of the guidelines that can be accessed and used to enhance patient care. Guidelines also can be used to increase your knowledge about many other health care topics. The NGC has approved guidelines for managing chronic pain, as well as guidelines on chronic diseases (e.g., diabetes mellitus, hypertension, chronic obstructive pulmonary disease). Many patients have chronic diseases, and you or your family members also may be affected by chronic disorders. These guidelines provide you with a quick overview of evidence-based treatment protocols. These guidelines are not a panacea for evidence-based practice, but using them is one way that perioperative nurses can enhance their clinical skills. Though not everyone has personal Internet access, most health care facilities do or can make access a reality. Other options include medical or public libraries. Then one simply has to access the NGC web site and join other professionals in improving the quality and timeliness of patient care.

  16. How good is the evidence base for test selection in clinical guidelines?

    PubMed

    Misra, Shivani; Barth, Julian H

    2014-05-15

    Clinical guidelines are ubiquitous, manifold and form an integral component of evidence-based clinical practice. Guidelines on test selection are often considered a useful adjunct to aid clinical decision-making, as test selection is a complex process that is influenced by many patient, clinician and laboratory factors. However, it is important to carefully evaluate several aspects of these guidelines, which include the context of the test in the guideline, the quality of the studies underpinning recommendations, the extent of the evaluation of effectiveness (or performance) of the specific test and in the clinical pathway, its applicability and ease of implementation. A robust evaluation of a diagnostic test should incorporate several stages including evaluation in healthy, symptomatic but unaffected and affected populations, and importantly a measurement of impact on patient outcomes. Few diagnostic studies meet these criteria, and therefore crucial aspects of test evaluation are overlooked prior to incorporation into clinical guidelines. Whilst efforts are made to standardise reporting of studies, strength of evidence and quality of guidelines, further work is required to improve the quality of the diagnostic studies that formulate these guidelines. It is important that clinicians using guidelines for test selection appreciate the limitations of the diagnostic test, and the guidelines themselves.

  17. Evidence-based clinical practice guidelines for managing depression in persons living with HIV.

    PubMed

    Relf, Michael V; Eisbach, Shelly; Okine, Kayj Nash; Ward, Terry

    2013-01-01

    Depressive symptoms and depression are prevalent among persons living with HIV (PLWH). Depression among PLWH is associated with a lower quality of life, reduced adherence to antiretroviral treatment, poorer self-care, worsened treatment outcomes, greater impairment in social and vocational functioning, and increased social isolation. Assessment of depression in PLWH is critical to facilitate referral and management. Fortunately, two simple screening questions can be used to assess for depression, and evidence supports the effective management of depression for PLWH. First-line treatment regimens for depression include selective serotonin reuptake inhibitors (SSRIs), cognitive behavioral therapy (CBT), or a combination of SSRI and CBT. This paper examines the contemporary evidence related to depression in the context of HIV infection. A case study has been included to illustrate an application of evidence-based treatment interventions recommended for clinical practice.

  18. Effects of Education Programs on Evidence-Based Practice Implementation for Clinical Nurses.

    PubMed

    Sim, Jae Youn; Jang, Keum Seong; Kim, Nam Young

    2016-08-01

    This study was conducted to identify the effectiveness of an education program for evidence-based practice (EBP) implementation of clinical nursing. EBP knowledge/skill, attitude, and belief; information search ability; and EBP implementation were significantly higher in the experimental group than in the control group. Furthermore, the effect on implementation was maintained at week 4 and week 8, indicating that the education program practically promotes the EBP implementation of nurses. Results confirm that the education program for EBP implementation is critical and the continuous education program is an essential part of EBP implementation. Also, to promote EBP implementation and disseminate it to nursing organizations, an immediate concern should be the cultivation of mentors for EBP and fortification of the belief and ability regarding EBP implementation. J Contin Educ Nurs. 2016;47(8):363-371.

  19. Clinical Evidence: a useful tool for promoting evidence-based practice?

    PubMed Central

    Formoso, Giulio; Moja, Lorenzo; Nonino, Francesco; Dri, Pietro; Addis, Antonio; Martini, Nello; Liberati, Alessandro

    2003-01-01

    Background Research has shown that many healthcare professionals have problems with guidelines as they would prefer to be given all relevent information relevent to decision-making rather than being told what they should do. This study assesses doctors' judgement of the validity, relevance, clarity and usability of the Italian translation of Clinical Evidence (CE) after its free distribution launched by the Italian Ministry of Health Methods Opinions elicited using a standardised questionnaire delivered either by mail or during educational or professional meetings Results Twenty percent (n = 1350) doctors participated the study. Most of them found CE's content valid, useful and relevant for their clinical practice, and said CE can foster communications among clinicians, particularly among GPs and specialists. Hospital doctors (63%) more often than GPs (48%) read the detailed presentation of individual chapters. Twenty-nine percent said CE brought changes in their clinical practice. Doctors appreciated CE's nature of an evidence-based information compendium and would have not preferred a collection of practice guidelines. Conclusions Overall, the pilot initiative launched by the Italian Ministry of Health seems to have been well received and to support the subsequent decision to make the Italian edition of Clinical Evidence concise available to all doctors practising in the country. Local implementation initiatives should be warranted to favour doctor's use of CE. PMID:14693035

  20. Clinical Sequencing Exploratory Research Consortium: Accelerating Evidence-Based Practice of Genomic Medicine.

    PubMed

    Green, Robert C; Goddard, Katrina A B; Jarvik, Gail P; Amendola, Laura M; Appelbaum, Paul S; Berg, Jonathan S; Bernhardt, Barbara A; Biesecker, Leslie G; Biswas, Sawona; Blout, Carrie L; Bowling, Kevin M; Brothers, Kyle B; Burke, Wylie; Caga-Anan, Charlisse F; Chinnaiyan, Arul M; Chung, Wendy K; Clayton, Ellen W; Cooper, Gregory M; East, Kelly; Evans, James P; Fullerton, Stephanie M; Garraway, Levi A; Garrett, Jeremy R; Gray, Stacy W; Henderson, Gail E; Hindorff, Lucia A; Holm, Ingrid A; Lewis, Michelle Huckaby; Hutter, Carolyn M; Janne, Pasi A; Joffe, Steven; Kaufman, David; Knoppers, Bartha M; Koenig, Barbara A; Krantz, Ian D; Manolio, Teri A; McCullough, Laurence; McEwen, Jean; McGuire, Amy; Muzny, Donna; Myers, Richard M; Nickerson, Deborah A; Ou, Jeffrey; Parsons, Donald W; Petersen, Gloria M; Plon, Sharon E; Rehm, Heidi L; Roberts, J Scott; Robinson, Dan; Salama, Joseph S; Scollon, Sarah; Sharp, Richard R; Shirts, Brian; Spinner, Nancy B; Tabor, Holly K; Tarczy-Hornoch, Peter; Veenstra, David L; Wagle, Nikhil; Weck, Karen; Wilfond, Benjamin S; Wilhelmsen, Kirk; Wolf, Susan M; Wynn, Julia; Yu, Joon-Ho

    2016-06-02

    Despite rapid technical progress and demonstrable effectiveness for some types of diagnosis and therapy, much remains to be learned about clinical genome and exome sequencing (CGES) and its role within the practice of medicine. The Clinical Sequencing Exploratory Research (CSER) consortium includes 18 extramural research projects, one National Human Genome Research Institute (NHGRI) intramural project, and a coordinating center funded by the NHGRI and National Cancer Institute. The consortium is exploring analytic and clinical validity and utility, as well as the ethical, legal, and social implications of sequencing via multidisciplinary approaches; it has thus far recruited 5,577 participants across a spectrum of symptomatic and healthy children and adults by utilizing both germline and cancer sequencing. The CSER consortium is analyzing data and creating publically available procedures and tools related to participant preferences and consent, variant classification, disclosure and management of primary and secondary findings, health outcomes, and integration with electronic health records. Future research directions will refine measures of clinical utility of CGES in both germline and somatic testing, evaluate the use of CGES for screening in healthy individuals, explore the penetrance of pathogenic variants through extensive phenotyping, reduce discordances in public databases of genes and variants, examine social and ethnic disparities in the provision of genomics services, explore regulatory issues, and estimate the value and downstream costs of sequencing. The CSER consortium has established a shared community of research sites by using diverse approaches to pursue the evidence-based development of best practices in genomic medicine.

  1. Evidence-based clinical practice guidelines for nonalcoholic fatty liver disease/nonalcoholic steatohepatitis.

    PubMed

    Watanabe, Sumio; Hashimoto, Etsuko; Ikejima, Kenichi; Uto, Hirofumi; Ono, Masafumi; Sumida, Yoshio; Seike, Masataka; Takei, Yoshiyuki; Takehara, Tetsuo; Tokushige, Katsutoshi; Nakajima, Atsushi; Yoneda, Masashi; Saibara, Toshiji; Shiota, Goshi; Sakaida, Isao; Nakamuta, Makoto; Mizuta, Toshihiko; Tsubouchi, Hirohito; Sugano, Kentaro; Shimosegawa, Tooru

    2015-04-01

    Nonalcoholic fatty liver disease (NAFLD) is currently the most common cause of chronic liver disease in industrialized countries worldwide, and has become a serious public health issue not only in Western countries but also in many Asian countries including Japan. Within the wide spectrum of NAFLD, nonalcoholic steatohepatitis (NASH) is a progressive form of disease, which often develops into liver cirrhosis and increases the risk of hepatocellular carcinoma. In turn, a large proportion of NAFLD/NASH is the liver manifestation of metabolic syndrome, suggesting that NAFLD/NASH plays a key role in the pathogenesis of systemic atherosclerotic diseases. Currently, a definite diagnosis of NASH requires liver biopsy, though various noninvasive measures are under development. The mainstays of prevention and treatment of NAFLD/NASH include dietary restriction and exercise; however, pharmacological approaches are often necessary. Currently, vitamin E and thiazolidinedione derivatives are the most evidence-based therapeutic options, although the clinical evidence for long-term efficacy and safety is limited. This practice guideline for NAFLD/NASH, established by the Japanese Society of Gastroenterology in cooperation with The Japan Society of Hepatology, covers lines of clinical evidence reported internationally in the period starting from 1983 to January 2012, and each clinical question was evaluated using the GRADE system. Based on the primary release of the full version in Japanese, this English summary provides the core essentials of this clinical practice guideline comprising the definition, diagnosis, and current therapeutic recommendations for NAFLD/NASH in Japan.

  2. A language activity monitor for supporting AAC evidence-based clinical practice.

    PubMed

    Hill, K J; Romich, B A

    2001-01-01

    Augmentative and alternative communication (AAC) evidence-based practice requires the collection and analysis of performance data. This article presents the development, evaluation, and application of automated performance monitoring tools for use in clinical practice. Language activity monitoring (LAM) is the systematic data collection of the actual language activity of an individual who relies on AAC. Work completed to date includes the development and evaluation of the language activity monitor function, which now is commercially available in three forms: (1) a standard feature built into modern high performance AAC systems, (2) an external add-on package for use with older AAC devices based on synthetic speech, and (3) software that allows the personal computer to serve as an LAM in the clinical environment. The LAM records the time and content of language events (the generation of one or more letters or words). A logging protocol suitable for clinical application has been in use since late 1998. The logged data is uploaded periodically to a computer for editing, analysis, and the generation of a summary measure report. The applications of this work in the areas of clinical service delivery are presented.

  3. Tacit knowledge as the unifying factor in evidence based medicine and clinical judgement

    PubMed Central

    Thornton, Tim

    2006-01-01

    The paper outlines the role that tacit knowledge plays in what might seem to be an area of knowledge that can be made fully explicit or codified and which forms a central element of Evidence Based Medicine. Appeal to the role the role of tacit knowledge in science provides a way to unify the tripartite definition of Evidence Based Medicine given by Sackett et al: the integration of best research evidence with clinical expertise and patient values. Each of these three elements, crucially including research evidence, rests on an ineliminable and irreducible notion of uncodified good judgement. The paper focuses on research evidence, drawing first on the work of Kuhn to suggest that tacit knowledge contributes, as a matter of fact, to puzzle solving within what he calls normal science. A stronger argument that it must play a role in research is first motivated by looking to Collins' first hand account of replication in applied physics and then broader considerations of replication in justifying knowledge claims in scientific research. Finally, consideration of an argument from Wittgenstein shows that whatever explicit guidelines can be drawn up to guide judgement the specification of what counts as correctly following them has to remain implicit. Overall, the paper sets out arguments for the claim that even though explicit guidelines and codifications can play a practical role in informing clinical practice, they rest on a body of tacit or implicit skill that is in principle ineliminable. It forms the bedrock of good judgement and unites the integration of research, expertise and values. PMID:16759426

  4. Tacit knowledge as the unifying factor in evidence based medicine and clinical judgement.

    PubMed

    Thornton, Tim

    2006-03-17

    The paper outlines the role that tacit knowledge plays in what might seem to be an area of knowledge that can be made fully explicit or codified and which forms a central element of Evidence Based Medicine. Appeal to the role the role of tacit knowledge in science provides a way to unify the tripartite definition of Evidence Based Medicine given by Sackett et al: the integration of best research evidence with clinical expertise and patient values. Each of these three elements, crucially including research evidence, rests on an ineliminable and irreducible notion of uncodified good judgement. The paper focuses on research evidence, drawing first on the work of Kuhn to suggest that tacit knowledge contributes, as a matter of fact, to puzzle solving within what he calls normal science. A stronger argument that it must play a role in research is first motivated by looking to Collins' first hand account of replication in applied physics and then broader considerations of replication in justifying knowledge claims in scientific research. Finally, consideration of an argument from Wittgenstein shows that whatever explicit guidelines can be drawn up to guide judgement the specification of what counts as correctly following them has to remain implicit.Overall, the paper sets out arguments for the claim that even though explicit guidelines and codifications can play a practical role in informing clinical practice, they rest on a body of tacit or implicit skill that is in principle ineliminable. It forms the bedrock of good judgement and unites the integration of research, expertise and values.

  5. A collaborative teaching strategy for enhancing learning of evidence-based clinical decision-making.

    PubMed

    Scott, P J; Altenburger, P A; Kean, J

    2011-01-01

    The educational literature cites a lack of student motivation to learn how to use research evidence in clinical decision-making because the students do not observe clinicians using evidence. This lack of motivation presents a challenge to educators as they seek to instill the value of evidence-based clinical decision-making (EBCD) in students. One problem is that students in entry-level programs do not have the experience needed to know what to look for, and secondly, clinical decision-making is contextually based in a patient problem. Our approach offers one solution to bridging the gap between classroom teaching and real-world implementation of EBCD through a three-phase collaborative approach. Occupational and physical therapy students are partnered with clinicians to find and appraise evidence to answer the real-world questions posed by these therapists. This paper describes the implementation of the partnership, teaching/learning outcomes, logistics, and implications for clinicians. We found this approach increased student motivation and greatly enhanced the learning experience. Future directions include implementing a framework which allows for the assessment of the strategy on the facility and creates opportunities to integrate the use of EBCD in all aspects of facility practice.

  6. Implementation outcomes of evidence-based quality improvement for depression in VA community based outpatient clinics

    PubMed Central

    2012-01-01

    Background Collaborative-care management is an evidence-based practice for improving depression outcomes in primary care. The Department of Veterans Affairs (VA) has mandated the implementation of collaborative-care management in its satellite clinics, known as Community Based Outpatient Clinics (CBOCs). However, the organizational characteristics of CBOCs present added challenges to implementation. The objective of this study was to evaluate the effectiveness of evidence-based quality improvement (EBQI) as a strategy to facilitate the adoption of collaborative-care management in CBOCs. Methods This nonrandomized, small-scale, multisite evaluation of EBQI was conducted at three VA Medical Centers and 11 of their affiliated CBOCs. The Plan phase of the EBQI process involved the localized tailoring of the collaborative-care management program to each CBOC. Researchers ensured that the adaptations were evidence based. Clinical and administrative staff were responsible for adapting the collaborative-care management program for local needs, priorities, preferences and resources. Plan-Do-Study-Act cycles were used to refine the program over time. The evaluation was based on the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) Framework and used data from multiple sources: administrative records, web-based decision-support systems, surveys, and key-informant interviews. Results Adoption: 69.0% (58/84) of primary care providers referred patients to the program. Reach: 9.0% (298/3,296) of primary care patients diagnosed with depression who were not already receiving specialty care were enrolled in the program. Fidelity: During baseline care manager encounters, education/activation was provided to 100% (298/298) of patients, barriers were assessed and addressed for 100% (298/298) of patients, and depression severity was monitored for 100% (298/298) of patients. Less than half (42.5%, 681/1603) of follow-up encounters during the acute stage were completed

  7. The Collaborative Assessment and Management of Suicidality (CAMS): An Evolving Evidence-Based Clinical Approach to Suicidal Risk

    ERIC Educational Resources Information Center

    Jobes, David A.

    2012-01-01

    The Collaborative Assessment and Management of Suicidality (CAMS) is an evidence-based clinical intervention that has significantly evolved over 25 years of clinical research. CAMS is best understood as a therapeutic framework that emphasizes a unique collaborative assessment and treatment planning process between the suicidal patient and…

  8. Effect of Clinically Discriminating, Evidence-Based Checklist Items on the Reliability of Scores from an Internal Medicine Residency OSCE

    ERIC Educational Resources Information Center

    Daniels, Vijay J.; Bordage, Georges; Gierl, Mark J.; Yudkowsky, Rachel

    2014-01-01

    Objective structured clinical examinations (OSCEs) are used worldwide for summative examinations but often lack acceptable reliability. Research has shown that reliability of scores increases if OSCE checklists for medical students include only clinically relevant items. Also, checklists are often missing evidence-based items that high-achieving…

  9. Chiropractic clinical practice guideline: evidence-based treatment of adult neck pain not due to whiplash

    PubMed Central

    Anderson-Peacock, Elizabeth; Blouin, Jean-Sébastien; Bryans, Roland; Danis, Normand; Furlan, Andrea; Marcoux, Henri; Potter, Brock; Ruegg, Rick; Gross Stein, Janice; White, Eleanor

    2005-01-01

    OBJECTIVE To provide an evidence-based clinical practice guideline for the chiropractic cervical treatment of adults with acute or chronic neck pain not due to whiplash. This is a considerable health concern considered to be a priority by stakeholders, and about which the scientific information was poorly organized. OPTIONS Cervical treatments: manipulation, mobilization, ischemic pressure, clinic- and home-based exercise, traction, education, low-power laser, massage, transcutaneous electrical nerve stimulation, pillows, pulsed electromagnetic therapy, and ultrasound. OUTCOMES The primary outcomes considered were improved (reduced and less intrusive) pain and improved (increased and easier) ranges of motion (ROM) of the adult cervical spine. EVIDENCE An “extraction” team recorded evidence from articles found by literature search teams using 4 separate literature searches, and rated it using a Table adapted from the Oxford Centre for Evidence-based Medicine. The searches were 1) Treatment; August, 2003, using MEDLINE, CINAHL, AMED, MANTIS, ICL, The Cochrane Library (includes CENTRAL), and EBSCO, identified 182 articles. 2) Risk management (adverse events); October, 2004, identified 230 articles and 2 texts. 3) Risk management (dissection); September, 2003, identified 79 articles. 4) Treatment update; a repeat of the treatment search for articles published between September, 2003 and November, 2004 inclusive identified 121 articles. VALUES To enable the search of the literature, the authors (Guidelines Development Committee [GDC]) regarded chiropractic treatment as including elements of “conservative” care in the search strategies, but not in the consideration of the range of chiropractic practice. Also, knowledge based only on clinical experience was considered less valid and reliable than good-caliber evidence, but where the caliber of the relevant evidence was low or it was non-existent, unpublished clinical experience was considered to be equivalent to

  10. Counseling in fetal medicine: evidence-based answers to clinical questions on morbidly adherent placenta.

    PubMed

    D'Antonio, F; Palacios-Jaraquemada, J; Lim, P S; Forlani, F; Lanzone, A; Timor-Tritsch, I; Cali, G

    2016-03-01

    Although the incidence of morbidly adherent placenta (MAP) has risen progressively in the last two decades, there remains uncertainty about the diagnosis and management of this condition. The aim of this review is to provide up-to-date and evidence-based answers to common clinical questions regarding the diagnosis and management of MAP. Different risk factors have been associated with MAP; however, previous Cesarean section and placenta previa are the most frequently associated. Ultrasound is the primary method for diagnosing MAP and has a good overall diagnostic accuracy for its detection. When considering the different ultrasound signs of MAP, color Doppler seems to provide the best diagnostic performance. Magnetic resonance imaging has the same accuracy in diagnosing MAP as does ultrasound examination; its use should be considered when a resective procedure, such as hysterectomy, is planned as it can provide detailed information about the topography of placental invasion and predict difficulties that may arise in surgery. The optimal gestational age for delivery in pregnancies with MAP is yet to be established; planning surgery between 35 and 36 weeks of gestation provides the best balance between fetal maturity and the risk of unexpected episodes of heavy bleeding, which are more likely to occur with delivery after this timepoint, especially in severe cases of MAP. The optimal surgical approach to MAP depends on multiple factors, including availability of an experienced team, specific surgical skills and hospital resources. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.

  11. The current evidence base for the clinical nurse leader: a narrative review of the literature.

    PubMed

    Bender, Miriam

    2014-01-01

    The clinical nurse leader (CNL) is a relatively new nursing role, introduced in 2003 through the American Association of Colleges of Nursing (AACN). A narrative review of the extant CNL literature was conducted with the aim of comprehensively summarizing the broad and methodologically diverse CNL evidence base. The review included 25 implementation reports, 1 CNL job analysis, 7 qualitative and/or survey studies, and 3 quantitative studies. All CNL implementation reports and studies described improved care quality outcomes after introduction of the role into a care delivery microsystem. Despite preliminary evidence supporting the CNL as an innovative new nursing role capable of consistently improving care quality wherever it is implemented, CNLs are still struggling to define the role to themselves and to the health care spectrum at large. Although the AACN CNL White Paper provides a concise model for CNL educational curriculum and end competencies, there is a compelling need for further research to substantively delineate the CNL role in practice, define care delivery structures and processes that influence CNL integration, and develop indicators capable of capturing CNL-specific contributions to improved care quality.

  12. Beyond the clinic: improving child health through evidence-based community development

    PubMed Central

    2013-01-01

    Background Promoting child wellbeing necessarily goes beyond the clinic as risks to child health and development are embedded in the social and physical environmental conditions in which children live. Pediatricians play a vital role in promoting the health of children in the communities they serve and can maximize their impact by advocating for and supporting efficacious, evidence-based strategies in their communities. Methods To provide a succinct guide for community pediatric efforts to advance the wellbeing of all children and particularly disadvantaged children in a community, we conducted a theory-driven and structured narrative review to synthesize published systematic and meta-analytic reviews of policy-relevant, local-level strategies addressing potent and malleable influences on child health and development. An exhaustive list of policy-relevant, local-level strategies for improving child health was used to conduct a comprehensive search of recent (1990–2012), English language peer-reviewed published meta-analyses and systematic reviews in the 10 core databases of scientific literature. Our review of the literature encompassed six key conceptual domains of intervention foci, including distal influences of child health (i.e., income and resources, social cohesion, and physical environment) and proximal influences (i.e., family, school and peer). We examined intervention effects on four key domains of child health and development: cognitive development, social and emotional competence, psychological and behavioral wellbeing, and physical health. Results Published reviews were identified for 98 distinct policy-relevant community interventions, evaluated across 288 outcomes. We classified 46 strategies as meeting scientific criteria for efficacy by having consistent, positive outcomes from high-quality trials (e.g., tenant-based rental assistance, neighborhood watch programs, urban design and land use policies, access to quality childcare services, class

  13. Evidence-based clinical practice guidelines for peptic ulcer disease 2015.

    PubMed

    Satoh, Kiichi; Yoshino, Junji; Akamatsu, Taiji; Itoh, Toshiyuki; Kato, Mototsugu; Kamada, Tomoari; Takagi, Atsushi; Chiba, Toshimi; Nomura, Sachiyo; Mizokami, Yuji; Murakami, Kazunari; Sakamoto, Choitsu; Hiraishi, Hideyuki; Ichinose, Masao; Uemura, Naomi; Goto, Hidemi; Joh, Takashi; Miwa, Hiroto; Sugano, Kentaro; Shimosegawa, Tooru

    2016-03-01

    The Japanese Society of Gastroenterology (JSGE) revised the evidence-based clinical practice guidelines for peptic ulcer disease in 2014 and has created an English version. The revised guidelines consist of seven items: bleeding gastric and duodenal ulcers, Helicobacter pylori (H. pylori) eradication therapy, non-eradication therapy, drug-induced ulcer, non-H. pylori, non-nonsteroidal anti-inflammatory drug (NSAID) ulcer, surgical treatment, and conservative therapy for perforation and stenosis. Ninety clinical questions (CQs) were developed, and a literature search was performed for the CQs using the Medline, Cochrane, and Igaku Chuo Zasshi databases between 1983 and June 2012. The guideline was developed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Therapy is initially provided for ulcer complications. Perforation or stenosis is treated with surgery or conservatively. Ulcer bleeding is first treated by endoscopic hemostasis. If it fails, surgery or interventional radiology is chosen. Second, medical therapy is provided. In cases of NSAID-related ulcers, use of NSAIDs is stopped, and anti-ulcer therapy is provided. If NSAID use must continue, the ulcer is treated with a proton pump inhibitor (PPI) or prostaglandin analog. In cases with no NSAID use, H. pylori-positive patients receive eradication and anti-ulcer therapy. If first-line eradication therapy fails, second-line therapy is given. In cases of non-H. pylori, non-NSAID ulcers or H. pylori-positive patients with no indication for eradication therapy, non-eradication therapy is provided. The first choice is PPI therapy, and the second choice is histamine 2-receptor antagonist therapy. After initial therapy, maintenance therapy is provided to prevent ulcer relapse.

  14. What do evidence-based secondary journals tell us about the publication of clinically important articles in primary healthcare journals?

    PubMed Central

    McKibbon, Kathleen Ann; Wilczynski, Nancy L; Haynes, Robert Brian

    2004-01-01

    Background We conducted this analysis to determine i) which journals publish high-quality, clinically relevant studies in internal medicine, general/family practice, general practice nursing, and mental health; and ii) the proportion of clinically relevant articles in each journal. Methods We performed an analytic survey of a hand search of 170 general medicine, general healthcare, and specialty journals for 2000. Research staff assessed individual articles by using explicit criteria for scientific merit for healthcare application. Practitioners assessed the clinical importance of these articles. Outcome measures were the number of high-quality, clinically relevant studies published in the 170 journal titles and how many of these were published in each of four discipline-specific, secondary "evidence-based" journals (ACP Journal Club for internal medicine and its subspecialties; Evidence-Based Medicine for general/family practice; Evidence-Based Nursing for general practice nursing; and Evidence-Based Mental Health for all aspects of mental health). Original studies and review articles were classified for purpose: therapy and prevention, screening and diagnosis, prognosis, etiology and harm, economics and cost, clinical prediction guides, and qualitative studies. Results We evaluated 60,352 articles from 170 journal titles. The pass criteria of high-quality methods and clinically relevant material were met by 3059 original articles and 1073 review articles. For ACP Journal Club (internal medicine), four titles supplied 56.5% of the articles and 27 titles supplied the other 43.5%. For Evidence-Based Medicine (general/family practice), five titles supplied 50.7% of the articles and 40 titles supplied the remaining 49.3%. For Evidence-Based Nursing (general practice nursing), seven titles supplied 51.0% of the articles and 34 additional titles supplied 49.0%. For Evidence-Based Mental Health (mental health), nine titles supplied 53.2% of the articles and 34 additional

  15. Clinical Guidelines and the Translation of Texts into Care: Overcoming Professional Conflicts Concerning Evidence-based Practice.

    ERIC Educational Resources Information Center

    Davenport, Elisabeth

    2000-01-01

    Reviews problems identified in previous research on evidence-based nursing practice; discusses conflicts between medical and nursing domains; explores the provenance and status of the clinical guideline as a translation artefact or bridging mechanism based on a social studies of science approach; and presents a case study of Scottish clinical…

  16. Meta-Analyses and Orthodontic Evidence-Based Clinical Practice in the 21st Century

    PubMed Central

    Papadopoulos, Moschos A.

    2010-01-01

    Introduction: Aim of this systematic review was to assess the orthodontic related issues which currently provide the best evidence as documented by meta-analyses, by critically evaluating and discussing the methodology used in these studies. Material and Methods: Several electronic databases were searched and handsearching was also performed in order to identify the corresponding meta-analyses investigating orthodontic related subjects. In total, 197 studies were retrieved initially. After applying specific inclusion and exclusion criteria, 27 articles were identified as meta-analyses treating orthodontic-related subjects. Results: Many of these 27 papers presented sufficient quality and followed appropriate meta-analytic approaches to quantitatively synthesize data and presented adequately supported evidence. However, the methodology used in some of them presented weaknesses, limitations or deficiencies. Consequently, the topics in orthodontics which currently provide the best evidence, include some issues related to Class II or Class III treatment, treatment of transverse problems, external apical root resorption, dental anomalies, such as congenital missing teeth and tooth transposition, frequency of severe occlusal problems, nickel hypersensitivity, obstructive sleep apnea syndrome, and computer-assisted learning in orthodontic education. Conclusions: Only a few orthodontic related issues have been so far investigated by means of MAs. In addition, for some of these issues investigated in the corresponding MAs no definite conclusions could be drawn, due to significant methodological deficiencies of these studies. According to this investigation, it can be concluded that at the begin of the 21st century there is evidence for only a few orthodontic related issues as documented by meta-analyses, and more well-conducted high quality research studies are needed to produce strong evidence in order to support evidence-based clinical practice in orthodontics. PMID

  17. Management of nonalcoholic fatty liver disease: An evidence-based clinical practice review

    PubMed Central

    Arab, Juan P; Candia, Roberto; Zapata, Rodrigo; Muñoz, Cristián; Arancibia, Juan P; Poniachik, Jaime; Soza, Alejandro; Fuster, Francisco; Brahm, Javier; Sanhueza, Edgar; Contreras, Jorge; Cuellar, M Carolina; Arrese, Marco; Riquelme, Arnoldo

    2014-01-01

    AIM: To build a consensus among Chilean specialists on the appropriate management of patients with nonalcoholic fatty liver disease (NAFLD) in clinical practice. METHODS: NAFLD has now reached epidemic proportions worldwide. The optimal treatment for NAFLD has not been established due to a lack of evidence-based recommendations. An expert panel of members of the Chilean Gastroenterological Society and the Chilean Hepatology Association conducted a structured analysis of the current literature on NAFLD therapy. The quality of the evidence and the level of recommendations supporting each statement were assessed according to the recommendations of the United States Preventive Services Task Force. A modified three-round Delphi technique was used to reach a consensus among the experts. RESULTS: A group of thirteen experts was established. The survey included 17 open-ended questions that were distributed among the experts, who assessed the articles associated with each question. The levels of agreement achieved by the panel were 93.8% in the first round and 100% in the second and third rounds. The final recommendations support the indication of lifestyle changes, including diet and exercise, for all patients with NAFLD. Proven pharmacological therapies include only vitamin E and pioglitazone, which can be used in nondiabetic patients with biopsy-proven nonalcoholic steatohepatitis (the progressive form of NAFLD), although the long-term safety and efficacy of these therapies have not yet been established. CONCLUSION: Current NAFLD management is rapidly evolving, and new pathophysiology-based therapies are expected to be introduced in the near future. All NAFLD patients should be evaluated using a three-focused approach that considers the risks of liver disease, diabetes and cardiovascular events. PMID:25232252

  18. Tips for teaching evidence-based medicine in a clinical setting: lessons from adult learning theory. Part one.

    PubMed

    Das, Kausik; Malick, Sadia; Khan, Khalid S

    2008-10-01

    Evidence-based medicine (EBM) is an indispensable tool in clinical practice. Teaching and training of EBM to trainee clinicians is patchy and fragmented at its best. Clinically integrated teaching of EBM is more likely to bring about changes in skills, attitudes and behaviour. Provision of evidence-based health care is the most ethical way to practice, as it integrates up-to-date, patient-oriented research into the clinical decision making process, thus improving patients' outcomes. In this article, we aim to dispel the myth that EBM is an academic and statistical exercise removed from practice by providing practical tips for teaching the minimum skills required to ask questions and critically identify and appraise the evidence and presenting an approach to teaching EBM within the existing clinical and educational training infrastructure.

  19. Evidence-based dentistry: Part II. Searching for answers to clinical questions: how to use MEDLINE.

    PubMed

    Sutherland, S E

    2001-05-01

    The ability to conduct efficient literature searches is fundamental to the practice of evidence-based dentistry. In the second part of this series on evidence-based dentistry, strategic literature search techniques are discussed. MEDLINE, because of its breadth, depth and continuous maintenance by the U.S. National Library of Medicine (NLM), is the best source of evidence for health care. Although there are many gateways to MEDLINE, this paper highlights the user-friendly versions of MEDLINE offered free on the Internet by the NLM. The use of well-established search tactics and the unique features of the NLM sites facilitate rapid, effective literature searches.

  20. Understanding the Common Elements of Evidence-Based Practice: Misconceptions and Clinical Examples

    ERIC Educational Resources Information Center

    Chorpita, Bruce F.; Becker, Kimberly D.; Daleiden, Eric L.

    2007-01-01

    In this article, the authors proposed a distillation and matching model (DMM) that describes how evidence-based treatment operations can be conceptualized at a lower order level of analysis than simply by their manuals. Also referred to as the "common elements" approach, this model demonstrates the feasibility of coding and identifying the…

  1. Evidence Based Clinical Assessment of Child and Adolescent Social Phobia: A Critical Review of Rating Scales

    ERIC Educational Resources Information Center

    Tulbure, Bogdan T.; Szentagotai, Aurora; Dobrean, Anca; David, Daniel

    2012-01-01

    Investigating the empirical support of various assessment instruments, the evidence based assessment approach expands the scientific basis of psychotherapy. Starting from Hunsley and Mash's evaluative framework, we critically reviewed the rating scales designed to measure social anxiety or phobia in youth. Thirteen of the most researched social…

  2. Methodological quality of systematic reviews and clinical trials on women's health published in a Brazilian evidence-based health journal

    PubMed Central

    Macedo, Cristiane Rufino; Riera, Rachel; Torloni, Maria Regina

    2013-01-01

    OBJECTIVES: To assess the quality of systematic reviews and clinical trials on women's health recently published in a Brazilian evidence-based health journal. METHOD: All systematic reviews and clinical trials on women's health published in the last five years in the Brazilian Journal of Evidence-based Health were retrieved. Two independent reviewers critically assessed the methodological quality of reviews and trials using AMSTAR and the Cochrane Risk of Bias Table, respectively. RESULTS: Systematic reviews and clinical trials accounted for less than 10% of the 61 original studies on women's health published in the São Paulo Medical Journal over the last five years. All five reviews were considered to be of moderate quality; the worst domains were publication bias and the appropriate use of study quality in formulating conclusions. All three clinical trials were judged to have a high risk of bias. The participant blinding, personnel and outcome assessors and allocation concealment domains had the worst scores. CONCLUSIONS: Most of the systematic reviews and clinical trials on women's health recently published in a Brazilian evidence-based journal are of low to moderate quality. The quality of these types of studies needs improvement. PMID:23778332

  3. Comparative outcome studies of clinical decision support software: limitations to the practice of evidence-based system acquisition.

    PubMed

    Dhiman, Gaurav Jay; Amber, Kyle T; Goodman, Kenneth W

    2015-04-01

    Clinical decision support systems (CDSSs) assist clinicians with patient diagnosis and treatment. However, inadequate attention has been paid to the process of selecting and buying systems. The diversity of CDSSs, coupled with research obstacles, marketplace limitations, and legal impediments, has thwarted comparative outcome studies and reduced the availability of reliable information and advice for purchasers. We review these limitations and recommend several comparative studies, which were conducted in phases; studies conducted in phases and focused on limited outcomes of safety, efficacy, and implementation in varied clinical settings. Additionally, we recommend the increased availability of guidance tools to assist purchasers with evidence-based purchases. Transparency is necessary in purchasers' reporting of system defects and vendors' disclosure of marketing conflicts of interest to support methodologically sound studies. Taken together, these measures can foster the evolution of evidence-based tools that, in turn, will enable and empower system purchasers to make wise choices and improve the care of patients.

  4. [Clinical trials: prerequisite of evidence-based oncology: reality, perspectives and a new tool recruited--the Internet].

    PubMed

    Mross, K; März, W

    2001-02-01

    Scientifically sound clinical research is an undispensable prerequisite to establish innovative therapeutic principles, to support applications for marketing authorization of proprietary new drugs, to advance therapeutic results in cancer therapy, and the only route towards an evidence-based clinical oncology at the advent of the 21st century. Treatment of cancer patients based on scientific evidence derived from clinical studies outperforms compassionate individual therapeutic decisions with a lack of evidence, whenever such evidence is available or whenever a clinical trial is addressing the clinical situation that must be addressed for an individual patient. A stable trend towards improved survival of cancer patients was first observed in 1999. The advent of new technologies of drug design, the integration of pharmacology, genomics and DNA microarray chip technologies will produce a myriad of new anticancer drugs with promising potential for cancer therapy that need to be tested in the clinical setting without delay. To match that challenge, clinical oncology must streamline the laborious process of conducting clinical trials. The process of planning, multicenter coordinating, recruiting, treatment, analyzing, and reporting of clinical trial results must be further optimized. The best possible quality control of all steps of that process is a prerequisite to motivate patients to participate in clinical trials of cancer therapy - always one of the most promising treatment options for patients seeking the best possible cancer care. At the same time as the internet goes mainstream and cancer care information is ubiquitously laymanized and dispersed via cancer cybermedicine, clinical researchers may employ the internet to exchange information, facilitate conduction of clinical trials, and facilitate recruitment to clinical studies via web-based trial registries. This will be more than an incremental step forward to deliver the best possible clinical care towards the

  5. Symptoms and clinical relevance: a dilemma for clinical trials on prevention of venous thromboembolism.

    PubMed

    Bounameaux, Henri; Agnelli, Giancarlo

    2013-04-01

    The outcomes of thromboprophylactic trials have been debated for decades. Recently, the 9th edition of the American College of Chest Physicians (ACCP) evidence-based clinical practice guidelines based their strong recommendations only on patient-important outcomes. Practically, symptoms were considered the crucial element. Consequently, studies that primarily aimed at reducing venographic thrombi were considered less pertinent than studies that focused on symptomatic thrombosis. In the present viewpoint, we challenge the argument that "symptomatic" and "clinically relevant" are interchangeable. In particular, the case is made that asymptomatic events may be clinically relevant and that asymptomatic venographically detected thrombosis is a clinically relevant surrogate outcome for fatal pulmonary embolism.

  6. The first center for evidence-based medicine in Lithuania: an opportunity to change culture and improve clinical practice.

    PubMed

    Beinortas, Tumas; Bauza, Karolis; Howick, Jeremy; Nunan, David; Mahtani, Kamal Ram

    2015-05-01

    In post-Soviet countries, where medical practice largely relies on experience alone, the incorporation of the best research evidence in clinical practice is limited. In order to promote the awareness and utilization of evidence-based medicine (EBM) among Lithuanian doctors, we organized EBM conferences in each of the two Lithuanian medical schools. More than 500 medical professionals and students attended the conferences in Vilnius (2013) and Kaunas (2014) demonstrating that there is a high demand for formal EBM teaching. Building on the success of these seminal conferences, and to start addressing the lack of EBM practice in the country, the first Lithuanian Centre for Evidence-Based Medicine was established at Vilnius University Medical Faculty in 2014. The Centre will focus on the implementation of EBM teaching in medical school curriculum, formulating management guidelines, writing systematic reviews and supporting Lithuanian authors in doing so.

  7. Nurses' Use of Evidence-Based Practice in Clinical Practice After Attending a Formal Evidence-Based Practice Course: A Quality Improvement Evaluation.

    PubMed

    Connor, Linda; Dwyer, Patricia; Oliveira, Joanne

    2016-01-01

    This quality improvement project explored whether participation in an evidence-based practice (EBP) course influenced the use of EBP in day-to-day nursing practice. Data from two focus groups highlighted the impact of the EBP course, areas for further development, and potential barriers to the utilization of EBP. The authors found that educational offerings that remove barriers to EBP (knowledge and time) improve nurses' utilization of EBP. Ongoing professional development support is needed to foster the use of EBP in practice.

  8. Evidence based clinical assessment of child and adolescent social phobia: a critical review of rating scales.

    PubMed

    Tulbure, Bogdan T; Szentagotai, Aurora; Dobrean, Anca; David, Daniel

    2012-10-01

    Investigating the empirical support of various assessment instruments, the evidence based assessment approach expands the scientific basis of psychotherapy. Starting from Hunsley and Mash's evaluative framework, we critically reviewed the rating scales designed to measure social anxiety or phobia in youth. Thirteen of the most researched social anxiety scales for children and adolescents were identified. An overview about the scientific support accumulated by these scales is offered. Our main results are consistent with recent reviews that consider the Social Phobia and Anxiety Scale for Children (SPAI-C) and the Social Anxiety Scale for Adolescents (SAS-A) among the most pertinent and empirically supported measures of social anxiety for youngsters. However, after considering the existing evidence, we highly recommend another couple of scales that proved to be empirically supported (i.e., the Social Phobia Inventory-SPIN, and the Liebowitz Social Anxiety Scale for Children and Adolescents-LSAS-CA).

  9. Steroids for chronic inflammatory demyelinating polyradiculoneuropathy: evidence base and clinical practice.

    PubMed

    Press, R; Hiew, F L; Rajabally, Y A

    2016-04-01

    Evidence-based therapies for chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) consist of corticosteroids, intravenous immunglobulins (IVIg), and plasma exchange. Steroids represent the oldest treatment used historically. In countries where readily available and affordable, IVIg tends to be favored as first-line treatment. The reason for this preference, despite substantially higher costs, is the perception that IVIg is more efficacious and safer than corticosteroids. However, the unselected use of IVIg as a first-line treatment option in all cases of CIDP raises issues of cost-effectiveness in the long-term. Furthermore, serious although rare, particularly thromboembolic side effects may result from their use. Recent data from randomized trials suggest pulsed corticosteroids to have a higher potential in achieving therapy-free remission or longer remission-free periods compared with IVIg, as well as relatively low rates of serious side effects when given as pulsed intravenous infusions during short periods of time. These specific advantages suggest that pulsed steroids could in many cases be used, as the first, rather than second choice of treatment when initiating immunomodulation in CIDP, primarily in hopes of achieving a remission after the short-term use. This article reviews the evidence base for the use of corticosteroids in its various forms in CIDP and factors that may influence clinicians' choice between IVIg and pulsed steroid treatment. The issue of efficacy, relapse rate and time, and side effect profile are analyzed, and some aspects from the authors' experience are discussed in relation to the possibility of using the steroid option as first-line therapy in a large proportion of patients with CIDP.

  10. Using evidence-based algorithms to improve clinical decision making: the case of a first-time anterior shoulder dislocation.

    PubMed

    Federer, Andrew E; Taylor, Dean C; Mather, Richard C

    2013-09-01

    Decision making in health care has evolved substantially over the last century. Up until the late 1970s, medical decision making was predominantly intuitive and anecdotal. It was based on trial and error and involved high levels of problem solving. The 1980s gave way to empirical medicine, which was evidence based probabilistic, and involved pattern recognition and less problem solving. Although this represented a major advance in the quality of medical decision making, limitations existed. The advantages of the gold standard of the randomized controlled clinical trial (RCT) are well-known and this technique is irreplaceable in its ability to answer critical clinical questions. However, the RCT does have drawbacks. RCTs are expensive and can only capture a snapshot in time. As treatments change and new technologies emerge, new expensive clinical trials must be undertaken to reevaluate them. Furthermore, in order to best evaluate a single intervention, other factors must be controlled. In addition, the study population may not match that of another organization or provider. Although evidence-based medicine has provided powerful data for clinicians, effectively and efficiently tailoring it to the individual has not yet evolved. We are now in a period of transition from this evidence-based era to one dominated by the personalization and customization of care. It will be fueled by policy decisions to shift financial responsibility to the patient, creating a powerful and sophisticated consumer, unlike any patient we have known before. The challenge will be to apply medical evidence and personal preferences to medical decisions and deliver it efficiently in the increasingly busy clinical setting. In this article, we provide a robust review of the concepts of customized care and some of techniques to deliver it. We will illustrate this through a personalized decision model for the treatment decision after a first-time anterior shoulder dislocation.

  11. Attitudes, knowledge and behavior of Japanese physical therapists with regard to evidence-based practice and clinical practice guidelines: a cross-sectional mail survey

    PubMed Central

    Fujimoto, Shuhei; Kon, Noriko; Takasugi, Jun; Nakayama, Takeo

    2017-01-01

    [Purpose] This study aimed to investigate Japanese physical therapists’ attitudes of evidence-based practice and clinical practice guidelines. [Subjects and Methods] In 2014, a cross-sectional postal mail survey using a self-administered questionnaire was conducted. Of 2,982 physical therapists belonging to the Chiba Prefecture Physical Therapist Association, 1,000 were randomly selected. The questionnaire comprised 42 items pertaining to the attitudes of and behavior toward evidence-based practice and clinical practice guidelines. It was investigated to reveal the relationship between clinical practice guidelines/evidence-based practice and therapist characteristics. [Results] The response rate was 39.6%, and 384 questionnaires were available. The main results were as follows: 83.3% participants agreed to the importance of evidence-based practice, 77.1% agree to that evidence-based practice supports clinical decision of physical therapists, and about 11% agreed to have been educated about evidence-based practice. Then, 29.2% used, 54.9% agreed to the importance of, and 13.3% agreed to the utility of clinical practice guidelines. An important factor related mostly to a positive attitude, knowledge and behavior of evidence-based practice and clinical practice guidelines was participating in research activities. [Conclusion] Many of physical therapists do not use and understand the importance of clinical practice guidelines. Participating in research activities may partially contribute to improving these conditions. PMID:28265139

  12. Attitudes, knowledge and behavior of Japanese physical therapists with regard to evidence-based practice and clinical practice guidelines: a cross-sectional mail survey.

    PubMed

    Fujimoto, Shuhei; Kon, Noriko; Takasugi, Jun; Nakayama, Takeo

    2017-02-01

    [Purpose] This study aimed to investigate Japanese physical therapists' attitudes of evidence-based practice and clinical practice guidelines. [Subjects and Methods] In 2014, a cross-sectional postal mail survey using a self-administered questionnaire was conducted. Of 2,982 physical therapists belonging to the Chiba Prefecture Physical Therapist Association, 1,000 were randomly selected. The questionnaire comprised 42 items pertaining to the attitudes of and behavior toward evidence-based practice and clinical practice guidelines. It was investigated to reveal the relationship between clinical practice guidelines/evidence-based practice and therapist characteristics. [Results] The response rate was 39.6%, and 384 questionnaires were available. The main results were as follows: 83.3% participants agreed to the importance of evidence-based practice, 77.1% agree to that evidence-based practice supports clinical decision of physical therapists, and about 11% agreed to have been educated about evidence-based practice. Then, 29.2% used, 54.9% agreed to the importance of, and 13.3% agreed to the utility of clinical practice guidelines. An important factor related mostly to a positive attitude, knowledge and behavior of evidence-based practice and clinical practice guidelines was participating in research activities. [Conclusion] Many of physical therapists do not use and understand the importance of clinical practice guidelines. Participating in research activities may partially contribute to improving these conditions.

  13. Evidence-based protocol for structural rehabilitation of the spine and posture: review of clinical biomechanics of posture (CBP®) publications

    PubMed Central

    Oakley, Paul A.; Harrison, Donald D.; Harrison, Deed E.; Haas, Jason W.

    2005-01-01

    BACKGROUND Although practice protocols exist for SMT and functional rehabilitation, no practice protocols exist for structural rehabilitation. Traditional chiropractic practice guidelines have been limited to acute and chronic pain treatment, with limited inclusion of functional and exclusion of structural rehabilitation procedures. OBJECTIVE (1) To derive an evidence-based practice protocol for structural rehabilitation from publications on Clinical Biomechanics of Posture (CBP®) methods, and (2) to compare the evidence for Diversified, SMT, and CBP®. METHODS Clinical control trials utilizing CBP® methods and spinal manipulative therapy (SMT) were obtained from searches in Mantis, CINAHL, and Index Medicus. Using data from SMT review articles, evidence for Diversified Technique (as taught in chiropractic colleges), SMT, and CBP® were rated and compared. RESULTS From the evidence from Clinical Control Trials on SMT and CBP®, there is very little evidence support for Diversified (our rating = 18), as taught in chiropractic colleges, for the treatment of pain subjects, while CBP® (our rating = 46) and SMT for neck pain (rating = 58) and low back pain (our rating = 202) have evidence-based support. CONCLUSIONS While CBP® Technique has approximately as much evidence-based support as SMT for neck pain, CBP® has more evidence to support its methods than the Diversified technique taught in chiropractic colleges, but not as much as SMT for low back pain. The evolution of chiropractic specialization has occurred, and doctors providing structural-based chiropractic care require protocol guidelines for patient quality assurance and standardization. A structural rehabilitation protocol was developed based on evidence from CBP® publications. PMID:17549209

  14. Applying psychological theory to evidence-based clinical practice: identifying factors predictive of taking intra-oral radiographs.

    PubMed

    Bonetti, Debbie; Pitts, Nigel B; Eccles, Martin; Grimshaw, Jeremy; Johnston, Marie; Steen, Nick; Glidewell, Liz; Thomas, Ruth; Maclennan, Graeme; Clarkson, Jan E; Walker, Anne

    2006-10-01

    This study applies psychological theory to the implementation of evidence-based clinical practice. The first objective was to see if variables from psychological frameworks (developed to understand, predict and influence behaviour) could predict an evidence-based clinical behaviour. The second objective was to develop a scientific rationale to design or choose an implementation intervention. Variables from the Theory of Planned Behaviour, Social Cognitive Theory, Self-Regulation Model, Operant Conditioning, Implementation Intentions and the Precaution Adoption Process were measured, with data collection by postal survey. The primary outcome was the number of intra-oral radiographs taken per course of treatment collected from a central fee claims database. Participants were 214 Scottish General Dental Practitioners. At the theory level, the Theory of Planned Behaviour explained 13% variance in the number of radiographs taken, Social Cognitive Theory explained 7%, Operant Conditioning explained 8%, Implementation Intentions explained 11%. Self-Regulation and Stage Theory did not predict significant variance in radiographs taken. Perceived behavioural control, action planning and risk perception explained 16% of the variance in number of radiographs taken. Knowledge did not predict the number of radiographs taken. The results suggest an intervention targeting predictive psychological variables could increase the implementation of this evidence-based practice, while influencing knowledge is unlikely to do so. Measures which predicted number of radiographs taken also predicted intention to take radiographs, and intention accounted for significant variance in behaviour (adjusted R(2)=5%: F(1,166)=10.28, p<.01), suggesting intention may be a possible proxy for behavioural data when testing an intervention prior to a service-level trial. Since psychological frameworks incorporate methodologies to measure and change component variables, taking a theory-based approach

  15. A pilot project using evidence-based clinical pathways and payment reform in China's rural hospitals shows early success.

    PubMed

    Cheng, Tsung-Mei

    2013-05-01

    Reforming China's public hospitals to curb widespread overtreatment and improve the quality and affordability of care has been the most challenging aspect of that nation's ambitious health reform, which began in 2009. This article describes a pilot project under way in several of China's provinces that combines payment reform with the implementation of evidence-based clinical pathways at a few hospitals serving rural areas. Results to date include reduced length-of-stay and prescription drug use and higher patient and provider satisfaction. These early results suggest that the pilot may be achieving its goals, which may have far-reaching and positive implications for China's ongoing reform.

  16. Changing Nephrology Nurses' Beliefs about the Value of Evidence-Based Practice and Their Ability to Implement in Clinical Practice.

    PubMed

    Hain, Debra; Haras, Mary S

    2015-01-01

    A rapidly evolving healthcare environment demands sound research evidence to inform clinical practice and improve patient outcomes. Over the past several decades, nurses have generated new knowledge by conducting research studies, but it takes time for this evidence to be implemented in practice. As nurses strive to be leaders and active participants in healthcare redesign, it is essential that they possess the requisite knowledge and skills to engage in evidence-based practice (EBP). Professional nursing organizations can make substantial contributions to the move healthcare quality forward by providing EBP workshops similar to those conducted by the American Nephrology Nurses'Association.

  17. Evidence-based Clinical Practice Guidelines for Interventional Pain Management in Cancer Pain

    PubMed Central

    Bhatnagar, Sushma; Gupta, Maynak

    2015-01-01

    Intractable cancer pain not amenable to standard oral or parenteral analgesics is a horrifying truth in 10–15% of patients. Interventional pain management techniques are an indispensable arsenal in pain physician's armamentarium for severe, intractable pain and can be broadly classified into neuroablative and neuromodulation techniques. An array of neurolytic techniques (chemical, thermal, or surgical) can be employed for ablation of individual nerve fibers, plexuses, or intrathecalneurolysis in patients with resistant pain and short life-expectancy. Neuraxial administration of drugs and spinal cord stimulation to modulate or alter the pain perception constitutes the most frequently employed neuromodulation techniques. Lately, there is a rising call for early introduction of interventional techniques in carefully selected patients simultaneously or even before starting strong opioids. After decades of empirical use, it is the need of the hour to head towards professionalism and standardization in order to secure credibility of specialization and those practicing it. Even though the interventional management has found a definite place in cancer pain, there is a dearth of evidence-based practice guidelines for interventional therapies in cancer pain. This may be because of paucity of good quality randomized controlled trials (RCTs) evaluating their safety and efficacy in cancer pain. Laying standardized guidelines based on existing and emerging evidence will act as a foundation step towards strengthening, credentialing, and dissemination of the specialty of interventional cancer pain management. This will also ensure an improved decision-making and quality of life (QoL) of the suffering patients. PMID:26009665

  18. Evidence-based Clinical Practice Guidelines for Interventional Pain Management in Cancer Pain.

    PubMed

    Bhatnagar, Sushma; Gupta, Maynak

    2015-01-01

    Intractable cancer pain not amenable to standard oral or parenteral analgesics is a horrifying truth in 10-15% of patients. Interventional pain management techniques are an indispensable arsenal in pain physician's armamentarium for severe, intractable pain and can be broadly classified into neuroablative and neuromodulation techniques. An array of neurolytic techniques (chemical, thermal, or surgical) can be employed for ablation of individual nerve fibers, plexuses, or intrathecalneurolysis in patients with resistant pain and short life-expectancy. Neuraxial administration of drugs and spinal cord stimulation to modulate or alter the pain perception constitutes the most frequently employed neuromodulation techniques. Lately, there is a rising call for early introduction of interventional techniques in carefully selected patients simultaneously or even before starting strong opioids. After decades of empirical use, it is the need of the hour to head towards professionalism and standardization in order to secure credibility of specialization and those practicing it. Even though the interventional management has found a definite place in cancer pain, there is a dearth of evidence-based practice guidelines for interventional therapies in cancer pain. This may be because of paucity of good quality randomized controlled trials (RCTs) evaluating their safety and efficacy in cancer pain. Laying standardized guidelines based on existing and emerging evidence will act as a foundation step towards strengthening, credentialing, and dissemination of the specialty of interventional cancer pain management. This will also ensure an improved decision-making and quality of life (QoL) of the suffering patients.

  19. Adopting evidence-based practice in clinical decision making: nurses' perceptions, knowledge, and barriers

    PubMed Central

    Majid, Shaheen; Foo, Schubert; Luyt, Brendan; Zhang, Xue; Theng, Yin-Leng; Chang, Yun-Ke; Mokhtar, Intan A

    2011-01-01

    Objective: Evidence-based practice (EBP) provides nurses with a method to use critically appraised and scientifically proven evidence for delivering quality health care to a specific population. The objective of this study was to explore nurses' awareness of, knowledge of, and attitude toward EBP and factors likely to encourage or create barriers to adoption. In addition, information sources used by nurses and their literature searching skills were also investigated. Method: A total of 2,100 copies of the questionnaire were distributed to registered nurses in 2 public hospitals in Singapore, and 1,486 completed forms were returned, resulting in a response rate of 70.8%. Results: More than 64% of the nurses expressed a positive attitude toward EBP. However, they pointed out that due to heavy workload, they cannot keep up to date with new evidence. Regarding self-efficacy of EBP-related abilities, the nurses perceived themselves to possess moderate levels of skills. The nurses also felt that EBP training, time availability, and mentoring by nurses with EBP experience would encourage them to implement EBP. The top three barriers to adopting EBP were lack of time, inability to understand statistical terms, and inadequate understanding of the jargon used in research articles. For literature searching, nurses were using basic search features and less than one-quarter of them were familiar with Boolean and proximity operators. Conclusion: Although nurses showed a positive attitude toward EBP, certain barriers were hindering their smooth adoption. It is, therefore, desirable that hospital management in Southeast Asia, particularly in Singapore, develop a comprehensive strategy for building EBP competencies through proper training. Moreover, hospital libraries should also play an active role in developing adequate information literacy skills among the nurses. PMID:21753915

  20. The Collaborative Assessment and Management of Suicidality (CAMS): an evolving evidence-based clinical approach to suicidal risk.

    PubMed

    Jobes, David A

    2012-12-01

    The Collaborative Assessment and Management of Suicidality (CAMS) is an evidence-based clinical intervention that has significantly evolved over 25 years of clinical research. CAMS is best understood as a therapeutic framework that emphasizes a unique collaborative assessment and treatment planning process between the suicidal patient and clinician. This process is designed to enhance the therapeutic alliance and increase treatment motivation in the suicidal patient. Central to the CAMS approach is the use of the Suicide Status Form (SSF), which is a multipurpose clinical assessment, treatment planning, tracking, and outcome tool. The original development of CAMS was largely rooted in SSF-based quantitative and qualitative assessment of suicidal risk. As this line of research progressed, CAMS emerged as a problem-focused clinical intervention that is designed to target and treat suicidal "drivers" and ultimately eliminate suicidal coping. To date, CAMS (and the clinical use of the SSF) has been supported by six published correlational studies and one randomized clinical trial (RCT). Currently, two well-powered RCTs are under way, and various new CAMS-related projects are also being pursued. The clinical and empirical evolution of CAMS-how it was developed and what are the next steps for this clinical approach-are described here.

  1. [Clinical orientation of post-marketing Chinese patent drugs: an evidence-based practice].

    PubMed

    Shang, Hong-Cai; Zhang, Bo-Li; Li, You-Ping

    2008-09-01

    Unclear clinical orientation in practice has become one of the common problems with the effective application of famous and excellent Chinese herbal drugs, consequently restricting their development. The authors suggest that there are three aspects to be considered in dealing with this problem. Clinical evaluation and orientation of the famous and excellent Chinese herbal drugs is an important task, and it is also a requirement for the internationalization of traditional Chinese medicine. Literature evaluation-pharmacology research-clinical expertise analysis method will establish a theoretical basis and method for post-marketing development of famous and excellent Chinese patent drugs.

  2. Evidence-Based Rationale for Ankle Cartilage Allograft Replacement: A Systematic Review of Clinical Outcomes.

    PubMed

    Johnson, Pierce; Lee, Daniel K

    2015-01-01

    The treatment of ankle arthritis remains controversial. Ankle cartilage allograft replacement is a novel and complex procedure. Many clinical studies have shown some level of promise, as well complications. We performed a systematic review of the clinical outcomes to describe and assess the different techniques and clinical outcomes for ankle cartilage allograft replacement. We performed a review of the published studies using MEDLINE(®) by way of PubMed(®) and Google Scholar(®) from January 2000 through October 2014, ranging from case reports to clinical studies. The inclusion criteria consisted of ankle cartilage allograft procedures with objective findings and clinical outcome scoring and complication and fusion rates and excluded nonallograft synthetic graft techniques, bone substitutes or expanders, review reports, and technique instructional manuals. Evidence with the combination of objective findings and clinical outcomes for all 3 type of allograft replacement (osteochondral, unipolar, and bipolar) is lacking. Several techniques for cartilage fixation have been described, including absorbable and metallic fixation. Most of the studies reported many occurrences and a variety of complications. A myriad of techniques for ankle cartilage allograft replacement exists. The results from the present systematic review of the published studies appear promising; however, the lack of statistical power and inconsistent documentation made it difficult to determine the superiority of any one intervention compared with another for the treatment of ankle arthritis.

  3. [Evidence-based medicine].

    PubMed

    Saad, E D; Grunspun, H

    1996-01-01

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

  4. Ketamine in adult cardiac surgery and the cardiac surgery Intensive Care Unit: An evidence-based clinical review

    PubMed Central

    Mazzeffi, Michael; Johnson, Kyle; Paciullo, Christopher

    2015-01-01

    Ketamine is a unique anesthetic drug that provides analgesia, hypnosis, and amnesia with minimal respiratory and cardiovascular depression. Because of its sympathomimetic properties it would seem to be an excellent choice for patients with depressed ventricular function in cardiac surgery. However, its use has not gained widespread acceptance in adult cardiac surgery patients, perhaps due to its perceived negative psychotropic effects. Despite this limitation, it is receiving renewed interest in the United States as a sedative and analgesic drug for critically ill-patients. In this manuscript, the authors provide an evidence-based clinical review of ketamine use in cardiac surgery patients for intensive care physicians, cardio-thoracic anesthesiologists, and cardio-thoracic surgeons. All MEDLINE indexed clinical trials performed during the last 20 years in adult cardiac surgery patients were included in the review. PMID:25849690

  5. Developing Memory Clinics in Primary Care: An Evidence-Based Interprofessional Program of Continuing Professional Development

    ERIC Educational Resources Information Center

    Lee, Linda; Weston, W. Wayne; Hillier, Loretta M.

    2013-01-01

    Introduction: Primary care is challenged to meet the needs of patients with dementia. A training program was developed to increase capacity for dementia care through the development of Family Health Team (FHT)-based interprofessional memory clinics. The interprofessional training program consisted of a 2-day workshop, 1-day observership, and 2-day…

  6. Tips for Teachers of Evidence-based Medicine: Clinical Prediction Rules (CPRs) and Estimating Pretest Probability

    PubMed Central

    McGinn, Thomas; Jervis, Ramiro; Wisnivesky, Juan; Keitz, Sheri

    2008-01-01

    Background Clinical prediction rules (CPR) are tools that clinicians can use to predict the most likely diagnosis, prognosis, or response to treatment in a patient based on individual characteristics. CPRs attempt to standardize, simplify, and increase the accuracy of clinicians’ diagnostic and prognostic assessments. The teaching tips series is designed to give teachers advice and materials they can use to attain specific educational objectives. Educational Objectives In this article, we present 3 teaching tips aimed at helping clinical learners use clinical prediction rules and to more accurately assess pretest probability in every day practice. The first tip is designed to demonstrate variability in physician estimation of pretest probability. The second tip demonstrates how the estimate of pretest probability influences the interpretation of diagnostic tests and patient management. The third tip exposes learners to various examples and different types of Clinical Prediction Rules (CPR) and how to apply them in practice. Pilot Testing We field tested all 3 tips with 16 learners, a mix of interns and senior residents. Teacher preparatory time was approximately 2 hours. The field test utilized a board and a data projector; 3 handouts were prepared. The tips were felt to be clear and the educational objectives reached. Potential teaching pitfalls were identified. Conclusion Teaching with these tips will help physicians appreciate the importance of applying evidence to their every day decisions. In 2 or 3 short teaching sessions, clinicians can also become familiar with the use of CPRs in applying evidence consistently in everyday practice. PMID:18491194

  7. Evidence-Based Decision about Test Scoring Rules in Clinical Anatomy Multiple-Choice Examinations

    ERIC Educational Resources Information Center

    Severo, Milton; Gaio, A. Rita; Povo, Ana; Silva-Pereira, Fernanda; Ferreira, Maria Amélia

    2015-01-01

    In theory the formula scoring methods increase the reliability of multiple-choice tests in comparison with number-right scoring. This study aimed to evaluate the impact of the formula scoring method in clinical anatomy multiple-choice examinations, and to compare it with that from the number-right scoring method, hoping to achieve an…

  8. Implementation of Evidence-Based Practice in Relation to a Clinical Nursing Ladder System: A National Survey in Taiwan

    PubMed Central

    Weng, Yi-Hao; Chen, Chiehfeng; Kuo, Ken N; Yang, Chun-Yuh; Lo, Heng-Lien; Chen, Kee-Hsin; Chiu, Ya-Wen

    2015-01-01

    Background Although evidence-based practice (EBP) has been widely investigated, few studies have investigated its correlation with a clinical nursing ladder system. The current national study evaluates whether EBP implementation has been incorporated into the clinical ladder system. Methods A cross-sectional questionnaire survey was conducted nationwide of registered nurses among regional hospitals of Taiwan in January to April 2011. Subjects were categorized into beginning nurses (N1 and N2) and advanced nurses (N3 and N4) by the clinical ladder system. Multivariate logistic regression model was used to adjust for possible confounding demographic factors. Results Valid postal questionnaires were collected from 4,206 nurses, including 2,028 N1, 1,595 N2, 412 N3, and 171 N4 nurses. Advanced nurses were more aware of EBP than beginning nurses (p < 0.001; 90.7% vs. 78.0%). In addition, advanced nurses were more likely to hold positive beliefs about and attitudes toward EBP (p < 0.001) and possessed more sufficient knowledge of and skills in EBP (p < 0.001). Furthermore, they more often implemented EBP principles (p < 0.001) and accessed online evidence-based retrieval databases (p < 0.001). The most common motivation for using online databases was self-learning for advanced nurses and positional promotion for beginning nurses. Multivariate logistic regression analyses showed advanced nurses were more aware of EBP, had higher knowledge and skills of EBP, and more often implemented EBP than beginning nurses. Linking Evidence to Action The awareness of, beliefs in, attitudes toward, knowledge of, skills in, and behaviors of EBP among advanced nurses were better than those among beginning nurses. The data indicate that a clinical ladder system can serve as a useful means to enhance EBP implementation. PMID:25588625

  9. Proposal for Development of EBM-CDSS (Evidence-based Clinical Decision Support System) to Aid Prognostication in Terminally Ill Patients

    DTIC Science & Technology

    2014-10-01

    TITLE: Proposal for Development of EBM-CDSS (Evidence-based Clinical Decision Support System) to Aid Prognostication in Terminally Ill Patients...SUBTITLE Proposal for development of EBM-CDSS (Evidence-based Clinical Decision Support System) to aid prognostication in terminally ill patients 5a...to improve prognostication of the life expectancy of terminally ill patients to improve referral of patients to hospice. In addition, the EBM-CDSS

  10. In search of evidence-based treatment for concussion: characteristics of current clinical trials

    PubMed Central

    Burke, Matthew J.; Fralick, Michael; Nejatbakhsh, Nasrin; Tartaglia, Maria C.; Tator, Charles H.

    2015-01-01

    Abstract Objective: To assess the characteristics of current clinical trials investigating the treatment of concussion. Background: Recent systematic literature reviews have concluded that there is minimal evidence to support any specific treatment for concussion, including the principles of return-to-activity protocols such as type or duration of rest. Design/methods: Clinical trial data was extracted from Clinicaltrials.gov and seven additional World Health Organization primary registries. The trial databases were accessed up until 3 October 2013. This study used search terms of ‘concussion’ or ‘mild traumatic brain injury’ (mTBI) and filtered for interventional trials. Trials that were terminated, already published or not interventional trials of concussion/mTBI were excluded. Results: Of the 142 concussion/mTBI interventional clinical trials identified, 71 met inclusion criteria. Trials had a median estimated enrolment of 60 participants. There was a wide-range of treatments studied, including cognitive/behavioural therapies (28.2%), medications (28.2%), devices (11.3%), dietary supplements (8.5%), return-to-activity/rest (1.4%) and others (22.4%). Heterogeneity among trials for concussion identification/diagnosis and primary outcomes utilized was evident. Symptom-based questionnaires (39.4%) and neuropsychological tests (28.2%) were the most common outcome measures. Conclusions: Diverse, potentially promising therapeutics are currently being studied for the treatment of concussion. However, several deficiencies were identified including a paucity of trials addressing return-to-activity principles. Also, small sample size and trial heterogeneity may threaten scientific evaluation and subsequent clinical application. PMID:25383510

  11. Incorporating equity into developing and implementing for evidence-based clinical practice guidelines.

    PubMed

    Eslava-Schmalbach, Javier; Sandoval-Vargas, Gisella; Mosquera, Paola

    2011-04-01

    Clinical practice guidelines (CPG) are useful tools for clinical decision making, processes standardization and quality of care improvements. The current General Social Security and Health System (GSSHS) in Colombia is promoting the initiative of developing and implementing CPG based on evidence in order to improve efficiency and quality of care. The reduction of inequalities in health should be an objective of the GSSHS. The main propose of this analysis is to argue why it is necessary to consider the incorporation of equity considerations in the development and implementation of clinical practice guidelines based on the evidence. A series of reflections were made. Narrative description was used for showing the arguments that support the main findings. Among them are: 1. Differential effectiveness by social groups of interventions could diminish final effectiveness of CPG in the GSSHS; 2. To not consider geographical, ethnic, socioeconomic, cultural and access diversity issues within the CPG could have a potential negative impacts of the CPG; 3. Overall effectiveness of GPC could be better if equity issues are included in the quality verification checklist of the guideline questions; 4. Incorporating equity issues in the process of developing CPG could be cost effective, because improve overall effectiveness of CPG. Conclusions To include equity issues in CPG can help in achieving more equitable health outcomes. From this point of view CPG could be key tools to promote equity in care and health outcomes.

  12. [Evidence based medicine].

    PubMed

    Cuestas, Eduardo

    2005-01-01

    Evidence based medicine is a systematic method employed to secure the best scientific available evidence when making clinical decisions. Several steps are taken in these process, describing a clinical scenario, formulating a specific clinical question, searching the literature for the pertinent studies, selecting the relevant articles using rules of evidence, understanding and calculating measures of effect, and finally incorporating the evidence and patients preferences in the clinical decision process.

  13. Counseling in the clinical setting to prevent unintended pregnancy: an evidence-based research agenda.

    PubMed

    Moos, Merry K; Bartholomew, Neva E; Lohr, Kathleen N

    2003-02-01

    Unintended pregnancies account for about half of all pregnancies in the United States and, in 1995, numbered nearly 3 million pregnancies. They pose appreciable medical, emotional, social and financial costs on women, their families and society. The US is not attaining national goals to decrease unintended pregnancies, and little is known about effective means for reducing unintended pregnancy rates in adults or adolescents.To examine the evidence about the effectiveness, benefits and harms of counseling in a clinical setting to prevent unintended pregnancy in adults and adolescents and to use the evidence to propose a research agenda.We identified English-language articles from comprehensive searches of the MEDLINE, CINAHL, PsychLit and other databases from 1985 through May 2000; the main clinical search terms included pregnancy (mistimed, unintended, unplanned, unwanted), family planning, contraceptive behavior, counseling, sex counseling, and knowledge, attitudes and behavior. We also used published systematic reviews, hand searching of relevant articles, the second Guide to Clinical Preventive Services and extensive peer review to identify important articles not otherwise found and to assure completeness. Of 673 abstracts examined, we retained 354 for full article review; of these, we used 74 for the systematic evidence review and abstracted data from 13 articles for evidence tables. Four studies addressed the effectiveness of counseling in a clinical setting in changing knowledge, skills and attitudes about contraception and pregnancy; all had poor internal validity and generalizability and collectively did not provide definitive guidance about effective counseling strategies. Nine studies (three in teenage populations) addressed the relationship of knowledge on contraceptive use and adherence. Knowledge of correct contraceptive methods may be positively associated with appropriate use, but reservations about the method itself, partner support of the method

  14. Evidence-Based Approach to Fiber Supplements and Clinically Meaningful Health Benefits, Part 2

    PubMed Central

    McRorie, Johnson W.

    2015-01-01

    Dietary fiber that is intrinsic and intact in fiber-rich foods (eg, fruits, vegetables, legumes, whole grains) is widely recognized to have beneficial effects on health when consumed at recommended levels (25 g/d for adult women, 38 g/d for adult men). Most (90%) of the US population does not consume this level of dietary fiber, averaging only 15 g/d. In an attempt to bridge this “fiber gap,” many consumers are turning to fiber supplements, which are typically isolated from a single source. Fiber supplements cannot be presumed to provide the health benefits that are associated with dietary fiber from whole foods. Of the fiber supplements on the market today, only a minority possess the physical characteristics that underlie the mechanisms driving clinically meaningful health benefits. In this 2-part series, the first part (previous issue) described the 4 main characteristics of fiber supplements that drive clinical efficacy (solubility, degree/rate of fermentation, viscosity, and gel formation), the 4 clinically meaningful designations that identify which health benefits are associated with specific fibers, and the gel-dependent mechanisms in the small bowel that drive specific health benefits (eg, cholesterol lowering, improved glycemic control). The second part (current issue) of this 2-part series will focus on the effects of fiber supplements in the large bowel, including the 2 mechanisms by which fiber prevents/relieves constipation (insoluble mechanical irritant and soluble gel-dependent water-holding capacity), the gel-dependent mechanism for attenuating diarrhea and normalizing stool form in irritable bowel syndrome, and the combined large bowel/small bowel fiber effects for weight loss/maintenance. The second part will also discuss how processing for marketed products can attenuate efficacy, why fiber supplements can cause gastrointestinal symptoms, and how to avoid symptoms for better long-term compliance. PMID:25972619

  15. Gingival recession and adult orthodontics: a clinical evidence-based treatment proposal.

    PubMed

    Dersot, Jean-Marc

    2012-03-01

    The presence of a gingival recession prior to orthodontic treatment is a real problem. Patients are concerned about losing their teeth but may also complain of their unpleasant appearance or root sensitivity in the exposed area. The orthodontist is not sure whether orthodontic treatment can be performed or whether the tooth movement will not aggravate the recession and whether periodontal surgery needs to be done before or after orthodontic treatment. The aim of this paper is to present recent data from the literature and several clinical situations in adults in order to submit a treatment sequence and clarify the role of different periodontal plastic surgery root coverage procedures.

  16. Thrombin use in surgery: an evidence-based review of its clinical use

    PubMed Central

    Ham, Sung W; Lew, Wesley K; Weaver, Fred A

    2010-01-01

    When surgical ligation of bleeding fails, or is not possible, surgeons rely on a number of hemostatic aids, including thrombin. This review discusses the history, pharmacology and clinical application of thrombin as a surgical hemostat. The initial thrombin was bovine in origin, but its use has been complicated by the formation of antibodies that cross-react with human coagulation factors. This has been associated with life-threatening bleeding and in some circumstances anaphylaxis and death. Human thrombin, isolated from pooled plasma of donors, was developed in an effort to minimize these risks, but its downsides are its limited availability and the potential for transmitting blood-borne pathogens. Recently a recombinant thrombin has been developed, and approved for use by the FDA. It has the advantage of being minimally antigenic and devoid of the risk of viral transmission. Thrombin is often used in conjunction with other hemostatic aids, including absorbable agents such as Gelfoam, and with fibrinogen in fibrin glues. The last part of this review will discuss these agents in detail, and review their clinical applications. PMID:22282693

  17. Clinical Practice: Evidence-Based Recommendations for the Treatment of Cervical Dystonia with Botulinum Toxin

    PubMed Central

    Contarino, Maria Fiorella; Van Den Dool, Joost; Balash, Yacov; Bhatia, Kailash; Giladi, Nir; Koelman, Johannes H.; Lokkegaard, Annemette; Marti, Maria J.; Postma, Miranda; Relja, Maja; Skorvanek, Matej; Speelman, Johannes D.; Zoons, Evelien; Ferreira, Joaquim J.; Vidailhet, Marie; Albanese, Alberto; Tijssen, Marina A. J.

    2017-01-01

    Cervical dystonia (CD) is the most frequent form of focal dystonia. Symptoms often result in pain and functional disability. Local injections of botulinum neurotoxin are currently the treatment of choice for CD. Although this treatment has proven effective and is widely applied worldwide, many issues still remain open in the clinical practice. We performed a systematic review of the literature on botulinum toxin treatment for CD based on a question-oriented approach, with the aim to provide practical recommendations for the treating clinicians. Key questions from the clinical practice were explored. Results suggest that while the beneficial effect of botulinum toxin treatment on different aspects of CD is well established, robust evidence is still missing concerning some practical aspects, such as dose equivalence between different formulations, optimal treatment intervals, treatment approaches, and the use of supportive techniques including electromyography or ultrasounds. Established strategies to prevent or manage common side effects (including excessive muscle weakness, pain at injection site, dysphagia) and potential contraindications to this treatment (pregnancy and lactation, use of anticoagulants, neurological comorbidities) should also be further explored. PMID:28286494

  18. Clinical Practice: Evidence-Based Recommendations for the Treatment of Cervical Dystonia with Botulinum Toxin.

    PubMed

    Contarino, Maria Fiorella; Van Den Dool, Joost; Balash, Yacov; Bhatia, Kailash; Giladi, Nir; Koelman, Johannes H; Lokkegaard, Annemette; Marti, Maria J; Postma, Miranda; Relja, Maja; Skorvanek, Matej; Speelman, Johannes D; Zoons, Evelien; Ferreira, Joaquim J; Vidailhet, Marie; Albanese, Alberto; Tijssen, Marina A J

    2017-01-01

    Cervical dystonia (CD) is the most frequent form of focal dystonia. Symptoms often result in pain and functional disability. Local injections of botulinum neurotoxin are currently the treatment of choice for CD. Although this treatment has proven effective and is widely applied worldwide, many issues still remain open in the clinical practice. We performed a systematic review of the literature on botulinum toxin treatment for CD based on a question-oriented approach, with the aim to provide practical recommendations for the treating clinicians. Key questions from the clinical practice were explored. Results suggest that while the beneficial effect of botulinum toxin treatment on different aspects of CD is well established, robust evidence is still missing concerning some practical aspects, such as dose equivalence between different formulations, optimal treatment intervals, treatment approaches, and the use of supportive techniques including electromyography or ultrasounds. Established strategies to prevent or manage common side effects (including excessive muscle weakness, pain at injection site, dysphagia) and potential contraindications to this treatment (pregnancy and lactation, use of anticoagulants, neurological comorbidities) should also be further explored.

  19. Enhanced Evidence-Based Chinese Medicine Clinical Practice Guidelines in Hong Kong: A Study Protocol for Three Common Diseases

    PubMed Central

    Shi, Nannan; Zhong, Linda L. D.; Han, XueJie; Ng, Bacon; Bian, Zhaoxiang; Lu, Aiping

    2015-01-01

    We presented a study protocol of developing Chinese medicine clinical practice guidelines for three common diseases in Hong Kong, including insomnia, chronic gastritis, and cerebral infarction. This research project will be conducted in three phases. First phase is the preparation stage which consists of the establishment of steering committee and panel. Second phase involves 6 steps, which are searching and identifying evidence, text mining process, Delphi survey, synthesizing of data, consensus conference, and drafting guidelines. In this phase, text mining technique, evidence-based method, and formal consensus method are combined to get consolidated supporting data as the source of CM CPGs. The final phase comprised external reviews, dissemination, and updating. The outputs from this project will provide three CM CPGs for insomnia, chronic gastritis, and cerebral infarction for Hong Kong local use. PMID:25815035

  20. Policies and Procedures That Facilitate Implementation of Evidence-Based Clinical Guidelines in U.S. Dental Schools.

    PubMed

    Polk, Deborah E; Nolan, Beth A D; Shah, Nilesh H; Weyant, Robert J

    2016-01-01

    The aim of this study was to determine the degree to which dental schools in the United States have policies and procedures in place that facilitate the implementation of evidence-based clinical guidelines. The authors sent surveys to all 65 U.S. dental schools in 2014; responses were obtained from 38 (58%). The results showed that, of the nine policies and procedures examined, only two were fully implemented by 50% or more of the responding schools: guidelines supported through clinical faculty education or available chairside (50%), and students informed of guidelines in both the classroom and clinic (65.8%). Although 92% of the respondents reported having an electronic health record, 80% of those were not using it to track compliance with guidelines. Five schools reported implementing more policies than the rest of the schools. The study found that the approach to implementing guidelines at most of the responding schools did not follow best practices although five schools had an exemplary set of policies and procedures to support guideline implementation. These results suggest that most dental schools are currently not implementing guidelines effectively and efficiently, but that the goal of schools' having a comprehensive implementation program for clinical guidelines is achievable since some are doing so. Future studies should determine whether interventions to improve implementation in dental schools are needed.

  1. Steroid injections in the upper extremity: experienced clinical opinion versus evidence-based practices.

    PubMed

    Kegel, Gary; Marshall, Astrid; Barron, O Alton; Catalano, Louis W; Glickel, Steven Z; Kuhn, Margaret

    2013-09-01

    A survey regarding upper-extremity steroid injection practices was distributed to all active members of the American Society for Surgery of the Hand (ASSH) and American Shoulder and Elbow Surgeons (ASES) using SurveyMonkey. Response rates for the ASSH and ASES were 26% and 24%, respectively. The potency-adjusted dose of steroid injected for common hand and wrist injections ranged from 0.375 to 133.33 mg and for shoulder injections ranged from 0.375 to 250 mg. These ranges span 356-fold and 667-fold differences, respectively. Potency-adjusted doses differed significantly between steroid types for all injections evaluated in this study. American Society for Surgery of the Hand members gave significantly smaller doses of steroid for the glenohumeral and acromioclavicular joints than ASES members. Only 9% of respondents based injection practice on a scientific reference. Sixteen percent of ASSH and 31% of ASES respondents reported no specific rationale for their steroid injection practice; 78% of ASSH and 52% of ASES respondents attributed their rationale to some kind of instruction from their mentors or colleagues. Upper-extremity surgeons demonstrate substantial variability in their practice of steroid injections, with up to a 667-fold range in steroid dose. Experienced clinical opinion is the principal rationale for these injection practices; little rationale is based on formal scientific evidence.

  2. Evidence-based medicine: the design and interpretation of noninferiority clinical trials in veterinary medicine.

    PubMed

    Freise, K J; Lin, T-L; Fan, T M; Recta, V; Clark, T P

    2013-01-01

    Noninferiority trials are clinical studies designed to demonstrate that an investigational drug is at least as effective as an established treatment within a predetermined margin. They are conducted, in part, because of ethical concerns of administering a placebo to veterinary patients when an established effective treatment exists. The use of noninferiority trial designs has become more common in veterinary medicine with the increasing number of established veterinary therapeutics and the desire to eliminate potential pain or distress in a placebo-controlled study. Selecting the appropriate active control and an a priori noninferiority margin between the investigational and active control drug are unique and critical design factors for noninferiority studies. Without reliable historical knowledge of the disease response in the absence of treatment and of the response to the selected active control drug, proper design and interpretation of a noninferiority trial is not possible. Despite the appeal of conducting noninferiority trials to eliminate ethical concerns of placebo-controlled studies, there are real limitations and possible ethical conundrums associated with noninferiority trials. The consequences of incorrect study conclusions because of poor noninferiority trial design need careful attention. Alternative trial designs to typical noninferiority studies exist, but these too have limitations and must also be carefully considered.

  3. Evidence-based interventional pain medicine according to clinical diagnoses. 18. Painful diabetic polyneuropathy.

    PubMed

    Pluijms, Wouter; Huygen, Frank; Cheng, Jianguo; Mekhail, Nagy; van Kleef, Maarten; Van Zundert, Jan; van Dongen, Robert

    2011-01-01

    In the industrialized world, polyneuropathy induced by diabetes mellitus (DM) is one of the most prevalent forms of neuropathy. Diabetic neuropathy can result from a direct toxic effect of glucose on nerve cells. Additionally, the damage of the nerve structures (central and peripheral) is accompanied by a microvascular dysfunction, which damages the vasa nervorum. More than 80% of the patients with DM-induced polyneuropathy have a distal and symmetric presentation. The initial symptoms are: signs of diminished sensation, burning feet, which may occur particularly during the night and worsen when touched, and tingling sensation in the feet. Attacks of shooting pain may also occur. Proper control of DM is mandatory. Based on the recently published National Institute for Health and Clinical Excellence guidelines, treatment of painful diabetic neuropathy should start with duloxetine or amitriptyline if duloxetine is contraindicated. If pain relief is inadequate, monotherapy with amitriptyline or pregabalin, or combination therapy with amitriptyline and pregabalin should be considered. If pain relief is still insufficient, tramadol instead of or in combination with a second-line agent should be considered. In patients who are unable to take oral medication, topical lidocaine can be considered for localized pain. There are currently four studies showing that spinal cord stimulation can potentially provide pain alleviation for the longer term in patients with painful diabetic polyneuropathy. Complications are mainly implant related, though infections also occur. The available evidence (2 C+) justifies spinal cord stimulation to be considered, preferably study related.

  4. Integrating Chemotherapy into the Management of Oligometastatic Colorectal Cancer: Evidence based Approach Using Clinical Trial Findings

    PubMed Central

    Semrad, Thomas J.; Fahrni, Ana Rodriguez; Gong, I-Yeh; Khatri, Vijay P.

    2015-01-01

    Purpose With the use of case presentations, we present a review of the role of systemic chemotherapy in oligometastatic colorectal cancer and suggest ways to integrate clinical research findings into the interdisciplinary management of this potentially curable subset of patients. Methods This educational review discusses the role of chemotherapy in the management of oligometastatic metastatic colorectal cancer. Results In initially resectable oligometastatic colorectal cancer, the goal of chemotherapy is to eradicate micrometastatic disease. Perioperative 5-fluorouracil and oxaliplatin along with surgical resection can result in 5-year survival rates as high as 57%. With the development of increasingly successful chemotherapy regimens, attention is being paid to the use of chemotherapy to convert patients with initially unresectable metastasis into patients with a chance of surgical cure. The choice of chemotherapy regimen requires consideration of the goals of therapy and assessment of both tumor and patient-specific factors. Discussion Herein we discuss the choice and timing of chemotherapy in patients with initially resectable and borderline resectable metastatic colorectal cancer. Coordinated multidisciplinary care of such patients can optimize survival outcomes and result in the cure of patients with this otherwise lethal disease. PMID:26100816

  5. Intentional burn injury: an evidence-based, clinical and forensic review.

    PubMed

    Greenbaum, Adam R; Donne, Jeremy; Wilson, Diana; Dunn, Kenneth W

    2004-11-01

    Burn injury can be inflicted intentionally either by one person to another whenever one has the ability to physically control the other, or it can be self-inflicted. There is scant evidential basis for much that is written about and practiced in the evaluation and care of patients that have sustained intentional burn injuries. Yet this is an area in which medical personnel must necessarily be trained in both the therapeutic and forensic aspects of a complex problem. Failure to appreciate the complexity of medical and forensic interactions may have far reaching effects. A missed diagnosis can result in inappropriate medical care, on-going abuse and future fatality. Inept management can result on the one hand, in blame levelled inappropriately placing incomparable strain on family units and innocent parties, and on the other, allow abusers to continue unchecked. This is the first review on the subject in which lawyers and doctors collaborate to produce a holistic approach to this subject. In it we describe the legal considerations that medical staff must appreciate when approaching patients who may have suffered intentional burns. We analyse the various scenarios in which intentional burning can be found and challenge the clinical dogma with much of the management of paediatric inflicted burns has become imbued. We suggest a rational and balanced approach to all intentional burn injuries-especially when children are involved. In the light of current case law in which dogmatic medical evidence has been implicated in wrongful convictions for child abuse in the UK, it is imperative that medical professionals gather evidence carefully and completely and apply it with logic and impartiality. This paper will aid clinicians who may not be experienced in dealing with burn injuries, but find themselves in the position of seeing a burn acutely, to avoid common mistakes.

  6. Evidence-based neurosurgery

    PubMed Central

    Esene, Ignatius N.; Baeesa, Saleh S.; Ammar, Ahmed

    2016-01-01

    Medical evidence is obtainable from approaches, which might be descriptive, analytic and integrative and ranked into levels of evidence, graded according to quality and summarized into strengths of recommendation. Sources of evidence range from expert opinions through well-randomized control trials to meta-analyses. The conscientious, explicit, and judicious use of current best evidence in making decisions related to the care of individual patients defines the concept of evidence-based neurosurgery (EBN). We reviewed reference books of clinical epidemiology, evidence-based practice and other previously related articles addressing principles of evidence-based practice in neurosurgery. Based on existing theories and models and our cumulative years of experience and expertise conducting research and promoting EBN, we have synthesized and presented a holistic overview of the concept of EBN. We have also underscored the importance of clinical research and its relationship to EBN. Useful electronic resources are provided. The concept of critical appraisal is introduced. PMID:27356649

  7. Vestibular Rehabilitation for Peripheral Vestibular Hypofunction: An Evidence-Based Clinical Practice Guideline

    PubMed Central

    Herdman, Susan J.; Whitney, Susan L.; Cass, Stephen P.; Clendaniel, Richard A.; Fife, Terry D.; Furman, Joseph M.; Getchius, Thomas S. D.; Goebel, Joel A.; Shepard, Neil T.; Woodhouse, Sheelah N.

    2016-01-01

    Background: Uncompensated vestibular hypofunction results in postural instability, visual blurring with head movement, and subjective complaints of dizziness and/or imbalance. We sought to answer the question, “Is vestibular exercise effective at enhancing recovery of function in people with peripheral (unilateral or bilateral) vestibular hypofunction?” Methods: A systematic review of the literature was performed in 5 databases published after 1985 and 5 additional sources for relevant publications were searched. Article types included meta-analyses, systematic reviews, randomized controlled trials, cohort studies, case control series, and case series for human subjects, published in English. One hundred thirty-five articles were identified as relevant to this clinical practice guideline. Results/Discussion: Based on strong evidence and a preponderance of benefit over harm, clinicians should offer vestibular rehabilitation to persons with unilateral and bilateral vestibular hypofunction with impairments and functional limitations related to the vestibular deficit. Based on strong evidence and a preponderance of harm over benefit, clinicians should not include voluntary saccadic or smooth-pursuit eye movements in isolation (ie, without head movement) as specific exercises for gaze stability. Based on moderate evidence, clinicians may offer specific exercise techniques to target identified impairments or functional limitations. Based on moderate evidence and in consideration of patient preference, clinicians may provide supervised vestibular rehabilitation. Based on expert opinion extrapolated from the evidence, clinicians may prescribe a minimum of 3 times per day for the performance of gaze stability exercises as 1 component of a home exercise program. Based on expert opinion extrapolated from the evidence (range of supervised visits: 2-38 weeks, mean = 10 weeks), clinicians may consider providing adequate supervised vestibular rehabilitation sessions for the

  8. The updated clinical guideline development process in Estonia is an efficient method for developing evidence-based guidelines.

    PubMed

    Bero, Lisa A; Hill, Suzanne; Habicht, Jarno; Mathiesen, Mari; Starkopf, Joel

    2013-02-01

    Clinical practice guidelines are one of the tools available to improve the quality of health care. However, it may be difficult for countries to develop their own national guidelines "from scratch" because of limitations in time, expertise, and financial resources. The Estonian Health Insurance Fund (EHIF), in collaboration with other stakeholders, has launched a national effort to develop and implement evidence-based clinical practice guidelines aimed at improving the quality of care. Although the first EHIF handbook for preparing guidelines was published in 2004, there has been wide variation in the format and quality of guidelines prepared by medical specialty societies, EHIF, and other organizations in Estonia. An additional challenge to guideline development in Estonia is that it is a country with limited human resources. Therefore, revision of the Estonian guideline process was aimed at developing an efficient method for adapting current high-quality guidelines to the Estonian setting without compromising their quality. In 2010, a comprehensive assessment of guideline development in Estonia was made by the World Health Organization, EHIF, the Medical Faculty at the University of Tartu, and selected national and international experts in an effort to streamline and harmonize the principles and processes of guideline development in Estonia. This study summarizes the evaluation of and revisions to the process. Estonia has made substantial changes in its processes of clinical practice guideline development and implementation as part of an overall program aiming for systematic quality improvement in health care. This experience may be relevant to other small or resource-limited countries.

  9. Evidence-Based Medicine: Rhinoplasty.

    PubMed

    Lee, Matthew K; Most, Sam P

    2015-08-01

    Evidence-based medicine has become increasingly prominent in the climate of modern day healthcare. The practice of evidence-based medicine involves the integration of the best available evidence with clinical experience and expertise to help guide clinical decision-making. The essential tenets of evidence-based medicine can be applied to both functional and aesthetic rhinoplasty. Current outcome measures in functional and aesthetic rhinoplasty, including objective, subjective, and clinician-reported measures, is summarized and the current data is reviewed.

  10. Estimating the Likely Public Health Impact of Partner Notification for a Clinical Service: An Evidence-Based Algorithm

    PubMed Central

    Aicken, Catherine R. H.; Brook, M. Gary; Estcourt, Claudia S.; Cassell, Jackie A.

    2011-01-01

    Objectives. We present the first evidence-based method for estimating public health and cost impacts of partner notification (PN) that takes account of sexual partnership type. Methods. Our algorithm uses routine clinical data, probability survey data, and transmission parameters. We propose 2 new epidemiological concepts to quantify PN impact: “[the] absolute reduction in onward transmission” and its reciprocal, “[the] number needed to treat to interrupt transmission” (i.e., the number of partners who need to be treated to interrupt 1 onward transmission). We demonstrate these concepts for 273 chlamydia cases diagnosed at a UK genitourinary medicine clinic. Results. The number needed to treat to interrupt transmission (overall, for casual partners, and for regular partners, respectively) was 1.47, 1.11, and 2.50, respectively, for men younger than 25 years; 1.60, 0.83, and 1.25, respectively, for women younger than 25 years; 2.35, 1.39, and 2.08, respectively, for men older than 25 years; and 2.14, 0.93, and 2.08, respectively, for women older than 25 years. Conclusions. PN that targets casual partners, rather than regular or live-in partners, prevents more secondary transmissions per partnership; it is also more resource intensive, but the public health benefit is greater. PMID:21940925

  11. Psychometric instrumentation: reliability and validity of instruments used for clinical practice, evidence-based practice projects and research studies.

    PubMed

    Mayo, Ann M

    2015-01-01

    It is important for CNSs and other APNs to consider the reliability and validity of instruments chosen for clinical practice, evidence-based practice projects, or research studies. Psychometric testing uses specific research methods to evaluate the amount of error associated with any particular instrument. Reliability estimates explain more about how well the instrument is designed, whereas validity estimates explain more about scores that are produced by the instrument. An instrument may be architecturally sound overall (reliable), but the same instrument may not be valid. For example, if a specific group does not understand certain well-constructed items, then the instrument does not produce valid scores when used with that group. Many instrument developers may conduct reliability testing only once, yet continue validity testing in different populations over many years. All CNSs should be advocating for the use of reliable instruments that produce valid results. Clinical nurse specialists may find themselves in situations where reliability and validity estimates for some instruments that are being utilized are unknown. In such cases, CNSs should engage key stakeholders to sponsor nursing researchers to pursue this most important work.

  12. [Evidence-based clinical practice guidelines in oral care 3. Support for the development of clinical practice guidelines].

    PubMed

    van Dam, B A F M; Oosterkamp, B C M; den Boer, J C L; Bruers, J J M

    2015-02-01

    Support is an important factor in the implementation of clinical practice guidelines. Data from 5 studies from 1998 through 2013 offer insight into the support for clinical practice guidelines among dentists, orthodontists, dental hygienists and denturists in the Netherlands. In these, attitudes, opinions, knowledge and behaviour were seen as indicators of support. Dentists have an increasingly positive attitude towards clinical practice guidelines. The majority is aware of and uses at least 1 of the guidelines available to them and are in favour of the development of clinical practice guidelines. Orthodontists and dental hygienists have available few such guidelines, but the majority of both groups favour their development. Among denturists, who also have little experience with clinical practice guidelines, there are fewer supporters for their development. All in all, among caregivers in oral healthcare in the Netherlands, support for the use and development of clinical practice guidelines is growing.

  13. Is the Information about a Test Important? Applying the Methods of Evidence-Based Medicine to the Clinical Examination of Swallowing

    ERIC Educational Resources Information Center

    Rosenbek, John C.; McCullough, Gary H.; Wertz, Robert T.

    2004-01-01

    A hotly debated topic in oropharyngeal dysphagia is the Clinical Swallowing Examination's (CSE) importance in clinical practice. That debate can profit from the application of evidence-based medicine's (EBM) principles and procedures. These can guide both appropriate data collection and interpretation as will be demonstrated in the present report.…

  14. iPadagogy 101: Using Clinical ORthopedic Exam (C.O.R.E.) to Facilitate Evidence-Based Practice in the Orthopaedic Evaluation Classroom

    ERIC Educational Resources Information Center

    Hamson-Utley, J. Jordan; Stiller-Ostrowski, Jennifer L.

    2013-01-01

    Evidence-based practice (EBP) and educational technology have become fundamental skills within athletic training programs. The objective of this article is to share experiences implementing clinical orthopaedic evaluation applications ("apps") that can be integrated into classroom and clinical education to enhance students' proficiency…

  15. Improving risk assessment of violence among military Veterans: An evidence-based approach for clinical decision-making

    PubMed Central

    Elbogen, Eric B.; Fuller, Sara; Johnson, Sally C.; Brooks, Stephanie; Kinneer, Patricia; Calhoun, Patrick; Beckham, Jean C.

    2010-01-01

    Despite increased media attention on violent acts against others committed by military Veterans, few models have been developed to systematically guide violence risk assessment among Veterans. Ideally, a model would identify which Veterans are most at risk for violence and increased attention could then be turned to determining what could be done to prevent violent behavior. This article suggests how empirical approaches to risk assessment used successfully in civilian populations can be applied to Veterans. A review was conducted of the scientific literature on Veteran populations regarding factors related to interpersonal violence generally and to domestic violence specifically. A list was then generated of empirically-supported risk factors for clinicians to consider in practice. To conceptualize how these known risk factors relate to a Veteran’s violence potential, risk assessment scholarship was utilized to develop an evidence-based method to guide mental health professionals. The goals of this approach are to integrate science into practice, overcome logistical barriers, and permit more effective assessment, monitoring, and management of violence risk for clinicians working with Veterans, both in Veteran Administration settings and in the broader community. It is likely that the use of a systematic, empirical framework could lead to improved clinical decision-making in the area of risk assessment, and help reduce violence among Veterans. PMID:20627387

  16. Improving risk assessment of violence among military veterans: an evidence-based approach for clinical decision-making.

    PubMed

    Elbogen, Eric B; Fuller, Sara; Johnson, Sally C; Brooks, Stephanie; Kinneer, Patricia; Calhoun, Patrick S; Beckham, Jean C

    2010-08-01

    Increased media attention to post-deployment violence highlights the need to develop effective models to guide risk assessment among military Veterans. Ideally, a method would help identify which Veterans are most at risk for violence so that it can be determined what could be done to prevent violent behavior. This article suggests how empirical approaches to risk assessment used successfully in civilian populations can be applied to Veterans. A review was conducted of the scientific literature on Veteran populations regarding factors related to interpersonal violence generally and to domestic violence specifically. A checklist was then generated of empirically-supported risk factors for clinicians to consider in practice. To conceptualize how these known risk factors relate to a Veteran's violence potential, risk assessment scholarship was utilized to develop an evidence-based method to guide mental health professionals. The goals of this approach are to integrate science into practice, overcome logistical barriers, and permit more effective assessment, monitoring, and management of violence risk for clinicians working with Veterans, both in Department of Veteran Affairs settings and in the broader community. Research is needed to test the predictive validity of risk assessment models. Ultimately, the use of a systematic, empirical framework could lead to improved clinical decision-making in the area of risk assessment and potentially help prevent violence among Veterans.

  17. A Clinical Trial of Translation of Evidence Based Interventions to Mobile Tablets and Illness Specific Internet Sites

    PubMed Central

    Smith, Carol E; Piamjariyakul, Ubolrat; Werkowitch, Marilyn; Yadrich, Donna Macan; Thompson, Noreen; Hooper, Dedrick; Nelson, Eve-Lynn

    2016-01-01

    This article describes a method to translate an evidence based health care intervention to the mobile environment. This translation assisted patient participants to: avoid life threatening infections; monitor emotions and fatigue; keep involved in healthy activities. The mobile technology also decreased costs by reducing for example travel to visit health care providers. Testing of this translation method and its use by comparison groups of patients adds to the knowledge base for assessing technology for its impact on health outcome measures. The challenges and workflow of designing materials for the mobile format are described. Transitioning clinical trial verified interventions, previously provided in person to patients, onto tablet and internet platforms is an important process that must be evaluated. In this study, our evidence based guide’s intravenous (IV) homeCare interventions (IVhomeCare) were delivered via Apple iPad mini™ tablet audiovisual instruction / discussion sessions and on a website. Each iPad audiovisual session (n = 41), included three to five families, a mental health specialist, and healthcare professionals. Patients and their family caregivers readily learned to use the wireless mobile tablets, and the IVhomeCare interventions, as described here, were successfully translated onto these mobile technology platforms. Using Likert scale responses on a questionnaire (1 = not helpful and 5 = very helpful) participants indicated that they gained problem solving skills for home care through iPad group discussion (M = 4.60, SD = 0.60). The firewall protected videoconferencing in real time with multiple healthcare professionals effectively allowed health history taking and visual inspection of the patient’s IV insertion site for signs of infection. Supportive interactions with peer families on videoconferencing were documented during discussions. Discussion topics included low moods, fatigue, infection worry, how to maintain independence, and

  18. A Clinical Trial of Translation of Evidence Based Interventions to Mobile Tablets and Illness Specific Internet Sites.

    PubMed

    Smith, Carol E; Piamjariyakul, Ubolrat; Werkowitch, Marilyn; Yadrich, Donna Macan; Thompson, Noreen; Hooper, Dedrick; Nelson, Eve-Lynn

    2016-03-01

    This article describes a method to translate an evidence based health care intervention to the mobile environment. This translation assisted patient participants to: avoid life threatening infections; monitor emotions and fatigue; keep involved in healthy activities. The mobile technology also decreased costs by reducing for example travel to visit health care providers. Testing of this translation method and its use by comparison groups of patients adds to the knowledge base for assessing technology for its impact on health outcome measures. The challenges and workflow of designing materials for the mobile format are described. Transitioning clinical trial verified interventions, previously provided in person to patients, onto tablet and internet platforms is an important process that must be evaluated. In this study, our evidence based guide's intravenous (IV) homeCare interventions (IVhomeCare) were delivered via Apple iPad mini™ tablet audiovisual instruction / discussion sessions and on a website. Each iPad audiovisual session (n = 41), included three to five families, a mental health specialist, and healthcare professionals. Patients and their family caregivers readily learned to use the wireless mobile tablets, and the IVhomeCare interventions, as described here, were successfully translated onto these mobile technology platforms. Using Likert scale responses on a questionnaire (1 = not helpful and 5 = very helpful) participants indicated that they gained problem solving skills for home care through iPad group discussion (M = 4.60, SD = 0.60). The firewall protected videoconferencing in real time with multiple healthcare professionals effectively allowed health history taking and visual inspection of the patient's IV insertion site for signs of infection. Supportive interactions with peer families on videoconferencing were documented during discussions. Discussion topics included low moods, fatigue, infection worry, how to maintain independence, and need

  19. Systematic evidence-based clinical practice guidelines are ushering in a new stage of standardized management of hepatocellular carcinoma in Japan.

    PubMed

    Song, Peipei; Tang, Wei; Hasegawa, Kiyoshi; Kokudo, Norihiro

    2014-04-01

    Since the European Association for the Study of the Liver published their guidelines for hepatocellular carcinoma HCC (EASL Guideline) in 2001, there have been many explorations of "transferring best current evidence into clinical decision-making" around the worldwide. Comparative analysis on current 17 characteristic guidelines for HCC indicated that evidence-based clinical practice guidelines for HCC are urgently needed and appropriate constructing approach is the factor most significantly influencing their implementation. The construction of evidence-based clinical practice guidelines for HCC in Japan made a good example of this practice. In accordance with evidence-based medicine (EBM), the first version of the J-HCC Guidelines was published in 2005, then revised in 2009, and the third version has just been published on October 15, 2013 with the incorporation of new evidence, which marks the construction of evidence-based clinical practice guidelines for HCC step into a systematic process in Japan. In order to make a more clear description on how to construct evidence-based clinical practice guidelines for HCC in Japan, the three versions of the J-HCC Guidelines were comparatively analyzed in this paper. Focus on methodology used to develop the updated version, the decision tree of 2013 J-HCC Guideline and its features were also revealed. It is expected that J-HCC Guidelines could be useful not only for Japanese physicians and patients in decision making at every clinical step, but also to benefit users internationally with the accumulated evidence and its interpretation in the guidelines.

  20. Clinical Decision-Making in Community Children's Mental Health: Using Innovative Methods to Compare Clinicians with and without Training in Evidence-Based Treatment

    ERIC Educational Resources Information Center

    Baker-Ericzén, Mary J.; Jenkins, Melissa M.; Park, Soojin; Garland, Ann F.

    2015-01-01

    Background: Mental health professionals' decision-making practice is an area of increasing interest and importance, especially in the pediatric research and clinical communities. Objective: The present study explored the role of prior training in evidence-based treatments (EBTs) on clinicians' assessment and treatment formulations using…

  1. Do Workshops in Evidence-Based Practice Equip Participants to Identify and Answer Questions Requiring Consideration of Clinical Research? A Diagnostic Skill Assessment

    ERIC Educational Resources Information Center

    Wyer, Peter C,; Naqvi, Zoon; Dayan, Peter S.; Celentano, James J.; Eskin, Barnet; Graham, Mark J.

    2009-01-01

    Evidence-based practice (EBP) requires practitioners to identify and formulate questions in response to patient encounters, and to seek, select, and appraise applicable clinical research. A standardized workshop format serves as the model for training of medical educators in these skills. We developed an evaluation exercise to assess the ability…

  2. Evaluation of Organizational Readiness in Clinical Settings for Social Supporting Evidence-Based Information Seeking Behavior after Introducing IT in a Developing Country.

    PubMed

    Kahouei, Mehdi; Alaei, Safollah; Panahi, Sohaila Sadat Ghazavi Shariat; Zadeh, Jamileh Mahdi

    2015-01-01

    The health sector of Iran has endeavored to encourage physicians and medical students to use research findings in their practice. Remarkable changes have occurred, including: holding computer skills courses, digital library workshops for physicians and students, and establishing websites in hospitals. The findings showed that a small number of the participants completely agreed that they were supported by supervisors and colleagues to use evidence-based information resources in their clinical decisions. Health care organizations in Iran need other organizational facilitators such as social influences, organizational support, leadership, strong organizational culture, and climate in order to implement evidence-based practice.

  3. Multi-criteria clinical decision support: A primer on the use of multiple criteria decision making methods to promote evidence-based, patient-centered healthcare

    PubMed Central

    Dolan, James G.

    2010-01-01

    Current models of healthcare quality recommend that patient management decisions be evidence-based and patient-centered. Evidence-based decisions require a thorough understanding of current information regarding the natural history of disease and the anticipated outcomes of different management options. Patient-centered decisions incorporate patient preferences, values, and unique personal circumstances into the decision making process and actively involve both patients along with health care providers as much as possible. Fundamentally, therefore, evidence-based, patient-centered decisions are multi-dimensional and typically involve multiple decision makers. Advances in the decision sciences have led to the development of a number of multiple criteria decision making methods. These multi-criteria methods are designed to help people make better choices when faced with complex decisions involving several dimensions. They are especially helpful when there is a need to combine “hard data” with subjective preferences, to make trade-offs between desired outcomes, and to involve multiple decision makers. Evidence-based, patient-centered clinical decision making has all of these characteristics. This close match suggests that clinical decision support systems based on multi-criteria decision making techniques have the potential to enable patients and providers to carry out the tasks required to implement evidence-based, patient-centered care effectively and efficiently in clinical settings. The goal of this paper is to give readers a general introduction to the range of multi-criteria methods available and show how they could be used to support clinical decision-making. Methods discussed include the balance sheet, the even swap method, ordinal ranking methods, direct weighting methods, multi-attribute decision analysis, and the analytic hierarchy process (AHP) PMID:21394218

  4. Applying Critical Consciousness and Evidence-Based Practice Decision-Making: A Framework for Clinical Social Work Practice

    ERIC Educational Resources Information Center

    O'Neill, Margaret

    2015-01-01

    Social work education is increasingly driven by the established movement of evidence-based practice (EBP) that drives the delivery of mental health care with the promise of providing treatments that work and greater efficiency. This emphasis on EBP coexists with the profession's expressed commitment to social justice. Social work literature rarely…

  5. Parent Perspectives of an Evidence-Based Intervention for Children with Autism Served in Community Mental Health Clinics

    ERIC Educational Resources Information Center

    Stadnick, Nicole A.; Drahota, Amy; Brookman-Frazee, Lauren

    2013-01-01

    Research suggests that improvements to community mental health (CMH) care for children with autism spectrum disorders (ASD) are needed. Recent research examining the feasibility of training CMH therapists to deliver a package of evidence-based practice intervention strategies (EBPs) targeting challenging behaviors for school-age children with ASD…

  6. Yield of CT Pulmonary Angiography in the Emergency Department When Providers Override Evidence-based Clinical Decision Support.

    PubMed

    Yan, Zihao; Ip, Ivan K; Raja, Ali S; Gupta, Anurag; Kosowsky, Joshua M; Khorasani, Ramin

    2017-03-01

    Purpose To determine the frequency of, and yield after, provider overrides of evidence-based clinical decision support (CDS) for ordering computed tomographic (CT) pulmonary angiography in the emergency department (ED). Materials and Methods This HIPAA-compliant, institutional review board-approved study was performed at a tertiary care, academic medical center ED with approximately 60 000 annual visits and included all patients who were suspected of having pulmonary embolism (PE) and who underwent CT pulmonary angiography between January 1, 2011, and August 31, 2013. The requirement to obtain informed consent was waived. Each CT order for pulmonary angiography was exposed to CDS on the basis of the Wells criteria. For patients with a Wells score of 4 or less, CDS alerts suggested d-dimer testing because acute PE is highly unlikely in these patients if d-dimer levels are normal. The yield of CT pulmonary angiography (number of positive PE diagnoses/total number of CT pulmonary angiographic examinations) was compared in patients in whom providers overrode CDS alerts (by performing CT pulmonary angiography in patients with a Wells score ≤4 and a normal d-dimer level or no d-dimer testing) (override group) and those in whom providers followed Wells criteria (CT pulmonary angiography only in patients with Wells score >4 or ≤4 with elevated d-dimer level) (adherent group). A validated natural language processing tool identified positive PE diagnoses, with subsegmental and/or indeterminate diagnoses removed by means of chart review. Statistical analysis was performed with the χ(2) test, the Student t test, and logistic regression. Results Among 2993 CT pulmonary angiography studies in 2655 patients, 563 examinations had a Wells score of 4 or less but did not undergo d-dimer testing and 26 had a Wells score of 4 or less and had normal d-dimer levels. The yield of CT pulmonary angiography was 4.2% in the override group (25 of 589 studies, none with a normal d

  7. A clinical education program for speech-language pathologists applying reflective practice, evidence-based practice and case-based learning.

    PubMed

    Meilijson, Sara; Katzenberger, Irit

    2014-01-01

    This paper presents a comprehensive clinical education program for speech-language pathology students while considering the learning process and gradual acquisition of knowledge and skills for becoming a practicing speech-language pathologist. It describes the clinical speech and language education program for speech-language pathology students at Hadassah Academic College Jerusalem (HAC) based on three facets of learning: reflective practice, evidence-based practice and case-based learning. Also described are the choice of the model of learning and its implementation. The clinical education program presented reflects the professional development of the faculty at HAC as well as recent trends in clinical education methods.

  8. Clinical practice guideline dissemination and a new approach using Haddon matrix as a conceptual framework of evidence-based implementation strategies

    PubMed Central

    Pang, Peter

    2010-01-01

    To err is human. Clinical practice guidelines (CPGs) are often not followed and lead to adverse outcomes. The issue on implementation of CPG is complex. A review of CPG implementation is done to identify the barriers and enablers. For the first time, a fishbone diagram is used to delineate the root-causes. And Haddon matrix is applied to help understand the complexity of evidence-based implementation (EBI) strategies. PMID:25214934

  9. Proposal for Development of EBM-CDSS (Evidence-Based Clinical Decision Support System) to Aid Prognostication in Terminally Ill Patients

    DTIC Science & Technology

    2010-10-01

    regarding continuation of life-sustaining vs. palliative care . Finally, using regret DCA, the optimal decision for the specific patient is suggested...is to develop an Evidence-based Clinical Decision Support (CDSS-EBM) system and make it available at the point of care to improve prognostication of...Analysis and Regret theory to compare multiple decision strategies based on the decision maker’s personal attitudes towards each strategy

  10. The perioperative management of antithrombotic therapy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition).

    PubMed

    Douketis, James D; Berger, Peter B; Dunn, Andrew S; Jaffer, Amir K; Spyropoulos, Alex C; Becker, Richard C; Ansell, Jack

    2008-06-01

    This article discusses the perioperative management of antithrombotic therapy and is part of the American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). The primary objectives of this article are the following: (1) to address the perioperative management of patients who are receiving vitamin K antagonists (VKAs) or antiplatelet drugs, such as aspirin and clopidogrel, and require an elective surgical or other invasive procedures; and (2) to address the perioperative use of bridging anticoagulation, typically with low-molecular-weight heparin (LMWH) or unfractionated heparin (UFH). A secondary objective is to address the perioperative management of such patients who require urgent surgery. The recommendations in this article incorporate the grading system that is discussed in this supplement (Guyatt G et al, CHEST 2008; 133:123S-131S). Briefly, Grade 1 recommendations are considered strong and indicate that the benefits do (or do not) outweigh risks, burden, and costs, whereas Grade 2 recommendations are referred to as suggestions and imply that individual patient values may lead to different management choices. The key recommendations in this article include the following: in patients with a mechanical heart valve or atrial fibrillation or venous thromboembolism (VTE) at high risk for thromboembolism, we recommend bridging anticoagulation with therapeutic-dose subcutaneous (SC) LMWH or IV UFH over no bridging during temporary interruption of VKA therapy (Grade 1C); in patients with a mechanical heart valve or atrial fibrillation or VTE at moderate risk for thromboembolism, we suggest bridging anticoagulation with therapeutic-dose SC LMWH, therapeutic-dose IV UFH, or low-dose SC LMWH over no bridging during temporary interruption of VKA therapy (Grade 2C); in patients with a mechanical heart valve or atrial fibrillation or VTE at low risk for thromboembolism, we suggest low-dose SC LMWH or no bridging over bridging with

  11. Evidence-based clinical audit criteria for the prevention and management of delirium in the postoperative patient with a hip fracture.

    PubMed

    Holly, Cheryl; Rittenmeyer, Leslie; Weeks, Susan Mace

    2014-01-01

    Delirium is a frequent, yet often unrecognized, occurrence in elderly hospitalized patients. In patients with hip fracture, the incidence of delirium is reported to be as high as 62% and even greater if over 65 years of age. One approach to the prevention and management of postoperative delirium in elderly patients with hip fracture is the clinical audit. A clinical audit is a retrospective assessment of clinical care of patients and is guided by criteria that are evidence-based statements of best practice. The use of measurable, objective criterion, with an agreed standard of performance is the hallmark of an audit. The clinical audit criteria presented in this article for the prevention and management of delirium in hospitalized elderly with hip fracture were determined by a compilation of systematic reviews and existing evidence-based clinical guidelines. The following 5 audit criteria are discussed: (1) All elderly patients with a hip fracture are assessed for risk factors for developing delirium daily using a valid and reliable tool; (2) the environment of the patient with hip fracture is assessed daily for conduciveness to maintaining sensory orientation; (3) all patients with hip fracture receive essential nursing care; (4) appropriate clinical criteria are applied to confirm a diagnosis of delirium in patients with hip fracture; and (5) nonpharmacologic interventions are employed before pharmacologic interventions in patients with hip fracture with a diagnosis of delirium.

  12. Evidence-Based Psychological Interventions for the Management of Pediatric Chronic Pain: New Directions in Research and Clinical Practice

    PubMed Central

    Coakley, Rachael; Wihak, Tessa

    2017-01-01

    Over the past 20 years our knowledge about evidence-based psychological interventions for pediatric chronic pain has dramatically increased. Overall, the evidence in support of psychological interventions for pediatric chronic pain is strong, demonstrating positive psychological and behavioral effects for a variety of children with a range of pain conditions. However, wide scale access to effective psychologically-based pain management treatments remains a challenge for many children who suffer with pain. Increasing access to care and reducing persistent biomedical biases that inhibit attainment of psychological services are a central focus of current pain treatment interventions. Additionally, as the number of evidence-based treatments increase, tailoring treatments to a child or family’s particular needs is increasingly possible. This article will (1) discuss the theoretical frameworks as well as the specific psychological skills and strategies that currently hold promise as effective agents of change; (2) review and summarize trends in the development of well-researched outpatient interventions over the past ten years; and (3) discuss future directions for intervention research on pediatric chronic pain. PMID:28165415

  13. Teaching nurses to provide patient centered evidence-based care through the use of informatics tools that promote safety, quality and effective clinical decisions.

    PubMed

    Norton, Michele; Skiba, Diane J; Bowman, Jeanette

    2006-01-01

    Schools of Nursing face the challenge of providing students with experiences to use evidence-based consumer centric care information tools. To facilitate this challenge, a unique partnership was forged between a school of nursing and a leading clinical information systems corporation. This strategic partnership was created to advance the field of nursing informatics through the sharing of intellectual capital. Through this sharing, the goal is to study how technology can promote patient safety, support evidence-based care and facilitate consumer involvement in health care decisions. This paper describes the design, development and testing of a multimedia product that can be used by schools of nursing. This product can be integrated into a nursing curriculum to promote the use of informatics tools as an integral practice component. The multimedia product embraces the core competencies advocated by the Institute of Medicine's Health Professions Education Report.

  14. [Evidence-based medicine. 2. Research of clinically relevant biomedical information. Gruppo Italiano per la Medicina Basata sulle Evidenze--GIMBE].

    PubMed

    Cartabellotta, A

    1998-05-01

    Evidence-based Medicine is a product of the electronic information age and there are several databases useful for practice it--MEDLINE, EMBASE, specialized compendiums of evidence (Cochrane Library, Best Evidence), practice guidelines--most of them free available through Internet, that offers a growing number of health resources. Because searching best evidence is a basic step to practice Evidence-based Medicine, this second review (the first one has been published in the issue of March 1998) has the aim to provide physicians tools and skills for retrieving relevant biomedical information. Therefore, we discuss about strategies for managing information overload, analyze characteristics, usefulness and limits of medical databases and explain how to use MEDLINE in day-to-day clinical practice.

  15. Impact of evidence-based standardized assessment on the disability clinical interview for diagnosis of service-connected PTSD: a cluster-randomized trial.

    PubMed

    Speroff, Theodore; Sinnott, Patricia L; Marx, Brian; Owen, Richard R; Jackson, James C; Greevy, Robert; Sayer, Nina; Murdoch, Maureen; Shane, Andrea C; Smith, Jeffrey; Alvarez, JoAnn; Nwosu, Samuel K; Keane, Terence; Weathers, Frank; Schnurr, Paula P; Friedman, Matthew J

    2012-12-01

    Posttraumatic stress disorder (PTSD) is one of the fastest growing compensated medical conditions. The present study compared usual disability examiner practices for PTSD with a standardized assessment that incorporates evidence-based assessments. The design was a multicenter, cluster randomized, parallel-group study involving 33 clinical examiners and 384 veterans at 6 Veterans Affairs medical centers. The standardized group incorporated the Clinician Administered PTSD Scale and the World Health Organization Disability Assessment Schedule-II into their assessment interview. The main outcome measures were completeness and accuracy of PTSD diagnosis and completeness of functional assessment. The standardized assessments were 85% complete for diagnosis compared to 30% for nonstandardized assessments (p < .001), and, for functional impairment, 76% versus 3% (p < .001). The findings demonstrate that the quality of PTSD disability examination would be improved by using evidence-based assessment.

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

    PubMed Central

    Castelnuovo, Gianluca

    2010-01-01

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

  17. Use of an evidence-based protocol to screen for sleep-disordered breathing in a heart failure disease management clinic.

    PubMed

    Garner, Shelby L; Traverse, Ramona D

    2014-01-01

    Undiagnosed and untreated sleep-disordered breathing can lead to negative health outcomes and increased utilization of health resources among patients with heart failure. The purpose of this evidence-based practice project was to implement and evaluate a new multifaceted sleep-disordered breathing screening protocol in a heart failure disease management clinic. The combined use of a symptoms questionnaire, the Epworth sleepiness scale, and overnight pulse oximetry was significantly more effective in identifying patients with a positive diagnosis of sleep-disordered breathing than using the Epworth sleepiness scale alone (P < .05).

  18. The MRI-Linear Accelerator Consortium: Evidence-Based Clinical Introduction of an Innovation in Radiation Oncology Connecting Researchers, Methodology, Data Collection, Quality Assurance, and Technical Development.

    PubMed

    Kerkmeijer, Linda G W; Fuller, Clifton D; Verkooijen, Helena M; Verheij, Marcel; Choudhury, Ananya; Harrington, Kevin J; Schultz, Chris; Sahgal, Arjun; Frank, Steven J; Goldwein, Joel; Brown, Kevin J; Minsky, Bruce D; van Vulpen, Marco

    2016-01-01

    An international research consortium has been formed to facilitate evidence-based introduction of MR-guided radiotherapy (MR-linac) and to address how the MR-linac could be used to achieve an optimized radiation treatment approach to improve patients' survival, local, and regional tumor control and quality of life. The present paper describes the organizational structure of the clinical part of the MR-linac consortium. Furthermore, it elucidates why collaboration on this large project is necessary, and how a central data registry program will be implemented.

  19. The MRI-Linear Accelerator Consortium: Evidence-Based Clinical Introduction of an Innovation in Radiation Oncology Connecting Researchers, Methodology, Data Collection, Quality Assurance, and Technical Development

    PubMed Central

    Kerkmeijer, Linda G. W.; Fuller, Clifton D.; Verkooijen, Helena M.; Verheij, Marcel; Choudhury, Ananya; Harrington, Kevin J.; Schultz, Chris; Sahgal, Arjun; Frank, Steven J.; Goldwein, Joel; Brown, Kevin J.; Minsky, Bruce D.; van Vulpen, Marco

    2016-01-01

    An international research consortium has been formed to facilitate evidence-based introduction of MR-guided radiotherapy (MR-linac) and to address how the MR-linac could be used to achieve an optimized radiation treatment approach to improve patients’ survival, local, and regional tumor control and quality of life. The present paper describes the organizational structure of the clinical part of the MR-linac consortium. Furthermore, it elucidates why collaboration on this large project is necessary, and how a central data registry program will be implemented. PMID:27790408

  20. Acceptability and Feasibility of an Evidence-Based Requisition for Bone Mineral Density Testing in Clinical Practice

    PubMed Central

    Butt, Debra A.; Anantharajah, Rokeni (Sumi); Huang, Susana; Allin, Sonya; Bereket, Tarik

    2016-01-01

    Introduction. The purpose of this study is to understand the experience of primary care providers (PCPs) using an evidence-based requisition for bone mineral density (BMD) testing. Methods. A qualitative descriptive approach was adopted. Participants were given 3 BMD Recommended Use Requisitions (RUR) to use over a 2-month period. Twenty-six PCPs were interviewed before using the RUR. Those who had received at least one BMD report resulting from RUR use were then interviewed again. An inductive thematic analysis was performed. Results. We identified four themes in interview data: (1) positive and negative characteristics of the RUR, (2) facilitators and barriers for implementation, (3) impact of the RUR, and (4) requisition preference. Positive characteristics of the RUR related to both its content and format. Negative characteristics related to the increased amount of time needed to complete the form. Facilitators to implementation included electronic availability and organizational endorsement. Time constraints were identified as a barrier to implementation. Participants perceived that the RUR would promote appropriate referrals and the majority of participants preferred the RUR to their current requisition. Conclusions. Findings from this study provide support for the RUR as an acceptable point-of-care tool for PCPs to promote appropriate BMD testing. PMID:28050306

  1. A survey of the perceptions and behaviors of chiropractic interns pertaining to evidence-based principles in clinical decision making

    PubMed Central

    Dane, Dawn E.; Dane, Andrew B.; Crowther, Edward R.

    2016-01-01

    Objective: This study explored how chiropractic interns applied evidenced-based concepts, the sources of evidence they used, and how useful they perceived these sources to be in clinical decision making. Methods: A questionnaire containing 13 items in a Likert 5-point scale was administered to 28 chiropractic interns to gather information on the evidence types they commonly accessed and their perceived usefulness of these sources in clinical decision making. The interns were in the 8th semester of the training program. Results: There was a 93% (n = 26) response rate. Clinical guidelines were rated as the most helpful resource in clinical decision making (81%), followed by lecture materials (77%), journals (54%), databases (50%), and textbooks (35%). Students recognized scientific evidence as the most important aspect in clinical decision making. They found their personal experience and the views of their clinician to be equally important and patient preference the least. Conclusion: Interns routinely employed high-quality levels of evidence in clinical decision making. They also considered their early, limited clinical experience as important as that of their clinical supervisor in decision making. This finding should be investigated further. PMID:27389528

  2. A standardized, evidence-based protocol to assess clinical actionability of genetic disorders associated with genomic variation

    PubMed Central

    Hunter, Jessica Ezzell; Irving, Stephanie A.; Biesecker, Leslie G.; Buchanan, Adam; Jensen, Brian; Lee, Kristy; Martin, Christa Lese; Milko, Laura; Muessig, Kristin; Niehaus, Annie D.; O'Daniel, Julianne; Piper, Margaret A.; Ramos, Erin M.; Schully, Sheri D.; Scott, Alan F.; Slavotinek, Anne; Sobreira, Nara; Strande, Natasha; Weaver, Meredith; Webber, Elizabeth M.; Williams, Marc S.; Berg, Jonathan S.; Evans, James P.; Goddard, Katrina A.B.

    2016-01-01

    Purpose: Genome and exome sequencing can identify variants unrelated to the primary goal of sequencing. Detecting pathogenic variants associated with an increased risk of a medical disorder enables clinical interventions to improve future health outcomes in patients and their at-risk relatives. The Clinical Genome Resource, or ClinGen, aims to assess clinical actionability of genes and associated disorders as part of a larger effort to build a central resource of information regarding the clinical relevance of genomic variation for use in precision medicine and research. Methods: We developed a practical, standardized protocol to identify available evidence and generate qualitative summary reports of actionability for disorders and associated genes. We applied a semiquantitative metric to score actionability. Results: We generated summary reports and actionability scores for the 56 genes and associated disorders recommended by the American College of Medical Genetics and Genomics for return as secondary findings from clinical genome-scale sequencing. We also describe the challenges that arose during the development of the protocol that highlight important issues in characterizing actionability across a range of disorders. Conclusion: The ClinGen framework for actionability assessment will assist research and clinical communities in making clear, efficient, and consistent determinations of actionability based on transparent criteria to guide analysis and reporting of findings from clinical genome-scale sequencing. Genet Med 18 12, 1258–1268. PMID:27124788

  3. Recovery entails bridging the multiple realms of best practice: towards a more integrated approach to evidence-based clinical treatment and psychosocial disability support for mental health recovery.

    PubMed

    Rosen, A; O'Halloran, P

    2014-09-01

    While mental health recovery is a very personal process, the approach also offers possibilities as a meta-framework for improving quality of services to support people with severe and enduring mental illness. This paper explores how a recovery paradigm offers opportunities to better understand how efforts within the personal, clinical, and psychosocial disability domains of well-being relate and need bridging and integration with an evidence-based framework of practice to optimise outcomes. Recovery from a severe and persisting mental illness such as schizophrenia is optimised by a holistic approach integrating the domains of clinical treatment and psychosocial rehabilitation with the personal efforts of individuals. For service providers, a monolithic or single paradigm approach with an exclusive or predominant biological, psychological, social, or cultural focus is unable to offer effective guidance on the treatment and rehabilitation support needed to enable community participation and ameliorate the impact which problems associated with mental illness have on individuals, their families, and their wider communities. Moreover, recovery-oriented services need to be effective, embracing evidence-based policy, practice and service delivery by providing treatment and support which actually work to improve outcomes for consumers and families.

  4. Evidence-based clinical practice: Overview of threats to the validity of evidence and how to minimise them.

    PubMed

    Garattini, Silvio; Jakobsen, Janus C; Wetterslev, Jørn; Bertelé, Vittorio; Banzi, Rita; Rath, Ana; Neugebauer, Edmund A M; Laville, Martine; Masson, Yvonne; Hivert, Virginie; Eikermann, Michaela; Aydin, Burc; Ngwabyt, Sandra; Martinho, Cecilia; Gerardi, Chiara; Szmigielski, Cezary A; Demotes-Mainard, Jacques; Gluud, Christian

    2016-07-01

    Using the best quality of clinical research evidence is essential for choosing the right treatment for patients. How to identify the best research evidence is, however, difficult. In this narrative review we summarise these threats and describe how to minimise them. Pertinent literature was considered through literature searches combined with personal files. Treatments should generally not be chosen based only on evidence from observational studies or single randomised clinical trials. Systematic reviews with meta-analysis of all identifiable randomised clinical trials with Grading of Recommendations Assessment, Development and Evaluation (GRADE) assessment represent the highest level of evidence. Even though systematic reviews are trust worthier than other types of evidence, all levels of the evidence hierarchy are under threats from systematic errors (bias); design errors (abuse of surrogate outcomes, composite outcomes, etc.); and random errors (play of chance). Clinical research infrastructures may help in providing larger and better conducted trials. Trial Sequential Analysis may help in deciding when there is sufficient evidence in meta-analyses. If threats to the validity of clinical research are carefully considered and minimised, research results will be more valid and this will benefit patients and heath care systems.

  5. Evidence-based risk recommendations for best practices in the training of qualified exercise professionals working with clinical populations.

    PubMed

    Warburton, Darren E R; Bredin, Shannon S D; Charlesworth, Sarah A; Foulds, Heather J A; McKenzie, Don C; Shephard, Roy J

    2011-07-01

    This systematic review examines critically "best practices" in the training of qualified exercise professionals. Particular attention is given to the core competencies and educational requirements needed for working with clinical populations. Relevant information was obtained by a systematic search of 6 electronic databases, cross-referencing, and through the authors' knowledge of the area. The level and grade of the available evidence was established. A total of 52 articles relating to best practices and (or) core competencies in clinical exercise physiology met our eligibility criteria. Overall, current literature supports the need for qualified exercise professionals to possess advanced certification and education in the exercise sciences, particularly when dealing with "at-risk" populations. Current literature also substantiates the safety and effectiveness of exercise physiologist supervised stress testing and training in clinical populations.

  6. New EMA report on paliperidone 3-month injections: taking clinical and policy decisions without an adequate evidence base.

    PubMed

    Ostuzzi, G; Papola, D; Gastaldon, C; Barbui, C

    2016-12-22

    Three-month long-acting paliperidone is a new, recently marketed, formulation of paliperidone, characterised by the longest available dosing interval among long-acting antipsychotics. The clinical profile of 3-month long-acting paliperidone was recently summarised by the European Medicines Agency (EMA) in a public assessment report, released in April 2016. In this commentary, the main strengths and limitations of the EMA assessment report were appraised and discussed, in order to highlight possible implications for clinical practice, future research and regulatory practices for drug approval.

  7. A primer on selected aspects of evidence-based practice to questions of treatment. Part 2: interpreting results, application to clinical practice, and self-evaluation.

    PubMed

    Noteboom, J Timothy; Allison, Stephen C; Cleland, Joshua A; Whitman, Julie M

    2008-08-01

    The process of evidence-based practice (EBP) guides clinicians in the integration of individual clinical expertise, patient values and expectations, and the best available evidence. Becoming proficient with this process takes time and consistent practice, but should ultimately lead to improved patient outcomes. The EBP process entails 5 steps: (1) formulating an appropriate question, (2) performing an efficient literature search, (3) critically appraising the best available evidence, (4) applying the best evidence to clinical practice, and (5) assessing outcomes of care. This second commentary in a 2-part series will review principles relating to steps 3 through 5 of this 5-step model. The purpose of this commentary is to provide a perspective to assist clinicians in interpreting results, applying the evidence to patient care, and evaluating proficiency with EBP skills in studies of interventions for orthopaedic and sports physical therapy.

  8. Patience, Persistence and Pragmatism: Experiences and Lessons Learnt from the Implementation of Clinically Integrated Teaching and Learning of Evidence-Based Health Care – A Qualitative Study

    PubMed Central

    Young, Taryn; Rohwer, Anke; van Schalkwyk, Susan; Volmink, Jimmy; Clarke, Mike

    2015-01-01

    Background Clinically integrated teaching and learning are regarded as the best options for improving evidence-based healthcare (EBHC) knowledge, skills and attitudes. To inform implementation of such strategies, we assessed experiences and opinions on lessons learnt of those involved in such programmes. Methods and Findings We conducted semi-structured interviews with 24 EBHC programme coordinators from around the world, selected through purposive sampling. Following data transcription, a multidisciplinary group of investigators carried out analysis and data interpretation, using thematic content analysis. Successful implementation of clinically integrated teaching and learning of EBHC takes much time. Student learning needs to start in pre-clinical years with consolidation, application and assessment following in clinical years. Learning is supported through partnerships between various types of staff including the core EBHC team, clinical lecturers and clinicians working in the clinical setting. While full integration of EBHC learning into all clinical rotations is considered necessary, this was not always achieved. Critical success factors were pragmatism and readiness to use opportunities for engagement and including EBHC learning in the curriculum; patience; and a critical mass of the right teachers who have EBHC knowledge and skills and are confident in facilitating learning. Role modelling of EBHC within the clinical setting emerged as an important facilitator. The institutional context exerts an important influence; with faculty buy-in, endorsement by institutional leaders, and an EBHC-friendly culture, together with a supportive community of practice, all acting as key enablers. The most common challenges identified were lack of teaching time within the clinical curriculum, misconceptions about EBHC, resistance of staff, lack of confidence of tutors, lack of time, and negative role modelling. Conclusions Implementing clinically integrated EBHC curricula

  9. Ottawa Panel Evidence-Based Clinical Practice Guidelines for Patient Education Programmes in the Management of Osteoarthritis

    ERIC Educational Resources Information Center

    Health Education Journal, 2011

    2011-01-01

    Objective: The purpose of this study was to develop guidelines and recommendations on patient education programmes of any type, targeted specially to individuals with OA and which were designed to improve the clinical effectiveness of managing OA. Methods: The Ottawa Methods Group contacted specialized organizations that focus on management for…

  10. EULAR evidence based recommendations for the management of hand osteoarthritis: Report of a Task Force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT)

    PubMed Central

    Zhang, W; Doherty, M; Leeb, B F; Alekseeva, L; Arden, N K; Bijlsma, J W; Dinçer, F; Dziedzic, K; Häuselmann, H J; Herrero‐Beaumont, G; Kaklamanis, P; Lohmander, S; Maheu, E; Martín‐Mola, E; Pavelka, K; Punzi, L; Reiter, S; Sautner, J; Smolen, J; Verbruggen, G; Zimmermann‐Górska, I

    2007-01-01

    Objectives To develop evidence based recommendations for the management of hand osteoarthritis (OA). Methods The multidisciplinary guideline development group comprised 16 rheumatologists, one physiatrist, one orthopaedic surgeon, two allied health professionals, and one evidence based medicine expert, representing 15 different European countries. Each participant contributed up to 10 propositions describing key clinical points for management of hand OA. Final recommendations were agreed using a Delphi consensus approach. A systematic search of Medline, Embase, CINAHL, Science Citation Index, AMED, Cochrane Library, HTA, and NICE reports was used to identify the best available research evidence to support each proposition. Where possible, the effect size and number needed to treat were calculated for efficacy. Relative risk or odds ratio was estimated for safety, and incremental cost effectiveness ratio was used for cost effectiveness. The strength of recommendation was provided according to research evidence, clinical expertise, and perceived patient preference. Results Eleven key propositions involving 17 treatment modalities were generated through three Delphi rounds. Treatment topics included general considerations (for example, clinical features, risk factors, comorbidities), non‐pharmacological (for example, education plus exercise, local heat, and splint), pharmacological (for example, paracetamol, NSAIDs, NSAIDs plus gastroprotective agents, COX‐2 inhibitors, systemic slow acting disease modifying drugs, intra‐articular corticosteroids), and surgery. Of 17 treatment modalities, only six were supported by research evidence (education plus exercise, NSAIDs, COX‐2 inhibitors, topical NSAIDs, topical capsaicin, and chondroitin sulphate). Others were supported either by evidence extrapolated from studies of OA affecting other joint sites or by expert opinion. Strength of recommendation varied according to level of evidence, benefits and harms/costs of

  11. Does Glucagon-like Peptide-1 Ameliorate Oxidative Stress in Diabetes? Evidence Based on Experimental and Clinical Studies

    PubMed Central

    Petersen, Karen Ekkelund; Rakipovski, Günaj; Raun, Kirsten; Lykkesfeldt, Jens

    2016-01-01

    Glucagon-like peptide-1 (GLP-1) has shown to influence the oxidative stress status in a number of in vitro, in vivo and clinical studies. Well-known effects of GLP-1 including better glycemic control, decreased food intake, increased insulin release and increased insulin sensitivity may indirectly contribute to this phenomenon, but glucose-independent effects on ROS level, production and antioxidant capacity have been suggested to also play a role. The potential ‘antioxidant’ activity of GLP-1 along with other proposed glucose-independent modes of action related to ameliorating redox imbalance remains a controversial topic but could hold a therapeutic potential against micro- and macrovascular diabetic complications. This review discusses the presently available knowledge from experimental and clinical studies on the effects of GLP-1 on oxidative stress in diabetes and diabetes-related complications. PMID:26381142

  12. Astragalus in the Prevention of Upper Respiratory Tract Infection in Children with Nephrotic Syndrome: Evidence-Based Clinical Practice

    PubMed Central

    Zou, Chuan; Su, Guobin; Wu, Yuchi; Lu, Fuhua; Mao, Wei; Liu, Xusheng

    2013-01-01

    Aims. To explore whether Astragalus or its formulations could prevent upper respiratory infection in children with nephrotic syndrome and how best to use it. Methods. We transformed a common clinical question in practice to an answerable question according to the PICO principle. Databases, including the Cochrane Library (Issue 5, 2012), PUBMED (1966–2012.8), CBM (1978–2012.8), VIP (1989–2012.8), and CNKI (1979–2012.8), were searched to identify Cochrane systematic reviews and clinical trials. Then, the quality of and recommendations from the clinical evidence were evaluated using the GRADEpro software. Results. The search yielded 537 papers. Only two studies with high validity were included for synthesis calculations. The results showed that Astragalus granules could effectively reduce URTI in children with nephrotic syndrome compared with prednisone treatment alone (23.9% versus 42.9%; RR = 0.56 and 95% CI = 0.33–0.93). The dose of Astragalus granules was 2.25 gram (equivalent to 15 gram crude Astragalus) twice per day, at least for 3–6 months. The level of evidence quality was low, but we still recommended the evidence to the patient according to GRADEpro with the opinion of the expert. Followup showed the incidence of URTI in this child decreased significantly. Conclusions. Astragalus granules may reduce the incidence of URTI in children with nephrotic syndrome. PMID:23662131

  13. An evidence-based approach to establish the functional and clinical significance of CNVs in intellectual and developmental disabilities

    PubMed Central

    Kaminsky, Erin B.; Kaul, Vineith; Paschall, Justin; Church, Deanna M.; Bunke, Brian; Kunig, Dawn; Moreno-De-Luca, Daniel; Moreno-De-Luca, Andres; Mulle, Jennifer G.; Warren, Stephen T.; Richard, Gabriele; Compton, John G.; Fuller, Amy E.; Gliem, Troy J.; Huang, Shuwen; Collinson, Morag N.; Beal, Sarah J.; Ackley, Todd; Pickering, Diane L.; Golden, Denae M.; Aston, Emily; Whitby, Heidi; Shetty, Shashirekha; Rossi, Michael R.; Rudd, M. Katharine; South, Sarah T.; Brothman, Arthur R.; Sanger, Warren G.; Iyer, Ramaswamy K.; Crolla, John A.; Thorland, Erik C.; Aradhya, Swaroop; Ledbetter, David H.; Martin, Christa L.

    2013-01-01

    Purpose Copy number variants (CNVs) have emerged as a major cause of human disease such as autism and intellectual disabilities. Because CNVs are common in normal individuals, determining the functional and clinical significance of rare CNVs in patients remains challenging. The adoption of whole-genome chromosomal microarray analysis (CMA) as a first-tier diagnostic test for individuals with unexplained developmental disabilities provides a unique opportunity to obtain large CNV datasets generated through routine patient care. Methods A consortium of diagnostic laboratories was established [the International Standards for Cytogenomic Arrays (ISCA) consortium] to share CNV and phenotypic data in a central, public database. We present the largest CNV case-control study to date comprising 15,749 ISCA cases and 10,118 published controls, focusing our initial analysis on recurrent deletions and duplications involving 14 CNV regions. Results Compared to controls, fourteen deletions, and seven duplications were significantly overrepresented in cases, providing a clinical diagnosis as pathogenic. Conclusion Given the rapid expansion of clinical CMA testing, very large datasets will be available to determine the functional significance of increasingly rare CNVs. This data will provide an evidenced-based guide to clinicians across many disciplines involved in the diagnosis, management, and care of these patients and their families. PMID:21844811

  14. Evidence-based practice in nephrology: critical appraisal of nephrology clinical research: were the correct statistical tests used?

    PubMed

    Podoll, Amber S; Bell, Cynthia S; Molony, Donald A

    2012-01-01

    Nephrologists rely on valid clinical studies to inform their health care decisions. Knowledge of simple statistical principles equips the prudent nephrologist with the skills that allow him or her to critically evaluate clinical studies and to determine the validity of the results. Important in this process is knowing when certain statistical tests are used appropriately and if their application in interpreting research data will most likely lead to the most robust or valid conclusions. The research team bears the responsibility for determining the statistical analysis during the design phase of the study and subsequently for carrying out the appropriate analysis. This will ensure that bias is minimized and "valid" results are reported. We have summarized the important caveats and components in correctly choosing a statistical test with a series of tables. With this format, we wish to provide a tool for the nephrologist/researcher that he or she can use when required to decide if an appropriate statistical analysis plan was implemented for any particular study. We have included in these tables the types of statistical tests that might be used best for analysis of different types of comparisons on small and on larger patient samples.

  15. An evidence-based laparoscopic simulation curriculum shortens the clinical learning curve and reduces surgical adverse events

    PubMed Central

    De Win, Gunter; Van Bruwaene, Siska; Kulkarni, Jyotsna; Van Calster, Ben; Aggarwal, Rajesh; Allen, Christopher; Lissens, Ann; De Ridder, Dirk; Miserez, Marc

    2016-01-01

    Background Surgical simulation is becoming increasingly important in surgical education. However, the method of simulation to be incorporated into a surgical curriculum is unclear. We compared the effectiveness of a proficiency-based preclinical simulation training in laparoscopy with conventional surgical training and conventional surgical training interspersed with standard simulation sessions. Materials and methods In this prospective single-blinded trial, 30 final-year medical students were randomized into three groups, which differed in the way they were exposed to laparoscopic simulation training. The control group received only clinical training during residency, whereas the interval group received clinical training in combination with simulation training. The Center for Surgical Technologies Preclinical Training Program (CST PTP) group received a proficiency-based preclinical simulation course during the final year of medical school but was not exposed to any extra simulation training during surgical residency. After 6 months of surgical residency, the influence on the learning curve while performing five consecutive human laparoscopic cholecystectomies was evaluated with motion tracking, time, Global Operative Assessment of Laparoscopic Skills, and number of adverse events (perforation of gall bladder, bleeding, and damage to liver tissue). Results The odds of adverse events were 4.5 (95% confidence interval 1.3–15.3) and 3.9 (95% confidence interval 1.5–9.7) times lower for the CST PTP group compared with the control and interval groups. For raw time, corrected time, movements, path length, and Global Operative Assessment of Laparoscopic Skills, the CST PTP trainees nearly always started at a better level and were never outperformed by the other trainees. Conclusion Proficiency-based preclinical training has a positive impact on the learning curve of a laparoscopic cholecystectomy and diminishes adverse events. PMID:27512343

  16. Assisting undergraduate nursing students to learn evidence-based practice through self-directed learning and workshop strategies during clinical practicum.

    PubMed

    Zhang, Qi; Zeng, Tieying; Chen, Ying; Li, Xiaopan

    2012-07-01

    To equip undergraduate nursing students with basic knowledge and skills and foster positive attitudes toward evidence-based practice (EBP), a pilot learning program during their clinical practicum was developed in a teaching hospital in China. This article describes the specific learning process through which self-directed learning and workshop strategies were used, and a pre- and post-intervention survey were conducted to evaluate the effectiveness of the learning strategies. The findings show a significant improvement in their perceptions of EBP knowledge, attitudes and beliefs, and behavior levels. Beginning competencies in EBP were achieved. Participants reported great satisfaction and have found this program helpful in promoting their analytical and problem-solving abilities, independent learning ability, and cooperative and communication abilities as well.

  17. Consensus evidence-based guidelines for insulin therapy in patients with type 1 diabetes mellitus as per Indian clinical practice.

    PubMed

    Kanungo, Alok; Jhingan, Ashok; Sahay, Rakesh Kumar; Muruganathan, A; Das, Ashok Kumar

    2014-07-01

    Type 1 diabetes mellitus (T1DM) is a chronic disease characterised by auto-immune destruction of insulin producing beta cells of the pancreas. Most cases of T1DM are diagnosed during childhood and adolescence, and it remains the predominant form of the disease in this population. Early identification and treatment of T1DM is important in reducing complications of this form of disease. Because individuals with T1DM lack endogenous insulin production, the current consensus guideline recommends administration of rapid-acting and long-acting analogues for all patients with T1DM to achieve glycaemic goals and reduce insulin-induced side effects like weight gain and hypoglycaemia. It also emphasises that effective use of insulin requires an understanding of various insulin treatment and regimens, sick-day management regarding insulin use, and ability to manage insulin-induced hypoglycaemia to achieve the individualised treatment goals established between the patient, family and diabetes care team. The current consensus guideline has been developed by a panel of experts based on the existing guidelines which aims to provide better clinical practice in the Indian scenario for the management of T1DM.

  18. Antiseptic use in the neonatal intensive care unit - a dilemma in clinical practice: An evidence based review

    PubMed Central

    Sathiyamurthy, Sundar; Banerjee, Jayanta; Godambe, Sunit V

    2016-01-01

    Infants in the neonatal intensive care unit are highly susceptible to healthcare associated infections (HAI), with a substantial impact on mortality, morbidity and healthcare costs. Effective skin disinfection with topical antiseptic agents is an important intervention in the prevention or reduction of HAI. A wide array of antiseptic preparations in varying concentrations and combinations has been used in neonatal units worldwide. In this article we have reviewed the current evidence of a preferred antiseptic of choice over other agents for topical skin disinfection in neonates. Chlorhexidine (CHG) appears to be a promising antiseptic agent; however there exists a significant concern regarding the safety of all agents used including CHG especially in preterm and very low birth weight infants. There is substantial evidence to support the use of CHG for umbilical cord cleansing and some evidence to support the use of topical emollients in reducing the mortality in infants born in developing countries. Well-designed large multicentre randomized clinical trials are urgently needed to guide us on the most appropriate and safe antiseptic to use in neonates undergoing intensive care, especially preterm infants. PMID:27170926

  19. Promoting Early Presentation of Breast Cancer in Older Women: Implementing an Evidence-Based Intervention in Routine Clinical Practice

    PubMed Central

    Forbes, Lindsay J. L.; Forster, Alice S.; Dodd, Rachael H.; Tucker, Lorraine; Laming, Rachel; Sellars, Sarah; Patnick, Julietta; Ramirez, Amanda J.

    2012-01-01

    Background. Women over 70 with breast cancer have poorer one-year survival and present at a more advanced stage than younger women. Promoting early symptomatic presentation in older women may reduce stage cost effectively and is unlikely to lead to overdiagnosis. After examining efficacy in a randomised controlled trial, we piloted a brief health professional-delivered intervention to equip women to present promptly with breast symptoms, as an integral part of the final invited mammogram at age ~70, in the English National Health Service Breast Screening Programme. Methods. We trained mammographers, who then offered the intervention to older women in four breast screening services. We examined breast cancer awareness at baseline and one month in women receiving the intervention, and also in a service where the intervention was not offered. Results. We trained 27 mammographers to deliver the intervention confidently to a high standard. Breast cancer awareness increased 7-fold at one month in women receiving the intervention compared with 2-fold in the comparison service (odds ratio 15.2, 95% confidence interval 10.0 to 23.2). Conclusions. The PEP Intervention can be implemented in routine clinical practice with a potency similar to that achieved in a randomised controlled trial. It has the potential to reduce delay in diagnosis for breast cancer in older women. PMID:23213334

  20. EBMPracticeNet: A Bilingual National Electronic Point-Of-Care Project for Retrieval of Evidence-Based Clinical Guideline Information and Decision Support

    PubMed Central

    2013-01-01

    Background In Belgium, the construction of a national electronic point-of-care information service, EBMPracticeNet, was initiated in 2011 to optimize quality of care by promoting evidence-based decision-making. The collaboration of the government, health care providers, evidence-based medicine (EBM) partners, and vendors of electronic health records (EHR) is unique to this project. All Belgian health care professionals get free access to an up-to-date database of validated Belgian and nearly 1000 international guidelines, incorporated in a portal that also provides EBM information from other sources than guidelines, including computerized clinical decision support that is integrated in the EHRs. Objective The objective of this paper was to describe the development strategy, the overall content, and the management of EBMPracticeNet which may be of relevance to other health organizations creating national or regional electronic point-of-care information services. Methods Several candidate providers of comprehensive guideline solutions were evaluated and one database was selected. Translation of the guidelines to Dutch and French was done with translation software, post-editing by translators and medical proofreading. A strategy is determined to adapt the guideline content to the Belgian context. Acceptance of the computerized clinical decision support tool has been tested and a randomized controlled trial is planned to evaluate the effect on process and patient outcomes. Results Currently, EBMPracticeNet is in "work in progress" state. Reference is made to the results of a pilot study and to further planned research including a randomized controlled trial. Conclusions The collaboration of government, health care providers, EBM partners, and vendors of EHRs is unique. The potential value of the project is great. The link between all the EHRs from different vendors and a national database held on a single platform that is controlled by all EBM organizations in Belgium

  1. Clinical utility of patiromer, sodium zirconium cyclosilicate, and sodium polystyrene sulfonate for the treatment of hyperkalemia: an evidence-based review

    PubMed Central

    Beccari, Mario V; Meaney, Calvin J

    2017-01-01

    Introduction Hyperkalemia is a serious medical condition that often manifests in patients with chronic kidney disease and heart failure. Renin–angiotensin–aldosterone system inhibitors are known to improve outcomes in these disease states but can also cause drug-induced hyperkalemia. New therapeutic options exist for managing hyperkalemia in these patients which warrant evidence-based evaluation. Aim The objective of this article was to review the efficacy and safety evidence for patiromer, sodium zirconium cyclosilicate (ZS9), and sodium polystyrene sulfonate (SPS) for the treatment of hyperkalemia. Evidence review Current treatment options to enhance potassium excretion are SPS and loop diuretics, which are complicated by ambiguous efficacy and known toxicities. Patiromer and ZS9 are new agents designed to address this treatment gap. Both unabsorbable compounds bind potassium in the gastrointestinal (GI) tract to facilitate fecal excretion. The capacity to bind other medications in the GI tract infers high drug–drug interaction potential, which has been demonstrated with patiromer but not yet investigated with ZS9 or SPS. Phase II and III clinical trials of patiromer and ZS9 demonstrated clear evidence of a dose-dependent potassium-lowering effect and the ability to initiate, maintain, or titrate renin–angiotensin–aldosterone system inhibitors. There is limited evidence base for SPS: two small clinical trials indicated potassium reduction in chronic hyperkalemia. All agents may cause adverse GI effects, although they are less frequent with ZS9. Concerns remain for SPS to cause rare GI damage. Electrolyte abnormalities occurred with patiromer and SPS, whereas urinary tract infections, edema, and corrected QT-interval prolongations were reported with ZS9. Conclusion Patiromer and ZS9 have improved upon the age-old standard SPS for the treatment of hyperkalemia. Additional research should focus on drug–drug interactions in patients on multiple

  2. Evidence-based interventional pain medicine according to clinical diagnoses. 17. Herpes zoster and post-herpetic neuralgia.

    PubMed

    van Wijck, Albert J M; Wallace, Mark; Mekhail, Nagy; van Kleef, Maarten

    2011-01-01

    Herpes zoster infection is caused by a reactivation of the latent varicella zoster virus that causes chicken pox. It appears predominantly in older adults whose immunity for the virus has waned. The natural course of the disease is usually favorable, and the symptoms disappear spontaneously within a few weeks. Some patients, however, have prolonged pain: post-herpetic neuralgia. The diagnosis of acute zoster infection is made on the clinical signs including the appearance of rash. Post-herpetic neuralgia is described as sharp, burning, aching, or shooting constantly present in the dermatome that corresponds with the earlier rash. The objectives of treating herpes zoster are: (1) acute pain reduction; (2) promotion of recovery of epidermal defects and prevention of secondary infections; and (3) reduction or prevention of post-herpetic neuralgia. The objective of the treatment of post-herpetic neuralgia is primarily pain alleviation and improvement of the quality of life. Early treatment of the infection and the pain is believed to reduce the risk for post-herpetic neuralgia. This persistent pain syndrome is difficult to treat. Antiepileptic drugs and tricyclic antidepressants are the first choice. Interventional treatments, such as epidural injections of corticosteroids and local anesthetic drugs, have an effect on the acute pain but are of limited use in preventing post-herpetic neuralgia. When conservative treatment fails in providing satisfactory relief of post-herpetic neuralgia, a sympathetic block may be considered (2 C+); if this treatment provides unsatisfactory results, spinal cord stimulation may be considered, in a study context (2 C+).

  3. [Evidence-based clinical practice guidelines for the treatment of dural tears and the consequent cerebrospinal fluid leak during spine surgery].

    PubMed

    2017-02-01

    Dural tears (DT) and the consequent cerebral spinal fluid (CSF) leak are not rare in spine surgeries. CSF leak can be troublesome, leading to pseudomeningocele, cutaneous CSF fistula, and meningitis. Revision surgery is unavoidable in some cases. The reported incidences of DT and CSF leak are different according to the various pathologies. Ossification of the posterior longitudinal ligament, revision spine surgery and multi-segment laminectomy have higher risks for DT. Various techniques have been described to manage this complication, such as bed rest, repair with dural substitutes, fibrin glue, gelatin sponge, lumbar drain, muscle flap, etc.Through objective evaluation of the evidence and transparency in the process of making recommendations, it is Chinese Association of Orthopaedic Surgeons' goal to develop evidence-based clinical practice guidelines for the treatment of incidental DT and the consequent CSF leak during spine surgery. The current clinical guidelines focus on 9 clinical questions and the strength of recommendations were made based on the quality of the literature. The work group considers that this guideline recommendations aim to assist in delivering optimum, efficacious treatment and functional recovery from this complication.

  4. Key process issues in Cognitive Behavioral Analysis System of Psychotherapy (CBASP): translation of an evidence-based model into clinical practice and training.

    PubMed

    Vivian, Dina; Salwen, Jessica

    2013-09-01

    Our "desired outcome" in writing this article was to present not only key process issues stemming from the Cognitive Behavioral Analysis System of Psychotherapy (CBASP; McCullough, 2000), but to highlight those therapy maneuvers that we, a "seasoned" clinician/supervisor and a clinical trainee, find most useful in delivering treatment and in conducting supervision. We strongly believe that it is only through the translation of evidence-based therapeutic models, such as CBASP, into effective training that a true integration of science and practice can be obtained. Thus, the congruence of trainer's and trainee's views on what constitute top process issues in therapy is important in evaluating the reliability of a therapy model; with this in mind, we focus on three process issues, as follows: (1) problems are anchored to the "here and now" and to specific situational outcomes; (2) patients are encouraged to identify the role they play in affecting their distressing outcomes and to take responsibility for "fixing" them; and (3) the therapist planfully engages in the process of change via disciplined personal involvement. Research and theory supporting these maneuvers are presented, in conjunction with clinical examples.

  5. A clinically integrated curriculum in Evidence-based Medicine for just-in-time learning through on-the-job training: The EU-EBM project

    PubMed Central

    Coppus, Sjors FPJ; Emparanza, Jose I; Hadley, Julie; Kulier, Regina; Weinbrenner, Susanne; Arvanitis, Theodoros N; Burls, Amanda; Cabello, Juan B; Decsi, Tamas; Horvath, Andrea R; Kaczor, Marcin; Zanrei, Gianni; Pierer, Karin; Stawiarz, Katarzyna; Kunz, Regina; Mol, Ben WJ; Khan, Khalid S

    2007-01-01

    Background Over the last years key stake holders in the healthcare sector have increasingly recognised evidence based medicine (EBM) as a means to improving the quality of healthcare. However, there is considerable uncertainty about the best way to disseminate basic knowledge of EBM. As a result, huge variation in EBM educational provision, setting, duration, intensity, content, and teaching methodology exists across Europe and worldwide. Most courses for health care professionals are delivered outside the work context ('stand alone') and lack adaptation to the specific needs for EBM at the learners' workplace. Courses with modern 'adaptive' EBM teaching that employ principles of effective continuing education might fill that gap. We aimed to develop a course for post-graduate education which is clinically integrated and allows maximum flexibility for teachers and learners. Methods A group of experienced EBM teachers, clinical epidemiologists, clinicians and educationalists from institutions from eight European countries participated. We used an established methodology of curriculum development to design a clinically integrated EBM course with substantial components of e-learning. An independent European steering committee provided input into the process. Results We defined explicit learning objectives about knowledge, skills, attitudes and behaviour for the five steps of EBM. A handbook guides facilitator and learner through five modules with clinical and e-learning components. Focussed activities and targeted assignments round off the learning process, after which each module is formally assessed. Conclusion The course is learner-centred, problem-based, integrated with activities in the workplace and flexible. When successfully implemented, the course is designed to provide just-in-time learning through on-the-job-training, with the potential for teaching and learning to directly impact on practice. PMID:18042271

  6. Designing evidence-based medicine training to optimize the transfer of skills from the classroom to clinical practice: applying the four component instructional design model.

    PubMed

    Maggio, Lauren A; Cate, Olle Ten; Irby, David M; O'Brien, Bridget C

    2015-11-01

    Evidence-based medicine (EBM) skills, although taught in medical schools around the world, are not optimally practiced in clinical environments because of multiple barriers, including learners' difficulty transferring EBM skills learned in the classroom to clinical practice. This lack of skill transfer may be partially due to the design of EBM training. To facilitate the transfer of EBM skills from the classroom to clinical practice, the authors explore one instructional approach, called the Four Component Instructional Design (4C/ID) model, to guide the design of EBM training. On the basis of current cognitive psychology, including cognitive load theory, the premise of the 4C/ID model is that complex skills training, such as EBM training, should include four components: learning tasks, supportive information, procedural information, and part-task practice. The combination of these four components can inform the creation of complex skills training that is designed to avoid overloading learners' cognitive abilities; to facilitate the integration of the knowledge, skills, and attitudes needed to execute a complex task; and to increase the transfer of knowledge to new situations. The authors begin by introducing the 4C/ID model and describing the benefits of its four components to guide the design of EBM training. They include illustrative examples of educational practices that are consistent with each component and that can be applied to teaching EBM. They conclude by suggesting that medical educators consider adopting the 4C/ID model to design, modify, and/or implement EBM training in classroom and clinical settings.

  7. The Good-Enough Science-and-Politics of Anthropological Collaboration with Evidence-Based Clinical Research: Four Ethnographic Case Studies

    PubMed Central

    Messac, Luke; Ciccarone, Dan; Draine, Jeffrey; Bourgois, Philippe

    2013-01-01

    The apolitical legitimacy of "evidence-based medicine" offers a practical means for ethnography and critical social-science-and-humanities-of-health theory to transfer survival resources to structurally vulnerable populations and to engage policy and services audiences with urgent political problems imposed on the urban poor in the United States that harm health: most notably, homelessness, hyperincarceration, social service cut-backs and the War on Drugs. We present four examples of collaborations between ethnography and clinical research projects that demonstrate the potentials and limits of promoting institutional reform, political debate and action through distinct strategies of cross-methodological dialogue with epidemiological and clinical services research. Ethnographic methods alone, however, are simply a technocratic add-on. They must be informed by critical theory to contribute effectively and transformatively to applied health initiatives. Ironically, technocratic, neoliberal logics of cost-effectiveness can sometimes render radical service and policy reform initiatives institutionally credible, fundable and capable of generating wider political support, even though the rhetoric of economic efficacy is a double-edged sword. To extend the impact of ethnography and interdisciplinary theories of political-economic, cultural and disciplinary power relations into applied clinical and public health research, anthropologists--and their fellow travelers--have to be able to strategically, but respectfully learn to see through the positivist logics of clinical services research as well as epidemiological epistemology in order to help clinicians achieve--and extend--their applied priorities. In retrospect, these four very differently-structured collaborations suggest the potential for "good-enough” humble scientific and political strategies to work for, and with, structurally vulnerable populations in a punitive neoliberal era of rising social inequality

  8. The good-enough science-and-politics of anthropological collaboration with evidence-based clinical research: Four ethnographic case studies.

    PubMed

    Messac, Luke; Ciccarone, Dan; Draine, Jeffrey; Bourgois, Philippe

    2013-12-01

    The apolitical legitimacy of "evidence-based medicine" offers a practical means for ethnography and critical social-science-and-humanities-of-health theory to transfer survival resources to structurally vulnerable populations and to engage policy and services audiences with urgent political problems imposed on the urban poor in the United States that harm health: most notably, homelessness, hyperincarceration, social service cut-backs and the War on Drugs. We present four examples of collaborations between ethnography and clinical research projects that demonstrate the potentials and limits of promoting institutional reform, political debate and action through distinct strategies of cross-methodological dialog with epidemiological and clinical services research. Ethnographic methods alone, however, are simply a technocratic add-on. They must be informed by critical theory to contribute effectively and transformatively to applied health initiatives. Ironically, technocratic, neoliberal logics of cost-effectiveness can sometimes render radical service and policy reform initiatives institutionally credible, fundable and capable of generating wider political support, even though the rhetoric of economic efficacy is a double-edged sword. To extend the impact of ethnography and interdisciplinary theories of political-economic, cultural and disciplinary power relations into applied clinical and public health research, anthropologists - and their fellow travelers - have to be able to strategically, but respectfully learn to see through the positivist logics of clinical services research as well as epidemiological epistemology in order to help clinicians achieve - and extend - their applied priorities. In retrospect, these four very differently-structured collaborations suggest the potential for "good-enough" humble scientific and political strategies to work for, and with, structurally vulnerable populations in a punitive neoliberal era of rising social inequality

  9. Clinical and pharmacogenomic data mining: 4. The FANO program and command set as an example of tools for biomedical discovery and evidence based medicine.

    PubMed

    Robson, Barry

    2008-09-01

    The culmination of methodology explored and developed in the preceding three papers is described in terms of the FANO program (also known as CliniMiner) and specifically in terms of the contemporary command set for data mining. This provides a more detailed account of how strategies were implemented in applications described elsewhere, in the previous papers in the series and in a paper on the analysis of 667 000 patient records. Although it is not customary to think of a command set as the output of research, it represents the elements and strategies for data mining biomedical and clinical data with many parameters, that is, in a high dimensional space that requires skilful navigation. The intent is not to promote FANO per se, but to report its science and methodologies. Typical example rules from traditional data mining are that A and B and C associate, or IF A & B THEN C. We need much higher complexity rules for clinical data especially with inclusion of proteomics and genomics. FANO's specific goal is to be able routinely to extract from clinical record repositories and other data not only the complex rules required for biomedical research and the clinical practice of evidence based medicine, but to quantify their uncertainty, that is, their essentially probabilistic nature. The underlying information and number theoretic basis previously described is less of an issue here, being "under the hood", although the fundamental role and use of the Incomplete (generalized) Riemann Zeta Function as a general surprise measure is highlighted, along with its covariance or multivariance analogue, as it appears to be a unique and powerful feature. Another characteristic described is the very general tactic of the metadata operator ':='. It allows decomposition of diverse data types such as trees, spreadsheets, biosequences, sets of objects, amorphous data collections with repeating items, XML structures, and so forth into universally atomic data items with or without

  10. EULAR evidence based recommendations for gout. Part I: Diagnosis. Report of a task force of the standing committee for international clinical studies including therapeutics (ESCISIT)

    PubMed Central

    Zhang, W; Doherty, M; Pascual, E; Bardin, T; Barskova, V; Conaghan, P; Gerster, J; Jacobs, J; Leeb, B; Lioté, F; McCarthy, G; Netter, P; Nuki, G; Perez‐Ruiz, F; Pignone, A; Pimentão, J; Punzi, L; Roddy, E; Uhlig, T; Zimmermann‐Gòrska, I

    2006-01-01

    Objective To develop evidence based recommendations for the diagnosis of gout. Methods The multidisciplinary guideline development group comprised 19 rheumatologists and one evidence based medicine expert, representing 13 European countries. Ten key propositions regarding diagnosis were generated using a Delphi consensus approach. Research evidence was searched systematically for each proposition. Wherever possible the sensitivity, specificity, likelihood ratio (LR), and incremental cost‐effectiveness ratio were calculated for diagnostic tests. Relative risk and odds ratios were estimated for risk factors and co‐morbidities associated with gout. The quality of evidence was categorised according to the evidence hierarchy. The strength of recommendation (SOR) was assessed using the EULAR visual analogue and ordinal scales. Results 10 key propositions were generated though three Delphi rounds including diagnostic topics in clinical manifestations, urate crystal identification, biochemical tests, radiographs, and risk factors/co‐morbidities. Urate crystal identification varies according to symptoms and observer skill but is very likely to be positive in symptomatic gout (LR = 567 (95% confidence interval (CI), 35.5 to 9053)). Classic podagra and presence of tophi have the highest clinical diagnostic value for gout (LR = 30.64 (95% CI, 20.51 to 45.77), and LR = 39.95 (21.06 to 75.79), respectively). Hyperuricaemia is a major risk factor for gout and may be a useful diagnostic marker when defined by the normal range of the local population (LR = 9.74 (7.45 to 12.72)), although some gouty patients may have normal serum uric acid concentrations at the time of investigation. Radiographs have little role in diagnosis, though in late or severe gout radiographic changes of asymmetrical swelling (LR = 4.13 (2.97 to 5.74)) and subcortical cysts without erosion (LR = 6.39 (3.00 to 13.57)) may be useful to differentiate chronic gout from other joint

  11. Evaluation of a Shared Decision-Making Intervention on the Utilization of Evidence-Based Psychotherapy in a VA Outpatient PTSD Clinic.

    PubMed

    Hessinger, Jonathan D; London, Melissa J; Baer, Sheila M

    2017-03-13

    The Veterans Health Administration (VHA) has continued to emphasize the availability, access, and utilization of high quality mental health care particularly in the treatment of posttraumatic stress disorder (PTSD). While dissemination and availability of evidence-based psychotherapies (EBPs) have only increased, treatment engagement and utilization have continued to be oft-noted challenges. Administrators, researchers, and individual clinicians have continued to develop and explore novel systemic and individualized interventions to address these issues. Pilot studies utilizing shared decision-making models to aid in veteran treatment selection have demonstrated the impact this approach may have on selection of and engagement in EBPs for PTSD. Based on these promising studies, a Department of Veterans Affairs (VA) outpatient PTSD clinic began to implement a shared-decision making intervention as part of a clinic redesign. In seeking to evaluate the impact of this intervention, archival clinical data from 1,056 veterans were reviewed by the authors for rates of treatment selection, EBP initiation, session attendance, and EBP completion. Time elapsed from consult until EBP initiation was also computed by the authors. These variables were then compared on the basis of whether the veteran received the shared-decision making intervention. Veterans who received the intervention were more likely to select and thus initiate an EBP for PTSD sooner than veterans who did not receive this intervention. Veterans, whether receiving the intervention or not, did not differ in therapy session attendance and completion. Implications of these findings and directions for future study are further discussed. (PsycINFO Database Record

  12. Evidence-based policy as reflexive practice. What can we learn from evidence-based medicine?

    PubMed

    Bal, Roland

    2016-10-13

    The call for evidence-based policy is often accompanied by rather uncritical references to the success of evidence-based medicine, leading to often unsuccessful translation attempts. In this paper, I reflect on the practice of evidence-based medicine in an attempt to sketch a more productive approach to translating evidence into the practice of policy making. Discussing three episodes in the history of evidence-based medicine - clinical trials, and the production and use of clinical guidelines - I conclude that the success of evidence-based medicine is based on the creation of reflexive practices in which evidence and practice can be combined productively. In the conclusion, I discuss the prospects of such a practice for evidence-based policy.

  13. Translating an Evidence-Based Behavioral Intervention for Women Living with HIV into Clinical Practice: The SMART/EST Women’s Program

    PubMed Central

    Weiss, Stephen M.; Tobin, Jonathan N.; Lopez, Maria; Simons, Hannah; Cook, Ryan; Jones, Deborah L.

    2016-01-01

    Background The process of translating scientific findings into clinical and public health settings has only recently received priority attention within the scientific community. Purpose Fueled by “Funding Opportunity Announcements” from the National Institutes of Health and Centers for Disease Control and Prevention, scientists have begun to explore the pathways to effectively “transfer” promising research accomplishments into effective and sustainable service programs within the health care delivery system. Method Using Glasgow’s RE-AIM (Reach, Effectiveness, A-doption, Implementation and Maintenance) model as a guide, this research team enrolled 428 socially disadvantaged, culturally diverse women living with HIV/AIDS to test the dissemination and implementation of an evidence-based behavioral intervention designed to improve and sustain the physical and emotional health of participants into the Community Health Center (CHC) setting when conducted by trained CHC staff. Results Findings demonstrate the ability of trained CHC staff group leaders to attain results equivalent or superior to those achieved when conducted by research staff on the three principal study outcomes: depression, medication adherence and HIV viral load. Four of five CHCs involved in the study also identified and successfully obtained funding to continue to run intervention groups, supporting the adoption and sustainability components of the translation model. Conclusion This study confirmed (a) the “translatability” of the Stress Management And Relaxation Training/Emotional Supportive Therapy (SMART/EST) Women’s Program, from academic to CHC settings in two geographic regions with high HIV prevalence among women, (b) the ability of local staff (using the “train the trainer” model) to successfully achieve program fidelity and clinical outcomes, and (c) the sustainability the program beyond the auspices of research support, through supportive CHC leadership securing

  14. Evidence-Based Medicine and the Recognition and Treatment of Exertional Heat Stroke, Part II: A Perspective From the Clinical Athletic Trainer

    PubMed Central

    Mazerolle, Stephanie M.; Pinkus, Danielle E.; Casa, Douglas J.; McDermott, Brendon P.; Pagnotta, Kelly D.; Ruiz, Roberto C.; Armstrong, Lawrence E.; Maresh, Carl M.

    2011-01-01

    Context: Exertional heat stroke (EHS) is one of the leading causes of death in athletes. Certified athletic trainers (ATs) demonstrate strong knowledge of recommended practices with EHS but are apprehensive in implementing 2 basic procedures: rectal temperature assessment and cold water immersion. This apprehension might lead to deaths from EHS that could have been prevented. Objective: To investigate why collegiate and high school ATs do not implement best practices for the recognition and treatment of EHS. Design: Qualitative study. Setting: In-person focus groups consisting of 3 to 6 collegiate or high school ATs. Patients or Other Participants: A total of 19 ATs (9 men, 10 women; age = 36 ± 10 years, length of certification = 12 ± 9 years) employed at either the collegiate (n = 10) or high school (n = 9) level participated in the study. Data Collection and Analysis: Interviews were transcribed verbatim, and data were analyzed using deductive data analysis. Peer review and multiple-analyst data triangulation were conducted to establish trustworthiness of the data. Results: Five emergent themes explained the lack of evidence-based practice (EBP) regarding recognition and treatment of EHS. Three themes (lack of knowledge, comfort level, lack of initiative) were common in both the collegiate and high school settings, and 2 separate themes (liability concerns, lack of resources) were present in the high school setting. Conclusions: Our findings are consistent with those in the literature on EBP and EHS. Regardless of clinical setting, ATs have basic information on recognition and treatment of EHS, but 5 themes act as barriers to implementing proper management in the clinical setting. Workshops or hands-on training sessions need to be made available to improve students' comfort levels so ATs will implement EBP into everyday settings. PMID:22488141

  15. Timing of Decompressive Surgery of Spinal Cord after Traumatic Spinal Cord Injury: An Evidence-Based Examination of Pre-Clinical and Clinical Studies

    PubMed Central

    Furlan, Julio C.; Noonan, Vanessa; Cadotte, David W.

    2011-01-01

    Abstract While the recommendations for spine surgery in specific cases of acute traumatic spinal cord injury (SCI) are well recognized, there is considerable uncertainty regarding the role of the timing of surgical decompression of the spinal cord in the management of patients with SCI. Given this, we sought to critically review the literature regarding the pre-clinical and clinical evidence on the potential impact of timing of surgical decompression of the spinal cord on outcomes after traumatic SCI. The primary literature search was performed using MEDLINE, CINAHL, EMBASE, and Cochrane databases. A secondary search strategy incorporated articles referenced in prior meta-analyses and systematic and nonsystematic review articles. Two reviewers independently assessed every study with regard to eligibility, level of evidence, and study quality. Of 198 abstracts of pre-clinical studies, 19 experimental studies using animal SCI models fulfilled our inclusion and exclusion criteria. Despite some discrepancies in the results of those pre-clinical studies, there is evidence for a biological rationale to support early decompression of the spinal cord. Of 153 abstracts of clinical studies, 22 fulfilled the inclusion and exclusion criteria. While the vast majority of the clinical studies were level-4 evidence, there were two studies of level-2b evidence. The quality assessment scores varied from 7 to 25 with a mean value of 12.41. While 2 of 22 clinical studies assessed feasibility and safety, 20 clinical studies examined efficacy of early surgical intervention to stabilize and align the spine and to decompress the spinal cord; the most common definitions of early operation used 24 and 72 h after SCI as timelines. A number of studies indicated that patients who undergo early surgical decompression can have similar outcomes to patients who received a delayed decompressive operation. However, there is evidence to suggest that early surgical intervention is safe and feasible

  16. Does integrated training in evidence-based medicine (EBM) in the general practice (GP) specialty training improve EBM behaviour in daily clinical practice? A cluster randomised controlled trial

    PubMed Central

    Kortekaas, M F; Bartelink, M E L; Zuithoff, N P A; van der Heijden, G J M G; de Wit, N J; Hoes, A W

    2016-01-01

    Objectives Evidence-based medicine (EBM) is an important element in the general practice (GP) specialty training. Studies show that integrating EBM training into clinical practice brings larger benefits than stand-alone modules. However, these studies have neither been performed in GP nor assessed EBM behaviour of former trainees in daily clinical practice. Setting GP specialty training in the Netherlands. Participants All 82 third year GP trainees who started their final third year in 2011 were approached for inclusion, of whom 79 (96%) participated: 39 in the intervention group and 40 in the control group. Intervention Integrated EBM training, in which EBM is embedded closely within the clinical context by joint assignments for the trainee and supervisor in daily practice, and teaching sessions based on dilemmas from actual patient consultations. Comparison Stand-alone EBM training at the institute only. Primary and secondary outcomes Our primary outcome was EBM behaviour, assessed by measuring guideline adherence (incorporating rational, motivated deviation) and information-seeking behaviour. Our secondary outcomes were EBM attitude and EBM knowledge. Data were acquired using logbooks and questionnaires, respectively. Analyses were performed using mixed models. Results Logbook data were available from 76 (96%) of the participating trainees at baseline (7614 consultations), 60 (76%) at the end of the third year (T1, 4973 consultations) and 53 (67%) 1 year after graduation (T2, 3307 consultations). We found no significant differences in outcomes between the 2 groups, with relative risks for guideline adherence varying between 0.96 and 0.99 (95% CI 0.86 to 1.11) at T1, and 0.99 and 1.10 (95% CI 0.92 to 1.25) at T2, and for information-seeking behaviour between 0.97 and 1.16 (95% CI 0.70 to 1.91) and 0.90 and 1.10 (95% CI 0.70 to 1.32), respectively. Conclusions Integrated EBM training compared with stand-alone EBM training does not improve EBM behaviour, attitude

  17. EULAR evidence based recommendations for the management of hip osteoarthritis: report of a task force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT)

    PubMed Central

    Zhang, W; Doherty, M; Arden, N; Bannwarth, B; Bijlsma, J; Gunther, K; Hauselmann, H; Herrero-Beaumont, G; Jordan, K; Kaklamanis, P; Leeb, B; Lequesne, M; Lohmander, S; Mazieres, B; Martin-Mola, E; Pavelka, K; Pendleton, A; Punzi, L; Swoboda, B; Varatojo, R; Verbruggen, G; Zimmermann-Gorska, I; Dougados, M

    2005-01-01

    Objective: To develop evidence based recommendations for the management of hip osteoarthritis (OA). Methods: The multidisciplinary guideline development group comprised 18 rheumatologists, 4 orthopaedic surgeons, and 1 epidemiologist, representing 14 European countries. Each participant contributed up to 10 propositions describing key clinical aspects of hip OA management. Ten final recommendations were agreed using a Delphi consensus approach. Medline, Embase, CINAHL, Cochrane Library, and HTA reports were searched systematically to obtain research evidence for each proposition. Where possible, outcome data for efficacy, adverse effects, and cost effectiveness were abstracted. Effect size, rate ratio, number needed to treat, and incremental cost effectiveness ratio were calculated. The quality of evidence was categorised according to the evidence hierarchy. The strength of recommendation was assessed using the traditional A–D grading scale and a visual analogue scale. Results: Ten key treatment propositions were generated through three Delphi rounds. They included 21 interventions, such as paracetamol, NSAIDs, symptomatic slow acting disease modifying drugs, opioids, intra-articular steroids, non-pharmacological treatment, total hip replacement, osteotomy, and two general propositions. 461 studies were identified from the literature search for the proposed interventions of efficacy, side effects, and cost effectiveness. Research evidence supported 15 interventions in the treatment of hip OA. Evidence specific for the hip was strikingly lacking. Strength of recommendation varied according to category of research evidence and expert opinion. Conclusion: Ten key recommendations for the treatment of hip OA were developed based on research evidence and expert consensus. The effectiveness and cost effectiveness of these recommendations were evaluated and the strength of recommendation was scored. PMID:15471891

  18. Evidence-based periodontal therapy: An overview

    PubMed Central

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

    2008-01-01

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

  19. Evidence-Based Medicine in the Education of Psychiatrists

    ERIC Educational Resources Information Center

    Srihari, Vinod

    2008-01-01

    Objective: Evidence-based medicine has an important place in the teaching and practice of psychiatry. Attempts to teach evidence-based medicine skills can be weakened by conceptual confusions feeding a false polarization between traditional clinical skills and evidence-based medicine. Methods: The author develops a broader conception of clinical…

  20. Evidence-based dentistry: what's new?

    PubMed

    Ballini, A; Capodiferro, S; Toia, M; Cantore, S; Favia, G; De Frenza, G; Grassi, F R

    2007-06-06

    The importance of evidence for every branch of medicine in teaching in order to orient the practitioners among the great amount of most actual scientific information's, and to support clinical decisions, is well established in health care, including dentistry. The practice of evidence-based medicine is a process of lifelong, self-directed, problem-based learning which leads to the need for clinically important information about diagnosis, prognosis, therapy and other clinical and health care issues. Nowadays the practice of dentistry is becoming more complex and challenging because of the continually changing in dental materials and equipments, an increasingly litigious society, an increase in the emphasis of continuing professional development, the information explosion and the consumer movement associated with advances on the Internet. The need for reliable information and the electronic revolution have come together to allow the "paradigm shift" towards evidence-based health care. Recent years have seen an increase in the importance of evidence-based dentistry, aiming to reduce to the maximum the gap between clinical research and real world dental practice. Aim of evidence-based practice is the systematic literature review, which synthesizes the best evidences and provides the basis for clinical practice guidelines. These practice guidelines give a brief review of what evidence-based dentistry is and how to use it.

  1. Theory- and Evidence- Based Intervention: Practice-Based Evidence--Integrating Positive Psychology into a Clinical Psychological Assessment and Intervention Model and How to Measure Outcome

    ERIC Educational Resources Information Center

    Nissen, Poul

    2011-01-01

    In this paper, a model for assessment and intervention is presented. This model explains how to perform theory- and evidence- based as well as practice-based assessment and intervention. The assessment model applies a holistic approach to treatment planning, which includes recognition of the influence of community, school, peers, family and the…

  2. Effect of Evidence-based Clinical Decision Support on the Use and Yield of CT Pulmonary Angiographic Imaging in Hospitalized Patients

    PubMed Central

    Ip, Ivan K.; Abbett, Sarah; Gershanik, Esteban F.; Raja, Ali S.; Hunsaker, Andetta; Khorasani, Ramin

    2015-01-01

    Purpose To determine the effect of clinical decision support (CDS) on the use and yield of inpatient computed tomographic (CT) pulmonary angiography for acute pulmonary embolism (PE). Materials and Methods This HIPAA-compliant, institutional review board-approved study with waiver of informed consent included all adults admitted to a 793-bed teaching hospital from April 1, 2007, to June 30, 2012. The CDS intervention, implemented after a baseline observation period, informed providers who placed an order for CT pulmonary angiographic imaging about the pretest probability of the study based on a validated decision rule. Use of CT pulmonary angiographic and admission data from administrative databases was obtained for this study. By using a validated natural language processing algorithm on radiology reports, each CT pulmonary angiographic examination was classified as positive or negative for acute PE. Primary outcome measure was monthly use of CT pulmonary angiography per 1000 admissions. Secondary outcome was CT pulmonary angiography yield (percentage of CT pulmonary angiographic examinations that were positive for acute PE). Linear trend analysis was used to assess for effect and trend differences in use and yield of CT pulmonary angiographic imaging before and after CDS. Results In 272 374 admissions over the study period, 5287 patients underwent 5892 CT pulmonary angiographic examinations. A 12.3% decrease in monthly use of CT pulmonary angiography (26.0 to 22.8 CT pulmonary angiographic examinations per 1000 admissions before and after CDS, respectively; P = .008) observed 1 month after CDS implementation was sustained over the ensuing 32-month period. There was a nonsignificant 16.3% increase in monthly yield of CT pulmonary angiography or percentage of CT pulmonary angiographic examinations positive for acute PE after CDS (P = .65). Conclusion Implementation of evidence-based CDS for inpatients was associated with a 12.3% immediate and sustained decrease in

  3. Evidence-based practice. The role of staff development.

    PubMed

    Krugman, Mary

    2003-01-01

    Knowledge and use of evidence-based practice are essential to ensure best practices and safe patient outcomes. Staff development specialists must be leaders in this initiative to support clinical nurses toward improved practice outcomes. This article describes the background for understanding the historical evolution from research utilization to evidence-based practice, defines some key concepts related to evidence-based practice, and suggests essential components for building evidence-based practice programs in healthcare institutions.

  4. Teaching strategies to support evidence-based practice.

    PubMed

    Winters, Charlene A; Echeverri, Rebecca

    2012-06-01

    Evidence-based practice is an expected core competency of all health care clinicians regardless of discipline. Use of evidence-based practice means integrating the best research with clinical expertise and patient values to achieve optimal health outcomes. Evidence-based practice requires nurses to access and appraise evidence rapidly before integrating it into clinical practice. Role modeling and integrating the skills necessary to develop evidence-based practice into clinical and nonclinical courses is an important part in developing positive attitudes toward evidence-based practice, an essential first step to using evidence to guide practice decisions. The step-by-step approach to evidence-based practice proposed by Melnyk and colleagues provides an excellent organizing framework for teaching strategies specifically designed to facilitate nurses' knowledge and skill development in evidence-based practice.

  5. Redesigning Radiotherapy Quality Assurance: Opportunities to Develop an Efficient, Evidence-Based System to Support Clinical Trials-Report of the National Cancer Institute Work Group on Radiotherapy Quality Assurance

    SciTech Connect

    Bekelman, Justin E.; Deye, James A.; Vikram, Bhadrasain; Bentzen, Soren M.; Bruner, Deborah; Curran, Walter J.; Dignam, James; Efstathiou, Jason A.; FitzGerald, T.J.; Hurkmans, Coen; Ibbott, Geoffrey S.; Lee, J. Jack; Merchant, Thomas E.; Michalski, Jeff; Palta, Jatinder R.; Simon, Richard; Ten Haken, Randal K.; Timmerman, Robert; Tunis, Sean; Coleman, C. Norman; and others

    2012-07-01

    Purpose: In the context of national calls for reorganizing cancer clinical trials, the National Cancer Institute sponsored a 2-day workshop to examine challenges and opportunities for optimizing radiotherapy quality assurance (QA) in clinical trial design. Methods and Materials: Participants reviewed the current processes of clinical trial QA and noted the QA challenges presented by advanced technologies. The lessons learned from the radiotherapy QA programs of recent trials were discussed in detail. Four potential opportunities for optimizing radiotherapy QA were explored, including the use of normal tissue toxicity and tumor control metrics, biomarkers of radiation toxicity, new radiotherapy modalities such as proton beam therapy, and the international harmonization of clinical trial QA. Results: Four recommendations were made: (1) to develop a tiered (and more efficient) system for radiotherapy QA and tailor the intensity of QA to the clinical trial objectives (tiers include general credentialing, trial-specific credentialing, and individual case review); (2) to establish a case QA repository; (3) to develop an evidence base for clinical trial QA and introduce innovative prospective trial designs to evaluate radiotherapy QA in clinical trials; and (4) to explore the feasibility of consolidating clinical trial QA in the United States. Conclusion: Radiotherapy QA can affect clinical trial accrual, cost, outcomes, and generalizability. To achieve maximum benefit, QA programs must become more efficient and evidence-based.

  6. Risk Assessment: Evidence Base

    NASA Technical Reports Server (NTRS)

    Johnson-Throop, Kathy A.

    2007-01-01

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

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

    PubMed Central

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

    2015-01-01

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

  8. Evidence-based practice in psychology.

    PubMed

    2006-01-01

    The evidence-based practice movement has become an important feature of health care systems and health care policy. Within this context, the APA 2005 Presidential Task Force on Evidence-Based Practice defines and discusses evidence-based practice in psychology (EBPP). In an integration of science and practice, the Task Force's report describes psychology's fundamental commitment to sophisticated EBPP and takes into account the full range of evidence psychologists and policymakers must consider. Research, clinical expertise, and patient characteristics are all supported as relevant to good outcomes. EBPP promotes effective psychological practice and enhances public health by applying empirically supported principles of psychological assessment, case formulation, therapeutic relationship, and intervention. The report provides a rationale for and expanded discussion of the EBPP policy statement that was developed by the Task Force and adopted as association policy by the APA Council of Representatives in August 2005.

  9. EULAR evidence based recommendations for gout. Part II: Management. Report of a task force of the EULAR Standing Committee For International Clinical Studies Including Therapeutics (ESCISIT)

    PubMed Central

    Zhang, W; Doherty, M; Bardin, T; Pascual, E; Barskova, V; Conaghan, P; Gerster, J; Jacobs, J; Leeb, B; Lioté, F; McCarthy, G; Netter, P; Nuki, G; Perez‐Ruiz, F; Pignone, A; Pimentão, J; Punzi, L; Roddy, E; Uhlig, T; Zimmermann‐Gòrska, I

    2006-01-01

    Objective To develop evidence based recommendations for the management of gout. Methods The multidisciplinary guideline development group comprised 19 rheumatologists and one evidence based medicine expert representing 13 European countries. Key propositions on management were generated using a Delphi consensus approach. Research evidence was searched systematically for each proposition. Where possible, effect size (ES), number needed to treat, relative risk, odds ratio, and incremental cost‐effectiveness ratio were calculated. The quality of evidence was categorised according to the level of evidence. The strength of recommendation (SOR) was assessed using the EULAR visual analogue and ordinal scales. Results 12 key propositions were generated after three Delphi rounds. Propositions included both non‐pharmacological and pharmacological treatments and addressed symptomatic control of acute gout, urate lowering therapy (ULT), and prophylaxis of acute attacks. The importance of patient education, modification of adverse lifestyle (weight loss if obese; reduced alcohol consumption; low animal purine diet) and treatment of associated comorbidity and risk factors were emphasised. Recommended drugs for acute attacks were oral non‐steroidal anti‐inflammatory drugs (NSAIDs), oral colchicine (ES = 0.87 (95% confidence interval, 0.25 to 1.50)), or joint aspiration and injection of corticosteroid. ULT is indicated in patients with recurrent acute attacks, arthropathy, tophi, or radiographic changes of gout. Allopurinol was confirmed as effective long term ULT (ES = 1.39 (0.78 to 2.01)). If allopurinol toxicity occurs, options include other xanthine oxidase inhibitors, allopurinol desensitisation, or a uricosuric. The uricosuric benzbromarone is more effective than allopurinol (ES = 1.50 (0.76 to 2.24)) and can be used in patients with mild to moderate renal insufficiency but may be hepatotoxic. When gout is associated with the use of diuretics, the

  10. Evidence based contraceptive choices.

    PubMed

    Scott, Alison; Glasier, Anna

    2006-10-01

    People who attend for contraceptive advice have usually formulated an idea of the type of contraceptive that will suit them best. They may wish to use a method that is long, short or medium acting. These are defined as follows: Long-acting method requires renewal no more frequently than every 3 months (e.g. injectable or intrauterine). Short-acting method used daily or with every act of intercourse (e.g. pills, condoms) Medium-acting method requires renewal weekly or monthly (e.g. ring, patch). For men the choice is limited to condoms or vasectomy. Some women do not wish to use hormonal preparations or have an intrauterine device (IUD) or implant inserted. There may also be cultural influences making certain methods of contraception unacceptable. Each of these factors influences the final decision of which method of contraception is decided upon. In addition to taking a full medical and sexual history to identify any risks to the individual's health, which might be increased by a particular contraceptive, time must be spent discussing the options available. It is important to ensure that there is a full understanding of the advantages and disadvantages of each method. The most successful contraceptive method is likely to be the one that the woman (or man) chooses, rather than the one the clinician chooses for them. Access for women to contraception can be improved by having convenient clinic times and service developments such as nurse prescribing and Patient Group Directions.

  11. Evidence-based management of ANCA vasculitis.

    PubMed

    Carruthers, David; Sherlock, Jonathan

    2009-06-01

    The vasculitides associated with antineutrophil cytoplasmic antibodies (ANCAs) present to and are managed by a wide spectrum of physicians, reflecting the multi-organ nature of the conditions. Treatment strategies for these primary inflammatory vascular diseases have varied based on the outcomes of different clinical trials and practice reviews. The individual drugs used and their route of administration, dose, and duration of therapy have varied and have been the source of much debate. Advances in our understanding of disease immunopathogenesis, clinical assessment and outcome have formed the basis for several recent good-quality clinical trials. Now, with the results of these large-scale multicentre collaborative studies, there is a firmer evidence base to guide management decisions for individual patients. This evidence base, reviewed here, has led to the publication of treatment guidelines which importantly encompass many of the broader aspects of disease management.

  12. Evidence-based medicine: quality and comparability of clinical trials investigating the efficacy of prostaglandin F(2α) for the treatment of bovine endometritis.

    PubMed

    Haimerl, Peggy; Arlt, Sebastian; Heuwieser, Wolfgang

    2012-08-01

    The objective of this study was to evaluate the quality and comparability of published literature, and to summarize the effect of prostaglandin F(2α) (PGF(2α)) for the treatment of endometritis. It has been postulated that there is a dearth of high-level evidence-based research results in veterinary medicine. Also, there is a marked variation in the quality of studies in veterinary and animal science. Post-partum uterine infections occur commonly in dairy cattle and are reported to have a negative impact on reproductive performance. A comprehensive literature search was conducted utilizing online databases revealing a total of 2723 references. After applying specific exclusion criteria, a total of 68 trials were eligible for further analysis. These articles were evaluated utilizing specific parameters listed in an evaluation form such as randomization and the involvement of control groups. The analysis revealed that more than half of the trials (51·5%) were at least 20 years old. Furthermore, we found that about one third (36·8%) of all trials were controlled and randomized, while 3 of those (4·4%) were also blinded. Of those trials which calculated a calving-to-conception interval (n=30), 50% of the authors claimed an improvement, which was statistically significant in 23·3% of the cases. We conclude that there is a wide discrepancy between research results investigating the efficacy of PGF(2α).

  13. Evidence-Based Cancer Imaging

    PubMed Central

    Khorasani, Ramin

    2017-01-01

    With the advances in the field of oncology, imaging is increasingly used in the follow-up of cancer patients, leading to concerns about over-utilization. Therefore, it has become imperative to make imaging more evidence-based, efficient, cost-effective and equitable. This review explores the strategies and tools to make diagnostic imaging more evidence-based, mainly in the context of follow-up of cancer patients. PMID:28096722

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

    ERIC Educational Resources Information Center

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

    2001-01-01

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

  15. How to understand and conduct evidence-based medicine

    PubMed Central

    2016-01-01

    Evidence-based medicine (EBM) is the conscientious, explicit, and judicious use of current best evidence in making decisions regarding the care of individual patients. This concept has gained popularity recently, and its applications have been steadily expanding. Nowadays, the term "evidence-based" is used in numerous situations and conditions, such as evidence-based medicine, evidence-based practice, evidence-based health care, evidence-based social work, evidence-based policy, and evidence-based education. However, many anesthesiologists and their colleagues have not previously been accustomed to utilizing EBM, and they have experienced difficulty in understanding and applying the techniques of EBM to their practice. In this article, the author discusses the brief history, definition, methods, and limitations of EBM. As EBM also involves making use of the best available information to answer questions in clinical practice, the author emphasizes the process of performing evidence-based medicine: generate the clinical question, find the best evidence, perform critical appraisal, apply the evidence, and then evaluate. Levels of evidence and strength of recommendation were also explained. The author expects that this article may be of assistance to readers in understanding, conducting, and evaluating EBM. PMID:27703623

  16. How to understand and conduct evidence-based medicine.

    PubMed

    Kang, Hyun

    2016-10-01

    Evidence-based medicine (EBM) is the conscientious, explicit, and judicious use of current best evidence in making decisions regarding the care of individual patients. This concept has gained popularity recently, and its applications have been steadily expanding. Nowadays, the term "evidence-based" is used in numerous situations and conditions, such as evidence-based medicine, evidence-based practice, evidence-based health care, evidence-based social work, evidence-based policy, and evidence-based education. However, many anesthesiologists and their colleagues have not previously been accustomed to utilizing EBM, and they have experienced difficulty in understanding and applying the techniques of EBM to their practice. In this article, the author discusses the brief history, definition, methods, and limitations of EBM. As EBM also involves making use of the best available information to answer questions in clinical practice, the author emphasizes the process of performing evidence-based medicine: generate the clinical question, find the best evidence, perform critical appraisal, apply the evidence, and then evaluate. Levels of evidence and strength of recommendation were also explained. The author expects that this article may be of assistance to readers in understanding, conducting, and evaluating EBM.

  17. Towards evidence-based emergency medicine: best BETs from the Manchester Royal Infirmary. BET 3: what are the clinical features of Salvia divinorum toxicity?

    PubMed

    Dueweke, Justin R

    2013-04-01

    A short-cut review was carried out to determine the clinical features associated with acute intoxication with Salvia divinorum. Sixty-six papers were found using the reported searches, of which three presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these best papers are tabulated. It is concluded that the most common features of intoxication are tachycardia, hallucinations and acute alteration in mental status.

  18. Therapeutic efficiency of antibiotics and prostaglandin F2α in postpartum dairy cows with clinical endometritis: an evidence-based evaluation.

    PubMed

    Lefebvre, Rejean C; Stock, Angelika E

    2012-03-01

    The occurrence of vaginal discharge in postpartum dairy cows is generally diagnosed as clinical endometritis. This uterine condition is associated with reduced fertility and economic loss for the dairy industry. Therapeutic approaches include the systemic or intrauterine application of antibiotics or the injection of prostaglandin F2α and analogues to cause luteolysis and uterine contractions to evacuate the infected content. The treatment of clinical endometritis remains a subject of considerable controversy in the literature. Better understanding of the reproductive biology of normal versus abnormal uterine involution and immune mechanisms will allow more efficient diagnostic methods and a more efficient therapeutic approach.

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

    PubMed

    Thomas, Marie H; Baker, Susan Scott

    2011-01-01

    Evidence-based nursing requires that students think reflectively and use clinical inquiry to develop clinical reasoning and decision-making skills. Likewise, nursing students need a strategy to be successful in passing the NCLEX-RN. The authors identify strategies based on nursing research to facilitate student success. While learning the evidence-based nursing process, the student must begin to think like a nurse while answering clinical practice questions. Using the skills taught for evidence-based nursing can be a powerful tool to approach the NCLEX-RN and succeed.

  20. Evidence-based concepts and procedures for bonded inlays and onlays. Part I. Historical perspectives and clinical rationale for a biosubstitutive approach.

    PubMed

    Dietschi, Didier; Spreafico, Roberto

    2015-01-01

    This first article in the series (Part I) aims to present an updated rationale and treatment approach for indirect adhesive posterior restorations based on the best scientific and long-term clinical evidence available. The proposed treatment concept relies on the basic ideas of (1) the placement of an adhesive base/liner (Dual Bonding [DB] and Cavity Design Optimization [CDO]) and, when needed, (2) a simultaneous relocation of deep cervical margins (Cervical Margin Relocation [CMR]), prior to (3) impression taking to ensure a more conservative preparation and easier-to-follow clinical steps, and the use of (4) a highly filled, light-curing restorative material for the cementation (Controlled Adhesive Cementation [CAC]), together with restoration insertion facilitation, the application of sonic/ultrasonic energy, and/or material heating. The suggested clinical protocol will help the practitioner to eliminate the most frequently experienced difficulties relating to the preparation, isolation, impression taking and cementation of tooth-colored inlays and onlays. This protocol can be applied to both ceramics and composites as no material has been proven to be the most feasible or reliable in all clinical indications regarding its physicochemical and handling characteristics. For the time being, however, we have to regard such indirect restorations as a biosubstitution due to the monolithic nature of the restoration, with still very imperfect replication of the specific natural dentin-enamel assemblage.

  1. Addressing Mental Health Disparities through Clinical Competence Not Just Cultural Competence: The Need for Assessment of Sociocultural Issues in the Delivery of Evidence-Based Psychosocial Rehabilitation Services

    PubMed Central

    Yamada, Ann-Marie; Brekke, John S

    2008-01-01

    Recognition of ethnic/racial disparities in mental health services has not directly resulted in the development of culturally responsive psychosocial interventions. There remains a fundamental need for assessment of sociocultural issues that have been linked with the expectations, needs, and goals of culturally diverse consumers with severe and persistent mental illness. The authors posit that embedding the assessment of sociocultural issues into psychosocial rehabilitation practice is one step in designing culturally relevant empirically supported practices. It becomes a foundation on which practitioners can examine the relevance of their interventions to the diversity encountered in everyday practice. This paper provides an overview of the need for culturally and clinically relevant assessment practices and asserts that by improving the assessment of sociocultural issues the clinical competence of service providers is enhanced. The authors offer a conceptual framework for linking clinical assessment of sociocultural issues to consumer outcomes and introduce an assessment tool adapted to facilitate the process in psychosocial rehabilitation settings. Emphasizing competent clinical assessment skills will ultimately offer a strategy to address disparities in treatment outcomes for understudied populations of culturally diverse consumers with severe and persistent mental illness. PMID:18778881

  2. Molecular biology of lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines.

    PubMed

    Nana-Sinkam, Serge Patrick; Powell, Charles A

    2013-05-01

    Based on recent bench and clinical research, the treatment of lung cancer has been refined, with treatments allocated according to histology and specific molecular features. For example, targeting mutations such as epidermal growth factor receptor (EGFR) with tyrosine kinase inhibitors has been particularly successful as a treatment modality, demonstrating response rates in selected patients with adenocarcinoma tumors harboring EGFR mutations that are significantly higher than those for conventional chemotherapy. However, the development of new targeted therapies is, in part, highly dependent on an improved understanding of the molecular underpinnings of tumor initiation and progression, knowledge of the role of molecular aberrations in disease progression, and the development of highly reproducible platforms for high-throughput biomarker discovery and testing. In this article, we review clinically relevant research directed toward understanding the biology of lung cancer. The clinical purposes of this research are (1) to identify susceptibility variants and field molecular alterations that will promote the early detection of tumors and (2) to identify tumor molecular alterations that serve as therapeutic targets, prognostic biomarkers, or predictors of tumor response. We focus on research developments in the understanding of lung cancer somatic DNA mutations, chromosomal aberrations, epigenetics, and the tumor microenvironment, and how they can advance diagnostics and therapeutics.

  3. Evidence-based guideline recommendations on multiparametric magnetic resonance imaging in the diagnosis of prostate cancer: A Cancer Care Ontario clinical practice guideline

    PubMed Central

    Haider, Masoom A.; Yao, Xiaomei; Loblaw, Andrew; Finelli, Antonio

    2017-01-01

    This clinical guideline focuses on: 1) the use of multiparametric magnetic resonance imaging (mpMRI) in diagnosing clinically significant prostate cancer (CSPC) in patients with an elevated risk of CSPC and who are biopsy-naïve; and 2) the use of mpMRI in diagnosing CSPC in patients with a persistently elevated risk of having CSPC and who have a negative transrectal ultrasound (TRUS)-guided systematic biopsy. The methods of the Practice Guideline Development Cycle were used. MEDLINE, EMBASE, the Cochrane Library (1997‒April 2014), main guideline websites, and relevant annual meeting abstracts (2011‒2014) were searched. Internal and external reviews were conducted. The two main recommendations are: Recommendation 1: In patients with an elevated risk of CSPC (according to prostate-specific antigen [PSA] levels and/or nomograms) who are biopsy-naïve: mpMRI followed by targeted biopsy (biopsy directed at cancer-suspicious foci detected with mpMRI) should not be considered the standard of care.Data from future research studies are essential and should receive high-impact trial funding to determine the value of mpMRI in this clinical context.Recommendation 2: In patients who had a prior negative TRUS-guided systematic biopsy and demonstrate an increasing risk of having CSPC since prior biopsy (e.g., continued rise in PSA and/or change in findings from digital rectal examination): mpMRI followed by targeted biopsy may be considered to help in detecting more CSPC patients compared with repeated TRUS-guided systematic biopsy. PMID:28163805

  4. Bringing evidence to practice: a team approach to teaching skills required for an informationist role in evidence-based clinical and public health practice*†

    PubMed Central

    Oliver, Kathleen Burr; Dalrymple, Prudence; Lehmann, Harold P.; McClellan, Deborah Ann; Robinson, Karen A.; Twose, Claire

    2008-01-01

    Objective: The objectives were (1) to develop an academic, graduate-level course designed for information professionals seeking to bring evidence to clinical medicine and public health practice and to address, in the course approach, the “real-world” time constraints of these domains and (2) to further specify and realize identified elements of the “informationist” concept. Setting: The course took place at the Division of Health Sciences Informatics, School of Medicine, Johns Hopkins University. Participants: A multidisciplinary faculty, selected for their expertise in the course core competencies, and three students, two post-graduate National Library of Medicine (NLM) informationist fellows and one NLM second-year associate, participated in the research. Intervention: A 1.5-credit, graduate-level course, “Informationist Seminar: Bringing the Evidence to Practice,” was offered in October to December 2006. In this team-taught course, a series of lectures by course faculty and panel discussions involving outside experts were combined with in-class discussion, homework exercises, and a major project that involved choosing and answering, in both oral and written form, a real-world question based on a case scenario in clinical or public health practice. Conclusion: This course represents an approach that could be replicated in other academic health centers with similar pools of expertise. Ongoing journal clubs that reiterate the question-and-answer process with new questions derived from clinical and public health practice and incorporate peer review and faculty mentoring would reinforce the skills acquired in the seminar. PMID:18219381

  5. Validity and clinical utility of the DSM-5 severity specifier for bulimia nervosa: results from a multisite sample of patients who received evidence-based treatment.

    PubMed

    Dakanalis, Antonios; Bartoli, Francesco; Caslini, Manuela; Crocamo, Cristina; Zanetti, Maria Assunta; Riva, Giuseppe; Clerici, Massimo; Carrà, Giuseppe

    2016-07-19

    A new "severity specifier" for bulimia nervosa (BN), based on the frequency of inappropriate weight compensatory behaviours (IWCBs), was added to the DSM-5 as a means of documenting heterogeneity and variability in the severity of the disorder. Yet, evidence for its validity in clinical populations, including prognostic significance for treatment outcome, is currently lacking. Existing data from 281 treatment-seeking patients with DSM-5 BN, who received the best available treatment for their disorder (manual-based cognitive behavioural therapy; CBT) in an outpatient setting, were re-analysed to examine whether these patients subgrouped based on the DSM-5 severity levels would show meaningful and consistent differences on (a) a range of clinical variables assessed at pre-treatment and (b) post-treatment abstinence from IWCBs. Results highlight that the mild, moderate, severe, and extreme severity groups were statistically distinguishable on 22 variables assessed at pre-treatment regarding eating disorder pathological features, maintenance factors of BN, associated (current) and lifetime psychopathology, social maladjustment and illness-specific functional impairment, and abstinence outcome. Mood intolerance, a maintenance factor of BN but external to eating disorder pathological features (typically addressed within CBT), emerged as the primary clinical variable distinguishing the severity groups showing a differential treatment response. Overall, the findings speak to the concurrent and predictive validity of the new DSM-5 severity criterion for BN and are important because a common benchmark informing patients, clinicians, and researchers about severity of the disorder and allowing severity fluctuation and patient's progress to be tracked does not exist so far. Implications for future research are outlined.

  6. Evidence-based Medicine in Animal Reproduction.

    PubMed

    Arlt, S P; Heuwieser, W

    2014-09-01

    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.

  7. School Centered Evidence Based Accountability

    ERIC Educational Resources Information Center

    Milligan, Charles

    2015-01-01

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

  8. The promising anticancer drug 3-bromopyruvate is metabolized through glutathione conjugation which affects chemoresistance and clinical practice: An evidence-based view.

    PubMed

    El Sayed, Salah Mohamed; Baghdadi, Hussam; Zolaly, Mohammed; Almaramhy, Hamdi H; Ayat, Mongi; Donki, Jagadish G

    2017-03-01

    3-Bromopyruvate (3BP) is a promising effective anticancer drug against many different tumors in children and adults. 3BP exhibited strong anticancer effects in both preclinical and human studies e.g. energy depletion, oxidative stress, anti-angiogenesis, anti-metastatic effects, targeting cancer stem cells and antagonizing the Warburg effect. There is no report about 3BP metabolism to guide researchers and oncologists to improve clinical practice and prevent drug resistance. In this article, we provide evidences that 3BP is metabolized through glutathione (GSH) conjugation as a novel report where 3BP was confirmed to be attached to GSH followed by permanent loss of pharmacological effects in a picture similar to cisplatin. Both cisplatin and 3BP are alkylating agents. Reported decrease in endogenous cellular GSH content upon 3BP treatment was confirmed to be due to the formation of 3BP-GSH complex i.e. GSH consumption for conjugation with 3BP. Cancer cells having high endogenous GSH exhibit resistance to 3BP while 3BP sensitive cells acquire resistance upon adding exogenous GSH. Being a thiol blocker, 3BP may attack thiol groups in tissues and serum proteins e.g. albumin and GSH. That may decrease 3BP-induced anticancer effects and the functions of those proteins. We proved here that 3BP metabolism is different from metabolism of hydroxypyruvate that results from metabolism of D-serine using D-amino acid oxidase. Clinically, 3BP administration should be monitored during albumin infusion and protein therapy where GSH should be added to emergency medications. GSH exerts many physiological effects and is safe for human administration both orally and intravenously. Based on that, reported GSH-induced inhibition of 3BP effects makes 3BP effects reversible, easily monitored and easily controlled. This confers a superiority of 3BP over many anticancer agents.

  9. Efficacy of a modern neuroscience approach versus usual care evidence-based physiotherapy on pain, disability and brain characteristics in chronic spinal pain patients: protocol of a randomized clinical trial

    PubMed Central

    2014-01-01

    Background Among the multiple conservative modalities, physiotherapy is a commonly utilized treatment modality in managing chronic non-specific spinal pain. Despite the scientific progresses with regard to pain and motor control neuroscience, treatment of chronic spinal pain (CSP) often tends to stick to a peripheral biomechanical model, without targeting brain mechanisms. With a view to enhance clinical efficacy of existing physiotherapeutic treatments for CSP, the development of clinical strategies targeted at ‘training the brain’ is to be pursued. Promising proof-of-principle results have been reported for the effectiveness of a modern neuroscience approach to CSP when compared to usual care, but confirmation is required in a larger, multi-center trial with appropriate evidence-based control intervention and long-term follow-up. The aim of this study is to assess the effectiveness of a modern neuroscience approach, compared to usual care evidence-based physiotherapy, for reducing pain and improving functioning in patients with CSP. A secondary objective entails examining the effectiveness of the modern neuroscience approach versus usual care physiotherapy for normalizing brain gray matter in patients with CSP. Methods/Design The study is a multi-center, triple-blind, two-arm (1:1) randomized clinical trial with 1-year follow-up. 120 CSP patients will be randomly allocated to either the experimental (receiving pain neuroscience education followed by cognition-targeted motor control training) or the control group (receiving usual care physiotherapy), each comprising of 3 months treatment. The main outcome measures are pain (including symptoms and indices of central sensitization) and self-reported disability. Secondary outcome measures include brain gray matter structure, motor control, muscle properties, and psychosocial correlates. Clinical assessment and brain imaging will be performed at baseline, post-treatment and at 1-year follow-up. Web

  10. The feasibility of implementing an evidence-based core set of clinical pharmacy services in 2020: manpower, marketplace factors, and pharmacy leadership.

    PubMed

    Bond, C A; Raehl, Cynthia L; Patry, Roland

    2004-04-01

    Development of a national plan to implement a core set of clinical pharmacy services in United States hospitals by 2020 requires assertive leadership from pharmacy organizations and state boards of pharmacy, and a commitment from the profession. Factors that may affect the development are grouped into three areas: manpower, marketplace variables, and pharmacy leadership. Although the number of pharmacy school graduates (7000) was about the same in 1990 and 2000, a greater number of pharmacy schools and high student enrollment, coupled with the Accreditation Council for Pharmacy Education's acceptance of foreign-trained pharmacists, suggest that the number of pharmacists will increase substantially in the near future. We estimate that the net increase in pharmacists (new pharmacy graduates less pharmacists who retire or die) in the United States will be 139,929 from 2000-2020, for a total of 335,040 pharmacists (71% increase). The number of pharmacy technicians increased substantially (66%), from 150,000 in 1996 to 250,000 in 2002. The number of residents in programs accredited by the American Society of Health-System Pharmacists increased 148%, from 435 in 1990 to 1080 in 2002. We conservatively project an increase of 33,000 pharmacists who complete residencies from 2000-2020. The pharmacy marketplace has changed dramatically over the last 12 years, with 10,754 independent community pharmacies closing (2.46 pharmacies/day) and 8459 chain outlets opening (1.93 chains/day). In recent years, mail-order pharmacies have expanded faster than other retail outlets and now process over 18% of U.S. prescriptions. Increased use of robotic systems (some can process 5000 prescriptions/hr) and technicians will diminish the demand for dispensing pharmacists. In addition, up to 10% of U.S. retail prescriptions may be filled outside the country's borders. These data indicate that there will be a sufficient supply of pharmacists and technicians in the future. Thus, it is feasible

  11. EULAR Recommendations 2003: an evidence based approach to the management of knee osteoarthritis: Report of a Task Force of the Standing Committee for International Clinical Studies Including Therapeutic Trials (ESCISIT)

    PubMed Central

    Jordan, K; Arden, N; Doherty, M; Bannwarth, B; Bijlsma, J; Dieppe, P; Gunther, K; Hauselmann, H; Herrero-Beaumont, G; Kaklamanis, P; Lohmander, S; Leeb, B; Lequesne, M; Mazieres, B; Martin-Mola, E; Pavelka, K; Pendleton, A; Punzi, L; Serni, U; Swoboda, B; Verbruggen, G; Zimmerman-Gorska, I; Dougados, M

    2003-01-01

    Objectives: To update the EULAR recommendations for management of knee osteoarthritis (OA) by an evidence based medicine and expert opinion approach. Methods: The literature search and guidelines were restricted to treatments for knee OA pertaining to clinical and/or radiological OA of any compartment of the knee. Papers for combined treatment of knee and other types of OA were excluded. Medline and Embase were searched using a combination of subject headings and key words. Searches for those treatments previously investigated were conducted for January 1999 to February 2002 and for those treatments not previously investigated for 1966 to February 2002. The level of evidence found for each treatment was documented. Quality scores were determined for each paper, an effect size comparing the treatment with placebo was calculated, where possible, and a toxicity profile was determined for each treatment modality. Results: 497 new publications were identified by the search. Of these, 103 were intervention trials and included in the overall analysis, and 33 treatment modalities were identified. Previously identified publications which were not exclusively knee OA in the initial analysis were rejected. In total, 545 publications were included. Based on the results of the literature search and expert opinion, 10 recommendations for the treatment of knee OA were devised using a five stage Delphi technique. Based on expert opinion, a further set of 10 items was identified by a five stage Delphi technique as important for future research. Conclusion: The updated recommendations support some of the previous propositions published in 2000 but also include modified statements and new propositions. Although a large number of treatment options for knee OA exist, the evidence based format of the EULAR Recommendations continues to identify key clinical questions that currently are unanswered. PMID:14644851

  12. [Acupressure and Evidence-Based Nursing].

    PubMed

    Chen, Li-Li; Lin, Jun-Dai

    2015-12-01

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

  13. Evidence-based pathology: umbilical cord coiling.

    PubMed

    Khong, T Y

    2010-12-01

    The generation of a pathology test result must be based on criteria that are proven to be acceptably reproducible and clinically relevant to be evidence-based. This review de-constructs the umbilical cord coiling index to illustrate how it can stray from being evidence-based. Publications related to umbilical cord coiling were retrieved and analysed with regard to how the umbilical coiling index was calculated, abnormal coiling was defined and reference ranges were constructed. Errors and other influences that can occur with the measurement of the length of the umbilical cord or of the number of coils can compromise the generation of the coiling index. Definitions of abnormal coiling are not consistent in the literature. Reference ranges defining hypocoiling or hypercoiling have not taken those potential errors or the possible effect of gestational age into account. Even the way numerical test results in anatomical pathology are generated, as illustrated by the umbilical coiling index, warrants a critical analysis into its evidence base to ensure that they are reproducible or free from errors.

  14. Mental health clinicians' experiences of implementing evidence-based treatments.

    PubMed

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

    2013-10-01

    Implementation research has tremendous potential to bridge the research-practice gap; however, we know more about barriers to evidence-based care than the factors that contribute to the adoption and sustainability of evidence-based treatments. In this qualitative study the authors explore the experiences of clinicians (N = 11) who were implementing evidence-based treatments, 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 evidence-based treatments, as well as other stakeholders who wish to develop and test strategies for moving evidence-based treatments into routine care.

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

    PubMed Central

    Goldenberg, Maya J

    2005-01-01

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

  16. Approach to outcome measurement in the prevention of thrombosis in surgical and medical patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines.

    PubMed

    Guyatt, Gordon H; Eikelboom, John W; Gould, Michael K; Garcia, David A; Crowther, Mark; Murad, M Hassan; Kahn, Susan R; Falck-Ytter, Yngve; Francis, Charles W; Lansberg, Maarten G; Akl, Elie A; Hirsh, Jack

    2012-02-01

    This article provides the rationale for the approach to making recommendations primarily used in four articles of the Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines: orthopedic surgery, nonorthopedic surgery, nonsurgical patients, and stroke. Some of the early clinical trials of antithrombotic prophylaxis with a placebo or no treatment group used symptomatic VTE and fatal PE to measure efficacy of the treatment. These trials suggest a benefit of thromboprophylaxis in reducing fatal PE. In contrast, most of the recent clinical trials comparing the efficacy of alternative anticoagulants used a surrogate outcome, asymptomatic DVT detected at mandatory venography. This outcome is fundamentally unsatisfactory because it does not allow a trade-off with serious bleeding; that trade-off requires knowledge of the number of symptomatic events that thromboprophylaxis prevents. In this article, we review the merits and limitations of four approaches to estimating reduction in symptomatic thrombosis: (1) direct measurement of symptomatic thrombosis, (2) use of asymptomatic events for relative risks and symptomatic events from randomized controlled trials for baseline risk, (3) use of baseline risk estimates from studies that did not perform surveillance and relative effect from asymptomatic events in randomized controlled trials, and (4) use of available data to estimate the proportion of asymptomatic events that will become symptomatic. All approaches have their limitations. The optimal choice of approach depends on the nature of the evidence available.

  17. Research fellowship programs as a pathway for training independent clinical pharmacy scientists.

    PubMed

    Mueller, Eric W; Bishop, Jeffrey R; Kanaan, Abir O; Kiser, Tyree H; Phan, Hanna; Yang, Katherine Y

    2015-03-01

    The American College of Clinical Pharmacy (ACCP) Research Affairs Committee published a commentary in 2013 on training clinical pharmacy scientists in the context of changes in economic, professional, political, and research environments. The commentary centered on the opportunities for pharmacists in clinical/translational research including strategies for ACCP, colleges of pharmacy, and the profession to increase the number and impact of clinical pharmacy scientists. A postdoctoral fellowship is cited as a current training pathway, capable of producing independent and productive pharmacy researchers. However, a decline in the number of programs, decreased funding availability, and variability in fellowship program activities and research focus have brought into question the relevance of this research training pathway to meet demand and opportunities. In response to these points, this commentary examines the state of research fellowship training including the current ACCP research fellowship review process, the need for standardization of research fellowship programs, and strategies to strengthen and promote research fellowships as relevant researcher training pathways.

  18. Follow-up of patients who are clinically disease-free after primary treatment for fallopian tube, primary peritoneal, or epithelial ovarian cancer: a Program in Evidence-Based Care guideline adaptation

    PubMed Central

    Le, T.; Kennedy, E.B.; Dodge, J.; Elit, L.

    2016-01-01

    Background A need for follow-up recommendations for survivors of fallopian tube, primary peritoneal, or epithelial ovarian cancer after completion of primary treatment was identified by Cancer Care Ontario’s Program in Evidence-Based Care. Methods We searched for existing guidelines, conducted a systematic review (medline, embase, and cdsr, January 2010 to March 2015), created draft recommendations, and completed a comprehensive review process. Outcomes included overall survival, quality of life, and patient preferences. Results The Cancer Australia guidance document Follow Up of Women with Epithelial Ovarian Cancer was adapted for the Ontario context. A key randomized controlled trial found that the overall survival rate did not differ between asymptomatic women who received early treatment based on elevated serum cancer antigen 125 (ca125) alone and women who waited for the appearance of clinical symptoms before initiating treatment (hazard ratio: 0.98; 95% confidence interval: 0.80 to 1.20; p = 0.85); in addition, patients in the delayed treatment group reported good global health scores for longer. No randomized studies were found for other types of follow-up. We recommend that survivors be made aware of the potential harms and benefits of surveillance, including a discussion of the limitations of ca125 testing. Women could be offered the option of no formal follow-up or a follow-up schedule that is agreed upon by the woman and her health care provider. Education about the most common symptoms of recurrence should be provided. Alternative models of care such as nurse-led or telephone-based follow-up (or both) could be emerging options. Conclusions The recommendations provided in this guidance document have a limited evidence base. Recommendations should be updated as further information becomes available. PMID:27803599

  19. The architecture of evidence-based gynaecology.

    PubMed

    Khan, Khalid S

    2006-10-01

    Modern evidence-based medicine (EBM) and its predecessor 'Medecin d'Observation' both emphasise that potential advances in healthcare must be researched and proven to do more good than harm using the principles of clinical epidemiology before they are incorporated into medical practice. EBM is considered an important advance in improving clinical care in gynaecology but EBM skills have traditionally not been covered in undergraduate or postgraduate education. Therefore there is a perceived need to compile texts on various aspects of gynaecological practice using EBM principles. This is what these two issues of the Best Practice series hope to achieve. The various chapters will provide readers with clinical advice generated from critically appraised information that has been identified as addressing relevant questions.

  20. Evidence-based management of recurrent miscarriages

    PubMed Central

    Jeve, Yadava B.; Davies, William

    2014-01-01

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

  1. From evidence based bioethics to evidence based social policies

    PubMed Central

    2007-01-01

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

  2. Evidence-based curriculum reform: the Kentucky Experience.

    PubMed

    Thomas, Mark V; Robinson, Fonda G; Nihill, Patricia

    2009-01-01

    Evidence-based health care seeks to base clinical practice and decision-making on best evidence, while allowing for modifications because of patient preferences and individual clinical situations. Dentistry has been slow to embrace this discipline, but this is changing. In the Graduate Periodontology Program (GPP) of the University of Kentucky, an evidence-based clinical curriculum was implemented in 2004. The tools of evidence-based health care (EBHC) were used to create evidence-based protocols to guide clinical decision-making by faculty and residents. The program was largely successful, although certain challenges were encountered. As a result of the positive experience with the GPP, the college is implementing a wider program in which evidence-based protocols will form the basis for all patient care and clinical education in the predoctoral clinics. A primary component of this is a computerized risk assessment tool that will aid in clinical decision-making. Surveys of alumni of the periodontal graduate program show that the EBHC program has been effective in changing practice patterns, and similar follow-up studies are planned to assess the effectiveness of the predoctoral EBHC program.

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

    PubMed Central

    Kowalski, Evan.; Chung, Kevin C.

    2012-01-01

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

  4. Evidence-based radiology: review and dissemination.

    PubMed

    Medina, L Santiago; Blackmore, C Craig

    2007-08-01

    Evidence-based radiology (EBR) is an important tool for the practice of radiology. The user of the EBR approach identifies evidence in a systematic fashion and then assimilates information through in-depth, explicit critical review of the best-designed and most recent literature on the subject in question. Clinical decision making is then based on the best current evidence, clinical expertise, and patient values. Substantial progress has been made in the review and dissemination of EBR. Dissemination of EBR within radiology has two critical aspects. The first is increased understanding of the methods required for EBR and of the appropriate use of EBR. The second important component is the dissemination of the data and critical literature reviews necessary to allow use of the EBR approach. Resources available for both EBR methods and EBR data in radiology include societies, journals, medical meetings, Web sites, and textbooks. Although radiology has made important progress in this field in recent years, the specialty is still behind other specialties that have been at the forefront of evidence-based medicine in the past decade.

  5. [Evidence-based orthodontics, still a long way to go].

    PubMed

    Kuijpers-Jagtman, A M

    2003-01-01

    Clinical performance can be kept up to date by learning how to practice evidence-based orthodontics, by seeking and appraising evidence-based summaries from the literature and by applying evidence-based strategies to change clinical behaviour. A MEDLINE search over the period 1990-2000 identified 8345 publications on clinical orthodontic subjects. Of these articles 49.5% was published in five specific orthodontic journals, while the others were published in about seventy other journals making it difficult for the clinician to stay current easily. Systematic reviews are an efficient and reliable source of information, but due to a lack of well-designed randomised clinical trials systematic reviews in orthodontics are still rare.

  6. Evidence-based Science Communication

    NASA Astrophysics Data System (ADS)

    Kahan, D.

    2012-12-01

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

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

    ERIC Educational Resources Information Center

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

    2013-01-01

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

  8. Informatics and evidence-based medicine: prescription for success.

    PubMed

    Starmer, John M; Wright Pinson, C; Lorenzi, Nancy M

    2010-01-01

    This article reports on the experience of one organization between 2004 and 2009 to develop an effective people-process-technology system to better manage the quality of health care. The creation of this system started with creating a strategic plan for quality and then establishing a structure to implement the plan. The next phase consisted of establishing a number of simultaneous steps that ranged from identifying and leveraging the appropriate informatics tools to the oversight process, and from the implementation team to strategies for working with clinical groups. The outcome as of 2009 is a well established evidence-based quality process and team in place. There are over 450 evidence-based medicine quality sets. More than 52% of all patients are admitted on quality evidence-based medicine pathways and protocols. This article reflects a successful prescription for combining informatics and evidence-based medicine to improve the quality of health care.

  9. Evidence-based Assessment of Pediatric Pain

    PubMed Central

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

    2008-01-01

    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

  10. Who needs evidence-based health care?

    PubMed Central

    Tsafrir, J; Grinberg, M

    1998-01-01

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

  11. Evidence-Based Practice in Psychology

    ERIC Educational Resources Information Center

    American Psychologist, 2006

    2006-01-01

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

  12. The pharmacology and management of the vitamin K antagonists: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy.

    PubMed

    Ansell, Jack; Hirsh, Jack; Poller, Leon; Bussey, Henry; Jacobson, Alan; Hylek, Elaine

    2004-09-01

    This article concerning the pharmacokinetics and pharmacodynamics of vitamin K antagonists (VKAs) is part of the Seventh American College of Chest Physicians Conference on Antithrombotic and Thrombolytic Therapy: Evidence-Based Guidelines. The article describes the antithrombotic effect of VKAs, the monitoring of anticoagulation intensity, the clinical applications of VKA therapy, and the optimal therapeutic range of VKAs, and provides specific management recommendations. Grade 1 recommendations are strong, and indicate that the benefits do, or do not, outweigh the risks, burdens, and costs. Grade 2 suggests that individual patient's values may lead to different choices (for a full understanding of the grading see Guyatt et al, CHEST 2004; 126:179S-187S). Among the key recommendations in this article are the following: for dosing of VKAs, we suggest the initiation of oral anticoagulation therapy with doses between 5 and 10 mg for the first 1 or 2 days for most individuals, with subsequent dosing based on the international normalized ratio (INR) response (Grade 2B). In the elderly and in other patient subgroups with an elevated bleeding risk, we suggest a starting dose at < or = 5 mg (Grade 2C). We recommend basing subsequent doses after the initial two or three doses on the results of INR monitoring (Grade 1C). The article also includes several specific recommendations for the management of patients with INRs above the therapeutic range and for patients requiring invasive procedures. For example, in patients with mild to moderately elevated INRs without major bleeding, we suggest that when vitamin K is to be given it be administered orally rather than subcutaneously (Grade 1A). For the management of patients with a low risk of thromboembolism, we suggest stopping warfarin therapy approximately 4 days before they undergo surgery (Grade 2C). For patients with a high risk of thromboembolism, we suggest stopping warfarin therapy approximately 4 days before surgery, to

  13. [Evidence-based TEP technique].

    PubMed

    Köckerling, F

    2017-01-13

    The guidelines of all international hernia societies recommend as procedures of choice the laparoendoscopic techniques total extraperitoneal patch plasty (TEP) and transabdominal preperitoneal patch plasty (TAPP) as well as the open Lichtenstein operation for elective inguinal hernia repair. The learning curve associated with the laparoendoscopic techniques, in particular TEP, is longer than that for the open Lichtenstein technique due to the complexity of the procedures. Accordingly, for laparoendoscopic techniques it is particularly important that the operations are conducted in a standardized manner in compliance with the evidence-based recommendations given for the technical details. When procedures are carried out in strict compliance with the guidelines of the international hernia societies, low rates of perioperative complications, complication-related reoperations, recurrences and chronic pain can be expected for TEP. Compliance with the guidelines can also positively impact mastery of the learning curve for TEP. The technical guidelines on TEP are based on study results and on the experiences of numerous experts; therefore, it is imperative that they are implemented in routine surgical practice.

  14. Evidence-based neuroethics for neurodevelopmental disorders.

    PubMed

    Racine, Eric; Bell, Emily; Di Pietro, Nina C; Wade, Lucie; Illes, Judy

    2011-03-01

    Many neurodevelopmental disorders affect early brain development in ways that are still poorly understood; yet, these disorders can place an enormous toll on patients, families, and society as a whole and affect all aspects of daily living for patients and their families. We describe a pragmatic, evidence-based framework for engaging in empiric ethics inquiry for a large consortium of researchers in neurodevelopmental disorders and provide relevant case studies of pragmatic neuroethics. The 3 neurodevelopmental disorders that are at the focus of our research, cerebral palsy (CP), autism spectrum disorder (ASD), and fetal alcohol spectrum disorder (FASD), bring unique and intersecting challenges of translating ethically research into clinical care for children and neonates. We identify and discuss challenges related to health care delivery in CP; neonatal neurological decision making; alternative therapies; and identity, integrity, and personhood.

  15. Faculty Training in Evidence-Based Medicine: Improving Evidence Acquisition and Critical Appraisal

    ERIC Educational Resources Information Center

    Nicholson, Laura J.; Warde, Carole M.; Boker, John R.

    2007-01-01

    Introduction: Evidence-based medicine (EBM) integrates published clinical evidence with patient values and clinical expertise, the output of which is informed medical decision making. Key skills for evidence-based practice include acquisition and appraisal of clinical information. Faculty clinicians often lack expertise in these skills and are…

  16. Evidence-based laboratory medicine: is it working in practice?

    PubMed

    Price, Christopher P

    2012-02-01

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

  17. Nanotheranostics in evidence based personalized medicine.

    PubMed

    Sharma, Sushil

    2014-01-01

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

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

    ERIC Educational Resources Information Center

    Rubin, Allen

    2015-01-01

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

  19. Evidence-Based Management of Anticoagulant Therapy

    PubMed Central

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

    2012-01-01

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

  20. Lost in translation: bibliotherapy and evidence-based medicine.

    PubMed

    Dysart-Gale, Deborah

    2008-03-01

    Evidence-based medicine's (EBM) quantitative methodologies reflect medical science's long-standing mistrust of the imprecision and subjectivity of ordinary descriptive language. However, EBM's attempts to replace subjectivity with precise empirical methods are problematic when clinicians must negotiate between scientific medicine and patients' experience. This problem is evident in the case of bibliotherapy (patient reading as treatment modality), a practice widespread despite its reliance on anecdotal evidence. While EBM purports to replace such flawed practice with reliable evidence-based methods, this essay argues that its aversion to subjective language prevents EBM from effectively evaluating bibliotherapy or making it amenable to clinical and research governance.

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

    PubMed

    Rolloff, Mary

    2010-01-01

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

  2. The development of evidence-based nursing.

    PubMed

    French, P

    1999-01-01

    This paper argues that the current conception of evidence-based medicine has its limitations in the promotion of research which effects the quality of service in any health care system. It also poses something of a difficulty for the development of evidence-based nursing in particular. This paper advocates the more broad based concept of evidence-based practice and discusses its potential for addressing theory/practice problems and the uptake of nursing research. The broader conceptualization of evidence-based practice focuses on the integration of available evidence and the tacit knowledge of the investigator. An evidence-based practice project undertaken in Hong Kong is outlined as this provided the basis of many of the conclusions made in this paper. Three vignettes are given in order to demonstrate the nature of the evidence-based practice projects which have been conducted. The critical elements of evidence-based practice projects are outlined. Finally issues concerning the process of generating evidence, the relationship to continuous quality improvement and the cost effectiveness of evidence-based practice are discussed in more detail.

  3. Making Evidence-based Practice Educational.

    ERIC Educational Resources Information Center

    Elliott, John

    2001-01-01

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

  4. An evidence-based business planning process.

    PubMed

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

    2009-12-01

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

  5. Evidence-Based Practices in Secondary Transition

    ERIC Educational Resources Information Center

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

    2009-01-01

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

  6. Inquiry in baccalaureate nursing education: fostering evidence-based practice.

    PubMed

    Callister, Lynn Clark; Matsumura, Gerry; Lookinland, Sandra; Mangum, Sandra; Loucks, Carol

    2005-02-01

    With the increasing emphasis on evidence-based nursing practice, nurse educators need to more fully implement teaching strategies that help students gain critical thinking skills related to inquiry and understand the importance of evidence-based nursing practice. Research and scholarship emphases in one baccalaureate nursing program, student-identified benefits, and challenges associated with incorporating inquiry across the curriculum are described in this article. In clinical journal entries, students described the following benefits associated with curricular emphasis on inquiry: increased interest in evidence-based nursing practice and participating in the generation of research; enhanced critical thinking skills through the development of knowledge, experience, and competencies; increased motivation to continue professional growth and development by participating in lifelong learning; the desire to become better consumers of research findings; better understanding of the "real world" of clinical research; and increased desire to pursue graduate studies in nursing. The challenge to promote student growth toward competence in the application of evidence-based principles in clinical practice is ongoing.

  7. Towards Evidence Based Usability in Health Informatics?

    PubMed

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

    2015-01-01

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

  8. [Evidence-based cesarean section].

    PubMed

    Salo, Heini; Tekay, Aydin; Mäkikallio, Kaarin

    2015-01-01

    Cesarean delivery is the most frequent major surgery in Finland: in 2013 over 16% of the deliveries were via cesarean route. 27% of the mothers are estimated to face complications. Optimal surgical techniques and other operation-related measures aim to reduce the incidence of complications. Recommendations favor preoperative antibiotics, vaginal preparation, transversal skin incision, non-development of bladder flap, blunt cephalo-caudad uterine extension, spontaneous placental removal, late cord clamping, continuous sutures for uterine closure and subcutaneous skin sutures. Optimal measures will not only reduce complications in cesarean deliveries but bring cost savings and unify the clinical routines and training in specialization programs.

  9. Implementing an Evidence Based Preceptorship Program in a Military Center

    DTIC Science & Technology

    2014-11-05

    ACRONYM(S) TriService Nursing Research TSNRP Program, 4301 Jones Bridge RD Bethesda, MD 20814 11. SPONSOR/MONITOR’S REPORT NUMBER(S...Model of Evidence-based Practice served as the model for this project. Methods: The EB Vermont Nurses in Partnership (VNIP) clinical coaching program...included 34 interdisciplinary staff (Rehab, Education, Respiratory Therapy, and Clinic Staff), Staff Nurses (n=43) and 100% of identified preceptors (n

  10. Evidence based review on levosalbutamol.

    PubMed

    Gupta, Mukesh Kumar; Singh, Meenu

    2007-02-01

    Salbutamol, the most commonly used bronchodilator, is a chiral drug with R (levosalbutamol) and S-isomers (also known as enantiomer). The commonly used formulation is a racemic mixture that contains equal amounts of both R and S isomers. Levosalbutamol is the therapeutically active isomer and has all the beta 2 agonist activity. Until recently S-salbutamol was considered inert filler in the racemic mixture but animal as well as human studies have shown that S-salbutamol is not inert rather it may have some deleterious effects. Enantioselective metabolism of salbutamol leads to higher and sustained plasma levels of S-salbutamol with repeated dosing. There has been concern that chronic use of racemic salbutamol may lead to loss of effectiveness and clinical deterioration. Formulation of salbutamol containing only R- isomer (levosalbutamol) has been available in international market since last few years. Clinical trials in acute as well as chronic asthma in adults as well as children have shown that it has therapeutic advantage over racemic salbutamol and also is more cost effective. But, large multicenter trials are needed to prove its therapeutic superiority and cost-effectiveness in long term.

  11. [Searching for evidence-based data].

    PubMed

    Dufour, J-C; Mancini, J; Fieschi, M

    2009-08-01

    The foundation of evidence-based medicine is critical analysis and synthesis of the best data available concerning a given health problem. These factual data are accessible because of the availability on the Internet of web tools specialized in research for scientific publications. A bibliographic database is a collection of bibliographic references describing the documents indexed. Such a reference includes at least the title, summary (or abstract), a set of keywords, and the type of publication. To conduct a strategically effective search, it is necessary to formulate the question - clinical, diagnostic, prognostic, or related to treatment or prevention - in a form understandable by the research engine. Moreover, it is necessary to choose the specific database or databases, which may have particular specificity, and to analyze the results rapidly to refine the strategy. The search for information is facilitated by the knowledge of the standardized terms commonly used to describe the desired information. These come from a specific thesaurus devoted to document indexing. The most frequently used is MeSH (Medical Subject Heading). The principal bibliographic database whose references include a set of describers from the MeSH thesaurus is Medical Literature Analysis and Retrieval System Online (Medline), which has in turn become a subpart of a still more vast bibliography called PubMed, which indexes an additional 1.4 million references. Numerous other databases are maintained by national or international entities. These include the Cochrane Library, Embase, and the PASCAL and FRANCIS databases.

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

    PubMed

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

    2015-07-01

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

  13. Evidence based practice: are critical care nurses ready for it?

    PubMed

    Bucknall, T; Copnell, B; Shannon, K; McKinley, D

    2001-08-01

    In the emergence of the evidence based practice movement, critical care nurses have struggled to identify scientific evidence on which to base their clinical practice. While the lack of critical care nursing research is a major concern, other important issues have significantly stalled the implementation of evidence even when it is available. A descriptive study of 274 critical care nurses was undertaken to examine nursing research activity in Victorian critical care units. The study aimed to identify critical care nurses' research skills, the barriers encountered in participation and implementation and the current availability of resources. Results revealed that 42 per cent of the nurses who participated in the study believed that they were not prepared adequately to evaluate research, and less than a third believed they were sufficiently skilled to conduct valid scientific studies. An association was found between nurses' ability to confidently perform research activities and higher academic qualifications. The study found that there is a lack of organisational support and management commitment for the development of evidence based nursing. In order to facilitate the implementation of evidence based practice, clinicians must be made aware of the available resources, be educated and mentored when carrying out and using clinical research, and be supported in professional initiatives that promote evidence based practice. It is argued that this will have positive implications for patient outcomes in the critical care environment.

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

    PubMed

    Alexandroff, A B; Harman, K E

    2010-08-01

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

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

    PubMed

    Munro, Nancy

    2004-01-01

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

  16. Evidence-Based Heart Failure Medications and Cognition

    PubMed Central

    Bratzke, Lisa C.; Moser, Debra K.; Pelter, Michele M.; Paul, Steven M.; Nesbitt, Thomas S.; Cooper, Lawton S.; Dracup, Kathleen A.

    2014-01-01

    Background The etiology of cognitive impairment in heart failure (HF) is controversial and likely multifactorial. Physicians may hesitate to prescribe evidence-based HF medication because of concerns related to potential negative changes in cognition among a population that is already frequently impaired. We conducted a study to determine if prescription of evidence-based HF medications (specifically, beta-blockers, angiotensin-converting enzyme inhibitors, angiotensin-receptor blocking agents, diuretics, and aldosterone inhibitors) was associated with cognition in a large HF sample. Methods Six-hundred and twelve patients completed baseline data collection for the Rural Education to improve OuTcomEs in Heart Failure clinical trial (REMOTE-HF), including information about medications. Global cognition was evaluated using the Mini-Cog. Results The sample mean age was 66-years old (SD 13 years), 58% were male, 89% Caucasian. Global cognitive impairment was identified in 206 (34%) of the 612 patients. Prescription of evidence-based HF medications was not related to global cognitive impairment in this sample. This relationship was maintained even after adjusting for potential confounders (e.g. age, education, and comorbid burden). Conclusion Prescription of evidence-based HF medications is not related to low scores of a measure of global cognitive function in rural patients with HF. PMID:25419943

  17. Dissemination of Evidence-Based Standards of Care

    PubMed Central

    Barkhordarian, Andre; Hacker, Brett; Chiappelli, Francesco

    2011-01-01

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

  18. Picture Exchange Communication System (PECS) or Sign Language: An Evidence-Based Decision-Making Example

    ERIC Educational Resources Information Center

    Spencer, Trina D.; Petersen, Douglas B.; Gillam, Sandra L.

    2008-01-01

    Evidence-based practice (EBP) refers to clinical decisions as a result of the careful integration of research evidence and student needs. Legal mandates such as No Child Left Behind require teachers to employ evidence-based practices in their classrooms, yet teachers receive little guidance regarding how to determine which practices are…

  19. Implementation of Evidence-Based Practice Concepts in Undergraduate Athletic Training Education: Experiences of Select Educators

    ERIC Educational Resources Information Center

    Manspeaker, Sarah A.; Van Lunen, Bonnie

    2010-01-01

    Context: Professional athletic training education must transition toward instruction of evidence-based practice in order to maintain progress with other health professions' clinical practices and educational standards. Objective: To evaluate athletic training educators' experience with implementation of evidence-based practice concepts in CAATE…

  20. Measuring Practitioner Attitudes toward Evidence-Based Treatments: A Validation Study

    ERIC Educational Resources Information Center

    Ashcraft, Rindee G. P.; Foster, Sharon L.; Lowery, Amy E.; Henggeler, Scott W.; Chapman, Jason E.; Rowland, Melisa D.

    2011-01-01

    A better understanding of clinicians' attitudes toward evidence-based treatments (EBT) will presumably enhance the transfer of EBTs for substance-abusing adolescents from research to clinical application. The reliability and validity of two measures of therapist attitudes toward EBT were examined: the Evidence-Based Practice Attitude Scale…

  1. Evidence-based practice: management of adult sensorineural hearing loss.

    PubMed

    Chau, Justin K; Cho, John J W; Fritz, Dieter K

    2012-10-01

    Sensorineural hearing loss is a complex disease state influenced by genetics, age, noise, and many other factors. This article reviews our current knowledge regarding the causes of sensorineural hearing loss and reviews the more challenging clinical presentations of sensorineural hearing loss. We have reviewed the latest medical literature in an attempt to provide an evidence-based strategy for the assessment and management of sudden sensorineural hearing loss, rapidly progressive sensorineural hearing loss, and asymmetric/unilateral sensorineural hearing loss.

  2. Understanding evidence-based public health policy.

    PubMed

    Brownson, Ross C; Chriqui, Jamie F; Stamatakis, Katherine A

    2009-09-01

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

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

    ERIC Educational Resources Information Center

    TEACHING Exceptional Children, 2014

    2014-01-01

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

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

    PubMed

    Wendland, Claire L

    2007-06-01

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

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

    PubMed

    Gattinoni, Luciano; Carlesso, Eleonora; Santini, Alessandro

    2015-01-01

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

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

    PubMed Central

    2015-01-01

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

  7. Evidence-Based Classroom Behaviour Management Strategies

    ERIC Educational Resources Information Center

    Parsonson, Barry S.

    2012-01-01

    This paper reviews a range of evidence-based strategies for application by teachers to reduce disruptive and challenging behaviours in their classrooms. These include a number of antecedent strategies intended to help minimise the emergence of problematic behaviours and a range of those which provide positive consequences for appropriate student…

  8. Evidence-Based Teaching: Rhetoric and Reality

    ERIC Educational Resources Information Center

    Wrigley, Terry

    2015-01-01

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

  9. Evidence-based orthopaedics: A brief history

    PubMed Central

    Hoppe, Daniel J; Bhandari, Mohit

    2008-01-01

    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

  10. Evidence Based Education Request Desk. EBE #510

    ERIC Educational Resources Information Center

    Regional Educational Laboratory Southeast, 2009

    2009-01-01

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

  11. Finding Evidence-Based Practice Information

    ERIC Educational Resources Information Center

    Childs, Gary M.

    2009-01-01

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

  12. Evidence-Based Practices and Autism

    ERIC Educational Resources Information Center

    Mesibov, Gary B.; Shea, Victoria

    2011-01-01

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

  13. Evidence-Based Practice Goes beyond Google

    ERIC Educational Resources Information Center

    Klitzing, Sandra

    2012-01-01

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

  14. Multicultural Issues in Evidence-Based Interventions

    ERIC Educational Resources Information Center

    Ingraham, Colette L.; Oka, Evelyn R.

    2006-01-01

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

  15. The case against evidence-based principles in psychiatry.

    PubMed

    Levine, Robert; Fink, Max

    2006-01-01

    There is an organized movement by governmental, academic and commercial interests to make evidence-based practice the standard of care in the United States. There is little proof that this model can be adapted to psychiatry. We examine the diagnostic system, the validity of the data from clinical trials and how these are applied to clinical practice. The discipline of psychiatry relies on imprecise and unstable diagnostic criteria. It divides psychiatric disorders into discrete categories based on discussion and consultations among designated experts in the field. The diagnostic system is based on consensus and not experimental evidence. In fact, psychiatric disorders are not discrete. High co-morbidities between disorders and the propensity of one condition to change into another makes the present diagnostic system extremely questionable. Outcomes of clinical trials are defined by fractional reductions in the number and severity of symptoms measured by rating scales and not remission of illness. The data obtained from clinical trials are flawed in design, execution and the selective reporting of outcomes. There is substantial evidence to indicate that both investigators and patients can distinguish between active treatment and placebo in double blind studies. In addition, negative outcomes are frequently not reported. Such evidence impacts not only on the specific study, used as evidence, but invalidates the value of meta analyses. Financial considerations lead to the inclusion of inappropriate subjects into studies and favor newer, patented treatments. When the conclusions derived from evidence-based psychiatry are applied to clinical practice they have little to offer and often produce poor treatment outcomes. In fact, when the data used to support the principles of evidence-based psychiatry are examined, they are unsound. The system itself is best considered an untested hypothesis. The diagnostic system, the manner in which data are gathered, and financial

  16. [Evidence based medicine. A new paradigm for medical practice].

    PubMed

    Carneiro, A V

    1998-01-01

    Modern medical practice is an ever-changing process, and the doctor's need for information has been partially met by continuous medical education (CME) activities. It has been shown that CME activities have not prevented clinical knowledge, as well as medical practice, from deteriorating with time. When faced with the need to get the most recent and relevant information possible, the busy clinician has two major problems: most of the published medical literature is either irrelevant or not useful; and there is little time to read it. Evidence-based medicine constitutes a new paradigm for medical practice in the sense that it tries to transform clinical problems into well formulated clinical questions, selecting and critically appraising scientific evidence with predefined and rigorous rules. It combines the expertise of the individual clinician with the best external evidence from clinical research for rational, ethical and efficacious practice. Evidence-based medicine can be taught and practiced by physicians with different degrees of autonomy, with several subspecialties, working in the hospital or in outpatient clinics, alone or in groups.

  17. Evidence-based therapy for cutaneous sarcoidosis.

    PubMed

    Doherty, Christy B; Rosen, Ted

    2008-01-01

    Although healthcare providers have arrived at a relatively comfortable zone of accepted clinical practice in the management of cutaneous sarcoidosis, virtually every treatment is based on minimal evidence-based data and relies almost exclusively on anecdotal information. Although it would be convenient to blame this state of affairs on the lack of certainty about disease aetiology, the unavoidable fact is that little has been executed, even in the realm of well designed comparative trials. Nonetheless, worldwide accepted standard therapies for sarcoidosis include the administration of corticosteroids, antimalarials and methotrexate. A stepwise approach to patient care is appropriate, and potent topical corticosteroids (e.g. clobetasol) or repeated intralesional injections of triamcinolone (3-10 mg/mL) may be all that is needed in mild skin-limited disease. In patients requiring systemic therapy for recalcitrant or deforming skin lesions (or for widespread disease), corticosteroids (e.g. prednisone 40-80 mg/day, tapered accordingly) used alone or in combination with antimalarials or methotrexate may be indicated. Antimalarials and methotrexate are considered second-line interventions and may be used as monotherapy for steroid-resistant sarcoidosis or in patients unable to tolerate steroids. Given the concern regarding ocular toxicity, the maximum dosages of chloroquine and hydroxychloroquine should not exceed 3.5 and 6.5 mg/kg/day, respectively. Methotrexate is given in weekly doses of 10-30 mg, with the caveat that haematological, gastrointestinal, pulmonary and hepatic toxicities are possible. Despite universal acceptance as standard care, the aforementioned treatments often result in an incomplete clinical response or unacceptable adverse events. In such situations, more innovative treatment options may be used. Treatments that may well gain widespread future use include the tumour necrosis factor-alpha inhibitors infliximab and adalimumab. Experience is limited

  18. The care and feeding of evidence based medicine.

    PubMed

    Tabrah, Frank L

    2012-04-01

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

  19. The Care and Feeding of Evidence Based Medicine

    PubMed Central

    2012-01-01

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

  20. The need for perspective in evidence-based medicine.

    PubMed

    Woolf, S H

    Research advances are generating a growing body of clinical trial and other data on the effects of tests and treatments on outcomes, but there is no information resource within the health care system that systematically puts that information in perspective. Policy makers, clinicians, and individuals lack a ready means to compare the relative effectiveness of various interventions in prolonging survival or preventing the occurrence or complications of a disease: information that is critical in setting priorities. A crude analysis of preventable deaths suggests that evidence-based primary prevention (getting the population to stop smoking, exercise, lower cholesterol levels, and control blood pressure) would prevent considerably more deaths per year than would various evidence-based treatments for cardiovascular disease. Examining evidence from this perspective calls attention to mismatched priorities-most health care expenditures in the United States go toward treatment of diseases and their late-stage complications and relatively few resources are devoted to primary prevention and health promotion. Similar analyses at the individual level can help patients put personal options in perspective. This article proposes a bibliographic evidence-collection center and simulation modeling program to estimate potential benefits and harms of competing interventions for populations and individuals. Such evidence-based projections would enable policy makers, clinicians, and patients to judge whether they give due priority to the interventions most likely to improve health. With the steady growth in research data, the need for a system that enables society and individuals to put evidence in perspective will become progressively more urgent.

  1. [Transformative Care Rooted in Evidence-Based Nursing].

    PubMed

    Chiang, Li-Chi; Liao, Mei-Nan

    2017-02-01

    As clinical scientists on the interdisciplinary healthcare team, nurses use the art and science of current nursing knowledge to provide evidence-based healthcare to each patient and his/her family. Nurses not only comprise the largest contingent of medical personnel and provide 24-hour patient care but are also professional scientists that develop unique nursing knowledge through reflective practice. Five strategies for expanding the body of current evidence-based nursing scientific knowledge include: (1) reflecting empirically on the practice-service domain, (2) developing nursing knowledge using rigorous methodology, (3) emancipating nursing knowledge using innovative transformation, (4) using collaborative interdisciplinary healthcare that is based in patient-centered care, and (5) initiating innovative transformation in nursing education. Nurses are critical healthcare providers that make important contributions to today's healthcare system. Nursing scientists provide frontline, evidence-based transforming care that deserves to be respected and valued on an equal basis with the care and services that are provided by other medical personnel.

  2. Evidence-based medicine in metastatic spine disease.

    PubMed

    Dea, Nicolas; Fisher, Charles G

    2014-06-01

    Treatment modalities for metastatic spine disease have significantly expanded over the last two decades. This expansion occurred in many different fields. Improvement in surgical techniques and instrumentation now allow the oncologic spine surgeons to effectively circumferentially decompress the neural elements without compromising stability. Percutaneous techniques, both vertebral augmentation and pre-operative endovascular embolization procedures, also greatly benefit patients suffering from spinal column metastasis. Imaging technology advances has contributed to better pre-operative planning and the development of highly conformational radiation techniques, thus permitting the delivery of high-dose radiation to tumors, while avoiding radiotoxicity to the spinal cord and other vital structures. These new developments, combined with evidence-based stability and disease-specific quality of life scores now allow not only better treatment, but also a solid foundation for high-quality research. Spine oncology literature currently suffers from a lack of high-quality evidence due to low prevalence of the disease and complex methodological issues. However, when following evidence-based medicine principles, which incorporate best available evidence, clinical expertise and patient preference, sound, evidence-based recommendations can be made regarding the abovementioned treatment modalities.

  3. Evidence-Based Parenting Interventions to Promote Secure Attachment

    PubMed Central

    Wright, Barry; Edginton, Elizabeth

    2016-01-01

    Various interventions are used in clinical practice to address insecure or disorganized attachment patterns and attachment disorders. The most common of these are parenting interventions, but not all have a robust empirical evidence base. We undertook a systematic review of randomized trials comparing a parenting intervention with a control, where these used a validated attachment instrument, in order to evaluate the clinical and cost-effectiveness of interventions aiming to improve attachment in children with severe attachment problems (mean age <13 years). This article aims to inform clinicians about the parenting interventions included in our systematic review that were clinically effective in promoting secure attachment. For completeness, we also briefly discuss other interventions without randomized controlled trial evidence, identified in Patient Public Involvement workshops and expert groups at the point our review was completed as being used or recommended. We outline the key implications of our findings for clinical practice and future research. PMID:27583298

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

    PubMed

    Coiera, Enrico

    2016-03-01

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

  5. Evidence-based guidelines in labor management.

    PubMed

    Millen, Katherine Rodewald; Kuo, Kelly; Zhao, Lulu; Gecsi, Kimberly

    2014-04-01

    Evidence-based care of women in labor requires a thorough understanding of both "normal" and abnormal labor progress. In response to the growing cesarean delivery rate for dystocia at our institution, a multidisciplinary team of attending physicians, nurse-midwives, resident physicians, and nurses was established to review the literature and create evidence-based guidelines. This article describes the background literature and consensus guidelines reached for the diagnosis of active phase labor, active phase arrest, second-stage arrest, protraction of the active phase, and failed induction of labor. Our review illustrates that slower labor patterns than traditionally described often result in a vaginal delivery without unacceptable increases in maternal or neonatal morbidity.

  6. Critical thinking and evidence-based practice.

    PubMed

    Profetto-McGrath, Joanne

    2005-01-01

    Critical thinking (CT) is vital to evidence-based nursing practice. Evidence-based practice (EBP) supports nursing care and can contribute positively to patient outcomes across a variety of settings and geographic locations. The nature of EBP, its relevance to nursing, and the skills needed to support it should be required components of baccalaureate education and must be introduced early in students' development as independent, self-directed learners and as professional nurses. Among the knowledge, skills, and processes needed to support EBP, CT is paramount. The development of CT can prepare nurses with the necessary skills and dispositions (habits of mind, attitudes, and traits) to support EBP. The intents of this study were to explore the importance of CT as an essential skill to support EBP and to describe some of the strategies and processes considered key to the ongoing development of CT.

  7. Evidence-based practice of periodontics.

    PubMed

    Cobb, Charles M; MacNeill, Simon R; Satheesh, Keerthana

    2010-01-01

    Evidence-based practice involves complex and conscientious decision making based not only on the available evidence but also on patient characteristics, situations, and preferences. It recognizes that care is individualized and ever-changing and involves uncertainties and probabilities. The specialty of periodontics has abundant high-level evidence upon which treatment decisions can be determined. This paper offers a brief commentary and overview of the available evidence commonly used in the private practice of periodontics.

  8. Evidence-based practices and autism.

    PubMed

    Mesibov, Gary B; Shea, Victoria

    2011-01-01

    Interventions for autism are increasing being held to standards such as 'evidence-based practice' in psychology and 'scientifically-based research' in education. When these concepts emerged in the context of adult psychotherapy and regular education, they caused considerable controversy. Application of the concepts to autism treatments and special education has raised additional concerns. An analysis of the benefits and limitations of current approaches to empiricism in autism interventions is presented, and suggestions for future research are made.

  9. Evidence-based librarianship: an overview

    PubMed Central

    Eldredge, Jonathan D.

    2000-01-01

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

  10. What Is Evidence-Based Behavior Analysis?

    PubMed Central

    Smith, Tristram

    2013-01-01

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

  11. Therapeutic management of anal eczema: an evidence-based review

    PubMed Central

    Havlickova, B; Weyandt, G H

    2014-01-01

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

  12. The long-term treatment of restless legs syndrome/Willis-Ekbom disease: evidence-based guidelines and clinical consensus best practice guidance: a report from the International Restless Legs Syndrome Study Group.

    PubMed

    Garcia-Borreguero, Diego; Kohnen, Ralf; Silber, Michael H; Winkelman, John W; Earley, Christopher J; Högl, Birgit; Manconi, Mauro; Montplaisir, Jacques; Inoue, Yuichi; Allen, Richard P

    2013-07-01

    A Task Force was established by the International Restless Legs Syndrome Study Group (IRLSSG) to develop evidence-based and consensus-based recommendations for the long-term pharmacologic treatment of restless legs syndrome/Willis-Ekbom disease (RLS/WED). The Task Force reviewed the results of all studies of RLS/WED treatments with durations of 6 months or longer presented at meetings over the past 2 years, posted on Web sites of pharmaceutical companies, or published in peer-reviewed journals, asking the questions, "What is the efficacy of this treatment in patients with RLS/WED?" and "What is the safety of this treatment in patients with RLS/WED?" The Task Force developed guidelines based on their review of 61 papers meeting inclusion criteria, and using a modified evidence-grading scheme. Pregabalin has been established as effective for up to 1 year in treating RLS/WED (Level A evidence). Pramipexole, ropinirole, and rotigotine have been established as effective for up to 6 months in treating RLS/WED (Level A). The following drugs have been established as probably effective (Level B) in treating RLS/WED for durations ranging from 1 to 5 years: gabapentin enacarbil, pramipexole, and ropinirole (1 year); levodopa (2 years); and rotigotine (5 years). Because of associated safety concerns, pergolide and cabergoline should not be used in the treatment of RLS/WED unless the benefits clearly outweigh the risks. Other pharmacologic therapies have insufficient evidence to support their long-term use in treating RLS/WED. The IRLSSG Task Force also developed consensus-based strategies for the prevention and treatment of complications (such as augmentation, loss of efficacy, excessive daytime sleepiness, and impulse control disorders) that may develop with the long-term pharmacologic treatment of RLS/WED. The use of either a dopamine-receptor agonist or α2δ calcium-channel ligand is recommended as the first-line treatment of RLS/WED for most patients, with the choice of

  13. Implementation of evidence-based practice and organizational performance.

    PubMed

    Hovmand, Peter S; Gillespie, David F

    2010-01-01

    Administrators of mental health services may expect evidence-based practice (EBP) to offer strategic benefits. Existing theory suggests that the benefits of implementing EBP vary by organizational characteristics. This paper presents a conceptual framework for considering how implementation impacts organizational performance. The framework is developed as a system dynamics simulation model based on existing literature, organizational theory, and key informant interviews with mental health services administrators and clinical directors. Results from the simulations show how gains in performance depended on organizations' initial inertia and initial efficiency and that only the most efficient organizations may see benefits in organizational performance from implementing EBP. Implications for administrators, policy makers, and services researchers are discussed.

  14. Interdisciplinary evidence-based practice: moving from silos to synergy.

    PubMed

    Newhouse, Robin P; Spring, Bonnie

    2010-01-01

    Despite the assumption that health care providers work synergistically in practice, professions have tended to be more exclusive than inclusive when it comes to educating students in a collaborative approach to interdisciplinary evidence-based practice (EBP). This article explores the state of academic and clinical training regarding interdisciplinary EBP, describes efforts to foster interdisciplinary EBP, and suggests strategies to accelerate the translation of EBP across disciplines. Moving from silos to synergy in interdisciplinary EBP will require a paradigm shift. Changes can be leveraged professionally and politically using national initiatives currently in place on improving quality and health care reform.

  15. Evidence-based quality improvement: the state of the science.

    PubMed

    Shojania, Kaveh G; Grimshaw, Jeremy M

    2005-01-01

    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 research and practice. However, in sharp contrast to the paradigm of evidence-based medicine, these efforts often proceed on the basis of intuition and anecdotal accounts of successful strategies for changing provider behavior or achieving organizational change. We review problems with current approaches to QI research and outline the steps required to make QI efforts based as much on evidence as the practices they seek to implement.

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

    ERIC Educational Resources Information Center

    Thordardottir, Elin

    2010-01-01

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

  17. Irish psychiatric nurses' self-reported barriers, facilitators and skills for developing evidence-based practice.

    PubMed

    Yadav, B L; Fealy, G M

    2012-03-01

    Evidence-based practice places an emphasis on integration of clinical expertise with available best evidence, patient's clinical information and preferences, and with local health resources. This paper reports the findings of a study that investigated the barriers, facilitators and skills in developing evidence-based practice among psychiatric nurses in Ireland. A postal survey was conducted among a random sample of Irish psychiatric nurses and survey data were collected using the Development of Evidence-Based Practice Questionnaire. Respondents reported that insufficient time to find and read research reports and insufficient resources to change practice were the greatest barriers to the development of evidence-based practice. Practice development coordinators were perceived as the most supportive resource for changing practice. Using the Internet to search for information was the highest-rated skill and using research evidence to change practice was the lowest-rated skill for developing evidence-based practice. Nurses' precursor skills for developing evidence-based practice, such as database searching and information retrieval, may be insufficient in themselves for promoting evidence-based practice if they cannot find evidence relating to their particular field of practice or if they do not have the time, resources and supports to develop their practice in response to evidence.

  18. Evidence-based decision-making: an argumentative approach.

    PubMed

    Dickinson, H D

    1998-01-01

    A practical theory of argumentation is outlined and applied to a hypothetical clinical scenario to elucidate the use of research evidence in individual treatment decisions. The primary role of research evidence is to establish warrants as opposed to warrant using. Warrants are defined as the rules, principles or interpretive rationales used to justify an inference from observed data to conclusion, or clinical claim. Clarity on the appropriate use of research evidence in clinical decision-making can help resolve current debates over the nature and consequences of evidence-based medicine. The theory of argumentation has potential to inform both the design of decision support tools and to provide criteria for assessing decisional performance.

  19. Embedding evidence-based practice among nursing undergraduates: Results from a pilot study.

    PubMed

    André, Beate; Aune, Anne G; Brænd, Jorunn A

    2016-05-01

    Evidence-based practice is currently one of the most important developments in health care. Research in nursing science is rapidly growing; however, translating the knowledge based on this research into clinical practice is often hampered, and may be dependent on reflective skills. The aim of this study was to see how undergraduate nursing students in nursing should increase their skills and knowledge related to evidence-based practice through participation in clinical research projects. A qualitative approach was used in collecting and analyzing the data. Students participated in a pilot clinical research project and a received guidance related to their bachelor thesis. After the project was completed, all students filled in a questionnaire. The students' motivation to participate in this study was reported to be high, but they reported low knowledge related to evidence-based practice. All students reported that their attitude towards evidence-based practice changed in a positive direction during their participation in the project. Evidence-based practice influenced nursing practices by putting more focus on critical thinking, increasing pride and giving a sense of ownership in the clinical field. The curricula and the pedagogical perspectives in nursing education can influence the attitude towards evidence-based practice and skills among nursing bachelor students.

  20. Queer challenges to evidence-based practice.

    PubMed

    Zeeman, Laetitia; Aranda, Kay; Grant, Alec

    2014-06-01

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

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

    PubMed

    Osborn, John

    2002-01-01

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

  2. Progress in evidence based reproductive surgery

    PubMed Central

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

    2011-01-01

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

  3. Increasing exclusive breastfeeding rates in the well-baby population: an evidence-based change project.

    PubMed

    Davis, Susan Kinney; Stichler, Jaynelle F; Poeltler, Debra M

    2012-12-01

    This article describes an evidence-based project that increased the rate of exclusive breastfeeding in a well-baby population by providing breastfeeding basics to nursing staff on the Mother Infant Services (MIS) units. The clinical implications are that nurses' attitudes and care significantly influence exclusive breastfeeding rates. We contend that resources should be allocated to provide nurses with current evidence-based breastfeeding education.

  4. Introduction to the basics of evidence-based dentistry: concepts and skills.

    PubMed

    Forrest, Jane L

    2009-09-01

    The purpose of this section of the ADA Champions Pre-Conference is to review the basics of Evidence-based dentistry (EBD), research designs and levels of evidence, and identify the skills necessary for clinicians to efficiently use an evidence-based approach in practice. This session of the pre-conference preceded the session on the skills needed to define a clinical question and search for the evidence to answer that question.

  5. Evidence-based recommendations for short- and long-term management of uninvestigated dyspepsia in primary care: an update of the Canadian Dyspepsia Working Group (CanDys) clinical management tool.

    PubMed

    Veldhuyzen van Zanten, Sander J O; Bradette, Marc; Chiba, Naoki; Armstrong, David; Barkun, Alan; Flook, Nigel; Thomson, Alan; Bursey, Ford

    2005-05-01

    The present paper is an update to and extension of the previous systematic review on the primary care management of patients with uninvestigated dyspepsia (UD). The original publication of the clinical management tool focused on the initial four- to eight-week assessment of UD. This update is based on new data from systematic reviews and clinical trials relevant to UD. There is now direct clinical evidence supporting a test-and-treat approach in patients with nondominant heartburn dyspepsia symptoms, and head-to-head comparisons show that use of a proton pump inhibitor is superior to the use of H2-receptor antagonists (H2RAs) in the initial treatment of Helicobacter pylori-negative dyspepsia patients. Cisapride is no longer available as a treatment option and evidence for other prokinetic agents is lacking. In patients with long-standing heartburn-dominant (ie, gastroesophageal reflux disease) and nonheartburn-dominant dyspepsia, a once-in-a-lifetime endoscopy is recommended. Endoscopy should also be considered in patients with new-onset dyspepsia that develops after the age of 50 years. Conventional nonsteroidal anti-inflammatory drugs, acetylsalicylic acid and cyclooxygenase-2-selective inhibitors can all cause dyspepsia. If their use cannot be discontinued, cotherapy with either a proton pump inhibitor, misoprostol or high-dose H2RAs is recommended, although the evidence is based on ulcer data and not dyspepsia data. In patients with nonheartburn-dominant dyspepsia, noninvasive testing for H pylori should be performed and treatment given if positive. When starting nonsteroidal anti-inflammatory drugs for a prolonged course, testing and treatment with H2RAs are advised if patients have a history of previous ulcers or ulcer bleeding.

  6. A consensus statement on the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) algorithm for the management of knee osteoarthritis-From evidence-based medicine to the real-life setting.

    PubMed

    Bruyère, Olivier; Cooper, Cyrus; Pelletier, Jean-Pierre; Maheu, Emmanuel; Rannou, François; Branco, Jaime; Luisa Brandi, Maria; Kanis, John A; Altman, Roy D; Hochberg, Marc C; Martel-Pelletier, Johanne; Reginster, Jean-Yves

    2016-02-01

    The European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) published a treatment algorithm for the management of knee osteoarthritis (OA) in 2014, which provides practical guidance for the prioritization of interventions. Further analysis of real-world data for OA provides additional evidence in support of pharmacological interventions, in terms of management of OA pain and function, avoidance of adverse events, disease-modifying effects and long-term outcomes, e.g., delay of total joint replacement surgery, and pharmacoeconomic factors such as reduction in healthcare resource utilization. This article provides an updated assessment of the literature for selected interventions in OA, focusing on real-life data, with the aim of providing easy-to-follow advice on how to establish a treatment flow in patients with knee OA in primary care clinical practice, in support of the clinicians' individualized assessment of the patient. In step 1, background maintenance therapy with symptomatic slow-acting drugs for osteoarthritis (SYSADOAs) is recommended, for which high-quality evidence is provided only for the prescription formulations of patented crystalline glucosamine sulfate and chondroitin sulfate. Paracetamol may be added for rescue analgesia only, due to limited efficacy and increasing safety signals. Topical non-steroidal anti-inflammatory drugs (NSAIDs) may provide additional symptomatic treatment with the same degree of efficacy as oral NSAIDs without the systemic safety concerns. Oral NSAIDs maintain a central role in step 2 advanced management of persistent symptoms. However, oral NSAIDs are highly heterogeneous in terms of gastrointestinal and cardiovascular safety profile, and patient stratification with careful treatment selection is advocated to maximize the risk:benefit ratio. Intra-articular hyaluronic acid as a next step provides sustained clinical benefit with effects lasting up to 6 months after a short-course of

  7. Epilepsy, Antiepileptic Drugs, and Aggression: An Evidence-Based Review

    PubMed Central

    Besag, Frank; Ettinger, Alan B.; Mula, Marco; Gobbi, Gabriella; Comai, Stefano; Aldenkamp, Albert P.; Steinhoff, Bernhard J.

    2016-01-01

    Antiepileptic drugs (AEDs) have many benefits but also many side effects, including aggression, agitation, and irritability, in some patients with epilepsy. This article offers a comprehensive summary of current understanding of aggressive behaviors in patients with epilepsy, including an evidence-based review of aggression during AED treatment. Aggression is seen in a minority of people with epilepsy. It is rarely seizure related but is interictal, sometimes occurring as part of complex psychiatric and behavioral comorbidities, and it is sometimes associated with AED treatment. We review the common neurotransmitter systems and brain regions implicated in both epilepsy and aggression, including the GABA, glutamate, serotonin, dopamine, and noradrenaline systems and the hippocampus, amygdala, prefrontal cortex, anterior cingulate cortex, and temporal lobes. Few controlled clinical studies have used behavioral measures to specifically examine aggression with AEDs, and most evidence comes from adverse event reporting from clinical and observational studies. A systematic approach was used to identify relevant publications, and we present a comprehensive, evidence-based summary of available data surrounding aggression-related behaviors with each of the currently available AEDs in both adults and in children/adolescents with epilepsy. A psychiatric history and history of a propensity toward aggression/anger should routinely be sought from patients, family members, and carers; its presence does not preclude the use of any specific AEDs, but those most likely to be implicated in these behaviors should be used with caution in such cases. PMID:27255267

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

    PubMed

    Oh, Eui Geum

    2016-06-01

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

  9. From both sides now: librarians' experiences at the Rocky Mountain Evidence-Based Health Care Workshop

    PubMed Central

    Traditi, Lisa K.; Le Ber, Jeanne Marie; Beattie, Michelle; Meadows, Susan E.

    2004-01-01

    The Colorado Health Outcomes (COHO) Department of the School of Medicine at the University of Colorado Health Sciences Center (UCHSC) coordinates the Rocky Mountain Evidence-Based Health Care (EBHC) Workshop, which has been held annually since 1999. The goals of the workshop include helping participants—physicians, pharmacists, health care policy makers, journalists and librarians—learn and apply skills for critically appraising medical research literature and for effective use of evidence-based information resources. Participants are encouraged to share ideas and to plan local services and instruction for those working in clinical settings. Each year, librarians from UCHSC Denison Memorial Library participate as faculty by teaching searching skills (PubMed, Cochrane Library, ACP Journal Club, etc.), providing support to small groups, and staffing two computer labs. In 2002, Denison Library received a National Network of Libraries of Medicine (NN/LM) MidContinental Region Impact Award to fund the attendance of three health sciences librarians from the MidContinental Region, an academic education librarian, a clinical medical librarian, and a department librarian. In this paper, the participating librarians share the lessons they learned about how health care practitioners approach evidence-based practice. The participating librarians also share how they incorporated these lessons into their support of evidence-based practice related to teaching about evidence-based resources, assisting health care practitioners with developing answerable questions, enhancing the clinician-librarian partnership, and assisting practitioners in selecting evidence-based resources for quick answers to clinical questions. PMID:14762465

  10. ENIGMA--evidence-based network for the interpretation of germline mutant alleles: an international initiative to evaluate risk and clinical significance associated with sequence variation in BRCA1 and BRCA2 genes.

    PubMed

    Spurdle, Amanda B; Healey, Sue; Devereau, Andrew; Hogervorst, Frans B L; Monteiro, Alvaro N A; Nathanson, Katherine L; Radice, Paolo; Stoppa-Lyonnet, Dominique; Tavtigian, Sean; Wappenschmidt, Barbara; Couch, Fergus J; Goldgar, David E

    2012-01-01

    As genetic testing for predisposition to human diseases has become an increasingly common practice in medicine, the need for clear interpretation of the test results is apparent. However, for many disease genes, including the breast cancer susceptibility genes BRCA1 and BRCA2, a significant fraction of tests results in the detection of a genetic variant for which disease association is not known. The finding of an "unclassified" variant (UV)/variant of uncertain significance (VUS) complicates genetic test reporting and counseling. As these variants are individually rare, a large collaboration of researchers and clinicians will facilitate studies to assess their association with cancer predisposition. It was with this in mind that the ENIGMA consortium (www.enigmaconsortium.org) was initiated in 2009. The membership is both international and interdisciplinary, and currently includes more than 100 research scientists and clinicians from 19 countries. Within ENIGMA, there are presently six working groups focused on the following topics: analysis, clinical, database, functional, tumor histopathology, and mRNA splicing. ENIGMA provides a mechanism to pool resources, exchange methods and data, and coordinately develop and apply algorithms for classification of variants in BRCA1 and BRCA2. It is envisaged that the research and clinical application of models developed by ENIGMA will be relevant to the interpretation of sequence variants in other disease genes.

  11. Organizational Strategies for Building Capacity in Evidence-Based Oncology Nursing Practice: A Case Report of an Australian Tertiary Cancer Center.

    PubMed

    Chan, Raymond Javan; Bowers, Alison; Barton-Burke, Margaret

    2017-03-01

    The ever-increasing cancer care demand has posed a challenge for oncology nurses to deliver evidence-based, innovative care. Despite efforts to promote evidence-based practice, barriers remain and executives find it difficult to implement evidence-based practice efficiently. Using the successful experience of an Australian tertiary cancer center, this paper depicts 4 effective strategies for facilitating evidence-based practice at the organizational level-the Embedded Scholar: Enabler, Enactor, and Engagement (4 Es) Model-includes a 12-week evidence-based practice program that prioritizes relevant research proposed by clinical staff and endorses high-quality, evidence-based point-of-care resources.

  12. [Scientific evidence-based cardiology: the principles and practice].

    PubMed

    Carneiro, A V

    2000-09-01

    Every clinical cardiologist, no matter what the clinical work (invasive or non-invasive), has to face several problems concerning clinical knowledge and medical information in everyday practice. Diagnostic and therapeutic advances in cardiology are occurring at an increasing pace and every cardiologist responsible for patient care in hospitals, clinics or emergency rooms needs to be up-to-date in order to provide the best possible medical care. On the other hand, society is increasingly making doctors accountable for the provision of good quality care in a cost-effective way. In the context of scarce resources, this situation requires a rigorous and rational approach by the individual cardiologist. These apparent contradictions can be solved by practicing evidence-based cardiology (EBC). This review introduces the concept of EBC, its principles, practice, and methodological steps: 1) formulation of a structured clinical activity; 2) scientific evidence; 3) critical appraisal of this evidence using explicit methods; and 4) synthesis and practical application of this evidence. In this sense, EBC arises from the patient, and after the best possible scientific evidence is selected, it is applied to the individual case. EBC allows the individual cardiologist to keep up with the medical literature while improving reading habits and the form in which relevant clinical information is selected. It also increases confidence in the clinical decisions, reducing practice variation as well as improving doctor-patient communication. Lastly EBC can be used as a powerful tool for pre, post and continuous medical education.

  13. Evidence-Based Complementary Medicine in Breast Cancer Therapy

    PubMed Central

    Beuth, Josef

    2009-01-01

    Summary Complementary medicine is currently widely debated by the oncologic community, because the required scientific proof of safety and effectiveness for most of the therapeutic approaches ha s not yet been met with definite results. In the past years, basic research and clinical evaluation of defined complementary therapeutic concepts in oncology have been intensified in an attempt to integrate these procedures into evidence-based medicine. According to definition, scientifically-based therapies of complementary medicine cannot replace the well-studied conventional cancer-destructive therapies such as surgery, chemotherapy, radiotherapy, or hormone therapy. Complementary approaches in oncology that are recommended as an addition to standard cancer-destructive therapies claim to optimize this therapy. A great body of data emerging from scientifically sound clinical trials prove that defined complementary procedures are beneficial for the patients. PMID:20877679

  14. [Evidence Based Medicine, in Revista Médica de Chile].

    PubMed

    Reyes, Humberto; Palma, Joaquín; Andresen, Max

    2003-08-01

    Since the beginning of the 20th century, the principles of the experimental method in biological sciences have been progressively applied in biomedical and clinical research. After the pioneering work of AB Hill et al, biostatistics became a fundamental tool in the appraisal of new therapeutic agents or methods, and of diagnostic tests. From 1990 on, "Evidence based Medicine" has been added to it. This journal opens in this issue a section containing critical analysis of articles published in the medical literature deserving the attention of its readers. However, as several other medical journals have stressed, we recommend that the conclusions of these analysis should not be used as a substitute for clinical judgment and they do not represent an official position of our journal. Revista Médica de Chile welcomes the new Section and invites contributions to it.

  15. Curing neurophobia in medical schools: evidence-based strategies

    PubMed Central

    Abushouk, Abdelrahman Ibrahim; Duc, Nguyen Minh

    2016-01-01

    Medical students often perceive neurology as the most difficult medical specialty. This perception is described as ‘neurophobia’ in the medical literature. Several studies have cited poor teaching, complex examination, and separation of basic and clinical sciences as major factors in the development of neurophobia. These negative perceptions can have serious implications, such as decreasing the students’ desire to consider neurology as a future career and increasing referrals from other specialists to avoid dealing with neurological conditions. Faced with increasing demands of healthcare systems and the global burden of neurological conditions, there is a rising need for further research and innovative strategies to improve students’ perceptions of clinical neurology. This review discusses evidence-based recommendations and educational interventions to cure neurophobia in medical education. PMID:27680578

  16. Why evidence-based medicine is a good approach in physical and rehabilitation medicine. Thesis.

    PubMed

    Negrini, S

    2014-10-01

    According to a good definition, evidence-based medicine (EBM) is: "The explicit, conscientious, and judicious use of the current best evidence in making decisions about the care of individual patients (and populations)". More appropriate in a clinical context like that of physical and rehabilitation medicine (PRM) is looking at evidence based clinical practice (EBCP), whose definition is: "The integration of best research evidence with clinical expertise and patient values". In the past the term evidence-based physical and rehabilitation medicine (EBPRM) was also proposed. In this thesis, after some historical notes on EBM and on PRM, we will discuss why in our view EBPRM must be the real foundation of our everyday PRM clinical practice.

  17. Sepsis management: An evidence-based approach.

    PubMed

    Baig, Muhammad Akbar; Shahzad, Hira; Jamil, Bushra; Hussain, Erfan

    2016-03-01

    The Surviving Sepsis Campaign (SSC) guidelines have outlined an early goal directed therapy (EGDT) which demonstrates a standardized approach to ensure prompt and effective management of sepsis. Having said that, there are barriers associated with the application of evidence-based practice, which often lead to an overall poorer adherence to guidelines. Considering the global burden of disease, data from low- to middle-income countries is scarce. Asia is the largest continent but most Asian countries do not have a well-developed healthcare system and compliance rates to resuscitation and management bundles are as low as 7.6% and 3.5%, respectively. Intensive care units are not adequately equipped and financial concerns limit implementation of expensive treatment strategies. Healthcare policy-makers should be notified in order to alleviate financial restrictions and ensure delivery of standard care to septic patients.

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

    PubMed

    Vardell, Emily; Malloy, Michele

    2013-01-01

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

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

    ERIC Educational Resources Information Center

    Schoenwald, Sonja K.

    2008-01-01

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

  20. Operationalizing Evidence-Based Practice: The Development of an Institute for Evidence-Based Social Work

    ERIC Educational Resources Information Center

    Regehr, Cheryl; Stern, Susan; Shlonsky, Aron

    2007-01-01

    Although evidence-based practice (EBP) has received increasing attention in social work in the past few years, there has been limited success in moving from academic discussion to engaging social workers in the process of implementing EBP in practice. This article describes the challenges, successes, and future aims in the process of developing a…

  1. Comorbidity, Case Complexity, and Effects of Evidence-Based Treatment for Children Referred for Disruptive Behavior

    ERIC Educational Resources Information Center

    Kazdin, Alan E.; Whitley, Moira K.

    2006-01-01

    Comorbidity and complexity of cases seen in clinical work form a basis for discounting the applicability and generality of evidence-based treatments (EBTs). The authors evaluated treatment outcomes in 2 samples of clinically referred children who met criteria for oppositional defiant disorder (n = 183; 42 girls, 141 boys; ages 3-14) or conduct…

  2. Generalizability of Evidence-Based Assessment Recommendations for Pediatric Bipolar Disorder

    ERIC Educational Resources Information Center

    Jenkins, Melissa M.; Youngstrom, Eric A.; Youngstrom, Jennifer Kogos; Feeny, Norah C.; Findling, Robert L.

    2012-01-01

    Bipolar disorder is frequently clinically diagnosed in youths who do not actually satisfy Diagnostic and Statistical Manual of Mental Disorders (4th ed., text revision; DSM-IV-TR; American Psychiatric Association, 1994) criteria, yet cases that would satisfy full DSM-IV-TR criteria are often undetected clinically. Evidence-based assessment methods…

  3. Evidence-Based Practice in an Age of Relativism: Toward a Model for Practice

    ERIC Educational Resources Information Center

    McNeill, Ted

    2006-01-01

    Evidence-based practice (EBP) is considered a hallmark of excellence in clinical practice. However, many social workers are uncertain about how to implement this approach to practice. EBP involves integrating clinical expertise and values with the best available evidence from systematic research while simultaneously considering the client's values…

  4. Developing research competence to support evidence-based practice.

    PubMed

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

    2005-01-01

    This article describes one step in the process that was undertaken to prepare for the introduction of evidence-based practice (EBP) into the curriculum across the Bachelor of Science in Nursing, Master of Science in Nursing, and Doctor of Philosophy programs, as well as the programs that were under development, Clinical Nurse Leader and Doctor of Nursing Practice, at the University of Pittsburgh School of Nursing. Expected research competencies were identified for each level or academic year within each program. Based on these competencies, recommendations on how to modify the curriculum into one that would support students' acquisition and development of the skills necessary to be successful in matriculating through an EBP curriculum were developed. Evaluation mechanisms for the achievement of these competencies vary across the academic programs and will include performance on capstone projects, comprehensive examinations, and program milestones for doctoral students. The establishment of evidence-based competencies provided a foundation for the development of new teaching approaches and the curricular revisions across the three academic programs. Thus, the University of Pittsburgh model of educating for EBP is based on a sequential layering of research competencies throughout the curriculum.

  5. Management of the infertile couple: an evidence-based protocol

    PubMed Central

    2010-01-01

    Background Infertility is defined as inability of a couple to conceive naturally after one year of regular unprotected sexual intercourse. It remains a major clinical and social problem, affecting perhaps one couple in six. Evaluation usually starts after 12 months; however it may be indicated earlier. The most common causes of infertility are: male factor such as sperm abnormalities, female factor such as ovulation dysfunction and tubal pathology, combined male and female factors and unexplained infertility. Objectives The aim of this study is to provide the healthcare professionals an evidence-based management protocol for infertile couples away from medical information overload. Methods A comprehensive review where the literature was searched for "Management of infertility and/or infertile couples" at library website of University of Bristol (MetaLib) by using a cross-search of different medical databases besides the relevant printed medical journals and periodicals. Guidelines and recommendations were retrieved from the best evidence reviews such as that from the American College of Obstetricians and Gynaecologists (ACOG), American Society for Reproductive Medicine (ASRM), Canadian Fertility and Andrology Society (CFAS), and Royal College of Obstetricians and Gynaecologists (RCOG). Results A simple guide for the clinicians to manage the infertile couples. Conclusions The study deploys a new strategy to translate the research findings and evidence-base recommendations into a simplified focused guide to be applied on routine daily practice. It is an approach to disseminate the recommended medical care for infertile couple to the practicing clinicians. PMID:20205744

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

    PubMed Central

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

    2014-01-01

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

  7. Rural Doctors’ Views on and Experiences with Evidence-Based Medicine: The FrEEDoM Qualitative Study

    PubMed Central

    Hisham, Ranita; Liew, Su May; Ng, Chirk Jenn; Mohd Nor, Kamaliah; Osman, Iskandar Firzada; Ho, Gah Juan; Hamzah, Nurazira; Glasziou, Paul

    2016-01-01

    Background Evidence-based medicine is the integration of individual clinical expertise, best external evidence and patient values which was introduced more than two decades ago. Yet, primary care physicians in Malaysia face unique barriers in accessing scientific literature and applying it to their clinical practice. Aim This study aimed to explore the views and experiences of rural doctors’ about evidence-based medicine in their daily clinical practice in a rural primary care setting. Methods Qualitative methodology was used. The interviews were conducted in June 2013 in two rural health clinics in Malaysia. The participants were recruited using purposive sampling. Four focus group discussions with 15 medical officers and three individual in-depth interviews with family medicine specialists were carried out. All interviews were conducted using a topic guide and were audio-recorded, transcribed verbatim, checked and analyzed using a thematic approach. Results Key themes identified were: (1) doctors viewed evidence-based medicine mainly as statistics, research and guidelines, (2) reactions to evidence-based medicine were largely negative, (3) doctors relied on specialists, peers, guidelines and non-evidence based internet sources for information, (4) information sources were accessed using novel methods such as mobile applications and (5) there are several barriers to evidence-based practice, including doctor-, evidence-based medicine-, patient- and system-related factors. These included inadequacies in knowledge, attitude, management support, time and access to evidence-based information sources. Participants recommended the use of online services to support evidence-based practice in the rural settings. Conclusion The level of evidence-based practice is low in the rural setting due to poor awareness, knowledge, attitude and resources. Doctors use non-evidence based sources and access them through new methods such as messaging applications. Further research is

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

    ERIC Educational Resources Information Center

    Morgan, Gareth

    2010-01-01

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

  9. E-Learning and Evidence Based Practice in Schools

    ERIC Educational Resources Information Center

    Quong, Terrence

    2016-01-01

    JCTIC has used open source software to develop a unique school online environment that has made evidence based practice viable in their school. In this paper the proposition is made that eLearning enables evidence based practice which in turn leads to improved student outcomes. Much has been written about evidence based practice in schools, but…

  10. Evidence-Based Dentistry in Oral Surgery: Could We Do Better?”

    PubMed Central

    Nocini, Pier Francesco; Verlato, Giuseppe; Frustaci, Andrea; de Gemmis, Antonio; Rigoni, Giovanni; De Santis, Daniele

    2010-01-01

    Evidence-based Dentistry (EBD), like Evidence-based Medicine (EBM), was born in order to seek the “best available research evidence” in the field of dentistry both in research and clinical routine. But evidence is not clearly measurable in all fields of healthcare: in particular, while drug effect is rather independent from clinician’s characteristics, the effectiveness of surgical procedures is strictly related to surgeon’s expertise, which is difficult to quantify. The research problems of dentistry have a lot in common with other surgical fields, where at the moment the best therapeutic recommendations and guidelines originates from an integration of evidence-based medicine and data from consensus conferences. To cope with these problems, new instruments have been developed, aimed at standardizing clinical procedures (CAD-CAM technology) and at integrating EBM achievements with the opinions of expert clinicians (GRADE System). One thing we have to remember however: it is necessary to use the instruments developed by evidence-based medicine but is impossible to produce sound knowledge without considering clinical expertise and quality of surgical procedures simultaneously. Only in this way we will obtain an evidence-based dentistry both in dental research and clinical practice, which is up to third millennium standards. PMID:20871758

  11. Implementation of evidence-based practice by nurses working in community settings and their strategies to mentor student nurses to develop evidence-based practice: A qualitative study.

    PubMed

    Brooke, Joanne Mary; Mallion, Jaimee

    2016-08-01

    The aim of the study was to explore how community nurses apply the best available evidence to their practice, and how they mentor student nurses to conceptualize and implement evidence-based practice in community settings. In the UK, the expansion of health-care provision in the community has supported the development of highly skilled community nurses. However, there is limited literature regarding the strategies used by community nurses to implement evidence-based practice and mentor student nurses to conceptualize evidence-based practice in community placements. An exploratory qualitative approach applying inductive reasoning to focus group data was used. As a result, nurses working for a community NHS Foundation Trust in South England with a mentor qualification were invited to participate in one of the seven focus groups, 33 nurses participated. Data were analyzed with thematic analysis. The themes discussed in this paper are: 'our practice is evidence-based' as guidelines and policies provided structure, but occasionally stifled autonomous clinical decision-making, and 'time' as a barrier and facilitator to mentoring student nurses in community settings. In conclusion, nurses need to develop the ability to incorporate patients' needs and wishes within evidence-based care. Time was a facilitator for some community mentors, but protected time is required to complete the necessary practice documentation of student nurses.

  12. [Prevention of atopic eczema. Evidence based guidelines].

    PubMed

    Schäfer, T

    2005-03-01

    With an estimated prevalence of 12% for preschool children and 3% for adults, atopic eczema is a serious public health problem. This disease severely jeopardizes quality of life and is associated with considerable costs. Since there is still no causal therapy, primary and secondary prevention are especially important. Here the evidence basis for recommendations on prevention of atopic eczema is discussed on the basis of the first evidence-based consensus guideline (S3) on allergy prevention. This recommends that babies should be breastfed exclusively for at least 4 months and exposure to passive smoking be avoided even during pregnancy; restriction of the maternal diet during pregnancy has no influence, though during breastfeeding it can lower the incidence of eczema among babies at risk. Thereby this measure should be balanced with potential consequences of malnutrition. There seems to be a positive correlation between keeping small rodents (rabbits, guinea pigs), and possibly cats, and the occurrence of atopic eczema, while keeping dogs has no effect or even a protective effect. Avoidance of an unfavorable indoor climate is probably also helpful in preventing eczema. There is no evidence to support deviating from the current recommendations of the standing committee for vaccination.

  13. [Computer work and De Quervain's tenosynovitis: an evidence based approach].

    PubMed

    Gigante, M R; Martinotti, I; Cirla, P E

    2012-01-01

    The debate around the role of the work at personal computer as cause of De Quervain's Tenosynovitis was developed partially, without considering multidisciplinary available data. A systematic review of the literature, using an evidence-based approach, was performed. In disorders associated with the use of VDU, we must distinguish those at the upper limbs and among them those related to an overload. Experimental studies on the occurrence of De Quervain's Tenosynovitis are quite limited, as well as clinically are quite difficult to prove the professional etiology, considering the interference due to other activities of daily living or to the biological susceptibility (i.e. anatomical variability, sex, age, exercise). At present there is no evidence of any connection between De Quervain syndrome and time of use of the personal computer or keyboard, limited evidence of correlation is found with time using a mouse. No data are available regarding the use exclusively or predominantly for personal laptops or mobile "smart phone".

  14. Knowledge sources for evidence-based practice in rheumatology nursing.

    PubMed

    Neher, Margit; Ståhl, Christian; Ellström, Per-Erik; Nilsen, Per

    2015-12-01

    As rheumatology nursing develops and extends, knowledge about current use of knowledge in rheumatology nursing practice may guide discussions about future knowledge needs. To explore what perceptions rheumatology nurses have about their knowledge sources and about what knowledge they use in their practice, 12 nurses working in specialist rheumatology were interviewed using a semi-structured interview guide. The data were analyzed using conventional qualitative content analysis. The analysis yielded four types of knowledge sources in clinical practice: interaction with others in the workplace, contacts outside the workplace, written materials, and previous knowledge and experience. Colleagues, and physicians in particular, were important for informal learning in daily rheumatology practice. Evidence from the medical arena was accessed through medical specialists, while nursing research was used less. Facilitating informal learning and continuing formal education is proposed as a way toward a more evidence-based practice in extended roles.

  15. Integration of Evidence Base into a Probabilistic Risk Assessment

    NASA Technical Reports Server (NTRS)

    Saile, Lyn; Lopez, Vilma; Bickham, Grandin; Kerstman, Eric; FreiredeCarvalho, Mary; Byrne, Vicky; Butler, Douglas; Myers, Jerry; Walton, Marlei

    2011-01-01

    INTRODUCTION: A probabilistic decision support model such as the Integrated Medical Model (IMM) utilizes an immense amount of input data that necessitates a systematic, integrated approach for data collection, and management. As a result of this approach, IMM is able to forecasts medical events, resource utilization and crew health during space flight. METHODS: Inflight data is the most desirable input for the Integrated Medical Model. Non-attributable inflight data is collected from the Lifetime Surveillance for Astronaut Health study as well as the engineers, flight surgeons, and astronauts themselves. When inflight data is unavailable cohort studies, other models and Bayesian analyses are used, in addition to subject matters experts input on occasion. To determine the quality of evidence of a medical condition, the data source is categorized and assigned a level of evidence from 1-5; the highest level is one. The collected data reside and are managed in a relational SQL database with a web-based interface for data entry and review. The database is also capable of interfacing with outside applications which expands capabilities within the database itself. Via the public interface, customers can access a formatted Clinical Findings Form (CLiFF) that outlines the model input and evidence base for each medical condition. Changes to the database are tracked using a documented Configuration Management process. DISSCUSSION: This strategic approach provides a comprehensive data management plan for IMM. The IMM Database s structure and architecture has proven to support additional usages. As seen by the resources utilization across medical conditions analysis. In addition, the IMM Database s web-based interface provides a user-friendly format for customers to browse and download the clinical information for medical conditions. It is this type of functionality that will provide Exploratory Medicine Capabilities the evidence base for their medical condition list

  16. Staying in the Clinical Ballpark while Running the Evidence Bases

    ERIC Educational Resources Information Center

    Chorpita, Bruce F.; Viesselman, John O.

    2005-01-01

    Leimomi was a 16-year-old female of Asian Pacific Island descent born and raised on Oahu who was referred to the Department of Health's Child and Adolescent Mental Health Division (CAMHD) by her public school student services coordinator for running away, chronic truancy, aggressiveness, and drug abuse. She had been diagnosed with systemic lupus…

  17. Hypomagnesemia: an evidence-based approach to clinical cases.

    PubMed

    Assadi, Farahnak

    2010-01-01

    Hypomagnesemia is defined as a serum magnesium level less than 1.8 mg/dL (< 0.74 mmol/L). Hypomagnesemia may result from inadequate magnesium intake, increased gastrointestinal or renal losses, or redistribution from extracellular to intracellular space. Increased renal magnesium loss can result from genetic or acquired renal disorders. Most patients with hypomagnesemia are asymptomatic and symptoms usually do not arise until the serum magnesium concentration falls below 1.2 mg/dL. One of the most life-threatening effects of hypomagnesemia is ventricular arrhythmia. The first step to determine the likely cause of the hypomagnesemia is to measure fractional excretion of magnesium and urinary calcium-creatinine ratio. The renal response to magnesium deficiency due to increased gastrointestinal loss is to lower fractional excretion of magnesium to less than 2%. A fractional excretion above 2% in a subject with normal kidney function indicates renal magnesium wasting. Barter syndrome and loop diuretics which inhibit sodium chloride transport in the ascending loop of Henle are associated with hypokalemia, metabolic alkalosis, renal magnesium wasting, hypomagnesemia, and hypercalciuria. Gitelman syndrome and thiazide diuretics which inhibit sodium chloride cotransporter in the distal convoluted tubule are associated with hypokalemia, metabolic alkalosis, renal magnesium wasting, hypomagnesemia, and hypocalciuria. Familial renal magnesium wasting is associated with hypercalciuria, nephrocalcinosis, and nephrolithiasis. Asymptomatic patients should be treated with oral magnesium supplements. Parenteral magnesium should be reserved for symptomatic patients with severe magnesium deficiency (< 1.2 mg/dL). Establishment of adequate renal function is required before administering any magnesium supplementation.

  18. Practicing the skills of evidence-based veterinary medicine through case-based pharmacology rounds.

    PubMed

    Fajt, Virginia R; Brown, Dimitri; Scott, Maya M

    2009-01-01

    Accessing new knowledge and using it to make decisions is the foundation of evidence-based veterinary medicine (EBVM), the integration of best research evidence with clinical expertise and owner/manager values. Reflecting on our experience with an EBVM-based clinical pharmacology assignment during a clinical rotation, we present the justification for the addition of an EBVM assignment to the clinical (fourth) year at the College of Veterinary Medicine and Biomedical Sciences at Texas A&M University. We also present an in-depth analysis of the addition, recommendations for the assessment of this exercise as a method of improving evidence-based veterinary practice, and recommendations and implications for other instructors interested in adding EBVM-related learning to their professional curricula. We recommend adding EBVM skill practice in pre-clinical training, abbreviated exercises in EBVM skills on clinical rotations, and increased attention to critical-thinking skills in veterinary education.

  19. Use of three evidence-based postoperative pain assessment practices by registered nurses.

    PubMed

    Carlson, Cathy L

    2009-12-01

    To provide optimal postoperative pain relief, nursing practice should be based on the best evidence available. For over 20 years, results of studies regarding nurses' use of evidence-based practices, including postoperative pain assessment practices, have shown that nurses use the practices inconsistently. The present cross-sectional survey study was conducted to: 1) determine the extent to which registered nurses caring for postoperative patients experiencing pain used three evidence-based postoperative pain assessment practices; and 2) identify relationships among the level of adoption of evidence-based postoperative pain assessment practices and selected characteristics of registered nurses. Data were collected from a convenience sample of all nurses caring for adult postoperative patients in two Midwestern hospitals where 443 surveys (46.9%) were returned. Respondents were aware of, but not using, three evidence-based postoperative pain assessment practices consistently. Registered nurses who used multiple sources to identify solutions to clinical practice problems or read one or two professional journals regularly were more likely to have adopted the three evidence-based postoperative pain assessment practices. Registered nurses need to be encouraged to use multiple sources to identify solutions to clinical practice problems, including professional nursing journals. Innovative approaches to promote the application of research to education and practice settings are needed. It is important to identify opinion leaders, because opinion leaders are an important resource in overcoming the barriers so that adoption of pain of evidence-based postoperative pain assessment practices can proceed. Additional research is needed to identify what variables effect the adoption of evidence-based practices and identify interventions to improve the level of adoption.

  20. Information systems: the key to evidence-based health practice.

    PubMed Central

    Rodrigues, R. J.

    2000-01-01

    Increasing prominence is being given to the use of best current evidence in clinical practice and health services and programme management decision-making. The role of information in evidence-based practice (EBP) is discussed, together with questions of how advanced information systems and technology (IS&T) can contribute to the establishment of a broader perspective for EBP. The author examines the development, validation and use of a variety of sources of evidence and knowledge that go beyond the well-established paradigm of research, clinical trials, and systematic literature review. Opportunities and challenges in the implementation and use of IS&T and knowledge management tools are examined for six application areas: reference databases, contextual data, clinical data repositories, administrative data repositories, decision support software, and Internet-based interactive health information and communication. Computerized and telecommunications applications that support EBP follow a hierarchy in which systems, tasks and complexity range from reference retrieval and the processing of relatively routine transactions, to complex "data mining" and rule-driven decision support systems. PMID:11143195

  1. Cultural competence in the era of evidence-based practice.

    PubMed

    Engebretson, Joan; Mahoney, Jane; Carlson, Elizabeth D

    2008-01-01

    Cultural competence has become an important concern for contemporary health care delivery, with ethical and legal implications. Numerous educational approaches have been developed to orient clinicians, and standards and position statements promoting cultural competence have been published by both the American Medical Association and the American Nurses Association. Although a number of health care regulatory agencies have developed standards or recommendations, clinical application to patient care has been challenging. These challenges include the abstract nature of the concept, essentializing culture to race or ethnicity, and the attempts to associate culture with health disparities. To make cultural competence relevant to clinical practice, we linked a cultural competency continuum that identifies the levels of cultural competency (cultural destructiveness, cultural incapacity, cultural blindness, cultural precompetence, and cultural proficiency) to well-established values in health care. This situates cultural competence and proficiency in alignment with patient-centered care. A model integrating the cultural competency continuum with the components of evidence-based care (i.e., best research practice, clinical expertise, and patient's values and circumstances) is presented.

  2. Evidence-Based Psychosocial Treatments for Ethnic Minority Youth

    PubMed Central

    Huey, Stanley J.; Polo, Antonio J.

    2008-01-01

    This article reviews research on evidence-based treatments (EBTs) for ethnic minority youth using criteria from Chambless et al. (1998), Chambless et al. (1996), and Chambless and Hollon (1998). Although no well-established treatments were identified, probably efficacious or possibly efficacious treatments were found for ethnic minority youth with anxiety-related problems, attention-deficit/hyperactivity disorder, depression, conduct problems, substance use problems, trauma-related syndromes, and other clinical problems. In addition, all studies met either Nathan and Gorman's (2002) Type 1 or Type 2 methodological criteria. A brief meta-analysis showed overall treatment effects of medium magnitude (d = .44). Effects were larger when EBTs were compared to no treatment (d = .58) or psychological placebos (d = .51) versus treatment as usual (d = .22). Youth ethnicity (African American, Latino, mixed/other minority), problem type, clinical severity, diagnostic status, and culture-responsive treatment status did not moderate treatment outcome. Most studies had low statistical power and poor representation of less acculturated youth. Few tests of cultural adaptation effects have been conducted in the literature and culturally validated outcome measures are mostly lacking. Recommendations for clinical practice and future research directions are provided. PMID:18444061

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

    PubMed

    Brown, Carlton G

    2014-04-01

    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.

  4. Preparing Dental Students and Residents to Overcome Internal and External Barriers to Evidence-Based Practice.

    PubMed

    Coleman, Brandon G; Johnson, Thomas M; Erley, Kenneth J; Topolski, Richard; Rethman, Michael; Lancaster, Douglas D

    2016-10-01

    In recent years, evidence-based dentistry has become the ideal for research, academia, and clinical practice. However, barriers to implementation are many, including the complexity of interpreting conflicting evidence as well as difficulties in accessing it. Furthermore, many proponents of evidence-based care seem to assume that good evidence consistently exists and that clinicians can and will objectively evaluate data so as to apply the best evidence to individual patients' needs. The authors argue that these shortcomings may mislead many clinicians and that students should be adequately prepared to cope with some of the more complex issues surrounding evidence-based practice. Cognitive biases and heuristics shape every aspect of our lives, including our professional behavior. This article reviews literature from medicine, psychology, and behavioral economics to explore the barriers to implementing evidence-based dentistry. Internal factors include biases that affect clinical decision making: hindsight bias, optimism bias, survivor bias, and blind-spot bias. External factors include publication bias, corporate bias, and lack of transparency that may skew the available evidence in the peer-reviewed literature. Raising awareness of how these biases exert subtle influence on decision making and patient care can lead to a more nuanced discussion of addressing and overcoming barriers to evidence-based practice.

  5. Prospects for Evidence -Based Software Assurance: Models and Analysis

    DTIC Science & Technology

    2015-09-01

    PROSPECTS FOR EVIDENCE-BASED SOFTWARE ASSURANCE: MODELS AND ANALYSIS CARNEGIE MELLON UNIVERSITY SEPTEMBER 2015 FINAL TECHNICAL REPORT APPROVED...TITLE AND SUBTITLE PROSPECTS FOR EVIDENCE-BASED SOFTWARE ASSURANCE: MODELS AND ANALYSIS 5a. CONTRACT NUMBER FA8750-12-2-0139 5b. GRANT NUMBER N/A...assurance case, sandboxing, adaptive software 147 i Prospects for evidence-based software assurance: models and analysis Final Technical Report

  6. Implementing Evidence-Based Practice: A Review of the Empirical Research Literature

    ERIC Educational Resources Information Center

    Gray, Mel; Joy, Elyssa; Plath, Debbie; Webb, Stephen A.

    2013-01-01

    The article reports on the findings of a review of empirical studies examining the implementation of evidence-based practice (EBP) in the human services. Eleven studies were located that defined EBP as a research-informed, clinical decision-making process and identified barriers and facilitators to EBP implementation. A thematic analysis of the…

  7. Reliability and Validity of the Evidence-Based Practice Confidence (EPIC) Scale

    ERIC Educational Resources Information Center

    Salbach, Nancy M.; Jaglal, Susan B.; Williams, Jack I.

    2013-01-01

    Introduction: The reliability, minimal detectable change (MDC), and construct validity of the evidence-based practice confidence (EPIC) scale were evaluated among physical therapists (PTs) in clinical practice. Methods: A longitudinal mail survey was conducted. Internal consistency and test-retest reliability were estimated using Cronbach's alpha…

  8. Three PubMed skills to support evidence-based dentistry.

    PubMed

    Deahl, S Thomas

    2011-02-01

    The National Library of Medicine's PubMed database can powerfully assist dentists in evidence-based practice. Three useful PubMed skills can improve the efficiency of the clinician's search: (1) Use of MeSH terms; (2) Use of Limits; (3) Use of Clinical Queries.

  9. Concepts, Challenges, Barriers, and Opportunities Related to Evidence-Based Practice in Rehabilitation Counseling

    ERIC Educational Resources Information Center

    Chan, Fong; Bezyak, Jill; Ramirez, Maria Romero; Chiu, Chung-Yi; Sung, Connie; Fujikawa, Mayu

    2010-01-01

    Evidence-based practice espouses that all healthcare professionals should provide their clients with the most effective clinical services based on sound research evidence. This philosophy of practice has since permeated to an array of health care and human service disciplines, and the rehabilitation counseling profession is no exception. Although…

  10. An Evidence-Based Systematic Review of Goji (Lycium spp.) by the Natural Standard Research Collaboration.

    PubMed

    Ulbricht, Catherine; Bryan, J Kathryn; Costa, Dawn; Culwell, Samantha; Giese, Nicole; Isaac, Richard; Nummy, Katie; Pham, Thien; Rapp, Cathleen; Rusie, Erica; Weissner, Wendy; Windsor, Regina C; Woods, Jen; Zhou, Sara

    2015-06-01

    An evidence-based systematic review of goji (Lycium spp.) by the Natural Standard Research Collaboration consolidates the safety and efficacy data available in the scientific literature using a validated, reproducible grading rationale. This article includes written and statistical analysis of clinical trials, plus a compilation of expert opinion, folkloric precedent, history, pharmacology, kinetics/dynamics, interactions, adverse effects, toxicology, and dosing.

  11. Single-Case Research Design: An Alternative Strategy for Evidence-Based Practice

    ERIC Educational Resources Information Center

    Stapleton, Drue; Hawkins, Andrew

    2015-01-01

    Objective: The trend of utilizing evidence-based practice (EBP) in athletic training is now requiring clinicians, researchers, educators, and students to be equipped to both engage in and make judgments about research evidence. Single-case design (SCD) research may provide an alternative approach to develop such skills and inform clinical and…

  12. Using a Critical Appraisal Assignment to Infuse Evidence-Based Practice into a Therapeutic Modality Course

    ERIC Educational Resources Information Center

    Zwart, Mary Beth; Olson, Bernadette

    2014-01-01

    Context: It is the responsibility of athletic training educators, through curriculum and clinical experiences, to engage students towards adopting evidence-based practice (EBP) into their practice. The initial task of implementing EBP into a curriculum or course can seem like a large task for educators and students. As a way to start scaffolding…

  13. An evidence-based systematic review of kudzu (Pueraria lobata) by the Natural Standard Research Collaboration.

    PubMed

    Ulbricht, Catherine; Costa, Dawn; Dam, Chi; D'Auria, Denise; Giese, Nicole; Isaac, Richard; LeBlanc, Yvonne; Rusie, Erica; Weissner, Wendy; Windsor, Regina C

    2015-03-01

    An evidence-based systematic review of kudzu (Pueraria lobata) by the Natural Standard Research Collaboration consolidates the safety and efficacy data available in the scientific literature using a validated, reproducible grading rationale. This article includes written and statistical analysis of clinical trials, plus a compilation of expert opinion, folkloric precedent, history, pharmacology, kinetics/dynamics, interactions, adverse effects, toxicology, and dosing.

  14. Variation, Certainty, Evidence, and Change in Dental Education: Employing Evidence-based Dentistry in Dental Education.

    ERIC Educational Resources Information Center

    Marinho, Valeria Coelho Catao; Richards, Derek; Niederman, Richard

    2001-01-01

    Using a case-based dental scenario, presents systematic evidence-based methods for accessing dental health care information, evaluating this information for validity and importance, and using this information to make informed curricular and clinical decisions. Also discusses barriers inhibiting these systematic approaches to evidence-based…

  15. Clinician Resources to Improve Evidence-Based Sexual Healthcare: Does Content and Design Matter?

    ERIC Educational Resources Information Center

    Hosseinzadeh, Hassan; Dadich, Ann; Bourne, Chris; Murray, Carolyn

    2014-01-01

    This study examines how the design and content of printed educational materials (PEMs) influence clinician capacity to deliver evidence-based sexual healthcare. General practitioners in New South Wales, Australia (n = 214), completed a survey about their use and perceptions of PEMs - a clinical aide, sexual health articles, and an educational…

  16. The Delphi Method: An Approach for Facilitating Evidence Based Practice in Athletic Training

    ERIC Educational Resources Information Center

    Sandrey, Michelle A.; Bulger, Sean M.

    2008-01-01

    Objective: The growing importance of evidence based practice in athletic training is necessitating academics and clinicians to be able to make judgments about the quality or lack of the body of research evidence and peer-reviewed standards pertaining to clinical questions. To assist in the judgment process, consensus methods, namely brainstorming,…

  17. Developing an open platform for evidence-based microwave ablation treatment planning and validation

    NASA Astrophysics Data System (ADS)

    Deshazer, Garron; Dupuy, Damian E.; Walsh, Edward; Prakash, Punit; Fairchild, Dillon; Glidden, David; Collins, Scott A.; Cook, Madeleine L.; Ryan, Thomas P.; Merck, Derek

    2015-03-01

    The clinical utility of current thermal ablation planning tools is severely limited by treatment variability. We discuss the development of an open platform for evidence-based thermal ablation treatment planning and validation. Improved predictive treatment modeling and consistent outcome analysis are crucial components for useful planning and guidance tools.

  18. Using Qualitative Research to Develop Culturally Competent Evidence-Based Practice

    ERIC Educational Resources Information Center

    Silverstein, Louise Bordeaux; Auerbach, Carl F.

    2009-01-01

    Kazdin pointed out that the requirement for evidence-based practice (EBP) has made the long-standing gap between research and practice in clinical psychology even more salient. He offered several strategies for bridging this gap: investigating mechanisms and moderators of therapeutic change, and qualitative research. We agree that qualitative…

  19. Librarians, clinicians, evidence-based medicine, and the division of labor.

    PubMed Central

    Holtum, E A

    1999-01-01

    Have librarians promoted end user searching to the detriment of the profession and promoted clinical inefficiency from causally trained health practitioners? Issues related to the complexity of bibliographic retrieval in the networked environment are explored within the context of evidence-based medicine and the division of labor. PMID:10550025

  20. A Clinician's Quick Guide of Evidence-Based Approaches Number 2: Depression

    ERIC Educational Resources Information Center

    Moulds, Michelle L.; Werner-Seidler, Aliza; Dalgleish, Tim

    2013-01-01

    This quick guide presents resources for clinicians on evidence-based approaches for assessing and treating depression. It also briefly describes the mood disorder module of the clinician administered Structured Clinical Interview for DSM-IV Axis I Disorders, treatment approaches, and new and emerging developments demonstrating the effectiveness of…

  1. The Technology of Evidence-Based Practice: Tools for Navigating the Health Sciences Literature

    ERIC Educational Resources Information Center

    Townsend, Whitney

    2011-01-01

    Medical and health sciences libraries have incorporated the elements of evidence-based practice (EBP) into their reference services, instruction, and online resource development for years. While EBP focuses on the use of medical and health sciences literature in the clinical environment (i.e., making decisions about how to treat a particular…

  2. Using Spiritual Interventions in Practice: Developing Some Guidelines from Evidence-Based Practice

    ERIC Educational Resources Information Center

    Hodge, David R.

    2011-01-01

    Research indicates that many social work practitioners are interested in using spiritual interventions in clinical settings. Unfortunately, studies also indicate that practitioners have frequently received minimal training on the topic during their graduate education. Drawing from the evidence-based practice movement, this article develops some…

  3. Using evidence-based internet interventions to reduce health disparities worldwide.

    PubMed

    Muñoz, Ricardo F

    2010-12-17

    Health disparities are a persistent problem worldwide. A major obstacle to reducing health disparities is reliance on "consumable interventions," that is, interventions that, once used, cannot be used again. To reduce health disparities, interventions are required that can be used again and again without losing their therapeutic power, that can reach people even if local health care systems do not provide them with needed health care, and that can be shared globally without taking resources away from the populations where the interventions were developed. This paper presents the argument that automated self-help evidence-based Internet interventions meet the above criteria and can contribute to the reduction of health disparities worldwide. Proof-of-concept studies show that evidence-based Internet interventions can reach hundreds of thousands of people worldwide and could be used in public sector settings to augment existing offerings and provide services not currently available (such as prevention interventions). This paper presents a framework for systematically filling in a matrix composed of columns representing common health problems and rows representing languages. To bring the benefits of evidence-based Internet interventions to the underserved, public sector clinics should establish eHealth resource centers, through which patients could be screened online for common disorders and provided with evidence-based Internet intervention services not currently available at the clinics. These resources should be available in the patients' languages, in formats that do not require literacy, and that can be accessed with mobile devices. Such evidence-based Internet interventions should then be shared with public sector clinics as well as individuals anywhere in the world. Finally, this paper addresses sustainability and describes a continuum of evidence-based Internet interventions to share nationally and across the world. This approach to expanding health service

  4. The state of evidence-based practice in US nurses: critical implications for nurse leaders and educators.

    PubMed

    Melnyk, Bernadette Mazurek; Fineout-Overholt, Ellen; Gallagher-Ford, Lynn; Kaplan, Louise

    2012-09-01

    This descriptive survey assessed the perception of evidence-based practice (EBP) among nurses in the United States. Although evidence-based healthcare results in improved patient outcomes and reduced costs, nurses do not consistently implement evidence-based best practices. A descriptive survey was conducted with a random sample of 1015 RNs who are members of the American Nurses Association. Although nurses believe in evidence-based care, barriers remain prevalent, including resistance from colleagues, nurse leaders, and managers. Differences existed in responses of nurses from Magnet® versus non-Magnet institutions as well as nurses with master's versus nonmaster's degrees. Nurse leaders and educators must provide learning opportunities regarding EBP and facilitate supportive cultures to achieve the Institute of Medicine's 2020 goal that 90% of clinical decisions be evidence-based.

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

    PubMed

    Ross, Jacqueline

    2010-04-01

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

  6. Incorporating Mobile Phone Technologies to Expand Evidence-Based Care.

    PubMed

    Jones, Deborah J; Anton, Margaret; Gonzalez, Michelle; Honeycutt, Amanda; Khavjou, Olga; Forehand, Rex; Parent, Justin

    2015-08-01

    Ownership of mobile phones is on the rise, a trend in uptake that transcends age, region, race, and ethnicity, as well as income. It is precisely the emerging ubiquity of mobile phones that has sparked enthusiasm regarding their capacity to increase the reach and impact of health care, including mental health care. Community-based clinicians charged with transporting evidence-based interventions beyond research and training clinics are in turn, ideally and uniquely situated to capitalize on mobile phone uptake and functionality to bridge the efficacy to effectiveness gap. As such, this article delineates key considerations to guide these frontline clinicians in mobile phone-enhanced clinical practice, including an overview of industry data on the uptake of and evolution in the functionality of mobile phone platforms, conceptual considerations relevant to the integration of mobile phones into practice, representative empirical illustrations of mobile-phone enhanced assessment and treatment, and practical considerations relevant to ensuring the feasibility and sustainability of such an approach.

  7. A small group learning model for evidence-based medicine

    PubMed Central

    Al Achkar, Morhaf; Davies, M Kelly

    2016-01-01

    Background Evidence-based medicine (EBM) skills are invaluable tools for residents and practicing physicians. The purpose of this study is to evaluate the effectiveness of small-group learning models in teaching fundamental EBM skills. Methods The intervention consisted of an EBM bootcamp divided into four 2-hour sessions across 4-week rotations. Residents worked in small groups of three to four to explore fundamentals of EBM through interactive dialogue and mock clinical scenario practice. The intervention’s effectiveness was evaluated using pre- and post-assessments. Results A total of 40 (93.0%) residents out of a potential 43 participated in the EBM bootcamps across the 3 years. There was significant improvement of 3.28 points on self-assessed EBM skills from an average of 9.66–12.945 out of a maximum score of 15 (P=0.000). There was significant improvement of 1.68 points on the EBM skills test from an average of 6.02–7.71 out of a maximum score of 9 (P=0.00). All residents (100%) agreed or strongly agreed that EBM is important for a physician’s clinical practice. This view did not change after the training. Conclusion A brief small-group interactive workshop in EBM basic skills at the start of residency was effective in developing fundamental EBM skills. PMID:27822132

  8. Evidence-based prognostication in a case of sciatica

    PubMed Central

    Emary, Peter C.

    2015-01-01

    Objective: To present an evidence-based case report on the prognosis of a patient with sciatica. Case: A 43-year-old man presented with right-sided buttock and lower extremity pain and numbness of 10 weeks’ duration. Magnetic resonance imaging revealed a lumbosacral disc herniation. Straight leg raise testing provoked the patient’s right sciatic pain, and neurologic examination revealed a diminished right Achilles tendon reflex and mild hypoesthesia along the patient’s outer right foot. Outcome: PubMed was searched and two cohort studies relevant to sciatic prognosis were found. These articles were critically appraised for their validity, importance, and applicability in making a prognostic estimate for this particular patient. Based on the appraised research evidence, and the confidence intervals calculated therein, the overall prognosis for sciatic pain recovery with conservative care was estimated as favourable for this patient, though sensory recovery (even with surgical care) was not. Summary: This case report illustrates how to use research literature in estimating the clinical prognosis for an individual patient, and how this can be useful towards clinical decision-making concerning treatment. PMID:25729082

  9. Incorporating Mobile Phone Technologies to Expand Evidence-Based Care

    PubMed Central

    Jones, Deborah J.; Anton, Margaret; Gonzalez, Michelle; Honeycutt, Amanda; Khavjou, Olga; Forehand, Rex; Parent, Justin

    2014-01-01

    Ownership of mobile phones is on the rise, a trend in uptake that transcends age, region, race, and ethnicity, as well as income. It is precisely the emerging ubiquity of mobile phones that has sparked enthusiasm regarding their capacity to increase the reach and impact of health care, including mental health care. Community-based clinicians charged with transporting evidence-based interventions beyond research and training clinics are in turn, ideally and uniquely situated to capitalize on mobile phone uptake and functionality to bridge the efficacy to effectiveness gap. As such, this article delineates key considerations to guide these frontline clinicians in mobile phone-enhanced clinical practice, including an overview of industry data on the uptake of and evolution in the functionality of mobile phone platforms, conceptual considerations relevant to the integration of mobile phones into practice, representative empirical illustrations of mobile-phone enhanced assessment and treatment, and practical considerations relevant to ensuring the feasibility and sustainability of such an approach. PMID:26213458

  10. Evidence Based Surgery: How Difficult is the Implication in Routine Practice?

    PubMed Central

    Maheshwari, Gaurav; Maheshwari, Namrata

    2012-01-01

    Surgery as a discipline has perhaps been slower than other specialties to embrace evidence based principles. Today, surgeons all over Asia are prepared to challenge the dogma of yesterday. Surgical science which rests on a strong foundation of laboratory and clinical research can now be broadened to include the armamentarium of evidence based practice to advance surgical knowledge. The sheer volume of easily accessed information creates a new challenge. This article discusses keeping up with new information and finding the best available answers to specific questions amidst all the other information. PMID:22359733

  11. Evidence-based management of statin myopathy.

    PubMed

    Harper, Charles R; Jacobson, Terry A

    2010-09-01

    Statin-associated muscle symptoms are a relatively common condition that may affect 10% to 15% of statin users. Statin myopathy includes a wide spectrum of clinical conditions, ranging from mild myalgia to rhabdomyolysis. The etiology of myopathy is multifactorial. Recent studies suggest that statins may cause myopathy by depleting isoprenoids and interfering with intracellular calcium signaling. Certain patient and drug characteristics increase risk for statin myopathy, including higher statin doses, statin cytochrome metabolism, and polypharmacy. Genetic risk factors have been identified, including a single nucleotide polymorphism of SLCO1B1. Coenzyme Q10 and vitamin D have been used to prevent and treat statin myopathy; however, clinical trial evidence demonstrating their efficacy is limited. Statin-intolerant patients may be successfully treated with either low-dose statins, alternate-day dosing, or using twice-weekly dosing with longer half-life statins. An algorithm is presented to assist the clinician in managing myopathy in patients with dyslipidemia.

  12. Online tools for teaching evidence-based veterinary medicine.

    PubMed

    Steele, Michael; Crabb, Nicholas P; Moore, Lynda J; Reyher, Kristen K; Baillie, Sarah; Eisler, Mark C

    2013-01-01

    Evidence-based veterinary medicine (EBVM) is of interest and relevance to veterinary practitioners. Consequently, veterinary schools take responsibility for teaching students how to appraise scientific articles and for equipping them with the skills needed to obtain and evaluate the best evidence and to apply this approach to their own cases. As part of our farm animal clinical rotation, we train students in qualitative and quantitative EBVM methods using an e-learning environment, online teaching materials, a wiki (a Web site that allows its users to edit its content via a Web browser), and face-to-face tutorials that support learning. Students working in small groups use a wiki to record details of the history, clinical presentation, diagnostic tests, herd data, and management plans for their chosen farm animal clinical cases. Using a standardized patient, intervention, comparison, and outcome (PICO) format, each group formulates a patient question based on either a proposed intervention or diagnostic procedure for the case and conducts an online scientific literature database search. The students appraise the articles retrieved using EBVM approaches and record the information in the wiki. The summation of this body of work, the group's critically appraised topic (CAT), includes the original PICO, a standardized table of the scientific evidence for the effectiveness of the intervention or diagnostic procedure, a summary statement in the form of a clinical bottom line, and their reflections upon the CAT. At the end of the rotation, students take part in a structured "CAT Club" where they present and discuss their findings with fellow students and clinicians.

  13. Evidence-Based Practice: SLTs under Siege or Opportunity for Growth? The Use and Nature of Research Evidence in the Profession

    ERIC Educational Resources Information Center

    McCurtin, Arlene; Roddam, Hazel

    2012-01-01

    Background: Speech and language therapists are encouraged to be evidence-based practitioners in contemporary clinical practice. This apparently signifies their commitment to "good" practice. An examination of evidence-based practice (EBP) and its adoption in clinical practice is therefore warranted. Aims: This paper aims to explore EBP,…

  14. Evidence-based techniques to assess the performance of dental implants.

    PubMed

    Kashi, Ajay; Saha, Subrata

    2013-12-01

    The clinical use of evidence-based medicine has been regarded as one of the most significant medical advancements of the last century. As the costs of medical care escalate, clinical decisions have to be made prudently and with a high degree of efficacy. One of the most expensive treatments in dentistry includes the use of dental implants to rehabilitate partial and fully edentulous patients. Due to the high costs of treatments and the ever increasing varieties of dental implants becoming available, the clinician is often faced with a challenging situation to decide the best prostheses for their patients. Furthermore, navigating through the vast database of literature pertaining to dental implants and their related research can be very time consuming and challenging to a dental surgeon before they can make appropriate clinical decisions. Similar to other orthopedic implants, dental implants need to be evaluated for their long-term efficacy in vivo before they are clinically acceptable. In order to help clinician(s) make patient oriented decisions, evidence-based techniques are becoming increasingly popular. This can be a very useful tool in translating research findings into clinical practice, thus narrowing the gap between research and clinical dentistry. This article discusses ways in which evidence-based techniques can help dental surgeons analyze and make informed clinical decisions about dental implant treatments.

  15. [Use of PubMed to improve evidence-based medicine in routine urological practice].

    PubMed

    Rink, M; Kluth, L A; Shariat, S F; Chun, F K; Fisch, M; Dahm, P

    2013-03-01

    Applying evidence-based medicine in daily clinical practice is the basis of patient-centered medicine and knowledge of accurate literature acquisition skills is necessary for informed clinical decision-making. PubMed is an easy accessible, free bibliographic database comprising over 21 million citations from the medical field, life-science journals and online books. The article summarizes the effective use of PubMed in routine urological clinical practice based on a common case scenario. This article explains the simple use of PubMed to obtain the best search results with the highest evidence. Accurate knowledge about the use of PubMed in routine clinical practice can improve evidence-based medicine and also patient treatment.

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

    ERIC Educational Resources Information Center

    Tuchman, Ellen; Lalane, Monique

    2011-01-01

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

  17. Opening Pandora's Box: Evidence-Based Practice for Educational Psychologists

    ERIC Educational Resources Information Center

    Fox, Mark

    2003-01-01

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

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

    ERIC Educational Resources Information Center

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

    2010-01-01

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

  19. The Evidence-Based Manifesto for School Librarians

    ERIC Educational Resources Information Center

    Todd, Ross

    2008-01-01

    School Library Journal's 2007 Leadership Summit, "Where's the Evidence? Understanding the Impact of School Libraries," focused on the topic of evidence-based practice. Evidence-based school librarianship is a systematic approach that engages research-derived evidence, school librarian-observed evidence, and user-reported evidence in the processes…

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

    ERIC Educational Resources Information Center

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

    2016-01-01

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

  1. Teaching Evidence-Based Physical Diagnosis: Six Bedside Lessons.

    PubMed

    McGee, Steven

    2016-12-01

    Evidence-based physical diagnosis is an essential part of the bedside curriculum. By using the likelihood ratio, a simple measure of diagnostic accuracy, teachers can quickly adapt this approach to their bedside teaching. Six recurring themes in evidence-based physical diagnosis are fully reviewed, with examples, in this article.

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

    ERIC Educational Resources Information Center

    Prins, David; Ingham, Roger J.

    2009-01-01

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

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

    ERIC Educational Resources Information Center

    Sturmey, Peter

    2009-01-01

    Recent reviews of evidence-based treatment for depression did not identify behavioral activation as an evidence-based practice. Therefore, this article conducted a systematic review of behavioral activation treatment of depression, which identified three meta-analyses, one recent randomized controlled trial and one recent follow-up of an earlier…

  4. 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...

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

    PubMed

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

    2015-09-01

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

  6. [Big data analysis and evidence-based medicine: controversy or cooperation].

    PubMed

    Chen, Xinzu; Hu, Jiankun

    2016-01-01

    The development of evidence-based medicince should be an important milestone from the empirical medicine to the evidence-driving modern medicine. With the outbreak in biomedical data, the rising big data analysis can efficiently solve exploratory questions or decision-making issues in biomedicine and healthcare activities. The current problem in China is that big data analysis is still not well conducted and applied to deal with problems such as clinical decision-making, public health policy, and should not be a debate whether big data analysis can replace evidence-based medicine or not. Therefore, we should clearly understand, no matter whether evidence-based medicine or big data analysis, the most critical infrastructure must be the substantial work in the design, constructure and collection of original database in China.

  7. Using evidence-based leadership initiatives to create a healthy nursing work environment.

    PubMed

    Nayback-Beebe, Ann M; Forsythe, Tanya; Funari, Tamara; Mayfield, Marie; Thoms, William; Smith, Kimberly K; Bradstreet, Harry; Scott, Pamela

    2013-01-01

    In an effort to create a healthy nursing work environment in a military hospital Intermediate Care Unit (IMCU), a facility-level Evidence Based Practice working group composed of nursing.Stakeholders brainstormed and piloted several unit-level evidence-based leadership initiatives to improve the IMCU nursing work environment. These initiatives were guided by the American Association of Critical Care Nurses Standards for Establishing and Sustaining Healthy Work Environments which encompass: (1) skilled communication, (2) true collaboration, (3) effective decision making, (4) appropriate staffing, (5) meaningful recognition, and (6) authentic leadership. Interim findings suggest implementation of these six evidence-based, relationship-centered principals, when combined with IMCU nurses' clinical expertise, management experience, and personal values and preferences, improved staff morale, decreased staff absenteeism, promoted a healthy nursing work environment, and improved patient care.

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

    PubMed

    Aravind, Maya; Chung, Kevin C

    2010-01-01

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

  9. Evidence-based benefit design: toward a sustainable health care future for employers.

    PubMed

    Bunn, William B; Stave, Gregg M; Allen, Harris; Naim, Ahmad B

    2010-10-01

    Health care costs for employers are rising much faster than inflation. The common approach to health benefit design of increasing cost sharing has failed to contain costs. Some employers, however, have been successful at mitigating the cost trend or actually reducing health care costs. These employers have in common a dedication to data analysis, a search for cost drivers, and a willingness to adjust their approach to health benefit design to address these cost drivers. This approach has much in common with the movement in clinical practice toward evidence-based medicine. We propose that employers adopt a similar approach toward health benefits termed evidence-based benefit design, which is based on a health and productivity framework focused on direct and indirect costs. Evidence-based benefit design incorporates the relevant literature and employer-specific data that are integrated and regularly analyzed.

  10. Procedures for identifying evidence-based psychological treatments for older adults.

    PubMed

    Yon, Adriana; Scogin, Forrest

    2007-03-01

    The authors describe the methods used to identify evidence-based psychological treatments for older adults in this contribution to the special section. Coding teams were assembled to review the literature on several problems relevant to mental health and aging. These teams used the manual developed by the Committee on Science and Practice of the Society for Clinical Psychology (Division 12) of the American Psychological Association that provided definitions of key constructs used in coding. The authors provide an overview of the process followed by the review teams and of some of the issues that emerged to illustrate the steps involved in the coding procedure. Identifying evidence-based treatments is a fundamental aspect of promoting evidence-based practice with older adults; such practice is advocated by most health care disciplines, including psychology.

  11. Evidence Base Update for Psychosocial Treatments for Pediatric Obsessive-Compulsive Disorder

    PubMed Central

    Freeman, Jennifer; Garcia, Abbe; Frank, Hannah; Benito, Kristen; Conelea, Christine; Walther, Michael; Edmunds, Julie

    2013-01-01

    Objective Pediatric Obsessive Compulsive Disorder (OCD) is a chronic and impairing condition that often persists into adulthood. Barrett and colleagues (2008), in this journal, provided a detailed review of evidence based psychosocial treatments for youth with OCD. The current review provides an evidence base update of the pediatric OCD psychosocial treatment literature with particular attention to advances in the field as well as to the methodological challenges inherent in evaluating such findings. Method Psychosocial treatment studies conducted since the last review are described and evaluated according to methodological rigor and evidence-based classification using the JCCAP evidence based treatment (EBT) evaluation criteria (Southam-Gerow and Prinstein, this issue). Results Findings from this review clearly converge in support of CBT as an effective and appropriate first line treatment for youth with OCD (either alone or in combination with medication). Although no treatment for pediatric OCD has yet to be designated as “well established”, both individual and individual family based treatments have been shown to be “probably efficacious.” Conclusions Moderators and predictors of treatment outcome are discussed as are the areas where we have advanced the field and the areas where we have room to grow. The methodological and clinical challenges inherent in a review of the evidence base are reviewed. Finally, future research directions are outlined. PMID:23746138

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

    PubMed

    Griffiths, Peter

    2005-03-01

    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.

  13. Merging Evidence-Based Psychosocial Interventions in Schizophrenia

    PubMed Central

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

    2014-01-01

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

  14. Hospital readiness for undertaking evidence-based practice: A survey.

    PubMed

    Nguyen, Thi Ngoc Minh; Wilson, Anne

    2016-12-01

    Despite the fact that evidence-based practice has increasing emphasis in health care, organizations are not always prepared for its implementation. Identifying organizational preparedness for implementing evidence-based practice is desirable prior to application. A cross-sectional survey was developed to explore nurses' perception of organizational support for evidence-based practice and was implemented via a self-enumerated survey completed by 234 nurses. Data were analyzed with descriptive and inferential statistics. Nurses reported that implementation of evidence-based practice is complex and fraught with challenges because of a lack of organizational support. A conceptual framework comprising three key factors: information resources, nursing leadership, and organizational infrastructure was proposed to assist health authorities in the implementation of evidence-based practice. Suggestions of how organizations can be more supportive of research utilization in practice include establishing a library, journal clubs/mentoring programs, nurses' involvement in decision-making at unit level, and a local nursing association.

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

    PubMed

    Qiu, Yun-Liang; Peng, Ming-Qi

    2013-12-01

    As an important component of judicial expertise, forensic science is broad and highly specialized. With development of network technology, increasement of information resources, and improvement of people's legal consciousness, forensic scientists encounter many new problems, and have been required to meet higher evidentiary standards in litigation. In view of this, evidence-based concept should be established in forensic medicine. We should find the most suitable method in forensic science field and other related area to solve specific problems in the evidence-based mode. Evidence-based practice can solve the problems in legal medical field, and it will play a great role in promoting the progress and development of forensic science. This article reviews the basic theory of evidence-based medicine and its effect, way, method, and evaluation in the forensic medicine in order to discuss the application value of forensic evidence-based medicine in computer communication networks.

  16. Evidence-based treatments for cluster headache

    PubMed Central

    Gooriah, Rubesh; Buture, Alina; Ahmed, Fayyaz

    2015-01-01

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

  17. An evidence-based approach to earlier initiation of dialysis.

    PubMed

    Churchill, D N

    1997-12-01

    The objective was to review evidence addressing the optimal time to initiate dialysis treatment. The database was derived from an evidence-based review of the medical literature and from the Canada-United States peritoneal dialysis study. The publications were divided into (1) those addressing the clinical impact of early versus late referral to a dialysis program; (2) those evaluating the association between residual renal function at initiation of dialysis and the concurrent nutritional status; (3) those evaluating the association between residual renal function at initiation of dialysis and subsequent clinical outcomes, including patient survival. There were five studies evaluating early versus late referral, three cohort design and two case-control design. Late referrals had worse outcomes than early referrals. The former had more serious comorbidity and many had been noncompliant with follow-up. The latter were more likely to have hereditary renal disease. Renal function was slightly worse at initiation among those referred late. Three studies addressed the association between renal function at initiation of dialysis and concurrent nutritional status. Two showed decreased protein intake with diminished glomerular filtration rate (GFR). Poor nutritional status is associated with decreased patient survival among both incident and prevalent dialysis patients. The third study reported excellent patient survival among patients with late initiation of dialysis. These patients had received a supplemented low-protein diet and were not malnourished at initiation of dialysis. Three groups have studied the association between GFR at initiation of dialysis and clinical outcomes. Decreased GFR at initiation of dialysis is associated with a increased probability of hospitalization and death. None of these studies has used the rigorous randomized clinical trial design, and they are therefore subject to bias. Referral time bias, comorbidity, patient compliance, and starting

  18. USPSTF perspective on evidence-based preventive recommendations for children.

    PubMed

    Melnyk, Bernadette Mazurek; Grossman, David C; Chou, Roger; Mabry-Hernandez, Iris; Nicholson, Wanda; DeWitt, Thomas G; Cantu, Adelita G; Flores, Glenn

    2012-08-01

    The development and use of evidence-based recommendations for preventive care by primary care providers caring for children is an ongoing challenge. This issue is further complicated by the fact that a higher proportion of recommendations by the US Preventive Services Task Force (USPSTF) for pediatric preventive services in comparison with adult services have insufficient evidence to recommend for or against the service. One important root cause for this problem is the relative lack of high quality screening and counseling studies in pediatric primary care settings. The paucity of studies limits the development of additional evidence-based guidelines to enhance best practices for pediatric and adolescent conditions. In this article, we describe the following: (1) evidence-based primary care preventive services as a strategy for addressing important pediatric morbidities, (2) the process of making evidence-based screening recommendations by the USPSTF, (3) the current library of USPSTF recommendations for children and adolescents, and (4) factors influencing the use of USPSTF recommendations and other evidence-based guidelines by clinicians. Strategies to accelerate the implementation of evidence-based services and areas of need for future research to fill key gaps in evidence-based recommendations and guidelines are highlighted.

  19. Managing acute cough in children: evidence-based guidelines.

    PubMed

    Kelley, Laura K; Allen, Patricia Jackson

    2007-01-01

    This article examines the evidence-based guidelines for diagnosis and treatment of acute cough in children. Cough is a common symptom in children and a frequent reason for consultation in primary care. Generally, an acute cough is a self-limiting condition resulting from expected childhood viral illnesses. However, a child should be thoroughly evaluated to rule out a serious underlying condition or disease responsible for the cough. Parents are often concerned and anxious about their child's cough. The use of over-the-counter cough and cold medications is widespread and parents commonly request primary care providers to provide prescriptions to alleviate cough symptoms. The American College of Chest Physicians has recommended clinical practice guidelines based on the conclusion of systematic reviews. These reviews indicate that cough medications offer no symptomatic relief for acute cough in children, and the use of cough and cold medications is inappropriate in young children and also places young children at risk for potential side effects and adverse reactions. The management of acute cough in children is based on a "wait, watch, review" approach. Clinicians should educate parents on expected illness duration, the risks of using over-the-counter medications, and discuss safe, supportive care measures to alleviate the child's discomfort.

  20. Disruptive innovations for designing and diffusing evidence-based interventions.

    PubMed

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

    2012-09-01

    Evidence-based therapeutic and preventive intervention programs (EBIs) have been growing exponentially. 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 reexamine our scientific conventions and norms. Innovation may be spurred by reexamining the traditional biomedical model for validating, implementing, and diffusing EBI products and science. The model of disruptive innovations suggests that we reengineer EBIs on the basis of their most robust features in order to serve more people in less time and at lower cost. A disruptive innovation provides a simpler and less expensive alternative that meets the essential needs for the majority of consumers and is more accessible, scalable, replicable, and sustainable. Examples of disruptive innovations from other fields include minute clinics embedded in retail chain drug stores, $2 generic eyeglasses, automated teller machines, and telemedicine. Four new research approaches 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 monitoring 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.

  1. Evidence-based guideline: Treatment of painful diabetic neuropathy

    PubMed Central

    Bril, V.; England, J.; Franklin, G.M.; Backonja, M.; Cohen, J.; Del Toro, D.; Feldman, E.; Iverson, D.J.; Perkins, B.; Russell, J.W.; Zochodne, D.

    2011-01-01

    Objective: To develop a scientifically sound and clinically relevant evidence-based guideline for the treatment of painful diabetic neuropathy (PDN). Methods: We performed a systematic review of the literature from 1960 to August 2008 and classified the studies according to the American Academy of Neurology classification of evidence scheme for a therapeutic article, and recommendations were linked to the strength of the evidence. The basic question asked was: “What is the efficacy of a given treatment (pharmacologic: anticonvulsants, antidepressants, opioids, others; and nonpharmacologic: electrical stimulation, magnetic field treatment, low-intensity laser treatment, Reiki massage, others) to reduce pain and improve physical function and quality of life (QOL) in patients with PDN?” Results and Recommendations: Pregabalin is established as effective and should be offered for relief of PDN (Level A). Venlafaxine, duloxetine, amitriptyline, gabapentin, valproate, opioids (morphine sulfate, tramadol, and oxycodone controlled-release), and capsaicin are probably effective and should be considered for treatment of PDN (Level B). Other treatments have less robust evidence or the evidence is negative. Effective treatments for PDN are available, but many have side effects that limit their usefulness, and few studies have sufficient information on treatment effects on function and QOL. PMID:21482920

  2. Nursing faculties’ knowledge and attitude on evidence-based practice

    PubMed Central

    Mehrdad, Neda; Joolaee, Soodabeh; Joulaee, Azadeh; Bahrani, Naser

    2012-01-01

    Background: Evidence-based practice (EBP) is one of the main professional competencies for health care professionals and a priority for medicine and nursing curriculum as well. EBP leads to improve effective and efficient care and patient outcomes. Nurse educators have responsibility to teach the future nurses, and an opportunity to promote patient outcomes. Therefore, the aim of this study was to describe nurse educators’ knowledge and attitude on EBP. Materials and Methods: This was a descriptive study conducted in nursing faculties of two major universities of medical sciences affiliated to Ministry of Health and Medical Sciences in Tehran, Iran. Data were gathered using a three-section questionnaire. Content and face validity was further enhanced by submitting it to nursing research and education experts. Statistical analysis was carried out using SPSS 11 software. Results: According the results, nursing faculties’ knowledge of EBP was mainly moderate (47.1%). Significant statistical relationship was found between the level of knowledge with education and teaching experience in different nursing programs. Nurses generally held positive attitudes toward EBP (88.6%) and there was no statistical significant relationship with demographic variables. Conclusion: Nursing educators are in a position to influence nursing research in clinical practice in the future. Therefore, it is critical to achieve implementation of EBP and be a change agent for a paradigm shift toward EBP. PMID:23922597

  3. Pain in Intellectually Disabled Children: Towards Evidence-Based Pharmacotherapy?

    PubMed

    Valkenburg, Abraham J; de Leeuw, Tom G; van Dijk, Monique; Tibboel, Dick

    2015-10-01

    This critical opinion article deals with the challenges of finding the most effective pharmacotherapeutic options for the management of pain in intellectually disabled children and provides recommendations for clinical practice and research. Intellectual disability can be caused by a wide variety of underlying diseases and may be associated with congenital anomalies such as cardiac defects, small-bowel obstructions or limb abnormalities as well as with comorbidities such as scoliosis, gastro-esophageal reflux disease, spasticity, and epilepsy. These conditions themselves or any necessary surgical interventions are sources of pain. Epilepsy often requires chronic pharmacological treatment with antiepileptic drugs. These antiepileptic drugs can potentially cause drug-drug interactions with analgesic drugs. It is unfortunate that children with intellectual disabilities often cannot communicate pain to caregivers. Although these children are at high risk of experiencing pain, researchers nevertheless often have to exclude them from trials on pain management because of ethical considerations. We therefore make a plea for prescribers, researchers, patient organizations, pharmaceutical companies, and policy makers to study evidence-based, safe and effective pharmacotherapy in these children through properly designed studies. In the meantime, parents and clinicians must resort to validated pain assessment tools such as the revised FLACC scale.

  4. Evidence-Based Redesign of the COMLEX-USA Series.

    PubMed

    Gimpel, John R; Horber, Dorothy; Sandella, Jeanne M; Knebl, Janice A; Thornburg, John E

    2017-04-01

    To ensure that the Comprehensive Osteopathic Medical Licensing Examination-USA (COMLEX-USA) reflects the evolving practice of osteopathic medicine, the National Board of Osteopathic Medical Examiners has developed new content and format specifications for an enhanced, competency-based examination program to be implemented with COMLEX-USA Level 3 in 2018. This article summarizes the evidence-based design processes that served as the foundation for blueprint development and the evidence supporting its validity. An overview is provided of the blueprint's 2 dimensions: Competency Domains and Clinical Presentations. The authors focus on the evidence that supports interpretation of test scores for the primary and intended purpose of COMLEX-USA, which is osteopathic physician licensure. Important secondary uses and the educational and catalytic effect of assessments are also described. This article concludes with the National Board of Osteopathic Medical Examiners' plans to ensure that the COMLEX-USA series remains current and meets the needs of its stakeholders-the patients who seek care from osteopathic physicians.

  5. Thymic epithelial neoplasms: a review of current concepts using an evidence-based pathology approach.

    PubMed

    Marchevsky, Alberto M; McKenna, Robert J; Gupta, Ruta

    2008-06-01

    Evidence-based pathology promotes the critical evaluation of current clinical information and the development of evidence-based diagnostic and prognostic guidelines. No randomized clinical trials of patients who have thymomas or thymic carcinomas are available to evaluate the validity of the current World Health Organization (WHO) histologic classification or the widely used Masaoka staging system. A meta-analysis of over 2000 thymoma patients estimated that only three WHO histologic types of thymomas are associated with significant survival differences. Prospective randomized clinical trials and an international registry of patients who have Thymic epithelial neoplasms are needed to stratify patients who may benefit from neoadjuvant chemotherapy, postoperative radiation therapy, and other nonsurgical modalities.

  6. Complementarity of Clinician Judgment and Evidence Based Models in Medical Decision Making: Antecedents, Prospects, and Challenges

    PubMed Central

    Asante Antwi, Henry

    2016-01-01

    Early accounts of the development of modern medicine suggest that the clinical skills, scientific competence, and doctors' judgment were the main impetus for treatment decision, diagnosis, prognosis, therapy assessment, and medical progress. Yet, clinician judgment has its own critics and is sometimes harshly described as notoriously fallacious and an irrational and unfathomable black box with little transparency. With the rise of contemporary medical research, the reputation of clinician judgment has undergone significant reformation in the last century as its fallacious aspects are increasingly emphasized relative to the evidence based options. Within the last decade, however, medical forecasting literature has seen tremendous change and new understanding is emerging on best ways of sharing medical information to complement the evidence based medicine practices. This review revisits and highlights the core debate on clinical judgments and its interrelations with evidence based medicine. It outlines the key empirical results of clinician judgments relative to evidence based models and identifies its key strengths and prospects, the key limitations and conditions for the effective use of clinician judgment, and the extent to which it can be optimized and professionalized for medical use. PMID:27642588

  7. [Pediatric pancreatitis. Evidence based management guidelines of the Hungarian Pancreatic Study Group].

    PubMed

    Párniczky, Andrea; Czakó, László; Dubravcsik, Zsolt; Farkas, Gyula; Hegyi, Péter; Hritz, István; Kelemen, Dezső; Morvay, Zita; Oláh, Attila; Pap, Ákos; Sahin-Tóth, Miklós; Szabó, Flóra; Szentkereszti, Zsolt; Szmola, Richárd; Takács, Tamás; Tiszlavicz, László; Veres, Gábor; Szücs, Ákos; Lásztity, Natália

    2015-02-22

    Pediatric pancreatitis is a rare disease with variable etiology. In the past 10-15 years the incidence of pediatric pancreatitis has been increased. The management of pediatric pancreatitis requires up-to-date and evidence based management guidelines. The Hungarian Pancreatic Study Group proposed to prepare an evidence based guideline based on the available international guidelines and evidences. The preparatory and consultation task force appointed by the Hungarian Pancreatic Study Group translated and complemented and/or modified the international guidelines if it was necessary. In 8 clinical topics (diagnosis; etiology; prognosis; imaging; therapy; biliary tract management; complications; chronic pancreatitis) 50 relevant questions were defined. Evidence was classified according to the UpToDate(®) grading system. The draft of the guidelines was presented and discussed at the consensus meeting on September 12, 2014. All clinical statements were accepted with total (more than 95%) agreement. The present Hungarian Pancreatic Study Group guideline is the first evidence based pediatric pancreatitis guideline in Hungary. The present guideline is the first evidence-based pancreatic cancer guideline in Hungary that provides a solid ground for teaching purposes, offers quick reference for daily patient care in pediatric pancreatitis and guides financing options. The authors strongly believe that these guidelines will become a standard reference for pancreatic cancer treatment in Hungary.

  8. Complementarity of Clinician Judgment and Evidence Based Models in Medical Decision Making: Antecedents, Prospects, and Challenges.

    PubMed

    Lulin, Zhou; Yiranbon, Ethel; Asante Antwi, Henry

    2016-01-01

    Early accounts of the development of modern medicine suggest that the clinical skills, scientific competence, and doctors' judgment were the main impetus for treatment decision, diagnosis, prognosis, therapy assessment, and medical progress. Yet, clinician judgment has its own critics and is sometimes harshly described as notoriously fallacious and an irrational and unfathomable black box with little transparency. With the rise of contemporary medical research, the reputation of clinician judgment has undergone significant reformation in the last century as its fallacious aspects are increasingly emphasized relative to the evidence based options. Within the last decade, however, medical forecasting literature has seen tremendous change and new understanding is emerging on best ways of sharing medical information to complement the evidence based medicine practices. This review revisits and highlights the core debate on clinical judgments and its interrelations with evidence based medicine. It outlines the key empirical results of clinician judgments relative to evidence based models and identifies its key strengths and prospects, the key limitations and conditions for the effective use of clinician judgment, and the extent to which it can be optimized and professionalized for medical use.

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

    PubMed

    Packard, Thomas; Shih, Amber

    2014-01-01

    Planned organizational change processes can be used to address the many challenges facing human service organizations (HSOs) and improve organizational outcomes. There is massive literature on organizational change, ranging from popular management books to academic research on specific aspects of change. Regarding HSOs, there is a growing literature, including increasing attention to implementation science and evidence-based practices. However, research which offers generalizable, evidence-based guidelines for implementing change is not common. The purpose of the authors was to assess the evidence base in this organizational change literature to lay the groundwork for more systematic knowledge development in this important field.

  10. A web-based library consult service for evidence-based medicine: Technical development

    PubMed Central

    Schwartz, Alan; Millam, Gregory

    2006-01-01

    Background Incorporating evidence based medicine (EBM) into clinical practice requires clinicians to learn to efficiently gain access to clinical evidence and effectively appraise its validity. Even using current electronic systems, selecting literature-based data to solve a single patient-related problem can require more time than practicing physicians or residents can spare. Clinical librarians, as informationists, are uniquely suited to assist physicians in this endeavor. Results To improve support for evidence-based practice, we have developed a web-based EBM library consult service application (LCS). Librarians use the LCS system to provide full text evidence-based literature with critical appraisal in response to a clinical question asked by a remote physician. LCS uses an entirely Free/Open Source Software platform and will be released under a Free Software license. In the first year of the LCS project, the software was successfully developed and a reference implementation put into active use. Two years of evaluation of the clinical, educational, and attitudinal impact on physician-users and librarian staff are underway, and expected to lead to refinement and wide dissemination of the system. Conclusion A web-based EBM library consult model may provide a useful way for informationists to assist clinicians, and is feasible to implement. PMID:16542453

  11. Prior conditions influencing nurses' decisions to adopt evidence-based postoperative pain assessment practices.

    PubMed

    Carlson, Cathy L

    2010-12-01

    Over the past 30 years, postoperative pain relief has been shown to be inadequate. To provide optimal postoperative pain relief, it is imperative for nurses to use evidence-based postoperative pain assessment practices. This correlational descriptive study was conducted to identify factors, termed prior conditions, that influenced nurses' decisions to adopt three evidence-based postoperative pain assessment practices. A convenience sample of nurses who cared for adult postoperative patients in two Midwestern hospitals were surveyed, and 443 (46.9%) nurses responded. The previous practice and innovativeness of nurses were supportive of adoption of the three practices. Nurses felt that patients received adequate pain relief, which is unsupportive of adoption of the three practices because there is no impetus to change. Nurses who perceived the prior conditions as being supportive of adoption of pain management practices used multiple sources to identify solutions to clinical practice problems, and those who read professional nursing journals were more likely to have adopted the three practices and were more innovative. The number of sources used to identify solutions to clinical practice problems, previous practices, and innovativeness were predictive of nurses' adoption of the three evidence-based postoperative pain assessment practices. Nurses need to be encouraged to use multiple sources, including professional nursing journals, to identify solutions to clinical practice problems. Innovative nurses may be considered to be opinion leaders and need to be identified to promote the adoption of evidence-based postoperative pain assessment practices. Further exploration of the large unexplained variance in adoption of evidence-based postoperative pain assessment practices is needed.

  12. Evidence-Based Appraisal of Antireflux Fundoplication

    PubMed Central

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

    2004-01-01

    recurrence when compared with no division. The use of ultrasonic scalpel compared with clips or bipolar cautery for the division of short gastric vessels showed no significant effect on operative time, postoperative complications, and costs. Conclusions: Laparoscopic antireflux surgery is at least as safe and as effective as its open counterpart, with reduced morbidity, shortened postoperative stay, and sick leave. Partial fundoplication significantly reduces the risk of reoperations for failure over total fundoplication. Routine versus no division of short gastric vessels showed no significant advantages. A word of caution is needed when implementing these results derived from RCTs performed in specialized centers into everyday clinical practice, where experience and skills may be suboptimal. PMID:15075649

  13. Rotator cuff tears: An evidence based approach

    PubMed Central

    Sambandam, Senthil Nathan; Khanna, Vishesh; Gul, Arif; Mounasamy, Varatharaj

    2015-01-01

    Lesions of the rotator cuff (RC) are a common occurrence affecting millions of people across all parts of the globe. RC tears are also rampantly prevalent with an age-dependent increase in numbers. Other associated factors include a history of trauma, limb dominance, contralateral shoulder, smoking-status, hypercholesterolemia, posture and occupational dispositions. The challenge lies in early diagnosis since a high proportion of patients are asymptomatic. Pain and decreasing shoulder power and function should alert the heedful practitioner in recognizing promptly the onset or aggravation of existing RC tears. Partial-thickness tears (PTT) can be bursal-sided or articular-sided tears. Over the course of time, PTT enlarge and propagate into full-thickness tears (FTT) and develop distinct chronic pathological changes due to muscle retraction, fatty infiltration and muscle atrophy. These lead to a reduction in tendon elasticity and viability. Eventually, the glenohumeral joint experiences a series of degenerative alterations - cuff tear arthropathy. To avert this, a vigilant clinician must utilize and corroborate clinical skill and radiological findings to identify tear progression. Modern radio-diagnostic means of ultrasonography and magnetic resonance imaging provide excellent visualization of structural details and are crucial in determining further course of action for these patients. Physical therapy along with activity modifications, anti-inflammatory and analgesic medications form the pillars of nonoperative treatment. Elderly patients with minimal functional demands can be managed conservatively and reassessed at frequent intervals. Regular monitoring helps in isolating patients who require surgical interventions. Early surgery should be considered in younger, active and symptomatic, healthy patients. In addition to being cost-effective, this helps in providing a functional shoulder with a stable cuff. An easily reproducible technique of maximal strength and

  14. The Evidence-Based Practice of Applied Behavior Analysis.

    PubMed

    Slocum, Timothy A; Detrich, Ronnie; Wilczynski, Susan M; Spencer, Trina D; Lewis, Teri; Wolfe, Katie

    2014-05-01

    Evidence-based practice (EBP) is a model of professional decision-making in which practitioners integrate the best available evidence with client values/context and clinical expertise in order to provide services for their clients. This framework provides behavior analysts with a structure for pervasive use of the best available evidence in the complex settings in which they work. This structure recognizes the need for clear and explicit understanding of the strength of evidence supporting intervention options, the important contextual factors including client values that contribute to decision making, and the key role of clinical expertise in the conceptualization, intervention, and evaluation of cases. Opening the discussion of EBP in this journal, Smith (The Behavior Analyst, 36, 7-33, 2013) raised several key issues related to EBP and applied behavior analysis (ABA). The purpose of this paper is to respond to Smith's arguments and extend the discussion of the relevant issues. Although we support many of Smith's (The Behavior Analyst, 36, 7-33, 2013) points, we contend that Smith's definition of EBP is significantly narrower than definitions that are used in professions with long histories of EBP and that this narrowness conflicts with the principles that drive applied behavior analytic practice. We offer a definition and framework for EBP that aligns with the foundations of ABA and is consistent with well-established definitions of EBP in medicine, psychology, and other professions. In addition to supporting the systematic use of research evidence in behavior analytic decision making, this definition can promote clear communication about treatment decisions across disciplines and with important outside institutions such as insurance companies and granting agencies.

  15. Evidence-based medicine: a new tool for resource allocation?

    PubMed

    Nunes, Rui

    2003-01-01

    Evidence-Based Medicine (EBM) is defined as the conscious, and judicious use of current best evidence in making decisions about the care of individual patients. The greater the level of evidence the greater the grade of recommendation. This pioneering explicit concept of EBM is embedded in a particular view of medical practice namely the singular nature of the patient-physician relation and the commitment of the latter towards a specific goal: the treatment and the well being of his or her client. Nevertheless, in many European countries as well as in the United States, this "integration of the best evidence from systematic research with clinical expertise and patient values" appears to be re-interpreted in light of the scarcity of healthcare resources. The purpose of this paper is double. First, to claim that from an ethical perspective EBM should be a guideline to clinical practice; and second, that in specific circumstances EBM might be a useful tool in macro-allocation of healthcare resources. Methodologically the author follows Norman Daniels' theory of "democratic accountability" to justify this assumption. That is, choices in healthcare must be accountable by democratic procedures. This perspective of distributive justice is responsible for the scope and limits of healthcare services. It follows that particular entitlements to healthcare--namely expensive innovative treatments and medicines--may be fairly restricted as long as this decision is socially and democratically accountable and imposed by financial restrictions of the system. In conclusion, the implementation of EBM, as long as it limits the access to drugs and treatments of unproven scientific results is in accordance with this perspective. The use of EBM is regarded as an instrument to facilitate the access of all citizens to a reasonable level of healthcare and to promote the efficiency of the system.

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

    PubMed

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

    2007-07-01

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

  17. How to Reach Evidence-Based Usability Evaluation Methods.

    PubMed

    Marcilly, Romaric; Peute, Linda

    2017-01-01

    This paper discusses how and why to build evidence-based knowledge on usability evaluation methods. At each step of building evidence, requisites and difficulties to achieve it are highlighted. Specifically, the paper presents how usability evaluation studies should be designed to allow capitalizing evidence. Reciprocally, it presents how evidence-based usability knowledge will help improve usability practice. Finally, it underlines that evaluation and evidence participate in a virtuous circle that will help improve scientific knowledge and evaluation practice.

  18. Organizational change strategies for evidence-based practice.

    PubMed

    Newhouse, Robin P; Dearholt, Sandi; Poe, Stephanie; Pugh, Linda C; White, Kathleen M

    2007-12-01

    Evidence-based practice, a crucial competency for healthcare providers and a basic force in Magnet hospitals, results in better patient outcomes. The authors describe the strategic approach to support the maturation of The Johns Hopkins Nursing evidence-based practice model through providing leadership, setting expectations, establishing structure, building skills, and allocating human and material resources as well as incorporating the model and tools into undergraduate and graduate education at the affiliated university.

  19. Nutritional interventions in primary mitochondrial disorders: Developing an evidence base.

    PubMed

    Camp, Kathryn M; Krotoski, Danuta; Parisi, Melissa A; Gwinn, Katrina A; Cohen, Bruce H; Cox, Christine S; Enns, Gregory M; Falk, Marni J; Goldstein, Amy C; Gopal-Srivastava, Rashmi; Gorman, Gráinne S; Hersh, Stephen P; Hirano, Michio; Hoffman, Freddie Ann; Karaa, Amel; MacLeod, Erin L; McFarland, Robert; Mohan, Charles; Mulberg, Andrew E; Odenkirchen, Joanne C; Parikh, Sumit; Rutherford, Patricia J; Suggs-Anderson, Shawne K; Tang, W H Wilson; Vockley, Jerry; Wolfe, Lynne A; Yannicelli, Steven; Yeske, Philip E; Coates, Paul M

    2016-11-01

    In December 2014, a workshop entitled "Nutritional Interventions in Primary Mitochondrial Disorders: Developing an Evidence Base" was convened at the NIH with the goals of exploring the use of nutritional interventions in primary mitochondrial disorders (PMD) and identifying knowledge gaps regarding their safety and efficacy; identifying research opportunities; and forging collaborations among researchers, clinicians, patient advocacy groups, and federal partners. Sponsors included the NIH, the Wellcome Trust, and the United Mitochondrial Diseases Foundation. Dietary supplements have historically been used in the management of PMD due to their potential benefits and perceived low risk, even though little evidence exists regarding their effectiveness. PMD are rare and clinically, phenotypically, and genetically heterogeneous. Thus patient recruitment for randomized controlled trials (RCTs) has proven to be challenging. Only a few RCTs examining dietary supplements, singly or in combination with other vitamins and cofactors, are reported in the literature. Regulatory issues pertaining to the use of dietary supplements as treatment modalities further complicate the research and patient access landscape. As a preface to exploring a research agenda, the workshop included presentations and discussions on what PMD are; how nutritional interventions are used in PMD; challenges and barriers to their use; new technologies and approaches to diagnosis and treatment; research opportunities and resources; and perspectives from patient advocacy, industry, and professional organizations. Seven key areas were identified during the workshop. These areas were: 1) defining the disease, 2) clinical trial design, 3) biomarker selection, 4) mechanistic approaches, 5) challenges in using dietary supplements, 6) standards of clinical care, and 7) collaboration issues. Short- and long-term goals within each of these areas were identified. An example of an overarching goal is the enrollment

  20. Evidence-based genetic counselling implications for Huntington disease intermediate allele predictive test results.

    PubMed

    Semaka, A; Hayden, M R

    2014-04-01

    Intermediate alleles (IAs) for Huntington disease (HD) contain 27-35 CAG repeats, a range that falls just below the disease threshold of 36 repeats. While there is no firm evidence that IAs confer the HD phenotype, they are prone to germline CAG repeat instability, particularly repeat expansion when paternally transmitted. Consequently, offspring may inherit a new mutation and develop the disease later in life. Over the last 5 years there has been a renewed interest in IAs. This article provides an overview of the latest research on IAs, including their clinical implications, frequency, haplotype, and likelihood of CAG repeat expansion, as well as patient understanding and current genetic counselling practices. The implications of this growing evidence base for clinical practice are also highlighted. These evidence-based genetic counselling implications may help ensure individuals with an IA predictive test result receive appropriate support, education, and counselling.

  1. Some limits to evidence-based medicine: a case study from elective orthopaedics

    PubMed Central

    Ferlie, E.; Wood, M.; Fitzgerald, L.

    1999-01-01

    There has been growing interest in recent years in the application of the principles of evidence-based medicine (EBM), although implementation is complex. Scientific, organisational, and behavioural factors all combine to shape clinical behaviour change. Case study based qualitative data are presented which illuminate such processes within one clinical setting (elective orthopaedics), drawn from a larger study. It is suggested that (1) there are alternative models of what constitutes "evidence" in use; (2) scientific knowledge is in part socially constructed; and (3) clinical professionals retain a monopoly of technical knowledge. The implication is that there may be severe obstacles to the rapid or broad implementation of EBM. PMID:10557685

  2. Evidence-Based Practice in Communication Disorders: What Do We Know, and When Do We Know It?

    ERIC Educational Resources Information Center

    Dollaghan, Christine A.

    2004-01-01

    Evidence-based practice (EBP), a framework that originated in clinical medicine, offers a principled means of addressing longstanding questions about clinical practice in communication disorders. However, in several respects EBP represents a radical departure from traditional thinking in speech-language pathology and audiology. In this paper, I…

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

    PubMed

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

    2014-01-01

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

  4. Strengths and Limitations of Evidence-Based Dermatology

    PubMed Central

    Williams, Hywel C

    2014-01-01

    The need for understanding and reflecting on evidence-based dermatology (EBD) has never been greater given the exponential growth of new external evidence to inform clinical practice. Like any other branch of medicine, dermatologists need to acquire new skills in constructing answerable questions, efficiently searching electronic bibliographic databases, and critically appraising different types of studies. Secondary summaries of evidence in the form of systematic reviews (SR), that is, reviews that are conducted in a systematic, unbiased and explicit manner, reside at the top of the evidence hierarchy, because they are less prone to bias than traditional expert reviews. In addition to providing summaries of the best external evidence, systematic reviews and randomized controlled trials (RCTs) are also powerful ways of identifying research gaps and ultimately setting the agenda of future clinical research in dermatology. But like any paradigm, EBD can have its limitations. Wrong application, misuse and overuse of EBD can have serious consequences. For example, mindless pooling together of data from dissimilar studies in a meta-analysis may render it a form of reductionism that does not make any sense. Similarly, even highly protocolised study designs such as SRs and RCTs are still susceptible to some degree of dishonesty and bias. Over-reliance on randomized controlled trials (RCT) may be inappropriate, as RCTs are not a good source for picking up rare but important adverse effects such as lupus syndrome with minocycline. A common criticism leveled against SRs is that these frequently conclude that there is lack of sufficient evidence to inform current clinical practice, but arguably, such a perception is grounded more on the interpretation of the SRs than anything else. The apparent absence of evidence should not paralyze the dermatologist to adopt a state of therapeutic nihilism. Poor primary data and an SR based on evidence that is not up-to-date are also

  5. Nursing faculty mentors as facilitators for evidence-based nursing practice.

    PubMed

    Jeffers, Brenda Recchia; Robinson, Sherry; Luxner, Karla; Redding, Donna

    2008-01-01

    Increasing use of evidence-based practice (EBP) within complex healthcare organizations requires the identification of individuals who will support and facilitate new practice patterns. In a large Midwestern hospital, a diverse group of academic nursing faculty functioning as mentors to develop clinical nurses' skills in the use of EBP has demonstrated early success. This article highlights the context, challenges, and successes of faculty mentors for developing nursing staff's involvement in and use of EBP.

  6. The information infrastructure that supports evidence-based veterinary medicine: a comparison with human medicine.

    PubMed

    Toews, Lorraine

    2011-01-01

    In human medicine, the information infrastructure that supports the knowledge translation processes of exchange, synthesis, dissemination, and application of the best clinical intervention research has developed significantly in the past 15 years, facilitating the uptake of research evidence by clinicians as well as the practice of evidence-based medicine. Seven of the key elements of this improved information infrastructure are clinical trial registries, research reporting standards, systematic reviews, organizations that support the production of systematic reviews, the indexing of clinical intervention research in MEDLINE, clinical search filters for MEDLINE, and point-of-care decision support information resources. The objective of this paper is to describe why these elements are important for evidence-based medicine, the key developments and issues related to these seven information infrastructure elements in human medicine, how these 7 elements compare with the corresponding infrastructure elements in veterinary medicine, and how all of these factors affect the translation of clinical intervention research into clinical practice. A focused search of the Ovid MEDLINE database was conducted for English language journal literature published between 2000 and 2010. Two bibliographies were consulted and selected national and international Web sites were searched using Google. The literature reviewed indicates that the information infrastructure supporting evidence-based veterinary medicine practice in all of the 7 elements reviewed is significantly underdeveloped in relation to the corresponding information infrastructure in human medicine. This lack of development creates barriers to the timely translation of veterinary medicine research into clinical practice and also to the conduct of both primary clinical intervention research and synthesis research.

  7. Perspectives on evidence based practice in ABI rehabilitation. "Relevant Research": who decides?

    PubMed

    Wiseman-Hakes, Catherine; MacDonald, Sheila; Keightley, Michelle

    2010-01-01

    Growing evidence suggests that acquired brain injury (ABI) rehabilitation and research should be guided by a philosophy that focuses on: restoration, compensation, function and participation in all aspects of daily life. Such a broad, more pluralistic approach influences ABI rehabilitation research at a number of levels, including both the generation of evidence, and in searching for, critiquing and applying the evidence to practice. The objective of evidence based medicine/practice (EBM/EBP) is to apply and integrate clinical expertise with evidence gained through systematic research and scientific inquiry to medical/clinical practice. While there is abundant literature debating the practical and sociological implications of EBP, there has been limited examination of EBP within the inherently complex nature of ABI rehabilitation and rehabilitation research. This paper provides a framework for clinical decision making regarding evidence based practice in the context of ABI rehab including: 1. A discussion of the purpose of evidence based practice, 2. Levels of evidence relevant to ABI rehabilitation research, and 3. A rationale for incorporating a broader, more pluralistic concept of evidence or "person-centred EBP". We conclude with a series of key questions for the evaluation and application of systematic reviews of the evidence in the context of ABI rehabilitation.

  8. [Acute pancreatitis. Evidence-based practice guidelines, prepared by the Hungarian Pancreatic Study Group].

    PubMed

    Hritz, István; Czakó, László; Dubravcsik, Zsolt; Farkas, Gyula; Kelemen, Dezső; Lásztity, Natália; Morvay, Zita; Oláh, Attila; Pap, Ákos; Párniczky, Andrea; Sahin-Tóth, Miklós; Szentkereszti, Zsolt; Szmola, Richárd; Szücs, Ákos; Takács, Tamás; Tiszlavicz, László; Hegyi, Péter

    2015-02-15

    Acute pancreatitis is one of the most common diseases of the gastrointestinal tract associated with significant morbidity and mortality that requires up-to-date and evidence based treatment guidelines. The Hungarian Pancreatic Study Group proposed to prepare evidence based guideline for the medical and surgical management of acute pancreatitis based on the available international guidelines and evidence. The preparatory and consultation task force appointed by the Hungarian Pancreatic Study Group translated and, if it was necessary, complemented and/or modified the international guidelines. All together 42 relevant clinical questions were defined in 11 topics (Diagnosis and etiology, Prognosis, Imaging, Fluid therapy, Intensive care management, Prevention of infectious complications, Nutrition, Biliary interventions, Post-endoscopic retrograde cholangio-pancreatography pancreatitis, Indication, timing and strategy for intervention in necrotizing pancreatitis, Timing of cholecystectomy [or endoscopic sphincterotomy]). Evidence was classified according to the UpToDate® grading system. The draft of the guideline was presented and discussed at the consensus meeting on September 12, 2014. 25 clinical questions with almost total (more than 95%) and 17 clinical questions with strong (more than 70%) agreement were accepted. The present guideline is the first evidence based acute pancreatitis guideline in Hungary. The guideline may provide important help for tuition, everyday practice and for establishment of proper finance of acute pancreatitis. Therefore, the authors believe that these guidelines will widely become as basic reference in Hungary.

  9. Using Evidence-Based Design to Improve Pharmacy Department Efficiency.

    PubMed

    Greenroyd, Fraser L; Hayward, Rebecca; Price, Andrew; Demian, Peter; Sharma, Shrikant

    2016-10-01

    Using a case study of a pharmacy department rebuild in the South West of England, this article examines the use of evidence-based design to improve the efficiency and staff well-being with a new design. This article compares three designs, the current design, an anecdotal design, and an evidence-based design, to identify how evidence-based design can improve efficiency and staff well-being by reducing walking time and distance. Data were collected from the existing building and used to measure the efficiency of the department in its current state. These data were then mapped onto an anecdotal design, produced by architects from interviews and workshops with the end users, and an evidence-based design, produced by highlighting functions with high adjacencies. This changed the view on the working processes within the department, shifting away from a focus on the existing robotic dispensing system. Using evidence-based design was found to decrease the walking time and distance for staff by 24%, as opposed to the anecdotal design, which increased these parameters by 9%, and is predicted to save the department 248 min across 2 days in staff time spent walking.

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed

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

    2015-04-21

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

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

    PubMed

    Evans, R

    2009-01-01

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

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

    PubMed

    Lindoerfer, Doris; Mansmann, Ulrich

    2016-01-01

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

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

    PubMed

    Robb, Meigan; Shellenbarger, Teresa

    2014-10-01

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

  15. Evidence based mental healthcare and service innovation: review of concepts and challenges.

    PubMed

    Kouimtsidis, Ch; John-Smith, St; Kemp, P; Ikkos, G

    2013-01-01

    Health provision systems in the developed western nations are currently facing major financial challenges. In order to meet these challenges, a number of new approaches used to assist the provision of health have been introduced, including the practice of health professionals. These approaches utilize specific methods of data capture and summarization such as: evidence based medicine (EBM) and practice guidelines. Evidence is generated from systematic clinical research as well as reported clinical experience and individually case based empirical evidence. All types of research though (quantitative or qualitative) have limitations. Similarly all types of evidence have advantages and disadvantages and can be complimentary to each other. Evidencebased individual decision (EBID) making is the commonest evidence-based medicine as practiced by the individual clinician in making decisions about the care of the individual patient. It involves integrating individual clinical expertise with the best available external clinical evidence from systematic research. However this sort of evidence-based medicine, focuses excessively on the individual (potentially at the expense of others) in a system with limited budgets. Evidence-based guidelines (EBG) also support the practice of evidence-based medicine but at the organizational or institutional level. The main aim is to identify which interventions, over a range of patients, work best and which is cost-effective in order to guide service development and provision at a strategic level. Doing this effectively is a scientific and statistical skill in itself and the quality of guidelines is based primarily on the quality research evidence. It is important to note that lack of systematic evidence to support an intervention does not automatically mean that an intervention must instantly be abandoned. It is also important that guidelines are understood for what they are, i.e. not rules, or complete statements of knowledge. EBM will

  16. Meeting the information needs of clinicians for the practice of evidence-based healthcare.

    PubMed

    Pyne, T; Newman, K; Leigh, S; Cowling, A; Rounce, K

    1999-03-01

    This article reports on clinicians' use of library resources and the competencies they require to access information necessary for the practice of evidence-based healthcare. It is based on the results of a study commissioned by North Thames Region to identify the training needs of clinicians for the adoption and practice of evidence-based healthcare. Participants in this qualitative research study included librarians, clinicians (doctors, nurses and PAMs) and managers from four Acute and Community Trusts in and around London. The research indicates that the majority of clinicians recognize the need to keep up-to-date with changes in their specialty and many visit their libraries on a frequent basis, however, few appear to be searching for information with which to inform their immediate clinical decisions. Our sample acknowledged their low usage of journals such as Bandolier, the Health Effectiveness Bulletin and Journal of Evidence-Based Medicine. Similarly, low use of electronic databases, such as Cochrane and Cinahl, were reported. Examination of skill and self-efficacy levels in accessing and using information databases revealed wide variations across professions, specialities and Trusts. Qualitative research methods were employed to elicit the key competencies required to access clinically relevant research evidence, and a framework for integrating these competencies is presented.

  17. [Chronic pancreatitis. Evidence based management guidelines of the Hungarian Pancreatic Study Group].

    PubMed

    Takács, Tamás; Czakó, László; Dubravcsik, Zsolt; Farkas, Gyula; Hegyi, Péter; Hritz, István; Kelemen, Dezső; Lásztity, Natália; Morvay, Zita; Oláh, Attila; Pap, Ákos; Párniczky, Andrea; Patai, Árpád; Sahin-Tóth, Miklós; Szentkereszti, Zsolt; Szmola, Richárd; Tiszlavicz, László; Szücs, Ákos

    2015-02-15

    Chronic pancreatitis is an inflammatory disease associated with structural and functional damage of the pancreas. In most cases pain, maldigestion and weight loss are the leading symptoms, which significantly worsen the quality of life. Correct diagnosis and differential diagnosis of chronic pancreatitis and treatment of these patients requires up-to-date and evidence based treatment guidelines. The Hungarian Pancreatic Study Group proposed to prepare an evidence based guideline based on the available international guidelines and evidence. The preparatory and consultation task force appointed by the Hungarian Pancreatic Study Group translated and complemented and/or modified the international guidelines if it was necessary. 123 relevant clinical questions in 11 topics were defined. Evidence was classified according to the UpToDate® grading system. The draft of the guidelines were presented and discussed at the consensus meeting in September 12, 2014. All clinical questions were accepted with total or strong agreement. The present guideline is the first evidence based guideline for chronic pancreatitis in Hungary. This guideline provides very important and helpful data for tuition, everyday practice and proper financing of chronic pancreatitis. Therefore, the authors believe that these guidelines will widely become a basic reference in Hungary.

  18. Application of the principles of evidence-based medicine to laboratory medicine.

    PubMed

    Price, Christopher P

    2003-07-15

    The principles of evidence-based medicine and the consequent search for robust evidence on outcomes plays a central role in the practice of laboratory medicine. The core of the evidence lies in an explicit recognition of the clinical question(s) that the test result can address. Studies that focus on the relevant patient cohort and clinical setting for the test, and identify the appropriate outcome measure will generate information that can be used to guide use of the test, identify the benefits, and thereby support the case for investment of resources to deliver the service.

  19. An evidence-based journal club for dental residents in a GPR program.

    PubMed

    Grant, William D

    2005-06-01

    The journal club offers a significant opportunity to serve as both an educational experience but also as a real-world example of the application of the principles and practices of evidence-based dentistry (EBD). Designed around the American Dental Association's recommended four steps in the implementation of the EBD process, the journal clubs are held once per month for GPR residents. The structured process allows residents to formulate answerable clinical questions, track down with maximum efficiency the best evidence with which to answer the questions, critically appraise the evidence for its validity and usefulness, and apply the results of this appraisal in clinical practice as appropriate.

  20. Evidence based practice and advanced competencies in a MHS-CLS program.

    PubMed

    Russell, Barbara; Kraj, Barbara; Pretlow, Lester; Ranne, Anne; Leibach, Elizabeth K

    2011-01-01

    The goals, curriculum, implementation, and immediate impacts of an entry-level Master of Health Science in Clinical Laboratory Science (MHS-CLS) degree are described as compared to the baccalaureate program (BS-CLS) in the same institution. The MHS-CLS program was instituted in fall semester, 2008; the inaugural class graduated in spring semester 2010. To document the need for the MHS-CLS, program statistics, such as the number of students entering the current BS-CLS program with previous baccalaureate degrees, numbers of students graduating with biology and chemistry degrees in the United States, CLS workforce shortages and pending retirement statistics were used. The shortage of CLS practitioners able to perform and publish evidence-based practice research also supported program need. The MHS-CLS curriculum includes advanced courses, advanced competencies incorporated into existing BS-CLS courses, and a capstone research project in evidence based practice.

  1. Proof of concept: Developing a peer reviewed, evidence-based, interactive e-learning programme.

    PubMed

    Sinclair, Peter; Schoch, Monica; Black, Kirsten; Woods, Matthew

    2011-06-01

    Knowledge and skill acquisition related to vascular access are traditionally individual institutional educational initiatives. Australia currently has no national evidence based education programme for renal nurses. A survey of Australian and New Zealand Nephrology Educators' conducted in 2009, identified the need for more effective and consistent delivery of clinical education for nurses using innovative, web-based approaches supporting the tenets of e-learning methodologies. This paper discusses the development, implementation and proposed evaluation of a peer reviewed Australasian e-learning programme on buttonhole cannulation. It will further highlight the benefits of inter-organisational partnerships and how these partnerships can facilitate positive change in teaching and learning practices. This project has unique characteristics that collectively provide value, distinction and innovation to nurses, patients and renal departments. As the e-learning programme was founded on a platform of evidence-based practice it is therefore easily transferable to an international context.

  2. Understanding barriers to evidence-based assessment: Clinician attitudes toward standardized assessment tools

    PubMed Central

    Jensen-Doss, Amanda; Hawley, Kristin M.

    2010-01-01

    In an era of evidence-based practice, why are clinicians not typically engaged in evidence-based assessment? To begin to understand this issue, a national multidisciplinary survey was conducted to examine clinician attitudes toward standardized assessment tools. 1442 child clinicians provided opinions about the psychometric qualities of these tools, their benefit over clinical judgment alone, and their practicality. Doctoral-level clinicians and psychologists expressed more positive ratings in all three domains than master’s-level clinicians and non-psychologists respectively, although only the disciplinary differences remained significant when predictors were examined simultaneously. All three attitude scales were predictive of standardized assessment tool use, although practical concerns were the strongest and only independent predictor of use. PMID:21058134

  3. Implications of holding ideas of evidence-based practice in nursing.

    PubMed

    Mitchell, Gail J

    2013-04-01

    The author of this paper examines emerging implications of holding ideas about evidence and evidence-based practice. Evidence has a very specific role in the delivery of safe clinical care, but it is creating a serious problematic for the practice of nursing. It is proposed that: evidence-based practice be re-situated or reconstructed as a collective and organizational responsibility and not the responsibility of individual nurses in practice; nurses re-focus on articulating a more ethical foundation for praxis, one that emerges from nursing philosophy and one that is co-constituted with persons/families/groups; and nurse leaders and educators establish teaching-learning and practice environments that enable a peer-to-peer process of critical review and curious inquiry of available evidence in the contexts of shared work.

  4. Research to support evidence-based practice in COPD community nursing.

    PubMed

    Kirkpatrick, Pamela; Wilson, Ethel; Wimpenny, Peter

    2012-10-01

    Evidence-based practice (EBP) is a requirement of nurses through the generation of evidence to implementing it, in a bid to to improve clinical practice. However, EBP is difficult to achieve. This paper highlights an approach to generating evidence for enhancing community nursing services for patients with chronic obstructive pulmonary disease (COPD) through a collaborative partnership. A district nurse and two nursing lecturers formed a partnership to devise a systematic review protocol and perform a systematic review to enhance COPD practice. This paper illustrates the Joanna Briggs Institute (JBI) systematic review process, the review outcomes and the practitioner learning. Collaborative partnerships between academics, researchers and clinicians are a potentially useful model to facilitate enhanced outcomes in evidence-based practice and evidence application.

  5. Parent ADHD and Evidence-Based Treatment for Their Children: Review and Directions for Future Research.

    PubMed

    Chronis-Tuscano, Andrea; Wang, Christine H; Woods, Kelsey E; Strickland, Jennifer; Stein, Mark A

    2017-04-01

    One fourth to one half of parents of children with attention-deficit/hyperactivity disorder (ADHD) have ADHD themselves, complicating delivery of evidence-based child behavioral and pharmacological treatments. In this article, we review the literature examining the relation between parent ADHD and outcomes following behavioral and pharmacological treatments for children with ADHD. We also review research that has incorporated treatment of parent ADHD (either alone or in combination with child treatment) with the goal of improving parenting and child outcomes. Finally, we offer recommendations for future research on the relation between parent ADHD and evidence-based treatment outcomes for their children, with the purpose of advancing the science and informing clinical care of these families.

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

    ERIC Educational Resources Information Center

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

    2012-01-01

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

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

    ERIC Educational Resources Information Center

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

    2009-01-01

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

  8. Interteaching: An Evidence-Based Approach to Instruction

    ERIC Educational Resources Information Center

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

    2014-01-01

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

  9. Evidence-Based Interprofessional Practice: Learning and Behaviour

    ERIC Educational Resources Information Center

    Littek, Celeste

    2013-01-01

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

  10. An Evidence-Based Course in Complementary Medicines

    PubMed Central

    Hughes, Jeff

    2012-01-01

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

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

    ERIC Educational Resources Information Center

    Embry, Dennis D.; Biglan, Anthony

    2008-01-01

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

  12. Evidence-Based Practice in Adapted Physical Education

    ERIC Educational Resources Information Center

    Jin, Jooyeon; Yun, Joonkoo

    2010-01-01

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

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

    ERIC Educational Resources Information Center

    Schaffner, Angela D.; Buchanan, Linda Paulk

    2010-01-01

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

  14. 75 FR 79455 - OPEN GOVERNMENT AND EVIDENCE-BASED REGULATION

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-12-20

    ... providing people with information that they ``can readily find and use.'' For this reason, he has said that agencies ``should harness new technologies'' and ``solicit public feedback to identify information of... EVIDENCE-BASED REGULATION There is a close connection, even an inextricable relationship, between...

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

    ERIC Educational Resources Information Center

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

    2015-01-01

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

  16. Toward an Evidence-Based Assessment of Pediatric Bipolar Disorder

    ERIC Educational Resources Information Center

    Youngstrom, Eric A.; Findling, Robert L.; Kogos Youngstrom, Jen; Calabrese, Joseph R.

    2005-01-01

    This article outlines a provisional evidence-based approach to the assessment of pediatric bipolar disorder (PBD). Public attention to PBD and the rate of diagnosis have both increased substantially in the past decade. Accurate diagnosis is crucial to avoid harm due to mislabeling or unnecessary medication exposure. Because there are no proven…

  17. Evidence-Based Assessment of Depression in Adults

    ERIC Educational Resources Information Center

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

    2005-01-01

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

  18. Barriers and Enablers to Evidence-Based Practices

    ERIC Educational Resources Information Center

    Foster, Robyn

    2014-01-01

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

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

    ERIC Educational Resources Information Center

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

    2012-01-01

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

  20. Evidence-Based Library Management: The Leadership Challenge

    ERIC Educational Resources Information Center

    Lakos, Amos

    2007-01-01

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

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

    ERIC Educational Resources Information Center

    Kosciulek, John F.

    2010-01-01

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

  2. Unraveling Evidence-Based Practices in Special Education

    ERIC Educational Resources Information Center

    Cook, Bryan G.; Cook, Sara Cothren

    2013-01-01

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

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

    ERIC Educational Resources Information Center

    Hempenstall, Kerry

    2014-01-01

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

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

    ERIC Educational Resources Information Center

    Cook, Bryan G.; Odom, Samuel L.

    2013-01-01

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

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

    ERIC Educational Resources Information Center

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

    2005-01-01

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

  6. Evidence Based Education Request Desk. EBE #833A

    ERIC Educational Resources Information Center

    Regional Educational Laboratory Southeast, 2011

    2011-01-01

    Over the past decade, research on dropout prevention has become focused on using evidence-based practice, and data-driven decisions, to mitigate students' dropping out of high school and instead, support and prepare students for career and college. Early warning systems or on-track indicators, in which readily available student-level data are used…

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

    ERIC Educational Resources Information Center

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

    2003-01-01

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

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

    PubMed

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

    2010-10-01

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

  9. Evidence-Based Psychosocial Treatments for Ethnic Minority Youth

    ERIC Educational Resources Information Center

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

    2008-01-01

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

  10. Evidence-Based Psychotherapy Practice in College Mental Health

    ERIC Educational Resources Information Center

    Cooper, Stewart E.

    2005-01-01

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

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

    ERIC Educational Resources Information Center

    David-Ferdon, Corinne; Kaslow, Nadine J.

    2008-01-01

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

  12. Organizing for Evidence-Based Decision Making and Improvement

    ERIC Educational Resources Information Center

    Leimer, Christina

    2012-01-01

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

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

    PubMed

    Beck, Mary S; Staffileno, Beth A

    2012-01-01

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

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

    ERIC Educational Resources Information Center

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

    2009-01-01

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

  15. An Evidence Based Approach to Sepsis: Educational Program

    ERIC Educational Resources Information Center

    Perez, Dolores

    2015-01-01

    Evidence-based guidelines for recognizing and treating sepsis have been available for decades, yet healthcare providers do not adhere to the recommendations. Sepsis can progress rapidly if not recognized early. Literature reports reveal that sepsis is the leading cause of death in non-cardiac intensive care units (ICUs), and it is one of the most…

  16. Evidence-Based Practice among Speech-Language Pathologists

    ERIC Educational Resources Information Center

    Zipoli, Richard P., Jr.; Kennedy, Marianne

    2005-01-01

    A total of 240 speech-language pathologists responded to a questionnaire examining attitudes toward and use of research and evidence-based practice (EBP). Perceived barriers to EBP were also explored. Positive attitudes toward research and EBP were reported. Attitudes were predicted by exposure to research and EBP practice during graduate training…

  17. Not Funding the Evidence-Based Model in Ohio

    ERIC Educational Resources Information Center

    Edlefson, Carla

    2010-01-01

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

  18. [Evaluation of an internet site on evidence-based medicine].

    PubMed

    Mathys, J; Steurer, J

    2000-10-19

    The present study evaluated a Swiss internet provider of Evidence-based Medicine (EBM) with regard to its utilization and function for medical practitioners. The internet provider under study (www.evimed.ch) primarily provides abstracts of original articles relevant to medical practice that are presented according to the criteria of EBM and includes information about EBM itself. In March 1999 a survey was conducted to better appraise the benefits gained from the information provided from the website visitors' point of view. Around 400 persons who had entered their names in the homepage guest book were informed about the survey by e-mail. A total of 167 questionnaires were filled in online, which is equivalent to the reply rate of close to 42%. The majority of the replies (63.5%) were from private-practice physicians, 22.2% from hospital-based physicians. The average age ranged between 40 and 49 years. 67.7% of the 167 respondents had internet access at their workplace, 72.5% had private internet access. For their own practical work, 61.1% of the respondents rated the information provided by www.evimed.ch as generally useful. The clinical relevance of the studies presented in the Journal Club was rated as good by 55.7% and as very good by 26.9%. The reliability of the information provided was rated as good by 56.3% and as very good by 35.3%. The majority regarded the following homepage sites as personally important: Journal Club (55.7%), articles about EBM (46.1%), MEDLINE access (37.7%) and article citations/links (41.3%). The homepage was visited at an average frequency of 1-3 times a month. 50.3% preferred electronic media (40.1% using various internet providers, 10.2% www.evimed.ch) and 44.3% preferred print media to search for specialist information on a specific medical subject. With regard to new medical findings, 44.9% of the respondents stated that they used print media, 17.4% the www.evimed.ch homepage and 28.7% other internet sources as their primary

  19. Pregnancy after kidney transplantation: an evidence-based approach.

    PubMed

    Mezza, E; Oggé, G; Attini, R; Rossetti, M; Soragna, G; Consiglio, V; Burdese, M; Vespertino, E; Tattoli, F; Gai, M; Motta, D; Segoloni, G P; Todros, T; Piccoli, G B

    2004-12-01

    Despite the relatively little space for transplantation in most medical schools, this issue is considered interesting by the students both for its clinical and ethical implications. The students were asked to choose a particular aspect of nephrology for a 2-hour case discussion. They chose the case of a 35-year-old female, kidney transplant recipient now 1.5 years postoperatively, who was coming to seek advice about pregnancy. The aim of the present work is to report an integration between narrative and evidence-based medicine (EBM) approaches. The search strategy was developed within a multidisciplinary working group, two of whose members were also masters in the methodology of systematic revisions. The first step in the discussion was the identification of ethical and methodological problem. In a rapidly developing field, books are unlikely to be able to give updated information. One needs to interact with electronic databases. In this context, no randomized controlled trial on pregnancy is expected. The evidence is likely to be heterogeneous. Prenatal care delivery differs around the world in part related to attitudes toward pregnancy, which depend upon religion and traditions. The second step was the definition of the search strategy. The third step, was selecting and cataloging the evidence. The titles and abstracts retrieved by the search strategy (272 items) were examined to identify full papers to be retrieved. The evidence retrieved was screened for the type of paper (reviews, primary studies, case reports, case series) and for the authors to give an indirect idea of duplicate publication bias. Teaching a complex and ever-changing subject, such as kidney transplantation, is a difficult task. The case of a young woman seeking information on the probability to undergo a successful pregnancy was particularly likely to exemplify the importance of being aware of the biases of the book-based information and on the need to interact with the internet. The search

  20. Evidence-Based Practice: Promoting Evidence-Based Interventions in School Psychology. WCER Working Paper No. 2003-13

    ERIC Educational Resources Information Center

    Kratochwill, Thomas R.; Shernoff, Elisa Steele

    2003-01-01

    The Evidence-Based Intervention (EBI) movement has gained tremendous momentum in the past few years with developments in psychology, medicine (e.g., psychiatry), education, and prevention science. The purpose of this paper is to present some of the issues relating to the adoption of EBIs in practice and, specifically, the multiple roles…