Portable Data Assistants: Potential in Evidence-Based Practice Autism Treatment

ERIC Educational Resources Information Center

Dunkel-Jackson, Sarah M.; Dixon, Mark R.; Szekely, Susan

2012-01-01

The emerging era of "evidence-based practice" emphasizes that human service agencies need to find effective and efficient means of training staff and implementing systems change based on scientific evidence. Additional advancements in technology use across populations and settings within the field have also served as a catalyst for the development…

Comment: What Constitutes Evidence in Science Education Research?

ERIC Educational Resources Information Center

Roth, Wolff-Michael

2011-01-01

In the wake of an increasing political commitment to evidence-based decision making and evidence-based educational reform that emerged with the No Child Left Behind effort, the question of what counts as evidence has become increasingly important in the field of science education. In current public discussions, academics, politicians, and other…

UK Parents' Beliefs about Applied Behaviour Analysis as an Approach to Autism Education

ERIC Educational Resources Information Center

Denne, Louise D.; Hastings, Richard P.; Hughes, J. Carl

2017-01-01

Research into factors underlying the dissemination of evidence-based practice is limited within the field of Applied Behaviour Analysis (ABA). This is pertinent, particularly in the UK where national policies and guidelines do not reflect the emerging ABA evidence base, or policies and practices elsewhere. Theories of evidence-based practice in…

Physician Leadership: Influence on Practice-Based Learning and Improvement

ERIC Educational Resources Information Center

Prather, Stephen E.; Jones, David N.

2003-01-01

In response to the technology and information explosion, practice-based learning and improvement is emerging within the medical field to deliver systematic practice-linked improvements. However, its emergence has been inhibited by the slow acceptance of evidence-based medicine among physicians, who are reluctant to embrace proven high-performance…

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…

An evidence-based approach to the evaluation and treatment of low back pain in the emergency department.

PubMed

Borczuk, Pierre

2013-07-01

Low back pain is the most common musculoskeletal complaint that results in a visit to the emergency department, and it is 1 of the top 5 most common complaints in emergency medicine. Estimates of annual healthcare expenditures for low back pain in the United States exceed $90 billion annually, not even taking lost productivity and business costs into account. This review explores an evidence-based rationale for the evaluation of the patient with low back pain, and it provides guidance on risk stratification pertaining to laboratory assessment and radiologic imaging in the emergency department. Published guidelines from the American College of Physicians and American Pain Society are reviewed, with emphasis on best evidence for pharmacologic treatments, self-care interventions, and more invasive procedures and surgery in management of low back pain. Utilizing effective and proven strategies will avoid medical errors, provide better care for patients, and help manage healthcare resources and costs.

Evidence-Based Practice at a Crossroads: The Timely Emergence of Common Elements and Common Factors

ERIC Educational Resources Information Center

Barth, Richard P.; Lee, Bethany R.; Lindsey, Michael A.; Collins, Kathryn S.; Strieder, Frederick; Chorpita, Bruce F.; Becker, Kimberly D.; Sparks, Jacqueline A.

2012-01-01

Social work is increasingly embracing evidence-based practice (EBP) as a decision-making process that incorporates the best available evidence about effective treatments given client values and preferences, in addition to social worker expertise. Yet, social work practitioners have typically encountered challenges with the application of…

Evidence-Based Practice and School Libraries: Interconnections of Evidence, Advocacy, and Actions

ERIC Educational Resources Information Center

Todd, Ross J.

2015-01-01

This author states that a professional focus on evidence based practice (EBP) for school libraries emerged from the International Association of School Librarianship conference when he presented the concept. He challenged the school library profession to actively engage in professional and reflective practices that chart, measure, document, and…

Evidence mapping: illustrating an emerging methodology to improve evidence-based practice in youth mental health.

PubMed

Hetrick, Sarah E; Parker, Alexandra G; Callahan, Patrick; Purcell, Rosemary

2010-12-01

Within the field of evidence-based practice, a process termed 'evidence mapping' is emerging as a less exhaustive yet systematic and replicable methodology that allows an understanding of the extent and distribution of evidence in a broad clinical area, highlighting both what is known and where gaps in evidence exist. This article describes the general principles of mapping methodology by using illustrations derived from our experience conducting an evidence map of interventions for youth mental-health disorders. Evidence maps are based on an explicit research question relating to the field of enquiry, which may vary in depth, but should be informed by end-users. The research question then drives the search for, and collection of, appropriate studies utilizing explicit and reproducible methods at each stage. This includes clear definition of components of the research question, development of a thorough and reproducible search strategy, development of explicit inclusion and exclusion criteria, and transparent decisions about the level of information to be obtained from each study. Evidence mapping is emerging as a rigorous methodology for gathering and disseminating up-to-date information to end-users. Thoughtful planning and assessment of available resources (e.g. staff, time, budget) are required by those applying this methodology to their particular field of clinical enquiry given the potential scope of the work. The needs of the end-user need to be balanced with available resources. Information derived needs to be effectively communicated, with the uptake of that evidence into clinical practice the ultimate aim. © 2010 The Authors. Journal compilation © 2010 Blackwell Publishing Ltd.

Contemporary evidence-based practice in Canadian emergency medical services: a vision for integrating evidence into clinical and policy decision-making.

PubMed

Jensen, Jan L; Travers, Andrew H

2017-05-01

Nationally, emphasis on the importance of evidence-based practice (EBP) in emergency medicine and emergency medical services (EMS) has continuously increased. However, meaningful incorporation of effective and sustainable EBP into clinical and administrative decision-making remains a challenge. We propose a vision for EBP in EMS: Canadian EMS clinicians and leaders will understand and use the best available evidence for clinical and administrative decision-making, to improve patient health outcomes, the capability and quality of EMS systems of care, and safety of patients and EMS professionals. This vision can be implemented with the use of a structure, process, system, and outcome taxonomy to identify current barriers to true EBP, to recognize the opportunities that exist, and propose corresponding recommended strategies for local EMS agencies and at the national level. Framing local and national discussions with this approach will be useful for developing a cohesive and collaborative Canadian EBP strategy.

Using Data to Advance Learning Outcomes in Schools

ERIC Educational Resources Information Center

VanDerHeyden, Amanda; Harvey, Mark

2013-01-01

This article describes the emergence and influence of evidence-based practice and data-based decision making in educational systems. Increasingly, educators and consumers want to know that resources allocated to educational efforts yield strong effects for all learners. This trend is reflected by the widespread influence of evidence-based practice…

Delivering the "Learning Factory"?: Evidence on HR Roles in Contemporary Manufacturing

ERIC Educational Resources Information Center

Barton, Harry; Delbridge, Rick

2006-01-01

Purpose: The purpose of this paper is to evidence the emergence of new forms of work organisation which if observed could be seen as consistent with the concept of the "learning factory". This is attempted through reporting the views of those workers engaged in team based operations and reflects upon the emerging role of first-line and…

Implementing evidence-based practices in an emergency department: contradictions exposed when prioritising a flow culture.

PubMed

Kirk, Jeanette W; Nilsen, Per

2016-02-01

An emergency department is typically a place of high activity where practitioners care for unanticipated presentations, which yields a flow culture so that actions that secure available beds are prioritised by the practitioners. How does the flow culture in an emergency department influence nurses' use of a research-based clinical guideline and a nutrition screening routine. Ethnographic fieldwork was carried out over three months. The first author followed nurses, medical secretaries and doctors in the emergency department. Data were also collected by means of semi-structured interviews. An activity system analysis, as described in the Cultural Historical Activity Theory, was conducted to identify various contradictions that could exist between different parts of the activity system. The main contradiction identified was that guidelines and screening routines provided a flow stop. Four associated contradictions were identified: insufficient time to implement guidelines; guilty conscience due to perceived nonadherence to evidence-based practices; newcomers having different priorities; and conflicting views of what constituted being a professional. We found that research-supported guidelines and screening routines were not used if they were perceived to stop the patient flow, suggesting that the practice was not fully evidence based. © 2016 The Authors. Journal of Clinical Nursing Published by John Wiley & Sons Ltd.

Evidence-based management of neonatal vomiting in the emergency department.

PubMed

Ratnayake, Kristin; Kim, Tommy Y

2014-11-01

Vomiting accounts for up to 36% of neonatal visits to the emergency department. The causes of vomiting can range from benign to life-threatening. Evidence to guide the diagnosis and management of neonatal vomiting in the emergency department is limited. History and physical examination are extremely important in these cases, especially in identifying red flags such as bilious or projectile emesis. A thorough review is presented, discussing various imaging modalities, including plain abdominal radiography, upper gastrointestinal studies, ultrasonography, and contrast enema. A systematic approach in the emergency department, as outlined in this review, is required to identify the serious causes of vomiting in the neonate.

An Evidence-based Guideline for the air medical transportation of prehospital trauma patients.

PubMed

Thomas, Stephen H; Brown, Kathleen M; Oliver, Zoë J; Spaite, Daniel W; Lawner, Benjamin J; Sahni, Ritu; Weik, Tasmeen S; Falck-Ytter, Yngve; Wright, Joseph L; Lang, Eddy S

2014-01-01

Decisions about the transportation of trauma patients by helicopter are often not well informed by research assessing the risks, benefits, and costs of such transport. The objective of this evidence-based guideline (EBG) is to recommend a strategy for the selection of prehospital trauma patients who would benefit most from aeromedical transportation. A multidisciplinary panel was recruited consisting of experts in trauma, EBG development, and emergency medical services (EMS) outcomes research. Representatives of the Federal Interagency Committee on Emergency Medical Services (FICEMS), the National Highway Traffic Safety Administration (NHTSA) (funding agency), and the Children's National Medical Center (investigative team) also contributed to the process. The panel used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology to guide question formulation, evidence retrieval, appraisal/synthesis, and formulate recommendations. The process followed the National Evidence-Based Guideline Model Process, which has been approved by the Federal Interagency Committee on EMS and the National EMS Advisory Council. Two strong and three weak recommendations emerged from the process, all supported only by low or very low quality evidence. The panel strongly recommended that the 2011 CDC Guideline for the Field Triage of Injured Patients be used as the initial step in the triage process, and that ground emergency medical services (GEMS) be used for patients not meeting CDC anatomic, physiologic, and situational high-acuity criteria. The panel issued a weak recommendation to use helicopter emergency medical services (HEMS) for higher-acuity patients if there is a time-savings versus GEMS, or if an appropriate hospital is not accessible by GEMS due to systemic/logistical factors. The panel strongly recommended that online medical direction should not be required for activating HEMS. Special consideration was given to the potential need for local adaptation. Systematic and transparent methodology was used to develop an evidence-based guideline for the transportation of prehospital trauma patients. The recommendations provide specific guidance regarding the activation of GEMS and HEMS for patients of varying acuity. Future research is required to strengthen the data and recommendations, define optimal approaches for guideline implementation, and determine the impact of implementation on safety and outcomes including cost.

The Development of a Veterans Health Administration Emergency Management Research Agenda

PubMed Central

Dobalian, Aram; Claver, Maria; Riopelle, Deborah; Wyte-Lake, Tamar; Canelo, Ismelda

2017-01-01

Introduction: The Veterans Health Administration (VHA), the largest integrated healthcare delivery system in the United States, is charged with ensuring timely access to high-quality care for veterans during disasters, and supporting national, state, local, and tribal emergency management and homeland security efforts. In 2008, the VHA Office of Public Health (OPH) sponsored the first VHA Emergency Management Research Agenda-setting conference to develop research priorities that address the needs of veterans and to position VHA as a national leader in emergency management by having VHA serve as a “laboratory” for the development of evidence-based emergency management practices. Methods: We focused on four steps: #1: Appraising the emergency management research portfolio of VHA-based researchers; #2: Obtaining systematic information on VHA’s role in emergency management and the healthcare needs of veterans during disasters; #3: Based upon gaps between the current research portfolio and the existing evidence base, identifying strategic priorities using a research agenda-setting conference; and #4: Laying the groundwork to foster the conduct of emergency management research within VHA. Results: Identified research priorities included how to prevent and treat behavioral health problems related to a disaster, the efficacy of training programs, crisis communication strategies, workforce resilience, and evacuating veterans from health care facilities. Conclusion: VHA is uniquely situated to answer research questions that cannot be readily addressed in other settings. VHA should partner with other governmental and private entities to build on existing work and establish shared research priorities. PMID:28439447

Challenging gender inequity through male involvement in maternal and newborn health: critical assessment of an emerging evidence base

PubMed Central

Comrie-Thomson, Liz; Tokhi, Mariam; Ampt, Frances; Portela, Anayda; Chersich, Matthew; Khanna, Renu; Luchters, Stanley

2015-01-01

Men's involvement in the health of women and children is considered an important avenue for addressing gender influences on maternal and newborn health. The impact of male involvement around the time of childbirth on maternal and newborn health outcomes was examined as one part of a systematic review of maternal health intervention studies published between 2000 and 2012. Of 33,888 articles screened, 13 eligible studies relating to male involvement were identified. The interventions documented in these studies comprise an emerging evidence base for male involvement in maternal and newborn health. We conducted a secondary qualitative analysis of the 13 studies, reviewing content that had been systematically extracted. A critical assessment of this extracted content finds important gaps in the evidence base, which are likely to limit how ‘male involvement’ is understood and implemented in maternal and newborn health policy, programmes and research. Collectively, the studies point to the need for an evidence base that includes studies that clearly articulate and document the gender-transformative potential of involving men. This broader evidence base could support the use of male involvement as a strategy to improve both health and gender equity outcomes. PMID:26159766

Developing Academic Language and Content for Emergent Bilinguals through a Science Inquiry Unit

ERIC Educational Resources Information Center

Mercuri, Sandra; Ebe, Ann E.

2011-01-01

There is growing evidence that schools are not meeting the needs of emergent bilinguals who are falling behind in both academic language development and content knowledge learning. In response to this concern, this article proposes five research-based guidelines for promoting effective instruction for emergent bilinguals. In order to connect…

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…

Caring for patients with kidney disease: shifting the paradigm from evidence-based medicine to patient-centered care

PubMed Central

O'Hare, Ann M.; Rodriguez, Rudolph A.; Bowling, Christopher Barrett

2016-01-01

The last several decades have witnessed the emergence of evidence-based medicine as the dominant paradigm for medical teaching, research and practice. Under an evidence-based approach, populations rather than individuals become the primary focus of investigation. Treatment priorities are largely shaped by the availability, relevance and quality of evidence and study outcomes and results are assumed to have more or less universal significance based on their implications at the population level. However, population-level treatment goals do not always align with what matters the most to individual patients—who may weigh the risks, benefits and harms of recommended treatments quite differently. In this article we describe the rise of evidence-based medicine in historical context. We discuss limitations of this approach for supporting real-world treatment decisions—especially in older adults with confluent comorbidity, functional impairment and/or limited life expectancy—and we describe the emergence of more patient-centered paradigms to address these limitations. We explain how the principles of evidence-based medicine have helped to shape contemporary approaches to defining, classifying and managing patients with chronic kidney disease. We discuss the limitations of this approach and the potential value of a more patient-centered paradigm, with a particular focus on the care of older adults with this condition. We conclude by outlining ways in which the evidence-base might be reconfigured to better support real-world treatment decisions in individual patients and summarize relevant ongoing initiatives. PMID:25637639

Evidence-based prosthodontics: fundamental considerations, limitations, and guidelines.

PubMed

Bidra, Avinash S

2014-01-01

Evidence-based dentistry is rapidly emerging to become an integral part of patient care, dental education, and research. Prosthodontics is a unique dental specialty that encompasses art, philosophy, and science and includes reversible and irreversible treatments. It not only affords good applicability of many principles of evidence-based dentistry but also poses numerous limitations. This article describes the epidemiologic background, fundamental considerations, scrutiny of levels of evidence, limitations, guidelines, and future perspectives of evidence-based prosthodontics. Understanding these principles can aid clinicians in appropriate appraisal of the prosthodontics literature and use the best available evidence for making confident clinical decisions and optimizing patient care. Copyright © 2014 Elsevier Inc. All rights reserved.

Implementing Evidence-Based Practices for People With Schizophrenia

PubMed Central

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

2009-01-01

Over the last decade, a consensus has emerged regarding a set of evidence-based practices for schizophrenia that address symptom management and psychosocial functioning. Yet, surveys suggest that the great majority of the population of individuals with schizophrenia do not receive evidence-based care. In this article, we review the empirical literature on implementation of evidence-based practices for schizophrenia patients. We first examine lessons learned from implementation studies in general medicine. We then summarize the implementation literature specific to schizophrenia, including medication practices, psychosocial interventions, information technology, and state- and federal-level interventions. We conclude with recommendations for future directions. PMID:19491315

Effectiveness of Occupation-Based Interventions to Improve Areas of Occupation and Social Participation After Stroke: An Evidence-Based Review

PubMed Central

Chuh, Adrianna; Floyd, Tracy; McInnis, Karen; Williams, Elizabeth

2015-01-01

This evidence-based review examined the evidence supporting the use of occupation-based interventions to improve areas of occupation and social participation poststroke. A total of 39 studies met the inclusion criteria and were critically evaluated. Most of the literature targeted activity of daily living (ADL)–based interventions and collectively provided strong evidence for the use of occupation-based interventions to improve ADL performance. The evidence related to instrumental ADLs was much more disparate, with limited evidence to support the use of virtual reality interventions and emerging evidence to support driver education programs to improve occupational performance poststroke. Only 6 studies addressed leisure, social participation, or rest and sleep, with sufficient evidence to support only leisure-based interventions. The implications of this review for research, education, and practice in occupational therapy are also discussed. PMID:25553745

Proposed Performance Measures and Strategies for Implementation of the Fatigue Risk Management Guidelines for Emergency Medical Services

DOT National Transportation Integrated Search

2018-01-11

Background: Performance measures are a key component of implementation, dissemination, and evaluation of evidence-based guidelines (EBGs). We developed performance measures for Emergency Medical Services (EMS) stakeholders to enable the implementatio...

Blood pressure in firefighters, police officers, and other emergency responders.

PubMed

Kales, Stefanos N; Tsismenakis, Antonios J; Zhang, Chunbai; Soteriades, Elpidoforos S

2009-01-01

Elevated blood pressure is a major risk factor for cardiovascular morbidity and mortality. Increased risk begins in the prehypertensive range and increases further with higher pressures. The strenuous duties of emergency responders (firefighters, police officers, and emergency medical services (EMS) personnel) can interact with their personal risk profiles, including elevated blood pressure, to precipitate acute cardiovascular events. Approximately three-quarters of emergency responders have prehypertension or hypertension, a proportion which is expected to increase, based on the obesity epidemic. Elevated blood pressure is also inadequately controlled in these professionals and strongly linked to cardiovascular disease morbidity and mortality. Notably, the majority of incident cardiovascular disease events occur in responders who are initially prehypertensive or only mildly hypertensive and whose average premorbid blood pressures are in the range in which many physicians would hesitate to prescribe medications (140-146/88-92). Laws mandating public benefits for emergency responders with cardiovascular disease provide an additional rationale for aggressively controlling their blood pressure. This review provides a background on emergency responders, summarizes occupational risk factors for hypertension and the metabolic syndrome, their prevalence of elevated blood pressure, and evidence linking hypertension with adverse outcomes in these professions. Next, discrepancies between relatively outdated medical standards for emergency responders and current, evidence-based guidelines for blood pressure management in the general public are highlighted. Finally, a workplace-oriented approach for blood pressure control among emergency responders is proposed, based on the seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure.

The impact of nurse practitioner services on cost, quality of care, satisfaction and waiting times in the emergency department: a systematic review.

PubMed

Jennings, Natasha; Clifford, Stuart; Fox, Amanda R; O'Connell, Jane; Gardner, Glenn

2015-01-01

To provide the best available evidence to determine the impact of nurse practitioner services on cost, quality of care, satisfaction and waiting times in the emergency department for adult patients. The delivery of quality care in the emergency department is emerging as one of the most important service indicators in health delivery. Increasing service pressures in the emergency department have resulted in the adoption of service innovation models: the most common and rapidly expanding of these is emergency nurse practitioner services. The rapid uptake of emergency nurse practitioner service in Australia has outpaced the capacity to evaluate this service model in terms of outcomes related to safety and quality of patient care. Previous research is now outdated and not commensurate with the changing domain of delivering emergency care with nurse practitioner services. A comprehensive search of four electronic databases from 2006 to 2013 was conducted to identify research evaluating nurse practitioner service impact in the emergency department. English language articles were sought using MEDLINE, CINAHL, Embase and Cochrane and included two previous systematic reviews completed five and seven years ago. A three step approach was used. Following a comprehensive search, two reviewers assessed all identified studies against the inclusion criteria. From the original 1013 studies, 14 papers were retained for critical appraisal on methodological quality by two independent reviewers and data were extracted using standardised tools. Narrative synthesis was conducted to summarise and report the findings as insufficient data was available for meta-analysis of results. This systematic review has shown that emergency nurse practitioner service has a positive impact on quality of care, patient satisfaction and waiting times. There was insufficient evidence to draw conclusions regarding outcomes of a cost benefit analysis. Synthesis of the available research attempts to provide an evidence base for emergency nurse practitioner service to guide healthcare leaders, policy makers and clinicians in reform of emergency service provision. The findings suggest that further high quality research is required for comparative measures of clinical and service effectiveness of emergency nurse practitioner service. In the context of increased health service demand and the need to provide timely and effective care to patients, such measures will assist in evidence based health service planning. Copyright © 2014 Elsevier Ltd. All rights reserved.

An innovative approach to capability-based emergency operations planning

PubMed Central

Keim, Mark E

2013-01-01

This paper describes the innovative use information technology for assisting disaster planners with an easily-accessible method for writing and improving evidence-based emergency operations plans. This process is used to identify all key objectives of the emergency response according to capabilities of the institution, community or society. The approach then uses a standardized, objective-based format, along with a consensus-based method for drafting capability-based operational-level plans. This information is then integrated within a relational database to allow for ease of access and enhanced functionality to search, sort and filter and emergency operations plan according to user need and technological capacity. This integrated approach is offered as an effective option for integrating best practices of planning with the efficiency, scalability and flexibility of modern information and communication technology. PMID:28228987

An innovative approach to capability-based emergency operations planning.

PubMed

Keim, Mark E

2013-01-01

This paper describes the innovative use information technology for assisting disaster planners with an easily-accessible method for writing and improving evidence-based emergency operations plans. This process is used to identify all key objectives of the emergency response according to capabilities of the institution, community or society. The approach then uses a standardized, objective-based format, along with a consensus-based method for drafting capability-based operational-level plans. This information is then integrated within a relational database to allow for ease of access and enhanced functionality to search, sort and filter and emergency operations plan according to user need and technological capacity. This integrated approach is offered as an effective option for integrating best practices of planning with the efficiency, scalability and flexibility of modern information and communication technology.

Evidence-Based Guidelines for Fatigue Risk Management in Emergency Medical Services

DOT National Transportation Integrated Search

2018-01-11

Background: Administrators of Emergency Medical Services (EMS) operations lack guidance on how to mitigate workplace fatigue, which affects greater than half of all EMS personnel. The primary objective of the Fatigue in EMS Project was to create an e...

CE: Original Research: Exploring Clinicians' Perceptions About Sustaining an Evidence-Based Fall Prevention Program.

PubMed

Porter, Rebecca B; Cullen, Laura; Farrington, Michele; Matthews, Grace; Tucker, Sharon

2018-05-01

: Purpose: This study aimed to address the knowledge gap between implementing and sustaining evidence-based fall prevention practices for hospitalized patients by exploring perspectives of the interprofessional health care team. A qualitative design was used to capture insights from clinicians across disciplines in a large midwestern academic medical center. Four homogenous semistructured focus groups and three individual interviews involving a total of 20 clinicians were conducted between October 2013 and March 2014. Audio-recorded data were transcribed and analyzed using inductive qualitative analysis. Two primary themes emerged from participants regarding the sustainability of an evidence-based fall prevention program: communication patterns within the interprofessional health care team and influences of hospital organizational practices and elements. Several subthemes also emerged. Participants gave nursing staff primary responsibility for fall risk assessment and prevention. Individual professional perceptions and practices, as well as organizational characteristics, affect the sustainability of evidence-based fall prevention practices. While all team members recognized patient falls as a significant quality and safety issue, most believed that direct care nurses hold primary responsibility for leading fall prevention efforts. The data support the importance of effective interprofessional team communication and organizational practices in sustaining an evidence-based fall prevention program across inpatient units. Furthermore, the data call into question the wisdom in labeling quality indicators as "nursing sensitive"; the evidence indicates that a team approach is best.

Best practices in managing child and adolescent behavioral health emergencies.

PubMed

Feuer, Vera; Rocker, Joshua; Saggu, Babar M; Andrus, Jason M

2018-01-01

Behavioral health emergencies most commonly present as depression, suicidal behavior, aggression, and severe disorganization. Emergency clinicians should avoid relying solely on past medical history or previous psychiatric diagnoses that might prematurely rule out medical pathologies. Treatments for behavioral health emergencies consist of de-escalation interventions aimed at preventing agitation, aggression, and harm. This issue reviews medical pathologies and underlying causes that can result in psychiatric presentations and summarizes evidence-based practices to evaluate, manage, and refer patients with behavioral health emergencies.

Optimizing nursing care by integrating theory-driven evidence-based practice.

PubMed

Pipe, Teri Britt

2007-01-01

An emerging challenge for nursing leadership is how to convey the importance of both evidence-based practice (EBP) and theory-driven care in ensuring patient safety and optimizing outcomes. This article describes a specific example of a leadership strategy based on Rosswurm and Larrabee's model for change to EBP, which was effective in aligning the processes of EBP and theory-driven care.

Best practices in managing child and adolescent behavioral health emergencies [digest].

PubMed

Feuer, Vera; Rocker, Joshua; Saggu, Babar M; Andrus, Jason M; Wormley, Molly

2018-01-22

Behavioral health emergencies most commonly present as depression, suicidal behavior, aggression, and severe disorganization. Emergency clinicians should avoid relying solely on past medical history or previous psychiatric diagnoses that might prematurely rule out medical pathologies. Treatments for behavioral health emergencies consist of de-escalation interventions aimed at preventing agitation, aggression, and harm. This issue reviews medical pathologies and underlying causes that can result in psychiatric presentations and summarizes evidence-based practices to evaluate, manage, and refer patients with behavioral health emergencies. [Points & Pearls is a digest of Pediatric Emergency Medicine Practice].

Blog and Podcast Watch: Cutaneous Emergencies.

PubMed

Grock, Andrew; Morley, Eric J; Roppolo, Lynn; Khadpe, Jay; Ankel, Felix; Lin, Michelle

2017-02-01

The WestJEM Blog and Podcast Watch presents high quality open-access educational blogs and podcasts in emergency medicine (EM) based on the ongoing Academic Life in Emergency Medicine (ALiEM) Approved Instructional Resources (AIR) and AIR-Professional series. Both series critically appraise resources using an objective scoring rubric. This installment of the Blog and Podcast Watch highlights the topic of cutaneous emergencies from the AIR series. The AIR series is a continuously building curriculum that follows the Council of Emergency Medicine Residency Directors (CORD) annual testing schedule. For each module, relevant content is collected from the top 50 most accessed sites per the Social Media Index published within the previous 12 months and scored by eight board members using five equally weighted measurement outcomes: Best Evidence in Emergency Medicine (BEEM) score, accuracy, educational utility, evidence based, and references. Resources scoring ≥30 out of 35 available points receive an AIR label. Resources scoring 27-29 receive an "honorable mention" label, if the editorial board agrees that the post is accurate and educationally valuable. A total of 35 blog posts and podcasts were evaluated. None scored ≥30 points necessary for the AIR label, although four honorable mention posts were identified. Key educational pearls from these honorable mention posts are summarized. This Blog and Podcast Watch series is based on the AIR and AIR-Pro series, which attempts to identify high quality educational content on open-access blogs and podcasts. This series provides an expert-based, post-publication curation of educational social media content for EM clinicians with this installment focusing on cutaneous emergencies.

Blog and Podcast Watch: Cutaneous Emergencies

PubMed Central

Grock, Andrew; Morley, Eric J.; Roppolo, Lynn; Khadpe, Jay; Ankel, Felix; Lin, Michelle

2017-01-01

Introduction The WestJEM Blog and Podcast Watch presents high quality open-access educational blogs and podcasts in emergency medicine (EM) based on the ongoing Academic Life in Emergency Medicine (ALiEM) Approved Instructional Resources (AIR) and AIR-Professional series. Both series critically appraise resources using an objective scoring rubric. This installment of the Blog and Podcast Watch highlights the topic of cutaneous emergencies from the AIR series. Methods The AIR series is a continuously building curriculum that follows the Council of Emergency Medicine Residency Directors (CORD) annual testing schedule. For each module, relevant content is collected from the top 50 most accessed sites per the Social Media Index published within the previous 12 months and scored by eight board members using five equally weighted measurement outcomes: Best Evidence in Emergency Medicine (BEEM) score, accuracy, educational utility, evidence based, and references. Resources scoring ≥30 out of 35 available points receive an AIR label. Resources scoring 27–29 receive an “honorable mention” label, if the editorial board agrees that the post is accurate and educationally valuable. Results A total of 35 blog posts and podcasts were evaluated. None scored ≥30 points necessary for the AIR label, although four honorable mention posts were identified. Key educational pearls from these honorable mention posts are summarized. Conclusion This Blog and Podcast Watch series is based on the AIR and AIR-Pro series, which attempts to identify high quality educational content on open-access blogs and podcasts. This series provides an expert-based, post-publication curation of educational social media content for EM clinicians with this installment focusing on cutaneous emergencies. PMID:28210366

Blog and Podcast Watch: Neurologic Emergencies

PubMed Central

Grock, Andrew; Joshi, Nikita; Swaminathan, Anand; Rezaie, Salim; Gaafary, Chris; Lin, Michelle

2016-01-01

Introduction The WestJEM Blog and Podcast Watch presents high quality open-access educational blogs and podcasts in emergency medicine (EM) based on the ongoing ALiEM Approved Instructional Resources (AIR) and AIR-Professional series. Both series critically appraise resources using an objective scoring rubric. This installment of the Blog and Podcast Watch highlights the topic of neurologic emergencies from the AIR series. Methods The AIR series is a continuously building curriculum that follows the Council of Emergency Medicine Residency Director’s (CORD) annual testing schedule. For each module, relevant content is collected from the top 50 Social Media Index sites published within the previous 12 months, and scored by eight board members using five equally weighted measurement outcomes: Best Evidence in Emergency Medicine (BEEM) score, accuracy, educational utility, evidence based, and references. Resources scoring ≥30 out of 35 available points receive an AIR label. Resources scoring 27–29 receive an honorable mention label, if the executive board agrees that the post is accurate and educationally valuable. Results A total of 125 blog posts and podcasts were evaluated. Key educational pearls from the 14 AIR posts are summarized, and the 20 honorable mentions are listed. Conclusion The WestJEM Blog and Podcast Watch series is based on the AIR and AIR-Pro series, which attempts to identify high quality educational content on open-access blogs and podcasts. This series provides an expert-based, post-publication curation of educational social media content for EM clinicians with this installment focusing on neurologic emergencies. PMID:27833680

Blog and Podcast Watch: Neurologic Emergencies.

PubMed

Grock, Andrew; Joshi, Nikita; Swaminathan, Anand; Rezaie, Salim; Gaafary, Chris; Lin, Michelle

2016-11-01

The WestJEM Blog and Podcast Watch presents high quality open-access educational blogs and podcasts in emergency medicine (EM) based on the ongoing ALiEM Approved Instructional Resources (AIR) and AIR-Professional series. Both series critically appraise resources using an objective scoring rubric. This installment of the Blog and Podcast Watch highlights the topic of neurologic emergencies from the AIR series. The AIR series is a continuously building curriculum that follows the Council of Emergency Medicine Residency Director's (CORD) annual testing schedule. For each module, relevant content is collected from the top 50 Social Media Index sites published within the previous 12 months, and scored by eight board members using five equally weighted measurement outcomes: Best Evidence in Emergency Medicine (BEEM) score, accuracy, educational utility, evidence based, and references. Resources scoring ≥30 out of 35 available points receive an AIR label. Resources scoring 27-29 receive an honorable mention label, if the executive board agrees that the post is accurate and educationally valuable. A total of 125 blog posts and podcasts were evaluated. Key educational pearls from the 14 AIR posts are summarized, and the 20 honorable mentions are listed. The WestJEM Blog and Podcast Watch series is based on the AIR and AIR-Pro series, which attempts to identify high quality educational content on open-access blogs and podcasts. This series provides an expert-based, post-publication curation of educational social media content for EM clinicians with this installment focusing on neurologic emergencies.

Blog and Podcast Watch: Orthopedic Emergencies.

PubMed

Grock, Andrew; Rezaie, Salim; Swaminathan, Anand; Min, Alice; Shah, Kaushal H; Lin, Michelle

2017-04-01

The WestJEM Blog and Podcast Watch presents high quality open-access educational blogs and podcasts in emergency medicine (EM) based on the ongoing ALiEM Approved Instructional Resources (AIR) and AIR-Professional series. Both series critically appraise resources using an objective scoring rubric. This installment of the Blog and Podcast Watch highlights the topic of orthopedic emergencies from the AIR series. The AIR series is a continuously building curriculum that follows the Council of Emergency Medicine Residency Directors (CORD) annual testing schedule. For each module, relevant content is collected from the top 50 Social Media Index sites published within the previous 12 months, and scored by eight AIR board members using five equally weighted measurement outcomes: Best Evidence in Emergency Medicine (BEEM) score, accuracy, educational utility, evidence based, and references. Resources scoring ≥30 out of 35 available points receive an AIR label. Resources scoring 27-29 receive an honorable mention label, if the executive board agrees that the post is accurate and educationally valuable. A total of 87 blog posts and podcasts were evaluated. Key educational pearls from the three AIR posts and the 14 honorable mentions are summarized. The WestJEM Blog and Podcast Watch series is based on the AIR and AIR-Pro series, which attempts to identify high quality educational content on open-access blogs and podcasts. This series provides an expert-based, post-publication curation of educational social media content for EM clinicians with this installment focusing on orthopedic emergencies.

Blog and Podcast Watch: Orthopedic Emergencies

PubMed Central

Grock, Andrew; Rezaie, Salim; Swaminathan, Anand; Min, Alice; Shah, Kaushal H.; Lin, Michelle

2017-01-01

Introduction The WestJEM Blog and Podcast Watch presents high quality open-access educational blogs and podcasts in emergency medicine (EM) based on the ongoing ALiEM Approved Instructional Resources (AIR) and AIR-Professional series. Both series critically appraise resources using an objective scoring rubric. This installment of the Blog and Podcast Watch highlights the topic of orthopedic emergencies from the AIR series. Methods The AIR series is a continuously building curriculum that follows the Council of Emergency Medicine Residency Directors (CORD) annual testing schedule. For each module, relevant content is collected from the top 50 Social Media Index sites published within the previous 12 months, and scored by eight AIR board members using five equally weighted measurement outcomes: Best Evidence in Emergency Medicine (BEEM) score, accuracy, educational utility, evidence based, and references. Resources scoring ≥30 out of 35 available points receive an AIR label. Resources scoring 27–29 receive an honorable mention label, if the executive board agrees that the post is accurate and educationally valuable. Results A total of 87 blog posts and podcasts were evaluated. Key educational pearls from the three AIR posts and the 14 honorable mentions are summarized. Conclusion The WestJEM Blog and Podcast Watch series is based on the AIR and AIR-Pro series, which attempts to identify high quality educational content on open-access blogs and podcasts. This series provides an expert-based, post-publication curation of educational social media content for EM clinicians with this installment focusing on orthopedic emergencies. PMID:28435507

Emergency Medicine Management of Sickle Cell Disease Complications: An Evidence-Based Update.

PubMed

Simon, Erica; Long, Brit; Koyfman, Alex

2016-10-01

Sickle cell disease (SCD) affects approximately 100,000 individuals in the United States. Due to alterations in the structural conformation of hemoglobin molecules under deoxygenated conditions, patients with SCD are predisposed to numerous sequelae, many of which require acute intervention. Our aim was to provide emergency physicians with an evidence-based update regarding the diagnosis and management of SCD complications. SCD patients experience significant morbidity and mortality secondary to cerebrovascular accident, acute chest syndrome, acute vaso-occlusive pain crises, SCD-related multi-organ failure, cholecystitis, acute intrahepatic cholestasis, acute sickle hepatic crisis, acute hepatic sequestration, priapism, and renal disease. Emergency physicians must recognize acute manifestations of SCD in order to deliver timely management and determine patient disposition. A comprehensive review of the emergency department management of acute SCD complications is provided. Comprehensive understanding of these aspects of SCD can assist physicians in expediting patient evaluation and treatment, thus decreasing the morbidity and mortality associated with this hemoglobinopathy. Copyright © 2016 Elsevier Inc. All rights reserved.

What's the Evidence: A Review of the One-Minute Preceptor Model of Clinical Teaching and Implications for Teaching in the Emergency Department.

PubMed

Farrell, Susan E; Hopson, Laura R; Wolff, Margaret; Hemphill, Robin R; Santen, Sally A

2016-09-01

The 2012 Academic Emergency Medicine Consensus Conference, "Education Research in Emergency Medicine: Opportunities, Challenges, and Strategies for Success" noted that emergency medicine (EM) educators often rely on theory and tradition in molding their approaches to teaching and learning, and called on the EM education community to advance the teaching of our specialty through the performance and application of research in teaching and assessment methods, cognitive function, and the effects of education interventions. The purpose of this article is to review the research-based evidence for the effectiveness of the one-minute preceptor (OMP) teaching method, and to provide suggestions for its use in clinical teaching and learning in EM. This article reviews hypothesis-testing education research related to the use of the OMP as a pedagogical method applicable to clinical teaching. Evidence indicates that the OMP prompts the teaching of higher level concepts, facilitates the assessment of students' knowledge, and prompts the provision of feedback. Students indicate satisfaction with this method of clinical case-based discussion teaching. Advancing EM education will require that high quality education research results be translated into actual curricular, pedagogical, assessment, and professional development changes. The OMP is a pedagogical method that is applicable to teaching in the emergency department. Copyright © 2016 Elsevier Inc. All rights reserved.

Managing Ethical Challenges to Mental Health Research in Post-Conflict Settings.

PubMed

Chiumento, Anna; Khan, Muhammad Naseem; Rahman, Atif; Frith, Lucy

2016-04-01

Recently the World Health Organization (WHO) has highlighted the need to strengthen mental health systems following emergencies, including natural and manmade disasters. Mental health services need to be informed by culturally attuned evidence that is developed through research. Therefore, there is an urgent need to establish rigorous ethical research practice to underpin the evidence-base for mental health services delivered during and following emergencies. © 2015 The Authors. Developing World Bioethics published by John Wiley & Sons Ltd.

Concept and practice of evidence-based psychiatry and its application in Nigerian psychiatry: a critical review.

PubMed

Onifade, P O; Oluwole, L O

2006-01-01

The practice of Evidence-Based Psychiatry started in the 1990's, however prior to this time the practice of psychiatry did have an evidenced base though not structured and systematically spelt out. This study aimed to review the development of the concept and practice of Evidence-Based Psychiatry and to identify position of Nigerian psychiatry in it. Narrative reviews were made from information obtained from scientific publications i.e. (books and journals) and internet-based electronic articles. Evidence-Based Psychiatry emerged from Evidence-Based Medicine in the 1990's and aims to base practice on the best available evidence. The evidence is graded into A, B, and C, depending on the study design. Also critical to the practice of Evidence-Based Psychiatry is the availability of high-grade evidence and an efficient means of storing and retrieving it. Evidence-Based Psychiatry uses a systematic approach and involves five steps. Its scope covers aetiology, diagnosis, intervention, and prognosis. A comprehensive definition of Evidence-Based Psychiatry is given. There is a suggestion to change the term 'Evidence-Based' to 'Systematic Evidence-Based'. The right way to determine if a therapeutic intervention is evidence-based is to consider if the process that led to it is systematic in terms of the five steps of Evidence-Based Psychiatry. Nigeria is yet to develop structures required for Systematic Evidence-Based Psychiatry.

[Interdisciplinary consensus statement on alternative airway management with supraglottic airway devices in pediatric emergency medicine: Laryngeal mask is state of the art].

PubMed

Keil, J; Jung, P; Schiele, A; Urban, B; Parsch, A; Matsche, B; Eich, C; Becke, K; Landsleitner, B; Russo, S G; Bernhard, M; Nicolai, T; Hoffmann, F

2016-01-01

Airway management with supraglottic airway devices (SGA) in life-threatening emergencies involving children is becoming increasingly more important. The laryngeal mask (LM) and the laryngeal tube (LT) are devices commonly used for this purpose. This article presents a literature review and consensus statement by various societies on the use of SGA in pediatric emergency medicine. Literature search in the database PubMed and classification of studies according to the criteria of the Oxford Centre for Evidence-based Medicine levels of evidence. The evidence for successful application of the various types of LM is significantly higher than for LT application. Reports of smaller series of successful applications of LT are currently limited to selected research groups and centers. Insufficient evidence currently exists for the successful application of the LT especially for children below 10 kg body weight and, therefore, its routine use cannot currently be recommended. SGAs used for emergencies should have a possibility for gastric drainage. Considering the scientific data and the large clinical experience with the LM in medical routine and emergency situations in children, currently only the LM can be recommended for alternative (i.e. non-intubation) airway management in children. If alternative airway management is part of a local emergency strategy, the LM should be provided in all pediatric sizes (1, 1.5, 2, 2.5, 3, 4 and 5) for prehospital and in-hospital emergency use and all users should be regularly trained in its application.

Inter-University Collaboration for Online Teaching Innovation: An Emerging Model

ERIC Educational Resources Information Center

Nerlich, Andrea Perkins; Soldner, James L.; Millington, Michael J.

2012-01-01

Distance education is constantly evolving and improving. To stay current, effective online instructors must utilize the most innovative, evidence-based teaching methods available to promote student learning and satisfaction in their courses. One emerging teaching method, referred to as blended online learning (BOL), involves collaborative…

Evidence-based toxicology for the 21st century: opportunities and challenges.

PubMed

Stephens, Martin L; Andersen, Melvin; Becker, Richard A; Betts, Kellyn; Boekelheide, Kim; Carney, Ed; Chapin, Robert; Devlin, Dennis; Fitzpatrick, Suzanne; Fowle, John R; Harlow, Patricia; Hartung, Thomas; Hoffmann, Sebastian; Holsapple, Michael; Jacobs, Abigail; Judson, Richard; Naidenko, Olga; Pastoor, Tim; Patlewicz, Grace; Rowan, Andrew; Scherer, Roberta; Shaikh, Rashid; Simon, Ted; Wolf, Douglas; Zurlo, Joanne

2013-01-01

The Evidence-based Toxicology Collaboration (EBTC) was established recently to translate evidence-based approaches from medicine and health care to toxicology in an organized and sustained effort. The EBTC held a workshop on "Evidence-based Toxicology for the 21st Century: Opportunities and Challenges" in Research Triangle Park, North Carolina, USA on January 24-25, 2012. The presentations largely reflected two EBTC priorities: to apply evidence-based methods to assessing the performance of emerging pathway-based testing methods consistent with the 2007 National Research Council report on "Toxicity Testing in the 21st Century" as well as to adopt a governance structure and work processes to move that effort forward. The workshop served to clarify evidence-based approaches and to provide food for thought on substantive and administrative activities for the EBTC. Priority activities include conducting pilot studies to demonstrate the value of evidence-based approaches to toxicology, as well as conducting educational outreach on these approaches.

Re-emerging Lassa fever outbreaks in Nigeria: Re-enforcing "One Health" community surveillance and emergency response practice.

PubMed

Tambo, Ernest; Adetunde, Oluwasegun T; Olalubi, Oluwasogo A

2018-04-28

We evaluated the impact of man-made conflict events and climate change impact in guiding evidence-based community "One Health" epidemiology and emergency response practice against re-/emerging epidemics. Increasing evidence of emerging and re-emerging zoonotic diseases including recent Lassa fever outbreaks in almost 20 states in Nigeria led to 101 deaths and 175 suspected and confirmed cases since August 2015. Of the 75 laboratory confirmed cases, 90 deaths occurred representing 120% laboratory-confirmed case fatality. The outbreak has been imported into neighbouring country such as Benin, where 23 deaths out of 68 cases has also been reported. This study assesses the current trends in re-emerging Lassa fever outbreak in understanding spatio-geographical reservoir(s), risk factors pattern and Lassa virus incidence mapping, inherent gaps and raising challenges in health systems. It is shown that Lassa fever peak endemicity incidence and prevalence overlap the dry season (within January to March) and reduced during the wet season (of May to November) annually in Sierra Leone, Senegal to Eastern Nigeria. We documented a scarcity of consistent data on rodent (reservoirs)-linked Lassa fever outbreak, weak culturally and socio-behavioural effective prevention and control measures integration, weak or limited community knowledge and awareness to inadequate preparedness capacity and access to affordable case management in affected countries. Hence, robust sub/regional leadership commitment and investment in Lassa fever is urgently needed in building integrated and effective community "One Health" surveillance and rapid response approach practice coupled with pest management and phytosanitation measures against Lassa fever epidemic. This offers new opportunities in understanding human-animal interactions in strengthening Lassa fever outbreak early detection and surveillance, warning alerts and rapid response implementation in vulnerable settings. Leveraging on Africa CDC centre, advances in cloud-sourcing and social media tools and solutions is core in developing and integrating evidence-based and timely risk communication, and reporting systems in improving contextual community-based immunization and control decision making policy to effectively defeat Lassa fever outbreak and other emerging pandemics public health emergencies in Africa and worldwide.

Proceedings of resources for optimal care of acute care and emergency surgery consensus summit Donegal Ireland.

PubMed

Sugrue, M; Maier, R; Moore, E E; Boermeester, M; Catena, F; Coccolini, F; Leppaniemi, A; Peitzman, A; Velmahos, G; Ansaloni, L; Abu-Zidan, F; Balfe, P; Bendinelli, C; Biffl, W; Bowyer, M; DeMoya, M; De Waele, J; Di Saverio, S; Drake, A; Fraga, G P; Hallal, A; Henry, C; Hodgetts, T; Hsee, L; Huddart, S; Kirkpatrick, A W; Kluger, Y; Lawler, L; Malangoni, M A; Malbrain, M; MacMahon, P; Mealy, K; O'Kane, M; Loughlin, P; Paduraru, M; Pearce, L; Pereira, B M; Priyantha, A; Sartelli, M; Soreide, K; Steele, C; Thomas, S; Vincent, J L; Woods, L

2017-01-01

Opportunities to improve emergency surgery outcomes exist through guided better practice and reduced variability. Few attempts have been made to define optimal care in emergency surgery, and few clinically derived key performance indicators (KPIs) have been published. A summit was therefore convened to look at resources for optimal care of emergency surgery. The aim of the Donegal Summit was to set a platform in place to develop guidelines and KPIs in emergency surgery. The project had multidisciplinary global involvement in producing consensus statements regarding emergency surgery care in key areas, and to assess feasibility of producing KPIs that could be used to monitor process and outcome of care in the future. Forty-four key opinion leaders in emergency surgery, across 7 disciplines from 17 countries, composed evidence-based position papers on 14 key areas of emergency surgery and 112 KPIs in 20 acute conditions or emergency systems. The summit was successful in achieving position papers and KPIs in emergency surgery. While position papers were limited by non-graded evidence and non-validated KPIs, the process set a foundation for the future advancement of emergency surgery.

Caring for patients with kidney disease: shifting the paradigm from evidence-based medicine to patient-centered care.

PubMed

O'Hare, Ann M; Rodriguez, Rudolph A; Bowling, Christopher Barrett

2016-03-01

The last several decades have witnessed the emergence of evidence-based medicine as the dominant paradigm for medical teaching, research and practice. Under an evidence-based approach, populations rather than individuals become the primary focus of investigation. Treatment priorities are largely shaped by the availability, relevance and quality of evidence and study outcomes and results are assumed to have more or less universal significance based on their implications at the population level. However, population-level treatment goals do not always align with what matters the most to individual patients-who may weigh the risks, benefits and harms of recommended treatments quite differently. In this article we describe the rise of evidence-based medicine in historical context. We discuss limitations of this approach for supporting real-world treatment decisions-especially in older adults with confluent comorbidity, functional impairment and/or limited life expectancy-and we describe the emergence of more patient-centered paradigms to address these limitations. We explain how the principles of evidence-based medicine have helped to shape contemporary approaches to defining, classifying and managing patients with chronic kidney disease. We discuss the limitations of this approach and the potential value of a more patient-centered paradigm, with a particular focus on the care of older adults with this condition. We conclude by outlining ways in which the evidence-base might be reconfigured to better support real-world treatment decisions in individual patients and summarize relevant ongoing initiatives. Published by Oxford University Press on behalf of ERA-EDTA 2015. This work is written by (a) US Government employee(s) and is in the public domain in the US.

Evidence-Based Practice in Special Education and Cultural Adaptations: Challenges and Implications for Research

ERIC Educational Resources Information Center

Wang, Mian; Lam, Yeana

2017-01-01

Many issues arise in the discussion of the evidence-based practice (EBP) movement and implementation science in special education and specific educational practices for students with severe disabilities. Yet cultural adaptations of EBPs, which have emerged as an area of research in other fields, are being left out as a focus of EBP discourse. The…

Post-wildfire seeding in forests of the western United States: An evidence-based review

Treesearch

Donna Peppin; Peter Z. Fule; Carolyn Hull Sieg; Jan L. Beyers; Molly E. Hunter

2010-01-01

Broadcast seeding is one of the most widely used post-wildfire emergency response treatments intended to reduce soil erosion, increase vegetative ground cover, and minimize establishment and spread of non-native plant species. We conducted an evidence-based review to examine the effectiveness and effects of post-wildfire seeding treatments on soil stabilization, non-...

Imitation Therapy for Non-Verbal Toddlers

ERIC Educational Resources Information Center

Gill, Cindy; Mehta, Jyutika; Fredenburg, Karen; Bartlett, Karen

2011-01-01

When imitation skills are not present in young children, speech and language skills typically fail to emerge. There is little information on practices that foster the emergence of imitation skills in general and verbal imitation skills in particular. The present study attempted to add to our limited evidence base regarding accelerating the…

Evidence-Based Evaluation And Management Of Patients With Pharyngitis In The Emergency Department.

PubMed

Hildreth, Amy F; Takhar, Sukhjit; Clark, Mark Andrew; Hatten, Benjamin

2015-09-01

Pharyngitis is a common presentation, but it can also be associated with life-threatening processes, including sepsis and airway compromise. Other conditions, such as thyroid disease and cardiac disease, may mimic pharyngitis. The emergency clinician must sort through the broad differential for this complaint using a systematic approach that protects against early closure of the diagnosis. This issue reviews the various international guidelines for pharyngitis and notes controversies in diagnostic and treatment strategies, specifically for management of suspected bacterial, viral, and fungal etiology. A management algorithm is presented, with recommendations based on a review of the best available evidence, taking into account patient comfort and outcomes, the need to reduce bacterial resistance, and costs.

Improving the governance of patient safety in emergency care: a systematic review of interventions

PubMed Central

Hesselink, Gijs; Berben, Sivera; Beune, Thimpe

2016-01-01

Objectives To systematically review interventions that aim to improve the governance of patient safety within emergency care on effectiveness, reliability, validity and feasibility. Design A systematic review of the literature. Methods PubMed, EMBASE, Cumulative Index to Nursing and Allied Health Literature, the Cochrane Database of Systematic Reviews and PsychInfo were searched for studies published between January 1990 and July 2014. We included studies evaluating interventions relevant for higher management to oversee and manage patient safety, in prehospital emergency medical service (EMS) organisations and hospital-based emergency departments (EDs). Two reviewers independently selected candidate studies, extracted data and assessed study quality. Studies were categorised according to study quality, setting, sample, intervention characteristics and findings. Results Of the 18 included studies, 13 (72%) were non-experimental. Nine studies (50%) reported data on the reliability and/or validity of the intervention. Eight studies (44%) reported on the feasibility of the intervention. Only 4 studies (22%) reported statistically significant effects. The use of a simulation-based training programme and well-designed incident reporting systems led to a statistically significant improvement of safety knowledge and attitudes by ED staff and an increase of incident reports within EDs, respectively. Conclusions Characteristics of the interventions included in this review (eg, anonymous incident reporting and validation of incident reports by an independent party) could provide useful input for the design of an effective tool to govern patient safety in EMS organisations and EDs. However, executives cannot rely on a robust set of evidence-based and feasible tools to govern patient safety within their emergency care organisation and in the chain of emergency care. Established strategies from other high-risk sectors need to be evaluated in emergency care settings, using an experimental design with valid outcome measures to strengthen the evidence base. PMID:26826151

Proton beam therapy and the convoluted pathway to incorporating emerging technology into routine medical care in the United States.

PubMed

Steinberg, Michael L; Konski, Andre

2009-01-01

The pathway that emerging medical technologies take to incorporation into routine medical care in the United States is a product of the social, economic, and political milieu. Our review explores how this milieu brought the incorporation of proton beam therapy into the healthcare delivery system to its current point. We look at how new technologies are presently accepted into this system and discuss the emerging trends--such as the use of evidence-based assessment of technology, coverage with evidence policies, and comparative effectiveness analysis--that are affecting proton beam therapy's effort to finds its place in the pantheon of available medical treatments for patients with cancer.

Organisational support for evidence-based practice: occupational therapists perceptions.

PubMed

Bennett, Sally; Allen, Shelley; Caldwell, Elizabeth; Whitehead, Mary; Turpin, Merrill; Fleming, Jennifer; Cox, Ruth

2016-02-01

Barriers to the use of evidence-based practice extend beyond the individual clinician and often include organisational barriers. Adoption of systematic organisational support for evidence-based practice in health care is integral to its use. This study aimed to explore the perceptions of occupational therapy staff regarding the influence of organisational initiatives to support evidence-based practice on workplace culture and clinical practice. This study used semi-structured interviews with 30 occupational therapists working in a major metropolitan hospital in Brisbane, Australia regarding their perceptions of organisational initiatives designed to support evidence-based practice. Four themes emerged from the data: (i) firmly embedding a culture valuing research and EBP, (ii) aligning professional identity with the Research and Evidence in Practice model, (iii) experiences of change: pride, confidence and pressure and (iv) making evidence-based changes to clinical practices. Organisational initiatives for evidence-based practice were perceived as influencing the culture of the workplace, therapists' sense of identity as clinicians, and as contributing to changes in clinical practice. It is therefore important to consider organisational factors when attempting to increase the use of evidence in practice. © 2016 Occupational Therapy Australia.

Evidence-based disease management: its role in cardiovascular risk reduction.

PubMed

Fanning, Etta L

2004-01-01

Cardiovascular disease remains the most pressing healthcare problem in the United States. Traditional risk factors--hypertension, obesity, and diabetes-are still unresolved issues; and new risk factors--pre-diabetes, insulin resistance, and pediatric and adolescent diabetes-have emerged. There is an urgent need to identify the risk factors for cardiovascular disease, and address risk reduction with disease management and treatment for each factor, based on qualitative and quantitative approaches for developing the evidence base for public health action. The objectives of this paper are to review (i) the burden of cardiovascular illness-morbidity, mortality, and cost; (ii) risk factors and the emerging epidemic of adolescent obesity; (iii) the challenges of attaining target endpoints; and (iv) the attributes of a successful programmatic healthcare initiative for potential impact on cardiovascular care and, eventually, public health.

Alternative Setting-Wide Positive Behavior Support

ERIC Educational Resources Information Center

Simonsen, Brandi; Jeffrey-Pearsall, Jennifer; Sugai, George; McCurdy, Barry

2011-01-01

School-wide positive behavior support (SWPBS) has an established evidence base in general education settings, and emerging evidence suggests that SWPBS may be effective in alternative settings (e.g., alternative, residential, or hospital schools; psychiatric hospitals). Given the intense educational and behavioral needs of students typically…

ALiEM Blog and Podcast Watch: Procedures in Emergency Medicine.

PubMed

Joshi, Nikita; Morley, Eric J; Taira, Taku; Branzetti, Jeremy; Grock, Andrew

2017-10-01

The WestJEM Blog and Podcast Watch presents high-quality, open-access educational blogs and podcasts in emergency medicine (EM) based on the ongoing Academic Life in EM (ALiEM) Approved Instructional Resources (AIR) and AIR-Professional series. Both series critically appraise resources using an objective scoring rubric. This installment of the Blog and Podcast Watch highlights the topic of procedure emergencies from the AIR Series. The AIR Series is a continuously building curriculum that follows the Council of Emergency Medicine Residency Directors' (CORD) annual testing schedule. For each module, relevant content is collected from the top 50 Social Media Index sites published within the previous 12 months, and scored by eight AIR board members using five equally weighted measurement outcomes: Best Evidence in Emergency Medicine (BEEM) score, accuracy, educational utility, evidence based, and references. Resources scoring ≥30 out of 35 available points receive an AIR label. Resources scoring 27-29 receive an "honorable mention" label if the executive board agrees that the post is accurate and educationally valuable. A total of 85 blog posts and podcasts were evaluated in June 2016. This report summarizes key educational pearls from the three AIR posts and the 10 Honorable Mentions. The WestJEM Blog and Podcast Watch series is based on the AIR and AIR-Pro series, which attempts to identify high-quality educational content on open-access blogs and podcasts. This series provides an expert-based, post-publication curation of educational social media content for EM clinicians, with this installment focusing on procedure emergencies within the AIR series.

ALiEM Blog and Podcast Watch: Procedures in Emergency Medicine

PubMed Central

Joshi, Nikita; Morley, Eric J.; Taira, Taku; Branzetti, Jeremy; Grock, Andrew

2017-01-01

Introduction The WestJEM Blog and Podcast Watch presents high-quality, open-access educational blogs and podcasts in emergency medicine (EM) based on the ongoing Academic Life in EM (ALiEM) Approved Instructional Resources (AIR) and AIR-Professional series. Both series critically appraise resources using an objective scoring rubric. This installment of the Blog and Podcast Watch highlights the topic of procedure emergencies from the AIR Series. Methods The AIR Series is a continuously building curriculum that follows the Council of Emergency Medicine Residency Directors’ (CORD) annual testing schedule. For each module, relevant content is collected from the top 50 Social Media Index sites published within the previous 12 months, and scored by eight AIR board members using five equally weighted measurement outcomes: Best Evidence in Emergency Medicine (BEEM) score, accuracy, educational utility, evidence based, and references. Resources scoring ≥30 out of 35 available points receive an AIR label. Resources scoring 27–29 receive an “honorable mention” label if the executive board agrees that the post is accurate and educationally valuable. Results A total of 85 blog posts and podcasts were evaluated in June 2016. This report summarizes key educational pearls from the three AIR posts and the 10 Honorable Mentions. Conclusion The WestJEM Blog and Podcast Watch series is based on the AIR and AIR-Pro series, which attempts to identify high-quality educational content on open-access blogs and podcasts. This series provides an expert-based, post-publication curation of educational social media content for EM clinicians, with this installment focusing on procedure emergencies within the AIR series. PMID:29085547

Development of a guideline for treatment of deep and superficial venous thrombosis in the emergency department.

PubMed

Tosone, Nancy C; Costanzo, Cindy

2012-01-01

Patients with DVT, aged 45.64 years, often present to the ED, with an annual cost of $1.5-$3.2 billion per year. This paper describes the process used to implement an evidence-based guideline on deep venous thrombosis (DVT) for the emergency department (ED). Specific aims were to (a) conduct an organizational assessment of DVT treatment practices; (b) compare organizational results with evidence-based treatment guidelines; (c) develop recommendations for the treatment of DVT for ED discharge; and (d) conduct an interdisciplinary evaluation of the evidence-based guideline. A retrospective review of 149 records of adults in an urban Midwestern ED in 2010 was undertaken. Differences in provider practices were identified. A guideline was developed that included clinical management, social/financial concerns, patient education, anticoagulation monitoring, and outpatient follow-up. Implementation and evaluation were accomplished through electronic and paper communication, medical record monitoring, and patient call back. Evaluation also included simulation exercises with an interdisciplinary team.

Fever management in the emergency department of the Children's Hospital of Fudan University: a best practice implementation project.

PubMed

Hu, Fei; Zhang, Jiayan; Shi, Shupeng; Zhou, Zhang

2016-09-01

Febrile illness in young children usually indicates an underlying infection and is a cause of concern for parents and carers. It is very important that healthcare professionals know how to recognize fever, assess children with fever, treat children with fever and role of nurses and parents. This paper outlines a best practice implementation project on the management of fever in children in an emergency department. To audit current practice of fever management for children in an emergency department and to implement strategies to standardize pediatric fever management based on evidence-based practice guidelines. We used the Joanna Briggs Institute's Practical Application of Clinical Evidence System and Getting Research into Practice to examine compliance with fever management criteria based on the best available evidence before and after the implementation of strategies to spread the use of evidence-based practice protocols. We found significant improvements in pediatric fever management as measured by the knowledge scores of parents (54.5-83.7) and nurses (67.6-90.3). This suggested a need for continuous education. We found a noticeable improvement in compliance across all the five criteria; using correct methods to measure temperature (86-98%), staff education (0-100%), parents education (0-100%), using assessment tools (0-100%) and observed management (0-98%). This best practice implementation project demonstrated the use of effective strategies to standardize the protocol for fever management, implement assessment tool, develop multimedia materials, deliver continuous staff education and update nursing documentation and patient education pamphlets to ensure best practice is delivered by nurses to improve patient outcomes.

Appraising the evidence for public health policy components using the quality and impact of component evidence assessment.

PubMed

Barbero, Colleen; Gilchrist, Siobhan; Schooley, Michael W; Chriqui, Jamie F; Luke, Douglas A; Eyler, Amy A

2015-03-01

An essential strategy expected to reduce the global burden of chronic and cardiovascular disease is evidence-based policy. However, it is often unknown what specific components should constitute an evidence-based policy intervention. We have developed an expedient method to appraise and compare the strengths of the evidence bases suggesting that individual components of a policy intervention will contribute to the positive public health impact of that intervention. Using a new definition of "best available evidence," the Quality and Impact of Component (QuIC) Evidence Assessment analyzes dimensions of evidence quality and evidence of public health impact to categorize multiple policy component evidence bases along a continuum of "emerging," "promising impact," "promising quality," and "best." QuIC was recently applied to components from 2 policy interventions to prevent and improve the outcomes of cardiovascular disease: public-access defibrillation and community health workers. Results illustrate QuIC's utility in international policy practice and research. Copyright © 2015 World Heart Federation (Geneva). All rights reserved.

[Evidence-based medicine as a fundamental principle of health care management for workers].

PubMed

Amirov, N Kh; Fatkhutdinova, L M

2011-01-01

Evidence-based principles in occupational medicine should include prevention, diagnosis, treatment and rehabilitation. Specific feature of occupational medicine is necessity to prove cause-effect relationships between occupational factor and the disease emerged. Important place is occupied by cohort and intervention studies, systematic reviews and meta-analysis. Information obtained by scientific society should be presented to practical specialists and put into everyday activities.

Guidelines and Value-Based Decision Making: An Evolving Role for Payers.

PubMed

McCauley, Janet L

2015-01-01

Payers use evidence-based guidelines to promote effective health diagnoses and treatments for their members and to ensure that members are not subject to harmful or wasteful care. Payer guidelines inform coverage, but the content of these guidelines relies on the same evidentiary base as clinical treatment guidelines. Recent strategies to foster value through benefit design and alternative reimbursement methodologies illustrate emerging applications for evidence-based guidelines. The current focus on cost effectiveness within health technology assessment, comparative effectiveness research in collaboration with payers, and transparency around payer evidence assessment could better align payers' interests in evidence-based care with those of other stakeholders. The move to value in health care will depend upon credible clinical evidence to enable informed decision making. ©2015 by the North Carolina Institute of Medicine and The Duke Endowment. All rights reserved.

Addressing sexual health behaviour during emerging adulthood: a critical review of the literature

PubMed Central

Alexander, Kamila A; Jemmott1, Loretta S; Teitelman, Anne M; D’Antonio, Patricia

2016-01-01

Aims and objectives In this critical literature review, we examine evidence-based interventions that target sexual behaviours of 18- to 25-year-old emerging adult women. Background Nurses and clinicians implement theory-driven research programmes for young women with increased risk of HIV/AIDS and sexually transmitted infections. Strategies to decrease transmission of HIV and sexually transmitted infections are rigorously evaluated and promoted by public health agencies such as the United States Centers for Disease Control and Prevention. While many interventions demonstrate episodic reductions in sexual risk behaviours and infection transmission, there is little evidence they build sustainable skills and behaviours. Programmes may not attend to contextual and affective influences on sexual behaviour change. Design Discursive paper. Methods We conducted a conceptually based literature review and critical analysis of the Centers for Disease Control and Prevention’s best-evidence and good-evidence HIV behavioural interventions. In this review, we examined three contextual and affective influences on the sexual health of emerging adult women: (1) developmental age, (2) reproduction and pregnancy desires and (3) sexual security or emotional responses accompanying relationship experiences. Results Our analyses revealed intervention programmes paid little attention to ways age, desires for pregnancy or emotional factors influence sexual decisions. Some programmes included 18- to 25-year-olds, but they made up small percentages of the sample and did not attend to unique emerging adult experiences. Second, primary focus on infection prevention overshadowed participant desires for pregnancy. Third, few interventions considered emotional mechanisms derived from relationship experiences involved in sexual decision-making. Conclusions Growing evidence demonstrates sexual health interventions may be more effective if augmented to attend to contextual and affective influences on relationship risks and decision-making. Modifying currently accepted strategies may enhance sustainability of sexual health-promoting behaviours. PMID:24988875

Copper intrauterine device for emergency contraception: clinical practice among contraceptive providers.

PubMed

Harper, Cynthia C; Speidel, J Joseph; Drey, Eleanor A; Trussell, James; Blum, Maya; Darney, Philip D

2012-02-01

The copper intrauterine device (IUD) is the most effective emergency contraceptive available but is largely ignored in clinical practice. We examined clinicians' recommendations of the copper IUD for emergency contraception in a setting with few cost obstacles. We conducted a survey among clinicians (n=1,246; response rate 65%) in a California State family planning program, where U.S. Food and Drug Administration-approved contraceptives are available at no cost to low-income women. We used multivariable logistic regression to measure the association of intrauterine contraceptive training and evidence-based knowledge with having recommended the copper IUD for emergency contraception. The large majority of clinicians (85%) never recommended the copper IUD for emergency contraception, and most (93%) required two or more visits for an IUD insertion. Multivariable analyses showed insertion skills were associated with having recommended the copper IUD for emergency contraception, but the most significant factor was evidence-based knowledge of patient selection for IUD use. Clinicians who viewed a wide range of patients as IUD candidates were twice as likely to have recommended the copper IUD for emergency contraception. Although more than 93% of obstetrician-gynecologists were skilled in inserting the copper IUD, they were no more likely to have recommended it for emergency contraception than other physicians or advance practice clinicians. Recommendation of the copper IUD for emergency contraception is rare, despite its high efficacy and long-lasting contraceptive benefits. Recommendation would require clinic flow and scheduling adjustments to allow same-day IUD insertions. Patient-centered and high-quality care for emergency contraception should include a discussion of the most effective method. III.

Developing Handheld Video Intervention for Students with Autism Spectrum Disorder

ERIC Educational Resources Information Center

Hughes, Elizabeth M.; Yakubova, Gulnoza

2016-01-01

Video-based intervention (VBI) has strong evidence supporting efficiency in teaching social, communication, functional, behavior, play, and self-help skills and emerging evidence for teaching academic skills to students with autism spectrum disorder (ASD). VBI allows opportunities to electronically provide personalized, consistent, and prerecorded…

Implementing best practice into the emergency department triage process.

PubMed

Burgess, Luke; Kynoch, Kathryn; Hines, Sonia

2018-05-17

Triage is the process by which emergency departments (EDs) sort patients presenting for medical treatment. The Australasian Triage Scale, validated to measure urgency, answers the question 'This patient should wait for medical assessment and treatment no longer than…' Multiple patients may present within short time frames, and some will have conditions that have outcomes directly related to timeliness of treatment such as stroke, sepsis and myocardial infarction. The safety of patients within the ED is thus directly related to the triage system. This project aimed to compare current triage practice within a metropolitan ED with evidence-based practice guidelines produced by the Australasian College for Emergency Medicine and College of Emergency Nurses Australasia. The clinical audit project was undertaken in an ED in a large metropolitan hospital. Two hundred episodes of triage were audited, 100 in the preimplementation and 100 in the postimplementation phase. Current practice was compared with triage guidelines, barriers to adherence to evidence-based practice identified, and interventions were planned and implemented to address these. The audits of practice focused on five key areas and were assessed against 12 criteria: arrival and triage, documentation, compliance with policy, communication, and triage staff. Overall five criteria showed improvement, with reassessment of patients waiting for treatment, and the time taken for each triage episode achieving the greatest amount of improvement. Four criteria showed no improvement or a decline, and two achieved 100% adherence in both audits. The project sought to undertake a clinical audit of triage practice to evaluate the adherence of practice to evidence-based guidelines. The project has provided strong support for the implementation of a formal nursing role to support the care of waiting room patients, and act as a second triage nurse during periods of high activity. The physical triage environment has been identified as a barrier to optimal adherence to evidence-based practice guidelines. Using effective communication to manage the waiting experience of patients can have positive benefits for both patients and staff.

Effective Emergency Management: Making Improvements for Communities and People with Disabilities

ERIC Educational Resources Information Center

Davis, Elizabeth; Phillips, Brenda

2009-01-01

This report offers information and advice to assist all levels of government in its work to establish evidence-based policies, programs, and practices across the life cycle of disasters. This report provides examples of effective community efforts with respect to people with disabilities, and evaluates many emergency preparedness, disaster relief,…

A Comparative Analysis of Learning Tactics Employed in the Workplace by Leaders from Emerging Generational Cohorts

ERIC Educational Resources Information Center

DePinto, Ross M.

2013-01-01

Much of the relevant literature in the domains of leadership development, succession planning, and cross-generational issues that discusses learning paradigms associated with emerging generational cohorts has been based on qualitative research and anecdotal evidence. In contrast, this study employed quantitative research methods using a validated…

Children's Mental Health: The Changing Interface between Primary and Specialty Care. Reprint.

ERIC Educational Resources Information Center

Steinberg, A. G.; Gadomski, A.; Wilson, M. D.

The landscape for children's mental health services has changed dramatically due to the confluence of several factors. The emergence of managed care has influenced access to as well as the scope of primary care practice. Evidence-based medicine is steadily emerging and driving practice guideline development. In the rapidly changing and…

Evidence-based approach for disaster preparedness authorities to inform the contents of repositories for prescription medications for chronic disease management and control.

PubMed

Brown, David W; Young, Stacy L; Engelgau, Michael M; Mensah, George A

2008-01-01

Chronic diseases are major causes of death and disability and often require multiple prescribed medications for treatment and control. Public health emergencies (e.g., disasters due to natural hazards) that disrupt the availability or supply of these medications may exacerbate chronic disease or even cause death. A repository of chronic disease pharmaceuticals and medical supplies organized for rapid response in the event of a public health emergency is desirable. However, there is no science base for determining the contents of such a repository. This study provides the first step in an evidence-based approach to inform the planning, periodic review, and revision of repositories of chronic disease medications. Data from the 2004 National Hospital Ambulatory Medical Care Survey (NHAMCS) were used to examine the prescription medication needs of persons presenting to US hospital emergency departments for chronic disease exacerbations. It was assumed that the typical distribution of cases for an emergency department will reflect the patient population treated in the days after a public health emergency. The estimated numbers of prescribed drugs for chronic conditions that represent the five leading causes of death, the five leading primary diagnoses for physician office visits, and the five leading causes of disease burden assessed by disability-adjusted life years are presented. The 2004 NHAMCS collected data on 36,589 patient visits that were provided by 376 emergency departments. Overall, the five drug classes mentioned most frequently for emergency department visits during 2004 were narcotic analgesics (30.7 million), non-steroidal anti-inflammatory drugs (25.2 million), non-narcotic analgesics (15.2 million), sedatives and hypnotics (10.4 million), and cephalosporins (8.2 million). The drug classes mentioned most frequently for chronic conditions were: (1) for heart disease, antianginal agents/vasodilators (715,000); (2) for cancer, narcotic analgesics (53,000); (3) for stroke, non-narcotic analgesics (138,000); (4) for chronic obstructive pulmonary disease, anti-asthmatics/bronchodilators (3.2 million); and (5) for diabetes, hypoglycemic agents (261,000). Ten medication categories were common across four or more chronic conditions. Persons with chronic diseases have an urgent need for ongoing care and medical support after public health emergencies. These findings provide one evidence-based approach for informing public health preparedness in terms of planning for and review of the prescription medication needs of clinically vulnerable populations with prevalent chronic disease.

Optimizing diagnostic imaging in the emergency department.

PubMed

Mills, Angela M; Raja, Ali S; Marin, Jennifer R

2015-05-01

While emergency diagnostic imaging use has increased significantly, there is a lack of evidence for corresponding improvements in patient outcomes. Optimizing emergency department (ED) diagnostic imaging has the potential to improve the quality, safety, and outcomes of ED patients, but to date, there have not been any coordinated efforts to further our evidence-based knowledge in this area. The objective of this article is to discuss six aspects of diagnostic imaging to provide background information on the underlying framework for the 2015 Academic Emergency Medicine consensus conference, "Diagnostic Imaging in the Emergency Department: A Research Agenda to Optimize Utilization." The consensus conference aims to generate a high priority research agenda for emergency diagnostic imaging that will inform the design of future investigations. The six components herein will serve as the group topics for the conference: 1) patient-centered outcomes research; 2) clinical decision rules; 3) training, education, and competency; 4) knowledge translation and barriers to image optimization; 5) use of administrative data; and 6) comparative effectiveness research: alternatives to traditional CT use. © 2015 by the Society for Academic Emergency Medicine.

Dealing with office emergencies. Stepwise approach for family physicians.

PubMed Central

Sempowski, Ian P.; Brison, Robert J.

2002-01-01

OBJECTIVE: To develop a simple stepwise approach to initial management of emergencies in family physicians' offices; to review how to prepare health care teams and equipment; and to illustrate a general approach to three of the most common office emergencies. QUALITY OF EVIDENCE: MEDLINE was searched from January 1980 to December 2001. Articles were selected based on their clinical relevance, quality of evidence, and date of publication. We reviewed American family medicine, pediatric, dental, and dermatologic articles, but found that the area has not been well studied from a Canadian family medicine perspective. Consensus statements by specialty professional groups were used to identify accepted emergency medical treatments. MAIN MESSAGE: Family medicine offices are frequently poorly equipped and inadequately prepared to deal with emergencies. Straightforward emergency response plans can be designed and tailored to an office's risk profile. A systematic team approach and effective use of skills, support staff, and equipment is important. The general approach can be modified for specific patients or conditions. CONCLUSION: Family physicians can plan ahead and use a team approach to develop a simple stepwise response to emergency situations in the office. PMID:12371305

78 FR 79697 - Statement of Organization, Functions, and Delegations of Authority

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-31

... new initiatives based on emerging issues, science, and policy; (6) supports the harmonization and..., and programmatic efforts; (10) manages evaluation fellowship; (11) guides performance-based strategic... improvement based on effective program evaluation, and performance measurement; (14) supports evidence-driven...

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. © 2013 John Wiley & Sons Ltd.

Spinal immobilisaton in pre-hospital and emergency care: A systematic review of the literature.

PubMed

Hood, Natalie; Considine, Julie

2015-08-01

Spinal immobilisation has been a mainstay of trauma care for decades and is based on the premise that immobilisation will prevent further neurological compromise in patients with a spinal column injury. The aim of this systematic review was to examine the evidence related to spinal immobilisation in pre-hospital and emergency care settings. In February 2015, we performed a systematic literature review of English language publications from 1966 to January 2015 indexed in MEDLINE and Cochrane library using the following search terms: 'spinal injuries' OR 'spinal cord injuries' AND 'emergency treatment' OR 'emergency care' OR 'first aid' AND immobilisation. EMBASE was searched for keywords 'spinal injury OR 'spinal cord injury' OR 'spine fracture AND 'emergency care' OR 'prehospital care'. There were 47 studies meeting inclusion criteria for further review. Ten studies were case series (level of evidence IV) and there were 37 studies from which data were extrapolated from healthy volunteers, cadavers or multiple trauma patients. There were 15 studies that were supportive, 13 studies that were neutral, and 19 studies opposing spinal immobilisation. There are no published high-level studies that assess the efficacy of spinal immobilisation in pre-hospital and emergency care settings. Almost all of the current evidence is related to spinal immobilisation is extrapolated data, mostly from healthy volunteers. Copyright © 2015 College of Emergency Nursing Australasia Ltd. Published by Elsevier Ltd. All rights reserved.

Australasian emergency physicians: a learning and educational needs analysis. Part Four: CPD topics desired by emergency physicians.

PubMed

Dent, Andrew W; Weiland, Tracey J; Paltridge, Debbie

2008-06-01

To report the preferences of Fellows of the Australasian College for Emergency Medicine for topics they would desire for their continuing professional development (CPD). A mailed survey of Fellows of the Australasian College for Emergency Medicine asked for Likert type responses on the desirability of CPD on 15 procedural skills, 13 management skills, 11 clinical emergency topics, 9 topics related to teaching, 7 related to diagnostics and 5 evidence based practice topics. CPD in procedural skills of advanced and surgical airways, ED ultrasound, ventilation, skills, plastic procedures and regional anaesthesia were nominated as desirable by 85% of emergency physicians (EP). More than 90% desired CPD in ophthalmological, otorhinolaryngeal, neonatal and paediatric emergencies. Of diagnostic skills, more than 80% considered CPD on computerized tomography, electrocardiography and plain X-ray interpretation as desirable, well as CPD about teaching in general, simulation and preparing candidates for fellowship exams. Of the 12 management skills, 11 were seen as desirable topics by more than 70%, with counter disaster planning, giving feedback and dealing with complaints the most popular. All evidence based practice related skills, including interpreting statistics and undertaking literature searches were seen as desirable topics by more than 80% of EP. This information may assist in the planning of future educational interventions for emergency physicians. EP seek CPD on management, educational and other non clinical skills, as well as topics relating directly to patient care.

Case study and case-based research in emergency nursing and care: Theoretical foundations and practical application in paramedic pre-hospital clinical judgment and decision-making of patients with mental illness.

PubMed

Shaban, Ramon Z; Considine, Julie; Fry, Margaret; Curtis, Kate

2017-02-01

Generating knowledge through quality research is fundamental to the advancement of professional practice in emergency nursing and care. There are multiple paradigms, designs and methods available to researchers to respond to challenges in clinical practice. Systematic reviews, randomised control trials and other forms of experimental research are deemed the gold standard of evidence, but there are comparatively few such trials in emergency care. In some instances it is not possible or appropriate to undertake experimental research. When exploring new or emerging problems where there is limited evidence available, non-experimental methods are required and appropriate. This paper provides the theoretical foundations and an exemplar of the use of case study and case-based research to explore a new and emerging problem in the context of emergency care. It examines pre-hospital clinical judgement and decision-making of mental illness by paramedics. Using an exemplar the paper explores the theoretical foundations and conceptual frameworks of case study, it explains how cases are defined and the role researcher in this form of inquiry, it details important principles and the procedures for data gathering and analysis, and it demonstrates techniques to enhance trustworthiness and credibility of the research. Moreover, it provides theoretically and practical insights into using case study in emergency care. Copyright © 2017 College of Emergency Nursing Australasia. Published by Elsevier Ltd. All rights reserved.

Getting the Argument Started: A Variation on the Density Investigation

ERIC Educational Resources Information Center

Walker, Joi P.; Wolf, Steven F.

2017-01-01

The ability to "engage in argument from evidence" is one of the eight practices identified in the "Next Generation Science Standards" as well as an emerging focus of undergraduate chemistry curricula. Guiding students to make evidence-based claims that engender argumentation will require faculty to revise conventional…

The Emergency Department: Challenges and Opportunities for Suicide Prevention.

PubMed

Asarnow, Joan Rosenbaum; Babeva, Kalina; Horstmann, Elizabeth

2017-10-01

Emergency departments (EDs) can offer life-saving suicide prevention care. This article focuses on the ED and emergency services as service delivery sites for suicide prevention. Characteristics of EDs, models of emergency care, ED screening and brief intervention models, and practice guidelines and parameters are reviewed. A care process model for youths at risk for suicide and self-harm is presented, with guidance for clinicians based on the scientific evidence. Strengthening emergency infrastructure and integrating effective suicide prevention strategies derived from scientific research are critical for advancing suicide prevention objectives. Copyright © 2017 Elsevier Inc. All rights reserved.

Laying a Firm Foundation: Embedding Evidence-Based Emergent Literacy Practices Into Early Intervention and Preschool Environments.

PubMed

Terrell, Pamela; Watson, Maggie

2018-04-05

As part of this clinical forum on curriculum-based intervention, the goal of this tutorial is to share research about the importance of language and literacy foundations in natural environments during emergent literacy skill development, from infancy through preschool. Following an overview of intervention models in schools by Powell (2018), best practices at home, in child care, and in preschool settings are discussed. Speech-language pathologists in these settings will be provided a toolbox of best emergent literacy practices. A review of published literature in speech-language pathology, early intervention, early childhood education, and literacy was completed. Subsequently, an overview of the impact of early home and preschool literacy experiences are described. Research-based implementation of best practice is supported with examples of shared book reading and child-led literacy embedded in play within the coaching model of early intervention. Finally, various aspects of emergent literacy skill development in the preschool years are discussed. These include phonemic awareness, print/alphabet awareness, oral language skills, and embedded/explicit literacy. Research indicates that rich home literacy environments and exposure to rich oral language provide an important foundation for the more structured literacy environments of school. Furthermore, there is a wealth of evidence to support a variety of direct and indirect intervention practices in the home, child care, and preschool contexts to support and enhance all aspects of oral and written literacy. Application of this "toolbox" of strategies should enable speech-language pathologists to address the prevention and intervention of literacy deficits within multiple environments during book and play activities. Additionally, clinicians will have techniques to share with parents, child care providers, and preschool teachers for evidence-based literacy instruction within all settings during typical daily activities.

The implementation and evaluation of an evidence-based statewide prehospital pain management protocol developed using the national prehospital evidence-based guideline model process for emergency medical services.

PubMed

Brown, Kathleen M; Hirshon, Jon Mark; Alcorta, Richard; Weik, Tasmeen S; Lawner, Ben; Ho, Shiu; Wright, Joseph L

2014-01-01

In 2008, the National Highway Traffic Safety Administration funded the development of a model process for the development and implementation of evidence-based guidelines (EBGs) for emergency medical services (EMS). We report on the implementation and evaluation of an evidence-based prehospital pain management protocol developed using this model process. An evidence-based protocol for prehospital management of pain resulting from injuries and burns was reviewed by the Protocol Review Committee (PRC) of the Maryland Institute for Emergency Medical Services Systems (MIEMSS). The PRC recommended revisions to the Maryland protocol that reflected recommendations in the EBG: weight-based dosing and repeat dosing of morphine. A training curriculum was developed and implemented using Maryland's online Learning Management System and successfully accessed by 3,941 paramedics and 15,969 BLS providers. Field providers submitted electronic patient care reports to the MIEMSS statewide prehospital database. Inclusion criteria were injured or burned patients transported by Maryland ambulances to Maryland hospitals whose electronic patient care records included data for level of EMS provider training during a 12-month preimplementation period and a 12-month postimplementation period from September 2010 through March 2012. We compared the percentage of patients receiving pain scale assessments and morphine, as well as the dose of morphine administered and the use of naloxone as a rescue medication for opiate use, before and after the protocol change. No differences were seen in the percentage of patients who had a pain score documented or the percent of patients receiving morphine before and after the protocol change, but there was a significant increase in the total dose and dose in mg/kg administered per patient. During the postintervention phase, patients received an 18% higher total morphine dose and a 14.9% greater mg/kg dose. We demonstrated that the implementation of a revised statewide prehospital pain management protocol based on an EBG developed using the National Prehospital Evidence-based Guideline Model Process was associated with an increase in dosing of narcotic pain medication consistent with that recommended by the EBG. No differences were seen in the percentage of patients receiving opiate analgesia or in the documentation of pain scores.

From creatures of habit to goal-directed learners: Tracking the developmental emergence of model-based reinforcement learning

PubMed Central

Decker, Johannes H.; Otto, A. Ross; Daw, Nathaniel D.; Hartley, Catherine A.

2016-01-01

Theoretical models distinguish two decision-making strategies that have been formalized in reinforcement-learning theory. A model-based strategy leverages a cognitive model of potential actions and their consequences to make goal-directed choices, whereas a model-free strategy evaluates actions based solely on their reward history. Research in adults has begun to elucidate the psychological mechanisms and neural substrates underlying these learning processes and factors that influence their relative recruitment. However, the developmental trajectory of these evaluative strategies has not been well characterized. In this study, children, adolescents, and adults, performed a sequential reinforcement-learning task that enables estimation of model-based and model-free contributions to choice. Whereas a model-free strategy was evident in choice behavior across all age groups, evidence of a model-based strategy only emerged during adolescence and continued to increase into adulthood. These results suggest that recruitment of model-based valuation systems represents a critical cognitive component underlying the gradual maturation of goal-directed behavior. PMID:27084852

Evidence Base Update: 50 Years of Research on Treatment for Child and Adolescent Anxiety.

PubMed

Higa-McMillan, Charmaine K; Francis, Sarah E; Rith-Najarian, Leslie; Chorpita, Bruce F

2016-01-01

Anxiety disorders are the most common mental health disorder among children and adolescents. We examined 111 treatment outcome studies testing 204 treatment conditions for child and adolescent anxiety published between 1967 and mid-2013. Studies were selected for inclusion in this review using the PracticeWise Evidence-Based Services database. Using guidelines identified by this journal (Southam-Gerow & Prinstein, 2014), studies were included if they were conducted with children and/or adolescents (ages 1-19) with anxiety and/or avoidance problems. In addition to reviewing the strength of the evidence, the review also examined indicators of effectiveness, common practices across treatment families, and mediators and moderators of treatment outcome. Six treatments reached well-established status for child and adolescent anxiety, 8 were identified as probably efficacious, 2 were identified as possibly efficacious, 6 treatments were deemed experimental, and 8 treatments of questionable efficacy emerged. Findings from this review suggest substantial support for cognitive-behavioral therapy (CBT) as an effective and appropriate first-line treatment for youth with anxiety disorders. Several other treatment approaches emerged as probably efficacious that are not primarily CBT based, suggesting that there are alternative evidence-based treatments that practitioners can turn to for children and adolescents who do not respond well to CBT. The review concludes with a discussion of treatments that improve functioning in addition to reducing symptoms, common practices derived from evidence-based treatments, mediators and moderators of treatment outcomes, recommendations for best practice, and suggestions for future research.

A workshop report on HIV mHealth synergy and strategy meeting to review emerging evidence-based mHealth interventions and develop a framework for scale-up of these interventions

PubMed Central

Karanja, Sarah; Mbuagbaw, Lawrence; Ritvo, Paul; Law, Judith; Kyobutungi, Catherine; Reid, Graham; Ram, Ravi; Estambale, Benson; Lester, Richard

2011-01-01

mHealth is a term used to refer to mobile technologies such as personal digital assistants and mobile phones for healthcare. mHealth initiatives to support care and treatment of patients are emerging globally and this workshop brought together researchers, policy makers, information, communication and technology programmers, academics and civil society representatives for one and a half days synergy meeting in Kenya to review regional evidence based mHealth research for HIV care and treatment, review mHealth technologies for adherence and retention interventions in anti-retroviral therapy (ART) programs and develop a framework for scale up of evidence based mHealth interventions. The workshop was held in May 2011 in Nairobi, Kenya and was funded by the Canadian Global Health Research Initiatives (GHRI) and the US Centre for Disease Control and Prevention (CDC). At the end of the workshop participants came up with a framework to guide mHealth initiatives in the region and a plan to work together in scaling up evidence based mHealth interventions. The participants acknowledged the importance of the meeting in setting the pace for strengthening and coordinating mHealth initiatives and unanimously agreed to hold a follow up meeting after three months. PMID:22187619

A workshop report on HIV mHealth synergy and strategy meeting to review emerging evidence-based mHealth interventions and develop a framework for scale-up of these interventions.

PubMed

Karanja, Sarah; Mbuagbaw, Lawrence; Ritvo, Paul; Law, Judith; Kyobutungi, Catherine; Reid, Graham; Ram, Ravi; Estambale, Benson; Lester, Richard

2011-01-01

mHealth is a term used to refer to mobile technologies such as personal digital assistants and mobile phones for healthcare. mHealth initiatives to support care and treatment of patients are emerging globally and this workshop brought together researchers, policy makers, information, communication and technology programmers, academics and civil society representatives for one and a half days synergy meeting in Kenya to review regional evidence based mHealth research for HIV care and treatment, review mHealth technologies for adherence and retention interventions in anti-retroviral therapy (ART) programs and develop a framework for scale up of evidence based mHealth interventions. The workshop was held in May 2011 in Nairobi, Kenya and was funded by the Canadian Global Health Research Initiatives (GHRI) and the US Centre for Disease Control and Prevention (CDC). At the end of the workshop participants came up with a framework to guide mHealth initiatives in the region and a plan to work together in scaling up evidence based mHealth interventions. The participants acknowledged the importance of the meeting in setting the pace for strengthening and coordinating mHealth initiatives and unanimously agreed to hold a follow up meeting after three months.

Preventive interventions addressing underage drinking: state of the evidence and steps toward public health impact.

PubMed

Spoth, Richard; Greenberg, Mark; Turrisi, Robert

2008-04-01

The epidemiological features of underage drinking and evidence of its social, health, and economic consequences suggest compelling reasons for the development and dissemination of effective preventive interventions. To clarify the nature and extent of the current evidence base on preventive interventions addressing underage drinking, a review of the literature was conducted through extensive searches of the research literature on outcome evaluations, existing reviews of this body of outcome research (N = 25), and summary reports of evidence on specific interventions. More than 400 interventions were identified and screened, and the evidence for 127 was reviewed. Criteria for the evaluation of evidence were established for intervention studies with alcohol-specific outcome measures for 3 developmental periods (< 10, 10-15, and 16 to > or = 20 years of age). Ultimately, 12 interventions met criteria for "most promising" evidence and 29 met criteria for "mixed or emerging" evidence. Conducting this review revealed clear advances in the number of evidence-based interventions available and the quality of outcome research; however, much work remains to achieve greater public health impact through evidence-based interventions. This work should consider (1) the great need for intervention research related to understudied developmental phases, intervention domains (eg, family, school, community, and media), and populations (eg, early tweens, late teens, young adults not attending college, and nonmajority populations); (2) the critical importance of addressing key issues in research design and methods (eg, limited longitudinal studies, replication studies, and dissemination research); and (3) the need for improved consistency in application of evidence and reporting standards. Finally, we recommend the application of emerging consumer-oriented and community-participatory models for intervention development and research, designed to increase the likelihood of "real-world" public health impact through improved translation of intervention science into practice.

The impact of humanitarian emergencies on the prevalence of violence against children: an evidence-based ecological framework.

PubMed

Rubenstein, Beth L; Stark, Lindsay

2017-03-01

Little is known about the patterns and mechanisms by which humanitarian emergencies may exacerbate violence against children. In this article, we propose using the ecological framework to examine the impact of humanitarian emergencies on interpersonal violence against children. We consider the literature that supports this framework and suggest future directions for research to fill identified gaps in the framework. The relationship between humanitarian emergencies and violence against children depends on risk factors at multiple levels, including a breakdown of child protection systems, displacement, threats to livelihoods, changing gender roles, changing household composition, overcrowded living conditions, early marriage, exposure to conflict or other emergency events, and alcohol abuse. The empirical evidence supporting the proposed emergency/violence framework is limited by cross-sectional study designs and a propensity to predominantly examine individual-level determinants of violence, especially exposure to conflict or emergency events. Thus, there is a pressing need to contextualize the relationship between conflict or emergency events and violence against children within the wider ecological and household dynamics that occur during humanitarian emergencies. Ultimately, this will require longitudinal observations of children, families and communities from before the emergency through recovery and improvements to ongoing global surveillance systems. More complete data will enable the humanitarian community to design effective, appropriate and well-targeted interventions.

Care for emergency department patients who have experienced domestic violence: a review of the evidence base.

PubMed

Olive, Philippa

2007-09-01

A literature review was conducted to identify and evaluate the research base underpinning care for emergency department patients who have experienced domestic violence. The extent of domestic violence in the general population has placed it high on health and social policy agendas. The Department of Health has recognized the role of health care professionals to identify and provide interventions for patients who have experienced domestic violence. Systematic review. At least 6% of emergency department patients have experienced domestic violence in the previous 12 months although actual prevalence rates are probably higher. Simple direct questioning in a supportive environment is effective in facilitating disclosure and hence detecting cases of abuse. Although routine screening is most effective, index of suspicion screening is the current mode of practice in the UK. Index of suspicion screening is likely to contribute to under-detection and result in inequitable health care. Patients with supportive networks have reduced adverse mental health outcomes. Women will have negative perceptions of emergency care if their abuse is minimalized or not identified. Women want their needs and the needs of their children to be explored and addressed. Access to community resources is increased if patients receive education and information. Domestic violence is an indisputable health issue for many emergency department patients. Practitioners face challenges from ambiguity in practice guidelines and the paucity of research to support interventions. Recommendations for practice based on the current evidence base are presented. The nursing care for patients in emergency and acute health care settings who have experienced domestic violence should focus on three domains of: (1) Providing physical, psychological and emotional support; (2) Enhancing safety of the patient and their family; (3) Promoting self-efficacy.

A Review of Current and Emerging Approaches to Pain Management in the Emergency Department.

PubMed

Todd, Knox H

2017-12-01

Pain is the most common symptom prompting an emergency department visit and emergency physicians are responsible for managing both acute pain and acute exacerbations of chronic pain resulting from a broad range of illnesses and injuries. The responsibility to treat must be balanced by the duty to limit harm resulting from analgesics. In recent years, opioid-related adverse effects, including overdose and deaths, have increased dramatically in the USA. In response to the US opioid crisis, emergency physicians have broadened their analgesic armamentarium to include a variety of non-opioid approaches. For some of these therapies, sparse evidence exists to support their efficacy for emergency department use. The purpose of this paper is to review historical trends and emerging approaches to emergency department analgesia, with a particular focus on the USA and Canada. We conducted a qualitative review of past and current descriptive studies of emergency department pain practice, as well as clinical trials of emerging pain treatment modalities. The review considers the increasing use of non-opioid and multimodal analgesic therapies, including migraine therapies, regional anesthesia, subdissociative-dose ketamine, nitrous oxide, intravenous lidocaine and gabapentinoids, as well as broad programmatic initiatives promoting the use of non-opioid analgesics and nonpharmacologic interventions. While migraine therapies, regional anesthesia, nitrous oxide and subdissociative-dose ketamine are supported by a relatively robust evidence base, data supporting the emergency department use of intravenous lidocaine, gabapentinoids and various non-pharmacologic analgesic interventions remain sparse. Additional research on the relative safety and efficacy of non-opioid approaches to emergency department analgesia is needed. Despite a limited research base, it is likely that non-opioid analgesic modalities will be employed with increasing frequency. A new generation of emergency physicians is seeking additional training in pain medicine and increasing dialogue between emergency medicine and pain medicine researchers, educators and clinicians could contribute to better management of emergency department pain.

Pre-hospital care after a seizure: Evidence base and United Kingdom management guidelines.

PubMed

Osborne, Andrew; Taylor, Louise; Reuber, Markus; Grünewald, Richard A; Parkinson, Martin; Dickson, Jon M

2015-01-01

Seizures are a common presentation to pre-hospital emergency services and they generate significant healthcare costs. This article summarises the United Kingdom (UK) Ambulance Service guidelines for the management of seizures and explores the extent to which these guidelines are evidence-based. Summary of the Clinical Practice Guidelines of the UK Joint Royal Colleges Ambulance Liaison Committee relating to the management of seizures. Review of the literature relating to pre-hospital management of seizure emergencies. Much standard practice relating to the emergency out of hospital management of patients with seizures is drawn from generic Advanced Life Support (ALS) guidelines although many patients do not need ALS during or after a seizure and the benefit of many ALS interventions in seizure patients remains to be established. The majority of studies identified pertain to medical treatment of status epilepticus. These papers show that benzodiazepines are safe and effective but it is not possible to draw definitive conclusions about the best medication or the optimal route of administration. The evidence base for current pre-hospital guidelines for seizure emergencies is incomplete. A large proportion of patients are transported to hospital after a seizure but many of these may be suitable for home management. However, there is very little research into alternative care pathways or criteria that could be used to help paramedics avoid transport to hospital. More research is needed to improve care for people after a seizure and to improve the cost-effectiveness of the healthcare systems within which they are treated. Copyright © 2014 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

Projecting the global distribution of the emerging amphibian fungal pathogen, batrachochytrium dendrobatidis, based on IPCC climate futures

Treesearch

Gisselle Yang Xie; Deanna H. Olson; Andrew R. Blaustein

2016-01-01

Projected changes in climate conditions are emerging as significant risk factors to numerous species, affecting habitat conditions and community interactions. Projections suggest species range shifts in response to climate change modifying environmental suitability and is supported by observational evidence. Both pathogens and their hosts can shift ranges with climate...

The Dangerous Myth of Emerging Adulthood: An Evidence-Based Critique of a Flawed Developmental Theory

ERIC Educational Resources Information Center

Côté, James E.

2014-01-01

This article examines the theory of emerging adulthood, introduced into the literature by Arnett (2000), in terms of its methodological and evidential basis, and finds it to be unsubstantiated on numerous grounds. Other, more convincing, formulations of variations in the transition to adulthood are examined. Most flawed academic theories are…

Perspectives of Young Emerging Adults with Serious Mental Health Conditions on Vocational Peer Mentors

ERIC Educational Resources Information Center

Klodnick, Vanessa V.; Sabella, Kathryn; Brenner, Christopher J.; Krzos, Izabela M.; Ellison, Marsha L.; Kaiser, Susan M.; Davis, Maryann; Fagan, Marc A.

2015-01-01

For early emerging adults with serious mental health conditions, vocational services with peer mentors are a promising adaptation of adult system evidence-based practices. Peer mentors were added to the Individual Placement and Support model of supported employment for 17- to 20-year-olds receiving residential and psychiatric care. To explore the…

Optimizing Diagnostic Imaging in the Emergency Department

PubMed Central

Mills, Angela M.; Raja, Ali S.; Marin, Jennifer R.

2015-01-01

While emergency diagnostic imaging use has increased significantly, there is a lack of evidence for corresponding improvements in patient outcomes. Optimizing emergency department (ED) diagnostic imaging has the potential to improve the quality, safety, and outcomes of ED patients, but to date, there have not been any coordinated efforts to further our evidence-based knowledge in this area. The objective of this article is to discuss six aspects of diagnostic imaging in order to provide background information on the underlying framework for the 2015 Academic Emergency Medicine consensus conference, “Diagnostic Imaging in the Emergency Department: A Research Agenda to Optimize Utilization.” The consensus conference aims to generate a high priority research agenda for emergency diagnostic imaging that will inform the design of future investigations. The six components herein will serve as the group topics for the conference: 1) patient-centered outcomes research; 2) clinical decision rules; 3) training, education, and competency; 4) knowledge translation and barriers to image optimization; 5) use of administrative data; and 6) comparative effectiveness research: alternatives to traditional CT use. PMID:25731864

Complementary and alternative medicine treatments for children with autism spectrum disorders.

PubMed

Levy, Susan E; Hyman, Susan L

2008-10-01

Complementary and alternative medical (CAM) treatments are commonly used for children with autism spectrum disorders. This review discusses the evidence supporting the most frequently used treatments, including categories of mind-body medicine, energy medicine, and biologically based, manipulative, and body-based practices, with the latter two treatments the most commonly selected by families. Clinical providers need to understand the evidence for efficacy (or lack thereof) and potential side effects. Some CAM practices have evidence to reject their use, such as secretin, whereas others have emerging evidence to support their use, such as melatonin. Most treatments have not been adequately studied and do not have evidence to support their use.

Assessing Team Leadership in Emergency Medicine: The Milestones and Beyond

PubMed Central

Rosenman, Elizabeth D.; Branzetti, Jeremy B.; Fernandez, Rosemarie

2016-01-01

Background Team leadership is a critical skill for emergency medicine physicians that directly affects team performance and the quality of patient care. There exists a robust body of team science research supporting team leadership conceptual models and behavioral skill sets. However, to date, this work has not been widely incorporated into health care team leadership education. Objective This narrative review has 3 aims: (1) to synthesize the team science literature and to translate important concepts and models to health care team leadership; (2) to describe how team leadership is currently represented in the health care literature and in the Accreditation Council for Graduate Medical Education Milestones for emergency medicine; and (3) to propose a novel, evidence-based framework for the assessment of team leadership in emergency medicine. Methods We conducted a narrative review of the team science and health care literature. We summarized our findings and identified a list of team leadership behaviors that were then used to create a framework for team leadership assessment. Results Current health care team leadership measurement tools do not incorporate evidence-based models of leadership concepts from other established domains. The emergency medicine milestones include several team leadership behaviors as part of a larger resident evaluation program. However, they do not offer a comprehensive or cohesive representation of the team leadership construct. Conclusions Despite the importance of team leadership to patient care, there is no standardized approach to team leadership assessment in emergency medicine. Based on the results of our review, we propose a novel team leadership assessment framework that is supported by the team science literature. PMID:27413434

Emergency department clinical redesign, team-based care and improvements in hospital performance: A time series analysis.

PubMed

Dinh, Michael M; Green, Timothy C; Bein, Kendall J; Lo, Serigne; Jones, Aaron; Johnson, Terence

2015-08-01

The objective was to evaluate the impact of an ED clinical redesign project that involved team-based care and early senior assessment on hospital performance. This was an interrupted time series analysis performed using daily hospital performance data 6 months before and 8 months after the implementation of the clinical redesign intervention that involved Emergency Consultant-led team-based care, redistribution of ED beds and implementation of a senior nursing coordination roles in the ED. The primary outcome was the daily National Emergency Access Target (NEAT) performance (proportion of total daily ED presentations that were admitted to an inpatient ward or discharged from ED within 4 h of arrival). Secondary outcomes were daily ALOS in ED, inpatient Clinical Emergency Response System (CERS) calls and hospital mortality. Autoregressive Integrated Moving Average analysis was used to model NEAT performance. Hospital mortality was modelled using negative binomial regression. After adjusting for patient volume, inpatient admissions, ambulance, hospital occupancy, weekends ED Consultant numbers, weekends and underlying trends, there was a 17% improvement in NEAT associated with the post-intervention period (95% CI 12, 19% P < 0.001). There was no change in the number of CERS calls and the median daily hospital mortality rate reduced from 1.04% to 0.96% (P = 0.025). An ED-focused clinical redesign project was associated with a 17% improvement in NEAT performance with no evidence of an increase in clinical deterioration on inpatient wards and evidence for an improvement in hospital mortality. © 2015 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

Assessing Team Leadership in Emergency Medicine: The Milestones and Beyond.

PubMed

Rosenman, Elizabeth D; Branzetti, Jeremy B; Fernandez, Rosemarie

2016-07-01

Team leadership is a critical skill for emergency medicine physicians that directly affects team performance and the quality of patient care. There exists a robust body of team science research supporting team leadership conceptual models and behavioral skill sets. However, to date, this work has not been widely incorporated into health care team leadership education. This narrative review has 3 aims: (1) to synthesize the team science literature and to translate important concepts and models to health care team leadership; (2) to describe how team leadership is currently represented in the health care literature and in the Accreditation Council for Graduate Medical Education Milestones for emergency medicine; and (3) to propose a novel, evidence-based framework for the assessment of team leadership in emergency medicine. We conducted a narrative review of the team science and health care literature. We summarized our findings and identified a list of team leadership behaviors that were then used to create a framework for team leadership assessment. Current health care team leadership measurement tools do not incorporate evidence-based models of leadership concepts from other established domains. The emergency medicine milestones include several team leadership behaviors as part of a larger resident evaluation program. However, they do not offer a comprehensive or cohesive representation of the team leadership construct. Despite the importance of team leadership to patient care, there is no standardized approach to team leadership assessment in emergency medicine. Based on the results of our review, we propose a novel team leadership assessment framework that is supported by the team science literature.

Evidence-based medicine and the anecdote: Uneasy bedfellows or ideal couple?

PubMed Central

Kosko, Jilleen; Klassen, Terry P; Bishop, Ted; Hartling, Lisa

2006-01-01

Over the past 30 years, there has been a resurgence in the use of storytelling and narrative in medicine. At first glance, the trend to incorporate art forms into medicine appears to run counter to the rise of the more objective and positivist evidence-based medicine movement. In the present article, the authors provide examples of the use of storytelling and narrative in medicine, describe their origins, and contrast this approach with evidence-based medicine. The authors suggest that storytelling and narrative offer a complement to the science of evidence-based medicine. Finally, the authors describe a program of research to develop and evaluate the use of storytelling as a communication tool between physicians and parents/caregivers of children presenting to the emergency department. PMID:19030250

Implementation science: how to jump‐start infection prevention.

PubMed

Saint, Sanjay; Howell, Joel D; Krein, Sarah L

2010-11-01

Implementing evidence‐based infection prevention practices is challenging. Implementation science, which is the study of methods promoting the uptake of evidence into practice, addresses the gap between theory and practice. Just as healthcare epidemiology has emerged as a paradigm for patient safety, infection prevention may serve as a clinical model for implementation researchers.

The Dollars and Senselessness in Failing to Prioritize Childhood Maltreatment Prevention

ERIC Educational Resources Information Center

Wekerle, Christine

2011-01-01

Childhood maltreatment captured medical attention almost 50 years ago. Reviews considering the evidence for published maltreatment prevention programming emerged about 20 years ago. In the second decade of the 21st century, evidence-based maltreatment prevention is a reality for at-risk groups; however, the research-to-practice and policy gap…

Coaching as a Family-Centred, Occupational Therapy Intervention for Autism: A Literature Review

ERIC Educational Resources Information Center

Simpson, Desley

2015-01-01

Occupational therapy interventions for autism spectrum disorder (ASD) require a sound evidence-base. In the context of emerging evidence on coaching interventions in paediatric occupational therapy practice, a review of the occupational therapy literature was conducted to investigate the use of coaching interventions for children and adolescents…

Emerging Evidence for Instructional Practice: Repeated Viewings of Sign Language Models

ERIC Educational Resources Information Center

Beal-Alvarez, Jennifer S.; Huston, Sandra G.

2014-01-01

Current initiatives in education, such as No Child Left Behind and the National Common Core Standards movement, call for the use of evidence-based practices, or those instructional practices that are supported by documentation of their effectiveness related to student learning outcomes, including students with special needs. While hearing loss is…

Governing Education without Reform: The Power of the Example

ERIC Educational Resources Information Center

Simons, Maarten

2015-01-01

There is an increasing emphasis today on different forms of evidence-based policy in education. Several authors address the related emergence of new patterns of governing and describe forms of governing by numbers and related practices of governing by comparison. There is, however, less focus on the governmental use of soft evidence such as…

Evidence-based management - healthcare manager viewpoints.

PubMed

Janati, Ali; Hasanpoor, Edris; Hajebrahimi, Sakineh; Sadeghi-Bazargani, Homayoun

2018-06-11

Purpose Hospital manager decisions can have a significant impact on service effectiveness and hospital success, so using an evidence-based approach can improve hospital management. The purpose of this paper is to identify evidence-based management (EBMgt) components and challenges. Consequently, the authors provide an improving evidence-based decision-making framework. Design/methodology/approach A total of 45 semi-structured interviews were conducted in 2016. The authors also established three focus group discussions with health service managers. Data analysis followed deductive qualitative analysis guidelines. Findings Four basic themes emerged from the interviews, including EBMgt evidence sources (including sub-themes: scientific and research evidence, facts and information, political-social development plans, managers' professional expertise and ethical-moral evidence); predictors (sub-themes: stakeholder values and expectations, functional behavior, knowledge, key competencies and skill, evidence sources, evidence levels, uses and benefits and government programs); EBMgt barriers (sub-themes: managers' personal characteristics, decision-making environment, training and research system and organizational issues); and evidence-based hospital management processes (sub-themes: asking, acquiring, appraising, aggregating, applying and assessing). Originality/value Findings suggest that most participants have positive EBMgt attitudes. A full evidence-based hospital manager is a person who uses all evidence sources in a six-step decision-making process. EBMgt frameworks are a good tool to manage healthcare organizations. The authors found factors affecting hospital EBMgt and identified six evidence sources that healthcare managers can use in evidence-based decision-making processes.

Strategies for strengthening the evidence base for employee health promotion programs.

PubMed

Goetzel, Ron Z; Schoenman, Julie A; Chapman, Larry S; Anderson, David R; Ozminkowski, Ronald J; Lindsay, Garry M

2011-01-01

Employee health promotion programs have been a visible facet of the American workplace for more than 30 years. During that time, a substantial amount of research on best practices has been conducted, but because of a lack of significant public investment in research funding there is still much to be done. Most researchers and practitioners familiar with the literature recognize the need to strengthen the evidence base for the field. In this edition of The Art of Health Promotion we examine the primary recommendations emerging from a recent federally sponsored effort to identify strategies for strengthening the evidence base for employee health promotion.

Pattern Search in Multi-structure Data: A Framework for the Next-Generation Evidence-based Medicine

DOE Office of Scientific and Technical Information (OSTI.GOV)

Sukumar, Sreenivas R; Ainsworth, Keela C

With the advent of personalized and evidence-based medicine, the need for a framework to analyze/interpret quantitative measurements (blood work, toxicology, etc.) with qualitative descriptions (specialist reports after reading images, bio-medical knowledge-bases) to predict diagnostic risks is fast emerging. Addressing this need, we pose and address the following questions (i) How can we jointly analyze both qualitative and quantitative data ? (ii) Is the fusion of multi-structure data expected to provide better insights than either of them individually ? We present experiments on two bio-medical data sets - mammography and traumatic brain studies to demonstrate architectures and tools for evidence-pattern search.

The role of state mental health authorities in managing change for the implementation of evidence-based practices.

PubMed

Isett, Kimberley Roussin; Burnam, M Audrey; Coleman-Beattie, Brenda; Hyde, Pamela S; Morrissey, Joseph P; Magnabosco, Jennifer L; Rapp, Charles; Ganju, Vijay; Goldman, Howard H

2008-06-01

The evidence-based practice demonstration for services to adults with serious mental illness has ended its pilot stage. This paper presents the approaches states employed to combine traditional policy levers with more strategic/institutional efforts (e.g., leadership) to facilitate implementation of these practices. Two rounds of site visits were completed and extensive interview data collected. The data were analyzed to find trends that were consistent across states and across practices. Two themes emerged for understanding implementation of evidence-based practices: the support and influence of the state mental health authority matters and so does the structure of the mental health systems.

"In rape cases we can use this pill": a multimethods assessment of emergency contraception knowledge, access, and needs on the Thailand-Burma border.

PubMed

Hobstetter, Margaret; Sietstra, Cari; Walsh, Meredith; Leigh, Jennifer; Foster, Angel M

2015-08-01

To evaluate availability, service delivery, and barriers to access to emergency contraceptive pills (ECPs) along the Thailand-Burma border. From June 2010 to May 2011 we undertook a multimethods qualitative assessment among cross-border populations, migrants, and refugees. We conducted 46 key informant interviews with representatives from 25 organizations, 18 focus group discussions with migrant adults, migrant adolescents, and healthcare workers, and a service mapping exercise with 22 stakeholders. We found low use of ECPs among the target populations. Structural barriers and lack of evidence-based reproductive health protocols, education, and information restrict access to the limited family planning resources available in this region. Misinformation about ECPs was widespread among health workers and organizational policies were often non-evidence based. Potential policy and program interventions to improve access to ECPs along the Thailand-Burma border include integrating evidence-based practices into community efforts, expanding training opportunities for health workers, and improving communication and coordination among organizations serving populations on both sides of the border. Copyright © 2015. Published by Elsevier Ireland Ltd.

The Emergence of Systematic Review in Toxicology

PubMed Central

Stephens, Martin L.; Betts, Kellyn; Beck, Nancy B.; Cogliano, Vincent; Dickersin, Kay; Fitzpatrick, Suzanne; Freeman, James; Gray, George; Hartung, Thomas; McPartland, Jennifer; Rooney, Andrew A.; Scherer, Roberta W.; Verloo, Didier; Hoffmann, Sebastian

2016-01-01

The Evidence-based Toxicology Collaboration hosted a workshop on “The Emergence of Systematic Review and Related Evidence-based Approaches in Toxicology,” on November 21, 2014 in Baltimore, Maryland. The workshop featured speakers from agencies and organizations applying systematic review approaches to questions in toxicology, speakers with experience in conducting systematic reviews in medicine and healthcare, and stakeholders in industry, government, academia, and non-governmental organizations. Based on the workshop presentations and discussion, here we address the state of systematic review methods in toxicology, historical antecedents in both medicine and toxicology, challenges to the translation of systematic review from medicine to toxicology, and thoughts on the way forward. We conclude with a recommendation that as various agencies and organizations adapt systematic review methods, they continue to work together to ensure that there is a harmonized process for how the basic elements of systematic review methods are applied in toxicology. PMID:27208075

The Emerging Role of Meditation in Addressing Psychiatric Illness, with a Focus on Substance Use Disorders

PubMed Central

Dakwar, Elias; Levin, Frances R.

2011-01-01

Over the past 30 years the practice of meditation has become increasingly popular in clinical settings. In addition to evidence-based medical uses, meditation may have psychiatric benefits. In this review, the literature on the role of meditation in addressing psychiatric issues, and specifically substance use disorders, is discussed. Each of the three meditation modalities that have been most widely studied—transcendental meditation, Buddhist meditation, and mindfulness-based meditation—is critically examined in terms of its background, techniques, mechanisms of action, and evidence-based clinical applications, with special attention given to its emerging role in the treatment of substance use disorders. The unique methodological difficulties that beset the study of meditation are also considered. A brief discussion then integrates the research that has been completed thus far, elucidates the specific ways that meditation may be helpful for substance use disorders, and suggests new avenues for research. PMID:19637074

Drug Prices and Emergency Department Mentions for Cocaine and Heroin

PubMed Central

Caulkins, Jonathan P.

2001-01-01

Objectives. In this report, the author illustrates the historic relation between retail drug prices and emergency department mentions for cocaine and heroin. Methods. Price series based on the Drug Enforcement Administration's System to Retrieve Information From Drug Evidence database were correlated with data on emergency department mentions from the Drug Abuse Warning Network for cocaine (1978–1996) and heroin (1981–1996). Results. A simple model in which emergency department mentions are driven by only prices explains more than 95% of the variation in emergency department mentions. Conclusions. Fluctuations in prices are an important determinant of adverse health outcomes associated with drugs. PMID:11527779

[Breaking bad news in the emergency room: Suggestions and future challenges].

PubMed

Landa-Ramírez, Edgar; López-Gómez, Antonio; Jiménez-Escobar, Irma; Sánchez-Sosa, Juan José

2017-01-01

The aim of this paper is to describe educational programs that reportedly teach how to break bad news in the emergency department. We also suggest some recommendations on how to communicate bad news based on the research of evidence available in the field. The examined evidence points toward six major components with which physicians should familiarize when communicating bad news: 1) doctor-patient empathic communication, 2) establishing a proper space to give the news, 3) identifying characteristics of the person who receives the news, 4) essential aspects for communicating the news; 5) emotional support, and 6) medical and administrative aspects of the encounter. Finally, we point out several limitations in the studies in the field and future challenges identified in the communication of bad news in emergency room facilities.

A systematic review and qualitative analysis to inform the development of a new emergency department-based geriatric case management model.

PubMed

Sinha, Samir K; Bessman, Edward S; Flomenbaum, Neal; Leff, Bruce

2011-06-01

We inform the future development of a new geriatric emergency management practice model. We perform a systematic review of the existing evidence for emergency department (ED)-based case management models designed to improve the health, social, and health service utilization outcomes for noninstitutionalized older patients within the context of an index ED visit. This was a systematic review of English-language articles indexed in MEDLINE and CINAHL (1966 to 2010), describing ED-based case management models for older adults. Bibliographies of the retrieved articles were reviewed to identify additional references. A systematic qualitative case study analytic approach was used to identify the core operational components and outcome measures of the described clinical interventions. The authors of the included studies were also invited to verify our interpretations of their work. The determined patterns of component adherence were then used to postulate the relative importance and effect of the presence or absence of a particular component in influencing the overall effectiveness of their respective interventions. Eighteen of 352 studies (reported in 20 articles) met study criteria. Qualitative analyses identified 28 outcome measures and 8 distinct model characteristic components that included having an evidence-based practice model, nursing clinical involvement or leadership, high-risk screening processes, focused geriatric assessments, the initiation of care and disposition planning in the ED, interprofessional and capacity-building work practices, post-ED discharge follow-up with patients, and evaluation and monitoring processes. Of the 15 positive study results, 6 had all 8 characteristic components and 9 were found to be lacking at least 1 component. Two studies with positive results lacked 2 characteristic components and none lacked more than 2 components. Of the 3 studies with negative results demonstrating no positive effects based on any outcome tested, one lacked 2, one lacked 3, and one lacked 4 of the 8 model components. Successful models of ED-based case management models for older adults share certain key characteristics. This study builds on the emerging literature in this area and leverages the differences in these models and their associated outcomes to support the development of an evidence-based normative and effective geriatric emergency management practice model designed to address the special care needs and thereby improve the health and health service utilization outcomes of older patients. Copyright © 2010 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.

Establishment of the Ivermectin Research for Malaria Elimination Network: updating the research agenda.

PubMed

Chaccour, Carlos J; Rabinovich, N Regina; Slater, Hannah; Canavati, Sara E; Bousema, Teun; Lacerda, Marcus; Ter Kuile, Feiko; Drakeley, Chris; Bassat, Quique; Foy, Brian D; Kobylinski, Kevin

2015-06-11

The potential use of ivermectin as an additional vector control tool is receiving increased attention from the malaria elimination community, driven by the increased importance of outdoor/residual malaria transmission and the threat of insecticide resistance where vector tools have been scaled-up. This report summarizes the emerging evidence presented at a side meeting on "Ivermectin for malaria elimination: current status and future directions" at the annual meeting of the American Society of Tropical Medicine and Hygiene in New Orleans on November 4, 2014. One outcome was the creation of the "Ivermectin Research for Malaria Elimination Network" whose main goal is to establish a common research agenda to generate the evidence base on whether ivermectin-based strategies should be added to the emerging arsenal to interrupt malaria transmission.

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

PubMed

Archibald, Thomas

2015-02-01

Community education and outreach programs should be evidence-based. This dictum seems at once warranted, welcome, and slightly platitudinous. However, the "evidence-based" movement's more narrow definition of evidence--privileging randomized controlled trials as the "gold standard"--has fomented much debate. Such debate, though insightful, often lacks grounding in actual practice. To address that lack, the purpose of the study presented in this paper was to examine what actually happens, in practice, when people support the implementation of evidence-based programs (EBPs) or engage in related efforts to make non-formal education more "evidence-based." Focusing on three cases--two adolescent sexual health projects (one in the United States and one in Kenya) and one more general youth development organization--I used qualitative methods to address the questions: (1) How is evidence-based program and evidence-based practice work actually practiced? (2) What perspectives and assumptions about what non-formal education is are manifested through that work? and (3) What conflicts and tensions emerge through that work related to those perspectives and assumptions? Informed by theoretical perspectives on the intersection of science, expertise, and democracy, I conclude that the current dominant approach to making non-formal education more evidence-based by way of EBPs is seriously flawed. Copyright © 2014 Elsevier Ltd. All rights reserved.

Bridging Theory and Practice in the Leadership Classroom: Intentional Emergence as a Modern Pedagogy

ERIC Educational Resources Information Center

Werner, Linnette; Hellstrom, David; Chung, Jessica; Kessenich, Katherine; Taylor, Leonard, Jr.; Capeder, Anna

2016-01-01

With leadership education expanding at an unprecedented rate, there is an acute need for an evidence-based leadership pedagogy that can bridge the gap between leadership theory and student practice both in the classroom and beyond its boundaries. This paper will give an overview of the Intentional Emergence Model as a way to teach leadership to…

2016 Emergent Data on Students in Australian Schools Receiving Adjustments for Disability. Nationally Consistent Collection of Data. School Students with Disability

ERIC Educational Resources Information Center

Education Council, 2016

2016-01-01

The Nationally Consistent Collection of Data on School Students with Disability (the collection) identified 685,911 students received an educational adjustment due to disability. Through this collection, teachers use their professional judgement based on evidence to capture information. This report looks at the emergent data on students in…

Differences between Girls and Boys in Emerging Language Skills: Evidence from 10 Language Communities

ERIC Educational Resources Information Center

Eriksson, Marten; Marschik, Peter B.; Tulviste, Tiia; Almgren, Margareta; Perez Pereira, Miguel; Wehberg, Sonja; Marjanovic-Umek, Ljubica; Gayraud, Frederique; Kovacevic, Melita; Gallego, Carlos

2012-01-01

The present study explored gender differences in emerging language skills in 13,783 European children from 10 non-English language communities. It was based on a synthesis of published data assessed with adapted versions of the MacArthur-Bates Communicative Development Inventories (CDIs) from age 0.08 to 2.06. The results showed that girls are…

Alternative therapies for chronic rhinosinusitis: A review.

PubMed

Griffin, Aaron S; Cabot, Peter; Wallwork, Ben; Panizza, Ben

2018-03-01

The use of alternative medicine in chronic rhinosinusitis (CRS) continues to increase in popularity, for the most part without meeting the burden of being based on sound clinical evidence. New and emerging treatments, both natural and developed, are numerous, and it remains a challenge for otolaryngologists as well as general practitioners to keep up to date with these therapies and their efficacy. In this systematic review, we discuss a number of alternative therapies for CRS, their proposed physiologic mechanisms, and evidence supporting their use. This analysis is based on our review of the English-language literature on alternative therapies for CRS (we did not include any therapies that are already recommended by accepted professional bodies). Data collection was performed using the PubMed database (not restricted to MEDLINE due to the nature of the subject matter), the Cochrane databases, and bibliography searches. We found that while many of the alternative therapies we reviewed might have a firm basis in science, they lack any clinical evidence to support their use specifically for CRS. Some emerging therapies, such as therapeutic ultrasonography and phonophoresis, show some promise, based on a growing body of positive evidence. In addition, the use of baby shampoo, thyme honey, and bromelain additives to saline lavage in CRS are all supported by clinical evidence, as is Sinupret, an oral preparation that contains echinacea. However, higher levels of evidence gleaned from large, well-designed, prospective, randomized, controlled trials are needed before any of these therapies can be recommended.

A marketing perspective on disseminating evidence-based approaches to disease prevention and health promotion.

PubMed

Maibach, Edward W; Van Duyn, Mary Ann S; Bloodgood, Bonny

2006-07-01

Evidence-based disease prevention practice guidelines can provide a rationale for health programming decisions, which should, in turn, lead to improved public health outcomes. This logic has stimulated the creation of a growing number of evidence-based prevention practice guidelines, including the Guide to Community Preventive Services. Few systematic efforts have been made to document the degree of adoption and implementation of these approaches, although the evidence on translation of research into practice in other health fields indicates that the adoption and implementation rate is low. Drawing on the marketing literature, we suggest three approaches to enhance the adoption and implementation of evidence-based approaches: 1) conducting consumer research with prospective adopters to identify their perspectives on how evidence-based prevention programs can advance their organization's mission, 2) building sustainable distribution channels to promote and deliver evidence-based programs to prospective adopters, and 3) improving access to easily implemented programs that are consistent with evidence-based guidelines. Newly emerging paradigms of prevention research (e.g., RE-AIM) that are more attuned to the needs of the marketplace will likely yield a new generation of evidence-based preventive approaches that can be more effectively disseminated. We suggest that the public health community prioritize the dissemination of evidence-based prevention approaches, because doing so is a potent environmental change strategy for enhancing health.

The importance of improving the quality of emergency surgery for a regional quality collaborative.

PubMed

Smith, Margaret; Hussain, Adnan; Xiao, Jane; Scheidler, William; Reddy, Haritha; Olugbade, Kola; Cummings, Dustin; Terjimanian, Michael; Krapohl, Greta; Waits, Seth A; Campbell, Darrell; Englesbe, Michael J

2013-04-01

Within a large, statewide collaborative, significant improvement in surgical quality has been appreciated (9.0% reduction in morbidity for elective general and vascular surgery). Our group has not noted such quality improvement in the care of patients who had emergency operations. With this work, we aim to describe the scope of emergency surgical care within the Michigan Surgical Quality Collaborative, variations in outcomes among hospitals, and variations in adherence to evidence-based process measures. Overall, these data will form a basis for a broad-based quality improvement initiative within Michigan. We report morbidity, mortality, and costs of emergency and elective general and vascular surgery cases (N = 190,826) within 34 hospitals participating in the Michigan Surgical Quality Collaborative from 2005 to 2010. Adjusted hospital-specific outcomes were calculated using a stepwise multivariable logistic regression model. Adjustment covariates included patient specific comorbidities and case complexity. Hospitals were also compared on the basis of their adherence to evidence-based process measures [measures at the patient level for each case-Surgical Care Improvement Project (SCIP)-1 and SCIP-2 compliance]. Emergency procedures account for approximately 11% of total cases, yet they represented 47% of mortalities and 28% of surgical complications. The complication-specific cost to payers was $126 million for emergency cases and $329 million for elective cases. Adjusted patient outcomes varied widely within Michigan Surgical Quality Collaborative hospitals; morbidity and mortality rates ranged from 16.3% to 33.9% and 4.0% to 12.4%, respectively. The variation among hospitals was not correlated with volume of emergency cases and case complexity. Hospital performance in emergency surgery was found to not depend on its share of emergent cases but rather was found to directly correlate with its performance in elective surgery. For emergency colectomies, there was a wide variation in compliance with SCIP-1 and SCIP-2 measures and overall compliance (42.0%) was markedly lower than that for elective colon surgery (81.7%). Emergency surgical procedures are an important target for future quality improvement efforts within Michigan. Future work will identify best practices within high-performing hospitals and disseminate these practices within the collaborative.

Bradford Hill's criteria, emerging zoonoses, and One Health.

PubMed

Asokan, G V; Asokan, Vanitha

2016-09-01

Zoonoses constitute more than 60% of infectious diseases and 75% of emerging infectious diseases. Inappropriate overemphasis of specialization of disciplines has ignored public health. Identifying the causes of disease and determining how exposures are related to outcomes in "emerging zoonoses" affecting multiple species are considered to be the hallmarks of public health research and practice that compels the adoption of "One Health". The interactions within and among populations of vertebrates in the causation and transmissions of emerging zoonotic diseases are inherently dynamic, interdependent, and systems based. Disease causality theories have moved from one or several agents causing disease in a single species, to one infectious agent causing disease in multiple species-emerging zoonoses. Identification of the causative pathogen components or structures, elucidating the mechanisms of species specificity, and understanding the natural conditions of emergence would facilitate better derivation of the causal mechanism. Good quality evidence on causation in emerging zoonoses affecting multiple species makes a strong recommendation under the One Health approach for disease prevention and control from diagnostic tests, treatment, antimicrobial resistance, preventive vaccines, and evidence informed health policies. In the tenets of One Health, alliances work best when the legitimate interests of the different partners combine to prevent and control emerging zoonoses. Copyright © 2015 Ministry of Health, Saudi Arabia. Published by Elsevier Ltd. All rights reserved.

Myths and realities of training in obstetric emergencies.

PubMed

Draycott, Timothy J; Collins, Katherine J; Crofts, Joanna F; Siassakos, Dimitrios; Winter, Cathy; Weiner, Carl P; Donald, Fiona

2015-11-01

Training for intrapartum emergencies is a promising strategy to reduce preventable harm during birth; however, not all training is clinically effective. Many myths have developed around such training. These principally derive from misinformed beliefs that all training must be effective, cheap, independent of context and sustainable. The current evidence base for effective training supports local, unit-based and multi-professional training, with appropriate mannequins, and practice-based tools to support the best care. Training programmes based on these principles are associated with improved clinical outcomes, but we need to understand how and why that is, and also why some training is associated with no improvements, or even deterioration in outcomes. Effective training is not cheap, but it can be cost-effective. Insurers have the fiscal power to incentivise training, but they should demand the evidence of clinical effect; aspiration and proxies alone should no longer be sufficient for funding, in any resource setting. Copyright © 2015 Elsevier Ltd. All rights reserved.

Prolonged labour as indication for emergency caesarean section: a quality assurance analysis by criterion-based audit at two Tanzanian rural hospitals.

PubMed

Maaløe, N; Sorensen, B L; Onesmo, R; Secher, N J; Bygbjerg, I C

2012-04-01

To audit the quality of obstetric management preceding emergency caesarean sections for prolonged labour. A quality assurance analysis of a retrospective criterion-based audit supplemented by in-depth interviews with hospital staff. Two Tanzanian rural mission hospitals. Audit of 144 cases of women undergoing caesarean sections for prolonged labour; in addition, eight staff members were interviewed. Criteria of realistic best practice were established, and the case files were audited and compared with these. Hospital staff were interviewed about what they felt might be the causes for the audit findings. Prevalence of suboptimal management and themes emerging from an analysis of the transcripts. Suboptimal management was identified in most cases. Non-invasive interventions to potentially avoid operative delivery were inadequately used. When deciding on caesarean section, in 26% of the cases labour was not prolonged, and in 16% the membranes were still intact. Of the women with genuine prolonged labour, caesarean sections were performed with a fully dilated cervix in 36% of the cases. Vacuum extraction was not considered. Amongst the hospital staff interviewed, the awareness of evidence-based guidelines was poor. Word of mouth, personal experience, and fear, especially of HIV transmission, influenced management decisions. The lack of use and awareness of evidence-based guidelines led to misinterpretation of clinical signs, fear of simple interventions, and an excessive rate of emergency caesarean sections. © 2012 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2012 RCOG.

Addressing sexual health behaviour during emerging adulthood: a critical review of the literature.

PubMed

Alexander, Kamila A; Jemmott, Loretta S; Teitelman, Anne M; D'Antonio, Patricia

2015-01-01

In this critical literature review, we examine evidence-based interventions that target sexual behaviours of 18- to 25-year-old emerging adult women. Nurses and clinicians implement theory-driven research programmes for young women with increased risk of HIV/AIDS and sexually transmitted infections. Strategies to decrease transmission of HIV and sexually transmitted infections are rigorously evaluated and promoted by public health agencies such as the United States Centers for Disease Control and Prevention. While many interventions demonstrate episodic reductions in sexual risk behaviours and infection transmission, there is little evidence they build sustainable skills and behaviours. Programmes may not attend to contextual and affective influences on sexual behaviour change. Discursive paper. We conducted a conceptually based literature review and critical analysis of the Centers for Disease Control and Prevention's best-evidence and good-evidence HIV behavioural interventions. In this review, we examined three contextual and affective influences on the sexual health of emerging adult women: (1) developmental age, (2) reproduction and pregnancy desires and (3) sexual security or emotional responses accompanying relationship experiences. Our analyses revealed intervention programmes paid little attention to ways age, desires for pregnancy or emotional factors influence sexual decisions. Some programmes included 18- to 25-year-olds, but they made up small percentages of the sample and did not attend to unique emerging adult experiences. Second, primary focus on infection prevention overshadowed participant desires for pregnancy. Third, few interventions considered emotional mechanisms derived from relationship experiences involved in sexual decision-making. Growing evidence demonstrates sexual health interventions may be more effective if augmented to attend to contextual and affective influences on relationship risks and decision-making. Modifying currently accepted strategies may enhance sustainability of sexual health-promoting behaviours. This study provides nurses and public health educators with recommendations for broadening the content of sexual health promotion intervention programming. © 2014 John Wiley & Sons Ltd.

Research Use by Cooperative Extension Educators in New York State

ERIC Educational Resources Information Center

Hamilton, Stephen F.; Chen, Emily K.; Pillemer, Karl; Meador, Rhoda H.

2013-01-01

A Web-based survey of 388 off-campus Cornell Extension educators in New York State examined their attitudes toward research, sources of research-based information, knowledge and beliefs about evidence-based programs, and involvement in research activities. Strong consensus emerged that research is central and that educators are capable of reading…

Empirically Supported Family-Based Treatments for Conduct Disorder and Delinquency in Adolescents

ERIC Educational Resources Information Center

Henggeler, Scott W.; Sheidow, Ashli J.

2012-01-01

Several family-based treatments of conduct disorder and delinquency in adolescents have emerged as evidence-based and, in recent years, have been transported to more than 800 community practice settings. These models include multisystemic therapy, functional family therapy, multidimensional treatment foster care, and, to a lesser extent, brief…

Family presence during trauma activations and medical resuscitations in a pediatric emergency department: an evidence-based practice project.

PubMed

Kingsnorth, Jennifer; O'Connell, Karen; Guzzetta, Cathie E; Edens, Jacki Curreri; Atabaki, Shireen; Mecherikunnel, Anne; Brown, Kathleen

2010-03-01

The existing family presence literature indicates that implementation of a family presence policy can result in positive outcomes. The purpose of our evidence-based practice project was to evaluate a family presence intervention using the 6 A's of the evidence cycle (ask, acquire, appraise, apply, analyze, and adopt/adapt). For step 1 (ask), we propose the following question: Is it feasible to implement a family presence intervention during trauma team activations and medical resuscitations in a pediatric emergency department using national guidelines to ensure appropriate family member behavior and uninterrupted patient care? Regarding steps 2 through 4 (acquire, appraise, and apply), our demonstration project was conducted in a pediatric emergency department during the implementation of a new family presence policy. Our family presence intervention incorporated current appraisal of literature and national guidelines including family screening, family preparation, and use of family presence facilitators. We evaluated whether it was feasible to implement the steps of our intervention and whether the intervention was safe in ensuring uninterrupted patient care. With regard to step 5 (analyze), family presence was evaluated in 106 events, in which 96 families were deemed appropriate and chose to be present. Nearly all families (96%) were screened before entering the room, and all were deemed appropriate candidates. Facilitators guided the family during all events. One family presence event was terminated. In all cases patient care was not interrupted. Regarding step 6 (adopt/adapt), our findings document the feasibility of implementing a family presence intervention in a pediatric emergency department while ensuring uninterrupted patient care. We have adopted family presence as a standard practice. This project can serve as the prototype for others. Copyright (c) 2010 Emergency Nurses Association. Published by Mosby, Inc. All rights reserved.

Factors influencing rural and urban emergency clinicians' participation in an online knowledge exchange intervention.

PubMed

Curran, Janet A; Murphy, Andrea L; Sinclair, Douglas; McGrath, Patrick

2013-01-01

Rural emergency departments (EDs) generally have limited access to continuing education and are typically staffed by clinicians without pediatric emergency specialty training. Emergency care of children is complex and the majority of children receive emergency care in non-pediatric tertiary care centers. In recent decades, there has been a call to action to improve quality and safety in the emergency care of children. Of the one million ED visits by children in Ontario in 2005-2006, one in three visited more than once in a year and one in 15 returned to the ED within 72 hours of the index visit. This study explored factors influencing rural and urban ED clinicians' participation in a Web-based knowledge exchange intervention that focused on best practice knowledge about pediatric emergency care. The following questions guided the study: (i) What are the individual, context of practice or knowledge factors which impact a clinician's decision to participate in a Web-based knowledge exchange intervention?; (ii) What are clinicians' perceptions of organizational expectations regarding knowledge and information sources to be used in practice?; and (iii) What are the preferred knowledge sources of rural and urban emergency clinicians? A Web-based knowledge exchange intervention, the Pediatric Emergency Care Web Based Knowledge Exchange Project, for rural and urban ED clinicians was developed. The website contained 12 pediatric emergency practice learning modules with linked asynchronous discussion forums. The topics for the modules were determined through a needs assessment and the module content was developed by known experts in the field. A follow-up survey was sent to a convenience sample of 187 clinicians from nine rural and two urban Canadian EDs participating in the pediatric emergency Web-based knowledge exchange intervention study. The survey response rate was 56% (105/187). Participation in the knowledge exchange intervention was related to individual involvement in research activities (χ(2)=5.23, p=0.019), consultation with colleagues from other EDs (χ(2)=6.37, p=0.01) and perception of organizational expectations to use research evidence to guide practice (χ(2)=5.52, p=0.015). Most clinicians (95/105 or 92%) reported relying on colleagues from their own ED as a primary knowledge source. Urban clinicians were more likely than their rural counterparts to perceive that use of research evidence to guide practice was an expectation. Rural clinicians were more likely to rely on physicians from their own ED as a preferred knowledge source. The decision made by emergency clinicians to participate in a Web-based knowledge exchange intervention was influenced by a number of individual and contextual factors. Differences in these factors and preferences for knowledge sources require further characterization to enhance engagement of rural ED clinicians in online knowledge exchange interventions.

Bayesian analysis of the astrobiological implications of life’s early emergence on Earth

PubMed Central

Spiegel, David S.; Turner, Edwin L.

2012-01-01

Life arose on Earth sometime in the first few hundred million years after the young planet had cooled to the point that it could support water-based organisms on its surface. The early emergence of life on Earth has been taken as evidence that the probability of abiogenesis is high, if starting from young Earth-like conditions. We revisit this argument quantitatively in a Bayesian statistical framework. By constructing a simple model of the probability of abiogenesis, we calculate a Bayesian estimate of its posterior probability, given the data that life emerged fairly early in Earth’s history and that, billions of years later, curious creatures noted this fact and considered its implications. We find that, given only this very limited empirical information, the choice of Bayesian prior for the abiogenesis probability parameter has a dominant influence on the computed posterior probability. Although terrestrial life's early emergence provides evidence that life might be abundant in the universe if early-Earth-like conditions are common, the evidence is inconclusive and indeed is consistent with an arbitrarily low intrinsic probability of abiogenesis for plausible uninformative priors. Finding a single case of life arising independently of our lineage (on Earth, elsewhere in the solar system, or on an extrasolar planet) would provide much stronger evidence that abiogenesis is not extremely rare in the universe. PMID:22198766

Bayesian analysis of the astrobiological implications of life's early emergence on Earth.

PubMed

Spiegel, David S; Turner, Edwin L

2012-01-10

Life arose on Earth sometime in the first few hundred million years after the young planet had cooled to the point that it could support water-based organisms on its surface. The early emergence of life on Earth has been taken as evidence that the probability of abiogenesis is high, if starting from young Earth-like conditions. We revisit this argument quantitatively in a bayesian statistical framework. By constructing a simple model of the probability of abiogenesis, we calculate a bayesian estimate of its posterior probability, given the data that life emerged fairly early in Earth's history and that, billions of years later, curious creatures noted this fact and considered its implications. We find that, given only this very limited empirical information, the choice of bayesian prior for the abiogenesis probability parameter has a dominant influence on the computed posterior probability. Although terrestrial life's early emergence provides evidence that life might be abundant in the universe if early-Earth-like conditions are common, the evidence is inconclusive and indeed is consistent with an arbitrarily low intrinsic probability of abiogenesis for plausible uninformative priors. Finding a single case of life arising independently of our lineage (on Earth, elsewhere in the solar system, or on an extrasolar planet) would provide much stronger evidence that abiogenesis is not extremely rare in the universe.

Community pharmacy supply of emergency hormonal contraception: a structured literature review of international evidence.

PubMed

Anderson, C; Blenkinsopp, A

2006-01-01

We could find no previous published review of the evidence relating to pharmacy supply of emergency hormonal contraception (EHC). Our objectives were to review, summarize and evaluate the peer-reviewed evidence relating to community pharmacy supply of EHC both in the UK and internationally. Systematic searches were conducted for peer-reviewed international research from January 1990 to January 2005. The UK Health Development Agency's Evidence Base 2000 standards and the evidence categories used by the UK Department of Health were applied to each paper. We included 24 peer-reviewed papers. There was one randomized controlled trial (RCT); the remainder of the studies were qualitative or observational studies. Pharmacy supply of EHC enables most women to receive it within 24 h of unprotected sexual intercourse. Services were highly rated by women. One RCT showed that improving access to EHC did not reduce the use of other contraceptives, lead to an increase in risky sexual behaviour or increase the incidence of sexually transmitted infections (STIs). Users expressed some concerns about the appropriateness of receiving additional pharmacist advice regarding future contraception use and STIs. One study found pharmacy supply had led to a decrease in attendances at accident and emergency departments. There is good evidence that community pharmacy EHC services provide timely access to treatment and are highly rated by women.

An Evidence-Based Alcohol Screening, Brief Intervention and Referral to Treatment (SBIRT) Curriculum for Emergency Department (ED) Providers Improves Skills and Utilization

ERIC Educational Resources Information Center

Substance Abuse, 2007

2007-01-01

Objective: Emergency Departments (EDs) offer an opportunity to improve the care of patients with at-risk and dependent drinking by teaching staff to screen, perform brief intervention and refer to treatment (SBIRT). We describe here the implementation at 14 Academic EDs of a structured SBIRT curriculum to determine if this learning experience…

Evidence-Based Practice: Video-Discharge Instructions in the Pediatric Emergency Department.

PubMed

Wood, Elyssa B; Harrison, Gina; Trickey, Amber; Friesen, Mary Ann; Stinson, Sarah; Rovelli, Erin; McReynolds, Serena; Presgrave, Kristina

2017-07-01

While a high quality discharge from a Pediatric Emergency Department helps caregivers feel informed and prepared to care for their sick child at home, poor adherence to discharge instructions leads to unnecessary return visits, negative health outcomes, and decreased patient satisfaction. Nurses at the Inova Loudoun Pediatric ED utilized the Johns Hopkins Model of Evidence Based Practice to answer the following question: Among caregivers who have children discharged from the ED, does the addition of video discharge instructions (VDI) to standard written/verbal discharge instructions (SDI) result in improved knowledge about the child's diagnosis, treatment, illness duration, and when to seek further medical care? A multidisciplinary team reviewed available evidence and created VDI for three common pediatric diagnoses: gastroenteritis, bronchiolitis, and fever. Knowledge assessments were collected before and after delivery of discharge instructions to caregivers for both the SDI and VDI groups. Analysis found that the VDI group achieved significantly higher scores on the post test survey (P < .001) than the SDI group, particularly regarding treatment and when to seek further medical care. After integrating the best evidence with clinical expertise and an effective VDI intervention, the team incorporated VDI into the discharge process. VDI offer nurses an efficient, standardized method of providing enhanced discharge instructions in the ED. Future projects will examine whether VDI are effective for additional diagnoses and among caregivers for whom English is not the primary language. Copyright © 2017 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.

Bridging the Research-to-Practice Gap: The Role of the Nurse Scientist.

PubMed

Brant, Jeannine M

2015-11-01

To describe the emerging role of the nurse scientist in health care organizations. Historical perspectives of the role are explored along with the roles of the nurse scientist, facilitators, barriers, and future implications. Relevant literature on evidence-based practice and research in health care organizations; nurse scientist role; interview with University of Colorado nurse scientist. The nurse scientist role is integral for expanding evidence-based decisions and nursing research. A research mentor is considered the most important facilitator for a successful nursing research program. Organizations should consider including the nurse scientist role to facilitate evidence-based practice and expand opportunities for nursing research. Copyright © 2015 Elsevier Inc. All rights reserved.

American Association for Emergency Psychiatry Task Force on Medical Clearance of Adults Part I: Introduction, Review and Evidence-Based Guidelines

PubMed Central

Anderson, Eric L.; Nordstrom, Kimberly; Wilson, Michael P.; Peltzer-Jones, Jennifer M.; Zun, Leslie; Ng, Anthony; Allen, Michael H.

2017-01-01

Introduction In the United States, the number of patients presenting to the emergency department (ED) for a mental health concern is significant and expected to grow. The breadth of the medical evaluation of these patients is controversial. Attempts have been made to establish a standard evaluation for these patients, but to date no nationally accepted standards exist. A task force of the American Association of Emergency Psychiatry, consisting of physicians from emergency medicine and psychiatry, and a psychologist was convened to form consensus recommendations on the medical evaluation of psychiatric patients presenting to EDs. Methods The task force reviewed existing literature on the topic of medical evaluation of psychiatric patients in the ED (Part I) and then combined this with expert consensus (Part II). Results In Part I, we discuss terminological issues and existing evidence on medical exams and laboratory studies of psychiatric patients in the ED. Conclusion Emergency physicians should work cooperatively with psychiatric receiving facilities to decrease unnecessary testing while increasing the quality of medical screening exams for psychiatric patients who present to EDs. PMID:28210358

Common elements of adolescent prevention programs: minimizing burden while maximizing reach.

PubMed

Boustani, Maya M; Frazier, Stacy L; Becker, Kimberly D; Bechor, Michele; Dinizulu, Sonya M; Hedemann, Erin R; Ogle, Robert R; Pasalich, Dave S

2015-03-01

A growing number of evidence-based youth prevention programs are available, but challenges related to dissemination and implementation limit their reach and impact. The current review identifies common elements across evidence-based prevention programs focused on the promotion of health-related outcomes in adolescents. We reviewed and coded descriptions of the programs for common practice and instructional elements. Problem-solving emerged as the most common practice element, followed by communication skills, and insight building. Psychoeducation, modeling, and role play emerged as the most common instructional elements. In light of significant comorbidity in poor outcomes for youth, and corresponding overlap in their underlying skills deficits, we propose that synthesizing the prevention literature using a common elements approach has the potential to yield novel information and inform prevention programming to minimize burden and maximize reach and impact for youth.

Joint BAP NAPICU evidence-based consensus guidelines for the clinical management of acute disturbance: De-escalation and rapid tranquillisation.

PubMed

Patel, Maxine X; Sethi, Faisil N; Barnes, Thomas Re; Dix, Roland; Dratcu, Luiz; Fox, Bernard; Garriga, Marina; Haste, Julie C; Kahl, Kai G; Lingford-Hughes, Anne; McAllister-Williams, Hamish; O'Brien, Aileen; Parker, Caroline; Paterson, Brodie; Paton, Carol; Posporelis, Sotiris; Taylor, David M; Vieta, Eduard; Völlm, Birgit; Wilson-Jones, Charlotte; Woods, Laura

2018-06-01

The British Association for Psychopharmacology and the National Association of Psychiatric Intensive Care and Low Secure Units developed this joint evidence-based consensus guideline for the clinical management of acute disturbance. It includes recommendations for clinical practice and an algorithm to guide treatment by healthcare professionals with various options outlined according to their route of administration and category of evidence. Fundamental overarching principles are included and highlight the importance of treating the underlying disorder. There is a focus on three key interventions: de-escalation, pharmacological interventions pre-rapid tranquillisation and rapid tranquillisation (intramuscular and intravenous). Most of the evidence reviewed relates to emergency psychiatric care or acute psychiatric adult inpatient care, although we also sought evidence relevant to other common clinical settings including the general acute hospital and forensic psychiatry. We conclude that the variety of options available for the management of acute disturbance goes beyond the standard choices of lorazepam, haloperidol and promethazine and includes oral-inhaled loxapine, buccal midazolam, as well as a number of oral antipsychotics in addition to parenteral options of intramuscular aripiprazole, intramuscular droperidol and intramuscular olanzapine. Intravenous options, for settings where resuscitation equipment and trained staff are available to manage medical emergencies, are also included.

Periodontics--tissue engineering and the future.

PubMed

Douglass, Gordon L

2005-03-01

Periodontics has a long history of utilizing advances in science to expand and improve periodontal therapies. Recently the American Academy of Periodontology published the findings of the Contemporary Science Workshop, which conducted state-of-the-art evidence-based reviews of current and emerging areas in periodontics. The findings of this workshop provide the basis for an evidence-based approach to periodontal therapy. While the workshop evaluated all areas of periodontics, it is in the area of tissue engineering that the most exciting advances are becoming a reality.

Public Health System Research in Public Health Emergency Preparedness in the United States (2009–2015): Actionable Knowledge Base

PubMed Central

Lin, Leesa; Bernard, Dottie; Klein, Noah; James, Lyndon P.; Guicciardi, Stefano

2017-01-01

Background. In 2008, the Institute of Medicine released a letter report identifying 4 research priority areas for public health emergency preparedness in public health system research: (1) enhancing the usefulness of training, (2) improving timely emergency communications, (3) creating and maintaining sustainable response systems, and (4) generating effectiveness criteria and metrics. Objectives. To (1) identify and characterize public health system research in public health emergency preparedness produced in the United States from 2009 to 2015, (2) synthesize research findings and assess the level of confidence in these findings, and (3) describe the evolution of knowledge production in public health emergency preparedness system research. Search Methods and Selection Criteria. We reviewed and included the titles and abstracts of 1584 articles derived from MEDLINE, EMBASE, and gray literature databases that focused on the organizational or financial aspects of public health emergency preparedness activities and were grounded on empirical studies. Data Collection and Analysis. We included 156 articles. We appraised the quality of the studies according to the study design. We identified themes during article analysis and summarized overall findings by theme. We determined level of confidence in the findings with the GRADE-CERQual tool. Main Results. Thirty-one studies provided evidence on how to enhance the usefulness of training. Results demonstrated the utility of drills and exercises to enhance decision-making capabilities and coordination across organizations, the benefit of cross-sector partnerships for successfully implementing training activities, and the value of integrating evaluation methods to support training improvement efforts. Thirty-six studies provided evidence on how to improve timely communications. Results supported the use of communication strategies that address differences in access to information, knowledge, attitudes, and practices across segments of the population as well as evidence on specific communication barriers experienced by public health and health care personnel. Forty-eight studies provided evidence on how to create and sustain preparedness systems. Results included how to build social capital across organizations and citizens and how to develop sustainable and useful planning efforts that maintain flexibility and rely on available medical data. Twenty-six studies provided evidence on the usefulness of measurement efforts, such as community and organizational needs assessments, and new methods to learn from the response to critical incidents. Conclusions: In the United States, the field of public health emergency preparedness system research has been supported by the US Centers for Disease Control and Prevention since the release of the 2008 Institute of Medicine letter report. The first definition of public health emergency preparedness appeared in 2007, and before 2008 there was a lack of research and empirical evidence across all 4 research areas identified by the Institute of Medicine. This field can be considered relatively new compared with other research areas in public health; for example, tobacco control research can rely on more than 70 years of knowledge production. However, this review demonstrates that, during the past 7 years, public health emergency preparedness system research has evolved from generic inquiry to the analysis of specific interventions with more empirical studies. Public Health Implications: The results of this review provide an evidence base for public health practitioners responsible for enhancing key components of preparedness and response such as communication, training, and planning efforts. PMID:28892437

Public Health System Research in Public Health Emergency Preparedness in the United States (2009-2015): Actionable Knowledge Base.

PubMed

Savoia, Elena; Lin, Leesa; Bernard, Dottie; Klein, Noah; James, Lyndon P; Guicciardi, Stefano

2017-09-01

In 2008, the Institute of Medicine released a letter report identifying 4 research priority areas for public health emergency preparedness in public health system research: (1) enhancing the usefulness of training, (2) improving timely emergency communications, (3) creating and maintaining sustainable response systems, and (4) generating effectiveness criteria and metrics. To (1) identify and characterize public health system research in public health emergency preparedness produced in the United States from 2009 to 2015, (2) synthesize research findings and assess the level of confidence in these findings, and (3) describe the evolution of knowledge production in public health emergency preparedness system research. Search Methods and Selection Criteria. We reviewed and included the titles and abstracts of 1584 articles derived from MEDLINE, EMBASE, and gray literature databases that focused on the organizational or financial aspects of public health emergency preparedness activities and were grounded on empirical studies. We included 156 articles. We appraised the quality of the studies according to the study design. We identified themes during article analysis and summarized overall findings by theme. We determined level of confidence in the findings with the GRADE-CERQual tool. Thirty-one studies provided evidence on how to enhance the usefulness of training. Results demonstrated the utility of drills and exercises to enhance decision-making capabilities and coordination across organizations, the benefit of cross-sector partnerships for successfully implementing training activities, and the value of integrating evaluation methods to support training improvement efforts. Thirty-six studies provided evidence on how to improve timely communications. Results supported the use of communication strategies that address differences in access to information, knowledge, attitudes, and practices across segments of the population as well as evidence on specific communication barriers experienced by public health and health care personnel. Forty-eight studies provided evidence on how to create and sustain preparedness systems. Results included how to build social capital across organizations and citizens and how to develop sustainable and useful planning efforts that maintain flexibility and rely on available medical data. Twenty-six studies provided evidence on the usefulness of measurement efforts, such as community and organizational needs assessments, and new methods to learn from the response to critical incidents. In the United States, the field of public health emergency preparedness system research has been supported by the US Centers for Disease Control and Prevention since the release of the 2008 Institute of Medicine letter report. The first definition of public health emergency preparedness appeared in 2007, and before 2008 there was a lack of research and empirical evidence across all 4 research areas identified by the Institute of Medicine. This field can be considered relatively new compared with other research areas in public health; for example, tobacco control research can rely on more than 70 years of knowledge production. However, this review demonstrates that, during the past 7 years, public health emergency preparedness system research has evolved from generic inquiry to the analysis of specific interventions with more empirical studies. Public Health Implications: The results of this review provide an evidence base for public health practitioners responsible for enhancing key components of preparedness and response such as communication, training, and planning efforts.

Delivering patient decision aids on the Internet: definitions, theories, current evidence, and emerging research areas

PubMed Central

2013-01-01

Background In 2005, the International Patient Decision Aids Standards Collaboration identified twelve quality dimensions to guide assessment of patient decision aids. One dimension—the delivery of patient decision aids on the Internet—is relevant when the Internet is used to provide some or all components of a patient decision aid. Building on the original background chapter, this paper provides an updated definition for this dimension, outlines a theoretical rationale, describes current evidence, and discusses emerging research areas. Methods An international, multidisciplinary panel of authors examined the relevant theoretical literature and empirical evidence through 2012. Results The updated definition distinguishes Internet-delivery of patient decision aids from online health information and clinical practice guidelines. Theories in cognitive psychology, decision psychology, communication, and education support the value of Internet features for providing interactive information and deliberative support. Dissemination and implementation theories support Internet-delivery for providing the right information (rapidly updated), to the right person (tailored), at the right time (the appropriate point in the decision making process). Additional efforts are needed to integrate the theoretical rationale and empirical evidence from health technology perspectives, such as consumer health informatics, user experience design, and human-computer interaction. Despite Internet usage ranging from 74% to 85% in developed countries and 80% of users searching for health information, it is unknown how many individuals specifically seek patient decision aids on the Internet. Among the 86 randomized controlled trials in the 2011 Cochrane Collaboration’s review of patient decision aids, only four studies focused on Internet-delivery. Given the limited number of published studies, this paper particularly focused on identifying gaps in the empirical evidence base and identifying emerging areas of research. Conclusions As of 2012, the updated theoretical rationale and emerging evidence suggest potential benefits to delivering patient decision aids on the Internet. However, additional research is needed to identify best practices and quality metrics for Internet-based development, evaluation, and dissemination, particularly in the areas of interactivity, multimedia components, socially-generated information, and implementation strategies. PMID:24625064

Mass Casualty Decontamination Guidance and Psychosocial Aspects of CBRN Incident Management: A Review and Synthesis

PubMed Central

Carter, Holly; Amlôt, Richard

2016-01-01

Introduction: Mass casualty decontamination is an intervention employed by first responders at the scene of an incident involving noxious contaminants.  Many countries have sought to address the challenge of decontaminating large numbers of affected casualties through the provision of rapidly deployable temporary showering structures, with accompanying decontamination protocols.  In this paper we review decontamination guidance for emergency responders and associated research evidence, in order to establish to what extent psychosocial aspects of casualty management have been considered within these documents. The review focuses on five psychosocial aspects of incident management: likely public behaviour; responder management style; communication strategy; privacy/ modesty concerns; and vulnerable groups. Methods: Two structured literature reviews were carried out; one to identify decontamination guidance documents for first responders, and another to identify evidence which is relevant to the understanding of the psychosocial aspects of mass decontamination.  The guidance documents and relevant research were reviewed to identify whether the guidance documents contain information relating to psychosocial issues and where it exists, that the guidance is consistent with the existing evidence-base. Results: Psychosocial aspects of incident management receive limited attention in current decontamination guidance.  In addition, our review has identified a number of gaps and inconsistencies between guidance and research evidence.  For each of the five areas we identify: what is currently presented in guidance documents, to what extent this is consistent with the existing research evidence and where it diverges.  We present a series of evidence-based recommendations for updating decontamination guidance to address the psychosocial aspects of mass decontamination. Conclusions: Effective communication and respect for casualties’ needs are critical in ensuring decontamination is completed quickly and effectively.  We identify a number of areas requiring further research including: identifying effective methods for communicating in an emergency; better understanding of the needs of vulnerable groups during decontamination; effective training for emergency responders on psychosocial issues, and pre-incident public education for incidents involving emergency decontamination.  It is essential that the psychosocial aspects of mass decontamination are not neglected in the pursuit of solely technical solutions. PMID:27790383

44 CFR 68.9 - Admissible evidence.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Admissible evidence. 68.9 Section 68.9 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF... admissible. (b) Documentary and oral evidence shall be admissible. (c) Admissibility of non-expert testimony...

Concussion Care Practices and Utilization of Evidence-Based Guidelines in the Evaluation and Management of Concussion: A Survey of New England Emergency Departments.

PubMed

Stern, Robert A; Seichepine, Daniel; Tschoe, Christine; Fritts, Nathan G; Alosco, Michael L; Berkowitz, Oren; Burke, Peter; Howland, Jonathan; Olshaker, Jonathan; Cantu, Robert C; Baugh, Christine M; Holsapple, James W

2017-02-15

Evidence-based clinical practice guidelines can facilitate proper evaluation and management of concussions in the emergency department (ED), often the initial and primary point of contact for concussion care. There is no universally adopted set of guidelines for concussion management, and extant evidence suggests that there may be variability in concussion care practices and limited application of clinical practice guidelines in the ED. This study surveyed EDs throughout New England to examine current practices of concussion care and utilization of evidence-based clinical practice guidelines in the evaluation and management of concussions. In 2013, a 32-item online survey was e-mailed to 149/168 EDs throughout New England (Connecticut, Rhode Island, Massachusetts, Vermont, New Hampshire, Maine). Respondents included senior administrators asked to report on their EDs use of clinical practice guidelines, neuroimaging decision-making, and discharge instructions for concussion management. Of the 72/78 respondents included, 35% reported absence of clinical practice guidelines, and 57% reported inconsistency in the type of guidelines used. Practitioner preference guided neuroimaging decision-making for 57%. Although 94% provided written discharge instructions, there was inconsistency in the recommended time frame for follow-up care (13% provided no specific time frame), the referral specialist to be seen (25% did not recommend any specialist), and return to activity instructions were inconsistent. There is much variability in concussion care practices and application of evidence-based clinical practice guidelines in the evaluation and management of concussions in New England EDs. Knowledge translational efforts will be critical to improve concussion management in the ED setting.

The effectiveness of community-based loan funds for transport during obstetric emergencies in developing countries: a systematic review.

PubMed

Nwolise, Chidiebere Hope; Hussein, Julia; Kanguru, Lovney; Bell, Jacqueline; Patel, Purvi

2015-09-01

Scarcity and costs of transport have been implicated as key barriers to accessing care when obstetric emergencies occur in community settings. Community-based loans have been used to increase utilization of health facilities and potentially reduce maternal mortality by providing funding at community level to provide emergency transport. This review aimed to provide evidence of the effect of community-based loan funds on utilization of health facilities and reduction of maternal mortality in developing countries. Electronic databases of published literature and websites were searched for relevant literature using a pre-defined set of search terms, inclusion and exclusion criteria. Screening of titles, abstracts and full-text articles were done by at least two reviewers independently. Quality assessment was carried out on the selected papers. Data related to deliveries and obstetric complications attended at facilities, maternal deaths and live births were extracted to measure and compare the effects of community-based loan funds using odds ratios (ORs) and reductions in maternal mortality ratio. Forest plots are presented where possible. The results of the review show that groups where community-based loan funds were implemented (alongside other interventions) generally recorded increases in utilization of health facilities for deliveries, with ORs of 3.5 (0.97-15.48) and 3.55 (1.56-8.05); and an increase in utilization of emergency obstetric care with ORs of 2.22 (0.51-10.38) and 3.37 (1.78-6.37). Intervention groups also experienced a positive effect on met need for complications and a reduction in maternal mortality. There is some evidence to suggest that community-based loan funds as part of a multifaceted intervention have positive effects. Conclusions are limited by challenges of study design and bias. Further studies which strengthen the evidence of the effects of loan funds, and mechanism for their functionality, are recommended. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2014; all rights reserved.

Key Factors of e-Learning: A Case Study at a Spanish Bank

ERIC Educational Resources Information Center

Andreu, Rafael; Jauregui, Kety

2005-01-01

Given the evident potential shown by developing new technologies, there are increasingly more companies that develop and implement training programs that use the new-technology-based facilities. Likewise, suppliers developing new-technology-based programs have emerged seeking greater effectiveness and cost reduction as opposed to traditional…

Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2017 update of the evidence-based guidelines from the world society of emergency surgery ASBO working group.

PubMed

Ten Broek, Richard P G; Krielen, Pepijn; Di Saverio, Salomone; Coccolini, Federico; Biffl, Walter L; Ansaloni, Luca; Velmahos, George C; Sartelli, Massimo; Fraga, Gustavo P; Kelly, Michael D; Moore, Frederick A; Peitzman, Andrew B; Leppaniemi, Ari; Moore, Ernest E; Jeekel, Johannes; Kluger, Yoram; Sugrue, Michael; Balogh, Zsolt J; Bendinelli, Cino; Civil, Ian; Coimbra, Raul; De Moya, Mark; Ferrada, Paula; Inaba, Kenji; Ivatury, Rao; Latifi, Rifat; Kashuk, Jeffry L; Kirkpatrick, Andrew W; Maier, Ron; Rizoli, Sandro; Sakakushev, Boris; Scalea, Thomas; Søreide, Kjetil; Weber, Dieter; Wani, Imtiaz; Abu-Zidan, Fikri M; De'Angelis, Nicola; Piscioneri, Frank; Galante, Joseph M; Catena, Fausto; van Goor, Harry

2018-01-01

Adhesive small bowel obstruction (ASBO) is a common surgical emergency, causing high morbidity and even some mortality. The adhesions causing such bowel obstructions are typically the footprints of previous abdominal surgical procedures. The present paper presents a revised version of the Bologna guidelines to evidence-based diagnosis and treatment of ASBO. The working group has added paragraphs on prevention of ASBO and special patient groups. The guideline was written under the auspices of the World Society of Emergency Surgery by the ASBO working group. A systematic literature search was performed prior to the update of the guidelines to identify relevant new papers on epidemiology, diagnosis, and treatment of ASBO. Literature was critically appraised according to an evidence-based guideline development method. Final recommendations were approved by the workgroup, taking into account the level of evidence of the conclusion. Adhesion formation might be reduced by minimally invasive surgical techniques and the use of adhesion barriers. Non-operative treatment is effective in most patients with ASBO. Contraindications for non-operative treatment include peritonitis, strangulation, and ischemia. When the adhesive etiology of obstruction is unsure, or when contraindications for non-operative management might be present, CT is the diagnostic technique of choice. The principles of non-operative treatment are nil per os, naso-gastric, or long-tube decompression, and intravenous supplementation with fluids and electrolytes. When operative treatment is required, a laparoscopic approach may be beneficial for selected cases of simple ASBO.Younger patients have a higher lifetime risk for recurrent ASBO and might therefore benefit from application of adhesion barriers as both primary and secondary prevention. This guideline presents recommendations that can be used by surgeons who treat patients with ASBO. Scientific evidence for some aspects of ASBO management is scarce, in particular aspects relating to special patient groups. Results of a randomized trial of laparoscopic versus open surgery for ASBO are awaited.

Managing Ethical Challenges to Mental Health Research in Post‐Conflict Settings

PubMed Central

Khan, Muhammad Naseem; Rahman, Atif; Frith, Lucy

2015-01-01

Abstract Recently the World Health Organization (WHO) has highlighted the need to strengthen mental health systems following emergencies, including natural and manmade disasters. Mental health services need to be informed by culturally attuned evidence that is developed through research. Therefore, there is an urgent need to establish rigorous ethical research practice to underpin the evidence‐base for mental health services delivered during and following emergencies. PMID:25580875

A systematic review of community-based interventions for emerging zoonotic infectious diseases in Southeast Asia

PubMed Central

Halton, Kate; Sarna, Mohinder; Barnett, Adrian; Leonardo, Lydia; Graves, Nicholas

2013-01-01

Executive Summary Background Southeast Asia has been at the epicentre of recent epidemics of emerging and re-emerging zoonotic diseases. Community-based surveillance and control interventions have been heavily promoted but the most effective interventions have not been identified. Objectives This review evaluated evidence for the effectiveness of community-based surveillance interventions at monitoring and identifying emerging infectious disease; the effectiveness of community-based control interventions at reducing rates of emerging infectious disease; and contextual factors that influence intervention effectiveness. Inclusion criteria Participants Communities in Brunei, Cambodia, Indonesia, Laos, Malaysia, Myanmar, the Philippines, Singapore, Thailand and Viet Nam. Types of intervention(s) Non-pharmaceutical, non-vaccine, and community-based surveillance or prevention and control interventions targeting rabies, Nipah virus, dengue, SARS or avian influenza. Types of outcomes Primary outcomes: measures: of infection or disease; secondary outcomes: measures of intervention function. Types of studies Original quantitative studies published in English. Search strategy Databases searched (1980 to 2011): PubMed, CINAHL, ProQuest, EBSCOhost, Web of Science, Science Direct, Cochrane database of systematic reviews, WHOLIS, British Development Library, LILACS, World Bank (East Asia), Asian Development Bank. Methodological quality Two independent reviewers critically appraised studies using standard Joanna Briggs Institute instruments. Disagreements were resolved through discussion. Data extraction A customised tool was used to extract quantitative data on intervention(s), populations, study methods, and primary and secondary outcomes; and qualitative contextual information or narrative evidence about interventions. Data synthesis Data was synthesised in a narrative summary with the aid of tables. Meta-analysis was used to statistically pool quantitative results. Results Fifty-seven studies were included. Vector control interventions using copepods, environmental cleanup and education are effective and sustainable at reducing dengue in rural and urban communities, whilst insecticide spraying is effective in urban outbreak situations. Community-based surveillance interventions can effectively identify avian influenza in backyard flocks, but have not been broadly applied. Outbreak control interventions for Nipah virus and SARS are effective but may not be suitable for ongoing control. Canine vaccination and education is more acceptable than culling, but still fails to reach coverage levels required to effectively control rabies. Contextual factors were identified that influence community engagement with, and ultimately effectiveness of, interventions. Conclusion Despite investment in community-based disease control and surveillance in Southeast Asia, published evidence evaluating interventions is limited in quantity and quality. Nonetheless this review identified a number of effective interventions, and several contextual factors influencing effectiveness. Identification of the best programs will require comparative evidence of effectiveness acceptability, cost-effectiveness and sustainability. Implications for practice Interventions are more effective if there are high levels of community ownership and engagement. Linkages between veterinary and public health surveillance systems are essential. Interventions are not well accepted when they fail to acknowledge the importance of animals for economic activity in communities. Implications for research Evidence is needed on functioning and outcomes of current surveillance systems and novel low-cost methods of surveillance. Evaluations of control interventions should control for confounding and report measures of disease, cost and sustainability. Translational research is needed to assess generalisability and evaluate roll-out of effective interventions as regional or national programs.

The Emergence of Systematic Review in Toxicology.

PubMed

Stephens, Martin L; Betts, Kellyn; Beck, Nancy B; Cogliano, Vincent; Dickersin, Kay; Fitzpatrick, Suzanne; Freeman, James; Gray, George; Hartung, Thomas; McPartland, Jennifer; Rooney, Andrew A; Scherer, Roberta W; Verloo, Didier; Hoffmann, Sebastian

2016-07-01

The Evidence-based Toxicology Collaboration hosted a workshop on "The Emergence of Systematic Review and Related Evidence-based Approaches in Toxicology," on November 21, 2014 in Baltimore, Maryland. The workshop featured speakers from agencies and organizations applying systematic review approaches to questions in toxicology, speakers with experience in conducting systematic reviews in medicine and healthcare, and stakeholders in industry, government, academia, and non-governmental organizations. Based on the workshop presentations and discussion, here we address the state of systematic review methods in toxicology, historical antecedents in both medicine and toxicology, challenges to the translation of systematic review from medicine to toxicology, and thoughts on the way forward. We conclude with a recommendation that as various agencies and organizations adapt systematic review methods, they continue to work together to ensure that there is a harmonized process for how the basic elements of systematic review methods are applied in toxicology. © The Author 2016. Published by Oxford University Press on behalf of the Society of Toxicology.

Health Information Technology Evaluation Framework (HITREF) Comprehensiveness as Assessed in Electronic Point-of-Care Documentation Systems Evaluations.

PubMed

Sockolow, Paulina S; Bowles, Kathryn H; Rogers, Michelle

2015-01-01

We assessed the Health Information Technology (HIT) Reference-based Evaluation Framework (HITREF) comprehensiveness in two HIT evaluations in settings different from that in which the HITREF was developed. Clinician satisfaction themes that emerged from clinician interviews in the home care and the hospital studies were compared to the framework components. Across both studies, respondents commented on 12 of the 20 HITREF components within 5 of the 6 HITREF concepts. No new components emerged that were missing from the HITREF providing evidence that the HITREF is a comprehensive framework. HITREF use in a range of HIT evaluations by researchers new to the HITREF demonstrates that it can be used as intended. Therefore, we continue to recommend the HITREF as a comprehensive, research-based HIT evaluation framework to increase the capacity of informatics evaluators' use of best practice and evidence-based practice to support the credibility of their findings for fulfilling the purpose of program evaluation.

Paediatric obstructive sleep apnoea: is our operative management evidence-based?

PubMed

Pabla, L; Duffin, J; Flood, L; Blackmore, K

2018-04-01

Despite the plethora of publications on the subject of paediatric obstructive sleep apnoea, there seems to be wide variability in the literature and in practice, regarding recourse to surgery, the operation chosen, the benefits gained and post-operative management. This may reflect a lack of high-level evidence. A systematic review of four significant controversies in paediatric ENT was conducted from the available literature: tonsillectomy versus tonsillotomy, focusing on the evidence base for each; anaesthetic considerations in paediatric obstructive sleep apnoea surgery; the objective evidence for the benefits of surgical treatment for obstructive sleep apnoea; and the medical treatment options for residual obstructive sleep apnoea after surgical treatment. There are many gaps in the evidence base for the surgical correction of obstructive sleep apnoea. There is emerging evidence favouring subtotal tonsillectomy. There is continuing uncertainty around the prediction of the level of post-operative care that any individual child might require. The long-term benefit of surgical correction is a particularly fertile ground for further research.

Harnessing the language of overdose prevention to advance evidence-based responses to the opioid crisis.

PubMed

Collins, Alexandra B; Bluthenthal, Ricky N; Boyd, Jade; McNeil, Ryan

2018-05-01

Language has significant implications for how we view and respond to public health issues. Conventional moralistic messaging around drug use stigmatizes people who use drugs and inhibits the implementation of evidence-based harm reduction interventions that do not condemn drug use. However, within the context of the unprecedented North American opioid overdose crisis, we argue that shifting conventional moral messaging around overdose prevention and response strategies is key to supporting the rapid roll-out of evidence-based harm reduction interventions. Reframing overdose prevention to highlight the imperative to address the ongoing public health emergency is an important first step in implementing urgently needed response strategies. Copyright © 2018 Elsevier B.V. All rights reserved.

Medical education research in the context of translational science.

PubMed

Santen, Sally A; Deiorio, Nicole M; Gruppen, Larry D

2012-12-01

Health care struggles to transfer recent discoveries into high-quality medical care. Therefore, translational science seeks to improve the health of patients and communities by studying and promoting the translation of findings from bench research into clinical care. Similarly, medical education practice may be slow to adopt proven evidence of better learning and assessment. The Academic Emergency Medicine (AEM) consensus conference was designed to promote the dissemination of evidence-based education research and practice. We will pull from the work developed by the consensus conference as a means to create a roadmap for future medical education research using the framework of translational science. © 2012 by the Society for Academic Emergency Medicine.

Multinational Alcohol Market Development and Public Health: Diageo in India.

PubMed

Esser, Marissa B; Jernigan, David H

2015-11-01

Alcohol is a risk factor for communicable and noncommunicable diseases, and alcohol consumption is rising steadily in India. The growth of multinational alcohol corporations, such as Diageo, contributes to India's changing alcohol environment. We provide a brief history of India's alcohol regulation for context and examine Diageo's strategies for expansion in India in 2013 and 2014. Diageo is attracted to India's younger generation, women, and emerging middle class for growth opportunities. Components of Diageo's responsibility strategy conflict with evidence-based public health recommendations for reducing harmful alcohol consumption. Diageo's strategies for achieving market dominance in India are at odds with public health evidence. We conclude with recommendations for protecting public health in emerging markets.

Consensus statement on advancing research in emergency department operations and its impact on patient care.

PubMed

Yiadom, Maame Yaa A B; Ward, Michael J; Chang, Anna Marie; Pines, Jesse M; Jouriles, Nick; Yealy, Donald M

2015-06-01

The consensus conference on "Advancing Research in Emergency Department (ED) Operations and Its Impact on Patient Care," hosted by The ED Operations Study Group (EDOSG), convened to craft a framework for future investigations in this important but understudied area. The EDOSG is a research consortium dedicated to promoting evidence-based clinical practice in emergency medicine. The consensus process format was a modified version of the NIH Model for Consensus Conference Development. Recommendations provide an action plan for how to improve ED operations study design, create a facilitating research environment, identify data measures of value for process and outcomes research, and disseminate new knowledge in this area. Specifically, we call for eight key initiatives: 1) the development of universal measures for ED patient care processes; 2) attention to patient outcomes, in addition to process efficiency and best practice compliance; 3) the promotion of multisite clinical operations studies to create more generalizable knowledge; 4) encouraging the use of mixed methods to understand the social community and human behavior factors that influence ED operations; 5) the creation of robust ED operations research registries to drive stronger evidence-based research; 6) prioritizing key clinical questions with the input of patients, clinicians, medical leadership, emergency medicine organizations, payers, and other government stakeholders; 7) more consistently defining the functional components of the ED care system, including observation units, fast tracks, waiting rooms, laboratories, and radiology subunits; and 8) maximizing multidisciplinary knowledge dissemination via emergency medicine, public health, general medicine, operations research, and nontraditional publications. © 2015 by the Society for Academic Emergency Medicine.

Is Project Based Learning More Effective than Direct Instruction in School Science Classrooms? An Analysis of the Empirical Research Evidence

NASA Astrophysics Data System (ADS)

Dann, Clifford

An increasingly loud call by parents, school administrators, teachers, and even business leaders for "authentic learning", emphasizing both group-work and problem solving, has led to growing enthusiasm for inquiry-based learning over the past decade. Although "inquiry" can be defined in many ways, a curriculum called "project-based learning" has recently emerged as the inquiry practice-of-choice with roots in the educational constructivism that emerged in the mid-twentieth century. Often, project-based learning is framed as an alternative instructional strategy to direct instruction for maximizing student content knowledge. This study investigates the empirical evidence for such a comparison while also evaluating the overall quality of the available studies in the light of accepted standards for educational research. Specifically, this thesis investigates what the body of quantitative research says about the efficacy of project-based learning vs. direct instruction when considering student acquisition of content knowledge in science classrooms. Further, existing limitations of the research pertaining to project based learning and secondary school education are explored. The thesis concludes with a discussion of where and how we should focus our empirical efforts in the future. The research revealed that the available empirical research contains flaws in both design and instrumentation. In particular, randomization is poor amongst all the studies considered. The empirical evidence indicates that project-based learning curricula improved student content knowledge but that, while the results were statistically significant, increases in raw test scores were marginal.

Effects of Tai Chi exercise on physical and psychological health of older people.

PubMed

Blake, Holly; Hawley, Helen

2012-02-01

Tai Chi is a traditional Chinese form of conditioning exercise derived from martial arts and rooted in eastern philosophy and Chinese Medicine. Based on the inter-relatedness of mind, body and spirit this form of exercise focuses on producing an inner calmness which is thought to have both physical and psychological therapeutic value. This article provides a brief overview of selected current evidence examining the relationship between Tai Chi and physical, neurocognitive and psychosocial outcomes in older people. This is an emerging and growing area of research and improvements have often been reported in health functioning, physical and emotional health, reducing falls, fear of falling and risk of falls, and possibly enhancing cardiovascular functioning in older adults although the effects on bone density, cognitive and immunological functioning are less clear. Results overall are inconsistent and health improvements have not been evident in all studies. Tai Chi is becoming increasingly popular in practice, and more recent evidence is emerging which is based on experimental and longitudinal designs, although many of the proposed benefits of Tai Chi are yet to be validated in large, randomised controlled trials.

Bats and zoonotic viruses: can we confidently link bats with emerging deadly viruses?

PubMed Central

Moratelli, Ricardo; Calisher, Charles H

2015-01-01

An increasingly asked question is 'can we confidently link bats with emerging viruses?'. No, or not yet, is the qualified answer based on the evidence available. Although more than 200 viruses - some of them deadly zoonotic viruses - have been isolated from or otherwise detected in bats, the supposed connections between bats, bat viruses and human diseases have been raised more on speculation than on evidence supporting their direct or indirect roles in the epidemiology of diseases (except for rabies). However, we are convinced that the evidence points in that direction and that at some point it will be proved that bats are competent hosts for at least a few zoonotic viruses. In this review, we cover aspects of bat biology, ecology and evolution that might be relevant in medical investigations and we provide a historical synthesis of some disease outbreaks causally linked to bats. We provide evolutionary-based hypotheses to tentatively explain the viral transmission route through mammalian intermediate hosts and to explain the geographic concentration of most outbreaks, but both are no more than speculations that still require formal assessment. PMID:25742261

Emerging Issues and Models in College Mental Health Services

ERIC Educational Resources Information Center

Locke, Ben; Wallace, David; Brunner, Jon

2016-01-01

This chapter provides a brief overview of the psychological issues facing today's college students, information about students receiving mental health services, and an evidence-based model describing the practice and functions of today's counseling centers.

On-treatment decrease of NKG2D correlates to early emergence of clinically evident hepatocellular carcinoma after interferon-free therapy for chronic hepatitis C.

PubMed

Chu, Po-Sung; Nakamoto, Nobuhiro; Taniki, Nobuhito; Ojiro, Keisuke; Amiya, Takeru; Makita, Yuko; Murata, Hiroko; Yamaguchi, Akihiro; Shiba, Shunsuke; Miyake, Rei; Katayama, Tadashi; Ugamura, Aya; Ikura, Akihiko; Takeda, Karin; Ebinuma, Hirotoshi; Saito, Hidetsugu; Kanai, Takanori

2017-01-01

Interferon (IFN)- free direct antiviral agents (DAAs) with rapid HCV eradication might evoke immunological reconstitutions, and some early recurrences of HCC after IFN-free DAAs have been reported. This study aimed to investigate whether natural killer group 2, member D (NKG2D) predicts early emergence of HCC after IFN-free DAAs. We conducted a clinical practice-based observational study of 101 patients infected with genotype 1 HCV who received IFN-free (DAAs), and stratified them into those who did or did not develop early (i.e., during the 6-month surveillance period following treatment.) recurrence or occurrence of clinically evident HCC. We also analyzed the peripheral blood mononuclear cells, both before treatment and at end of treatment (EOT), of 24 of the patients who received IFN-free DAAs, and 16 who received IFN-combined protease inhibitor. We found early emergence of clinically evident HCC after IFN-free DAAs in 12 (12%) patients. Higher pre-treatment NKG2D expression, higher FIB-4 score, previous HCC history and failure to achieve sustained viral response were significant factors correlating to early HCC emergence. After IFN-free DAAs, a rapid decrease of NKG2D at EOT correlated with early HCC emergence in the IFN-free DAA-treated patients, but not in patients treated with the IFN-combined regimen. The decrease of NKG2D until EOT was predictive of early HCC emergence at a cut-off of -52% (AUC = 0.92). On-treatment decrease of NKG2D may be a useful predictor of early emerging HCC in patients treated with IFN-free DAAs.

Value-Added Assessment of Teacher Preparation: An Illustration of Emerging Technology

ERIC Educational Resources Information Center

Noell, George H.; Burns, Jeanne L.

2006-01-01

Broad-based empirical outcomes assessment is an increasingly evident part of governmental services and this trend is particularly apparent in education. The clearest manifestation of this trend in education has been the advent of high-stakes broad-based testing and accountability programs in K-12 education. Although this assessment regime has not…

Principles of Curriculum Design and Construction Based on the Concepts of Educational Neuroscience

ERIC Educational Resources Information Center

Watagodakumbura, Chandana

2017-01-01

With the emergence of a wealth of research-based information in the field of educational neuroscience, educators are now able to make more evidence-based decisions in the important area of curriculum design and construction. By viewing from the perspective of educational neuroscience, we can give a more meaningful and lasting purpose of leading to…

Research Priorities in the Utilization and Interpretation of Diagnostic Imaging: Education, Assessment, and Competency.

PubMed

Lewiss, Resa E; Chan, Wilma; Sheng, Alexander Y; Soto, Jorge; Castro, Alexandra; Meltzer, Andrew C; Cherney, Alan; Kumaravel, Manickam; Cody, Dianna; Chen, Esther H

2015-12-01

The appropriate selection and accurate interpretation of diagnostic imaging is a crucial skill for emergency practitioners. To date, the majority of the published literature and research on competency assessment comes from the subspecialty of point-of-care ultrasound. A group of radiologists, physicists, and emergency physicians convened at the 2015 Academic Emergency Medicine consensus conference to discuss and prioritize a research agenda related to education, assessment, and competency in ordering and interpreting diagnostic imaging. A set of questions for the continued development of an educational curriculum on diagnostic imaging for trainees and competency assessment using specific assessment methods based on current best practices was delineated. The research priorities were developed through an iterative consensus-driven process using a modified nominal group technique that culminated in an in-person breakout session. The four recommendations are: 1) develop a diagnostic imaging curriculum for emergency medicine (EM) residency training; 2) develop, study, and validate tools to assess competency in diagnostic imaging interpretation; 3) evaluate the role of simulation in education, assessment, and competency measures for diagnostic imaging; 4) study is needed regarding the American College of Radiology Appropriateness Criteria, an evidence-based peer-reviewed resource in determining the use of diagnostic imaging, to maximize its value in EM. In this article, the authors review the supporting reliability and validity evidence and make specific recommendations for future research on the education, competency, and assessment of learning diagnostic imaging. © 2015 by the Society for Academic Emergency Medicine.

The use of subdissociative-dose ketamine for acute pain in the emergency department.

PubMed

Sin, Billy; Ternas, Theologia; Motov, Sergey M

2015-03-01

Ketamine is a well-known anesthetic with its use trailing back to the 1960s. It has antagonistic effects at the N-methyl-d-aspartate receptor. There is emerging literature to suggest the use of subdissociative-dose ketamine (SDDK) for pain reduction. This evidence-based review evaluates the evidence regarding the use of SDDK for acute pain control in the emergency department (ED). The MEDLINE and EMBASE databases were searched. Randomized controlled trials (RCTs) that described or evaluated the use of SDDK for acute pain in the ED were included. Literature was excluded if it was not published in English. Duplicate articles, unpublished reports, abstracts, and review articles were also excluded. Quality assessment and evaluation of literature were evaluated based on the GRADE criteria. The primary outcome of interest in this review was the difference in pain score from baseline to cutoff time as specified in the studies. Secondary outcome measures were the incidence of adverse events and reduction in the amount of adjuvant opioids consumed by patients who received SDDK. Four RCTs met the inclusion criteria, which enrolled a total of 428 patients. Three adult trials and one pediatric trial were identified. The level of evidence for the individual trials ranged from low to moderate. A significant reduction in pain scores was only found in two of the four trials. One trial found a significant reduction in mean pain scores when ketamine was compared to morphine (p < 0.05). Another trial reported a significant decrease in mean distress scores, favoring SDDK over fentanyl (1.0 vs. 2.7, p < 0.05). One trial found a significant reduction in the amount of morphine consumed, favoring ketamine over placebo (0.14 mg/kg, 95% confidence interval [CI] = 0.13 to 0.16 mg/kg vs. 0.2 mg/kg, 95% CI = 0.18 to 0.22 mg/kg; p < 0.001). An emergence phenomenon was reported in one trial. Four RCTs with methodologic limitations failed to provide convincing evidence to either support or refute the use of SDDK for acute pain control in the ED. © 2015 by the Society for Academic Emergency Medicine.

Infection Prevention in the Emergency Department

PubMed Central

Liang, Stephen Y.; Theodoro, Daniel L.; Schuur, Jeremiah D.; Marschall, Jonas

2014-01-01

Infection prevention remains a major challenge in emergency care. Acutely ill and injured patients seeking evaluation and treatment in the emergency department (ED) not only have the potential to spread communicable infectious diseases to healthcare personnel and other patients, but are vulnerable to acquiring new infections associated with the care they receive. This article will evaluate these risks and review the existing literature for infection prevention practices in the ED, ranging from hand hygiene, standard and transmission-based precautions, healthcare personnel vaccination, and environmental controls to strategies for preventing healthcare-associated infections. We will conclude by examining what can be done to optimize infection prevention in the ED and identify gaps in knowledge where further research is needed. Successful implementation of evidence-based practices coupled with innovation of novel approaches and technologies tailored specifically to the complex and dynamic environment of the ED are the keys to raising the standard for infection prevention and patient safety in emergency care. PMID:24721718

[Vertigo in the Emergency Department: new bedside tests].

PubMed

Tamás, T László; Garai, Tibor; Tompos, Tamás; Szirmai, Ágnes

2016-03-13

According to international statistics, the first examination of 25% of patients with vertigo is carried out in Emergency Departments. The most important task of the examining physician is to diagnose life threatening pathologic processes. One of the most difficult otoneurological diagnostic challange in Emergency Departments is to differentiate between dangerous posterior scale stroke presenting with isolated vertigo and the benign vestibular neuritis.These two disorders can be safely differentiated using fast, non-invasive, evidence based bedside tests which have been introduced in the past few years. 35% of stroke cases mimicking vestibular neuritis (pseudoneuritis) are misdiagnosed at the Emergency Department, and 40% of these cases develop complications. During the first 48 hours, sensitivity for stroke of the new test that is based on the malfunction of the oculomotor system is better than the diffusion-weighted cranial magnetic resonance imaging. Using special test glasses each component of the new test can be made objective and repeatable.

Applying hospital evidence to paramedicine: issues of indirectness, validity and knowledge translation.

PubMed

Bigham, Blair; Welsford, Michelle

2015-05-01

The practice of emergency medicine (EM) has been intertwined with emergency medical services (EMS) for more than 40 years. In this commentary, we explore the practice of translating hospital based evidence into the prehospital setting. We will challenge both EMS and EM dogma-bringing hospital care to patients in the field is not always better. In providing examples of therapies championed in hospitals that have failed to translate into the field, we will discuss the unique prehospital environment, and why evidence from the hospital setting cannot necessarily be translated to the prehospital field. Paramedicine is maturing so that the capability now exists to conduct practice-specific research that can inform best practices. Before translation from the hospital environment is implemented, evidence must be evaluated by people with expertise in three domains: critical appraisal, EM, and EMS. Scientific evidence should be assessed for: quality and bias; directness, generalizability, and validity to the EMS population; effect size and anticipated benefit from prehospital application; feasibility (including economic evaluation, human resource availability in the mobile environment); and patient and provider safety.

[Electrocardiographic diagnosis: when QRS is wide.

PubMed

Conti, Matilde; Bregani, Enrico Rino

2018-04-01

Differential diagnosis of one or more wide QRS complexes on an electrocardiogram under emergency conditions takes into account three main sets of clinical conditions: ventricular pre-excitation, aberrant conduction and ventricular beats and it is based on the morphological analysis of the ECG and patient's anamnestic data. Several criteria can facilitate the differential diagnosis and if properly used and integrated with clinic data they can achieve good diagnostic accuracy in most cases. In this review several criteria based on evidence and literature are presented, paying attention in recognizing some morphologic pathways that can be used in emergency room and allow a correct ECG assessment.

Doctor of Nursing Practice: The Role of the Advanced Practice Nurse.

PubMed

Walker, Deborah Kirk; Polancich, Shea

2015-11-01

To explore the evolution and emerging roles of the Doctor of Nursing Practice (DNP) Advanced Practice Nurse (APN). Published peer reviewed literature, cancer-related professional resources, and Web-based resources. The DNP education has prepared the APN for process improvement initiatives, providing quality care, and evidence-based practice translation, which are critical with the emerging trends in this complex health care environment. DNP-prepared APNs have the opportunity to impact oncology care across the cancer trajectory, in various settings, and in various innovative roles as entrepreneurs. Copyright © 2015 Elsevier Inc. All rights reserved.

Update on Smoking Cessation: E-Cigarettes, Emerging Tobacco Products Trends, and New Technology-Based Interventions.

PubMed

Das, Smita; Tonelli, Makenzie; Ziedonis, Douglas

2016-05-01

Tobacco use disorders (TUDs) continue to be overly represented in patients treated in mental health and addiction treatment settings. It is the most common substance use disorder (SUD) and the leading cause of health disparities and increased morbidity/mortality amongst individuals with a psychiatric disorder. There are seven Food and Drug Administration (FDA) approved medications and excellent evidence-based psychosocial treatment interventions to use in TUD treatment. In the past few years, access to and use of other tobacco or nicotine emerging products are on the rise, including the highly publicized electronic cigarette (e-cigarette). There has also been a proliferation of technology-based interventions to support standard TUD treatment, including mobile apps and web-based interventions. These tools are easily accessed 24/7 to support outpatient treatment. This update will review the emerging products and counter-measure intervention technologies, including how clinicians can integrate these tools and other community-based resources into their practice.

Improving Uptake of Key Perinatal Interventions Using Statewide Quality Collaboratives.

PubMed

Pai, Vidya V; Lee, Henry C; Profit, Jochen

2018-06-01

Regional and statewide quality improvement collaboratives have been instrumental in implementing evidence-based practices and facilitating quality improvement initiatives within neonatology. Statewide collaboratives emerged from larger collaborative organizations, like the Vermont Oxford Network, and play an increasing role in collecting and interpreting data, setting priorities for improvement, disseminating evidence-based clinical practice guidelines, and creating regional networks for synergistic learning. In this review, we highlight examples of successful statewide collaborative initiatives, as well as challenges that exist in initiating and sustaining collaborative efforts. Copyright © 2018 Elsevier Inc. All rights reserved.

Promising intervention strategies to reduce parents' use of physical punishment.

PubMed

Gershoff, Elizabeth T; Lee, Shawna J; Durrant, Joan E

2017-09-01

The strong and ever-growing evidence base demonstrating that physical punishment places children at risk for a range of negative outcomes, coupled with global recognition of children's inherent rights to protection and dignity, has led to the emergence of programs specifically designed to prevent physical punishment by parents. This paper describes promising programs and strategies designed for each of three levels of intervention - indicated, selective, and universal - and summarizes the existing evidence base of each. Areas for further program development and evaluation are identified. Copyright © 2017 Elsevier Ltd. All rights reserved.

Exploring arts-based knowledge translation: sharing research findings through performing the patterns, rehearsing the results, staging the synthesis.

PubMed

Rieger, Kendra; Schultz, Annette S H

2014-04-01

Cultivation of knowledge translation (KT) strategies that actively engage health professionals in critical reflection of their practice and research-based evidence are imperative to address the research-practice gap. While research-based evidence is exponentially growing, our ability to facilitate uptake by nurses and other health professionals has not kept pace. Innovative approaches that extend epistemological bias beyond a singular standpoint of postpositivism, such as the utilization of arts-based methods, expand the possibility to address the complexities of context, engage audience members, promote dissemination within communities of practice, and foster new audiences interested in research findings. In this paper, we address the importance of adopting a social constructivist epistemological stance to facilitate knowledge translation to diverse audiences, explore various arts-based knowledge translation (ABKT) strategies, and open a dialogue concerning evaluative tenets of ABKT. ABKT utilizes various art forms to disseminate research knowledge to diverse audiences and promote evidence-informed practice. ABKT initiatives translate knowledge not based upon a linear model, which views knowledge as an objective entity, but rather operate from the premise that knowledge is socially situated, which demands acknowledging and engaging the learner within their context. Theatre, dance, photography, and poetry are art forms that are commonly used to communicate research findings to diverse audiences. Given the emerging interest and importance of utilizing this KT strategy situated within a social constructivist epistemology, potential challenges and plausible evaluative criteria specific to ABKT are presented. ABKT is an emerging KT strategy that is grounded in social constructivist epistemological tenets, and holds potential for meaningfully sharing new research knowledge with diverse audiences. ABKT is an innovative and synergistic approach to traditional dissemination strategies. This creative KT approach is emerging as potent transformational learning tools that are congruent with the relational nature of nursing practice. ABKT facilitates learning about new research findings in an engaging and critical reflective manner that promotes learning within communities of practice. © 2014 Sigma Theta Tau International.

Concussion Care Practices and Utilization of Evidence-Based Guidelines in the Evaluation and Management of Concussion: A Survey of New England Emergency Departments

PubMed Central

Seichepine, Daniel; Tschoe, Christine; Fritts, Nathan G.; Alosco, Michael L.; Berkowitz, Oren; Burke, Peter; Howland, Jonathan; Olshaker, Jonathan; Cantu, Robert C.; Baugh, Christine M.; Holsapple, James W.

2017-01-01

Abstract Evidence-based clinical practice guidelines can facilitate proper evaluation and management of concussions in the emergency department (ED), often the initial and primary point of contact for concussion care. There is no universally adopted set of guidelines for concussion management, and extant evidence suggests that there may be variability in concussion care practices and limited application of clinical practice guidelines in the ED. This study surveyed EDs throughout New England to examine current practices of concussion care and utilization of evidence-based clinical practice guidelines in the evaluation and management of concussions. In 2013, a 32-item online survey was e-mailed to 149/168 EDs throughout New England (Connecticut, Rhode Island, Massachusetts, Vermont, New Hampshire, Maine). Respondents included senior administrators asked to report on their EDs use of clinical practice guidelines, neuroimaging decision-making, and discharge instructions for concussion management. Of the 72/78 respondents included, 35% reported absence of clinical practice guidelines, and 57% reported inconsistency in the type of guidelines used. Practitioner preference guided neuroimaging decision-making for 57%. Although 94% provided written discharge instructions, there was inconsistency in the recommended time frame for follow-up care (13% provided no specific time frame), the referral specialist to be seen (25% did not recommend any specialist), and return to activity instructions were inconsistent. There is much variability in concussion care practices and application of evidence-based clinical practice guidelines in the evaluation and management of concussions in New England EDs. Knowledge translational efforts will be critical to improve concussion management in the ED setting. PMID:27112592

Adherence to Preexposure Prophylaxis: Current, Emerging, and Anticipated Bases of Evidence

PubMed Central

Amico, K. Rivet; Stirratt, Michael J.

2014-01-01

Despite considerable discussion and debate about adherence to preexposure prophylaxis (PrEP) for human immunodeficiency virus (HIV), scant data are available that characterize patterns of adherence to open-label PrEP. The current evidence base is instead dominated by research on adherence to placebo-controlled investigational drug by way of drug detection in active-arm participants of large randomized controlled trials (RCTs). Important differences between the context of blinded RCTs and open-label use suggest caution when generalizing from study product adherence to real-world PrEP use. Evidence specific to open-label PrEP adherence is presently sparse but will expand rapidly over the next few years as roll-out, demonstration projects, and more rigorous research collect and present findings. The current evidence bases established cannot yet predict uptake, adherence, or persistence with open-label effective PrEP. Emerging evidence suggests that some cohorts could execute better adherence in open-label use vs placebo-controlled research. Uptake of PrEP is presently slow in the United States; whether this changes as grassroots and community efforts increase awareness of PrEP as an effective HIV prevention option remains to be determined. As recommended by multiple guidelines for PrEP use, all current demonstration projects offer PrEP education and/or counseling. PrEP support approaches generally fall into community-based, technology, monitoring, and integrated sexual health promotion approaches. Developing and implementing research that moves beyond simple correlates of either study product use or open-label PrEP adherence toward more comprehensive models of sociobehavioral and socioecological adherence determinants would greatly accelerate progress. Intervention research is needed to identify effective models of support for open-label PrEP adherence. PMID:24926036

Screening and brief interventions for hazardous alcohol use in accident and emergency departments: a randomised controlled trial protocol

PubMed Central

Coulton, Simon; Perryman, Katherine; Bland, Martin; Cassidy, Paul; Crawford, Mike; Deluca, Paolo; Drummond, Colin; Gilvarry, Eilish; Godfrey, Christine; Heather, Nick; Kaner, Eileen; Myles, Judy; Newbury-Birch, Dorothy; Oyefeso, Adenekan; Parrott, Steve; Phillips, Tom; Shenker, Don; Shepherd, Jonathan

2009-01-01

Background There is a wealth of evidence regarding the detrimental impact of excessive alcohol consumption on the physical, psychological and social health of the population. There also exists a substantial evidence base for the efficacy of brief interventions aimed at reducing alcohol consumption across a range of healthcare settings. Primary research conducted in emergency departments has reinforced the current evidence regarding the potential effectiveness and cost-effectiveness. Within this body of evidence there is marked variation in the intensity of brief intervention delivered, from very minimal interventions to more intensive behavioural or lifestyle counselling approaches. Further the majority of primary research has been conducted in single centre and there is little evidence of the wider issues of generalisability and implementation of brief interventions across emergency departments. Methods/design The study design is a prospective pragmatic factorial cluster randomised controlled trial. Individual Emergency Departments (ED) (n = 9) are randomised with equal probability to a combination of screening tool (M-SASQ vs FAST vs SIPS-PAT) and an intervention (Minimal intervention vs Brief advice vs Brief lifestyle counselling). The primary hypothesis is that brief lifestyle counselling delivered by an Alcohol Health Worker (AHW) is more effective than Brief Advice or a minimal intervention delivered by ED staff. Secondary hypotheses address whether short screening instruments are more acceptable and as efficient as longer screening instruments and the cost-effectiveness of screening and brief interventions in ED. Individual participants will be followed up at 6 and 12 months after consent. The primary outcome measure is performance using a gold-standard screening test (AUDIT). Secondary outcomes include; quantity and frequency of alcohol consumed, alcohol-related problems, motivation to change, health related quality of life and service utilisation. Discussion This paper presents a protocol for a large multi-centre pragmatic factorial cluster randomised trial to evaluate the effectiveness and cost-effectiveness of screening and brief interventions for hazardous alcohol users attending emergency departments. Trial Registration ISRCTN 93681536 PMID:19575791

Emergency contraception review: evidence-based recommendations for clinicians

PubMed Central

Cleland, Kelly; Raymond, Elizabeth G.; Westley, Elizabeth; Trussell, James

2014-01-01

Several options for emergency contraception are available in the United States. This article describes each method, including efficacy, mode of action, safety, side effect profile and availability. The most effective emergency contraceptive is the copper IUD, followed by ulipristal acetate and levonorgestrel pills. Levonorgestrel is available for sale without restrictions, while ulipristal acetate is available with prescription only, and the copper IUD must be inserted by a clinician. Although EC pills have not been shown to reduce pregnancy or abortion rates at the population level, they are an important option for individual women seeking to prevent pregnancy after sex. PMID:25254919

Inequality in Landownership, the Emergence of Human-Capital Promoting Institutions, and the Great Divergence

PubMed Central

GALOR, ODED; MOAV, OMER; VOLLRATH, DIETRICH

2013-01-01

This paper suggests that inequality in the distribution of landownership adversely affected the emergence of human-capital promoting institutions (e.g. public schooling), and thus the pace and the nature of the transition from an agricultural to an industrial economy, contributing to the emergence of the great divergence in income per capita across countries. The prediction of the theory regarding the adverse effect of the concentration of landownership on education expenditure is established empirically based on evidence from the beginning of the 20th century in the U.S. PMID:23946551

Priority setting for health in emerging markets.

PubMed

Glassman, Amanda; Giedion, Ursula; McQueston, Kate

2013-05-01

The use of health technology assessment research in emerging economies is becoming an increasingly important tool to determine the uses of health spending. As low- and middle-income countries' gross domestic product grows, the funding available for health has increased in tandem. There is growing evidence that comparative effectiveness research and cost-effectiveness can be used to improve health outcomes within a predefined financial space. The use of these evaluation tools, combined with a systematized process of priority setting, can help inform national and global health payers. This review of country institutions for health technology assessment illustrates two points: the efforts underway to use research to inform priorities are widespread and not confined to wealthier countries; and many countries' efforts to create evidence-based policy are incomplete and more country-specific research will be needed. Further evidence shows that there is scope to reduce these gaps and opportunity to support better incorporation of data through better-defined priority-setting processes.

Hospital-based emergency nursing in rural settings.

PubMed

Brown, Jennifer F

2008-01-01

In 2006, the Institute of Medicine (IOM) released a series of reports that highlighted the urgent need for improvements in the nation's emergency health services. This news has provided new energy to a growing body of research about the development and implementation of best practices in emergency care. Despite evidence of geographical disparities in health services, relatively little attention has been focused on rural emergency services to identify environmental differences. The purpose of this chapter is to summarize the contributions of nursing research to the rural emergency services literature. The research resembles a so-called shotgun effect as the exploratory and interventional studies cover a wide range of topics without consistency or justification. Emergency nursing research has been conducted primarily in urban settings, with small samples and insufficient methodological rigor. This chapter will discuss the limitations of the research and set forth an agenda of critical topics that need to be explored related to emergency nursing in rural settings.

Implementation strategies in pediatric neurocritical care.

PubMed

Markham, Christopher; Proctor, Enola K; Pineda, Jose A

2017-06-01

Brain-directed critical care for children is a relatively new area of subspecialization in pediatric critical care. Pediatric neurocritical care teams combine the expertise of neurology, neurosurgery, and critical care medicine. The positive impact of delivering specialized care to pediatric patients with acute neurological illness is becoming more apparent, but the optimum way to implement and sustain the delivery of this is complicated and poorly understood. We aim to provide emerging evidence supporting that effective implementation of pediatric neurocritical care pathways can improve patient survival and outcomes. We also provide an overview of the most effective strategies across the field of implementation science that can facilitate deployment of neurocritical care pathways in the pediatric ICU. Implementation strategies can broadly be grouped according to six categories: planning, educating, restructuring, financing, managing quality, and attending to the policy context. Using a combination of these strategies in the last decade, several institutions have improved patient morbidity and mortality. Although much work remains to be done, emerging evidence supports that implementation of evidence-based care pathways for critically ill children with two common neurological diagnoses - status epilepticus and traumatic brain injury - improves outcomes. Pediatric and neonatal neurocritical care programs that support evidence-based care can be effectively structured using appropriately sequenced implementation strategies to improve outcomes across a variety of patient populations and in a variety of healthcare settings.

Sex as a Biological Variable in Emergency Medicine Research and Clinical Practice: A Brief Narrative Review

PubMed Central

McGregor, Alyson J.; Beauchamp, Gillian A.; Wira, Charles R.; Perman, Sarah M.; Safdar, Basmah

2017-01-01

The National Institutes of Health recently highlighted the significant role of sex as a biological variable (SABV) in research design, outcome and reproducibility, mandating that this variable be accounted for in all its funded research studies. This move has resulted in a rapidly increasing body of literature on SABV with important implications for changing the clinical practice of emergency medicine (EM). Translation of this new knowledge to the bedside requires an understanding of how sex-based research will ultimately impact patient care. We use three case-based scenarios in acute myocardial infarction, acute ischemic stroke and important considerations in pharmacologic therapy administration to highlight available data on SABV in evidence-based research to provide the EM community with an important foundation for future integration of patient sex in the delivery of emergency care as gaps in research are filled. PMID:29085541

Missed opportunities: racial and neighborhood socioeconomic disparities in emergency colorectal cancer diagnosis and surgery.

PubMed

Pruitt, Sandi L; Davidson, Nicholas O; Gupta, Samir; Yan, Yan; Schootman, Mario

2014-12-09

Disparities by race and neighborhood socioeconomic status exist for many colorectal cancer (CRC) outcomes, including screening use and mortality. We used population-based data to determine if disparities also exist for emergency CRC diagnosis and surgery. We examined two emergency CRC outcomes using 1992-2005 population-based U.S. SEER-Medicare data. Among CRC patients aged ≥66 years, we examined racial (African American vs. white) and neighborhood poverty disparities in two emergency outcomes defined as: 1) newly diagnosed CRC or 2) CRC surgery associated with: obstruction, perforation, or emergency inpatient admission. Multilevel logistic regression (patients nested in census tracts) analyses adjusted for sociodemographic, tumor, and clinical covariates. Of 83,330 CRC patients, 29.1% were diagnosed emergently. Of 55,046 undergoing surgery, 26.0% had emergency surgery. For both outcomes, race and neighborhood poverty disparities were evident. A significant race by poverty interaction (p < .001) was noted: poverty rate was associated with both outcomes among African Americans, but not whites. Compared to whites in low poverty (<10%) neighborhoods, African Americans in high poverty (≥20%) neighborhoods had increased odds of emergency diagnosis (AOR: 1.50, 95% CI: 1.38-1.63) and surgery (AOR: 1.63, 95% CI: 1.47-1.81). Emergency CRC outcomes are associated with high poverty residence among African Americans in this population-based study, potentially contributing to observed disparities in CRC morbidity and mortality. Targeted efforts to increase CRC screening among African Americans living in high poverty neighborhoods could reduce preventable disparities.

The impact of primary care reform on health system performance in Canada: a systematic review.

PubMed

Carter, Renee; Riverin, Bruno; Levesque, Jean-Frédéric; Gariepy, Geneviève; Quesnel-Vallée, Amélie

2016-07-30

We aimed to synthesize the evidence of a causal effect and draw inferences about whether Canadian primary care reforms improved health system performance based on measures of health service utilization, processes of care, and physician productivity. We searched the Embase, PubMed and Web of Science databases for records from 2000 to September 2015. We based our risk of bias assessment on the Grading of Recommendations Assessment, Development and Evaluation guidelines. Full-text studies were synthesized and organized according to the three outcome categories: health service utilization, processes of care, and physician costs and productivity. We found moderate quality evidence that team-based models of care led to reductions in emergency department use, but the evidence was mixed for hospital admissions. We also found low quality evidence that team-based models, blended capitation models and pay-for-performance incentives led to small and sometimes non-significant improvements in processes of care. Studies examining new payment models on physician costs and productivity were of high methodological quality and provided a coherent body of evidence assessing enhanced fee-for-service and blended capitation payment models. A small number of studies suggested that team-based models contributed to reductions in emergency department use in Quebec and Alberta. Regarding processes of diabetes care, studies found higher rates of testing for blood glucose levels, retinopathy and cholesterol in Alberta's team-based primary care model and in practices eligible for pay-for-performance incentives in Ontario. However pay-for-performance in Ontario was found to have null to moderate effects on other prevention and screening activities. Although blended capitation payment in Ontario contributed to decreases in the number of services delivered and patients seen per day, the number of enrolled patients and number of days worked in a year was similar to that of enhanced fee-for-service practices.

Evidence-based support for the all-hazards approach to emergency preparedness

PubMed Central

2012-01-01

Background During the last decade there has been a need to respond and recover from various types of emergencies including mass casualty events (MCEs), mass toxicological/chemical events (MTEs), and biological events (pandemics and bio-terror agents). Effective emergency preparedness is more likely to be achieved if an all-hazards response plan is adopted. Objectives To investigate if there is a relationship among hospitals' preparedness for various emergency scenarios, and whether components of one emergency scenario correlate with preparedness for other emergency scenarios. Methods Emergency preparedness levels of all acute-care hospitals for MCEs, MTEs, and biological events were evaluated, utilizing a structured evaluation tool based on measurable parameters. Evaluations were made by professional experts in two phases: evaluation of standard operating procedures (SOPs) followed by a site visit. Relationships among total preparedness and different components' scores for various types of emergencies were analyzed. Results Significant relationships were found among preparedness for different emergencies. Standard Operating Procedures (SOPs) for biological events correlated with preparedness for all investigated emergency scenarios. Strong correlations were found between training and drills with preparedness for all investigated emergency scenarios. Conclusions Fundamental critical building blocks such as SOPs, training, and drill programs improve preparedness for different emergencies including MCEs, MTEs, and biological events, more than other building blocks, such as equipment or knowledge of personnel. SOPs are especially important in unfamiliar emergency scenarios. The findings support the adoption of an all-hazards approach to emergency preparedness. PMID:23098065

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

PubMed Central

2014-01-01

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

Early warnings: health care preparedness.

PubMed

Rebmann, Terri

2005-11-01

As nurses, we represent the backbone of the health care system. It is essential that we have a core understanding of infectious disease emergencies and begin to use the strengths that characterize nursing. These strengths include the ability to evaluate situations and use evidence on which to base our actions. Early identification of an infectious disease emergency is one example of using nursing skills to strengthen emergency preparedness. During an infectious disease emergency, nurses certainly will bear the burden of patient management. Because of this, the need for infectious disease emergency preparedness has become a national priority and a moral imperative for all nurses. One topic necessary for ED and OH nurses' preparedness has been discussed in this article, but nurses must take the initiative to learn more about disaster preparedness and incorporate these skills into everyday practice.

Global music approach to persons with dementia: evidence and practice

PubMed Central

Raglio, Alfredo; Filippi, Stefania; Bellandi, Daniele; Stramba-Badiale, Marco

2014-01-01

Music is an important resource for achieving psychological, cognitive, and social goals in the field of dementia. This paper describes the different types of evidence-based music interventions that can be found in literature and proposes a structured intervention model (global music approach to persons with dementia, GMA-D). The literature concerning music and dementia was considered and analyzed. The reported studies included more recent studies and/or studies with relevant scientific characteristics. From this background, a global music approach was proposed using music and sound–music elements according to the needs, clinical characteristics, and therapeutic–rehabilitation goals that emerge in the care of persons with dementia. From the literature analysis the following evidence-based interventions emerged: active music therapy (psychological and rehabilitative approaches), active music therapy with family caregivers and persons with dementia, music-based interventions, caregivers singing, individualized listening to music, and background music. Characteristics of each type of intervention are described and discussed. Standardizing the operational methods and evaluation of the single activities and a joint practice can contribute to achieve the validation of the application model. The proposed model can be considered a low-cost nonpharmacological intervention and a therapeutic–rehabilitation method for the reduction of behavioral disturbances, for stimulation of cognitive functions, and for increasing the overall quality of life of persons with dementia. PMID:25336931

Global music approach to persons with dementia: evidence and practice.

PubMed

Raglio, Alfredo; Filippi, Stefania; Bellandi, Daniele; Stramba-Badiale, Marco

2014-01-01

Music is an important resource for achieving psychological, cognitive, and social goals in the field of dementia. This paper describes the different types of evidence-based music interventions that can be found in literature and proposes a structured intervention model (global music approach to persons with dementia, GMA-D). The literature concerning music and dementia was considered and analyzed. The reported studies included more recent studies and/or studies with relevant scientific characteristics. From this background, a global music approach was proposed using music and sound-music elements according to the needs, clinical characteristics, and therapeutic-rehabilitation goals that emerge in the care of persons with dementia. From the literature analysis the following evidence-based interventions emerged: active music therapy (psychological and rehabilitative approaches), active music therapy with family caregivers and persons with dementia, music-based interventions, caregivers singing, individualized listening to music, and background music. Characteristics of each type of intervention are described and discussed. Standardizing the operational methods and evaluation of the single activities and a joint practice can contribute to achieve the validation of the application model. The proposed model can be considered a low-cost nonpharmacological intervention and a therapeutic-rehabilitation method for the reduction of behavioral disturbances, for stimulation of cognitive functions, and for increasing the overall quality of life of persons with dementia.

Evidence based practice in clinical physiotherapy education: a qualitative interpretive description

PubMed Central

2013-01-01

Background Health care undergraduate students are expected to practice evidence-based after they graduate. Previous research indicates that students face several problems with transferring evidence-based practice to real patient situations. Few studies have explored reasons for this. The aim of this study was to explore beliefs, experiences and attitudes related to third year students’ use of evidence-based practice in clinical physiotherapy education among students, clinical instructors and visiting teachers. Methods In total, six focus group interviews were conducted: three with 16 students, two with nine clinical instructors and one with four visiting teachers. In addition, one individual interview and one interview in a pair were conducted with clinical instructors. Interviewing three different participant-categories ensured comparative analysis and enabled us to exploit differences in perspectives and interactions. Interpretive description guided this process. Results Four integrative themes emerged from the analysis: “attempt to apply evidence-based practice”, “novices in clinical practice”, “prioritize practice experience over evidence-based practice” and “lack role models in evidence-based practice”. Students tried to search for research evidence and to apply this knowledge during clinical placements; a behaviour that indicated a positive attitude towards evidence-based practice. At the same time, students were novices and required basic background information more than research information. As novices they tended to lean on their clinical instructors, and were more eager to gain practical experience than practicing evidence-based; a behaviour that clinical instructors and visiting teachers often supported. Students noticed a lack of an EBP culture. Both students and clinical instructors perceived a need for role models in evidence-based practice. Conclusions Clinical instructors are in a position to influence students during clinical education, and thus, important potential role models in evidence-based practice. Actions from academic and clinical settings are needed to improve competence in evidence-based practice among clinical instructors, and future research is needed to investigate the effect of such efforts on students’ behaviour. PMID:23578211

Evidence based practice in clinical physiotherapy education: a qualitative interpretive description.

PubMed

Olsen, Nina R; Bradley, Peter; Lomborg, Kirsten; Nortvedt, Monica W

2013-04-11

Health care undergraduate students are expected to practice evidence-based after they graduate. Previous research indicates that students face several problems with transferring evidence-based practice to real patient situations. Few studies have explored reasons for this. The aim of this study was to explore beliefs, experiences and attitudes related to third year students' use of evidence-based practice in clinical physiotherapy education among students, clinical instructors and visiting teachers. In total, six focus group interviews were conducted: three with 16 students, two with nine clinical instructors and one with four visiting teachers. In addition, one individual interview and one interview in a pair were conducted with clinical instructors. Interviewing three different participant-categories ensured comparative analysis and enabled us to exploit differences in perspectives and interactions. Interpretive description guided this process. Four integrative themes emerged from the analysis: "attempt to apply evidence-based practice", "novices in clinical practice", "prioritize practice experience over evidence-based practice" and "lack role models in evidence-based practice". Students tried to search for research evidence and to apply this knowledge during clinical placements; a behaviour that indicated a positive attitude towards evidence-based practice. At the same time, students were novices and required basic background information more than research information. As novices they tended to lean on their clinical instructors, and were more eager to gain practical experience than practicing evidence-based; a behaviour that clinical instructors and visiting teachers often supported. Students noticed a lack of an EBP culture. Both students and clinical instructors perceived a need for role models in evidence-based practice. Clinical instructors are in a position to influence students during clinical education, and thus, important potential role models in evidence-based practice. Actions from academic and clinical settings are needed to improve competence in evidence-based practice among clinical instructors, and future research is needed to investigate the effect of such efforts on students' behaviour.

Emergency treatment of hypoglycaemia: a guideline and evidence review.

PubMed

Villani, M; de Courten, B; Zoungas, S

2017-09-01

To examine the current treatment guidelines for the emergency management of hypoglycaemia and the evidence underpinning recommendations. International diabetes agencies were searched for hypoglycaemia treatment guidelines. Guidelines were assessed using the Appraisal of Guidelines Research and Evaluation II (AGREE II) instrument. An electronic database search was conducted for evidence regarding emergency treatment of hypoglycaemia in adults, and relevant articles were critically appraised. Of the international diabetes agencies, six sets of guidelines were deemed relevant and of sufficient detail for appraisal by AGREE II. The evidence search returned 2649 articles, of which 17 pertaining to the emergency management of hypoglycaemia were included. High-quality evidence for the management of hypoglycaemia was lacking, limiting treatment recommendations. In general, guidelines and studies were somewhat concordant and recommended 15-20 g of oral glucose or sucrose, repeated after 10-15 min for treatment of the responsive adult, and 10% intravenous dextrose or 1 mg intramuscular glucagon for treatment of the unresponsive adult. No evidence was found for other treatment approaches. Evidence for the emergency treatment of hypoglycaemia in adults is limited, is often low grade and mostly pre-dates contemporary management of diabetes. Guideline recommendations are limited by the lack of randomized trials. Further high-quality studies are required to inform the optimum management of this frequently occurring emergency condition. © 2017 Diabetes UK.

A Community-Based Treatment for Native American Historical Trauma: Prospects for Evidence-Based Practice

ERIC Educational Resources Information Center

Gone, Joseph P.

2009-01-01

Nineteen staff and clients in a Native American healing lodge were interviewed regarding the therapeutic approach used to address the legacy of Native American historical trauma. On the basis of thematic content analysis of interviews, 4 components of healing discourse emerged. First, clients were understood by their counselors to carry pain,…

Multinational Alcohol Market Development and Public Health: Diageo in India

PubMed Central

Jernigan, David H.

2015-01-01

Alcohol is a risk factor for communicable and noncommunicable diseases, and alcohol consumption is rising steadily in India. The growth of multinational alcohol corporations, such as Diageo, contributes to India’s changing alcohol environment. We provide a brief history of India’s alcohol regulation for context and examine Diageo’s strategies for expansion in India in 2013 and 2014. Diageo is attracted to India’s younger generation, women, and emerging middle class for growth opportunities. Components of Diageo’s responsibility strategy conflict with evidence-based public health recommendations for reducing harmful alcohol consumption. Diageo’s strategies for achieving market dominance in India are at odds with public health evidence. We conclude with recommendations for protecting public health in emerging markets. PMID:26378848

Implementation of an evidence-based model of care for low back pain in emergency departments: protocol for the Sydney Health Partners Emergency Department (SHaPED) trial

PubMed Central

Richards, Bethan; Needs, Chris; Buchbinder, Rachelle; Harris, Ian A; Howard, Kirsten; McCaffery, Kirsten; Billot, Laurent; Edwards, James; Rogan, Eileen; Facer, Rochelle; Lord Cowell, David; Maher, Chris G

2018-01-01

Introduction Patients with low back pain often seek care in emergency departments, but the problem is that many patients receive unnecessary or ineffective interventions and at the same time miss out on the basics of care, such as advice on self-management. This pattern of care has important consequences for the healthcare system (expensive and inefficient) and for patients (poor health outcomes). We hypothesised that the implementation of an evidence-based model of care for low back pain will improve emergency care by reducing inappropriate overuse of tests and treatments and improving patient outcomes. Methods and analysis A stepped-wedge cluster randomised controlled trial will be conducted to implement and evaluate the use of the Agency for Clinical Innovation (ACI) model of care for acute low back pain at four emergency departments in New South Wales, Australia. Clinician participants will be emergency physicians, nurses and physiotherapists. Codes from the Systematised Nomenclature of Medicine—Clinical Terms—Australian version will be used to identify low back pain presentations. The intervention, targeting emergency clinicians, will comprise educational materials and seminars and an audit and feedback approach. Health service delivery outcomes are routinely collected measures of imaging (primary outcome), opioid use and inpatient admission. A random subsample of 200 patient participants from each trial period will be included to measure patient outcomes (pain intensity, physical function, quality of life and experience with emergency service). The effectiveness of the intervention will be assessed by comparing the postintervention period with the retrospective baseline control period. Ethics and dissemination The study received ethical approval from the Sydney Local Health District (Royal Prince Alfred Hospital zone) Ethics Committee (X17-0043). The results of this study will be published in peer-reviewed journals and presented at international conferences. Trial registration number Australia New Zealand Clinical Trials Registry: ACTRN 12617001160325. PMID:29674362

Reducing emergency bed-days for older people? Network governance lessons from the 'Improving the Future for Older People' programme.

PubMed

Sheaff, Rod; Windle, Karen; Wistow, Gerald; Ashby, Sue; Beech, Roger; Dickinson, Angela; Henderson, Catherine; Knapp, Martin

2014-04-01

In 2007, the UK government set performance targets and public service agreements to control the escalation of emergency bed-days. Some years earlier, nine English local authorities had each created local networks with their health and third sector partners to tackle this increase. These networks formed the 'Improving the Future for Older People' initiative (IFOP), one strand of the national 'Innovation Forum' programme, set up in 2003. The nine sites set themselves one headline target to be achieved jointly over three years; a 20 per cent reduction in the number of emergency bed-days used by people aged 75 and over. Three ancillary targets were also monitored: emergency admissions, delayed discharges and project sustainability. Collectively the sites exceeded their headline target. Using a realistic evaluation approach, we explored which aspects of network governance appeared to have contributed to these emergency bed-day reductions. We found no simple link between network governance type and outcomes. The governance features associated with an effective IFOP network appeared to suggest that the selection and implementation of a small number of evidence-based services was central to networks' effectiveness. Each service needed to be coordinated by a network-based strategic group and hierarchically implemented at operational level by the responsible network member. Having a network-based implementation group with a 'joined-at-the-top' governance structure also appeared to promote network effectiveness. External factors, including NHS incentives, health reorganisations and financial targets similarly contributed to differences in performance. Targets and financial incentives could focus action but undermine horizontal networking. Local networks should specify which interventions network structures are intended to deliver. Effective projects are those likely to be evidence based, unique to the network and difficult to implement through vertical structures alone. Copyright © 2014 Elsevier Ltd. All rights reserved.

Students' attitudes and perceptions of teaching and assessment of evidence-based practice in an occupational therapy professional Master's curriculum: a mixed methods study.

PubMed

Thomas, Aliki; Han, Lu; Osler, Brittony P; Turnbull, Emily A; Douglas, Erin

2017-03-27

Most health professions, including occupational therapy, have made the application of evidence-based practice a desired competency and professional responsibility. Despite the increasing emphasis on evidence-based practice for improving patient outcomes, there are numerous research-practice gaps in the health professions. In addition to efforts aimed at promoting evidence-based practice with clinicians, there is a strong impetus for university programs to design curricula that will support the development of the knowledge, attitudes, skills and behaviours associated with evidence-based practice. Though occupational therapy curricula in North America are becoming increasingly focused on evidence-based practice, research on students' attitudes towards evidence-based practice, their perceptions regarding the integration and impact of this content within the curricula, and the impact of the curriculum on their readiness for evidence-based practice is scarce. The present study examined occupational therapy students' perceptions towards the teaching and assessment of evidence-based practice within a professional master's curriculum and their self-efficacy for evidence-based practice. The study used a mixed methods explanatory sequential design. The quantitative phase included a cross-sectional questionnaire exploring attitudes towards evidence-based practice, perceptions of the teaching and assessment of evidence-based practice and evidence-based practice self-efficacy for four cohorts of students enrolled in the program and a cohort of new graduates. The questionnaire was followed by a focus group of senior students aimed at further exploring the quantitative findings. All student cohorts held favourable attitudes towards evidence-based practice; there was no difference across cohorts. There were significant differences with regards to perceptions of the teaching and assessment of evidence-based practice within the curriculum; junior cohorts and students with previous education had less favourable perceptions. Students' self-efficacy for evidence-based practice was significantly higher across cohorts. Four main themes emerged from the focus group data: (a) Having mixed feelings about the value of evidence-based practice (b) Barriers to the application of evidence-based practice; (c) Opposing worlds and (d) Vital and imperfect role of the curriculum. This study provides important data to support the design and revision of evidence-based practice curricula within professional rehabilitation programs.

A Methodological Analysis of Randomized Clinical Trials of Computer-Assisted Therapies for Psychiatric Disorders: Toward Improved Standards for an Emerging Field

PubMed Central

Kiluk, Brian D.; Sugarman, Dawn E.; Nich, Charla; Gibbons, Carly J.; Martino, Steve; Rounsaville, Bruce J.; Carroll, Kathleen M.

2013-01-01

Objective Computer-assisted therapies offer a novel, cost-effective strategy for providing evidence-based therapies to a broad range of individuals with psychiatric disorders. However, the extent to which the growing body of randomized trials evaluating computer-assisted therapies meets current standards of methodological rigor for evidence-based interventions is not clear. Method A methodological analysis of randomized clinical trials of computer-assisted therapies for adult psychiatric disorders, published between January 1990 and January 2010, was conducted. Seventy-five studies that examined computer-assisted therapies for a range of axis I disorders were evaluated using a 14-item methodological quality index. Results Results indicated marked heterogeneity in study quality. No study met all 14 basic quality standards, and three met 13 criteria. Consistent weaknesses were noted in evaluation of treatment exposure and adherence, rates of follow-up assessment, and conformity to intention-to-treat principles. Studies utilizing weaker comparison conditions (e.g., wait-list controls) had poorer methodological quality scores and were more likely to report effects favoring the computer-assisted condition. Conclusions While several well-conducted studies have indicated promising results for computer-assisted therapies, this emerging field has not yet achieved a level of methodological quality equivalent to those required for other evidence-based behavioral therapies or pharmacotherapies. Adoption of more consistent standards for methodological quality in this field, with greater attention to potential adverse events, is needed before computer-assisted therapies are widely disseminated or marketed as evidence based. PMID:21536689

Reducing quality-of-care disparities in childhood asthma: La Red de Asma Infantil intervention in San Juan, Puerto Rico.

PubMed

Lara, Marielena; Ramos-Valencia, Gilberto; González-Gavillán, Jesús A; López-Malpica, Fernando; Morales-Reyes, Beatriz; Marín, Heriberto; Rodríguez-Sánchez, Mario H; Mitchell, Herman

2013-03-01

Although children living in Puerto Rico have the highest asthma prevalence of all US children, little is known regarding the quality-of-care disparities they experience nor the adaptability of existing asthma evidence-based interventions to reduce these disparities. The objective of this study was to describe our experience in reducing quality-of-care disparities among Puerto Rican children with asthma by adapting 2 existing evidence-based asthma interventions. We describe our experience in adapting and implementing 2 previously tested asthma evidence-based interventions: the Yes We Can program and the Inner-City Asthma Study intervention. We assessed the feasibility of combining key components of the 2 interventions to reduce asthma symptoms and estimated the potential cost savings associated with reductions in asthma-related hospitalizations and emergency department visits. A total of 117 children with moderate and severe asthma participated in the 12-month intervention in 2 housing projects in San Juan, Puerto Rico. A community-academic team with the necessary technical and cultural competences adapted and implemented the intervention. Our case study revealed the feasibility of implementing the combined intervention, henceforth referred to as La Red intervention, in the selected Puerto Rican communities experiencing a disproportionately high level of asthma burden. After 1-year follow-up, La Red intervention significantly reduced asthma symptoms and exceeded reductions of the original interventions. Asthma-related hospitalizations and emergency department use, and their associated high costs, were also significantly reduced. Asthma evidence-based interventions can be adapted to improve quality of care for children with asthma in a different cultural community setting.

An Overview of Evidence-Based Program Registers (EBPRs) for Behavioral Health

PubMed Central

Burkhardt, Jason T.; Schröter, Daniela C.; Magura, Stephen; Means, Stephanie N.; Coryn, Chris L.S.

2015-01-01

Evaluations of behavioral health interventions have identified many that are potentially effective. However, clinicians and other decision makers typically lack the time and ability to effectively search and synthesize the relevant research literature. In response to this opportunity, and to increasing policy and funding pressures for the use of evidence-based practices, a number of “what works” websites have emerged to assist decision makers in selecting interventions with the highest probability of benefit. However, these registers as a whole are not well understood. This article, which represents phase one of a concurrent mixed methods study, presents a review of the scopes, structures, dissemination strategies, uses, and challenges faced by evidence-based registers in the behavioral health disciplines. The major findings of this study show that in general, registers of evidence-based practices are able, to a degree, to identify the most effective practices and meet the needs of decision makers. However, much needs to be done to improve the ability of the registers to fully realize their purpose. PMID:25450777

One health: the Hong Kong experience with avian influenza.

PubMed

Sims, L D; Peiris, Malik

2013-01-01

The occurrence of avian influenza A(H5N1) in Hong Kong in 1997 led to the development of a "One-Health" approach to deal with emerging infectious diseases that has been applied to other emergent diseases such as SARS and the pandemic H1N1 2009. Evaluation of poultry marketing and production systems and investigations at the animal-human interface, led to defining the routes of human exposure to avian influenza and factors that allowed virus to multiply and persist. Active and systematic surveillance of apparently healthy as well as diseased poultry and wild birds provided evidence of ongoing virus evolution in the wider region. Epidemiological studies, supplemented with molecular epidemiology, helped to elucidate the role of the poultry marketing system and live poultry markets in the persistence of avian influenza viruses and provided evidence for the impact of interventions designed to interrupt virus transmission. Enhanced bio-security, active surveillance together with targeted and evidence-based interventions in the poultry production, and marketing system together with poultry vaccination has prevented further human H5N1 disease and minimized outbreaks of poultry disease in Hong Kong. Similar strategies have led to the understanding of the emergence of SARS and provided options for preventing the re-emergence of this disease. Surveillance of influenza in swine has provided insights into the emergence of the 2009 pandemic, to the reverse zoonosis of the pandemic virus from humans to swine and to the emergence of novel reassortant viruses within swine. "One Health" strategies are not "cost-free" and require sensitive implementation to optimize food-safety and food security, while safeguarding the economics of animal husbandry and the environment and remaining sensitive to cultural practices.

Barriers to access and utilization of emergency obstetric care at health facilities in sub-Saharan Africa-a systematic review protocol.

PubMed

Geleto, Ayele; Chojenta, Catherine; Mussa, Abdulbasit; Loxton, Deborah

2018-04-16

Nearly 15% of all pregnancies end in fatal perinatal obstetric complications including bleeding, infections, hypertension, obstructed labor, and complications of abortion. Between 1990 and 2015, an estimated 10.7 million women died due to obstetric complications. Almost all of these deaths (99%) happened in developing countries, and 66% of maternal deaths were attributed to sub-Saharan Africa. The majority of cases of maternal mortalities can be prevented through provision of evidence-based potentially life-saving signal functions of emergency obstetric care. However, different factors can hinder women's ability to access and use emergency obstetric services in sub-Saharan Africa. Therefore, the aim of this review is to synthesize current evidence on barriers to accessing and utilizing emergency obstetric care in sub-Saharan African. Decision-makers and policy formulators will use evidence generated from this review in improving maternal healthcare particularly the emergency obstetric care. Electronic databases including MEDLINE, CINAHL, Embase, and Maternity and Infant Care will be searched for studies using predefined search terms. Articles published in English language between 2010 and 2017 with quantitative and qualitative design will be included. The identified papers will be assessed for meeting eligibility criteria. First, the articles will be screened by examining their titles and abstracts. Then, two reviewers will review the full text of the selected articles independently. Two reviewers using a standard data extraction format will undertake data extraction from the retained studies. The quality of the included papers will be assessed using the mixed methods appraisal tool. Results from the eligible studies will be qualitatively synthesized using the narrative synthesis approach and reported using the three delays model. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist will be employed to present the findings. This systematic review will present a detailed synthesis of the evidence for barriers to access and utilization of emergency obstetric care in sub-Saharan Africa over the last 7 years. This systematic review is expected to provide clear information that can help in designing maternal health policy and interventions particularly in emergency obstetric care in sub-Saharan Africa where maternal mortality remains high. PROSPERO CRD42017074102 .

Detection limits of tidal-wetland sequences to identify variable rupture modes of megathrust earthquakes

NASA Astrophysics Data System (ADS)

Shennan, Ian; Garrett, Ed; Barlow, Natasha

2016-10-01

Recent paleoseismological studies question whether segment boundaries identified for 20th and 21st century great, >M8, earthquakes persist through multiple earthquake cycles or whether smaller segments with different boundaries rupture and cause significant hazards. The smaller segments may include some currently slipping rather than locked. In this review, we outline general principles regarding indicators of relative sea-level change in tidal wetlands and the conditions in which paleoseismic indicators must be distinct from those resulting from non-seismic processes. We present new evidence from sites across southcentral Alaska to illustrate different detection limits of paleoseismic indicators and consider alternative interpretations for marsh submergence and emergence. We compare predictions of coseismic uplift and subsidence derived from geophysical models of earthquakes with different rupture modes. The spatial patterns of agreement and misfits between model predictions and quantitative reconstructions of coseismic submergence and emergence suggest that no earthquake within the last 4000 years had a pattern of rupture the same as the Mw 9.2 Alaska earthquake in 1964. From the Alaska examples and research from other subduction zones we suggest that If we want to understand whether a megathrust ruptures in segments of variable length in different earthquakes, we need to be site-specific as to what sort of geological-based criteria eliminate the possibility of a particular rupture mode in different earthquakes. We conclude that coastal paleoseismological studies benefit from a methodological framework that employs rigorous evaluation of five essential criteria and a sixth which may be very robust but only occur at some sites: 1 - lateral extent of peat-mud or mud-peat couplets with sharp contacts; 2 - suddenness of submergence or emergence, and replicated within each site; 3 - amount of vertical motion, quantified with 95% error terms and replicated within each site; 4 - syncroneity of submergence and emergence based on statistical age modelling; 5 - spatial pattern of submergence and emergence; 6 - possible additional evidence, such as evidence of a tsunami or liquefaction concurrent with submergence or emergence. We suggest that it is possible to consider detection limits as low as 0.1-0.2 m coseismic vertical change.

China-Africa Health Development Initiatives: Benefits and Implications for Shaping Innovative and Evidence-informed National Health Policies and Programs in Sub-saharan African Countries.

PubMed

Tambo, Ernest; Ugwu, Chidiebere E; Guan, Yayi; Wei, Ding; Xiao-Ning; Xiao-Nong, Zhou

2016-01-01

This review paper examines the growing implications of China's engagement in shaping innovative national initiatives against infectious diseases and poverty control and elimination in African countries. It seeks to understand the factors and enhancers that can promote mutual and innovative health development initiatives, and those that are necessary in generating reliable and quality data for evidence-based contextual policy, priorities and programs. We examined the China-Africa health cooperation in supporting global health agenda on infectious diseases such as malaria, schistosomiasis, Ebola, TB, HIV/AIDS, neglected tropical diseases (NTDs) prevention, control and elimination spanning a period of 10 years. We reviewed referenced publications, global support data, and extensive sources related to and other emerging epidemics and infectious diseases of poverty, programs and interventions, health systems development issues, challenges, opportunities and investments. Published literature in PubMed, Scopus, Google Scholar, Books and web-based peer-reviewed journal articles, government annual reports were assessed from the first Forum on China-Africa Cooperation (FOCAC) in November 2006 to December 2015 Third Ministerial conferences. Our findings highlight current shared public health challenges and emphasize the need to nurture, develop and establish effective, functional and sustainable health systems capacity to detect and respond to all public health threats and epidemic burdens, evidence-based programs and quality care outcomes. China's significant health diplomacy emphasizes the importance of health financing in establishing health development commitment and investment in improving the gains and opportunities, importantly efficiency and value health priorities and planning. Strengthening China-Africa health development agenda towards collective commitment and investment in quality care delivery, effective programs coverage and efficiency, preparedness and emergency response is needed in transforming African health information systems, and local health governance structures and management in emerging epidemics. Furthermore, innovative evidence of operational joint solutions and strategies are critical in advancing healthcare delivery, and further enhancing Universal Health Care, and Sustainable Development Goals to attain global health improvements and economic prosperity.

Issues and Challenges in the Design of Culturally Adapted Evidence-Based Interventions

PubMed Central

Castro, Felipe González; Barrera, Manuel; Holleran Steiker, Lori K.

2014-01-01

This article examines issues and challenges in the design of cultural adaptations that are developed from an original evidence-based intervention (EBI). Recently emerging multistep frameworks or stage models are examined, as these can systematically guide the development of culturally adapted EBIs. Critical issues are also presented regarding whether and how such adaptations may be conducted, and empirical evidence is presented regarding the effectiveness of such cultural adaptations. Recent evidence suggests that these cultural adaptations are effective when applied with certain subcultural groups, although they are less effective when applied with other subcultural groups. Generally, current evidence regarding the effectiveness of cultural adaptations is promising but mixed. Further research is needed to obtain more definitive conclusions regarding the efficacy and effectiveness of culturally adapted EBIs. Directions for future research and recommendations are presented to guide the development of a new generation of culturally adapted EBIs. PMID:20192800

Introduction to the special section on developing guidelines for the evidence-based assessment (EBA) of adult disorders.

PubMed

Hunsley, John; Mash, Eric J

2005-09-01

The goal of this special section is to encourage greater awareness of evidence-based assessment (EBA) in the development of a scientifically supported clinical psychology. In this introductory article, the authors describe the elements that authors in this special section were asked to consider in their focused reviews (including the scope of available psychometric evidence, advancements in psychopathology research, and evidence of attention to factors such as gender, age, and ethnicity in measure validation). The authors then present central issues evident in the articles that deal with anxiety, depression, personality disorders, and couple distress and in the accompanying commentaries. The authors conclude by presenting key themes emerging from the articles in this special section, including gaps in psychometric information, limited information about the utility of assessment, the discrepancy between recommended EBAs and current training and practice, and the need for further data on the process of clinical assessment.

Ethical standards for mental health and psychosocial support research in emergencies: review of literature and current debates.

PubMed

Chiumento, Anna; Rahman, Atif; Frith, Lucy; Snider, Leslie; Tol, Wietse A

2017-02-08

Research in emergencies is needed to understand the prevalence of mental health and psychosocial problems and strengthen the evidence base for interventions. All research - including operational needs assessments, programme monitoring and evaluation, and formal academic research - must be conducted ethically. While there is broad consensus on fundamental principles codified in research ethics guidelines, these do not address the ethical specificities of conducting mental health and psychosocial support (MHPSS) research with adults in emergencies. To address this gap, this paper presents a review of multidisciplinary literature to identify specific ethical principles applicable to MHPSS research in emergencies. Fifty-nine sources meeting the literature review inclusion criteria were analysed following a thematic synthesis approach. There was consensus on the relevance of universal ethical research principles to MHPSS research in emergencies, including norms of participant informed consent and protection; ensuring benefit arises from research participation; researcher neutrality, accountability, and safety; and the duty to ensure research is well designed and accounts for contextual factors in emergency settings. We go onto discuss unresolved issues by highlighting six current debates relating to the application of ethics in emergency settings: (1) what constitutes fair benefits?; (2) how should informed consent be operationalised?; (3) is there a role for decision making capacity assessments?; (4) how do risk management approaches impact upon the construction of ethical research?; (5) how can ethical reflection best be achieved?, and (6) are ethical review boards sufficiently representative and equipped to judge the ethical and scientific merit of emergency MHPSS research? Underlying these debates is a systemic tension between procedural ethics and ethics in practice. In summary, underpinning the literature is a desire to ensure the protection of participants exposed to emergencies and in need of evidence-based MHPSS. However, there is a lack of agreement on how to contextualise guidelines and procedures to effectively maximise the perspectives of researchers, participants and ethical review boards. This is a tension that the field must address to strengthen ethical MHPSS research in emergencies.

A collaborative quality improvement model and electronic community of practice to support sepsis management in emergency departments: investigating care harmonization for provincial knowledge translation.

PubMed

Ho, Kendall; Marsden, Julian; Jarvis-Selinger, Sandra; Novak Lauscher, Helen; Kamal, Noreen; Stenstrom, Rob; Sweet, David; Goldman, Ran D; Innes, Grant

2012-07-12

Emergency medicine departments within several organizations are now advocating the adoption of early intervention guidelines for patients with the signs and symptoms of sepsis. This proposed research will lead to a comprehensive understanding of how diverse emergency department (ED) sites across British Columbia (BC), Canada, engage in a quality improvement collaborative to lead to improvements in time-based process measures and clinical outcomes for septic patients in EDs. To address the challenge of sepsis management, in 2007, the BC Ministry of Health began working with emergency health professionals, including health administrators, to establish a provincial ED collaborative: Evidence to Excellence (E2E). The E2E initiative employs the Institute for Healthcare Improvement (IHI) model and is supported by a Web-based community of practice (CoP) in emergency medicine. It aims to (1) support clinicians in accessing and applying evidence to clinical practice in emergency medicine, (2) support system change and clinical process improvement, and (3) develop resources and strategies to facilitate knowledge translation and process improvement. Improving sepsis management is one of the central foci of the E2E initiative. The primary purpose of our research is to investigate whether the application of sepsis management protocols leads to improved time-based process measures and clinical outcomes for patients presenting to EDs with sepsis. Also, we seek to investigate the implementation of sepsis protocols among different EDs. For example: (1) How can sepsis protocols be harmonized among different EDs? (2) What are health professionals' perspectives on interprofessional collaboration with various EDs? and (3) What are the factors affecting the level of success among EDs? Lastly, working in collaboration with the BC Ministry of Health as our policy-maker partner, the research will investigate how the demonstrated efficacy of this research can be applied on a provincial and national level to establish a template for policy makers from other jurisdictions to translate knowledge into action for EDs. This research study will employ the IHI model for improvement, incorporate the principles of participatory action research, and use the E2E online CoP to engage ED practitioners (eg, physicians, nurses, and administrators, exchanging ideas, engaging in discussions, sharing resources, and amalgamating knowledge) from across BC to (1) share the evidence of early intervention in sepsis, (2) adapt the evidence to their patterns of practice, (3) develop a common set of orders for implementing the sepsis pathway, and (4) agree on common indicators to measure clinical outcomes. Our hypothesis is that combining the social networking ability of an electronic CoP and its inherent knowledge translation capacity with the structured project management of the IHI model will result in widespread and sustained improvement in the emergency and overall care of patients with severe sepsis presenting to EDs throughout BC.

Consensus Statement on Advancing Research in Emergency Department Operations and Its Impact on Patient Care

PubMed Central

Ward, Michael J.; Chang, Anna Marie; Pines, Jesse M.; Jouriles, Nick; Yealy, Donald M.

2016-01-01

The Consensus Conference on “Advancing Research in Emergency Department (ED) Operations and Its Impact on Patient Care,” hosted by The ED Operations Study Group (EDOSG), convened to craft a framework for future investigations in this important but underserved area. The EDOSG is a research consortium dedicated to promoting evidence based clinical practice in Emergency Medicine. The consensus process format was a modified version of the NIH Model for Consensus Conference Development. Recommendations provide an action plan for how to improve ED operations study design, create a facilitating research environment, identify data measures of value for process and outcomes research, and disseminate new knowledge in this area. Specifically, we called for eight key initiatives: 1) the development of universal measures for ED patient care processes; 2) attention to patient outcomes, in addition to process efficiency and best practice compliance; 3) the promotion of multi-site clinical operations studies to create more generalizable knowledge; 4) encouraging the use of mixed methods to understand the social community and human behavior factors that influence ED operations; 5) the creation of robust ED operations research registries to drive stronger evidence based research, 6) prioritizing key clinical questions with the input of patients, clinicians, medical leadership, emergency medicine organizations, payers, and other government stakeholders; 7) more consistently defining the functional components of the ED care system including observation units, fast tracks, waiting rooms, laboratories and radiology sub-units; and 8) maximizing multidisciplinary knowledge dissemination via emergency medicine, public health, general medicine, operations research and nontraditional publications. PMID:26014365

Evidence-Based Medicine Curriculum Improves Pediatric Emergency Fellows' Scores on In-Training Examinations.

PubMed

Tavarez, Melissa M; Kenkre, Tanya S; Zuckerbraun, Noel

2017-05-30

The aim of this study was to determine if implementation of our evidence-based medicine (EBM) curriculum had an effect on pediatric emergency medicine fellows' scores on the relevant section of the in-training examination (ITE). We obtained deidentified subscores for 22 fellows over 6 academic years for the Core Knowledge in Scholarly Activities (SA) and, as a balance measure, Emergencies Treated Medically sections. We divided the subscores into the following 3 instruction periods: "baseline" for academic years before our current EBM curriculum, "transition" for academic years with use of a research method curriculum with some overlapping EBM content, and "EBM" for academic years with our current EBM curriculum. We analyzed data using the Kruskal-Wallis test, the Mann-Whitney U test, and multivariate mixed-effects linear models. The SA subscore median was higher during the EBM period in comparison with the baseline and transition periods. In contrast, the Emergencies Treated Medically subscore median was similar across instruction periods. Multivariate modeling demonstrated that our EBM curriculum had the following independent effects on the fellows' SA subscore: (1) in comparison with the transition period, the fellows' SA subscore was 21 percentage points higher (P = 0.005); and (2) in comparison to the baseline period, the fellows' SA subscore was 28 percentage points higher during the EBM curriculum instruction period (P < 0.001). Our EBM curriculum was associated with significantly higher scores on the SA section of the ITE. Pediatric emergency medicine educators could consider using fellows' scores on this section of the ITE to assess the effect of their EBM curricula.

The intellectual structure and substance of the knowledge utilization field: a longitudinal author co-citation analysis, 1945 to 2004.

PubMed

Estabrooks, Carole A; Derksen, Linda; Winther, Connie; Lavis, John N; Scott, Shannon D; Wallin, Lars; Profetto-McGrath, Joanne

2008-11-13

It has been argued that science and society are in the midst of a far-reaching renegotiation of the social contract between science and society, with society becoming a far more active partner in the creation of knowledge. On the one hand, new forms of knowledge production are emerging, and on the other, both science and society are experiencing a rapid acceleration in new forms of knowledge utilization. Concomitantly since the Second World War, the science underpinning the knowledge utilization field has had exponential growth. Few in-depth examinations of this field exist, and no comprehensive analyses have used bibliometric methods. Using bibliometric analysis, specifically first author co-citation analysis, our group undertook a domain analysis of the knowledge utilization field, tracing its historical development between 1945 and 2004. Our purposes were to map the historical development of knowledge utilization as a field, and to identify the changing intellectual structure of its scientific domains. We analyzed more than 5,000 articles using citation data drawn from the Web of Science. Search terms were combinations of knowledge, research, evidence, guidelines, ideas, science, innovation, technology, information theory and use, utilization, and uptake. We provide an overview of the intellectual structure and how it changed over six decades. The field does not become large enough to represent with a co-citation map until the mid-1960s. Our findings demonstrate vigorous growth from the mid-1960s through 2004, as well as the emergence of specialized domains reflecting distinct collectives of intellectual activity and thought. Until the mid-1980s, the major domains were focused on innovation diffusion, technology transfer, and knowledge utilization. Beginning slowly in the mid-1980s and then growing rapidly, a fourth scientific domain, evidence-based medicine, emerged. The field is dominated in all decades by one individual, Everett Rogers, and by one paradigm, innovation diffusion. We conclude that the received view that social science disciplines are in a state where no accepted set of principles or theories guide research (i.e., that they are pre-paradigmatic) could not be supported for this field. Second, we document the emergence of a new domain within the knowledge utilization field, evidence-based medicine. Third, we conclude that Everett Rogers was the dominant figure in the field and, until the emergence of evidence-based medicine, his representation of the general diffusion model was the dominant paradigm in the field.

The intellectual structure and substance of the knowledge utilization field: A longitudinal author co-citation analysis, 1945 to 2004

PubMed Central

Estabrooks, Carole A; Derksen, Linda; Winther, Connie; Lavis, John N; Scott, Shannon D; Wallin, Lars; Profetto-McGrath, Joanne

2008-01-01

Background It has been argued that science and society are in the midst of a far-reaching renegotiation of the social contract between science and society, with society becoming a far more active partner in the creation of knowledge. On the one hand, new forms of knowledge production are emerging, and on the other, both science and society are experiencing a rapid acceleration in new forms of knowledge utilization. Concomitantly since the Second World War, the science underpinning the knowledge utilization field has had exponential growth. Few in-depth examinations of this field exist, and no comprehensive analyses have used bibliometric methods. Methods Using bibliometric analysis, specifically first author co-citation analysis, our group undertook a domain analysis of the knowledge utilization field, tracing its historical development between 1945 and 2004. Our purposes were to map the historical development of knowledge utilization as a field, and to identify the changing intellectual structure of its scientific domains. We analyzed more than 5,000 articles using citation data drawn from the Web of Science®. Search terms were combinations of knowledge, research, evidence, guidelines, ideas, science, innovation, technology, information theory and use, utilization, and uptake. Results We provide an overview of the intellectual structure and how it changed over six decades. The field does not become large enough to represent with a co-citation map until the mid-1960s. Our findings demonstrate vigorous growth from the mid-1960s through 2004, as well as the emergence of specialized domains reflecting distinct collectives of intellectual activity and thought. Until the mid-1980s, the major domains were focused on innovation diffusion, technology transfer, and knowledge utilization. Beginning slowly in the mid-1980s and then growing rapidly, a fourth scientific domain, evidence-based medicine, emerged. The field is dominated in all decades by one individual, Everett Rogers, and by one paradigm, innovation diffusion. Conclusion We conclude that the received view that social science disciplines are in a state where no accepted set of principles or theories guide research (i.e., that they are pre-paradigmatic) could not be supported for this field. Second, we document the emergence of a new domain within the knowledge utilization field, evidence-based medicine. Third, we conclude that Everett Rogers was the dominant figure in the field and, until the emergence of evidence-based medicine, his representation of the general diffusion model was the dominant paradigm in the field. PMID:19014512

Haemostatic monitoring during postpartum haemorrhage and implications for management

PubMed Central

Solomon, C.; Collis, R. E.; Collins, P. W.

2012-01-01

Summary Postpartum haemorrhage (PPH) is a major risk factor for maternal morbidity and mortality. PPH has numerous causative factors, which makes its occurrence and severity difficult to predict. Underlying haemostatic imbalances such as consumptive and dilutional coagulopathies may develop during PPH, and can exacerbate bleeding and lead to progression to severe PPH. Monitoring coagulation status in patients with PPH may be crucial for effective haemostatic management, goal-directed therapy, and improved outcomes. However, current PPH management guidelines do not account for the altered baseline coagulation status observed in pregnant patients, and the appropriate transfusion triggers to use in PPH are unknown, due to a lack of high-quality studies specific to this area. In this review, we consider the evidence for the use of standard laboratory-based coagulation tests and point-of-care viscoelastic coagulation monitoring in PPH. Many laboratory-based tests are unsuitable for emergency use due to their long turnaround times, so have limited value for the management of PPH. Emerging evidence suggests that viscoelastic monitoring, using thrombelastography- or thromboelastometry-based tests, may be useful for rapid assessment and for guiding haemostatic therapy during PPH. However, further studies are needed to define the ranges of reference values that should be considered ‘normal’ in this setting. Improving awareness of the correct application and interpretation of viscoelastic coagulation monitoring techniques may be critical in realizing their emergency diagnostic potential. PMID:23075633

Interventions and controls to prevent emergency service vehicle incidents: A mixed methods review.

PubMed

Bui, David P; Balland, Samantha; Giblin, Casey; Jung, Alesia M; Kramer, Sandy; Peng, Abigail; Aquino, Marie Corazon Ponce; Griffin, Stephanie; French, Dustin D; Pollack Porter, Keshia; Crothers, Steve; Burgess, Jefferey L

2018-06-01

Emergency service vehicle incidents (ESVI), including crashes, rollovers, and roadside struck-by-incidents, are a leading cause of occupational fatality and injury among firefighters and other emergency responders. Though there are numerous strategies and interventions to prevent ESVIs, the evidence base for these strategies is limited and dispersed. The goal of this study was to gather and present a review of evidence-based ESVI interventions. We searched five academic databases for articles published within the last decade featuring interventions to reduce or prevent ESVIs. We interviewed key informants from fire departments serving major metropolitan areas for additional interventions. Interventions from both sources were summarized and data on intervention effectiveness were reported when available. Sixty-five articles were included in the final review and 17 key informant interviews were completed. Most articles focused on vehicle engineering interventions (38%), followed by policy and administration interventions (26%), environmental engineering interventions (19%) and education or training (17%). Most key informants reported policy (49%) and training interventions (29%). Enhanced drivers' training and risk management programs were associated with 19-50% and 19-58% reductions in ESVIs, respectively. Only a limited number of interventions to address ESVIs had adequate outcome data. Based on the available data, training and risk management approaches may be particularly effective approaches to reducing ESVIs. Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.

Post resuscitation management of cardiac arrest patients in the critical care environment: A retrospective audit of compliance with evidence based guidelines.

PubMed

Milonas, Annabel; Hutchinson, Ana; Charlesworth, David; Doric, Andrea; Green, John; Considine, Julie

2017-11-01

There is a clear relationship between evidence-based post resuscitation care and survival and functional status at hospital discharge. The Australian Resuscitation Council (ARC) recommends protocol driven care to enhance chance of survival following cardiac arrest. Healthcare providers have an obligation to ensure protocol driven post resuscitation care is timely and evidence based. The aim of this study was to examine adherence to best practice guidelines for post resuscitation care in the first 24h from Return of Spontaneous Circulation for patients admitted to the intensive care unit from the emergency department having suffered out of hospital or emergency department cardiac arrest and survived initial resuscitation. A retrospective audit of medical records of patients who met the criteria for survivors of cardiac arrest was conducted at two health services in Melbourne, Australia. Criteria audited were: primary cardiac arrest characteristics, oxygenation and ventilation management, cardiovascular care, neurological care and patient outcomes. The four major findings were: (i) use of fraction of inspired oxygen (FiO 2 ) of 1.0 and hyperoxia was common during the first 24h of post resuscitation management, (ii) there was variability in cardiac care, with timely 12 lead Electrocardiograph and majority of patients achieving systolic blood pressure (SBP) greater than 100mmHg, but delays in transfer to cardiac catheterisation laboratory, (iii) neurological care was suboptimal with a high incidence of hyperglycaemia and failure to provide therapeutic hypothermia in almost 50% of patients and (iv) there was an association between in-hospital mortality and specific elements of post resuscitation care during the first 24h of hospital admission. Evidence-based context-specific guidelines for post resuscitation care that span the whole patient journey are needed. Reliance on national guidelines does not necessarily translate to evidence based care at a local level, so strategies to ensure effective guideline implementation are urgently required. Crown Copyright © 2016. Published by Elsevier Ltd. All rights reserved.

ANMCO/SIT Consensus Document: telemedicine for cardiovascular emergency networks

PubMed Central

Gulizia, Michele Massimo; Gabrielli, Domenico; Sicuro, Marco; De Gennaro, Luisa; Giammaria, Massimo; Grieco, Niccolò Brenno; Grosseto, Daniele; Mantovan, Roberto; Mazzanti, Marco; Menotti, Alberto; Brunetti, Natale Daniele; Severi, Silva; Russo, Giancarmine; Gensini, Gian Franco

2017-01-01

Abstract Telemedicine has deeply innovated the field of emergency cardiology, particularly the treatment of acute myocardial infarction. The ability to record an ECG in the early prehospital phase, thus avoiding any delay in diagnosing myocardial infarction with direct transfer to the cath-lab for primary angioplasty, has proven to significantly reduce treatment times and mortality. This consensus document aims to analyse the available evidence and organizational models based on a support by telemedicine, focusing on technical requirements, education, and legal aspects. PMID:28751844

Value-based insurance design: benefits beyond cost and utilization.

PubMed

Gibson, Teresa B; Maclean, Ross J; Chernew, Michael E; Fendrick, A Mark; Baigel, Colin

2015-01-01

As value-based insurance design (VBID) programs proliferate, evidence is emerging on the impact of VBID. To date, studies have largely measured VBID impact on utilization, and a few studies have assessed its impact on quality, outcomes, and cost. In this commentary we discuss these domains, summarize evidence, and propose the extension of measurement of VBID impact into areas including workplace productivity and quality of life, employee and patient engagement, and talent attraction and retention. We contend that VBID evaluations should consider a broad variety of programmatic dividends on both humanistic and health-related outcomes.

Chinese guidelines for treatment of adult primary immune thrombocytopenia.

PubMed

Liu, Xin-Guang; Bai, Xiao-Chuan; Chen, Fang-Ping; Cheng, Yun-Feng; Dai, Ke-Sheng; Fang, Mei-Yun; Feng, Jian-Ming; Gong, Yu-Ping; Guo, Tao; Guo, Xin-Hong; Han, Yue; Hong, Luo-Jia; Hu, Yu; Hua, Bao-Lai; Huang, Rui-Bing; Li, Yan; Peng, Jun; Shu, Mi-Mi; Sun, Jing; Sun, Pei-Yan; Sun, Yu-Qian; Wang, Chun-Sen; Wang, Shu-Jie; Wang, Xiao-Min; Wu, Cong-Ming; Wu, Wen-Man; Yan, Zhen-Yu; Yang, Feng-E; Yang, Lin-Hua; Yang, Ren-Chi; Yang, Tong-Hua; Ye, Xu; Zhang, Guang-Sen; Zhang, Lei; Zheng, Chang-Cheng; Zhou, Hu; Zhou, Min; Zhou, Rong-Fu; Zhou, Ze-Ping; Zhu, Hong-Li; Zhu, Tie-Nan; Hou, Ming

2018-06-01

Primary immune thrombocytopenia (ITP) is a bleeding disorder commonly encountered in clinical practice. The International Working Group (IWG) on ITP has published several landmark papers on terminology, definitions, outcome criteria, bleeding assessment, diagnosis, and management of ITP. The Chinese consensus reports for diagnosis and management of adult ITP have been updated to the 4th edition. Based on current consensus positions and new emerging clinical evidence, the thrombosis and hemostasis group of the Chinese Society of Hematology issued Chinese guidelines for management of adult ITP, which aim to provide evidence-based recommendations for clinical decision making.

Clinical librarians as facilitators of nurses' evidence-based practice.

PubMed

Määttä, Sylvia; Wallmyr, Gudrun

2010-12-01

The aim of this study was to explore nurses' and ward-based clinical librarians' reflections on ward-based clinical librarians as facilitators for nurses' use of evidences-based practice. Nurses' use of evidence-based practice is reported to be weak. Studies have suggested that clinical librarians may promote evidence-based practice. To date, little is known about clinical librarians participating nurses in the wards. A descriptive, qualitative design was adopted for the study. In 2007, 16 nurses who had been attended by a clinical librarian in the wards were interviewed in focus groups. Two clinical librarians were interviewed by individual interviews. In the analysis, a content analysis was used. Three themes were generated from the interviews with nurses: 'The grip of everyday work', 'To articulate clinical nursing issues' and 'The clinical librarians at a catalyst'. The nurses experienced the grip of everyday work as a hindrance and had difficulties to articulate and formulate relevant nursing issues. In such a state, the nurses found the clinical librarian presence in the ward as enhancing the awareness of and the use of evidence-based practice. Three themes emerged from the analysis with the librarians. They felt as outsiders, had new knowledge and acquired a new role as ward-based clinical librarians. Facilitation is needed if nurses' evidence-based practice is going to increase. The combined use of nurses and clinical librarians' knowledge and skills can be optimised. To achieve this, nurses' skills in consuming and implementing evidence ought to be strengthened. The fusion of the information and knowledge management skill of the ward-based clinical librarian and the clinical expertise of the nurses can be of value. With such a collaborative model, nurse and ward-based clinical librarian might join forces to increase the use of evidence-based practice. © 2010 Blackwell Publishing Ltd.

[Preclinical treatment of multiple trauma : what is important?].

PubMed

Schweigkofler, U; Hoffmann, R

2013-09-01

Multiple trauma is still the most common cause of death in the age group below 40 years but rarely occurs in prehospital emergencies in Germany. Therefore, personal experience of emergency physicians in prehospital treatment of multiple trauma is often limited. Priority-based therapy according to standardized algorithms and advances in clinical and intensive care have reduced hospital mortality down to 13 %. Time factors, treatment and transport by Helicopter Emergency Medical Services seem to have had a significant impact on the outcome. The current German multiple trauma S3 guidelines provide algorithms for preclinical treatment. The underlying scientific evidence in this respect is, however, low.

[Evidence-based medicine - the current self-reflection of an individualised approach to medicine as an action science].

PubMed

Behrens, Johann

2010-01-01

Evidence-based Medicine (EbM) is the ongoing self-reflection of an individualised approach to medicine in terms of a science that originates from and focuses on clinical decision-making (pragmatic science="Handlungswissenschaft"). EbM is particularly suitable for self-reflecting individualised medicine on the basis of decision-oriented pragmatic science because it consistently distinguishes between external evidence (i.e., other subjects' experience gained through "qualitative" and "quantitative" scientific methods) and internal evidence, i.e., the individual user's, or patient's, own experience manifesting and developing in the individual contact between therapist and patient. Therefore, internal evidence is completely different from the individual clinical experience, expertise, and conviction which therapists contribute to the encounter with clients. A deeper understanding of internal evidence as a result of this encounter has emerged only in the past 15 years. However, it is an integral part of the logic of evidence-based professional decision-making. Scientifically justified beneficial and effective treatment in the individual case cannot be deduced from external evidence but can only be gathered from internal evidence for which the best external evidence available has been utilised. In the past 15 years nursing science has not only carved out the decision-oriented scientific core of evidence-based practice but has also tried to increase the validity of studies on external evidence by employing a combination of 'qualitative' social science studies and clinical epidemiological methods. Copyright © 2010. Published by Elsevier GmbH.

Barriers and perceived needs for understanding and using research among emergency nurses.

PubMed

Chan, Garrett K; Barnason, Susan; Dakin, Cynthia L; Gillespie, Gordon; Kamienski, Mary C; Stapleton, Stephen; Williams, Jennifer; Juarez, Altair; Li, Suling

2011-01-01

Nurses are involved in conducting research and incorporating evidence into their practice. However, barriers exist at the individual, unit, and organizational level related to understanding, conducting, and evaluating the evidence. The Emergency Nurses Association (ENA) conducted a study to understand levels of education in research, the extent of experience, and needs and barriers to research at the individual and organizational levels in emergency nursing. A cross-sectional survey design was used to poll members of the ENA. A 62-item survey instrument was designed to assess five areas: 1) nurses' research values, skills, experience, and awareness; 2) organizational settings' opportunities, barriers, and limitations to research; 3) nurses' understanding and comprehension of research and evidence; 4) presentation and accessibility of research; and 5) continuing educational topics to improve knowledge of the research process. Respondents (n = 948) identified barriers at the individual level that included lack of knowledge about critiquing research studies and familiarity with the research process. Barriers at the unit level included obtaining help from administrators and other staff in starting a project or having the authority to change practice. Barriers at the institution level included lack of support systems such as protected time to conduct research or implement changes in practice. Emergency nurses are highly motivated and interested in learning more about conducting and utilizing research to improve practice. Perceived personal, unit-based, and organizational barriers were identified through this research in an effort to highlight areas for improvement at the local and national levels. Copyright © 2011 Emergency Nurses Association. Published by Mosby, Inc. All rights reserved.

Knowledge translation to fitness trainers: A systematic review

PubMed Central

2010-01-01

Background This study investigates approaches for translating evidence-based knowledge for use by fitness trainers. Specific questions were: Where do fitness trainers get their evidence-based information? What types of interventions are effective for translating evidence-based knowledge for use by fitness trainers? What are the barriers and facilitators to the use of evidence-based information by fitness trainers in their practice? Methods We describe a systematic review of studies about knowledge translation interventions targeting fitness trainers. Fitness trainers were defined as individuals who provide exercise program design and supervision services to the public. Nurses, physicians, physiotherapists, school teachers, athletic trainers, and sport team strength coaches were excluded. Results Of 634 citations, two studies were eligible for inclusion: a survey of 325 registered health fitness professionals (66% response rate) and a qualitative study of 10 fitness instructors. Both studies identified that fitness trainers obtain information from textbooks, networking with colleagues, scientific journals, seminars, and mass media. Fitness trainers holding higher levels of education are reported to use evidence-based information sources such as scientific journals compared to those with lower education levels, who were reported to use mass media sources. The studies identified did not evaluate interventions to translate evidence-based knowledge for fitness trainers and did not explore factors influencing uptake of evidence in their practice. Conclusion Little is known about how fitness trainers obtain and incorporate new evidence-based knowledge into their practice. Further exploration and specific research is needed to better understand how emerging health-fitness evidence can be translated to maximize its use by fitness trainers providing services to the general public. PMID:20398317

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

ILCOR Scientific Knowledge Gaps and Clinical Research Priorities for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care: A Consensus Statement.

PubMed

Kleinman, Monica E; Perkins, Gavin D; Bhanji, Farhan; Billi, John E; Bray, Janet E; Callaway, Clifton W; de Caen, Allan; Finn, Judith C; Hazinski, Mary Fran; Lim, Swee Han; Maconochie, Ian; Morley, Peter; Nadkarni, Vinay; Neumar, Robert W; Nikolaou, Nikolaos; Nolan, Jerry P; Reis, Amelia; Sierra, Alfredo F; Singletary, Eunice M; Soar, Jasmeet; Stanton, David; Travers, Andrew; Welsford, Michelle; Zideman, David

2018-04-26

Despite significant advances in the field of resuscitation science, important knowledge gaps persist. Current guidelines for resuscitation are based on the International Liaison Committee on Resuscitation 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations, which includes treatment recommendations supported by the available evidence. The writing group developed this consensus statement with the goal of focusing future research by addressing the knowledge gaps identified during and after the 2015 International Liaison Committee on Resuscitation evidence evaluation process. Key publications since the 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations are referenced, along with known ongoing clinical trials that are likely to affect future guidelines. © 2018 European Resuscitation Council and American Heart Association, Inc. Published by Elsevier B.V. All rights reserved. Copyright © 2018 European Resuscitation Council and American Heart Association, Inc. Published by Elsevier B.V. All rights reserved.

Bicarbonate in diabetic ketoacidosis - a systematic review

PubMed Central

2011-01-01

Objective This study was designed to examine the efficacy and risk of bicarbonate administration in the emergent treatment of severe acidemia in diabetic ketoacidosis (DKA). Methods PUBMED database was used to identify potentially relevant articles in the pediatric and adult DKA populations. DKA intervention studies on bicarbonate administration versus no bicarbonate in the emergent therapy, acid-base studies, studies on risk association with cerebral edema, and related case reports, were selected for review. Two reviewers independently conducted data extraction and assessed the citation relevance for inclusion. Results From 508 potentially relevant articles, 44 were included in the systematic review, including three adult randomized controlled trials (RCT) on bicarbonate administration versus no bicarbonate in DKA. We observed a marked heterogeneity in pH threshold, concentration, amount, and timing for bicarbonate administration in various studies. Two RCTs demonstrated transient improvement in metabolic acidosis with bicarbonate treatment within the initial 2 hours. There was no evidence of improved glycemic control or clinical efficacy. There was retrospective evidence of increased risk for cerebral edema and prolonged hospitalization in children who received bicarbonate, and weak evidence of transient paradoxical worsening of ketosis, and increased need for potassium supplementation. No studies involved patients with an initial pH < 6.85. Conclusions The evidence to date does not justify the administration of bicarbonate for the emergent treatment of DKA, especially in the pediatric population, in view of possible clinical harm and lack of sustained benefits. PMID:21906367

Medical rehabilitation after natural disasters: why, when, and how?

PubMed

Rathore, Farooq A; Gosney, James E; Reinhardt, Jan D; Haig, Andrew J; Li, Jianan; DeLisa, Joel A

2012-10-01

Natural disasters can cause significant numbers of severe, disabling injuries, resulting in a public health emergency and requiring foreign assistance. However, since medical rehabilitation services are often poorly developed in disaster-affected regions and not highly prioritized by responding teams, physical and rehabilitation medicine (PRM) has historically been underemphasized in global disaster planning and response. Recent development of the specialties of "disaster medicine" and "disaster rehabilitation" has raised awareness of the critical importance of rehabilitation intervention during the immediate postdisaster emergency response. The World Health Organization Liaison Sub-Committee on Rehabilitation Disaster Relief of the International Society of Physical and Rehabilitation Medicine has authored this report to assess the role of emergency rehabilitation intervention after natural disasters based on current scientific evidence and subject matter expert accounts. Major disabling injury types are identified, and spinal cord injury, limb amputation, and traumatic brain injury are used as case studies to exemplify the challenges to effective management of disabling injuries after disasters. Evidence on the effectiveness of disaster rehabilitation interventions is presented. The authors then summarize the current state of disaster-related research, as well as lessons learned from PRM emergency rehabilitation response in recent disasters. Resulting recommendations for greater integration of PRM services into the immediate emergency disaster response are provided. This report aims to stimulate development of research and practice in the emerging discipline of disaster rehabilitation within organizations that provide medical rehabilitation services during the postdisaster emergency response. Copyright © 2012 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Behavioral Emergency Response Team: Implementation Improves Patient Safety, Staff Safety, and Staff Collaboration.

PubMed

Zicko, Cdr Jennifer M; Schroeder, Lcdr Rebecca A; Byers, Cdr William S; Taylor, Lt Adam M; Spence, Cdr Dennis L

2017-10-01

Staff members working on our nonmental health (non-MH) units (i.e., medical-surgical [MS] units) were not educated in recognizing or deescalating behavioral emergencies. Published evidence suggests a behavioral emergency response team (BERT) composed of MH experts who assist with deescalating behavioral emergencies may be beneficial in these situations. Therefore, we sought to implement a BERT on the inpatient non-MH units at our military treatment facility. The objectives of this evidence-based practice process improvement project were to determine how implementation of a BERT affects staff and patient safety and to examine nursing staffs' level of knowledge, confidence, and support in caring for psychiatric patients and patients exhibiting behavioral emergencies. A BERT was piloted on one MS unit for 5 months and expanded to two additional units for 3 months. Pre- and postimplementation staff surveys were conducted, and the number of staff assaults and injuries, restraint usage, and security intervention were compared. The BERT responded to 17 behavioral emergencies. The number of assaults decreased from 10 (pre) to 1 (post); security intervention decreased from 14 to 1; and restraint use decreased from 8 to 1. MS staffs' level of BERT knowledge and rating of support between MH staff and their staff significantly increased. Both MS and MH nurses rated the BERT as supportive and effective. A BERT can assist with deescalating behavioral emergencies, and improve staff collaboration and patient and staff safety. © 2017 Sigma Theta Tau International.

"Make Not Your Prisons Your Prisons": Participant-Percieved Potential Outcomes of a Shakespeare Focussed Alternative to Juvenile Incarceration in the USA

ERIC Educational Resources Information Center

Nicklin, Laura Louise

2017-01-01

For over two decades, there has been a progressive emergence of Shakespeare-focussed, performance-based programmes intended for use as criminal rehabilitation in the USA. Prison based criminal retribution, though historically prevalent, remains controversial. Although it is still used as a common method for rehabilitation, evidence demonstrates…

Development and Evaluation of the "Tigriopus" Course-Based Undergraduate Research Experience: Impacts on Students' Content Knowledge, Attitudes, and Motivation in a Majors Introductory Biology Course

ERIC Educational Resources Information Center

Olimpo, Jeffrey T.; Fisher, Ginger R.; DeChenne-Peters, Sue Ellen

2016-01-01

Within the past decade, course-based undergraduate research experiences (CUREs) have emerged as a viable mechanism to enhance novices' development of scientific reasoning and process skills in the science, technology, engineering, and mathematics disciplines. Recent evidence within the bioeducation literature suggests that student engagement in…

Evaluating Claims to Avoid Pseudoscientific and Unproven Practices in Special Education

ERIC Educational Resources Information Center

Travers, Jason C.

2017-01-01

Special education professionals are charged with using evidence-based practices, but various unproven, disproven, and pseudoscientific interventions continue to proliferate. Unproven and ineffective interventions emerge and are adopted for various reasons. Ineffective interventions are inevitably harmful and require professionals to adopt a…

Evidence-based pain management: is the concept of integrative medicine applicable?

PubMed Central

2012-01-01

This article is dedicated to the concept of predictive, preventive, and personalized (integrative) medicine beneficial and applicable to advance pain management, overviews recent insights, and discusses novel minimally invasive tools, performed under ultrasound guidance, enhanced by model-guided approach in the field of musculoskeletal pain and neuromuscular diseases. The complexity of pain emergence and regression demands intellectual-, image-guided techniques personally specified to the patient. For personalized approach, the combination of the modalities of ultrasound, EMG, MRI, PET, and SPECT gives new opportunities to experimental and clinical studies. Neuromuscular imaging should be crucial for emergence of studies concerning advanced neuroimaging technologies to predict movement disorders, postural imbalance with integrated application of imaging, and functional modalities for rehabilitation and pain management. Scientific results should initiate evidence-based preventive movement programs in sport medicine rehabilitation. Traditional medicine and mathematical analytical approaches and education challenges are discussed in this review. The physiological management of exactly assessed pathological condition, particularly in movement disorders, requires participative medical approach to gain harmonized and sustainable effect. PMID:23088743

The pluralization of the international: Resistance and alter-standardization in regenerative stem cell medicine

PubMed Central

Rosemann, Achim; Chaisinthop, Nattaka

2016-01-01

The article explores the formation of an international politics of resistance and ‘alter-standardization’ in regenerative stem cell medicine. The absence of internationally harmonized regulatory frameworks in the clinical stem cell field and the presence of lucrative business opportunities have resulted in the formation of transnational networks adopting alternative research standards and practices. These oppose, as a universal global standard, strict evidence-based medicine clinical research protocols as defined by scientists and regulatory agencies in highly developed countries. The emergence of transnational spaces of alter-standardization is closely linked to scientific advances in rapidly developing countries such as China and India, but calls for more flexible regulatory frameworks, and the legitimization of experimental for-profit applications outside of evidence-based medical care, are emerging increasingly also within more stringently regulated countries, such as the United States and countries in the European Union. We can observe, then, a trend toward the pluralization of the standards, practices, and concepts in the stem cell field. PMID:26983174

The state of readiness for evidence-based practice among nurses: An integrative review.

PubMed

Saunders, Hannele; Vehviläinen-Julkunen, Katri

2016-04-01

To review factors related to nurses' individual readiness for evidence-based practice and to determine the current state of nurses' evidence-based practice competencies. An integrative review study. Thirty-seven (37) primary research studies on nurses' readiness for evidence-based practice, of which 30 were descriptive cross-sectional surveys, 5 were pretest-posttest studies, and one study each was an experimental pilot study and a descriptive qualitative study. Included studies were published from the beginning of 2004 through end of January 2015. The integrative review study used thematic synthesis, in which the quantitative studies were analyzed deductively and the qualitative studies inductively. Outcomes related to nurses' readiness for evidence-based practice were grouped according to the four main themes that emerged from the thematic synthesis: (1) nurses' familiarity with evidence-based practice (EBP); (2) nurses' attitudes toward and beliefs about evidence-based practice; (3) nurses' evidence-based practice knowledge and skills; and (4) nurses' use of research in practice. Methodological quality of the included studies was evaluated with Joanna Briggs Institute critical appraisal tools. Although nurses were familiar with, had positive attitudes toward, and believed in the value of EBP in improving care quality and patient outcomes, they perceived their own evidence-based practice knowledge and skills insufficient for employing evidence-based practice, and did not use best evidence in practice. The vast majority (81%) of included studies were descriptive cross-sectional surveys, 84% used a non-probability sampling method, sample sizes were small, and response rates low. Most included studies were of modest quality. More robust, theoretically-based and psychometrically sound nursing research studies are needed to test and evaluate the effectiveness of interventions designed to advance nurses' evidence-based practice competencies, especially teaching them how to integrate evidence-based practice into clinical decision-making. All efforts should be focused on systematically using knowledge transformation strategies shown to be effective in rigorous studies, to translate best evidence into practice-friendly, readily usable forms that are easily accessible to nurses to integrate into their clinical practice. Copyright © 2015 Elsevier Ltd. All rights reserved.

Evidence-based surgery: barriers, solutions, and the role of evidence synthesis.

PubMed

Garas, George; Ibrahim, Amel; Ashrafian, Hutan; Ahmed, Kamran; Patel, Vanash; Okabayashi, Koji; Skapinakis, Petros; Darzi, Ara; Athanasiou, Thanos

2012-08-01

Surgery is a rapidly evolving field, making the rigorous testing of emerging innovations vital. However, most surgical research fails to employ randomized controlled trials (RCTs) and has particularly been based on low-quality study designs. Subsequently, the analysis of data through meta-analysis and evidence synthesis is particularly difficult. Through a systematic review of the literature, this article explores the barriers to achieving a strong evidence base in surgery and offers potential solutions to overcome the barriers. Many barriers exist to evidence-based surgical research. They include enabling factors, such as funding, time, infrastructure, patient preference, ethical issues, and additionally barriers associated with specific attributes related to researchers, methodologies, or interventions. Novel evidence synthesis techniques in surgery are discussed, including graphics synthesis, treatment networks, and network meta-analyses that help overcome many of the limitations associated with existing techniques. They offer the opportunity to assess gaps and quantitatively present inconsistencies within the existing evidence of RCTs. Poorly or inadequately performed RCTs and meta-analyses can give rise to incorrect results and thus fail to inform clinical practice or revise policy. The above barriers can be overcome by providing academic leadership and good organizational support to ensure that adequate personnel, resources, and funding are allocated to the researcher. Training in research methodology and data interpretation can ensure that trials are conducted correctly and evidence is adequately synthesized and disseminated. The ultimate goal of overcoming the barriers to evidence-based surgery includes the improved quality of patient care in addition to enhanced patient outcomes.

Diagnosis and treatment of acute ankle injuries: development of an evidence-based algorithm

PubMed Central

Polzer, Hans; Kanz, Karl Georg; Prall, Wolf Christian; Haasters, Florian; Ockert, Ben; Mutschler, Wolf; Grote, Stefan

2011-01-01

Acute ankle injuries are among the most common injuries in emergency departments. However, there are still no standardized examination procedures or evidence-based treatment. Therefore, the aim of this study was to systematically search the current literature, classify the evidence, and develop an algorithm for the diagnosis and treatment of acute ankle injuries. We systematically searched PubMed and the Cochrane Database for randomized controlled trials, meta-analyses, systematic reviews or, if applicable, observational studies and classified them according to their level of evidence. According to the currently available literature, the following recommendations have been formulated: i) the Ottawa Ankle/Foot Rule should be applied in order to rule out fractures; ii) physical examination is sufficient for diagnosing injuries to the lateral ligament complex; iii) classification into stable and unstable injuries is applicable and of clinical importance; iv) the squeeze-, crossed leg- and external rotation test are indicative for injuries of the syndesmosis; v) magnetic resonance imaging is recommended to verify injuries of the syndesmosis; vi) stable ankle sprains have a good prognosis while for unstable ankle sprains, conservative treatment is at least as effective as operative treatment without the related possible complications; vii) early functional treatment leads to the fastest recovery and the least rate of reinjury; viii) supervised rehabilitation reduces residual symptoms and re-injuries. Taken these recommendations into account, we present an applicable and evidence-based, step by step, decision pathway for the diagnosis and treatment of acute ankle injuries, which can be implemented in any emergency department or doctor's practice. It provides quality assurance for the patient and promotes confidence in the attending physician. PMID:22577506

Emerging evidence of ozone metabolic effects and potential mechanisms

EPA Science Inventory

SOT 2014 Abstract: Invitational Emerging evidence of ozone metabolic effects and potential mechanisms U.P. Kodavanti NHEERL, USEPA, Research Triangle Park, NC Recent evidence suggests that air pollutants are linked to metabolic syndrome and impact several key metabolic proce...

The National Falls and Bone Health Audit: implications for UK emergency care.

PubMed

Banerjee, Jay; Benger, Jonathan; Treml, Jonathan; Martin, Finbarr C; Grant, Rob; Lowe, Derek; Potter, Jonathan; Husk, Janet

2012-10-01

The National Clinical Audit of Falls and Bone Health, coordinated by the Royal College of Physicians, assesses progress in implementing integrated falls services across the UK against national standards and enables benchmarking between service providers. Nationally, falls are a leading contributor towards mortality and morbidity in older people and account for 700,000 visits to emergency departments and 4 million annual bed days in England alone. Two rounds of national organisational audit in 2005 and 2008 and one national clinical audit in 2006 were carried out based on indicators developed by a multidisciplinary group. These showed that management of falls and bone health in older people remains suboptimal in emergency departments and minor injury units and opportunities are being missed in carrying out evidence-based risk assessment and management. Older people attending emergency departments in the UK following a fall are receiving a poor deal. There is an urgent need to ensure more effective assessment and management to prevent further falls and fractures.

Quantitative analysis of factors that affect oil pipeline network accident based on Bayesian networks: A case study in China

NASA Astrophysics Data System (ADS)

Zhang, Chao; Qin, Ting Xin; Huang, Shuai; Wu, Jian Song; Meng, Xin Yan

2018-06-01

Some factors can affect the consequences of oil pipeline accident and their effects should be analyzed to improve emergency preparation and emergency response. Although there are some qualitative analysis models of risk factors' effects, the quantitative analysis model still should be researched. In this study, we introduce a Bayesian network (BN) model of risk factors' effects analysis in an oil pipeline accident case that happened in China. The incident evolution diagram is built to identify the risk factors. And the BN model is built based on the deployment rule for factor nodes in BN and the expert knowledge by Dempster-Shafer evidence theory. Then the probabilities of incident consequences and risk factors' effects can be calculated. The most likely consequences given by this model are consilient with the case. Meanwhile, the quantitative estimations of risk factors' effects may provide a theoretical basis to take optimal risk treatment measures for oil pipeline management, which can be used in emergency preparation and emergency response.

Undertaking an information-needs analysis of the emergency-care physician to inform the role of the clinical librarian: a Greek perspective.

PubMed

Lappa, E

2005-06-01

The primary focus of this pilot study was to gain a better understanding of the information needs of emergency-care clinicians. The secondary focus was to compare the traditional current practice of information provision within other emergency departments in Greek hospitals, with the new model of clinical librarianship (CL). Clinical staff in the emergency department deal with a variety of cases, they have no time to visit the library, but need information instantly in their place of work. Clinical decision making in the emergency department setting frequently requires the clinician to obtain additional sources of information and clinical librarians may facilitate this. The present study focused on two professional groups: medical librarians (group A) and clinicians (consultants, senior registrars, registrars, nurses (group B), working in the emergency departments of two Greek hospitals. The study was organized through a questionnaire survey and some in-depth interviews. This study showed that, for 100% of the clinicians in daily practice, the main information needs arise while treating patients, and that information would help in making patient-care decisions. Clinicians made little use of hospital libraries because they are usually under tremendous time pressure. The main outcome of the study was the use of a clinical librarian as an information provider. Clinical librarians supply information to assist decisions, based on this model. This extends the librarian's role in evidence-based medicine, giving much stronger attention to the relevant evidence in clinical practice. Nowadays, health services are facing organizational change. The introduction of new technology, and rapid growth of medical knowledge creates a demand for new ways of providing information. Clinical librarian programmes may deliver patients specific information in a timely manner. The mission of the clinical librarian is to facilitate access to quality information which is necessary for improving health, and to act as an informationist in the emergency department.

Results of an asthma disease management program in an urban pediatric community clinic.

PubMed

Newcomb, Patricia

2006-07-01

Asthma is increasing in incidence, but adherence to national diagnosis and treatment guidelines is poor. The Children's Asthma Management Program (CHAMP) was designed and implemented by nurse practitioners to address the problem of inconsistent asthma management. This is an outcome-based evaluation of a novel asthma management program in which practitioners created a structured mechanism for implementing national evidence-based asthma treatment guidelines. Children who completed the program experienced an 85% decrease in hospitalizations for asthma, 87% decrease in emergency room visits for asthma, and 71% decrease in acute office visits for asthma exacerbations. Patients may benefit from microsystem structures intentionally designed to facilitate implementation of evidence-based guidelines.

Recent advances in the neurophysiology of chronic pain.

PubMed

Baker, Kylie

2005-02-01

The chronic pain syndrome patient has become the 'leper' of emergency medicine. There are no emergency medicine guidelines and minimal research into managing this challenging group of patients. To summarize the recent advances in laboratory research into the development of chronic pain that have relevance to emergency management. When the level of supporting evidence is low, it is imperative that emergency physicians understand the physiology that underpins those expert opinions upon which they base their treatment strategies. Literature was searched via Medline, Cochrane, Cinahl, and PsycINFO from 1996 to 2004, under 'chronic pain and emergency management'. Medline from 1996 was searched for 'chronic pain and prevention', 'chronic pain and emergency' and 'chronic pain'. Bibliographies were manually searched for older keynote articles. Advances in understanding the biochemical changes of chronic pain are paralleled by lesser known advances in delineation of the corticol processing. Drug manipulation causes complex action and reaction in chronic pain. Emergency physicians must also optimize cognitive and behavioural aspects of treatment to successfully manage this systemic disease.

Evidence Aid approach to gap analysis and priority setting of questions for systematic reviews in disasters.

PubMed

Kayabu, Bonnix

2015-02-01

This article is based on a presentation at the Evidence Aid Symposium, on 20 September 2014, at Hyderabad, India. Ten years after the Indian Ocean Tsunami, Evidence Aid and it parters and other humanitarian stakeholders met to update about Evidence Aid work and discussed it future. The Evidence Aid approach to fill in the gap on the production and use of evidence in disater sector and other humanitarian health emergencies was widely discussed. Iterative approach to prioritise evidence reinforced Evidence Aid principle of independacy and a coordinated international orgasisation. The generation of 30 research questions during the prioritisation process contitute the first big step for Evidence Aid to become a one stop shop for the seach evidence on the effectiveness of interventions in disasters. © 2015 Chinese Cochrane Center, West China Hospital of Sichuan University and Wiley Publishing Asia Pty Ltd.

44 CFR 11.14 - Administrative claim; evidence and information to be submitted.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 44 Emergency Management and Assistance 1 2011-10-01 2011-10-01 false Administrative claim; evidence and information to be submitted. 11.14 Section 11.14 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY GENERAL CLAIMS Administrative Claims Under...

44 CFR 11.14 - Administrative claim; evidence and information to be submitted.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 44 Emergency Management and Assistance 1 2012-10-01 2011-10-01 true Administrative claim; evidence and information to be submitted. 11.14 Section 11.14 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY GENERAL CLAIMS Administrative Claims Under...

44 CFR 11.14 - Administrative claim; evidence and information to be submitted.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 44 Emergency Management and Assistance 1 2013-10-01 2013-10-01 false Administrative claim; evidence and information to be submitted. 11.14 Section 11.14 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY GENERAL CLAIMS Administrative Claims Under...

44 CFR 11.14 - Administrative claim; evidence and information to be submitted.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 44 Emergency Management and Assistance 1 2014-10-01 2014-10-01 false Administrative claim; evidence and information to be submitted. 11.14 Section 11.14 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY GENERAL CLAIMS Administrative Claims Under...

44 CFR 11.14 - Administrative claim; evidence and information to be submitted.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Administrative claim; evidence and information to be submitted. 11.14 Section 11.14 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY GENERAL CLAIMS Administrative Claims Under...

Clinical handover of patients arriving by ambulance to the emergency department - a literature review.

PubMed

Bost, Nerolie; Crilly, Julia; Wallis, Marianne; Patterson, Elizabeth; Chaboyer, Wendy

2010-10-01

To provide a critical review of research on clinical handover between the ambulance service and emergency department (ED) in hospitals. Data base and hand searches were conducted using the keywords ambulance, handover, handoff, emergency department, emergency room, ER, communication, and clinical handover. Data were extracted, summarised and critically assessed to provide evidence of current clinical handover processes. From 252 documents, eight studies fitted the inclusion criteria of clinical handover and the ambulance to ED patient transfer. Three themes were identified in the review: (1) important information may be missed during clinical handover; (2) structured handovers that include both written and verbal components may improve information exchange; (3) multidisciplinary education about the clinical handover process may encourage teamwork, a shared common language and a framework for minimum patient information to be transferred from the ambulance service to the hospital ED. Knowledge gaps exist concerning handover information, consequences of poor handover, transfer of responsibility, staff perception of handovers, staff training and evaluation of recommended strategies to improve clinical handover. Evidence of strategies being implemented and further research is required to examine the ongoing effects of implementing the strategies. Copyright © 2009 Elsevier Ltd. All rights reserved.

APIC State-of-the-Art Report: the role of the infection preventionist in emergency management.

PubMed

Rebmann, Terri

2009-05-01

This report summarizes the scope and role of infection preventionists in emergency management for all types of disasters. Preventing the transmission of infectious agents during a disaster is an essential component of emergency management. Previous disasters have illustrated the need for better infection prevention and the involvement of an infection prevention professional in planning for and responding to such events. An evidence-based approach was used, consisting of a literature review and review by members of the Association for Professionals in Infection Control and Epidemiology, Inc, Emergency Preparedness Committee. Nine domains were identified that describe the role of the infection preventionist in emergency management: knowledge of disasters and emergency management, assessing readiness and emergency management plans, infection prevention coverage, participation in disaster response and recovery, health care policy development, surveillance, patient management, physical plant issues, and infection preventionist as educator. Details for each domain are provided. Infection preventionists need to become more involved in emergency management at the personal, facility, and community level. This report outlines the infection preventionist's responsibilities related to emergency management.

An Evidence-based Curriculum To Prepare Students for Global Nursing Practice.

ERIC Educational Resources Information Center

Veenema, Tener Goodwin

2001-01-01

A curriculum to prepare nurses for global public health practice contains eight modules: global burden of disease, epidemiology in developing countries, international health organizations, comparative public health, emerging infections, maternal/child health, economic development and health, and traditional/indigenous medicine. The course makes…

Unlocking ePortfolio Practice: Teaching Beliefs

ERIC Educational Resources Information Center

Henscheid, Jean M.; Brown, Gary; Gordon, Aifang; Chen, Helen L.

2014-01-01

The Association for Authentic, Experiential, and Evidence-Based Learning (AAEEBL) annual ePortfolio survey focuses on understanding ePortfolio practitioners' teaching beliefs and practices. The action research reported here extends that survey research to a population of emerging educators (i.e., graduate students in education). In addition to…

Nurses' barriers to learning: an integrative review.

PubMed

Santos, Marion C

2012-07-01

This integrative review of the literature describes nurses' barriers to learning. Five major themes emerged: time constraints, financial constraints, workplace culture, access/relevance, and competency in accessing electronic evidence-based practice literature. The nurse educator must address these barriers for the staff to achieve learning and competency.

Supplement to Petition for Rulemaking to Amend the National Contingency Plan Product Schedule and Other Subparts Relating to Product Use

EPA Pesticide Factsheets

Supliments petition submitted November 12, 2012 by The Citizens’ Coalition to Ban Toxic Dispersants based on new evidence and scientific information, as well as the USDOT's recent emergency regulations for handling crude oil by rail.

How robust is the evidence of an emerging or increasing female excess in physical morbidity between childhood and adolescence? Results of a systematic literature review and meta-analyses

PubMed Central

MacLean, Alice; Sweeting, Helen; Egan, Matt; Der, Geoff; Adamson, Joy; Hunt, Kate

2013-01-01

For asthma and psychological morbidity, it is well established that higher prevalence among males in childhood is replaced by higher prevalence among females by adolescence. This review investigates whether there is evidence for a similar emerging female ‘excess’ in relation to a broad range of physical morbidity measures. Establishing whether this pattern is generalised or health outcome-specific will further understandings of the aetiology of gender differences in health. Databases (Medline; Embase; CINAHL; PsycINFO; ERIC) were searched for English language studies (published 1992–2010) presenting physical morbidity prevalence data for males and females, for at least two age-bands within the age-range 4–17 years. A three-stage screening process (initial sifting; detailed inspection; extraction of full papers), was followed by study quality appraisals. Of 11 245 identified studies, 41 met the inclusion criteria. Most (n = 31) presented self-report survey data (five longitudinal, 26 cross-sectional); 10 presented routinely collected data (GP/hospital statistics). Extracted data, supplemented by additional data obtained from authors of the included studies, were used to calculate odds ratios of a female excess, or female:male incident rate ratios as appropriate. To test whether these changed with age, the values were logged and regressed on age in random effects meta-regressions. These showed strongest evidence of an emerging/increasing female excess for self-reported measures of headache, abdominal pain, tiredness, migraine and self-assessed health. Type 1 diabetes and epilepsy, based on routinely collected data, did not show a significant emerging/increasing female excess. For most physical morbidity measures reviewed, the evidence broadly points towards an emerging/increasing female excess during the transition to adolescence, although results varied by morbidity measure and study design, and suggest that this may occur at a younger age than previously thought. PMID:23273876

The practice of evidence-based medicine involves the care of whole persons.

PubMed

Richardson, W Scott

2017-04-01

In this issue of the Journal, Dr. Fava posits that evidence-based medicine (EBM) was bound to fail. I share some of the concerns he expresses, yet I see more reasons for optimism. Having been on rounds with both Drs. Engel and Sackett, I reckon they would have agreed more than they disagreed. Their central teaching was the compassionate and well-informed care of sick persons. The model that emerged from these rounds was that patient care could be both person-centered and evidence-based, that clinical judgment was essential to both, and the decisions could and should be shared. Both clinicians and patients can bring knowledge from several sources into the shared decision making process in the clinical encounter, including evidence from clinical care research. I thank Dr. Fava for expressing legitimate doubts and providing useful criticism, yet I am cautiously optimistic that the model of EBM described here is robust enough to meet the challenges and is not doomed to fail. Copyright © 2017 Elsevier Inc. All rights reserved.

Music therapy with disorders of consciousness: current evidence and emergent evidence-based practice.

PubMed

Magee, Wendy L; O'Kelly, Julian

2015-03-01

Patients with prolonged disorders of consciousness (PDOC) stemming from acquired brain injury present one of the most challenging clinical populations in neurological rehabilitation. Because of the complex clinical presentation of PDOC patients, treatment teams are confronted with many medicolegal, ethical, philosophical, moral, and religious issues in day-to-day care. Accurate diagnosis is of central concern, relying on creative approaches from skilled clinical professionals using combined behavioral and neurophysiological measures. This paper presents the latest evidence for using music as a diagnostic tool with PDOC, including recent developments in music therapy interventions and measurement. We outline standardized clinical protocols and behavioral measures to produce diagnostic outcomes and examine recent research illustrating a range of benefits of music-based methods at behavioral, cardiorespiratory, and cortical levels using video, electrocardiography, and electroencephalography methods. These latest developments are discussed in the context of evidence-based practice in rehabilitation with clinical populations. © 2014 New York Academy of Sciences.

Ethical and scientific issues surrounding solid organ transplantation in HIV-positive patients: Absence of evidence is not evidence of absence.

PubMed

Christie, Timothy; Jiwani, Bashir; Asrat, Getnet; Montessori, Valentina; Mathias, Richard; Montaner, Julio

2006-01-01

End-stage liver disease is emerging as a leading cause of death among HIV-positive patients. Historically, an HIV diagnosis was a contraindication for a liver transplant; however, because of the efficacy of highly active antiretroviral therapy (HAART), HIV-positive patients have one-year, two-year, and three-year post-transplantation survival rates similar to that of HIV-negative patients. Based on this evidence, HIV-positive patients are now considered eligible for transplantation. However, newly emerging guidelines include the stipulation that HIV-positive patients must be on HAART to be placed on a waiting list for transplantation. The purpose of the present paper is to evaluate the scientific and ethical probity of requiring HIV-positive patients to be on HAART as a condition for being on a liver transplant waiting list. It is argued that the emphasis should be placed on the probability of post-transplantation HAART tolerance, and that concerns about pretransplantation HAART tolerance are of secondary importance.

Ethical and scientific issues surrounding solid organ transplantation in HIV-positive patients: Absence of evidence is not evidence of absence

PubMed Central

Christie, Timothy; Jiwani, Bashir; Asrat, Getnet; Montessori, Valentina; Mathias, Richard; Montaner, Julio

2006-01-01

End-stage liver disease is emerging as a leading cause of death among HIV-positive patients. Historically, an HIV diagnosis was a contraindication for a liver transplant; however, because of the efficacy of highly active antiretroviral therapy (HAART), HIV-positive patients have one-year, two-year, and three-year post-transplantation survival rates similar to that of HIV-negative patients. Based on this evidence, HIV-positive patients are now considered eligible for transplantation. However, newly emerging guidelines include the stipulation that HIV-positive patients must be on HAART to be placed on a waiting list for transplantation. The purpose of the present paper is to evaluate the scientific and ethical probity of requiring HIV-positive patients to be on HAART as a condition for being on a liver transplant waiting list. It is argued that the emphasis should be placed on the probability of post-transplantation HAART tolerance, and that concerns about pretransplantation HAART tolerance are of secondary importance. PMID:18418478

Barriers to evidence-based medicine: a systematic review.

PubMed

Sadeghi-Bazargani, Homayoun; Tabrizi, Jafar Sadegh; Azami-Aghdash, Saber

2014-12-01

Evidence-based medicine (EBM) has emerged as an effective strategy to improve health care quality. The aim of this study was to systematically review and carry out an analysis on the barriers to EBM. Different database searching methods and also manual search were employed in this study using the search words ('evidence-based' or 'evidence-based medicine' or 'evidence-based practice' or 'evidence-based guidelines' or 'research utilization') and (barrier* or challenge or hinder) in the following databases: PubMed, Scopus, Web of Knowledge, Cochrane library, Pro Quest, Magiran, SID. Out of 2592 articles, 106 articles were finally identified for study. Research barriers, lack of resources, lack of time, inadequate skills, and inadequate access, lack of knowledge and financial barriers were found to be the most common barriers to EBM. Examples of these barriers were found in primary care, hospital/specialist care, rehabilitation care, medical education, management and decision making. The most common barriers to research utilization were research barriers, cooperation barriers and changing barriers. Lack of resources was the most common barrier to implementation of guidelines. The result of this study shows that there are many barriers to the implementation and use of EBM. Identifying barriers is just the first step to removing barriers to the use of EBM. Extra resources will be needed if these barriers are to be tackled. © 2014 John Wiley & Sons, Ltd.

Guiding Principles for Implementing School-Based Management Programs: An Online Toolkit Providing General Principles That Can Be Applied to the Implementation of School-Based Management Reforms

ERIC Educational Resources Information Center

Patrinos, Harry Anthony; Fasih, Tazeen; Barrera, Felipe; Garcia-Moreno, Vicente A.; Bentaouet-Kattan, Raja; Baksh, Shaista; Wickramasekera, Inosha

2007-01-01

School-based management (SBM) has become a very popular movement over the past decade. The World Bank Education Team's SBM work program emerged out of a need to define the concept more clearly, review the evidence, support impact assessments in various countries, and provide some initial feedback to teams preparing education projects. During the…

Physiological scoring: an aid to emergency medical services transport decisions?

PubMed

Challen, Kirsty; Walter, Darren

2010-01-01

Attendance at UK emergency departments is rising steadily despite the proliferation of alternative unscheduled care providers. Evidence is mixed on the willingness of emergency medical services (EMS) providers to decline to transport patients and the safety of incorporating such an option into EMS provision. Physiologically based Early Warning Scores are in use in many hospitals and emergency departments, but not yet have been proven to be of benefit in the prehospital arena. The use of a physiological-social scoring system could safely identify patients calling EMS who might be diverted from the emergency department to an alternative, unscheduled, care provider. This was a retrospective, cohort study of patients with a presenting complaint of "shortness of breath" or "difficulty breathing" transported to the emergency department by EMS. Retrospective calculation of a physiological social score (PMEWS) based on first recorded data from EMS records was performed. Outcome measures of hospital admission and need for physiologically stabilizing treatment in the emergency department also were performed. A total of 215 records were analyzed. One hundred thirty-nine (65%) patients were admitted from the emergency department or received physiologically stabilizing treatment in the emergency department. Area Under the Receiver Operating Characteristic Curve (AUROC) for hospital admission was 0.697 and for admission or physiologically stabilizing treatment was 0.710. No patient scoring<2 was admitted or received stabilizing treatment. Despite significant over-triage, this system could have diverted 79 patients safely from the emergency department to alternative, unscheduled, care providers.

Emergent Writing in Preschoolers: Preliminary Evidence for a Theoretical Framework

PubMed Central

Puranik, Cynthia S.; Lonigan, Christopher J.

2014-01-01

Researchers and educators use the term emergent literacy to refer to a broad set of skills and attitudes that serve as foundational skills for acquiring success in later reading and writing; however, models of emergent literacy have generally focused on reading and reading-related behaviors. Hence, the primary aim of this study was to articulate and evaluate a theoretical model of the components of emergent writing. Alternative models of the structure of individual and developmental differences of emergent writing and writing-related skills were examined in 372 preschool children who ranged in age from 3- to 5-years using confirmatory factor analysis. Results from a confirmatory factor analysis provide evidence that these emergent writing skills are best described by three correlated but distinct factors, (a) Conceptual Knowledge, (b) Procedural Knowledge, and (c) Generative Knowledge. Evidence that these three emergent writing factors show different patterns of relations to emergent literacy constructs is presented. Implications for understanding the development of writing and assessment of early writing skills are discussed. PMID:25316955

Physiotherapists in emergency departments: responsibilities, accountability and education.

PubMed

Crane, Jacqueline; Delany, Clare

2013-06-01

Emergency physiotherapy roles have evolved within the UK and are increasingly being adopted in Australia in response to a need for greater workforce flexibility and improved service provision to meet growing patient demand. This paper discusses the need for the physiotherapy profession to develop evidence-based regulatory, ethical and educative frameworks to keep pace with the changing clinical environment and service delivery in emergency departments. Definitions of Emergency Physiotherapy as either advanced practice or extended scope of practice are identified, and the implications for both regulation of practice and education are highlighted. Suggestions for education in areas of clinical skills, ethical understanding and legal and professional knowledge are highlighted as important areas to support physiotherapists moving into this area of practice. Copyright © 2012 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

Putting equity center stage: challenging evidence-free reforms.

PubMed

Whitehead, Margaret; Dahlgren, Göran; McIntyre, Di

2007-01-01

Do we have an "evidence-free zone" around the health sector reforms that have taken place over the past few decades? Certainly, many of the policy prescriptions have been based on ideology and assumptions about the likely impact of policies, rather than evidence-based. The provision of health care is increasingly treated as a commodity that can be subjected to the same prescription as other goods: privatization, competition, deregulation, decentralization. Evidence has slowly emerged over the 1990s and early 2000s on the adverse effects of these policy prescriptions on equity, particularly in low- and middle-income countries, but a shift in policy is barely perceptible. There is a need for a fresh approach that puts equity center stage. A gap that must be filled is on the "demand" or "need" side: in particular, the impact of policy changes on families and communities. This article is the first in a series of eight articles that present the findings of studies that attempt to fill this gap, helping to develop a more evidence-based approach to equity and health sector policy from the users'/potential patients' perspective.

The probability of probability and research truths.

PubMed

Fatovich, Daniel M; Phillips, Michael

2017-04-01

The foundation of much medical research rests on the statistical significance of the P-value, but we have fallen prey to the seductive certainty of significance. Other scientific disciplines work to a different standard. This may partly explain why medical reversal is an increasing phenomenon, whereby new studies (based on the 0.05 standard) overturn previous significant findings. This has generated a crisis in the rigour of evidence-based medicine, as many people erroneously believe that a P < 0.05 means the treatment effect is clinically important. However, statistics are not facts about the world. Nor should they be based on an arbitrary threshold that arose for historical reasons. This arbitrary threshold encourages an unthinking automatic response that contributes to industry's influence on medical research. Examples from emergency medicine practice illustrate these themes. Study replication needs to be valued as much as discovery. Careful and thoughtful unbiased thinking about the results we do have is undervalued. © 2017 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

Operator models for delivering municipal solid waste management services in developing countries. Part A: The evidence base.

PubMed

Wilson, David C; Kanjogera, Jennifer Bangirana; Soós, Reka; Briciu, Cosmin; Smith, Stephen R; Whiteman, Andrew D; Spies, Sandra; Oelz, Barbara

2017-08-01

This article presents the evidence base for 'operator models' - that is, how to deliver a sustainable service through the interaction of the 'client', 'revenue collector' and 'operator' functions - for municipal solid waste management in emerging and developing countries. The companion article addresses a selection of locally appropriate operator models. The evidence shows that no 'standard' operator model is effective in all developing countries and circumstances. Each city uses a mix of different operator models; 134 cases showed on average 2.5 models per city, each applying to different elements of municipal solid waste management - that is, street sweeping, primary collection, secondary collection, transfer, recycling, resource recovery and disposal or a combination. Operator models were analysed in detail for 28 case studies; the article summarises evidence across all elements and in more detail for waste collection. Operators fall into three main groups: The public sector, formal private sector, and micro-service providers including micro-, community-based and informal enterprises. Micro-service providers emerge as a common group; they are effective in expanding primary collection service coverage into poor- or peri-urban neighbourhoods and in delivering recycling. Both public and private sector operators can deliver effective services in the appropriate situation; what matters more is a strong client organisation responsible for municipal solid waste management within the municipality, with stable political and financial backing and capacity to manage service delivery. Revenue collection is also integral to operator models: Generally the municipality pays the operator from direct charges and/or indirect taxes, rather than the operator collecting fees directly from the service user.

Searching for a business case for quality in Medicaid managed care.

PubMed

Greene, Sandra B; Reiter, Kristin L; Kilpatrick, Kerry E; Leatherman, Sheila; Somers, Stephen A; Hamblin, Allison

2008-01-01

Despite the prevalence of evidence-based interventions to improve quality in health care systems, there is a paucity of documented evidence of a financial return on investment (ROI) for these interventions from the perspective of the investing entity. To report on a demonstration project designed to measure the business case for selected quality interventions in high-risk high-cost patient populations in 10 Medicaid managed care organizations across the United States. Using claims and enrollment data gathered over a 3-year period and data on the costs of designing, implementing, and operating the interventions, ROIs were computed for 11 discrete evidence-based quality-enhancing interventions. A complex case management program to treat adults with multiple comorbidities achieved the largest ROI of 12.21:1. This was followed by an ROI of 6.35:1 for a program which treated children with asthma with a history of high emergency room (ER) use and/or inpatient admissions for their disease. An intervention for high-risk pregnant mothers produced a 1.26:1 ROI, and a program for adult patients with diabetes resulted in a 1.16:1 return. The remaining seven interventions failed to show positive returns, although four sites came close to realizing sufficient savings to offset investment costs. Evidence-based interventions designed to improve the quality of patient care may have the best opportunity to yield a positive financial return if it is focused on high-risk high-cost populations and conditions associated with avoidable emergency and inpatient utilization. Developing the necessary tracking systems for the claims and financial investments is critical to perform accurate financial ROI analyses.

Review of 'emerging' organic contaminants in biosolids and assessment of international research priorities for the agricultural use of biosolids.

PubMed

Clarke, Bradley O; Smith, Stephen R

2011-01-01

A broad spectrum of organic chemicals is essential to modern society. Once discharged from industrial, domestic and urban sources into the urban wastewater collection system they may transfer to the residual solids during wastewater treatment and assessment of their significance and implications for beneficial recycling of the treated sewage sludge biosolids is required. Research on organic contaminants (OCs) in biosolids has been undertaken for over thirty years and the increasing body of evidence demonstrates that the majority of compounds studied do not place human health at risk when biosolids are recycled to farmland. However, there are 143,000 chemicals registered in the European Union for industrial use and all could be potentially found in biosolids. Therefore, a literature review of 'emerging' OCs in biosolids has been conducted for a selection of chemicals of potential concern for land application based upon human toxicity, evidence of adverse effects on the environment and endocrine disruption. To identify monitoring and research priorities the selected chemicals were ranked using an assessment matrix approach. Compounds were evaluated based upon environmental persistence, human toxicity, evidence of bioaccumulation in humans and the environment, evidence of ecotoxicity and the number and quality of studies focussed on the contaminant internationally. The identified chemicals of concern were ranked in decreasing order of priority: perfluorinated chemicals (PFOS, PFOA); polychlorinated alkanes (PCAs), polychlorinated naphthalenes (PCNs); organotins (OTs), polybrominated diphenyl ethers (PBDEs), triclosan (TCS), triclocarban (TCC); benzothiazoles; antibiotics and pharmaceuticals; synthetic musks; bisphenol A, quaternary ammonium compounds (QACs), steroids; phthalate acid esters (PAEs) and polydimethylsiloxanes (PDMSs). A number of issues were identified and recommendations for the prioritisation of further research and monitoring of 'emerging' OCs for the agricultural use of biosolids are provided. In particular, a number of 'emerging' OCs (PFOS, PFOA and PCAs) were identified for priority attention that are environmentally persistent and potentially toxic with unique chemical properties, or are present in large concentrations in sludge, that make it theoretically possible for them to enter human and ecological food-chains from biosolids-amended soil. Copyright © 2010 Elsevier Ltd. All rights reserved.

Treatment of maladaptive aggression in youth: CERT guidelines II. Treatments and ongoing management.

PubMed

Scotto Rosato, Nancy; Correll, Christoph U; Pappadopulos, Elizabeth; Chait, Alanna; Crystal, Stephen; Jensen, Peter S

2012-06-01

To develop guidelines for management and treatment of maladaptive aggression in youth in the areas of psychosocial interventions, medication treatments, and side-effect management. Evidence was assembled and evaluated in a multistep process, including systematic reviews of published literature; an expert survey of recommended practices; a consensus conference of researchers, policymakers, clinicians, and family advocates; and review by the steering committee of successive drafts of the recommendations. The Center for Education and Research on Mental Health Therapeutics Treatment of Maladaptive Aggression in Youth guidelines reflect a synthesis of the available evidence, based on this multistep process. This article describes the content, rationale, and evidence for 11 recommendations. Key treatment principles include considering psychosocial interventions, such as evidence-based parent and child skills training as the first line of treatment; targeting the underlying disorder first following evidence-based guidelines; considering individual psychosocial and medical factors, including cardiovascular risk in the selection of agents if medication treatment (ideally with the best evidence base) is initiated; avoiding the use of multiple psychotropic medications simultaneously; and careful monitoring of treatment response, by using structured rating scales, as well as close medical monitoring for side effects, including metabolic changes. Treatment of children with maladaptive aggression is a "moving target" requiring ongoing assimilation of new evidence as it emerges. Based on the existing evidence, the Treatment of Maladaptive Aggression in Youth guidelines provide a framework for management of maladaptive aggression in youth, appropriate for use by primary care clinicians and mental health providers.

Preliminary Evidence for the Emergence of a Health Care Online Community of Practice: Using a Netnographic Framework for Twitter Hashtag Analytics.

PubMed

Roland, Damian; Spurr, Jesse; Cabrera, Daniel

2017-07-14

Online communities of practice (oCoPs) may emerge from interactions on social media. These communities offer an open digital space and flat role hierarchy for information sharing and provide a strong group identity, rapid flow of information, content curation, and knowledge translation. To date, there is only a small body of evidence in medicine or health care to verify the existence of an oCoP. We aimed to examine the emergence of an oCoP through the study of social media interactions of the free open access medical education (FOAM) movement. We examined social media activity in Twitter by analyzing the network centrality metrics of tweets with the #FOAMed hashtag and compared them with previously validated criteria of a community of practice (CoP). The centrality analytics of the FOAM community showed concordance with aspects of a general CoP (in terms of community, domain, and practice), as well as some specific traits of a health care community, including social control, common purpose, flat hierarchy, and network-based and concrete achievement. This study demonstrated preliminary evidence of an oCoP focused on education and based on social media interactions. Further examination of the topology of the network is needed to definitely prove the existence of an oCoP. Given that these communities result in significant knowledge translation and practice change, further research in this area appears warranted. ©Damian Roland, Jesse Spurr, Daniel Cabrera. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 14.07.2017.

Evidence-Based Supplements for the Enhancement of Athletic Performance.

PubMed

Peeling, Peter; Binnie, Martyn J; Goods, Paul S R; Sim, Marc; Burke, Louise M

2018-03-01

A strong foundation in physical conditioning and sport-specific experience, in addition to a bespoke and periodized training and nutrition program, are essential for athlete development. Once these underpinning factors are accounted for, and the athlete reaches a training maturity and competition level where marginal gains determine success, a role may exist for the use of evidence-based performance supplements. However, it is important that any decisions surrounding performance supplements are made in consideration of robust information that suggests the use of a product is safe, legal, and effective. The following review focuses on the current evidence-base for a number of common (and emerging) performance supplements used in sport. The supplements discussed here are separated into three categories based on the level of evidence supporting their use for enhancing sports performance: (1) established (caffeine, creatine, nitrate, beta-alanine, bicarbonate); (2) equivocal (citrate, phosphate, carnitine); and (3) developing. Within each section, the relevant performance type, the potential mechanisms of action, and the most common protocols used in the supplement dosing schedule are summarized.

Increasing the public health impact of evidence-based interventions in behavioral medicine: new approaches and future directions.

PubMed

Buscemi, Joanna; Janke, E Amy; Kugler, Kari C; Duffecy, Jenna; Mielenz, Thelma J; St George, Sara M; Sheinfeld Gorin, Sherri N

2017-02-01

The dissemination and implementation of evidence-based behavioral medicine interventions into real world practice has been limited. The purpose of this paper is to discuss specific limitations of current behavioral medicine research within the context of the RE-AIM framework, and potential opportunities to increase public health impact by applying novel intervention designs and data collection approaches. The MOST framework has recently emerged as an alternative approach to development and evaluation that aims to optimize multicomponent behavioral and bio-behavioral interventions. SMART designs, imbedded within the MOST framework, are an approach to optimize adaptive interventions. In addition to innovative design strategies, novel data collection approaches that have the potential to improve the public-health dissemination include mHealth approaches and considering environment as a potential data source. Finally, becoming involved in advocacy via policy related work may help to improve the impact of evidence-based behavioral interventions. Innovative methods, if increasingly implemented, may have the ability to increase the public health impact of evidence-based behavioral interventions to prevent disease.

Emergency management of severe hyperkalemia: Guideline for best practice and opportunities for the future.

PubMed

Rossignol, Patrick; Legrand, Matthieu; Kosiborod, Mikhail; Hollenberg, Steven M; Peacock, W Frank; Emmett, Michael; Epstein, Murray; Kovesdy, Csaba P; Yilmaz, Mehmet Birhan; Stough, Wendy Gattis; Gayat, Etienne; Pitt, Bertram; Zannad, Faiez; Mebazaa, Alexandre

2016-11-01

Hyperkalemia is a common electrolyte disorder, especially in chronic kidney disease, diabetes mellitus, or heart failure. Hyperkalemia can lead to potentially fatal cardiac dysrhythmias, and it is associated with increased mortality. Determining whether emergency therapy is warranted is largely based on subjective clinical judgment. The Investigator Network Initiative Cardiovascular and Renal Clinical Trialists (INI-CRCT) aimed to evaluate the current knowledge pertaining to the emergency treatment of hyperkalemia. The INI-CRCT developed a treatment algorithm reflecting expert opinion of best practices in the context of current evidence, identified gaps in knowledge, and set priorities for future research. We searched PubMed (to August 4, 2015) for consensus guidelines, reviews, randomized clinical trials, and observational studies, limited to English language but not by publication date. Treatment approaches are based on small studies, anecdotal experience, and traditional practice patterns. The safety and real-world effectiveness of standard therapies remain unproven. Prospective research is needed and should include studies to better characterize the population, define the serum potassium thresholds where life-threatening arrhythmias are imminent, assess the potassium and electrocardiogram response to standard interventions. Randomized, controlled trials are needed to test the safety and efficacy of new potassium binders for the emergency treatment of severe hyperkalemia in hemodynamically stable patients. Existing emergency treatments for severe hyperkalemia are not supported by a compelling body of evidence, and they are used inconsistently across institutions, with potentially significant associated side effects. Further research is needed to fill knowledge gaps, and definitive clinical trials are needed to better define optimal management strategies, and ultimately to improve outcomes in these patients. Copyright © 2016 Elsevier Ltd. All rights reserved.

Medical education, cost and policy: what are the drivers for change? Commentary.

PubMed

Walsh, Kieran

2014-01-01

Medical education is expensive. Its expense has led many stakeholders to speculate on how costs could be reduced. In an ideal world such decisions would be made on sound evidence; however this is impossible in the absence of evidence. Sometimes practice will be informed by policy, but policy will not always be evidence based. So how is policy in the field of cost and value in medical education actually developed? The foremost influence on policy in cost and value should be evidence-based knowledge. Unfortunately policy is sometimes influenced by what might at best be termed tradition and at worst inertia. Another influence on policy will be people--but some individuals may have more influence than others. A further influence on policy in this field is events, and mainly events that have gone wrong. One final influence on emerging policy in medical education cost analysis is that of the media.

Why research-informed teaching in engineering education? A review of the evidence

NASA Astrophysics Data System (ADS)

Bubou, Gordon Monday; Offor, Ibebietei Temple; Bappa, Abubakar Saddiq

2017-05-01

Challenges of today's engineering education (EE) are emergent, necessitating calls for its reformation to empower future engineers function optimally as innovative leaders, in both local and international contexts. These challenges: keeping pace with technological dynamism; high attrition; and most importantly, quality teaching/learning require multifaceted approaches. But how can EE respond to the growing demand for relevant teaching? What can we do for engineering faculties to leverage on quality teaching? How do we embed quality teaching in EE? Scholarship of teaching and learning is advocated as one viable approach. It uses evidence-based teaching (EBT) strategies, and research-informed evidence to guide educational decisions regarding teaching and learning. We review the theories underpinning EBT, the scientific evidence on which it is based, and innovative instructional strategies that enhance active learning. Some of these issues have been discussed already, largely through developing countries lens. Nevertheless, linkages to equivalent global perspectives are presented here.

Changing Provider Behavior in the Context of Chronic Disease Management: Focus on Clinical Inertia.

PubMed

Lavoie, Kim L; Rash, Joshua A; Campbell, Tavis S

2017-01-06

Widespread acceptance of evidence-based medicine has led to the proliferation of clinical practice guidelines as the primary mode of communicating current best practices across a range of chronic diseases. Despite overwhelming evidence supporting the benefits of their use, there is a long history of poor uptake by providers. Nonadherence to clinical practice guidelines is referred to as clinical inertia and represents provider failure to initiate or intensify treatment despite a clear indication to do so. Here we review evidence for the ubiquity of clinical inertia across a variety of chronic health conditions, as well as the organizational and system, patient, and provider factors that serve to maintain it. Limitations are highlighted in the emerging literature examining interventions to reduce clinical inertia. An evidence-based framework to address these limitations is proposed that uses behavior change theory and advocates for shared decision making and enhanced guideline development and dissemination.

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

New additions to the cancer precision medicine toolkit.

PubMed

Mardis, Elaine R

2018-04-13

New computational and database-driven tools are emerging to aid in the interpretation of cancer genomic data as its use becomes more common in clinical evidence-based cancer medicine. Two such open source tools, published recently in Genome Medicine, provide important advances to address the clinical cancer genomics data interpretation bottleneck.

Emerging ecological datasets with application for modeling North American dust emissions

USDA-ARS?s Scientific Manuscript database

In 2011 the US Bureau of Land Management (BLM) established the Assessment, Inventory and Monitoring (AIM) program to monitor the condition of BLM land and to provide data to support evidence-based management of multi-use public lands. The monitoring program shares core data collection methods with t...

Making the Personal Visible: Emotion in the Nursery

ERIC Educational Resources Information Center

Davis, Belinda; Dunn, Rosemary

2018-01-01

In Birth-2 early childhood education and care (ECEC) settings, where evidence-based practices are still emerging, tensions exist about what it means to be an infant educator. While it is widely accepted that infants require responsive, supportive and care, relationships between educators and infants in early childhood settings necessarily involve…

Teaching the Prescriber's Role: The Psychology of Psychopharmacology

ERIC Educational Resources Information Center

Mintz, David L.

2005-01-01

Objective: The author examines one aspect of the psychopharmacology curriculum: the psychology of psychopharmacology. Method: Drawing from his experience teaching this subject to trainees at many different levels and from an emerging evidence base suggesting that psychosocial factors in the doctor-patient relationship may be crucial for medication…

The Limits of Mindfulness: Emerging Issues for Education

ERIC Educational Resources Information Center

Hyland, Terry

2016-01-01

Mindfulness-based interventions (MBIs) are being actively implemented in a wide range of fields--psychology, mind/body health care and education at all levels--and there is growing evidence of their effectiveness in aiding present-moment focus, fostering emotional stability, and enhancing general mind/body well-being. However, as often happens…

Examining Paraprofessional Interventions to Increase Social Communication for Young Children with ASD

ERIC Educational Resources Information Center

Mrachko, Alicia A.; Kaczmarek, Louise A.

2017-01-01

Social communication skills are considered a core deficit in children diagnosed with autism spectrum disorder (ASD). Evidence-based practices that have emerged to address these critical skills in children with ASD have largely been implemented by researchers, teachers, and parents. Only recently have researchers studied paraprofessionals as…

Making the Grade: Assessing the Evidence for Integrated Student Supports. Publication #2014-07

ERIC Educational Resources Information Center

Child Trends, 2014

2014-01-01

Integrated student supports (ISS), sometimes referred to as integrated student services, represents an emerging field of practice that aims to address persistent disparities in educational achievement and attainment. ISS is a school-based approach to promoting students' academic achievement and educational attainment by coordinating a seamless…

Personality Theory and TESOL

ERIC Educational Resources Information Center

Al Shalabi, M. Fadi; Salmani Nodoushan, Mohammad Ali

2009-01-01

In this paper, it is argued, based on evidence from psychological literature, that there are three major approaches to the study of personality, namely (1) situationism, (2) interactionism, and (3) constructivism. It is also noticed that these approaches have resulted in the emergence of three major types of personality theories: (i) type…

Personality Theory and TESOL

ERIC Educational Resources Information Center

Al Shalabi, M. Fadi; Nodoushan, Mohammad Ali Salmani

2009-01-01

In this paper, it is argued, based on evidence from psychological literature, that there are three major approaches to the study of personality, namely (a) situationism, (b) interactionism, and (c) constructivism. It is also noticed that these approached have resulted in the emergence of three major types of personality theories: (1) type…

Implementing elements of evidence-based practice into scientist-practitioner training at the University of Nebraska-Lincoln.

PubMed

DiLillo, David; McChargue, Dennis

2007-07-01

Evidence-based practice (EBP) has become the predominant model of training and is emerging as a common model of practice for many non-psychology health care professions. Recognizing the relevance of EBP to psychology, the American Psychological Association (APA) developed and endorsed an official policy statement on EBP for the practice of professional psychology. There is now a pressing need to consider ways that EBP can inform scientist-practitioner training. The present article proposes clinical competencies associated with the practice of EBP, and describes initial efforts to implement elements of EBP into training at the University of Nebraska-Lincoln. These efforts have occurred in both the classroom and practicum training experiences, and are geared toward helping students become more effective users of the evidence base through their clinical work. Challenges to the implementation of EBP in clinical psychology training are discussed as well.

VA Residential Provider Perceptions of Dissuading Factors to the Use of Two Evidence-Based PTSD Treatments

PubMed Central

Cook, Joan M.; Dinnen, Stephanie; Simiola, Vanessa; Thompson, Richard; Schnurr, Paula P.

2014-01-01

Providers (N = 198) from 38 Department of Veterans Affairs residential posttraumatic stress disorder treatment programs across the United States completed qualitative interviews regarding implementation of 2 evidence-based treatments: prolonged exposure and cognitive processing therapy. As part of this investigation, providers were asked how they decide which patients are appropriate for these treatments. Many indicated that they did not perceive any patient factors that dissuade their use of either evidence-based treatment. However, 3 broad categories emerged surrounding reasons that patients were perceived to be less suitable candidates for the treatments: the presence of psychiatric comorbidities, cognitive limitations, and low levels of patient motivation. Interestingly, providers’ perceived reasons for limited or nonuse of a treatment did not correspond entirely to those espoused by treatment developers. Possible solutions to address provider concerns, including educational and motivational interventions, are noted. PMID:25309031

Update in feline therapeutics: clinical use of 10 emerging therapies.

PubMed

Whitehouse, William; Viviano, Katrina

2015-03-01

The field of veterinary medicine is constantly evolving. New medications are being introduced into clinical practice, and novel uses for established medications are frequently being discovered as new information comes to light. Therapeutic options for our feline patients can be restricted based on inadequate clinical evidence, adverse effects and patient compliance concerns. Additionally, with the reduced availability of commonly used medications in some regions, clinicians are forced to utilize alternatives with which they may have limited experience. This review article is directed towards primary care veterinarians working with feline patients. The selection of medications discussed is based on many of the clinical challenges commonly encountered in practice. The evidence for use of some of these medications is limited due to their novelty. Known mechanisms of action, pharmacokinetic and pharmacodynamics data, adverse effects and clinical uses are reviewed where possible, with clinical recommendations made based on the evidence of data available. © ISFM and AAFP 2015.

Policies and Practices in the Delivery of HIV Services in Correctional Agencies and Facilities: Results from a Multi-Site Survey

PubMed Central

Belenko, Steven; Hiller, Matthew; Visher, Christy; Copenhaver, Michael; O’Connell, Daniel; Burdon, William; Pankow, Jennifer; Clarke, Jennifer; Oser, Carrie

2013-01-01

HIV risk is disproportionately high among incarcerated individuals. Corrections agencies have been slow to implement evidence-based guidelines and interventions for HIV prevention, testing, and treatment. The emerging field of implementation science focuses on organizational interventions to facilitate adoption and implementation of evidence-based practices. A survey of among CJ-DATS correctional agency partners revealed that HIV policies and practices in prevention, detection and medical care varied widely, with some corrections agencies and facilities closely matching national guidelines and/or implementing evidence-based interventions. Others, principally attributed to limited resources, had numerous gaps in delivery of best HIV service practices. A brief overview is provided of a new CJ-DATS cooperative research protocol, informed by the survey findings, to test an organization-level intervention to reduce HIV service delivery gaps in corrections. PMID:24078624

Emergency management of blunt chest trauma in children: an evidence-based approach.

PubMed

Pauzé, Denis R; Pauzé, Daniel K

2013-11-01

Pediatric trauma is commonly encountered in the emergency department, and trauma to the head, chest, and abdomen may be a source of significant morbidity and mortality. As children have unique thoracic anatomical and physiological properties, they may present with diagnostic challenges that the emergency clinician must be aware of. This review examines the effects of blunt trauma to the pediatric chest, as well as its relevant etiologies and associated mortality. Diagnostic and treatment options for commonly encountered injuries such as pulmonary contusions, rib fractures, and pneumothoraces are examined. Additionally, this review discusses rarely encountered--yet highly lethal--chest wall injuries such as blunt cardiac injuries, commotio cordis, nonaccidental trauma, and aortic injuries.

Vitex agnus-castus (Chaste-Tree/Berry) in the treatment of menopause-related complaints.

PubMed

van Die, Margaret Diana; Burger, Henry G; Teede, Helena J; Bone, Kerry M

2009-08-01

The origin of the current practice of administering Vitex agnus-castus in menopause-related complaints is uncertain, but appears to be relatively recent. Here we review the evidence for this application of Vitex based on evidence from pharmacological studies and clinical research. The mechanisms of potential relevance in the context of menopause are explored with reference to the current understanding of the endocrinology and neuroendocrinology of menopause and associated symptoms. We conclude that, while evidence from rigorous randomized controlled trials is lacking for the individual herb in this context, emerging pharmacological evidence supports a role for V. agnus-castus in the alleviation of menopausal symptoms and suggests that further investigation may be appropriate.

Toward a definition of teamwork in emergency medicine.

PubMed

Fernandez, Rosemarie; Kozlowski, Steve W J; Shapiro, Marc J; Salas, Eduardo

2008-11-01

The patient safety literature from the past decade emphasizes the importance of teamwork skills and human factors in preventing medical errors. Simulation has been used within aviation, the military, and now health care domains to effectively teach and assess teamwork skills. However, attempts to expand and generalize research and training principles have been limited due to a lack of a well-defined, well-researched taxonomy. As part of the 2008 Academic Emergency Medicine Consensus Conference on "The Science of Simulation in Healthcare," a subset of the group expertise and group assessment breakout sections identified evidence-based recommendations for an emergency medicine (EM) team taxonomy and performance model. This material was disseminated within the morning session and was discussed both during breakout sessions and via online messaging. Below we present a well-defined, well-described taxonomy that will help guide design, implementation, and assessment of simulation-based team training programs.

Can primary care and community-based models of emergency care substitute for the hospital accident and emergency (A & E) department?

PubMed

Roberts, E; Mays, N

1998-06-01

This systematic review assesses the extent to which primary-secondary substitution is possible in the field of emergency care where the range of options for the delivery of care is increasing in the UK and elsewhere. Thirty-four studies were located which met the review inclusion criteria, covering a range of interventions. This evidence suggested that broadening access to primary care and introducing user charges or other barriers to the hospital accident and emergency (A & E) department can reduce demand for expensive secondary care, although the relative cost-effectiveness of these interventions remains unclear. On a smaller scale, employing primary care professionals in the hospital A & E department to treat patients attending with minor illness or injury seems to be a cost-effective method of substituting primary for secondary care resources. Interventions that addressed both sides of the primary-secondary interface and recognised the importance of patient preferences in the largely demand-driven emergency service were more likely to succeed in complementing rather than duplicating existing services. The evidence on other interventions such as telephone triage, minor injuries units and general practitioner out of hours co-operatives was sparse despite the fact that these interventions are growing rapidly in the UK. Quantifying the scope for substitution in any one health system is difficult since the evidence comes from international research studies undertaken in a variety of very different health settings. Simply transferring interventions which succeed in one setting without understanding the underlying process of change is likely to result in unexpected consequences locally. Nevertheless, the review findings clearly demonstrate that shifting the balance of care is possible. It also highlights a persistent gap in professional and lay perceptions of appropriate sources of care for minor illness and injury.

An emerging evidence base for the management of neonatal hypoglycaemia.

PubMed

Harding, Jane E; Harris, Deborah L; Hegarty, Joanne E; Alsweiler, Jane M; McKinlay, Christopher Jd

2017-01-01

Neonatal hypoglycaemia is common, and screening and treatment of babies considered at risk is widespread, despite there being little reliable evidence upon which to base management decisions. Although there is now evidence about which babies are at greatest risk, the threshold for diagnosis, best approach to treatment and later outcomes all remain uncertain. Recent studies suggest that treatment with dextrose gel is safe and effective and may help support breast feeding. Thresholds for intervention require a wide margin of safety in light of information that babies with glycaemic instability and with low glucose concentrations may be associated with a higher risk of later higher order cognitive and learning problems. Randomised trials are urgently needed to inform optimal thresholds for intervention and appropriate treatment strategies. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

An Emerging Evidence Base for the Management of Neonatal Hypoglycaemia

PubMed Central

Harding, Jane E; Harris, Deborah L; Hegarty, Joanne E; Alsweiler, Jane M; McKinlay, Christopher JD

2016-01-01

Neonatal hypoglycaemia is common, and screening and treatment of babies considered at risk is widespread, despite there being little reliable evidence upon which to base management decisions. Although there is now evidence about which babies are at greatest risk, the threshold for diagnosis, best approach to treatment and later outcomes all remain uncertain. Recent studies suggest that treatment with dextrose gel is safe and effective and may help support breast feeding. Thresholds for intervention require a wide margin of safety in light of information that babies with glycaemic instability and with low glucose concentrations may be associated with a higher risk of later higher order cognitive and learning problems. Randomised trials are urgently needed to inform optimal thresholds for intervention and appropriate treatment strategies. PMID:27989586

Managing Workplace Violence With Evidence-Based Interventions: A Literature Review.

PubMed

Martinez, Angel Johann Solorzano

2016-09-01

Workplace violence in health care settings is an occupational issue concerning nurses and other health care professionals. Patient aggression against nurses is often the most common form of violence in clinical settings, occurring in emergency departments, inpatient psychiatric settings, and nursing homes. Physical and verbal assaults are the major forms of workplace violence encountered by nurses. Current research has identified staff, environmental, and patient risk factors as the major precursors of workplace violence initiated by patients. Nurses often experience significant physical and psychological negative consequences after an episode of workplace violence. A review of the evidence was conducted to identify current evidence-based interventions that can help nurses minimize the incidence of workplace violence. [Journal of Psychosocial Nursing and Mental Health Services, 54(9), 31-36.]. Copyright 2016, SLACK Incorporated.

[Ethics, empiricism and uncertainty].

PubMed

Porz, R; Zimmermann, H; Exadaktylos, A K

2011-01-01

Accidents can lead to difficult boundary situations. Such situations often take place in the emergency units. The medical team thus often and inevitably faces professional uncertainty in their decision-making. It is essential to communicate these uncertainties within the medical team, instead of downplaying or overriding existential hurdles in decision-making. Acknowledging uncertainties might lead to alert and prudent decisions. Thus uncertainty can have ethical value in treatment or withdrawal of treatment. It does not need to be covered in evidence-based arguments, especially as some singular situations of individual tragedies cannot be grasped in terms of evidence-based medicine. © Georg Thieme Verlag KG Stuttgart · New York.

Empirically Based Strategies for Preventing Juvenile Delinquency.

PubMed

Pardini, Dustin

2016-04-01

Juvenile crime is a serious public health problem that results in significant emotional and financial costs for victims and society. Using etiologic models as a guide, multiple interventions have been developed to target risk factors thought to perpetuate the emergence and persistence of delinquent behavior. Evidence suggests that the most effective interventions tend to have well-defined treatment protocols, focus on therapeutic approaches as opposed to external control techniques, and use multimodal cognitive-behavioral treatment strategies. Moving forward, there is a need to develop effective policies and procedures that promote the widespread adoption of evidence-based delinquency prevention practices across multiple settings. Copyright © 2016 Elsevier Inc. All rights reserved.

Evidence-Based Medicine: A Genealogy of the Dominant Science of Medical Education.

PubMed

Hanemaayer, Ariane

2016-12-01

Debates about how knowledge is made and valued in evidence-based medicine (EBM) have yet to understand what discursive, social, and historical conditions allowed the EBM approach to stabilize and proliferate across western medical education. This paper uses a genealogical approach to examine the epistemological tensions that emerged as a result of various problematizations of uncertainty in medical practice. I explain how the problematization of uncertainty in the literature and the contingency of specific social, political, economic, and historical relations allowed the EBM approach to become a programmatic and pedagogical focus of the Faculty of Medicine at McMaster University and beyond.

Ascertaining top evidence in emergency medicine: A modified Delphi study.

PubMed

Bazak, Stephanie J; Sherbino, Jonathan; Upadhye, Suneel; Chan, Teresa

2018-06-21

CLINICIAN'S CAPSULE What is known about the topic? EM is a specialty with a broad knowledge base making it daunting for a junior resident to know where to begin the acquisition of evidence-based knowledge. What did the study ask? What list of "top papers" was formulated in the field of EM using a national Canadian Delphi approach to achieve an expert consensus? What did the study find? A list was produced of top studies relevant for Canadian EM physicians in training. Why does this study matter to clinicians? The list produced can be used as an educational resource for junior residents.

Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. Glucagon for the treatment of symptomatic beta blocker overdose.

PubMed

Boyd, R; Ghosh, A

2003-05-01

A short cut review was carried out to establish whether the intravenous glucagon can support blood pressure in beta blocker overdose. A total of 51 papers were found using the reported search, of which six 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. A clinical bottom line is stated.

Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. Electrical stimulation and Bell's palsy.

PubMed

Buttress, Susan; Herren, Katrina

2002-09-01

A short cut review was carried out to establish whether electrical stimulation had any advantages over facial exercises in promoting recovery after Bell's palsy. Altogether 270 papers were found using the reported search, of which one 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 this best paper are tabulated. A clinical bottom line is stated.

Racial and ethnic disparities in the clinical practice of emergency medicine.

PubMed

Richardson, Lynne D; Babcock Irvin, Charlene; Tamayo-Sarver, Joshua H

2003-11-01

There is convincing evidence that racial and ethnic disparities exist in the provision of health care, including the provision of emergency care; and that stereotyping, biases, and uncertainty on the part of health care providers all contribute to unequal treatment. Situations, such as the emergency department (ED), that are characterized by time pressure, incomplete information, and high demands on attention and cognitive resources increase the likelihood that stereotypes and bias will affect diagnostic and treatment decisions. It is likely that there are many as-yet-undocumented disparities in clinical emergency practice. Racial and ethnic disparities may arise in decisions made by out-of-hospital personnel regarding ambulance destination, triage assessments made by nursing personnel, diagnostic testing ordered by physicians or physician-extenders, and in disposition decisions. The potential for disparate treatment includes the timing and intensity of ED therapy as well as patterns of referral, prescription choices, and priority for hospital admission and bed assignment. At a national roundtable discussion, strategies suggested to address these disparities included: increased use of evidence-based clinical guidelines; use of continuous quality improvement methods to document individual and institutional disparities in performance; zero tolerance for stereotypical remarks in the workplace; cultural competence training for emergency providers; increased workforce diversity; and increased epidemiologic, clinical, and services research. Careful scrutiny of the clinical practice of emergency medicine and diligent implementation of strategies to prevent disparities will be required to eliminate the individual behaviors and systemic processes that result in the delivery of disparate care in EDs.

Five-year forward view: lessons from emergency care at the extremes of age.

PubMed

Minhas, J S; Minhas, D; Coats, T; Banerjee, J; Roland, D

2018-03-01

Objective The progressive rise in demand on NHS emergency care resources is partly attributable to increases in attendances of children and older people. A quality gap exists in the care provision for the old and the young. The Five Year Forward View suggested new models of care but that the "answer is not one-size-fits-all". This article discusses the urgent need for person-centred outcome measures to bridge the gap that exists between demand and provision. Design This review is based on evidence gathered from literature searching across several platforms using a variety of search terms to account for the obvious heterogeneity, drawing on key 'think-tank' evidence. Settings Qualitative and quantitative studies examining approaches to caring for individuals at the extremes of age. Participants Individuals at the extremes of age (infants and older people). Main Outcome Measures Understanding similarities and disparities in the care of individuals at the extremes of age in an emergency and non-emergency context. Results There exists several similarities and disparities in the care of individuals at the extremes of age. The increasing burden of health disease on the economy must acknowledge the challenges that exist in managing patients in emergency settings at the extremes of age and build systems to acknowledge the traits these individuals exhibit. Conclusion Commissioners of services must optimise the models of care delivery by appreciating the similarities and differences between care requirements in these two large groups seeking emergency care.

Shoulder dystocia: management and documentation.

PubMed

Stitely, Michael L; Gherman, Robert B

2014-06-01

Shoulder dystocia is an obstetric emergency that occurs when the fetal shoulders become impacted at the pelvic inlet. Management is based on performing maneuvers to alleviate this impaction. A number of protocols and training mnemonics have been developed to assist in managing shoulder dystocia when it occurs. This article reviews the evidence regarding the performance, timing, and sequence of these maneuvers; reviews the mechanism of fetal injury in relation to shoulder dystocia; and discusses issues concerning documentation of the care provided during this obstetric emergency. Copyright © 2014 Elsevier Inc. All rights reserved.

Variability of DKA Management Among Pediatric Emergency Room and Critical Care Providers: A Call for More Evidence-Based and Cost-Effective Care?

PubMed

Clark, Matthew G; Dalabih, Abdallah

2014-09-01

Management protocols have been shown to be effective in the pediatric emergency medicine (PEM) and pediatric critical care (PCC) settings. Treatment protocols define clear goals which are achieved with consistency in implementation. Over the last decade, many new recommendations have been proposed on managing diabetic ketoacidosis (DKA). Although no perfect set of guidelines exist, many institutions are developing DKA treatment protocols. We sought to determine the variability between institutions in implementation of these protocols.

Linking research to practice: the rise of evidence-based health sciences librarianship.

PubMed

Marshall, Joanne Gard

2014-01-01

The lecture explores the origins of evidence-based practice (EBP) in health sciences librarianship beginning with examples from the work of Janet Doe and past Doe lecturers. Additional sources of evidence are used to document the rise of research and EBP as integral components of our professional work. FOUR SOURCES OF EVIDENCE ARE USED TO EXAMINE THE RISE OF EBP: (1) a publication by Doe and research-related content in past Doe lectures, (2) research-related word usage in articles in the Bulletin of the Medical Library Association and Journal of the Medical Library Association between 1961 and 2010, (3) Medical Library Association activities, and (4) EBP as an international movement. These sources of evidence confirm the rise of EBP in health sciences librarianship. International initiatives sparked the rise of evidence-based librarianship and continue to characterize the movement. This review shows the emergence of a unique form of EBP that, although inspired by evidence-based medicine (EBM), has developed its own view of evidence and its application in library and information practice. Health sciences librarians have played a key role in initiating, nurturing, and spreading EBP in other branches of our profession. Our close association with EBM set the stage for developing our own EBP. While we relied on EBM as a model for our early efforts, we can observe the continuing evolution of our own unique approach to using, creating, and applying evidence from a variety of sources to improve the quality of health information services.

Implementation of an evidence-based model of care for low back pain in emergency departments: protocol for the Sydney Health Partners Emergency Department (SHaPED) trial.

PubMed

Machado, Gustavo C; Richards, Bethan; Needs, Chris; Buchbinder, Rachelle; Harris, Ian A; Howard, Kirsten; McCaffery, Kirsten; Billot, Laurent; Edwards, James; Rogan, Eileen; Facer, Rochelle; Lord Cowell, David; Maher, Chris G

2018-04-19

Patients with low back pain often seek care in emergency departments, but the problem is that many patients receive unnecessary or ineffective interventions and at the same time miss out on the basics of care, such as advice on self-management. This pattern of care has important consequences for the healthcare system (expensive and inefficient) and for patients (poor health outcomes). We hypothesised that the implementation of an evidence-based model of care for low back pain will improve emergency care by reducing inappropriate overuse of tests and treatments and improving patient outcomes. A stepped-wedge cluster randomised controlled trial will be conducted to implement and evaluate the use of the Agency for Clinical Innovation (ACI) model of care for acute low back pain at four emergency departments in New South Wales, Australia. Clinician participants will be emergency physicians, nurses and physiotherapists. Codes from the Systematised Nomenclature of Medicine-Clinical Terms-Australian version will be used to identify low back pain presentations. The intervention, targeting emergency clinicians, will comprise educational materials and seminars and an audit and feedback approach. Health service delivery outcomes are routinely collected measures of imaging (primary outcome), opioid use and inpatient admission. A random subsample of 200 patient participants from each trial period will be included to measure patient outcomes (pain intensity, physical function, quality of life and experience with emergency service). The effectiveness of the intervention will be assessed by comparing the postintervention period with the retrospective baseline control period. The study received ethical approval from the Sydney Local Health District (Royal Prince Alfred Hospital zone) Ethics Committee (X17-0043). The results of this study will be published in peer-reviewed journals and presented at international conferences. Australia New Zealand Clinical Trials Registry: ACTRN 12617001160325. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Understanding practice: the factors that influence management of mild traumatic brain injury in the emergency department--a qualitative study using the Theoretical Domains Framework.

PubMed

Tavender, Emma J; Bosch, Marije; Gruen, Russell L; Green, Sally E; Knott, Jonathan; Francis, Jill J; Michie, Susan; O'Connor, Denise A

2014-01-13

Mild traumatic brain injury is a frequent cause of presentation to emergency departments. Despite the availability of clinical practice guidelines in this area, there is variation in practice. One of the aims of the Neurotrauma Evidence Translation program is to develop and evaluate a targeted, theory- and evidence-informed intervention to improve the management of mild traumatic brain injury in Australian emergency departments. This study is the first step in the intervention development process and uses the Theoretical Domains Framework to explore the factors perceived to influence the uptake of four key evidence-based recommended practices for managing mild traumatic brain injury. Semi-structured interviews were conducted with emergency staff in the Australian state of Victoria. The interview guide was developed using the Theoretical Domains Framework to explore current practice and to identify the factors perceived to influence practice. Two researchers coded the interview transcripts using thematic content analysis. A total of 42 participants (9 Directors, 20 doctors and 13 nurses) were interviewed over a seven-month period. The results suggested that (i) the prospective assessment of post-traumatic amnesia was influenced by: knowledge; beliefs about consequences; environmental context and resources; skills; social/professional role and identity; and beliefs about capabilities; (ii) the use of guideline-developed criteria or decision rules to inform the appropriate use of a CT scan was influenced by: knowledge; beliefs about consequences; environmental context and resources; memory, attention and decision processes; beliefs about capabilities; social influences; skills and behavioral regulation; (iii) providing verbal and written patient information on discharge was influenced by: beliefs about consequences; environmental context and resources; memory, attention and decision processes; social/professional role and identity; and knowledge; (iv) the practice of providing brief, routine follow-up on discharge was influenced by: environmental context and resources; social/professional role and identity; knowledge; beliefs about consequences; and motivation and goals. Using the Theoretical Domains Framework, factors thought to influence the management of mild traumatic brain injury in the emergency department were identified. These factors present theoretically based targets for a future intervention.

Achievements and Limitations of Evidence-Based Medicine.

PubMed

Sheridan, Desmond J; Julian, Desmond G

2016-07-12

Evidence-based medicine (EBM) has a long history, but was revived in the early 1990s by a campaign mounted by a movement that took its name. The EBM movement focused attention on the need for greater objectivity in medical decision-making and led to the Cochrane Collaboration, which provides reviews of evidence on the basis of comparative research. Important limitations of EBM's effect on medicine have also emerged. Failure to acknowledge the limitations of clinical trials and systematic reviews has limited their applicability to individual patients' circumstances. An almost exclusive focus on drugs and devices has left vast areas of health care in an evidence vacuum. An overdependence on commissions for its research may have limited its independence in selecting what it investigates. EBM needs to widen its scope beyond drugs and devices to address many areas that often lack evidence at present, notably, health policy, management, and reforms. Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

A Research Agenda to Assure Equity During Periods of Emergency Department Crowding

PubMed Central

Hwang, Ula; Weber, Ellen J.; Richardson, Lynne D.; Sweet, Vicki; Todd, Knox; Abraham, Gallane; Ankel, Felix

2012-01-01

The effect of emergency department (ED) crowding on equitable care is the least studied of the domains of quality as defined by the Institute of Medicine (IOM). Inequities in access and treatment throughout the health care system are well documented in all fields of medicine. While there is little evidence demonstrating that inequity is worsened by crowding, theory and evidence from social science disciplines, as well as known barriers to care for vulnerable populations, would suggest that crowding will worsen inequities. To design successful interventions, however, it is important to first understand how crowding can result in disparities and base interventions on these mechanisms. A research agenda is proposed to understand mechanisms that may threaten equity during periods of crowding and design and test potential interventions that may ensure the equitable aspect of quality of care. PMID:22168197

Mechanical Ventilation in Acute Hypoxemic Respiratory Failure: A Review of New Strategies for the Practicing Hospitalist

PubMed Central

Wilson, Jennifer G.; Matthay, Michael A.

2014-01-01

BACKGROUND The goal of mechanical ventilation in acute hypoxemic respiratory failure is to support adequate gas exchange without harming the lungs. How patients are mechanically ventilated can significantly impact their ultimate outcomes. METHODS This review focuses on emerging evidence regarding strategies for mechanical ventilation in patients with acute hypoxemic respiratory failure including: low tidal volume ventilation in the acute respiratory distress syndrome (ARDS), novel ventilator modes as alternatives to low tidal volume ventilation, adjunctive strategies that may enhance recovery in ARDS, the use of lung-protective strategies in patients without ARDS, rescue therapies in refractory hypoxemia, and an evidence-based approach to weaning from mechanical ventilation. RESULTS Once a patient is intubated and mechanically ventilated, low tidal volume ventilation remains the best strategy in ARDS. Adjunctive therapies in ARDS include a conservative fluid management strategy, as well as neuromuscular blockade and prone positioning in moderate-to-severe disease. There is also emerging evidence that a lung-protective strategy may benefit non-ARDS patients. For patients with refractory hypoxemia, extracorporeal membrane oxygenation should be considered. Once the patient demonstrates signs of recovery, the best approach to liberation from mechanical ventilation involves daily spontaneous breathing trials and protocolized assessment of readiness for extubation. CONCLUSIONS Prompt recognition of ARDS and use of lung-protective ventilation, as well as evidence-based adjunctive therapies, remain the cornerstones of caring for patients with acute hypoxemic respiratory failure. In the absence of contraindications, it is reasonable to consider lung-protective ventilation in non-ARDS patients as well, though the evidence supporting this practice is less conclusive. PMID:24733692

Nucleotide synthetase ribozymes may have emerged first in the RNA world

PubMed Central

Ma, Wentao; Yu, Chunwu; Zhang, Wentao; Hu, Jiming

2007-01-01

Though the “RNA world” hypothesis has gained a central role in ideas concerning the origin of life, the scenario concerning its emergence remains uncertain. It has been speculated that the first scene may have been the emergence of a template-dependent RNA synthetase ribozyme, which catalyzed its own replication: thus, “RNA replicase.” However, the speculation remains uncertain, primarily because of the large sequence length requirement of such a replicase and the lack of a convincing mechanism to ensure its self-favoring features. Instead, we propose a nucleotide synthetase ribozyme as an alternative candidate, especially considering recent experimental evidence suggesting the possibility of effective nonenzymatic template-directed synthesis of RNA. A computer simulation was conducted to support our proposal. The conditions for the emergence of the nucleotide synthetase ribozyme are discussed, based on dynamic analysis on a computer. We suggest the template-dependent RNA synthetase ribozyme emerged later, perhaps after the emergence of protocells. PMID:17878321

Emerging Regenerative Approaches for Periodontal Reconstruction: Practical Applications From the AAP Regeneration Workshop

PubMed Central

Rios, Hector F.; Bashutski, Jill D.; McAllister, Bradley S.; Murakami, Shinya; Cobb, Charles M.; Chun, Yong-Hee Patricia; Lin, Zhao; Mandelaris, George A.; Cochran, David L.

2015-01-01

Focused Clinical Question Can emerging technologies for periodontal regeneration become clinical reality? Summary Emerging technologies are presenting options to hopefully improve the outcomes of regeneration in challenging clinical scenarios. Cellular allografts represent a current technology in which cells and scaffolds are being delivered directly to the periodontal lesion. Recombinant human fibroblast growth factor 2 and teriparatide (parathyroid 1–34) have each been tested in controlled prospective human randomized clinical trials, and both have been shown to have potential for periodontal regeneration. These examples, as well as other emerging technologies, show promise for continued advancement in the field of periodontal regenerative therapy. Conclusions At present, there are indications that emerging technologies can be used successfully for periodontal regeneration. Case reports and clinical trials are being conducted with a variety of emerging technologies. However, many are yet to be approved by a regulatory agency, or there is a lack of evidence-based literature to validate their expanded use. PMID:26146593

Perioperative antibiotic prophylaxis in the treatment of acute cholecystitis (PEANUTS II trial): study protocol for a randomized controlled trial.

PubMed

Loozen, Charlotte S; van Santvoort, Hjalmar C; van Geloven, Antoinette A W; Nieuwenhuijzen, Grard A P; de Reuver, Philip R; Besselink, Mark H G; Vlaminckx, Bart; Kelder, Johannes C; Knibbe, Catherijne A J; Boerma, Djamila

2017-08-23

The additional value of perioperative antibiotic prophylaxis in preventing infectious complications after emergency cholecystectomy for acute cholecystitis is a much-debated subject in the surgical community. Evidence-based guidelines are lacking, and consequently the use of antibiotic prophylaxis varies greatly among surgeons and hospitals. Recently, high-level evidence became available demonstrating that postoperative antibiotic prophylaxis in patients with acute cholecystitis does not reduce the risk of infectious complications. Preoperative antibiotic prophylaxis in relation to the risk of infectious complications, however, has never been studied. The PEANUTS II trial is a randomized, controlled, multicenter, open-label noninferiority trial whose aim is to determine the utility of preoperative antibiotic prophylaxis in patients undergoing emergency cholecystectomy for acute calculous cholecystitis. Patients with mild or moderate acute cholecystitis, as defined according the Tokyo Guidelines, will be randomly assigned to a single preoperative dose of antibiotic prophylaxis (2000 mg of first-generation cephalosporin delivered intravenously) or no antibiotic prophylaxis before emergency cholecystectomy. The primary endpoint is a composite endpoint consisting of all postoperative infectious complications occurring during the first 30 days after surgery. Secondary endpoints include all the individual components of the primary endpoint, all other complications, duration of hospital stay, and total costs. The hypothesis is that the absence of antibiotic prophylaxis is noninferior to the presence of antibiotic prophylaxis. A noninferiority margin of 10% is assumed. With a 1-sided risk of 2.5% and a power of 80%, a total of 454 subjects will have to be included. Analysis will be performed according to the intention-to-treat principle. The PEANUTS II trial will provide evidence-based advice concerning the utility of antibiotic prophylaxis in patients undergoing emergency cholecystectomy for acute calculous cholecystitis. Netherlands Trial Register, NTR5802 . Registered on 4 June 2016.

Translating the evidence for emergency equipment and supplies into practice among healthcare providers in a tertiary mental health institution: a best practice implementation project.

PubMed

Lu, Qiufen; Ng, Hui Chin; Xie, Huiting

2015-05-15

In the mental health care setting, patients are more vulnerable to choking and the risk of cardiac and respiratory problems due to behavioral problems and use of rapid tranquilization. Poorly maintained, incomplete or damaged equipment in emergency trolleys have previously been documented in various articles as a major contributing factor to deaths and delayed response to resuscitation attempts. This project aimed to examine the current practices for managing emergency equipment. An evidence implementation project was undertaken by utilizing the Joanna Briggs Institute's Practical Application of Clinical Evidence System and Getting Research Into Practice programs. Pre- and post-implementation audits were conducted in a mental health institution over 25 months. Strategies were implemented between audits to enhance adoption of the best available evidence regarding the checking and maintenance of emergency equipment. The baseline audit data showed that adherence was lowest in ensuring the functional status of emergency equipment (53%), followed by conducting regular checks for functional status, using inventory, and documenting these checks (60%). In line with the Getting Research Into Practice module, barriers such as the lack of knowledge and skills regarding emergency equipment were addressed with town hall meetings, code blue drills and education sessions. Follow-up audit results showed improvement in all areas. The greatest improvement was in documentation of emergency equipment checks, which improved by 18%, from 80% to 98%. Audits enabled the timely identification of potential lapses in the management of emergency equipment so that the barriers could be addressed, and strategies in line with the best available evidence regarding the checking and maintenance of emergency equipment were adopted. The Joanna Briggs Institute.

Training Psychiatry Residents in Psychotherapy: The Role of Manualized Treatments.

PubMed

Pagano, Joshua; Kyle, Brandon N; Johnson, Toni L; Saeed, Sy Atezaz

2017-06-01

Evidence-based treatment and manualized psychotherapy have a recent but rich history. As interest and research have progressed, defining the role of treatment manuals in resident training and clinical practice has become more important. Although there is not a universal definition of treatment manual, most clinicians and researchers agree that treatment manuals are an essential piece of evidence-based therapy, and that despite several limitations, they offer advantages in training residents in psychotherapy. Requirements for resident training in psychotherapy have changed over the years, and treatment manuals offer a simple and straightforward way to meet training requirements. In a search limited to only depression, two treatment manuals emerged with the support of research regarding both clinical practice and resident training. In looking toward the future, it will be important for clinicians to remain updated on further advances in evidence based manualized treatment as a tool for training residents in psychotherapy, including recent developments in online and smartphone based treatments.

Where Does Human Plague Still Persist in Latin America?

PubMed Central

Schneider, Maria Cristina; Najera, Patricia; Aldighieri, Sylvain; Galan, Deise I.; Bertherat, Eric; Ruiz, Alfonso; Dumit, Elsy; Gabastou, Jean Marc; Espinal, Marcos A.

2014-01-01

Background Plague is an epidemic-prone disease with a potential impact on public health, international trade, and tourism. It may emerge and re-emerge after decades of epidemiological silence. Today, in Latin America, human cases and foci are present in Bolivia, Brazil, Ecuador, and Peru. Aims The objective of this study is to identify where cases of human plague still persist in Latin America and map areas that may be at risk for emergence or re-emergence. This analysis will provide evidence-based information for countries to prioritize areas for intervention. Methods Evidence of the presence of plague was demonstrated using existing official information from WHO, PAHO, and Ministries of Health. A geo-referenced database was created to map the historical presence of plague by country between the first registered case in 1899 and 2012. Areas where plague still persists were mapped at the second level of the political/administrative divisions (counties). Selected demographic, socioeconomic, and environmental variables were described. Results Plague was found to be present for one or more years in 14 out of 25 countries in Latin America (1899–2012). Foci persisted in six countries, two of which have no report of current cases. There is evidence that human cases of plague still persist in 18 counties. Demographic and poverty patterns were observed in 11/18 counties. Four types of biomes are most commonly found. 12/18 have an average altitude higher than 1,300 meters above sea level. Discussion Even though human plague cases are very localized, the risk is present, and unexpected outbreaks could occur. Countries need to make the final push to eliminate plague as a public health problem for the Americas. A further disaggregated risk evaluation is recommended, including identification of foci and possible interactions among areas where plague could emerge or re-emerge. A closer geographical approach and environmental characterization are suggested. PMID:24516682

Where does human plague still persist in Latin America?

PubMed

Schneider, Maria Cristina; Najera, Patricia; Aldighieri, Sylvain; Galan, Deise I; Bertherat, Eric; Ruiz, Alfonso; Dumit, Elsy; Gabastou, Jean Marc; Espinal, Marcos A

2014-02-01

Plague is an epidemic-prone disease with a potential impact on public health, international trade, and tourism. It may emerge and re-emerge after decades of epidemiological silence. Today, in Latin America, human cases and foci are present in Bolivia, Brazil, Ecuador, and Peru. The objective of this study is to identify where cases of human plague still persist in Latin America and map areas that may be at risk for emergence or re-emergence. This analysis will provide evidence-based information for countries to prioritize areas for intervention. Evidence of the presence of plague was demonstrated using existing official information from WHO, PAHO, and Ministries of Health. A geo-referenced database was created to map the historical presence of plague by country between the first registered case in 1899 and 2012. Areas where plague still persists were mapped at the second level of the political/administrative divisions (counties). Selected demographic, socioeconomic, and environmental variables were described. Plague was found to be present for one or more years in 14 out of 25 countries in Latin America (1899-2012). Foci persisted in six countries, two of which have no report of current cases. There is evidence that human cases of plague still persist in 18 counties. Demographic and poverty patterns were observed in 11/18 counties. Four types of biomes are most commonly found. 12/18 have an average altitude higher than 1,300 meters above sea level. Even though human plague cases are very localized, the risk is present, and unexpected outbreaks could occur. Countries need to make the final push to eliminate plague as a public health problem for the Americas. A further disaggregated risk evaluation is recommended, including identification of foci and possible interactions among areas where plague could emerge or re-emerge. A closer geographical approach and environmental characterization are suggested.

A Developmental Neuroscience Approach to the Search for Biomarkers in Autism Spectrum Disorder

PubMed Central

Varcin, Kandice J.; Nelson, Charles A.

2016-01-01

Purpose of review The delineation of biomarkers in autism spectrum disorder (ASD) offers a promising approach to inform precision-medicine based approaches to ASD diagnosis and treatment and to move toward a mechanistic description of the disorder. However, biomarkers with sufficient sensitivity or specificity for clinical application in ASD are yet to be realized. Here, we review recent evidence for early, low-level alterations in brain and behavior development that may offer promising avenues for biomarker development in ASD. Recent findings Accumulating evidence suggests that signs associated with ASD may unfold in a manner that maps onto the hierarchical organization of brain development. Genetic and neuroimaging evidence points towards perturbations in brain development early in life, and emerging evidence indicates that sensorimotor development may be amongst the earliest emerging signs associated with ASD, preceding social and cognitive impairment. Summary The search for biomarkers of risk, prediction and stratification in ASD may be advanced through a developmental neuroscience approach that looks outside of the core signs of ASD and considers the bottom-up nature of brain development alongside the dynamic nature of development over time. We provide examples of assays that could be incorporated in studies to target low-level circuits. PMID:26953849

China-Africa Health Development Initiatives: Benefits and Implications for Shaping Innovative and Evidence-informed National Health Policies and Programs in Sub-saharan African Countries

PubMed Central

Tambo, Ernest; Ugwu, Chidiebere E.; Guan, Yayi; Wei, Ding; Xiao-Ning; Xiao-Nong, Zhou

2016-01-01

Background and Introduction: This review paper examines the growing implications of China’s engagement in shaping innovative national initiatives against infectious diseases and poverty control and elimination in African countries. It seeks to understand the factors and enhancers that can promote mutual and innovative health development initiatives, and those that are necessary in generating reliable and quality data for evidence-based contextual policy, priorities and programs. Methods: We examined the China-Africa health cooperation in supporting global health agenda on infectious diseases such as malaria, schistosomiasis, Ebola, TB, HIV/AIDS, neglected tropical diseases (NTDs) prevention, control and elimination spanning a period of 10 years. We reviewed referenced publications, global support data, and extensive sources related to and other emerging epidemics and infectious diseases of poverty, programs and interventions, health systems development issues, challenges, opportunities and investments. Published literature in PubMed, Scopus, Google Scholar, Books and web-based peer-reviewed journal articles, government annual reports were assessed from the first Forum on China-Africa Cooperation (FOCAC) in November 2006 to December 2015 Third Ministerial conferences. Results: Our findings highlight current shared public health challenges and emphasize the need to nurture, develop and establish effective, functional and sustainable health systems capacity to detect and respond to all public health threats and epidemic burdens, evidence-based programs and quality care outcomes. China’s significant health diplomacy emphasizes the importance of health financing in establishing health development commitment and investment in improving the gains and opportunities, importantly efficiency and value health priorities and planning. Conclusions and Global Health Implications: Strengthening China-Africa health development agenda towards collective commitment and investment in quality care delivery, effective programs coverage and efficiency, preparedness and emergency response is needed in transforming African health information systems, and local health governance structures and management in emerging epidemics. Furthermore, innovative evidence of operational joint solutions and strategies are critical in advancing healthcare delivery, and further enhancing Universal Health Care, and Sustainable Development Goals to attain global health improvements and economic prosperity. PMID:28058199

Knowledge Translation Tools are Emerging to Move Neck Pain Research into Practice.

PubMed

Macdermid, Joy C; Miller, Jordan; Gross, Anita R

2013-01-01

Development or synthesis of the best clinical research is in itself insufficient to change practice. Knowledge translation (KT) is an emerging field focused on moving knowledge into practice, which is a non-linear, dynamic process that involves knowledge synthesis, transfer, adoption, implementation, and sustained use. Successful implementation requires using KT strategies based on theory, evidence, and best practice, including tools and processes that engage knowledge developers and knowledge users. Tools can provide instrumental help in implementing evidence. A variety of theoretical frameworks underlie KT and provide guidance on how tools should be developed or implemented. A taxonomy that outlines different purposes for engaging in KT and target audiences can also be useful in developing or implementing tools. Theoretical frameworks that underlie KT typically take different perspectives on KT with differential focus on the characteristics of the knowledge, knowledge users, context/environment, or the cognitive and social processes that are involved in change. Knowledge users include consumers, clinicians, and policymakers. A variety of KT tools have supporting evidence, including: clinical practice guidelines, patient decision aids, and evidence summaries or toolkits. Exemplars are provided of two KT tools to implement best practice in management of neck pain-a clinician implementation guide (toolkit) and a patient decision aid. KT frameworks, taxonomies, clinical expertise, and evidence must be integrated to develop clinical tools that implement best evidence in the management of neck pain.

Evidence-informed primary health care workforce policy: are we asking the right questions?

PubMed

Naccarella, Lucio; Buchan, Jim; Brooks, Peter

2010-01-01

Australia is facing a primary health care workforce shortage. To inform primary health care (PHC) workforce policy reforms, reflection is required on ways to strengthen the evidence base and its uptake into policy making. In 2008 the Australian Primary Health Care Research Institute funded the Australian Health Workforce Institute to host Professor James Buchan, Queen Margaret University, UK, an expert in health services policy research and health workforce planning. Professor Buchan's visit enabled over forty Australian PHC workforce mid-career and senior researchers and policy stakeholders to be involved in roundtable policy dialogue on issues influencing PHC workforce policy making. Six key thematic questions emerged. (1) What makes PHC workforce planning different? (2) Why does the PHC workforce need to be viewed in a global context? (3) What is the capacity of PHC workforce research? (4) What policy levers exist for PHC workforce planning? (5) What principles can guide PHC workforce planning? (6) What incentives exist to optimise the use of evidence in policy making? The emerging themes need to be discussed within the context of current PHC workforce policy reforms, which are focussed on increasing workforce supply (via education/training programs), changing the skill mix and extending the roles of health workers to meet patient needs. With the Australian government seeking to reform and strengthen the PHC workforce, key questions remain about ways to strengthen the PHC workforce evidence base and its uptake into PHC workforce policy making.

Translating Evidence Into Practice via Social Media: A Mixed-Methods Study.

PubMed

Maloney, Stephen; Tunnecliff, Jacqueline; Morgan, Prue; Gaida, Jamie E; Clearihan, Lyn; Sadasivan, Sivalal; Davies, David; Ganesh, Shankar; Mohanty, Patitapaban; Weiner, John; Reynolds, John; Ilic, Dragan

2015-10-26

Approximately 80% of research evidence relevant to clinical practice never reaches the clinicians delivering patient care. A key barrier for the translation of evidence into practice is the limited time and skills clinicians have to find and appraise emerging evidence. Social media may provide a bridge between health researchers and health service providers. The aim of this study was to determine the efficacy of social media as an educational medium to effectively translate emerging research evidence into clinical practice. The study used a mixed-methods approach. Evidence-based practice points were delivered via social media platforms. The primary outcomes of attitude, knowledge, and behavior change were assessed using a preintervention/postintervention evaluation, with qualitative data gathered to contextualize the findings. Data were obtained from 317 clinicians from multiple health disciplines, predominantly from the United Kingdom, Australia, the United States, India, and Malaysia. The participants reported an overall improvement in attitudes toward social media for professional development (P<.001). The knowledge evaluation demonstrated a significant increase in knowledge after the training (P<.001). The majority of respondents (136/194, 70.1%) indicated that the education they had received via social media had changed the way they practice, or intended to practice. Similarly, a large proportion of respondents (135/193, 69.9%) indicated that the education they had received via social media had increased their use of research evidence within their clinical practice. Social media may be an effective educational medium for improving knowledge of health professionals, fostering their use of research evidence, and changing their clinical behaviors by translating new research evidence into clinical practice.

A systematic review of team-building interventions in non-acute healthcare settings.

PubMed

Miller, Christopher J; Kim, Bo; Silverman, Allie; Bauer, Mark S

2018-03-01

Healthcare is increasingly delivered in a team-based format emphasizing interdisciplinary coordination. While recent reviews have investigated team-building interventions primarily in acute healthcare settings (e.g. emergency or surgery departments), we aimed to systematically review the evidence base for team-building interventions in non-acute settings (e.g. primary care or rehabilitation clinics). We conducted a systematic review in PubMed and Embase to identify team-building interventions, and conducted follow-up literature searches to identify articles describing empirical studies of those interventions. This process identified 14 team-building interventions for non-acute healthcare settings, and 25 manuscripts describing empirical studies of these interventions. We evaluated outcomes in four domains: trainee evaluations, teamwork attitudes/knowledge, team functioning, and patient impact. Trainee evaluations for team-building interventions were generally positive, but only one study associated team-building with statistically significant improvement in teamwork attitudes/knowledge. Similarly mixed results emerged for team functioning and patient impact. The evidence base for healthcare team-building interventions in non-acute healthcare settings is much less developed than the parallel literature for short-term team function in acute care settings. Only one intervention we identified has been tested in multiple non-acute settings by distinct research teams. Positive findings regarding the utility of team-building interventions are tempered by a lack of control conditions, inconsistency in outcome measures, and high probability of bias. Considering these results alongside the well-recognized costs of poor healthcare teamwork suggests that additional research is sorely needed to develop the evidence base for team-building in non-acute settings.

78 FR 75923 - Advisory Committee on Breast Cancer in Young Women (ACBCYW)

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-13

... Committee on Breast Cancer in Young Women (ACBCYW) In accordance with section 10(a)(2) of the Federal... evaluation of evidence-based activities designed to prevent breast cancer (particularly among those at... include discussions on the current and emerging topics related to breast cancer in young women. These may...

Implementing the Flipped Classroom in Teacher Education: Evidence from Turkey

ERIC Educational Resources Information Center

Kurt, Gökçe

2017-01-01

The flipped classroom, a form of blended learning, is an emerging instructional strategy reversing a traditional lecture-based teaching model to improve the quality and efficiency of the teaching and learning process. The present article reports a study that focused on the implementation of the flipped approach in a higher education institution in…

An Evidence-Based Environmental Perspective Of Manufactured Silver Nanoparticle In Syntheses And Applications: A Systematic Review And Critical Appraisal Of Peer-Reviewed Scientific Papers

EPA Science Inventory

Most recently, renewed interest has arisen in manufactured silver nanoparticles because of their unusually enhanced physiochemical properties and biological activities compared to the bulk parent materials. A wide range of applications has emerged in consumer products ranging fr...

Codeswitching Techniques: Evidence-Based Instructional Practices for the ASL/English Bilingual Classroom

ERIC Educational Resources Information Center

Andrews, Jean F.; Rusher, Melissa

2010-01-01

The authors present a perspective on emerging bilingual deaf students who are exposed to, learning, and developing two languages--American Sign Language (ASL) and English (spoken English, manually coded English, and English reading and writing). The authors suggest that though deaf children may lack proficiency or fluency in either language during…

Antidoping Education Using a Lifelong Situated Activity-Based Approach: Evidence, Conception, and Challenges

ERIC Educational Resources Information Center

Hauw, Denis

2017-01-01

Studies have shown that doping behavior emerges from contexts. Educational research would therefore be enriched by explorations of the situatedness of athletes' activity and its dynamics of development inside sporting life courses. The principles can be summarized as (a) the connection between antidoping and athletes' time-specific and meaningful…

Special Report: Rhetorical Criticism: The State of the Art.

ERIC Educational Resources Information Center

Leff, Michael C., Ed.

1980-01-01

The seven articles in this journal issue survey and assess the art of rhetorical criticism based on evidence derived from critical practice. The first five articles analyze the literature subsumed with certain approaches to rhetorical criticism and are arranged in the chronological order of the emergence of the approach: neo-classical criticism,…

A Scientific Framework for Social Work Doctoral Education in the 21st Century

ERIC Educational Resources Information Center

Guerrero, Erick G.; Moore, Hadass; Pitt-Catsouphes, Marcie

2018-01-01

The emerging discourse about the science of social work has urged doctoral social work programs to reexamine assumptions about conducting research and responding to new expectations for scholarship. This article examines three promising models to guide scientific research in social work (evidence-based practice, team science, and multi- and…

New Beginnings: Using Federal Title I Funds to Support Local Pre-K Efforts. Federal Policy Series

ERIC Educational Resources Information Center

Gayl, Chrisanne L.; Young, Marci; Patterson, Kathy

2009-01-01

High-quality, voluntary pre-kindergarten has emerged as an important policy to improve the nation's education system. Based on strong evidence from rigorous longitudinal research and recent program evaluations, reform-minded principals, superintendents, school board members and other leaders have embraced early education as an effective strategy…

Evidence-Based Leadership Development: The 4L Framework

ERIC Educational Resources Information Center

Scott, Shelleyann; Webber, Charles F.

2008-01-01

Purpose: This paper aims to use the results of three research initiatives to present the life-long learning leader 4L framework, a model for leadership development intended for use by designers and providers of leadership development programming. Design/methodology/approach: The 4L model is a conceptual framework that emerged from the analysis of…

Online Continuing Education for Health Professionals: Does Sticky Design Promote Practice-Relevance?

ERIC Educational Resources Information Center

Zaghab, Roxanne Ward; Maldonado, Carlos; Whitehead, Dongsook; Bartlett, Felicia; de Bittner, Magaly Rodriguez

2015-01-01

Online continuing education (CE) holds promise as an effective method for rapid dissemination of emerging evidence-based practices in health care. Yet, the field of CE continues to develop and delivery is predominately face-to-face programs. Practice-oriented online educational methods and e-learning platforms are not fully utilized. Educational…

Treatment of Children with Speech Oral Placement Disorders (OPDs): A Paradigm Emerges

ERIC Educational Resources Information Center

Bahr, Diane; Rosenfeld-Johnson, Sara

2010-01-01

Epidemiological research was used to develop the Speech Disorders Classification System (SDCS). The SDCS is an important speech diagnostic paradigm in the field of speech-language pathology. This paradigm could be expanded and refined to also address treatment while meeting the standards of evidence-based practice. The article assists that process…

Describing an Academic and Nonprofit Organization Partnership to Educate At-Risk Adolescents about Cardiovascular Health

ERIC Educational Resources Information Center

Palazzo, Steven J.; Skager, Cherie; Kraiger, Anneliese

2014-01-01

There is emerging evidence to suggest community-based interventions can change community-wide behaviors and attitudes toward cardiovascular health. This article describes a partnership between an academic institution and a community nonprofit organization to develop and implement a cardiovascular health promotion program targeting at risk high…

Literacy Training for Early Childhood Providers: Changes in Knowledge, Beliefs, and Instructional Practices

ERIC Educational Resources Information Center

Armstrong, Kathleen; Cusumano, Dale Lynn; Todd, Melissa; Cohen, Rachel

2008-01-01

While it is clear that reading is critical to children's success throughout schooling and reading instruction research has dramatically increased over the past 2 decades, few early childhood providers have the necessary knowledge, skills and/or confidence to effectively implement evidence-based, emergent literacy strategies in their settings. This…

The Technological Barriers of Using Video Modeling in the Classroom

ERIC Educational Resources Information Center

Marino, Desha; Myck-Wayne, Janice

2015-01-01

The purpose of this investigation is to identify the technological barriers teachers encounter when attempting to implement video modeling in the classroom. Video modeling is an emerging evidence-based intervention method used with individuals with autism. Research has shown the positive effects video modeling can have on its recipients. Educators…

The Effects of a Team Charter on Student Team Behaviors

ERIC Educational Resources Information Center

Aaron, Joshua R.; McDowell, William C.; Herdman, Andrew O.

2014-01-01

The authors contribute to growing evidence that team charters contribute positively to performance by empirically testing their effects on key team process outcomes. Using a sample of business students in a team-based task requiring significant cooperative and coordinative behavior, the authors compare emergent team norms under a variety of team…

Additive, Multi-Component Treatment of Emerging Refusal Topographies in a Pediatric Feeding Disorder

ERIC Educational Resources Information Center

Sharp, William G.; Jaquess, David L.; Bogard, Jennifer D.; Morton, Jane F.

2010-01-01

This case study describes inter-disciplinary treatment of chronic food refusal and tube dependency in a 2-year-old female with a pediatric feeding disorder. Evidence-based behavioral components--including escape extinction (EE), differential reinforcement of alterative mealtime behavior (DRA), and stimulus fading--were introduced sequentially as…

Knowledge to Manage the Knowledge Society

ERIC Educational Resources Information Center

Minati, Gianfranco

2012-01-01

Purpose: The purpose of this research is to make evident the inadequateness of concepts and language based on industrial knowledge still used in current practices by managers to cope with problems of the post-industrial societies characterised by non-linear process of emergence and acquisition of properties. The purpose is to allow management to…

Pivotal Response Treatment for Children with Autism: Core Principles and Applications for School Psychologists

ERIC Educational Resources Information Center

Renshaw, Tyler L.; Kuriakose, Sarah

2011-01-01

During the past 2 decades, pivotal response treatment (PRT) has emerged as an evidence-based methodology for intervening with the behavioral, communicative, social, and academic impairments of children with autism. Unlike other highly structured behavioral interventions for autism, PRT emphasizes principles over procedures and focuses on enhancing…

An Agent-Based Model for the Role of Short-Term Memory Enhancement in the Emergence of Grammatical Agreement.

PubMed

Vera, Javier

2018-01-01

What is the influence of short-term memory enhancement on the emergence of grammatical agreement systems in multi-agent language games? Agreement systems suppose that at least two words share some features with each other, such as gender, number, or case. Previous work, within the multi-agent language-game framework, has recently proposed models stressing the hypothesis that the emergence of a grammatical agreement system arises from the minimization of semantic ambiguity. On the other hand, neurobiological evidence argues for the hypothesis that language evolution has mainly related to an increasing of short-term memory capacity, which has allowed the online manipulation of words and meanings participating particularly in grammatical agreement systems. Here, the main aim is to propose a multi-agent language game for the emergence of a grammatical agreement system, under measurable long-range relations depending on the short-term memory capacity. Computer simulations, based on a parameter that measures the amount of short-term memory capacity, suggest that agreement marker systems arise in a population of agents equipped at least with a critical short-term memory capacity.

Research ethics in the context of humanitarian emergencies.

PubMed

O'Mathúna, Dónal

2015-02-01

Research is needed to make responses to disasters and humanitarian emergencies more evidence-based. Such research must also adhere to the generally accepted principles of research ethics. While research into health interventions used in disasters raises distinctive ethical concerns, seven ethical principles developed for clinical research are applied here to disaster research. Practical examples from disaster settings are used to demonstrate how these ethical principles can be applied. This reveals that research ethics needs to be seen as much more than a mechanism to obtain ethical approval for research. Research ethics involves ethical principles and governance frameworks, but must also consider the role of ethical virtues in research. Virtues are essential to ensure that researchers do what they believe is ethically right and resist what is unethical. Research ethics that truly protects participants and promotes respect needs to include training in ethical virtues to ensure disaster research is carried out to the highest ethical standards. This article is based on a presentation at the Evidence Aid Symposium on 20 September 2014, in Hyderabad, India. © 2015 Chinese Cochrane Center, West China Hospital of Sichuan University and Wiley Publishing Asia Pty Ltd.

Nonsurgical management of hypertrophic scars: evidence-based therapies, standard practices, and emerging methods.

PubMed

Atiyeh, Bishara S

2007-01-01

Hypertrophic scars, resulting from alterations in the normal processes of cutaneous wound healing, are characterized by proliferation of dermal tissue with excessive deposition of fibroblast-derived extracellular matrix proteins, especially collagen, over long periods, and by persistent inflammation and fibrosis. Hypertrophic scars are among the most common and frustrating problems after injury. As current aesthetic surgical techniques become more standardized and results more predictable, a fine scar may be the demarcating line between acceptable and unacceptable aesthetic results. However, hypertrophic scars remain notoriously difficult to eradicate because of the high recurrence rates and the incidence of side effects associated with available treatment methods. This review explores the various treatment methods for hypertrophic scarring described in the literature including evidence-based therapies, standard practices, and emerging methods, attempting to distinguish those with clearly proven efficiency from anecdotal reports about therapies of doubtful benefits while trying to differentiate between prophylactic measures and actual treatment methods. Unfortunately, the distinction between hypertrophic scar treatments and keloid treatments is not obvious in most reports, making it difficult to assess the efficacy of hypertrophic scar treatment.

Learning in the zone: toward workforce development of evidence-based public policy communication.

PubMed

Meyerson, Beth E; Haderxhanaj, Laura T; Comer, Karen; Zimet, Gregory D

2018-06-05

Evidence-based policy communication (EBPC) is an important, emerging focus in public health research. However, we have yet to understand public health workforce ability to develop and/or use it. The study objective was to characterize capacity to develop and use EBPC and identify cooperative learning and development opportunities using the case of Human papillomavirus (HPV). Vygotsky's Zone of Proximal Development (ZPD) informed guided interviews with 27 advocates in Indiana from government, industry, research, state associations and individuals. Participants focused on HPV, cancer, women's health, school health and minority health. Capacity to develop and use EBPC was reported to develop through cooperative learning opportunities on the job or in advocacy focused coalitions. Coalition learning appeared to translate across health topics. Notably, policy experience did not assure understanding or use of EBPC. The ZPD framework can inform workforce EBPC interventions by focusing on actual development, potential development and factors for learning and development in the ZPD. Future studies should further clarify and evaluate emerging indicators in additional public health policy areas with a larger sample.

Review of interventions to reduce ultraviolet tanning: Need for treatments targeting excessive tanning, an emerging addictive behavior.

PubMed

Stapleton, Jerod L; Hillhouse, Joel; Levonyan-Radloff, Kristine; Manne, Sharon L

2017-12-01

Millions of Americans engage in tanning each year, defined as intentional ultraviolet radiation (UVR) exposure in the form of sunbathing or the use of indoor tanning beds. An emerging body of research suggests that UVR has addictive properties and some tanners engage in excessive tanning. This article provides an overview of the evidence of tanning addiction and a systematic review of existing tanning interventions with the goal of evaluating their potential to impact addicted tanners. Our search identified 24 intervention studies that were summarized and discussed according to 3 primary themes. First, there is a dearth of tanning interventions that target excessive tanning or are designed as treatments for tanning addiction. Second, tanning interventions are primarily educational interventions designed to increase knowledge of the risks of tanning. Third, there are notable aspects of existing tanning interventions that are relevant to addiction science, including the use of brief motivational and cognitive-behavioral-based interventions. Future directions are considered including recommendations for utilizing the existing evidence base to formulate interventions targeting excessive tanners. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Reconciling evidence-based medicine and patient-centred care: defining evidence-based inputs to patient-centred decisions.

PubMed

Weaver, Robert R

2015-12-01

Evidence-based and patient-centred health care movements have each enhanced the discussion of how health care might best be delivered, yet the two have evolved separately and, in some views, remain at odds with each other. No clear model has emerged to enable practitioners to capitalize on the advantages of each so actual practice often becomes, to varying degrees, an undefined mishmash of each. When faced with clinical uncertainty, it becomes easy for practitioners to rely on formulas for care developed explicitly by expert panels, or on the tacit ones developed from experience or habit. Either way, these tendencies towards 'cookbook' medicine undermine the view of patients as unique particulars, and diminish what might be considered patient-centred care. The sequence in which evidence is applied in the care process, however, is critical for developing a model of care that is both evidence based and patient centred. This notion derives from a paradigm for knowledge delivery and patient care developed over decades by Dr. Lawrence Weed. Weed's vision enables us to view evidence-based and person-centred medicine as wholly complementary, using computer tools to more fully and reliably exploit the vast body of collective knowledge available to define patients' uniqueness and identify the options to guide patients. The transparency of the approach to knowledge delivery facilitates meaningful practitioner-patient dialogue in determining the appropriate course of action. Such a model for knowledge delivery and care is essential for integrating evidence-based and patient-centred approaches. © 2015 The Authors. Journal of Evaluation in Clinical Practice published by John Wiley & Sons, Ltd.

Evidence of Early Emergence of the Primary Dentition in a Northern Plains American Indian Population.

PubMed

Dawson, D V; Blanchette, D R; Douglass, J M; Tinanoff, N; Kramer, K W O; Warren, J J; Phipps, K R; Starr, D E; Marshall, T A; Mabry, T R; Pagan-Rivera, K; Banas, J A; Drake, D R

2018-04-01

The purposes of this study were to describe primary tooth emergence in an American Indian (AI) population during the first 36 mo of life to compare 1) patterns of emergence between male and female children and 2) tooth emergence between these AI children and other U.S. ethnic groups. Data were derived from a birth cohort of 239 AI children from a Northern Plains tribe participating in a longitudinal study of early childhood caries, with examination data at target ages of 8, 12, 16, 22, 28, and 36 mo of age (±1 mo). Patterns of emergence in AI children were characterized and sex comparisons accomplished with interval-censored survival methodology. Numbers of erupted teeth in AI children at each age were compared via Kruskal-Wallis tests against those in children of the same age, as drawn from a cross-sectional study of dental caries patterns in Arizona; these comparisons were based on the dental examinations of 547 White non-Hispanic and 677 Hispanic children. Characterization of time to achievement of various milestones-including emergence of the anterior teeth, the first molars, and the complete primary dentition-provided no evidence of sex differences among AI children. AI children had significantly more teeth present at 8 mo (median, 3) than either White non-Hispanic ( P < 0.0063) or Hispanic ( P < 0.0001) children (median, 2 each). This was also true at 12 mo ( P < 0.001; medians, 8 vs. 6 and 7, respectively) and 16 mo ( P < 0.001; medians, 12 vs. 11 each). Less pronounced differences were seen at 22 mo ( P < 0.0001). White non-Hispanic and Hispanic children did not differ at any time considered ( P > 0.05). These results provide evidence of earlier tooth emergence in AI children than in the other 2 ethnicities. Although the underlying etiology of the severity of early childhood caries in AI children is likely to be multifactorial, earlier tooth emergence may be a contributing factor. Knowledge Transfer Statement: The findings of this study have practical implications for practitioners providing childhood oral health care to ethnic groups with early tooth emergence. It may be important to provide parents with information on toothbrushing, dentist visits, and other practices supportive of good oral health as early as possible to protect their children's primary dentition.

Barriers to evidence-based acute stroke care in Ghana: a qualitative study on the perspectives of stroke care professionals

PubMed Central

Baatiema, Leonard; de-Graft Aikins, Ama; Sav, Adem; Mnatzaganian, George; Chan, Carina K Y; Somerset, Shawn

2017-01-01

Objective Despite major advances in research on acute stroke care interventions, relatively few stroke patients benefit from evidence-based care due to multiple barriers. Yet current evidence of such barriers is predominantly from high-income countries. This study seeks to understand stroke care professionals’ views on the barriers which hinder the provision of optimal acute stroke care in Ghanaian hospital settings. Design A qualitative approach using semistructured interviews. Both thematic and grounded theory approaches were used to analyse and interpret the data through a synthesis of preidentified and emergent themes. Setting A multisite study, conducted in six major referral acute hospital settings (three teaching and three non-teaching regional hospitals) in Ghana. Participants A total of 40 participants comprising neurologists, emergency physician specialists, non-specialist medical doctors, nurses, physiotherapists, clinical psychologists and a dietitian. Results Four key barriers and 12 subthemes of barriers were identified. These include barriers at the patient (financial constraints, delays, sociocultural or religious practices, discharge against medical advice, denial of stroke), health system (inadequate medical facilities, lack of stroke care protocol, limited staff numbers, inadequate staff development opportunities), health professionals (poor collaboration, limited knowledge of stroke care interventions) and broader national health policy (lack of political will) levels. Perceived barriers varied across health professional disciplines and hospitals. Conclusion Barriers from low/middle-income countries differ substantially from those in high-income countries. For evidence-based acute stroke care in low/middle-income countries such as Ghana, health policy-makers and hospital managers need to consider the contrasts and uniqueness in these barriers in designing quality improvement interventions to optimise patient outcomes. PMID:28450468

Evidence-Based Point-of-Care Diagnostics: Current Status and Emerging Technologies

NASA Astrophysics Data System (ADS)

Chan, Cangel Pui Yee; Mak, Wing Cheung; Cheung, Kwan Yee; Sin, King Keung; Yu, Cheuk Man; Rainer, Timothy H.; Renneberg, Reinhard

2013-06-01

Point-of-care (POC) diagnostics brings tests nearer to the site of patient care. The turnaround time is short, and minimal manual interference enables quick clinical management decisions. Growth in POC diagnostics is being continuously fueled by the global burden of cardiovascular and infectious diseases. Early diagnosis and rapid initiation of treatment are crucial in the management of such patients. This review provides the rationale for the use of POC tests in acute coronary syndrome, heart failure, human immunodeficiency virus, and tuberculosis. We also consider emerging technologies that are based on advanced nanomaterials and microfluidics, improved assay sensitivity, miniaturization in device design, reduced costs, and high-throughput multiplex detection, all of which may shape the future development of POC diagnostics.

Emotional reasoning and parent-based reasoning in non-clinical children, and their prospective relationships with anxiety symptoms.

PubMed

Morren, Mattijn; Muris, Peter; Kindt, Merel; Schouten, Erik; van den Hout, Marcel

2008-12-01

Emotional and parent-based reasoning refer to the tendency to rely on personal or parental anxiety response information rather than on objective danger information when estimating the dangerousness of a situation. This study investigated the prospective relationships of emotional and parent-based reasoning with anxiety symptoms in a sample of non-clinical children aged 8-14 years (n = 122). Children completed the anxiety subscales of the Revised Children's Anxiety and Depression Scale (Muris et al. Clin Psychol Psychother 9:430-442, 2002) and provided danger ratings of scenarios that systematically combined objective danger and objective safety information with anxiety-response and positive-response information. These measurements were repeated 10 months later (range 8-11 months). Emotional and parent-based reasoning effects emerged on both occasions. In addition, both effects were modestly stable, but only in case of objective safety. Evidence was found that initial anxiety levels were positively related to emotional reasoning 10 months later. In addition, initial levels of emotional reasoning were positively related to anxiety at a later time, but only when age was taken into account. That is, this relationship changed with increasing age from positive to negative. No significant prospective relationships emerged between anxiety and parent-based reasoning. As yet the clinical implications of these findings are limited, although preliminary evidence indicates that interpretation bias can be modified to decrease anxiety.

Towards evidence-based emergency medicine: best BETs from the Manchester Royal Infirmary. BET 4: does size matter? Chest drains in haemothorax following trauma.

PubMed

2013-11-01

A short-cut review was carried out to establish whether the size of chest drain inserted is important in haemothoraces. Forty-nine papers were found of which four 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 shown in table 4. The clinical bottom line is that while the available evidence suggests that small bore drains may be as effective as large bore drains in resolving traumatic haemothoraces without additional complications, there is insufficient evidence currently available to recommend a change to standard practice (ie, large bore drains).

Atypical femur fractures: a review of the evidence and its implication to clinical practice

PubMed Central

Girgis, Christian M.

2011-01-01

Whilst bisphosphonates are an established modality in the treatment of osteoporosis, there have been increasing concerns regarding the risk of an unusual form of femur fracture amongst patients receiving bisphosphonates for prolonged periods. These fractures, referred to as ‘atypical’, have been characterized by a number of clinical and radiographic features that distinguish them from ‘typical’ osteoporotic fractures. The evidence base is currently split between a large number of case series demonstrating an association between the occurrence of atypical fractures and bisphosphonate use and several population-based studies that do not confirm such an association. Hence, a degree of uncertainty surrounds this important issue. In this review, we examine the emerging evidence on atypical femur fractures, assess hypotheses on their biomechanical evolution and discuss the wider clinical implications of this phenomenon. PMID:22870488

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

PubMed

Reddy, K Srikanth; Sahay, Seema

2016-01-01

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

Mental illness and well-being: the central importance of positive psychology and recovery approaches

PubMed Central

2010-01-01

Background A new evidence base is emerging, which focuses on well-being. This makes it possible for health services to orientate around promoting well-being as well as treating illness, and so to make a reality of the long-standing rhetoric that health is more than the absence of illness. The aim of this paper is to support the re-orientation of health services around promoting well-being. Mental health services are used as an example to illustrate the new knowledge skills which will be needed by health professionals. Discussion New forms of evidence give a triangulated understanding about the promotion of well-being in mental health services. The academic discipline of positive psychology is developing evidence-based interventions to improve well-being. This complements the results emerging from synthesising narratives about recovery from mental illness, which provide ecologically valid insights into the processes by which people experiencing mental illness can develop a purposeful and meaningful life. The implications for health professionals are explored. In relation to working with individuals, more emphasis on the person's own goals and strengths will be needed, with integration of interventions which promote well-being into routine clinical practice. In addition, a more societally-focussed role for professionals is envisaged, in which a central part of the job is to influence local and national policies and practices that impact on well-being. Summary If health services are to give primacy to increasing well-being, rather than to treating illness, then health workers need new approaches to working with individuals. For mental health services, this will involve the incorporation of emerging knowledge from recovery and from positive psychology into education and training for all mental health professionals, and changes to some long-established working practices. PMID:20102609

Mental illness and well-being: the central importance of positive psychology and recovery approaches.

PubMed

Slade, Mike

2010-01-26

A new evidence base is emerging, which focuses on well-being. This makes it possible for health services to orientate around promoting well-being as well as treating illness, and so to make a reality of the long-standing rhetoric that health is more than the absence of illness. The aim of this paper is to support the re-orientation of health services around promoting well-being. Mental health services are used as an example to illustrate the new knowledge skills which will be needed by health professionals. New forms of evidence give a triangulated understanding about the promotion of well-being in mental health services. The academic discipline of positive psychology is developing evidence-based interventions to improve well-being. This complements the results emerging from synthesising narratives about recovery from mental illness, which provide ecologically valid insights into the processes by which people experiencing mental illness can develop a purposeful and meaningful life. The implications for health professionals are explored. In relation to working with individuals, more emphasis on the person's own goals and strengths will be needed, with integration of interventions which promote well-being into routine clinical practice. In addition, a more societally-focussed role for professionals is envisaged, in which a central part of the job is to influence local and national policies and practices that impact on well-being. If health services are to give primacy to increasing well-being, rather than to treating illness, then health workers need new approaches to working with individuals. For mental health services, this will involve the incorporation of emerging knowledge from recovery and from positive psychology into education and training for all mental health professionals, and changes to some long-established working practices.

Preventing Child Abuse and Neglect in Saudi Arabia: Are We Ready?

PubMed Central

Almuneef, Maha; Al-Eissa, Majid

2011-01-01

Although child abuse and neglect (CAN) have been recognized by medical professionals for the last 20 years, child protection services and child maltreatment prevention programs are still emerging in Saudi Arabia. This paper will review the progress made in the country in terms of recognition and implementation of child protection services. Furthermore, it will draw attention to the essential steps required to start child maltreatment prevention programs, as CAN prevention is currently viewed as a global healthcare priority with an emphasis on evidence-based interventions. In addition, this paper will assess Saudi Arabia's readiness to prevent CAN and the challenges that will be faced by the professionals in implementing evidence-based CAN prevention programs. PMID:22048511

Chronic disease management: implementation and coordination of healthcare systems for depressed elderly persons.

PubMed

Severinsson, Elisabeth; Holm, Anne Lise

2014-12-01

The aim of this study was to evaluate the implementation of the research-based Chronic Care Model (CCM), discuss methods and summarise research recommendations for improving the care of depressed elderly persons. Interviews were conducted and state-of-the-art reviews employed. Three important areas emerged: (1) barriers to and facilitating factors in the implementation of the CCM; (2) the challenges involved in re-designing the delivery system and interdisciplinary team collaboration; and (3) empirical evidence pertaining to self-management support and how older persons manage to live with depressive ill-health. In conclusion, implementation research requires evidence-based knowledge, staff involvement and familiarity with the context in which development occurs.

Value-at-risk estimation with wavelet-based extreme value theory: Evidence from emerging markets

NASA Astrophysics Data System (ADS)

Cifter, Atilla

2011-06-01

This paper introduces wavelet-based extreme value theory (EVT) for univariate value-at-risk estimation. Wavelets and EVT are combined for volatility forecasting to estimate a hybrid model. In the first stage, wavelets are used as a threshold in generalized Pareto distribution, and in the second stage, EVT is applied with a wavelet-based threshold. This new model is applied to two major emerging stock markets: the Istanbul Stock Exchange (ISE) and the Budapest Stock Exchange (BUX). The relative performance of wavelet-based EVT is benchmarked against the Riskmetrics-EWMA, ARMA-GARCH, generalized Pareto distribution, and conditional generalized Pareto distribution models. The empirical results show that the wavelet-based extreme value theory increases predictive performance of financial forecasting according to number of violations and tail-loss tests. The superior forecasting performance of the wavelet-based EVT model is also consistent with Basel II requirements, and this new model can be used by financial institutions as well.

Linking research to practice: the rise of evidence-based health sciences librarianship*

PubMed Central

Marshall, Joanne Gard

2014-01-01

Purpose: The lecture explores the origins of evidence-based practice (EBP) in health sciences librarianship beginning with examples from the work of Janet Doe and past Doe lecturers. Additional sources of evidence are used to document the rise of research and EBP as integral components of our professional work. Methods: Four sources of evidence are used to examine the rise of EBP: (1) a publication by Doe and research-related content in past Doe lectures, (2) research-related word usage in articles in the Bulletin of the Medical Library Association and Journal of the Medical Library Association between 1961 and 2010, (3) Medical Library Association activities, and (4) EBP as an international movement. Results: These sources of evidence confirm the rise of EBP in health sciences librarianship. International initiatives sparked the rise of evidence-based librarianship and continue to characterize the movement. This review shows the emergence of a unique form of EBP that, although inspired by evidence-based medicine (EBM), has developed its own view of evidence and its application in library and information practice. Implications: Health sciences librarians have played a key role in initiating, nurturing, and spreading EBP in other branches of our profession. Our close association with EBM set the stage for developing our own EBP. While we relied on EBM as a model for our early efforts, we can observe the continuing evolution of our own unique approach to using, creating, and applying evidence from a variety of sources to improve the quality of health information services. PMID:24415915

A Web-based Decision Tool to Estimate Subarachnoid Hemorrhage Risk in Emergency Department Patients

PubMed Central

Manella, Haley; Sivasankar, Shyam; Perry, Jeffrey J; Pfeil, Sam; Senyak, Josh; Shachter, Ross

2018-01-01

Subarachnoid hemorrhage (SAH) from a leaking aneurysm is a neurological emergency. SAH patients often present with headache—a common chief complaint among emergency department patients. If unrecognized, 70% of the patients with re-bleeds die and one third are left with neurological deficits. Therefore, it is critical to distinguish the signs and symptoms of SAH from benign causes of headache, perform the appropriate diagnostic tests and treat in a timely manner in order to reduce the disability and mortality associated with this condition. In patients with suspected SAH, traditional diagnostic strategies in the emergency department employ non-contrast computed tomography (CT) of the brain to detect blood in the subarachnoid space followed by lumbar puncture if there is a high clinical probability of aneurysmal bleed without any evidence of blood on CT scan. While the older generation CT scanners were less sensitive to blood detection in the subarachnoid space, recent advances in CT imaging have resulted in sensitivity approaching 100% for detection of blood in the subarachnoid space specifically within six hours of symptom onset. Therefore, the benefit of lumbar puncture is controversial when performed within the first six hours of symptom onset. Despite this, lumbar puncture is still commonly performed in the emergency department, exposing patients to unnecessary procedural risks. The objective of this research study is to develop a web-based risk calculator that estimates the risk of SAH based on time to emergency department presentation after symptom onset, physical findings and imaging characteristics with the goal of reducing unnecessary lumbar punctures in the emergency department. In this technical report, we describe the prototype calculator, the mathematical basis of the model and provide a link to the web-based prototype. In the future, we will refine the prototype, make it user-friendly to physicians, staff and patients and study its benefits in the emergency department. PMID:29568717

Integrating horizon scanning and strategic risk prioritisation using a weight of evidence framework to inform policy decisions.

PubMed

Garnett, K; Lickorish, F A; Rocks, S A; Prpich, G; Rathe, A A; Pollard, S J T

2016-08-01

Poor connection between data on emerging issues and credible policy decisions continues to challenge governments, and is only likely to grow as demands on time and resources increase. Here we summarise recent efforts to integrate horizon scanning and risk prioritisation approaches to better connect emerging issues to the political discourse on environmental and food-related issues. Our categorisation of insights including potential future risks and opportunities to inform policy discussions has emerged from a structured three-year programme of horizon scanning for a UK pan-governmental futures partnership led by the Department for Environment, Food and Rural Affairs (Defra). Our efforts to integrate horizon scanning and risk prioritisation, utilising a qualitative weight of evidence framework, has created a systematic process for identifying all signals of potential future change with significant impact for the strategic mission and underlying values of policy actors. Our approach encourages an exploration of factors out of the control of organisations, recognising that resilience depends on the flexibility of management strategies and the preparedness to deal with a variety of unexpected outcomes. We discuss how this approach addresses key cultural and evaluative challenges that policy actors have had in embedding horizon scanning in evidence-based policy processes, and suggest further developments to build confidence in the use of horizon scanning for strategic planning. Copyright © 2016 Elsevier B.V. All rights reserved.

'That doesn't translate': the role of evidence-based practice in disempowering speech pathologists in acute aphasia management.

PubMed

Foster, Abby; Worrall, Linda; Rose, Miranda; O'Halloran, Robyn

2015-07-01

An evidence-practice gap has been identified in current acute aphasia management practice, with the provision of services to people with aphasia in the acute hospital widely considered in the literature to be inconsistent with best-practice recommendations. The reasons for this evidence-practice gap are unclear; however, speech pathologists practising in this setting have articulated a sense of dissonance regarding their limited service provision to this population. A clearer understanding of why this evidence-practice gap exists is essential in order to support and promote evidence-based approaches to the care of people with aphasia in acute care settings. To provide an understanding of speech pathologists' conceptualization of evidence-based practice for acute post-stroke aphasia, and its implementation. This study adopted a phenomenological approach, underpinned by a social constructivist paradigm. In-depth interviews were conducted with 14 Australian speech pathologists, recruited using a purposive sampling technique. An inductive thematic analysis of the data was undertaken. A single, overarching theme emerged from the data. Speech pathologists demonstrated a sense of disempowerment as a result of their relationship with evidence-based practice for acute aphasia management. Three subthemes contributed to this theme. The first described a restricted conceptualization of evidence-based practice. The second revealed speech pathologists' strained relationships with the research literature. The third elucidated a sense of professional unease over their perceived inability to enact evidence-based clinical recommendations, despite their desire to do so. Speech pathologists identified a current knowledge-practice gap in their management of aphasia in acute hospital settings. Speech pathologists place significant emphasis on the research evidence; however, their engagement with the research is limited, in part because it is perceived to lack clinical utility. A sense of professional dissonance arises from the conflict between a desire to provide best practice and the perceived barriers to implementing evidence-based recommendations clinically, resulting in evidence-based practice becoming a disempowering concept for some. © 2015 Royal College of Speech and Language Therapists.

Patients and their families weigh in on evidence-based hospital design.

PubMed

Trochelman, Kathleen; Albert, Nancy; Spence, Jacqueline; Murray, Terri; Slifcak, Ellen

2012-02-01

In 2 landmark publications, the Institute of Medicine reported on significant deficiencies in our current health care system. In response, an area of research examining the role of the physical environment in influencing outcomes for patients and staff gained momentum. The concept of evidence-based design has evolved, and the development of structural guidelines for new hospital construction was instituted by the American Institute of Architects in 2006. To determine perceptions of patients and their families of evidence-based design features in a new heart center. Hospitalized patients and their families, most of whom were in intensive care and step-down units, were surveyed and data from the Hospital Consumer Assessment of Healthcare Providers and Systems were reviewed to determine perceptions of evidence-based design features incorporated into a new heart center and to assess patients' satisfaction with the environment. Results Responses were reviewed and categorized descriptively. Five general environment topics of focus emerged: privacy, space, noise, light, and overall atmosphere. Characteristics perceived as being dissatisfying and satisfying are discussed. Critical care nurses must be aware of the current need to recognize how much the physical environment influences care delivery and take steps to maximize patients' safety, satisfaction, and quality of care.

Not another boring lecture: engaging learners with active learning techniques.

PubMed

Wolff, Margaret; Wagner, Mary Jo; Poznanski, Stacey; Schiller, Jocelyn; Santen, Sally

2015-01-01

Core content in Emergency Medicine Residency Programs is traditionally covered in didactic sessions, despite evidence suggesting that learners do not retain a significant portion of what is taught during lectures. We describe techniques that medical educators can use when leading teaching sessions to foster engagement and encourage self-directed learning, based on current literature and evidence about learning. When these techniques are incorporated, sessions can be effective in delivering core knowledge, contextualizing content, and explaining difficult concepts, leading to increased learning. Copyright © 2015 Elsevier Inc. All rights reserved.

Towards evidence-based emergency medicine: best BETs from the Manchester Royal Infirmary. BET 4: Hydrotherapy following rotator cuff repair.

PubMed

Hay, Laura; Wylie, Katherine

2011-07-01

A short cut review was carried out to establish whether hydrotherapy is beneficial in rehabilitation after rotator cuff repair. 27 papers were found using the reported searches, of which one 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 that best paper are tabulated. It is concluded that while there may be some short term benefit to passive range of movement, further research is needed.

Music-based interventions in neurological rehabilitation.

PubMed

Sihvonen, Aleksi J; Särkämö, Teppo; Leo, Vera; Tervaniemi, Mari; Altenmüller, Eckart; Soinila, Seppo

2017-08-01

During the past ten years, an increasing number of controlled studies have assessed the potential rehabilitative effects of music-based interventions, such as music listening, singing, or playing an instrument, in several neurological diseases. Although the number of studies and extent of available evidence is greatest in stroke and dementia, there is also evidence for the effects of music-based interventions on supporting cognition, motor function, or emotional wellbeing in people with Parkinson's disease, epilepsy, or multiple sclerosis. Music-based interventions can affect divergent functions such as motor performance, speech, or cognition in these patient groups. However, the psychological effects and neurobiological mechanisms underlying the effects of music interventions are likely to share common neural systems for reward, arousal, affect regulation, learning, and activity-driven plasticity. Although further controlled studies are needed to establish the efficacy of music in neurological recovery, music-based interventions are emerging as promising rehabilitation strategies. Copyright © 2017 Elsevier Ltd. All rights reserved.

Destroying myths.

PubMed

Moeen ul Haq, Sheikh; Butt, Mehmood; Ali, Raza; Bhattacharya, Amlan

2008-01-01

Palliative care emergencies such as spinal cord compression require prompt diagnosis and treatment to get the best results. Hospitals dealing with these emergencies need to develop pathways of care for these patients based on best evidence derived from hard data. The authors looked at all spinal cord compressions that presented to their hospital over a 10-year period. The authors found that the commonest day of presentation of this condition was on Mondays and not Fridays as had been widely believed prior to this study. Hospitals are encouraged to look at hard data and not anecdotes when developing pathways of care for their patients.

Child Development and Emergent Literacy.

ERIC Educational Resources Information Center

Whitehurst, Grover J.; Lonigan, Christopher J.

1998-01-01

Offers a typology of emergent literacy skills, reviews research relating emergent literacy to reading, and reviews evidence linking emergent literacy environments and development of emergent literacy skills. Proposes that emergent literacy consists of inside-out skills and outside-in skills that are influential at different times during reading…

Pathogenesis of chronic pancreatitis: an evidence-based review of past theories and recent developments.

PubMed

Stevens, Tyler; Conwell, Darwin L; Zuccaro, Gregory

2004-11-01

In the past several decades, four prominent theories of chronic pancreatitis pathogenesis have emerged: the toxic-metabolic theory, the oxidative stress hypothesis, the stone and duct obstruction theory, and the necrosis-fibrosis hypothesis. Although these traditional theories are formulated based on compelling scientific observations, substantial contradictory data also exist for each. Furthermore, the basic premises of some of these theories are directly contradictory. Because of the recent scientific progress in the underlying genetic, cellular, and molecular pathophysiology, there have been substantial advances in the understanding of chronic pancreatitis pathogenesis. This paper will provide an evidence-based review and critique of the traditional pathogenic theories, followed by a discussion of the new advances in pancreatic fibrogenesis. Moreover, we will discuss plausible pathogenic sequences applied to each of the known etiologies.

Helioseismology of pre-emerging active regions. III. Statistical analysis

DOE Office of Scientific and Technical Information (OSTI.GOV)

Barnes, G.; Leka, K. D.; Braun, D. C.

The subsurface properties of active regions (ARs) prior to their appearance at the solar surface may shed light on the process of AR formation. Helioseismic holography has been applied to samples taken from two populations of regions on the Sun (pre-emergence and without emergence), each sample having over 100 members, that were selected to minimize systematic bias, as described in Paper I. Paper II showed that there are statistically significant signatures in the average helioseismic properties that precede the formation of an AR. This paper describes a more detailed analysis of the samples of pre-emergence regions and regions without emergencemore » based on discriminant analysis. The property that is best able to distinguish the populations is found to be the surface magnetic field, even a day before the emergence time. However, after accounting for the correlations between the surface field and the quantities derived from helioseismology, there is still evidence of a helioseismic precursor to AR emergence that is present for at least a day prior to emergence, although the analysis presented cannot definitively determine the subsurface properties prior to emergence due to the small sample sizes.« less

Review article: Methodology for the 'rapid review' series on musculoskeletal injuries in the emergency department.

PubMed

Strudwick, Kirsten; McPhee, Megan; Bell, Anthony; Martin-Khan, Melinda; Russell, Trevor

2018-02-01

Musculoskeletal injuries are a common presentation to the ED, with significant costs involved in the management of these injuries, variances in care within the ED and associated morbidity. A series of rapid review papers were completed to guide best practice for the assessment and management of common musculoskeletal injuries presenting to the ED. This paper presents the methodology used across the rapid reviews. PubMed, CINAHL, EMBASE, TRIP and the grey literature, including relevant organisational websites, were searched in 2015. The search was repeated consistently for each topic area (injuries of the foot and ankle, knee, hand and wrist, elbow, shoulder, lumbar spine and cervical spine). English-language primary studies, systematic reviews and guidelines that were published in the last 10 years and addressed acute musculoskeletal injury management were considered for inclusion. Data extraction of each included article was conducted, followed by a quality appraisal. The extracted data from each article was synthesised to group similar evidence together. For each rapid review, the evidence has been organised in a way that a clinician can direct their attention to a specific component of the clinical cycle of care in the ED, such as the assessment, diagnostic tests, management and follow-up considerations from ED. The series of rapid reviews are designed to foster evidence-based practice within the ED, targeting the injuries most commonly presenting. The reviews provide clinicians in EDs with rapid access to the best current evidence, which has been synthesised and organised to assist decision-making. © 2017 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

Evidence and consensus based guideline for the management of delirium, analgesia, and sedation in intensive care medicine. Revision 2015 (DAS-Guideline 2015) - short version.

PubMed

Baron, Ralf; Binder, Andreas; Biniek, Rolf; Braune, Stephan; Buerkle, Hartmut; Dall, Peter; Demirakca, Sueha; Eckardt, Rahel; Eggers, Verena; Eichler, Ingolf; Fietze, Ingo; Freys, Stephan; Fründ, Andreas; Garten, Lars; Gohrbandt, Bernhard; Harth, Irene; Hartl, Wolfgang; Heppner, Hans-Jürgen; Horter, Johannes; Huth, Ralf; Janssens, Uwe; Jungk, Christine; Kaeuper, Kristin Maria; Kessler, Paul; Kleinschmidt, Stefan; Kochanek, Matthias; Kumpf, Matthias; Meiser, Andreas; Mueller, Anika; Orth, Maritta; Putensen, Christian; Roth, Bernd; Schaefer, Michael; Schaefers, Rainhild; Schellongowski, Peter; Schindler, Monika; Schmitt, Reinhard; Scholz, Jens; Schroeder, Stefan; Schwarzmann, Gerhard; Spies, Claudia; Stingele, Robert; Tonner, Peter; Trieschmann, Uwe; Tryba, Michael; Wappler, Frank; Waydhas, Christian; Weiss, Bjoern; Weisshaar, Guido

2015-01-01

In 2010, under the guidance of the DGAI (German Society of Anaesthesiology and Intensive Care Medicine) and DIVI (German Interdisciplinary Association for Intensive Care and Emergency Medicine), twelve German medical societies published the "Evidence- and Consensus-based Guidelines on the Management of Analgesia, Sedation and Delirium in Intensive Care". Since then, several new studies and publications have considerably increased the body of evidence, including the new recommendations from the American College of Critical Care Medicine (ACCM) in conjunction with Society of Critical Care Medicine (SCCM) and American Society of Health-System Pharmacists (ASHP) from 2013. For this update, a major restructuring and extension of the guidelines were needed in order to cover new aspects of treatment, such as sleep and anxiety management. The literature was systematically searched and evaluated using the criteria of the Oxford Center of Evidence Based Medicine. The body of evidence used to formulate these recommendations was reviewed and approved by representatives of 17 national societies. Three grades of recommendation were used as follows: Grade "A" (strong recommendation), Grade "B" (recommendation) and Grade "0" (open recommendation). The result is a comprehensive, interdisciplinary, evidence and consensus-based set of level 3 guidelines. This publication was designed for all ICU professionals, and takes into account all critically ill patient populations. It represents a guide to symptom-oriented prevention, diagnosis, and treatment of delirium, anxiety, stress, and protocol-based analgesia, sedation, and sleep-management in intensive care medicine.

Bedside, classroom and bench: collaborative strategies to generate evidence-based knowledge for nursing practice.

PubMed

Weaver, Charlotte A; Warren, Judith J; Delaney, Connie

2005-12-01

The rise of evidence-base practice (EBP) as a standard for care delivery is rapidly emerging as a global phenomenon that is transcending political, economic and geographic boundaries. Evidence-based nursing (EBN) addresses the growing body of nursing knowledge supported by different levels of evidence for best practices in nursing care. Across all health care, including nursing, we face the challenge of how to most effectively close the gap between what is known and what is practiced. There is extensive literature on the barriers and difficulties of translating research findings into practical application. While the literature refers to this challenge as the "Bench to Bedside" lag, this paper presents three collaborative strategies that aim to minimize this gap. The Bedside strategy proposes to use the data generated from care delivery and captured in the massive data repositories of electronic health record (EHR) systems as empirical evidence that can be analysed to discover and then inform best practice. In the Classroom strategy, we present a description for how evidence-based nursing knowledge is taught in a baccalaureate nursing program. And finally, the Bench strategy describes applied informatics in converting paper-based EBN protocols into the workflow of clinical information systems. Protocols are translated into reference and executable knowledge with the goal of placing the latest scientific knowledge at the fingertips of front line clinicians. In all three strategies, information technology (IT) is presented as the underlying tool that makes this rapid translation of nursing knowledge into practice and education feasible.

A Review of Online Evidence-based Practice Point-of-Care Information Summary Providers

PubMed Central

Liberati, Alessandro; Moschetti, Ivan; Tagliabue, Ludovica; Moja, Lorenzo

2010-01-01

Background Busy clinicians need easy access to evidence-based information to inform their clinical practice. Publishers and organizations have designed specific tools to meet doctors’ needs at the point of care. Objective The aim of this study was to describe online point-of-care summaries and evaluate their breadth, content development, and editorial policy against their claims of being “evidence-based.” Methods We searched Medline, Google, librarian association websites, and information conference proceedings from January to December 2008. We included English Web-based point-of-care summaries designed to deliver predigested, rapidly accessible, comprehensive, periodically updated, evidence-based information to clinicians. Two investigators independently extracted data on the general characteristics and content presentation of summaries. We assessed and ranked point-of-care products according to: (1) coverage (volume) of medical conditions, (2) editorial quality, and (3) evidence-based methodology. We explored how these factors were associated. Results We retrieved 30 eligible summaries. Of these products, 18 met our inclusion criteria and were qualitatively described, and 16 provided sufficient data for quantitative evaluation. The median volume of medical conditions covered was 80.6% (interquartile range, 68.9% - 84.2%) and varied for the different products. Similarly, differences emerged for editorial policy (median 8.0, interquartile range 5.8 - 10.3) and evidence-based methodology scores (median 10.0, interquartile range 1.0 - 12.8) on a 15-point scale. None of these dimensions turned out to be significantly associated with the other dimensions (editorial quality and volume, Spearman rank correlation r = -0.001, P = .99; evidence-based methodology and volume, r = -0.19, P = .48; editorial and evidence-based methodology, r = 0.43, P =.09). Conclusions Publishers are moving to develop point-of-care summary products. Some of these have better profiles than others, and there is room for improved reporting of the strengths and weaknesses of these products. PMID:20610379

Sentence-Based Attentional Mechanisms in Word Learning: Evidence from a Computational Model

PubMed Central

Alishahi, Afra; Fazly, Afsaneh; Koehne, Judith; Crocker, Matthew W.

2012-01-01

When looking for the referents of novel nouns, adults and young children are sensitive to cross-situational statistics (Yu and Smith, 2007; Smith and Yu, 2008). In addition, the linguistic context that a word appears in has been shown to act as a powerful attention mechanism for guiding sentence processing and word learning (Landau and Gleitman, 1985; Altmann and Kamide, 1999; Kako and Trueswell, 2000). Koehne and Crocker (2010, 2011) investigate the interaction between cross-situational evidence and guidance from the sentential context in an adult language learning scenario. Their studies reveal that these learning mechanisms interact in a complex manner: they can be used in a complementary way when context helps reduce referential uncertainty; they influence word learning about equally strongly when cross-situational and contextual evidence are in conflict; and contextual cues block aspects of cross-situational learning when both mechanisms are independently applicable. To address this complex pattern of findings, we present a probabilistic computational model of word learning which extends a previous cross-situational model (Fazly et al., 2010) with an attention mechanism based on sentential cues. Our model uses a framework that seamlessly combines the two sources of evidence in order to study their emerging pattern of interaction during the process of word learning. Simulations of the experiments of (Koehne and Crocker, 2010, 2011) reveal an overall pattern of results that are in line with their findings. Importantly, we demonstrate that our model does not need to explicitly assign priority to either source of evidence in order to produce these results: learning patterns emerge as a result of a probabilistic interaction between the two clue types. Moreover, using a computational model allows us to examine the developmental trajectory of the differential roles of cross-situational and sentential cues in word learning. PMID:22783211

Exploring the key predictors of retention in emergency nurses.

PubMed

Sawatzky, Jo-Ann V; Enns, Carol L

2012-07-01

To explore the factors that predict the retention of nurses working in emergency departments. The escalating shortage of nurses is one of the most critical issues facing specialty areas, such as the emergency department. Therefore, it is important to identify the key influencing and intermediary factors that affect emergency department nurses' intention to leave. As part of a larger study, a cross-sectional survey was completed by 261 registered nurses working in the 12 designated emergency departments within rural, urban community and tertiary hospitals in Manitoba, Canada. Twenty-six per cent of the respondents will probably/definitely leave their current emergency department jobs within the next year. Engagement was the key predictor of intention to leave (P < 0.001). Engagement was also associated with job satisfaction, compassion satisfaction, compassion fatigue, and burnout (P < 0.05). In an ordinal least-squares model (R(2) = 0.44), nursing management, professional practice, collaboration with physicians, staffing resources and shift work emerged as significant influencing factors for engagement. Engagement plays a central role in emergency department nurses intention to leave. Addressing the factors that influence engagement may reduce emergency department nurses' intention to leave. This study highlights the value of research-based evidence as the foundation for developing innovative strategies for the retention of emergency department nurses. © 2012 Blackwell Publishing Ltd.

Consensus Guidelines on Evaluation and Management of the Febrile Child Presenting to the Emergency Department in India.

PubMed

Mahajan, Prashant; Batra, Prerna; Thakur, Neha; Patel, Reena; Rai, Narendra; Trivedi, Nitin; Fassl, Bernhard; Shah, Binita; Lozon, Marie; Oteng, Rockerfeller A; Saha, Abhijeet; Shah, Dheeraj; Galwankar, Sagar

2017-08-15

India, home to almost 1.5 billion people, is in need of a country-specific, evidence-based, consensus approach for the emergency department (ED) evaluation and management of the febrile child. We held two consensus meetings, performed an exhaustive literature review, and held ongoing web-based discussions to arrive at a formal consensus on the proposed evaluation and management algorithm. The first meeting was held in Delhi in October 2015, under the auspices of Pediatric Emergency Medicine (PEM) Section of Academic College of Emergency Experts in India (ACEE-INDIA); and the second meeting was conducted at Pune during Emergency Medical Pediatrics and Recent Trends (EMPART 2016) in March 2016. The second meeting was followed with futher e-mail-based discussions to arrive at a formal consensus on the proposed algorithm. To develop an algorithmic approach for the evaluation and management of the febrile child that can be easily applied in the context of emergency care and modified based on local epidemiology and practice standards. We created an algorithm that can assist the clinician in the evaluation and management of the febrile child presenting to the ED, contextualized to health care in India. This guideline includes the following key components: triage and the timely assessment; evaluation; and patient disposition from the ED. We urge the development and creation of a robust data repository of minimal standard data elements. This would provide a systematic measurement of the care processes and patient outcomes, and a better understanding of various etiologies of febrile illnesses in India; both of which can be used to further modify the proposed approach and algorithm.

Consistency assessment with global and bridging development strategies in emerging markets.

PubMed

Li, Gang; Chen, Josh; Quan, Hui; Shentu, Yue

2013-11-01

Global trial strategy with the participation of all major regions including countries from emerging markets surely increases new drug development efficiency. Nevertheless, there are circumstances in which some countries in emerging markets cannot join the original global trial. To evaluate the extrapolability of the original trial results to a new country, a bridging trial in the country has to be conducted. In this paper, we first evaluate the efficiency loss of the bridging trial strategy compared to that of the global trial strategy as a function of between-study variability from consistency assessment perspective. The provided evidence should encourage countries in emerging markets to make a greater effort to participate in the original global trial. We then discuss sample size requirement for desired assurance probability for consistency assessment based on various approaches for both global and bridging trial strategies. Examples are presented for numerical demonstration and comparisons. Copyright © 2013 Elsevier Inc. All rights reserved.

Pre-hospital management of patients with chest pain and/or dyspnoea of cardiac origin. A position paper of the Acute Cardiovascular Care Association (ACCA) of the ESC.

PubMed

Beygui, Farzin; Castren, Maaret; Brunetti, Natale Daniele; Rosell-Ortiz, Fernando; Christ, Michael; Zeymer, Uwe; Huber, Kurt; Folke, Fredrik; Svensson, Leif; Bueno, Hector; Van't Hof, Arnoud; Nikolaou, Nikolaos; Nibbe, Lutz; Charpentier, Sandrine; Swahn, Eva; Tubaro, Marco; Goldstein, Patrick

2015-08-27

Chest pain and acute dyspnoea are frequent causes of emergency medical services activation. The pre-hospital management of these conditions is heterogeneous across different regions of the world and Europe, as a consequence of the variety of emergency medical services and absence of specific practical guidelines. This position paper focuses on the practical aspects of the pre-hospital treatment on board and transfer of patients taken in charge by emergency medical services for chest pain and dyspnoea of suspected cardiac aetiology after the initial assessment and diagnostic work-up. The objective of the paper is to provide guidance, based on evidence, where available, or on experts' opinions, for all emergency medical services' health providers involved in the pre-hospital management of acute cardiovascular care. © The European Society of Cardiology 2015.

Predictive genetic testing for complex diseases: a public health perspective

PubMed Central

Marzuillo, C.; De Vito, C.; D’Andrea, E.; Rosso, A.

2014-01-01

From a public health perspective, systematic, evidence-based technology assessments and economic evaluations are needed to guide the incorporation of genomics into clinical and public health practice. However, scientific evidence on the effectiveness of predictive genetic tests is difficult to obtain. This review first highlights the similarities and differences between traditional screening tests and predictive genetic testing for complex diseases and goes on to describe frameworks for the evaluation of genetic testing that have been developed in recent years providing some evidence that currently genetic tests are not used in an appropriate way. Nevertheless, evidence-based recommendations are already available for some genomic applications that can reduce morbidity and mortality and many more are expected to emerge over the next decade. The time is now ripe for the introduction of a range of genetic tests into healthcare practice, but this will require the development of specific health policies, proper public health evaluations, organizational changes within the healthcare systems, capacity building among the healthcare workforce and the education of the public. PMID:24049051

Teachers' Dispositions towards the Role of Digital Devices in Play-Based Pedagogy in Early Childhood Education

ERIC Educational Resources Information Center

Palaiologou, Ioanna

2016-01-01

A body of research is emerging on early childhood education teachers' views on the integration of digital technologies in their practice. Despite evidence of the digitalisation of homes in affluent societies and children's interactions in highly mediated digital environments, few teachers so far have integrated digital devices into a play-based…

An Analysis of Electronic Media to Prepare Children for Safe and Ethical Practices in Digital Environments

ERIC Educational Resources Information Center

Berson, Ilene R.; Berson, Michael J.; Desai, Shreya; Falls, Donald; Fenaughty, John

2008-01-01

A range of electronic resources, including video-based instruction, are used to promote cybersafety to young people at school. This evaluation analyzed seven distinct programs that use electronic media in Internet safety initiatives in schools. The findings highlight emerging evidence on successful approaches to engage children in assessing risky…

Curriculum Analytics: Application of Social Network Analysis for Improving Strategic Curriculum Decision-Making in a Research-Intensive University

ERIC Educational Resources Information Center

Dawson, Shane; Hubball, Harry

2014-01-01

This paper provides insight into the use of curriculum analytics to enhance learning-centred curricula in diverse higher education contexts. Engagement in evidence-based practice to evaluate and monitor curricula is vital to the success and sustainability of efforts to reform undergraduate and graduate programs. Emerging technology-enabled inquiry…

Transforming Leadership Development for Significant Learning.

PubMed

Owen, Julie E

2015-01-01

Leadership education is undergoing a transformation where powerful pedagogies and emerging knowledge about the scholarship of teaching and learning supplant long held and often-outmoded practices of leadership education. This transformation requires new commitments to evidence-based practice, critical consciousness, and more complex understanding of the levers of leadership learning. © 2015 Wiley Periodicals, Inc., A Wiley Company.

Toward an Economic Mobility Ranking of U.S. Colleges. Evidence Speaks Reports, Vol 1, #6

ERIC Educational Resources Information Center

Chingos, Matthew M.; Blagg, Kristin

2015-01-01

The release of institution-level earnings information as part of the Obama Administration's new College Scorecard data has already spawned new "value-added" rankings based on the economic outcomes of students who attended similar institutions. These emerging rankings are an improvement on simple unadjusted rankings, but the wide variance…

Recovery from a Subarachnoid Hemorrhage: Days 1 through 22

ERIC Educational Resources Information Center

Brice, Alejandro E.; Brice, Roanne G.; Wallace, Sarah E.

2016-01-01

Subarachnoid hemorrhages (SAHs) are a serious medical emergency, as 30% to 50% of all SAHs can result in death. Personal accounts and case studies are an important aspect of evidence-based practice. This first article of two presents a review of AB's (patient) condition immediately following an SAH in the intensive care and immediately post…

Big Data & Learning Analytics: A Potential Way to Optimize eLearning Technological Tools

ERIC Educational Resources Information Center

García, Olga Arranz; Secades, Vidal Alonso

2013-01-01

In the information age, one of the most influential institutions is education. The recent emergence of MOOCS [Massively Open Online Courses] is a sample of the new expectations that are offered to university students. Basing decisions on data and evidence seems obvious, and indeed, research indicates that data-driven decision-making improves…

The Evidence Base for Early Childhood Education and Care Programme Investment: What We Know, What We Don't Know

ERIC Educational Resources Information Center

White, Linda A.; Prentice, Susan; Perlman, Michal

2015-01-01

An expanding body of research demonstrates that high quality early childhood education and care (ECEC) programmes generate positive outcomes for children; in response, policy makers in a number of countries are making significant programme investments. No research consensus, however, has emerged around the specific types of policy intervention…

The Violation of Childhood: A Review of Possible Effects on Development of Toxic Chemical and Nuclear Waste.

ERIC Educational Resources Information Center

Evans, Roy

Emphasizing that for any known teratogen no safe dosage level exists, this case-illustrated review identifies the bases for current concern about the pollution of the environment, reflects on the promise and complexities of the emerging disciplines of behavioral toxicology and behavioral teratology, and describes existing evidence of teratogenic…

Domain Specific vs Domain General: Implications for Dynamic Assessment

ERIC Educational Resources Information Center

Kaniel, Shlomo

2010-01-01

The article responds to the need for evidence-based dynamic assessment. The article is divided into two sections: In Part 1 we examine the scientific answer to the question of how far human mental activities and capabilities are domain general (DG) / domain specific (DS). A highly complex answer emerges from the literature review of domains such…

Teaching Strategies for Developing Students' Argumentation Skills about Socioscientific Issues in High School Genetics

ERIC Educational Resources Information Center

Dawson, Vaille Maree; Venville, Grady

2010-01-01

An outcome of science education is that young people have the understandings and skills to participate in public debate and make informed decisions about science issues that influence their lives. Toulmin's argumentation skills are emerging as an effective strategy to enhance the quality of evidence based decision making in science classrooms. In…

Employing a Teen Advisory Board to Adapt an Evidence-Based HIV/STD Intervention for Incarcerated African-American Adolescent Women

ERIC Educational Resources Information Center

Latham, Teaniese P.; Sales, Jessica M.; Renfro, Tiffaney L.; Boyce, Lorin S.; Rose, Eve; Murray, Colleen C.; Wingood, Gina M.; DiClemente, Ralph J.

2012-01-01

This manuscript assesses priorities and challenges of adolescent females by conducting a meeting with teen advisory board (TAB) members to collect information regarding their lives and experiences pre-, during and post-incarceration in a juvenile detention facility. Multiple themes emerged regarding the impact of incarceration on young…

Using the Knowledge to Action Process Model to Incite Clinical Change

ERIC Educational Resources Information Center

Petzold, Anita; Korner-Bitensky, Nicol; Menon, Anita

2010-01-01

Introduction: Knowledge translation (KT) has only recently emerged in the field of rehabilitation with attention on creating effective KT interventions to increase clinicians' knowledge and use of evidence-based practice (EBP). The uptake of EBP is a complex process that can be facilitated by the use of the Knowledge to Action Process model. This…

Evidence for Use of Mathematical Inversion by Three-Year-Old Children

ERIC Educational Resources Information Center

Sherman, Jody; Bisanz, Jeffrey

2007-01-01

The principle of inversion--that a + b - b must equal a--requires a sensitivity to the relation between addition and subtraction that is critical for understanding arithmetic. Use of inversion, albeit inconsistent, has been observed in school-age children, but when use of a computational shortcut based on inversion emerges and how awareness of the…

Three Key Conditions to Revitialise an ePortfolio Program in Response to Increasing Regulation of Teacher Education

ERIC Educational Resources Information Center

Kertesz, John Leslie

2016-01-01

This paper describes a study undertaken within the education faculty of a mid-sized university in response to the recommendations of the Teacher Education Ministerial Advisory Group (TEMAG) (2014) that initial teacher education (ITE) graduates emerge with an evidence-based professional standards-focused portfolio of teaching competency. In…

Implementing Effective Educational Practices at Scales of Social Importance.

PubMed

Horner, Robert H; Sugai, George; Fixsen, Dean L

2017-03-01

Implementing evidence-based practices is becoming both a goal and standard across medicine, psychology, and education. Initial successes, however, are now leading to questions about how successful demonstrations may be expanded to scales of social importance. In this paper, we review lessons learned about scaling up evidence-based practices gleaned from our experience implementing school-wide positive behavioral interventions and supports (PBIS) across more than 23,000 schools in the USA. We draw heavily from the work of Flay et al. (Prev Sci 6:151-175, 2005. doi: 10.1007/s11121-005-5553-y ) related to defining evidence-based practices, the significant contributions from the emerging "implementation science" movement (Fixsen et al. in Implementation research: a synthesis of the literature, University of South Florida, Louis de la Parte Florida Mental Health Institute, The National Implementation Research Network (FMHI Publication #231), Tampa 2005), and guidance we have received from teachers, family members, students, and administrators who have adopted PBIS.

A call for evidence-based medical treatment of opioid dependence in the United States and Canada.

PubMed

Nosyk, Bohdan; Anglin, M Douglas; Brissette, Suzanne; Kerr, Thomas; Marsh, David C; Schackman, Bruce R; Wood, Evan; Montaner, Julio S G

2013-08-01

Despite decades of experience treating heroin or prescription opioid dependence with methadone or buprenorphine--two forms of opioid substitution therapy--gaps remain between current practices and evidence-based standards in both Canada and the United States. This is largely because of regulatory constraints and pervasive suboptimal clinical practices. Fewer than 10 percent of all people dependent on opioids in the United States are receiving substitution treatment, although the proportion may increase with expanded health insurance coverage as a result of the Affordable Care Act. In light of the accumulated evidence, we recommend eliminating restrictions on office-based methadone prescribing in the United States; reducing financial barriers to treatment, such as varying levels of copayment in Canada and the United States; reducing reliance on less effective and potentially unsafe opioid detoxification; and evaluating and creating mechanisms to integrate emerging treatments. Taking these steps can greatly reduce the harms of opioid dependence by maximizing the individual and public health benefits of treatment.

Managing Acute Behavioural Disturbances in the Emergency Department Using the Environment, Policies and Practices: A Systematic Review.

PubMed

Weiland, Tracey J; Ivory, Sean; Hutton, Jennie

2017-06-01

Effective strategies for managing acute behavioural disturbances (ABDs) within emergency departments (EDs) are needed given their rising occurrence and negative impact on safety, psychological wellbeing, and staff turnover. Non-pharmacological interventions for ABD management generally fall into four categories: environmental modifications; policies; practice changes; and education. Our objective was to systematically review the efficacy of strategies for ABD management within EDs that involved changes to environment, architecture, policy and practice. We performed systematic searches of CINAHL Plus with Full Text, PsycINFO, MEDLINE, and EMBASE, as well as reference lists of relevant review articles to identify relevant studies published between January 1985 - April 2016. We included studies written in English, which reported management of behavioural disturbances in adults associated with the ED through the use of environmental modifiers (including seclusion, restraint, specialised rooms, architectural changes), policy, and practice-based interventions excepting education-only interventions. Efficacy outcomes of interest included incidence, severity, and duration of ABD, incidence of injuries, staff absenteeism, restraint use, restraint duration, and staff and patient perceptions. Two reviewers independently screened titles and abstracts, and assessed the relevancy and eligibility of studies based on full-text articles. Two authors independently appraised included studies. A narrative synthesis of findings was undertaken. Studies reporting interventions for managing ABDs within the ED are limited in number and quality. The level of evidence for efficacy is low, requiring caution in conclusions. While there is preliminary evidence for environmental change in the form of specialised behavioural rooms, security upgrades and ED modifications, these are not supported by evidence from controlled studies. Many of these "common sense" environmental changes recommended in many guidelines have been widely implemented in EDs. There is an unambiguous gap in the literature regarding the efficacy of interventions for ABD management in EDs involving environmental, policy or practice-based changes. With growing demand on EDs, and with increasing numbers of ABDs, identification of robust evidence-based interventions for safe and effective ABD management is vital.

Emerging infectious diseases of wildlife: a critical perspective.

PubMed

Tompkins, Daniel M; Carver, Scott; Jones, Menna E; Krkošek, Martin; Skerratt, Lee F

2015-04-01

We review the literature to distinguish reports of vertebrate wildlife disease emergence with sufficient evidence, enabling a robust assessment of emergence drivers. For potentially emerging agents that cannot be confirmed, sufficient data on prior absence (or a prior difference in disease dynamics) are frequently lacking. Improved surveillance, particularly for neglected host taxa, geographical regions and infectious agents, would enable more effective management should emergence occur. Exposure to domestic sources of infection and human-assisted exposure to wild sources were identified as the two main drivers of emergence across host taxa; the domestic source was primary for fish while the wild source was primary for other taxa. There was generally insufficient evidence for major roles of other hypothesized drivers of emergence. Copyright © 2015 Elsevier Ltd. All rights reserved.

Self-fill oxygen technology: benefits for patients, healthcare providers and the environment

PubMed Central

Hex, Nick; Setters, Jo; Little, Stuart

2016-01-01

“Non-delivery” home oxygen technologies that allow self-filling of ambulatory oxygen cylinders are emerging. They can offer a relatively unlimited supply of ambulatory oxygen in suitably assessed people who require long-term oxygen therapy (LTOT), providing they can use these systems safely and effectively. This allows users to be self-sufficient and facilitates longer periods of time away from home. The evolution and evidence base of this technology is reported with the experience of a national service review in Scotland (UK). Given that domiciliary oxygen services represent a significant cost to healthcare providers globally, these systems offer potential cost savings, are appealing to remote and rural regions due to the avoidance of cylinder delivery and have additional lower environmental impact due to reduced fossil fuel consumption and subsequently reduced carbon emissions. Evidence is emerging that self-fill/non-delivery oxygen systems can meet the ambulatory oxygen needs of many patients using LTOT and can have a positive impact on quality of life, increase time spent away from home and offer significant financial savings to healthcare providers. Educational aims Provide update for oxygen prescribers on options for home oxygen provision. Provide update on the evidence base for available self-fill oxygen technologies. Provide and update for healthcare commissioners on the potential cost-effective and environmental benefits of increased utilisation of self-fill oxygen systems. PMID:27408629

Translating Evidence Into Practice via Social Media: A Mixed-Methods Study

PubMed Central

Tunnecliff, Jacqueline; Morgan, Prue; Gaida, Jamie E; Clearihan, Lyn; Sadasivan, Sivalal; Davies, David; Ganesh, Shankar; Mohanty, Patitapaban; Weiner, John; Reynolds, John; Ilic, Dragan

2015-01-01

Background Approximately 80% of research evidence relevant to clinical practice never reaches the clinicians delivering patient care. A key barrier for the translation of evidence into practice is the limited time and skills clinicians have to find and appraise emerging evidence. Social media may provide a bridge between health researchers and health service providers. Objective The aim of this study was to determine the efficacy of social media as an educational medium to effectively translate emerging research evidence into clinical practice. Methods The study used a mixed-methods approach. Evidence-based practice points were delivered via social media platforms. The primary outcomes of attitude, knowledge, and behavior change were assessed using a preintervention/postintervention evaluation, with qualitative data gathered to contextualize the findings. Results Data were obtained from 317 clinicians from multiple health disciplines, predominantly from the United Kingdom, Australia, the United States, India, and Malaysia. The participants reported an overall improvement in attitudes toward social media for professional development (P<.001). The knowledge evaluation demonstrated a significant increase in knowledge after the training (P<.001). The majority of respondents (136/194, 70.1%) indicated that the education they had received via social media had changed the way they practice, or intended to practice. Similarly, a large proportion of respondents (135/193, 69.9%) indicated that the education they had received via social media had increased their use of research evidence within their clinical practice. Conclusions Social media may be an effective educational medium for improving knowledge of health professionals, fostering their use of research evidence, and changing their clinical behaviors by translating new research evidence into clinical practice. PMID:26503129

Mindfulness-based treatments for posttraumatic stress disorder: a review of the treatment literature and neurobiological evidence

PubMed Central

Boyd, Jenna E.; Lanius, Ruth A.; McKinnon, Margaret C.

2018-01-01

Mindfulness-based treatments for posttraumatic stress disorder (PTSD) have emerged as promising adjunctive or alternative intervention approaches. A scoping review of the literature on PTSD treatment studies, including approaches such as mindfulness-based stress reduction, mindfulness-based cognitive therapy and metta mindfulness, reveals low attrition with medium to large effect sizes. We review the convergence between neurobiological models of PTSD and neuroimaging findings in the mindfulness literature, where mindfulness interventions may target emotional under- and overmodulation, both of which are critical features of PTSD symptomatology. Recent emerging work indicates that mindfulness-based treatments may also be effective in restoring connectivity between large-scale brain networks among individuals with PTSD, including connectivity between the default mode network and the central executive and salience networks. Future directions, including further identification of the neurobiological mechanisms of mindfulness interventions in patients with PTSD and direct comparison of these interventions to first-line treatments for PTSD are discussed. PMID:29252162

The public vs private debate: separating facts from values.

PubMed

Narad, R A; Gillespie, W

1998-01-01

The choice between public and private emergency ambulance services is generally based on histological experience within the community. No empirical evidence exists that supports an argument that either public or private emergency ambulance services are better, per se. On a macro level, this debate is based on the question of the role of government and the role of the marketplace in the delivery of public services and medical care, and the comparative efficiencies of public and private organizations. On a micro or community level, these philosophical concerns are supplemented with issues relating to protection of individual jobs and investments, upholding of community tradition, and maintenance of existing relationships. Other specific values that are considered include the role of profit and equity--fairness of coverage. A rational choice would be based on consideration of efficiency and effectiveness. The effectiveness of an emergency medical services system is primarily based on its ability to provide patients with the level of care that they need within a clinically appropriate time. Efficiency is the ratio between inputs and outputs. One factor that can increase efficiency is the availability of excess production capacity that can be used to provide emergency ambulance service, with a low marginal cost of adding this to the other functions. A rational model is intended to change the level of the debate to one that is less based on values, but it is impossible for a community to select an ambulance provider in a value-free environment.

Building an evidence-base for the training of evidence-based treatments in community settings: Use of an expert-informed approach.

PubMed

Scudder, Ashley; Herschell, Amy D

2015-08-01

In order to make EBTs available to a large number of children and families, developers and expert therapists have used their experience and expertise to train community-based therapists in EBTs. Understanding current training practices of treatment experts may be one method for establishing best practices for training community-based therapists prior to comprehensive empirical examinations of training practices. A qualitative study was conducted using surveys and phone interviews to identify the specific procedures used by treatment experts to train and implement an evidence-based treatment in community settings. Twenty-three doctoral-level, clinical psychologists were identified to participate because of their expertise in conducting and training Parent-Child Interaction Therapy. Semi-structured qualitative interviews were completed by phone, later transcribed verbatim, and analyzed using thematic coding. The de-identified data were coded by two independent qualitative data researchers and then compared for consistency of interpretation. The themes that emerged following the final coding were used to construct a training protocol to be empirically tested. The goal of this paper is to not only understand the current state of training practices for training therapists in a particular EBT, Parent-Child Interaction Therapy, but to illustrate the use of expert opinion as the best available evidence in preparation for empirical evaluation.

Family Therapy for Child and Adolescent Eating Disorders: A Critical Review.

PubMed

Jewell, Tom; Blessitt, Esther; Stewart, Catherine; Simic, Mima; Eisler, Ivan

2016-09-01

Eating disorder-focused family therapy has emerged as the strongest evidence-based treatment for adolescent anorexia nervosa, supported by evidence from nine RCTs, and there is increasing evidence of its efficacy in treating adolescent bulimia nervosa (three RCTs). There is also emerging evidence for the efficacy of multifamily therapy formats of this treatment, with a recent RCT demonstrating the benefits of this approach in the treatment of adolescent anorexia nervosa. In this article, we critically review the evidence for eating disorder-focused family therapy through the lens of a moderate common factors paradigm. From this perspective, this treatment is likely to be effective as it provides a supportive and nonblaming context that: one, creates a safe, predictable environment that helps to contain anxiety generated by the eating disorder; two, promotes specific change early on in treatment in eating disorder-related behaviors; and three, provides a vehicle for the mobilization of common factors such as hope and expectancy reinforced by the eating disorder expertise of the multidisciplinary team. In order to improve outcomes for young people, there is a need to develop an improved understanding of the moderators and mediators involved in this treatment approach. Such an understanding could lead to the refining of the therapy, and inform adaptations for those families who do not currently benefit from treatment. © 2016 Family Process Institute.

Utilizing DMAIC six sigma and evidence-based medicine to streamline diagnosis in chest pain.

PubMed

Kumar, Sameer; Thomas, Kory M

2010-01-01

The purpose of this study was to quantify the difference between the current process flow model for a typical patient workup for chest pain and development of a new process flow model that incorporates DMAIC (define, measure, analyze, improve, control) Six Sigma and evidence-based medicine in a best practices model for diagnosis and treatment. The first stage, DMAIC Six Sigma, is used to highlight areas of variability and unnecessary tests in the current process flow for a patient presenting to the emergency department or physician's clinic with chest pain (also known as angina). The next stage, patient process flow, utilizes DMAIC results in the development of a simulated model that represents real-world variability in the diagnosis and treatment of a patient presenting with angina. The third and final stage is used to analyze the evidence-based output and quantify the factors that drive physician diagnosis accuracy and treatment, as well as review the potential for a broad national evidence-based database. Because of the collective expertise captured within the computer-oriented evidence-based model, the study has introduced an innovative approach to health care delivery by bringing expert-level care to any physician triaging a patient for chest pain anywhere in the world. Similar models can be created for other ailments as well, such as headache, gastrointestinal upset, and back pain. This updated way of looking at diagnosing patients stemming from an evidence-based best practice decision support model may improve workflow processes and cost savings across the health care continuum.

Staff views on supporting evidence based practice for children with ASD.

PubMed

Trembath, David; Sulek, Rhylee; Paynter, Jessica; Simpson, Kate; Keen, Deb

2017-11-22

A variety of empirically supported interventions are available for children with autism spectrum disorder (ASD), but previous research suggests that their selection and use within an evidence-based practice (EBP) framework in clinical settings is challenging. To date, research has primarily focused on identifying individual, organisational, and contextual barriers to EBP rather than identifying collaborative solutions to these barriers through consultation with staff. The aim of our study was to explore staff views on supporting EBP in their work with children with ASD. We conducted five focus groups involving 29 professional (e.g., speech pathologists, teachers), paraprofessional (e.g., childcare workers), and managerial staff to explore their views. Audio recordings were transcribed verbatim and analysed using thematic analysis. Two central themes, comprising six categories, emerged to account for the participants' views. Initiative and Effort accounted for the range of creative strategies staff had developed to support their engagement in EBP. They also expressed the need for A Better Way involving organisational-wide support such as this engagement, including peer-to-peer mentoring. The findings suggest that an organisational-wide model to support engagement in EBP, with peer-to-peer mentoring at its foundation, may provide a desirable, ecologically valid, and acceptable model. Implications for Rehabilitation Clinicians and educators recognise the importance of evidence-based practice. Efforts to support evidence-based practice have focused mostly on access to research evidence. Clinicians and educators in this study were developing their own strategies based on intuition. They identified a need for organisation-wide approaches to supporting evidence-based practice. Peer-to-peer mentoring appears to be an acceptable and viable strategy.

What Constitutes Evidence in Human Rights-Based Approaches to Health? Learning from Lived Experiences of Maternal and Sexual Reproductive Health.

PubMed

Unnithan, Maya

2015-12-10

The impact of human rights interventions on health outcomes is complex, multiple, and difficult to ascertain in the conventional sense of cause and effect. Existing approaches based on probable (experimental and statistical) conclusions from evidence are limited in their ability to capture the impact of rights-based transformations in health. This paper argues that a focus on plausible conclusions from evidence enables policy makers and researchers to take into account the effects of a co-occurrence of multiple factors connected with human rights, including the significant role of "context" and power. Drawing on a subject-near and interpretive (in other words, with regard to meaning) perspective that focuses on the lived experiences of human rights-based interventions, the paper suggests that policy makers and researchers are best served by evidence arrived at through plausible, observational modes of ascertaining impact. Through an examination of what human rights-based interventions mean, based on the experience of their operationalization on the ground in culturally specific maternal and reproductive health care contexts, this paper contributes to an emerging scholarship that seeks to pluralize the concept of evidence and to address the methodological challenges posed by heterogeneous forms of evidence in the context of human rights as applied to health. Copyright © 2015 Unnithan. This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original author and source are credited.

Towards evidence based emergency medicine: Best BETs from the Manchester Royal Infirmary. BET 3: Toe fractures in adults.

PubMed

Paradise, David

2012-11-01

A short cut review was carried out to establish whether intervention and follow up of patients with toe phalanx fractures is better than no treatment at reducing time to return to normal activity and need for surgical intervention. 40 papers were found using the reported searches, of which 1 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 this best paper is tabulated. It is concluded that there is no evidence to determine whether intervention of any type improves outcome in toe phalanx fractures.

Early management of acute pancreatitis: A review of the best evidence.

PubMed

Stigliano, Serena; Sternby, Hanna; de Madaria, Enrique; Capurso, Gabriele; Petrov, Maxim S

2017-06-01

In the 20th century early management of acute pancreatitis often included surgical intervention, despite overwhelming mortality. The emergence of high-quality evidence (randomized controlled trials and meta-analyses) over the past two decades has notably shifted the treatment paradigm towards predominantly non-surgical management early in the course of acute pancreatitis. The present evidence-based review focuses on contemporary aspects of early management (which include analgesia, fluid resuscitation, antibiotics, nutrition, and endoscopic retrograde cholangiopancreatography) with a view to providing clear and succinct guidelines on early management of patients with acute pancreatitis in 2017 and beyond. Copyright © 2017 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

General surgery 2.0: the emergence of acute care surgery in Canada

PubMed Central

Hameed, S. Morad; Brenneman, Frederick D.; Ball, Chad G.; Pagliarello, Joe; Razek, Tarek; Parry, Neil; Widder, Sandy; Minor, Sam; Buczkowski, Andrzej; MacPherson, Cailan; Johner, Amanda; Jenkin, Dan; Wood, Leanne; McLoughlin, Karen; Anderson, Ian; Davey, Doug; Zabolotny, Brent; Saadia, Roger; Bracken, John; Nathens, Avery; Ahmed, Najma; Panton, Ormond; Warnock, Garth L.

2010-01-01

Over the past 5 years, there has been a groundswell of support in Canada for the development of organized, focused and multidisciplinary approaches to caring for acutely ill general surgical patients. Newly forged acute care surgery (ACS) services are beginning to provide prompt, evidence-based and goal-directed care to acutely ill general surgical patients who often present with a diverse range of complex pathologies and little or no pre- or postoperative planning. Through a team-based structure with attention to processes of care and information sharing, ACS services are well positioned to improve outcomes, while finding and developing efficiencies and reducing costs of surgical and emergency health care delivery. The ACS model also offers enhanced opportunities for surgical education for students, residents and practicing surgeons, and it will provide avenues to strengthen clinical and academic bonds between the community and academic surgical centres. In the near future, cooperation of ACS services from community and academic hospitals across the country will lead to the formation of systems of acute surgical care whose development will be informed by rigorous data collection and research and evidence-based quality-improvement initiatives. In an era of increasing subspecialization, ACS is a strong unifying force in general surgery and a platform for collective advocacy for an important patient population. PMID:20334738

[Telepsychiatry provides new opportunities for the prevention and treatment of mental health disorders].

PubMed

Folker, Marie Paldam; Helverskov, Trine; Nielsen, Amalie Søgaard; Jørgensen, Ulla Skov; Larsen, John Teilmann

2018-04-23

Digital technologies in mental healthcare are envisioned to offer easier, faster and more cost-effective access to mental healthcare. The scope for integrating digital technology into mental healthcare is vast: video conferencing, developing novel treatments using interactive software, mobile applications, and sensor technologies. We outline technology-based interventions, which are relevant to clinical practice, and present the evidence base for using digital technology as well as emerging challenges for their implementation in clinical practice.

Evidence-based policy-making in the NHS: exploring the interface between research and the commissioning process.

PubMed

Harries, U; Elliott, H; Higgins, A

1999-03-01

The UK National Health Service (NHS) R&D strategy acknowledges the importance of developing an NHS where practice and policy is more evidence-based. This paper is based on a qualitative study which aimed to identify factors which facilitate or impede evidence-based policy-making at a local level in the NHS. The study involved a literature review and case studies of social research projects which were initiated by NHS health authority managers or general practitioner (GP) fundholders in one region of the NHS. Data were collected through in-depth interviews with lead policy-makers, GPs and researchers working on each of the case studies and analysis of project documentation. An over-arching theme from the analysis was that of the complexity of R&D in purchasing. The two worlds of research and health services management often sit uncomfortably together. For this reason it was not possible to describe a 'blueprint' for successful R&D, although several important issues emerged. These include sharing an appropriate model for research utilization, the importance of relationships in shaping R&D, the importance of influence and commitment in facilitating evidence-based change, and the resourcing of R&D in purchasing. These issues have important implications for the strategic development of R&D as well as for individual project application. Moving beyond the rhetoric of evidence-based policy-making is more likely if both policy-makers and researchers openly acknowledge this complexity and give due concern to the issues outlined.

The research-design interaction: lessons learned from an evidence-based design studio.

PubMed

Haq, Saif; Pati, Debajyoti

2010-01-01

As evidence-based design (EBD) emerges as a model of design practice, considerable attention has been given to its research component. However, this overshadows another essential component of EBD-the change agent, namely the designer. EBD introduced a new skill set to the practitioner: the ability to interact with scientific evidence. Industry sources suggest adoption of the EBD approach across a large number of design firms. How comfortable are these designers in integrating research with design decision making? Optimizing the interaction between the primary change agent (the designer) and the evidence is crucial to producing the desired outcomes. Preliminary to examining this question, an architectural design studio was used as a surrogate environment to examine how designers interact with evidence. Twelve students enrolled in a healthcare EBD studio during the spring of 2009. A three-phase didactic structure was adopted: knowing a hospital, knowing the evidence, and designing with knowledge and evidence. Products of the studio and questionnaire responses from the students were used as the data for analysis. The data suggest that optimization of the research-design relationship warrants consideration in four domains: (1) a knowledge structure that is easy to comprehend; (2) phase-complemented representation of evidence; (3) access to context and precedence information; and (4) a designer-friendly vocabulary.

Applying Multi-Criteria Decision Analysis (MCDA) Simple Scoring as an Evidence-based HTA Methodology for Evaluating Off-Patent Pharmaceuticals (OPPs) in Emerging Markets.

PubMed

Brixner, Diana; Maniadakis, Nikos; Kaló, Zoltán; Hu, Shanlian; Shen, Jie; Wijaya, Kalman

2017-09-01

Off-patent pharmaceuticals (OPPs) represent more than 60% of the pharmaceutical market in many emerging countries, where they are frequently evaluated primarily on cost rather than with health technology assessment. OPPs are assumed to be identical to the originators. Branded and unbranded generic versions can, however, vary from the originator in active pharmaceutical ingredients, dosage, consistency formulation, excipients, manufacturing processes, and distribution, for example. These variables can alter the efficacy and safety of the product, negatively impacting both the anticipated cost savings and the population's health. In addition, many health care systems lack the resources or expertise to evaluate such products, and current assessment methods can be complex and difficult to adapt to a health system's needs. Multicriteria decision analysis (MCDA) simple scoring is an evidence-based health technology assessment methodology for evaluating OPPs, especially in emerging countries in which resources are limited but decision makers still must balance affordability with factors such as drug safety, level interchangeability, manufacturing site and active pharmaceutical ingredient quality, supply track record, and real-life outcomes. MCDA simple scoring can be applied to pharmaceutical pricing, reimbursement, formulary listing, and drug procurement. In November 2015, a workshop was held at the International Society for Pharmacoeconomics and Outcomes Research Annual Meeting in Milan to refine and prioritize criteria that can be used in MCDA simple scoring for OPPs, resulting in an example MCDA process and 22 prioritized criteria that health care systems in emerging countries can easily adapt to their own decision-making processes. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

A report on the Academic Emergency Medicine 2015 consensus conference "Diagnostic imaging in the emergency department: a research agenda to optimize utilization".

PubMed

Gunn, Martin L; Marin, Jennifer R; Mills, Angela M; Chong, Suzanne T; Froemming, Adam T; Johnson, Jamlik O; Kumaravel, Manickam; Sodickson, Aaron D

2016-08-01

In May 2015, the Academic Emergency Medicine consensus conference "Diagnostic imaging in the emergency department: a research agenda to optimize utilization" was held. The goal of the conference was to develop a high-priority research agenda regarding emergency diagnostic imaging on which to base future research. In addition to representatives from the Society of Academic Emergency Medicine, the multidisciplinary conference included members of several radiology organizations: American Society for Emergency Radiology, Radiological Society of North America, the American College of Radiology, and the American Association of Physicists in Medicine. The specific aims of the conference were to (1) understand the current state of evidence regarding emergency department (ED) diagnostic imaging utilization and identify key opportunities, limitations, and gaps in knowledge; (2) develop a consensus-driven research agenda emphasizing priorities and opportunities for research in ED diagnostic imaging; and (3) explore specific funding mechanisms available to facilitate research in ED diagnostic imaging. Through a multistep consensus process, participants developed targeted research questions for future research in six content areas within emergency diagnostic imaging: clinical decision rules; use of administrative data; patient-centered outcomes research; training, education, and competency; knowledge translation and barriers to imaging optimization; and comparative effectiveness research in alternatives to traditional computed tomography use.

Emerging infection and sepsis biomarkers: will they change current therapies?

PubMed Central

Jacobs, Lauren

2016-01-01

Introduction Sepsis is a heterogeneous syndrome characterized by both immune hyperactivity and relative immune suppression. Biomarkers have the potential to improve recognition and management of sepsis through three main applications: diagnosis, monitoring response to treatment, and stratifying patients based on prognosis or underlying biological response. Areas Covered This review focuses on specific examples of well-studied, evidence-supported biomarkers, and discusses their role in clinical practice with special attention to antibiotic stewardship and cost-effectiveness. Biomarkers were selected based on availability of robust prospective trials and meta-analyses which supported their role as emerging tools to improve the clinical management of sepsis. Expert Commentary Great strides have been made in candidate sepsis biomarker discovery and testing, with the biomarkers in this review showing promise. Yet sepsis remains a dynamic illness with a great degree of biological heterogeneity – heterogeneity which may be further resolved by recently discovered gene expression-based endotypes in septic shock. PMID:27533847

Use of antibacterial prophylaxis for patients with neutropenia. Australian Consensus Guidelines 2011 Steering Committee.

PubMed

Slavin, M A; Lingaratnam, S; Mileshkin, L; Booth, D L; Cain, M J; Ritchie, D S; Wei, A; Thursky, K A

2011-01-01

The use of oral prophylactic antibiotics in patients with neutropenia is controversial and not recommended by this group because of a lack of evidence showing a reduction in mortality and concerns that such practice promotes antimicrobial resistance. Recent evidence has demonstrated non-significant but consistent, improvement in all-cause mortality when fluoroquinolones (FQs) are used as primary prophylaxis. However, the consensus was that this evidence was not strong enough to recommend prophylaxis. The evidence base for FQ prophylaxis is presented alongside current consensus opinion to guide the appropriate and judicious use of these agents. Due consideration is given to patient risk, as it pertains to specific patient populations, as well as the net effect on selective pressure from antibiotics if FQ prophylaxis is routinely used in a target population. The potential costs and consequences of emerging FQ resistance, particularly among Escherichia coli, Clostridium difficile and Gram-positive organisms, are considered. As FQ prophylaxis has been advocated in some chemotherapy protocols, specific regard is given to whether FQ prophylaxis should be used to support these regimens. The group also provides recommendations for monitoring and surveillance of emerging resistance in those centres that have adopted FQ prophylaxis. © 2011 The Authors. Internal Medicine Journal © 2011 Royal Australasian College of Physicians.

From Delivery to Adoption of Physical Activity Guidelines: Realist Synthesis

PubMed Central

2017-01-01

Background: Evidence-based guidelines published by health authorities for the promotion of health-enhancing physical activity (PA), continue to be implemented unsuccessfully and demonstrate a gap between evidence and policies. This review synthesizes evidence on factors influencing delivery, adoption and implementation of PA promotion guidelines within different policy sectors (e.g., health, transport, urban planning, sport, education). Methods: Published literature was initially searched using PubMed, EBSCO, Google Scholar and continued through an iterative snowball technique. The literature review spanned the period 2002–2017. The realist synthesis approach was adopted to review the content of 39 included studies. An initial programme theory with a four-step chain from evidence emersion to implementation of guidelines was tested. Results: The synthesis furthers our understanding of the link between PA guidelines delivery and the actions of professionals responsible for implementation within health services, school departments and municipalities. The main mechanisms identified for guidance implementation were scientific legitimation, enforcement, feasibility, familiarity with concepts and PA habits. Threats emerged to the successful implementation of PA guidelines at national/local jurisdictional levels. Conclusions: The way PA guidelines are developed may influence their adoption by policy-makers and professionals. Useful lessons emerged that may inform synergies between policymaking and professional practices, promoting win-win multisectoral strategies. PMID:28991184

Emergency general surgery in the geriatric patient.

PubMed

Desserud, K F; Veen, T; Søreide, K

2016-01-01

Emergency general surgery in the elderly is a particular challenge to the surgeon in charge of their care. The aim was to review contemporary aspects of managing elderly patients needing emergency general surgery and possible alterations to their pathways of care. This was a narrative review based on a PubMed/MEDLINE literature search up until 15 September 2015 for publications relevant to emergency general surgery in the geriatric patient. The number of patients presenting as an emergency with a general surgical condition increases with age. Up to one-quarter of all emergency admissions to hospital may be for general surgical conditions. Elderly patients are a particular challenge owing to added co-morbidity, use of drugs and risk of poor outcome. Frailty is an important potential risk factor, but difficult to monitor or manage in the emergency setting. Risk scores are not available universally. Outcomes are usually severalfold worse than after elective surgery, in terms of both higher morbidity and increased mortality. A care bundle including early diagnosis, resuscitation and organ system monitoring may benefit the elderly in particular. Communication with the patient and relatives throughout the care pathway is essential, as indications for surgery, level of care and likely outcomes may evolve. Ethical issues should also be addressed at every step on the pathway of care. Emergency general surgery in the geriatric patient needs a tailored approach to improve outcomes and avoid futile care. Although some high-quality studies exist in related fields, the overall evidence base informing perioperative acute care for the elderly remains limited. © 2015 BJS Society Ltd Published by John Wiley & Sons Ltd.

Over-the-counter access to emergency contraception without age restriction: an opinion of the Women's Health Practice and Research Network of the American College of Clinical Pharmacy.

PubMed

Rafie, Sally; McIntosh, Jennifer; Gardner, Debra K; Gawronski, Kristen M; Karaoui, Lamis R; Koepf, Erin R; Lehman, Katherine Joy; McBane, Sarah; Patel-Shori, Nima M

2013-05-01

Family planning remains a high priority area for the United States, with goals to increase the proportion of pregnancies that are intended, reduce pregnancy rates among adolescents, and increase contraceptive use prioritized in the Healthy People 2020 objectives. Contraception intended for use after unprotected intercourse, known as emergency contraception, remains underutilized. Levonorgestrel is one method of oral emergency contraception, which prevents fertilization and does not disrupt an already established pregnancy; thus, timing of administration is critical. Despite data demonstrating safety and efficacy, evidence-based decision making has been overshadowed by politically charged actions involving levonorgestrel emergency contraception for over a decade. The Women's Health Practice and Research Network of the American College of Clinical Pharmacy supports expanded access to levonorgestrel emergency contraception and removal of barriers such as age restrictions on the nonprescription drug product. Pharmacists remain a key provider of emergency contraceptive services and can help ensure timely access. In states where direct pharmacy access to emergency contraception is available, pharmacists are encouraged to participate. Education, research, and advocacy are other important responsibilities for pharmacists in this arena. © 2013 Pharmacotherapy Publications, Inc.

Optimising the emergency to ward handover process: A mixed methods study.

PubMed

Bakon, Shannon; Millichamp, Tracey

2017-11-01

The effective handover of patient health data from the emergency department to other hospital units is integral for the continuity of patient care. Yet no handover process has been identified as superior to others within this context. This study within a regional Australian hospital employed mixed methods approach including focus groups and key stakeholder consultation to develop a handover form appropriate for patient transfer from the emergency department to a variety of clinical areas. Paper-based surveys and audits were then employed to evaluate the implementation and understand staff perceptions of the form. The implementation of a patient handover form within the emergency setting was well received. Participants indicated that the form is clear, well designed and easy to navigate. It provided prompts to standardise their clinical handover and increased their accountability and responsibility within this process. To deliver an optimal nursing handover from the emergency department to various wards handovers should be structured and provide standardised content. The positive reception and use of this form provides evidence that a structured handover process can ensure standardisation of emergency department to ward nursing handovers. Copyright © 2017 College of Emergency Nursing Australasia. Published by Elsevier Ltd. All rights reserved.

Impact of vehicular networks on emergency medical services in urban areas.

PubMed

Lee, Chun-Liang; Huang, Chung-Yuan; Hsiao, Tzu-Chien; Wu, Chun-Yen; Chen, Yaw-Chung; Wang, I-Cheng

2014-10-31

The speed with which emergency personnel can provide emergency treatment is crucial to reducing death and disability among acute and critically ill patients. Unfortunately, the rapid development of cities and increased numbers of vehicles are preventing emergency vehicles from easily reaching locations where they are needed. A significant number of researchers are experimenting with vehicular networks to address this issue, but in most studies the focus has been on communication technologies and protocols, with few efforts to assess how network applications actually support emergency medical care. Our motivation was to search the literature for suggested methods for assisting emergency vehicles, and to use simulations to evaluate them. Our results and evidence-based studies were cross-referenced to assess each method in terms of cumulative survival ratio (CSR) gains for acute and critically ill patients. Simulation results indicate that traffic light preemption resulted in significant CSR increases of between 32.4% and 90.2%. Route guidance was found to increase CSRs from 14.1% to 57.8%, while path clearing increased CSRs by 15.5% or less. It is our hope that this data will support the efforts of emergency medical technicians, traffic managers, and policy makers.

Impact of Vehicular Networks on Emergency Medical Services in Urban Areas

PubMed Central

Lee, Chun-Liang; Huang, Chung-Yuan; Hsiao, Tzu-Chien; Wu, Chun-Yen; Chen, Yaw-Chung; Wang, I.-Cheng

2014-01-01

The speed with which emergency personnel can provide emergency treatment is crucial to reducing death and disability among acute and critically ill patients. Unfortunately, the rapid development of cities and increased numbers of vehicles are preventing emergency vehicles from easily reaching locations where they are needed. A significant number of researchers are experimenting with vehicular networks to address this issue, but in most studies the focus has been on communication technologies and protocols, with few efforts to assess how network applications actually support emergency medical care. Our motivation was to search the literature for suggested methods for assisting emergency vehicles, and to use simulations to evaluate them. Our results and evidence-based studies were cross-referenced to assess each method in terms of cumulative survival ratio (CSR) gains for acute and critically ill patients. Simulation results indicate that traffic light preemption resulted in significant CSR increases of between 32.4% and 90.2%. Route guidance was found to increase CSRs from 14.1% to 57.8%, while path clearing increased CSRs by 15.5% or less. It is our hope that this data will support the efforts of emergency medical technicians, traffic managers, and policy makers. PMID:25365059

Emergency management leadership in 2030: Shaping the next generation meta-leader.

PubMed

Cwiak, Carol L; Campbell, Ronald; Cassavechia, Matthew G; Haynes, Chuck; Lloyd, Lanita A; Brockway, Neil; Navarini, George O; Piatt, Byron E; Senger, Mary

The complexities, interdependencies, and ambiguity that face next generation emergency management meta-leaders in an ever-evolving global community heighten the expectation and need for competencies that far exceed those common in practice today and necessitate the ability to move seamlessly through the dimensions of meta-leadership (ie, the person, the situation, and connectivity) while utilizing scientific-based evidence, information, resources, processes, and tools. The objective of this effort was to examine the recently developed next generation emergency management competencies through a meta-leadership lens by juxtaposing the competencies and the meta-leadership model. This resulted in a new framing of the skills and attributes within the meta-leadership model as they are relevant to each competency. Selected trends, drivers, and challenges were used to provide examples within each competency area of the utility of meta-leadership to next generation emergency management practice. This effort also offers training and education implications for next generation emergency management meta-leaders. The examination of the new framing created in this effort is intended to prompt dialog and research within the emergency management practice and academic communities that furthers the practice and study of emergency management.

The impact of thunderstorm asthma on emergency department attendances across London during July 2013.

PubMed

Elliot, A J; Hughes, H E; Hughes, T C; Locker, T E; Brown, R; Sarran, C; Clewlow, Y; Murray, V; Bone, A; Catchpole, M; McCloskey, B; Smith, G E

2014-08-01

This study illustrates the potential of using emergency department attendance data, routinely accessed as part of a national syndromic surveillance system, to monitor the impact of thunderstorm asthma. The Emergency Department Syndromic Surveillance System (EDSSS) routinely monitors anonymised attendance data on a daily basis across a sentinel network of 35 emergency departments. Attendance data for asthma, wheeze and difficulty breathing are analysed on a daily basis. A statistically significant spike in asthma attendances in two EDSSS emergency departments in London was detected on 23 July 2013, coinciding with a series of large violent thunderstorms across southern England. There was also an increase in the reported severity of these attendances. This preliminary report illustrates the potential of the EDSSS to monitor the impact of thunderstorms on emergency department asthma attendances. Further work will focus on how this system can be used to quantify the impact on emergency departments, thus potentially improving resource planning and also adding to the thunderstorm asthma evidence-base. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Emerging Technologies for Environmental Remediation: Integrating Data and Judgment.

PubMed

Bates, Matthew E; Grieger, Khara D; Trump, Benjamin D; Keisler, Jeffrey M; Plourde, Kenton J; Linkov, Igor

2016-01-05

Emerging technologies present significant challenges to researchers, decision-makers, industry professionals, and other stakeholder groups due to the lack of quantitative risk, benefit, and cost data associated with their use. Multi-criteria decision analysis (MCDA) can support early decisions for emerging technologies when data is too sparse or uncertain for traditional risk assessment. It does this by integrating expert judgment with available quantitative and qualitative inputs across multiple criteria to provide relative technology scores. Here, an MCDA framework provides preliminary insights on the suitability of emerging technologies for environmental remediation by comparing nanotechnology and synthetic biology to conventional remediation methods. Subject matter experts provided judgments regarding the importance of criteria used in the evaluations and scored the technologies with respect to those criteria. The results indicate that synthetic biology may be preferred over nanotechnology and conventional methods for high expected benefits and low deployment costs but that conventional technology may be preferred over emerging technologies for reduced risks and development costs. In the absence of field data regarding the risks, benefits, and costs of emerging technologies, structuring evidence-based expert judgment through a weighted hierarchy of topical questions may be helpful to inform preliminary risk governance and guide emerging technology development and policy.

Evidence for the use of Levomepromazine for symptom control in the palliative care setting: a systematic review

PubMed Central

2013-01-01

Background Levomepromazine is an antipsychotic drug that is used clinically for a variety of distressing symptoms in palliative and end-of-life care. We undertook a systematic review based on the question “What is the published evidence for the use of levomepromazine in palliative symptom control?”. Methods To determine the level of evidence for the use of levomepromazine in palliative symptom control, and to discover gaps in evidence, relevant studies were identified using a detailed, multi-step search strategy. Emerging data was then scrutinized using appropriate assessment tools, and the strength of evidence systematically graded in accordance with the Oxford Centre for Evidence-Based Medicine’s ‘levels of evidence’ tool. The electronic databases Medline, Embase, Cochrane, PsychInfo and Ovid Nursing, together with hand-searching and cross-referencing provided the full research platform on which the review is based. Results 33 articles including 9 systematic reviews met the inclusion criteria: 15 on palliative sedation, 8 regarding nausea and three on delirium and restlessness, one on pain and six with other foci. The studies varied greatly in both design and sample size. Levels of evidence ranged from level 2b to level 5, with the majority being level 3 (non-randomized, non-consecutive or cohort studies n = 22), with the quality of reporting for the included studies being only low to medium. Conclusion Levomepromazine is widely used in palliative care as antipsychotic, anxiolytic, antiemetic and sedative drug. However, the supporting evidence is limited to open series and case reports. Thus prospective randomized trials are needed to support evidence-based guidelines. PMID:23331515

Family-based treatment of a 17-year-old twin presenting with emerging anorexia nervosa: a case study using the "Maudsley method".

PubMed

Loeb, Katharine L; Hirsch, Alicia M; Greif, Rebecca; Hildebrandt, Thomas B

2009-01-01

This article describes the successful application of family-based treatment (FBT) for a 17-year-old identical twin presenting with a 4-month history of clinically significant symptoms of anorexia nervosa (AN). FBT is a manualized treatment that has been studied in randomized controlled trials for adolescents with AN. This case study illustrates the administration of this evidence-based intervention in a clinical setting, highlighting how the best available research was used to make clinical decisions at each stage of treatment delivery.

The Imperial Paediatric Emergency Training Toolkit (IPETT) for use in paediatric emergency training: development and evaluation of feasibility and validity.

PubMed

Lambden, Simon; DeMunter, Claudine; Dowson, Anne; Cooper, Mehrengise; Gautama, Sanjay; Sevdalis, Nick

2013-06-01

To develop and test the feasibility, reliability, and validity of a practical toolkit for the assessment and feedback of skills required to manage paediatric emergencies in critical care settings. The Imperial Paediatric Emergency Training Toolkit (IPETT) was developed based on current evidence-base and expert input. IPETT assesses both technical and non-technical skills. The technical component covers skills in the areas of clinical assessment, airway and breathing, cardiovascular, and drugs. The non-technical component is based on the validated NOTECHS tool and covers communication and interaction, cooperation and team skills, leadership and managerial skills, and decision-making. The reliability (internal consistency), content validity (inter-correlations between different skills) and concurrent validity (correlations between global technical and non-technical scores) of IPETT were prospectively evaluated in 45 simulated paediatric crises carried out in a PICU with anaesthetic and paediatric trainees (N=52). Non-parametric analyses were carried out. Significance was set at P<0.05. Cronbach alpha reliability coefficients were overall acceptable for the technical (alpha range=0.638-0.810) and good for the non-technical (alpha range=0.701-0.899) component of IPETT. The median inter-skill correlation was rho=0.564 and rho=0.549 for the technical and non-technical components, respectively. These indicate good content validity, as the skills were inter-related but not redundant. We also demonstrate a correlation between the global technical and non-technical scores (rho=0.471) - all Ps<0.05 during the assessments. IPETT offers a psychometrically viable and feasible to use tool in the context of paediatric emergencies training. This study shows that assessment of technical and non-technical skills in combination may offer a more clinically relevant model for training in paediatric emergencies. Further validation should aim to demonstrate skill retention over time and skill transfer from simulation-based training to real emergencies. Copyright © 2013. Published by Elsevier Ireland Ltd.

Place shaping to create health and wellbeing using health impact assessment: health geography applied to develop evidence-based practice.

PubMed

Learmonth, Alyson; Curtis, Sarah

2013-11-01

In a political milieu where there is pressure towards localised and participative decisionmaking, and an environment of global recession and environmental degradation, it is crucial that population health considerations inform strategic decisions. The paper puts forward 'place shaping to create health and wellbeing' as a strategic tool, drawing on ideas that are fundamental in health geography, and argues that this is an important emerging application of Health Impact Assessment (HIA), as part of evidence-based practice. These views developed primarily from case study work in the North East of England aiming to enhance health and wellbeing in a population with significant health disadvantages. © 2013 Elsevier Ltd. All rights reserved.

Pneumothorax In Pediatric Patients: Management Strategies To Improve Patient Outcomes.

PubMed

Harris, Matthew; Rocker, Joshua

2017-03-01

The clinical presentation of pneumothorax is highly variable. Spontaneous pneumothoraces may present with subtle symptoms when a small air leak is present, but can progress to hemodynamic instability in the setting of tension physiology. The etiologies are broad and the severity can vary greatly. A trauma patient with a pneumothorax may also have the added complexity of other potentially life-threatening injuries. While there is a wealth of evidence-based guidelines for the management of pneumothoraces in the adult literature, the approach to pediatric patients is largely extrapolated from that literature without a significant evidence base. In this issue, aspects of the history and physical examination, the use of various diagnostic imaging modalities, and the range of interventions available to the emergency clinician are discussed.

A new evidence-based risk stratification system for cutaneous squamous cell carcinoma into low, intermediate, and high risk groups with implications for management.

PubMed

Baum, Christian L; Wright, Adam C; Martinez, Juan-Carlos; Arpey, Christopher J; Brewer, Jerry D; Roenigk, Randall K; Otley, Clark C

2018-01-01

Most primary cutaneous squamous cell carcinomas are cured with surgery. A subset, however, may develop local and nodal metastasis that may eventuate in disease-specific; death. This subset has been variably termed high risk. Herein, we review; an emerging body of data on the risks of these outcomes and propose an evidence-based; risk stratification for low-, intermediate-, and high-risk tumors that takes into; account both tumor and patient characteristics. Finally, we discuss a framework for; management of these tumors on the basis of data, when available, and our; recommendations when data are sparse. Copyright © 2017 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

Identifying barriers to emergency care services.

PubMed

Cannoodt, Luk; Mock, Charles; Bucagu, Maurice

2012-01-01

This paper aims to present a review of published evidence of barriers to emergency care, with attention towards both financial and other barriers. With the keywords (financial) accessibility, barriers and emergency care services, citations in PubMed were searched and further selected in the context of the objective of this article. Forty articles, published over a period of 15 years, showed evidence of significant barriers to emergency care. These barriers often tend to persist, despite the fact that the evidence was published many years ago. Several publications stressed the importance of the financial barriers in foregoing or delaying potentially life-saving emergency services, both in poor and rich countries. Other publications report non-financial barriers that prevent patients in need of emergency care (pre-hospital and in-patient care) from seeking care, from arriving in the proper emergency department without undue delay or from receiving proper treatment when they do arrive in these departments. It is clear that timely access to life-saving and disability-preventing emergency care is problematic in many settings. Yet, low-cost measures can likely be taken to significantly reduce these barriers. It is time to make an inventory of these measures and to implement the most cost-effective ones worldwide. Copyright © 2011 John Wiley & Sons, Ltd.

Modelling optimal location for pre-hospital helicopter emergency medical services.

PubMed

Schuurman, Nadine; Bell, Nathaniel J; L'Heureux, Randy; Hameed, Syed M

2009-05-09

Increasing the range and scope of early activation/auto launch helicopter emergency medical services (HEMS) may alleviate unnecessary injury mortality that disproportionately affects rural populations. To date, attempts to develop a quantitative framework for the optimal location of HEMS facilities have been absent. Our analysis used five years of critical care data from tertiary health care facilities, spatial data on origin of transport and accurate road travel time catchments for tertiary centres. A location optimization model was developed to identify where the expansion of HEMS would cover the greatest population among those currently underserved. The protocol was developed using geographic information systems (GIS) to measure populations, distances and accessibility to services. Our model determined Royal Inland Hospital (RIH) was the optimal site for an expanded HEMS - based on denominator population, distance to services and historical usage patterns. GIS based protocols for location of emergency medical resources can provide supportive evidence for allocation decisions - especially when resources are limited. In this study, we were able to demonstrate conclusively that a logical choice exists for location of additional HEMS. This protocol could be extended to location analysis for other emergency and health services.

Precise genotyping and recombination detection of Enterovirus

PubMed Central

2015-01-01

Enteroviruses (EV) with different genotypes cause diverse infectious diseases in humans and mammals. A correct EV typing result is crucial for effective medical treatment and disease control; however, the emergence of novel viral strains has impaired the performance of available diagnostic tools. Here, we present a web-based tool, named EVIDENCE (EnteroVirus In DEep conception, http://symbiont.iis.sinica.edu.tw/evidence), for EV genotyping and recombination detection. We introduce the idea of using mixed-ranking scores to evaluate the fitness of prototypes based on relatedness and on the genome regions of interest. Using phylogenetic methods, the most possible genotype is determined based on the closest neighbor among the selected references. To detect possible recombination events, EVIDENCE calculates the sequence distance and phylogenetic relationship among sequences of all sliding windows scanning over the whole genome. Detected recombination events are plotted in an interactive figure for viewing of fine details. In addition, all EV sequences available in GenBank were collected and revised using the latest classification and nomenclature of EV in EVIDENCE. These sequences are built into the database and are retrieved in an indexed catalog, or can be searched for by keywords or by sequence similarity. EVIDENCE is the first web-based tool containing pipelines for genotyping and recombination detection, with updated, built-in, and complete reference sequences to improve sensitivity and specificity. The use of EVIDENCE can accelerate genotype identification, aiding clinical diagnosis and enhancing our understanding of EV evolution. PMID:26678286

Communication of Science Advice to Government.

PubMed

Hutchings, Jeffrey A; Stenseth, Nils Chr

2016-01-01

There are various ways to construct good processes for soliciting and understanding science. Our critique of advisory models finds that a well-supported chief science advisor (CSA) best ensures the provision of deliberative, informal, and emergency advice to government. Alternatively, bias, increasingly manifest as science-based advocacy, can hinder communication, diminish credibility, and distort scientific evidence. Copyright © 2015 Elsevier Ltd. All rights reserved.

School Library Media Specialists Inform Technology Preparation of Library Science Students: An Evidence-Based Discussion

ERIC Educational Resources Information Center

Snyder, Donna L.; Miller, Andrea L.

2009-01-01

What is the relative importance of current and emerging technologies in school library media programs? In order to answer this question, in Fall 2007 the authors administered a survey to 1,053 school library media specialists (SLMSs) throughout the state of Pennsylvania. As a part of the MSLS degree with Library Science K-12 certification, Clarion…

Emerging Opportunities for School Psychologists to Enhance our Remediation Procedure Evidence Base as We Apply Response to Intervention

ERIC Educational Resources Information Center

Skinner, Christopher H.; McCleary, Daniel F.; Skolits, Gary L.; Poncy, Brian C.; Cates, Gary L.

2013-01-01

The success of Response-to-Intervention (RTI) and similar models of service delivery is dependent on educators being able to apply effective and efficient remedial procedures. In the process of implementing problem-solving RTI models, school psychologists have an opportunity to contribute to and enhance the quality of our remedial-procedure…

Associations between Expressive and Receptive Language and Internalizing and Externalizing Behaviours in a Community-Based Prospective Study of Slow-to-Talk Toddlers

ERIC Educational Resources Information Center

Conway, Laura J.; Levickis, Penny A.; Mensah, Fiona; McKean, Cristina; Smith, Kylie; Reilly, Sheena

2017-01-01

Background: Evidence suggests that language and social, emotional and behavioural (SEB) difficulties are associated in children and adolescents. When these associations emerge and whether they differ by language or SEB difficulty profile is unclear. This knowledge is crucial to guide prevention and intervention programmes for children with…

A Secure Base from Which to Regulate: Attachment Security in Toddlerhood as a Predictor of Executive Functioning at School Entry

ERIC Educational Resources Information Center

Bernier, Annie; Beauchamp, Miriam H.; Carlson, Stephanie M.; Lalonde, Gabrielle

2015-01-01

In light of emerging evidence suggesting that the affective quality of parent-child relationships may relate to individual differences in young children's executive functioning (EF) skills, the aim of this study was to investigate the prospective associations between attachment security in toddlerhood and children's EF skills in kindergarten.…

Evidence-based review of seeding in post-fire rehabilitation and native plant market feasibility

Treesearch

Donna L. Peppin

2009-01-01

A changing climate and fire regime shifts in the western United States have led to an increase in revegetation activities, in particular post-wildfire rehabilitation and the need for locally-adapted plant materials. Broadcast seeding is one of the most widely used post-wildfire emergency response treatments to minimize soil erosion, promote plant community recovery,...

Impacts of Academic R&D on High-Tech Manufacturing Products: Tentative Evidence from Supercomputer Data

ERIC Educational Resources Information Center

Le, Thanh; Tang, Kam Ki

2015-01-01

This paper empirically examines the impact of academic research on high-tech manufacturing growth of 28 Organisation for Economic Co-operation and Development (OECD) and emerging countries over the 1991-2005 period. A standard research and development (R&D) expenditure based measure is found to be too general to capture the input in high-tech…

The Ambiguity of Perception: Virtual Art Museology, Free-Choice Learning, and Children's Art Education

ERIC Educational Resources Information Center

Mulligan, Christine Susan

2010-01-01

With many art museums uploading web-based art activities for youngsters, an online phenomenon is burgeoning, and a research domain is emerging. In an effort to contribute empirical evidence to an area of educational research that I refer to as "virtual art museology," or the study of art museum's online art activities for young people, this…

Lift-Off for Early Literacy: Directed Reading Opportunities for Struggling Students

ERIC Educational Resources Information Center

Iannone-Campbell, Charlene; Lattimore, Susan Lloyd

2011-01-01

As early as preschool, children who struggle with emergent literacy skills can benefit from effective response to intervention. Don't wait until later grades when they've already fallen behind--improve their literacy skills now with this evidence-based Tier 2 RTI curriculum, ready for any pre-K educator to pick up and use right away. Created by…

Will MOOCs Transform Learning and Teaching in Higher Education? Engagement and Course Retention in Online Learning Provision

ERIC Educational Resources Information Center

de Freitas, Sara Isabella; Morgan, John; Gibson, David

2015-01-01

Massive open online courses (MOOCs) have been the subject of much polarised debate around their potential to transform higher education in terms of opening access. Although MOOCs have been attracting large learner cohorts, concerns have emerged from the early evidence base centring upon issues of quality in learning and teaching provision, and…

Research Review: DSM-V Conduct Disorder--Research Needs for an Evidence Base

ERIC Educational Resources Information Center

Moffitt, Terrie E.; Arseneault, Louise; Jaffee, Sara R.; Kim-Cohen, Julia; Koenen, Karestan C.; Odgers, Candice L.; Slutske, Wendy S.; Viding, Essi

2008-01-01

This article charts a strategic research course toward an empirical foundation for the diagnosis of conduct disorder in the forthcoming DSM-V. Since the DSM-IV appeared in 1994, an impressive amount of new information about conduct disorder has emerged. As a result of this new knowledge, reasonable rationales have been put forward for adding to…

The I3E Model for Embedding Education for Sustainability within Higher Education Institutions

ERIC Educational Resources Information Center

Cebrián, Gisela

2018-01-01

This paper presents an evidence-based model (the I3E model) for embedding education for sustainability (EfS) within a higher education institution. This model emerged from a doctoral research that examined organisational learning and change processes at the University of Southampton to build EfS into the university curriculum. The researcher aimed…

Integrating Social Services and Home-Based Primary Care for High-Risk Patients.

PubMed

Feinglass, Joe; Norman, Greg; Golden, Robyn L; Muramatsu, Naoko; Gelder, Michael; Cornwell, Thomas

2018-04-01

There is a consensus that our current hospital-intensive approach to care is deeply flawed. This review article describes the research evidence for developing a better system of care for high-cost, high-risk patients. It reviews the evidence that home-centered care and integration of health care with social services are the cornerstones of a more humane and efficient system. The article describes the strengths and weaknesses of research evaluating the effects of social services in addressing social determinants of health, and how social support is critical to successful acute care transition programs. It reviews the history of incorporating social services into care management, and the prospects that recent payment reforms and regulatory initiatives can succeed in stimulating the financial integration of social services into new care coordination initiatives. The article reviews the literature on home-based primary care for the chronically ill and disabled, and suggests that it is the emergence of this care modality that holds the greatest promise for delivery system reform. In the hope of stimulating further discussion and debate, the authors summarize existing viewpoints on how a home-centered system, which integrates social and medical services, might emerge in the next few years.

Volunteer driven home safety intervention results in significant reduction in pediatric injuries: A model for community based injury reduction.

PubMed

Falcone, Richard A; Edmunds, Patrick; Lee, Emily; Gardner, Dawne; Price, Kimberly; Gittelman, Michael; Pomerantz, Wendy; Besl, John; Madhavan, Gowri; Phelan, Kieran J

2016-07-01

Home based injuries account for a significant number of injuries to children between 1 and 5years old. Evidence-based safety interventions delivered in the home with installation of safety equipment have been demonstrated to reduce injury rates. The aim of this study was to evaluate the impact of a community based volunteer implemented home safety intervention. In partnership with a community with high injury rates for children between 1 and 5years old, a home safety bundle was developed and implemented by volunteers. The safety bundle included installing evidence based safety equipment. Monthly community emergency room attended injury rates as well as emergency room attended injuries occurring in intervention and nonintervention homes was tracked throughout the study. Between May 2012 and May 2014 a total of 207 homes with children 1-5years old received the home safety bundle. The baseline monthly emergency room attended injury rate for children aged 1-5years within our target community was 11.3/1000 and that within our county was 8.7/1000. Following the intervention current rates are now 10.3/1000 and 9.2/1000 respectively. Within intervention homes the injury rate decreased to 4.2/1000 while the rate in the homes not receiving the intervention experienced an increase in injury rate to 12/1000 (p<0.05). When observed vs. expected injuries were examined the intervention group demonstrated 59% fewer injuries while the nonintervention group demonstrated a 6% increase (p<0.05). Children in homes that received a volunteer-provided, free home safety bundle experienced 59% fewer injuries than would have been expected. By partnering with community leaders and organizing volunteers, proven home safety interventions were successfully provided to 207 homes during a two-year period, and a decline in community injury rates for children younger than 5years was observed compared to county wide injury rates. Copyright © 2016 Elsevier Inc. All rights reserved.

Consolidating emerging evidence surrounding HIVST and HIVSS: a rapid systematic mapping protocol.

PubMed

Witzel, T Charles; Weatherburn, Peter; Burns, Fiona M; Johnson, Cheryl C; Figueroa, Carmen; Rodger, Alison J

2017-04-05

HIV self-testing (HIVST) is becoming popular with policy makers and commissioners globally, with a key aim of expanding access through reducing barriers to testing for individuals at risk of HIV infection. HIV self-sampling (HIVSS) was available previously to self-testing but was confined mainly to the USA and the UK. It remains to be seen whether the momentum behind HIVST will also energise efforts to expand HIVSS. Recent years have seen a rapid growth in the type of evidence related to these interventions as well as several systematic reviews. The vast majority of this evidence relates to acceptability as well as values and preferences, although new types of evidence are emerging. This systematic map aims to consolidate all emerging evidence related to HIVST and HIVSS to respond to this rapidly changing area. We will systematically search databases and the abstracts of five conferences from 2006 to the present date, with monthly-automated database searches. Searches will combine key terms relating to HIV (e.g. HIV, AIDS, human immune-deficiency syndrome) with terms related to self-testing (e.g. home-test, self-test, mail-test, home dried blood spot test). Abstracts will be reviewed against inclusion criteria in duplicate. Data will be manually extracted through a standard form and then entered to an open access relational map (HIVST.org). When new and sufficient evidence emerges which addresses existing knowledge gaps, we will complete a review on a relevant topic. This innovative approach will allow rapid cataloguing, documenting and dissemination of new evidence and key findings as they emerge into the public domain. This protocol has not been registered with PROSPERO as they do not register systematic maps.

Diabetes UK evidence-based nutrition guidelines for the prevention and management of diabetes.

PubMed

Dyson, P A; Twenefour, D; Breen, C; Duncan, A; Elvin, E; Goff, L; Hill, A; Kalsi, P; Marsland, N; McArdle, P; Mellor, D; Oliver, L; Watson, K

2018-05-01

A summary of the latest evidence-based nutrition guidelines for the prevention and management of diabetes is presented. These guidelines are based on existing recommendations last published in 2011, and were formulated by an expert panel of specialist dietitians after a literature review of recent evidence. Recommendations have been made in terms of foods rather than nutrients wherever possible. Guidelines for education and care delivery, prevention of Type 2 diabetes, glycaemic control for Type 1 and Type 2 diabetes, cardiovascular disease risk management, management of diabetes-related complications, other considerations including comorbidities, nutrition support, pregnancy and lactation, eating disorders, micronutrients, food supplements, functional foods, commercial diabetic foods and nutritive and non-nutritive sweeteners are included. The sections on pregnancy and prevention of Type 2 diabetes have been enlarged and the weight management section modified to include considerations of remission of Type 2 diabetes. A section evaluating detailed considerations in ethnic minorities has been included as a new topic. The guidelines were graded using adapted 'GRADE' methodology and, where strong evidence was lacking, grading was not allocated. These 2018 guidelines emphasize a flexible, individualized approach to diabetes management and weight loss and highlight the emerging evidence for remission of Type 2 diabetes. The full guideline document is available at www.diabetes.org.uk/nutrition-guidelines. © 2018 Diabetes UK.

Evaluation of a program to increase evidence-based practice change.

PubMed

Larrabee, June H; Sions, Jacqueline; Fanning, Mary; Withrow, Mary Lynne; Ferretti, Andrea

2007-06-01

The study evaluated a nursing research program designed to achieve systematic evidence-based practice change. Specifically, change in nurse attitudes about use of research and research conduct, practice change projects, and nurse participation in research-related activities were evaluated. Evidence indicates that successful evidence-based practice change in an organization requires senior leadership support and a systematic program for practice change. Evaluation of program effectiveness provides evidence about opportunities for further improvement. Quantitative evaluation used a pretest-posttest design. The site was an academic medical center in rural West Virginia. Participants were registered nurses from all inpatients units, perioperative services, and emergency departments. Surveys used Alcock et al's Staff Nurses and Research Activities scale. Descriptive evaluation included the number of nurses who attended the workshop, practice change projects, scholarly products disseminated, and outcome of a Magnet review. First, knowledge about the availability of support services increased between 1999 and 2002 and was associated with higher attitude scores about research and research utilization. Second, registered nurses who reported participating in research-related activities had more positive scores on all attitudes than registered nurses who reported not participating. Nurse leaders may improve participation and attitudes about research and research utilization by internally marketing the support available for research-related activities.

A Systematic Review of Home-Based Childhood Obesity Prevention Studies

PubMed Central

Fawole, Oluwakemi; Segal, Jodi; Wilson, Renee F.; Cheskin, Lawrence J.; Bleich, Sara N.; Wu, Yang; Lau, Brandyn; Wang, Youfa

2013-01-01

BACKGROUND AND OBJECTIVES: Childhood obesity is a global epidemic. Despite emerging research about the role of the family and home on obesity risk behaviors, the evidence base for the effectiveness of home-based interventions on obesity prevention remains uncertain. The objective was to systematically review the effectiveness of home-based interventions on weight, intermediate (eg, diet and physical activity [PA]), and clinical outcomes. METHODS: We searched Medline, Embase, PsychInfo, CINAHL, clinicaltrials.gov, and the Cochrane Library from inception through August 11, 2012. We included experimental and natural experimental studies with ≥1-year follow-up reporting weight-related outcomes and targeting children at home. Two independent reviewers screened studies and extracted data. We graded the strength of the evidence supporting interventions targeting diet, PA, or both for obesity prevention. RESULTS: We identified 6 studies; 3 tested combined interventions (diet and PA), 1 used diet intervention, 1 combined intervention with primary care and consumer health informatics components, and 1 combined intervention with school and community components. Select combined interventions had beneficial effects on fruit/vegetable intake and sedentary behaviors. However, none of the 6 studies reported a significant effect on weight outcomes. Overall, the strength of evidence is low that combined home-based interventions effectively prevent obesity. The evidence is insufficient for conclusions about home-based diet interventions or interventions implemented at home in association with other settings. CONCLUSIONS: The strength of evidence is low to support the effectiveness of home-based child obesity prevention programs. Additional research is needed to test interventions in the home setting, particularly those incorporating parenting strategies and addressing environmental influences. PMID:23753095

The Evidence-base for Using Ontologies and Semantic Integration Methodologies to Support Integrated Chronic Disease Management in Primary and Ambulatory Care: Realist Review. Contribution of the IMIA Primary Health Care Informatics WG.

PubMed

Liyanage, H; Liaw, S-T; Kuziemsky, C; Terry, A L; Jones, S; Soler, J K; de Lusignan, S

2013-01-01

Most chronic diseases are managed in primary and ambulatory care. The chronic care model (CCM) suggests a wide range of community, technological, team and patient factors contribute to effective chronic disease management. Ontologies have the capability to enable formalised linkage of heterogeneous data sources as might be found across the elements of the CCM. To describe the evidence base for using ontologies and other semantic integration methods to support chronic disease management. We reviewed the evidence-base for the use of ontologies and other semantic integration methods within and across the elements of the CCM. We report them using a realist review describing the context in which the mechanism was applied, and any outcome measures. Most evidence was descriptive with an almost complete absence of empirical research and important gaps in the evidence-base. We found some use of ontologies and semantic integration methods for community support of the medical home and for care in the community. Ubiquitous information technology (IT) and other IT tools were deployed to support self-management support, use of shared registries, health behavioural models and knowledge discovery tools to improve delivery system design. Data quality issues restricted the use of clinical data; however there was an increased use of interoperable data and health system integration. Ontologies and semantic integration methods are emergent with limited evidence-base for their implementation. However, they have the potential to integrate the disparate community wide data sources to provide the information necessary for effective chronic disease management.

Improved statistical signal detection in pharmacovigilance by combining multiple strength-of-evidence aspects in vigiRank.

PubMed

Caster, Ola; Juhlin, Kristina; Watson, Sarah; Norén, G Niklas

2014-08-01

Detection of unknown risks with marketed medicines is key to securing the optimal care of individual patients and to reducing the societal burden from adverse drug reactions. Large collections of individual case reports remain the primary source of information and require effective analytics to guide clinical assessors towards likely drug safety signals. Disproportionality analysis is based solely on aggregate numbers of reports and naively disregards report quality and content. However, these latter features are the very fundament of the ensuing clinical assessment. Our objective was to develop and evaluate a data-driven screening algorithm for emerging drug safety signals that accounts for report quality and content. vigiRank is a predictive model for emerging safety signals, here implemented with shrinkage logistic regression to identify predictive variables and estimate their respective contributions. The variables considered for inclusion capture different aspects of strength of evidence, including quality and clinical content of individual reports, as well as trends in time and geographic spread. A reference set of 264 positive controls (historical safety signals from 2003 to 2007) and 5,280 negative controls (pairs of drugs and adverse events not listed in the Summary of Product Characteristics of that drug in 2012) was used for model fitting and evaluation; the latter used fivefold cross-validation to protect against over-fitting. All analyses were performed on a reconstructed version of VigiBase(®) as of 31 December 2004, at around which time most safety signals in our reference set were emerging. The following aspects of strength of evidence were selected for inclusion into vigiRank: the numbers of informative and recent reports, respectively; disproportional reporting; the number of reports with free-text descriptions of the case; and the geographic spread of reporting. vigiRank offered a statistically significant improvement in area under the receiver operating characteristics curve (AUC) over screening based on the Information Component (IC) and raw numbers of reports, respectively (0.775 vs. 0.736 and 0.707, cross-validated). Accounting for multiple aspects of strength of evidence has clear conceptual and empirical advantages over disproportionality analysis. vigiRank is a first-of-its-kind predictive model to factor in report quality and content in first-pass screening to better meet tomorrow's post-marketing drug safety surveillance needs.

Palliative Care Psychiatry: Update on an Emerging Dimension of Psychiatric Practice

PubMed Central

Fairman, Nathan

2013-01-01

Palliative care psychiatry is an emerging subspecialty field at the intersection of Palliative Medicine and Psychiatry. The discipline brings expertise in understanding the psychosocial dimensions of human experience to the care of dying patients and support of their families. The goals of this review are (1) to briefly define palliative care and summarize the evidence for its benefits, (2) to describe the roles for psychiatry within palliative care, (3) to review recent advances in the research and practice of palliative care psychiatry, and (4) to delineate some steps ahead as this sub-field continues to develop, in terms of research, education, and systems-based practice. PMID:23794027

Care of the suicidal pediatric patient in the ED: a case study.

PubMed

Schmid, Alexis M; Truog, Amy W; Damian, Frances J

2011-09-01

The suicide rate among children and adolescents has increased worldwide over the past few decades, and many who attempt suicide are first seen at EDs. At Childrens Hospital Boston (CHB), an algorithm-the Risk of Suicidality Clinical Practice Algorithm-has been developed to ensure evidence-based care supported by best practice guidelines. The authors of this article provide an overview of pediatric suicide and suicide attempts; describe screening, assessment, and interventions used at CHB; and discuss the nursing implications. An illustrative case study is also provided. algorithm, Asperger's syndrome, attempted suicide, bullying, emergency, emergency department, patient safety, pediatrics, pediatric suicide, suicide, suicide screening, triage.

On the night shift: advanced nurse practice in emergency medicine.

PubMed

Jenkins, Jennifer

2016-05-01

Advanced nurse practitioners in the author's emergency department (ED) work autonomously and as part of a team to assess, diagnose and treat patients with unexplained and undiagnosed illnesses and injuries over a 24-hour cycle of care. The complexity of the role in EDs is often not fully understood, and expectations can vary between trusts and between different clinical areas within trusts. This article describes one night shift in the author's ED to explain the complexity of advanced nurse practitioners' roles in this environment. The article focuses on autonomous decision-making skills and the use of advanced clinical skills in the context of evidence-based practice.

Improving Injury Prevention Through Health Information Technology

PubMed Central

Haegerich, Tamara M.; Sugerman, David E.; Annest, Joseph L.; Klevens, Joanne; Baldwin, Grant T.

2015-01-01

Health information technology is an emerging area of focus in clinical medicine with the potential to improve injury and violence prevention practice. With injuries being the leading cause of death for Americans aged 1–44 years, greater implementation of evidence-based preventive services, referral to community resources, and real-time surveillance of emerging threats is needed. Through a review of the literature and capturing of current practice in the field, this paper showcases how health information technology applied to injury and violence prevention can lead to strengthened clinical preventive services, more rigorous measurement of clinical outcomes, and improved injury surveillance, potentially resulting in health improvement. PMID:25441230

Emerging therapeutic uses of direct-acting oral anticoagulants: An evidence-based perspective.

PubMed

Raschi, Emanuel; Bianchin, Matteo; De Ponti, Roberto; De Ponti, Fabrizio; Ageno, Walter

2017-06-01

Direct-acting oral anticoagulants (DOACs) were claimed to cause a potential paradigm shift in the therapeutic scenario of patients requiring short- and long-term anticoagulation, by virtue of their pharmacological properties, perceived as innovative. The evidence gathered so far (from pre-approval pivotal trials to real-world post-marketing observational data) consistently confirmed that DOACs are overall comparable to vitamin-K antagonists (VKAs) in terms of safety, efficacy and effectiveness and unequivocally documented a consistent and clinically relevant reduced risk of intracranial bleeding in the settings of non-valvular atrial fibrillation (NVAF) and venous thromboembolism (VTE). Interestingly, two parallel paths can be identified in the current research scenario: A) in the aforementioned consolidated therapeutic indications, an innovative approach is directed towards tailored treatment strategies, to identify patients most likely to benefit from one of the different anticoagulant drugs, in particular subpopulations at increased risk of adverse events (e.g., bleeding); B) in unconventional settings, DOACs are gaining interest for potential use in emerging diseases characterized by arterial and venous thromboembolic risk. In these scenarios, the risk-benefit profile of DOACs, as compared to VKAs or heparins, is less defined. The aim of this review is to critically assess the body of evidence underlying emerging therapeutic uses of DOACs (e.g., heparin-induced thrombocytopenia, anti-phospholipid antibody syndrome), including evolving issues in special populations (e.g., patients with VTE and cancer or cirrhosis). This will be achieved by analyzing the strength (i.e., systematic reviews, randomized clinical trials, observational studies, case report/series) and consistency (i.e., concordance) of both published and unpublished evidence registered in major public repositories. Copyright © 2017 Elsevier Ltd. All rights reserved.

Sex offender polygraph examination: an evidence-based case management tool for social workers.

PubMed

Levenson, Jill S

2009-10-01

This article will review the use of polygraphy in the assessment and treatment of sexual perpetrators. Such information can be utilized by social workers who are involved in the treatment and case management of child sexual abuse cases. First, the controversial literature regarding the validity and reliability of polygraph examination in general will be reviewed. Next, an emerging body of evidence supporting the utility of polygraph testing with sex offenders will be discussed. Finally, ways that social workers can incorporate this knowledge into their case management and clinical roles will be offered.

Clinical nurse specialists: essential resource for an effective NHS.

PubMed

Vidall, Cheryl; Barlow, Helen; Crowe, Maggie; Harrison, Isabel; Young, Annie

Despite emerging evidence for the clinical and financial efficacy of the clinical nurse specialist (CNS), the provision of this role is patchy across the country. There is also a risk that incumbent CNS' may be redirected to less specialist work in trusts that do not appreciate the full value of the service that these nurses provide. Optimal and equitable patient access to CNS care will require the development of a strong evidence base showing that specialist nurses not only deliver patient-focused care, but that they can also help to meet healthcare managers' objectives of streamlined, cost-effective clinical services.

Emergence of Lying in Very Young Children

ERIC Educational Resources Information Center

Evans, Angela D.; Lee, Kang

2013-01-01

Lying is a pervasive human behavior. Evidence to date suggests that from the age of 42 months onward, children become increasingly capable of telling lies in various social situations. However, there is limited experimental evidence regarding whether very young children will tell lies spontaneously. The present study investigated the emergence of…

Making microbiology of the built environment relevant to design.

PubMed

Brown, G Z; Kline, Jeff; Mhuireach, Gwynne; Northcutt, Dale; Stenson, Jason

2016-02-16

Architects are enthusiastic about "bioinformed design" as occupant well-being is a primary measure of architectural success. However, architects are also under mounting pressure to create more sustainable buildings. Scientists have a critical opportunity to make the emerging field of microbiology of the built environment more relevant and applicable to real-world design problems by addressing health and sustainability in tandem. Practice-based research, which complements evidence-based design, represents a promising approach to advancing knowledge of the indoor microbiome and translating it to architectural practice.

Meeting the needs of people in emergencies: a review of UK experiences and capability

PubMed Central

Eyre, A

2008-01-01

This article summarises the key findings of two research studies conducted for the UK Government in 2006–2007. The first was a literature review of evidence about provisions and interventions to meet the needs of people affected by ‘emergencies’ as defined within the Civil Contingencies Act (2004). Drawing on both historical and contemporary research and practice, the literature review presented an assessment of people's psychosocial needs after events such as natural disasters, terrorism, and other major incidents. Although some reference was made about the needs of and consequences on disaster workers responding to these events, the main emphasis was on those directly affected as bereaved people and/or injured survivors. The review offered best practice guidelines based on the most effective methods of humanitarian assistance in the immediate, short-term, and long-term aftermath of major emergencies. The second report was a follow-up study conducted in 2007. This was a piece of primary research focusing on the UK's current capability in humanitarian assistance in terms of the extent of planning, training, exercising, and experience relating to meeting people's needs in emergencies. A variety of methods were used to gather quantitative and qualitative evidence of the nature and status of such activity across the UK, including questionnaires, focus groups, and a review of literature and documentary evidence. The report included a number of good practice case studies and made recommendations for the development of best practice in humanitarian assistance within the UK. PMID:22460218

An emerging cell-based strategy in orthopaedics: endothelial progenitor cells.

PubMed

Atesok, Kivanc; Matsumoto, Tomoyuki; Karlsson, Jon; Asahara, Takayuki; Atala, Anthony; Doral, M Nedim; Verdonk, Rene; Li, Ru; Schemitsch, Emil

2012-07-01

The purpose of this article was to analyze the results of studies in the literature, which evaluated the use of endothelial progenitor cells (EPCs) as a cell-based tissue engineering strategy. EPCs have been successfully used in regenerative medicine to augment neovascularization in patients after myocardial infarction and limb ischemia. EPCs' important role as vasculogenic progenitors presents them as a potential source for cell-based therapies to promote bone healing. EPCs have been shown to have prominent effects in promoting bone regeneration in several animal models. Evidence indicates that EPCs promote bone regeneration by stimulating both angiogenesis and osteogenesis through a differentiation process toward endothelial cell lineage and formation of osteoblasts. Moreover, EPCs increase vascularization and osteogenesis by increased secretion of growth factors and cytokines through paracrine mechanisms. EPCs offer the potential to emerge as a new strategy among other cell-based therapies to promote bone regeneration. Further investigations and human trials are required to address current questions with regard to biology and mechanisms of action of EPCs in bone tissue engineering.

Global Mental Health: A Call for Increased Awareness and Action for Family Therapists.

PubMed

Patterson, Jo Ellen; Edwards, Todd M; Vakili, Susanna

2018-03-01

Global mental health (GMH) is an emerging field that focuses on the need for culturally sensitive mental health services in low- and middle-income countries (LMICs). While many new initiatives have been established worldwide to understand GMH needs and to provide care in LMICs, family therapists have primarily worked with families in high-income countries. The few existing family-based initiatives in GMH focus on psychoeducation and are typically not based on general systems theory. However, emerging trends in family therapy may enable family therapists to impact mental health issues in LMICs. These trends, which are shared interests of both family therapy and GMH, include collaborative care, a growing emphasis on the importance of culture in understanding and treating mental health issues, recognition of the ability of families to support or impede recovery from mental illness, and the use of strength-based and evidence-based treatments. This paper describes ways for family therapists to become active in the GMH community. © 2017 Family Process Institute.

Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder

PubMed Central

Lam, Raymond W.; McIntyre, Roger S.; Tourjman, S. Valérie; Bhat, Venkat; Blier, Pierre; Hasnain, Mehrul; Jollant, Fabrice; Levitt, Anthony J.; MacQueen, Glenda M.; McInerney, Shane J.; McIntosh, Diane; Milev, Roumen V.; Müller, Daniel J.; Parikh, Sagar V.; Pearson, Norma L.; Ravindran, Arun V.; Uher, Rudolf

2016-01-01

Background: The Canadian Network for Mood and Anxiety Treatments (CANMAT) conducted a revision of the 2009 guidelines by updating the evidence and recommendations. The scope of the 2016 guidelines remains the management of major depressive disorder (MDD) in adults, with a target audience of psychiatrists and other mental health professionals. Methods: Using the question-answer format, we conducted a systematic literature search focusing on systematic reviews and meta-analyses. Evidence was graded using CANMAT-defined criteria for level of evidence. Recommendations for lines of treatment were based on the quality of evidence and clinical expert consensus. “Pharmacological Treatments” is the third of six sections of the 2016 guidelines. With little new information on older medications, treatment recommendations focus on second-generation antidepressants. Results: Evidence-informed responses are given for 21 questions under 4 broad categories: 1) principles of pharmacological management, including individualized assessment of patient and medication factors for antidepressant selection, regular and frequent monitoring, and assessing clinical and functional outcomes with measurement-based care; 2) comparative aspects of antidepressant medications based on efficacy, tolerability, and safety, including summaries of newly approved drugs since 2009; 3) practical approaches to pharmacological management, including drug-drug interactions and maintenance recommendations; and 4) managing inadequate response and treatment resistance, with a focus on switching antidepressants, applying adjunctive treatments, and new and emerging agents. Conclusions: Evidence-based pharmacological treatments are available for first-line treatment of MDD and for management of inadequate response. However, given the limitations of the evidence base, pharmacological management of MDD still depends on tailoring treatments to the patient. PMID:27486148