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Sample records for evidence based complementary

  1. An Evidence-Based Course in Complementary Medicines

    PubMed Central

    Hughes, Jeff

    2012-01-01

    Objective. To evaluate the impact of an evidence-based course in complementary medicines on the attitudes, knowledge, and professional practice behavior of undergraduate pharmacy students. Design. A required 12-week evidence-based complementary medicine course was designed and introduced into the third-year undergraduate pharmacy curriculum. The course included a combination of traditional lectures, interactive tutorial sessions, and a range of formal assessments. Assessment. Pre- and post-course survey instruments were administered to assess changes in students’ attitudes, perceptions, knowledge, and the likelihood they would recommend the use of complementary medicines in a pharmacy practice environment. Conclusion. Completion of a required evidence-based complementary medicines course resulted in a positive change in pharmacy students’ perceptions of the value of various complementary medicines as well as in their willingness to recommend them, and provided students with the required knowledge to make patient-centered recommendations for use of complementary medicines in a professional pharmacy practice setting. These findings support the need for greater evidence-based complementary medicine education within pharmacy curricula to meet consumer demand and to align with pharmacists’ professional responsibilities. PMID:23275665

  2. Complementary and Alternative Therapies: An Evidence-Based Framework

    ERIC Educational Resources Information Center

    Shaw, Steven R.

    2008-01-01

    Complementary and alternative medicine (CAM) has experienced a dramatic growth in use and acceptability over the last 20 years. CAM is a diverse collection of medical and healthcare systems, practices, and products that are not presently considered a component of conventional medicine. CAM traditionally has been practiced by informally educated…

  3. Cultural Competence and Evidence-Based Practice in Mental Health Services: A Complementary Perspective

    ERIC Educational Resources Information Center

    Whaley, Arthur L.; Davis, King E.

    2007-01-01

    The need for cultural competence and the need for evidence-based practice in mental health services are major issues in contemporary discourse, especially in the psychological treatment of people of color. Although these 2 paradigms are complementary in nature, there is little cross-fertilization in the psychological literature. The present…

  4. Evidence-based Research in Complementary and Alternative Medicine I: History

    PubMed Central

    2005-01-01

    Contemporary Western medicine has witnessed a fragmentation of our conceptualization of the medical endeavor into ‘traditional medicine’ and ‘non-traditional medicine’. The former is meant to refer to the Western medical tradition, the latter encompasses both ‘complementary’ and ‘alternative’ medical practices. Complementary medicine complements conventional medical treatments, and alternative modes of medical interventions are meant to replace traditional Western medicine. Evidence-based research must be directed at establishing the best available evidence in complementary and alternative medicine. This paper is the first of a set of four ‘lectures’ that reviews the process of evidence-based research, and discusses its implications and applications for the early decades of the 21st century. The purpose of this paper is to introduce the series by examining some of the historical and philosophical foundations of this research endeavor. PMID:16322801

  5. Teaching Evidence-Based Medicine at Complementary and Alternative Medicine Institutions: Strategies, Competencies, and Evaluation

    PubMed Central

    Schiffke, Heather; Fleishman, Susan; Haas, Mitch; Cruser, des Anges; LeFebvre, Ron; Sullivan, Barbara; Taylor, Barry; Gaster, Barak

    2014-01-01

    Abstract Background: As evidence-based medicine (EBM) becomes a standard in health care, it is essential that practitioners of complementary and alternative medicine (CAM) become experts in searching and evaluating the research literature. In support of this goal, the National Institutes of Health (NIH) National Center for Complementary and Alternative Medicine (NCCAM) provided R25 funding to nine CAM colleges to develop individual programs focused on teaching EBM. An overarching goal of these research education grants has been to provide CAM faculty and students with the skills they need to apply a rigorous evidence-based perspective to their training and practice. Methods/Results: This paper reviews the competencies and teaching strategies developed and implemented to enhance research literacy at all nine R25-funded institutions. While each institution designed approaches suitable for its research culture, the guiding principles were similar: to develop evidence-informed skills and knowledge, thereby helping students and faculty to critically appraise evidence and then use that evidence to guide their clinical practice. Curriculum development and assessment included faculty-driven learning activities and longitudinal curricular initiatives to encourage skill reinforcement and evaluate progress. Conclusion: As the field of integrative medicine matures, the NIH-NCCAM research education grants provide essential training for future clinicians and clinician-researchers. Building this workforce will facilitate multidisciplinary collaborations that address the unique needs for research that informs integrative clinical practice. PMID:25380144

  6. Complementary and alternative medicine approaches to blood pressure reduction: An evidence-based review.

    PubMed

    Nahas, Richard

    2008-11-01

    ABSTRACTOBJECTIVETo review the evidence supporting complementary and alternative medicine approaches used in the treatment of hypertension.QUALITY OF EVIDENCEMEDLINE and EMBASE were searched from January 1966 to May 2008 combining the key words hypertension or blood pressure with acupuncture, chocolate, cocoa, coenzyme Q10, ubiquinone, melatonin, vitamin D, meditation, and stress reduction. Clinical trials, prospective studies, and relevant references were included.MAIN MESSAGEEvidence from systematic reviews supports the blood pressure-lowering effects of coenzyme Q10, polyphenol-rich dark chocolate, Qigong, slow breathing, and transcendental meditation. Vitamin D deficiency is associated with hypertension and cardiovascular risk; supplementation lowered blood pressure in 2 trials. Acupuncture reduced blood pressure in 3 trials; in 1 of these it was no better than an invasive placebo. Melatonin was effective in 2 small trials, but caution is warranted in patients taking pharmacotherapy.CONCLUSIONSeveral complementary and alternative medicine therapies can be considered as part of an evidence-based approach to the treatment of hypertension. The potential benefit of these interventions warrants further research using cardiovascular outcomes.

  7. Complementary & alternative management of Parkinson's disease: an evidence-based review of eastern influenced practices.

    PubMed

    Bega, Danny; Zadikoff, Cindy

    2014-10-01

    The prevalence of Parkinson's disease (PD) appears to be lower in Asia compared to the Western world. It is unclear if this is related to the ubiquitous use of traditional medicine in Eastern healthcare, but the use of complementary and alternative medicine (CAM) modalities in countries like Korea may be as high as 76%. Among patients with PD, herbal medicines, health supplement foods, and acupuncture are interventions which are increasingly used throughout the world. Countries like Korea, China, India, and Japan have long embraced and incorporated traditional medicine into modern management of conditions such as PD, but research into various CAM modalities remains in its infancy limiting evidence-based recommendations for many treatments. We reviewed the literature on CAM treatments for PD, focusing on mind-body interventions and natural products. Based on evidence limited to randomized-controlled trials we found that mind-body interventions are generally effective forms of physical activity that are likely to foster good adherence and may reduce disability associated with PD. Based on the current data, modalities like Tai Chi and dance are safe and beneficial in PD, but better studies are needed to assess the effects of other frequently used modalities such as yoga and acupuncture. Furthermore, despite centuries of experience using medicinal herbs and plants in Eastern countries, and despite substantial preclinical data on the beneficial effects of nutritional antioxidants as neuroprotective agents in PD, there is insufficient clinical evidence that any vitamin, food additive, or supplement, can improve motor function or delay disease progression in PD. PMID:25360229

  8. Complementary & alternative management of Parkinson's disease: an evidence-based review of eastern influenced practices.

    PubMed

    Bega, Danny; Zadikoff, Cindy

    2014-10-01

    The prevalence of Parkinson's disease (PD) appears to be lower in Asia compared to the Western world. It is unclear if this is related to the ubiquitous use of traditional medicine in Eastern healthcare, but the use of complementary and alternative medicine (CAM) modalities in countries like Korea may be as high as 76%. Among patients with PD, herbal medicines, health supplement foods, and acupuncture are interventions which are increasingly used throughout the world. Countries like Korea, China, India, and Japan have long embraced and incorporated traditional medicine into modern management of conditions such as PD, but research into various CAM modalities remains in its infancy limiting evidence-based recommendations for many treatments. We reviewed the literature on CAM treatments for PD, focusing on mind-body interventions and natural products. Based on evidence limited to randomized-controlled trials we found that mind-body interventions are generally effective forms of physical activity that are likely to foster good adherence and may reduce disability associated with PD. Based on the current data, modalities like Tai Chi and dance are safe and beneficial in PD, but better studies are needed to assess the effects of other frequently used modalities such as yoga and acupuncture. Furthermore, despite centuries of experience using medicinal herbs and plants in Eastern countries, and despite substantial preclinical data on the beneficial effects of nutritional antioxidants as neuroprotective agents in PD, there is insufficient clinical evidence that any vitamin, food additive, or supplement, can improve motor function or delay disease progression in PD.

  9. Summary of evidence-based guideline: Complementary and alternative medicine in multiple sclerosis

    PubMed Central

    Yadav, Vijayshree; Bever, Christopher; Bowen, James; Bowling, Allen; Weinstock-Guttman, Bianca; Cameron, Michelle; Bourdette, Dennis; Gronseth, Gary S.; Narayanaswami, Pushpa

    2014-01-01

    Objective: To develop evidence-based recommendations for complementary and alternative medicine (CAM) in multiple sclerosis (MS). Methods: We searched the literature (1970–March 2011; March 2011−September 2013 MEDLINE search), classified articles, and linked recommendations to evidence. Results and recommendations: Clinicians might offer oral cannabis extract for spasticity symptoms and pain (excluding central neuropathic pain) (Level A). Clinicians might offer tetrahydrocannabinol for spasticity symptoms and pain (excluding central neuropathic pain) (Level B). Clinicians should counsel patients that these agents are probably ineffective for objective spasticity (short-term)/tremor (Level B) and possibly effective for spasticity and pain (long-term) (Level C). Clinicians might offer Sativex oromucosal cannabinoid spray (nabiximols) for spasticity symptoms, pain, and urinary frequency (Level B). Clinicians should counsel patients that these agents are probably ineffective for objective spasticity/urinary incontinence (Level B). Clinicians might choose not to offer these agents for tremor (Level C). Clinicians might counsel patients that magnetic therapy is probably effective for fatigue and probably ineffective for depression (Level B); fish oil is probably ineffective for relapses, disability, fatigue, MRI lesions, and quality of life (QOL) (Level B); ginkgo biloba is ineffective for cognition (Level A) and possibly effective for fatigue (Level C); reflexology is possibly effective for paresthesia (Level C); Cari Loder regimen is possibly ineffective for disability, symptoms, depression, and fatigue (Level C); and bee sting therapy is possibly ineffective for relapses, disability, fatigue, lesion burden/volume, and health-related QOL (Level C). Cannabinoids may cause adverse effects. Clinicians should exercise caution regarding standardized vs nonstandardized cannabis extracts and overall CAM quality control/nonregulation. Safety/efficacy of other CAM

  10. Food Based Complementary Feeding Strategies for Breastfed Infants: What's the Evidence that it Matters?

    PubMed Central

    Krebs, Nancy F.

    2015-01-01

    The period of complementary feeding represents a major portion of the 1000 day critical window and thus impacts a period of substantial and dynamic infant development. This review highlights and synthesizes findings of several recent studies conducted to evaluate food based strategies on outcomes related to micronutrient status, growth and neurocognitive development. Particular emphasis is placed on interventions using meat or fortified products to impact iron and zinc intakes, due to the dependence of breastfed infants on complementary food choices to meet requirements for these two critical micronutrients. Regular consumption of modest amounts of meat or fortified cereals provides adequate absorbed zinc to meet estimated physiologic requirements, whereas homeostatic adaptation to lower zinc intake from unfortified cereal/plant staples is inadequate to meet requirements. Iron fortification of cereals may be somewhat more effective than meat to improve iron status, but neither prevents iron deficiency in breastfed infants, even in westernized settings. Improvements in the quality of complementary foods have had very modest effects on linear growth in settings where stunting is prevalent. Maternal education is strongly associated with both linear growth and with child neurodevelopment. The determinants of early growth faltering are more complex and intractable than ‘simple’ dietary deficiencies of micronutrients. Solutions to growth faltering in young children most likely need to be multi-factorial, and almost certainly will need to start earlier than the complementary feeding period. PMID:26549893

  11. Evidence-Based Evaluation of Complementary Health Approaches for Pain Management in the United States.

    PubMed

    Nahin, Richard L; Boineau, Robin; Khalsa, Partap S; Stussman, Barbara J; Weber, Wendy J

    2016-09-01

    Although most pain is acute and resolves within a few days or weeks, millions of Americans have persistent or recurring pain that may become chronic and debilitating. Medications may provide only partial relief from this chronic pain and can be associated with unwanted effects. As a result, many individuals turn to complementary health approaches as part of their pain management strategy. This article examines the clinical trial evidence for the efficacy and safety of several specific approaches-acupuncture, manipulation, massage therapy, relaxation techniques including meditation, selected natural product supplements (chondroitin, glucosamine, methylsulfonylmethane, S-adenosylmethionine), tai chi, and yoga-as used to manage chronic pain and related disability associated with back pain, fibromyalgia, osteoarthritis, neck pain, and severe headaches or migraines. PMID:27594189

  12. Complementary and Alternative Medicine and Cardiovascular Disease: An Evidence-Based Review

    PubMed Central

    Rabito, Matthew J.; Kaye, Alan David

    2013-01-01

    Complementary and alternative medicine (CAM) plays a significant role in many aspects of healthcare worldwide, including cardiovascular disease (CVD). This review describes some of the challenges of CAM in terms of scientific research. Biologically-based therapies, mind-body therapies, manipulative and body-based therapies, whole medical systems, and energy medicine are reviewed in detail with regard to cardiovascular risk factors and mediation or modulation of cardiovascular disease pathogenesis. CAM use among patients with CVD is prevalent and in many instances provides positive and significant effects, with biologically-based and mind-body therapies being the most commonly used treatment modalities. More rigorous research to determine the precise physiologic effects and long-term benefits on cardiovascular morbidity and mortality with CAM usage, as well as more open lines of communication between patients and physicians regarding CAM use, is essential when determining optimal treatment plans. PMID:23710229

  13. Complementary and alternative medicine and cardiovascular disease: an evidence-based review.

    PubMed

    Rabito, Matthew J; Kaye, Alan David

    2013-01-01

    Complementary and alternative medicine (CAM) plays a significant role in many aspects of healthcare worldwide, including cardiovascular disease (CVD). This review describes some of the challenges of CAM in terms of scientific research. Biologically-based therapies, mind-body therapies, manipulative and body-based therapies, whole medical systems, and energy medicine are reviewed in detail with regard to cardiovascular risk factors and mediation or modulation of cardiovascular disease pathogenesis. CAM use among patients with CVD is prevalent and in many instances provides positive and significant effects, with biologically-based and mind-body therapies being the most commonly used treatment modalities. More rigorous research to determine the precise physiologic effects and long-term benefits on cardiovascular morbidity and mortality with CAM usage, as well as more open lines of communication between patients and physicians regarding CAM use, is essential when determining optimal treatment plans. PMID:23710229

  14. Complementary and integrative medicine for breast cancer patients - Evidence based practical recommendations.

    PubMed

    Witt, C M; Cardoso, M J

    2016-08-01

    On average half of the breast cancer patients' population uses complementary and integrative medicine (CIM) therapies and many of them would like to receive information on CIM from their conventional treatment team. However, often they don't feel comfortable in discussing CIM related questions, with their conventional treatment team, because they think they don't have enough expertise and available time to deal with this topic. Furthermore, information on the evidence of CIM is not easily accessible and the available information is not always reliable. The purpose of the current paper is to provide: 1) an overview about the CIM interventions that have shown positive effects in breast cancer patients and might be useful in supportive cancer care, 2) practical guidance on how to choose and find a qualified referral to a CIM treatment: 3) recommendations on how these interventions could be integrated into Breast Cancer Centers and which factors should be taken into consideration in this setting. This paper takes available CIM practice guidelines for cancer patients and previous research on CIM implementation models into account. There are CIM interventions that have shown a potential to reduce symptoms of cancer or cancer treatments in breast cancer patients and the vast majority uses a non-pharmacological approach and have a good potential for implementation. Nevertheless, further and more rigorous research is still needed.

  15. Complementary and integrative medicine for breast cancer patients - Evidence based practical recommendations.

    PubMed

    Witt, C M; Cardoso, M J

    2016-08-01

    On average half of the breast cancer patients' population uses complementary and integrative medicine (CIM) therapies and many of them would like to receive information on CIM from their conventional treatment team. However, often they don't feel comfortable in discussing CIM related questions, with their conventional treatment team, because they think they don't have enough expertise and available time to deal with this topic. Furthermore, information on the evidence of CIM is not easily accessible and the available information is not always reliable. The purpose of the current paper is to provide: 1) an overview about the CIM interventions that have shown positive effects in breast cancer patients and might be useful in supportive cancer care, 2) practical guidance on how to choose and find a qualified referral to a CIM treatment: 3) recommendations on how these interventions could be integrated into Breast Cancer Centers and which factors should be taken into consideration in this setting. This paper takes available CIM practice guidelines for cancer patients and previous research on CIM implementation models into account. There are CIM interventions that have shown a potential to reduce symptoms of cancer or cancer treatments in breast cancer patients and the vast majority uses a non-pharmacological approach and have a good potential for implementation. Nevertheless, further and more rigorous research is still needed. PMID:27203402

  16. The paradox of non-evidence based, publicly funded complementary alternative medicine in the English National Health Service: An explanation.

    PubMed

    Sheppard, Maria K

    2015-10-01

    Despite the unproven effectiveness of many practices that are under the umbrella term 'complementary alternative medicine' (CAM), there is provision of CAM within the English National Health Service (NHS). Moreover, although the National Institute for Health and Care Excellence was established to promote scientifically validated medicine in the NHS, the paradox of publicly funded, non-evidence based CAM can be explained as linked with government policy of patient choice and specifically patient treatment choice. Patient choice is useful in the political and policy discourse as it is open to different interpretations and can be justified by policy-makers who rely on the traditional NHS values of equity and universality. Treatment choice finds expression in the policy of personalised healthcare linked with patient responsibilisation which finds resonance in the emphasis CAM places on self-care and self-management. More importantly, however, policy-makers also use patient choice and treatment choice as a policy initiative with the objective of encouraging destabilisation of the entrenched healthcare institutions and practices considered resistant to change. This political strategy of system reform has the unintended, paradoxical consequence of allowing for the emergence of non-evidence based, publicly funded CAM in the NHS. The political and policy discourse of patient choice thus trumps evidence based medicine, with patients that demand access to CAM becoming the unwitting beneficiaries.

  17. Treatment of Fibromyalgia Syndrome: Recommendations of Recent Evidence-Based Interdisciplinary Guidelines with Special Emphasis on Complementary and Alternative Therapies

    PubMed Central

    Fitzcharles, Mary-Ann; Buskila, Dan; Shir, Yoram; Sommer, Claudia

    2013-01-01

    Objective. Current evidence indicates that there is no single ideal treatment for fibromyalgia syndrome (FMS). First choice treatment options remain debatable, especially concerning the importance of complementary and alternative medicine (CAM) treatments. Methods. Three evidence-based interdisciplinary guidelines on FMS in Canada, Germany, and Israel were compared for their first choice and CAM-recommendations. Results. All three guidelines emphasized a patient-tailored approach according to the key symptoms. Aerobic exercise, cognitive behavioral therapy, and multicomponent therapy were first choice treatments. The guidelines differed in the grade of recommendation for drug treatment. Anticonvulsants (gabapentin, pregabalin) and serotonin noradrenaline reuptake inhibitors (duloxetine, milnacipran) were strongly recommended by the Canadian and the Israeli guidelines. These drugs received only a weak recommendation by the German guideline. In consideration of CAM-treatments, acupuncture, hypnosis/guided imagery, and Tai Chi were recommended by the German and Israeli guidelines. The Canadian guidelines did not recommend any CAM therapy. Discussion. Recent evidence-based interdisciplinary guidelines concur on the importance of treatment tailored to the individual patient and further emphasize the need of self-management strategies (exercise, and psychological techniques). PMID:24348701

  18. Treatment of fibromyalgia syndrome: recommendations of recent evidence-based interdisciplinary guidelines with special emphasis on complementary and alternative therapies.

    PubMed

    Ablin, Jacob; Fitzcharles, Mary-Ann; Buskila, Dan; Shir, Yoram; Sommer, Claudia; Häuser, Winfried

    2013-01-01

    Objective. Current evidence indicates that there is no single ideal treatment for fibromyalgia syndrome (FMS). First choice treatment options remain debatable, especially concerning the importance of complementary and alternative medicine (CAM) treatments. Methods. Three evidence-based interdisciplinary guidelines on FMS in Canada, Germany, and Israel were compared for their first choice and CAM-recommendations. Results. All three guidelines emphasized a patient-tailored approach according to the key symptoms. Aerobic exercise, cognitive behavioral therapy, and multicomponent therapy were first choice treatments. The guidelines differed in the grade of recommendation for drug treatment. Anticonvulsants (gabapentin, pregabalin) and serotonin noradrenaline reuptake inhibitors (duloxetine, milnacipran) were strongly recommended by the Canadian and the Israeli guidelines. These drugs received only a weak recommendation by the German guideline. In consideration of CAM-treatments, acupuncture, hypnosis/guided imagery, and Tai Chi were recommended by the German and Israeli guidelines. The Canadian guidelines did not recommend any CAM therapy. Discussion. Recent evidence-based interdisciplinary guidelines concur on the importance of treatment tailored to the individual patient and further emphasize the need of self-management strategies (exercise, and psychological techniques). PMID:24348701

  19. Chapter 5 mantram repetition: an evidence-based complementary practice for military personnel and veterans in the 21st century.

    PubMed

    Bormann, Jill E; Weinrich, Sally; Allard, Carolyn B; Beck, Danielle; Johnson, Brian D; Holt, Lindsay Cosco

    2014-01-01

    Today in the digital age, with our advances in modern technology and communication, there are additional stressors for our military personnel and Veterans. Constant dangers exist both on and off the battlefield, unlike prior wars that had clearly-defined war zones. In addition, medical advances have assisted in saving the lives of many more gravely injured troops than ever previously possible. As the wars in Iraq and Afghanistan come to an end, large numbers of service men and women are returning home with multiple injuries. This group of Veterans has significantly higher rates of posttraumatic stress disorder (PTSD) and traumatic brain injury than ever before reported. Although existing PTSD therapies have been found to be highly effective for many Veterans, there is a substantial minority unsatisfactorily treated. Mantram repetition, an innovative, complementary, evidence-based treatment, is proving to be successful for these new Veterans. When used regularly it helps with "road rage, impatience, anger, frustration, and being out of control." A mantram is a brief, sacred word or phrase that embodies divine power or the greatest positive energy one can imagine (Easwaran, 2008a). Mantram repetition is a simple, quick, personal, portable, and private complementary practice that may be used as an adjunct to current treatments for PTSD. Growing research evidence supports mantram repetition's value for dissemination and adoption in the 21st century. This chapter summarizes Mantram Program research conducted from 2003 to 2014. It describes the health-related benefits of the Mantram Program in various populations. The current research focuses on benefits for managing psychological distress and promoting quality of life in Veterans. Future areas for research are suggested. PMID:25222539

  20. Chapter 5 mantram repetition: an evidence-based complementary practice for military personnel and veterans in the 21st century.

    PubMed

    Bormann, Jill E; Weinrich, Sally; Allard, Carolyn B; Beck, Danielle; Johnson, Brian D; Holt, Lindsay Cosco

    2014-01-01

    Today in the digital age, with our advances in modern technology and communication, there are additional stressors for our military personnel and Veterans. Constant dangers exist both on and off the battlefield, unlike prior wars that had clearly-defined war zones. In addition, medical advances have assisted in saving the lives of many more gravely injured troops than ever previously possible. As the wars in Iraq and Afghanistan come to an end, large numbers of service men and women are returning home with multiple injuries. This group of Veterans has significantly higher rates of posttraumatic stress disorder (PTSD) and traumatic brain injury than ever before reported. Although existing PTSD therapies have been found to be highly effective for many Veterans, there is a substantial minority unsatisfactorily treated. Mantram repetition, an innovative, complementary, evidence-based treatment, is proving to be successful for these new Veterans. When used regularly it helps with "road rage, impatience, anger, frustration, and being out of control." A mantram is a brief, sacred word or phrase that embodies divine power or the greatest positive energy one can imagine (Easwaran, 2008a). Mantram repetition is a simple, quick, personal, portable, and private complementary practice that may be used as an adjunct to current treatments for PTSD. Growing research evidence supports mantram repetition's value for dissemination and adoption in the 21st century. This chapter summarizes Mantram Program research conducted from 2003 to 2014. It describes the health-related benefits of the Mantram Program in various populations. The current research focuses on benefits for managing psychological distress and promoting quality of life in Veterans. Future areas for research are suggested.

  1. [Martin Heidegger, beneficence, health, and evidence based medicine--contemplations regarding ethics and complementary and alternative medicine].

    PubMed

    Oberbaum, Menachem; Gropp, Cornelius

    2015-03-01

    Beneficence is considered a core principle of medical ethics. Evidence Based Medicine (EBM) is used almost synonymously with beneficence and has become the gold standard of efficiency of conventional medicine. Conventional modern medicine and EBM in particular are based on what Heidegger called calculative thinking, whereas complementary medicine (CM) is often based on contemplative thinking according to Heidegger's distinction of different thinking processes. A central issue of beneficence is the striving for health and wellbeing. EBM is little concerned directly with wellbeing, though it does claim to aim at improving quality of life by correcting pathological processes and conditions like infectious diseases, ischemic heart disease but also hypertension and hyperlipidemia. On the other hand, wellbeing is central to therapeutic efforts of CM. Scientific methods to gauge results of EBM are quantitative and based on calculative thinking, while results of treatments with CM are expressed in a qualitative way and based on meditative thinking. In order to maximize beneficence it seems important and feasible to use both approaches, by combining EBM and CM in the best interest of the individual patient.

  2. Complementary & Alternative Management of Parkinson’s Disease: An Evidence-Based Review of Eastern Influenced Practices

    PubMed Central

    Bega, Danny; Zadikoff, Cindy

    2014-01-01

    The prevalence of Parkinson’s disease (PD) appears to be lower in Asia compared to the Western world. It is unclear if this is related to the ubiquitous use of traditional medicine in Eastern healthcare, but the use of complementary and alternative medicine (CAM) modalities in countries like Korea may be as high as 76%. Among patients with PD, herbal medicines, health supplement foods, and acupuncture are interventions which are increasingly used throughout the world. Countries like Korea, China, India, and Japan have long embraced and incorporated traditional medicine into modern management of conditions such as PD, but research into various CAM modalities remains in its infancy limiting evidence-based recommendations for many treatments. We reviewed the literature on CAM treatments for PD, focusing on mind-body interventions and natural products. Based on evidence limited to randomized-controlled trials we found that mind-body interventions are generally effective forms of physical activity that are likely to foster good adherence and may reduce disability associated with PD. Based on the current data, modalities like Tai Chi and dance are safe and beneficial in PD, but better studies are needed to assess the effects of other frequently used modalities such as yoga and acupuncture. Furthermore, despite centuries of experience using medicinal herbs and plants in Eastern countries, and despite substantial preclinical data on the beneficial effects of nutritional antioxidants as neuroprotective agents in PD, there is insufficient clinical evidence that any vitamin, food additive, or supplement, can improve motor function or delay disease progression in PD. PMID:25360229

  3. Best Available Evidence: Three Complementary Approaches

    ERIC Educational Resources Information Center

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

    2012-01-01

    The best available evidence is one of the three critical features of evidence-based practice. Best available evidence is often considered to be synonymous with extremely high standards for research methodology. However, this notion may limit the scope and impact of evidence based practice to those educational decisions on which high quality…

  4. Reiki and related therapies in the dialysis ward: an evidence-based and ethical discussion to debate if these complementary and alternative medicines are welcomed or banned

    PubMed Central

    2013-01-01

    Background Complementary and Alternative Medicines (CAMs) are increasingly practiced in the general population; it is estimated that over 30% of patients with chronic diseases use CAMs on a regular basis. CAMs are also used in hospital settings, suggesting a growing interest in individualized therapies. One potential field of interest is pain, frequently reported by dialysis patients, and seldom sufficiently relieved by mainstream therapies. Gentle-touch therapies and Reiki (an energy based touch therapy) are widely used in the western population as pain relievers. By integrating evidence based approaches and providing ethical discussion, this debate discusses the pros and cons of CAMs in the dialysis ward, and whether such approaches should be welcomed or banned. Discussion In spite of the wide use of CAMs in the general population, few studies deal with the pros and cons of an integration of mainstream medicine and CAMs in dialysis patients; one paper only regarded the use of Reiki and related practices. Widening the search to chronic pain, Reiki and related practices, 419 articles were found on Medline and 6 were selected (1 Cochrane review and 5 RCTs updating the Cochrane review). According to the EBM approach, Reiki allows a statistically significant but very low-grade pain reduction without specific side effects. Gentle-touch therapy and Reiki are thus good examples of approaches in which controversial efficacy has to be balanced against no known side effect, frequent free availability (volunteer non-profit associations) and easy integration with any other pharmacological or non pharmacological therapy. While a classical evidence-based approach, showing low-grade efficacy, is likely to lead to a negative attitude towards the use of Reiki in the dialysis ward, the ethical discussion, analyzing beneficium (efficacy) together with non maleficium (side effects), justice (cost, availability and integration with mainstream therapies) and autonomy (patients

  5. Arithmetic, mutually unbiased bases and complementary observables

    NASA Astrophysics Data System (ADS)

    Sheppeard, M. D.

    2010-02-01

    Complementary observables in quantum mechanics may be viewed as Frobenius structures in a dagger monoidal category, such as the category of finite dimensional Hilbert spaces over the complex numbers. On the other hand, their properties crucially depend on the discrete Fourier transform and its associated quantum torus, requiring only the finite fields that underlie mutually unbiased bases. In axiomatic topos theory, the complex numbers are difficult to describe and should not be invoked unnecessarily. This paper surveys some fundamentals of quantum arithmetic using finite field complementary observables, with a view considering more general axiom systems.

  6. Complementary Spiritist Therapy: Systematic Review of Scientific Evidence

    PubMed Central

    Lucchetti, Giancarlo; Lucchetti, Alessandra L. Granero; Bassi, Rodrigo M.; Nobre, Marlene Rossi Severino

    2011-01-01

    Spiritism is the third most common religion in Brazil, and its therapies have been used by millions worldwide. These therapies are based on therapeutic resources including prayer, laying on of hands, fluidotherapy (magnetized water), charity/volunteering, spirit education/moral values, and disobsession (spirit release therapy). This paper presents a systematic review of the current literature on the relationship among health outcomes and 6 predictors: prayer, laying on of hands, magnetized/fluidic water, charity/volunteering, spirit education (virtuous life and positive affect), and spirit release therapy. All articles were analyzed according to inclusion/exclusion criteria, Newcastle-Ottawa and Jadad score. At present, there is moderate to strong evidence that volunteering and positive affect are linked to better health outcomes. Furthermore, laying on of hands, virtuous life, and praying for oneself also seem to be associated to positive findings. Nevertheless, there is a lack of studies on magnetized water and spirit release therapy. In summary, science is indirectly demonstrating that some of these therapies can be associated to better health outcomes and that other therapies have been overlooked or poorly investigated. Further studies in this field could contribute to the disciplines of Complementary and Alternative Medicine by investigating the relationship between body, mind, and soul/spirit. PMID:21687790

  7. Complementary and Alternative Medicine in Cancer Treatment

    MedlinePlus

    ... Ask about Your Treatment Research Complementary and Alternative Medicine for Patients Complementary and alternative medicine (CAM) is ... based on scientific evidence from research studies. Complementary medicine refers to treatments that are used with standard ...

  8. High prevalence but limited evidence in complementary and alternative medicine: guidelines for future research

    PubMed Central

    2014-01-01

    The use of complementary and alternative Medicine (CAM) has increased over the past two decades in Europe. Nonetheless, research investigating the evidence to support its use remains limited. The CAMbrella project funded by the European Commission aimed to develop a strategic research agenda starting by systematically evaluating the state of CAM in the EU. CAMbrella involved 9 work packages covering issues such as the definition of CAM; its legal status, provision and use in the EU; and a synthesis of international research perspectives. Based on the work package reports, we developed a strategic and methodologically robust research roadmap based on expert workshops, a systematic Delphi-based process and a final consensus conference. The CAMbrella project suggests six core areas for research to examine the potential contribution of CAM to the health care challenges faced by the EU. These areas include evaluating the prevalence of CAM use in Europe; the EU cititzens’ needs and attitudes regarding CAM; the safety of CAM; the comparative effectiveness of CAM; the effects of meaning and context on CAM outcomes; and different models for integrating CAM into existing health care systems. CAM research should use methods generally accepted in the evaluation of health services, including comparative effectiveness studies and mixed-methods designs. A research strategy is urgently needed, ideally led by a European CAM coordinating research office dedicated to fostering systematic communication between EU governments, the public, charitable and industry funders, researchers and other stakeholders. A European Centre for CAM should also be established to monitor and further a coordinated research strategy with sufficient funds to commission and promote high quality, independent research focusing on the public’s health needs and pan-European collaboration. There is a disparity between highly prevalent use of CAM in Europe and solid knowledge about it. A strategic approach on

  9. High prevalence but limited evidence in complementary and alternative medicine: guidelines for future research.

    PubMed

    Fischer, Felix H; Lewith, George; Witt, Claudia M; Linde, Klaus; von Ammon, Klaus; Cardini, Francesco; Falkenberg, Torkel; Fønnebø, Vinjar; Johannessen, Helle; Reiter, Bettina; Uehleke, Bernhard; Weidenhammer, Wolfgang; Brinkhaus, Benno

    2014-02-06

    The use of complementary and alternative Medicine (CAM) has increased over the past two decades in Europe. Nonetheless, research investigating the evidence to support its use remains limited. The CAMbrella project funded by the European Commission aimed to develop a strategic research agenda starting by systematically evaluating the state of CAM in the EU. CAMbrella involved 9 work packages covering issues such as the definition of CAM; its legal status, provision and use in the EU; and a synthesis of international research perspectives. Based on the work package reports, we developed a strategic and methodologically robust research roadmap based on expert workshops, a systematic Delphi-based process and a final consensus conference. The CAMbrella project suggests six core areas for research to examine the potential contribution of CAM to the health care challenges faced by the EU. These areas include evaluating the prevalence of CAM use in Europe; the EU cititzens' needs and attitudes regarding CAM; the safety of CAM; the comparative effectiveness of CAM; the effects of meaning and context on CAM outcomes; and different models for integrating CAM into existing health care systems. CAM research should use methods generally accepted in the evaluation of health services, including comparative effectiveness studies and mixed-methods designs. A research strategy is urgently needed, ideally led by a European CAM coordinating research office dedicated to fostering systematic communication between EU governments, the public, charitable and industry funders, researchers and other stakeholders. A European Centre for CAM should also be established to monitor and further a coordinated research strategy with sufficient funds to commission and promote high quality, independent research focusing on the public's health needs and pan-European collaboration. There is a disparity between highly prevalent use of CAM in Europe and solid knowledge about it. A strategic approach on CAM

  10. Complementary medicine.

    PubMed Central

    Spiegel, D; Stroud, P; Fyfe, A

    1998-01-01

    The widespread use of complementary and alternative medicine techniques, often explored by patients without discussion with their primary care physician, is seen as a request from patients for care as well as cure. In this article, we discuss the reasons for the growth of and interest in complementary and alternative medicine in an era of rapidly advancing medical technology. There is, for instance, evidence of the efficacy of supportive techniques such as group psychotherapy in improving adjustment and increasing survival time of cancer patients. We describe current and developing complementary medicine programs as well as opportunities for integration of some complementary techniques into standard medical care. PMID:9584661

  11. A Methodological Framework for Evaluating the Evidence for Complementary and Alternative Medicine (CAM) for Cancer

    PubMed Central

    Zachariae, Robert; Johannessen, Helle

    2011-01-01

    In spite of lacking evidence for effects on cancer progression itself, an increasing number of cancer patients use various types of complementary and alternative medicine (CAM). There is disagreement between CAM practitioners, researchers and clinical oncologists, as to how evidence concerning effects of CAM can and should be produced, and how the existing evidence should be interpreted. This represents a considerable challenge for oncologists; both in terms of patient needs for an informed dialogue regarding CAM, and because some types of CAM may interact with standard treatments. There is a need for insight into which kinds of CAM may work, for whom they work, what the possible effects and side-effects are, and in what ways such effects may come about. The present article presents a framework for evaluating effects of CAM by suggesting a taxonomy of different levels of evidence related to different types of research questions and discussing the relevance of different research methodologies for different types of effects. PMID:24212640

  12. Complementary Medicine, Exercise, Meditation, Diet, and Lifestyle Modification for Anxiety Disorders: A Review of Current Evidence

    PubMed Central

    Sarris, J.; Moylan, S.; Camfield, D. A.; Pase, M. P.; Mischoulon, D.; Berk, M.; Jacka, F. N.; Schweitzer, I.

    2012-01-01

    Use of complementary medicines and therapies (CAM) and modification of lifestyle factors such as physical activity, exercise, and diet are being increasingly considered as potential therapeutic options for anxiety disorders. The objective of this metareview was to examine evidence across a broad range of CAM and lifestyle interventions in the treatment of anxiety disorders. In early 2012 we conducted a literature search of PubMed, Scopus, CINAHL, Web of Science, PsycInfo, and the Cochrane Library, for key studies, systematic reviews, and metaanalyses in the area. Our paper found that in respect to treatment of generalized anxiety or specific disorders, CAM evidence revealed current support for the herbal medicine Kava. One isolated study shows benefit for naturopathic medicine, whereas acupuncture, yoga, and Tai chi have tentative supportive evidence, which is hampered by overall poor methodology. The breadth of evidence does not support homeopathy for treating anxiety. Strong support exists for lifestyle modifications including adoption of moderate exercise and mindfulness meditation, whereas dietary improvement, avoidance of caffeine, alcohol, and nicotine offer encouraging preliminary data. In conclusion, certain lifestyle modifications and some CAMs may provide a beneficial role in the treatment of anxiety disorders. PMID:22969831

  13. Integrating complementary/alternative medicine into primary care: evaluating the evidence and appropriate implementation

    PubMed Central

    Wainapel, Stanley F; Rand, Stephanie; Fishman, Loren M; Halstead-Kenny, Jennifer

    2015-01-01

    The frequency with which patients utilize treatments encompassed by the term complementary/alternative medicine (CAM) is well documented. A number of these therapies are beginning to be integrated into contemporary medical practice. This article examines three of them: osteopathic manipulation, yoga, and acupuncture, with a focus on their physiological effects, efficacy in treating medical conditions commonly encountered by practitioners, precautions or contraindications, and ways in which they can be incorporated into clinical practice. Physicians should routinely obtain information about use of CAM as part of their patient history and should consider their role based on physiological effects and clinical research results. PMID:26673479

  14. Complementary/Integrative Therapies That Work: A Review of the Evidence.

    PubMed

    Kligler, Benjamin; Teets, Raymond; Quick, Melissa

    2016-09-01

    Significant evidence supports the effectiveness and safety of several complementary or integrative treatment approaches to common primary care problems. Acupuncture is effective in the management of chronic low back pain. Mind-body interventions such as cognitive behavior therapy, yoga, tai chi, qi gong, and music therapy may be helpful for treating insomnia. Exercise can reduce anxiety symptoms. Herbal preparations and nutritional supplements can be useful as first-line therapy for certain conditions, such as fish oil for hypertriglyceridemia, St. John's wort for depression, and Ginkgo biloba extract for dementia, or as adjunctive therapy, such as coenzyme Q10 for heart failure. Probiotic supplementation can significantly reduce the likelihood of antibiotic-associated diarrhea. Physicians should caution patients about interactions, and counsel them about the quality and safety of herbal and nutritional supplements. PMID:27583423

  15. [Evidence based medicine].

    PubMed

    Cuestas, Eduardo

    2005-01-01

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

  16. 08. The Practice and Evidence Basis for Tai Chi as a Complementary Modality: An Experiential Presentation

    PubMed Central

    2013-01-01

    Focus Area: Experiential Workshop Studies are showing that practicing Tai Chi can facilitate an individual's ability to increase physical stamina, reduce stress, enhance feelings of wellbeing, and improve resistance to illness. In this workshop, the principles and practice of a short form of Yang-style Tai Chi is presented for participants to experience and discuss the use of this evidence-based modality in a variety of healthcare settings. Evidence will be presented that suggests how Tai Chi would be an applicable intervention for the following: Physical therapyOccupational therapyCardiac rehabilitationOncologyBariatricRheumatologyPsychological disorders (eg, posttraumatic stress disorder)

  17. Complementary medicine.

    PubMed

    Schimpff, S C

    1997-07-01

    Complementary medicine can be described as additional approaches to care outside of mainstream medical practice but frequently based on traditional practices of nonwestern cultures. These include acupuncture, meditation, massage, diet manipulation, and many others. Recent reviews demonstrate wide and frequent use of these measures, often without concurrent discussion with the patient's physician. One estimate is that more than $13 billion is spent annually on complementary techniques in the United States alone. Many patients with cancer turn to these techniques. Care givers need to recognize this trend, learn about complementary medicine, and guide patients in their proper application when appropriate.

  18. An external cloak with arbitrary cross section based on complementary medium and coordinate transformation.

    PubMed

    Yang, Chengfu; Yang, Jingjing; Huang, Ming; Xiao, Zhe; Peng, Jinhui

    2011-01-17

    Electromagnetic cloak is a device which makes an object "invisible" for electromagnetic irradiation in a certain frequency range. Material parameters for the complementary medium-assisted external cylindrical cloak with arbitrary cross section are derived based on combining the concepts of complementary media and transformation optics. It can make the object with arbitrary shape outside the cloaking domain invisible, as long as an "antiobject" is embedded in the complementary media layer. Moreover, we find that the shape, size and the position of the "antiobject" is dependent on the contour of the cloak and the coordinate transformation. The external cloaking effect has been verified by full-wave simulation. PMID:21263655

  19. Evidence-based medicine

    PubMed Central

    Shah, Dheeraj; Sachdev, HPS

    2007-01-01

    Evidence based medicine is the practice of solving the clinical problems in one's practice by judicious and systematic use of the medical literature. This includes framing questions rightly and searching the right kind of literature. Thereafter, the available evidence needs to be evaluated for the validity, strength and effect size. Finally, the results are examined for applicability to the current problem which requires a detailed knowledge of the clinical setting, patient profile and the issues related to cost and harm. The present communication deals with these issues in a step-wise manner in order to stimulate readers to practise this important art. PMID:21124675

  20. Complementary Study

    SciTech Connect

    Yamada, H.

    2009-02-19

    In this lecture, it is emphasized that sufficient resolution of scientific issues for a fusion energy reactor can be given by complementary studies. Key scientific issues for a fusion energy reactor and ITER addressed by a complementary study in the Large Helical Device (LHD) are discussed. It should be noted that ITER is definitely a necessary condition but not a sufficient condition. Helical systems including stellarators and heliotrons are defined as alternative concepts. These approaches also aim at a fusion energy reactor based on their own concept and simultaneously benefit progress in tokamaks, more specifically ITER itself. The exact science to manage a 3-D geometry has been being developed in helical systems. A physical model with much accuracy and breadth will demonstrate its applicability to ITER. Topics to validate ''complementary'' approaches such as 3-D equilibrium, interchange MHD mode, control of radial electric field and structure formation, dynamics of a magnetic island, density limit and edge plasmas are discussed. Complementary is not Supplementary. ITER is complementary to development of a helical fusion energy reactor as well. Complementary approaches transcend existing disciplinary horizons and enable big challenges.

  1. Evidence-Based Anatomy

    PubMed Central

    Yammine, Kaissar

    2014-01-01

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

  2. Self-electroforming and high-performance complementary memristor based on ferroelectric tunnel junctions

    NASA Astrophysics Data System (ADS)

    Yan, Z. B.; Yau, H. M.; Li, Z. W.; Gao, X. S.; Dai, J. Y.; Liu, J.-M.

    2016-08-01

    Complementary resistive switching (CRS) has potential applications in ultra-high density three-dimensional crossbar arrays for resistive random access memories and Logic-in-Memories. For real applications, the good stability and electroforming-free character have become essential pre-requisites. In this work, we investigate the resistance switching behaviors of a CRS device based on two anti-serial Au/BaTiO3/Nb:SrTiO3 ferroelectric tunnel junctions (FTJs). This FTJ-based CRS device shows a stable butterfly-like resistance-voltage hysteresis, as well as self-electroforming, multi-switching, and good performance complementary switching behaviors. The present work presents a convincing demonstration of the complementary multi-switching states modulated by remnant ferroelectric polarization, making the FTJ structure good potentials for high-performance CRS memristors.

  3. Evidence-based management.

    PubMed

    Pfeffer, Jeffrey; Sutton, Robert I

    2006-01-01

    For the most part, managers looking to cure their organizational ills rely on obsolete knowledge they picked up in school, long-standing but never proven traditions, patterns gleaned from experience, methods they happen to be skilled in applying, and information from vendors. They could learn a thing or two from practitioners of evidence-based medicine, a movement that has taken the medical establishment by storm over the past decade. A growing number of physicians are eschewing the usual, flawed resources and are instead identifying, disseminating, and applying research that is soundly conducted and clinically relevant. It's time for managers to do the same. The challenge is, quite simply, to ground decisions in the latest and best knowledge of what actually works. In some ways, that's more difficult to do in business than in medicine. The evidence is weaker in business; almost anyone can (and many people do) claim to be a management expert; and a motley crew of sources--Shakespeare, Billy Graham,Jack Welch, Attila the Hunare used to generate management advice. Still, it makes sense that when managers act on better logic and strong evidence, their companies will beat the competition. Like medicine, management is learned through practice and experience. Yet managers (like doctors) can practice their craft more effectively if they relentlessly seek new knowledge and insight, from both inside and outside their companies, so they can keep updating their assumptions, skills, and knowledge.

  4. Underdetermination in evidence-based medicine.

    PubMed

    Chin-Yee, Benjamin H

    2014-12-01

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

  5. Evidence-Based Medicine: Rhinoplasty.

    PubMed

    Lee, Matthew K; Most, Sam P

    2015-08-01

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

  6. Complementary and Alternative Medicine

    MedlinePlus

    ... Help a Friend Who Cuts? Complementary and Alternative Medicine KidsHealth > For Teens > Complementary and Alternative Medicine Print ... replacement. continue How Is CAM Different From Conventional Medicine? Conventional medicine is based on scientific knowledge of ...

  7. Hybridization-based aptamer labeling using complementary oligonucleotide platform for PET and optical imaging.

    PubMed

    Park, Jun Young; Lee, Tae Sup; Song, In Ho; Cho, Ye Lim; Chae, Ju Ri; Yun, Mijin; Kang, Hyungu; Lee, Jung Hwan; Lim, Jong Hoon; Cho, Won Gil; Kang, Won Jun

    2016-09-01

    Aptamers are promising next-generation ligands used in molecular imaging and theragnosis. Aptamers are synthetic nucleic acids that can be held together with complementary sequences by base-pair hybridization. In this study, the complementary oligonucleotide (cODN) hybridization-based aptamer conjugation platform was developed to use aptamers as the molecular imaging agent. The cODN was pre-labeled with fluorescent dye or radioisotope and hybridized with a matched sequence containing aptamers in aqueous conditions. The cODN platform-hybridized aptamers exhibited good serum stability and specific binding affinity towards target cancer cells both in vitro and in vivo. These results suggest that the newly designed aptamer conjugation platform offers great potential for the versatile application of aptamers as molecular imaging agents. PMID:27258484

  8. Retinal Stimulation on Rabbit Using Complementary Metal Oxide Semiconductor Based Multichip Flexible Stimulator toward Retinal Prosthesis

    NASA Astrophysics Data System (ADS)

    Tokuda, Takashi; Asano, Ryosuke; Sugitani, Sachie; Taniyama, Mari; Terasawa, Yasuo; Nunoshita, Masahiro; Nakauchi, Kazuaki; Fujikado, Takashi; Tano, Yasuo; Ohta, Jun

    2008-04-01

    The Functionality of a complementary metal oxide semiconductor (CMOS) LSI-based, multichip flexible retinal stimulator was demonstrated in retinal stimulation experiments on rabbits. A 1×4-configured multichip stimulator was fabricated for application to experiments on animals. An experimental procedure including surgical operations was developed, and retinal stimulation was performed with the fabricated multichip stimulator. Neural responses on the visual cortex were successfully evoked by the fabricated stimulator. The stimulator is confirmed to be applicable to acute animal experiments.

  9. Fluorescent profiling of modular biosynthetic enzymes by complementary metabolic and activity based probes.

    PubMed

    Meier, Jordan L; Mercer, Andrew C; Burkart, Michael D

    2008-04-23

    The study of the enzymes responsible for natural product biosynthesis has proven a valuable source of new enzymatic activities and been applied to a number of biotechnology applications. Protein profiling could prove highly complementary to genetics based approaches by allowing us to understand the activity, transcriptional control, and post-translational modification of these enzymes in their native and dynamic proteomic environments. Here we present a method for the fluorescent profiling of PKS, NRPS, and FAS multidomain modular synthases in their whole proteomes using complementary metabolic and activity based probes. After first examining the reactivity of these activity based probes with a variety of purified recombinant PKS, NRPS, and FAS enzymes in vitro, we apply this duel labeling strategy to the analysis of modular synthases in a human breast cancer cell line and two strains of the natural product producer Bacillus subtilis. Collectively, these studies demonstrate that complementary protein profiling approaches can prove highly useful in the identification and assignment of inhibitor specificity and domain structure of these modular biosynthetic enzymes. PMID:18376827

  10. [Complementary therapies in cystic fibrosis: evidence of therapeutic benefits and treatment recommendations].

    PubMed

    Salcedo Posadas, A; Girón Moreno, R; Beltrán Bengoechea, B

    2003-01-01

    Cystic fibrosis (CF) is an autosomal-recessive disorder that predominantly affects the respiratory system. When this disease was described in 1938 the mortality rate was approximately 70 % in the first year of life. Survival has dramatically increased from a median of approximately 4 years in the 1960s to 19 years in the 1970s and 33 years in 2001 according to figures from the American Cystic Fibrosis Foundation. This impressive increase in the life expectancy of individuals with CF is undoubtedly related to recent advances in the organization of specialized CF units and to the use of new therapies against respiratory involvement.The traditional basis of treatment for CF lung disease includes nutritional support, antibiotic therapy, chest physical therapy and aerobic exercise. Preventive measures such as influenza vaccination and avoidance of tobacco smoke are also useful. Several new approaches such as ion transport therapy, protein therapy and gene therapy are currently being developed. Many studies have provided clear evidence of the therapeutic benefits of antibiotics, respiratory physiotherapy, exercise, and nutrition. In this article we review the scientific evidence on the advantages of the use of several therapeutic interventions against inflammation, increased sputum viscoelasticity and adhesiveness, and bronchial obstruction in CF patients. PMID:12628117

  11. Carbohydrate composition, viscosity, solubility, and sensory acceptance of sweetpotato- and maize-based complementary foods

    PubMed Central

    Amagloh, Francis Kweku; Mutukumira, Anthony N.; Brough, Louise; Weber, Janet L.; Hardacre, Allan; Coad, Jane

    2013-01-01

    Background Cereal-based complementary foods from non-malted ingredients form a relatively high viscous porridge. Therefore, excessive dilution, usually with water, is required to reduce the viscosity to be appropriate for infant feeding. The dilution invariably leads to energy and nutrient thinning, that is, the reduction of energy and nutrient densities. Carbohydrate is the major constituent of food that significantly influences viscosity when heated in water. Objectives To compare the sweetpotato-based complementary foods (extrusion-cooked ComFa, roller-dried ComFa, and oven-toasted ComFa) and enriched Weanimix (maize-based formulation) regarding their 1) carbohydrate composition, 2) viscosity and water solubility index (WSI), and 3) sensory acceptance evaluated by sub-Sahara African women as model caregivers. Methods The level of simple sugars/carbohydrates was analysed by spectrophotometry, total dietary fibre by enzymatic-gravimetric method, and total carbohydrate and starch levels estimated by calculation. A Rapid Visco™ Analyser was used to measure viscosity. WSI was determined gravimetrically. A consumer sensory evaluation was used to evaluate the product acceptance of the roller-dried ComFa, oven-toasted ComFa, and enriched Weanimix. Results The sweetpotato-based complementary foods were, on average, significantly higher in maltose, sucrose, free glucose and fructose, and total dietary fibre, but they were markedly lower in starch content compared with the levels in the enriched Weanimix. Consequently, the sweetpotato-based complementary foods had relatively low apparent viscosity, and high WSI, than that of enriched Weanimix. The scores of sensory liking given by the caregivers were highest for the roller-dried ComFa, followed by the oven-toasted ComFa, and, finally, the enriched Weanimix. Conclusion The sweetpotato-based formulations have significant advantages as complementary food due to the high level of endogenous sugars and low starch content that

  12. A high-performance complementary inverter based on transition metal dichalcogenide field-effect transistors

    NASA Astrophysics Data System (ADS)

    Cho, Ah-Jin; Park, Kee Chan; Kwon, Jang-Yeon

    2015-03-01

    For several years, graphene has been the focus of much attention due to its peculiar characteristics, and it is now considered to be a representative 2-dimensional (2D) material. Even though many research groups have studied on the graphene, its intrinsic nature of a zero band-gap, limits its use in practical applications, particularly in logic circuits. Recently, transition metal dichalcogenides (TMDs), which are another type of 2D material, have drawn attention due to the advantage of having a sizable band-gap and a high mobility. Here, we report on the design of a complementary inverter, one of the most basic logic elements, which is based on a MoS2 n-type transistor and a WSe2 p-type transistor. The advantages provided by the complementary metal-oxide-semiconductor (CMOS) configuration and the high-performance TMD channels allow us to fabricate a TMD complementary inverter that has a high-gain of 13.7. This work demonstrates the operation of the MoS2 n-FET and WSe2 p-FET on the same substrate, and the electrical performance of the CMOS inverter, which is based on a different driving current, is also measured.

  13. A high-performance complementary inverter based on transition metal dichalcogenide field-effect transistors.

    PubMed

    Cho, Ah-Jin; Park, Kee Chan; Kwon, Jang-Yeon

    2015-01-01

    For several years, graphene has been the focus of much attention due to its peculiar characteristics, and it is now considered to be a representative 2-dimensional (2D) material. Even though many research groups have studied on the graphene, its intrinsic nature of a zero band-gap, limits its use in practical applications, particularly in logic circuits. Recently, transition metal dichalcogenides (TMDs), which are another type of 2D material, have drawn attention due to the advantage of having a sizable band-gap and a high mobility. Here, we report on the design of a complementary inverter, one of the most basic logic elements, which is based on a MoS2 n-type transistor and a WSe2 p-type transistor. The advantages provided by the complementary metal-oxide-semiconductor (CMOS) configuration and the high-performance TMD channels allow us to fabricate a TMD complementary inverter that has a high-gain of 13.7. This work demonstrates the operation of the MoS2 n-FET and WSe2 p-FET on the same substrate, and the electrical performance of the CMOS inverter, which is based on a different driving current, is also measured. PMID:25852410

  14. CAMbase – A XML-based bibliographical database on Complementary and Alternative Medicine (CAM)

    PubMed Central

    Ostermann, Thomas; Zillmann, Hartmut; Raak, Christa K; Buessing, Arndt; Matthiessen, Peter F

    2007-01-01

    The term "Complementary and Alternative Medicine (CAM)" covers a variety of approaches to medical theory and practice, which are not commonly accepted by representatives of conventional medicine. In the past two decades, these approaches have been studied in various areas of medicine. Although there appears to be a growing number of scientific publications on CAM, the complete spectrum of complementary therapies still requires more information about published evidence. A majority of these research publications are still not listed in electronic bibliographical databases such as MEDLINE. However, with a growing demand by patients for such therapies, physicians increasingly need an overview of scientific publications on CAM. Bearing this in mind, CAMbase, a bibliographical database on CAM was launched in order to close this gap. It can be accessed online free of charge or additional costs. The user can peruse more than 80,000 records from over 30 journals and periodicals on CAM, which are stored in CAMbase. A special search engine performing syntactical and semantical analysis of textual phrases allows the user quickly to find relevant bibliographical information on CAM. Between August 2003 and July 2006, 43,299 search queries, an average of 38 search queries per day, were registered focussing on CAM topics such as acupuncture, cancer or general safety aspects. Analysis of the requests led to the conclusion that CAMbase is not only used by scientists and researchers but also by physicians and patients who want to find out more about CAM. Closely related to this effort is our aim to establish a modern library center on Complementary Medicine which offers the complete spectrum of a modern digital library including a document delivery-service for physicians, therapists, scientists and researchers. PMID:17407592

  15. Evidence-Based Language Practice

    ERIC Educational Resources Information Center

    Pollock, Eric J.

    2005-01-01

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

  16. Corroborating evidence-based medicine.

    PubMed

    Mebius, Alexander

    2014-12-01

    Proponents of evidence-based medicine (EBM) have argued convincingly for applying this scientific method to medicine. However, the current methodological framework of the EBM movement has recently been called into question, especially in epidemiology and the philosophy of science. The debate has focused on whether the methodology of randomized controlled trials provides the best evidence available. This paper attempts to shift the focus of the debate by arguing that clinical reasoning involves a patchwork of evidential approaches and that the emphasis on evidence hierarchies of methodology fails to lend credence to the common practice of corroboration in medicine. I argue that the strength of evidence lies in the evidence itself, and not the methodology used to obtain that evidence. Ultimately, when it comes to evaluating the effectiveness of medical interventions, it is the evidence obtained from the methodology rather than the methodology that should establish the strength of the evidence.

  17. A rational function approach for estimating land surface evapotranspiration based on the complementary hypothesis

    NASA Astrophysics Data System (ADS)

    Han, S.; Hu, H.; Tian, F.

    2007-12-01

    Evapotranspiration, which occurs in the boundary layer between the land surface and the bottom atmospheric layer, plays an important role in both water balance and energy balance. Models based on the Penman hypothesis (1948) and the Budyko hypothesis (1974) estimate actual evapotranspiration from a land surface process prospective, while models based on the complementary hypothesis (Bouchet, 1963) do this from the atmospheric perspective. Penman-based models require detailed data on soil moisture or stomatal resistance (Crago and Crowley, 2006); Budyko models, e.g. Fu's equation (1981), estimate the mean annual evapotranspiration only; while models based on the complementary hypothesis, including advection aridity model (AA for short) (Brutsaert and Stricker, 1979) and the Granger model (1989, 1991, 1996) estimate actual evapotranspiration at various time scales using climate data only. The AA and Granger models use different definitions for wet environment evaporation and potential evaporation and their comparative study are conducted by several researchers (Xu and Singh, 2005; Liu et al., 2006; Crago and Crowley, 2006). In this paper we explore the uniformity of the two complementary models by dimensional analysis. A new index (the proportion of the radiation term in Penman equation, termed the air humidity index) is proposed as a measure of the wetness of the evaporating surface via the wetness of over-passing air, and a general functional form for actual evaporation is developed in which the evaporation ratio is expressed as a function of the air humidity index. The similarity and differences between the AA and Granger models are interpreted via this rational function approach, and a new power function method is proposed. The theoretical analysis is confirmed by observational data under various climate conditions.

  18. Advancing complementary and alternative medicine through social network analysis and agent-based modeling.

    PubMed

    Frantz, Terrill L

    2012-01-01

    This paper introduces the contemporary perspectives and techniques of social network analysis (SNA) and agent-based modeling (ABM) and advocates applying them to advance various aspects of complementary and alternative medicine (CAM). SNA and ABM are invaluable methods for representing, analyzing and projecting complex, relational, social phenomena; they provide both an insightful vantage point and a set of analytic tools that can be useful in a wide range of contexts. Applying these methods in the CAM context can aid the ongoing advances in the CAM field, in both its scientific aspects and in developing broader acceptance in associated stakeholder communities.

  19. Complementary fMRI and EEG evidence for more efficient neural processing of rhythmic vs. unpredictably timed sounds

    PubMed Central

    van Atteveldt, Nienke; Musacchia, Gabriella; Zion-Golumbic, Elana; Sehatpour, Pejman; Javitt, Daniel C.; Schroeder, Charles

    2015-01-01

    The brain’s fascinating ability to adapt its internal neural dynamics to the temporal structure of the sensory environment is becoming increasingly clear. It is thought to be metabolically beneficial to align ongoing oscillatory activity to the relevant inputs in a predictable stream, so that they will enter at optimal processing phases of the spontaneously occurring rhythmic excitability fluctuations. However, some contexts have a more predictable temporal structure than others. Here, we tested the hypothesis that the processing of rhythmic sounds is more efficient than the processing of irregularly timed sounds. To do this, we simultaneously measured functional magnetic resonance imaging (fMRI) and electro-encephalograms (EEG) while participants detected oddball target sounds in alternating blocks of rhythmic (e.g., with equal inter-stimulus intervals) or random (e.g., with randomly varied inter-stimulus intervals) tone sequences. Behaviorally, participants detected target sounds faster and more accurately when embedded in rhythmic streams. The fMRI response in the auditory cortex was stronger during random compared to random tone sequence processing. Simultaneously recorded N1 responses showed larger peak amplitudes and longer latencies for tones in the random (vs. the rhythmic) streams. These results reveal complementary evidence for more efficient neural and perceptual processing during temporally predictable sensory contexts. PMID:26579044

  20. Risk Assessment: Evidence Base

    NASA Technical Reports Server (NTRS)

    Johnson-Throop, Kathy A.

    2007-01-01

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

  1. An External Cylindrical Cloak with N-Sided Regular Polygonal Cross-Section Based on Complementary Medium

    NASA Astrophysics Data System (ADS)

    Yang, Chengfu; Huang, Ming; Yang, Jingjing; Xiao, Zhe; Peng, Jinhui

    An electromagnetic cloak is a device which makes an object "invisible" for electromagnetic irradiation in a certain frequency range. Material parameters for the complementary medium-assisted external cylindrical cloak with N-sided regular polygonal cross-section are derived based on combining the concepts of complementary media and transformation optics. It can make the object with an arbitrary shape outside the cloaking domain invisible, as long as an "anti-object" is embedded in the complementary layer. The external cloaking effect has been verified by full-wave simulation.

  2. Retail Location Choice with Complementary Goods: An Agent-Based Model

    NASA Astrophysics Data System (ADS)

    Huang, Arthur; Levinson, David

    This paper models the emergence of retail clusters on a supply chain network comprised of suppliers, retailers, and consumers. Firstly, an agent-based model is proposed to investigate retail location distribution in a market of two complementary goods. The methodology controls for supplier locales and unit sales prices of retailers and suppliers, and a consumer’s willingness to patronize a retailer depends on the total travel distance of buying both goods. On a circle comprised of discrete locations, retailers play a non-cooperative game of location choice to maximize individual profits. Our findings suggest that the probability distribution of the number of clusters in equilibrium follows power law and that hierarchical distribution patterns are much more likely to occur than the spread-out ones. In addition, retailers of complementary goods tend to co-locate at supplier locales. Sensitivity tests on the number of retailers are also performed. Secondly, based on the County Business Patterns (CBP) data of Minneapolis-St. Paul from US Census 2000 database, we find that the number of clothing stores and the distribution of food stores at the zip code level follows power-law distribution.

  3. A Red Cy3-Based Biarsenical Fluorescent Probe Targeted to a Complementary Binding Peptide

    SciTech Connect

    Cao, Haishi; Xiong, Yijia; Wang, Ting; Chen, Baowei; Squier, Thomas C.; Mayer, M. Uljana

    2007-06-22

    Small-molecule biarsenical multiuse affinity probes (MAPs) FlAsH and ReAsH,1,2 in conjunction with complementary protein tags, are important new tools for analyzing cellular function through live-cell imaging,3,4 targeted protein inactivation,5 and the measurement of protein dynamics and binding.6 In addition, MAPs serve as affinity reagents for isolating intact protein complexes for complementary structural measurements.7 These first-generation MAPs bind to a tetracoordinate arsenic group (TAG) binding motif (i.e., CCXXCC or FlAsHTAG) genetically engineered onto a protein of interest. They are superior to other targeted labeling strategies (such as the Halo-tag, the SNAP tag, and fluorescent proteins) in that the small peptide tag does not disrupt protein protein interactions nor perturb the correct trafficking of tagged proteins.8,9 The conserved interatomic distance (*6 Å) between the two arsenic moieties in FlAsH and ReAsH complicates the selective labeling of multiple proteins with different reporters. To overcome these limitations, we have synthesized a new biarsenical MAP (i.e., AsCy3) based on Cy3, a member of the cyanine dye family, whose well-recognized brightness and photostability facilitate their utility in single-molecule measurements. The large interatomic distance between the two arsenics in AsCy3 (*14.5 Å) coupled with the identification of a complementary high-affinity binding sequence CCKAEAACC (Cy3TAG) permits the simultaneous application of both AsCy3 and FlAsH to selectively label their respective binding TAGs in different proteins. In addition, the fluorescence of FlAsH overlaps with the absorption of AsCy3, which can act as an acceptor of fluorescence resonance energy transfer (FRET) to allow ratiometric measurements of protein association.

  4. The Evidence Missing from Evidence-Based Practice

    ERIC Educational Resources Information Center

    Stuart, Richard B.; Lilienfeld, Scott O.

    2007-01-01

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

  5. Long-Term Homeostatic Properties Complementary to Hebbian Rules in CuPc-Based Multifunctional Memristor

    PubMed Central

    Wang, Laiyuan; Wang, Zhiyong; Lin, Jinyi; Yang, Jie; Xie, Linghai; Yi, Mingdong; Li, Wen; Ling, Haifeng; Ou, Changjin; Huang, Wei

    2016-01-01

    Most simulations of neuroplasticity in memristors, which are potentially used to develop artificial synapses, are confined to the basic biological Hebbian rules. However, the simplex rules potentially can induce excessive excitation/inhibition, even collapse of neural activities, because they neglect the properties of long-term homeostasis involved in the frameworks of realistic neural networks. Here, we develop organic CuPc-based memristors of which excitatory and inhibitory conductivities can implement both Hebbian rules and homeostatic plasticity, complementary to Hebbian patterns and conductive to the long-term homeostasis. In another adaptive situation for homeostasis, in thicker samples, the overall excitement under periodic moderate stimuli tends to decrease and be recovered under intense inputs. Interestingly, the prototypes can be equipped with bio-inspired habituation and sensitization functions outperforming the conventional simplified algorithms. They mutually regulate each other to obtain the homeostasis. Therefore, we develop a novel versatile memristor with advanced synaptic homeostasis for comprehensive neural functions. PMID:27762316

  6. A novel circuit design for complementary resistive switch-based stateful logic operations

    NASA Astrophysics Data System (ADS)

    Xiao-Ping, Wang; Lin, Chen; Yi, Shen; Bo-Wen, Xu

    2016-05-01

    Recently, it has been demonstrated that memristors can be utilized as logic operations and memory elements. In this paper, we present a novel circuit design for complementary resistive switch (CRS)-based stateful logic operations. The proposed circuit can automatically write the destructive CRS cells back to the original states. In addition, the circuit can be used in massive passive crossbar arrays which can reduce sneak path current greatly. Moreover, the steps for CRS logic operations using our proposed circuit are reduced compared with previous circuit designs. We validate the effectiveness of our scheme through Hspice simulations on the logic circuits. Project supported by the National Natural Science Foundation of China (Grant Nos. 61374150 and 11271146), the State Key Program of the National Natural Science Foundation of China (Grant No. 61134012), the Doctoral Fund of Ministry of Education of China (Grant No. 20130142130012), and the Science and Technology Program of Shenzhen City, China (Grant No. JCYJ20140509162710496).

  7. Broadband and energy-concentrating terahertz coherent perfect absorber based on a self-complementary metasurface

    NASA Astrophysics Data System (ADS)

    Urade, Yoshiro; Nakata, Yosuke; Nakanishi, Toshihiro; Kitano, Masao

    2016-10-01

    We demonstrate that a self-complementary checkerboard-like metasurface works as a broadband coherent perfect absorber (CPA) when symmetrically illuminated by two counter-propagating incident waves. A theoretical analysis based on wave interference and results of numerical simulations of the proposed metasurface are provided. In addition, we experimentally demonstrate the proposed CPA in the terahertz regime by using a time-domain spectroscopy technique. We observe that the metasurface can work as a CPA below its lowest diffraction frequency. The size of the absorptive areas of the proposed CPA can be much smaller than the incident wavelength. Unlike conventional CPAs, the presented one simultaneously achieves the broadband operation and energy concentration of electromagnetic waves at the deep-subwavelength scale.

  8. Complementary Constrains on Component based Multiphase Flow Problems, Should It Be Implemented Locally or Globally?

    NASA Astrophysics Data System (ADS)

    Shao, H.; Huang, Y.; Kolditz, O.

    2015-12-01

    Multiphase flow problems are numerically difficult to solve, as it often contains nonlinear Phase transition phenomena A conventional technique is to introduce the complementarity constraints where fluid properties such as liquid saturations are confined within a physically reasonable range. Based on such constraints, the mathematical model can be reformulated into a system of nonlinear partial differential equations coupled with variational inequalities. They can be then numerically handled by optimization algorithms. In this work, two different approaches utilizing the complementarity constraints based on persistent primary variables formulation[4] are implemented and investigated. The first approach proposed by Marchand et.al[1] is using "local complementary constraints", i.e. coupling the constraints with the local constitutive equations. The second approach[2],[3] , namely the "global complementary constrains", applies the constraints globally with the mass conservation equation. We will discuss how these two approaches are applied to solve non-isothermal componential multiphase flow problem with the phase change phenomenon. Several benchmarks will be presented for investigating the overall numerical performance of different approaches. The advantages and disadvantages of different models will also be concluded. References[1] E.Marchand, T.Mueller and P.Knabner. Fully coupled generalized hybrid-mixed finite element approximation of two-phase two-component flow in porous media. Part I: formulation and properties of the mathematical model, Computational Geosciences 17(2): 431-442, (2013). [2] A. Lauser, C. Hager, R. Helmig, B. Wohlmuth. A new approach for phase transitions in miscible multi-phase flow in porous media. Water Resour., 34,(2011), 957-966. [3] J. Jaffré, and A. Sboui. Henry's Law and Gas Phase Disappearance. Transp. Porous Media. 82, (2010), 521-526. [4] A. Bourgeat, M. Jurak and F. Smaï. Two-phase partially miscible flow and transport modeling in

  9. PSRna: Prediction of small RNA secondary structures based on reverse complementary folding method.

    PubMed

    Li, Jin; Xu, Chengzhen; Wang, Lei; Liang, Hong; Feng, Weixing; Cai, Zhongxi; Wang, Ying; Cong, Wang; Liu, Yunlong

    2016-08-01

    Prediction of RNA secondary structures is an important problem in computational biology and bioinformatics, since RNA secondary structures are fundamental for functional analysis of RNA molecules. However, small RNA secondary structures are scarce and few algorithms have been specifically designed for predicting the secondary structures of small RNAs. Here we propose an algorithm named "PSRna" for predicting small-RNA secondary structures using reverse complementary folding and characteristic hairpin loops of small RNAs. Unlike traditional algorithms that usually generate multi-branch loops and 5[Formula: see text] end self-folding, PSRna first estimated the maximum number of base pairs of RNA secondary structures based on the dynamic programming algorithm and a path matrix is constructed at the same time. Second, the backtracking paths are extracted from the path matrix based on backtracking algorithm, and each backtracking path represents a secondary structure. To improve accuracy, the predicted RNA secondary structures are filtered based on their free energy, where only the secondary structure with the minimum free energy was identified as the candidate secondary structure. Our experiments on real data show that the proposed algorithm is superior to two popular methods, RNAfold and RNAstructure, in terms of sensitivity, specificity and Matthews correlation coefficient (MCC). PMID:27045556

  10. PSRna: Prediction of small RNA secondary structures based on reverse complementary folding method.

    PubMed

    Li, Jin; Xu, Chengzhen; Wang, Lei; Liang, Hong; Feng, Weixing; Cai, Zhongxi; Wang, Ying; Cong, Wang; Liu, Yunlong

    2016-08-01

    Prediction of RNA secondary structures is an important problem in computational biology and bioinformatics, since RNA secondary structures are fundamental for functional analysis of RNA molecules. However, small RNA secondary structures are scarce and few algorithms have been specifically designed for predicting the secondary structures of small RNAs. Here we propose an algorithm named "PSRna" for predicting small-RNA secondary structures using reverse complementary folding and characteristic hairpin loops of small RNAs. Unlike traditional algorithms that usually generate multi-branch loops and 5[Formula: see text] end self-folding, PSRna first estimated the maximum number of base pairs of RNA secondary structures based on the dynamic programming algorithm and a path matrix is constructed at the same time. Second, the backtracking paths are extracted from the path matrix based on backtracking algorithm, and each backtracking path represents a secondary structure. To improve accuracy, the predicted RNA secondary structures are filtered based on their free energy, where only the secondary structure with the minimum free energy was identified as the candidate secondary structure. Our experiments on real data show that the proposed algorithm is superior to two popular methods, RNAfold and RNAstructure, in terms of sensitivity, specificity and Matthews correlation coefficient (MCC).

  11. School Centered Evidence Based Accountability

    ERIC Educational Resources Information Center

    Milligan, Charles

    2015-01-01

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

  12. Complementary Treatment

    MedlinePlus

    ... someone living with PD, this section focuses on herbs, vitamins and supplements. If you are considering complementary ... product recommendations regarding such products. Key Points Most herbs and supplements have not been rigorously studied as ...

  13. Complementary coding optical stealth transmission based on amplified spontaneous emission light source.

    PubMed

    Zhu, Huatao; Wang, Rong; Pu, Tao; Chen, Yinfang; Fang, Tao; Zheng, Jilin; Su, Guorui

    2014-11-17

    Complementary encoder of stealth signal is proposed and demonstrated for coding, modulating and enhancing the privacy of optical stealth transmission. With complementary encoding, the stealth signal carried by amplified spontaneous emission (ASE) light keeps the same characteristic to ASE noise and can be concealed well under public channel. The experiment results demonstrate the feasibility of the scheme and show the stealth signal has the same impact on public channel in transmission performance, compared to the ASE noise.

  14. Segmentation of complementary DNA microarray images by wavelet-based Markov random field model.

    PubMed

    Athanasiadis, Emmanouil I; Cavouras, Dionisis A; Glotsos, Dimitris Th; Georgiadis, Pantelis V; Kalatzis, Ioannis K; Nikiforidis, George C

    2009-11-01

    A wavelet-based modification of the Markov random field (WMRF) model is proposed for segmenting complementary DNA (cDNA) microarray images. For evaluation purposes, five simulated and a set of five real microarray images were used. The one-level stationary wavelet transform (SWT) of each microarray image was used to form two images, a denoised image, using hard thresholding filter, and a magnitude image, from the amplitudes of the horizontal and vertical components of SWT. Elements from these two images were suitably combined to form the WMRF model for segmenting spots from their background. The WMRF was compared against the conventional MRF and the Fuzzy C means (FCM) algorithms on simulated and real microarray images and their performances were evaluated by means of the segmentation matching factor (SMF) and the coefficient of determination (r2). Additionally, the WMRF was compared against the SPOT and SCANALYZE, and performances were evaluated by the mean absolute error (MAE) and the coefficient of variation (CV). The WMRF performed more accurately than the MRF and FCM (SMF: 92.66, 92.15, and 89.22, r2 : 0.92, 0.90, and 0.84, respectively) and achieved higher reproducibility than the MRF, SPOT, and SCANALYZE (MAE: 497, 1215, 1180, and 503, CV: 0.88, 1.15, 0.93, and 0.90, respectively).

  15. An associative capacitive network based on nanoscale complementary resistive switches for memory-intensive computing.

    PubMed

    Kavehei, Omid; Linn, Eike; Nielen, Lutz; Tappertzhofen, Stefan; Skafidas, Efstratios; Valov, Ilia; Waser, Rainer

    2013-06-01

    We report on the implementation of an Associative Capacitive Network (ACN) based on the nondestructive capacitive readout of two Complementary Resistive Switches (2-CRSs). ACNs are capable of performing a fully parallel search for Hamming distances (i.e. similarity) between input and stored templates. Unlike conventional associative memories where charge retention is a key function and hence, they require frequent refresh cycles, in ACNs, information is retained in a nonvolatile resistive state and normal tasks are carried out through capacitive coupling between input and output nodes. Each device consists of two CRS cells and no selective element is needed, therefore, CMOS circuitry is only required in the periphery, for addressing and read-out. Highly parallel processing, nonvolatility, wide interconnectivity and low-energy consumption are significant advantages of ACNs over conventional and emerging associative memories. These characteristics make ACNs one of the promising candidates for applications in memory-intensive and cognitive computing, switches and routers as binary and ternary Content Addressable Memories (CAMs) and intelligent data processing.

  16. Fully Automated Complementary DNA Microarray Segmentation using a Novel Fuzzy-based Algorithm.

    PubMed

    Saberkari, Hamidreza; Bahrami, Sheyda; Shamsi, Mousa; Amoshahy, Mohammad Javad; Ghavifekr, Habib Badri; Sedaaghi, Mohammad Hossein

    2015-01-01

    DNA microarray is a powerful approach to study simultaneously, the expression of 1000 of genes in a single experiment. The average value of the fluorescent intensity could be calculated in a microarray experiment. The calculated intensity values are very close in amount to the levels of expression of a particular gene. However, determining the appropriate position of every spot in microarray images is a main challenge, which leads to the accurate classification of normal and abnormal (cancer) cells. In this paper, first a preprocessing approach is performed to eliminate the noise and artifacts available in microarray cells using the nonlinear anisotropic diffusion filtering method. Then, the coordinate center of each spot is positioned utilizing the mathematical morphology operations. Finally, the position of each spot is exactly determined through applying a novel hybrid model based on the principle component analysis and the spatial fuzzy c-means clustering (SFCM) algorithm. Using a Gaussian kernel in SFCM algorithm will lead to improving the quality in complementary DNA microarray segmentation. The performance of the proposed algorithm has been evaluated on the real microarray images, which is available in Stanford Microarray Databases. Results illustrate that the accuracy of microarray cells segmentation in the proposed algorithm reaches to 100% and 98% for noiseless/noisy cells, respectively.

  17. Miniaturized sharp band-pass filter based on complementary electric-LC resonator

    NASA Astrophysics Data System (ADS)

    Torabi, Yalda; Dadashzadeh, Golamreza; Oraizi, Homayoon

    2016-04-01

    In this paper, a novel application of complementary electric-LC (CELC) resonator as a basic element to synthesize miniaturized sharp band-pass filters is introduced. The proposed metamaterial band-pass filter is a three-stage CELC-based device, where two shunt short-circuited stubs are employed in the input and output stages and a series gap is etched in the middle stage. By these means, a high-selectivity prototype band-pass filter with 2 % fractional bandwidth in S band is designed and fabricated. The out-of-band attenuation is better than 40 dB, and the upper and lower transition bands are also quite sharp due to the presence of two transmission zeros (nearly 60 and 30 dB fall in 0.2 GHz at lower and upper edges, respectively). Moreover, the filter is substantially miniaturized with a size of effective region of 1.3 cm × 1 cm at 2.9 GHz, which is quite smaller relative to conventional designs with the same performance. The fabrication and measurement of the proposed filter configuration attest to its expected desirable features. Therefore, the application of CELC resonator is proposed for super-compact sharp band-pass filters.

  18. An associative capacitive network based on nanoscale complementary resistive switches for memory-intensive computing

    NASA Astrophysics Data System (ADS)

    Kavehei, Omid; Linn, Eike; Nielen, Lutz; Tappertzhofen, Stefan; Skafidas, Efstratios; Valov, Ilia; Waser, Rainer

    2013-05-01

    We report on the implementation of an Associative Capacitive Network (ACN) based on the nondestructive capacitive readout of two Complementary Resistive Switches (2-CRSs). ACNs are capable of performing a fully parallel search for Hamming distances (i.e. similarity) between input and stored templates. Unlike conventional associative memories where charge retention is a key function and hence, they require frequent refresh cycles, in ACNs, information is retained in a nonvolatile resistive state and normal tasks are carried out through capacitive coupling between input and output nodes. Each device consists of two CRS cells and no selective element is needed, therefore, CMOS circuitry is only required in the periphery, for addressing and read-out. Highly parallel processing, nonvolatility, wide interconnectivity and low-energy consumption are significant advantages of ACNs over conventional and emerging associative memories. These characteristics make ACNs one of the promising candidates for applications in memory-intensive and cognitive computing, switches and routers as binary and ternary Content Addressable Memories (CAMs) and intelligent data processing.

  19. Complementary Amplicon-Based Genomic Approaches for the Study of Fungal Communities in Humans

    PubMed Central

    Heisel, Timothy; Podgorski, Heather; Staley, Christopher M.; Knights, Dan; Sadowsky, Michael J.; Gale, Cheryl A.

    2015-01-01

    Recent studies highlight the importance of intestinal fungal microbiota in the development of human disease. Infants, in particular, are an important population in which to study intestinal microbiomes because microbial community structure and dynamics during this formative window of life have the potential to influence host immunity and metabolism. When compared to bacteria, much less is known about the early development of human fungal communities, owing partly to their lower abundance and the relative lack of established molecular and taxonomic tools for their study. Herein, we describe the development, validation, and use of complementary amplicon-based genomic strategies to characterize infant fungal communities and provide quantitative information about Candida, an important fungal genus with respect to intestinal colonization and human disease. Fungal communities were characterized from 11 infant fecal samples using primers that target the internal transcribed spacer (ITS) 2 locus, a region that provides taxonomic discrimination of medically relevant fungi. Each sample yielded an average of 27,553 fungal sequences and Candida albicans was the most abundant species identified by sequencing and quantitative PCR (qPCR). Low numbers of Candida krusei and Candida parapsilosis sequences were observed in several samples, but their presence was detected by species-specific qPCR in only one sample, highlighting a challenge inherent in the study of low-abundance organisms. Overall, the sequencing results revealed that infant fecal samples had fungal diversity comparable to that of bacterial communities in similar-aged infants, which correlated with the relative abundance of C. albicans. We conclude that targeted sequencing of fungal ITS2 amplicons in conjunction with qPCR analyses of specific fungi provides an informative picture of fungal community structure in the human intestinal tract. Our data suggests that the infant intestine harbors diverse fungal species and

  20. Evidence-Based Practice and School Nursing

    ERIC Educational Resources Information Center

    Adams, Susan; McCarthy, Ann Marie

    2005-01-01

    School nurses need to demonstrate that their practice is based on the best evidence available, which is usually data obtained from research. Evidence-based practice involves combining the best evidence available with nursing expertise and patient and family preferences to determine optimum care. Evidence-based practice guidelines are developed by…

  1. Sound-impenetrable holes in water based on acoustic complementary medium

    NASA Astrophysics Data System (ADS)

    Liu, Chenkai; Bai, Ping; Lai, Yun

    2016-09-01

    By designing a two-dimension acoustic complementary medium of water, we demonstrate the possibility of realizing a sound-impenetrable hole that can block acoustic waves in water. The complementary medium is composed of core-shell rubber cylinders in a square lattice, and possesses the exact negative values of water in both the effective density and bulk modulus at a working frequency. The effects of negative refraction as well as the sound-impenetrable hole are verified by numerical simulations. Interestingly, by introducing a small amount of loss, we find that the functionality of such a sound-impenetrable hole becomes robust and works in a broad frequency range.

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

    PubMed

    Raditic, Donna M; Bartges, Joseph W

    2014-09-01

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

  3. Complementary and Alternative Medicine.

    PubMed

    Quezada, Sandra M; Briscoe, Jessica; Cross, Raymond K

    2016-06-01

    Inflammatory bowel disease is a complex, chronic, multifactorial inflammatory disorder of the digestive tract. Standard therapies include immunosuppressive and biological treatments, but there is increasing interest in the potential benefit of complementary and alternative medicine for the treatment of inflammatory bowel disease. Given the high prevalence of use of complementary and alternative medicine among inflammatory bowel disease patients, gastroenterologists must remain knowledgeable regarding the risks and benefits of these treatment options. This article reviews the updated scientific data on the use of biologically based complementary and alternative therapies for the treatment of inflammatory bowel disease.

  4. Complementary Hemispheric Asymmetries in Object Naming and Recognition: A Voxel-Based Correlational Study

    ERIC Educational Resources Information Center

    Acres, K.; Taylor, K. I.; Moss, H. E.; Stamatakis, E. A.; Tyler, L. K.

    2009-01-01

    Cognitive neuroscientific research proposes complementary hemispheric asymmetries in naming and recognising visual objects, with a left temporal lobe advantage for object naming and a right temporal lobe advantage for object recognition. Specifically, it has been proposed that the left inferior temporal lobe plays a mediational role linking…

  5. Outcome Prediction of Consciousness Disorders in the Acute Stage Based on a Complementary Motor Behavioural Tool

    PubMed Central

    Jöhr, Jane; Gilart de Keranflec'h, Charlotte; Van De Ville, Dimitri; Preti, Maria Giulia; Meskaldji, Djalel E.; Hömberg, Volker; Laureys, Steven; Draganski, Bogdan; Frackowiak, Richard; Diserens, Karin

    2016-01-01

    Introduction Attaining an accurate diagnosis in the acute phase for severely brain-damaged patients presenting Disorders of Consciousness (DOC) is crucial for prognostic validity; such a diagnosis determines further medical management, in terms of therapeutic choices and end-of-life decisions. However, DOC evaluation based on validated scales, such as the Revised Coma Recovery Scale (CRS-R), can lead to an underestimation of consciousness and to frequent misdiagnoses particularly in cases of cognitive motor dissociation due to other aetiologies. The purpose of this study is to determine the clinical signs that lead to a more accurate consciousness assessment allowing more reliable outcome prediction. Methods From the Unit of Acute Neurorehabilitation (University Hospital, Lausanne, Switzerland) between 2011 and 2014, we enrolled 33 DOC patients with a DOC diagnosis according to the CRS-R that had been established within 28 days of brain damage. The first CRS-R assessment established the initial diagnosis of Unresponsive Wakefulness Syndrome (UWS) in 20 patients and a Minimally Consciousness State (MCS) in the remaining13 patients. We clinically evaluated the patients over time using the CRS-R scale and concurrently from the beginning with complementary clinical items of a new observational Motor Behaviour Tool (MBT). Primary endpoint was outcome at unit discharge distinguishing two main classes of patients (DOC patients having emerged from DOC and those remaining in DOC) and 6 subclasses detailing the outcome of UWS and MCS patients, respectively. Based on CRS-R and MBT scores assessed separately and jointly, statistical testing was performed in the acute phase using a non-parametric Mann-Whitney U test; longitudinal CRS-R data were modelled with a Generalized Linear Model. Results Fifty-five per cent of the UWS patients and 77% of the MCS patients had emerged from DOC. First, statistical prediction of the first CRS-R scores did not permit outcome differentiation

  6. Integrative medicine: complementary therapies and supplements.

    PubMed

    Cassileth, Barrie R; Gubili, Jyothirmai; Simon Yeung, K

    2009-04-01

    Many patients with cancer or other urologic disorders use complementary therapies in an effort to control symptoms and to prevent and treat disease. Complementary modalities are adjuncts to mainstream treatment. These safe, evidence-based therapies reduce symptoms associated with treatment of urologic cancers and other illnesses. They are to be distinguished from 'alternative therapies', which are unproven, potentially harmful, and often promoted as substitutes for mainstream medical care. Accumulating evidence supports the beneficial impact of complementary therapies, such as acupuncture, yoga, meditation and physical activity, on physical and emotional symptoms associated with cancer treatment, for which there are few effective standard interventions. Herbs and other dietary supplements are unlikely to be beneficial, and might be problematic or dangerous when taken during cancer treatment.

  7. The evidence-based paradox.

    PubMed

    Hinojosa, Jim

    2013-01-01

    Many occupational therapy practitioners consider evidence-based practice (EBP) to be the means by which occupational therapy can prove the validity of its services and thus support the legitimacy of our profession. The unquestioned acceptance of EBP as the way to establish credibility concerns me; unchallenged acceptance of any idea concerns me. Do practitioners accept EBP as the paradigm for guiding occupational therapy practice and research solely because it is presented as what we must do? I believe that practitioners must examine the implications for our profession of accepting EBP without question. In this article, I review EBP, present criticisms and concerns voiced by other professions and, finally, examine the implications of adopting an EBP perspective that replaces theory-directed practice. PMID:23433283

  8. Evidence-based Science Communication

    NASA Astrophysics Data System (ADS)

    Kahan, D.

    2012-12-01

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

  9. Optimal model of PDIG based microgrid and design of complementary stabilizer using ICA.

    PubMed

    Amini, R Mohammad; Safari, A; Ravadanegh, S Najafi

    2016-09-01

    The generalized Heffron-Phillips model (GHPM) for a microgrid containing a photovoltaic (PV)-diesel machine (DM)-induction motor (IM)-governor (GV) (PDIG) has been developed at the low voltage level. A GHPM is calculated by linearization method about a loading condition. An effective Maximum Power Point Tracking (MPPT) approach for PV network has been done using sliding mode control (SMC) to maximize output power. Additionally, to improve stability of microgrid for more penetration of renewable energy resources with nonlinear load, a complementary stabilizer has been presented. Imperialist competitive algorithm (ICA) is utilized to design of gains for the complementary stabilizer with the multiobjective function. The stability analysis of the PDIG system has been completed with eigenvalues analysis and nonlinear simulations. Robustness and validity of the proposed controllers on damping of electromechanical modes examine through time domain simulation under input mechanical torque disturbances. PMID:27157850

  10. Multicultural competence and evidence-based practice in group therapy.

    PubMed

    Chen, Eric C; Kakkad, Dhruvi; Balzano, Julie

    2008-11-01

    The multicultural competence (MC) and evidence-based practice (EBP) initiatives have each generated healthy debates in the mental health field, with ample implications for clinical training and practice. Using two case illustrations, we highlight practical challenges and prospects in the intersection of MC and EBP. To facilitate complementary practice of MC and EBP, we offer strategies for the group therapist as a "local clinical scientist" to deliver culturally responsive treatments. We stress the importance of cultural adaptation of EBP models, namely, modifying evidence-based interventions that involve changes in service delivery, in the nature of the therapeutic relationship, or in components of the treatment itself to accommodate the cultural beliefs and behaviors of racial-cultural minority clients. Cultural adaptation of EBP in group therapy needs to be grounded in developmental contextualism and social justice. We discuss the two cases with an eye toward advancing multicultural competence in group therapy. PMID:18802951

  11. Multicultural competence and evidence-based practice in group therapy.

    PubMed

    Chen, Eric C; Kakkad, Dhruvi; Balzano, Julie

    2008-11-01

    The multicultural competence (MC) and evidence-based practice (EBP) initiatives have each generated healthy debates in the mental health field, with ample implications for clinical training and practice. Using two case illustrations, we highlight practical challenges and prospects in the intersection of MC and EBP. To facilitate complementary practice of MC and EBP, we offer strategies for the group therapist as a "local clinical scientist" to deliver culturally responsive treatments. We stress the importance of cultural adaptation of EBP models, namely, modifying evidence-based interventions that involve changes in service delivery, in the nature of the therapeutic relationship, or in components of the treatment itself to accommodate the cultural beliefs and behaviors of racial-cultural minority clients. Cultural adaptation of EBP in group therapy needs to be grounded in developmental contextualism and social justice. We discuss the two cases with an eye toward advancing multicultural competence in group therapy.

  12. [Complementary and alternative medicine in oncology].

    PubMed

    Hübner, J

    2013-06-01

    Complementary and alternative medicine are frequently used by cancer patients. The main benefit of complementary medicine is that it gives patients the chance to become active. Complementary therapy can reduce the side effects of conventional therapy. However, we have to give due consideration to side effects and interactions: the latter being able to reduce the effectiveness of cancer therapy and so to jeopardise the success of therapy. Therefore, complementary therapy should be managed by the oncologist. It is based on a common concept of cancerogenesis with conventional therapy. Complement therapy can be assessed in studies. Alternative medicine in contrast rejects common rules of evidence-based medicine. It starts from its own concepts of cancerogenesis, which is often in line with the thinking of lay persons. Alternative medicine is offered as either "alternative" to recommended cancer treatment or is used at the same time but without due regard for the interactions. Alternative medicine is a high risk to patients. In the following two parts of the article, the most important complementary and alternative therapies cancer patients use nowadays are presented and assessed according to published evidence.

  13. [Problems and strategies in developing Chinese medicine evidence-based clinical practice guidelines].

    PubMed

    Wang, Bo; Zhan, Si-yan; Liu, Bao-yan

    2011-11-01

    Some problems are confronted in the development of Chinese medicine (CM) evidence-based clinical practice guidelines in the aspects of individualized treatment, quality of research, reporting bias, safety assessment, and so on. After comprehensive retrieving of current methods for developing evidence-based clinical practice guidelines in the field of complementary and alternative medicine, and an optimal combining with widely accepted standardized methods in evidence-based clinical practice guidelines for allopathic medicine, we put forward strategies for these aforesaid problems. In terms of individualized treatment, practical randomized control trials could be considered for inclusion. In terms of quality of research, the method to formulate guideline recommendations was proposed in case of insufficient evidence. In terms of reporting bias, commonly used databases in complementary and alternative medicine were listed. In terms of safety evaluation, GRADE system was suggested to adopt.

  14. The Concept of Evidence in Evidence-Based Practice

    ERIC Educational Resources Information Center

    Kvernbekk, Tone

    2011-01-01

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

  15. Decisions to use complementary and alternative medicine (CAM) by male cancer patients: information-seeking roles and types of evidence used

    PubMed Central

    Evans, Maggie; Shaw, Alison; Thompson, Elizabeth A; Falk, Stephen; Turton, Pat; Thompson, Trevor; Sharp, Deborah

    2007-01-01

    therapies to use and sceptical about others, basing their choices on forms of 'evidence' that were personally meaningful: personal stories of individuals who had been helped by CAM; the long history and enduring popularity of some therapies; the plausibility of the mechanism of action; a belief or trust in individual therapies or their providers; scientific evidence. Scientific evidence ranked low in the men's personal decision-making about CAM, while it was recognised as important for NHS support for CAM. Conclusion These male cancer patients valued the support and guidance of 'trusted individuals' in making choices about CAM. Trusted health professionals could also play a significant role in helping patients to make informed choices. Any such dialogue must, however, acknowledge the different standards of evidence used by patients and clinicians to evaluate the benefits or otherwise of CAM therapies. Such open communication could help to foster an environment of mutual trust where patients are encouraged to discuss their interest in CAM, rather than perpetuate covert, undisclosed use of CAM with its attendant potential hazards. PMID:17683580

  16. Ag/GeSx/Pt-based complementary resistive switches for hybrid CMOS/Nanoelectronic logic and memory architectures

    NASA Astrophysics Data System (ADS)

    van den Hurk, Jan; Havel, Viktor; Linn, Eike; Waser, Rainer; Valov, Ilia

    2013-10-01

    Complementary resistive switches based on two anti-serially connected Ag/GeSx/Pt devices were studied. The main focus was placed on the pulse mode properties as typically required in memory and logic applications. A self-designed measurement setup was applied to access each CRS part-cell individually. Our findings reveal the existence of two distinct read voltage regimes enabling both spike read as well as level read approaches. Furthermore, we experimentally verified the theoretically predicted kinetic properties in terms of pulse height vs. switching time relationship. The results obtained by this alternative approach allow a significant improvement of the basic understanding of the interplay between the two part-cells in a complementary resistive switch configuration. Furthermore, from these observations we can deduce a simplified write voltage scheme which is applicable for the considered type of memory cell.

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

    PubMed

    Oh, Eui Geum

    2016-06-01

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

  18. 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.

  19. Printed dose-recording tag based on organic complementary circuits and ferroelectric nonvolatile memories

    PubMed Central

    Nga Ng, Tse; Schwartz, David E.; Mei, Ping; Krusor, Brent; Kor, Sivkheng; Veres, Janos; Bröms, Per; Eriksson, Torbjörn; Wang, Yong; Hagel, Olle; Karlsson, Christer

    2015-01-01

    We have demonstrated a printed electronic tag that monitors time-integrated sensor signals and writes to nonvolatile memories for later readout. The tag is additively fabricated on flexible plastic foil and comprises a thermistor divider, complementary organic circuits, and two nonvolatile memory cells. With a supply voltage below 30 V, the threshold temperatures can be tuned between 0 °C and 80 °C. The time-temperature dose measurement is calibrated for minute-scale integration. The two memory bits are sequentially written in a thermometer code to provide an accumulated dose record. PMID:26307438

  20. Towards Evidence Based Usability in Health Informatics?

    PubMed

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

    2015-01-01

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

  1. [Alternative medicines and "Evidence-Based Medicine" a possible reconciliation?].

    PubMed

    Vanherweghem, J-L

    2015-09-01

    The contrast between the efficiency of Evidence-Based Medicine (EBM), a scientific fact, and the popularity of Complementary and Alternative Medicines (CAM) is a paradox of the art of healing. EBM is based on the paradigm of positivism and materialism while CAM are based on those of relativism and vitalism. These paradigms are diametrically opposed and the aim of an integrative medicine is aporetic. However, EBM is today in a dead end. The objective proof of a disease according to the rules of EBM is often lacking face to the expectations of patients demanding their illness to be taken into account. EBM and CAM have thus to coexist. Lessons can be drawn from CAM : patient expectations should be given a meaning and be integrated in his or her psychosocial context.

  2. Complementary corner.

    PubMed

    2003-01-01

    Interest in nutritional health products stems from a number of observations. These include documented nutritional/vitamin deficiencies even in early stages of HIV infection and malnutrition associated with increased risk of HIV disease progression. There is great controversy, however, over whether or not using supplements is always a good idea and if it provides benefits in the long run. There has also been long-standing interest in complementary and alternative medicine (CAM) approaches to managing HIV infection and various conditions associated with HIV. The CAMs most commonly used by people living with HIV are not drugs, herbs or other pharmacologic agents, but rather things like meditation, massage, energy healing, acupuncture and the like. The following article contains summary highlights of studies of nutritional health products and CAM approaches in the setting of HIV presented at the World AIDS Conference in Barcelona.

  3. Electrically tunable terahertz wave modulator based on complementary metamaterial and graphene

    SciTech Connect

    He, Xun-jun Li, Teng-yue; Wang, Lei; Wang, Jian-min; Jiang, Jiu-xing; Yang, Guo-hui; Meng, Fan-yi; Wu, Qun

    2014-05-07

    In this paper, we design and numerically demonstrate an electrically controllable light-matter interaction in a hybrid material/metamaterial system consisting of an artificially constructed cross cut-wire complementary metamaterial and an atomically thin graphene layer to realize terahertz (THz) wave modulator. By applying a bias voltage between the metamaterial and the graphene layer, this modulator can dynamically control the amplitude and phase of the transmitted wave near 1.43 THz. Moreover, the distributions of current density show that this large modulation depth can be attributed to the resonant electric field parallel to the graphene sheet. Therefore, the modulator performance indicates the enormous potential of graphene for developing sophisticated THz communication systems.

  4. Implementing Evidence-Based Social Work Practice

    ERIC Educational Resources Information Center

    Mullen, Edward J.; Bledsoe, Sarah E.; Bellamy, Jennifer L.

    2008-01-01

    Recently, social work has been influenced by new forms of practice that hold promise for bringing practice and research together to strengthen the scientific knowledge base supporting social work intervention. The most recent new practice framework is evidence-based practice. However, although evidence-based practice has many qualities that might…

  5. Evidence-Based Research in Education.

    ERIC Educational Resources Information Center

    Research Exchange, 2003

    2003-01-01

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

  6. Complementary strategies for developing Gd-free high-field T₁ MRI contrast agents based on Mn(III) porphyrins.

    PubMed

    Cheng, Weiran; Haedicke, Inga E; Nofiele, Joris; Martinez, Francisco; Beera, Kiran; Scholl, Timothy J; Cheng, Hai-Ling Margaret; Zhang, Xiao-An

    2014-01-23

    Mn(III) porphyrin (MnP) holds the promise of addressing the emerging challenges associated with Gd-based clinical MRI contrast agents (CAs), namely, Gd-related adverse effect and decreasing sensitivity at high clinical magnetic fields. Two complementary strategies for developing new MnPs as Gd-free CAs with optimized biocompatibility were established to improve relaxivity or clearance rate. MnPs with distinct and tunable pharmacokinetic properties can consequently be constructed for different in vivo applications at clinical field of 3 T.

  7. Moral injury: A new challenge for complementary and alternative medicine.

    PubMed

    Kopacz, Marek S; Connery, April L; Bishop, Todd M; Bryan, Craig J; Drescher, Kent D; Currier, Joseph M; Pigeon, Wilfred R

    2016-02-01

    Moral injury represents an emerging clinical construct recognized as a source of morbidity in current and former military personnel. Finding effective ways to support those affected by moral injury remains a challenge for both biomedical and complementary and alternative medicine. This paper introduces the concept of moral injury and suggests two complementary and alternative medicine, pastoral care and mindfulness, which may prove useful in supporting military personnel thought to be dealing with moral injury. Research strategies for developing an evidence-base for applying these, and other, complementary and alternative medicine modalities to moral injury are discussed.

  8. Moral injury: A new challenge for complementary and alternative medicine.

    PubMed

    Kopacz, Marek S; Connery, April L; Bishop, Todd M; Bryan, Craig J; Drescher, Kent D; Currier, Joseph M; Pigeon, Wilfred R

    2016-02-01

    Moral injury represents an emerging clinical construct recognized as a source of morbidity in current and former military personnel. Finding effective ways to support those affected by moral injury remains a challenge for both biomedical and complementary and alternative medicine. This paper introduces the concept of moral injury and suggests two complementary and alternative medicine, pastoral care and mindfulness, which may prove useful in supporting military personnel thought to be dealing with moral injury. Research strategies for developing an evidence-base for applying these, and other, complementary and alternative medicine modalities to moral injury are discussed. PMID:26860798

  9. Modeling the Behavior of an Underwater Acoustic Relative Positioning System Based on Complementary Set of Sequences

    PubMed Central

    Aparicio, Joaquín; Jiménez, Ana; Álvarez, Fernando J.; Ureña, Jesús; De Marziani, Carlos; Diego, Cristina

    2011-01-01

    The great variability usually found in underwater media makes modeling a challenging task, but helpful for better understanding or predicting the performance of future deployed systems. In this work, an underwater acoustic propagation model is presented. This model obtains the multipath structure by means of the ray tracing technique. Using this model, the behavior of a relative positioning system is presented. One of the main advantages of relative positioning systems is that only the distances between all the buoys are needed to obtain their positions. In order to obtain the distances, the propagation times of acoustic signals coded by Complementary Set of Sequences (CSS) are used. In this case, the arrival instants are obtained by means of correlation processes. The distances are then used to obtain the position of the buoys by means of the Multidimensional Scaling Technique (MDS). As an early example of an application using this relative positioning system, a tracking of the position of the buoys at different times is performed. With this tracking, the surface current of a particular region could be studied. The performance of the system is evaluated in terms of the distance from the real position to the estimated one. PMID:22247661

  10. Complementary and alternative medicines and childhood eczema: a US population-based study.

    PubMed

    Silverberg, Jonathan I; Lee-Wong, Mary; Silverberg, Nanette B

    2014-01-01

    The prevalence of complementary and alternative medicine (CAM) use in US children with eczema is unknown. Furthermore, it is unknown whether CAM use in the United States is associated with higher eczema prevalence. We sought to determine the eczema prevalence in association with CAM usage. We analyzed data from the 2007 National Health Interview Survey that included a nationally representative sample of 9417 children ages 0 to 17 years. Overall, 46.9% (95% confidence interval, 45.6%-48.2%) of children in the United States used 1 or more CAM, of which 0.99% (0.28%-1.71%) used CAM specifically to treat their eczema, including herbal therapy (0.46%), vitamins (0.33%), Ayurveda (0.28%), naturopathy (0.24%), homeopathy (0.20%), and traditional healing (0.12%). Several CAMs used for other purposes were associated with increased eczema prevalence, including herbal therapy (survey logistic regression; adjusted odds ratio [95% confidence interval], 2.07 [1.40-3.06]), vitamins (1.45 [1.21-1.74]), homeopathic therapy (2.94 [1.43-6.00]), movement techniques (3.66 [1.62-8.30]), and diet (2.24 [1.10-4.58]), particularly vegan diet (2.53 [1.17-5.51]). In conclusion, multiple CAMs are commonly used for the treatment of eczema in US children. However, some CAMs may actually be harmful to the skin and be associated with higher eczema prevalence in the United States.

  11. Evaluation of the nutritional characteristics of a finger millet based complementary food.

    PubMed

    Mbithi-Mwikya, Stephen; Van Camp, John; Mamiro, Peter R S; Ooghe, Wilfried; Kolsteren, Patrick; Huyghebaert, Andre

    2002-05-01

    Finger millet (Eleusine coracana), kidney beans (Phaseolus vulgaris), peanuts (Arachis hypogoea), and mango (Mangifera indica) were processed separately and then combined, on the basis of their amino acid scores and energy content, into a complementary food for children of weaning age. The finger millet and kidney beans were processed by germination, autoclaving, and lactic acid fermentation. A mixture containing, on a dry matter basis, 65.2, 19.1, 8.0, and 7.7% of the processed finger millet, kidney beans, peanuts, and mango, respectively, gave a composite protein with an in vitro protein digestibility of 90.2% and an amino acid chemical score of 0.84. This mixture had an energy density of 16.3 kJ.g(-1) of dry matter and a decreased antinutrient content and showed a measurable improvement in the in vitro extractability for calcium, iron, and zinc. A 33% (w/v) pap made from a mix of the processed ingredients had an energy density of 5.4 kJ.g(-1) of pap, which is sufficient to meet the energy requirements of well-nourished children of 6-24 months of age at three servings a day and at the FAO average breast-feeding frequency. PMID:11982437

  12. Evidence-Based Clearinghouses in Social Work

    ERIC Educational Resources Information Center

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

    2010-01-01

    Objectives: The purpose of this article is to describe several evidence-based clearinghouses focused on social work and related intervention outcomes, placing them in the context of how such clearinghouses can contribute to research dissemination to foster effective, evidence-based practice. Method: The study employed an analysis of data provided…

  13. What's New about Evidence-Based Assessment?

    ERIC Educational Resources Information Center

    Barlow, David H.

    2005-01-01

    A clear consensus has emerged around the world concerning the desirability and even the urgency of basing health care delivery systems on evidence. Among behavioral health care providers such as psychologists, evidence-based practice (EBP) has been focused largely on interventions. Psychologists have long emphasized a scientifically based…

  14. Evidence-based medicine and levels of evidence.

    PubMed

    Wallace, David K

    2010-01-01

    Evidence-based medicine is the practice of making medical decisions based on evidence gained from applying the scientific method. Published studies are evaluated using three key questions: "Are the results valid?"; "What are the results?"; and "Can the results be applied to my patients?" The hierarchy of study methods for obtaining evidence is, in order from least to most useful: laboratory research, editorials, case reports and series, case-control studies, cohort studies, and randomized clinical trials. Retrospective case series can suffer from problems such as selection of a biased sample, mixing of treatment effects, and lack of control group. Randomized clinical trials (and meta-analyses of multiple trials) provide the highest level of evidence because randomization limits confounding and prevents bias of treatment assignment. In addition, randomized trials have standardization of interventions, prospective data collection, and masked outcome measures. Although every question cannot be addressed by a randomized clinical trial, the best available evidence should be sought and used to guide treatments. PMID:21061876

  15. Workplace accommodations: evidence based outcomes.

    PubMed

    Schartz, Helen A; Hendricks, D J; Blanck, Peter

    2006-01-01

    One central component to meaningful employment for people with disabilities is the ADA's workplace accommodation provision that allows qualified individuals to perform essential job functions. Little empirical evidence is available to evaluate the costs, benefits, and effectiveness of accommodations. Previous research has focused on direct costs. This article advocates an inclusive accommodation cost/benefit analysis to include direct and indirect costs and benefits and to differentiate disability-related accommodation costs from typical employee costs. The inclusive cost/benefit analysis is applied to preliminary data from interviews with employers who contacted the Job Accommodation Network (JAN). Results suggest that accommodations are low cost, beneficial and effective.

  16. Complementary monoclonal antibody-based dot ELISA for universal detection of H5 avian influenza virus

    PubMed Central

    2010-01-01

    Background Rapid diagnosis and surveillance for H5 subtype viruses are critical for the control of H5N1 infection. Results In this study, H5 Dot ELISA, a rapid test for the detection of avian H5N1 influenza virus, was developed with two complementary H5 monoclonal antibodies. HA sequencing of escape mutants followed by epitope mapping revealed that the two Mabs target the epitope component (189th amino acid) on the HA protein but are specific for different amino acids (189Lys or 189Arg). Gene alignment indicated that these two amino acids are the most frequent types on this position among all of the H5 AIV reported in GeneBank. These two H5 Mabs were used together in a dot ELISA to detect H5 viral antigen. The detection limit of the developed test for multiple clades of H5N1 viruses, including clades 0, 1, 2.1, 2.2, 2.3, 4, 7, and 8, was less than 0.5 hemagglutinin units. The specificity of the optimized dot ELISA was examined by using 100 H5 strains, including H5N1 HPAI strains from multiple clades, 36 non-H5N1 viruses, and 4 influenza B viruses. No cross-reactivity was observed for any of the non-H5N1 viruses tested. Among 200 random poultry samples, the test gave 100% positive results for all of the twelve RT-PCR-positive samples. Conclusions Considering that the test is convenient for field use, this H5 Dot ELISA can be used for on-site detection of H5N1 infection in clinical or environmental specimens and facilitate the investigation of H5N1 influenza outbreaks and surveillance in poultry. PMID:21192824

  17. Complementary and alternative medicines and childhood eczema: a US population-based study.

    PubMed

    Silverberg, Jonathan I; Lee-Wong, Mary; Silverberg, Nanette B

    2014-01-01

    The prevalence of complementary and alternative medicine (CAM) use in US children with eczema is unknown. Furthermore, it is unknown whether CAM use in the United States is associated with higher eczema prevalence. We sought to determine the eczema prevalence in association with CAM usage. We analyzed data from the 2007 National Health Interview Survey that included a nationally representative sample of 9417 children ages 0 to 17 years. Overall, 46.9% (95% confidence interval, 45.6%-48.2%) of children in the United States used 1 or more CAM, of which 0.99% (0.28%-1.71%) used CAM specifically to treat their eczema, including herbal therapy (0.46%), vitamins (0.33%), Ayurveda (0.28%), naturopathy (0.24%), homeopathy (0.20%), and traditional healing (0.12%). Several CAMs used for other purposes were associated with increased eczema prevalence, including herbal therapy (survey logistic regression; adjusted odds ratio [95% confidence interval], 2.07 [1.40-3.06]), vitamins (1.45 [1.21-1.74]), homeopathic therapy (2.94 [1.43-6.00]), movement techniques (3.66 [1.62-8.30]), and diet (2.24 [1.10-4.58]), particularly vegan diet (2.53 [1.17-5.51]). In conclusion, multiple CAMs are commonly used for the treatment of eczema in US children. However, some CAMs may actually be harmful to the skin and be associated with higher eczema prevalence in the United States. PMID:25207686

  18. Clinical Trial Adaptation by Matching Evidence in Complementary Patient Sub-groups of Auxiliary Blinding Questionnaire Responses.

    PubMed

    Arandjelović, Ognjen

    2015-01-01

    Clinical trial adaptation refers to any adjustment of the trial protocol after the onset of the trial. Such adjustment may take on various forms, including the change in the dose of administered medicines, the frequency of administering an intervention, the number of trial participants, or the duration of the trial, to name just some possibilities. The main goal is to make the process of introducing new medical interventions to patients more efficient, either by reducing the cost or the time associated with evaluating their safety and efficacy. The principal challenge, which is an outstanding research problem, is to be found in the question of how adaptation should be performed so as to minimize the chance of distorting the outcome of the trial. In this paper we propose a novel method for achieving this. Unlike most of the previously published work, our approach focuses on trial adaptation by sample size adjustment i.e. by reducing the number of trial participants in a statistically informed manner. We adopt a stratification framework recently proposed for the analysis of trial outcomes in the presence of imperfect blinding and based on the administration of a generic auxiliary questionnaire that allows the participants to express their belief concerning the assigned intervention (treatment or control). We show that this data, together with the primary measured variables, can be used to make the probabilistically optimal choice of the particular sub-group a participant should be removed from if trial size reduction is desired. Extensive experiments on a series of simulated trials are used to illustrate the effectiveness of our method.

  19. The value of site-based observations complementary to naturalistic driving observations: a pilot study on the right turn manoeuvre.

    PubMed

    van Nes, Nicole; Christoph, Michiel; Hoedemaeker, Marika; van der Horst, Richard A

    2013-09-01

    Naturalistic driving studies are increasingly applied in different shapes and sizes. The European project PROLOGUE has investigated the value and feasibility of a large-scale naturalistic driving study in Europe. Within PROLOGUE several pilot studies have been conducted in different countries. The Dutch field trial investigated the value and feasibility of adding site-based observations to in-vehicle observations. In this trial, one intersection was equipped with cameras for site-based observation. Additionally eight cars were equipped of drivers crossing this intersection regularly. On this small scale, combining the two observation methods turned out to be technically feasible. It was possible to recognise the instrumented vehicles in the site-based video data, to match cases from the different observations and the speed measures from the separate studies appeared to be similar. The value of combining these two observation methods lies in the possibility to enrich the data from one study with complementary data from the other study. The study illustrated that each type of observation has its unique values. From in-vehicle data it is possible to look in detail at the driving behaviour of the participants over time and in different situations. The site-based study offers information about the position and speed of other road users surrounding the participant's vehicle, including vulnerable road users such as cyclists and pedestrians. Two values of adding site-based observations to in-vehicle observations were identified: to obtain more in depth understanding and to relate the behaviour of participants of the naturalistic driving study to behaviour of the full population of drivers (non-participants). For a future (large-scale) naturalistic driving study two research topics are identified that could benefit from these complementary observations: driving behaviour in relation to specific infrastructure and the interaction between drivers and vulnerable road users.

  20. The challenges of evidence-based medicine: a philosophical perspective.

    PubMed

    Kulkarni, Abhaya V

    2005-01-01

    Although evidence-based medicine (EBM) has gained prominence in current medical practice and research, it has also had to deal with a number of problems and inconsistencies. For example, how do clinicians reconcile discordant results of randomized trials or how do they apply results of randomized trials to individual patients? In an attempt to examine such problems in a structured way, this essay describes EBM within a philosophical framework of science. Using this approach, some of the problems and challenges faced by EBM can be explained at a more fundamental level. As well, by employing a similar description of the competing alternative research tradition of clinical medicine, this essay not only highlights the philosophical differences between these two modes of medical practice, but suggests that they, in fact, play a de facto complementary role in current clinical medicine.

  1. Complementary medicine for depression.

    PubMed

    Pilkington, Karen; Rampes, Hagen; Richardson, Janet

    2006-11-01

    Surveys have demonstrated that complementary medicine use for depression is widespread, although patterns of use vary. A series of systematic reviews provide a summary of the current evidence for acupuncture, aromatherapy and massage, homeopathy, meditation, reflexology, herbal medicine, yoga, and several dietary supplements and relaxation techniques. The quantity and quality of individual studies vary widely, but research interest in complementary therapies is increasing, particularly in herbal and nutritional products. Major questions are still to be answered with respect to the effectiveness and appropriate role of these therapies in the management of depression. Areas for further research and some of the potential challenges to research design are discussed. Finally, several ongoing developments in information provision on this topic are highlighted.

  2. Highly sensitive sensors for alkali metal ions based on complementary-metal-oxide-semiconductor-compatible silicon nanowires

    NASA Astrophysics Data System (ADS)

    Zhang, Guo-Jun; Agarwal, Ajay; Buddharaju, Kavitha D.; Singh, Navab; Gao, Zhiqiang

    2007-06-01

    Highly sensitive sensors for alkali metal ions based on complementary-metal-oxide- semiconductor-compatible silicon nanowires (SiNWs) with crown ethers covalently immobilized on their surface are presented. A densely packed organic monolayer terminated with amine groups is introduced to the SiNW surface via hydrosilylation. Amine-modified crown ethers, acting as sensing elements, are then immobilized onto the SiNWs through a cross-linking reaction with the monolayer. The crown ether-functionalized SiNWs recognize Na+ and K+ according to their complexation ability to the crown ethers. The SiNW sensors are highly selective and capable of achieving an ultralow detection limit down to 50nM, over three orders of magnitude lower than that of conventional crown ether-based ion-selective electrodes.

  3. Evidence-based practice in pediatric rehabilitation.

    PubMed

    O'Donnell, Maureen E; Roxborough, Lori

    2002-11-01

    EBP is not a new concept. To practice using the newest and best research evidence, clinicians must have the knowledge and skills to find and appraise the quality of the evidence. This process starts with the formulation of a focused question, followed by an effective search for the best evidence, critical appraisal of the evidence retrieved, and integration of that best evidence into practice. There are an increasing number of resources that can provide clinicians with the best evidence and that can assist clinicians with enhancement of their EBP skills. Unique challenges exist in practicing in an evidence-based manner in the field of pediatric rehabilitation, but through the collaboration of clinicians and researchers, these challenges can be overcome.

  4. 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. PMID:26456314

  5. History of evidence-based medicine

    PubMed Central

    Sur, Roger L.; Dahm, Philipp

    2011-01-01

    This essay reviews the historical circumstances surrounding the introduction and evolution of evidence-based medicine. Criticisms of the approach are also considered. Weaknesses of existing standards of clinical practice and efforts to bring more certainty to clinical decision making were the foundation for evidence-based medicine, which integrates epidemiology and medical research. Because of its utility in designing randomized clinical trials, assessing the quality of the literature, and applying medical research at the bedside, evidence-based medicine will continue to have a strong influence on everyday clinical practice. PMID:22279315

  6. Evidence-based complementary and alternative medicine in inpatient care: take a look at Europe.

    PubMed

    Romeyke, Tobias; Stummer, Harald

    2015-04-01

    The aim of this report is to provide the reader an overview of the complex therapy currently used within the German health system. Complex therapies in inpatient care in Germany establish the basis for an integrative and interdisciplinary provision of services. They define minimal criteria for the organization of a hospital, enable the integration of different therapeutic approaches, and therefore, lead to an intensive and holistic treatment by a specially trained team. The German model can be viewed as a pilot program for the introduction of integrative patient-centered care in other hospitals around the world.

  7. Evidence-Based Dentistry: What's New?

    PubMed Central

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

    2007-01-01

    The importance of evidence for every branch of medicine in teaching in order to orient the practitioners among the great amount of most actual scientific information's, and to support clinical decisions, is well established in health care, including dentistry. The practice of evidence-based medicine is a process of lifelong, self-directed, problem-based learning which leads to the need for clinically important information about diagnosis, prognosis, therapy and other clinical and health care issues. Nowadays the practice of dentistry is becoming more complex and challenging because of the continually changing in dental materials and equipments, an increasingly litigious society, an increase in the emphasis of continuing professional development, the information explosion and the consumer movement associated with advances on the Internet. The need for reliable information and the electronic revolution have come together to allow the “paradigm shift” towards evidence-based health care. Recent years have seen an increase in the importance of evidence-based dentistry, aiming to reduce to the maximum the gap between clinical research and real world dental practice. Aim of evidence-based practice is the systematic literature review, which synthesizes the best evidences and provides the basis for clinical practice guidelines. These practice guidelines give a brief review of what evidence-based dentistry is and how to use it. PMID:17589569

  8. Evidence-Based ACL Reconstruction

    PubMed Central

    Rodriguez-Merchan, E. Carlos

    2015-01-01

    There is controversy in the literature regarding a number of topics related to anterior cruciate ligament (ACL) reconstruction. The purpose of this article is to answer the following questions: 1) Bone-patellar tendon-bone reconstruction (BPTB-R) or hamstrimg reconstruction (H-R); 2) Double bundle or single bundle; 3) Allograft or authograft; 4) Early or late reconstruction; 5) Rate of return to sports after ACL reconstruction; 6) Rate of osteoarthritis after ACL reconstruction. A Cochrane Library and PubMed (MEDLINE) search of systematic reviews and meta-analysis related to ACL reconstruction was performed. The key words were: ACL reconstruction, systematic reviews and meta-analysis. The main criteria for selection were that the articles were systematic reviews and meta-analyses focused on the aforementioned questions. Sixty-nine articles were found, but only 26 were selected and reviewed because they had a high grade (I-II) of evidence. BPTB-R was associated with better postoperative knee stability but with a higher rate of morbidity. However, the results of both procedures in terms of functional outcome in the long-term were similar. The double-bundle ACL reconstruction technique showed better outcomes in rotational laxity, although functional recovery was similar between single-bundle and double-bundle. Autograft yielded better results than allograft. There was no difference between early and delayed reconstruction. 82% of patients were able to return to some kind of sport participation. 28% of patients presented radiological signs of osteoarthritis with a follow-up of minimum 10 years. PMID:25692162

  9. Evidence-Based ACL Reconstruction.

    PubMed

    Rodriguez-Merchan, E Carlos

    2015-01-01

    There is controversy in the literature regarding a number of topics related to anterior cruciate ligament (ACL) reconstruction. The purpose of this article is to answer the following questions: 1) Bone-patellar tendon-bone reconstruction (BPTB-R) or hamstrimg reconstruction (H-R); 2) Double bundle or single bundle; 3) Allograft or authograft; 4) Early or late reconstruction; 5) Rate of return to sports after ACL reconstruction; 6) Rate of osteoarthritis after ACL reconstruction. A Cochrane Library and PubMed (MEDLINE) search of systematic reviews and meta-analysis related to ACL reconstruction was performed. The key words were: ACL reconstruction, systematic reviews and meta-analysis. The main criteria for selection were that the articles were systematic reviews and meta-analyses focused on the aforementioned questions. Sixty-nine articles were found, but only 26 were selected and reviewed because they had a high grade (I-II) of evidence. BPTB-R was associated with better postoperative knee stability but with a higher rate of morbidity. However, the results of both procedures in terms of functional outcome in the long-term were similar. The double-bundle ACL reconstruction technique showed better outcomes in rotational laxity, although functional recovery was similar between single-bundle and double-bundle. Autograft yielded better results than allograft. There was no difference between early and delayed reconstruction. 82% of patients were able to return to some kind of sport participation. 28% of patients presented radiological signs of osteoarthritis with a follow-up of minimum 10 years. PMID:25692162

  10. Evidence-Based Teaching: Rhetoric and Reality

    ERIC Educational Resources Information Center

    Wrigley, Terry

    2015-01-01

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

  11. Complementary and Alternative Medicine: Core Competencies for Family Nurse Practitioners.

    ERIC Educational Resources Information Center

    Burman, Mary E.

    2003-01-01

    Directors of family nurse practitioner education programs (n=141) reported inclusion of some complementary/alternative medicine content (CAM), most commonly interviewing patients about CAM, critical thinking, evidence-based medicine, laws, ethics, and spiritual/cultural beliefs. Definition of CAM was medically, not holistically based. More faculty…

  12. [Structural and Dipole Structure Peculiarities of Hoogsteen Base Pairs Formed in Complementary Nucleobases according to ab initio Quantum Mechanics Studies].

    PubMed

    Petrenko, Y M

    2015-01-01

    Ab initio quantum mechanics studies for the detection of structure and dipole structure peculiarities of Hoogsteen base pairs relative to Watson-Crick base pairs, were performed during our work. These base pairs are formed as a result of complementary interactions. It was revealed, that adenine-thymine Hoogsteen base pair and adenine-thymine Watson-Crick base pairs can be formed depending on initial configuration. Cytosine-guanine Hoogsteen pairs are formed only when cytosine was originally protonated. Both types of Hoogsteen pairs have noticeable difference in the bond distances and angles. These differences appeared in purine as well as in pyrimidine parts of the pairs. Hoogsteen pairs have mostly shorter hydrogen bond lengths and significantly larger angles of hydrogen bonds and larger angles between the hydrogen bonds than Watson-Crick base pairs. Notable differences are also observed with respect to charge distribution and dipole moment. Quantitative data on these differences are shown in our work. It is also reported that the values of local parameters (according to Cambridge classification of the parameters which determine DNA properties) in Hoogsteen base pairs, are greatly different from Watson-Crick ones.

  13. Complementary characterization data in support of uniaxially aligned electrospun nanocomposites based on a model PVOH-epoxy system

    PubMed Central

    Karimi, Samaneh; Staiger, Mark P.; Buunk, Neil; Fessard, Alison; Tucker, Nick

    2016-01-01

    This paper presents complementary data corresponding to characterization tests done for our research article entitled “Uniaxially aligned electrospun fibers for advanced nanocomposites based on a model PVOH-epoxy system” (Karimi et al., 2016) [1]. Poly(vinyl alcohol) and epoxy resin were selected as a model system and the effect of electrospun fiber loading on polymer properties was examined in conjunction with two manufacturing methods. A novel electrospinning technology for production of uniaxially aligned nanofiber arrays was used. A conventional wet lay-up fabrication method is compared against a novel, hybrid electrospinning–electrospraying approach. The structure and thermomechanical properties of resulting composite materials were examined using scanning electron microscopy, dynamic mechanical analysis, thermogravimetric analysis, differential scanning calorimetry, Fourier transform infrared spectroscopy, and tensile testing. For discussion of obtained results please refer to the research paper (Karimi et al., 2016) [1]. PMID:26977430

  14. Practice-Based Evidence: Delivering What Works

    ERIC Educational Resources Information Center

    Brendtro, Larry K.; Mitchell, Martin L.

    2012-01-01

    Many methods claim to be Evidence-Based Practices. Yet success comes not from a particular practice, but principles that underlie all effective helping. This article uses the principle of consilience to tap knowledge from science, values, and practical experience.

  15. Plasmonic-resonance-based ternary composite complementary enhancement of the performance of dye-sensitized solar cells

    NASA Astrophysics Data System (ADS)

    Bai, Lihua; Li, Meiya; Liu, Xiaolian; Luoshan, Mengdai; Zhang, Feng; Guo, Kaimo; Zhu, Yongdan; Sun, Beilei; Zhao, Xingzhong

    2016-10-01

    Graphene (G), TiO2 fusiform nanorods (TiO2NRs) adsorbed with Au nanoparticles (AuNPs) are prepared and blended as multifunctional materials into TiO2 nanocrystalline film to form a novel ternary (G-TiO2NRs-Au) composite photoanode in dye-sensitized solar cells (DSSCs). The effects of G-TiO2NRs-Au on the properties of the photoanode and DSSC are investigated. Results show that, by blending G-TiO2NRs-Au, the light absorption and scattering of the photoanode are obviously improved, and the charge transfer resistance R2 and electron recombination are decreased, resulting in a significant enhancement in the short-circuit current density (J sc) and the photoelectric conversion efficiency (PCE) of the DSSCs. The maximum J sc of 17.66 mA cm-2 and PCE of 8.56% are obtained in the optimal G-TiO2NRs-Au-based DSSC, about 33.6% and 35.0% higher than that obtained in the conventional TiO2-based DSSC. This significant improvement in the performance of the DSSC can be attributed to the ternary composite complementary effects of multi-functions from the surface plasmon resonance of AuNPs, light scattering of TiO2NRs, and the improved dye loading and fast electron transmission channel from graphene. This study provides an effective way of ternary composite complementary enhancement of the J sc and PCE of the DSSCs.

  16. Plasmonic-resonance-based ternary composite complementary enhancement of the performance of dye-sensitized solar cells.

    PubMed

    Bai, Lihua; Li, Meiya; Liu, Xiaolian; Luoshan, Mengdai; Zhang, Feng; Guo, Kaimo; Zhu, Yongdan; Sun, Beilei; Zhao, Xingzhong

    2016-10-14

    Graphene (G), TiO2 fusiform nanorods (TiO2NRs) adsorbed with Au nanoparticles (AuNPs) are prepared and blended as multifunctional materials into TiO2 nanocrystalline film to form a novel ternary (G-TiO2NRs-Au) composite photoanode in dye-sensitized solar cells (DSSCs). The effects of G-TiO2NRs-Au on the properties of the photoanode and DSSC are investigated. Results show that, by blending G-TiO2NRs-Au, the light absorption and scattering of the photoanode are obviously improved, and the charge transfer resistance R2 and electron recombination are decreased, resulting in a significant enhancement in the short-circuit current density (J sc) and the photoelectric conversion efficiency (PCE) of the DSSCs. The maximum J sc of 17.66 mA cm(-2) and PCE of 8.56% are obtained in the optimal G-TiO2NRs-Au-based DSSC, about 33.6% and 35.0% higher than that obtained in the conventional TiO2-based DSSC. This significant improvement in the performance of the DSSC can be attributed to the ternary composite complementary effects of multi-functions from the surface plasmon resonance of AuNPs, light scattering of TiO2NRs, and the improved dye loading and fast electron transmission channel from graphene. This study provides an effective way of ternary composite complementary enhancement of the J sc and PCE of the DSSCs. PMID:27595326

  17. Plasmonic-resonance-based ternary composite complementary enhancement of the performance of dye-sensitized solar cells.

    PubMed

    Bai, Lihua; Li, Meiya; Liu, Xiaolian; Luoshan, Mengdai; Zhang, Feng; Guo, Kaimo; Zhu, Yongdan; Sun, Beilei; Zhao, Xingzhong

    2016-10-14

    Graphene (G), TiO2 fusiform nanorods (TiO2NRs) adsorbed with Au nanoparticles (AuNPs) are prepared and blended as multifunctional materials into TiO2 nanocrystalline film to form a novel ternary (G-TiO2NRs-Au) composite photoanode in dye-sensitized solar cells (DSSCs). The effects of G-TiO2NRs-Au on the properties of the photoanode and DSSC are investigated. Results show that, by blending G-TiO2NRs-Au, the light absorption and scattering of the photoanode are obviously improved, and the charge transfer resistance R2 and electron recombination are decreased, resulting in a significant enhancement in the short-circuit current density (J sc) and the photoelectric conversion efficiency (PCE) of the DSSCs. The maximum J sc of 17.66 mA cm(-2) and PCE of 8.56% are obtained in the optimal G-TiO2NRs-Au-based DSSC, about 33.6% and 35.0% higher than that obtained in the conventional TiO2-based DSSC. This significant improvement in the performance of the DSSC can be attributed to the ternary composite complementary effects of multi-functions from the surface plasmon resonance of AuNPs, light scattering of TiO2NRs, and the improved dye loading and fast electron transmission channel from graphene. This study provides an effective way of ternary composite complementary enhancement of the J sc and PCE of the DSSCs.

  18. Complementary and Other Interventions

    MedlinePlus

    ... Treatment of ADHD Complementary and Other Interventions Coaching Neurofeedback (EEG Biofeedback) Fish Oil Supplements and ADHD Carrying Your ... and Other Interventions Complementary and Other Interventions Coaching Neurofeedback (EEG Biofeedback) Fish Oil Supplements and ADHD Complementary and ...

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

    PubMed

    Coiera, Enrico

    2016-03-01

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

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

    PubMed

    Coiera, Enrico

    2016-03-01

    e-Health is experiencing a difficult time. On the one side, the forecast is for a bright digital health future created by precision medicine and smart devices. On the other hand, most large scale e-health projects struggle to make a difference and are often controversial. Both futures fail because they are not evidence-based. Medical informatics should follow the example of evidence-based medicine, i.e. conduct rigorous research that gives us evidence to solve real world problems, synthesise that evidence and then apply it strictly. We already have the tools for creating a different universe. What we need is evidence, will, a culture of learning, and hard work. PMID:27030221

  1. Complementary and alternative medications for women's health issues.

    PubMed

    Lloyd, Kimberly Braxton; Hornsby, Lori B

    2009-01-01

    Women often seek alternative treatment options such as herbs, dietary supplements, and vitamins and minerals to treat women's health issues across the lifespan. Women may use complementary and alternative supplements for dysmenorrhea, premenstrual syndrome, infertility, nausea and vomiting during pregnancy, and symptoms of menopause. In general, there is a deficit of well-designed, randomized, controlled trials to evaluate the efficacy and safety of complementary and alternative medicine for these indications, which makes it difficult to provide evidence-based recommendations. This review outlines the evidence for efficacy and safety that is currently available for dietary supplement use by women to manage health conditions specific to the female patient.

  2. Organisation of evidence-based knowledge production: evidence hierarchies and evidence typologies.

    PubMed

    Hansen, Hanne Foss

    2014-03-01

    The evidence movement and the idea of systematically synthesising results from primary studies has gained support in recent years. As the movement has moved into still more policy fields, from medical treatment to, for example, public health, social welfare, and education, review practice has also been developed. The initial evidence hierarchy based standard given priority to randomised controlled trials and meta-analysis advocated by the Cochrane and Campbell collaborations has become supplemented with evidence typologies and review practice paradigms stressing the importance of contextual factors as explanations of differences in effects. In addition to analysing and discussing this development, the article discusses the organisation of dissemination of evidence. This topic is interesting because it is part of the self-perception of the evidence movement that evidence should be brought to use in both practice and policy making.

  3. The Complementary Roles of the School Nurse and School Based Health Centers. Position Statement

    ERIC Educational Resources Information Center

    Ondeck, Lynnette; Combe, Laurie; Baszler, Rita; Wright, Janet

    2015-01-01

    It is the position of the National Association of School Nurses (NASN) that the unique combination of school nursing services and school-based health centers (SBHCs) facilitate positive health outcomes for students. The registered professional school nurse (hereinafter referred to as school nurse) is responsible for management of the daily health…

  4. Large scale meta-analysis of fragment-based screening campaigns: privileged fragments and complementary technologies.

    PubMed

    Kutchukian, Peter S; Wassermann, Anne Mai; Lindvall, Mika K; Wright, S Kirk; Ottl, Johannes; Jacob, Jaison; Scheufler, Clemens; Marzinzik, Andreas; Brooijmans, Natasja; Glick, Meir

    2015-06-01

    A first step in fragment-based drug discovery (FBDD) often entails a fragment-based screen (FBS) to identify fragment "hits." However, the integration of conflicting results from orthogonal screens remains a challenge. Here we present a meta-analysis of 35 fragment-based campaigns at Novartis, which employed a generic 1400-fragment library against diverse target families using various biophysical and biochemical techniques. By statistically interrogating the multidimensional FBS data, we sought to investigate three questions: (1) What makes a fragment amenable for FBS? (2) How do hits from different fragment screening technologies and target classes compare with each other? (3) What is the best way to pair FBS assay technologies? In doing so, we identified substructures that were privileged for specific target classes, as well as fragments that were privileged for authentic activity against many targets. We also revealed some of the discrepancies between technologies. Finally, we uncovered a simple rule of thumb in screening strategy: when choosing two technologies for a campaign, pairing a biochemical and biophysical screen tends to yield the greatest coverage of authentic hits. PMID:25550355

  5. Evidence-based management of recurrent miscarriages

    PubMed Central

    Jeve, Yadava B.; Davies, William

    2014-01-01

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

  6. The end of evidence-based medicine?

    PubMed

    Clark, David A

    2012-08-01

    It is customary for physicians and surgeons to recommend treatments that have the highest probability of getting the patient a good outcome. Deciding treatment based on results (outcomes actually achieved) has been advocated for hundreds of years. We are now in an era when practice recommendations are supposed to be based on evidence from randomized controlled trials. There are many defects in relying on RCTs which are reviewed in this article. Advantages of observational studies are outlined, and the importance of assessing one's actual results when applying a treatment based on controlled trial evidence is set out.

  7. 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…

  8. Value Based Care and Patient-Centered Care: Divergent or Complementary?

    PubMed

    Tseng, Eric K; Hicks, Lisa K

    2016-08-01

    Two distinct but overlapping care philosophies have emerged in cancer care: patient-centered care (PCC) and value-based care (VBC). Value in healthcare has been defined as the quality of care (measured typically by healthcare outcomes) modified by cost. In this conception of value, patient-centeredness is one important but not necessarily dominant quality measure. In contrast, PCC includes multiple domains of patient-centeredness and places the patient and family central to all decisions and evaluations of quality. The alignment of PCC and VBC is complicated by several tensions, including a relative lack of patient experience and preference measures, and conceptions of cost that are payer-focused instead of patient-focused. Several strategies may help to align these two philosophies, including the use of patient-reported outcomes in clinical trials and value determinations, and the purposeful integration of patient preference in clinical decisions and guidelines. Innovative models of care, including accountable care organizations and oncology patient-centered medical homes, may also facilitate alignment through improved care coordination and quality-based payment incentives. Ultimately, VBC and PCC will only be aligned if patient-centered outcomes, perspectives, and preferences are explicitly incorporated into the definitions and metrics of quality, cost, and value that will increasingly influence the delivery of cancer care.

  9. [Treatment of atrophic and irritative vulvovaginal symptoms with an anhydrous lipogel and its complementary effect with vaginal estrogenic therapy: new evidences].

    PubMed

    Del Pup, L

    2010-08-01

    It is sometimes difficult to treat vulvovaginal itching and dryness, which represent frustrating symptoms for both patients and doctors. In case that the etiological agent is Candida albicans, effective antimycotic therapies are available; however, itching is often caused by aspecific allergic-irritative factors, which are difficult to be defined. In these cases, patients are invited to limit local irritative factors; nevertheless, this advice is not always taken and sometimes it turns out to be insufficient. Besides behavioral suggestions, a therapeutic support would be useful; medical doctors habitually prescribe local symptomatic treatments which, however, do not target numerous causes of irritative vulvovaginal symptomatology, though they are formulated for vulvovaginal application. If there is estrogenic deficit, the best therapeutic approach is based on topical estrogenic therapy, which is sometimes ineffective on vulvar symptoms. Frequently, it is necessary to choose a complementary therapeutic tool for vaginal application in order to alleviate itching, burning, erythema, dryness. The aim of this study was to evaluate the efficacy of an innovative anhydrous lipogel containing vitamin E and boswellic acids. Results of this study, performed on 34-58-year-old patients, confirmed the efficacy of the lipogel on irritative vulvovaginal symptoms. In postmenopausal women, the lipogel is a useful synergistic complement to topical hormonal therapy.

  10. Segmentation of brain PET-CT images based on adaptive use of complementary information

    NASA Astrophysics Data System (ADS)

    Xia, Yong; Wen, Lingfeng; Eberl, Stefan; Fulham, Michael; Feng, Dagan

    2009-02-01

    Dual modality PET-CT imaging provides aligned anatomical (CT) and functional (PET) images in a single scanning session, which can potentially be used to improve image segmentation of PET-CT data. The ability to distinguish structures for segmentation is a function of structure and modality and varies across voxels. Thus optimal contribution of a particular modality to segmentation is spatially variant. Existing segmentation algorithms, however, seldom account for this characteristic of PET-CT data and the results using these algorithms are not optimal. In this study, we propose a relative discrimination index (RDI) to characterize the relative abilities of PET and CT to correctly classify each voxel into the correct structure for segmentation. The definition of RDI is based on the information entropy of the probability distribution of the voxel's class label. If the class label derived from CT data for a particular voxel has more certainty than that derived from PET data, the corresponding RDI will have a higher value. We applied the RDI matrix to balance adaptively the contributions of PET and CT data to segmentation of brain PET-CT images on a voxel-by-voxel basis, with the aim to give the modality with higher discriminatory power a larger weight. The resultant segmentation approach is distinguished from traditional approaches by its innovative and adaptive use of the dual-modality information. We compared our approach to the non-RDI version and two commonly used PET-only based segmentation algorithms for simulation and clinical data. Our results show that the RDI matrix markedly improved PET-CT image segmentation.

  11. Evidence-based Practice of Radiology.

    PubMed

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

    2015-10-01

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

  12. Evidence-based Practice of Radiology.

    PubMed

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

    2015-10-01

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

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

    ERIC Educational Resources Information Center

    Wolf, Fredric M.

    2000-01-01

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

  14. Animal-Based Remedies as Complementary Medicines in the Semi-Arid Region of Northeastern Brazil

    PubMed Central

    Alves, Rômulo R. N.; Barbosa, José A. A.; Santos, Silene L. D. X.; Souto, Wedson M. S.; Barboza, Raynner R. D.

    2011-01-01

    Animals (and their derived products) are essential ingredients in the preparation of many traditional remedies. Despite its prevalence in traditional medical practices worldwide, research on medicinal animals has often been neglected in comparison to medicinal plant research. This work documents the medicinal animals used by a rural community in the semi-arid region, inserted in Caatinga Biome, where 66 respondents provided information on animal species used as medicine, body parts used to prepare the remedies and illnesses to which the remedies were prescribed. We calculated the informant consensus factor to determine the consensus over which species are effective for particular ailments, as well as the species use value to determine the extent of utilization of each species. We recorded the use of 51 animal species as medicines, whose products were recommended for the treatment of 68 illnesses. The informant consensus in the use of many specific remedies is fairly high, giving an additional validity to this folk medicine. Eight species not previously reported as having medicinal use were recorded. The local medicinal fauna is largely based on wild animals, including some endangered species. Given a high proportion of medicinal animals observed in the study area, it is logical to conclude that any conservation strategy should include access to modern health care. PMID:19729490

  15. Animal-based remedies as complementary medicines in Santa Cruz do Capibaribe, Brazil

    PubMed Central

    Alves, Rômulo RN; Lima, Helenice N; Tavares, Marília C; Souto, Wedson MS; Barboza, Raynner RD; Vasconcellos, Alexandre

    2008-01-01

    Background The use of animal products in healing is an ancient and widespread cross-cultural practice. In northeastern Brazil, especially in the semi-arid region, animals and plants are widely used in traditional medicine and play significant roles in healing practices. Zootherapies form an integral part of these cultures, and information about animals is passed from generation to generation through oral folklore. Nevertheless, studies on medicinal animals are still scarce in northeastern Brazil, especially when compared to those focusing on medicinal plants. This paper examines the use and commercialization of animals for medicinal purposes in Brazil's semi-arid caatinga region. Methods Data was obtained through field surveys conducted in the public markets in the city of Santa Cruz do Capibaribe, Pernambuco State, Brazil. We interviewed 16 merchants (9 men and 7 women) who provided information regarding folk remedies based on animal products. Results A total of 37 animal species (29 families), distributed among 7 taxonomic categories were found to be used to treat 51 different ailments. The most frequently cited treatments focused on the respiratory system, and were mainly related to problems with asthma. Zootherapeutic products are prescribed as single drugs or are mixed with other ingredients. Mixtures may include several to many more valuable medicinal animals added to other larger doses of more common medicinal animals and plants. The uses of certain medicinal animals are associated with popular local beliefs known as 'simpatias'. We identified 2 medicinal species (Struthio camelus and Nasutitermes macrocephalus) not previously documented for Brazil. The use of animals as remedies in the area surveyed is associated with socio economic and cultural factors. Some of the medicinal animal species encountered in this study are included in lists of endangered species. Conclusion Our results demonstrate that a large variety of animals are used in traditional

  16. Crime prevention: more evidence-based analysis.

    PubMed

    Garrido Genovés, Vicente; Farrington, David P; Welsh, Brandon C

    2008-02-01

    This paper introduces a new section of Psicothema dedicated to the evidence-based approach to crime prevention. Along with an original sexual-offender-treatment programme implemented in Spain, this section presents four systematic reviews of important subjects in the criminological arena, such as sexual offender treatment, the well-known programme, the effectiveness of custodial versus non-custodial sanctions in reoffending and the fight against terrorism. We also highlight some of the focal points that scientists, practitioners and governments should take into account in order to support this evidence-based viewpoint of crime prevention.

  17. Evidence-based healthcare in developing countries.

    PubMed

    Pearson, Alan; Jordan, Zoe

    2010-06-01

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

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

    ERIC Educational Resources Information Center

    TEACHING Exceptional Children, 2014

    2014-01-01

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

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

    ERIC Educational Resources Information Center

    Kratochwill, Thomas R.; Shernoff, Elisa Steele

    2003-01-01

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

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

    ERIC Educational Resources Information Center

    Kratochwill, Thomas R.; Steele Shernoff, Elisa

    2004-01-01

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

  1. All-Polymer Solar Cells Based on Absorption-Complementary Polymer Donor and Acceptor with High Power Conversion Efficiency of 8.27%.

    PubMed

    Gao, Liang; Zhang, Zhi-Guo; Xue, Lingwei; Min, Jie; Zhang, Jianqi; Wei, Zhixiang; Li, Yongfang

    2016-03-01

    High-efficiency all-polymer solar cells with less thickness-dependent behavior are demonstrated by using a low bandgap n-type conjugated polymer N2200 as acceptor and an absorption-complementary difluorobenzotriazole-based medium-bandgap polymer J51 as donor.

  2. Developmental outcomes among 18-month-old Malawians after a year of complementary feeding with lipid-based nutrient supplements or corn-soy flour

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The major aim of this trial was to compare the development of 18-month-old infants who received complementary feeding for 1 year with either lipid-based nutrient supplements or micronutrient-fortified corn-soy porridge. Our secondary aim was to determine the socio-economic factors associated with de...

  3. A comparative study of the electrochemical behavior of complementary polymer electrochromic devices based on different counter-electrodes

    NASA Astrophysics Data System (ADS)

    Du, Qing; Mi, Sai; Zheng, Jianming; Xu, Chunye

    2013-12-01

    8,11-di-(4-thiophen-2-yl)acenaphtho[1,2-b]quinoxaline (DTAQ) was successfully synthesized via a Stille coupling reaction and the corresponding polymer (PDTAQ) was prepared electrochemically. The spectroelectrochemical and electrochromic properties of the polymer film reveal that PDTAQ film shows distinct color states (purple in the neutral state and blue in the oxidized state), and optical contrast (ΔT%) of 45.16% at 772 nm and 49.39% at 1100 nm with switching times of 2.5 and 0.5 s. Complementary electrochromic devices, which are based on the PDTAQ film as the working electrode, Prussian blue (PB) and V2O5 as counter-electrodes, respectively, and LiClO4/PC solution as the electrolyte, were assembled and characterized. The results illustrate that the properties of the PDTAQ/PB and PDTAQ/V2O5 devices (including the absorption, color changes, ΔT% and response times) can be modified by the counter-electrodes. Furthermore, the PDTAQ/V2O5 device exhibits a significantly higher contrast ratio in the visible region (34.92% at 771 nm) and much faster response time (0.4 s) than the PDTAQ/PB device (21.32% at 552 nm).

  4. Evaluation of drug-induced neurotoxicity based on metabolomics, proteomics and electrical activity measurements in complementary CNS in vitro models.

    PubMed

    Schultz, Luise; Zurich, Marie-Gabrielle; Culot, Maxime; da Costa, Anaelle; Landry, Christophe; Bellwon, Patricia; Kristl, Theresa; Hörmann, Katrin; Ruzek, Silke; Aiche, Stephan; Reinert, Knut; Bielow, Chris; Gosselet, Fabien; Cecchelli, Romeo; Huber, Christian G; Schroeder, Olaf H-U; Gramowski-Voss, Alexandra; Weiss, Dieter G; Bal-Price, Anna

    2015-12-25

    The present study was performed in an attempt to develop an in vitro integrated testing strategy (ITS) to evaluate drug-induced neurotoxicity. A number of endpoints were analyzed using two complementary brain cell culture models and an in vitro blood-brain barrier (BBB) model after single and repeated exposure treatments with selected drugs that covered the major biological, pharmacological and neuro-toxicological responses. Furthermore, four drugs (diazepam, cyclosporine A, chlorpromazine and amiodarone) were tested more in depth as representatives of different classes of neurotoxicants, inducing toxicity through different pathways of toxicity. The developed in vitro BBB model allowed detection of toxic effects at the level of BBB and evaluation of drug transport through the barrier for predicting free brain concentrations of the studied drugs. The measurement of neuronal electrical activity was found to be a sensitive tool to predict the neuroactivity and neurotoxicity of drugs after acute exposure. The histotypic 3D re-aggregating brain cell cultures, containing all brain cell types, were found to be well suited for OMICs analyses after both acute and long term treatment. The obtained data suggest that an in vitro ITS based on the information obtained from BBB studies and combined with metabolomics, proteomics and neuronal electrical activity measurements performed in stable in vitro neuronal cell culture systems, has high potential to improve current in vitro drug-induced neurotoxicity evaluation.

  5. Evidence Based Education Request Desk. EBE #510

    ERIC Educational Resources Information Center

    Regional Educational Laboratory Southeast, 2009

    2009-01-01

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

  6. Evidence-Based Practice Goes beyond Google

    ERIC Educational Resources Information Center

    Klitzing, Sandra

    2012-01-01

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

  7. Evidence Based Research: Implications for Counselor Educators.

    ERIC Educational Resources Information Center

    Bartley, Amy E.; Biles, Kathy E.; Low, Lori L.; Nakazawa-Hewitt, M.; Windish, Bonnie L.

    For the past decade, the practice of evidence based research (EBR) in treatment decisions has been a standard in the medical field, and is quickly becoming a standard of practice in other human service fields. Counselor educators are faced with the necessity to begin to implement EBR into their teaching and scholarship, but have limited knowledge…

  8. The Evidence Base for Positive Peer Culture

    ERIC Educational Resources Information Center

    Laursen, Erik K.

    2010-01-01

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

  9. Evidence-Based Assessment of Personality Disorders

    ERIC Educational Resources Information Center

    Widiger, Thomas A.; Samuel, Douglas B.

    2005-01-01

    The purpose of this article is to provide a foundation for the development of evidence-based guidelines for the assessment of personality disorders, focusing in particular on integrated assessment strategies. The general strategy recommended herein is to first administer a self-report inventory to alert oneself to the potential presence of…

  10. Evidence Based Education Request Desk. EBE #555

    ERIC Educational Resources Information Center

    Regional Educational Laboratory Southeast, 2009

    2009-01-01

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

  11. Evidence-based Medicine in Animal Reproduction.

    PubMed

    Arlt, S P; Heuwieser, W

    2014-09-01

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

  12. Statewide Implementation of Evidence-Based Programs

    ERIC Educational Resources Information Center

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

    2013-01-01

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

  13. 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…

  14. Evidence-Based Education in Plastic Surgery.

    PubMed

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

    2015-08-01

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

  15. 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

  16. Complementary and alternative medicine therapies for perinatal depression.

    PubMed

    Deligiannidis, Kristina M; Freeman, Marlene P

    2014-01-01

    Complementary and alternative medicine therapies are increasingly sought out by people with psychiatric disorders. In this chapter, we review the evidence for several commonly used CAM therapies (i.e. omega-3 fatty acids, folate, S-adenosyl-methionine, St John's Wort, bright light therapy, exercise, massage, and acupuncture) in the treatment of perinatal depression. A number of these treatments may be reasonable to consider for women during pregnancy or postpartum, but the safety and efficacy of these relative to standard treatments must still be systematically determined. Evidence-based use of complementary and alternative medicine therapies treatments for perinatal depression is discussed. Adequately powered systematic studies are necessary to determine the role of complementary and alternative medicine therapies in the treatment of perinatal depression.

  17. Complementary media of electrons

    NASA Astrophysics Data System (ADS)

    Kobayashi, Katsuyoshi

    2006-04-01

    The concept of complementary media, which cause negative refraction and make perfect lenses, was first introduced to electromagnetic waves. This paper extends it to general waves by expressing the complementarity in terms of a transfer matrix. As an example, complementary media of electrons are discussed theoretically. An application of complementary media to subsurface imaging by scanning tunnelling microscopy is described. For realistic materials the formulation of complementary media is extended to take account of the scattering at interfaces, and effectively complementary systems formed by interfaces are discussed. Interfaces of the graphitic lattice forming complementary systems are designed.

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

    PubMed

    Osborn, John

    2002-01-01

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

  19. A one-step colorimetric acid-base titration sensor using a complementary color changing coordination system.

    PubMed

    Cho, Hui Hun; Kim, Si Hyun; Heo, Jun Hyuk; Moon, Young Eel; Choi, Young Hun; Lim, Dong Cheol; Han, Kwon-Hoon; Lee, Jung Heon

    2016-06-21

    We report the development of a colorimetric sensor that allows for the quantitative measurement of the acid content via acid-base titration in a single-step. In order to create the sensor, we used a cobalt coordination system (Co-complex sensor) that changes from greenish blue colored Co(H2O)4(OH)2 to pink colored Co(H2O)6(2+) after neutralization. Greenish blue and pink are two complementary colors with a strong contrast. As a certain amount of acid is introduced to the Co-complex sensor, a portion of greenish blue colored Co(H2O)4(OH)2 changes to pink colored Co(H2O)6(2+), producing a different color. As the ratio of greenish blue and pink in the Co-complex sensor is determined by the amount of neutralization reaction occurring between Co(H2O)4(OH)2 and an acid, the sensor produced a spectrum of green, yellow green, brown, orange, and pink colors depending on the acid content. In contrast, the color change appeared only beyond the end point for normal acid-base titration. When we mixed this Co-complex sensor with different concentrations of citric acid, tartaric acid, and malic acid, three representative organic acids in fruits, we observed distinct color changes for each sample. This color change could also be observed in real fruit juice. When we treated the Co-complex sensor with real tangerine juice, it generated diverse colors depending on the concentration of citric acid in each sample. These results provide a new angle on simple but quantitative measurements of analytes for on-site usage in various applications, such as in food, farms, and the drug industry. PMID:27143645

  20. A one-step colorimetric acid-base titration sensor using a complementary color changing coordination system.

    PubMed

    Cho, Hui Hun; Kim, Si Hyun; Heo, Jun Hyuk; Moon, Young Eel; Choi, Young Hun; Lim, Dong Cheol; Han, Kwon-Hoon; Lee, Jung Heon

    2016-06-21

    We report the development of a colorimetric sensor that allows for the quantitative measurement of the acid content via acid-base titration in a single-step. In order to create the sensor, we used a cobalt coordination system (Co-complex sensor) that changes from greenish blue colored Co(H2O)4(OH)2 to pink colored Co(H2O)6(2+) after neutralization. Greenish blue and pink are two complementary colors with a strong contrast. As a certain amount of acid is introduced to the Co-complex sensor, a portion of greenish blue colored Co(H2O)4(OH)2 changes to pink colored Co(H2O)6(2+), producing a different color. As the ratio of greenish blue and pink in the Co-complex sensor is determined by the amount of neutralization reaction occurring between Co(H2O)4(OH)2 and an acid, the sensor produced a spectrum of green, yellow green, brown, orange, and pink colors depending on the acid content. In contrast, the color change appeared only beyond the end point for normal acid-base titration. When we mixed this Co-complex sensor with different concentrations of citric acid, tartaric acid, and malic acid, three representative organic acids in fruits, we observed distinct color changes for each sample. This color change could also be observed in real fruit juice. When we treated the Co-complex sensor with real tangerine juice, it generated diverse colors depending on the concentration of citric acid in each sample. These results provide a new angle on simple but quantitative measurements of analytes for on-site usage in various applications, such as in food, farms, and the drug industry.

  1. Complementary and Integrative Medicine

    MedlinePlus

    ... medical treatments that are not part of mainstream medicine. When you are using these types of care, it may be called complementary, integrative, or alternative medicine. Complementary medicine is used together with mainstream medical ...

  2. Evidence-Based Chinese Medicine for Hypertension

    PubMed Central

    Wang, Jie; Xiong, Xingjiang

    2013-01-01

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

  3. Evidence-based medical education -quo vadis?

    PubMed

    Leung, Gabriel M; Johnston, Janice M

    2006-06-01

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

  4. Use of complementary therapies by Australian women with breast cancer.

    PubMed

    Kremser, T; Evans, A; Moore, A; Luxford, K; Begbie, S; Bensoussan, A; Marigliani, R; Zorbas, H

    2008-08-01

    International research suggests complementary therapy usage is common in women with breast cancer. Comparable data do not exist for Australia. A self-completed questionnaire was used to survey Australian women with breast cancer about their usage of complementary therapies. The survey was mailed to members of two breast cancer consumer advocacy groups, and assessed type of therapy used, reasons for use, and sources of information about complementary therapies. Of 367 respondents with breast cancer, 87.5% had used complementary therapies, with many using four or more therapies. Most commonly used were vitamin supplements (54.2%), support groups (49.8%), massage (41.4%) and meditation (38.7%). Common reasons for use included improving physical (86.3%) and emotional (83.2%) wellbeing and boosting the immune system (68.8%). Women sought information about complementary therapies from a variety of sources. The range of therapies used and the diverse reasons for use emphasise the need for reliable, evidence-based information about complementary therapies for women and clinicians.

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

    PubMed

    Fins, Joseph J

    2016-01-01

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

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

    PubMed

    Fins, Joseph J

    2016-01-01

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

  7. Evidence-based medicine and tort law.

    PubMed

    Foucar, Elliott; Wick, Mark R

    2005-05-01

    Recent statutes and legal decisions have been aimed at bettering the quality of tort-law decisions by substantively improving "expert" testimony. However, in analogy to the experience of physicians attempting to upgrade medical practice using the principles of evidence-based medicine, lawyers and the courts have found it much easier to describe ideal science than to actualize it. This is particularly so in a system (the Law) that has traditionally not been very discerning about scientific rigor, and which has established procedural priorities that are often incompatible with strict scientific standards. This overview will examine the American tort system from an evidence-based perspective. We include a discussion of standards that could be used for "outcomes analysis" in the Law; recognition and classification of errors made by the courts themselves; the relationship between medical errors, "negligence," and standard of care; and the problem of reconciling the rights of plaintiffs with medical-scientific facts. We also consider selected impediments to developing a legal system that is capable of consistently reaching evidence-based decisions concerning complex scientific information, including pathologic interpretation of tissue specimens. PMID:16639995

  8. Evidence-based periodontal regenerative therapy.

    PubMed

    McGuire, M K; Newman, M G; Whitley, N

    1996-01-01

    Periodontal health care has progressed into a new era. It is distinguished by a rapidly expanding volume of literature, rapid influx of new technologies, and need for new skills to perform increasingly complex procedures. Correspondingly, practice management changes are required to adapt to the extensive follow-up care associated with some of these new treatments. This must be accomplished while also acknowledging the deepening concern for escalating costs and increased attention to the quality of care provided. As with most change, clinicians can fight it by continuing to rely on old ways of doing things and hope to keep these issues at bay, but history would say they are unlikely to succeed. Instead, clinicians can embrace these changes and adapt to them by adding new tools, such as evidence-based methodology, to their armamentarium. The evidence-based approach offers a "bridge" from science to clinical practice. It can strengthen the foundation by providing a framework for integrating patient preferences, scientific knowledge, clinical judgment, and personal experience. By adapting the way treatment decisions are made in daily practice to an evidence-based approach, clinicians can deliver the highest quality care to their patients and be in better control of their own destiny. These new challenges can be perceived as problems or as opportunities--it is a choice!

  9. What Is Evidence-Based Behavior Analysis?

    PubMed Central

    Smith, Tristram

    2013-01-01

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

  10. Evidence Based Psychosocial Interventions in Substance Use

    PubMed Central

    Jhanjee, Sonali

    2014-01-01

    In recent years, there has been significant progress and expansion in the development of evidence-based psychosocial treatments for substance abuse and dependence. A literature review was undertaken using the several electronic databases (PubMed, Cochrane Database of systemic reviews and specific journals, which pertain to psychosocial issues in addictive disorders and guidelines on this topic). Overall psychosocial interventions have been found to be effective. Some interventions, such as cognitive behavior therapy, motivational interviewing and relapse prevention, appear to be effective across many drugs of abuse. Psychological treatment is more effective when prescribed with substitute prescribing than when medication or psychological treatment is used alone, particularly for opiate users. The evidence base for psychological treatment needs to be expanded and should also include research on optimal combinations of psychological therapies and any particular matching effects, if any. Psychological interventions are an essential part of the treatment regimen and efforts should be made to integrate evidence-based interventions in all substance use disorder treatment programs. PMID:24860208

  11. Evidence-Based Practice for Outpatient Clinical Teams

    ERIC Educational Resources Information Center

    Hamilton, John D.

    2006-01-01

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

  12. Determinants of complementary feeding practices among mothers of 6–24 months failure to thrive children based on behavioral analysis phase of PRECEDE model, Tehran

    PubMed Central

    Shams, Nasibeh; Mostafavi, Firoozeh; Hassanzadeh, Akbar

    2016-01-01

    Background: This study intended to clarify the determining factors of complementary feeding practices among Tehran 6–24 months failure to thrive children in order to use the results for planning the interventions to reduce the possible adverse effects. Materials and Methods: In this study, 132 mothers of three medical and health centers were chosen by random sampling among those centers operating under the supervision of south of Tehran District Health Center and study data were collected from them. A valid and reliable questionnaire as a data collection instrument developed based on behavioral analysis phase of PRECEDE model. Spearman and Pearson's correlation coefficient test were used to determine the statistical relationship between factors associated with complementary feeding practices among mothers. Results: The mothers’ knowledge was as follows: 0.8%, 20.4%, and 78.8% of them were good, medium, and poor, respectively. Mean scores for the mothers’ performance in terms of supplementary feeding was 66.8. Pearson correlation indicated a positive and significant correlation between the mothers’ performance with enabling and reinforcing factors, but there wasn’t any significant relationship between the mothers’ performance and knowledge about complementary feeding. Conclusions: According to the obtained results, reinforcing factors, and enabling factors are associated with the mothers’ performance in terms of complementary feeding. Hence, attention to these issues is essential for better health interventions planning. PMID:27500177

  13. Evidence-based medicine and prejudice-based medicine: the case of homeopathy.

    PubMed

    Barros, Nelson Filice de; Fiuza, Alessandra Rodrigues

    2014-11-01

    In recent decades an important social movement related to Complementary and Alternative Medicine has been identified worldwide. In Brazil, although homeopathy was recognized as a specialist medical area in 1980, few medical schools offer courses related to it. In a previous study, 176 resident doctors at the University of Campinas Medical School were interviewed and 86 (49%) rejected homeopathy as a subject in the core medical curriculum. Thus, this qualitative study was conducted to understand their reasons for refusing. 20 residents from 15 different specialist areas were interviewed. Very few of them admitted to a lack of knowledge for making a judgment about homeopathy; none of them made a conscientious objection to it; and the majority demonstrated prejudice, affirming that there is not enough scientific evidence to support homeopathy, defending their position based on personal opinion, limited clinical practice and on information circulated in the mass media. Finally, resident doctors' prejudices against homeopathy can be extended to practices other than allopathic medicine.

  14. The need for evidence-based conservation.

    PubMed

    Sutherland, William J; Pullin, Andrew S; Dolman, Paul M; Knight, Teri M

    2004-06-01

    Much of current conservation practice is based upon anecdote and myth rather than upon the systematic appraisal of the evidence, including experience of others who have tackled the same problem. We suggest that this is a major problem for conservationists and requires a rethinking of the manner in which conservation operates. There is an urgent need for mechanisms that review available information and make recommendations to practitioners. We suggest a format for web-based databases that could provide the required information in accessible form.

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

    PubMed Central

    Goldenberg, Maya J

    2005-01-01

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

  16. Evidence-based medicine must be ...

    PubMed

    La Caze, Adam

    2009-10-01

    Proponents of evidence-based medicine (EBM) provide the "hierarchy of evidence" as a criterion for judging the reliability of therapeutic decisions. EBM's hierarchy places randomized interventional studies (and systematic reviews of such studies) higher in the hierarchy than observational studies, unsystematic clinical experience, and basic science. Recent philosophical work has questioned whether EBM's special emphasis on evidence from randomized interventional studies can be justified. Following the critical literature, and in particular the work of John Worrall, I agree that many of the arguments put forward by advocates of EBM do not justify the ambitious claims that are often made on behalf of randomization. However, in contrast to the recent philosophical work, I argue that a justification for EBM's hierarchy of evidence can be provided. The hierarchy should be viewed as a hierarchy of comparative internal validity. Although this justification is defensible, the claims that EBM's hierarchy substantiates when viewed in this way are considerably more circumscribed than some claims found in the EBM literature.

  17. Complementary and Alternative Treatment for Allergic Conditions.

    PubMed

    Qiu, Juan; Grine, Kristen

    2016-09-01

    This article explains the proposed pathophysiology, evidence of efficacy, and adverse effects of several complementary and alternative medicine modalities, for the treatment of allergic conditions, such as traditional Chinese medicine formula, herbal treatments, acupuncture, and homeopathy. PMID:27545740

  18. How to teach evidence-based surgery.

    PubMed

    Fingerhut, Abe; Borie, Frédéric; Dziri, Chadli

    2005-05-01

    The objectives of teaching evidence-based surgery (EBS) are to inform and convince that EBS is a method of interrogation, reasoning, appraisal, and application of information to guide physicians in their decisions to best treat their patients. Asking the right, answerable questions, translating them into effective searches for the best evidence, critically appraising evidence for its validity and importance, and then integrating EBS with their patients' values and preferences are daily chores for all surgeons. Teaching and learning EBS should be patient-centered, learner-centered, and active and interactive. The teacher should be a model for students to become an expert clinician who is able to match and take advantage of the clinical setting and circumstances to ask and to answer appropriate questions. The process is multistaged. Teaching EBS in small groups is ideal. However, it is time-consuming for the faculty and must be clearly and formally structured. As well, evidence-based medicine (EBM) courses must cater to local institutional needs, must receive broad support from the instructors and the providers of information (librarians and computer science faculty), use proven methodologies, and avoid scheduling conflicts. In agreement with others, we believe that the ideal moment to introduce the concepts of EBM into the curriculum of the medical student is early, during the first years of medical school. Afterward, it should be continued every year. When this is not the case, as in many countries, it becomes the province of the surgeon in teaching hospitals, whether they are at the university, are university-affiliated, or not, to fulfill this role.

  19. Evidence Corner: Evidence-based Care for Malignant Wounds.

    PubMed

    Bolton, Laura

    2016-06-01

    Malignant fungating wounds occur in 5% to 10% of individuals with cancer.1 They arise "when malignant tumour cells infiltrate and erode through the skin."2 Guidelines for treating these malignant wounds (MW) often lack randomized, clinical trial (RCT) evidence supporting local wound care interventions that meet patients' physical or psychosocial needs or facilitate healing.3 The rarity of RCTs exploring healing of MWs likely results from their very low expectation of complete closure.1 Affected patients and their professional and family caregivers rate pain, infection, and odor management among the most important challenges in minimizing distress.4-6 Though a recently updated Cochrane review3 reminds us that evidence remains insufficient for firm conclusions supporting management of MW, it does cite 2 recent RCTs described herein7,8 that can serve as "current best evidence"9 to inform clinical decisions for alleviating some aspects of these patients' distress. PMID:27377612

  20. Who needs evidence-based health care?

    PubMed Central

    Tsafrir, J; Grinberg, M

    1998-01-01

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

  1. Disseminating evidence-based care into practice.

    PubMed

    Coleman, Eric A; Rosenbek, Susan A; Roman, Sarah P

    2013-08-01

    The Centers for Medicare and Medicaid Services (CMS) has launched the Partnership for Patients initiative, promising a 20% reduction in readmissions nationally across all payers by December 31, 2013. To address this ambitious goal, CMS has awarded grants to Hospital Engagement Networks, Pioneer Accountable Care Organizations, and the Community-based Care Transitions Program, as well as instituted new penalties for excessive readmission that began in October 2012. National efforts aimed at realizing this goal are predicated, in part, on our effectiveness in disseminating evidence-based care models into practice to improve outcomes and reduce costs. The Care Transitions Intervention (CTI) has been developed, tested, and disseminated to over 750 health care organizations in 40 states nationwide. Four factors promote wide-scale CTI dissemination. The first factor focuses on model fidelity whereby adopters are given insight into which elements of the intervention can be adapted and customized. The second factor concerns the selection of Transitions Coaches and reinforcement of their role through training and participation in a national peer learning network. The third factor relates to model execution with attention to integrating the intervention into existing workflows and fostering relationships with community stakeholders. The fourth factor involves cultivating the support to sustain or expand the intervention through continually making the business case in a changing health care landscape. The lessons learned through the dissemination and implementation of the CTI may be generalizable to the spread of a variety of evidence-based care models.

  2. Cultural considerations in evidence-based practice.

    PubMed

    Hulme, Polly A

    2010-07-01

    The role of culture in evidence-based practice (EBP) is examined using the components of the EBP process as a framework for discussion. Issues that are identified include the recruitment and retention of ethnic groups in research; paternalism and institutional racism in regard to those who cannot afford best practice; and cultural differences between health professionals and patients in their understanding of best practice, health, and illness. Strategies that are suggested to reduce cultural incongruence include shared clinical decision making and development of a cultural knowledge system to improve EBP and outcomes on an organizational level.

  3. Managing and reviewing evidence-based changes.

    PubMed

    Carter, Helen; Price, Lynda

    Nurses lead many projects to manage change aimed at improving patient safety and care. This two-part series offers practical guidance on how to bring about an evidence-based change in practice, and how to demonstrate the success, or otherwise, of that change. Part 2 is concerned with discovering why the practice is falling short, how to implement improvements and measure the effect of the changes. It also highlights ways in which nurses can use their work as part of the revalidation process. PMID:27089753

  4. Progress in evidence based reproductive surgery

    PubMed Central

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

    2011-01-01

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

  5. Colposcopy: an evidence-based update.

    PubMed

    Dresang, Lee T

    2005-01-01

    Colposcopy is a diagnostic procedure, most commonly used in the diagnosis of cervical intraepithelial neoplasia and lower genital tract carcinoma. In this article, evidence-based management strategies are updated with discussion of the 2001 American Society for Colposcopy and Cervical Pathology Consensus Guidelines. Practice management issues include methods to improve cervical cancer screening rates, coding and billing, and telemedicine. Textbooks, CD-ROMs, and courses are listed for new learners and experienced providers who want to update and sharpen their skills. PMID:16148248

  6. Complementary study based on DFT to describe the structure and properties relationship of diblock copolymer based on PVK and PPV

    NASA Astrophysics Data System (ADS)

    Mbarek, M.; Abbassi, F.; Alimi, K.

    2016-09-01

    The structure-properties relationships of copolymer involving N-vinylcarbazole (PVK) and poly (p-phenylene-vinylene) (PPV) blocks, denoted PVK-PPV, was investigated by calculations based on density functional theory (DFT) and completed by experimental analyses. Thus, vibrational, optical and emission spectra of model compound have been simulated and compared to the experiments observations published recently. Ionization potentials (IPs), electron affinities (EAs) and energy gaps were determined. Furthermore, quantum yields, radiative and nonradiative exciton lifetime was highlighted.

  7. Evidence-based medicine: medical librarians providing evidence at the point of care.

    PubMed

    Yaeger, Lauren H; Kelly, Betsy

    2014-01-01

    Evidence-based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. .. by best available external clinical evidence we mean clinically relevant research.' Health care reform authorized by the Affordable Care Act is based on the belief that evidence-based practice (EBP) generates cost savings due to the delivery of more effective care.2 Medical librarians, skilled in identifying appropriate resources and working with multiple complex interfaces, can support clinicians' efforts to practice evidence based medicine by providing time and expertise in articulating the clinical question and identifying the best evidence.

  8. Evidence-Based Practice Guidelines and School Nursing

    ERIC Educational Resources Information Center

    Adams, Susan; McCarthy, Ann Marie

    2007-01-01

    The use of evidence-based practice (EBP) has become the standard of health care practice. Nurses are expected to use best evidence on a wide range of topics, yet most nurses have limited time, resources, and/or skills to access and evaluate the quality of research and evidence needed to practice evidence-based nursing. EBP guidelines allow nurses…

  9. Teaching strategies to support evidence-based practice.

    PubMed

    Winters, Charlene A; Echeverri, Rebecca

    2012-06-01

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

  10. Conflicting evidence combination based on uncertainty measure and distance of evidence.

    PubMed

    Jiang, Wen; Zhuang, Miaoyan; Qin, Xiyun; Tang, Yongchuan

    2016-01-01

    Dempster-Shafer evidence theory is widely used in many fields of information fusion. However, the counter-intuitive results may be obtained when combining with highly conflicting evidence. To deal with such a problem, we put forward a new method based on the distance of evidence and the uncertainty measure. First, based on the distance of evidence, the evidence is divided into two parts, the credible evidence and the incredible evidence. Then, a novel belief entropy is applied to measure the information volume of the evidence. Finally, the weight of each evidence is obtained and used to modify the evidence before using the Dempster's combination rule. Numerical examples show that the proposed method can effectively handle conflicting evidence with better convergence.

  11. An Examination of the Bases of Evidence-Based Interventions.

    ERIC Educational Resources Information Center

    Wampold, Bruce E.

    2002-01-01

    School psychology has proposed a system to aid in the identification of evidence-based interventions (Kratochwill & Stoiber, this issue; Lewis-Snyder, Stoiber, & Kratochwill, this issue; Shernoff, Kratochwill, & Stoiber, this issue). In this commentary, issues related to the politics of exclusion, design and theory, methods, and multiculturalism…

  12. Compact Ultra Wide Band Microstrip Bandpass Filter Based on Multiple-Mode Resonator and Modified Complementary Split Ring Resonator

    PubMed Central

    Marcotegui, J. Antonio; Illescas, Jesús Miguel; Estevez, Aritz

    2013-01-01

    A new class of broadband microstrip filters for Ultra Wide Band (UWB) applications is proposed. In the design, different stages of parallel-coupled microstrip line and other stages with a Modified Complementary Split Ring Resonator (MCSRR)—a concept proposed here for the first time—are adjusted to obtain the desired response with broadband, sharp rejection, low insertion loss, and low return loss. Full wave simulation results as well as measurement results from fabricated prototypes are presented, showing good agreement. The proposed technique offers a new alternative to implement low-cost high-performance filter devices, applicable to a wide range of communication systems. PMID:24319366

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

    PubMed

    Pasleau, F

    2015-01-01

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

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

    PubMed

    Vardell, Emily; Malloy, Michele

    2013-01-01

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

  15. [Complementary treatment methods for depression in children and adolescents].

    PubMed

    Dolle, Kathrin; Schulte-Körne, Gerd

    2014-01-01

    Depressive disorders are among the more common mental illnesses around the world, about 1- 3% of prepubertal children and 6% of postpubertal children and adolescents are affected. They markedly impair psychosocial development and are associated with higher rate of morbidity and mortality throughout life. Many physicians are unsure about which treatment approaches are effective and how the treatment should be planned. A systematic literature search was carried out in electronic databases and study registries and as a manual search. More than 450 studies (mostly randomized controlled trials = RCTs) were identified and summarized in evidence tables. The ensuing recommendations were agreed upon in a consensus conference. The review summarizes the evidence of complementary treatment methods. The evidence for complementary treatment methods (art and music therapy, sleep deprivation, exercise, electroconvulsive therapy, massage, transcranial magnetic stimulation, relaxation, bibliotherapy, computer based therapy, light therapy, omega-3 treatment) is low or there is no evidence due to missing studies or studies of poor quality. For some methods, i. e. light therapy, relaxation and stress reduction and sleep deprivation there is limited indication for effectiveness without sufficient evidence for a practical guidance. There is an urgent need for adequately informative comparative studies on treatment of depression in children and adolescents considering also complementary methods.

  16. [Complementary treatment methods for depression in children and adolescents].

    PubMed

    Dolle, Kathrin; Schulte-Körne, Gerd

    2014-01-01

    Depressive disorders are among the more common mental illnesses around the world, about 1- 3% of prepubertal children and 6% of postpubertal children and adolescents are affected. They markedly impair psychosocial development and are associated with higher rate of morbidity and mortality throughout life. Many physicians are unsure about which treatment approaches are effective and how the treatment should be planned. A systematic literature search was carried out in electronic databases and study registries and as a manual search. More than 450 studies (mostly randomized controlled trials = RCTs) were identified and summarized in evidence tables. The ensuing recommendations were agreed upon in a consensus conference. The review summarizes the evidence of complementary treatment methods. The evidence for complementary treatment methods (art and music therapy, sleep deprivation, exercise, electroconvulsive therapy, massage, transcranial magnetic stimulation, relaxation, bibliotherapy, computer based therapy, light therapy, omega-3 treatment) is low or there is no evidence due to missing studies or studies of poor quality. For some methods, i. e. light therapy, relaxation and stress reduction and sleep deprivation there is limited indication for effectiveness without sufficient evidence for a practical guidance. There is an urgent need for adequately informative comparative studies on treatment of depression in children and adolescents considering also complementary methods. PMID:24707770

  17. Responsive feeding and child interest in food vary when rural Malawian children are fed lipid-based nutrient supplements or local complementary food.

    PubMed

    Flax, Valerie L; Mäkinen, Samppa; Ashorn, Ulla; Cheung, Yin Bun; Maleta, Kenneth; Ashorn, Per; Bentley, Margaret E

    2013-07-01

    Caregiver and child behaviours during feeding have been used to measure responsiveness, which has been recognised as important for child growth and development. The aims of this study were to understand how caregiver and child behaviours differ when feeding lipid-based nutrient supplements (LNS) vs. local complementary food and to detect associations between behaviours and child interest in food. Sixteen moderately underweight 6-17-month-old Malawian children receiving 50 g/day of supplementary LNS for 12 weeks were videotaped during LNS (n = 32) and local complementary feeding (n = 28) episodes. Behaviours were coded at the level of the intended bite (1674 total bites). The analysis used regression models adjusted for within-subject correlation. Caregivers were less likely to allow children to self-feed and more likely to use physical pressure during LNS vs. complementary food bites. Positive caregiver verbalization was infrequent and did not differ by type of food. Higher odds of accepting a bite were associated with the bite containing LNS, odds ratio (OR) 3.05; 90% confidence interval (CI) (1.98, 4.71), the child self-feeding, OR 5.70; 90% CI (2.77, 11.69), and positive caregiver verbalization, OR 2.46; 90% CI (1.26, 4.80), while lower odds of acceptance were associated with negative child verbalization during feeding, OR 0.27; 90% CI (0.17, 0.42). In this sample, caregivers used more responsive feeding practices during bites of local complementary food and were more controlling when feeding LNS. Responsive caregiver behaviours predicted child acceptance of food. These results could be used to design interventions in Malawi to improve responsive feeding practices in general and during LNS use.

  18. [Pressure ulcer management--Evidence-based interventions].

    PubMed

    Rocha, J A; Miranda, M J; Andrade, M J

    2006-01-01

    Despite improved awareness and quality of care among health care personnel, pressure ulcers prevalence remains high especially in the inpatient setting. Pressure ulcers are associated with increased morbidity and mortality, affecting the quality of life of patients and their caregivers, and significantly increasing direct and indirect healthcare costs. Early risk assessment for developing a pressure ulcer is essential to decide on the appropriate preventive measures and for initiation of a tailored therapeutic approach. Interventions include strategies to reduce extrinsic and intrinsic risk factors associated with tissue ischemia, optimization of patient's nutritional status, and local wound care. This revision intends to review current evidence-based therapeutic interventions in pressure ulcer care, and support implementation of management protocols in an inpatient ward.

  19. Sepsis management: An evidence-based approach.

    PubMed

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

    2016-03-01

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

  20. Complementary and Alternative Therapies

    PubMed Central

    Moore, Mary Lou

    2002-01-01

    Complementary and alternative therapies are increasingly used by many pregnant women in the United States; however, limited research is available on many therapies. The number of studies should increase with the establishment of the National Center for Complementary and Alternative Medicine by the National Institutes of Health. This column reviews recent studies of both herbal medicines and alternative therapies used in pregnancy. PMID:17273285

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

    ERIC Educational Resources Information Center

    Regehr, Cheryl; Stern, Susan; Shlonsky, Aron

    2007-01-01

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

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

    ERIC Educational Resources Information Center

    Schoenwald, Sonja K.

    2008-01-01

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

  3. Where's the evidence? An innovative approach to teaching staff about evidence-based practice.

    PubMed

    Phillips, Janice M; Heitschmidt, Mary; Joyce, Mary Beth; Staneva, Ilianna; Zemansky, Peggy; Francisco, Mary Ann; Powell, Barbara; Kennedy, Terri; Kranzer, Susan French

    2006-01-01

    Preparing nurses to incorporate research and evidence-based findings into nursing practice is important to meet the needs of patients and their families in today's healthcare arena. This article highlights the use of a mock trial as an innovative approach to educating staff nurses on evidence-based practice and identifies future implications for educating staff nurses on incorporating evidence into nursing practice.

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

    ERIC Educational Resources Information Center

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

    2007-01-01

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

  5. E-Learning and Evidence Based Practice in Schools

    ERIC Educational Resources Information Center

    Quong, Terrence

    2016-01-01

    JCTIC has used open source software to develop a unique school online environment that has made evidence based practice viable in their school. In this paper the proposition is made that eLearning enables evidence based practice which in turn leads to improved student outcomes. Much has been written about evidence based practice in schools, but…

  6. The ABCs of Evidence-Based Practice for Teachers

    ERIC Educational Resources Information Center

    Kretlow, Allison G.; Blatz, Sharon L.

    2011-01-01

    It is critical teachers adhere to federal policies regarding evidence-based practices. Quickly identifying and effectively using evidence-based programs and practices is particularly important for special educators, because students in special education often already have academic or behavioral deficits. Using evidence-based practices with…

  7. Evidence-Based Medicine in the Education of Psychiatrists

    ERIC Educational Resources Information Center

    Srihari, Vinod

    2008-01-01

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

  8. Evidence-Based Health Policy: A Preliminary Systematic Review

    ERIC Educational Resources Information Center

    Morgan, Gareth

    2010-01-01

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

  9. How to understand and conduct evidence-based medicine

    PubMed Central

    2016-01-01

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

  10. [Evidence-based treatment of canine demodicosis].

    PubMed

    Mueller, R S

    2011-01-01

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

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

    PubMed

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

    2014-02-01

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

  12. Inkjet-printed all solid-state electrochromic devices based on NiO/WO3 nanoparticle complementary electrodes

    NASA Astrophysics Data System (ADS)

    Cai, Guofa; Darmawan, Peter; Cui, Mengqi; Chen, Jingwei; Wang, Xu; Eh, Alice Lee-Sie; Magdassi, Shlomo; Lee, Pooi See

    2015-12-01

    Nanostructured thin films are important in the fields of energy conversion and storage. In particular, multi-layered nanostructured films play an important role as a part of the energy system for energy saving applications in buildings. Inkjet printing is a low-cost and attractive technology for patterning and deposition of multi-layered nanostructured materials on various substrates. However, it requires the development of a suitable ink formulation with optimum viscosity, surface tension and evaporation rate for various materials. In this study, a versatile ink formulation was successfully developed to prepare NiO and WO3 nanostructured films with strong adhesion to ITO coated glass using inkjet printing for energy saving electrochromic applications. We achieved a high performance electrochromic electrode, producing porous and continuous electrochromic films without aggregation. The NiO film with 9 printed layers exhibits an optical modulation of 64.2% at 550 nm and a coloration efficiency (CE) of 136.7 cm2 C-1. An inkjet-printed complementary all solid-state device was assembled, delivering a larger optical modulation of 75.4% at 633 nm and a higher CE of 131.9 cm2 C-1 among all solid-state devices. The enhanced contrast is due to the printed NiO film that not only performs as an ion storage layer, but also as a complementary electrochromic layer.Nanostructured thin films are important in the fields of energy conversion and storage. In particular, multi-layered nanostructured films play an important role as a part of the energy system for energy saving applications in buildings. Inkjet printing is a low-cost and attractive technology for patterning and deposition of multi-layered nanostructured materials on various substrates. However, it requires the development of a suitable ink formulation with optimum viscosity, surface tension and evaporation rate for various materials. In this study, a versatile ink formulation was successfully developed to prepare NiO and

  13. Complementary Metal Oxide Semiconductor Based Multimodal Sensor for In vivo Brain Function Imaging with a Function for Simultaneous Cell Stimulation

    NASA Astrophysics Data System (ADS)

    Tagawa, Ayato; Mitani, Masahiro; Minami, Hiroki; Noda, Toshihiko; Sasagawa, Kiyotaka; Tokuda, Takashi; Ohta, Jun

    2010-04-01

    We have developed a multimodal complementary metal oxide semiconductor (CMOS) sensor device embedded with Au electrodes for fluorescent imaging and cell stimulation in the deep brain of mice. The Au electrodes were placed on the pixel array of the image sensor. Windows over the photodiodes were opened in the electrode area for simultaneous fluorescent imaging and cell stimulation in the same area of the brain tissue. The sensor chip was shaped like a shank and was packaged by two packaging methods for high strength or minimal invasion. The experimental results showed that the 90 ×90 µm2 Au electrodes with windows were capable of injecting theta burst stimulation (TBS)-like current pulses at 0.2-1 mA in a saline solution. We successfully demonstrated that fluorescent imaging and TBS-like current injection can be simultaneously performed in the electrode area of a brain phantom.

  14. Complementary Metal Oxide Semiconductor Based Multimodal Sensor for In vivo Brain Function Imaging with a Function for Simultaneous Cell Stimulation

    NASA Astrophysics Data System (ADS)

    Ayato Tagawa,; Masahiro Mitani,; Hiroki Minami,; Toshihiko Noda,; Kiyotaka Sasagawa,; Takashi Tokuda,; Jun Ohta,

    2010-04-01

    We have developed a multimodal complementary metal oxide semiconductor (CMOS) sensor device embedded with Au electrodes for fluorescent imaging and cell stimulation in the deep brain of mice. The Au electrodes were placed on the pixel array of the image sensor. Windows over the photodiodes were opened in the electrode area for simultaneous fluorescent imaging and cell stimulation in the same area of the brain tissue. The sensor chip was shaped like a shank and was packaged by two packaging methods for high strength or minimal invasion. The experimental results showed that the 90 × 90 μm2 Au electrodes with windows were capable of injecting theta burst stimulation (TBS)-like current pulses at 0.2-1 mA in a saline solution. We successfully demonstrated that fluorescent imaging and TBS-like current injection can be simultaneously performed in the electrode area of a brain phantom.

  15. High-performance carbon-nanotube-based complementary field-effect-transistors and integrated circuits with yttrium oxide

    SciTech Connect

    Liang, Shibo; Zhang, Zhiyong Si, Jia; Zhong, Donglai; Peng, Lian-Mao

    2014-08-11

    High-performance p-type carbon nanotube (CNT) transistors utilizing yttrium oxide as gate dielectric are presented by optimizing oxidization and annealing processes. Complementary metal-oxide-semiconductor (CMOS) field-effect-transistors (FETs) are then fabricated on CNTs, and the p- and n-type devices exhibit symmetrical high performances, especially with low threshold voltage near to zero. The corresponding CMOS CNT inverter is demonstrated to operate at an ultra-low supply voltage down to 0.2 V, while displaying sufficient voltage gain, high noise margin, and low power consumption. Yttrium oxide is proven to be a competitive gate dielectric for constructing high-performance CNT CMOS FETs and integrated circuits.

  16. Ratiometric, filter-free optical sensor based on a complementary metal oxide semiconductor buried double junction photodiode.

    PubMed

    Yung, Ka Yi; Zhan, Zhiyong; Titus, Albert H; Baker, Gary A; Bright, Frank V

    2015-07-16

    We report a complementary metal oxide semiconductor integrated circuit (CMOS IC) with a buried double junction (BDJ) photodiode that (i) provides a real-time output signal that is related to the intensity ratio at two emission wavelengths and (ii) simultaneously eliminates the need for an optical filter to block Rayleigh scatter. We demonstrate the BDJ platform performance for gaseous NH3 and aqueous pH detection. We also compare the BDJ performance to parallel results obtained by using a slew scanned fluorimeter (SSF). The BDJ results are functionally equivalent to the SSF results without the need for any wavelength filtering or monochromators and the BDJ platform is not prone to errors associated with source intensity fluctuations or sensor signal drift.

  17. Evidence-based appointment and promotion of academic faculty at the University of Chicago.

    PubMed

    Feder, Martin E; Madara, James L

    2008-01-01

    The authors report how one academic medical center (AMC) and associated nonclinical departments implemented evidence-based academic criteria and an evidence-based academic vetting process, which may be models for other institutions. In 2004-2005, The University of Chicago Division of the Biological Sciences and Pritzker School of Medicine reconceptualized its appointment, promotion, and tenure criteria to recognize all forms of scholarship as equally legitimate bases for academic tenure. The revised criteria also accommodate differences in academic effort consistent with varying clinical demands. Implementation of these criteria, however, necessitated revised practices in providing objective evidence and analysis of their satisfaction. Three complementary mechanisms now yield excellent evidence and analysis. The first, electronic forms (e-forms) comprise highly specific response items with embedded instructions, advice, and rationale. The e-forms encourage candidates and departments to provide the evidence that subsequent review needs to evaluate appointment or promotion proposals. Unexpectedly, the e-forms have been coopted as effective mechanisms for faculty development. Second, a faculty dean of academic affairs, a regular faculty member, was appointed to provide robust academic authority and perspective to the process. Third, the promotion and tenure advisory committee was restricted to evaluating academic criteria, and from considerations of institutional value. This change interposed a "firewall" between academic and institutional review. These changes have attenuated dissatisfaction with the appointments and promotions process both within and outside the AMC. PMID:18162758

  18. Subjective evidence based ethnography: method and applications.

    PubMed

    Lahlou, Saadi; Le Bellu, Sophie; Boesen-Mariani, Sabine

    2015-06-01

    Subjective Evidence Based Ethnography (SEBE) is a method designed to access subjective experience. It uses First Person Perspective (FPP) digital recordings as a basis for analytic Replay Interviews (RIW) with the participants. This triggers their memory and enables a detailed step by step understanding of activity: goals, subgoals, determinants of actions, decision-making processes, etc. This paper describes the technique and two applications. First, the analysis of professional practices for know-how transferring purposes in industry is illustrated with the analysis of nuclear power-plant operators' gestures. This shows how SEBE enables modelling activity, describing good and bad practices, risky situations, and expert tacit knowledge. Second, the analysis of full days lived by Polish mothers taking care of their children is described, with a specific focus on how they manage their eating and drinking. This research has been done on a sub-sample of a large scale intervention designed to increase plain water drinking vs sweet beverages. It illustrates the interest of SEBE as an exploratory technique in complement to other more classic approaches such as questionnaires and behavioural diaries. It provides the detailed "how" of the effects that are measured at aggregate level by other techniques.

  19. Subjective evidence based ethnography: method and applications.

    PubMed

    Lahlou, Saadi; Le Bellu, Sophie; Boesen-Mariani, Sabine

    2015-06-01

    Subjective Evidence Based Ethnography (SEBE) is a method designed to access subjective experience. It uses First Person Perspective (FPP) digital recordings as a basis for analytic Replay Interviews (RIW) with the participants. This triggers their memory and enables a detailed step by step understanding of activity: goals, subgoals, determinants of actions, decision-making processes, etc. This paper describes the technique and two applications. First, the analysis of professional practices for know-how transferring purposes in industry is illustrated with the analysis of nuclear power-plant operators' gestures. This shows how SEBE enables modelling activity, describing good and bad practices, risky situations, and expert tacit knowledge. Second, the analysis of full days lived by Polish mothers taking care of their children is described, with a specific focus on how they manage their eating and drinking. This research has been done on a sub-sample of a large scale intervention designed to increase plain water drinking vs sweet beverages. It illustrates the interest of SEBE as an exploratory technique in complement to other more classic approaches such as questionnaires and behavioural diaries. It provides the detailed "how" of the effects that are measured at aggregate level by other techniques. PMID:25579747

  20. Complementary Barrier Infrared Detector

    NASA Technical Reports Server (NTRS)

    Ting, David Z.; Bandara, Sumith V.; Hill, Cory J.; Gunapala, Sarath D.

    2009-01-01

    The complementary barrier infrared detector (CBIRD) is designed to eliminate the major dark current sources in the superlattice infrared detector. The concept can also be applied to bulk semiconductor- based infrared detectors. CBIRD uses two different types of specially designed barriers: an electron barrier that blocks electrons but not holes, and a hole barrier that blocks holes but not electrons. The CBIRD structure consists of an n-contact, a hole barrier, an absorber, an electron barrier, and a p-contact. The barriers are placed at the contact-absorber junctions where, in a conventional p-i-n detector structure, there normally are depletion regions that produce generation-recombination (GR) dark currents due to Shockley-Read- Hall (SRH) processes. The wider-bandgap complementary barriers suppress G-R dark current. The barriers also block diffusion dark currents generated in the diffusion wings in the neutral regions. In addition, the wider gap barriers serve to reduce tunneling dark currents. In the case of a superlattice-based absorber, the superlattice itself can be designed to suppress dark currents due to Auger processes. At the same time, the barriers actually help to enhance the collection of photo-generated carriers by deflecting the photo-carriers that are diffusing in the wrong direction (i.e., away from collectors) and redirecting them toward the collecting contacts. The contact layers are made from materials with narrower bandgaps than the barriers. This allows good ohmic contacts to be made, resulting in lower contact resistances. Previously, THALES Research and Technology (France) demonstrated detectors with bulk InAsSb (specifically InAs0.91Sb0.09) absorber lattice-matched to GaSb substrates. The absorber is surrounded by two wider bandgap layers designed to minimize impedance to photocurrent flow. The wide bandgap materials also serve as contacts. The cutoff wavelength of the InAsSb absorber is fixed. CBIRD may be considered as a modified

  1. Evidence-Based Practice in Rehabilitation Counseling: Perceptions and Practices

    ERIC Educational Resources Information Center

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

    2010-01-01

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

  2. Creating Evidence-Based Research in Adapted Physical Activity

    ERIC Educational Resources Information Center

    Reid, Greg; Bouffard, Marcel; MacDonald, Catherine

    2012-01-01

    Professional practice guided by the best research evidence is a usually referred to as evidence-based practice. The aim of the present paper is to describe five fundamental beliefs of adapted physical activity practices that should be considered in an 8-step research model to create evidence-based research in adapted physical activity. The five…

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

    PubMed Central

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

    2012-01-01

    Modern clinical practice relies on evidence-based medicine (EBM) and evidence-based guidelines (EBGs). The critical evaluation of EBGs value is therefore an essential step to further improve clinical practice. In our opinion, correlating levels of evidence and grades of recommendation can be an easy tool to quickly display internal consistence of EBGs. PMID:26909252

  4. Complementary and Integrative Therapies

    MedlinePlus

    ... correctly • Supplement is free of harmful contents like pesticides and heavy metals (such as lead, arsenic or ... 1-888-644-6226 http://nccam.nih.gov Natural Medicines Information on complementary therapies http://naturaldatabase.therapeuticresearch. ...

  5. 'We hold these truths to be self-evident': deconstructing 'evidence-based' medical practice.

    PubMed

    Devisch, Ignaas; Murray, Stuart J

    2009-12-01

    Rationale, aims and objectives Evidence-based medicine (EBM) claims to be based on 'evidence', rather than 'intuition'. However, EBM's fundamental distinction between quantitative 'evidence' and qualitative 'intuition' is not self-evident. The meaning of 'evidence' is unclear and no studies of quality exist to demonstrate the superiority of EBM in health care settings. This paper argues that, despite itself, EBM holds out only the illusion of conclusive scientific rigour for clinical decision making, and that EBM ultimately is unable to fulfil its own structural criteria for 'evidence'. Methods Our deconstructive analysis of EBM draws on the work of the French philosopher, Jacques Derrida. Deconstruction works in the name of justice to lay bare, to expose what has been hidden from view. In plain language, we deconstruct EBM's paradigm of 'evidence', the randomized controlled trial (RCT), to demonstrate that there cannot be incontrovertible evidence for EBM as such. We argue that EBM therefore 'auto-deconstructs' its own paradigm, and that medical practitioners, policymakers and patients alike ought to be aware of this failure within EBM itself. Results EBM's strict distinction between admissible evidence (based on RCTs) and other supposedly inadmissible evidence is not itself based on evidence, but rather, on intuition. In other words, according to EBM's own logic, there can be no 'evidentiary' basis for its distinction between admissible and inadmissible evidence. Ultimately, to uphold this fundamental distinction, EBM must seek recourse in (bio)political ideology and an epistemology akin to faith. PMID:20367689

  6. Molecular mechanisms of a novel selenium-based complementary medicine which confers protection against hyperandrogenism-induced polycystic ovary.

    PubMed

    Rezvanfar, M A; Rezvanfar, M A; Ahmadi, A; Shojaei-Saadi, H A; Baeeri, M; Abdollahi, M

    2012-08-01

    The objective was to evaluate ovarian functionality and oxidative response in hyperandrogenism-induced polycystic ovary (PCO) and the protective effects of immunomodulator drug (IMOD), an electromagnetically-treated, selenium-based, herbal medicine. Daily oral administration of letrozole (1 mg/kg) for 21 consecutive days induced ovarian cysts in female rats. An effective dose of IMOD (30 mg/kg per day) was given intraperitoneally for 21 days. Biomarkers of ovarian function, serum concentrations of estradiol, progesterone, testosterone, and ovarian prostaglandin-E (PGE), were analyzed. To determine the role of oxidative stress (OS) in hyperandrogenism-induced PCO, concentrations of cellular lipid peroxidation (LPO), superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx), peroxynitrite (ONOO), and tumor necrosis factor (TNF)-α as a marker of inflammation and apoptosis were measured in serum and ovaries. Letrozole-induced PCO resulted in significant increases in concentrations of lipid peroxidation and peroxynitrite in serum and ovary, but significantly decreased superoxide dismutase, catalase, and glutathione peroxidase. Serum concentrations of testosterone and TNF-α, and ovarian prostaglandin-E were increased (P < 0.001) in animals with cysts versus control, whereas estradiol and progesterone were decreased (P < 0.01 and P < 0.001, respectively). When compared with controls, letrozole induced irregular cycles and PCO characterized by a high incidence of subcapsular ovarian cysts with a diminished granulosa cell layer, luteinized granulosa cells in the cyst wall, significantly more atretic preantral and antral follicles, and absence of CL. There were almost no intact primary, secondary, and tertiary follicles in PCO rats. All end points assessed were significantly improved by IMOD and reached close to normal levels. In conclusion, the present study provided evidence that toxic free radicals and TNF-α were involved in the pathogenesis of PCO

  7. Discovering hidden biodiversity: the use of complementary monitoring of fish diet based on DNA barcoding in freshwater ecosystems.

    PubMed

    Jo, Hyunbin; Ventura, Marc; Vidal, Nicolas; Gim, Jeong-Soo; Buchaca, Teresa; Barmuta, Leon A; Jeppesen, Erik; Joo, Gea-Jae

    2016-01-01

    Ecological monitoring contributes to the understanding of complex ecosystem functions. The diets of fish reflect the surrounding environment and habitats and may, therefore, act as useful integrating indicators of environmental status. It is, however, often difficult to visually identify items in gut contents to species level due to digestion of soft-bodied prey beyond visual recognition, but new tools rendering this possible are now becoming available. We used a molecular approach to determine the species identities of consumed diet items of an introduced generalist feeder, brown trout (Salmo trutta), in 10 Tasmanian lakes and compared the results with those obtained from visual quantification of stomach contents. We obtained 44 unique taxa (OTUs) belonging to five phyla, including seven classes, using the barcode of life approach from cytochrome oxidase I (COI). Compared with visual quantification, DNA analysis showed greater accuracy, yielding a 1.4-fold higher number of OTUs. Rarefaction curve analysis showed saturation of visually inspected taxa, while the curves from the DNA barcode did not saturate. The OTUs with the highest proportions of haplotypes were the families of terrestrial insects Formicidae, Chrysomelidae, and Torbidae and the freshwater Chironomidae. Haplotype occurrence per lake was negatively correlated with lake depth and transparency. Nearly all haplotypes were only found in one fish gut from a single lake. Our results indicate that DNA barcoding of fish diets is a useful and complementary method for discovering hidden biodiversity. PMID:26811787

  8. High gain, low noise, fully complementary logic inverter based on bi-layer WSe2 field effect transistors

    NASA Astrophysics Data System (ADS)

    Das, Saptarshi; Dubey, Madan; Roelofs, Andreas

    2014-08-01

    In this article, first, we show that by contact work function engineering, electrostatic doping and proper scaling of both the oxide thickness and the flake thickness, high performance p- and n-type WSe2 field effect transistors (FETs) can be realized. We report record high drive current of 98 μA/μm for the electron conduction and 110 μA/μm for the hole conduction in Schottky barrier WSe2 FETs. Then, we combine high performance WSe2 PFET with WSe2 NFET in double gated transistor geometry to demonstrate a fully complementary logic inverter. We also show that by adjusting the threshold voltages for the NFET and the PFET, the gain and the noise margin of the inverter can be significantly enhanced. The maximum gain of our chemical doping free WSe2 inverter was found to be ˜25 and the noise margin was close to its ideal value of ˜2.5 V for a supply voltage of VDD = 5.0 V.

  9. A Preference Based Measure of Complementary Feeding Quality: Application to the Avon Longitudinal Study of Parents and Children

    PubMed Central

    Mittinty, Murthy N.; Golley, Rebecca K.; Smithers, Lisa G.; Brazionis, Laima; Lynch, John W.

    2013-01-01

    This paper presents the development of the Complementary Feeding Utility Index (CFUI), a composite index aimed to measure adherence to infant feeding guidelines. Through an axiomatic characterization this paper shows the advantages in using the CFUI are the following: it avoids the use of arbitrary cut-offs, and by converting observed diet preferences into utilities, summing the score is meaningful. In addition, as the CFUI is designed to be scored continuously, it allows the transition from intake of beneficial foods (in low quantities) and intake of detrimental foods (in high quantities) to be more subtle. The paper first describes the rationale being the development of the CFUI and then elaborates on the methodology used to develop the CFUI, including the process of selecting the components. The methodology is applied to data collected from the Avon Longitudinal Study of Parents and Children to show the advantages of the CFUI over traditional diet index approaches. Unlike traditional approaches, the distribution of the CFUI does not peak towards mean value but distributes evenly towards the tails of the distribution. PMID:24155886

  10. Carcinogenic and non-carcinogenic risk of organochlorine pesticide residues in processed cereal-based complementary foods for infants and young children in Ghana.

    PubMed

    Akoto, Osei; Oppong-Otoo, John; Osei-Fosu, Paul

    2015-08-01

    Fourteen organochlorine pesticides (OCPs) residues were analyzed in 10 brands of processed cereal-based complementary foods with the aim of assessing the health risk to infants and young children. The QuEChERS method was used for extraction and clean-up of pesticide residues. Subsequent detection and quantification were done using GC with ECD and PFPD. Levels of p,p'-DDE, dieldrin, β-endosulfan, β-HCH, and γ-HCH detected in the processed cereal-based complementary food were higher than their respective MRL. The mean estimated daily intakes of OCPs in infants were significantly higher than that of young children. Exposure levels of heptachlor and dieldrin were higher than their respective ADI's. Their HIs recorded were greater than 1 indicating the possibility of adverse health effect on consumers. Hazard ratio for carcinogenic risk posed by β-HCH, dieldrin, heptachlor, γ-HCH and γ-chlordane were greater than 1. This result raises concerns of possible carcinogenicity for infants and young children.

  11. Introduction to the history and current status of evidence-based korean medicine: a unique integrated system of allopathic and holistic medicine.

    PubMed

    Yin, Chang Shik; Ko, Seong-Gyu

    2014-01-01

    Objectives. Korean medicine, an integrated allopathic and traditional medicine, has developed unique characteristics and has been active in contributing to evidence-based medicine. Recent developments in Korean medicine have not been as well disseminated as traditional Chinese medicine. This introduction to recent developments in Korean medicine will draw attention to, and facilitate, the advancement of evidence-based complementary alternative medicine (CAM). Methods and Results. The history of and recent developments in Korean medicine as evidence-based medicine are explored through discussions on the development of a national standard classification of diseases and study reports, ranging from basic research to newly developed clinical therapies. A national standard classification of diseases has been developed and revised serially into an integrated classification of Western allopathic and traditional holistic medicine disease entities. Standard disease classifications offer a starting point for the reliable gathering of evidence and provide a representative example of the unique status of evidence-based Korean medicine as an integration of Western allopathic medicine and traditional holistic medicine. Conclusions. Recent developments in evidence-based Korean medicine show a unique development in evidence-based medicine, adopting both Western allopathic and holistic traditional medicine. It is expected that Korean medicine will continue to be an important contributor to evidence-based medicine, encompassing conventional and complementary approaches.

  12. Complementary and alternative medicine: impact on dentistry.

    PubMed

    Little, James W

    2004-08-01

    Complementary and alternative medicine (CAM) represent a group of diverse medical and health care systems, practices, and products that are not considered to be part of conventional medicine. Biofeedback, acupuncture, herbal medication, massage, bioelectromagnetic therapy, meditation, and music therapy are examples of CAM treatments. Some dentists in the United States have used some of these treatments and products in their practices. Complementary medicines include herbal remedies, homeopathic medicines, and essential oils. There has been an increase in the use of herbal medicines in the US over the last 15-20 years. There is a public belief that these medicines are safe because they are made from natural sources. However, some of these products have associated adverse effects including toxicity and drug interactions. The health history taken by the dentist should include questions regarding the taking of herbal and over-the-counter medications. The dentist needs to be informed regarding the herbal and over-the-counter products that may impact the delivery of safe and effective dental treatment. In addition, the use of CAM treatments in dentistry should be based on evidence of effectiveness and safety as demonstrated in randomized clinical trials.

  13. Why the Evidence-Based Paradigm in Early Childhood Education and Care Is Anything but Evident

    ERIC Educational Resources Information Center

    Vandenbroeck, Michel; Roets, Griet; Roose, Rudi

    2012-01-01

    Praxeological research is a necessary contribution to the research field in early childhood education and care, which is currently dominated by an evidence-based paradigm that tends to consider the measurement of predefined outcomes as the most valid form of research. We analyse the history of the evidence-based paradigm in the field of medicine…

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

    ERIC Educational Resources Information Center

    Tuchman, Ellen; Lalane, Monique

    2011-01-01

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

  15. Evidence Based Practice of Chronic Pain

    PubMed Central

    Garg, Rakesh; Joshi, Saurabh; Mishra, Seema; Bhatnagar, Sushma

    2012-01-01

    The patients with chronic pain are increasingly reporting to the physicians for its management. Chronic pain are associated with head, neck and shoulder pain, spinal pain, pain in the joints and extremities, complex regional pain syndrome and phantom pain. The chronic pain is being managed worldwide. The different specialty of medicine is producing a lot of evidence through the published literature but the same is not being published in the field of chronic pain management. Though some evidence is being reported as to different aspects of pain management from different parts of the world but same is lacking from Indian subcontinent. This is in contrast to much done clinical work in this field as well. We present here the available evidence in relation to chronic pain management. PMID:23439674

  16. Static and Dynamic Performance of Complementary Inverters Based on Nanosheet α-MoTe2 p-Channel and MoS2 n-Channel Transistors.

    PubMed

    Pezeshki, Atiye; Hosseini Shokouh, Seyed Hossein; Jeon, Pyo Jin; Shackery, Iman; Kim, Jin Sung; Oh, Il-Kwon; Jun, Seong Chan; Kim, Hyungjun; Im, Seongil

    2016-01-26

    Molybdenum ditelluride (α-MoTe2) is an emerging transition-metal dichalcogenide (TMD) semiconductor that has been attracting attention due to its favorable optical and electronic properties. Field-effect transistors (FETs) based on few-layer α-MoTe2 nanosheets have previously shown ambipolar behavior with strong p-type and weak n-type conduction. We have employed a direct imprinting technique following mechanical nanosheet exfoliation to fabricate high-performance complementary inverters using α-MoTe2 as the semiconductor for the p-channel FETs and MoS2 as the semiconductor for the n-channel FETs. To avoid ambipolar behavior and produce α-MoTe2 FETs with clean p-channel characteristics, we have employed the high-workfunction metal platinum for the source and drain contacts. As a result, our α-MoTe2 nanosheet p-channel FETs show hole mobilities up to 20 cm(2)/(V s), on/off ratios up to 10(5), and a subthreshold slope of 255 mV/decade. For our complementary inverters composed of few-layer α-MoTe2 p-channel FETs and MoS2 n-channel FETs we have obtained voltage gains as high as 33, noise margins as high as 0.38 VDD, a switching delay of 25 μs, and a static power consumption of a few nanowatts. PMID:26631357

  17. Complementary Therapies and Medicines and Reproductive Medicine.

    PubMed

    Smith, Caroline A; Armour, Mike; Ee, Carolyn

    2016-03-01

    Complementary therapies and medicines are a broad and diverse range of treatments, and are frequently used by women and their partners during the preconception period to assist with infertility, and to address pregnancy-related conditions. Despite frequent use, the evidence examining the efficacy, effectiveness, and safety for many modalities is lacking, with variable study quality. In this article, we provide an overview of research evidence with the aim of examining the evidence to inform clinical practice. During the preconception period, there is mixed evidence for acupuncture to improve ovulation, or increase pregnancy rates. Acupuncture may improve sperm quality, but there is insufficient evidence to determine whether this results in improved pregnancy and live birth rates. Acupuncture can be described as a low-risk intervention. Chinese and Western herbal medicines may increase pregnancy rates; however, study quality is low. The evaluation of efficacy, effectiveness, and safety during the first trimester of pregnancy has most commonly reported on herbs, supplements, and practices such as acupuncture. There is high-quality evidence reporting the benefits of herbal medicines and acupuncture to treat nausea in pregnancy. The benefit from ginger to manage symptoms of nausea in early pregnancy is incorporated in national clinical guidelines, and vitamin B6 is recommended as a first-line treatment for nausea and vomiting in pregnancy. The safety of ginger and vitamin B6 is considered to be well established, and is based on epidemiological studies. Acupuncture has been shown to reduce back pain and improve function for women in early pregnancy. There is little evidence to support the use of cranberries in pregnancy for prevention of urinary tract infections, and chiropractic treatment for back pain. Overall the numbers of studies are small and of low quality, although the modalities appear to be low risk of harm. PMID:26866600

  18. Practitioner Expertise in Evidence-Based Practice Decision Making

    ERIC Educational Resources Information Center

    McCracken, Stanley G.; Marsh, Jeanne C.

    2008-01-01

    Evidence-based practice (EBP) is an orientation to practice that values evidence as a resource for clinical decision making while recognizing that evidence alone is never sufficient to make a clinical decision. Critics of EBP typically ignore, negate, or misrepresent the role of practitioner thinking processes and expertise in clinical settings.…

  19. Evidence-based practice: developing mentors to support students.

    PubMed

    Barry, Debbie; Houghton, Trish; Warburton, Tyler

    2016-08-17

    This article, the ninth in a series of 11, provides guidance for new and established mentors and practice teachers on evidence-based practice, the seventh domain of the Nursing and Midwifery Council's Standards to Support Learning and Assessment in Practice (SSLAP). Evidence-based practice is an important aspect of contemporary healthcare and is central to student preparation programmes for nursing, midwifery and specialist community public health nursing (SCPHN). The article describes evidence-based practice, discussing the importance and implementation of an evidence-based approach in the context of role development for mentors and practice teachers in the preparation of nursing, midwifery and SCPHN students. PMID:27533414

  20. Evidence-based surgery: The obstacles and solutions.

    PubMed

    Meshikhes, Abdul-Wahed Nasir

    2015-06-01

    Surgeons are often accused of lagging behind their medical colleagues in embracing evidence based medicine and utilizing new research tools to conducting high quality randomized controlled trials. Although there has been a noticeable improvement in the quantity and quality of high quality studies in surgical journals, the widespread practice of evidence based surgery is still poor. Unlike evidence based medicine, the practice of evidence based surgery is hampered by inherent problems and obstacles. This article reviews these difficulties and the limitations of randomized controlled trials in surgical practice. It also outlines some solutions that may help remedy this ongoing problem.

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

    PubMed

    Likosky, Donald S

    2006-12-01

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

  2. How close is evidence to truth in evidence-based treatment of mental disorders?

    PubMed

    Möller, Hans-Jürgen

    2012-06-01

    Given the importance of the term 'evidence' in evidence-based medicine (EBM), the meaning of this term is evaluated, going back to the philosophical tradition and current meaning of the terms 'evidence' and 'truth'. Based on this, current problems in the definition of evidence and in the grading of evidence in EBM are described, taking examples from the field of psychiatry and especially pharmacopsychiatry. These problems underline that the use of the term evidence in EBM is inconsistent and inconclusive. This should be fairly stated in all EBM-related publications, especially in EBM-based guidelines, to avoid severe misunderstandings in and outside the field of psychiatry. Although EBM might have increased empirically driven rational decision-making in psychiatry/medicine, the current limitations should be carefully considered.

  3. High-gain complementary metal-oxide-semiconductor inverter based on multi-layer WSe2 field effect transistors without doping

    NASA Astrophysics Data System (ADS)

    Kang, Won-Mook; Cho, In-Tak; Roh, Jeongkyun; Lee, Changhee; Lee, Jong-Ho

    2016-10-01

    A high-gain complementary metal-oxide-semiconductor (CMOS) logic inverter was implemented by fabricating p- and n-type field effect transistors (FETs) based on multi-layer WSe2 on the same wafer. Au as a high work-function metal is contacted to WSe2 for the source/drain of the p-type FET. The n-type FET has an Al electrode contacted to WSe2 for the source/drain. Both FETs were designed to have similar on-current densities (>10-7 A μm-1) and high on/off current ratios (>106). The inverter shows excellent switching characteristics including relatively high voltage gains (>25) and high noise margins (>0.9) in the range of supply voltage from 2 V to 8 V. This work has a great significance in the realization of a CMOS logic gate based on WSe2 without an additional doping scheme.

  4. [Evidence-based management of medical disposable materials].

    PubMed

    Yang, Hai

    2009-03-01

    Evidence-based management of medical disposable materials pays attention to collect evidence comprehensively and systematically, accumulate and create evidence through its own work and also evaluate evidence strictly. This can be used as a function to guide out job. Medical disposable materials evidence system contains product register qualification, product quality certification, supplier's behavior, internal and external communication evidence. Managers can find different ways in creating and using evidence referring to specific inside and outside condition. Evidence-based management can help accelerating the development of management of medical disposable materials from traditional experience pattern to a systematic and scientific pattern. It also has the very important meaning to improve medical quality, control the unreasonable growth of medical expense and make purchase and supply chain be more efficient. PMID:19565800

  5. Merging Evidence-Based Psychosocial Interventions in Schizophrenia

    PubMed Central

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

    2014-01-01

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

  6. Justifying Physical Education Based on Neuroscience Evidence

    ERIC Educational Resources Information Center

    Berg, Kris

    2010-01-01

    Research has shown that exercise improves cognitive function and psychological traits that influence behavior (e.g., mood, level of motivation). The evidence in the literature also shows that physical education may enhance learning or that academic performance is at least maintained despite a reduction in classroom time in order to increase time…

  7. Evidence-based equine upper respiratory surgery.

    PubMed

    Beard, Warren L; Waxman, Sarah

    2007-08-01

    The purpose of this article is to review the veterinary literature for various surgical procedures of the equine upper respiratory tract in an effort to evaluate the evidence supporting various therapies. This article focuses on the therapeutic benefit from more widely occurring conditions, such as laryngeal hemiplegia, dorsal displacement of the soft palate, arytenoid chondritis, and epiglottic entrapment.

  8. Investigating the Evidence Base of Social Stories

    ERIC Educational Resources Information Center

    Ali, Shama; Frederickson, Norah

    2006-01-01

    Social stories were developed in order to support individuals with autism to better cope with social situations, an area of particular difficulty for this population. Despite its growing popularity, there is limited research evidence on the effectiveness of this approach. A review of research on social stories undertaken between 1994 and 2004 was…

  9. IBD and Complementary and Alternative Medicine (CAM)

    MedlinePlus

    ... Alternative Medicine (CAM) Go Back Complementary and Alternative Medicine (CAM) Email Print + Share Crohn’s disease and ulcerative ... Energy Medicine, and Biologically-Based Practices. Mind-Body Medicine Mind-body medicine is a set of interventions ...

  10. Finding the common core: evidence-based practices, clinically relevant evidence, and core mechanisms of change.

    PubMed

    Sexton, Thomas L; Kelley, Susan Douglas

    2010-03-01

    Improving the quality of children's mental health care can benefit from the adoption of evidence based and evidence informed treatments. However, the promise of moving science into practice is hampered by three core elements that need to be addressed in the current conversation among key stakeholders: (1) expanding our understanding of the clinical relevance of different types of evidence, (2) emphasizing the identification of core mechanisms of change, and (3) re-conceptualizing what evidence-based practice means. This paper focuses on these elements in an attempt to find a common core among stakeholders that may create opportunities for more inclusive conversation to move the field of children's mental health care forward.

  11. Effective Application of Knowledge Management in Evidence-based Chinese Medicine: A Case Study

    PubMed Central

    Allan, Garry; Li, Chun Guang; Xue, Charlie Changli

    2009-01-01

    Chinese medicine (CM) practice, as a knowledge-based industry, has not embraced knowledge management (KM) techniques widely. However, KM may facilitate the adaptation and promotion of evidence-based CM. A KM framework was introduced to its activities in evidence-based CM through the development of a CM portal. A codification strategy was used to codify and store knowledge systematically in a database. Several approaches were developed and implemented to address specific needs for CM such as centralizing the information, encouraging collective efforts, promoting integration of explicit and tacit knowledge, and developing a flexible technology and support system. Following the established KM framework, the RMIT Chinese Medicine Portal (www.chinese-medicine.com.au) was built up with four major components: organizational knowledge, knowledge workers, KM processes and information technology. Knowledge on Chinese herbs was classified into core, advanced and innovative categories, which involved the development of the monograph template. A working group was organized including CM, pharmacology and information technology professionals to implement this proposal with following sequential development stages: knowledge creation/acquisition, storage/organization, distribution and application. User interface and web language were also defined and accomplished. This case study demonstrates the applicability of KM in evidence-based CM through a multidisciplinary collaboration, such as, an effective collaboration between CM and information technology. The study also shows the potential of KM application in other disciplines of complementary and alternative medicine. PMID:18955285

  12. Timing of introduction of complementary food: short- and long-term health consequences.

    PubMed

    Przyrembel, Hildegard

    2012-01-01

    Complementary food is needed when breast milk (or infant formula) alone is no longer sufficient for both nutritional and developmental reasons. The timing of its introduction, therefore, is an individual decision, although 6 months of exclusive breastfeeding can be recommended for most healthy term infants. The new foods are intended to 'complement' ongoing breastfeeding with those dietary items whose intake has become marginal or insufficient. Both breastfeeding and complementary feeding can have direct or later consequences on health. The evaluation of consequences of both early and late introduction of complementary food can neither disregard the effect of breastfeeding compared to formula feeding nor the composition or quality of the complementary food. Possible short-term health effects concern growth velocity and infections, and possible long-term effects may relate to atopic diseases, type 1 and 2 diabetes, obesity and neuromuscular development. On the basis of the currently available evidence, it is impossible to exactly determine the age when risks related to the start of complementary feeding are lowest or highest for most of these effects, with the possible exception of infections and early growth velocity. The present knowledge on undesirable health effects, however, is mainly based on observational studies, and although some mechanisms have been proposed, further prospective studies have to clarify these unsolved issues. Even less evidence on the consequences of the timing of complementary food introduction is available for formula-fed infants. PMID:22555185

  13. Evidence-based treatments for cluster headache

    PubMed Central

    Gooriah, Rubesh; Buture, Alina; Ahmed, Fayyaz

    2015-01-01

    Cluster headache (CH), one of the most painful syndromes known to man, is managed with acute and preventive medications. The brief duration and severity of the attacks command the use of rapid-acting pain relievers. Inhalation of oxygen and subcutaneous sumatriptan are the two most effective acute therapeutic options for sufferers of CH. Several preventive medications are available, the most effective of which is verapamil. However, most of these agents are not backed by strong clinical evidence. In some patients, these options can be ineffective, especially in those who develop chronic CH. Surgical procedures for the chronic refractory form of the disorder should then be contemplated, the most promising of which is hypothalamic deep brain stimulation. We hereby review the pathogenesis of CH and the evidence behind the treatment options for this debilitating condition. PMID:26635477

  14. Sideline emergencies: an evidence-based approach.

    PubMed

    Fitch, R Warne; Cox, Charles L; Hannah, Gene A; Diamond, Alex B; Gregory, Andrew J M; Wilson, Kristina M

    2011-01-01

    As participation in athletics continues to increase, so too will the occurrence of on-field injuries and medical emergencies. The field of sports medicine continues to advance and many events will have on-site medical staff present. This article reviews the most catastrophic injuries and medical emergencies that are encountered in sports and presents the highest level evidence in regards to on-field approach and management of the athlete.

  15. Topical Ivermectin 10 mg/g and Oral Doxycycline 40 mg Modified-Release: Current Evidence on the Complementary Use of Anti-Inflammatory Rosacea Treatments.

    PubMed

    Steinhoff, Martin; Vocanson, Marc; Voegel, Johannes J; Hacini-Rachinel, Feriel; Schäfer, Gregor

    2016-09-01

    Rosacea is a common, chronic inflammatory skin disease that can present with a variety of signs and symptoms. The potentially simultaneous occurrence of different signs and symptoms is due to different underlying inflammatory pathways, emphasizing the need for complementary treatment approaches. Topical ivermectin cream (10 mg/g) and systemic, oral anti-inflammatory doxycycline (40 mg modified-release) are both approved for the treatment of papulopustular rosacea (PPR). Whether or not a combined therapeutic approach may be more beneficial than monotherapy for patients with PPR remains to be tested. Here, we summarize underlying inflammatory pathways implicated in rosacea and clarify the impact of these two agents on selective pathways during inflammation, due to specific characteristics of their individual mechanisms of action (MoA). Based on the complementary MoA of doxycycline modified-release and ivermectin, a scientific rationale for a combined therapy targeting inflammatory lesions in rosacea is given. We propose that topical ivermectin cream is a promising new candidate as first-line treatment to target the inflammatory lesions of rosacea, which can be used in combination with systemic doxycycline modified-release to provide an optimal treatment approach considering all inflammatory pathways involved in PPR. Funding Galderma. PMID:27432381

  16. Evidence Based Medicine in Pediatric Practice: Brief Review

    PubMed Central

    Kianifar, Hamid-Reza; Akhondian, Javad; Najafi-Sani, Mehri; Sadeghi, Ramin

    2010-01-01

    Practicing medicine according to the best evidence is gaining popularity in the medical societies. Although this concept, which is usually called Evidence Based Medicine (EBM) has been explained in many resources, it has not been addressed enough in pediatrics. In this review, we briefly explained Evidence Based Medicine approach and its applications in pediatrics in order to help the pediatricians to efficiently integrate EBM into their daily practice. PMID:23056715

  17. Complementary Coffee Cups

    ERIC Educational Resources Information Center

    Banchoff, Thomas

    2006-01-01

    What may have been the birth of a new calculus problem took place when the author noticed that two coffee cups, one convex and one concave, fit nicely together, and he wondered which held more coffee. The fact that their volumes were about equal led to the topic of this article: complementary surfaces of revolution with equal volumes.

  18. Mutually Exclusive, Complementary, or . . .

    ERIC Educational Resources Information Center

    Schloemer, Cathy G.

    2016-01-01

    Whether students are beginning their study of probability or are well into it, distinctions between complementary sets and mutually exclusive sets can be confusing. Cathy Schloemer writes in this article that for years she used typical classroom examples but was not happy with the student engagement or the level of understanding they produced.…

  19. Personalizing Research: Special Educators' Awareness of Evidence-Based Practice

    ERIC Educational Resources Information Center

    Guckert, Mary; Mastropieri, Margo A.; Scruggs, Thomas E.

    2016-01-01

    Although evidence-based practices are considered critical to student success, a research-to-practice gap exists. This qualitative study examined practicing special education teachers' perceptions of their use of evidence-based practices. Special education teachers were interviewed and their classroom practices examined. Major themes emerged and…

  20. Barriers and Enablers to Evidence-Based Practices

    ERIC Educational Resources Information Center

    Foster, Robyn

    2014-01-01

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

  1. Behavioral Activation Is an Evidence-Based Treatment for Depression

    ERIC Educational Resources Information Center

    Sturmey, Peter

    2009-01-01

    Recent reviews of evidence-based treatment for depression did not identify behavioral activation as an evidence-based practice. Therefore, this article conducted a systematic review of behavioral activation treatment of depression, which identified three meta-analyses, one recent randomized controlled trial and one recent follow-up of an earlier…

  2. An innovative clinical practicum to teach evidence-based practice.

    PubMed

    Brancato, Vera C

    2006-01-01

    A clinical practicum was successfully implemented for RN to BSN students to apply evidence-based practice to actual clinical problems affecting nursing practice. The author describes how this practicum was implemented and the requisite resources and support systems. This senior-level capstone course enabled students to understand and value a lifelong learning approach to evidence-based practice.

  3. Evidence-based gene predictions in plant genomes

    Technology Transfer Automated Retrieval System (TEKTRAN)

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

  4. Evidence-Based Treatment and Stuttering--Historical Perspective

    ERIC Educational Resources Information Center

    Prins, David; Ingham, Roger J.

    2009-01-01

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

  5. [Forensic evidence-based medicine in computer communication networks].

    PubMed

    Qiu, Yun-Liang; Peng, Ming-Qi

    2013-12-01

    As an important component of judicial expertise, forensic science is broad and highly specialized. With development of network technology, increasement of information resources, and improvement of people's legal consciousness, forensic scientists encounter many new problems, and have been required to meet higher evidentiary standards in litigation. In view of this, evidence-based concept should be established in forensic medicine. We should find the most suitable method in forensic science field and other related area to solve specific problems in the evidence-based mode. Evidence-based practice can solve the problems in legal medical field, and it will play a great role in promoting the progress and development of forensic science. This article reviews the basic theory of evidence-based medicine and its effect, way, method, and evaluation in the forensic medicine in order to discuss the application value of forensic evidence-based medicine in computer communication networks.

  6. Molecular evidence-based medicine: evolution and integration of information in the genomic era.

    PubMed

    Ioannidis, J P A

    2007-05-01

    Evidence-based medicine and molecular medicine have both been influential in biomedical research in the last 15 years. Despite following largely parallel routes to date, the goals and principles of evidence-based and molecular medicine are complementary and they should be converging. I define molecular evidence-based medicine as the study of medical information that makes sense of the advances of molecular biological disciplines and where errors and biases are properly appreciated and placed in context. Biomedical measurement capacity improves very rapidly. The exponentially growing mass of hypotheses being tested requires a new approach to both statistical and biological inference. Multidimensional biology requires careful exact replication of research findings, but indirect corroboration is often all that is achieved at best. Besides random error, bias remains a major threat. It is often difficult to separate bias from the spirit of scientific inquiry to force data into coherent and 'significant' biological stories. Transparency and public availability of protocols, data, analyses and results may be crucial to make sense of the complex biology of human disease and avoid being flooded by spurious research findings. Research efforts should be integrated across teams in an open, sharing environment. Most research in the future may be designed, performed, and integrated in the public cyberspace. PMID:17461979

  7. Resourcing the clinical complementary medicine information needs of Australian medical students: Results of a grounded theory study.

    PubMed

    Templeman, Kate; Robinson, Anske; McKenna, Lisa

    2016-09-01

    The aim of this study was to identify Australian medical students' complementary medicine information needs. Thirty medical students from 10 medical education faculties across Australian universities were recruited. Data were generated using in-depth semi-structured interviews and constructivist grounded theory method was used to analyze and construct data. Students sought complementary medicine information from a range of inadequate sources, such as pharmacological texts, Internet searches, peer-reviewed medical journals, and drug databases. The students identified that many complementary medicine resources may not be regarded as objective, reliable, differentiated, or comprehensive, leaving much that medical education needs to address. Most students sought succinct, easily accessible, evidence-based information to inform safe and appropriate clinical decisions about complementary medicines. A number of preferred resources were identified that can be recommended and actively promoted to medical students. Therefore, specific, evidence-based complementary medicine databases and secondary resources should be subscribed and recommended to medical schools and students, to assist meeting professional responsibilities regarding complementary medicines. These findings may help inform the development of appropriate medical information resources regarding complementary medicines.

  8. Resourcing the clinical complementary medicine information needs of Australian medical students: Results of a grounded theory study.

    PubMed

    Templeman, Kate; Robinson, Anske; McKenna, Lisa

    2016-09-01

    The aim of this study was to identify Australian medical students' complementary medicine information needs. Thirty medical students from 10 medical education faculties across Australian universities were recruited. Data were generated using in-depth semi-structured interviews and constructivist grounded theory method was used to analyze and construct data. Students sought complementary medicine information from a range of inadequate sources, such as pharmacological texts, Internet searches, peer-reviewed medical journals, and drug databases. The students identified that many complementary medicine resources may not be regarded as objective, reliable, differentiated, or comprehensive, leaving much that medical education needs to address. Most students sought succinct, easily accessible, evidence-based information to inform safe and appropriate clinical decisions about complementary medicines. A number of preferred resources were identified that can be recommended and actively promoted to medical students. Therefore, specific, evidence-based complementary medicine databases and secondary resources should be subscribed and recommended to medical schools and students, to assist meeting professional responsibilities regarding complementary medicines. These findings may help inform the development of appropriate medical information resources regarding complementary medicines. PMID:26818009

  9. Evidence-based medicine for diagnostic questions.

    PubMed

    Evers, Johannes L H; Land, Jolande A; Mol, Ben W

    2003-02-01

    When searching the medical care literature for evidence on a diagnostic test, three questions should be addressed each time a study is found: (1) Is this evidence about a diagnostic test valid? (2) Does the test accurately discriminate between patients who do and patients who do not have a specific disorder? (3) Can the test be applied to this patient who is right now sitting in front of me? We will discuss hysterosalpingography (HSG) as an example of a valid and accurate diagnostic test to be applied in a general population of subfertile couples to assess tubal patency (specificity 0.83). HSG is an unreliable test for diagnosing tubal occlusion however (sensitivity 0.65). If HSG were normal, other investigations could be pursued and diagnostic laparoscopy (LS) only performed if conception had not occurred by a later date. If HSG were abnormal, LS would be needed to confirm or exclude tubal occlusion. Patients with risk factors for pelvic or tubal disease, including an abnormal Chlamydia antibody test (CAT) and those showing abnormalities at pelvic examination, should proceed directly to LS because they are significantly more likely to have pelvic pathology. A completely different issue would be HSG as a prognostic test for the occurrence of pregnancy. In theory, the occurrence of pregnancy may be considered a gold standard; however, in reproductive medicine, with so many causes of subfertility other than tubal pathology, a diagnostic test for one single disorder, if normal, will never be able to accurately predict the eventual occurrence of pregnancy.

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

    PubMed

    Thomas, Marie H; Baker, Susan Scott

    2011-01-01

    Evidence-based nursing requires that students think reflectively and use clinical inquiry to develop clinical reasoning and decision-making skills. Likewise, nursing students need a strategy to be successful in passing the NCLEX-RN. The authors identify strategies based on nursing research to facilitate student success. While learning the evidence-based nursing process, the student must begin to think like a nurse while answering clinical practice questions. Using the skills taught for evidence-based nursing can be a powerful tool to approach the NCLEX-RN and succeed. PMID:22024676

  11. Evidence based dental care: integrating clinical expertise with systematic research.

    PubMed

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

    2014-02-01

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

  12. Evidence-based medicine in health care reform.

    PubMed

    Hughes, Gordon B

    2011-10-01

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

  13. Integrating Multiple Evidence Sources to Predict Adverse Drug Reactions Based on a Systems Pharmacology Model

    PubMed Central

    Cao, D-S; Xiao, N; Li, Y-J; Zeng, W-B; Liang, Y-Z; Lu, A-P; Xu, Q-S; Chen, AF

    2015-01-01

    Identifying potential adverse drug reactions (ADRs) is critically important for drug discovery and public health. Here we developed a multiple evidence fusion (MEF) method for the large-scale prediction of drug ADRs that can handle both approved drugs and novel molecules. MEF is based on the similarity reference by collaborative filtering, and integrates multiple similarity measures from various data types, taking advantage of the complementarity in the data. We used MEF to integrate drug-related and ADR-related data from multiple levels, including the network structural data formed by known drug–ADR relationships for predicting likely unknown ADRs. On cross-validation, it obtains high sensitivity and specificity, substantially outperforming existing methods that utilize single or a few data types. We validated our prediction by their overlap with drug–ADR associations that are known in databases. The proposed computational method could be used for complementary hypothesis generation and rapid analysis of potential drug–ADR interactions. PMID:26451329

  14. Evidence-Based Laboratory Medicine: Is It Working in Practice?

    PubMed Central

    Price, Christopher P

    2012-01-01

    The principles of Evidence-Based Medicine have been established for about two decades, with the need for evidence-based clinical practice now being accepted in most health systems around the world. These principles can be employed in laboratory medicine. The key steps in evidence-based practice, namely (i) formulating the question; (ii) searching for evidence; (iii) appraising evidence; (iv) applying evidence; and (v) assessing the experience are all accepted but, as yet, translation into daily clinical and laboratory practice has been slow. Furthermore, the demand for evidence-based laboratory medicine (EBLM) has been slow to develop. There are many contrasting observations about laboratory medicine, for example (i) there is too much testing vs insufficient testing; (ii) testing is expensive vs laboratories are expected to generate income; and (iii) test results have little impact on outcomes vs test results are crucial to clinical decision making. However, there is little evidence to support any of these observations. Integrating the principles of EBLM into routine practice will help to resolve some of these issues by identifying (a) where laboratory medicine fits into the care pathway; (b) where testing is appropriate; (c) the nature and quality of evidence required to demonstrate the clinical utility of a test; (d) how the test result impacts on clinical actions; (e) where changes in the care pathway will occur; and (f) where benefit/value can be achieved. These answers will help to establish the culture of EBLM in clinical and laboratory practice. PMID:22363094

  15. Evidence-based dentistry as it relates to dental materials.

    PubMed

    Bayne, Stephen C; Fitzgerald, Mark

    2014-01-01

    Evidence-based dentistry (EBD) is reviewed in depth to underscore the limitations for evidence-based dental materials information that exist at this time. Anecdotal estimates of evidence for dental practice are in the range of 8 percent to 10 percent. While the process of evaluating the literature base for dental evidence began 20 years ago, it was not practical to implement it until high-speed wireless connections, open access to journals, and omnipresent connections via smart phones became a reality. EBD includes five stages of information collection and analysis, starting with a careful definition of a clinical question using the PICO(T) approach. Clinical evidence in randomized control trials is considered the best. Clinical trial perspectives (prospective, cross-sectional, retrospective) and outcome designs (RCTs, SCTs, CCTs, cohort studies, case-control studies) are quite varied. Aggregation techniques (including meta-analyses) allow meaningful combinations of clinical data from trials with similar designs but with fewer rigors. Appraisals attempt to assess the entire evidence base without bias and answer clinical questions. Varying intensities to these approaches, Cochrane Collaboration, ADA-EBD Library, UTHSCSA CATs Library, are used to answer questions. Dental materials evidence from clinical trials is infrequent, short-term, and often not compliant with current guidelines (registration, CONSORT, PRISMA). Reports in current evidence libraries indicate less than 5 percent of evidence is related to restorative dental materials. PMID:24571523

  16. Reciprocal immune benefit based on complementary production of antibiotics by the leech Hirudo verbana and its gut symbiont Aeromonas veronii

    PubMed Central

    Tasiemski, Aurélie; Massol, François; Cuvillier-Hot, Virginie; Boidin-Wichlacz, Céline; Roger, Emmanuel; Rodet, Franck; Fournier, Isabelle; Thomas, Frédéric; Salzet, Michel

    2015-01-01

    The medicinal leech has established a long-term mutualistic association with Aeromonas veronii, a versatile bacterium which can also display free-living waterborne and fish- or human-pathogenic lifestyles. Here, we investigated the role of antibiotics in the dynamics of interaction between the leech and its gut symbiont Aeromonas. By combining biochemical and molecular approaches, we isolated and identified for the first time the antimicrobial peptides (AMPs) produced by the leech digestive tract and by its symbiont Aeromonas. Immunohistochemistry data and PCR analyses evidenced that leech AMP genes are induced in the gut epithelial cells when Aeromonas load is low (starved animals), while repressed when Aeromonas abundance is the highest (post blood feeding). The asynchronous production of AMPs by both partners suggests that these antibiotic substances (i) provide them with reciprocal protection against invasive bacteria and (ii) contribute to the unusual simplicity of the gut microflora of the leech. This immune benefit substantially reinforces the evidence of an evolutionarily stable association between H. verbana and A. veronii. Altogether these data may provide insights into the processes making the association with an Aeromonas species in the digestive tract either deleterious or beneficial. PMID:26635240

  17. Reciprocal immune benefit based on complementary production of antibiotics by the leech Hirudo verbana and its gut symbiont Aeromonas veronii.

    PubMed

    Tasiemski, Aurélie; Massol, François; Cuvillier-Hot, Virginie; Boidin-Wichlacz, Céline; Roger, Emmanuel; Rodet, Franck; Fournier, Isabelle; Thomas, Frédéric; Salzet, Michel

    2015-12-04

    The medicinal leech has established a long-term mutualistic association with Aeromonas veronii, a versatile bacterium which can also display free-living waterborne and fish- or human-pathogenic lifestyles. Here, we investigated the role of antibiotics in the dynamics of interaction between the leech and its gut symbiont Aeromonas. By combining biochemical and molecular approaches, we isolated and identified for the first time the antimicrobial peptides (AMPs) produced by the leech digestive tract and by its symbiont Aeromonas. Immunohistochemistry data and PCR analyses evidenced that leech AMP genes are induced in the gut epithelial cells when Aeromonas load is low (starved animals), while repressed when Aeromonas abundance is the highest (post blood feeding). The asynchronous production of AMPs by both partners suggests that these antibiotic substances (i) provide them with reciprocal protection against invasive bacteria and (ii) contribute to the unusual simplicity of the gut microflora of the leech. This immune benefit substantially reinforces the evidence of an evolutionarily stable association between H. verbana and A. veronii. Altogether these data may provide insights into the processes making the association with an Aeromonas species in the digestive tract either deleterious or beneficial.

  18. Complementary computer generated holography for aesthetic watermarking.

    PubMed

    Martinez, Christophe; Lemonnier, Olivier; Laulagnet, Fabien; Fargeix, Alain; Tissot, Florent; Armand, Marie Françoise

    2012-02-27

    We present herein an original solution for the watermarking of holograms in binary graphic arts without unaesthetic diffractive effect. It is based on the Babinet principle of complementary diffractive structures adapted to Lohmann-type computer generated holograms. We introduce the concept and demonstrate its interest for anti-counterfeiting applications with the decoding of a hidden data matrix. A process of thermal lithography is used for the manufacturing of binary graphic arts containing complementary computer generated holograms.

  19. [Analysis of effectiveness of cDNA synthesis, induced using complementary primers and primers containing a noncomplementary base matrix].

    PubMed

    D'iachenko, L B; Chenchik, A A; Khaspekov, G L; Tatarenko, A O; Bibilashvili, R Sh

    1994-01-01

    We have studied the efficiency of DNA synthesis catalyzed by M-MLV reverse transcriptase or Thermus aquaticus DNA polymerase for primers (4-17 nucleotides long) either completely matched or possessing a single mismatched base pair at all possible positions in the primer. It has been shown that DNA synthesis efficiency depends not only on the position of mismatched base pair but on the length and primary structure of the primer. The enzyme, template, and primer concentrations determine the relative level of mismatched DNA synthesis.

  20. On evidence and evidence-based medicine: lessons from the philosophy of science.

    PubMed

    Goldenberg, Maya J

    2006-06-01

    The evidence-based medicine (EBM) movement is touted as a new paradigm in medical education and practice, a description that carries with it an enthusiasm for science that has not been seen since logical positivism flourished (circa 1920-1950). At the same time, the term "evidence-based medicine" has a ring of obviousness to it, as few physicians, one suspects, would claim that they do not attempt to base their clinical decision-making on available evidence. However, the apparent obviousness of EBM can and should be challenged on the grounds of how 'evidence' has been problematised in the philosophy of science. EBM enthusiasm, it follows, ought to be tempered. The post-positivist, feminist, and phenomenological philosophies of science that are examined in this paper contest the seemingly unproblematic nature of evidence that underlies EBM by emphasizing different features of the social nature of science. The appeal to the authority of evidence that characterizes evidence-based practices does not increase objectivity but rather obscures the subjective elements that inescapably enter all forms of human inquiry. The seeming common sense of EBM only occurs because of its assumed removal from the social context of medical practice. In the current age where the institutional power of medicine is suspect, a model that represents biomedicine as politically disinterested or merely scientific should give pause. PMID:16384628

  1. Shamanism and complementary therapy.

    PubMed

    Money, M

    1997-10-01

    Shamanism is an ancient tradition which may offer profound insights into the healing process and to our whole understanding of health. It has an extensive historical and geographical distribution, and may contain elements essential to our understanding of humanity. This paper outlines the origin and nature of shamanic practice, and considers its implications for a number of current healing issues. Several areas of potential relevance to complementary practitioners are explored. These include the shamanic concepts of illness, change and growth; illness and healing as rites of passage; death and dying; and the use of imagery in healing. This paper suggests that complementary practitioners may find some shamanic principles highly congruent with their own practice.

  2. Shamanism and complementary therapy.

    PubMed

    Money, M

    2000-11-01

    Shamanism is an ancient tradition which may offer profound insights into the healing process and to our whole understanding of health. It has an extensive historical and geographical distribution, and may contain elements essential to our understanding of humanity. This paper outlines the origin and nature of shamanic practice, and considers its implications for a number of current healing issues. Several areas of potential relevance to complementary practitioners are explored. These include the shamanic concepts of illness, change and growth; illness and healing as rites of passage; death and dying; and the use of imagery in healing. This paper suggests that complementary practitioners may find some shamanic principles highly congruent with their own practice.

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

    NASA Technical Reports Server (NTRS)

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

    2014-01-01

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

  4. Applying Evidence-Based Medicine Principles to Hip Fracture Management

    PubMed Central

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

    2014-01-01

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

  5. Applying evidence-based medicine principles to hip fracture management.

    PubMed

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

    2014-01-01

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

  6. An evidence-based approach to genioplasty.

    PubMed

    Sati, Shawkat; Havlik, Robert J

    2011-02-01

    The Maintenance of Certification module series is designed to help the clinician structure his or her study in specific areas appropriate to his or her clinical practice. This article is prepared to accompany practice-based assessment of preoperative assessment, anesthesia, surgical treatment plan, perioperative management, and outcomes. In this format, the clinician is invited to compare his or her methods of patient assessment and treatment, outcomes, and complications, with authoritative, information-based references. This information base is then used for self-assessment and benchmarking in parts II and IV of the Maintenance of Certification process of the American Board of Plastic Surgery. This article is not intended to be an exhaustive treatise on the subject. Rather, it is designed to serve as a reference point for further in-depth study by review of the reference articles presented.

  7. Dynamic DNA devices and assemblies formed by shape-complementary, non-base pairing 3D components.

    PubMed

    Gerling, Thomas; Wagenbauer, Klaus F; Neuner, Andrea M; Dietz, Hendrik

    2015-03-27

    We demonstrate that discrete three-dimensional (3D) DNA components can specifically self-assemble in solution on the basis of shape-complementarity and without base pairing. Using this principle, we produced homo- and heteromultimeric objects, including micrometer-scale one- and two-stranded filaments and lattices, as well as reconfigurable devices, including an actuator, a switchable gear, an unfoldable nanobook, and a nanorobot. These multidomain assemblies were stabilized via short-ranged nucleobase stacking bonds that compete against electrostatic repulsion between the components' interfaces. Using imaging by electron microscopy, ensemble and single-molecule fluorescence resonance energy transfer spectroscopy, and electrophoretic mobility analysis, we show that the balance between attractive and repulsive interactions, and thus the conformation of the assemblies, may be finely controlled by global parameters such as cation concentration or temperature and by an allosteric mechanism based on strand-displacement reactions. PMID:25814577

  8. Evidence-based medicine and the Cochrane Collaboration.

    PubMed

    Tanjong-Ghogomu, Elizabeth; Tugwell, Peter; Welch, Vivian

    2009-01-01

    Providing evidence-based care to patients involves turning a clinical problem into an answerable question, systematically searching for the best evidence relevant to the question, critically appraising that evidence, and, finally, using the evidence as the basis for clinical decisions to solve the problem. While the overload of medical information today presents a demanding challenge to physicians to sort and identify relevant and valid evidence, it is vitally important to translate that evidence into clinically useful terms. To apply evidence to patient clinical management, it is critical to discuss with patients the evidence, the benefits and the harms, and the alternative treatments, such that they understand and can fully participate in the decision-making process. The framework of evidenced-based medicine provides a concrete methodology to address these issues, here, framed and detailed in five steps. The Cochrane Collaboration has been at the forefront of applying the methods of evidence-based medicine (EBM) in the treatment and management of musculoskeletal and other disorders.

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

    PubMed Central

    Kowalski, Evan.; Chung, Kevin C.

    2012-01-01

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

  10. Using continuous quality improvement to implement evidence-based medicine.

    PubMed

    Quick, Barbara; Nordstrom, Sue; Johnson, Kevin

    2006-01-01

    The importance of implementing evidence-based medicine is being driven by public reporting of outcome data and linking these measures to reimbursement. Most hospitals are faced with many challenges in gaining sponsorship, staffing, creating tools, and reporting of evidence-based outcome measures. This article describes the use of the SSM Health Care (SSMHC) Continuous Quality Improvement model in implementing evidence-based practices at SSM DePaul Health Center, a community hospital member of SSMHC, including successes, opportunities for improvement, and lessons learned. Specifically, the article includes two different processes for data collection and interventions with staff, process requirements for each, and outcome data associated with each model. PMID:17135874

  11. Evidence-Based Practice: Separating Science From Pseudoscience

    PubMed Central

    Lee, Catherine M; Hunsley, John

    2015-01-01

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

  12. Setting Evidence-Based Language Goals

    ERIC Educational Resources Information Center

    Goertler, Senta; Kraemer, Angelika; Schenker, Theresa

    2016-01-01

    The purpose of this project was to identify target language benchmarks for the German program at Michigan State University (MSU) based on national and international guidelines and previous research, to assess language skills across course levels and class sections in the entire German program, and to adjust the language benchmarks as needed based…

  13. Evidence Based Education Request Desk. EBE #791

    ERIC Educational Resources Information Center

    Regional Educational Laboratory Southeast, 2011

    2011-01-01

    Would anyone in your network be aware of any states that might provide differentiated funding for virtual programs based on the model used--for example, curriculum-in-a-box vs. one with high student-teacher interaction? Are you aware of any research that examines what factors to consider when developing this type of differentiated funding? This…

  14. [Evidence-based medicine: a critical analysis of the concept of evidence in medicine].

    PubMed

    Federspil, G; Vettor, R

    2001-06-01

    There is currently a lively debate involving scholars from diverse cultural background on the subject of evidence-based medicine. In order to set out the grounds of discussion this paper deals with the problem of "evidence", both the concept and meaning of this term. After a brief history of the idea of "evidence" from antiquity to the present day, it will be underlined how modern day thinking recognizes the existence of two types of "evidence": rational evidence supported first by René Descartes, and perceptible evidence, defended by Francis Bacon. In contemporary epistemology the idea of "evidence" has been conceived above all as perceptible and is closely linked to the idea of fact. The concept of "scientific fact" will therefore be analyzed and will reveal how in science, contrary to prevailing opinion, "pure facts" practically do not exist and how the "facts" which scientists talk about in their research are always "facts depending on theory". Subsequently the capacity of "facts" to prove scientific hypothesis will be examined. In the light of more recent epistemological reflection the thesis will be maintained according to which facts are not capable of definitively proving the truth of a theory. Such reflection leads to the conclusion that in medicine "evidence" is always dependent on the theoretical and practical context in which researchers work. In the final part of the paper the epistemological presumptions and ambitions of evidence-based medicine will be examined. This analysis concludes that the epistemology on which evidence-based medicine relies upon does not grasp the true complexity of the scientific methodology and can weaken in doctors the beneficial stimulus that is doubt. PMID:11460834

  15. [Evidence-based medicine: a critical analysis of the concept of evidence in medicine].

    PubMed

    Federspil, G; Vettor, R

    2001-06-01

    There is currently a lively debate involving scholars from diverse cultural background on the subject of evidence-based medicine. In order to set out the grounds of discussion this paper deals with the problem of "evidence", both the concept and meaning of this term. After a brief history of the idea of "evidence" from antiquity to the present day, it will be underlined how modern day thinking recognizes the existence of two types of "evidence": rational evidence supported first by René Descartes, and perceptible evidence, defended by Francis Bacon. In contemporary epistemology the idea of "evidence" has been conceived above all as perceptible and is closely linked to the idea of fact. The concept of "scientific fact" will therefore be analyzed and will reveal how in science, contrary to prevailing opinion, "pure facts" practically do not exist and how the "facts" which scientists talk about in their research are always "facts depending on theory". Subsequently the capacity of "facts" to prove scientific hypothesis will be examined. In the light of more recent epistemological reflection the thesis will be maintained according to which facts are not capable of definitively proving the truth of a theory. Such reflection leads to the conclusion that in medicine "evidence" is always dependent on the theoretical and practical context in which researchers work. In the final part of the paper the epistemological presumptions and ambitions of evidence-based medicine will be examined. This analysis concludes that the epistemology on which evidence-based medicine relies upon does not grasp the true complexity of the scientific methodology and can weaken in doctors the beneficial stimulus that is doubt.

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

    ERIC Educational Resources Information Center

    Forrest, Jane L.; Miller, Syrene A.

    2001-01-01

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

  17. Need to Address Evidence-Based Practice in Educational Administration

    ERIC Educational Resources Information Center

    Kowalski, Theodore

    2009-01-01

    Purpose: This article presents a case for addressing evidence-based practice (EBP) in educational administration. Content is arranged around four objectives: (a) summarizing the status of educational administration as a profession, (b) defining evidence and the model, (c) explaining EBP's social and professional merit, and (d) identifying barriers…

  18. Practice-Based Evidence--Overcoming Insecure Attachments

    ERIC Educational Resources Information Center

    Fox, Mark

    2011-01-01

    This article examines educational psychologists' (EPs') engagement with evidence-based practice (EBP). In particular it considers the limitations of randomised controlled trials and the difficulties of obtaining sufficient evidence about the effectiveness of interventions. This means that there is a possibility that EPs continue to use…

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

    ERIC Educational Resources Information Center

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

    2013-01-01

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

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

    ERIC Educational Resources Information Center

    Roberts, Margaret

    2010-01-01

    Educationalists developed the concept of "evidence-based practice" during the 1990s because of concern about the relevance of educational research to practitioners and about its impact on their practice. This article outlines the different kinds of research evidence related to geographical education, which might inform practice. It then discusses…

  1. Homogenization analysis of complementary waveguide metamaterials

    NASA Astrophysics Data System (ADS)

    Landy, Nathan; Hunt, John; Smith, David R.

    2013-11-01

    We analyze the properties of complementary metamaterials as effective inclusions patterned into the conducting walls of metal waveguide structures. We show that guided wave metamaterials can be homogenized using the same retrieval techniques used for volumetric metamaterials, leading to a description in which a given complementary element is conceptually replaced by a block of material within the waveguide whose effective permittivity and permeability result in equivalent scattering characteristics. The use of effective constitutive parameters for waveguide materials provides an alternative point-of-view for the design of waveguide and microstrip based components, including planar lenses and filters, as well as devices with derived from a bulk material response. In addition to imparting effective constitutive properties to the waveguide, complementary metamaterials also couple energy from waveguide modes into radiation. Thus, complementary waveguide metamaterials can be used to modify and optimize a variety of antenna structures.

  2. A Note on Complementary Medicines

    MedlinePlus

    ... manipulation, and acupuncture are types of complementary and alternative medicine (CAM) currently being used by millions of Americans. ... conventional care. The National Center for Complementary and Alternative Medicine (NCCAM), part of NIH since 1999, funds and ...

  3. E-commerce application study and complementary services in the sector of laboratory diagnostics based on consumers' opinion.

    PubMed

    Kontis, Alexios-Patapios; Siassiakos, Konstantinos; Kaimakamis, Georgios; Lazakidou, Athina

    2010-01-01

    The field of the Laboratory Diagnostics (in vitro), a sector of the field of health services, constitutes an industrial market that includes activities of research, development, production and products distribution that are designated for laboratory use. These products are defined as techno-medical products including various categories of products such as simple medicines, advanced technological systems, etc. Despite the high performance, the enlargement and the increasing trends of the field, it is not recorded the expected progress in the methods and the ways of promotion, trading and supporting of these products in the market. The present paper aims at the investigation of the consumers' opinion and the specification of those services that are possible to be implemented in electronic services and commerce for a strongly competitive advantage for the enterprises of the sector. The analysis of the findings from the Consumer Purchase Decision Centres (CPDC) shows how important it is to implement web-based applications in the proposed services. PMID:21041180

  4. E-commerce application study and complementary services in the sector of laboratory diagnostics based on consumers' opinion.

    PubMed

    Kontis, Alexios-Patapios; Siassiakos, Konstantinos; Kaimakamis, Georgios; Lazakidou, Athina

    2010-01-01

    The field of the Laboratory Diagnostics (in vitro), a sector of the field of health services, constitutes an industrial market that includes activities of research, development, production and products distribution that are designated for laboratory use. These products are defined as techno-medical products including various categories of products such as simple medicines, advanced technological systems, etc. Despite the high performance, the enlargement and the increasing trends of the field, it is not recorded the expected progress in the methods and the ways of promotion, trading and supporting of these products in the market. The present paper aims at the investigation of the consumers' opinion and the specification of those services that are possible to be implemented in electronic services and commerce for a strongly competitive advantage for the enterprises of the sector. The analysis of the findings from the Consumer Purchase Decision Centres (CPDC) shows how important it is to implement web-based applications in the proposed services.

  5. Supplementation of soybean lecithin-based semen extender by antioxidants: complementary flowcytometric study on post-thawed ram spermatozoa.

    PubMed

    Sharafi, Mohsen; Zhandi, Mahdi; Akbari Sharif, Abbas

    2015-06-01

    The purpose of the current study was to evaluate the effects of cysteine (C) and glutathione (G) on the post-thawed ram sperm quality. Collected semen samples from four mature rams were diluted with five soybean lecithin (SL)-based extenders containing: no antioxidant (SL-0), 5 mM cysteine (SL-C5), 10 mM cysteine (SL-C10), 5 mM glutathione (SL-G5) and 10 mM glutathione (SL-G10). After freeze-thawing process, motion and velocity parameters, plasma membrane integrity and functionality, morphological abnormality, lipid peroxidation, acrosomal status, mitochondria activity, and apoptosis status of post-thawed ram spermatozoa were assessed. The results showed that SL-C10 increased the total motility and plasma membrane integrity (p < 0.05) of post-thawed ram spermatozoa (55.86 ± 1.37 and 60.57 ± 1.34 %) compared to other extenders. Progressive motility was significantly higher in SL-C10 (24.71 ± 1.13 %) compared to SL-0 (20 ± 1.13 %) and SL-G10 (15 ± 1.13 %). Mitochondrial activity was significantly higher in SL-C10 (56.83 ± 2.29 %) compared to SL-G10 (38.75 ± 2.29 %). Capacitation and acrosomal status, lipid peroxidation, and the percentage of dead spermatozoa were not affected by different extenders. The percentage of live spermatozoa was higher in SL-C10 (56.33 ± 1.35 %) compared to other extenders. Also, SL-C10 resulted in a lower percentage of apoptotic spermatozoa (14.17 ± 0.53 %) compared to other extenders. The results of this study showed that supplementation of SL-based ram semen extender with 10 mM cysteine resulted in an improved quality of post-thawed ram spermatozoa.

  6. The use of complementary and alternative medicine (CAM) in children: a telephone-based survey in Korea

    PubMed Central

    2012-01-01

    Background The purpose of this study was to estimate the prevalence and patterns of CAM use in Korean children via a telephone based survey. We also investigated parent satisfaction, a proxy for their child, with CAM therapy and determined the factors affecting satisfaction with CAM use. Methods This study used a landline telephone-based survey to examine a random sample representative of Korean children, aged 0 to 18 years. We assigned and surveyed 2,000 subjects according to age group, gender, and geographical distributions by proportionate quota and systematic sampling of children throughout Korea in 2010. A household of 1,184 with a 18.6% response rate was projected to yield 2,077 completed data. We performed statistical analyses using sampling weight. Results The prevalence of CAM use was 65.3% for the Korean children in our sample population. The most commonly used CAM category was natural products (89.3%). More than half of CAM user’s parents reported satisfaction with their therapies (52.7%), but only 29.1% among them had consulted a Western trained doctor regarding the CAM therapies used. Doctor visits were associated with lower satisfaction with CAM use but not with consultation rate with a doctor. Conclusions Our study suggests that CAM is widely used among children in Korea. Medical doctors should actively discuss the use of CAM therapies with their patients and provide information on the safety and efficacy of diverse CAM modalities to guide the choices of CAM users. PMID:22515558

  7. CDMBE: A Case Description Model Based on Evidence.

    PubMed

    Zhu, Jianlin; Yang, Xiaoping; Zhou, Jing

    2015-01-01

    By combining the advantages of argument map and Bayesian network, a case description model based on evidence (CDMBE), which is suitable to continental law system, is proposed to describe the criminal cases. The logic of the model adopts the credibility logical reason and gets evidence-based reasoning quantitatively based on evidences. In order to consist with practical inference rules, five types of relationship and a set of rules are defined to calculate the credibility of assumptions based on the credibility and supportability of the related evidences. Experiments show that the model can get users' ideas into a figure and the results calculated from CDMBE are in line with those from Bayesian model. PMID:26421006

  8. An evidence-based assessment of prescribed grazing practices

    Technology Transfer Automated Retrieval System (TEKTRAN)

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

  9. CDMBE: A Case Description Model Based on Evidence

    PubMed Central

    Zhu, Jianlin; Yang, Xiaoping; Zhou, Jing

    2015-01-01

    By combining the advantages of argument map and Bayesian network, a case description model based on evidence (CDMBE), which is suitable to continental law system, is proposed to describe the criminal cases. The logic of the model adopts the credibility logical reason and gets evidence-based reasoning quantitatively based on evidences. In order to consist with practical inference rules, five types of relationship and a set of rules are defined to calculate the credibility of assumptions based on the credibility and supportability of the related evidences. Experiments show that the model can get users' ideas into a figure and the results calculated from CDMBE are in line with those from Bayesian model. PMID:26421006

  10. An organizational cybernetics framework for achieving balance in evidence-based practice and practice-based evidence.

    PubMed

    Fitch, Dale

    2014-01-01

    This article applies the systems science of organizational cybernetics to the implementation of evidence-based practice (EBP) in the provision of social work services in a residential treatment center setting. It does so by systemically balancing EBP with practice-based evidence (PBE) with a focus on the organizational and information system infrastructures necessary to ensure successful implementation. This application is illustrated by discussing a residential treatment program that implemented evidence-based programming and evaluated the results; however, the systemic principles articulated can be applied to any human services organizational setting.

  11. Organizational change strategies for evidence-based practice.

    PubMed

    Newhouse, Robin P; Dearholt, Sandi; Poe, Stephanie; Pugh, Linda C; White, Kathleen M

    2007-12-01

    Evidence-based practice, a crucial competency for healthcare providers and a basic force in Magnet hospitals, results in better patient outcomes. The authors describe the strategic approach to support the maturation of The Johns Hopkins Nursing evidence-based practice model through providing leadership, setting expectations, establishing structure, building skills, and allocating human and material resources as well as incorporating the model and tools into undergraduate and graduate education at the affiliated university. PMID:18090518

  12. Teaching evidence-based practice: implications for psychology.

    PubMed

    Collins, Frank L; Leffingwell, Thad R; Belar, Cynthia D

    2007-07-01

    A movement advocating the use of evidence-based practice (EBP) is increasingly influencing health care and the practice of psychology. Thus, teaching evidence-based practice in psychology (EBPP) is critical to the preparation of future health service psychologists. In this article, the authors address common myths associated with EBP, propose core components involved in teaching EBPP, and describe an example of how such training can be incorporated into a professional psychology education and training curriculum.

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

    PubMed

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

    2011-01-01

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

  14. From Opinion-Based to Evidence-Based Social Work: The Swedish Case

    ERIC Educational Resources Information Center

    Sundell, Knut; Soydan, Haluk; Tengvald, Karin; Anttila, Sten

    2010-01-01

    This article presents an account of Sweden's Institute for Evidence-Based Social Work Practice (IMS), located in Stockholm, Sweden. The article places IMS in the context of making Swedish social care services less opinion-based and more evidence-based. The institute is an example of how policy-driven processes promote the use of evidence-based…

  15. Evidence-based medicine - are we boiling the frog?

    PubMed

    Muckart, D J J

    2013-07-01

    Evidence-based medicine has been defined as 'The conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients.' There are two major assumptions in this statement. First, it is assumed that the evidence is in fact the best. Unfortunately this is not necessarily so, and published evidence is affected by bias, sponsorship, and blind faith in mathematical probability which may not be clinically relevant. Second, the evidence is population based and may not be applicable to the individual, and blind adherence to this concept may cause harm. We must not abandon clinical experience and judgement in favour of a series of inanimate data points. Medicine is an uncertain science. PMID:23802201

  16. A novel fluorescent aptasensor based on hairpin structure of complementary strand of aptamer and nanoparticles as a signal amplification approach for ultrasensitive detection of cocaine.

    PubMed

    Emrani, Ahmad Sarreshtehdar; Danesh, Noor Mohammad; Ramezani, Mohammad; Taghdisi, Seyed Mohammad; Abnous, Khalil

    2016-05-15

    Cocaine is one of the most commonly misused stimulant which could influence the central nervous system. In this study, a fluorescent aptamer-based sensor (aptasensor) was designed for sensitive and selective detection of cocaine, based on hairpin structure of complementary strand of aptamer (CS), target-induced release of aptamer (Apt) from CS and two kinds of nanoparticles, including silica nanoparticles (SNPs) coated with streptavidin and gold nanoparticles (AuNPs). The designed aptasensor acquires characteristics of AuNPs such as unique optical properties and large surface area, SNPs as amplifiers of fluorescence intensity, higher affinity of Apt toward its target relative to its CS, and finally the hairpin structure of CS that brings the fluorophore (FAM) to close proximity to the surface of SNPs. In the absence of cocaine, FAM is in close proximity to the surface of AuNPs, resulting in a weak fluorescence emission. In the presence of target, FAM comes to close proximity to the surface of SNPs because of the formation of hairpin structure of CS, leading to a very strong fluorescence emission. The fabricated fluorescent aptasensor exhibited a good selectivity toward cocaine with a limit of detection (LOD) as low as 209 pM. Moreover, the designed aptasensor was successfully utilized to detect cocaine in serum with a LOD as low as 293 pM.

  17. Overcoming Challenges to Using Evidence-Based Interventions in Schools.

    ERIC Educational Resources Information Center

    Schaeffer, Cindy M.; Bruns, Eric; Weist, Mark; Stephan, Sharon Hoover; Goldstein, Julie; Simpson, Yolanda

    2005-01-01

    The Center for School Mental Health Assistance at the University of Maryland recently completed a review of evidence-based prevention and treatment programs that can be used by school mental health clinicians. Based on the review, a school-based program operating in 22 Baltimore City schools has purchased and trained clinicians in a number of…

  18. Shared Decision Making in Complementary and Alternative Medicine Therapies

    PubMed Central

    Jansons, Lauren L.; Lynch, Rachel L.; LeBlanc, Annie; Tilburt, Jon C.

    2013-01-01

    Objective This paper provides a structured approach for pediatricians responding to requests from patients and their families about the complementary medicine treatment options. Methods Using a case-based narrative review approach, the authors outline practical strategies for addressing conflict, uncertainty, and challenges in explaining alternative health paradigms in routine pediatric care. Reflections are drawn from the clinical experience of the authors, the literature, and recent high-profile cases in the United States. Results The discussion of common case-based scenarios illustrates a general guide for approaching conversations about complementary medicine in the care of the pediatric patient that is responsive to evidence and informed by patient and family values. Conclusions The principles of shared decision making can guide constructive conversations in this area in an effort to facilitate improved satisfaction for patient, family, and provider. Practice Implications Discussions of complementary and alternative medicine in pediatrics pose a specific challenge with regard to patient and/or family preferences and the duty of the provider to advocate for the safety of the child. The proposed structured approach is useful in navigating these important conversations. PMID:23205655

  19. [Iatrogenesis. From Iatromancy to Evidence-Based Medicine, to Iatromancy…].

    PubMed

    Campos, Alberto

    2016-01-01

    The qualities of what is considered evidence change and evolve according to theoretical tools of analysis, but also with what the physician perceives and processes cognitively. This includes models and tools such as statistics and evidence-based medicine. Under the term 'iatromancy' are included here different ways of making inductive inferences to establish diagnoses, be it the divinatory art, heuristics, statistics, Evidence-based Medicine (EBM), or the "clinical eye". The interrelationships of different kinds of experience are discussed as justifications for the beliefs of physicians to form judgments in the decision-making processes. PMID:27160625

  20. [Iatrogenesis. From Iatromancy to Evidence-Based Medicine, to Iatromancy…].

    PubMed

    Campos, Alberto

    2016-01-01

    The qualities of what is considered evidence change and evolve according to theoretical tools of analysis, but also with what the physician perceives and processes cognitively. This includes models and tools such as statistics and evidence-based medicine. Under the term 'iatromancy' are included here different ways of making inductive inferences to establish diagnoses, be it the divinatory art, heuristics, statistics, Evidence-based Medicine (EBM), or the "clinical eye". The interrelationships of different kinds of experience are discussed as justifications for the beliefs of physicians to form judgments in the decision-making processes.

  1. Evidence-based imaging and effective utilization: lessons in neuroradiology.

    PubMed

    Perez, Francisco A; Jarvik, Jeffrey G

    2012-08-01

    Expensive advanced imaging, such as magnetic resonance (MR) imaging, contributes to the unsustainable growth of health care costs in the United States. Evidence-based imaging decreases costs and improves outcomes by guiding appropriate utilization of imaging. Low back pain is an important case illustration. Despite strong evidence that early advanced imaging with MR imaging for uncomplicated low back pain leads to increased costs without significant clinical benefit, MR imaging utilization for acute low back pain has increased. Barriers to evidence-based imaging can be traced to patient- and physician-related factors. Radiologists have a critical role in addressing some of these barriers. PMID:22902115

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

    PubMed Central

    2015-01-01

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

  3. [The forgotten capitulation of evidence-based medicine].

    PubMed

    Schoemaker, Casper G; Smulders, Yvo M

    2015-01-01

    In 1992, the Canadian physician Gordon Guyatt wrote an article that is generally regarded as the starting point of evidence-based medicine (EBM). He described the ideas behind the McMaster residency programme for 'evidence-based practitioners', founded by David Sackett. Eight years later, in 2000, Guyatt concluded that this programme was too ambitious. In a new publication he described most doctors as 'evidence-users'. This editorial marks the transition from an individual to a collective form of EBM, emphasizing the use of evidence-based guidelines. The starting point of this collective form of EBM is not the well-known 1992 paper, but the forgotten editorial in 2000, which was described by Guyatt's colleagues as the capitulation of EBM.

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

    PubMed

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

    2015-07-01

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

  5. An evidence-based vector control strategy for military deployments: the British Army experience.

    PubMed

    Croft, A M; Baker, D; von Bertele, M J

    2001-01-01

    We describe the British Army's current strategy for controlling arthropod vectors of disease during overseas deployments. Military commanders and medical officers have different, but complementary responsibilities in achieving vector control. In this paper we define a hierarchy of evidence-based vector control guidelines. Field guidelines must be based on the best available research evidence, preferably that derived from pragmatic randomised controlled trials (RCTs), and from systematic reviews of trials. Assessing the effectiveness of different vector control measures involves a trade-off between the relative benefits and harm of different technology options. There is compelling scientific evidence that bed nets and screens treated with a pyrethroid insecticide are highly effective in protecting against nocturnally active, anthropophilic arthropods (including ectoparasites), and will reduce the incidence of malaria, leishmaniasis, lymphatic filariasis and Chagas' disease. Etofenprox and deltamethrin are the safest pyrethroids, and permethrin the least safe. Vector control strategies of probable effectiveness are the use of insecticide-treated clothing, the wearing of protective clothing, and the correct use of DEET-based topical insect repellents. Aerosol insecticides are of debatable effectiveness. Other effective vector control measures, of limited usefulness during deployments, include electric fans, mosquito coils/vaporising mats, and smoke. "Biological" vector control measures, and insect buzzers/electrocuters are ineffective. Practical insect avoidance measures, based on an understanding of vector biology, complete the military vector-control arsenal. We conclude that practical insect avoidance measures, combined with pyrethroid-treated nets and clothing, and DEET-based topical repellents, can achieve almost 100% protection against biting arthropods. PMID:11584666

  6. Alkylation of complementary ribonucleotides in nanoreactors.

    PubMed

    Angelico, Ruggero; Losito, Ilario; Cuomo, Francesca; Ceglie, Andrea; Palmisano, Francesco

    2013-01-14

    The aim of the present study was to provide experimental evidence that base pairing, commonly occurring between nucleic bases in more complex supramolecular arrangements, may affect the reaction pathways associated with the alkylation of bases themselves. In pursuit of this aim, dilute aqueous solutions of Cytidine- (CMP) and Guanosine-Mono-Phosphate (GMP) as single reactants or in an equimolar mixture were treated with the electrophilic alkylating agent 1,2-Dodecyl-Epoxide (DE), which was preventively dispersed into micellar solutions prepared with the cationic surfactant hexadecyltrimethylammonium bromide (CTAB). In the early stage of the reaction, CTAB micelles acted as micro-heterogeneous nanoreactors, but as the reaction progressed the systems evolved toward the formation of polydisperse aggregates, whose size and surface-charge properties were monitored as a function of reaction time. From mass spectrometry analyses, it was found that the deamination of cytosine, a side reaction related to the alkylation of the amino group of CMP, was reduced when both the complementary ribonucleotides were present in the same reaction mixture. The involvement of specific sites able to establish C:G interactions (possibly via H-bonding or π-π stacking) could explain the reduced reactivity occurring at the level of some of the nucleophilic centers responsible for molecular recognition.

  7. Developmental outcomes among 18-month-old Malawians after a year of complementary feeding with lipid-based nutrient supplements or corn-soy flour.

    PubMed

    Phuka, John C; Gladstone, Melissa; Maleta, Kenneth; Thakwalakwa, Chrissie; Cheung, Yin Bun; Briend, André; Manary, Mark J; Ashorn, Per

    2012-04-01

    The major aim of this trial was to compare the development of 18-month-old infants who received complementary feeding for 1 year either with lipid-based nutrient supplements or micronutrient fortified corn-soy porridge. Our secondary aim was to determine the socio-economic factors associated with developmental outcomes in the same population. A total of 163 six-month-old rural Malawian children were enrolled in a randomized controlled trial where the control population received daily supplementation with 71 g corn-soy flour [Likuni Phala (LP)] (282 kcal) and individuals in the intervention groups received daily either 50 g of lipid-based nutrient supplement (FS50) (264 kcal) or 25 g of lipid-based nutrient supplement (FS25) (130 kcal). The main outcome measures were Griffiths' developmental scores at 0-2 years. Independent comparison of study groups was carried out using analysis of variance (ANOVA) statistics where mean raw scores, quotients, or mental ages were compared. Association of developmental outcome with predictor variables were examined using multiple regression. At 18 months of chronological age, the mean ± standard deviation (SD) mental ages in the LP, FS50, and FS25 groups were 17.9 ± 1.3, 17.9 ± 1.3, and 17.9 ± 1.2 (P > 0.99), respectively. Likewise, the mean raw developmental scores and mean developmental quotients did not differ significantly. Length-for-age z-score gain during the intervention period, and maternal education were associated with developmental outcome at 18 months (P = 0.03 and P = 0.04; respectively). In conclusion, rural Malawian infants receiving 12-month daily supplementation of their diet either with the tested lipid-based nutrient supplements or fortified corn-soy flour have comparable development outcomes by 18 months of age. PMID:21342456

  8. Complementary LC-MS/MS-Based N-Glycan, N-Glycopeptide, and Intact N-Glycoprotein Profiling Reveals Unconventional Asn71-Glycosylation of Human Neutrophil Cathepsin G

    PubMed Central

    Loke, Ian; Packer, Nicolle H.; Thaysen-Andersen, Morten

    2015-01-01

    Neutrophil cathepsin G (nCG) is a central serine protease in the human innate immune system, but the importance of its N-glycosylation remains largely undescribed. To facilitate such investigations, we here use complementary LC-MS/MS-based N-glycan, N-glycopeptide, and intact glycoprotein profiling to accurately establish the micro- and macro-heterogeneity of nCG from healthy individuals. The fully occupied Asn71 carried unconventional N-glycosylation consisting of truncated chitobiose core (GlcNAcβ: 55.2%; Fucα1,6GlcNAcβ: 22.7%), paucimannosidic N-glycans (Manβ1,4GlcNAcβ1,4GlcNAcβ: 10.6%; Manβ1,4GlcNAcβ1,4(Fucα1,6)GlcNAcβ: 7.9%; Manα1,6Manβ1,4GlcNAcβ1,4GlcNAcβ: 3.7%, trace level of Manα1,6Manβ1,4GlcNAcβ1,4(Fucα1,6)GlcNAcβ), and trace levels of monoantennary α2,6- and α2,3-sialylated complex N-glycans. High-resolution/mass accuracy LC-MS profiling of intact nCG confirmed the Asn71-glycoprofile and identified two C-terminal truncation variants at Arg243 (57.8%) and Ser244 (42.2%), both displaying oxidation of solvent-accessible Met152. Asn71 appeared proximal (~19 Å) to the active site of nCG, but due to the truncated nature of Asn71-glycans (~5–17 Å) we questioned their direct modulation of the proteolytic activity of the protein. This work highlights the continued requirement of using complementary technologies to accurately profile even relatively simple glycoproteins and illustrates important challenges associated with the analysis of unconventional protein N-glycosylation. Importantly, this study now facilitates investigation of the functional role of nCG Asn71-glycosylation. PMID:26274980

  9. Note: A disposable x-ray camera based on mass produced complementary metal-oxide-semiconductor sensors and single-board computers

    NASA Astrophysics Data System (ADS)

    Hoidn, Oliver R.; Seidler, Gerald T.

    2015-08-01

    We have integrated mass-produced commercial complementary metal-oxide-semiconductor (CMOS) image sensors and off-the-shelf single-board computers into an x-ray camera platform optimized for acquisition of x-ray spectra and radiographs at energies of 2-6 keV. The CMOS sensor and single-board computer are complemented by custom mounting and interface hardware that can be easily acquired from rapid prototyping services. For single-pixel detection events, i.e., events where the deposited energy from one photon is substantially localized in a single pixel, we establish ˜20% quantum efficiency at 2.6 keV with ˜190 eV resolution and a 100 kHz maximum detection rate. The detector platform's useful intrinsic energy resolution, 5-μm pixel size, ease of use, and obvious potential for parallelization make it a promising candidate for many applications at synchrotron facilities, in laser-heating plasma physics studies, and in laboratory-based x-ray spectrometry.

  10. Three-Dimensional Flexible Complementary Metal-Oxide-Semiconductor Logic Circuits Based On Two-Layer Stacks of Single-Walled Carbon Nanotube Networks.

    PubMed

    Zhao, Yudan; Li, Qunqing; Xiao, Xiaoyang; Li, Guanhong; Jin, Yuanhao; Jiang, Kaili; Wang, Jiaping; Fan, Shoushan

    2016-02-23

    We have proposed and fabricated stable and repeatable, flexible, single-walled carbon nanotube (SWCNT) thin film transistor (TFT) complementary metal-oxide-semiconductor (CMOS) integrated circuits based on a three-dimensional (3D) structure. Two layers of SWCNT-TFT devices were stacked, where one layer served as n-type devices and the other one served as p-type devices. On the basis of this method, it is able to save at least half of the area required to construct an inverter and make large-scale and high-density integrated CMOS circuits easier to design and manufacture. The 3D flexible CMOS inverter gain can be as high as 40, and the total noise margin is more than 95%. Moreover, the input and output voltage of the inverter are exactly matched for cascading. 3D flexible CMOS NOR, NAND logic gates, and 15-stage ring oscillators were fabricated on PI substrates with high performance as well. Stable electrical properties of these circuits can be obtained with bending radii as small as 3.16 mm, which shows that such a 3D structure is a reliable architecture and suitable for carbon nanotube electrical applications in complex flexible and wearable electronic devices. PMID:26768020

  11. A novel electrochemical aptasensor based on Y-shape structure of dual-aptamer-complementary strand conjugate for ultrasensitive detection of myoglobin.

    PubMed

    Taghdisi, Seyed Mohammad; Danesh, Noor Mohammad; Ramezani, Mohammad; Emrani, Ahmad Sarreshtehdar; Abnous, Khalil

    2016-06-15

    Monitoring of myoglobin (Mb) in human blood serum is highly in demand for early diagnosis of acute myocardial infarction (AMI). Here, a novel electrochemical aptasensor was developed for ultrasensitive and selective detection of Mb, based on Y-shape structure of dual-aptamer (DApt)-complementary strand of aptamer (CS) conjugate, gold electrode and exonuclease I (Exo I). The designed aptasensor obtains features of gold, such as high electrochemical conductivity and large surface area, property of Y-shape structure of DApt-CS conjugate to function as a gate and obstacle for the access of redox probe to the surface of electrode, as well as high specificity and sensitivity of aptamer toward its target and Exo I as an enzyme which specifically degrades the 3'-end of single-stranded DNA (ssDNA). In the absence of Mb, the Y-shape structure remains intact. So, a weak electrochemical signal is observed. Upon addition of target, the DApt leave the CS and bind to Mb, leading to disassembly of Y-shape structure and following the addition of Exo I, a strong electrochemical signal could be recorded. The fabricated aptasensor showed high selectivity toward Mb with a limit of detection (LOD) as low as 27 pM. Besides, the developed aptasensor was effectively applied to detect Mb in human serum.

  12. Note: A disposable x-ray camera based on mass produced complementary metal-oxide-semiconductor sensors and single-board computers

    SciTech Connect

    Hoidn, Oliver R.; Seidler, Gerald T.

    2015-08-15

    We have integrated mass-produced commercial complementary metal-oxide-semiconductor (CMOS) image sensors and off-the-shelf single-board computers into an x-ray camera platform optimized for acquisition of x-ray spectra and radiographs at energies of 2–6 keV. The CMOS sensor and single-board computer are complemented by custom mounting and interface hardware that can be easily acquired from rapid prototyping services. For single-pixel detection events, i.e., events where the deposited energy from one photon is substantially localized in a single pixel, we establish ∼20% quantum efficiency at 2.6 keV with ∼190 eV resolution and a 100 kHz maximum detection rate. The detector platform’s useful intrinsic energy resolution, 5-μm pixel size, ease of use, and obvious potential for parallelization make it a promising candidate for many applications at synchrotron facilities, in laser-heating plasma physics studies, and in laboratory-based x-ray spectrometry.

  13. Use of complementary and alternative therapies in children.

    PubMed

    Woolf, A D; Gardiner, P

    2010-02-01

    The use of complementary and alternative therapies in children has recently shown explosive growth, despite little scientific evidence of benefit, a need for better regulatory oversight, and continuing gaps in the knowledge and attitudes of pediatric health professionals. PMID:20107449

  14. Evidence-based medicine and clinical fluorodeoxyglucose PET/MRI in oncology.

    PubMed

    Miles, Kenneth; McQueen, Liam; Ngai, Stanley; Law, Phillip

    2015-11-17

    Positron Emission Tomography/Magnetic Resonance Imaging (PET/MRI) is a hybrid of two technologies each with its own evidence for clinical effectiveness. This article amalgamates evidence for clinical effectiveness of fluorodeoxyglucose (FDG) PET/CT and MRI as separate modalities with current evidence for hybrid PET/MRI and considers whether such an approach might provide a stronger case for the clinical use of PET/MRI at an earlier stage.Because links between diagnostic accuracy and health outcomes have already been established for FDG-PET/CT in the investigation of suspected residual or recurrent malignancies, evidence showing improved diagnostic performance and therapeutic impact from the use of PET/MRI as an alternative would imply clinical effectiveness of this modality for this application. A meta-analysis of studies comparing FDG-PET/CT to MRI in patients with suspected residual disease or recurrence of tumours indicates complementary roles for these modalities. PET demonstrates greater sensitivity for recurrence within lymph nodes whereas MRI is more effective that PET/CT in the detection of skeletal and hepatic recurrence. A review of studies assessing therapeutic impact of PET/MRI suggests a greater likelihood for change in clinical management when PET/MRI is used for assessment of suspected residual or recurrent disease rather than tumour staging.Supplementing the evidence-base for FDG-PET/MRI with studies that compare the components of this hybrid technology deployed separately indicates that FDG-PET/MRI is likely to be clinical effective for the investigation of patients with a range of suspected residual or recurrent cancers. This indication should therefore be prioritised for further health technology assessment.

  15. Evidence-Based Practice: The Psychology of EBP Implementation.

    PubMed

    Rousseau, Denise M; Gunia, Brian C

    2016-01-01

    Evidence-based practice (EBP) is an approach used in numerous professions that focuses attention on evidence quality in decision making and action. We review research on EBP implementation, identifying critical underlying psychological factors facilitating and impeding its use. In describing EBP and the forms of evidence it employs, we highlight the challenges individuals face in appraising evidence quality, particularly that of their personal experience. We next describe critical EBP competencies and the challenges underlying their acquisition: foundational competencies of critical thinking and domain knowledge, and functional competencies such as question formulation, evidence search and appraisal, and outcome evaluation. We then review research on EBP implementation across diverse fields from medicine to management and organize findings around three key contributors to EBP: practitioner ability, motivation, and opportunity to practice (AMO). Throughout, important links between psychology and EBP are highlighted, along with the contributions psychological research can make to further EBP development and implementation.

  16. Archie Cochrane and his vision for evidence-based medicine

    PubMed Central

    Shah, Hriday M.; Chung, Kevin C.

    2009-01-01

    Archibald (Archie) Cochrane's most influential mark on healthcare was his 1971 publication, “Effectiveness and Efficiency.” This book strongly criticized the lack of reliable evidence behind many of the commonly accepted healthcare interventions at the time. His criticisms spurred rigorous evaluations of healthcare interventions and highlighted the need for evidence in medicine. His call for a collection of systematic reviews led to the creation of The Cochrane Collaboration. Archie Cochrane was a visionary person who helped lay down much of the foundation for evidence-based medicine. This paper will introduce evidence-based medicine to Plastic Surgery by tracing its history to the seminal efforts by Archie Cochrane. PMID:19730323

  17. Construct Definition Using Cognitively Based Evidence: A Framework for Practice

    ERIC Educational Resources Information Center

    Ketterlin-Geller, Leanne R.; Yovanoff, Paul; Jung, EunJu; Liu, Kimy; Geller, Josh

    2013-01-01

    In this article, we highlight the need for a precisely defined construct in score-based validation and discuss the contribution of cognitive theories to accurately and comprehensively defining the construct. We propose a framework for integrating cognitively based theoretical and empirical evidence to specify and evaluate the construct. We apply…

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

    ERIC Educational Resources Information Center

    David-Ferdon, Corinne; Kaslow, Nadine J.

    2008-01-01

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

  19. Evidence-Based Practice: A Framework for Making Effective Decisions

    ERIC Educational Resources Information Center

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

    2012-01-01

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

  20. [Interpretation and judgment formation influence evidence based guidelines].

    PubMed

    Brand, Paul L P

    2012-01-01

    A critical step in the development of evidence based guidelines is the interpretation and weighing-up of the epidemiological evidence. According to the model of human dynamic judgement formation, the personal views, convictions, and choices of the experts developing the guidelines play a part in determining this process. If such views, convictions, and choices are stated explicitly (as is recommended in the GRADE methodology for developing guidelines), physicians are more likely to really follow the guidelines.

  1. Using Evidence-Based Design to Improve Pharmacy Department Efficiency.

    PubMed

    Greenroyd, Fraser L; Hayward, Rebecca; Price, Andrew; Demian, Peter; Sharma, Shrikant

    2016-10-01

    Using a case study of a pharmacy department rebuild in the South West of England, this article examines the use of evidence-based design to improve the efficiency and staff well-being with a new design. This article compares three designs, the current design, an anecdotal design, and an evidence-based design, to identify how evidence-based design can improve efficiency and staff well-being by reducing walking time and distance. Data were collected from the existing building and used to measure the efficiency of the department in its current state. These data were then mapped onto an anecdotal design, produced by architects from interviews and workshops with the end users, and an evidence-based design, produced by highlighting functions with high adjacencies. This changed the view on the working processes within the department, shifting away from a focus on the existing robotic dispensing system. Using evidence-based design was found to decrease the walking time and distance for staff by 24%, as opposed to the anecdotal design, which increased these parameters by 9%, and is predicted to save the department 248 min across 2 days in staff time spent walking.

  2. Thinking about Complementary and Alternative Medicine

    MedlinePlus

    ... Free Copy This booklet covers: What complementary and alternative medicine is (CAM) is and why people use it The different types of CAM (mind-body methods, biologically based practices, body-based practices, energy medicine, and whole medical systems. How to talk ...

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

    PubMed

    Woolf, S H

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

  4. Untangling the Evidence: Introducing an Empirical Model for Evidence-Based Library and Information Practice

    ERIC Educational Resources Information Center

    Gillespie, Ann

    2014-01-01

    Introduction: This research is the first to investigate the experiences of teacher-librarians as evidence-based practice. An empirically derived model is presented in this paper. Method: This qualitative study utilised the expanded critical incident approach, and investigated the real-life experiences of fifteen Australian teacher-librarians,…

  5. 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…

  6. Pediatric Depression: Is There Evidence to Improve Evidence-Based Treatments?

    ERIC Educational Resources Information Center

    Brent, David A.; Maalouf, Fadi T.

    2009-01-01

    Although there have been advances in our ability to treat child and adolescent depression, use of evidence-based treatments still results in many patients with residual symptoms. Advances in our understanding of cognitive, emotional, and ecological aspects of early-onset depression have the potential to lead to improvements in the assessment and…

  7. Evidence and Rigor: Scrutinizing the Rhetorical Embrace of Evidence-Based Decision Making

    ERIC Educational Resources Information Center

    Baker, Bruce; Welner, Kevin G.

    2012-01-01

    The nation's lawmakers have frequently voiced the basic principle that important policy decisions should be evidence based. In this commentary, the authors describe the approach the U.S. Department of Education has taken in its Increasing Educational Productivity project. The authors argue that the department's actual practice in this instance has…

  8. Evidence-based practice: reflections from five European case studies.

    PubMed

    Baeza, Juan I; Fraser, Alec; Boaz, Annette

    2014-01-01

    Background Evidence-based practice (EBP) is now the accepted orthodoxy in clinical practice and developed from evidence-based medicine. EBP is based on a specific type of evidence that is derived from studies based on randomised controlled trials (RCT). This type of evidence is suited to acute medical care and is more problematic for other clinicians such as nurses and therapists, particularly when they are situated within community or primary care settings. Setting Five stroke care services in England (2), Sweden (2) and Poland (1). Aims To reflect on the evidence gained from these case studies to shed light on various aspects of EBP. This paper focuses on three key issues: (1) the importance of context for evidence, (2) the nature of knowledge, and (3) professional hierarchies. Methods Five qualitative case studies into stroke care were carried out in England, Sweden and Poland. One hundred and twenty semi-structured interviews were carried out with a range of healthcare staff who provided specialised and non-specialised stroke care in acute, community and primary care between October 2010 and September 2011. Medical doctors, nurses and different therapists were included in the samples in all five case studies. For this paper, we reflect on some aspects of this work to illuminate the different interprofessional perspectives relating to EBP in stroke care. Results The lack of RCT-based evidence in the community and primary care sectors can lead to the clinicians working in these sectors being perceived as having a lower status. Clinicians use both tacit and encoded knowledge to guide their practice and there existed both intraand interprofessional tensions in these two types of knowledge. The professional hierarchy of stroke teams varies with national context and the role of the non-specialists is less valued in stroke care. PMID:25949726

  9. Development of food-based complementary feeding recommendations for 9- to 11-month-old peri-urban Indonesian infants using linear programming.

    PubMed

    Santika, Otte; Fahmida, Umi; Ferguson, Elaine L

    2009-01-01

    Effective population-specific, food-based complementary feeding recommendations (CFR) are required to combat micronutrient deficiencies. To facilitate their formulation, a modeling approach was recently developed. However, it has not yet been used in practice. This study therefore aimed to use this approach to develop CFR for 9- to 11-mo-old Indonesian infants and to identify nutrients that will likely remain low in their diets. The CFR were developed using a 4-phase approach based on linear and goal programming. Model parameters were defined using dietary data collected in a cross-sectional survey of 9- to 11-mo-old infants (n = 100) living in the Bogor District, West-Java, Indonesia and a market survey of 3 local markets. Results showed theoretical iron requirements could not be achieved using local food sources (highest level achievable, 63% of recommendations) and adequate levels of iron, niacin, zinc, and calcium were difficult to achieve. Fortified foods, meatballs, chicken liver, eggs, tempe-tofu, banana, and spinach were the best local food sources to improve dietary quality. The final CFR were: breast-feed on demand, provide 3 meals/d, of which 1 is a fortified infant cereal; > or = 5 servings/wk of tempe/tofu; > or = 3 servings/wk of animal-source foods, of which 2 servings/wk are chicken liver; vegetables, daily; snacks, 2 times/d, including > or = 2 servings/wk of banana; and > or = 4 servings/wk of fortified-biscuits. Results showed that the approach can be used to objectively formulate population-specific CFR and identify key problem nutrients to strengthen nutrition program planning and policy decisions. Before recommending these CFR, their long-term acceptability, affordability, and effectiveness should be assessed.

  10. Developing traditional chinese medicine in the era of evidence-based medicine: current evidences and challenges.

    PubMed

    Fung, Foon Yin; Linn, Yeh Ching

    2015-01-01

    Evidence-based medicine (EBM), by integrating individual clinical expertise with the best available clinical evidence from systematic research, has in recent years been established as the standard of modern medical practice for greater treatment efficacy and safety. Traditional Chinese Medicine (TCM), on the other hand, evolved as a system of medical practice from ancient China more than 2000 years ago based on empirical knowledge as well as theories and concepts which are yet to be mapped by scientific equivalents. Despite the expanding TCM usage and the recognition of its therapeutic benefits worldwide, the lack of robust evidence from the EBM perspective is hindering acceptance of TCM by the Western medicine community and its integration into mainstream healthcare. For TCM to become an integral component of the healthcare system so that its benefits can be rationally harnessed in the best interests of patients, it is essential for TCM to demonstrate its efficacy and safety by high-level evidence in accordance with EBM, though much debate remains on the validity and feasibility of applying the EBM model on this traditional practice. This review aims to discuss the current status of research in TCM, explore the evidences available on its efficacy and safety, and highlight the issues and challenges faced in applying EBM to TCM.

  11. Developing Traditional Chinese Medicine in the Era of Evidence-Based Medicine: Current Evidences and Challenges

    PubMed Central

    Fung, Foon Yin; Linn, Yeh Ching

    2015-01-01

    Evidence-based medicine (EBM), by integrating individual clinical expertise with the best available clinical evidence from systematic research, has in recent years been established as the standard of modern medical practice for greater treatment efficacy and safety. Traditional Chinese Medicine (TCM), on the other hand, evolved as a system of medical practice from ancient China more than 2000 years ago based on empirical knowledge as well as theories and concepts which are yet to be mapped by scientific equivalents. Despite the expanding TCM usage and the recognition of its therapeutic benefits worldwide, the lack of robust evidence from the EBM perspective is hindering acceptance of TCM by the Western medicine community and its integration into mainstream healthcare. For TCM to become an integral component of the healthcare system so that its benefits can be rationally harnessed in the best interests of patients, it is essential for TCM to demonstrate its efficacy and safety by high-level evidence in accordance with EBM, though much debate remains on the validity and feasibility of applying the EBM model on this traditional practice. This review aims to discuss the current status of research in TCM, explore the evidences available on its efficacy and safety, and highlight the issues and challenges faced in applying EBM to TCM. PMID:25949261

  12. Evidence-based practices in community mental health: outcome evaluation.

    PubMed

    Painter, Kirstin

    2012-10-01

    In 2003, questions were being raised relating to the lack of evidence-based treatments available in public mental health and whether the use of treatments found effective in research settings would be equally effective in real world situations. In response, one state passed a bill mandating a disease management model of service delivery and the use of evidence-based practices designed to obtain better clinical and functional outcomes, and to maximize the possibility for recovery for adults experiencing a serious mental illness. The purpose of this article is to provide an overview of the re-engineered public mental health system and report on findings of a longitudinal time-series study of the redesigned community mental health system. Findings of the study suggest using evidence-based practices and following a disease management model of mental health service delivery can be effective in real world settings for adults experiencing serious mental health symptoms and functional impairment.

  13. Measuring use of evidence based psychotherapy for posttraumatic stress disorder.

    PubMed

    Shiner, Brian; D'Avolio, Leonard W; Nguyen, Thien M; Zayed, Maha H; Young-Xu, Yinong; Desai, Rani A; Schnurr, Paula P; Fiore, Louis D; Watts, Bradley V

    2013-07-01

    To improve methods of estimating use of evidence-based psychotherapy for posttraumatic stress disorder in the Veteran's health administration, we evaluated administrative data and note text for patients newly enrolling in six VHA outpatient PTSD clinics in New England during the 2010 fiscal year (n = 1,924). Using natural language processing, we developed machine learning algorithms that mimic human raters in classifying note text. We met our targets for algorithm performance as measured by precision, recall, and F-measure. We found that 6.3 % of our study population received at least one session of evidence-based psychotherapy during the initial 6 months of treatment. Evidence-based psychotherapies appear to be infrequently utilized in VHA outpatient PTSD clinics in New England. Our method could support efforts to improve use of these treatments. PMID:22535469

  14. Evidence-based causation in toxicology: A 10-year retrospective.

    PubMed

    James, R C; Britt, J K; Halmes, N C; Guzelian, P S

    2015-12-01

    We introduced Evidence-based Toxicology (EBT) in 2005 to address the disparities that exist between the various Weight-of-Evidence (WOE) methods typically applied in the regulatory hazard decision-making arena and urged toxicologists to adopt the evidence-based guidelines long-utilized in medicine (i.e., Evidence-Based Medicine or EBM). This review of the activities leading to the adoption of evidence-based methods and EBT during the last decade demonstrates how fundamental concepts that form EBT, such as the use of systematic reviews to capture and consider all available information, are improving toxicological evaluations performed by various groups and agencies. We reiterate how the EBT framework, a process that provides a method for performing human chemical causation analyses in an objective, transparent and reproducible manner, differs significantly from past and current regulatory WOE approaches. We also discuss why the uncertainties associated with regulatory WOE schemes lead to a definition of the term "risk" that contains unquantifiable uncertainties not present in this term as it is used in epidemiology and medicine. We believe this distinctly different meaning of "risk" should be clearly conveyed to those not familiar with this difference (e.g., the lay public), when theoretical/nomologic risks associated with chemical-induced toxicities are presented outside of regulatory and related scientific parlance.

  15. Evidence-based effect size estimation:An illustration using the case of acupuncture for cancer-related fatigue

    PubMed Central

    Johnston, Michael F; Hays, Ron D; Hui, Ka-Kit

    2009-01-01

    Background Estimating a realistic effect size is an important issue in the planning of clinical studies of complementary and alternative medicine therapies. When a minimally important difference is not available, researchers may estimate effect size using the published literature. This evidence-based effect size estimation may be used to produce a range of empirically-informed effect size and consequent sample size estimates. We provide an illustration of deriving plausible effect size ranges for a study of acupuncture in the relief of post-chemotherapy fatigue in breast cancer patients. Methods A PubMed search identified three uncontrolled studies reporting the effect of acupuncture in relieving fatigue. A separate search identified five randomized controlled trials (RCTs) with a wait-list control of breast cancer patients receiving standard care that reported data on fatigue. We use these published data to produce best, average, and worst-case effect size estimates and related sample size estimates for a trial of acupuncture in the relief of cancer-related fatigue relative to a wait-list control receiving standard care. Results Use of evidence-based effect size estimation to calculate sample size requirements for a study of acupuncture in relieving fatigue in breast cancer survivors relative to a wait-list control receiving standard care suggests that an adequately-powered phase III randomized controlled trial comprised of two arms would require at least 101 subjects (52 per arm) if a strong effect is assumed for acupuncture and 235 (118 per arm) if a moderate effect is assumed. Conclusion Evidence-based effect size estimation helps justify assumptions in light of empirical evidence and can lead to more realistic sample size calculations, an outcome that would be of great benefit for the field of complementary and alternative medicine. PMID:19144128

  16. Relationship between evidence and policy: a case of evidence-based policy or policy-based evidence?

    PubMed

    Hunter, D J

    2009-09-01

    The use (or non-use) of evidence in health policy is an issue of growing interest and concern among both academic researchers and policy makers. Most public health research is government funded, yet the extent to which its findings are used to shape and inform policy is variable in the extreme. Part of the problem lies in the nature of the evidence itself and the extent to which it addresses the complexities of the issue being researched. However, part of it also lies in the way that evidence gets communicated and transmitted to those intended to benefit from, or act on, it. This paper reviews such matters and argues in favour of research that is more attuned to the needs of policy makers and practitioners. To achieve this, a paradigm shift is needed in the way in which research is produced and consumed. Rather than academics exclusively setting the agenda, a new approach to knowledge co-creation is overdue whereby researchers, and those they are seeking to address, work together to define the research questions, agree the methods, and assess the implications of the data analysis and findings for policy and practice.

  17. School Psychology: A Public Health Framework: I. From Evidence-Based Practices to Evidence-Based Policies.

    ERIC Educational Resources Information Center

    Hoagwood, Kimberly; Johnson, Jacqueline

    2003-01-01

    Describes current perspectives on evidence-based practices in psychology, medicine, and education; discusses challenges in the implementation and dissemination of research-based findings into schools; describes differences between current models of organizational behavior as studied in children's mental health services and in education; and…

  18. Evidence-based uncertainty in mental health nursing.

    PubMed

    Franks, V

    2004-02-01

    The drive towards evidence-based practice is part of a modern reflective and caring service. However there is a paradox at the heart of the notion of evidence-based care. In order to perform any systemized examination of treatment there has to be a conscious acknowledgement of uncertainty about that treatment. This is uncomfortable and when research does find evidence in favour of a treatment, there is a relief and a return to conviction about what is the best. The paradox is that it seems the most valued research practices are predicated on generalizations about patient treatments and categories. However, nursing care is based on the notion of the uniqueness of the patient and the nurse-patient relationship. Sometimes it is necessary to address the particular and not to rush to generalizations and certainty. The psychoanalytic framework promotes a capacity to tolerate uncertainty and provides a model for understanding conflicting feelings, which can occur within the nurse-patient relationship. The author proposes the psychoanalytic observational method as an adjunct to other research methods. This method places certain kinds of evidence within the rubric of evidence-based nursing practice. The evidence collected in this method is the evidence of the conscious and unconscious experience within the nurse-patient relationship. The author will describe and argue for the place of this research method within the canon of other more widely practised methods within mental health practice. She will propose that for safe practice it is necessary to value and examine the veracity of the feelings and tacit understanding of the nurse. She contends that the current climate of excessive bureaucracy and persecutory risk management is having a damaging effect on both the research process and effective nursing care.

  19. Premenstrual syndrome. Evidence-based treatment in family practice.

    PubMed Central

    Douglas, Sue

    2002-01-01

    OBJECTIVE: To evaluate the strength of evidence for treatments for premenstrual syndrome (PMS) and to derive a set of practical guidelines for managing PMS in family practice. QUALITY OF EVIDENCE: An advanced MEDLINE search was conducted from January 1990 to December 2001. The Cochrane Library and personal contacts were also used. Quality of evidence in studies ranged from level I to level III, depending on the intervention. MAIN MESSAGE: Good scientific evidence shows that calcium carbonate (1200 mg/d) and selective serotonin reuptake inhibitors are effective treatments for PMS. The most commonly used therapies (including vitamin B6, evening primrose oil, and oral contraceptives) are based on inconclusive evidence. Other treatments for which there is inconclusive evidence include aerobic exercise, stress reduction, cognitive therapy, spironolactone, magnesium, nonsteroidal anti-inflammatory drugs, various hormonal regimens, and a complex carbohydrate-rich diet. Although evidence for them is inconclusive, it is reasonable to recommend healthy lifestyle changes given their overall health benefits. Progesterone and bromocriptine, which are still widely used, are ineffective. CONCLUSION: Calcium carbonate should be recommended as first-line therapy for women with mild-to-moderate PMS. Selective serotonin reuptake inhibitors can be considered as first-line therapy for women with severe affective symptoms and for women with milder symptoms who have failed to respond to other therapies. Other therapies may be tried if these measures fail to provide adequate relief. PMID:12489244

  20. Evidence-based public health: an evolving concept.

    PubMed

    Kohatsu, Neal D; Robinson, Jennifer G; Torner, James C

    2004-12-01

    Evidence-based public health (EBPH) has been proposed as a practice model that builds upon the success of evidence-based medicine (EBM). EBM has been described as a more scientific and systematic approach to the practice of medicine. It has enhanced medical training and practice in many settings. Both EBM and EBPH systematically use data, information, and scientific principles to enhance clinical care and population health, respectively. In this paper, we review the evolution of EBPH, propose a new definition for EBPH, and discuss developments that may support its further advancement.

  1. Strategies for searching and managing evidence-based practice resources.

    PubMed

    Robb, Meigan; Shellenbarger, Teresa

    2014-10-01

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

  2. Proposing an Evidence-Based Strategy for Software Requirements Engineering.

    PubMed

    Lindoerfer, Doris; Mansmann, Ulrich

    2016-01-01

    This paper discusses an evidence-based approach to software requirements engineering. The approach is called evidence-based, since it uses publications on the specific problem as a surrogate for stakeholder interests, to formulate risks and testing experiences. This complements the idea that agile software development models are more relevant, in which requirements and solutions evolve through collaboration between self-organizing cross-functional teams. The strategy is exemplified and applied to the development of a Software Requirements list used to develop software systems for patient registries.

  3. Evidence-Based Practice and Quality Improvement in Nursing Education.

    PubMed

    Balakas, Karen; Smith, Joan R

    2016-01-01

    For more than a decade, nursing education has experienced several significant changes in response to challenges faced by healthcare organizations. Accrediting organizations have called for improved quality and safety in care, and the Institute of Medicine has identified evidence-based practice and quality improvement as 2 core competencies to include in the curricula for all healthcare professionals. However, the application of these competencies reaches far beyond the classroom setting. For nurses to possess the knowledge, skills, and attitudes to apply evidence-based practice and quality improvement to the real-world setting, academic-clinical institution partnerships are vital. PMID:27465447

  4. Proposing an Evidence-Based Strategy for Software Requirements Engineering.

    PubMed

    Lindoerfer, Doris; Mansmann, Ulrich

    2016-01-01

    This paper discusses an evidence-based approach to software requirements engineering. The approach is called evidence-based, since it uses publications on the specific problem as a surrogate for stakeholder interests, to formulate risks and testing experiences. This complements the idea that agile software development models are more relevant, in which requirements and solutions evolve through collaboration between self-organizing cross-functional teams. The strategy is exemplified and applied to the development of a Software Requirements list used to develop software systems for patient registries. PMID:27577464

  5. Complementary and alternative medicine and the management of the metabolic syndrome.

    PubMed

    Hollander, Jason M; Mechanick, Jeffrey I

    2008-03-01

    More than one third of the population has the metabolic syndrome. Although aspects of the metabolic syndrome (MSDR) are readily treatable with evidence-based interventions, many patients and practitioners are looking for alternatives to pills and injectables. Complementary and alternative medicine may offer patients safe and effective options to target components of MSDR. This review covers the definition, pathophysiology, epidemiology, and population-based consequences of MSDR, defines complementary and alternative medicine, and applies evidence-based principles to the discussion of a number of alternative therapies purported to treat aspects of MSDR. It is time that the medical community becomes familiar with current fads in dietary supplements and nutraceuticals and begins to use the descriptors proven vs unproven in reference to alternative therapies. The proven alternative therapies discussed herein can provide a starting point for patients to gain ownership of their disease and to make positive choices into the future to halt the effects of MSDR.

  6. Evidence integration in model-based tree search

    PubMed Central

    Solway, Alec; Botvinick, Matthew M.

    2015-01-01

    Research on the dynamics of reward-based, goal-directed decision making has largely focused on simple choice, where participants decide among a set of unitary, mutually exclusive options. Recent work suggests that the deliberation process underlying simple choice can be understood in terms of evidence integration: Noisy evidence in favor of each option accrues over time, until the evidence in favor of one option is significantly greater than the rest. However, real-life decisions often involve not one, but several steps of action, requiring a consideration of cumulative rewards and a sensitivity to recursive decision structure. We present results from two experiments that leveraged techniques previously applied to simple choice to shed light on the deliberation process underlying multistep choice. We interpret the results from these experiments in terms of a new computational model, which extends the evidence accumulation perspective to multiple steps of action. PMID:26324932

  7. Evidence integration in model-based tree search.

    PubMed

    Solway, Alec; Botvinick, Matthew M

    2015-09-15

    Research on the dynamics of reward-based, goal-directed decision making has largely focused on simple choice, where participants decide among a set of unitary, mutually exclusive options. Recent work suggests that the deliberation process underlying simple choice can be understood in terms of evidence integration: Noisy evidence in favor of each option accrues over time, until the evidence in favor of one option is significantly greater than the rest. However, real-life decisions often involve not one, but several steps of action, requiring a consideration of cumulative rewards and a sensitivity to recursive decision structure. We present results from two experiments that leveraged techniques previously applied to simple choice to shed light on the deliberation process underlying multistep choice. We interpret the results from these experiments in terms of a new computational model, which extends the evidence accumulation perspective to multiple steps of action. PMID:26324932

  8. 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. PMID:27386775

  9. 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

  10. Complementary therapies in health care.

    PubMed

    van der Riet, Pamela

    2011-03-01

    In the past two decades, complementary therapies have grown in popularity in Western countries. The interest in complementary therapies could be explained by a "new consciousness" and the shift to a postmodern society. These therapies, embracing holistic practice, are derived from traditions of Eastern healing. There are many advantages of the complementary therapies that are playing a therapeutic role in the health care of individuals and, through the use of such therapies, nursing is developing a richness in holistic care. However, there are still barriers to be overcome; namely, the reluctance to accept complementary therapies in many contemporary healthcare settings. Through research and education, these barriers can be overcome.

  11. The evaluation of a lectin-agarose based subunit vaccine and complementary diagnostic antigen for Aujeszky's disease (pseudorabies) in the pig.

    PubMed

    Platt, K B

    1984-02-01

    Eleven out of 25 pigs were immunized with a lectin--agarose based subunit vaccine for Aujeszky's disease (AD). The vaccine was prepared by extracting protective antigens from a non-ionic detergent (Triton-X-100) extract of AD virus-infected PK-la cells with Lens culinaris agglutinin immobilized on agarose beads. Two groups of 3 and 4 pigs received 2 doses of vaccine each containing 426 micrograms of adsorbed protein. Two groups of 2 pigs each received 2 vaccine doses containing either 23 or 33 micrograms of adsorbed protein. All vaccinated pigs survived a nasal challenge of 10(8.5) PFU of virulent AD virus while 13 out of 14 (93%) uninoculated controls died between Days 5 and 9 post challenge. This immunizing preparation qualified as a practical subunit vaccine because pigs were protected with relatively small amounts of protective antigen while at the same time remained free of detectable antibody to a complementary diagnostic antigen. This antigen was obtained in relatively pure form from the maintenance medium of virus-infected cells 4 h post-inoculation. In addition both high and low dose vaccinates failed to produce detectable antibody to at least one other antigen complex. The composition of Lens culinaris agglutinin (LCA) and Ricinus communis agglutinin (RCA)-purified AD viral antigen preparations were also compared by crossed immunoelectrophoretic techniques. Both preparations contained two antigen complexes and two individual antigens in common. Each preparation also contained its own unique antigen complex. The RCA purified antigen preparation also contained small quantities of a single antigen that was not detectable in the LCA antigen preparation.

  12. Utilization Patterns of Conventional and Complementary/Alternative Treatments in Children with Autism Spectrum Disorders and Developmental Disabilities in a Population-Based Study

    PubMed Central

    Akins, CDR Roger Scott; Krakowiak, Paula; Angkustsiri, Kathleen; Hertz-Picciotto, Irva; Hansen, Robin L.

    2014-01-01

    Objective This study compared the utilization of conventional treatments to utilization of complementary and alternative medicine (CAM) in preschoolers with autism spectrum disorders (ASD) and other developmental disabilities (DD). Methods Participants were 578 children who were part of an ongoing population-based, case-control study of 2 to 5 year-olds with ASD, DD, and the general population. Parents completed an interview on past and current services. Results Four hundred fifty-three children with ASD and 125 DD children were included. ASD families received more hours of conventional services compared to DD (17.8 vs. 11; p<0.001). The use of psychotropic medications was low in both groups (~3%). CAM use overall was not significantly different in ASD (39%) versus DD (30%). Hispanic families in both groups used CAM less often than non-Hispanics. Variables such as level of function, immunization status, and presence of an identified neurogenetic disorder were not predictive of CAM use. A higher level of parental education was associated with increased CAM use in ASD and DD. Families who utilized >20 hours per week of conventional services were more likely to use CAM, including potentially unsafe or disproven CAM. Under-immunized children were marginally more likely to use CAM, but not more likely to have received potentially unsafe or disproven CAM. Conclusion CAM use is common in families of young children with neurodevelopmental disorders and is predicted by higher parental education and non-Hispanic ethnicity but not developmental characteristics. Further research should address how healthcare providers can support families in making decisions about CAM use. PMID:24399100

  13. Effect of Home-Based Complementary Food Fortification on Prevalence of Anemia Among Infants and Young Children Aged 6 to 23 Months in Poor Rural Regions of China.

    PubMed

    Huo, Junsheng; Sun, Jing; Fang, Zheng; Chang, Suying; Zhao, Liyun; Fu, Ping; Wang, Jie; Huang, Jian; Wang, Lijuan; Begin, France; Hipgrave, David B; Ma, Guansheng

    2015-12-01

    Following the 2008 Wenchuan earthquake, the Chinese government instituted an infant and young and child nutrition program that included promotion of in-home fortification of complementary food with ying yang bao (YYB), a soy-based powder containing iron, 2.5 mg as iron-EDTA and 5 mg as ferrous fumarate, and other micronutrients. Ying yang bao was provided to participating families in 8 poor rural counties in Sichuan, Shaanxi, and Gansu provinces by the Ministry of Health. We assessed hemoglobin levels among infants and young children (IYC) aged 6 to 23 months at baseline in May 2010 (n = 1290) and during follow-up in November 2010 (n = 1142), May 2011 (n = 1118), and November 2011 (n = 1040), using the Hemocue method. Interviewers collected basic demographic information and child feeding practices from the children's caretakers. Altitude-adjusted hemoglobin level averaged 10.8 g/dL, and total anemia prevalence was 49.5% at baseline. Average hemoglobin was 11.3 g/dL at 6 months, 11.6 g/dL at 12 months, and 11.7 g/dL at 18 months after introduction of YYB. Moderate anemia (hemoglobin: 70-99 g/dL) decreased from 20.3% at baseline to 7.5%, 5.8%, and 7.3% after 6, 12, and 18 months of home fortification, respectively (P < .001), whereas mild anemia (hemoglobin: 100-110 g/dL) decreased from 29.0% to 16.7%, 18.1%, and 15.4%, respectively (P < .001). Among infants aged 6 to 23 months, 95% had regularly been fed YYB during the observation period. Regression analysis showed that the duration of YYB consumption and number of sachets consumed per week correlated positively with hemoglobin levels and negatively with anemia rates. Home food fortification with YYB is feasible and effective for nutrition promotion among IYC in high-risk regions of China.

  14. Conventional Practitioners’ Communication of Integrative Alternatives for Chronic Back Pain: An Evidence-based, Patient-centered Model

    PubMed Central

    Russo, Ruthann

    2014-01-01

    Chronic back pain is one of the most common conditions treated in the United States. Informed consent is the communication of treatment alternatives, benefits, and risks and must be provided to patients in most instances. The alternatives provided during this discussion should include all options supported by research evidence and the patient’s preferences. This article proposes a model for chronic back pain that includes the communication of complementary therapies as part of a patient-centered, integrative approach to informed consent. The content of informed consent is determined by common law (court cases), legislation, regulations, and evidence-based research. The practitioner’s and patient’s knowledge and the patient’s values should be used to filter this information. Finally, shared decision making should be used to arrive at the patient’s final decision regarding informed consent for treatment. PMID:26770090

  15. [Pharmacist's requirements for evidence-based self-medication guidelines].

    PubMed

    Laven, Anna; Läer, Stephanie

    2013-03-01

    Due to the removal of many pharmaceuticals from the prescription requirement, self-medication implies an increasing responsibility for pharmacists towards their patients. The application of evidence-based guidelines could be a responsible basis for consulting in pharmacies. Evidence-based guidelines represent the systematically accumulated and evaluated facts (the evidence) of desired and undesired effects of pharmaceuticals in the population. We wanted to find out which interest pharmaceutical professionals have in evidence-based guidelines and which are the exact requirements on their content, deducted from public pharmacies everyday demands. With this purpose, three surveys were conducted between March and August 2012, in which 365, 350, and 486 pharmaceutical professionals participated respectively. The results show that pharmacy staff is very interested in evidence based guidelines. Furthermore, they suggest that the pharmacy staff feel safe with the self-diagnosis of the customer, with the consideration of limits of self-medication, as well as with the selection of the--according to own assessment--appropriate active substance. For the selection of the correct active substance, the following criteria are named: self-security in the counselling, first-hand experiences as well as the wish of the customer. At the same time, it is striking that the most frequent critique the pharmacy staff gets from pharmacy customers is the lack of effectiveness of the selected medication. With that in mind, it is possible that not the appropriate medication was selected, and the chosen criteria as selection method should be replaced by an evidence-based decision. Secondly, the results show that in up to 52% of the cases, depending on the indications, the participating consultants felt less certain to uncertain with regards to possible interactions or contraindications. Also in this context, it is desirable to prepare the existing data in such a practical way, that the

  16. Foundations for evidence-based intraoperative neurophysiological monitoring.

    PubMed

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

    2016-01-01

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

  17. Evidence-based medicine in metastatic spine disease.

    PubMed

    Dea, Nicolas; Fisher, Charles G

    2014-06-01

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

  18. EVIDENCEBASED MEDICINE/PRACTICE IN SPORTS PHYSICAL THERAPY

    PubMed Central

    Lehecka, B.J.

    2012-01-01

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

  19. Evidence, discovery and justification: the case of evidence-based medicine.

    PubMed

    Gaeta, Rodolfo; Gentile, Nelida

    2016-08-01

    The purpose of this paper is to develop some thoughts on philosophical issues surrounding evidence-based medicine (EBM), especially related to its epistemological dimensions. After considering the scope of several philosophical concepts that are relevant to the discussion, and drawing some distinctions among different aspects of EBM, we evaluate the status of EBM and suggest that EBM is mainly a meta-methodology. Then, we outline an evaluation of the thesis that EBM is a 'new paradigm' in the practice of medicine. We argue that EBM does not seem to have arisen in the way Kuhn imagined paradigms to arise but as a conscious, deliberate proposal, more as programme than as a reality. Furthermore, there is something paradoxical about appealing to evidence or to the best evidence as a way of promoting a new paradigm. For the proposal seems to assume that there is something that by its own virtue is the best evidence for a given time. But this idea would have been rejected by Kuhn. If EBM involves a genuine new alternative in the field of medicine and shows a way in which the discipline will endure henceforth, this indicates that it is not what Kuhn once called a 'paradigm' and even, paradoxically, it is good evidence that scientific paradigms do not exist, at least in medicine.

  20. Evidence-based decision-making 1: Critical appraisal.

    PubMed

    Twells, Laurie K

    2015-01-01

    This chapter provides an introduction to the concept of Evidence-based Medicine (EBM) including its history, rooted in Canada and its important role in modern medicine. The chapter both defines EBM and explains the process of conducting EBM. It includes a discussion of the hierarchy of evidence that exists with reference to common methods used to assess the levels of quality inherent in study designs. The focus of the chapter is on how to critically appraise the medical literature, as one step in the EBM process. Critical appraisal requires an understanding of the strengths and weaknesses of study design and how these in turn impact the validity and applicability of research findings. Strong critical appraisal skills are critical to evidence-based decision-making.

  1. A framework for disseminating evidence-based health promotion practices.

    PubMed

    Harris, Jeffrey R; Cheadle, Allen; Hannon, Peggy A; Forehand, Mark; Lichiello, Patricia; Mahoney, Eustacia; Snyder, Susan; Yarrow, Judith

    2012-01-01

    Wider adoption of evidence-based, health promotion practices depends on developing and testing effective dissemination approaches. To assist in developing these approaches, we created a practical framework drawn from the literature on dissemination and our experiences disseminating evidence-based practices. The main elements of our framework are 1) a close partnership between researchers and a disseminating organization that takes ownership of the dissemination process and 2) use of social marketing principles to work closely with potential user organizations. We present 2 examples illustrating the framework: EnhanceFitness, for physical activity among older adults, and American Cancer Society Workplace Solutions, for chronic disease prevention among workers. We also discuss 7 practical roles that researchers play in dissemination and related research: sorting through the evidence, conducting formative research, assessing readiness of user organizations, balancing fidelity and reinvention, monitoring and evaluating, influencing the outer context, and testing dissemination approaches. PMID:22172189

  2. Feedback informed treatment: evidence-based practice meets social construction.

    PubMed

    Tilsen, Julie; McNamee, Sheila

    2015-03-01

    This article explores the challenges presented by the mandate for evidence-based practice for family therapists who identify with the philosophical stance of social construction. The history of psychotherapy outcome research is reviewed, as are current findings that provide empirical evidence for an engaged, dialogic practice. The authors suggest that the binary between empiricism and social construction may be unhinged by understanding empiricism as a particular discursive frame (i.e., a particular way of talking, acting, and being in the world), one of many available as a way of understanding and talking about our work. Through a case vignette, the authors introduce the evidence-based practice of Feedback Informed Treatment as an elaboration of social construction, and as an example of bridging the gap between the discursive frames of empiricism and social construction.

  3. EditorialEvidence based library and information practice.

    PubMed

    Grant, Maria J

    2011-06-01

    Whilst many of us engage in supporting clinicians in identifying, appraising and using evidence, how many of us adopt the same approach to our own work? A recent survey by the UK LIS Research Coalition indicated that 60% of respondents use research reports as a source of information whilst a similar proportion of health library respondents use professional events such as conferences as a source of information. This summer sees the 6(th) International Evidence Based Library and Information Practice (EBLIP6) being held at the University of Salford, UK between 27(th) -30(th) June which will go some way to satisfying this latter information need whilst the Health Information and Libraries Journal can help satisfy the need for research reports. Whatever you're doing this summer, let's make it evidence based.

  4. Feedback informed treatment: evidence-based practice meets social construction.

    PubMed

    Tilsen, Julie; McNamee, Sheila

    2015-03-01

    This article explores the challenges presented by the mandate for evidence-based practice for family therapists who identify with the philosophical stance of social construction. The history of psychotherapy outcome research is reviewed, as are current findings that provide empirical evidence for an engaged, dialogic practice. The authors suggest that the binary between empiricism and social construction may be unhinged by understanding empiricism as a particular discursive frame (i.e., a particular way of talking, acting, and being in the world), one of many available as a way of understanding and talking about our work. Through a case vignette, the authors introduce the evidence-based practice of Feedback Informed Treatment as an elaboration of social construction, and as an example of bridging the gap between the discursive frames of empiricism and social construction. PMID:25394600

  5. Using Family Paradigms to Improve Evidence-Based Practice

    ERIC Educational Resources Information Center

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

    2009-01-01

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

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

    ERIC Educational Resources Information Center

    Schaffner, Angela D.; Buchanan, Linda Paulk

    2010-01-01

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

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

    ERIC Educational Resources Information Center

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

    2013-01-01

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

  8. Determining Evidence-Based Practices in Special Education

    ERIC Educational Resources Information Center

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

    2009-01-01

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

  9. Interteaching: An Evidence-Based Approach to Instruction

    ERIC Educational Resources Information Center

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

    2014-01-01

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

  10. Single-Subject Experimental Design for Evidence-Based Practice

    ERIC Educational Resources Information Center

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

    2012-01-01

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

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

    ERIC Educational Resources Information Center

    Rubin, Allen

    2015-01-01

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

  12. Evidence-Based Practices with Students Who Are Deaf

    ERIC Educational Resources Information Center

    Luckner, John L.

    2006-01-01

    Currently, professionals in all fields that work with students with disabilities, including education, face a "demand" that their decisions about which interventions to use be guided by evidence-based practices. The "gold standard" for evaluating the effectiveness of interventions is the use of randomized, controlled trials that are well designed…

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

    ERIC Educational Resources Information Center

    Kent, Ray D.

    2006-01-01

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

  14. Evidence-Based Kernels: Fundamental Units of Behavioral Influence

    ERIC Educational Resources Information Center

    Embry, Dennis D.; Biglan, Anthony

    2008-01-01

    This paper describes evidence-based kernels, fundamental units of behavioral influence that appear to underlie effective prevention and treatment for children, adults, and families. A kernel is a behavior-influence procedure shown through experimental analysis to affect a specific behavior and that is indivisible in the sense that removing any of…

  15. Evidence-Based Psychosocial Treatments for Ethnic Minority Youth

    ERIC Educational Resources Information Center

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

    2008-01-01

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

  16. Organizing for Evidence-Based Decision Making and Improvement

    ERIC Educational Resources Information Center

    Leimer, Christina

    2012-01-01

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

  17. Reflections on the Teaching of Evidence-Based Practice

    ERIC Educational Resources Information Center

    Shlonsky, Aron; Stern, Susan B.

    2007-01-01

    As the process of evidence-based practice (EBP) gains a foothold in the curricula of schools of social work and the various helping professions, instructors have been encountering a unique set of challenges. On one hand, educators must develop new curricula to convey material that is often complex and is, even in its most advanced state, still in…

  18. Commentary: evidence-based practice and forensic psychiatry.

    PubMed

    Schneider, Richard D

    2009-01-01

    A diverse sampling of articles was considered as a landscape against which evidence-based practice has been and should be a part of forensic psychiatry. Caveats were identified, limitations suggested, and recommendations made as to how such a marriage might work.

  19. Disseminating Evidence-Based Practices in Secondary Transition

    ERIC Educational Resources Information Center

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

    2013-01-01

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

  20. Evidence-Based Rehabilitation Counseling Practice: A Pedagogical Imperative

    ERIC Educational Resources Information Center

    Kosciulek, John F.

    2010-01-01

    This article describes how rehabilitation educators can aid students and practitioners in learning about and engaging in evidence-based rehabilitation counseling practice (EBRCP). Information describing (a) the definition and rationale for EBRCP, (b) controversies surrounding EBRCP, (c) facilitating rehabilitation counselor enthusiasm for EBRCP,…

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

    PubMed

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

    2010-10-01

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

  2. Unraveling Evidence-Based Practices in Special Education

    ERIC Educational Resources Information Center

    Cook, Bryan G.; Cook, Sara Cothren

    2013-01-01

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

  3. Evidence-Based Secondary Transition Practices for Enhancing School Completion

    ERIC Educational Resources Information Center

    Test, David W.; Fowler, Catherine H.; White, James; Richter, Sharon; Walker, Allison

    2009-01-01

    Approximately 28% of students with disabilities do not complete high school (National Longitudinal Transition Study-2, 2005). This increases the likelihood that these students will experience low wages, high rates of incarceration, and limited access to postsecondary education. This article reviews evidence-based secondary transition practices…

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

    ERIC Educational Resources Information Center

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

    2001-01-01

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

  5. Teaching Evidence-Based Medicine: A Regional Dissemination Model.

    ERIC Educational Resources Information Center

    Leipzig, Rosanne M.; Wallace, Eleanor Z.; Smith, Lawrence G.; Sullivant, Jean; Dunn, Kathel; McGinn, Thomas

    2003-01-01

    Described and evaluated an interactive course designed to create a cadre of medical school faculty in New York who could integrate evidence-based medicine into their training programs. Findings for representatives of 30 internal medicine residency programs show the usefulness of the regional dissemination model used. (SLD)

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

    ERIC Educational Resources Information Center

    Finn, Patrick

    2011-01-01

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

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

    ERIC Educational Resources Information Center

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

    2009-01-01

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

  8. Integrating Evidence-Based Practice and Social Work Field Education

    ERIC Educational Resources Information Center

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

    2006-01-01

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

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

    ERIC Educational Resources Information Center

    Annan, Jean

    2005-01-01

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

  10. An Evidence Based Approach to Sepsis: Educational Program

    ERIC Educational Resources Information Center

    Perez, Dolores

    2015-01-01

    Evidence-based guidelines for recognizing and treating sepsis have been available for decades, yet healthcare providers do not adhere to the recommendations. Sepsis can progress rapidly if not recognized early. Literature reports reveal that sepsis is the leading cause of death in non-cardiac intensive care units (ICUs), and it is one of the most…

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

    PubMed

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

    2010-10-01

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

  12. Implementing Evidence-Based Programs: Lessons Learned from the Field

    ERIC Educational Resources Information Center

    Powers, Jane; Maley, Mary; Purington, Amanda; Schantz, Karen; Dotterweich, Jutta

    2015-01-01

    Evidence-based programs (EBPs) are used in many health promotion efforts to ensure that the intended positive behavioral and health outcomes will be achieved. However, because EBPs are developed and tested in research settings, the contextual elements of real world implementation play an important role in their successful delivery in communities.…

  13. Evidence-Based Interprofessional Practice: Learning and Behaviour

    ERIC Educational Resources Information Center

    Littek, Celeste

    2013-01-01

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

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

    PubMed

    Alexandroff, A B; Harman, K E

    2010-08-01

    Summary Evidence-based update meetings are held annually by the Centre of Evidence Based Dermatology, University of Nottingham. Topics are chosen by delegates at the previous year's conference and in the past have included blistering disorders, psoriasis, hair disorders and skin cancers. Once the topic is identified, a trials database search is undertaken with the aim of including speakers who are actively involved in trials that address the subject in question. This year, the eighth Evidence Based Update meeting focused on urticaria and took place in Loughborough University on 14 May 2009. The latest data on the diagnosis and management of acute and chronic urticaria, including cold and solar urticaria, and the impact of food intolerance on chronic urticaria, were presented by an international panel of renowned speakers, who sometimes expressed different viewpoints. The highlights of the meeting included an informal atmosphere, an international perspective, and a practical question and answer session. Over 70% of the delegates stated that they would be changing their clinical practice following on from the meeting. The evidence-based update meeting in 2010 will be devoted to eczema. PMID:20666769

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

    PubMed

    Alexandroff, A B; Harman, K E

    2010-08-01

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

  16. Evidence-Based Practices and Implementation Science in Special Education

    ERIC Educational Resources Information Center

    Cook, Bryan G.; Odom, Samuel L.

    2013-01-01

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

  17. Evidence-Based Practices in Special Education: Some Practical Considerations

    ERIC Educational Resources Information Center

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

    2008-01-01

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

  18. Evidence-Based Practice in Adapted Physical Education

    ERIC Educational Resources Information Center

    Jin, Jooyeon; Yun, Joonkoo

    2010-01-01

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

  19. Evidence-Based Library Management: The Leadership Challenge

    ERIC Educational Resources Information Center

    Lakos, Amos

    2007-01-01

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

  20. Evidence Based Education Request Desk. EBE #833A

    ERIC Educational Resources Information Center

    Regional Educational Laboratory Southeast, 2011

    2011-01-01

    Over the past decade, research on dropout prevention has become focused on using evidence-based practice, and data-driven decisions, to mitigate students' dropping out of high school and instead, support and prepare students for career and college. Early warning systems or on-track indicators, in which readily available student-level data are used…

  1. Evidence-based medicine and the reconfiguration of medical knowledge.

    PubMed

    Timmermans, Stefan; Kolker, Emily S

    2004-01-01

    Over the past decade, different parties in the health care field have developed and disseminated clinical practice guidelines as part of evidence-based medicine. These formal tools based on a scientific evaluation of the research literature purport to tell health care professionals how to practice medicine. Because clinical practice guidelines shift the knowledge base in the health care field through standardization, they remain controversial within and outside medicine. In this paper, we evaluate the predictive accuracy of four medical professionalization theories--functionalism, Freidson's theory of professional dominance, deprofessionalization theory, and the theory of countervailing powers--to account for (1) the shift from pathophysiology to epidemiology with guidelines, (2) the creation of practice guidelines, and (3) the effects of clinical practice guidelines on the autonomy of health professionals. In light of the mixed predictive record of professionalization theories, we conclude with a need for "evidence-based sociology" and a recalibration of basic premises underlying professionalization theories.

  2. Modeling Sensor Reliability in Fault Diagnosis Based on Evidence Theory

    PubMed Central

    Yuan, Kaijuan; Xiao, Fuyuan; Fei, Liguo; Kang, Bingyi; Deng, Yong

    2016-01-01

    Sensor data fusion plays an important role in fault diagnosis. Dempster–Shafer (D-R) evidence theory is widely used in fault diagnosis, since it is efficient to combine evidence from different sensors. However, under the situation where the evidence highly conflicts, it may obtain a counterintuitive result. To address the issue, a new method is proposed in this paper. Not only the statistic sensor reliability, but also the dynamic sensor reliability are taken into consideration. The evidence distance function and the belief entropy are combined to obtain the dynamic reliability of each sensor report. A weighted averaging method is adopted to modify the conflict evidence by assigning different weights to evidence according to sensor reliability. The proposed method has better performance in conflict management and fault diagnosis due to the fact that the information volume of each sensor report is taken into consideration. An application in fault diagnosis based on sensor fusion is illustrated to show the efficiency of the proposed method. The results show that the proposed method improves the accuracy of fault diagnosis from 81.19% to 89.48% compared to the existing methods. PMID:26797611

  3. Modeling Sensor Reliability in Fault Diagnosis Based on Evidence Theory.

    PubMed

    Yuan, Kaijuan; Xiao, Fuyuan; Fei, Liguo; Kang, Bingyi; Deng, Yong

    2016-01-18

    Sensor data fusion plays an important role in fault diagnosis. Dempster-Shafer (D-R) evidence theory is widely used in fault diagnosis, since it is efficient to combine evidence from different sensors. However, under the situation where the evidence highly conflicts, it may obtain a counterintuitive result. To address the issue, a new method is proposed in this paper. Not only the statistic sensor reliability, but also the dynamic sensor reliability are taken into consideration. The evidence distance function and the belief entropy are combined to obtain the dynamic reliability of each sensor report. A weighted averaging method is adopted to modify the conflict evidence by assigning different weights to evidence according to sensor reliability. The proposed method has better performance in conflict management and fault diagnosis due to the fact that the information volume of each sensor report is taken into consideration. An application in fault diagnosis based on sensor fusion is illustrated to show the efficiency of the proposed method. The results show that the proposed method improves the accuracy of fault diagnosis from 81.19% to 89.48% compared to the existing methods.

  4. The role of evidence based medicine in neurotrauma.

    PubMed

    Honeybul, S; Ho, K M

    2015-04-01

    The introduction of evidence based medicine de-emphasised clinical experience and so-called "background information" and stressed the importance of evidence gained from clinical research when making clinical decisions. For many years randomised controlled trials have been seen to be the only way to advance clinical practice, however, applying this methodology in the context of severe trauma can be problematic. In addition, it is increasingly recognised that considerable clinical experience is required in order to critically evaluate the quality of the evidence and the validity of the conclusions as presented. A contemporary example is seen when considering the role of decompressive craniectomy in the management of neurotrauma. Although there is a considerable amount of evidence available attesting to the efficacy of the procedure, considerable clinical expertise is required in order to properly interpret the results of these studies and the implications for clinical practice. Given these limitations the time may have come for a redesign of the traditional pyramid of evidence, to a model that re-emphasises the importance of "background information" such as pathophysiology and acknowledges the role of clinical experience such that the evidence can be critically evaluated in its appropriate context and the subsequent implications for clinical practice be clearly and objectively defined.

  5. An Evidence-Based Combining Classifier for Brain Signal Analysis

    PubMed Central

    Kheradpisheh, Saeed Reza; Nowzari-Dalini, Abbas; Ebrahimpour, Reza; Ganjtabesh, Mohammad

    2014-01-01

    Nowadays, brain signals are employed in various scientific and practical fields such as Medical Science, Cognitive Science, Neuroscience, and Brain Computer Interfaces. Hence, the need for robust signal analysis methods with adequate accuracy and generalizability is inevitable. The brain signal analysis is faced with complex challenges including small sample size, high dimensionality and noisy signals. Moreover, because of the non-stationarity of brain signals and the impacts of mental states on brain function, the brain signals are associated with an inherent uncertainty. In this paper, an evidence-based combining classifiers method is proposed for brain signal analysis. This method exploits the power of combining classifiers for solving complex problems and the ability of evidence theory to model as well as to reduce the existing uncertainty. The proposed method models the uncertainty in the labels of training samples in each feature space by assigning soft and crisp labels to them. Then, some classifiers are employed to approximate the belief function corresponding to each feature space. By combining the evidence raised from each classifier through the evidence theory, more confident decisions about testing samples can be made. The obtained results by the proposed method compared to some other evidence-based and fixed rule combining methods on artificial and real datasets exhibit the ability of the proposed method in dealing with complex and uncertain classification problems. PMID:24392125

  6. Global health: the importance of evidence-based medicine

    PubMed Central

    2013-01-01

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

  7. Global health: the importance of evidence-based medicine.

    PubMed

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

    2013-01-01

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

  8. An Evidence Base for Human Spaceflight Risks in Wikipedia

    NASA Technical Reports Server (NTRS)

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

    2013-01-01

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

  9. [Integrating complementary medicines into care].

    PubMed

    Graz, Bertrand

    2016-04-01

    More and more research is being carried out into complementary medicines. It is no longer possible to say that these treatments have no scientific basis, as for some, their efficacy has been proven by clinical studies. Health services must move beyond ideological arguments and integrate safe and cost-effective complementary medicines.

  10. [Integrating complementary medicines into care].

    PubMed

    Graz, Bertrand

    2016-04-01

    More and more research is being carried out into complementary medicines. It is no longer possible to say that these treatments have no scientific basis, as for some, their efficacy has been proven by clinical studies. Health services must move beyond ideological arguments and integrate safe and cost-effective complementary medicines. PMID:27063880

  11. Evidence-based management of developmental dysplasia of the hip.

    PubMed

    Cooper, Anthony Philip; Doddabasappa, Siddesh Nandi; Mulpuri, Kishore

    2014-07-01

    Developmental Dysplasia of the Hip (DDH) refers to a spectrum of abnormalities involving the developing hip. These abnormalities range from mild instability to frank dislocation of the joint. It is important to treat the condition effectively in order to encourage the hip to develop normally and produce good long-term results. This article reviews the evidence related to the treatment of DDH. The quality of evidence for DDH management remains low, with little uniformity in terminology and most studies being retrospective in nature. Given this, it is not possible to recommend or reject most treatment modalities based on existing studies. PMID:24975762

  12. Strengthening the evidence base for health programming in humanitarian crises.

    PubMed

    Ager, A; Burnham, G; Checchi, F; Gayer, M; Grais, R F; Henkens, M; Massaquoi, M B F; Nandy, R; Navarro-Colorado, C; Spiegel, P

    2014-09-12

    Given the growing scale and complexity of responses to humanitarian crises, it is important to develop a stronger evidence base for health interventions in such contexts. Humanitarian crises present unique challenges to rigorous and effective research, but there are substantial opportunities for scientific advance. Studies need to focus where the translation of evidence from noncrisis scenarios is not viable and on ethical ways of determining what happens in the absence of an intervention. Robust methodologies suited to crisis settings have to be developed and used to assess interventions with potential for delivery at scale. Strengthening research capacity in the low- to middle-income countries that are vulnerable to crises is also crucial.

  13. Colonoscopy Comfort: An Evidence-Based Practice Project.

    PubMed

    McCommons, Robin; Wheeler, Megan; Houston, Susan

    2016-01-01

    Decreased discomfort after colonoscopy is a high priority for patients. Typically, air is used to insufflate the bowel during colonoscopy, but emerging literature shows that carbon dioxide insufflation decreases postoperative discomfort and flatus. An evidence-based practice project was developed and implemented by a surgical department at a community hospital. The Director of Surgical Services brought the evidence to the staff, secured agreement from a physician champion, and the new process was quickly adopted. Patients experienced less discomfort and flatus postprocedure with carbon dioxide insufflation, and were able to be discharged expediently. These patient outcomes validated the literature and confirmed the success of the practice change.

  14. How Quality Improvement Practice Evidence Can Advance the Knowledge Base.

    PubMed

    OʼRourke, Hannah M; Fraser, Kimberly D

    2016-01-01

    Recommendations for the evaluation of quality improvement interventions have been made in order to improve the evidence base of whether, to what extent, and why quality improvement interventions affect chosen outcomes. The purpose of this article is to articulate why these recommendations are appropriate to improve the rigor of quality improvement intervention evaluation as a research endeavor, but inappropriate for the purposes of everyday quality improvement practice. To support our claim, we describe the differences between quality improvement interventions that occur for the purpose of practice as compared to research. We then carefully consider how feasibility, ethics, and the aims of evaluation each impact how quality improvement interventions that occur in practice, as opposed to research, can or should be evaluated. Recommendations that fit the evaluative goals of practice-based quality improvement interventions are needed to support fair appraisal of the distinct evidence they produce. We describe a current debate on the nature of evidence to assist in reenvisioning how quality improvement evidence generated from practice might complement that generated from research, and contribute in a value-added way to the knowledge base. PMID:27584696

  15. Evidence-based Medicine Search: a customizable federated search engine

    PubMed Central

    Bracke, Paul J.; Howse, David K.; Keim, Samuel M.

    2008-01-01

    Purpose: This paper reports on the development of a tool by the Arizona Health Sciences Library (AHSL) for searching clinical evidence that can be customized for different user groups. Brief Description: The AHSL provides services to the University of Arizona's (UA's) health sciences programs and to the University Medical Center. Librarians at AHSL collaborated with UA College of Medicine faculty to create an innovative search engine, Evidence-based Medicine (EBM) Search, that provides users with a simple search interface to EBM resources and presents results organized according to an evidence pyramid. EBM Search was developed with a web-based configuration component that allows the tool to be customized for different specialties. Outcomes/Conclusion: Informal and anecdotal feedback from physicians indicates that EBM Search is a useful tool with potential in teaching evidence-based decision making. While formal evaluation is still being planned, a tool such as EBM Search, which can be configured for specific user populations, may help lower barriers to information resources in an academic health sciences center. PMID:18379665

  16. Management of fibromyalgia syndrome--an interdisciplinary evidence-based guideline.

    PubMed

    Häuser, Winfried; Arnold, Bernhard; Eich, Wolfgang; Felde, Eva; Flügge, Christl; Henningsen, Peter; Herrmann, Markus; Köllner, Volker; Kühn, Edeltraud; Nutzinger, Detlev; Offenbächer, Martin; Schiltenwolf, Marcus; Sommer, Claudia; Thieme, Kati; Kopp, Ina

    2008-12-09

    The prevalence of fibromyalgia syndrome (FMS) of 1-2% in the general population associated with high disease-related costs and the conflicting data on treatment effectiveness had led to the development of evidence-based guidelines designed to provide patients and physicians guidance in selecting among the alternatives. Until now no evidence-based interdisciplinary (including patients) guideline for the management of FMS was available in Europe. Therefore a guideline for the management of fibromyalgia syndrome (FMS) was developed by 13 German medical and psychological associations and two patient self-help organisations. The task was coordinated by two German scientific umbrella organisations, the Association of the Scientific Medical Societies in Germany AWMF and the German Interdisciplinary Association of Pain Therapy DIVS. A systematic search of the literature including all controlled studies, systematic reviews and meta-analyses of pharmacological and non-pharmacological treatments of FMS was performed in the Cochrane Library (1993-12/2006), Medline (1980-12/2006), PsychInfo (1966-12/2006) and Scopus (1980-12/ 2006). Levels of evidence were assigned according to the classification system of the Oxford-Centre for Evidence Based Medicine. Grading of the strengths of recommendations was done according to the German program for disease management guidelines. Standardized procedures were used to reach a consensus on recommendations. The guideline was reviewed and finally approved by the boards of the societies involved and published online by the AWMF on april 25, 2008: http://www.uni-duesseldorf.de/AWMF/ll/041-004.htm. A short version of the guideline for patients is available as well: http://www.uni-duesseldorf.de/AWMF/ll/041-004p.htm. The following procedures in the management of fms were strongly recommended: information on diagnosis and therapeutic options and patient-centered communication, aerobic exercise, cognitive and operant behavioural therapy

  17. Evidence-Based Assessment of Obsessive-Compulsive Disorder.

    PubMed

    Rapp, Amy M; Bergman, R Lindsay; Piacentini, John; McGuire, Joseph F

    2016-01-01

    Obsessive-compulsive disorder (OCD) is a neuropsychiatric illness that often develops in childhood, affects 1%-2% of the population, and causes significant impairment across the lifespan. The first step in identifying and treating OCD is a thorough evidence-based assessment. This paper reviews the administration pragmatics, psychometric properties, and limitations of commonly used assessment measures for adults and youths with OCD. This includes diagnostic interviews, clinician-administered symptom severity scales, self-report measures, and parent/child measures. Additionally, adjunctive measures that assess important related factors (ie, impairment, family accommodation, and insight) are also discussed. This paper concludes with recommendations for an evidence-based assessment based on individualized assessment goals that include generating an OCD diagnosis, determining symptom severity, and monitoring treatment progress. PMID:27594793

  18. Evidence-Based Assessment of Obsessive–Compulsive Disorder

    PubMed Central

    Rapp, Amy M.; Bergman, R. Lindsay; Piacentini, John; McGuire, Joseph F.

    2016-01-01

    Obsessive–compulsive disorder (OCD) is a neuropsychiatric illness that often develops in childhood, affects 1%–2% of the population, and causes significant impairment across the lifespan. The first step in identifying and treating OCD is a thorough evidence-based assessment. This paper reviews the administration pragmatics, psychometric properties, and limitations of commonly used assessment measures for adults and youths with OCD. This includes diagnostic interviews, clinician-administered symptom severity scales, self-report measures, and parent/child measures. Additionally, adjunctive measures that assess important related factors (ie, impairment, family accommodation, and insight) are also discussed. This paper concludes with recommendations for an evidence-based assessment based on individualized assessment goals that include generating an OCD diagnosis, determining symptom severity, and monitoring treatment progress.

  19. Evidence-based health information and risk competence

    PubMed Central

    Mühlhauser, Ingrid; Albrecht, Martina; Steckelberg, Anke

    2015-01-01

    Consumers and patients want to be included in decisions regarding their own health and have an ethically justified claim on informed decisions. Therefore, sound information is required, but health information is often misleading and based on different interests. The risks of disease and the benefits of medical interventions tend to be overestimated, whereas harm is often underestimated. Evidence-based health information has to fulfil certain criteria, for instance, it should be evidence-based, independent, complete, true as well as understandable. The aim of a medical intervention has to be explained. The different therapeutic options including the option not to intervene have to be delineated. The probabilities for success, lack of success and unwanted side effects have to be communicated in a numerical and understandable manner. Patients have the right to reject medical interventions without any sanctions. PMID:26195924

  20. Evidence-Based Behavioral Interventions for Repetitive Behaviors in Autism

    PubMed Central

    McDonough, Stephen G.; Bodfish, James W.

    2013-01-01

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

  1. Evidence-based orthopedic surgery: is it possible?

    PubMed

    Suk, Michael; Hanson, Beate; Helfet, David L

    2010-04-01

    The promise of evidence-based medicine is to integrate the highest levels of clinical data with patient outcomes. After framing the question and identifying appropriate studies, evaluating their relevance to clinical practice is highly dependent on the instruments and measures selected to demonstrate outcomes. Currently, there are hundreds of outcomes measures available in the orthopedic literature evaluating these treatments, and it is not uncommon for different measures to produce conflicting results. Consequently, the ability to evaluate an outcomes measure is critical in determining the value of a specific treatment intervention. Similarly, selecting the appropriate outcomes measure for research or clinical purposes is an important decision that may have far reaching implications on reimbursement, surgeon reputation, and patient treatment success. Evidence-based orthopedic surgery is indeed possible, but demands a detailed understanding of why appropriate outcomes selection is important, the difference between clinician-based and patient-reported outcomes (PROs), and potential future directions in orthopedics outcomes research. PMID:20399353

  2. Evidence-Based Assessment of Obsessive–Compulsive Disorder

    PubMed Central

    Rapp, Amy M.; Bergman, R. Lindsay; Piacentini, John; McGuire, Joseph F.

    2016-01-01

    Obsessive–compulsive disorder (OCD) is a neuropsychiatric illness that often develops in childhood, affects 1%–2% of the population, and causes significant impairment across the lifespan. The first step in identifying and treating OCD is a thorough evidence-based assessment. This paper reviews the administration pragmatics, psychometric properties, and limitations of commonly used assessment measures for adults and youths with OCD. This includes diagnostic interviews, clinician-administered symptom severity scales, self-report measures, and parent/child measures. Additionally, adjunctive measures that assess important related factors (ie, impairment, family accommodation, and insight) are also discussed. This paper concludes with recommendations for an evidence-based assessment based on individualized assessment goals that include generating an OCD diagnosis, determining symptom severity, and monitoring treatment progress. PMID:27594793

  3. An evidence-based review of dental matrix systems.

    PubMed

    Owens, Barry M; Phebus, Jeffrey G

    2016-01-01

    The restoration of proximal surface cavities, originating from Class II carious lesions, to "normal" anatomical specifications is a fundamental objective for the dental practitioner. Cognitive interpretation of tooth morphology attained from evidence-based resources, together with the necessary psychomotor skills for correct design and completion, are considered essential strategies for restoration success. Also, the visualization of the original tooth structure, if present, should substantially benefit the dentist in the creation of a clinically satisfactory restoration. The purpose of this evidence-based review is to define the cause and effect of decisions based on optimum treatment standards of care for the patient. The concepts of form and function, as related to the oral environment, and the consequences of unsatisfactory dental restorative care will be scrutinized. This article will identify and explain the different challenges and solutions for restoration of dental proximal lesions and provide an overview of past, present, and future procedures. PMID:27599285

  4. The relationship between fifth grade students' Understandings about Evidence-Based Explanations and their Abilities to Develop Evidence-Based Explanations

    NASA Astrophysics Data System (ADS)

    Ko, Eun Kyung

    The purpose of this study was to investigate how fifth grade students' abilities to develop evidence-based explanations are related to their understandings about evidence-based explanations. A total of 97 fifth graders' understandings about evidence-based explanations and their abilities to develop evidence-based explanations were examined by two open-ended questionnaires and follow-up interviews. The Understandings about Evidence-Based Explanations (UEBE) and the Abilities to Develop Evidence-Based Explanations (ADEE) were developed by the researcher and content validity and face validity were established. Data analysis involved a systematic process consistent with analytic induction as well as a statistical analysis. The patterns from students' understandings about evidence-based explanations and abilities to develop evidence-based explanations were explored and the relationship between understandings and abilities were examined by Fisher's Exact test at the .05 level of significance. Results indicated that there was no relationship between students' understandings about evidence-based explanations and their abilities to develop evidence-based explanations (p>.05). The results of this study do not support the appealing assumption held by many science educators that students' inquiry skills reflect their understandings about scientific inquiry. Instead, the findings suggest that students' understandings about evidence-based explanations should be assessed separately and students' abilities to develop evidence-based explanations should not be inferred by their understandings about evidence-based explanations. Overall, students' understandings about evidence-based explanations were not well developed compared to their abilities to develop evidence-based explanations. Therefore, it is necessary for science educators to teach both understandings about evidence-based explanations and abilities to develop evidence-based explanations.

  5. Pulmonary Metastasectomy: A Common Practice Based on Weak Evidence

    PubMed Central

    Treasure, Tom

    2007-01-01

    The resection of secondary metastases from the lungs is a wide-spread surgical practice. Patients are referred from coloproctology teams to thoracic surgeons specifically for this surgery. What is the expected benefit? I have explored the rationale and searched the literature in order to present these patients with a well-informed opinion for their consideration. I find only weak evidence based on uncontrolled retrospective series which have been interpreted as showing a survival benefit. This has been extrapolated to policy and practice that do not stand up to scrutiny. The practice has never been subjected to randomised trial and I will argue that the present evidence is insufficient to justify the uncontrolled use of an intervention with inescapable short-term morbidity, permanent loss of function, and major cost implications. I propose ways in which the evidence may be improved, including a trial in the areas of most uncertainty. PMID:17999813

  6. Neonatal Plasma Transfusion: An Evidence-Based Review.

    PubMed

    Keir, Amy K; Stanworth, Simon J

    2016-10-01

    Several clinical scenarios for plasma transfusion are repeatedly identified in audits, including treatment of bleeding in association with laboratory evidence of coagulopathy, correction of disseminated intravascular coagulation, prevention of intraventricular hemorrhage, management of critically ill neonates (eg, during sepsis or as a volume expander), or correction of markers of prolonged coagulation in the absence of bleeding. The findings of at least one national audit of transfusion practice indicated that almost half of plasma transfusions are given to neonates with abnormal coagulation values with no evidence of active bleeding, despite the limited evidence base to support the effectiveness of this practice. Plasma transfusions to neonates should be considered in the clinical context of bleeding (eg, vitamin K dependent), disseminated intravascular coagulation, and very rare inherited deficiencies of coagulation factors. There seems to be no role for prophylactic plasma to prevent intraventricular hemorrhage or for use as a volume expander. PMID:27473518

  7. Strengths and limitations of evidence-based dermatology.

    PubMed

    Williams, Hywel C

    2014-03-01

    The need for understanding and reflecting on evidence-based dermatology (EBD) has never been greater given the exponential growth of new external evidence to inform clinical practice. Like any other branch of medicine, dermatologists need to acquire new skills in constructing answerable questions, efficiently searching electronic bibliographic databases, and critically appraising different types of studies. Secondary summaries of evidence in the form of systematic reviews (SR), that is, reviews that are conducted in a systematic, unbiased and explicit manner, reside at the top of the evidence hierarchy, because they are less prone to bias than traditional expert reviews. In addition to providing summaries of the best external evidence, systematic reviews and randomized controlled trials (RCTs) are also powerful ways of identifying research gaps and ultimately setting the agenda of future clinical research in dermatology. But like any paradigm, EBD can have its limitations. Wrong application, misuse and overuse of EBD can have serious consequences. For example, mindless pooling together of data from dissimilar studies in a meta-analysis may render it a form of reductionism that does not make any sense. Similarly, even highly protocolised study designs such as SRs and RCTs are still susceptible to some degree of dishonesty and bias. Over-reliance on randomized controlled trials (RCT) may be inappropriate, as RCTs are not a good source for picking up rare but important adverse effects such as lupus syndrome with minocycline. A common criticism leveled against SRs is that these frequently conclude that there is lack of sufficient evidence to inform current clinical practice, but arguably, such a perception is grounded more on the interpretation of the SRs than anything else. The apparent absence of evidence should not paralyze the dermatologist to adopt a state of therapeutic nihilism. Poor primary data and an SR based on evidence that is not up-to-date are also

  8. Strengths and Limitations of Evidence-Based Dermatology

    PubMed Central

    Williams, Hywel C

    2014-01-01

    The need for understanding and reflecting on evidence-based dermatology (EBD) has never been greater given the exponential growth of new external evidence to inform clinical practice. Like any other branch of medicine, dermatologists need to acquire new skills in constructing answerable questions, efficiently searching electronic bibliographic databases, and critically appraising different types of studies. Secondary summaries of evidence in the form of systematic reviews (SR), that is, reviews that are conducted in a systematic, unbiased and explicit manner, reside at the top of the evidence hierarchy, because they are less prone to bias than traditional expert reviews. In addition to providing summaries of the best external evidence, systematic reviews and randomized controlled trials (RCTs) are also powerful ways of identifying research gaps and ultimately setting the agenda of future clinical research in dermatology. But like any paradigm, EBD can have its limitations. Wrong application, misuse and overuse of EBD can have serious consequences. For example, mindless pooling together of data from dissimilar studies in a meta-analysis may render it a form of reductionism that does not make any sense. Similarly, even highly protocolised study designs such as SRs and RCTs are still susceptible to some degree of dishonesty and bias. Over-reliance on randomized controlled trials (RCT) may be inappropriate, as RCTs are not a good source for picking up rare but important adverse effects such as lupus syndrome with minocycline. A common criticism leveled against SRs is that these frequently conclude that there is lack of sufficient evidence to inform current clinical practice, but arguably, such a perception is grounded more on the interpretation of the SRs than anything else. The apparent absence of evidence should not paralyze the dermatologist to adopt a state of therapeutic nihilism. Poor primary data and an SR based on evidence that is not up-to-date are also

  9. The need for evidence-based, non-drug medicine.

    PubMed

    Ventegodt, Søren; Orr, Gary; Merrick, Joav

    2012-01-01

    Evidence-based medicine (EBM) is defined as "the integration of best research evidence with clinical expertise and patient values." EBM is based on three equally important key factors: i) the best available scientific evidence; ii) the physician's experience and intuition; and, iii) the preferences and values of the patient. EBM uses a hierarchy of evidence and critical appraisal of the sources, which makes it possible to balance high quality evidence with documented effectiveness. A treatment that is more safe and effective, but less well documented may very well be the treatment of choice. Ethics (not putting the patient at risk of harm with a treatment if this can be avoided at all) is an important part of EBM. Many pharmaceutical drugs have a number needed to treat (NNT) of approximately 20 [NNT=20, confidence interval CI (5-50)] and the number needed to harm is less well understood and documented. The adverse effect profile of pharmacological agents can be more harmful than non-drug medicine. Most EBM-treatments are likely to be non-drug treatments in the future. There are six steps to the practice of EBM: i) the patients and the physician must work together to define the problem; ii) the patients and the physician must explore the patient's values and preferences; iii) the information about the possible alternative medical interventions must be discussed and critically appraised; iv) the best, relevant evidence must be applied to the patient as a treatment or cure; v) together, the patient and the physician must evaluate how useful the intervention was; and vi) if the intervention did not help sufficiently, the process must begin again. In this review, we explain, in our opinion, how non-drug EBM should be practiced. PMID:22909920

  10. Evidence-based surgery – evidence from survey and citation analysis in orthopaedic surgery

    PubMed Central

    Kumar, Malhar; Gopalakrishna, Chethan; Swaminath, Pazhayannur V; Mysore, Sanjay S

    2010-01-01

    INTRODUCTION The results of a survey on evidence-based surgery (EBS) among members of the American Academy of Orthopedic Surgeons (AAOS) and the British Orthopaedic Association (BOA) are presented. The study also analyzes the citations earned by articles with different levels of evidence (LOE) to see if LOE have any bearing on the importance attached to the articles by authors and contributors to the journals. SUBJECTS AND METHODS The questionnaire was e-mailed to 1000 randomly chosen consultant orthopaedic surgeons who were members of either the AAOS or the BOA. Participants were provided with the option of responding through web-based entry. For citation analysis, citation data were gathered from the Journal of Bone and Joint Surgery (American volume) between the years 2003 and 2007 (5-year period). RESULTS The survey showed that awareness and access to EBS have improved greatly over the years. At the present time, these factors are not important barriers to the implementation of EBS in clinical practice in developed countries. There was a statistically significant difference in those with and without additional qualifications with regard to the approach to EBS. However, an equal percentage of surgeons with and without additional qualifications felt that it was difficult to adhere to EBS guidelines in daily clinical practice. Citation analysis showed that readers of professional journals attach importance to LOE category of the article and tend to cite level-I evidence articles more than other articles. PMID:21073824

  11. Evidence-based medicine: what is the evidence that it has made a difference?

    PubMed

    McQuay, Henry

    2011-07-01

    Evidence-based medicine (EBM) has, over the past 20 years, made us all more critical in our thinking about the efficacy and safety of interventions. This is evident in the higher standards of our spoken and written work, formal and informal, and in our approach to the subject. The downside has been the coincidence of the squeeze on healthcare funding with the emergence of the EBM ideas - it has been all too easy to misuse the tools of EBM to deny patients access to treatment, and this, together with the off-putting political correctness of the EBM approach in some quarters, has made clinicians uneasy. Clinicians have to make decisions about therapy for the individual patient. Ideally this is guided by the best available evidence and their experience. EBM can guide one as to the population efficacy and safety of a particular intervention, but as we all know few patients are average. That guidance can only be given if there is adequate evidence, and the difficulty with guidance about symptom control is often the paucity of evidence of sufficient quality to yield credible guidance. Palliative care is often a 'complex intervention', and here EBM struggles to untangle which components, if any, of the complex interventions are important. The trial and review methodologies for complex intervention are wanting. Tom Chalmers, a grandfather of the EBM movement, argued late in his career that the most important function of the EBM approach was to frame the research agenda. This we think is correct. The process of systematic review of a topic throws up the deficits in trial methods and the lacunae in the data, and this then can show the way forward.

  12. [Complementary and alternative medicine for insomnia].

    PubMed

    Yamashita, Hidehisa; Machino, Akihiko; Shishida, Kazuhiro; Yoshino, Atsuo; Yamawaki, Shigeto

    2015-06-01

    Frequency of insomnia is increasing with age. Benzodiazepine receptor agonist has been prescribed for insomnia in the elderly, but there are some patients who complain the effect is not sufficient. Adherence for sleeping pills is very low in elderly Japanese, because there has been strong stigma against sleeping pills. Complementary and alternative medicine for insomnia is widely used in elderly Japanese. Sedative antidepressants, novel antipsychotics, anti-histamine drugs, and supplements are used for insomnia as complementary and alternative medicine. But evidence of these drugs for insomnia is insufficient. In this paper, we outline the previous reports such as the advantages and disadvantages of these drugs for the treatment of insomnia in the elderly. PMID:26065137

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

    PubMed Central

    Havlickova, B; Weyandt, G H

    2014-01-01

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

  14. Evidence-based guideline update: Plasmapheresis in neurologic disorders

    PubMed Central

    Cortese, I.; Chaudhry, V.; So, Y.T.; Cantor, F.; Cornblath, D.R.; Rae-Grant, A.

    2011-01-01

    Objective: To reassess the role of plasmapheresis in the treatment of neurologic disorders. Methods: We evaluated the available evidence based on a structured literature review for relevant articles from 1995 through September 2009. In addition, due to revision of the definitions of classification of evidence since the publication of the previous American Academy of Neurology assessment in 1996, the evidence cited in that manuscript was reviewed and reclassified. Results and Recommendations: Plasmapheresis is established as effective and should be offered in severe acute inflammatory demyelinating polyneuropathy (AIDP)/Guillain-Barré syndrome (GBS) and in the short-term management of chronic inflammatory demyelinating polyneuropathy (Class I studies, Level A). Plasmapheresis is established as ineffective and should not be offered for chronic or secondary progressive multiple sclerosis (MS) (Class I studies, Level A). Plasmapheresis is probably effective and should be considered for mild AIDP/GBS, as second-line treatment of steroid-resistant exacerbations in relapsing forms of MS, and for neuropathy associated with immunoglobulin A or immunoglobulin G gammopathy, based on at least one Class I or 2 Class II studies (Level B). Plasmapheresis is probably not effective and should not be considered for neuropathy associated with immunoglobulin M gammopathy, based on one Class I study (Level B). Plasmapheresis is possibly effective and may be considered for acute fulminant demyelinating CNS disease (Level C). There is insufficient evidence to support or refute the use of plasmapheresis for myasthenia gravis, pediatric autoimmune neuropsychiatric disorders associated with streptococcus infection, and Sydenham chorea (Class III evidence, Level U). PMID:21242498

  15. Paving the way for evidence-based medicine in Pakistan.

    PubMed

    Zaidi, Zareen; Hashim, Jawad; Iqbal, Mobeen; Quadri, K Mujtaba

    2007-11-01

    Evidence-based Medicine (EBM) is the process of systematically reviewing, appraising and using clinical research findings to aid the delivery of optimal clinical care to patients. EBM has become popular due to: the need for valid information about diagnosis, prognosis, therapy and prevention during patient care; traditional sources such as textbooks and expert opinion being frequently out-of-date; and knowledge of current best evidence declining with time from graduation from medical college. EBM has become feasible for practicing clinicians due to: new strategies for appraising studies; availability of systematic reviews (summaries) of current best evidence; and information technology (computers with Internet access). In a resource-limited country such as Pakistan, an evidence-based approach can be cost-effective by reducing clinical practices that have no proven benefit. Commonly perceived obstacles to EBM include limited access to computers, the Internet and online resources. Reliable resources of EBM are available (such as The Cochrane Database of Systematic Reviews http://www.cochrane.org) although many of these require paid subscriptions. Another difficulty is the issue of applicability of data from other countries to patients in our setting with different socio-economic factors. Other barriers to EBM in developing countries include: inexperience in small-group learning, limited time to attend workshops, and the lack of role models for practicing EBM. We have also tried to address the common fallacies related to EBM in the hope of greater use of these skills by busy clinicians as well as academic researchers. PMID:18062522

  16. Continuing to challenge practice to be evidence based.

    PubMed

    Makic, Mary Beth Flynn; Rauen, Carol; Jones, Kimmith; Fisk, Anna C

    2015-04-01

    Practice habits continue in clinical practice despite the availability of research and other forms of evidence that should be used to guide critical care practice interventions. This article is based on a presentation at the 2014 National Teaching Institute of the American Association of Critical-Care Nurses. The article is part of a series of articles that challenge critical care nurses to examine the evidence guiding nursing practice interventions. Four common practice interventions are reviewed: (1) weight-based medication administration, (2) chest tube patency maintenance, (3) daily interruption of sedation, and (4) use of chest physiotherapy in children. For weight-based administration of medication, the patient's actual weight should be measured, rather than using an estimate. The therapeutic effectiveness and dosages of medications used in obese patients must be critically evaluated. Maintaining patency of chest tubes does not require stripping and milking, which probably do more harm than good. Daily interruption of sedation and judicious use of sedatives are appropriate in most patients receiving mechanical ventilation. Traditional chest physiotherapy does not help children with pneumonia, bronchiolitis, or asthma and does not prevent atelectasis after extubation. Critical care nurses are challenged to evaluate their individual practice and to adopt current evidence-based practice interventions into their daily practice. PMID:25834007

  17. Management of REM sleep behavior disorder: An evidence based review

    PubMed Central

    Devnani, Preeti; Fernandes, Racheal

    2015-01-01

    Rapid eye movement (REM) sleep behavior disorder (RBD) is characterized by dream enactment behavior resulting from a loss of REM skeletal muscle atonia. The neurobiology of REM sleep and the characteristic features of REM atonia have an important basis for understanding the aggravating etiologies the proposed pharmacological interventions in its management. This review outlines the evidence for behavioral and therapeutic measures along with evidence-based guidelines for their implementation, impact on falls, and effect on polysomnography (PSG) while highlighting the non-motor, autonomic, and cognitive impact of this entity. PubMed databases were reviewed upto May 2013 in peer-reviewed scientific literature regarding the pathophysiology and management of RBD in adults. The literature was graded according to the Oxford centre of evidence-based Medicine Levels. An early intervention that helps prevent consequences such as falls and provides a base for intervention with neuroprotective mechanisms and allocates a unique platform that RBD portrays with its high risk of disease conversion with a sufficiently long latency. RBD provides a unique platform with its high risk of disease conversion with a sufficiently long latency, providing an opportunity for early intervention both to prevent consequences such as falls and provide a base for intervention with neuroprotective mechanisms. PMID:25745301

  18. High-Performance Non-Fullerene Polymer Solar Cells Based on a Pair of Donor-Acceptor Materials with Complementary Absorption Properties.

    PubMed

    Lin, Haoran; Chen, Shangshang; Li, Zhengke; Lai, Joshua Yuk Lin; Yang, Guofang; McAfee, Terry; Jiang, Kui; Li, Yunke; Liu, Yuhang; Hu, Huawei; Zhao, Jingbo; Ma, Wei; Ade, Harald; Yan, He

    2015-12-01

    A 7.3% efficiency non-fullerene polymer solar cell is realized by combining a large-bandgap polymer PffT2-FTAZ-2DT with a small-bandgap acceptor IEIC. The complementary absorption of donor polymer and small-molecule acceptor is responsible for the high-performance of the solar-cell device. This work provides important guidance to improve the performance of non-fullerene polymer solar cells.

  19. Review complementary and integrative interventions for cancer-related cognitive changes

    PubMed Central

    Myers, Jamie S.

    2015-01-01

    Cognitive sequelae from a diagnosis of cancer and the subsequent treatment impact survivors’ quality of life and can interfere with both social relationships and employment. The search for evidence-based prevention and intervention strategies continues for both central nervous system (CNS) and non-CNS cancer-related cognitive changes. Complementary therapies in conjunction with conventional medicine are being included in integrative programs designed to maximize symptom management in cancer treatment centers providing survivorship care. The purpose of this article is to review the existing evidence for the use of complementary and integrative interventions to prevent or treat cancer-related cognitive changes and to discuss the rationale for current and future research. Search terminology included: Complementary, alternative, and integrative medicine, cognition, cognitive function, and cancer, and yielded 20 studies that met criteria for inclusion. Preliminary results published to date indicate that some complementary therapies may be beneficial to cancer survivors experiencing cognitive concerns. A number of gaps in the literature remain primarily due to preliminary study designs, small sample sizes, lack of objective cognitive testing, and cognitive function not being a primary endpoint for much of the published work. PMID:26719850

  20. Complementary therapies for acne vulgaris

    PubMed Central

    Cao, Huijuan; Yang, Guoyan; Wang, Yuyi; Liu, Jian Ping; Smith, Caroline A; Luo, Hui; Liu, Yueming

    2015-01-01

    Background Acne is a chronic skin disease characterised by inflamed spots and blackheads on the face, neck, back, and chest. Cysts and scarring can also occur, especially in more severe disease. People with acne often turn to complementary and alternative medicine (CAM), such as herbal medicine, acupuncture, and dietary modifications, because of their concerns about the adverse effects of conventional medicines. However, evidence for CAM therapies has not been systematically assessed. Objectives To assess the effects and safety of any complementary therapies in people with acne vulgaris. Search methods We searched the following databases from inception up to 22 January 2014: the Cochrane Skin Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL; 2014, Issue 1), MEDLINE (from 1946), Embase (from 1974), PsycINFO (from 1806), AMED (from 1985), CINAHL (from 1981), Scopus (from 1966), and a number of other databases listed in the Methods section of the review. The Cochrane CAM Field Specialised Register was searched up to May 2014. We also searched five trials registers and checked the reference lists of articles for further references to relevant trials. Selection criteria We included parallel-group randomised controlled trials (or the first phase data of randomised cross-over trials) of any kind of CAM, compared with no treatment, placebo, or other active therapies, in people with a diagnosis of acne vulgaris. Data collection and analysis Three authors collected data from each included trial and evaluated the methodological quality independently. They resolved disagreements by discussion and, as needed, arbitration by another author. Main results We included 35 studies, with a total of 3227 participants. We evaluated the majority as having unclear risk of selection, attrition, reporting, detection, and other biases. Because of the clinical heterogeneity between trials and the incomplete data reporting, we could only include four

  1. Standardized Nursing Documentation Supports Evidence-Based Nursing Management.

    PubMed

    Mykkänen, Minna; Miettinen, Merja; Saranto, Kaija

    2016-01-01

    Nursing documentation is crucial to high quality, effective and safe nursing care. According to earlier studies nursing documentation practices vary and nursing classifications used in electronic patient records (EPR) are not yet standardized internationally nor nationally. A unified national model for documenting patient care improves information flow in nursing practice, management, research and development toward evidence-based nursing care. Nursing documentation quality, accuracy and development requires follow-up and evaluation. An audit instrument is used in the Kuopio University Hospital (KUH) when evaluating nursing documentation. The results of the auditing process suggest that the national nursing documentation model fulfills nurses' expectations of electronic tools, facilitating their important documentation duty. This paper discusses the importance of using information about nursing documentation and how we can take advantage of structural information in evidence-based nursing management. PMID:27332244

  2. Factors that influence effective evidence-based medicine instruction.

    PubMed

    Mi, Misa

    2013-01-01

    Evidence-based medicine (EBM) as a health care practice is being incorporated into education programs across the spectrum of medical education to develop lifelong learning skills and to enhance the practice of evidence-based health care. Since improving the quality of patient care is the ultimate goal of EBM, EBM learning must be integrated with clinical application, and resulted outcomes must be reflected in learning transfer (or EBM practice) within the context of solving patient problems. Different factors may constitute the context or environment in which EBM is learned, practiced, and sustained. However, these contextual factors are seldom considered and examined in the development, implementation, and evaluation of EBM instruction for learners at different levels. This article will introduce several contextual factors as tips and strategies that affect EBM learning and transfer. Also included in the article are recommended practices for designing effective EBM instruction that would contribute to a sustainable change in learner behavior. PMID:24180650

  3. Evidence-Based Staff Training: A Guide for Practitioners

    PubMed Central

    Parsons, Marsha B.; Rollyson, Jeannia H.; Reid, Dennis H.

    2012-01-01

    Behavior analysts in human service agencies are commonly expected to train support staff as one of their job duties. Traditional staff training is usually didactic in nature and generally has not proven particularly effective. We describe an alternative, evidence-based approach for training performance skills to human service staff. The description includes a specific means of conducting a behavioral skills training session with a group of staff followed by on-the-job training requirements. A brief case demonstration then illustrates application of the training approach and its apparent effectiveness for training staff in two distinct skill sets: use of most-to-least prompting within teaching procedures and use of manual signs. Practical issues associated with applying evidence-based behavioral training are presented with a focus on providing training that is effective, efficient, and acceptable to staff trainees. PMID:23730462

  4. Evidence-Based Ethics for Neurology and Psychiatry Research

    PubMed Central

    Kim, Scott Y. H.

    2004-01-01

    Summary: American bioethics, historically arising out of theology and philosophy, has been dominated by the method of normative analysis. Ethics as policy, however, requires in addition a solid evidence base. This paper discusses the background conditions that make neurotherapeutics research particularly challenging. Three key ethical issues are discussed within an evidence-based ethics framework: the ethical challenges arising from changes in the financial incentive structures for academic researchers and their institutions, the challenges of risk-benefit analysis for neurotherapeutics protocols testing innovative interventions, and the evolving issues surrounding impaired decision-making capacity and surrogate consent for research. For each of these issues, selected empirical data are reviewed, areas for further inquiry are noted, and the need for development of novel methods for bioethics policy research is discussed. PMID:15717040

  5. Establishing CASA as an evidence-based practice.

    PubMed

    Lawson, Jennifer; Berrick, Jill Duerr

    2013-01-01

    In this article the authors examine the evidentiary status of the Court Appointed Special Advocates (CASA) program through a review of current research findings and a critical analysis of the study methodologies used to produce those findings. Due to the equivocal research findings and widespread methodological weaknesses (most notably selection bias) in the literature base, it is determined that there is not currently enough evidence to establish CASA as an evidence-based practice. In spite of the challenges to the feasibility of such research, a future research agenda is suggested that calls for the execution of large randomized controlled trials in order to produce findings that will inform a deeper understanding of CASA effectiveness in improving child outcomes.

  6. Implementing evidence-based practices: considerations for the hospice setting.

    PubMed

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

    2010-09-01

    With increased regulation and scrutiny of outcomes, hospice programs are being challenged to consider the implementation of evidence-based practices (EBPs). This study reports findings from hospice director interviews and staff focus groups, which occurred following the completion of a multifaceted translating research into practice (TRIP) intervention designed to promote evidence-based pain management practices. The purpose of this article is to provide background on the use of EBPs, to report facilitators and barriers to overall implementation of pain management EBPs in hospice, and to provide recommendations for hospices interested in increasing the use of EBPs. Three areas for evaluation prior to implementing an EBP initiative in hospices were identified: community, agency, and staff cultures. Recommendations for implementation of EBPs in hospices are provided. PMID:20167834

  7. A conceptual model for growing evidence-based practice.

    PubMed

    Vratny, Amy; Shriver, Deb

    2007-01-01

    Nursing administration at a small medical center is developing and implementing an evidence-based practice (EBP) model of care to support a culture of quality care, clinical excellence, cost-effectiveness, critical thinking, empowerment of staff, and professional growth. The purpose of this article is to describe a conceptual model for EBP that addresses how to overcome barriers to implementation. Clinician expertise and values, experience, patient preference and expectation, and caring become grounded in a practice environment that must strive to become rooted in clinical research to evolve into a practice that is evidence-based. Education helps to nourish EBP, but leadership, enthusiasm, mentorship, clinical inquiry, and reflective practice make EBP thrive. The EBP ambassadors branch out to each department to grow journal clubs, EBP Web pages, EBP projects, research utilization projects, and staff-led practice reviews. The fruits are quality patient care and outcomes, clinical excellence, cost-effectiveness, critical thinking, empowerment of staff, and professional growth.

  8. Nausea and vomiting of pregnancy. Evidence-based treatment algorithm.

    PubMed Central

    Levichek, Zina; Atanackovic, Gardana; Oepkes, Dick; Maltepe, Carolyn; Einarson, Adrienne; Magee, Laura; Koren, Gideon

    2002-01-01

    QUESTION: One of my patients suffers from a moderate-to-severe form of morning sickness. She responded only partially to doxylamine and pyridoxine (Dicletin), and I wish to try adding another medication. What should my priority be? ANSWER: An algorithm used by Motherisk to manage thousands of patients takes a hierarchical approach to this condition. This approach is evidence based with regard to fetal safety as well as efficacy. PMID:11889884

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

    PubMed Central

    Loewy, Erich H.

    2007-01-01

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

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

    PubMed

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

    2012-10-01

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

  11. Stepwise expansion of evidence-based care is needed for mental health reform.

    PubMed

    McGorry, Patrick D; Hamilton, Matthew P

    2016-05-16

    Mortality from mental illnesses is increasing and, because they frequently occur early in the life cycle, they are the largest source of disability and reduced economic productivity of all non-communicable diseases. Successful mental health reform can reduce the mortality, morbidity, growing welfare costs and losses in economic productivity caused by mental illness. The government has largely adopted the recommendations of the National Mental Health Commission focusing on early intervention and stepwise care and will implement a reform plan that involves devolving commissioning of federally funded mental health services to primary health networks, along with a greater emphasis on e-mental health. Stepwise expanded investment in and structural support (data collection, evaluation, model fidelity, workforce training) for evidence-based care that rectifies high levels of undertreatment are essential for these reforms to succeed. However, the reforms are currently constrained by a cost-containment policy framework that envisages no additional funding. The early intervention reform aim requires financing for the next stage of development of Australia's youth mental health system, rather than redirecting funds from existing evidence-based programs. People with complex, enduring mental disorders need more comprehensive care. In the context of the National Disability Insurance Scheme, there is a risk that these already seriously underserved patients may paradoxically receive a reduction in coverage. E-health has a key role to play at all stages of illness but must be integrated in a complementary way, rather than as a barrier to access. Research and evaluation are the keys to cost-effective, sustainable reform. PMID:27169969

  12. Evidence-Based Care of Acute Wounds: A Perspective

    PubMed Central

    Ubbink, Dirk T.; Brölmann, Fleur E.; Go, Peter M. N. Y. H.; Vermeulen, Hester

    2015-01-01

    Significance: Large variation and many controversies exist regarding the treatment of, and care for, acute wounds, especially regarding wound cleansing, pain relief, dressing choice, patient instructions, and organizational aspects. Recent Advances: A multidisciplinary team developed evidence-based guidelines for the Netherlands using the AGREE-II and GRADE instruments. A working group, consisting of 17 representatives from all professional societies involved in wound care, tackled five controversial issues in acute-wound care, as provided by any caregiver throughout the whole chain of care. Critical Issues: The guidelines contain 38 recommendations, based on best available evidence, additional expert considerations, and patient experiences. In summary, primarily closed wounds need no cleansing; acute open wounds are best cleansed with lukewarm (drinkable) water; apply the WHO pain ladder to choose analgesics against continuous wound pain; use lidocaine or prilocaine infiltration anesthesia for wound manipulations or closure; primarily closed wounds may not require coverage with a dressing; use simple dressings for open wounds; and give your patient clear instructions about how to handle the wound. Future Directions: These evidence-based guidelines on acute wound care may help achieve a more uniform policy to treat acute wounds in all settings and an improved effectiveness and quality of wound care. PMID:26005594

  13. Social construction and the evidence-based drug policy endeavour.

    PubMed

    Lancaster, Kari

    2014-09-01

    'Evidence-based policy' has become the catch-cry of the drug policy field. A growing literature has been dedicated to better realising the goal of evidence-based drug policy: to maximise the use of the best quality research to inform policy decision-making and help answer the question of 'what works'. Alternative accounts in the policy processes literature conceptualise policy activity as an ambiguous and contested process, and the role of evidence as being only marginally influential. Multiple participants jostle for influence and seek to define what may be regarded as a policy problem, how it may be appropriately addressed, which participants may speak authoritatively, and what knowledge(s) may be brought to bear. The question posited in this article is whether the conceptual shift offered by thinking about policy activity as a process of social construction may be valuable for beginning to explore different perspectives of the evidence-based drug policy endeavour. Within a constructionist account of policy, what counts as valid 'evidence' will always be a constructed notion within a dynamic system, based on the privileging and silencing of participants and discourse, and the contestation of those many positions and perspectives. The social construction account shifts our focus from the inherent value of 'evidence' for addressing 'problems' to the ways in which policy knowledge is made valid, by whom and in what contexts. As such, social construction provides a framework for critically analysing the ways in which 'policy-relevant knowledge' may not be a stable concept but rather one which is constructed through the policy process, and, through a process of validation, is rendered useful. We have limited knowledge in the drug policy field about how this happens; how ambiguity about the problems to be addressed, which voices should be heard, and what activities may be appropriate is contested and managed. By unpicking the values and assumptions which underlie drug

  14. Safety of Transcranial Direct Current Stimulation: Evidence Based Update 2016.

    PubMed

    Bikson, Marom; Grossman, Pnina; Thomas, Chris; Zannou, Adantchede Louis; Jiang, Jimmy; Adnan, Tatheer; Mourdoukoutas, Antonios P; Kronberg, Greg; Truong, Dennis; Boggio, Paulo; Brunoni, André R; Charvet, Leigh; Fregni, Felipe; Fritsch, Brita; Gillick, Bernadette; Hamilton, Roy H; Hampstead, Benjamin M; Jankord, Ryan; Kirton, Adam; Knotkova, Helena; Liebetanz, David; Liu, Anli; Loo, Colleen; Nitsche, Michael A; Reis, Janine; Richardson, Jessica D; Rotenberg, Alexander; Turkeltaub, Peter E; Woods, Adam J

    2016-01-01

    This review updates and consolidates evidence on the safety of transcranial Direct Current Stimulation (tDCS). Safety is here operationally defined by, and limited to, the absence of evidence for a Serious Adverse Effect, the criteria for which are rigorously defined. This review adopts an evidence-based approach, based on an aggregation of experience from human trials, taking care not to confuse speculation on potential hazards or lack of data to refute such speculation with evidence for risk. Safety data from animal tests for tissue damage are reviewed with systematic consideration of translation to humans. Arbitrary safety considerations are avoided. Computational models are used to relate dose to brain exposure in humans and animals. We review relevant dose-response curves and dose metrics (e.g. current, duration, current density, charge, charge density) for meaningful safety standards. Special consideration is given to theoretically vulnerable populations including children and the elderly, subjects with mood disorders, epilepsy, stroke, implants, and home users. Evidence from relevant animal models indicates that brain injury by Direct Current Stimulation (DCS) occurs at predicted brain current densities (6.3-13 A/m(2)) that are over an order of magnitude above those produced by conventional tDCS. To date, the use of conventional tDCS protocols in human trials (≤40 min, ≤4 milliamperes, ≤7.2 Coulombs) has not produced any reports of a Serious Adverse Effect or irreversible injury across over 33,200 sessions and 1000 subjects with repeated sessions. This includes a wide variety of subjects, including persons from potentially vulnerable populations.

  15. Safety of Transcranial Direct Current Stimulation: Evidence Based Update 2016.

    PubMed

    Bikson, Marom; Grossman, Pnina; Thomas, Chris; Zannou, Adantchede Louis; Jiang, Jimmy; Adnan, Tatheer; Mourdoukoutas, Antonios P; Kronberg, Greg; Truong, Dennis; Boggio, Paulo; Brunoni, André R; Charvet, Leigh; Fregni, Felipe; Fritsch, Brita; Gillick, Bernadette; Hamilton, Roy H; Hampstead, Benjamin M; Jankord, Ryan; Kirton, Adam; Knotkova, Helena; Liebetanz, David; Liu, Anli; Loo, Colleen; Nitsche, Michael A; Reis, Janine; Richardson, Jessica D; Rotenberg, Alexander; Turkeltaub, Peter E; Woods, Adam J

    2016-01-01

    This review updates and consolidates evidence on the safety of transcranial Direct Current Stimulation (tDCS). Safety is here operationally defined by, and limited to, the absence of evidence for a Serious Adverse Effect, the criteria for which are rigorously defined. This review adopts an evidence-based approach, based on an aggregation of experience from human trials, taking care not to confuse speculation on potential hazards or lack of data to refute such speculation with evidence for risk. Safety data from animal tests for tissue damage are reviewed with systematic consideration of translation to humans. Arbitrary safety considerations are avoided. Computational models are used to relate dose to brain exposure in humans and animals. We review relevant dose-response curves and dose metrics (e.g. current, duration, current density, charge, charge density) for meaningful safety standards. Special consideration is given to theoretically vulnerable populations including children and the elderly, subjects with mood disorders, epilepsy, stroke, implants, and home users. Evidence from relevant animal models indicates that brain injury by Direct Current Stimulation (DCS) occurs at predicted brain current densities (6.3-13 A/m(2)) that are over an order of magnitude above those produced by conventional tDCS. To date, the use of conventional tDCS protocols in human trials (≤40 min, ≤4 milliamperes, ≤7.2 Coulombs) has not produced any reports of a Serious Adverse Effect or irreversible injury across over 33,200 sessions and 1000 subjects with repeated sessions. This includes a wide variety of subjects, including persons from potentially vulnerable populations. PMID:27372845

  16. The Four Cornerstones of Evidence-Based Practice in Social Work

    ERIC Educational Resources Information Center

    Gilgun, Jane F.

    2005-01-01

    The purpose of this article is to place evidence-based practice within its wider scholarly contexts and draw lessons from the experiences of other professions that are engaged in implementing it. The analysis is based primarily on evidence-based medicine, the parent discipline of evidence-based practice, but the author also draws on evidence-based…

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

    ERIC Educational Resources Information Center

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

    2008-01-01

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

  18. Putting evidence into practice: evidence-based interventions to prevent and manage anorexia.

    PubMed

    Adams, Lynn A; Shepard, Nancy; Caruso, Rose Ann; Norling, Martha J; Belansky, Heather; Cunningham, Regina S

    2009-02-01

    Anorexia is defined as an involuntary loss of appetite.Approximately 50% of newly diagnosed patients with cancer experience the symptom, which often is accompanied by weight loss and most typically associated with advanced disease.Anorexia significantly affects the clinical course of cancer; it can lead to the development or exacerbation of disease- or treatment-related symptoms, decreased functional status, and diminished quality of life.As part of the Oncology Nursing Society's Putting Evidence Into Practice initiative, a team of oncology nurses examined and evaluated published research literature for the purpose of developing an evidence-based practice resource focused on the management of cancer-related anorexia.Even though anorexia is common among newly diagnosed patients and those with advanced disease, interventions to prevent, treat, and manage the symptom are limited.The evidence revealed that only two pharmacologic interventions, corticosteroids and progestins, can be recommended for use in clinical practice, and dietary counseling was identified as likely to be effective.This article summarizes selected empirical literature on interventions used to prevent and manage anorexia in patients with cancer.Familiarity with the literature will assist oncology nurses in proactively identifying and effectively managing patients experiencing this distressing symptom.

  19. Tactics for teaching evidence-based practice: improving self-efficacy in finding and appraising evidence in a master's evidence-based practice unit.

    PubMed

    Chang, Anne; Levin, Rona F

    2014-08-01

    This column shares the best evidence-based strategies and innovative ideas on how to facilitate the learning of EBP principles and processes by clinicians as well as nursing and interprofessional students. Guidelines for submission are available at http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1741-6787. PMID:25131896

  20. Dedicated optoelectronic stochastic parallel processor for real-time image processing: motion-detection demonstration and design of a hybrid complementary-metal-oxide semiconductor- self-electro-optic-device-based prototype.

    PubMed

    Cassinelli, A; Chavel, P; Desmulliez, M P

    2001-12-10

    We report experimental results and performance analysis of a dedicated optoelectronic processor that implements stochastic optimization-based image-processing tasks in real time. We first show experimental results using a proof-of-principle-prototype demonstrator based on standard silicon-complementary-metal-oxide-semiconductor (CMOS) technology and liquid-crystal spatial light modulators. We then elaborate on the advantages of using a hybrid CMOS-self-electro-optic-device-based smart-pixel array to monolithically integrate photodetectors and modulators on the same chip, providing compact, high-bandwidth intrachip optoelectronic interconnects. We have modeled the operation of the monolithic processor, clearly showing system-performance improvement.