Management of patients with hyperglycaemia undergoing vascular and cardiac surgery is important, with mounting evidence that hyperglycaemia in this setting is associated with worse outcomes. Evidence-based guidelines for the management of these patients have been limited. Our institution was aware of the lack of standardization of care in this growing ...

The American Society of Regional Anesthesia and Pain Medicine Practice Advisory on Local Anesthetic Systemic Toxicity assimilates and summarizes current knowledge regarding the prevention, diagnosis, and treatment of this potentially fatal complication. It offers evidence-based and/or expert opinion-based recommendations for all physicians and advanced practitioners who routinely administer local anesthetics ...

OBJECTIVES: The American Society of Regional Anesthesia and Pain Medicine charged an expert panel to examine the evidence basis for ultrasound guidance as a nerve localization tool in the clinical practices of regional anesthesia and interventional pain medicine. METHODS: The panel searched, examined, and assessed the literature of ultrasound-guided regional ...

OBJECTIVE: To define the knowledge, perception, attitude, educational needs, and barriers in practicing Evidence Based Medicine (EBM) among physicians in Abha city, Kingdom of Saudi Arabia. METHODS: This is a cross-sectional study using a self-administered validated questionnaire distributed to 290 physicians between 1st July to 30th July 2008. This study ...

Neonatal-Perinatal Medicine has had both its triumphs and its disasters regarding the dissemination of new interventions. Evidence-based medicine (EBM), the integration of clinical expertise, patient values, and best evidence for decision making in patient care, provides a blueprint for how to safely and effectively continue make headway in our rapidly ...

Postpartum hemorrhage (PPH) remains a significant contributor to maternal morbidity and mortality throughout the world. The majority of research on this topic has focused on efforts to prevent PPH. Sound data exist that active management of the third stage of labor can reduce the occurrence of PPH. Although there remains ...

Given that changes in health care are now the norm, organizational change needs to be part of all nurses' curricula. Engaging students in learning how change happens by sharing real world examples can make the learning meaningful for students and increase the likelihood that the knowledge will be applied to ...

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 ...

This work was performed as part of the Portuguese participation in the 3E Initiative 2007-2008, dedicated to the use of methotrexate (MTX) in rheumatic conditions. Three questions raised by Portuguese rheumatologists and considered relevant to clinical practice remained out of the selection of a set of ten key questions formulated ...

Psychopharmacotherapy should now be regulated in the sense of evidence-based medicine, as is the case in other areas of clinical treatment in medicine. In general this is a meaningful development, which principally will have a positive impact on routine health care in psychiatry. But several related problems should not be ...

PURPOSE: The findings of an academic symposium as they relate to the history and role of the academic pharmacy clinician, the strengths and limitations of the academic pharmacy clinician model, and the framework for future synergistic work relations among clinical pharmacy practitioners are summarized. SUMMARY: On April 23, 2008, a ...

Acupuncture has been an integral part of Traditional Chinese Medicine for thousands of years. It has been used for the treatment of many painful and nonpainful conditions. Its use within Western medicine has increased since the 1970s and acupuncture is now practiced by a variety of healthcare practitioners across Europe. ...

AIM: Develop an evidence-based clinical algorithm integrating clinical decision making on intracranial pressure (ICP) monitoring and intracranial hypertension (ICH) management in the setting of fulminant hepatic failure (FHF). MATERIAL AND METHODS: An English-language literature review was conducted using the PubMed database in November 2007. In compiling evidence on current management ...

This chapter gives an educational overview of * The limitations of evidence-based practice. * Strengths and weaknesses of RCT and observational studies. * The general PBE-CPI study design. * Benefits of PBE-CPI studies and how they can enhance our ability to discover and establish standards for best practice. * The ...

The need to practice evidence-based medicine is the current prevailing paradigm within the medical community. Evidence to guide practice can and should come from a variety of sources, including clinical trials, observational studies, and meta-analyses of both or either. This paper discusses the relative strengths and weaknesses of data that ...

A regional integrated cancer network has implemented a program (educational workshops, reflective and mentoring activities) designed to support the uptake of evidence-informed interprofessional collaborative practices (referred to in this text as EIPCP) within cancer teams. This research project, which relates to the Registered Nurses' Association of Ontario (RNAO) Best Practice ...

Evidence-based management (EBMa) is the application of the evidence-based medicine process to making management decisions. EBMa has been described in a number of publications, which note the advantages of utilizing EBMa and offer generic guidance on the nature of EBMa evidence. This paper provides a specific EBMa pathway for physician ...

AIMS: To summarize current knowledge on the etiology, assessment, and management of urinary incontinence (UI) in frail older persons. "Frail" here indicates a person with a clinical phenotype combining impaired physical activity, mobility, muscle strength, cognition, nutrition, and endurance, associated with being homebound or in care institutions and a high ...

This paper describes how the trend toward emphasizing evidence-based practice and empirically supported treatments is likely to affect the practice of counseling and psychotherapy in the future. Several specific predictions are described and discussed, particularly those of Nicholas Cummings. Predictions include that evidence-based practice and general psychotherapy will diverge; eventually ...

Plasma protein therapies have been sheltered historically from the scrutiny of evidence-based medicine. Thus, a number of albumin solutions became part of the established therapeutic armamentarium with a very modest evidence base. As evidence-based medicine has turned its focus on plasma protein therapies, albumin's appropriate use has become increasingly questioned. ...

The literature relevant to the treatment of Whiplash-Associated Disorders (WAD) is extensive and heterogeneous. METHODS: A Participatory Action Research (PAR) approach was used to engage a chiropractic community of practice and stakeholders in a systematic review to address a general question: 'Does chiropractic management of WAD clients have an effect ...

OBJECTIVES: Recent important advances in the human genomics and post-genomic "omics" are now bringing about a new medical care which we call "omics-based medicine". In this article, we investigated the development and future possibilities of omics-based medicine. METHODS: We divided the development of omics-based medicine into three generations in order ...

OBJECTIVES: To survey and monitor trends in evidence for oncology manuscripts published in the Journal of Veterinary Internal Medicine (JVIM) between 1999 and 2007 based on an evidence-based medicine (EBM) standard. METHODS: All veterinary oncology-related articles published in JVIM and 7 other high-impact journals from 1999 to 2007 were collected ...

Gastroesophageal reflux disease (GERD) is one of the most common disorders in medical practice. A number of guidelines and recommendations for the diagnosis and management of GERD have been published in different countries, but a Brazilian accepted directive by the standards of evidence-based medicine is still lacking. As such, the ...

Competence is traditionally viewed as the attainment of a static set of attributes rather than a dynamic process in which physicians continuously use their practice experiences to "progress in competence" toward the attainment of expertise. A competency-based continuing professional development (CPD) model is premised on a set of learning competencies ...

This article reports on the experience of one organization between 2004 and 2009 to develop an effective people-process-technology system to better manage the quality of health care. The creation of this system started with creating a strategic plan for quality and then establishing a structure to implement the plan. The ...

To review the literature for evidence-based medicine (EBM), to assess the evidence for effectiveness of vision screening, and to propose moving toward value-based medicine (VBM) as a preferred basis for comparative effectiveness research. Literature based evidence is applied to five core questions concerning vision screening: (1) Is vision valuable (an ...

(1) To outline frameworks for neonatal physical therapy based on 3 theoretical models, (2) to describe emerging literature supporting neonatal physical therapy practice, and (3) to identify evidence-based practice recommendations. Three models are presented as a framework for neonatal practice: (1) dynamic systems theory including synactive theory and the theory ...

Occupational therapy practitioners may encounter challenges when they try to incorporate evidence into practice. To embrace evidence-based practice (EBP), clinicians must have readily available, relevant, and concisely summarized evidence. Although researchers have described the importance and process of EBP, less has been written about how to efficiently integrate evidence into ...

PURPOSE: To provide an overview of evidence-based medicine (EBM) in relation to radiology and to define a policy for adoption of this principle in the European radiological community. RESULTS: Starting from Sackett's definition of EBM we illustrate the top-down and bottom-up approaches to EBM as well as EBM's limitations. Delayed ...

The enthusiasm for evidence-based medicine (EBM) has not been accompanied by the same success in bridging the gap between theory and practice. This paper advances the hypothesis that the phenomenon psychologists call hypocognition may hinder the development of EBM. People tend to respond to frames rather than to facts. To ...

Evidence-based practice, the rigorous conduct of clinical analysis and intervention, includes practice-based evidence. Here, practice data were the source of three "clinical portraits" used for exploratory analysis of an array of cognitive and social problems in 30 children whose neurobehavioral profiles fulfilled psychometric criteria for a nonverbal learning disability (NLD). ...

INTRODUCTION: Priapism describes a persistent erection arising from dysfunction of mechanisms regulating penile tumescence, rigidity, and flaccidity. A correct diagnosis of priapism is a matter of urgency requiring identification of underlying hemodynamics. AIMS: To define the types of priapism, address its pathogenesis and epidemiology, and develop an evidence-based guideline for ...

A qualitative analysis of 1-year alumni surveys provided the basis for developing evidence-based curricular strategies to better prepare BSN graduates for their transition into practice. The authors discuss study results, curricular strategies initiated, and beginning feedback regarding their effectiveness in preparing BSN graduates for practice.

An exploration was completed of health professionals' experiences implementing evidence-based guidelines that promote intensive management (IM) for people with diabetes. In-depth, semi-structured interviews were conducted with 50 health professionals from across Canada. These professionals are considered to be opinion leaders in diabetes care. Interviews were audiotaped, transcribed verbatim, and coded ...

In an era of evidence-based practice, why are clinicians not typically engaged in evidence-based assessment? To begin to understand this issue, a national multidisciplinary survey was conducted to examine clinician attitudes toward standardized assessment tools. There were 1,442 child clinicians who provided opinions about the psychometric qualities of these tools, ...

Dermal fillers are an important tool in the armamentarium of an aesthetic dermatologist in the management of ageing skin. A surge in the use of fillers has been witnessed due to increasing awareness among people, easy availability of fillers and increased enthusiasm amongst the dermatologists and plastic surgeons to use ...

Infertility is defined as inability of a couple to conceive naturally after one year of regular unprotected sexual intercourse. It remains a major clinical and social problem, affecting perhaps one couple in six. Evaluation usually starts after 12 months; however it may be indicated earlier. The most common causes of ...

In this article we explore the role evidence ought to play in complementary and alternative medicine (CAM). First, we consider the claim that evidence in the form of randomized controlled trials (RCTs) cannot be obtained for CAMs. Second, we consider various claims to the effect that there are ways of ...

To consider the currently available knowledge and understanding of the symptom of urgency. Each faculty member reviewed the literature base of a different aspect of urgency and along with their personal clinical experience provided a base of evidence for discussion. This overview summarises relevant published literature and the current clinical ...

This is the second of 2 articles that focus on strategies to integrate an evidence-based decision-making (EBDM) approach into your practice. The previous article provided an overview of EBDM concepts and identified strategies for finding evidence to answer clinical questions, the first 2 steps in the evidence-based process. The next ...

Rationale Evidence-based medicine (EBM) has been acclaimed as a major advance in medical science, but criticized as a proposed alternative model for the practice and teaching of medicine. Ambiguity regarding the proper role of the contributions of EBM within the fabric of medicine and health care has contributed to this ...

OBJECTIVES: The aim of this cross-sectional study was to determine the awareness and attitude of hospital doctors towards evidence-based medicine (EBM) and their related educational needs. METHODS: A questionnaire study was performed on a randomly selected sample of 386 hospital doctors from both a teaching hospital and the Ministry of ...

Hypoglycaemia is associated with poor prognosis in many severe childhood illnesses especially in sub-Saharan Africa where the prevalence of malaria, diarrhoea and malnutrition remains high. Uncertainty, however, still persists regarding the significance, definition and management of childhood hypoglycaemia. As a step towards defining optimal, evidence-based diagnostic and management criteria, we ...

To date, the effectiveness of psychotherapy for the treatment of most mental disorders is empirically well documented. From an "evidence-based medicine" viewpoint, psychotherapy, as compared to other treatments in medicine, can be regarded as one of the most effective therapeutic approaches. The superiority of psychotherapy over pharmacotherapy is particularly pronounced ...

Psychopharmacotherapy should now be regulated in the sense of evidence-based medicine (EBM), as is the case in other areas of clinical treatment in medicine. In general this is a meaningful development, which will principally have a positive impact on routine health care in psychiatry. But several related problems should not ...

OBJECTIVES: Personalized medicine (PM) has attracted tremendous interest, but yielded few marketed products. We examined factors influencing the reimbursement of existing PM technologies. METHODS: We conducted six case studies of the following paired genetic tests and treatments: HER2/neu with trastuzumab (Herceptin); hepatitis C genotyping with ribavirin/pegylated interferon; Oncotype DX with ...

Endovascular abdominal aortic aneurysm (EVAR) repair has an established role in elective management of abdominal aortic aneurysms (AAA). The application of EVAR to ruptured AAAs (rAAA) is evolving and developing a strong evidence base in selected patients. Although EVAR has been utilized to manage rAAA for greater than ten years, ...

BACKGROUND: The evidence-based medicine (EBM) approach to clinical practice has been incorporated into medical training around the world. Whilst EBM is a component of the 'foundation years' (FY) programme, it appears to lack a firm foundation in the UK undergraduate curriculum. AIM: To identify whether the teaching of EBM is ...

OBJECTIVE: To provide clinician direction that is based on the best evidence available on suctioning at the perineum for infants born with meconium stained amniotic fluid. EVIDENCE: The Medline database was searched for articles published in English from 2000 to 2008 on the topic of management of meconium at birth. ...