PURPOSE: To determine the psychometric properties and validity of an OSCE to assess the competencies of Practice-Based Learning and Improvement (PBLI) and Systems-Based Practice (SBP) in graduate medical education. METHOD: An eight-station OSCE was piloted at the end of a three-week Quality Improvement elective for nine preventive medicine and endocrinology ...

Addiction medicine deals with problems arising from the use of psychoactive substances, and encompasses the disciplines of general practice and primary care, psychiatry, psychology, internal medicine, public health, pharmacology and sociology. Addiction is a chronic, relapsing illness that is difficult to cure. There are now effective, evidence-based interventions for the ...

'Evidence-Based Nursing: A Guide to Clinical Practice' aims to enable nurses to: frame their clinical questions to find the evidence to support their opinions; distinguish between strong and weak evidence; clearly understand study results; weigh the risks and benefits of management options; and apply the evidence to their individual patients. ...

PURPOSE OF REVIEW: To propose and discuss an evidence-based algorithm for the diagnosis and treatment of bacterial septic arthritis. Also, to review the recent literature on emerging management strategies and discuss the potential impact of these developments on clinical practice. RECENT FINDINGS: Evidence-based guidelines have recently been published to assist ...

This paper considers the problem of evaluating multimodal integrative medicine treatments for complex pathologic conditions. The example is given of evaluation of highly successful treatments of lymphedema using Ayurvedic and Yoga medicine practices together with modern medicine. For a framework to evaluate such a complex intervention, we base our proposal ...

Evidence-based medicine has emerged in response to empiric clinical decision-making with the quest of infusing more "science" into the process of caring for the sick. Yet, evidence-based medicine today is being applied to clinical practice in a rigid and, paradoxically, unscientific manner. The perception that evidence-based medicine is the "ultimate ...

There are active public campaigns both for and against homeopathy, and its continuing availability in the NHS is debated in the medical, scientific and popular press. However, there is a lack of clarity in key terms used in the debate, and in how the evidence base of homeopathy is described ...

Leaders must understand the essential characteristics and realities of creating an evidence-driven organization. It is especially important to comprehend and apply sound leadership and management of infrastructure, processes, and behaviors that incorporate evidence in every aspect of clinical practice. Evidence-driven practice is no longer optional and is now a fundamental ...

Infectious mononucleosis (IM) is a common medical condition that afflicts thousands of young athletes each year. Despite the self-limited nature of this disorder, the variability of the clinical presentation and the rare risk of splenic rupture routinely present sports medicine clinicians with difficult return-to-play decisions. Currently there are no evidence-based ...

The rise in popularity of complementary and alternative medicine (CAM) in the United States has stimulated increasing interest in researching CAM. One challenge to this research is determining the optimal dose of a CAM intervention. T'ai Chi Chuan (TCC) has received considerable attention as a mind-body practice; however, it remains ...

Few therapies in perinatal medicine have created as much controversy as corticosteroids. Despite five decades of extensive research and practice, major areas of uncertainty remain. In this article, we review the most current evidence on both antenatal and postnatal therapy. Overall, it is clear that we must continue to investigate ...

INTRODUCTION: The use of nasal creams and ointments in the conservative management of anterior epistaxis is well documented and supported. This study set out to obtain a national opinion, in order to establish current practice. DESIGN: A survey of all Scotland-based otolaryngology clinicians was conducted. Participants were asked which topical ...

PURPOSE OF REVIEW: Evidence-based medicine is a process that seeks to integrate the best research evidence with clinical expertise and patient values in order to optimize clinical outcomes for our patients. This article will review the benefits of and barriers to the use of evidence-based medicine in pediatrics in the ...

In the past 40 years imidazoles have been used extensively in medicine for their antifungal properties. All members of the azole antifungal family inhibit ergosterol biosynthesis. However, the discovery of an additional fungicidal mode of action for miconazole has drawn renewed attention to this compound. In this article we review ...

There is general consensus in the academic community that evidence-based medicine (EBM) teaching is essential. Unfortunately, many postgraduate programs have significant weakness in their EBM programs. The Family Medicine Residency committee at the University of Alberta felt their EBM curriculum would benefit from critical review and revision. An EBM Curriculum ...

OBJECTIVE: To develop an evidence based guideline, for the multidisciplinary management of early rheumatoid arthritis (RA). METHODS: Recommendations were developed using both an evidence-based approach and expert opinion. The scientific committee, composed of key members of the rheumatology multidisciplinary team used a Delphi approach to evaluate topics and standard statements, ...

Iodine and its antibacterial properties have been used for the prevention or management of wound infections for over 150 years. However, the use of solutions (tincture) of iodine has been replaced by the widespread use of povidone-iodine, a water-soluble compound, which is a combination of molecular iodine and polyvinylpyrrolidone. The ...

Axillary lymph node dissection after the finding of a positive sentinel lymph node is a common clinical practice. A review is performed for the efficacy and morbidity of axillary lymph node dissection, the rationale for nonsurgical management of the axilla, and the efficacy, technical limitations, and toxicity of axillary radiation ...

OPINION STATEMENT: Symptom management of the actively treated elderly cancer patient represents an undertreated and disproportionately understudied cohort in oncology. There is a dearth of specific recommendations or guidelines regarding drug selection, dosing, and side effects which account for changes in aging physiology, pharmacokinetics, and idiosynchratic reactions. In treating cardinal ...

Evidence-based practice is an approach that has gained recognition for facilitating the transfer of evidence into quality clinical practice. While occupational therapy clinicians have a professional responsibility to ensure that their practice is effective, managers also have a responsibility to implement structures and systems that will support therapists in doing ...

Evidence-based medicine (EBM) is defined as "the process of systematically finding, appraising and using contemporaneous research findings as the basis for clinical decisions". Although EBM has been extensively described across the Americas and Europe, no study has looked at the practice of EBM in Puerto Rico. A cross-sectional analysis based ...

To investigate current policy and practice in postnatal depression in Scotland and to consider how effectively guidelines were addressed. A questionnaire survey of all National Health Service Boards in Scotland between September 2003 and February 2004 to determine what written policies for postnatal depression were in place as at September ...

The objective was to determine the effects of wastewater effluent organic materials (EfOM) on fouling of ultrafilters (100kDa polyethersulfone (PES)). EfOM constituents were sequentially removed, first by removing particles down to the approximate ultrafilter pore size and then by removing dissolved EfOM based on functionality. Particles and colloids >20nm accounted ...

An information-based sensor management framework is presented that enables the automated tasking of a suite of sensors when detecting static targets. The sensor manager chooses the sensors to use and the grid-based locations to observe in order to maximize the expected information gain that will be obtained with each new ...

Intolerable side effects contribute to poor outcomes among patients managed with opioids, and negotiating these side effects remains an important clinical challenge. Evidence-based approaches to minimizing the side-effect burden from opioids compiled from the literature, and including clinical practice recommendations, focus on (1) reducing the doses of systemic opioids, (2) ...

Facial paralysis has fascinated physicians through the centuries. Management of the condition has evolved extensively over the past 50 years, relying largely upon neural repair techniques and static techniques prior to the 1940s, followed by heavy emphasis on regional muscle transfer by the 1970s. With the advent of the operating ...

Teaching evidence-based medicine (EBM) has become common in family medicine residency programs. EBM teaching usually takes the form of journal clubs or encouraging residents to use EBM summaries of original articles. Both have significant limitations. Residents and other physicians recognize that understanding statistics is important for interpreting results. Unfortunately, they ...

In December 2005, 11 Canadian hematologists met to develop an evidence-based clinical practice guideline that would address the diagnosis, monitoring, management, and rationale for the treatment of transfusional iron overload in patients with myelodysplastic syndromes (MDS). This Expert Panel consisted of hematologists from across Canada, each with an active practice ...

PURPOSE: The Quality Oncology Practice Initiative (QOPI) became available to all American Society of Clinical Oncology member physicians in 2006 as a voluntary medical oncology practice-based quality measurement and improvement project. QOPI assesses practice performance for a series of evidence- and consensus-based process measures, relying on practices to complete structured ...

This study is based on 25 well documented reports of cases which responded well to treatment with Petroleum. Materia medica data were compared with results in contemporary clinical practice. Many patients had characteristic skin problems; children often had recurrent or chronic upper respiratory tract problems. The most prominent mental feature ...

This paper provides an analysis on the discourses of reflective practice and evidence-based practice. It commences by examining the role of discourse in describing and defining our beliefs and attitudes. Consequently, it argues that each discourse is based on a certain epistemology, which in effect are language constructs that create ...

Pediatric laryngospasm is an anesthetic emergency. It is a relatively common phenomenon that occurs with varying frequency dependent on multiple factors. In view of this and the clear risks to the patient when it occurs, a consensus committee has been established to determine the evidence based management of this condition. ...

Falls and syncope are symptoms that commonly present to medical services. Detailed international guidelines for their management are available but tend to be aimed at specialists rather than generalists. Novel, evidence-based algorithms for the management of these symptoms when they present to acute medical services were formulated and their impact ...

Evidence-based medicine was recently noted as one of the top 15 most important medical discoveries over the past 160 years. Since the term was coined in 1990, EBM has seen unparalleled adoption in medicine and surgery. We discuss the early origins of EBM and its dissemination in medicine, especially orthopaedic ...

Evidence based medicine (EBM) is an expanding field that combines clinical intuition with the best available evidence in clinical decision making. The shift to evidence based rationale encourages educating future physicians to formulate appropriate research questions and develop critical appraisal skills that are needed to practice EBM. This article identifies ...

BACKGROUND: Challenges in implementing electronic health records (EHRs) have received some attention, but less is known about the process of transitioning from legacy EHRs to newer systems. OBJECTIVE: To determine how ambulatory leaders differentiate implementation approaches between practices that are currently paper-based and those with a legacy EHR system (EHR-based). ...

There is now strong evidence for an alternative pathway of colorectal carcinogenesis implicating hyperplastic polyps and serrated adenomas. This article briefly reviews the evidence for this serrated pathway, provides diagnostic criteria for clinically significant hyperplastic polyps and allied serrated polyps, and suggests how this information may be translated into safe, ...

We present a body of evidence for love medicine, originating in the shamanic physical/spiritual healing arts, embodying end-of-life (EOL) palliation through relationships of loving, artful witness between caregivers and receivers. We base the conclusions of our professional (doctor) and familial (spouse) practices on the practitioner/research methodology, Appreciative Inquiry , focused ...

OBJECTIVE: Recommendations and/or guidelines represent a popular way of integrating evidence-based medicine into clinical practice. The 3E Initiatives is a multi-national effort to develop recommendations for the management of rheumatic diseases, which involves a large number of experts combined with practising rheumatologists addressing specific questions relevant to clinical practice. METHODS: ...

Some authors challenge the dominance of evidence-based medicine (EBM) in current medical practice because of its tendency to disregard the patient in the clinical process and thus distort the clinician's view of the patient as the primary focus. This tendency to "scientize" the clinician-patient encounter threatens to seriously reduce the ...

Evidence-based medicine, systematic reviews, and guidelines are part of modern interventional pain management. As in other specialties in the United States, evidence-based medicine appears to motivate the search for answers to numerous questions related to costs and quality of health care as well as access to care. Scientific, relevant evidence ...

Case managers grapple with best methods to infuse case management evidence into their practice. This article examines the role of each case manager as a leader in evidence-based practice (EBP) and emphasizes proven strategies for case management leaders to move EBP into their case management environment. Special focus is placed ...

Evidence-based medicine's (EBM) quantitative methodologies reflect medical science's long-standing mistrust of the imprecision and subjectivity of ordinary descriptive language. However, EBM's attempts to replace subjectivity with precise empirical methods are problematic when clinicians must negotiate between scientific medicine and patients' experience. This problem is evident in the case of bibliotherapy ...

Evidence-based medicine practices are widely touted in medicine, although their adoption by busy practitioners is problematic and cumbersome. In this study, we examined published evidence underpinning 2 relevant clinical management questions in pediatric epilepsy: when to initiate an antiepileptic drug and when to prescribe the ketogenic diet. We surveyed practicing ...

This study determined the extent to which fall risk assessment and management practices for older patients were implemented in Medicare-certified home health agencies (HHAs) in a defined geographic area in southern New England that had participated in evidence-based fall prevention training between October 2001 and September 2004. The standardized in-service ...

Phosphorus (P) loss from agricultural watersheds is generally greater in storm rather than base flow. Although fundamental to P-based risk assessment tools, few studies have quantified the effect of storm size on P loss. Thus, the loss of P as a function of flow type (base and storm flow) and ...

Mechanical bowel cleansing (preparation) before colorectal surgery is commonly practiced, and medical care guidelines consent to this regimen. This has been an incontestable routine for surgeons for more than 100 years. However, during the last years, several randomized control trials and three meta-analyses led to the accumulation of enough evidence ...

Genital warts are the commonest viral STI in the UK, and the incidence continues to rise. Diagnosing, treating and advising patients about this infection remain a large part of the work in any department of GU Medicine. This article reviews and provides the levels of evidence currently available on data ...

The Acute Dialysis Quality Initiative (ADQI) is an ongoing process that seeks to produce evidence-based recommendations for the prevention and management of acute kidney injury (AKI) and on different issues concerning acute dialysis. Our methods involve a combination of both expert panel and evidence appraisal, and this approach was chosen ...

Osteopathic medicine is among the fastest-growing sectors of health care. By the year 2020, it is projected that approximately 100,000 doctors of osteopathic medicine will be practicing in the United States. Despite its growing popularity, osteopathic medicine is not as widely understood as traditional medicine, also known as allopathic medicine. ...