Evidence-based medicine originated at McMaster University, Hamilton, Ontario, Canada, where it was defined as "the integration of current best evidence with clinical expertise and patient values" by the Evidence-based Medicine Working Group led by Drs Gordon Guyatt and David Sackett. From this developed the McMaster University and National Health Service ...

This eighth best practice review examines four series of common primary care questions in laboratory medicine: (i) sodium abnormalities; (ii) faecal occult blood testing; (iii) warfarin management; and (iv) sputum cytology in diagnosis of bronchopulmonary malignancy. The review is presented in question-answer format, referenced for each question series. The recommendations ...

It is accepted that if fisheries resources are to remain renewable and able to sustain livelihoods, appropriate management practices must be implemented. Even while fisheries management grapples to resolve single-species issues, the biological and economic interactions among species mandate that to be effective, management techniques must be based on more ...

Medicine is increasingly a science and decreasingly an art. It is increasingly evidence-based. It now has right answers and wrong answers in a way inconceivable even a decade ago. The growth of evidence-based medicine is partly a consequence of genuine demonstration of optimal practice, and partly a consequence of increased ...

OBJECTIVE: To assess the awareness, attitude and practice of evidence base medicine (EBM) among Al-Taif Consultant Physicians and to define the perceived barriers for practicing EBM. METHODS: It is a cross-sectional study conducted during December, 2004, at all governmental hospitals in Western region of Saudi Arabia at Al-Taif Governorate. Two ...

OBJECTIVES: In this paper, we seek to clarify what is known about self-care in chronic illness and the impact of lay-led self-management programmes. The main focus of the paper is the specific 'lay-led' interventions developed by Kate Lorig and her collaborators in the USA, and in the context of the ...

Infliximab therapy should be optimized to minimize immunogenicity, to prevent infusion reactions, and to maintain clinical response. Based on best available evidence, strategies include minimizing the formation of ATI by administering infliximab as a multidose induction therapy followed by scheduled maintenance regiment, the use of concurrent immunomodulators, and possibly premedicating ...

Over the past 30 years, there has been a resurgence in the use of storytelling and narrative in medicine. At first glance, the trend to incorporate art forms into medicine appears to run counter to the rise of the more objective and positivist evidence-based medicine movement. In the present article, ...

As the focus on evidence-based healthcare delivery gains momentum, nurses need to critically reflect on their traditional practice base. Assessment is the cornerstone of safe and effective practice and goes hand in hand with the process of prioritising a sick child's needs. This article begins with a practical and critical ...

Despite its well-deserved strengths, Evidence-Based Medicine (EBM)'s shell still remains half-full. Its strong points are clouded in persisting philosophical gaps and mostly ideological advancements of its concepts and rules. Further clarification of its logic and critical use of evidence is required. In this non-systematic essay and review, several present and ...

OBJECTIVE: Collaborative quality improvement techniques were used to facilitate local quality improvement in the management of pain in infants. Several case studies are presented to highlight this process. METHODS: Twelve NICUs in the Neonatal Intensive Care Quality Improvement Collaborative 2002 focused on improving neonatal pain management and sedation practices. These ...

PROBLEM: Frequent obstetric perineal morbidity in a hospital setting with service providers inexperienced in getting evidence into practice. DESIGN: Clinical practice improvement methodology in a tertiary referral obstetric unit. STRATEGIES FOR CHANGE: To cease active instruction to push in the second stage of labour; encourage the adoption of the left ...

This article discusses the influence that professional socialisation can have on midwifery practice. Differences in beliefs and practices regarding the oral intake of labouring women were the basis for this paper's discussion. Midwives should be aware of the problems that may be caused by the socialisation processes experienced during the ...

Bronchiolitis is a disorder most commonly caused in infants by viral lower respiratory tract infection. It is the most common lower respiratory infection in this age group. It is characterized by acute inflammation, edema, and necrosis of epithelial cells lining small airways, increased mucus production, and bronchospasm. The American Academy ...

Authors report the available scientific evidence on the role of proton pump inhibitors and upper gastro-intestinal endoscopy in the management of patients with gastro-oesophageal reflux disease. Relative indications, advantages and pitfalls of various diagnostic and therapeutic strategies for cost-effective management of this condition are discussed. The most recent evidence-based guidelines ...

The aim of this paper is to describe a strategy--a partnership between a clinician manager and nurse academic--developed for the purpose of utilizing clinical governance literature to enhance management practice. The partnership is an initiative that has been implemented to fill a growing need for more collaboration between the tertiary ...

Rodents cause significant damage to lowland irrigated rice crops in the Red River Delta of Vietnam. A four-year study was conducted in 1999-2002 to examine the effectiveness of applying rodent control practices using the principles of ecologically based pest management. Four 100-150 ha study sites adjacent to villages were selected ...

Restless legs syndrome (RLS) is a common condition that is difficult to diagnose. However, once correctly diagnosed, its management is straightforward and evidence-based. The purpose of this article is to familiarise clinicians with both the symptoms and diagnostic criteria for RLS and to elucidate secondary and often curable causes of ...

Progress toward personalized medicine in the five years following the sequencing of the human genome has been slower than many expected. We focus on two potential factors that might be important in explaining this disappointing progress: the limitations of genetic prediction and the lack of appropriate economic incentives. Clinical application ...

PURPOSE: We investigated the attitudes and opinions of urologists toward evidence-based medicine. MATERIALS AND METHODS: In April of 2005 we contacted members of the American Urological Association listed with an e-mail address to participate in a web based survey. Participants were asked to characterize their level of agreement with statements ...

Pulmonary aspiration of gastric contents in the perioperative phase is associated with increased postoperative morbidity and mortality. For the management of aspiration, differentiation between acid-associated aspiration pneumonitis and aspiration pneumonia as a consequence of a secondary bacterial contamination is of crucial importance. The incidence of aspiration in elective surgery is ...

The term evidence-based practice is not new. For over twenty years the debate has been ongoing about how to make it happen. To practice within an evidence base, practitioners must determine if the evidence available is relevant for the particular patient (DiCenso et al 1998). This article aims to contextualise, ...

With a growing number of evidence-based resources being developed for use in veterinary medicine, the time is right for academicians, practitioners, and students to embrace the positive elements of evidence-based veterinary medicine. Clinical pharmacologists, more than most, have all the skills required to use an evidence-based approach effectively for the ...

The French physiologist Claude Bernard (1813-1878) has the unfair reputation of being ferociously opposed to the use of probabilities and statistics in medicine. In the 19th century, he would have been included among those who opposed the emergence of what would eventually become clinical epidemiology. The truth is that Bernard ...

Tough but constructive criticisms of evidence-based medicine (EBM) have without doubt informed the evolution and serial reconstitutions of this approach to clinical decision making and behaviour. Yet, concerns about EBM persist and as EBM changes in response to reflection and criticism, so too do the criticisms themselves. This paper describes ...

OBJECTIVES: To review published studies evaluating interventions for the prevention and management of radiation skin reactions/dermatitis. DATA SOURCES: Research studies, review articles, and clinical practice guidelines. CONCLUSION: There is insufficient evidence in the literature to recommend specific topical or oral agents in the prevention or management of skin reactions. Recent ...

In the past 14 years, Evidence-Based Medicine (EBM) has enjoyed unprecedented developments and gained widespread acceptance among health professionals. However, should we be content with producing, critically appraising and using the best evidence available for our understanding of health problems and decision making about them? Are our convictions about EBM's ...

The ACR Appropriateness Criteria are an important effort aimed at establishing when imaging should be used in medicine. However, substantial improvements in the Appropriateness Criteria are necessary for them to meet current standards for evidence-based guidelines. In this article, we provide concrete suggestions for improving the evidence basis of the ...

The purpose of this article is to review the history and development of evidence-based medicine, to provide a basic outline of its application to clinical care, and to discuss its pros and cons. This article can be used as a tool in podiatric medicine and surgery to ensure that current ...

Healthcare managers were early advocates of evidence-based medicine, given its promise of effectiveness, efficiency, and accountability in medical care. In the course of a decade, the call for evidence has swept the healthcare landscape in medicine and more recently in nursing. Somehow healthcare managers and leaders have largely escaped a ...

The clinicopathological conference, popularly known as CPC primarily relies on case method of teaching medicine. It is a teaching tool that illustrates the logical, measured consideration of a differential diagnosis used to evaluate patients. The process involves case presentation, diagnostic data, discussion of differential diagnosis, logically narrowing the list to ...

What we want is retention, not turnover, of our workforce. We should measure what we want-net retention-which is a fundamentally different metric from turnover (not its inverse). Net retention is a highly useful managerial tool, especially for fiscal and strategic planning. Retention enables learning and therefore can facilitate improved medical ...

Teams are the fundamental element of work in the contemporary clinical setting. As interdisciplinary teams become an essential component of the evidence-based framework for clinical practice, their formalization, integration, and synthesis within the practice framework will become increasingly mandatory. Outlined here is a contextual model for team action that is ...

It is increasingly recognized that comorbidity is common in all fields of psychiatry, and furthermore, it is acknowledged that a large number of individuals with genetically determined conditions have associated behavioural phenotypes, and are more susceptible to particular psychiatric and psychological comorbidities than others. It is also recognized that the ...

The concepts and methods of the different branches of epidemiology, particularly clinical epidemiology, have much to offer the discipline of theriogenology. As with theriogenology, epidemiologic methods evolve when technological innovation enables new approaches to old problems. The recent emergence, from clinical epidemiology, of the evidence-based medicine paradigm in human medicine, ...

Drug class reviews are blunt tools for medical decision making. The practice of evidence-based medicine is far more than simply systematic reviews: The patient and doctor are integral. Here we highlight areas of evidence-based coverage decision making where greater balance and transparency could serve to improve the current process, and ...

Current resuscitation practices are often poor in low-income settings. The purpose of this review was to summarise recent evidence, relevant to developing countries, on best practice in the provision of newborn resuscitation. Potential studies for inclusion were identified using structured searches of MEDLINE via PubMed. Two reviewers independently evaluated retrieved ...

Modern evidence-based medicine (EBM) and its predecessor 'Medecin d'Observation' both emphasise that potential advances in healthcare must be researched and proven to do more good than harm using the principles of clinical epidemiology before they are incorporated into medical practice. EBM is considered an important advance in improving clinical care ...

BACKGROUND AND PURPOSE: [corrected] Evidence-based practice is the explicit use of current best evidence in making decisions about the care of individual patients and is a concept of growing importance for physiotherapy. The aim of the present study was to investigate Australian physiotherapists' self-reported practice, skills and knowledge of evidence-based ...

In the quest for "evidence-based" medicine, an accepted hierarchy of evidence has been proposed. This hierarchy places in vitro studies and animal data at the base, and puts systematic reviews, meta-analyses, and randomized controlled trials at the pinnacle. However, when clinical medicine faces questions that have not yet been studied ...

Oral pathology is the specialty area of dentistry that deals with the diagnosis and management of oral diseases and more specifically, diseases other than dental caries, periodontal disease, restorative dentistry, and orthodontic therapy. Oral medicine represents the clinical arm of oral pathology and deals with diagnosis and treatment of soft-tissue ...

Leadership succession planning is a key business strategy to help organizational leaders deal effectively with the future. Evidence from industry provides a variety of best practices that can ensure that a pipeline of leaders will be available when they are needed. The author addresses the essential needs that individuals face ...

This third best practice review examines four series of common primary care questions in laboratory medicine: (i) 'minor' blood platelet count and haemoglobin abnormalities, (ii) diagnosis and monitoring of iron deficiency anaemia , (iii) secondary hyperlipidaemia and hypertriglyceridaemia and (iv) HbA1c and microalbumin use in diabetes. The review is presented ...

Probiotics have recently been advocated for the prevention and treatment of allergic disease (AD). In clinical practice they are increasingly being used for these purposes. Here we review the evidence base for the use of probiotics in the management of AD. We find support for their use in the treatment ...

Symplocarpus, Lysichiton, and Orontium (Orontioideae) are three of the few north temperate genera of the primarily tropical Araceae. Symplocarpus is disjunctly distributed in eastern Asia (3 spp.) and eastern North America (1 sp.); Lysichiton has an intercontinental discontinuous distribution in eastern Asia (1 sp.) and northwestern North America (1 sp.); ...

Clinically relevant attitudes and guidelines issued by a rational evidence based medicine (EBM) approach integrate individual clinical expertise with the best available external clinical evidence from systematic research. However, many physicians, while considering the ultraliberal world they are practising in and fearing that the primary goal of managed care in ...

Evidence-based medicine (EBM) has been advocated as a new paradigm in orthodox medicine and as a methodology for natural medicines, which are often accused of lacking an adequate scientific basis. This paper presents the voices of tradition-sensitive naturopathic practitioners in response to what they perceive as an ideologic assault by ...

OBJECTIVE: This guideline provides evidence-based recommendations to manage diffuse acute otitis externa (AOE), defined as generalized inflammation of the external ear canal, which may also involve the pinna or tympanic membrane. The primary purpose is to promote appropriate use of oral and topical antimicrobials and to highlight the need for ...

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

PURPOSE OF REVIEW: Over-the-counter cough and cold medicines are widely prescribed by general pediatricians in order to relieve cough and other symptoms in the setting of upper respiratory infections. This article will review the pharmacologic components found in over-the-counter cough medicines, the data concerning their use and efficacy in children, ...