Emphysematous pyelonephritis: Time for a management plan with an evidence-based approach

Unified management plan and treatment strategy for COVID-19 patients are yet to be discovered. Many trials on COVID-19 interventions have been registered or are ongoing. In this article the results of large-scale clinical trials on COVID-19 treatment are presented, the potential mechanism of action of some drugs is discussed, the features of the main pharmacological and non-pharmacological therapeutic options for COVID-19 patients are described.

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Topical Review: Vision and Gait in Older Adults: A Clinician’s Perspective

Vision Development & Rehabilitation ◽

10.31707/vdr2021.7.2.p95 ◽

2021 ◽

pp. 95-106

Keyword(s):

Sensory Integration ◽

Sensory Feedback ◽

Sensory Input ◽

Management Plan ◽

Vision Impairment ◽

Evidence Based ◽

Care Providers ◽

Risk Of Falling ◽

Human Function ◽

The Impact

Gait is an important human function, and vision is the dominant sensory input used during gait. Vision aids pathfinding decisions and provide ongoing sensory feedback to maintain appropriate balance and prevent falls. Eye care providers who wish to effectively address the impact of vision impairment on the risk of falling will customize their management plan based on specific impairments. This article provides an overview of normal sensory integration as it applies to gait, with an emphasis on vision. It also presents an evidence-based review of visual dysfunctions that cause falls, as well as strategies to reduce falls in adults with visual impairment, with emphasis on patients over age 65.

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Motivators and barriers to engagement with evidence-based practice among medical and dental trainees from the UK and Republic of Ireland: a national survey

BMJ Open ◽

10.1136/bmjopen-2019-031809 ◽

2019 ◽

Vol 9 (10) ◽

pp. e031809 ◽

Cited By ~ 2

Author(s):

Bosun Hong ◽

Eoin Daniel O'Sullivan ◽

Christin Henein ◽

Christopher Mark Jones

Keyword(s):

Response Rate ◽

Evidence Based Practice ◽

Evidence Base ◽

Management Plan ◽

Secondary Outcome ◽

Evidence Based ◽

Web Based ◽

Republic Of Ireland ◽

Mailing Lists ◽

The Uk

ObjectivesTo explore the extent to which doctors and dentists in training within the UK and Republic of Ireland (RoI) engage in and with evidence-based practice (EBP), and to identify motivators and barriers to them doing so.DesignAn observational, prepiloted web-based survey developed by a trainee-led focus group.SettingThe survey instrument was disseminated to doctors and dentists in training within the UK and RoI during June 2017 via social media and through deaneries, Royal Colleges and specialty-specific mailing lists.ParticipantsData from 243 trainees were analysed; 188 doctors from 31 specialties and 55 dentists from 9 specialties. Responses were received from trainees at all stages of postgraduate training though the overall response rate was low.Primary and secondary outcome measuresThe motivators and barriers to, and the extent of, trainee engagement with EBP.ResultsCronbach’s α was 0.83. Most trainees (87.6% (n=148) of doctors and 75.1% (n=39) of dentists) consulted the evidence base at least monthly, while 23.1% [n=39 doctors, 12 dentists] of both specialties did so daily. The two most commonly cited barriers to engagement with EBP for both doctors and dentists, respectively, were insufficient time (57.6% (n=95) and 45.1% (n=23)) and a tendency to follow departmental practice (40.6% (n=67) and 45.1% (n=23)). Key motivators for EBP included curiosity, following the example set by senior colleagues and a desire to avoid harm. Most trainees reported high levels of confidence interpreting evidence yet for 26.8% (n=45) of doctors and 36.5% (n=19) of dentists, medical hierarchy would impede them querying a colleague’s management plan based on their own reading of the evidence.ConclusionsTime, accepted departmental practice and the behaviour of senior clinicians all highly impact on trainee engagement with EBP. Given the low response rate, the extent to which these data represent the overall population is unclear.

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Applying Force Plate Technology to Inform Human Performance Programming in Tactical Populations

Applied Sciences ◽

10.3390/app11146538 ◽

2021 ◽

Vol 11 (14) ◽

pp. 6538

Author(s):

Justin J. Merrigan ◽

Jason D. Stone ◽

Joel R. Martin ◽

William Guy Hornsby ◽

Scott M. Galster ◽

...

Keyword(s):

Human Performance ◽

Force Plate ◽

Management Plan ◽

Neuromuscular Fatigue ◽

Evidence Based ◽

Evidence Based Practices ◽

Performance Profiling ◽

Training Adaptations ◽

Force Time ◽

Performance Programming

Force plate assessments, such as countermovement jumps and isometric mid-thigh pulls, examine performances (e.g., jump height, force, power) and movement strategies (e.g., asymmetries, durations), and are best suited to characterize and monitor physical capabilities, not predict injuries. To begin applying force plate technologies, users must first; (1) develop a data management plan to visualize and capture data over time; (2) select appropriate force plates for their scenario; (3) design appropriate testing protocols to ensure valid and reliable data. Force plate assessments may be added to existing testing, serve as separate testing batteries for annual profile testing to compare individuals and understand initial physical capabilities, or for more frequent testing (i.e., monthly or weekly) to monitor training-related adaptations or neuromuscular fatigue. Although these assessments inform evidence-based program designs, human performance practitioners must understand the considerations for conducting appropriate force plate testing, as well as proper visualizations and management of force plate data. Thus, the aim of this review is to provide evidence-based practices for utilizing force plates in tactical populations (e.g., military, firefighters, police). This includes best practices to implement testing for performance profiling, training adaptations, and monitoring neuromuscular fatigue and force asymmetries. Of note, due to the large amount of force-time metrics to choose from, this article provides general examples of important metrics to monitor and training recommendations based on changes to these force-time metrics, followed by specific examples in three case studies.

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Developing an Evidence-Based Coexistence Strategy to Promote Human and Wildlife Health in a Biodiverse Agroforest Landscape

Frontiers in Conservation Science ◽

10.3389/fcosc.2021.735367 ◽

2021 ◽

Vol 2 ◽

Author(s):

Elena Bersacola ◽

Hannah Parathian ◽

Amélia Frazão-Moreira ◽

Maimuna Jaló ◽

Américo Sanhá ◽

...

Keyword(s):

Knowledge Base ◽

Wildlife Conservation ◽

One Health ◽

Health Knowledge ◽

Critical Role ◽

Management Plan ◽

Theory Of Change ◽

Evidence Based ◽

Health Campaign ◽

Causal Pathway

Agroforest mosaics represent one of the most extensive human-impacted terrestrial systems worldwide and play an increasingly critical role in wildlife conservation. In such dynamic shared landscapes, coexistence can be compromised if people view wildlife as a source of infectious disease. A cross-disciplinary One Health knowledge base can help to identify evolving proponents and threats to sustainable coexistence and establish long-term project goals. Building on an existing knowledge base of human–wildlife interactions at Cantanhez National Park (NP), Guinea-Bissau, we developed a causal pathway Theory-of-Change approach in response to a newly identified disease threat of leprosy in the Critically Endangered western chimpanzee (Pan troglodytes verus). The goals of our project are to improve knowledge and surveillance of leprosy in humans and wildlife and increase capacity to manage human–wildlife interactions. We describe the core project activities that aim to (1) quantify space use by chimpanzees across Cantanhez NP and determine the distribution of leprosy in chimpanzees; (2) understand the health system and local perceptions of disease; and (3) identify fine-scale risk sites through participatory mapping of resources shared by humans and chimpanzees across target villages. We discuss the development of a biodiversity and health monitoring programme, an evidence-based One Health campaign, and a One Health environmental management plan that incorporates the sharing of space and resources, and the disease implications of human–non-human great ape interactions. We demonstrate the importance of multi-stakeholder engagement, and the development of strategy that fully considers interactions between people, wildlife, and the environment.

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Teaching Evidence Based Medicine in Surgical Education; the Challenges and Techniques in Training

Open Medicine Journal ◽

10.2174/1874220301603010337 ◽

2016 ◽

Vol 3 (1) ◽

pp. 337-345

Author(s):

M Griffin ◽

DJ Jordan ◽

A El Gawad

Keyword(s):

Clinical Practice ◽

Evidence Based Medicine ◽

Management Plan ◽

Evidence Based ◽

Clinical Expertise ◽

Medical Practitioners ◽

Excellent Teaching ◽

Journal Clubs ◽

Surgical Trainees ◽

Based Medicine

Evidence Based Medicine integrates clinical expertise, best available clinical evidence, as well as patient’s values and preferences to manage the care of patients. Surgeons have traditionally performed surgery according to their mentor teachings, these techniques being passed down through several generations. Current surgeon culture must evolve to integrate EBM into their clinical practice. The knowledge and skills required for searching and appraising critical literature needs to be taught to enable surgeons to implement it effectively. Evidence based surgery (EBS) will encourage surgeons to apply the best up-to-date knowledge to find the most effective surgical management plan for their patients. Several methods of teaching EBS to surgical trainees have shown to be effective including workshops, small group discussions, lecture style teaching and courses involving a combination of techniques. Journal clubs have gained in popularity and provided excellent teaching environments for surgeons to learn critical appraisal. Recently EBM has been introduced into the undergraduate programme to provide young medical practitioners with a strong foundation in EBM competency, and a positive attitude towards applying EBM to clinical practice. In this review, we aim to provide an overview of the principles of EBM and the success and challenges of teaching methods to deliver EBM for the surgical field.

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Treatment of shoulder and upper limb pain after stroke: an obstacle course for evidence-based practice

Reviews in Clinical Gerontology ◽

10.1017/s0959259804001091 ◽

2003 ◽

Vol 13 (4) ◽

pp. 321-333 ◽

Cited By ~ 6

Author(s):

Christopher IM Price

Keyword(s):

Shoulder Pain ◽

Upper Limb ◽

Motor Impairment ◽

Direct Consequence ◽

Management Plan ◽

Evidence Based ◽

Common Site ◽

Limb Pain ◽

Upper Limb Pain ◽

Site Pain

The upper limb (UL) is a common site for poststroke pain, which is often regarded as a direct consequence of proximal motor impairment. Although the subacromial region is the commonest site, pain can also occur lower down the UL and some causes are not directly related to hemiplegia. As distal clinical features unrelated to motor consequences of stroke can be useful for making a management plan for pain, this review will generally refer to poststroke upper limb pain (PULP) rather than use traditional terms such as hemiplegic shoulder pain (which may erroneously imply a proximal, purely motor related aetiology).

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Patients’ and health professionals’ perspectives on the outcomes, conduct, and medico-legal implications of multidisciplinary cancer meetings (MDMs).

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.e16562 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. e16562-e16562

Author(s):

Bianca Alix Devitt ◽

Jennifer Philip ◽

Madhu Sudan Singh ◽

Linda R. Mileshkin ◽

Sue-Anne McLachlan

Keyword(s):

Empirical Evidence ◽

Health Professionals ◽

Response Rate ◽

Social Issues ◽

Legal Protection ◽

Management Plan ◽

Treatment Modalities ◽

Evidence Based ◽

Legal Implications ◽

Patient Consent

e16562 Background: Multidisciplinary cancer meetings (MDMs) are a fundamental component of multidisciplinary cancer care. Guidelines relating to their conduct are largely based on expert opinion rather than empirical evidence. We examined patients and health professionals’ (HPs) attitudes to the outcomes, conduct and medico-legal implications of MDMs. Methods: Two study-specific questionnaires were developed based on qualitative research, published literature and guidelines, for health professionals who attend MDMs and patients with a current or previous diagnosis of cancer. The questionnaires were administered at 4 health services encompassing tertiary and regional centres in Victoria, Australia. Results: 170 HPs (response rate 62%) and 110 patients (response rate 83%) completed the questionnaire. 92% of patients want their case discussed at an MDM. HPs believe the focus of MDMs is to consider different treatment modalities (99%) and ensure patients receive evidence-based care (83%) rather than address psychosocial issues (52%). Similarly, patients allocated 71% of MDM discussion time to discussing possible treatment options, 15% to relevant social issues and 14% to psychological issues. More than 70% of patients and HPs thought no formal patient consent was required prior to discussion at MDM. 75% of HPs agreed MDMs provided them with increased medico-legal protection. 93% of HPs thought MDM discussions should result in a consensus on the proposed management plan. Patients would prefer to discuss the outcomes of the MDM personally with their treating doctor (81%) and 75% also desired written documentation. Conclusions: Patients and HPs agree the focus of MDMs is predominately medical with emphasis on treatment planning rather than the psychosocial needs of patients. Both groups believe MDM discussion forms part of standard care and formal consent is not required. HPs aim to develop an individualized, evidence-based management plan, agreed to by consensus. Strategies to improve communication of this plan to patients should be developed. This is the first empirical evidence on MDMs’ conduct and should help inform the development of future guidelines.

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