Research Consumerism 101: Evaluating External Evidence of Treatment Effectiveness

2008 ◽  
Vol 17 (2) ◽  
pp. 43-49
Author(s):  
James L. Coyle
Keyword(s):  
Treatment Effectiveness ◽  
Code Of Ethics ◽  
Oropharyngeal Dysphagia ◽  
Clinical Importance ◽  
Professional Services ◽  
Adverse Outcomes ◽  
Professional Judgment ◽  
Evidence Based ◽  
Intervention Selection ◽  
Published Research

Abstract The modern clinician is a research consumer. Rehabilitation of oropharyngeal impairments, and prevention of the adverse outcomes of dysphagia, requires the clinician to select interventions for which evidence of a reasonable likelihood of a successful, important outcome exists. The purpose of this paper is to provide strategies for evaluation of published research regarding treatment of oropharyngeal dysphagia. This article utilizes tutorial and examples to inform and educate practitioners in methods of appraising published research. It provides and encourages the use of methods of efficiently evaluating the validity and clinical importance of published research. Additionally, it discusses the importance of the ethical obligation we, as practitioners, have to use evidence-based treatment selection methods and measurement of patient performance during therapy. The reader is provided with tactics for evaluating treatment studies to establish a study's validity and, thereby, objectively select interventions. The importance of avoiding subjective or unsubstantiated claims and using objective methods of generating empirical clinical evidence is emphasized. The ability to evaluate the quality of research provides clinicians with objective intervention selection as an important, essential component of evidence-based clinical practice. ASHA Code of Ethics (2003): Principle I, Rule F: “Individuals shall fully inform the persons they serve of the nature and possible effects of services rendered and products dispensed…” (p. 2) Principle I, Rule G: “Individuals shall evaluate the effectiveness of services rendered and of products dispensed and shall provide services or dispense products only when benefit can reasonably be expected.” (p. 2) Principle IV, Rule G: “Individuals shall not provide professional services without exercising independent professional judgment, regardless of referral source or prescription.” (p. 4)

Será que estamos precisando de uma lava jato científica?

2019 ◽  
Vol 18 (1) ◽  
pp. 1
Author(s):  
Antonio Marcos Andrade
Keyword(s):  
Health Care ◽  
Medical Journal ◽  
British Medical Journal ◽  
Evidence Based Medicine ◽  
Evidence Based ◽  
Plos Medicine ◽  
De Se ◽  
Research Findings ◽  
Based Medicine ◽  
Published Research

Em 2005, o grego John Loannidis, professor da Universidade de Stanford, publicou um artigo na PLOS Medicine intitulado “Why most published research findings are false” [1]. Ele que é dos pioneiros da chamada “meta-ciência”, disciplina que analisa o trabalho de outros cientistas, avaliou se estão respeitando as regras fundamentais que definem a boa ciência. Esse trabalho foi visto com muito espanto e indignação por parte dos pesquisadores na época, pois colocava em xeque a credibilidade da ciência.Para muitos cientistas, isso acontece porque a forma de se produzir conhecimento ficou diferente, ao ponto que seria quase irreconhecível para os grandes gênios dos séculos passados. Antigamente, se analisavam os dados em estado bruto, os autores iam às academias reproduzir suas experiências diante de todos, mas agora isso se perdeu porque os estudos são baseados em seis milhões de folhas de dados. Outra questão importante que garantia a confiabilidade dos achados era que os cientistas, independentemente de suas titulações e da relevância de suas descobertas anteriores, tinham que demonstrar seus novos achados diante de seus pares que, por sua vez, as replicavam em seus laboratórios antes de dar credibilidade à nova descoberta. Contudo, na atualidade, essas garantias veem sendo esquecidas e com isso colocando em xeque a validade de muitos estudos na área de saúde.Preocupados com a baixa qualidade dos trabalhos atuais, um grupo de pesquisadores se reuniram em 2017 e construíram um documento manifesto que acabou de ser publicado no British Medical Journal “Evidence Based Medicine Manifesto for Better Health Care” [2]. O Documento é uma iniciativa para a melhoria da qualidade das evidências em saúde. Nele se discute as possíveis causas da pouca confiabilidade científica e são apresentadas algumas alternativas para a correção do atual cenário. Segundo seus autores, os problemas estão presentes nas diferentes fases da pesquisa:Fases da elaboração dos objetivos - Objetivos inúteis. Muito do que é produzido não tem impacto científico nem clínico. Isso porque os pesquisadores estão mais interessados em produzir um número grande de artigos do que gerar conhecimento. Quase 85% dos trabalhos não geram nenhum benefício direto a humanidade.Fase do delineamento do estudo - Estudos com amostras subdimensionados, que não previnem erros aleatórios. Métodos que não previnem erros sistemáticos (viés na escolha das amostras, falta de randomização correta, viés de confusão, desfechos muito abertos). Em torno de 35% dos pesquisadores assumem terem construídos seus métodos de maneira enviesada.Fase de análise dos dados - Trinta e cinco por cento dos pesquisadores assumem práticas inadequadas no momento de análise dos dados. Muitos assumem que durante esse processo realizam várias análises simultaneamente, e as que apresentam significância estatística são transformadas em objetivos no trabalho. As revistas também têm sua parcela de culpa nesse processo já que os trabalhos com resultados positivos são mais aceitos (2x mais) que trabalhos com resultados negativos.Fase de revisão do trabalho - Muitos revisores de saúde não foram treinados para reconhecer potenciais erros sistemáticos e aleatórios nos trabalhos.Em suma é necessário que pesquisadores e revistas científicas pensem nisso. Só assim, teremos evidências de maior qualidade, estimativas estatísticas adequadas, pensamento crítico e analítico desenvolvido e prevenção dos mais comuns vieses cognitivos do pensamento.

scholarly journals Translating evidence-based treatment for digital health delivery: a protocol for family-based treatment for anorexia nervosa using telemedicine

2020 ◽  
Vol 8 (1) ◽  
Author(s):  
A. Hambleton ◽  
D. Le Grange ◽  
J. Miskovic-Wheatley ◽  
S. Touyz ◽  
M. Cunich ◽  
...  
Keyword(s):  
Anorexia Nervosa ◽  
Young People ◽  
Treatment Effectiveness ◽  
Digital Health ◽  
Evidence Based ◽  
Treatment Needs ◽  
Evidence Based Treatment ◽  
Face To Face ◽  
Family Based Treatment ◽  
Family Based

Abstract Background Family-based treatment (FBT) is an efficacious outpatient intervention for young people diagnosed with Anorexia Nervosa (AN). To date, treatment to protocol has relied on standard face-to-face delivery. Face-to-face therapy is subject to geographic, temporal and human factors, rendering it particularly susceptible to inequities and disruption. This has resulted in poorer service provision for rural and regional families, and recently a significant challenge to providing face-to-face services during the COVID-19 global pandemic. The present study examines whether FBT for AN can be successfully translated to a digital delivery platform to address these access issues. Method Forty young people aged 12 to 18 years who meet DSM-5 diagnostic criteria for AN, and live in a rural or regional setting, will along with their family be recruited to the study. Trained therapists will provide 18 sessions of FBT over 9 months via telemedicine to the home of the young person and their family. The analysis will examine treatment effectiveness, feasibility, acceptability, and cost-effectiveness. Discussion The study addresses the treatment needs of families not able to attend face-to-face clinical services for evidence-based treatment for eating disorders. This might be due to several barriers, including a lack of local services or long travel distances to services. There has been a recent and unprecedented demand for telemedicine to facilitate the continuity of care during COVID-19 despite geographical circumstances. If delivering treatment in this modality is clinically and economically effective and feasible, it will facilitate access to potentially lifesaving, evidence-based treatments for families formerly unable to access such care and provide evidence for the continuity of services when and where face-to-face treatment is not feasible.

Instructional Practices, Priorities, and Preparedness for Educating Students With Autism and Intellectual Disability

2018 ◽  
Vol 34 (1) ◽  
pp. 3-14 ◽  
Author(s):  
Victoria F. Knight ◽  
Heartley B. Huber ◽  
Emily M. Kuntz ◽  
Erik W. Carter ◽  
A. Pablo Juarez
Keyword(s):  
Intellectual Disability ◽  
Instructional Practices ◽  
Special Educators ◽  
Future Research ◽  
Professional Judgment ◽  
Evidence Based ◽  
Wide Range ◽  
Students With Autism ◽  
Services And Supports ◽  
Instructional Decision

Improving educational outcomes for students with autism and intellectual disability requires delivering services and supports marked by evidence-based practices. We surveyed 535 special educators of students with autism and/or intellectual disability about (a) their implementation of 26 instructional practices, (b) their recent access to training and resources on those practices, (c) the factors they consider when deciding which practices to use, (d) the importance they place on various instructional areas (e.g., social skills, reading), and (e) their preparedness to provide that instruction. Although teachers reported implementing a wide range of evidence-based instructional practices, their recent access to training and resources was fairly limited. Special educators identified a constellation of factors informing their instructional decision making, placing emphasis on student needs and professional judgment. When considering instructional areas, a gap was evident between ratings of importance and preparedness. We address implications for strengthening professional development pathways and offer recommendations for future research.

Abstract P369: Polypharmacy, Adverse Outcomes, and Treatment Effectiveness in Elderly Patients With Atrial Fibrillation

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Aniqa Alam ◽  
Nemin Chen ◽  
Pamela L Lutsey ◽  
Richard MacLehose ◽  
J'Neka Claxton ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Elderly Patients ◽  
Rate Control ◽  
Treatment Effectiveness ◽  
Adverse Outcomes ◽  
Pharmacy Claims ◽  
Increased Risk ◽  
The Impact

Background: Polypharmacy is highly prevalent in elderly individuals with chronic conditions, including atrial fibrillation (AF). The impact of polypharmacy on adverse outcomes and on treatment effectiveness in elderly AF patients remains unaddressed. Methods: We studied 338,810 AF patients ≥75 years of age with 1,761,660 active prescriptions [mean (SD), 5.1 (3.8) per patient] enrolled in the MarketScan Medicare Supplemental database in 2007-2015. Polypharmacy was defined as ≥5 active prescriptions at AF diagnosis based on outpatient pharmacy claims. AF treatments (oral anticoagulation, rhythm and rate control) and cardiovascular endpoints (ischemic stroke, bleeding, heart failure) were defined based on inpatient, outpatient and pharmacy claims. Multivariable Cox models were used to estimate associations of polypharmacy with cardiovascular endpoints and the interaction between polypharmacy and AF treatments in relation to cardiovascular endpoints. Results: Prevalence of polypharmacy was 52% (176,007 of 338,810). Patients with polypharmacy had increased risk of major bleeding [hazard ratio (HR) 1.16, 95% confidence interval (CI) 1.12, 1.20] and heart failure (HR 1.33, 95%CI 1.29, 1.36), but not of ischemic stroke (HR 0.96, 95%CI 0.92, 1.00), compared to those not with polypharmacy (Table). Polypharmacy status did not consistently modify the effectiveness of oral anticoagulants. However, rhythm control (vs. rate control) was more effective in preventing heart failure hospitalization in patients not with polypharmacy (HR 0.87, 95%CI 0.76, 0.99) than among those with polypharmacy (HR 0.98, 95%CI 0.91, 1.07, p for interaction = 0.02). Conclusion: Polypharmacy is frequent among elderly patients with AF, associated with adverse outcomes, and potentially affecting the effectiveness of AF treatments. Optimizing management of polypharmacy in elderly AF patients may lead to improved outcomes.

Using Integrative Development to Create a Coaching Culture in a Professional Services Firm

2019 ◽  
pp. 506-514
Author(s):  
David B. Drake
Keyword(s):  
Human Resource Development ◽  
Human Resource ◽  
Adult Development ◽  
Case History ◽  
Organization Development ◽  
Professional Services ◽  
Evidence Based ◽  
Coaching Training ◽  
Professional Services Firm ◽  
Training Organization

This reflective case history introduces integrative development (ID) as an approach for evidence-based organizational change and development initiatives. ID brings adult development and organization development into a unified theory, and it aligns three human resource development disciplines (coaching, training, organization development) into a unified set of practices. The case history outlines how narrative coaching, an ID-based methodology, was used in creating a coaching culture in a professional services firm and offers principles and recommendations for EBOCD practitioners.

Caring for Older Adults During and After Critical Illness

2021 ◽  
pp. 216-234
Author(s):  
Maria C. Duggan ◽  
Julie Van ◽  
E. Wesley Ely
Keyword(s):  
Older Adults ◽  
Critical Illness ◽  
Health Care Professionals ◽  
Interdisciplinary Approach ◽  
Adverse Outcomes ◽  
Evidence Based ◽  
Complex Population ◽  
Multiple Domains ◽  
Over Time

Over half of people with critical illness are older adults, and the number of older adults admitted to intensive care units has been increasing over time. Older adults have increased vulnerability to disease, disability, and adverse outcomes across many domains. To address this most effectively, a unique, interdisciplinary approach is necessary to optimize not only survival but also functional status and quality of life. A shortage of health care professionals equipped to care for the aging population makes it imperative that all professionals become aware of basic principles of caring for older adults. To equip them to care for this complex population, this chapter provides an overview of how aging impacts multiple domains of an older person with critical illness and describes evidence-based approaches to caring for older adults with critical illness.

Targeting Sepsis as a Performance Improvement Metric

2014 ◽  
Vol 25 (2) ◽  
pp. 179-186
Author(s):  
Ruth Kleinpell ◽  
Christa A. Schorr
Keyword(s):  
Performance Improvement ◽  
Patient Outcomes ◽  
Significant Contribution ◽  
Early Recognition ◽  
Adverse Outcomes ◽  
Evidence Based ◽  
Systemic Response ◽  
Surviving Sepsis Campaign ◽  
Practice Care ◽  
Sepsis Care

Sepsis is the body’s systemic response to infection that can be complicated by acute organ dysfunction and is associated with high mortality rates and adverse outcomes for acute and critically ill patients. The 2012 Surviving Sepsis Campaign guidelines advocated for implementation of evidence-based practice care for sepsis, with a focus on quality improvement. Nurses are directly involved in identification and management of sepsis. Implementing performance improvement strategies aimed at early recognition and targeted treatment can further improve sepsis care and patient outcomes. This article presents an overview of the process of implementing performance improvement initiatives for sepsis care, highlighting the significant contribution of nursing care.

scholarly journals Cerumen Management: An Updated Clinical Review and Evidence-Based Approach for Primary Care Physicians

2020 ◽  
Vol 11 ◽  
pp. 215013272090418 ◽  
Author(s):  
Garret A. Horton ◽  
Matthew T. W. Simpson ◽  
Michael M. Beyea ◽  
Jason A. Beyea
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
English Language ◽  
Family Physicians ◽  
Neck Surgery ◽  
Adverse Outcomes ◽  
Cochrane Library ◽  
Evidence Based ◽  
The Cochrane Library ◽  
Cerumen Removal

Objective: To provide family physicians with a practical, evidence-based approach to managing patients with cerumen impaction. Methods: MEDLINE, The Cochrane Library, and the Turning Research Into Practice (TRIP) database were searched for English-language cerumen impaction guidelines and reviews. All such articles published between 1992 and 2018 were reviewed, with most providing level II and III evidence. Results: Cerumen impaction is a common presentation seen in primary care and cerumen removal is one of the most common otolaryngologic procedures performed in general practice. Cerumen impaction is often harmless but can be accompanied by more serious symptoms. Cerumenolytics and irrigation of the ear canal are reasonable first-line therapies and can be used in conjunction or isolation. If irrigation and cerumenolytics are contraindicated, manual removal is appropriate, but the tools necessary are not commonplace in primary care clinics and specialized training may be required to prevent adverse outcomes. Conclusion: Family physicians play a key role in the assessment and management of cerumen impaction and are well equipped to do so. Knowledge of the available techniques for cerumen removal as well as their contraindications ensures that cerumen is removed safely and effectively. When cerumen removal cannot be removed safely in a primary care setting, referral to Otolaryngology-Head and Neck Surgery is appropriate.

CONFUSION IN CLINICAL TRIALS OF ALZHEIMER'S DISEASE

2015 ◽  
Vol 86 (11) ◽  
pp. e4.137-e4
Author(s):  
Jeremy Hobart ◽  
Sophie Cleanthous ◽  
John Zajieck ◽  
Stefan Cano
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Clinical Trials ◽  
Clinical Outcome ◽  
Treatment Effectiveness ◽  
Measurement Properties ◽  
Assessment Instruments ◽  
Evidence Based ◽  
Fda Guidance ◽  
Literature Reviews

BackgroundNeurology clinical trials frequently use clinical outcome assessment instruments (COAs) as outcome measures. We question the extent to which measurement limitations of COAs contribute to clinical trials failures in Alzheimer's disease.ObjectivesWe conducted a series of literature reviews to: identify the concepts assessed in AD clinical trials, and how these concepts were defined and measured; identify which COAs have been used in AD clinical trials, and on which grounds they were selected. We examined published measurement properties of COAs used in AD clinical trials in accordance with FDA guidance.ResultsA set of literature reviews identified >6500 publications from PUBMED/EMBASE inception. In the extracted 850 articles, 984 uniquely named concepts were assessed and 1283 COAs were used. However, few trials provided definitions of the concepts they measured; very different COAs were used to measure the same (named) concepts; the same COAs were used to measure different concepts; COA selection was rarely justified or evidence-based. Further reviews of COA development papers (n=174) indicated most fail to meet recommended criteria.ConclusionsFindings imply substantial measurement confusion in AD clinical trials and suggest they have provided weak evaluations of treatment effectiveness. Findings were replicated in Parkinson's disease (n366 articles).

scholarly journals Delirium in the Intensive Care Unit: Is Dexmedetomidine Effective?

2019 ◽  
Vol 39 (4) ◽  
pp. e8-e21
Author(s):  
Joelle Ungarian ◽  
James A. Rankin ◽  
Karen L. Then
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critical Care Nurses ◽  
Screening Tools ◽  
Evidence Based ◽  
Antipsychotic Medications ◽  
Delirium Management ◽  
Atypical Antipsychotic Medications ◽  
Published Research ◽  
Evidence Based Nursing

Delirium in the intensive care unit affects approximately 30% of patients despite vigorous efforts to encourage the use of effective screening tools and preventive strategies. The success of pharmacological treatment of delirium remains equivocal; moreover, a paucity of research supports the use of atypical antipsychotic medications. However, dexmedetomidine appears to have a promising role in delirium management. This review includes an overview of the pathophysiology and types of delirium and describes 2 established tools used to screen for delirium. Published research related to the use of dexmedetomidine in the management of delirium is also discussed. The authors make recommendations for critical care nurses on dexmedetomidine use in the context of providing evidence-based nursing care to intensive care unit patients with delirium.

Sign in / Sign up

Export Citation Format

Share Document