scholarly journals History of the concept of ‘levels of evidence’ and their current status in relation to primary prevention through lifestyle interventions

2004 ◽  
Vol 7 (2) ◽  
pp. 279-284 ◽  
Author(s):  
A Kroke ◽  
H Boeing ◽  
K Rossnagel ◽  
SN Willich
Keyword(s):  
Primary Prevention ◽  
Clinical Research ◽  
Clinical Medicine ◽  
Lifestyle Changes ◽  
Current Status ◽  
Rational Approach ◽  
Lifestyle Interventions ◽  
Related Factors ◽  
Levels Of Evidence ◽  
Research Questions

AbstractPrimary prevention is a major option to reduce the burden of chronic disease in populations. Because lifestyle interventions have proved to be effective, lifestyle recommendations including nutritional advice are made abundantly. However, both their credibility and their effectiveness are often considered not to be high. Therefore, scientific evidence should form the basis of recommendations and, as in clinical medicine, a rational approach should be followed for the evaluation of evidence. In this paper, the development and current concepts of ‘levels of evidence’ as they are applied in clinical medicine are outlined and their impact on evidence-based recommendations is discussed. Next, the question is raised as to how far the existing schemes are applicable to the evaluation of issues pertaining to primary prevention through lifestyle changes. Current schemes were developed mainly for clinical research questions and therefore place major emphasis on randomised controlled trials as the main and most convincing evidence in the evaluation process. These types of study are rarely available for lifestyle-related factors and might even not be feasible to obtain. Arguments are advanced to support the notion that a modification of currently existing ‘levels of evidence’ as developed for clinical research questions might be necessary. Thereby, one might be able to accommodate the specific aspects of evidence-related issues of recommendations for primary prevention through lifestyle changes, like dietary changes.

scholarly journals Current status and related factors of turnover intention of primary medical staff in Anhui Province, China: a cross-sectional study

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Guimei Chen ◽  
Lingzhi Sang ◽  
Jian Rong ◽  
Huosheng Yan ◽  
Hongzhang Liu ◽  
...  
Keyword(s):  
Social Support ◽  
Human Resources ◽  
Turnover Intention ◽  
Medical Staff ◽  
Psychological Capital ◽  
Pearson Correlation ◽  
Job Burnout ◽  
Current Status ◽  
Capital Social ◽  
Related Factors

Abstract Background The shortage of primary medical staff is an important issue in the management of health human resources, and it is also a problem that all countries in the world need to face together. Since 2009, China has implemented a new series of medical system reforms and the shortage and loss of primary medical staff have been alleviated accordingly. However, China has a large population and it is difficult to distribute health human resources evenly across regions. This study aimed to explore the current status of turnover intention and its relationship with psychological capital, social support, and job burnout, as well as how these factors influence turnover intention of primary medical staff in Anhui province, China. Methods Using structured questionnaires to collect data, including demographic characteristics, turnover intention, psychological capital, social support, and Chinese Maslach Burnout Inventory scale. A total of 1152 primary medical workers of Anhui were investigated. Data were analyzed by t-test, analysis of variance (ANOVA), Pearson correlation analysis, and multiple linear regression model. Results Total scores of turnover intention, psychological capital, social support, and job burnout of subjects were 14.15 ± 4.35, 100.09 ± 15.98, 64.93 ± 13.23 and 41.07 ± 9.437, respectively. Multiple linear regression showed the related factors of turnover intention were age, job position, work unit, and scores of job burnout. Pearson correlation showed psychological capital and social support were negatively correlated with turnover intention, while the score of job burnout was positively correlated with turnover intention. Conclusion The improvement of psychological capital and social support and the reduction of job burnout may play an important role in reducing turnover intention of primary medical staff. Primary medical managers should strengthen the humanistic care for primary medical staff, optimize the incentive mechanism, and improve internal management of medical institutions for stability.

scholarly journals A Search for Causes of Rising Incidence of Differentiated Thyroid Cancer in Children and Adolescents after Chernobyl and Fukushima: Comparison of the Clinical Features and Their Relevance for Treatment and Prognosis

2021 ◽  
Vol 18 (7) ◽  
pp. 3444
Author(s):  
Valentina Drozd ◽  
Vladimir Saenko ◽  
Daniel I. Branovan ◽  
Kate Brown ◽  
Shunichi Yamashita ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Children And Adolescents ◽  
Differentiated Thyroid Cancer ◽  
Age Groups ◽  
Distant Metastases ◽  
Lifestyle Changes ◽  
Radiation Doses ◽  
Related Factors ◽  
Fukushima Accident ◽  
Tumor Stages

The incidence of differentiated thyroid cancer (DTC) is steadily increasing globally. Epidemiologists usually explain this global upsurge as the result of new diagnostic modalities, screening and overdiagnosis as well as results of lifestyle changes including obesity and comorbidity. However, there is evidence that there is a real increase of DTC incidence worldwide in all age groups. Here, we review studies on pediatric DTC after nuclear accidents in Belarus after Chernobyl and Japan after Fukushima as compared to cohorts without radiation exposure of those two countries. According to the Chernobyl data, radiation-induced DTC may be characterized by a lag time of 4–5 years until detection, a higher incidence in boys, in children of youngest age, extrathyroidal extension and distant metastases. Radiation doses to the thyroid were considerably lower by appr. two orders of magnitude in children and adolescents exposed to Fukushima as compared to Chernobyl. In DTC patients detected after Fukushima by population-based screening, most of those characteristics were not reported, which can be taken as proof against the hypothesis, that radiation is the (main) cause of those tumors. However, roughly 80% of the Fukushima cases presented with tumor stages higher than microcarcinomas pT1a and 80% with lymph node metastases pN1. Mortality rates in pediatric DTC patients are generally very low, even at higher tumor stages. However, those cases considered to be clinically relevant should be followed-up carefully after treatment because of the risk of recurrencies which is expected to be not negligible. Considering that thyroid doses from the Fukushima accident were quite small, it makes sense to assess the role of other environmental and lifestyle-related factors in thyroid carcinogenesis. Well-designed studies with assessment of radiation doses from medical procedures and exposure to confounders/modifiers from the environment as e.g., nitrate are required to quantify their combined effect on thyroid cancer risk.

A Powerful Antidote to Physician Burnout: Intensive Healthy Lifestyle and Positive Psychology Approaches

2021 ◽  
pp. 155982762110066
Author(s):  
Liana Lianov
Keyword(s):  
Healthy Lifestyle ◽  
Meaningful Work ◽  
Well Being ◽  
Evidence Base ◽  
Lifestyle Changes ◽  
Lifestyle Interventions ◽  
Physical And Mental Health ◽  
Physician Burnout ◽  
Lifestyle Medicine ◽  
Persistent Symptoms

Burnout rates among physicians are rapidly rising. Leaders in the movement to address burnout have made the case that health care workplaces need to foster a culture of well-being, including trusting coworker interactions, collaborative and transparent leadership, work-life balance, flexibility, opportunities for meaningful work and for professional development, and effective 2-way communication. The rationale for focusing on organizational change to prevent burnout has pointed to persistent symptoms of burnout even when individual healthy lifestyle interventions are adopted. However, a case can be made that the lifestyle interventions were not implemented at the level of intensity recommended by the lifestyle medicine evidence-base to secure the desired improvement in physical and mental health when facing significant personal and environmental stressors. The lifestyle medicine community has the ethical mandate to advocate for intensive healthy lifestyle approaches to burnout prevention, in conjunction with organizational supports. By combining comprehensive and intensive lifestyle changes with organizational cultures of well-being, we can more effectively turn the tide of physician burnout.

scholarly journals Applications of Smart Helmet in Applied Sciences: A Systematic Review

2021 ◽  
Vol 11 (11) ◽  
pp. 5039
Author(s):  
Yosoon Choi ◽  
Yeanjae Kim
Keyword(s):  
Applied Sciences ◽  
Wireless Communication ◽  
Communication Technology ◽  
Academic Research ◽  
Current Status ◽  
Smart Devices ◽  
The Past ◽  
Modular Concept ◽  
Research Questions ◽  
Cloud Servers

A smart helmet is a wearable device that has attracted attention in various fields, especially in applied sciences, where extensive studies have been conducted in the past decade. In this study, the current status and trends of smart helmet research were systematically reviewed. Five research questions were set to investigate the research status of smart helmets according to the year and application field, as well as the trend of smart helmet development in terms of types of sensors, microcontrollers, and wireless communication technology. A total of 103 academic research articles published in the past 11 years (2009–2020) were analyzed to address the research questions. The results showed that the number of smart helmet applications reported in literature has been increasing rapidly since 2018. The applications have focused mostly on ensuring the safety of motorcyclists. A single-board-based modular concept unit, such as the Arduino board, and sensor for monitoring human health have been used the most for developing smart helmets. Approximately 85% of smart helmets have been developed to date using wireless communication technology to transmit data obtained from smart helmets to other smart devices or cloud servers.

The Numbers Will Love You Back in Return—I Promise

2016 ◽  
Vol 11 (4) ◽  
pp. 551-554 ◽  
Author(s):  
Martin Buchheit
Keyword(s):  
Sample Size ◽  
Null Hypothesis ◽  
Clinical Medicine ◽  
Statistical Significance ◽  
Significance Testing ◽  
Null Hypothesis Significance Testing ◽  
Sport Science ◽  
Size Dependent ◽  
Research Questions ◽  
Per Se

The first sport-science-oriented and comprehensive paper on magnitude-based inferences (MBI) was published 10 y ago in the first issue of this journal. While debate continues, MBI is today well established in sport science and in other fields, particularly clinical medicine, where practical/clinical significance often takes priority over statistical significance. In this commentary, some reasons why both academics and sport scientists should abandon null-hypothesis significance testing and embrace MBI are reviewed. Apparent limitations and future areas of research are also discussed. The following arguments are presented: P values and, in turn, study conclusions are sample-size dependent, irrespective of the size of the effect; significance does not inform on magnitude of effects, yet magnitude is what matters the most; MBI allows authors to be honest with their sample size and better acknowledge trivial effects; the examination of magnitudes per se helps provide better research questions; MBI can be applied to assess changes in individuals; MBI improves data visualization; and MBI is supported by spreadsheets freely available on the Internet. Finally, recommendations to define the smallest important effect and improve the presentation of standardized effects are presented.

The Social Value of Research and Health Research Priority-Setting

2021 ◽  
Author(s):  
D.M. Wenner
Keyword(s):  
Clinical Research ◽  
Priority Setting ◽  
Health Research ◽  
Human Subjects ◽  
Social Value ◽  
Research Priority ◽  
The Social ◽  
Research Questions ◽  
Social Scientific ◽  
Health Research Priority Setting

This chapter discusses the social value requirement in clinical research and its intersection with health research priority-setting. The social value requirement states that clinical research involving human subjects is only ethical if it has the potential to produce socially valuable knowledge. The chapter discusses various ways to specify both the justification for and the content of the social value requirement. It goes on to consider the implications of various accounts of the content and justification for the requirement for the ethics of health research priority-setting, showing that while some accounts of the requirement are largely silent with respect to how research questions should be prioritized, others entail robust obligations to prioritize research that might benefit particular groups. The chapter also briefly examines potential arguments for something like a social value requirement in other kinds of research, specifically social scientific research.

scholarly journals Matching research design to clinical research questions

2012 ◽  
Vol 33 (1) ◽  
pp. 49 ◽  
Author(s):  
Sadaf Aslam ◽  
Kedar Mehta ◽  
Helen Georgiev ◽  
Ambuj Kumar
Keyword(s):  
Clinical Research ◽  
Research Design ◽  
Research Questions

scholarly journals Estimands: bringing clarity and focus to research questions in clinical trials

BMJ Open ◽  
2022 ◽  
Vol 12 (1) ◽  
pp. e052953
Author(s):  
Timothy Peter Clark ◽  
Brennan C Kahan ◽  
Alan Phillips ◽  
Ian White ◽  
James R Carpenter
Keyword(s):  
Clinical Trial ◽  
Sensitivity Analysis ◽  
Clinical Trials ◽  
Clinical Research ◽  
Recent Work ◽  
Treatment Effect ◽  
Research Question ◽  
Probability Of Success ◽  
Research Questions

Precise specification of the research question and associated treatment effect of interest is essential in clinical research, yet recent work shows that they are often incompletely specified. The ICH E9 (R1) Addendum on Estimands and Sensitivity Analysis in Clinical Trials introduces a framework that supports researchers in precisely and transparently specifying the treatment effect they aim to estimate in their clinical trial. In this paper, we present practical examples to demonstrate to all researchers involved in clinical trials how estimands can help them to specify the research question, lead to a better understanding of the treatment effect to be estimated and hence increase the probability of success of the trial.

Abstract TMP81: Regional, Race-Ethnic and Sex Disparities in Lifestyle Interventions: Data from the Florida Puerto Rico Collaboration to Reduce Stroke Disparities (FL-PR CReSD) Study - the NINDS Stroke Prevention Intervention Research Program

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Maria A Ciliberti-Vargas ◽  
Kefeng Wang ◽  
Sofia Oluwole ◽  
Erika Marulanda-Londoño ◽  
Maranatha Ayodele ◽  
...  
Keyword(s):  
Weight Loss ◽  
Lifestyle Modification ◽  
Lifestyle Changes ◽  
Lifestyle Interventions ◽  
Lifestyle Modifications ◽  
Sodium Diet ◽  
Low Sodium Diet ◽  
Low Sodium ◽  
Diet Counseling ◽  
To Receive

Background: As key components of the AHA Life’s Simple 7 campaign, lifestyle modifications play an integral role in the prevention of vascular disease. Little is known about the prevalence of lifestyle modification counseling in patients with acute ischemic stroke (AIS). We sought to investigate disparities in the delivery of lifestyle interventions to AIS patients in the large NINDS-funded FL-PR CReSD Registry of Get With The Guidelines-Stroke (GWTG-S) data. Methods: GWTG-S collects data on the provision of several lifestyle interventions including counseling on exercise/weight loss, Therapeutic Lifestyle Changes (TLC) diet, diabetes (DM) education and antihypertensive (low sodium) diet. 80,598 AIS cases were prospectively included from 82 sites (69 FL; 13 PR) from 2010-2016. Multilevel logistic regression models adjusted for age, race, and aphasia were used to evaluate differences in the provision of lifestyle interventions as indicated for patients prior to hospital discharge. Results: Among AIS cases, 51% were men, 62% non-Hispanic White (NHW), 18% NH-Black (NHB), 13% FL-Hispanic (FLH), and 6% PR-Hispanic (PRH). Mean age was 71±14 years. The highest mean BMI was in PRH (29±7 kg/m 2 ), with the lowest in NHW (27±6 kg/m 2 ) and FLH (28±6 kg/m 2 ). Despite this, PRH were less likely to receive exercise/weight loss counseling compared to NHW (OR 0.43, 95% CI 0.20-0.90) and FLH (OR 0.46, 95% CI 0.22-0.97). PRH also had lower odds of receiving TLC diet counseling compared to NHW and FLH (OR 0.32, 95% CI 0.15-0.68). Though NHB presented with higher rates of DM compared to NHW (38% vs. 25%), they were less likely to receive DM education (OR 0.95, 95% CI 0.91-0.99). Women were less likely to receive TLC diet counseling (OR 0.94, 95% CI 0.90-0.98) and DM education (OR 0.94, CI 0.92-0.97) compared to men. Despite higher HTN frequency in women and NHB (67% and 69%), both were less likely to receive low sodium diet recommendations as compared to men (OR 0.94, 95% CI 0.92-0.97) and NHW (OR 0.95, 95% CI 0.91-0.99). Conclusion: Overall, disparities were identified in the provision of several lifestyle interventions in AIS patients. These interventions can benefit all and providers should continue counseling patients regarding modifiable risk factors to prevent future stroke.

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