ESRA19-0338 Overcoming divergent surgical opinion to successfully implement an evidence based regional anaesthetic guideline: a marriage of published evidence and consultant preference

2019 ◽  
Author(s):  
D Stangoe ◽  
N Courtenay-Evans
Keyword(s):  
Evidence Based ◽  
Published Evidence

Evaluation, Development, and Implementation of Potentially Better Practices in Neonatal Intensive Care Nutrition

PEDIATRICS ◽  
2003 ◽  
Vol 111 (Supplement_E1) ◽  
pp. e461-e470
Author(s):  
Barbara Kuzma-O’Reilly ◽  
Maria L. Duenas ◽  
Coleen Greecher ◽  
Lois Kimberlin ◽  
Dennis Mujsce ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Neonatal Intensive Care ◽  
Outcome Measure ◽  
Implementation Strategies ◽  
Cost Savings ◽  
Nutrition Support ◽  
Evidence Based ◽  
Published Evidence ◽  
Support Practices ◽  
Neonatal Population

Objective. The desire for evidence-based clinical guidelines for nutritional support of the preterm infant has been identified. Published evidence has not yielded clear guidelines about the best method of delivery, substrate use, or appropriate outcome measure to evaluate nutrition support. In addition, reports on research of nutrition support often fail to give the most rudimentary process necessary to improve quality in various unit settings. Methods. The Vermont Oxford Network “Got Milk” focus group developed eight potentially better practices for nutrition support, implementation strategies for these practices, and a comprehensive appraisal process to measure nutrition outcome in preterm infants. Results. After implementation of the potentially better practices, all participating institutions showed earlier initiation of nutrition support, earlier attainment of adequate energy intakes, reduced delay in reaching full enteral feeds, more consistent nutrition support practice, decreased length of stay, cost savings, and improved growth at time of discharge. Conclusions. Development and implementation of evidence-based better nutrition support practices in neonates led to improved nutrient intake and growth with reduced length of stay and related costs. Consistent, comprehensive, multidisciplinary appraisal of practice is an integral component of improving nutrition outcomes in the neonatal population.

scholarly journals How pain management for children with cerebral palsy in South African schools complies with up-to-date knowledge

2019 ◽  
Vol 8 ◽  
Author(s):  
Ensa Johnson ◽  
Stefan Nilsson ◽  
Margareta Adolfsson
Keyword(s):  
Cerebral Palsy ◽  
Pain Management ◽  
South African ◽  
Scientific Knowledge ◽  
Waiting Times ◽  
System Level ◽  
Evidence Based ◽  
Special Educational Needs ◽  
Published Evidence ◽  
Children With Cerebral Palsy

Background: Pain in children with cerebral palsy (CP) has its sources in musculoskeletal problems that can influence learning in a school setting. Best pain management is essential for these children, but school staff may not keep up to date with the latest developments and interventions. Therefore, staff’s perceptions of beneficial strategies may not comply with contemporary scientific knowledge about effective evidence-based interventions.Objectives: This study investigated how pain management intervention for children with CP in South African schools complied with international scientific knowledge about evidence-based interventions. The intention was to provide support for an update of knowledge on both individual level (i.e. professionals) and system level (i.e. decision makers).Method: Five focus groups were conducted with staff members at five schools for children with special educational needs in South Africa. Manifest and latent content analyses of professional statements identified interventions reported as beneficial and related them to higher and lower levels of intervention evidence as reported at the time of data collection.Results: Most treatment strategies concerned motor functioning that fell within the framework of physiotherapists and occupational therapists. Access to orthopaedic expertise was limited, waiting times were long and medication for spasticity treatment was not offered.Conclusion: A discrepancy between published evidence and clinical practice for pain management in children with CP in South African school settings was noted. Suggestions for improved early intervention to identify children’s hips at risk through surveillance programmes; and orthopaedic management are proposed to prevent deformities and unnecessary suffering in South African children with CP.

Post-operative vital signs: How often is too often?

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 210-210
Author(s):  
Kristen Filson ◽  
Colleen Atherholt ◽  
Meredith Simoes ◽  
Michael DiPalma ◽  
Susheela John ◽  
...  
Keyword(s):  
Vital Sign ◽  
Best Practice ◽  
Vital Signs ◽  
Time Frame ◽  
Evidence Based ◽  
Background Current ◽  
Safe Patient Care ◽  
Published Evidence ◽  
Blood Pressures ◽  
Operative Monitoring

210 Background: Current protocol for post-operative patients admitted to medical-surgical/telemetry units from post anesthesia care units states vital signs are taken every 15 minutes for 1 hour, every 30 minutes for 2 hours and then, every 4 hours for 24 hours. To date, published evidence-based research regarding the frequency and duration of vital signs to safely monitor post-operative patients is limited. The goal is to determine best practice in post-operative vital sign monitoring to ensure safe patient care. The purpose of this review is to determine what frequency and duration of vital signs is required to identify a deviation greater than 20% of patient baseline to ensure safe post-operative monitoring of patients. Methods: A total of 742 post-operative patients’ charts were evaluated. A time frame in which vital signs deviated greater than 20% from patient baseline was established from the data collected. A chart was created depicting these results; listing the total deviations by individual vital sign and time frame. Results: Results show blood pressure and heart rate are the vital signs that have the greatest deviation from baseline followed by pulse-oximetry. Temperature deviations are widespread, while changes in respiratory rate are seen within the first hour. When looking at specific percentages, it was noted that 65% of the total patients reviewed had a 20% deviation from their baseline vital signs. Blood pressures made up 50% of those deviations, while heart rates made up 45%. A total of 27% of the deviations occurred 4-8 hours after admission, 13% of deviations occurred 8-12 hours after admission, 9% of deviations occurred 1.5 hours after admission, and 7% of deviations occurred 12-16 hours after admission. Conclusions: Based on these results, the best times to take post-operative vitals to ensure deviations are detected are: every 15 minutes for 30 minutes upon admission, 1.5 hours after admission, 4 hours after admission, and then every 4 hours for 20 hours. Findings indicate vital signs can safely be taken less frequently in post-operative patients admitted to medical-surgical/telemetry units.

scholarly journals Vestibular Physical Therapy Treatment of Individuals Exposed to Directed Energy

2021 ◽  
Author(s):  
Carrie W Hoppes ◽  
Karen H Lambert ◽  
Brooke N Klatt ◽  
Orlando D Harvard ◽  
Susan L Whitney
Keyword(s):  
Physical Therapy ◽  
Treatment Program ◽  
Best Practice ◽  
Physical Therapist ◽  
Health Condition ◽  
Evidence Based ◽  
Joint Force ◽  
Therapy Regimen ◽  
Published Evidence ◽  
Directed Energy

ABSTRACT Introduction Following suspected sonic attacks on U.S. Embassies, a subset of individuals presented with a unique cluster of symptoms believed to have resulted from exposure to directed energy. Directed energy has been described as exposure to a unique sound/pressure phenomenon such as infrasonic or ultrasonic acoustic or electromagnetic energy. The Joint Force does not have an established protocol to guide vestibular physical therapy for individuals exposed to directed energy. Therefore, we have provided evidence-based guidance for the treatment of oculomotor- and vestibular-related impairments from similar populations. Materials and Methods Published evidence was used to inform suggestions for clinical best practice. We offer resources for the management of non-oculomotor- and non-vestibular-related impairments, before discussing physical therapy interventions for dizziness and imbalance. Results The physical therapist should design a treatment program that addresses the individual’s health condition(s), body structure and function impairments, activity limitations, and participation restrictions after suspected directed energy exposure. This treatment program may include static standing, compliant surface standing, weight shifting, modified center of gravity, gait, and gaze stabilization or vestibular-ocular reflex training. Habituation may also be prescribed. Interventions were selected that require little to no specialized equipment, as such equipment may not be available in all settings (i.e., operational environments). Conclusions Evidence-based guidance for prescribing a comprehensive vestibular physical therapy regimen for individuals exposed to directed energy may aid in their rehabilitation and return to duty. This standardized approach can help physical therapists to treat complaints that do not match any previously known medical conditions but resemble brain injury or vestibular pathology.

Evidence-Based Data About Prevalence and Risk of Malignancy of Thyroid Incidentalomas Detected by Different PET Radiopharmaceuticals

2020 ◽  
Vol 13 (2) ◽  
pp. 89-93 ◽  
Author(s):  
Giovanni Signore ◽  
Domenico Albano ◽  
Luca Giovanella ◽  
Francesco Bertagna ◽  
Giorgio Treglia
Keyword(s):  
Systematic Reviews ◽  
Cochrane Library ◽  
Evidence Based ◽  
Published Evidence ◽  
Risk Of Malignancy ◽  
Focal Pattern ◽  
Reported Data ◽  
Meta Analyses ◽  
Specific Membrane ◽  
Pet Radiopharmaceuticals

Background: To date, several meta-analyses and systematic reviews have reported data about the prevalence and risk of malignancy of thyroid incidentalomas detected by different PET radiopharmaceuticals. Objective: This article aims to summarize the published evidence-based data about the prevalence and risk of malignancy of thyroid incidentalomas detected by different PET radiopharmaceuticals. Methods: A comprehensive computer literature search of systematic reviews and meta-analyses published up to July 2019 in PubMed/MEDLINE and Cochrane library databases regarding the prevalence and risk of malignancy of thyroid incidentalomas detected by different PET radiopharmaceuticals was carried out. Results: We have summarized the data about prevalence and risk of malignancy of thyroid incidentalomas detected by different PET radiopharmaceuticals (fluorine-18 fluorodeoxyglucose, radiolabelled choline and prostate-specific membrane antigen) taking into account 8 evidence-based articles. Conclusion: Evidence-based data demonstrated that thyroid incidentalomas detected by different PET radiopharmaceuticals are not infrequent and their risk of malignancy is not negligible, in particular if focal pattern is evident at PET, thus requiring further clinical and instrumental evaluation.

Implementation of an EMR integrated pathway for the management of malignant bowel obstruction.

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 813-813
Author(s):  
Darryl Schuitevoerder ◽  
Charles Christian Vining ◽  
Michael White ◽  
Claire Hoppenot ◽  
Isabel Lazo ◽  
...  
Keyword(s):  
Bowel Obstruction ◽  
Hospital Medicine ◽  
Surgical Oncology ◽  
Evidence Based ◽  
Malignant Bowel Obstruction ◽  
Educational Materials ◽  
Early Suggestion ◽  
Published Evidence ◽  
Integrated Pathway ◽  
Sustainability Framework

813 Background: Despite published evidence based interventions for malignant bowel obstruction (MBO), implementation of a standard pathway is challenging. We hypothesized that using industrial engineering techniques and a modified dynamic sustainability framework for implementation, we can implement an electronic medical record (EMR) based pathway in the management of MBO. Methods: A workflow in the management of MBO was developed using iterative meetings from 8/2018 to 4/2019 including gateway stakeholders (surgical oncology, gynecological oncology and medical oncology), interventional stakeholders (gastroenterology, interventional radiology) and supportive stakeholders (hospital medicine, palliative care, nutrition, nursing). Industrial engineers were utilized to study human factors, and perform a method study. EMR integration was performed using EPIC systems Agile MD pathway and educational materials were created. Interventions such as early placement of gastrostomy tubes, total parenteral nutrition and medications were protocolized. Results: Since implementation, over 6 months the pathway and order set has been activated 56 times. Orders have been employed 21 times through the AgileMD pathway demonstrating a pathway drift of 62.5%. Educational materials have been accessed routinely during this time. Conclusions: Feasibility of implementing an EMR integrated MBO pathway is demonstrated with early suggestion of pathway drift. Utilizing tools of implementation science are necessary to facilitate widespread adoption of evidence based interventions in the management of patients with MBO.

Pharmacotherapy in Acutely Anemic Jehovah’s Witnesses: An Evidence-Based Review

2018 ◽  
Vol 52 (9) ◽  
pp. 910-919 ◽  
Author(s):  
Sean M. McConachie ◽  
Zinah Almadrahi ◽  
Krista A. Wahby ◽  
Sheila M. Wilhelm
Keyword(s):  
Case Reports ◽  
Oxygen Carrier ◽  
High Dose ◽  
Pharmacokinetic Studies ◽  
Evidence Based ◽  
Severe Anemia ◽  
Oxygen Carriers ◽  
Jehovah’S Witnesses ◽  
Jehovah's Witnesses ◽  
Published Evidence

Objective: To determine the pharmacological treatment methods available to anemic Jehovah’s Witnesses (JW). Data Sources: MEDLINE and PubMed were searched from inception through February 2018 using the search terms Jehovah’s Witnesses, treatment, erythropoietin, hemoglobin-based oxygen carrier, Sanguinate, Hemopure, bleeding, and anemia. Study Selection and Data Extraction: All clinical trials, cohort studies, case-control studies, and observational trials involving pharmacotherapy in anemic JW patients were evaluated. Case reports and bibliographies were also analyzed for inclusion. Data Synthesis: Two studies involving the use of erythropoietin (EPO) and one study involving recombinant factor VIIa were included. Information was also included from other pharmacotherapeutic modalities that had case report data only. Current published evidence is limited with regard to evidence-based management of JW patients. High-dose EPO, intravenous iron supplementation, and hemostatic agents have demonstrated good clinical outcomes in case reports. EPO doses as high as 40 000 units daily have been advocated by some experts; however, pharmacokinetic studies do not support dose-dependent effects. Hemoglobin-based oxygen carriers (HBOCs) are currently not Food and Drug Administration approved. They are available through expanded access programs and may represent a lifesaving modality in the setting of severe anemia. Conclusions: There are currently not enough data to make definitive recommendations on the use of pharmacological agents to treat severe anemia in the JW population. Further evidence utilizing EPO and HBOCs will be beneficial to guide therapy.

Honey dressings for diabetic foot ulcers: overview of evidence-based practice for novice researchers

2020 ◽  
Vol 25 (Sup9) ◽  
pp. S14-S19
Author(s):  
Joseph Lewis Foster ◽  
Amanda McNaughton
Keyword(s):  
Literature Review ◽  
Diabetic Foot ◽  
Evidence Based Practice ◽  
Research Question ◽  
Lead Author ◽  
Foot Ulcers ◽  
Evidence Based ◽  
Diabetic Foot Ulcers ◽  
Published Evidence ◽  
Search And Retrieval

This article explores how nurses can use evidence-based practice to appraise the rationale and evidence for specific nursing procedures or practices. A literature review of published evidence on honey dressings for diabetic foot ulcers was conducted by a novice researcher (lead author) under the supervision of a lecturer (second author). A methodology was followed to construct an answerable research question and to guide the search and retrieval of evidence. The strengths and limitations of a selected study were appraised, and its implications for practice considered. This article highlights an area of practice that warrants further attention and demonstrates the use of evidence-based practice to consider the quality and utility of clinical research.

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