Artikel

2007 ◽  
Vol 24 (5) ◽  
pp. 519-529 ◽  
Author(s):  
Anders Bergmark
Keyword(s):  
Addiction Treatment ◽  
Western Hemisphere ◽  
Evidence Based ◽  
National Guidelines ◽  
National Board ◽  
Scientific Controversies ◽  
Professional Fields ◽  
Over Time

Evidence-based practice (EBP) has been advocated since the beginning of the 1990s and is today, at least within the western hemisphere, an established doctrine in many professional fields. This holds true also for addiction treatment. Over time EBP has come to signify a more general orientation to a scientifically secured knowledgebase and by this partly obscuring the fact there exists different and to some extent contradictory opinions on how EBP should be implemented. The paper aims at an analysis of the newly published Swedish national guidelines for addiction treatment. The analysis addresses several dimensions of the guidelines: a) the quality of the guidelines in terms of their scientific underpinning. b) The usefulness of the guidelines, i.e. to what extent it is possible to use the guidelines in actual practice. c). How the guidelines were produced (time-aspects, involvement of experts and the role of the National Board of Health and welfare as the responsible organisation). d) To what extent the guidelines have been developed with reference to and a discussion of some of the major scientific controversies related to the EBP issue.

Biopsychosocial Patterning of Multimorbidity and Its Consequences

2018 ◽  
pp. 220-236
Author(s):  
Elliot Friedman ◽  
Beth LeBreton ◽  
Lindsay Fuzzell ◽  
Elizabeth Wehrpsann
Keyword(s):  
Quality Of Life ◽  
Older Adults ◽  
Functional Outcomes ◽  
The United States ◽  
Chronic Medical Conditions ◽  
Quality Of Life Research ◽  
Increased Risk ◽  
Over Time

By many estimates the majority of adults over age 65 have two or more chronic medical conditions (multimorbidity) and are consequently at increased risk of adverse functional outcomes. Nonetheless, many older adults with multimorbidity are able to maintain high levels of function and retain good quality of life. Research presented here is designed to understand the influences that help ensure better functional outcomes in these older adults. This chapter presents findings that draw on data from the Midlife in the United States study. The independent and interactive contributions of diverse factors to multimorbidity and changes in multimorbidity over time are reviewed. The degree that multimorbidity increases risk of cognitive impairment and disability is examined. The role of inflammation as a mediator is considered. Multimorbidity is increasingly the norm for older adults, so better understanding of factors contributing to variability in multimorbidity-related outcomes can lead to improved quality of life.

scholarly journals Dynamic Signaling with Dropout Risk

2016 ◽  
Vol 8 (1) ◽  
pp. 57-82 ◽  
Author(s):  
Francesc Dilmé ◽  
Fei Li
Keyword(s):  
Time Varying ◽  
High Quality ◽  
Indivisible Good ◽  
Initial Belief ◽  
Costly Delay ◽  
Over Time

We study the role of dropout risk in dynamic signaling. A seller privately knows the quality of an indivisible good and decides when to trade. In each period, he may draw a dropout shock that forces him to trade immediately. To avoid costly delay, the seller with a low-quality good voluntarily pools with early dropouts, implying that the expected quality of the good increases over time. We characterize the time-varying equilibrium trading dynamics. It is demonstrated that the maximum equilibrium delay of trade is decreasing in the initial belief that the good is of high quality. (JEL C73, D82, D83)

scholarly journals Effective Implementation of Outcome-based Education: The Role of Faculty Awareness

2021 ◽  
Vol 4 (3) ◽  
pp. 380
Author(s):  
Srinivasa Pai P ◽  
Gururaj Upadhyaya
Keyword(s):  
Technical Education ◽  
Accreditation Body ◽  
Accreditation Process ◽  
Faculty Members ◽  
National Board ◽  
Technical Programs ◽  
Outcome Based Education ◽  
Autonomous Institution

Accreditation of technical institutions is very important to guarantee the quality of technical education that is being offered. Outcome based education (OBE) is followed in the delivery of technical education across all Institutions in India and the National Board of Accreditation (NBA), which is the nodal accreditation body for technical institutions in India follows outcome based accreditation (OBA) in the accreditation of technical programs. In the OBE and OBA, faculty constitutes the most important component and plays an important role in facilitation of the same. In this regard, the authors felt that there is a need to understand the level of awareness of faculty about the same and accordingly a survey was conducted among the faculty of the authors’ institution, which is an autonomous Institution and comes under Tier I scheme of NBA accreditation process. From among 285 faculty members, about 96 participated in the survey. This paper discusses the significance of faculty’s awareness and involvement in the accreditation process and implementation of OBE. The results of the survey indicate some interesting findings, which is discussed in detail. Some suggestions and guidelines are given at the end to increase the level of awareness and their involvement in the OBE and OBA processes respectively.

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.

6. The European Parliament:

2021 ◽  
pp. 128-148
Author(s):  
Ariadna Ripoll Servent ◽  
Olivier Costa
Keyword(s):  
European Parliament ◽  
Theoretical Explanation ◽  
The Political ◽  
The European Union ◽  
Theoretical Approaches ◽  
Democratic Quality ◽  
Future Challenges ◽  
Over Time

The European Parliament (EP) symbolizes many of the struggles that characterize the process of European integration and is at the core of many theoretical and empirical debates about representation, accountability, and legitimacy. This chapter draws on a variety of theoretical approaches to explain the complex role the EP plays in the political system of the European Union (EU). It starts with a brief overview of the history and functions of the assembly, followed by a theoretical explanation of its empowerment over time. Then, it determines the extent to which the EP is capable of influencing policymaking, both in legislative and non-legislative domains, as well as for the appointment of the Commission. It presents the political structure of the assembly and underlines the role of parliamentary groups and committees. It discusses the representativeness of the EP and the democratic quality of its internal functioning. Finally, it addresses current and future challenges for the EP.

scholarly journals Pearls for Interpreting Neurosurgical Systematic Reviews and Meta-Analyses: Lessons From a Collaborative Effort

Neurosurgery ◽  
2020 ◽  
Vol 87 (3) ◽  
pp. 435-441 ◽  
Author(s):  
Victor M Lu ◽  
Christopher S Graffeo ◽  
Avital Perry ◽  
Michael J Link ◽  
Fredric B Meyer ◽  
...  
Keyword(s):  
Systematic Reviews ◽  
Evidence Based Medicine ◽  
Lessons Learned ◽  
Evidence Based ◽  
Cranial Neuralgia ◽  
The Individual ◽  
Meta Analyses ◽  
Based Medicine ◽  
Over Time

Abstract Systematic reviews and meta-analyses in the neurosurgical literature have surged in popularity over the last decade. It is our concern that, without a renewed effort to critically interpret and appraise these studies as high or low quality, we run the risk of the quality and value of evidence-based medicine in neurosurgery being misinterpreted. Correspondingly, we have outlined 4 major domains to target in interpreting neurosurgical systematic reviews and meta-analyses based on the lessons learned by a collaboration of clinicians and academics summarized as 4 pearls. The domains of (1) heterogeneity, (2) modeling, (3) certainty, and (4) bias in neurosurgical systematic reviews and meta-analyses were identified as aspects in which the authors’ approaches have changed over time to improve robustness and transparency. Examples of how and why these pearls were adapted were provided in areas of cranial neuralgia, spine, pediatric, and neuro-oncology to demonstrate how neurosurgical readers and writers may improve their interpretation of these domains. The incorporation of these pearls into practice will empower neurosurgical academics to effectively interpret systematic reviews and meta-analyses, enhancing the quality of our evidence-based medicine literature while maintaining a critical focus on the needs of the individual patients in neurosurgery.

The Role of Novel Bone Forming Agents in the Treatment of Osteoporosis

2020 ◽  
pp. 089719002096122
Author(s):  
Hansita B. Patel ◽  
Lynsie J. Lyerly ◽  
Cheryl K. Horlen
Keyword(s):  
Elderly Population ◽  
Cost Effective ◽  
The Elderly ◽  
Bisphosphonate Therapy ◽  
Evidence Based ◽  
First Line ◽  
Treatment Of Osteoporosis ◽  
Cost Effective Treatment

Osteoporosis is a growing epidemic that leads to significant morbidity and mortality among the elderly population due to associated fractures that lead to disabilities and reduced quality of life. Bisphosphonates are well-established as a first-line and cost-effective treatment for osteoporosis. Unfortunately, clinicians are often uncertain as to how to select treatments when bisphosphonates are ineffective as initial treatment or contraindicated. Romosozumab and abaloparatide are 2 alternative agents that have been recently FDA approved for the treatment of osteoporosis in postmenopausal women at high risk for fracture or patients who have failed or are intolerant to other osteoporosis therapies. Currently, the National Osteoporosis Foundation (NOF) has no formal recommendations in regard to these 2 novel agents. The purpose of this review is to help guide pharmacists on how to ensure appropriate utilization of these 2 novel bone-forming agents as potential alternatives to bisphosphonate therapy by providing evidence-based recommendations according to the current literature and key counseling points.

Insight in psychosis: Standards, science, ethics and value judgment

2017 ◽  
Vol 63 (4) ◽  
pp. 345-351 ◽  
Author(s):  
KS Jacob
Keyword(s):  
Mental Illness ◽  
Clinical Assessment ◽  
Explanatory Models ◽  
Value Judgments ◽  
Value Judgment ◽  
Discussion Article ◽  
Complete Exclusion ◽  
Over Time

Background: The clinical assessment of insight solely employs biomedical perspectives and criteria to the complete exclusion of context and culture and to the disregard of values and value judgments. Aim: The aim of this discussion article is to examine recent research from India on insight and explanatory models in psychosis and re-examine the framework of assessment, diagnosis and management of insight and explanatory models. Methods: Recent research from India on insight in psychosis and explanatory models is reviewed. Results: Recent research, which has used longitudinal data and adjusted for pretreatment variables, suggests that insight and explanatory models of illness at baseline do not predict course, outcome and treatment response in schizophrenia, which seem to be dependent on the severity and quality of the psychosis. It supports the view that people with psychosis simultaneously hold multiple and contradictory explanatory models of illness, which change over time and with the trajectory of the illness. It suggests that insight, like all explanatory models, is a narrative of the person’s reality and a coping strategy to handle with the varied impact of the illness. Conclusion: This article argues that the assessment of insight necessarily involves value entailments, commitments and consequences. It supports a need for a broad-based approach to assess awareness, attribution and action related to mental illness and to acknowledge the role of values and value judgment in the evaluation of insight in psychosis.

scholarly journals Review of the role of NICE in promoting the adoption of innovative cardiac technologies

Heart ◽  
2018 ◽  
Vol 104 (22) ◽  
pp. 1817-1822 ◽  
Author(s):  
Peter H Groves ◽  
Chris Pomfrett ◽  
Mirella Marlow
Keyword(s):  
Medical Devices ◽  
Medical Technology ◽  
Professional Community ◽  
Evidence Based ◽  
Medical Technologies ◽  
Professional Societies ◽  
Diagnostic Technologies ◽  
Improve Health

The National Institute for Health and Care Excellence (NICE) Medical Technologies Evaluation Programme (MTEP) promotes the adoption of innovative diagnostic and therapeutic technologies into National Health Service (NHS) clinical practice through the publication of guidance and briefing documents. Since the inception of the programme in 2009, there have been 7 medical technologiesguidance, 3 diagnostics guidance and 23 medtechinnovation briefing documents published that are relevant to the heart and circulation. Medical technologies guidance is published by NICE for selected single technologies if they offer plausible additional benefits to patients and the healthcare system. Diagnostic guidance is published for diagnostic technologies if they have the potential to improve health outcomes, but if their introduction may be associated with an increase in overall cost to the NHS. Medtechinnovation briefings provide evidence-based advice to those considering the implementation of new medical devices or diagnostic technologies. This review provides reference to all of the guidance and briefing medical technology documents that NICE has published that are relevant to the heart and circulation and reflect on their diverse recommendations. The interaction of MTEP with other NICE programmes is integral to its effectiveness and the means by which consistency is ensured across the different NICE programmes is described. The importance of the input of clinical experts from the cardiovascular professional community and the engagement by NICE with cardiovascular professional societies is highlighted as being fundamental to ensuring the quality of guidance outputs as well as to promoting their implementation and adoption.

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