scholarly journals Implementation of evidence-based practices in the perineal pain management in the postpartum period

2022 ◽  
Vol 75 (2) ◽  
Author(s):  
Raquel Gomes de Oliveira Tomaz ◽  
Ana Paula Almeida Brito ◽  
Maria Luiza Gonzalez Riesco
Keyword(s):  
Pain Management ◽  
Professional Training ◽  
Scientific Evidence ◽  
Maternity Hospital ◽  
Perineal Pain ◽  
Evidence Based ◽  
Evidence Based Practices ◽  
Care Protocol ◽  
Nursing Professionals

ABSTRACT Objectives: To implement strategies for managing perineal pain in puerperal women admitted to a public maternity hospital in São Paulo state and to evaluate their compliance with evidence-based practices. Methods: Implementation study using the JBI model conducted with nursing professionals and puerperal women between September and December 2019. Interviews with puerperal women and medical record data were used to audit seven evidence-based criteria. The interventions adopted included a care protocol, professional training, and folder elaboration for puerperal women. Results: Prior to the intervention, deficits in audited practices and obstacles to pain management were identified, which were overcome by the strategies employed. The follow-up audit demonstrated improvements in compliance with best care practices. Conclusion: There was an increase in the criteria compliance evaluated after the implemented strategies, contributing to improving the nursing care results in the perineal pain management based on the best scientific evidence.

Unhealthy Politics

2020 ◽  
Author(s):  
Eric M. Patashnik ◽  
Alan S. Gerber ◽  
Conor M. Dowling
Keyword(s):  
United States ◽  
Health Care ◽  
Scientific Evidence ◽  
The United States ◽  
Evidence Base ◽  
Medical Industry ◽  
Evidence Based ◽  
Evidence Based Practices ◽  
Delivery Of Medical Care ◽  
Based Medicine

The U.S. medical system is touted as the most advanced in the world, yet many common treatments are not based on sound science. This book sheds new light on why the government's response to this troubling situation has been so inadequate, and why efforts to improve the evidence base of U.S. medicine continue to cause so much political controversy. The book paints a portrait of a medical industry with vast influence over which procedures and treatments get adopted, and a public burdened by the rising costs of health care yet fearful of going against “doctor's orders.” It offers vital insights into the limits of science, expertise, and professionalism in American politics. The book explains why evidence-based medicine is important. First, the delivery of unproven care can expose patients to serious risks. Second, the slow integration of evidence can lead to suboptimal outcomes for patients who receive treatments that work less well for their conditions than alternatives. Third, the failure to implement evidence-based practices encourages wasteful spending, causing the health care system to underperform relative to its level of investment. This book assesses whether the delivery of medical care in the United States is evidence based. It argues that by systematically ignoring scientific evidence (or the lack thereof), the United States is substantially out of balance.

scholarly journals Pancreatic cancer.Evidence based management guidelines of the Hungarian Pancreatic Study Group

2015 ◽  
Vol 156 (8) ◽  
pp. 326-339 ◽  
Author(s):  
Richárd Szmola ◽  
Gyula Farkas ◽  
Péter Hegyi ◽  
László Czakó ◽  
Zsolt Dubravcsik ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Scientific Evidence ◽  
Surgical Care ◽  
Study Group ◽  
Evidence Based ◽  
Management Guidelines ◽  
International Guidelines ◽  
Evidence Based Guideline ◽  
Cancer Network

Pancreatic cancer is a disease with a poor prognosis usually diagnosed at a late stage. Therefore, screening, diagnosis, treatment and palliation of pancreatic cancer patients require up-to-date and evidence based management guidelines. The Hungarian Pancreatic Study Group proposed to prepare an evidence based guideline based on the available scientific evidence and international guidelines. The preparatory and consultation board appointed by the Hungarian Pancreatic Study Group translated and complemented/modified the recent international guidelines. 37 clinical statements in 10 major topics were defined (Risk factors and genetics, Screening, Diagnosis, Staging, Surgical care, Pathology, Systemic treatment, Radiation therapy, Palliation and supportive care, Follow-up and recurrence). Evidence was graded according to the National Comprehensive Cancer Network (NCCN) grading system. The draft of the guideline was presented and discussed at the consensus meeting in September 12, 2014. Statements were accepted with either total (more than 95% of votes, n = 15) or strong agreement (more than 70% of votes, n = 22). The present guideline is the first evidence based pancreatic cancer guideline in Hungary that provides a solid ground for teaching purposes, offers quick reference in everyday patient care and guides patient financing options. The authors strongly believe that these guidelines will become a standard reference for pancreatic cancer treatment in Hungary. Orv. Hetil., 2015, 156(8), 326–339.

Introduction

2020 ◽  
pp. 1-20
Author(s):  
Eric M. Patashnik ◽  
Alan S. Gerber ◽  
Conor M. Dowling
Keyword(s):  
United States ◽  
Health Care ◽  
Resource Allocation ◽  
Scientific Evidence ◽  
The United States ◽  
Evidence Based ◽  
Evidence Based Practices ◽  
Delivery Of Medical Care ◽  
Based Medicine

This introductory chapter explains why evidence-based medicine is important. The sluggish incorporation of medical evidence into clinical practice is a concern for three key reasons: safety, quality, and the efficiency of resource allocation. First, the delivery of unproven care can expose patients to serious risks. Second, the slow integration of evidence can lead to suboptimal outcomes for patients who receive treatments that work less well for their conditions than alternatives. Third, the failure to implement evidence-based practices encourages wasteful spending, causing the health care system to underperform relative to its level of investment. This book assesses whether the delivery of medical care in the United States is evidence based. It argues that by systematically ignoring scientific evidence (or the lack thereof), the United States is substantially out of balance.

Assessing Adherence to Audiologic Parameters of Care for Children With Cleft Palate: A Quality Improvement Initiative

2021 ◽  
pp. 105566562110295
Author(s):  
Ursula M. Findlen ◽  
Jonathan Grischkan ◽  
Sandra Alston ◽  
Lauren Durinka ◽  
Adriane Baylis
Keyword(s):  
Quality Improvement ◽  
Cleft Palate ◽  
Cleft Lip ◽  
Quality Improvement Initiative ◽  
Evidence Based ◽  
Team Communication ◽  
Care Protocol ◽  
Management Protocol ◽  
Key Drivers

Objective: To evaluate and increase adherence to an evidence-based audiologic management protocol for children with cleft palate. Design: Prospective, multidisciplinary quality improvement initiative. Setting: Tertiary pediatric hospital. Patients, Participants: Children with cleft palate (with or without cleft lip) between the ages of 0 and 5 years (n = 205). Interventions: A multidisciplinary team identified key drivers for nonadherence to recommended audiological follow-up and implemented interventions to improve adherence. Key drivers included provider practices and preferences, clinic logistics and flow, and patient/family awareness and education. Several interventions were implemented between 2016 and 2020, including developing an evidence-based audiologic protocol, maximizing access to audiologic clinic visits across multiple departments, cleft team education, and improved team communication. Main Outcome Measure(s): Completion of recommended audiologic assessment at 5 separate care milestones. Results: After implementation of interventions between 2016 and 2020, adherence to recommended audiologic follow-up increased from 59% to 84%. Analysis of individual care milestones revealed that increased access to audiologic testing during team clinics resulted in the largest increase in adherence to recommended follow-up. Additionally, cause-effect analysis revealed that nonadherence due to provider-related causes decreased over the project period to a greater extent than patient/family-related causes. Conclusions: Implementation of an evidence-based audiologic care protocol and improvements in access to early hearing care are feasible in a high-volume multidisciplinary cleft clinic. Adherence to recommended audiologic management can be improved by establishing strategies to improve access to care, team member and family education, and enhanced team communication.

scholarly journals Thoracic Surgery in the COVID-19 Pandemic: A Novel Approach to Reach Guideline Consensus

2021 ◽  
Vol 10 (13) ◽  
pp. 2769
Author(s):  
Tomasz Dziodzio ◽  
Sebastian Knitter ◽  
Helen Hairun Wu ◽  
Paul Viktor Ritschl ◽  
Karl-Herbert Hillebrandt ◽  
...  
Keyword(s):  
Thoracic Surgery ◽  
Scientific Evidence ◽  
Healthcare Systems ◽  
Evidence Based ◽  
Prospective Data ◽  
National Healthcare ◽  
Novel Approach ◽  
High Degree ◽  
Key Questions

The COVID-19 pandemic challenges international and national healthcare systems. In the field of thoracic surgery, procedures may be deferred due to mandatory constraints of the access to diagnostics, staff and follow-up facilities. There is a lack of prospective data on the management of benign and malignant thoracic conditions in the pandemic. Therefore, we derived recommendations from 14 thoracic societies to address key questions on the topic of COVID-19 in the field of thoracic surgery. Respective recommendations were extracted and the degree of consensus among different organizations was calculated. A high degree of consensus was found to temporarily suspend non-critical elective procedures or procedures for benign conditions and to prioritize patients with symptomatic or advanced cancer. Prior to hospitalization, patients should be screened for respiratory symptoms indicating possible COVID-19 infection and most societies recommended to screen all patients for COVID-19 prior to admission. There was a weak consensus on the usage of serology tests and CT scans for COVID-19 diagnostics. Nearly all societies suggested to postpone elective procedures in patients with suspected or confirmed COVID-19 and recommended constant reevaluation of these patients. Additionally, we summarized recommendations focusing on precautions in the theater and the management of chest drains. This study provides a novel approach to informed guidance for thoracic surgeons during the COVID-19 pandemic in the absence of scientific evidence-based data.

Achieving Evidence-Based Practices in Colorectal Surgery

2014 ◽  
Author(s):  
Imran Hassan
Keyword(s):  
Colorectal Surgery ◽  
Evidence Based Medicine ◽  
Scientific Evidence ◽  
Evidence Based ◽  
Evidence Based Practices ◽  
The Past ◽  
Hierarchy Of Evidence ◽  
Evidence Based Surgery ◽  
Key Resources ◽  
Based Medicine

The concept of evidence-based medicine (EBM) and evidence-based surgery (EBS) involves combining the best scientific evidence available with the clinician’s judgment while also considering the patient’s needs and preferences. In the past, the practice of colorectal surgery was based on tradition and anecdotal experience from experts rather than scientific rationale. However, the rise of EBM has led to changes in how colorectal surgery is performed. This review discusses the hierarchy of evidence, fundamental principles of EBS, and practicing evidence-based colorectal surgery. Tables review the Oxford Centre for Evidence-Based Medicine revised levels of evidence, four steps of evidence-based surgery, key resources for evidence-based surgery, the “PICO” technique, and the Dindo-Clavien classification system. This review contains 5 tables and 69 references.

scholarly journals Using Data as a Source of Reflection in a Feedback Loop

2021 ◽  
pp. 63-72
Author(s):  
Rose M. Ylimaki ◽  
Lynnette A. Brunderman
Keyword(s):  
Scientific Evidence ◽  
Development Project ◽  
School Development ◽  
Evidence Based ◽  
Educational Values ◽  
Democratic Deliberation ◽  
Evidence Based Practices ◽  
Multinational Organizations ◽  
Using Data ◽  
Professional Judgement

AbstractThis chapter considers recent policy trends toward evidence-based practices in Arizona, the U.S., and across the globe. The rise in the use of “scientific” evidence for educational policymaking rests on two common beliefs about knowledge: (1) the belief that school knowledge is universal, and (2) the belief that empirical evidence or data is the primary indicator of knowledge and learning. Recent U.S. policies have reflected the importance of data or numeric evidence from externalized evaluations to guide school decisions. Internationally, multinational organizations, such as the World Bank, have also made evidence-based policymaking a priority both in their own work as influential research and policy organizations as well as their members. Yet there are cautions against this particular use of evidence to replace professional judgement and the wider democratic deliberation about the aims, ends and content of education. Our school development project considers evidence-based values and humanistic, democratic values at tension. School development participants applied a balanced perspective on data with numerical evidence subordinated to educational values, using all as a source of reflection and growth. The chapter, thus, defines data as information that educators, school teams, and other agency members use to inform professional judgement and influence.

Pain and pain management in hospitalized patients before and after an intervention

2017 ◽  
Vol 15 (1) ◽  
pp. 22-29 ◽  
Author(s):  
Viveka Andersson ◽  
Stefan Bergman ◽  
Ingela Henoch ◽  
Kerstin Wickström Ene ◽  
Eva Otterström-Rydberg ◽  
...  
Keyword(s):  
Pain Management ◽  
Severe Pain ◽  
Hospitalized Patients ◽  
Baseline Survey ◽  
Evidence Based ◽  
Pain Rating ◽  
Management Guidelines ◽  
Disturbed Sleep ◽  
Evidence Based Guidelines

AbstractBackground and aimStudies have shown that pain is common among hospitalized patients and that there is a lack of compliance with pain management guidelines. Improving pain management does not only involve developing new drugs or technology; even more important is an effective organisation that utilises existing expertise. The aim of this study was to investigate whether pain in hospitalized patients can be reduced by implementing evidence-based pain management guidelines, providing education for staff and an organisation that includes pain responsibility nurses.MethodsA cross-sectional study was carried out between 2009 and 2010 at two hospitals in southwest Sweden, comprising a baseline survey followed by an intervention. The study involved 306 patients, who answered questions about pain intensity at rest and while moving, disturbed sleep due to pain and whether they had used a pain rating scale while in hospital. Medical records were scrutinised for analgesic prescriptions. An intervention then took place, involving implementation of evidence-based guidelines, staff education and the introduction of pain responsibility nurses. A follow-up survey was carried out in 2012, in which 293 patients answered the same questions and their medical records were also reviewed. The baseline results were then compared with those of the follow-up survey.ResultsWhen compared with the baseline survey, the follow-up survey revealed significant differences in the use of validated pain rating instruments as well as the prescription of more appropriate analgesics. Prescription of paracetamol increased significantly in the follow-up survey; 56% of the patients were prescribed paracetamol on a regular basis, compared with 42% at baseline. There was also a significant increase in the use of strong opioids, from 38% at baseline to 55% at follow-up. Prescriptions of weak opioids decreased from 16% at baseline to 4% at follow-up. No significant differences were observed in patient pain levels in the follow-up survey. At baseline, 29% of the patients reported moderate to severe pain at rest (NRS 4–10) and at follow-up that figure was 24% (NRS 4–10). In both surveys, 41% reported moderate to severe pain (NRS 5–10) during movement. Thirty-nine percent reported disturbed sleep at night at both baseline and follow-up.ConclusionsThis study demonstrates that evidence-based guidelines made accessible to all staff as a pocket size booklet and on the intranet, in combination with staff education, pain responsibility nurses who informed other staff on their own wards, improved the prescription of analgesics in the hospitals studied. In order to achieve a noticeable effect for patients, i.e., reduced pain levels, an intervention containing more components than those employed in the present study is required.ImplicationsNurses and physicians need greater knowledge about the importance of pain rating. A vital part of pain management at hospitals is continuous evaluation of treatment outcomes to prevent severe pain and disturbed sleep. The complexity of pain and pain management requires commitment, time and knowledge on the part of healthcare staff. Multi-professional pain teams that support ward staff in pain management are necessary in order to reduce suffering and unnecessary pain in hospitalized patients.

scholarly journals The Rush Caregiver Initiative: A Model for Caregiver Health and Wellness in Age-Friendly Health Systems

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 307-307
Author(s):  
Leslie Pelton ◽  
Ellen Carbonell ◽  
Robyn Golden
Keyword(s):  
Family Care ◽  
Well Being ◽  
Lessons Learned ◽  
System Level ◽  
Evidence Based ◽  
Health And Wellness ◽  
Evidence Based Practices ◽  
Caregiver Health ◽  
Clinically Significant

Abstract The Rush Caregiver Health and Well-Being Initiative (Caregiver Initiative) draws together evidence-based practices into a single framework to improve care for older adults and caregivers. The Caregiver Initiative has two components: system-level and caregiver level interventions. The complexities of system change take place within leadership, data management, and provider teams throughout the health care system, and solutions to resistance have been developed. Caregiver-level interventions start with an assessment using evidence-based tools, and offer an opportunity to participate in a Teach-Back Clinic, Family Care Planning sessions, and/or Goals of Medical Care meetings, all connected to the 4Ms of an Age-Friendly Health System. Contact and follow-up issues were addressed, and as of February 2021, 191 caregivers have enrolled. Outcomes to date show statistically and clinically significant reductions in depression, anxiety, and caregiver burden. This presentation will highlight lessons learned in the development of the model and caregiver outcomes to date.

scholarly journals Opening Doors to Open Science and Scholarship for School Psychology Research, Training, and Practice

2020 ◽  
Author(s):  
Anthony J. Roberson ◽  
Ryan L. Farmer ◽  
Steven Shaw ◽  
Shelley Upton ◽  
Imad Zaheer
Keyword(s):  
School Psychology ◽  
School Psychologists ◽  
Research Training ◽  
Scientific Evidence ◽  
Open Science ◽  
Evidence Based ◽  
Evidence Based Practices ◽  
Questionable Research Practices ◽  
Science Practices ◽  
Research Findings

Trustworthy scientific evidence is essential if school psychologists are to use evidence-based practices to solve the big problems students, teachers, and schools face. Open science practices promote transparency, accessibility, and robustness of research findings, which increases the trustworthiness of scientific claims. Simply, when researchers, trainers, and practitioners can ‘look under the hood’ of a study, (a) the researchers who conducted the study are likely to be more cautious, (b) reviewers are better able to engage the self-correcting mechanisms of science, and (c) readers have more reason to trust the research findings. We discuss questionable research practices that reduce the trustworthiness of evidence; specific open science practices; applications specific to researchers, trainers, and practitioners in school psychology; and next steps in moving the field toward openness and transparency.

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