scholarly journals The Effect of Suture-Mediated Closure Device on Hemostasis in Patients after Transfemoral Cardiac Procedures - an Evidence-Based Practice

2021 ◽  
Vol 3 (1) ◽  
pp. 81-90
Author(s):  
Arif Nur Akhmad ◽  
Ching-I Liou ◽  
Li-Wen Su ◽  
Fifi Alviana ◽  
Candra Dewi Rahayu
Keyword(s):  
Evidence Based Practice ◽  
Vascular Complications ◽  
Closure Device ◽  
Evidence Based ◽  
Research Subjects ◽  
Level Of Evidence ◽  
Cardiac Procedures ◽  
Changhua Christian Hospital ◽  
Artery Disease ◽  
Christian Hospital

Patients who used manual compression after transfemoral cardiac procedures could suffer from several problems. The suture-mediated closure device may be proven as an effective alternative, offering earlier sheath removal, and potentially a reduction in vascular complications. The aim of this study was to discover empirical bases and clinical application of suture-mediated closure devices on hemostasis in patients after transfemoral cardiac procedures. This study was applied on evidence-based practice in the clinical setting. The search process for evidence-based practices used 3 databases such as MEDLINE, PubMed, and Web of Science, obtaining 14 studies published between 2000 and 2016. The studies selected were assessed by two reviewers for their methodological quality and level of evidence prior to inclusion in the review. Research subjects were patients at the age of ≥ 20 years old who suffered from coronary artery disease and required transfemoral cardiac procedures. This study was implemented in a Medical Intensive Care Unit, Changhua Christian Hospital. The hemostasis status was evaluated based on two categories of, bleeding or not bleeding. Six patients were included in this study. Most of the patients were male with average age of 69.33 ± 11.70 years old. Hypertension, diabetes mellitus, and hyperlipidemia were their common history of diseases. Based on the evaluation outcome, five patients showed hemostasis status and only one patient had bleeding after the compression procedures. This study concludes that the suture-mediated closure device is effective for patients after transfemoral cardiac procedures to reach hemostasis status quickly based on clinical evaluation.

scholarly journals P056: The state of the evidence for emergency medical services (EMS) care of blunt spinal trauma: an analysis of appraised research from the Canadian Prehospital Evidence-based Practice (PEP) Project

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S97-S97
Author(s):  
A. Carter ◽  
J. Greene ◽  
J. Cook ◽  
J. Goldstein ◽  
J. Jensen
Keyword(s):  
Evidence Based Practice ◽  
Spinal Injury ◽  
Spinal Trauma ◽  
Future Research ◽  
Evidence Based ◽  
High Quality ◽  
Level Of Evidence ◽  
Spinal Motion ◽  
Moderate Quality ◽  
Point Level

Introduction: The Canadian Prehospital Evidence-based Practice (PEP) project is an online, freely accessible, continuously updated EMS evidence repository. The summary of research evidence for EMS interventions used to care for blunt spinal trauma is described. Methods: PubMed was systematically searched. One author reviewed titles and abstracts for relevance. Included studies were scored by trained appraisers on a three-point Level of Evidence (LOE) scale (based on study design and quality) and three-point Direction of Evidence (DOE) scale (supportive, neutral, or opposing results). Second party appraisal was conducted for included studies. Interventions were plotted on a 3x3 table (DOE × LOE) for the spinal injury condition based on appraisal scores. The primary outcome was identified for each study and categorized. Results: Seventy-seven studies were included. Evidence for adult and paediatric blunt spinal trauma interventions was: supportive-high quality (n=1, 7 %), supportive-moderate quality (n=3, 21.4%), supportive-low quality (n=1, 7%), neutral-high quality (n=1, 7%), neutral-moderate quality (n=5, 35.7%), neutral-low quality (n=1, 7%), opposing-high quality (n=0, 0%), opposing-moderate quality (n=0, 0%), opposing-low quality (n=1, 7%). One (7%) intervention had no evidence. Interventions with supportive evidence were: steroids, cervical-spine clearance, scoop stretcher, self-extrication and “leaving helmet in place”. The evidence weakly opposed use of short extrication devices. Leading study primary outcomes were spinal motion, diagnostic accuracy, and pressure/discomfort. Conclusion: EMS blunt spinal trauma interventions are informed by moderate quality supportive and neutral evidence. Future research should focus on high quality studies filling identified evidence gaps using patient-oriented outcomes to best inform EMS care of blunt spinal injury.

Quality Appraisal: Part I

2015 ◽  
Vol 34 (4) ◽  
pp. 245-247
Author(s):  
Deborah A. Raines
Keyword(s):  
Evidence Based Practice ◽  
Scientific Research ◽  
Evidence Based ◽  
Quality Appraisal ◽  
Level Of Evidence ◽  
Essential Step

AbstractQuality appraisal is an essential step in the evidence-based practice process. This column focuses on designating the level of evidence of the scientific research.

Evidence-Based Practice Principles

2011 ◽  
Vol 17 (6) ◽  
pp. 445-448 ◽  
Author(s):  
Michael J. Rice
Keyword(s):  
Integrated Care ◽  
Scientific Knowledge ◽  
Stress Responses ◽  
Traumatic Stress ◽  
Psychiatric Care ◽  
Evidence Based Practice ◽  
Evidence Based ◽  
Level Of Evidence ◽  
Scientific Support

Clinicians providing psychiatric care are often faced with selecting interventions in areas of care for which there is limited scientific support, such as the information on traumatic stress responses and integrated care interventions. If they adhere to the principles of evidence-based practice (EBP), the lack of scientific support should not hamper clinicians from implementing the best EBP intervention. EBP interventions can be drawn from the literature provided clinicians accurately appraise the level of existing scientific knowledge. Regardless of the level of evidence, clinicians must discuss the recommended intervention, risks, benefits, and alternatives to achieve the best EBP outcome.

scholarly journals A plea for evidence in ecosystem service science: a framework and its application

2014 ◽  
Author(s):  
Anne-Christine Mupepele ◽  
Carsten F. Dormann
Keyword(s):  
Ecosystem Service ◽  
Political Action ◽  
Evidence Based Practice ◽  
Service Science ◽  
Evidence Based ◽  
Level Of Evidence ◽  
Services Science ◽  
Scientific Results ◽  
Study Designs ◽  
Quality Checklist

AbstractThe ecosystem service concept is at the interface of ecology, economics and politcs, with scientific results rapidly translated into management or political action. This emphasises the importance of reliable recommendations provided by scientist. We propose to use evidence-based practice in ecosystem service science in order to evaluate and improve the reliability of scientific statements. For this purpose, we introduce a level-of-evidence scale ranking study designs (e.g. review, case-control, descriptive) in combination with a study quality checklist. For illustration, the concept was directly applied to 12 case studies. We also review criticisms levered against evidence-based practice and how it applies to ecosystem services science. We further discuss who should use the evidence-based concept and suggest important next steps, with a focus on the development of guidelines for methods used in ecosystem service assessments.

scholarly journals POS1448 EVIDENCE BASED PRACTICE: WHAT IS THE EVIDENCE THAT BRITISH SOCIETY FOR RHEUMATOLOGY GUIDELINES ARE EVIDENCE BASED?

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1008.2-1008
Author(s):  
M. Lee ◽  
G. Reynolds ◽  
M. Yates ◽  
J. Galloway
Keyword(s):  
Practice Guidelines ◽  
Evidence Based Practice ◽  
British Society ◽  
Evidence Based ◽  
Supporting Evidence ◽  
Level Of Evidence ◽  
American College Of Rheumatology ◽  
Quality Guidelines ◽  
Wide Range ◽  
Level I

Background:Clinical practice guidelines are designed to ensure that patients are treated according to best evidence, with the goal of optimizing clinical outcomes and reducing unwarranted variation in care. They compile, rate and translate the data available into recommendations that form the basis of evidence-based practice for most clinicians. Despite their importance, the evidence base informing different guidelines varies in quality. A recent study of American College of Rheumatology (ACR) Practice Guidelines demonstrated only 17 of 35 class I (strong benefit to harm ratio) recommendations were supported by level A evidence (high quality randomized controlled trails or meta-analyses)1.Objectives:To review the evidence supporting the British Society for Rheumatology (BSR) guidelines.Methods:Thirteen sets of guidelines that were available on the BSR website as of October 16th 2019 were reviewed (https://www.rheumatology.org.uk/practice-quality/guidelines). A range of methodologies (including Grading of Recommendations Assessment, Development and Evaluation (GRADE), Scottish Intercollegiate Guidelines Network (SIGN), EULAR and Royal College of Physicians (RCP) recommendations) were used to assess the quality of evidence and strength of recommendation. For comparability between guidelines the level of evidence was converted to a score between I (highest quality) and IV (lowest quality) and the strength of recommendation was converted to a rating between A and D. The polymyalgia rheumatica guideline was not assessed due to unclear methodology and lack of level of evidence for all recommendations.Results:Of the 12 BSR guidelines assessed, there were 554 recommendations in total. The number of recommendations per guideline ranged between 13 and 80. Across all assessed guidelines, 94 recommendations (17.0%) were classified as level I, 161 (29.1%) as level 2 and 299 (54.0%) as level 3 or 4. These figures are similar to those reported in the ACR guidelines (23%, 19% and 58% respectively)1. The proportion of level I evidence varied from 46.2% (Axial Spondyloarthropathy guideline) to 0% (Hot Swollen Joint guideline).Conclusion:Over half of all BSR guideline recommendations have level of supporting evidence of III/IV. A wide range of methodologies are used to generate BSR guidelines (GRADE, SIGN, RCP / EULAR). This makes it challenging for readers unfamiliar with these approaches to interpret evidence and hinders comparisons between guidelines. A standardized methodology for future guideline development would overcome these barriers.References:[1]Duarte-Garcia A, Zamore R & Wong JB. The Evidence Basis for the American College of Rheumatology Practice Guidelines. JAMA Intern Med, 2018 Jan 1;178(1):146-148.Disclosure of Interests:None declared

scholarly journals LO18: The state of the evidence for emergency medical services (EMS) care of prehospital hypoglycemia: an analysis of appraised research from the Prehospital Evidence-based Practice Program

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S13-S13
Author(s):  
J. Greene ◽  
J. Goldstein ◽  
R. Brown ◽  
J. Swain ◽  
D. Fidgen ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Assessment Tool ◽  
Evidence Based Practice ◽  
Oral Glucose ◽  
Evidence Based ◽  
High Quality ◽  
Level Of Evidence ◽  
Glucose Testing ◽  
Published Evidence ◽  
Quality Evidence

Introduction: The Prehospital Evidence-based Practice (PEP) program is an online, freely accessible, continuously updated repository of appraised EMS research evidence. This report is an analysis of published evidence for EMS interventions used to assess and treat patients suffering from hypoglycemia. Methods: PubMed was systematically searched in June 2019. One author screened titles, abstracts and full-texts for relevance. Trained appraisers reviewed full text articles, scored each on a three-point Level of Evidence (LOE) scale (based on study design and quality) and three-point Direction of Evidence (DOE) scale (supportive, neutral, or opposing findings for each intervention's primary outcome), abstracted the primary outcome, setting and assigned an outcome category (patient or process). Second party appraisal was conducted for all included studies. The level and direction of each intervention was plotted in an evidence matrix, based on appraisals. Results: Twenty-nine studies were included and appraised for seven interventions: 5 drugs (Dextrose 50% (D50), Dextrose 10% (D10), glucagon, oral glucose and thiamine), one assessment tool (point-of-care (POC) glucose testing) and one call disposition (treat-and-release). The most frequently reported study primary outcomes were related to: clinical improvement (n = 15, 51.7%), feasibility/safety (n = 8, 27.6%), and diagnostics (n = 6, 20.7%). The majority of outcomes were patient focused (n = 18, 62.0%). Conclusion: EMS interventions for treating hypoglycemia are informed by high-quality supportive evidence. Both D50 and D10 are supported by high-quality evidence; suggesting D10 may be an effective alternative to the standard D50. “Treat-and-release” practices for hypoglycemia are supported by moderate-quality evidence for the patient related outcomes of relapse, patient preference and complications. This body of evidence is high-quality, patient-focused and conducted in the prehospital setting thus generalizable paramedic practice.

scholarly journals P060: State of the evidence for prehospital use of point-of-care lactate in patients with sepsis: A report from the Prehospital Evidence Based Practice (PEP) program

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S85
Author(s):  
J. Greene ◽  
A. Carter ◽  
J. Goldstein ◽  
J. Jensen ◽  
J. Swain ◽  
...  
Keyword(s):  
Evidence Based Practice ◽  
Point Of Care ◽  
Serum Lactate ◽  
Outcome Data ◽  
The Body ◽  
Prehospital Setting ◽  
Critical Conditions ◽  
Severe Illness ◽  
Evidence Based ◽  
Level Of Evidence

Introduction: Early and accurate diagnosis of critical conditions is essential in emergency medical services (EMS). Serum lactate testing may be used to identify patients with worse prognosis, including sepsis. Recently, the use of a point-of-care lactate (POCL) test has been evaluated in guiding treatment in patients with sepsis. Operating as part of the Prehospital Evidence Based Practice (PEP) Program, the authors sought to identify and describe the body of evidence for POCL use in EMS and the emergency department (ED) for patients with sepsis. Methods: Following PEP methodology, in May 2018, PubMed was searched in a systematic manner. Title and abstract screening were conducted by the program coordinator. These studies were collected, appraised and added to the existing body of literature contained within the PEP database. Evidence appraisal was conducted by two reviewers who assigned both a level of evidence (LOE) on a novel three tier scale and a direction of evidence (supportive, neutral or opposing; based on primary outcome). Data on setting and study design were also extracted. Results: Eight studies were included in our analysis. Three of these studies were conducted in the ED setting; each investigating the POCL test's ability to predict severe sepsis, ICU admission or death. All three studies found supportive results for POCL. A systematic review on the use of POCL in the ED determined that this test can also improve time to treatment. Five of the total 8 studies were conducted prehospitally. Two of these studies were supportive of POCL use in the prehospital setting; in terms of feasibility and the ability to predict sepsis. Both of these study sites used this early information as part of initiating a “sepsis alert” pathway. The other three prehospital studies provide neutral support for POCL. One study demonstrated moderate ability of POCL to predict severe illness. Two studies found poor agreement between prehospital POCL and serum lactate values. Conclusion: Limited low and moderate quality evidence suggest POCL may be feasible and helpful in predicting sepsis in the prehospital setting. However, there is sparse and inconsistent support for specific important outcomes, including accuracy.

scholarly journals A framework of evidence-based practice for digital support, co-developed with and for the autism community

Autism ◽  
2020 ◽  
Vol 24 (6) ◽  
pp. 1411-1422 ◽  
Author(s):  
Vanessa Zervogianni ◽  
Sue Fletcher-Watson ◽  
Gerardo Herrera ◽  
Matthew Goodwin ◽  
Patricia Pérez-Fuster ◽  
...  
Keyword(s):  
Delphi Study ◽  
Evidence Based Practice ◽  
Informed Choice ◽  
Online Reviews ◽  
Good Evidence ◽  
Evidence Based ◽  
Level Of Evidence ◽  
Autistic People ◽  
Hands On ◽  
Study Methodology

A wide array of digital supports (such as apps) have been developed for the autism community, many of which have little or no evidence to support their effectiveness. A Delphi study methodology was used to develop a consensus on what constitutes good evidence for digital supports among the broader autism community, including autistic people and their families, as well as autism-related professionals and researchers. A four-phase Delphi study consultation with 27 panel members resulted in agreement on three categories for which evidence is required: reliability, engagement and effectiveness of the technology. Consensus was also reached on four key sources of evidence for these three categories: hands-on experience, academic sources, expert views and online reviews. These were differentially weighted as sources of evidence within these three categories. Lay abstract Digital supports are any type of technologies that have been intentionally developed to improve daily living in some way. A wide array of digital supports (such as apps) have been developed for the autism community specifically, but there is little or no evidence of whether they work or not. This study sought to identify what types of evidence the autistic community valued and wanted to see provided to enable an informed choice to be made regarding digital supports. A consensus was developed between autistic people and their families, practitioners (such as therapists and teachers) as well as researchers, to identify the core aspects of evidence that everyone agreed were useful. In all, 27 people reached agreement on three categories for which evidence is required: reliability, engagement and the effectiveness of the technology. Consensus was also reached on four key sources of evidence for these three categories: hands-on experience, academic sources, expert views and online reviews. The resulting framework allows for any technology to be evaluated for the level of evidence identifying how effective it is. The framework can be used by autistic people, their families, practitioners and researchers to ensure that decisions concerning the provision of support for autistic people is informed by evidence, that is, ‘evidence-based practice’.

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