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Barriers Evidence Based Medicine

Katherine Rouleau, Monique Bourget, Patrick Chege, Francois Couturier, Paula Godoy-Ruiz, Paul H Grand'Maison, Melanie Henry, Kerling Israel, Videsh Kapoor, Hendra Kurniawan, Louella Lobo, Mahamane Maiga, Samantha Pereira Franca, Lynda Redwood-Campbell, Jamie Rodas, Raman Sohal, Dawit Wondimagegn, Robert Woolard
BACKGROUND AND OBJECTIVES: There is a limited evidentiary base on the development of family medicine in different contexts and countries. The lack of evidence impedes our ability to compare and characterize family medicine models and identify areas of success that have led to the effective provision of care. This paper offers a comparative compilation and analysis of the development of family medicine training programs in seven countries: Brazil, Canada, Ethiopia, Haiti, Indonesia, Kenya, and Mali...
March 8, 2018: Family Medicine
Claudia Conte, Francesca Mastrotto, Vincenzo Taresco, Aleksandra Tchoryk, Fabiana Quaglia, Snjezana Stolnik, Cameron Alexander
In the treatment of lung cancer, there is an urgent need of innovative medicines to optimize pharmacological responses of conventional chemotherapeutics while attenuating side effects. Here, we have exploited some relatively unexplored subtle differences in reduction potential, associated with cancer cell microenvironments in addition to the well-known changes in intracellular redox environment. We report the synthesis and application of novel redox-responsive PLGA (poly(lactic-co-glycolic acid)) -PEG (polyethylene glycol) nanoparticles (RR-NPs) programmed to change surface properties when entering tumor microenvironments, thus enhance cell internalization of the particles and their drug cargo...
March 10, 2018: Journal of Controlled Release: Official Journal of the Controlled Release Society
Zhimin Du, Ki Hyung Kim, Juil Kim, Yuseok Moon
Adlay is a cereal crop that has long been used as traditional herbal medicine and as a highly nourishing food. However, deoxynivalenol (DON), the most prevalent trichothecene mycotoxin worldwide, frequently spoils grains, including adlay, via fungal infection. On the basis of an assumption that the actions of DON in the gut could be modified by adlay consumption, we simulated the impacts of co-exposure in enterocytes and investigated the effectiveness of treatment with adlay for reducing the risk of DON-induced inflammation and epithelia barrier injury...
2018: Frontiers in Immunology
V M A Voorn, L van Bodegom-Vos, C So-Osman
Despite the increasing availability of evidence in transfusion medicine literature, this evidence does not automatically find its way into practice. This is also applicable to patient blood management (PBM). It may concern the lack of implementation of effective new techniques or treatments, or it may apply to the (over)use of techniques and treatments (e.g. inappropriate transfusions) that have proven to be of limited benefit for patients (low-value care) and could be abandoned (de-implementation). In PBM literature, the implementation of restrictive transfusion thresholds and the de-implementation of inappropriate transfusions are described...
March 6, 2018: Transfusion Medicine
Lisa Jane Gould, Peter Griffiths, Hannah Ruth Barker, Paula Libberton, Ines Mesa-Eguiagaray, Ruth M Pickering, Lisa Jane Shipway, Jackie Bridges
OBJECTIVE: Compassionate care continues to be a focus for national and international attention, but the existing evidence base lacks the experimental methodology necessary to guide the selection of effective interventions for practice. This study aimed to evaluate the Creating Learning Environments for Compassionate Care (CLECC) intervention in improving compassionate care. SETTING: Ward nursing teams (clusters) in two English National Health Service hospitals randomised to intervention (n=4) or control (n=2)...
February 22, 2018: BMJ Open
Leah K Crockett, Carly Leggett, Janet A Curran, Lisa Knisley, Gwenyth Brockman, Shannon D Scott, Lisa Hartling, Mona Jabbour, Terry P Klassen
CLINICIAN'S CAPSULE What is known about this topic? Evidence-based pediatric emergency care is variably applied across general and pediatric emergency departments. What did this study ask? What are the information-seeking patterns of pediatric emergency medicine network members? What did this study find? There remains a need to share successful methods of local dissemination and implementation across the network, and to leverage local professional champions such as clinical nurse liaisons. Why does this study matter to clinicians? Tailoring knowledge mobilization efforts to end-user priorities is essential to ensure impact and spread of outreach efforts...
February 22, 2018: CJEM
Jing Sun, Cecile Jia Hu, Mark Stuntz, Hans Hogerzeil, Yuanli Liu
BACKGROUND: Despite recent reforms, distorting funding mechanisms and over-prescribing still maintain severe financial barriers to medicines access in China. Complicated and interrelated problems in the pharmaceutical sector require a common framework to be resolved as fragmented solutions do not work. We present a preliminary assessment of the impact of the national healthcare reforms on access to medicines, and propose policy recommendations for promoting universal access to medicines in China...
February 20, 2018: BMC Health Services Research
Peter R Giacobbi, Jonathan Stewart, Keeley Chaffee, Anna-Marie Jaeschke, Meagan Stabler, George A Kelley
Introduction: Guided imagery involves the controlled visualization of detailed mental images. This integrative health technique is used for healing, health maintenance, or the treatment of specific conditions. Guided imagery is an integral part of mindfulness meditation, hypnosis, and various relaxation exercises. However, evidence to support the widespread use and dissemination of guided imagery interventions has been lacking. The purposes of this scoping review were to document the scope of health outcomes and disease processes examined by guided imagery researchers and the journal outlets where this work has been published...
December 2017: Progress in Preventive Medicine
Sushma Bhatnagar, Anuradha Patel, Srinivasa N Raja
Background: Pain medicine is a developing specialty, aimed at relieving pain and suffering, enhancing function, and improving the quality of life of patients. Pain is often ignored, under-reported and mismanaged by health-care providers. Aspiring pain physicians in India face many challenges and barriers in advancing their specialty. Objectives: The objective of this study is to determine the challenges in establishing a pain practice in India and to discuss the opportunities and strategies to overcome these barriers...
January 2018: Indian Journal of Palliative Care
O O Babatunde, V Tan, J L Jordan, K Dziedzic, C A Chew-Graham, C Jinks, J Protheroe, D A van der Windt
BACKGROUND & AIMS: Barriers to dissemination and engagement with evidence pose a threat to implementing evidence-based medicine. Understanding, retention and recall can be enhanced by visual presentation of information. The aim of this exploratory research was to develop and evaluate the accessibility and acceptability of visual summaries for presenting evidence syntheses with multiple exposures or outcomes to professional and lay audiences. METHODS: 'Evidence flowers' were developed as a visual method of presenting data from four case scenarios: two complex evidence syntheses with multiple outcomes, Cochrane reviews and clinical guidelines...
February 13, 2018: Research Synthesis Methods
Mary-Anne Ahiabu, Pascal Magnussen, Ib Christian Bygbjerg, Britt Pinkowski Tersbøl
INTRODUCTION: Antibiotic resistance, associated with inappropriate drug use, is a global public health threat. The pharmaceutical sectors in developing countries are poorly regulated leading to antibiotic sales and use without a prescription. The study documents the treatment of acute illnesses in households and the antibiotic dispensing practices of medicine sales outlets in Eastern region, Ghana. METHOD: Twice-weekly illness recall visits were made to 12 households in three rural communities over eight consecutive weeks...
February 7, 2018: Research in Social & Administrative Pharmacy: RSAP
Reshma Ambulkar, Priya Ranganathan, Vasanth Karthik, Jigeeshu Divatia
Background and Aims: Evidence-based medicine (EBM) is defined as the use of scientifically proven evidence for delivering best possible health care to patients. Despite growing emphasis on the need for EBM-based practice, acceptability, and perceptions toward EBM might differ among health professionals. The objective of this study was to assess the attitude, knowledge, and current practices of EBM among perioperative care health professionals in India. Material and Methods: This was a single point paper-based questionnaire survey carried out in February 2014 among delegates registered for an EBM conference on "perioperative care" held at a Tertiary referral Cancer Centre in India...
October 2017: Journal of Anaesthesiology, Clinical Pharmacology
Allison K Ikeda, Paul Hong, Stacey L Ishman, Stephanie A Joe, Gregory W Randolph, Jennifer J Shin
Shared decision making (SDM) is a collaborative process in which patients, families, and clinicians develop a mutually agreed upon treatment plan when more than one reasonable treatment option exists. This cooperative engagement fosters improvements in patient satisfaction, disease management, and outcomes and also has the capacity to promote evidence-based care. Thus, this seventh installment of our Evidence-Based Medicine in Otolaryngology series focuses on SDM. We introduce SDM, including its potential to reduce decisional conflict and decisional regret, when it should be used, its potential benefits, barriers to implementation, and its role in the management of chronic disease and otolaryngological conditions...
February 1, 2018: Otolaryngology—Head and Neck Surgery
K Kumar, C Roberts, E Bartle, D S Eley
Written tests for selection into medicine have demonstrated reliability and there is accumulating evidence regarding their validity, but we know little about the broader impacts or consequences of medical school selection tests from the perspectives of key stakeholders. In this first Australian study of its kind, we use consequential validity as a theoretical lens to examine how medical school students and applicants view and experience the Graduate Medical Schools Admission Test (GAMSAT), and the consequences of testing...
January 31, 2018: Advances in Health Sciences Education: Theory and Practice
Michael W Manning, Eric W Bean, Andrew C Miller, Suzanne J Templer, Richard S Mackenzie, David M Richardson, Kristin A Bresnan, Marna R Greenberg
Introduction: The Association of American Medical Colleges' (AAMC) initiative for Core Entrustable Professional Activities for Entering Residency includes as an element of Entrustable Professional Activity 13 to "identify system failures and contribute to a culture of safety and improvement." We set out to determine the feasibility of using medical students' action learning projects (ALPs) to expedite implementation of evidence-based pathways for three common patient diagnoses in the emergency department (ED) setting (Atrial fibrillation, congestive heart failure, and pulmonary embolism)...
January 2018: Western Journal of Emergency Medicine
Giuseppe Micali, Valentina Paternò, Rossella Cannarella, Franco Dinotta, Francesco Lacarrubba
Skin barrier restoration represents the mainstay of the treatment of atopic dermatitis and the use of moisturizers is recommended by several international guidelines. The aim of the study was to investigate through an evidence-based medicine analysis the effectiveness and safety of different moisturizing products available for a non-pharmacological treatment of atopic dermatitis. A total of 92 randomized controlled trials (RCTs) have been identified and analyzed. The results confirm the presence of a reasonable number of studies highlighting moisturizers safety and effectiveness in the treatment of atopic dermatitis by improving disease severity, increasing the time of relapse and reducing the time of flares...
January 24, 2018: Giornale Italiano di Dermatologia e Venereologia: Organo Ufficiale, Società Italiana di Dermatologia e Sifilografia
Anuradha Sujai Joshi, Jaishree Deepak Ganjiwale, Jagdish Varma, Praveen Singh, Jyoti Nath Modi, Tejinder Singh
Background: Globally, students with top academic performance and high intellectual capacity usually opt to study medicine. However, once students get enrolled, their academic performance varies widely. Such variations appear to be determined by various factors, one of them being types of learning strategies adopted by students. The learning strategies utilized by the students with better academic performance are likely to be more effective learning strategies. Aims and Objectives: The objective is to identify effective learning strategies used by medical students...
December 2017: International Journal of Applied and Basic Medical Research
J William Kerns, Jonathan D Winter, Katherine M Winter, Terry Boyd, Rebecca S Etz
BACKGROUND: Guidelines, policies, and warnings have been applied to reduce the use of medications for behavioral and psychological symptoms of dementia (BPSD). Because of rare dangerous side effects, antipsychotics have been singled out in these efforts. However, antipsychotics are still prescribed "off label" to hundreds of thousands of seniors residing in nursing homes and communities. Our objective was to evaluate how and why primary-care physicians (PCPs) employ nonpharmacologic strategies and drugs for BPSD...
January 2018: Journal of the American Board of Family Medicine: JABFM
Ali Jasem Buabbas, Fatemah Mohammad Alsaleh, Hamza Mohamad Al-Shawaf, Ali Abdullah, Abdullah Almajran
BACKGROUND: The evolving role of pharmacists in providing pharmaceutical care, as part of the healthcare team, challenges them to acquire up-to-date knowledge of medicines to make the best clinical decisions. The volume of medical literature is on the increase, and it is important to utilise these resources to optimise patients' therapeutic outcomes. This study aimed at assessing the readiness of government hospital pharmacists in practising evidence-based medicine (EBM) in Kuwait in regards to their attitude, knowledge and skills, as well as the perceived barriers and facilitators...
January 11, 2018: BMC Medical Informatics and Decision Making
Helen Kalies, Rieke Schöttmer, Steffen T Simon, Raymond Voltz, Alexander Crispin, Claudia Bausewein
BACKGROUND: In 2015, an evidence- and consensus-based palliative care guideline in adults with incurable cancer was published by the German Guideline Program. Barriers and enablers for the guideline implementation of members of the German Association for Palliative Medicine (DGP) were unknown. Therefore, the aims of this study were (1) to evaluate professionals' knowledge, motivation, and outcome expectancy towards already existing recommendations for palliative care and (2) to evaluate the self-experienced competence in five medical key topics presented in the new guideline...
January 5, 2018: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
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