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Barriers Evidence Based Medicine

Rae Woong Park
Big data indicates the large and ever-increasing volumes of data adhere to the following 4Vs: volume (ever-increasing amount), velocity (quickly generated), variety (many different types), veracity (from trustable sources). The last decade has seen huge advances in the amount of data we routinely generate and collect in pretty much everything we do, as well as our ability to use technology to analyze and understand it. The routine operation of modern health care systems also produces an abundance of electronically stored data on an ongoing basis as a byproduct of clinical practice...
September 2016: Journal of Hypertension
Sairam Parthasarathy, Mary A Carskadon, Girardin Jean-Louis, Judith Owens, Adam Bramoweth, Daniel Combs, Lauren Hale, Elizabeth Harrison, Chantelle N Hart, Brant P Hasler, Sarah M Honaker, Elisabeth Hertenstein, Samuel Kuna, Clete Kushida, Jessica C Levenson, Caitlin Murray, Allan I Pack, Vivek Pillai, Kristi Pruiksma, Azizi Seixas, Patrick Strollo, Saurabh S Thosar, Natasha Williams, Daniel Buysse
A wealth of scientific knowledge is being generated in sleep and circadian science. In order for us to realize the return on investment for such scientific knowledge and to improve the health of the nation, we need to disseminate and implement research findings into practice. An implementation gap - termed a "quality chasm" by the Institutes of Medicine - separates the scientific knowledge we possess and the implementation of such knowledge into preventative interventions or healthcare treatments. It is frequently reported that a time lag of 17 years transpires before medical research reaches clinical practice...
October 10, 2016: Sleep
Chana Wiesman, Esther Rose, Allison Grant, Adam Zimilover, Susan Klugman, Nicole Schreiber-Agus
PURPOSE: The notion of offering population-based screening to the Ashkenazi Jewish (AJ) population for the BRCA1/2 founder mutations continues to gain support. A program called the BRCAcommunity initiative was designed to identify the benefits and barriers associated with implementing this screening in a clinical setting. METHODS: Interested AJ individuals were stratified into high-risk (HR) and low-risk (LR) groups based on self-reported cancer histories. Those at HR were offered traditional genetic counseling/testing; those at LR were offered group genetic counseling and subsidized AJ BRCA founder mutation testing...
October 13, 2016: Genetics in Medicine: Official Journal of the American College of Medical Genetics
Bvudzai Priscilla Magadzire, Bruno Marchal, Kim Ward
BACKGROUND: The rising demand for chronic disease treatment and the barriers to accessing these medicines have led to the development of novel models for distributing medicines in South Africa's public sector, including distribution away from health centres, known as community-based distribution (CBD). In this article, we provide a typology of CBD models and outline perceived facilitators and barriers to their implementation using an adapted health systems framework with a view to analysing how future policy decisions on CBD could impact existing models and the health system as a whole...
2016: Journal of Pharmaceutical Policy and Practice
William H Gruber, Adam C Powell, John B Torous
Historically, the process of scientific discovery and the process of clinical delivery have been poorly integrated. As a result of the Decade of Health Information Technology (2004-2014), many of the former barriers to capturing, processing, and retrieving medical information at the point of care have been surmounted. This change has the potential to both transform how new medical discoveries are made and how evidence-based medicine is put into practice. To illustrate the impact of this ongoing change, several examples are provided of institutions which have innovatively used information at the point of care...
October 6, 2016: Healthcare
Brandon G Coleman, Thomas M Johnson, Kenneth J Erley, Richard Topolski, Michael Rethman, Douglas D Lancaster
In recent years, evidence-based dentistry has become the ideal for research, academia, and clinical practice. However, barriers to implementation are many, including the complexity of interpreting conflicting evidence as well as difficulties in accessing it. Furthermore, many proponents of evidence-based care seem to assume that good evidence consistently exists and that clinicians can and will objectively evaluate data so as to apply the best evidence to individual patients' needs. The authors argue that these shortcomings may mislead many clinicians and that students should be adequately prepared to cope with some of the more complex issues surrounding evidence-based practice...
October 2016: Journal of Dental Education
Fiona Runacres, Heidi Gregory, Anna Ugalde
BACKGROUND: Palliative care patients have numerous rehabilitation needs that increase with disease progression. Palliative rehabilitation practices and perceptions of palliative medicine physicians towards the role of rehabilitation are largely unstudied. AIM: To explore palliative medicine physicians' attitudes and perceptions towards rehabilitation delivered within inpatient palliative care units. DESIGN: Qualitative study utilizing semi-structured interviews...
September 26, 2016: Palliative Medicine
Jan L Jensen, Andrew H Travers
Nationally, emphasis on the importance of evidence-based practice (EBP) in emergency medicine and emergency medical services (EMS) has continuously increased. However, meaningful incorporation of effective and sustainable EBP into clinical and administrative decision-making remains a challenge. We propose a vision for EBP in EMS: Canadian EMS clinicians and leaders will understand and use the best available evidence for clinical and administrative decision-making, to improve patient health outcomes, the capability and quality of EMS systems of care, and safety of patients and EMS professionals...
September 23, 2016: CJEM
Karriem S Watson, Amanda C Blok, Joanna Buscemi, Yamile Molina, Marian Fitzgibbon, Melissa A Simon, Lance Williams, Kameron Matthews, Jamie L Studts, Sarah E Lillie, Jamie S Ostroff, Lisa Carter-Harris, Robert A Winn
The Society of Behavioral Medicine (SBM) supports the United States Preventive Services Task Force (USPSTF) recommendation of low-dose computed tomography (LDCT) screening of the chest for eligible populations to reduce lung cancer mortality. Consistent with efforts to translate research findings into real-world settings, SBM encourages health-care providers and health-care systems to (1) integrate evidence-based tobacco treatment as an essential component of LDCT-based lung cancer screening, (2) examine the structural barriers that may impact screening uptake, and (3) incorporate shared decision-making as a clinical platform to facilitate consultations and engagement with individuals at high risk for lung cancer about the potential benefits and harms associated with participation in a lung cancer screening program...
September 19, 2016: Translational Behavioral Medicine
Rae Woong Park
Big data indicates the large and ever-increasing volumes of data adhere to the following 4Vs: volume (ever-increasing amount), velocity (quickly generated), variety (many different types), veracity (from trustable sources). The last decade has seen huge advances in the amount of data we routinely generate and collect in pretty much everything we do, as well as our ability to use technology to analyze and understand it. The routine operation of modern health care systems also produces an abundance of electronically stored data on an ongoing basis as a byproduct of clinical practice...
September 2016: Journal of Hypertension
Joanna Veazey Brooks
PURPOSE: The environment during medical school has been shown to dissuade students from choosing primary care careers. The purpose of this study was (1) to explore how long-standing this hostility toward primary care is historically and (2) to understand the mechanisms through which the environment conveys disparagement of primary care to students. METHODS: The study is based on a qualitative analysis of 52 primary care physician oral histories. The data are from the Primary Care Oral History Collection, created by Fitzhugh Mullan and deposited in the National Library of Medicine...
September 2016: Annals of Family Medicine
June C Carroll, Roland Grad, Judith E Allanson, Pierre Pluye, Joanne A Permaul, Nicholas Pimlott, Brenda J Wilson
INTRODUCTION: Primary care providers (PCP) will need to be integrally involved in the delivery of genomic medicine. The GenetiKit trial demonstrated effectiveness of a knowledge translation intervention on family physicians' (FP) genetics referral decision-making. Most wanted to continue receiving Gene Messengers (GM), evidence-based summaries of new genetic tests with primary care recommendations. Our objective was to determine the value of GMs as a continuing education (CE) strategy in genomic medicine for FPs...
2016: Journal of Continuing Education in the Health Professions
Surya Devkota, Raja Ram Dhungana, Achyut Raj Pandey, Bihungum Bista, Savyata Panthi, Kartikesh Kumar Thakur, Ratna Mani Gajurel
INTRODUCTION: Despite the established evidence on benefits of controlling raised blood pressure and development of several guidelines on detection and management of hypertension, people often have untreated or uncontrolled hypertension. In this context, we undertook this study to identify the barriers existing in hypertension treatment and control in the municipalities of Kathmandu district in Nepal. METHODS: This was a community based, cross-sectional mixed method study conducted in the municipalities of Kathmandu district in Nepal between January and July 2015...
2016: Frontiers in Cardiovascular Medicine
João Bernardo, Patrícia Valentão, Clara Grosso, Paula Andrade
The central nervous system (CNS) is a mythical target for drug delivery. There is an ongoing debate over the brain accessibility of flavonoids, a group of plant-derived secondary metabolites widely known by their multifarious bioactivities achieved by distinct mechanisms. Recently, their applicability in the management of neurologic and psychiatric disorders, such as Alzheimer's and Parkinson's diseases, and major depression, has received particular attention. To reach their target, flavonoids must cross over the ultimate obstacle - the blood-brain barrier - at pharmacologically effective concentrations...
August 8, 2016: Current Medicinal Chemistry
James R Lawrence, Gwendoline J Baxter, John R Paterson
Aspirin (ASA), increasingly accepted as predominantly a cyclooxygenase (COX)-1 inhibitor, is a prodrug for salicylic acid (SA) which has no such activity. SA is widespread in nature, vital in plants, and present in drug free serum from animals and man. Evolutionary conserved SA receptors are found in human tissues. Very low doses of ASA will, on repeat dosing, produce near maximal platelet COX-1 inhibition. Evidence for cancer prophylaxis is based on ASA doses of at least 75mg/day. Pleiotropic mechanisms underlie low dose ASA's undoubted efficacy in preventive medicine but the key barrier to its more widespread use is gastrointestinal toxicity...
September 2016: Medical Hypotheses
Carole Decker, Linda Garavalia, Brian Garavalia, Elizabeth Gialde, Robert W Yeh, John Spertus, Adnan K Chhatriwalla
BACKGROUND: The foundation of precision medicine is the ability to tailor therapy based upon the expected risks and benefits of treatment for each individual patient. In a prior study, we implemented a software platform, ePRISM, to execute validated risk-stratification models for patients undergoing percutaneous coronary intervention and found substantial variability in the use of the personalized estimates to tailor care. A better understanding of physicians' perspectives about the use of individualized risk-estimates is needed to overcome barriers to their adoption...
August 2016: American Heart Journal
Shannon R Moore, Céline Heu, Nicole Y C Yu, Renee M Whan, Ulf R Knothe, Stefan Milz, Melissa L Knothe Tate
: : An abundance of surgical studies during the past 2 centuries provide empirical evidence of periosteum's regenerative power for reconstructing tissues as diverse as trachea and bone. This study aimed to develop quantitative, efficacy-based measures, thereby providing translational guidelines for the use of periosteum to harness the body's own healing potential and generate target tissues. The current study quantitatively and qualitatively demonstrated tissue generation modulated by a periosteum substitute membrane that replicates the structural constituents of native periosteum (elastin, collagen, progenitor cells) and its barrier, extracellular, and cellular properties...
July 27, 2016: Stem Cells Translational Medicine
Melissa Tibbits, Mohammad Siahpush
Although community-wide, multilevel interventions are widely regarded as the most effective method for addressing complex health issues such as sexually transmitted infections (STIs), there is a dearth of research about the implementation of interventions of this nature. The aim of this study was to determine the implementation of locally developed and evidence-based STI interventions across an urban community using the Institute of Medicine's intervention spectrum as a framework, to highlight collaborations, and to identify barriers to the implementation of community-wide, multilevel interventions...
July 25, 2016: Health Promotion Practice
Suzanne Shurtz, Virginia Fajt, Erla P Heyns, Hannah F Norton, Sandra Weingart
There is no comprehensive review of the extent to which evidence-based veterinary medicine (EBVM) is taught in AVMA-accredited colleges of veterinary medicine in the US and Canada. We surveyed teaching faculty and librarians at these institutions to determine what EBVM skills are currently included in curricula, how they are taught, and to what extent librarians are involved in this process. Librarians appear to be an underused resource, as 59% of respondents did not use librarians/library resources in teaching EBVM...
July 14, 2016: Journal of Veterinary Medical Education
Zhijun Wang, Xuefeng Liu, Rebecca Lucinda Ka Yan Ho, Christopher Wai Kei Lam, Moses Sing Sum Chow
Although over 100 chemotherapeutic agents are currently available for the treatment of cancer patients, the overall long term clinical benefit is disappointing due to the lack of effectiveness or severe side effects from these agents. In order to improve the therapeutic outcome, a new approach called precision medicine or personalized medicine has been proposed and initiated by the U.S. National Institutes of Health. However, the limited availability of effective medications and the high cost are still the major barriers for many cancer patients...
2016: Molecules: a Journal of Synthetic Chemistry and Natural Product Chemistry
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