Beyond “nil per mouth”: towards evidence-based fasting and medication practices

The importance of evidence-based practice in healthcare for improving patient outcomes is widely recognized. While nursing research primarily generates new knowledge, evidence-based nursing practice focuses on applying the best available evidence to guide care. There's a growing trend in research to effectively translate evidence into practice. It's clear that having research-based evidence alone isn't enough; it must also be successfully integrated into a supportive environment to yield meaningful results. In nursing, evidence-based practice means delivering comprehensive, high-quality care based on the latest research and knowledge rather than relying solely on traditional methods, advice from peers, or personal beliefs. Implementing evidence-based practice in nursing bridges the gap between theory and actual patient care, leading to innovative healthcare that incorporates the latest discoveries. Evidence-based practice remains a central theme throughout a nursing career, with its origins dating back to Florence Nightingale, the pioneer of modern nursing. Nightingale collected data and established a connection between unhygienic conditions and declining health, a concept that remains relevant today. Over the past century, advancements in technology and human ingenuity have led to solutions that were unimaginable just 50 years ago. Many diseases have been conquered, countless lives saved, and the pursuit of improved healthcare solutions continues. Evidence-based practice in nursing underscores the notion that medical practices should evolve continually based on an ongoing cycle of evidence, theory, and research. Changes in practice stimulate further research, and the theories arising from that research serve as evidence to drive additional improvements in practice

Superstition is a belief that is not based on scientific knowledge. Traditional healers usually use superstition in their practices to manage human health problems and diseases; such practices create a conflict with the medical profession and its evidence-based practices. Medical professionals confirm that this kind of practice is unsafe as it is performed by untrained people (e.g., traditional healers) utilizing unsterilized instruments within unhygienic environments. Most of the cases eventually develop a variety of complications, which are sometimes fatal. Female genital mutilation, uvulectomy, oral mutilation (tooth bud extraction to cure “Ibyinyo”), and eyebrow incisions are examples of the many different types of superstitious practices which occur commonly in other parts of the world. We describe how these traditional practices of superstition have been and continue to be performed in various parts of the world, their complications on oral and general health, and how such practices hinder modern medical practices and highlight huge inequalities and disparities in healthcare-seeking behavior among different social groups. This paper aims to increase health literacy and awareness of these superstition-driven traditional and potentially harmful practices by promoting the importance of evidence-based medical practices.

Philosophy, ethics, medicine and health care: the urgent need for critical practice

Evidence-Based Practice and Associated Factors Among Health Care Providers Working in Public Hospitals in Northwest Ethiopia During 2017

INTRODUCTION: The world is culturally endowed with various forms of traditional healing practices. Nepal is situated between India and China. Ayurveda of the Indian subcontinent, the Traditional Chinese Medicine of China, the Tibetan Medicine so close with Nepalese society since hundreds of years. Still, the people have faith and practice to follow the oral health history of such practice in the community. METHODS: To find out the knowledge, practice, belief and health literacy of skin infections among traditional healing faith community. It was the in-depth interview done among the patients with skin infections attending hospital Skin department and having faith in traditional medicine practices. Dermatology quality of life (DQLI) also done. Data were analyzed with SPSS, Epi Info. RESULTS: The total number of patients were 3420 in an eight months period (Jan-Aug 2015). Among them 8% having viral infections (herpes zoster). Male were 42% and female were 58%. 62% of the patients were above 50 years old. Most of the patients (92%) came to hospital for check up after going to traditional healer. 23% have adverse effects. They believe that the disease was due to god and demon angriness. So, as soon as the traditional healer should make the artistic picture of lion, dragon etc. If the two sides artistic picture meet, the chances of death will very high. DQLI is less in those patients. CONCLUSION: Traditional healers in developing country are still one of the consultation practices due to long term belief in oral health history. Evidence based practice and its Health literacy awareness program is essential to improve the quality of life of people. It is not changing over-anight to many generations who have faith on oral history in medical practices, which is the most challenging job in the era of globalization especially developing country like Nepal.

Evidence-based practice (EBP) and Shared decision-making (SDM) are changing the nature of healthcare decisions. Evidence-based practice is a systematic approach of critical importance to medical practice intended to optimise decision-making by emphasising the value and use of evidence from scientific resources. Shared decision-making involves treating patients as partners, involving them in decision-making, and enlisting their sense of responsibility for their care while respecting their individual values and concerns. This study is theoretically driven by a curiosity of understanding the link between evidence-based practice, shared decision-making and patient-centred communication in order to achieve optimal care. It is broadly accepted that healthcare decisions require the integration of both research evidence and individual preferences. In the last decades, SDM has been hailed as the new paradigm for the doctor-patient relationship by health institutions and policy makers. However, the meaning and practical implications of such a new paradigm have been difficult to ascertain. To date, the need to consider patients as active partners in healthcare decision-making is growing. Yet, there has been little discussion resolving the potential conflict between promoting patient participation in decision-making regarding their health and the reliant on evidenced-based options. The thesis original contribution to knowledge is to fill these knowledge gaps by exploring the views and experiences of both users and providers of diabetes care about patient involvement in decision-making. This research, using interviews, aims to develop a greater understanding of patients and doctors experience of communicating treatment and management during medical encounters, in light of the need for a more person-centred approach in decision-making to enhance quality of patient care and improve outcomes. Forty-six semi-structured interviews were conducted with doctors and patients with Type 2 Diabetes from one of the government hospitals in Eastern Province, Saudi Arabia. Data were analysed with the aid of NVivo using thematic analysis. Evidence suggests that people living with diabetes in Saudi Arabia seem to value opportunities to be involved in everyday decision-making about their care. How these opportunities are created, understood, supported and sustained in healthcare settings remains to be determined. In this study, most of the doctors reported that involving patients into decision-making was challenging because most patients did not feel they had sufficient knowledge and confidence to do so; however, many patients reported that they did want to engage in decisions about their health but did not feel actively listened to, respected, and empowered to do so. Both groups of participants identified contrasting expectations and perceptions regarding communication within the doctor-patient relationship. The findings of this study demonstrate the need for doctors to collaboratively pursue opportunities to ensure that person-centred interactions are more consistently evident in practice. The study not only adds to what is known about the benefits of patient participation, but also provides robust evidence for policy makers and practitioners arguing for the benefits of this. Keywords: Evidence-based practice, shared decision-making, type 2 diabetes, patients’ preferences and participation, self-management.

Time pressures often require highly efficient, intuitive approaches to decision making. On the fly, we depend upon short cuts, or heuristics, to make rapid, efficient decisions. Heuristics are indispensable cognitive...

Can Western Quality Improvement Methods Transform the Russian Health Care System?

The federal government has a fundamental as well as critical role in the successful development, implementation and utilization of controlled medications for the treatment of opioid abuse and dependence. The development and implementation of a federal regulatory structure establishes minimum standards which provide the basis for the development of treatment policies and medical best practices for the treatment of drug abuse and dependence. In the United States, the use of pharmacotherapies in combination with counseling, behavior therapies and other core services including primary medical care provide a comprehensive therapeutic approach termed as an evidence-based best practice termed "Medication Assisted Treatment" (MAT). Federally supported research studies have shown that the most efficacious treatment for opioid abuse and dependence comprises treatment programs that utilize pharmacotherapies and include psychosocial counseling, financial, legal, educational services as well as wrap around social services (NIDA, 2000). Federal programs catalogue such evidence-based best medical practices and promote their implementation in the care and treatment of patients to optimize good medical outcomes. In a non regulatory role, federal programs can also mandate medical education and training as well as support the piloting of treatment improvement projects to develop national implementation strategies. Drug treatment programs that utilize MAT are regulated by the federal government in their adherence to treatment standards through accreditation and in their record keeping requirements for use of controlled pharmaceuticals. Thus, multiple federal agencies combine to support MAT in the treatment of opioid dependence throughout the treatment continuum from drug discovery to patient care and treatment outcome. Salient policy issues that involve MAT as a direct result of the federal regulatory structure(s) include the provision and integration of medical services into Opioid Treatment Programs (OTPs), infectious diseases prevention counseling, the availability of opioid treatment using either buprenorphine or methadone, the limited use of Suboxone/Subutex in OTPs and which health care providers can prescribe as well as the number of patients prescribed Suboxone/Subutex in an office based setting.

BackgroundMore effective methods are needed to implement evidence-based findings into practice. The Advancing Recovery Framework offers a multi-level approach to evidence-based practice implementation by aligning purchasing and regulatory policies at the payer level with organizational change strategies at the organizational level.MethodsThe Advancing Recovery Buprenorphine Implementation Study is a cluster-randomized controlled trial designed to increase use of the evidence-based practice buprenorphine medication to treat opiate addiction. Ohio Alcohol, Drug Addiction, and Mental Health Services Boards (ADAMHS), who are payers, and their addiction treatment organizations were recruited for a trial to assess the effects of payer and treatment organization changes (using the Advancing Recovery Framework) versus treatment organization changes alone on the use of buprenorphine. A matched-pair randomization, based on county characteristics, was applied, resulting in seven county ADAMHS boards and twenty-five treatment organizations in each arm. Opioid dependent patients are nested within cluster (treatment organization), and treatment organization clusters are nested within ADAMHS county board. The primary outcome is the percentage of individuals with an opioid dependence diagnosis who use buprenorphine during the 24-month intervention period and the 12-month sustainability period. The trial is currently in the baseline data collection stage.DiscussionAlthough addiction treatment providers are under increasing pressure to implement evidence-based practices that have been proven to improve patient outcomes, adoption of these practices lags, compared to other areas of healthcare. Reasons frequently cited for the slow adoption of EBPs in addiction treatment include, regulatory issues, staff, or client resistance and lack of resources. Yet the way addiction treatment is funded, the payer’s role—has not received a lot of attention in research on EBP adoption.This research is unique because it investigates the role of payers in evidence-based practice implementation using a randomized controlled design instead of case examples. The testing of the Advancing Recovery Framework is designed to broaden the understanding of the impact payers have on evidence-based practice (EBP) adoption.Trial registrationhttp://NCT01702142 (ClinicalTrials.gov registry, USA)

Improvement in Medical Practice: Performance in Practice: Improvement in Medical Practice: Clinical Modules for Screening and for the Assessment and Treatment of Adults With Substance Use Disorders

Speeding the Translation of Research into Evidence‐Based Practice and Conducting Projects That Impact Healthcare Quality, Patient Outcomes and Costs: The “So What” Outcome Factors

Enigmas and evidence

Recently, when asked why “cosmetogynecology” was wrong a colleague retorted, “Because there is no evidence.” The response poses an interesting question in whether evidence renders an ethic since ethics are dedicated to right conduct and correspondingly assign the labels right and wrong or good and bad. The outcry for restraint in the adoption of new pelvic floor repair kits or cosmetogynecology largely stems from the lack of evidence [1–3]. While evidence-based medical practice is certainly ethical, evidence is not an ethic, and if evidence is not an ethic, but a compliment to an ethic, how do we judge medical practice? Medicine is not ethically neutral. When we identify disease as “bad” and health as “good” we pronounce judgment on equally natural processes. While it is true that medicine can borrow ethical principles from a physician’s individual world-view, medicine has an intrinsic ethic. It can be convincingly argued that the Hippocratic Oath captures the salient features of this intrinsic ethic [4]. What is the fundamental goal of medicine? According to the Hippocratic oath a physician intervenes to “benefit the sick.” In essence physicians restore health, since this is what will benefit the sick. Who and in what ways an individual is sick can be reasonably debated, but physician duties are restorative. In one sense health is a unidirectional concept (e.g., healthy bowel function cannot be improved) and as such physicians do not apply therapies to create super-normal function. The ethics of medical enhancement to otherwise normal human function is ethically and culturally charged [5] and beyond this editorial. It will suffice to say that evidence can aid in defining normal, and with this medical practice, but the evidence only informs the overarching ethical principle to restore health; not included, as a first principle, is remuneration, ego, or personal advancement. It has been said that management of pelvic floor dysfunction is not about what could be done but what should be done. This is not a neutral statement. Questions of “should” bespeak judgments that are rooted in ethics. If physicians regularly practice interventions that evidence has consistently shown to be ineffective, this is fraud. Conversely, if a practice has abundant evidence documenting efficacy, is it de facto ethical? Obviously not, since harvesting organs from non-consenting trauma victims is wrong despite the evidence that organ transplantation can be highly effective (it is worth noting the presently simmering issue of presumed consent in organ donation). Ignorance can soften the first situation but the latter arises from a darkened world-view that is outside of any intrinsic medical ethic. When looking for a rule for practice and likewise rules to judge the ethics of any practice in medicine, we must recognize that individual world-views, in cooperation with the intrinsic medical ethic, can underlie the process. Such individual world-views can reorder care priorities to where the ends justify the means. If evidence demonstrated a therapy ineffective, yet it was practiced routinely, this would be bad. As stated above the situation is at least dishonest, but why is dishonesty bad? If self-interest is the prevailing human ethic then would not any medical practice that does not majority benefit the physician be bad? In 1991 Dr. L.D. Rue proposed at the American Academy for the Advancement of Science that modern culture needed a “noble lie” to foster moral behavior. The “lie” would be necessary as an authority to impart value to the universe and ourselves. While medicine Int Urogynecol J (2008) 19:745–746 DOI 10.1007/s00192-008-0617-8

The naissance of evidence-based medicine raises profound changes of medical practice mode all over the world. Evidence-based nursing follows the same methodology and principle with evidence-based medicine. This paper discussed how the evidence-based practice assisted development of nursing subject from three aspects including decision-making, thinking and culture. In decision-making, we should be based on the best research evidence, professional judgment and benefits of patients. In thinking, we should make clinical problems structured and scientific. In culture, we should evaluate evidences with critical eyes and establish transformative, enlightened, inclusive organization culture. Key words: Evidence-based nursing; Decision making; Nursing subject