Basis Of Research Evidence Research Articles

Clinical practice recommendations for the use of imaging in the diagnosis and management of axial spondyloarthritis in Taiwan.

Axial spondyloarthritis (axSpA) is a chronic inflammatory disease bearing challenges in early diagnosis. To improve clinical diagnosis and management of axSpA, recommendations were developed with current axSpA classification criteria and recent advances in medical imaging applications. A systematic literature review was conducted by 10 rheumatologists and radiologists in Taiwan to retrieve research evidence on the utilization of imaging modalities, including conventional radiography (CR), magnetic resonance imaging (MRI), computed tomography (CT), ultrasound (US), quantitative sacroiliac scintigraphy (QSS), and dual-energy X-ray absorptiometry (DXA). The panel of experts proposed six key issues on the role of imaging in early diagnosis of axSpA, monitoring of disease activity and structural changes, predicting treatment effects, and assessing complications such as osteoporosis and spinal fracture. The consensus was established on the basis of research evidence, clinical experiences and expert opinions. For each recommendation statement, the level of evidence was evaluated, the strength of recommendation was graded and the final level of agreement was determined through voting. In total, four overarching principles and 13 recommendations were formulated. These recommendations outlined different imaging approaches in the diagnosis and management of axSpA disease progression. Considering CT is easy to perform when MRI is less available in Taiwan, the expert panel proposed a concise and practical diagnostic scheme to strengthen the valuable role of MRI and CT in the diagnostic evaluation of axSpA without evident radiographic features. These modified recommendations provide guidance for rheumatologists, radiologists and healthcare professionals on timely diagnosis of axSpA and disease management with appropriate imaging modalities.

Incorporation of a health economic modelling tool into public health commissioning: Evidence use in a politicised context

This paper explores how commissioners working in an English local government authority (LA) viewed a health economic decision tool for planning services in relation to diabetes. We conducted 15 interviews and 2 focus groups between July 2015 and February 2016, with commissioners (including public health managers, data analysts and council members). Two overlapping themes were identified explaining the obstacles and enablers of using such a tool in commissioning: a) evidence cultures, and b) system interdependency. The former highlighted the diverse evidence cultures present in the LA with politicians influenced by the 'soft' social care agendas affecting their local population and treating local opinion as evidence, whilst public health managers prioritised the scientific view of evidence informed by research. System interdependency further complicated the decision making process by recognizing interlinking with departments and other disease groups. To achieve legitimacy within the commissioning arena health economic modelling needs to function effectively in a highly politicised environment where decisions are made not only on the basis of research evidence, but on grounds of 'soft' data, personal opinion and intelligence. In this context decisions become politicised, with multiple opinions seeking a voice. The way that such decisions are negotiated and which ones establish authority is of importance. We analyse the data using Larson's (1990) discursive field concept to show how the tool becomes an object of research push and pull likely to be used instrumentally by stakeholders to advance specific agendas, not a means of informing complex decisions. In conclusion, LA decision making is underpinned by a transactional business ethic which is a further potential 'pull' mechanism for the incorporation of health economic modelling in local commissioning.

Otitis Media: To Treat, To Refer, To Do Nothing: A Review for the Practitioner.

.On the basis of research evidence, a recommended strategy for improving the care of middle ear infections is to identify the subset of patients least likely to benefit from antibiotic therapy. They include children ages 6 months to 23 months with unilateral disease without severe signs and symptoms (moderate or severe otalgia, otalgia lasting more than 48 hours,or temperature of 39°C [102.2°F]), and those older than 2 years ofage with unilateral or bilateral disease who have mild signs andsymptoms.(9) On the basis of research evidence, the initial treatment of otitis media with effusion is watchful observation. There is little harm in observing a child who is not at risk for speech, language, or learning difficulties compared to medical or surgical intervention.(4) On the basis of research evidence, administration of the annual influenza vaccine and the conjugated pneumococcal vaccination has been shown to have a small but statistically significant impact on the frequency of middle ear disease. (7)(8) On the basis of expert opinion, optimal outcomes depend oncommunication between clinicians and parents. At a minimum , primary care clinicians should state their reasons for their own clinical judgment about appropriate management and for referral to otolaryngology if necessary.

Worm Infections in Children.

• On the basis of research evidence, worm infections are important global child health conditions causing chronic disability that lasts from childhood into adulthood (Table 1). (2)(3) Evidence Quality: B • On the basis of research evidence, the major worm infections found in developing countries include ascariasis, trichuriasis, hookworm infection, and schistosomiasis; toxocariasis, enterobiasis, and cysticercosis are also found in poor regions of North America and Europe. (4)(9)(13) Evidence Quality: B • On the basis of expert consensus, children and adolescents are often vulnerable to acquiring large numbers of worms, ie, high-intensity infections (Fig 1)(21)(22)(23) Evidence Quality: D • On the basis of expert consensus and research evidence, moderate and heavy worm burdens cause increased morbidity because of growth and intellectual stunting in children and adolescents. Many of these effects may result from helminth-induced malnutrition. (21)(22)(23) Evidence Quality: C • On the basis of expert consensus and research evidence, worm infections are also commonly associated with eosinophilia. (48) (49) Evidence Quality: B • On the basis of research evidence as well as consensus, helminthes can cause inflammation in the lung (asthma), gastrointestinal tract (enteritis and colitis), liver (hepatitis and fibrosis), and urogenital tract. (7)(21)(22)(23)(27)(28)(40)(41)(43) Evidence Quality: B • On the basis of research evidence, microscopy techniques for diagnosis of worm infections in children often exhibit suboptimal sensitivities and specificities, necessitating new or improved diagnostic modalities such as polymerase chain reaction. (54)(55) Evidence Quality: A • On the basis of research evidence and expert consensus, mass drug administration (“preventive chemotherapy”) has becomea standard practice for ministries of health in low- and middle-income countries to control intestinal helminth infections and schistosomiasis. (67)(68) Evidence Quality: B.

Hyperthyroidism in Children

On the basis of strong research evidence, hyperthyroidism is a rare but potentially serious disorder in childhood that, if uncontrolled, can lead to a wide range of complications, including effects on growth and development. • On the basis of strong research evidence, Graves' disease is the most common cause of hyperthyroidism in children, accounting for greater than 95% of cases. It is caused by stimulating antibodies to the thyroid-stimulating hormone receptor. • On the basis of some research evidence and consensus, history, physical examination, and thyroid function tests help diagnose hyperthyroidism. The condition is characterized by suppressed serum thyrotropin and elevated serum triiodothyronine and thyroxine. Radioactive iodine (or technetium-99) uptake and serum thyroid antibody measurements help determine the cause of hyperthyroidism. • On the basis of some research evidence and consensus, treatment options for Graves' disease in children include antithyroid medications, radioactive iodine, and surgery. Antithyroid medications are commonly used as the first-line therapy in children. However, because of the low rates of spontaneous remission, most children eventually require permanent treatment with radioactive iodine or surgery. Of the available antithyroid medications, current guidelines recommend use of methimazole and not propylthiouracil because of the unacceptable risk of hepatotoxicity associated with propylthiouracil. • On the basis of strong research evidence, thyroid storm is a rare life-threatening endocrine emergency that should be suspected in children with hyperthyroidism who demonstrate evidence of systemic decompensation. • On the basis of strong research evidence, neonatal hyperthyroidism can occur in infants born to mothers with a history of Graves' disease due to transplacental passage of TSH receptor stimulating antibodies.

Nephrotic syndrome.

On the basis of observational studies, the most common cause of nephrotic syndrome in school-aged children is minimal change disease. On the basis of research evidence and consensus, corticosteroids are considered first-line therapy for treatment of nephrotic syndrome. On the basis of consensus, prednisone therapy should be initiated at doses of 60 mg/m2 per day (2 mg/kg per day) administered for 4 to 6 weeks, followed by 40 mg/m2 per dose (1.5 mg/kg) every other day for at least 6 to 8 weeks. On the basis of consensus and expert opinion, it is important to recognize and manage the complications that can arise in patients with nephrotic syndrome, such as dyslipidemia, infection, and thrombosis. On the basis of research evidence, consensus, and expert opinion, several alternative therapies have been observed to have variable efficacy in children with both corticosteroid-dependent and corticosteroid-resistant nephrotic syndrome, although caution must be exercised in the administration of these corticosteroid-sparing medications secondary to toxic adverse effects. On the basis of observational studies, the course of nephrotic syndrome in most patients is that of relapse and remission.

The Hormonal Physiology of Women and their Fetuses and Mothers and their Infants

In January 2015, Childbirth Connection released a report titled Hormonal Physiology of Childbearing: Evidence and Implications for Women, Babies, and Maternity Care ( Buckley, 2015 Buckley S.J. Hormonal physiology of childbearing: Evidence and implications for women, babies, and maternity care. Childbirth Connection Programs, National Partnership for Women & Families, Washington, DC2015 Google Scholar ). In this commissioned report, author Sarah Buckley summarized research evidence to describe current understanding of the physiology of childbearing in four hormonal systems: oxytocin, beta‐endorphins, the stress‐related systems of epinephrine‐norepinephrine and cortisol, and prolactin. For each hormonal system, the author described the normal physiology and how common maternity care practices may affect that specific physiology on the basis of research evidence. Dr. Buckley argued that despite incomplete knowledge, what is known “reveals profound interconnections between mothers and babies, among hormone systems, and across childbearing processes and the life course” (p. i). Although this idea may not be new for many of us, Dr. Buckley concluded, “A growing body of research finds that common maternity care interventions may disturb hormonal processes, reduce their benefits, and create new challenges and concerns, including the possibility of adverse longer‐term developmental and epigenetic effects” (p. i). An important contemporary field of biology, epigenetics is the study of how external influences can switch genes on or off to affect the specific proteins transcribed independent of the individual's DNA sequence. Such changes may make the individual more or less prone to certain diseases or more or less likely to experience specific developmental alterations.

Respiratory failure.

On the basis of research evidence, (1)(2) numerous diseases and conditions can impair gas exchange, resulting in failure to meet the body's metabolic demands and leading to respiratory failure. On the basis of consensus, (1)(2)(7)(8)(9)(10) the clinical presentations of respiratory failure depend on the underlying cause and the level of hypoxemia and hypercapnia. Early diagnosis, close monitoring, and timely intervention are of utmost importance. On the basis of research evidence, (5)(14)(25) interventions range from noninvasive methods, such as close monitoring and supplemental oxygen, to full respiratory support with mechanical ventilation and in extreme cases even the use of extracorporeal membrane oxygenation.

Celiac Disease

On the basis of strong evidence, gastrointestinal symptoms and failure to thrive are classic presentations of celiac disease, but atypical, nongastrointestinal symptoms are also extremely common, particularly in the older child and adolescent. (3)(4)(8). On the basis of some research evidence and consensus, guidelines recommend celiac testing in symptomatic children with typical and atypical symptoms and consideration of testing in those with associated conditions and first-degree relatives of those with celiac disease. (3)(9). On the basis of strong research evidence, measurement of tTG IgA and total serum IgA level has been reported to be the most cost-effective and accurate means of serologic testing for celiac disease and is the test of choice unless the child is younger than 2 years or IgA deficient. (9). On the basis of strong research evidence, children with elevated titers of celiac antibodies or strong clinical suspicion for celiac disease should be referred to a gastroenterologist for upper endoscopy and biopsy. Until this procedure is performed, the child should continue on a diet with ingestion of gluten. (3)(9). On the basis of strong research evidence, all those with a confirmed diagnosis of celiac disease should follow a strict gluten-free diet for life, with avoidance of all foods that contain wheat, barley, and rye ingredients. (3)(4). Referral to a health care professional with specialized knowledge of celiac disease and the gluten-free diet is critical because of the numerous ways, often hidden, in which gluten may be present in the diet and environment.

Investigating the photostability of quantum dots at the single-molecule level.

Quantum dots (QDs) have shown great potential to provide spatial, temporal, and structural information for biological systems. However, blinking, photobleaching, and spectral blueshift are adverse effects on their practical applications in biomedical research. An investigation of the effects of six reducing agents including cysteine (Cys), 1,4-dithiothreitol (DTT), ethyl gallate (EG), L-glutathione (GSH), mercaptoacetic acid (MAA), and thiourea (TU) on the photostability of single QDs was studied. Our experiments demonstrate that both DTT and EG effectively inhibit blinking, photobleaching, and spectral blueshift. GSH molecules block blinking and photobleaching of QDs. The other reagents, Cys, MAA, and TU, only have the ability to counteract blinking. Possible explanations are given on the basis of research evidence. The results suggest possibilities for significant improvements in QDs for biological applications by adjusting the environmental conditions.

Pediatric asthma in a nutshell.

On the basis of strong research evidence, asthma is a leading cause of emergency department visits and hospital admissions for children. On the basis of research evidence, implementation of asthma guidelines by medical professionals in not optimal. On the basis of research evidence, the Asthma Predictive Index supports a diagnosis of chronic asthma in children younger than 3 years. On the basis of strong research evidence, premedication with a short-acting β2-agonist is the preferred initial therapy for exercise-induced asthma. On the basis of strong research evidence, anti-inflammatory therapy with inhaled corticosteroids is an effective treatment for asthma. On the basis of research and consensus, assessment of impairment and risk followed by scheduled assessment for asthma control is recommended. On the basis of research and consensus, the establishment of a close cooperative relationship among medical professionals, patients with asthma, and their families is an important component of asthma management.

Noncontraceptive use of contraceptive agents.

• On the basis of strong research evidence, there are many noncontraceptive advantages to use of hormonal contraceptive agents in adolescent girls. (3) (4)(5)(7)(10)(11)(12)(13)(14). • On the basis of research evidence and consensus, most of these agents are safe with minor adverse effects. (2)(3)(4)(5)(7)(10)(11)(12)(13)(14). • On the basis of research evidence and consensus, through application of evidence-based approaches and proper counseling, pediatricians can use various contraceptive agents to treat several medical conditions and to help alleviate many of the undesired symptoms and complications associated with menstrual periods. (2)(3)(4)(5)(7)(10)(11)(12)(13) (14). • On the basis of research evidence and consensus, these agents may be used in sexually active adolescents to simultaneously help prevent unintended adolescent pregnancies. (2)(3)(4)(5)(7)(10)(11)(12)(13)(14).

Influenza and parainfluenza viral infections in children.

• On the basis of strong epidemiologic evidence, influenza and parainfluenza viruses are responsible for significant morbidity and mortality in young infants and children and in persons with chronic medical conditions. (1)(4)(26)(27)(35). • On the basis of research evidence, influenza vaccines are effective in preventing disease in high-risk individuals. (8)(17)(18). • On the basis of strong research evidence, influenza vaccines are safe in young infants and children 6 months or older. (8)(15).• On the basis of research evidence, the use of corticosteroids and epinephrine is beneficial in the treatment of laryngotracheitis caused by parainfluenza viruses. (44)(45)(46)(47). • Strong evidence supports the use of influenza vaccines in pregnant mothers as a strategy to prevent disease in infants younger than 6 months. (17)(18)(19).

Keeping an open attitude towards the RDoC project

In the 1970s, a programme was launched in the United States which had two objectives: a) to improve the reliability of psychiatric diagnoses under ordinary clinical conditions; b) to facilitate the elucidation of the pathophysiology of mental disorders. In order to pursue these different objectives, the same tool was regarded as appropriate: a diagnostic system based on operational criteria defining in an explicit and precise way the various mental disorders.

The Role of the DSM-5 Personality Trait Model in Moving Toward a Quantitative and Empirically Based Approach to Classifying Personality and Psychopathology

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) represents a watershed moment in the history of official psychopathology classification systems because it is the first DSM to feature an empirically based model of maladaptive personality traits. Attributes of patients with personality disorders were discussed by the DSM-5 Personality and Personality Disorders Work Group and then operationalized and refined in the course of an empirical project that eventuated in the construction of the Personality Inventory for DSM-5 (PID-5). We review research to date on the DSM-5 trait model, with a primary aim of discussing how this kind of research could serve to better tether the DSM to data as it continues to evolve. For example, studies to date suggest that the DSM-5 trait model provides reasonable coverage of personality pathology but also suggest areas for continued refinement. This kind of research provides a way of evolving psychopathology classification on the basis of research evidence as opposed to clinical authority.

Managing Feeding Problems and Feeding Disorders

On the basis of strong research evidence, feeding problems and feeding disorders are common,especially in children who have developmental disabilities. (1) (3) On the basis of strong research evidence, a variety of prenatal, medical, environmental, behavioral, and parental factors contribute to childhood feeding disorders. (1) (3) On the basis of some research evidence plus consensus, many feeding problems are preventable or easily treated.On the basis of strong research evidence, left untreated, feeding disorders may result in complications, including aspiration pneumonitis,failure to thrive, and parent-child conflict. On the basis of some research evidence plus consensus,treatment of feeding disorders improves nutritional status, growth, feeding safety, and quality of life.

Human Metapneumovirus

On the basis of strong research evidence and consensus, (1) (2) (3) (4) human metapneumovirus is a leading cause of upper and lower respiratory tract infections in children. On the basis of research evidence and consensus, (3) (5) (6) (7) the clinical features of MPV-associated disease are similar to those of RSV. MPV is an important cause of asthma exacerbations, bronchiolitis, and pneumonia. Bacterial superinfection can occur.On the basis of research evidence and consensus, (2) (3) (8) the mean age of infection is 6 to 12 months, and nearly all school-age children are seropositive. However, infection can recur, likely in part due to impaired CD8+ T-cell response. On the basis of research evidence and consensus, (9) (10) (11) morbidity and mortality are the highest in patients who are premature, are immunosuppressed, or have underlying cardiopulmonary abnormalities. On the basis of research evidence and consensus, (2) commercially available diagnostic tests exist, and reverse transcriptase–PCR is the most commonly used. On the basis of consensus, because of a lack of relevant clinical studies, recombinant virus vaccines and monoclonal antibodies may be useful as prophylactics or therapeutics. (10)

Evidence-based policy or policy-based evidence? Higher education policies and policymaking 1987–2012

The article discusses higher education policies and policy making during the period of the author's direct involvement between the mid-80s and the present. The author points to an increasingly ideological form of policy making which has emphasised the economic role of higher education and created a higher education 'market'. As the scope of government has widened, the role of the Civil Service as a check on Ministers has reduced. Whilst the sector's influence on policies has also lessened, there is still more the universities could do to protect themselves as the case of quality assurance demonstrates. However this would require a willingness to act on the basis of research evidence, of which the author still sees little sign.

Psychosis in Children and Youth: Focus on Early-Onset Schizophrenia

On the basis of strong research evidence (1)(3) very early onset (VEOS) and early onset schizophrenia (EOS) carry significant morbidity and mortality risks for children and adolescents. On the basis of strong research evidence, the pathogenesis of EOS is linked to a dysregulation of dopamine and morphologic brain changes. (6)(7) On the basis of some research evidence and consensus, development of schizophrenia is the result of the interplay between genetic and environmental risk factors. (4) On the basis of strong research evidence, antipsychotic medications are the cornerstones of treatment for EOS. (11)(12)(13) On the basis of some research evidence and consensus, (13) treatment for schizophrenia should be timely, multimodal and multidisciplinary, including both pharmacologic and nonpharmacologic modalities tooptimize recovery.

Contributions of Formal Education to Social Development – What do we Know on the Basis of Research Evidence?

This article gives an overview, on the basis of existing synthesis reports and articles, of the current state of knowledge on the role of formal education in promoting social development. The existing evidence is contrasted with simplistic assumptions that abound in the political discussions on education and development. At the same time, the limitations of the potential of research to serve as a guide to policy decisions are also acknowledged. DOI: http://dx.doi.org/10.3126/jer.v2i0.7616 Journal of Education and Research Vol. 2, 2010 p.1-8