Application Of Clinical Evidence Research Articles

Guideline for the application of chromosomal microarray analysis in prenatal diagnosis (2023)

After the promulgation of the first edition of expert consensus on the application of chromosomal microarray analysis (CMA) technology in prenatal diagnosis in 2014, after 8 years of clinical and technical development, CMA technology has become a first-line diagnosis technology for fetal chromosome copy number deletion or duplication abnormalities, and is widely used in the field of prenatal diagnosis in China. However, with the development of the industry and the accumulation of experience in case diagnosis, the application of CMA technology in many important aspects of prenatal diagnosis, such as clinical diagnosis testimony, data analysis and genetic counseling before and after testing, needs to be further standardized and improved, so as to make the application of CMA technology more in line with clinical needs. The revision of the guideline was led by the National Prenatal Diagnostic Technical Expert Group, and several prenatal diagnostic institutions such as Peking Union Medical College Hospital were commissioned to write, discuss and revise the first draft, which was discussed and reviewed by all the experts of the National Prenatal Diagnostic Technical Expert Group, and was finally formed after extensive review and revision. This guideline is aimed at the important aspects of the application of CMA technology in prenatal diagnosis and clinical diagnosis, from the clinical application of evidence, test quality control, data analysis and interpretation, diagnosis report writing, genetic counseling before and after testing and other work specifications are elaborated and introduced in detail. It fully reflects the integrated experience, professional thinking and guidance of the current Chinese expert team on the prenatal diagnosis application of CMA technology. The compilation of the guideline for the application of CMA technology in prenatal diagnosis will strive to promote the standardization and advancement of prenatal diagnosis of fetal chromosome diseases in China.

Research Mentoring: Decreasing the Gap in Clinical Application of Evidence in the School-Based Setting

Purpose The purpose of this article was to describe how effective research mentoring, with emphasis on implementation science, may contribute to speech-language pathologists' experiences integrating current evidence into practice in the school-based setting during the clinical fellowship (CF) year. A case example will be used to illustrate mentoring outcomes and provide insight from a 1st year professional, currently in the CF year, who completed a research mentoring program. This case example will detail a faculty-graduate student research mentorship experience and the carryover influence on the new fellow's 1st year of clinical practice. Conclusion Research mentoring emphasizing implementation science methods and identified qualities of effective mentoring has the potential to contribute to speech-language pathologists' experiences integrating current evidence into practice in the school-based setting during the CF year. Certainly, outcomes of mentorship experiences are contingent on the quality of mentoring activities and the characteristics of both mentor and mentee. However, it is important to consider that the value of good mentoring may add to the transition from student to professional, particularly with regard to implementing research-supported strategies and techniques into daily practice.

Evaluation of readiness of evidence-based practice for the prevention and management of deep vein thrombosis after spinal orthopedic surgery

Objective To understand the preparation of evidence-based nursing practice for postoperative venous thrombosis in the department of spine and orthopedics in our hospital, and to identify the obstacle factors in the process of evidence-based nursing practice so as to promote the successful transformation and application of evidence. Methods A questionnaire survey was conducted among 164 nurses in Department of Orthopedics of Wuhan Union Hospital in Hubei Province by using self-made general data questionnaire and Clinic Readiness of Evidence-Based Nursing Assessment (CREBNA). Results The total score of CREBNA was (135.99 ±14.52) points, accounting for 87.10% of the full score. The average score of each subscale item was from high to low: organization environment subscale (4.44±0.67) points, evidence subscale (4.41±0.60) points and promotion factor subscale (4.31±0.69) points. Multiple stepwise regression analysis showed that different levels of understanding of evidence-based nursing practice was the main influencing factor of spine orthopedic nurses′ evidence-based practice readiness (P<0.05). Conclusion In this study, there were good level of readiness for evidence-based nursing practice and the current environment is conducive to the development of evidence-based practice programs. Before the application of evidence, managers should clarify the obstacles to change and formulate individual intervention measures to promote the clinical application of evidence. Key words: Evidence application; Readiness for evidence-based practice; Evidence-based nursing

The practice of evidence-based nursing of non-humidified of continuing nasal cannula oxygen therapy

Objective To make a reasonable evidence-based nursing scheme for the oxygen non-humidified of continuing nasal cannula oxygen therapy. Method Adopting the JBI clinical evidence application system, make sure the evidence baseline investigated before application, used during clinical application, and reviewed after application. Based on the now available best evidence, making examination standard and apply it to clinical care. During the application of evidence, 81 continuing low-flow (oxygen flow≤4L/min) nasal cannula oxygen patients were taken. Making assessment on the experiment group(oxygen non-humidified) and control group (oxygen humidified) in three aspects: the comfort level and effect of oxygen therapy, and humidification bottles contamination. Results During the application of evidence, the difference between experiment group and control group shows no statistical significance (P>0.05);the experiment group in oxygen therapy operating time was (162.93±40.18) s, the control group operating time was (258.60±56.97) s, the difference of two groups in shows statistical significance (t=8.752, P<0.01) . Conclusion The continuing low-flow (oxygen flow≤4L/min) nasal cannula oxygen therapy do not need humidification. And the clinical application of this best evidence standardizes the clinical nurses oxygen nursing behavior, reduces the nursing cost and enhances the quality of clinical nursing. Key words: Evidence-based nursing; Oxygen Inhalation therapy; Non-humidified; Best practice

Findings From a Pilot Study: Bringing Evidence-Based Practice to the Bedside.

To translate research supporting inpatient care outcomes and provide evidence-based care, registered nurses (RNs) need continuing education and mentoring support to adopt evidence-based practice (EBP). The aim of this study was to assess a demonstration project intended to pilot and evaluate a structured EBP education with mentoring innovation for nurses in a multihospital system. Nurses from five units in five hospitals were included in an education with mentoring innovation to implement the Johns Hopkins Nursing Evidence-Based Practice Model and the Advancing Research and Clinical practice through close Collaboration (ARCC) Model. To determine outcomes, the EBP beliefs scale (EBPB) and implementation scale (EBPI) were administered before and after the education with mentoring innovation. Eighty-three RNs completed both preintervention surveys. A total of 57 RNs completed the postintervention surveys. In addition, qualitative data were obtained from focus groups involving 24 participants. Statistical analysis indicated positive movement toward EBP in project participants. Qualitative analysis revealed perceived successes and challenges involved with implementing an evidence-based program, provided logistical lessons learned, and indicated that nurses at all levels of practice require mentoring and coaching to foster EBP sustainment. The engagement of nurses in this project supported professional development and clinical application of evidence at the point of care. The pilot project's outcome informed a decision by health system administrators to fund more nurse driven EBP projects in the five hospitals. This innovative program provides a replicable structure for deployment and appraisal of EBP nursing model implementation.

Clinical application of evidence- based care for maternal childbirth

Objective To investigate the clinical application of evidence- based care for maternal childbirth. Methods 180 cases of maternal childbirth were selected as research subjects from March 2012 to August 2013 in the hospital and were randomly divided into two groups according to random number table.90 cases were treated with evidence- based measures in observation group, while the other 90 cases were with conventional methods of care in control group.Mode of delivery, rates of postpartum hemorrhage, neonatal asphyxia, and delivery time were compared between two groups. Results After treatment, maternal cesarean section rate was 24.4% in observation group, which was significantly lower than that of control group.Maternal vaginal delivery rate in observation group was 61.1%, which was significantly higher than that of control group, postpartum hemorrhage and neonatal asphyxia rate in observation group were significantly lower than those of control group(P< 0.05).The first, second and third delivery time of observation group were all significantly lower than those of control group. Conclusions Evidence- based care measures are benefit to enhancing maternity confidence and improving the success rate of maternal vaginal delivery, decreasing cesarean section rate, thereby reducing postpartum maternal complications, greatly improving the quality of life of mothers, which is worthy of clinical application. Key words: Evidence- based care; Maternal childbirth; Cesarean

Clinical application of evidence- based nursing in elderly patients with cardiovascular interventional surgery during perioperative period

Objective To evaluate clinical value of evidence-based nursing intervention in treatment of elderly patients with cardiovascular interventional surgery during perioperative period. Methods 150 cases of elderly patients with cardiovascular diseases who underwent interventional surgical treatment were selected.They were randomly divided into the observation group(80 cases)and the control group(70 patients). Results The occurrence and degree of discomfort of bedridden patients in the observation group were milder,and the complications due to use of anticoagulants and pressing dressing were significantly less than the control group.The satisfaction degree and mastering of disease related knowledge in the observation group were significantly better than that of the control group. Conclusions Application of evidence-based nursing intervention during perioperative period for elderly patients with cardiovascular interventional surgery can reduce discomfort and complications of patients,as well as improve satisfaction degree and mastering of disease-related knowledge of patients and their families,which is worthy of promotion. Key words: Evidence-based care; Senile; Cardiovascular disease; Interventional procedures

Welcome to perioperative medicine.

We are proud to welcome you to the launch issue of Perioperative Medicine. Many before us have campaigned for improvements in the care of patients undergoing surgery and for us this is a major milestone in our clinical and academic careers. As a group we have drawn much inspiration and leadership from Professor David Bennett and have done the majority of our research and teaching on perioperative medicine with the explicit aim of improving the outcome of patients undergoing major surgery [1]. With David and colleagues we have campaigned and lobbied for improved and consistent standards of care [2,3]. We started the Evidence Based Perioperative Medicine International Congress (EBPOM) over a decade ago and now work closely with sister organizations around the world [4,5]. Perioperative medicine is now rightly recognized as a legitimate and independent sub-specialty but the journey is only just beginning [6-8]. The recent publication from the UK’s National Confidential Enquiry into Patient Outcome and Death entitled ‘Peri-operative Care: Knowing the Risk (2011)’ paints a grim picture [9]. It concludes that overall the care of patients was substandard in the majority of high-risk patients. The thirty day mortality in those patients in whom the advisors considered there to have been inadequate pre-operative fluid management was 20.5% compared to 4.7% mortality in those with adequate pre-operative fluid therapy. Patients who suffered intra-operative complications had a thirty day mortality of 13.2% compared to 5.7% in those without. Yet, cardiac output monitoring was rarely used in high-risk patients and inadequate intra-operative monitoring was associated with a three-fold increase in mortality. Reports from the USA tell similar stories. For example, the Veterans’ Association National Surgical Quality Improvement Program (NSQIP) found that the occurrence of a thirty day postoperative complication is the single most important factor determining survival after major surgery [10]. More recently Birkmeyer et al. demonstrated that the costs of inpatient surgery are thousands of dollars more per patient on average at hospitals with high complications. They concluded that their “findings suggest that local, regional, and national efforts aimed at improving surgical quality may ultimately reduce costs and improve outcomes” [11]. They went on to note that “achieving superior outcomes in surgery may require that hospitals invest in expensive resources, such as intensivist-staffed intensive care units, high nurse-to-bed ratios, advanced technology, and specialist services”. If improvements are to be made then we must share, spread and adopt best practice whilst examining the efficacy and effectiveness of innovative care pathways and technologies. This is a core objective of the new journal, Perioperative Medicine. In the UK we have recently seen dramatic improvements in the care of patients undergoing elective major surgery as a result of a government-funded Enhanced Recovery Partnership Programme [12]. This is an exemplar of the power of the spread and adoption of best evidence practices through education informed by research. The recently published report demonstrates improved quality of care and cost effectiveness whilst promoting and recognizing investment in innovation [12]. We are delighted to be publishing a Consensus Statement on Perioperative Fluid Management in Enhanced Recovery by the Clinical Leaders of the English Enhanced Recovery Partnership in this, our first issue of Perioperative Medicine. Care of the surgical patient is increasingly recognised to rely on a coordinated approach to healthcare by a multidisciplinary team. Perioperative Medicine brings together the best research from all of these fields and applies it to the care of patients undergoing surgery to help healthcare providers improve their patients' outcomes. With the change in population demographics post-operative morbidity has been recognised as one of the epidemics of the 21st century. High quality cost effective changes in practice demand a robust evidence base. Perioperative Medicine is an open access peer-reviewed journal that publishes highly topical clinical research relating to the perioperative care of surgical patients. Its essence is the distillation, examination and application of clinical evidence to improve surgical outcome. Modern perioperative medicine is a true multidisciplinary specialty and the journal welcomes research in all areas relevant to perioperative medicine from any healthcare professional. You will see from our editorial board that we are truly international with members from every continent. This first issue of Perioperative Medicine exemplifies our mission to look across the continuum of care from around the world. It includes articles on pre-operative assessment from China (Lee et al.), emergency pain relief for hip fracture patients from Ireland (Szucs et al.), quality improvement strategies (Speck et al.) and renal failure (Calvert and Shaw) from the USA and peri-operative fluid management from England (Mythen et al.). We hope you enjoy Perioperative Medicine and hope that you will engage with comment and submissions.

Pediatric residents as learners and teachers of evidence-based medicine.

Residents must learn to assess the medical literature and apply it clinically. We designed and implemented a curriculum to support resident acquisition and use of skills required for critical review and clinical application of evidence from the pediatrics literature. The experience provided an opportunity for residents to observe, demonstrate under supervision, and practice evidence-based skills using the "see one, do one, practice many" approach. We revised our residents' evidence-based pediatrics journal club curriculum to provide specific learning objectives to be accomplished by residents during the three years of residency. Curriculum objectives address study design, definition of the research question, characterization of variable type and choices of statistical methods, attention to sample size, diagnostic test characteristics, identification of sources of bias, and generalization and specific application of research findings to our clinical setting. We implemented a three-stage approach to skills learning. First-year residents participate in a monthly journal-club presented by the second-year residents ("see one"). During the second year, residents present noon conferences based on the curriculum objectives. The second-year resident meets with a faculty member to select a journal article for discussion, identify key curriculum objectives illustrated by the study, and choose pertinent clinical epidemiology references. The resulting presentation is given as a noon conference to an audience of residents, students, and faculty ("do one"). During the remainder of residency, residents continue to attend a monthly journal club that equips them with new skills and allows them to take a more meaningful part in the discussions ("practice many"). Curriculum faculty attend the monthly journal club to help direct the discussion of the article to fulfill curriculum objectives. Skills are best acquired in an environment which promotes active learning supervised by experts and provides frequent opportunities to practice the skills. Residents have responded positively to our curriculum and have presented high-quality conferences. Evaluation data being collected now (resident self-assessments and evaluations of the experience, faculty assessments of presentations, pre- and post-second year written assessments of knowledge) will inform us if the desired outcomes are being attained. Over the first two years of implementation of this curriculum, we have observed that it takes no more faculty time to supervise resident preparation and presentation than it would for the faculty to prepare and present material concerning similar curriculum objectives in a lecture or conference format. Additional benefits for residents include creating materials for presentation with experienced faculty, making presentations for peer groups, and assuming the role of teacher.