Development Of Evidence-based Practice Guidelines Research Articles

A qualitative exploration of gynaecological healthcare experiences of lesbian, gay, bisexual, transgender, queer people assigned female at birth.

Lesbian, gay, bisexual, transgender, queer, asexual/aromantic (LGBTQA+) people, assigned female at birth (AFAB), experience disproportionately poorer gynaecological healthcare outcomes compared to their cisgender, heterosexual peers. The barriers to gynaecological care remain poorly understood. In a step toward bridging this gap, the current study explored the lived gynaecological healthcare experiences of Australian LGBTQA+ AFAB people and the barriers they experience in accessing care. Semi-structured interviews were conducted with 22 LGBTQA+ AFAB people. An inductive thematic qualitative design was used to explore the lived experiences and identify themes associated with the reported experiences. Thematic analysis identified seven themes related to experiences in accessing gynaecological healthcare, including discrimination, fear, perceived provider or cultural incompetency, accessibility, and gender identity. Several sub-themes were also identified such as refusal of care, microaggression, misgendering, and patient as educator. Participants suggested that barriers to care could be alleviated by the integration of LGBTQA+ specific healthcare training into the university-level medical curriculum and professional development programs that address cultural competency and inclusive healthcare. These preliminary findings inform the necessity for the development of evidence-based practice guidelines that specifically address the unique and diverse needs of the LGBTQA+ AFAB population.

Proposed Mechanism of Adherence in Caregivers Providing Care to Adults Living with a Left Ventricular Assist Device.

Introduction: The left ventricular assist device (VAD) is commonly used as the bridge-to-transplantation therapy for heart failure patients who are on waitlist of heart transplant. The caregivers' adherence to the homecare regimen plays a vital role in patient outcomes. There is little evidence about the factors related to the caregiver adherence. The purpose of this study was to determine the factors influencing adherence in caring for patients living with a left ventricular device. Methods: The data were collected from 4 online caregiver support groups. Multiple linear regression models were used to determine associations between key variables. The structure equation modeling was used to identify the mediators of caregiver adherence. Results: A total of 96 participants' data entered the final analysis. The average age of the participants was 49.8 (SD = 12.88) years, majority were white (84%), female (80%), and married (81%). Caregiver self-efficacy was positively related to their adherence (r = 0.460, P < 0.001). Caregiver knowledge did not mediate the effect of training on self-efficacy. Caregiver self-efficacy did not mediate the effect of knowledge on adherence. There was no interaction between practice hours and knowledge on adherence. Discussion: The findings suggest significant association between caregiver self-efficacy and adherence to left ventricular assist home-care regimens. Additional research is needed to identify factors influencing caregiver adherence, leading to the development of evidence-based practice guidelines and to improve the outcomes in advanced heart failure patients living with left VAD.

After nectarine: how should we provide anesthesia for neonates?

Neonates have a high risk of perioperative morbidity and mortality. The NEonate and Children audiT of Anaesthesia pRactice IN Europe (NECTARINE) investigated the anesthesia practice, complications and perioperative morbidity and mortality in neonates and infants <60 weeks post menstrual age requiring anesthesia across 165 European hospitals. The goal of this review is to highlight recent publications in the context of the NECTARINE findings and subsequent changes in clinical practice. A perioperative triad of hypoxia, anemia, and hypotension is associated with an increased overall mortality at 30 days. Hypoxia is frequent at induction and during maintenance of anesthesia and is commonly addressed once oxygen saturation fall below 85%.Blood transfusion practices vary widely variable among anesthesiologists and blood pressure is only a poor surrogate of tissue perfusion. Newer technologies, whereas acknowledging important limitations, may represent the currently best tools available to monitor tissue perfusion. Harmonization of pediatric anesthesia education and training, development of evidence-based practice guidelines, and provision of centralized care appear to be paramount as well as pediatric center referrals and international data collection networks. The NECTARINE provided new insights into European neonatal anesthesia practice and subsequent morbidity and mortality.Maintenance of physiological homeostasis, optimization of oxygen delivery by avoiding the triad of hypotension, hypoxia, and anemia are the main factors to reduce morbidity and mortality. Underlying and preexisting conditions such as prematurity, congenital abnormalities carry high risk of morbidity and mortality and require specialist care in pediatric referral centers.

Dutch Design: Practice Guidelines for Group Treatment in the Netherlands

ABSTRACT The American Group Psychotherapy Association (AGPA) Practice Guidelines helped inspire the Dutch Group Therapy Association (NVGP) to develop the Dutch Practice Guidelines for Group Treatment. In this article, we provide a short review of the history of Dutch group psychotherapy. We discuss socioeconomic developments in the Netherlands and their consequences for health care in general and group psychotherapy in particular. After that, we introduce the procedures of the NVGP Dutch Task Force in developing their Practice Guidelines including their process to reach expert consensus. We then elaborate on the similarities and differences between the American and the Dutch Practice Guidelines. We end by presenting future directions and thoughts on international cooperation in the development of evidence-based practice guidelines for group treatment.

Maternal and Child Health Bureau's Autism Research Program.

To provide an overview and quantitatively demonstrate the reach of the Health Resources and Services Administration's Maternal and Child Health Bureau autism research program. We reviewed program reports and internal data from 59 autism research grantees. The US federal Interagency Autism Coordinating Committee's strategic plan questions were used as a framework to highlight the contributions of the autism research program in advancing the field. The autism research program grantees advance research in several ways. Grantees have strengthened the evidence for autism interventions by conducting 89 studies at 79 distinct research sites. A total of 212 708 participants have enrolled in autism research program studies and 361 researchers have contributed to furthering autism research. The program addresses topics that align with the majority of the Interagency Autism Coordinating Committee's priority topic areas, including advancements in treatments and interventions, services and supports, and identifying risk factors. Grantee products include 387 peer-reviewed publications, 19 tools, and 13 practice guidelines for improving care and intervention practices. The autism research program has contributed to medical advances in research, leveraged innovative training platforms to provide specialized training, and provided access to health services through research-based screening and diagnostic procedures. Autism research program studies have contributed to the development of evidence-based practice guidelines, informed policy guidelines, and quality improvement efforts to bolster advancements in the field. Although disparities still exist, the Health Resources and Services Administration's Maternal and Child Health Bureau can reduce gaps in screening and diagnosis by targeting interventions to underserved populations including minority and rural communities.

Substance abuse and the family: An examination of the South African policy context

National policy documents are important platforms for the prioritisation of social issues which is likely to spur research into the development of evidence-based practice guidelines that are effective and cost-efficient. In relation to the impact of substance abuse on the family, carefully designed policies that magnify support for the family can help lessen the burden of substance abuse on families. Using the Family Impact Lens (FIL) framework, this paper explored how family issues in relation to substance abuse are addressed within three South African policy and strategic documents: the Prevention of and Treatment for Substance Abuse (PTSA) Act (2008), the National drug master plan (NDMP; 2013–2017) and the White paper on families in South Africa (2012). In keeping with the framework of the FIL, we evaluated whether the policies (1) mention the effects of substance abuse on the family, (2) recognise the importance of the family in the relative’s rehabilitation and (3) address the needs of family members by providing policy directives to support families who are affected by substance abuse (affected family members (AFMs)). Although all three policies recognise that families are negatively impacted by a relative’s substance abuse, the policies are overly focussed on individual approaches to deal with substance abuse and fail to adequately address the support needs of AFMs. Research on the support needs of AFMs is warranted in addition to the evaluation or development of evidence-based strategies to support AFMs. Further implications and recommendations for policy-makers, researchers and practitioners are provided in the paper.

Developing the Evidence Base in Pediatric Oncology Nursing Practice for Promoting Health-Related Quality of Life in Pediatric Oncology Patients.

Research has shown that self-esteem and hopefulness are positively related among female childhood cancer survivors (CCS) and contribute to their health-related quality of life (HRQOL). HRQOL remains a significant outcome of treatment for CCS. This study examined the relationships among self-esteem, hopefulness, and HRQOL in young adult female CCS to inform the development of evidence-based practice guidelines for pediatric oncology nursing practice. An online survey was conducted with a sample of young adult female CCS from 58 treatment centers across the United States at 4 time points: at baseline and at 6 weeks, 3 months, and 6 months after initial measurement time. The relationships between self-esteem, hopefulness, and HRQOL were statistically significant (Time 1, P = .05; Times 2, 3, and 4, P = .01) across all measurement times. These findings identify hopefulness and self-esteem as determinants of HRQOL and suggest that caring practices among pediatric oncology nurses that support psychosocial adjustment through promoting self-esteem and hopefulness have the potential to support HRQOL among young adult female CCS. These outcomes support the development of evidence-based practice guidelines to influence HRQOL outcomes among these survivors.

The nature and meaning of insulin pump use in emerging adults with type 1 diabetes.

Objective. The purpose of this study is to investigate the meaning of living with an insulin pump for the management of type 1 diabetes during the period of emerging adulthood. Through a phenomenological narrative, this study contributes to the reflective understanding of the everyday life experiences of this population.Methods. A hermeneutic phenomenological design was used for this study of nine emerging adults (aged 19–24 years). Data were generated through face-to-face interviews and analyzed using the phenomenological approach of Max van Manen.Results. Four themes represent the essence of the day-to-day experiences of these emerging adults: seeking control, becoming responsible, staying connected, and accepting me.Conclusions. An in-depth understanding of the meaning of daily experiences with insulin pump technology has the potential to promote a developmentally appropriate approach to this age-group. The human understanding gained through this study is essential to the development of evidence-based practice guidelines and resources for this vulnerable population.

Chapter 25 - Clinical management of the minimally conscious state

The minimally conscious state (MCS) was defined as a disorder of consciousness (DoC) distinct from the vegetative state more than a decade ago. While this condition has become widely recognized, there are still no guidelines to steer the approach to assessment and treatment. The development of evidence-based practice guidelines for MCS has been hampered by ambiguity around the concept of consciousness, the lack of accurate methods of assessment, and the dearth of well-designed clinical trials. This chapter provides a critical review of existing assessment procedures, critically reviews available treatment options and identifies knowledge gaps. We close with practice-based recommendations for a rational approach to clinical management of this challenging population.

A generalizability theory study of athletic taping using the Technical Skill Assessment Instrument.

Athletic taping skills are highly valued clinical competencies in the athletic therapy and training profession. The Technical Skill Assessment Instrument (TSAI) has been content validated and tested for intrarater reliability. To test the reliability of the TSAI using a more robust measure of reliability, generalizability theory, and to hypothetically and mathematically project the optimal number of raters and scenarios to reliably measure athletic taping skills in the future. Mount Royal University. Observational study. A total of 29 university students (8 men, 21 women; age = 20.79 ± 1.59 years) from the Athletic Therapy Program at Mount Royal University. Participants were allowed 10 minutes per scenario to complete prophylactic taping for a standardized patient presenting with (1) a 4-week-old second-degree ankle sprain and (2) a thumb that had been hyperextended. Two raters judged student performance using the TSAI. Generalizability coefficients were calculated using variance scores for raters, participants, and scenarios. A decision study was calculated to project the optimal number of raters and scenarios to achieve acceptable levels of reliability. Generalizability coefficients were interpreted the same as other reliability coefficients, with 0 indicating no reliability and 1.0 indicating perfect reliability. The result of our study design (2 raters, 1 standardized patient, 2 scenarios) was a generalizability coefficient of 0.67. Decision study projects indicated that 4 scenarios were necessary to reliably measure athletic taping skills. We found moderate reliability coefficients. Researchers should include more scenarios to reliably measure athletic taping skills. They should also focus on the development of evidence-based practice guidelines and standards of athletic taping and should test those standards using a psychometrically sound instrument, such as the TSAI.

A Generalizability Theory Study of Athletic Taping Using the Technical Skill Assessment Instrument.

Context : Athletic taping skills are highly valued clinical competencies in the athletic therapy and training profession. The Technical Skill Assessment Instrument (TSAI) has been content validated and tested for intrarater reliability. Objective : To test the reliability of the TSAI using a more robust measure of reliability, generalizability theory, and to hypothetically and mathematically project the optimal number of raters and scenarios to reliably measure athletic taping skills in the future. Setting : Mount Royal University. Design : Observational study. Patients or Other Participants : A total of 29 university students (8 men, 21 women; age = 20.79 ± 1.59 years) from the Athletic Therapy Program at Mount Royal University. Intervention(s) : Participants were allowed 10 minutes per scenario to complete prophylactic taping for a standardized patient presenting with (1) a 4-week-old second-degree ankle sprain and (2) a thumb that had been hyperextended. Two raters judged student performance using the TSAI. Main Outcome Measure(s) : Generalizability coefficients were calculated using variance scores for raters, participants, and scenarios. A decision study was calculated to project the optimal number of raters and scenarios to achieve acceptable levels of reliability. Generalizability coefficients were interpreted the same as other reliability coefficients, with 0 indicating no reliability and 1.0 indicating perfect reliability. Results : The result of our study design (2 raters, 1 standardized patient, 2 scenarios) was a generalizability coefficient of 0.67. Decision study projects indicated that 4 scenarios were necessary to reliably measure athletic taping skills. Conclusions : We found moderate reliability coefficients. Researchers should include more scenarios to reliably measure athletic taping skills. They should also focus on the development of evidence-based practice guidelines and standards of athletic taping and should test those standards using a psychometrically sound instrument, such as the TSAI.

Using a wiki platform to promote guidelines internationally and maintain their currency: evidence‐based guidelines for the nutritional management of adult patients with head and neck cancer

The present study describes the development of evidence-based practice guidelines for the nutritional management of adult patients with head and neck cancer using a wiki platform to enable wide international stakeholder consultation and maintain currency. A dietitian steering committee and a multidisciplinary steering committee were established for consultation. Traditional methods of evidence-based guideline development were utilised to perform the literature review, assess the evidence and produce a draft document. This was transferred to a wiki platform for stakeholder consultation and international endorsement processes in Australia, New Zealand and the UK. Data were collected on website traffic utilising Google Analytics. In addition to broad stakeholder consultation through the steering committees, an additional twenty comments were received via the wiki by twelve individuals covering six different professions from three different countries, compared to four comments by e-mail. The guidelines were subsequently endorsed by the dietetic associations of Australia, New Zealand and the UK. During a 4-month period monitoring the use of the guidelines, there were 2303 page views to the landing page from 33 countries. The average number of pages accessed per visit was five and the duration of time spent on the website was approximately 6min. Using a wiki platform for guideline development and dissemination is a successful method for producing high-quality resources that can undergo wide international stakeholder review and include open public consultation. This can replace conventional methods whereby guidelines can quickly become outdated.

A National Study of the Provision of Oncofertility Services to Female Patients in Canada

ObjectiveThis study aimed to gain a better understanding of the fertility preservation services provided by Canadian fertility clinics to women with cancer. MethodsWe invited a total of 76 fertility clinics across Canada to complete a mailed questionnaire related to the availability, accessibility, affordability, and utilization of fertility preservation services for oncology patients. ResultsThe total response rate was 59.2%: 72.4% for IVF clinics and 51.1% for fertility centres without on-site IVF. Not all the responding IVF centres accepted oncology referrals for women. Six clinics without on-site IVF accepted cancer patients for consultation. The medical consultation fees are covered by public health insurance in all provinces. The majority of respondents expedited the referrals to schedule an initial medical appointment within three days. Despite that, the referral volume reported by respondents was markedly low for all except two facilities. With over 4000 young women of reproductive age given a diagnosis of cancer each year in Canada, the findings suggest that cancer patients are severely under-served by fertility clinics. ConclusionThere is a need to develop a stronger partnership between the fields of oncology and reproductive medicine to further improve access of patients with cancer to fertility preservation services. Development of evidence-based practice guidelines covering medical, clinical, psychosocial, ethical, and legal aspects geared to the Canadian health care system would help to avoid ambiguity relating to the roles and responsibilities in the provision of fertility preservation services. Such processes would ensure optimization of services so that all young cancer patients would receive the best care in protecting their fertility.

Psychologische Interventionen in der Rehabilitation von Patienten mit koronarer Herzerkrankung: Zusammenfassung der Evidenz und der Empfehlungen aus systematischen Übersichtsarbeiten und Leitlinien

To summarize national and international evidence and recommendations for psychological interventions in the rehabilitation of patients with coronary heart disease. Background is a project for the development of evidence-based practice guidelines for psychological interventions in the rehabilitation of patients with coronary heart disease. A systematic literature search in several databases and on the websites of professional associations was conducted in order to identify relevant reviews and guidelines. A handsearch was conducted in addition to the electronic search. Eligible publications were selected, and evidence for psychological interventions was extracted as well as recommendations relative to psychological diagnostics or interventions. 5 systematic reviews and 34 guidelines were included. Recommendations and (partially restricted) evidence from systematic reviews was found for the following psychological interventions: patient counselling and health education; screening and treatment of comorbid psychological disorders; occupational counselling; stress management; relaxation training; interventions for smoking cessation; interventions promoting appropriate nutrition and weight management; interventions enhancing sufficient, regular physical activity; interventions enhancing social support; specific interventions for women; involvement of family members or partners; discussion of sexual activity. For several psychological interventions in the treatment of patients with coronary heart disease we found empirical evidence from systematic reviews. For other psychological interventions, no empirical evidence from systematic reviews was found. The summary of guidelines shows that both in Germany and abroad, a number of psychologically grounded interventions are an inherent part of cardiac rehabilitation. However, many recommendations which refer to psychological diagnostics and interventions are not precise enough to guide psychological care of individual patients. In particular, there are no statements in many guidelines on which (psychological) treatments should be considered for which problems. Moreover, hardly any evidence or recommendations were found for specific interventions referring to special groups of patients (e.g., women, patients with low socio-economic status or migration background). Further research is needed in these respects in order to answer questions concerning the indication and effectiveness of such tailored interventions.

Guidelines across the health and social care divides: The example of the NICE-SCIE dementia guideline

Increasingly, mental health services are delivered through multidisciplinary teams and settings. This creates particular challenges for the development of evidence-based practice guidelines when different professional groups represented within teams might have different traditions and cultures in relation to what counts as ‘evidence’, and how that might be synthesized to produce guidance that supports best practice across professional divides. These challenges are explored in relation to integration between health and social care services, where social work in particular has traditionally expressed scepticism about guideline development where it does not incorporate knowledge drawn from qualitative research and perspectives of stakeholders such as service users and carers. This article takes the NICE-SCIE guideline on dementia care as an exemplar of how an integrated process of guideline development can deliver guidance for best practice across integrated mental health services. Finally, some of the issues still facing inter-professional guideline development are considered, and pointers given to eclectic approaches that are beginning to emerge from within social work.

Needs of Older Cancer Survivors in a Community Cancer Care Setting

This study describes the unique supportive care needs and associated distress among older adults receiving cancer survivorship care in a community cancer center. The psychological and social changes that accompany aging may influence the impact of cancer, so documenting the distinctive experiences of older survivors is critical to the development of evidence-based practice guidelines. A secondary analysis of data was conducted using results from a survey of adult cancer survivors. Data were available from a convenience sample of 307 survivors receiving care in a community cancer care setting who volunteered to complete a Survey of Needs. Fatigue, fear of recurrence, sleep disturbance, balance/walking/mobility difficulties, long-term effects of treatment, and body changes were most frequently reported. Results suggest assessment of older adult cancer survivors' experiences related to physical symptoms, symptom management, and interest in education targeting physical effects common to survivorship.

Use of a Delphi panel to establish consensus for recommended uses of selected balance assessment approaches

The Delphi survey is a useful mechanism to make recommendations for clinical judgments in the absence of practice guidelines for evidence-based decision making. Although there is a great deal of literature about the topic of various methods of balance assessment, decisions about application of research evidence for clinical practice may be subject to personal interpretation and/or biases of the reader. In this study, a panel of informed experts was used through a Delphi process to establish consensus regarding the recommended use of selected balance assessment methods based on the literature. Selective recruitment of experienced faculty members with advanced degrees and/or specialist certification in the content area identified seven knowledgeable informants. The panel participated in three rounds of discussion to develop a consensus-based summary of the recommended use of balance assessment methods commonly used in clinical practice and suggest how those measures fit within the framework of the Patient/Client Management Model of physical therapy practice. The outcomes of the Delphi process form a basis for recommended practice in the examination of patients with balance deficits and serve as a starting point in the development of evidence-based practice guidelines.

Conversational discourse analysis procedures: A comparison of two paradigms

Background: Previous research has suggested that individuals with closed head injury (CHI) have difficulty with the communication skills required for a successful conversational exchange. A variety of analysis paradigms have been used with this population and provide evidence to support that conversational discourse deficits do exist in individuals with CHI. However, the use of various analytical procedures renders it difficult for researchers to draw consistent conclusions and hinders the development of evidence-based practice guidelines for conversational discourse evaluation or treatment for individuals with CHI. Aims: The purpose of this study was to evaluate two conversational discourse analysis procedures. It was hypothesised that modifying a Conversational Appropriateness paradigm used successfully in previous research would provide additional information about conversational ability ultimately leading to more conclusive results. Methods & Procedures: A series of conversations elicited from one individual with CHI were analysed using two analysis schemes: Conversational Appropriateness (e.g., Blank & Franklin, 1980; Coelho, Youse, & Le, 2002) and a Modified Conversational Appropriateness paradigm designed for this study. Outcomes & Results: The results supported the hypothesis suggesting the original Conversational Appropriateness paradigm may not be completely representational of conversation ability of individuals with CHI. A Modified Conversational Appropriateness procedure may be more appropriate for the CHI population, as it appears to capture the nuances that are known to affect conversational performance in individuals with CHI revealing greater detail regarding deficits in conversational participation. Conclusions: Comparing two conversational discourse analysis paradigms provided valuable insight into measures that may more adequately define the conversation ability of individuals with CHI. Modifying a discourse analysis procedure that has been shown to be successful in the past can provide additional detail for therapists to utilise when assessing and designing therapy goals for an individual with CHI. Although further research is needed, if a reliable, valid procedure can be developed for clinical use the possibility of developing evidence-based practice guidelines for discourse assessment and treatment may be more attainable.

NNN Language and Evidence-Based Practice Guidelines for Acute Cardiac Care

Multidisciplinary management of the acute cardiac patient, for decades, has been driven by best practices, treatment algorithms, and research-based protocols. As nurses continue to develop and implement evidence-based care, they must ensure that the essence of nursing is not lost in the process. In this article, strategies for the development of evidence-based practice guidelines for acute cardiac patients using standardized nursing language are provided.

Does implementation of a paediatric asthma clinical practice guideline worksheet change clinical practice?

BackgroundDespite the development of evidence-based practice guidelines in many countries for asthma treatment in children, there is limited evidence that using such guidelines improves patient care.AimsOur aim was to evaluate whether the implementation of an evidence-based asthma clinical practice guideline (CPG) worksheet changes clinical practice.MethodsThe study was a before and after study of the implementation of a paediatric asthma CPG in a tertiary paediatric emergency department (ED). All children aged 2–16 years who had a diagnosis of asthma were included. Clinical data were obtained by retrospective chart review for time periods before (May to September 2003) and after (May to September 2005) the introduction of the CPG worksheet. Primary outcomes were: use of spacers for salbutamol instead of nebulisers, use of ipratropium and use of corticosteroids. Secondary outcomes were use of an ED action plan, ordering chest X-rays (CXR) and admission rate.ResultsBefore implementation, 240 children presented with asthma and after implementation, 286 children presented. The two groups had similar ages, asthma severity, admission respiratory rate (RR) and oxygen saturation. Following implementation there was an increase in spacer use from 17 to 26% [+9%; 95% confidence interval (CI): 2–16%; p = 0.015] and a reduction in ipratropium use from 58 to 44% (−13%; 95% CI: −22 to −5%; p = 0.0029). The proportion of patients treated with corticosteroids did not change. The number of patients with an ED action plan increased. The number of CXR ordered decreased and the hospital admission rate decreased.ConclusionsThe study demonstrates that implementation of an asthma CPG worksheet in a tertiary paediatric ED resulted in modest changes in clinical practice, mainly by increasing clinician adherence to the guidelines.