Evidence-based Clinical Algorithms Research Articles

Clinical algorithms for the monitoring and management of spontaneous, uncomplicated labour and childbirth.

To develop evidence-based clinical algorithms for the assessment and management of spontaneous, uncomplicated labour and vaginal birth. Pregnant women at any stage of labour, with singleton, term pregnancies considered to be at low risk of developing complications. Health facilities in low- and middle-income countries. We searched for relevant published algorithms, guidelines, systematic reviews and primary research studies on Cochrane Library, PubMed, and Google on terms related to spontaneous, uncomplicated labour and childbirth up to 01 June 2023. Three case scenarios were developed to cover assessments and management for spontaneous, uncomplicated first, second and third stage of labour. The algorithms provide pathways for definition, assessments, diagnosis, and links to other algorithms in this series for management of complications. We have developed three clinical algorithms to support evidence-based decision making during spontaneous, uncomplicated labour and vaginal birth. These algorithms may help guide health care staff to institute respectful care, appropriate interventions where needed, and potentially reduce the unnecessary use of interventions during labour and childbirth.

Advanced machine learning techniques for cardiovascular disease early detection and diagnosis

The identification and prognosis of the potential for developing Cardiovascular Diseases (CVD) in healthy individuals is a vital aspect of disease management. Accessing the comprehensive health data on CVD currently available within hospital databases holds significant potential for the early detection and diagnosis of CVD, thereby positively impacting disease outcomes. Therefore, the incorporation of machine learning methods holds significant promise in the advancement of clinical practice for the management of Cardiovascular Diseases (CVDs). By providing a means to develop evidence-based clinical guidelines and management algorithms, these techniques can eliminate the need for costly and extensive clinical and laboratory investigations, reducing the associated financial burden on patients and the healthcare system. In order to optimize early prediction and intervention for CVDs, this study proposes the development of novel, robust, effective, and efficient machine learning algorithms, specifically designed for the automatic selection of key features and the detection of early-stage heart disease. The proposed Catboost model yields an F1-score of about 92.3% and an average accuracy of 90.94%. Therefore, Compared to many other existing state-of-art approaches, it successfully achieved and maximized classification performance with higher percentages of accuracy and precision.

INCOG 2.0 Guidelines for Cognitive Rehabilitation Following Traumatic Brain Injury: Methods, Overview, and Principles.

Moderate to severe traumatic brain injury (TBI) results in complex cognitive sequelae. Despite hundreds of clinical trials in cognitive rehabilitation, the translation of these findings into clinical practice remains a challenge. Clinical practice guidelines are one solution. The objective of this initiative was to reconvene the international group of cognitive researchers and clinicians (known as INCOG) to develop INCOG 2.0: Guidelines for Cognitive Rehabilitation Following TBI. The guidelines adaptation and development cycle was used to update the recommendations and derive new ones. The team met virtually and reviewed the literature published since the original INCOG (2014) to update the recommendations and decision algorithms. The team then prioritized the recommendations for implementation and modified the audit tool accordingly to allow for the evaluation of adherence to best practices. In total, the INCOG update contains 80 recommendations (25 level A, 15 level B, and 40 level C) of which 27 are new. Recommendations developed for posttraumatic amnesia, attention, memory, executive function and cognitive-communication are outlined in other articles, whereas this article focuses on the overarching principles of care for which there are 38 recommendations pertaining to: assessment (10 recommendations), principles of cognitive rehabilitation (6 recommendations), medications to enhance cognition (10 recommendations), teleassessment (5 recommendations), and telerehabilitation intervention (7 recommendations). One recommendation was supported by level A evidence, 7 by level B evidence, and all remaining recommendations were level C evidence. New to INCOG are recommendations for telehealth-delivered cognitive assessment and rehabilitation. Evidence-based clinical algorithms and audit tools for evaluating the state of current practice are also provided. Evidence-based cognitive rehabilitation guided by these recommendations should be offered to individuals with TBI. Despite the advancements in TBI rehabilitation research, further high-quality studies are needed to better understand the role of cognitive rehabilitation in improving patient outcomes after TBI.

Management of maternal pulse and blood pressure abnormalities during labour and childbirth: evidence-based algorithms for intrapartum care decision support.

To develop evidence-based clinical algorithms for assessment and management of abnormal maternal pulse and blood pressure during the intrapartum period. Low risk singleton, term, pregnant women in labour. Institutional births in low- and middle-income countries. A review of the literature was performed to retrieve evidence-based guidelines, systematic reviews, and papers on maternal pulse and blood pressure during labour. We searched a number of international clinical guidelines and PubMed using the corresponding key terms in November 2018 and updated the search in May 2020. Four common intrapartum case scenarios of abnormal pulse and blood pressure were identified for which algorithms were developed: hypertension, hypotension, tachycardia and bradycardia. Algorithms were constructed after reviewing guidelines and relevant papers, with input from a panel of experts. Thresholds for upper and lower limits of normal maternal pulse and blood pressure measurements are defined, evidence-based interventions for the initial management of abnormal parameters are described (resuscitation and monitoring) and guidance is provided on exploration of the potential causes for each case scenario, with links to pathways for their management. Evidence-based algorithms to support the identification, and management of deviations in pulse and blood pressure during intrapartum care have been developed for hypertension, hypotension, tachycardia and bradycardia. The algorithms focus on initial resuscitation and monitoring, with an exploration of causes and early identification of underlying maternal conditions. These algorithms will help provide a standardised approach to investigation and management of these abnormal parameters to guide clinical practice. Algorithms for abnormal maternal pulse and blood pressure during labour allow standardised approach to early identification and management of complications.

Development and validation of patient-community pharmacist encounter toolkit regarding substance misuse: Delphi procedure

BackgroundPharmacists’ roles and services for patients with substance use are not well defined and inconsistent from site to site. Several barriers have been identified that hinder pharmacists’ care for people who use substances, such as a lack of training and resources. Clinical practice tools can aid in transferring evidence-based approaches to the practice sphere. ObjectivesThe aim of the study was to develop a substance misuse management toolkit for community pharmacists to help them manage their encounters with people who use substances. MethodsA focused literature review was conducted and 2 needs assessment studies, one for community pharmacists and one for patients informed the development of the toolkit. The toolkit is an adaption of the screening, brief intervention, and referral to treatment (SBIRT) approach, which is one of the most well-defined and effective strategies for substance use management. However, SBIRT is a novel care model in community pharmacy settings. Therefore, a substance misuse management toolkit with 20 items was created for community pharmacists incorporating evidence-based strategies and clinical algorithms. Delphi procedure was used to validate the toolkit. ResultsTwo rounds of questions were sent to experts in the field of substance misuse, some of whom were pharmacists. In both rounds, these experts were asked to rate the appropriateness and clarity of items in the toolkit and provide comments and suggestions. Items with a median rating of 7 or more out of 10 were included in the toolkit. In the second round, the experts were asked to rerate the revised version and provide additional feedback. After the second round, agreement was reached for almost all items of the toolkit. ConclusionA Delphi procedure was successfully used to provide evidence of the validity of the new guiding toolkit for community pharmacists. The toolkit will be implemented and evaluated to provide additional evidence of validity in practice.

Neurodevelopmental-behavioural paediatrics.

Neurodevelopmental-behavioural paediatrics (NBP) is a field of medical practice that has arisen in response to recent changes in child health epidemiology. This review considers how the profession of NBP is addressing clinical need, and discusses possibilities for future development of the field. Research publications relevant to NBP clinical practice focus primarily on cause (e.g. biology, imaging, neuropsychology), early detection, diagnostic methodologies and initial treatment strategies, with emphasis on psychotropic medication. Translation of this research implies that NBP clinical services should be undertaken using algorithmic methodologies, and evaluated against treatment attributable outcomes. These strategies and outcomes potentially define the central purpose of the profession; however, they may not be sufficient to best help the children seen. Two sets of information inform and extend consideration of NBP purpose and strategy. Firstly, longitudinal and adult studies indicate that even with treatment, problems persist in adult life for a significant proportion of children with neurodevelopmental-behavioural disorders. Secondly, NBP clinical practice deals with significant, irreducible complexity and uncertainty, arising from both child-diagnostic and contextual factors. Complexity limits the extent to which evidence-based clinical algorithms are able to inform care. Suggestions for how to address both challenges are offered.

Outcomes of Joint Preservation Procedures for Cartilage Injuries in the Hip: A Systematic Review and Meta-analysis.

Background:The detection and management of chondral injuries of the hip, especially in a younger patient population, may preempt joint degeneration. Although the outcomes of preservation techniques have been well described for other weightbearing joints, such as the knee, evidence for hip joint preservation after procedures such as microfracture and autologous chondrocyte implantation remains in its infancy.Purpose:To evaluate outcomes of joint preservation procedures in the hip, including the success rate and patient-reported outcomes (PROs).Study Design:Systematic review; Level of evidence, 4.Methods:This review was performed using the terms “hip arthroscopy,” “microfracture,” “autologous chondrocyte implantation,” “fibrin glue,” “osteochondral transfer,” and variations thereof in 5 electronic databases, yielding 325 abstracts. After the application of eligibility criteria, 19 articles were included. Weighted means were calculated for PROs, and pooled estimates were calculated for age, follow-up, chondral lesion size, and success of hip preservation procedures with a random-effects proportion meta-analysis.Results:A total of 1484 patients (1502 hips) were identified across 19 studies (mean age, 38.0 ± 1.3 years; mean follow-up, 31.8 ± 9.6 months). Hip joint preservation techniques demonstrated a high success rate, ranging from 85.6% to 99.7%. The mean pooled chondral lesion size was 2.5 ± 0.3 cm2 (95% CI, 1.9-3.0 cm2). Microfracture was the most frequent technique, utilized by 11 studies, and demonstrated an 89.6% success rate (95% CI, 82.4%-96.7%). The highest pooled success rate was exhibited by autologous membrane-induced chondrogenesis in 3 studies (99.7% [95% CI, 99.0%-100.0%]). All PROs demonstrated a statistically significant increase postoperatively, including the modified Harris Hip Score, Nonarthritic Hip Score, and Hip Outcome Score–Activities of Daily Living and Hip Outcome Score–Sports-Specific Subscale (all P < .05). The visual analog scale for pain also demonstrated a statistically significant decrease of 37.2% (P < .05).Conclusion:Hip preservation procedures demonstrate a high success rate, with microfracture representing the most frequently utilized cartilage preservation technique in the peer-reviewed literature. PROs significantly improved after surgery. Further investigation of hip preservation modalities with long-term follow-up is required to create evidence-based clinical recommendations and treatment algorithms.

Practical approach to the gastrointestinal manifestations of cystic fibrosis.

Cystic fibrosis (CF) is the most common, life-shortening, genetic illness affecting children in Australia and New Zealand. The genetic abnormality results in abnormal anion transport across the apical membrane of epithelial cells in a number of organs, including the lungs, gastrointestinal tract, liver and genito-urinary tract. Thus, CF is a multi-system disorder that requires a multi-disciplinary approach. Respiratory disease is the predominant cause of both morbidity and mortality in patients with CF. However, there are significant and clinically relevant gastrointestinal, liver, pancreatic and nutritional manifestations that must be detected and managed in a timely and structured manner. The aim of this review is to provide evidence-based information and clinical algorithms to guide the nutritional and gastrointestinal management of patients with CF.

Point-of-care tests for infectious diseases: barriers to implementation across three London teaching hospitals.

Existing Point-of-care tests (POCT) to help identify infection-related causes of illness can complement diagnostic and disposition decisions in children attending emergency departments.(1) Evidence-based clinical algorithms can integrate such POCT to aid in the admission and discharge decision process. Paediatric studies validating these tools are scarce, with very few studies conducted in UK centres.(2-5) POCT can be based on host infection markers (e.g. finger prick tests for C-reactive protein (CRP) to help decide if the patient has a bacterial or viral infection) or pathogen detection tests (e.g. throat/nose swabs to rapidly diagnose viral infections such as RSV or influenza). This article is protected by copyright. All rights reserved.

P120: Clinical decision rule evidence ranking and use in clinical practice

Introduction: The 2007 SAEM Knowledge Translation consensus conference proposed areas of research in evidence-based clinical algorithms (EBCAs) using clinical decision rules (CDRs) and practice guidelines (CPGs). This project sought to explore the evidence awareness and utilization of various clinical decision rules (CDRs) in emergency medicine (EM) practice. This project sought to explore the evidence awareness and utilization of various clinical decision rules (CDRs) in emergency medicine (EM) practice. Methods: An international survey was administered via international EM organizations using modified Dillman methods. Categories of CDRs included imaging (7), infections (3), neurology (2), venous thromboembolism (VTE; 2), and other (2). Evidence levels were queried using JAMA User’s Guide CDR rating scales (Levels I-IV). Confidence with supporting evidence and utilization of CDRs in practice were assessed on 7-point Likert scales. Correlation of evidence understanding and practice utilization were calculated using Spearman rho methods. Results: The majority of respondents (n=378) were Canadian (72%), &amp;lt;15 years full practice (64%), residency trained (90%), and trained in CDR methods (73%). Evidence ratings were deemed high for all CDRs, although confidence in evidence ratings and practice utilization were more variable for specific rules. Comfort with evidence ranking and utilization in clinical practice were highly correlated (ρ&amp;lt;0.0002). Conclusion: Among Canadian residency CDR trained physicians, evidence ranking is strongly correlated with use in self-reported clinical practice. There is insufficient data from non-Canadian respondents to draw firm correlations. Their remains opportunity to fully disseminate high quality CDRs and encourage incorporation into EBCA practice.

The Essential Burn Unit Handbook, 2nd Edition

As a service to our readers, Plastic and Reconstructive Surgery® reviews books, DVDs, practice management software, and electronic media items of educational interest to reconstructive and aesthetic surgeons. All items are copyrighted and available commercially. The Journal actively solicits information in digital format for review. Reviewers are selected on the basis of relevant interest. Reviews are solely the opinion of the reviewer; they are usually published as submitted, with only copy editing. Plastic and Reconstructive Surgery® does not endorse or recommend any review so published. Send books, DVDs, and any other material for consideration to: Arun K. Gosain, M.D., Review Editor, Plastic and Reconstructive Surgery, Brookriver Executive Center, 8150 Brookriver Drive, Suite S-415, Dallas, Texas 75247. Arun K. Gosain, M.D. Review EditorThroughout residency, both general surgery and plastic surgery trainees must maintain excellence in patient care while learning a new breadth of knowledge. In this process, it is critical to have a resource that summarizes the important aspects of clinical care that can be read in a quick, timely, immediate fashion to facilitate application to challenging or new case scenarios. The management of patients after burn injuries is an area of clinical care that is lacking such a resource, as chapters on this particular topic are often insufficient in the detail required for proper clinical translation. In addition, many chapters on burn injury are buried within the confines of texts with a broader focus, limiting the ability to reference information quickly and efficiently in a field that requires inherent skill and intuitive decision-making. The Essential Burn Unit Handbook is a concise review of all aspects of management important in caring for patients with burns. The discussion of a wide breadth of topics ranging from the initial diagnosis and stabilization of patients who have just suffered burns to the details of inpatient care and complications functions as a comprehensive overview to a very complex subject. In this manner, this textbook is excellent for junior and senior residents alike who are new to a burn unit. The practicality of the book is demonstrated by its white coat–appropriate size, presentation of clinical worksheet templates important for maintaining organization for new trainees, and use of example order sets for both adult and pediatric patients. The book is organized into 12 chapters, all of which are incredibly concise and appropriate for all levels of training. Unlike many other texts that consolidate the major points of the chapter at the end of a section, this handbook very thoughtfully highlights the take-home objectives at the beginning, optimizing the efficiency with which trainees can quickly reference and hone in on the subject matter within the shortest amount of time. Well-organized tables are used to highlight enteral feeding formulas and wound care options, and clear, concise examples are given to improve the trainee’s understanding of ventilator settings and intravenous fluid management strategies. Figures within each chapter provide an excellent depiction of surgical incision designs and critical operative steps. References at the end of each chapter provide the opportunity for further reading. As the book was written by residents during their final years of training, The Essential Burn Unit Handbook clearly satisfies an unmet need given its applicability to the practical, day-to-day aspects of patient care in a specific critical care setting. This direct translatability to clinical care is the most important and unique aspect of this book. With an elegant balance of epidemiology and evidence-based clinical algorithms, The Essential Burn Unit Handbook is an excellent resource for those taking part in the care of patients after burn injuries, and serves as a practical tool for any trainee interested in burn care.

Development of evidence-based clinical algorithms for prescription of exercise-based cardiac rehabilitation.

BackgroundGuideline adherence with respect to exercise-based cardiac rehabilitation (CR) is hampered by a large variety of complex guidelines and position statements, and the fact that these documents are not specifically designed for healthcare professionals prescribing exercise-based CR programs. This study aimed to develop clinical algorithms that can be used in clinical practice for prescription and evaluation of exercise-based CR in patients with coronary artery disease (CAD) and chronic heart failure (CHF).MethodsThe clinical algorithms were developed using a systematic approach containing four steps. First, all recent Dutch and European cardiac rehabilitation guidelines and position statements were reviewed and prioritised. Second, training goals requiring a differentiated training approach were selected. Third, documents were reviewed on variables to set training intensity, modalities, volume and intensity and evaluation instruments. Finally, the algorithms were constructed.ResultsThree Dutch guidelines and three European position statements were reviewed. Based on these documents, five training goals were selected and subsequently five algorithms for CAD patients and five for CHF patients were developed.ConclusionsThis study presents evidence-based clinical algorithms for exercise-based CR in patients with CAD and CHF according to their training goals. These algorithms may serve to improve guideline adherence and the effectiveness of exercise-based CR.

Expert consensus for the management of advanced or metastatic pancreatic neuroendocrine and carcinoid tumors.

Neuroendocrine tumors (NETs) are rare tumors that have been increasing in incidence over the last 30years with no significant changes in survival. As survival of patients with these tumors depends greatly on stage and histology, early diagnosis, classification and staging of tumors in patients in whom NETs are suspected are of great importance. Surgery, either with curative or palliative intent, is the mainstay of treatment for localized NETs. Therapeutic options for this disease almost invariably include somatostatin analogs to alleviate the symptoms of excessive hormone secretion. Other approaches for advanced disease may include hepatic artery embolization or ablation, peptide receptor radionuclide therapy and systemic chemotherapy. Recent advances regarding the signaling pathways involved in tumor development have allowed the development of novel targeted therapies. However, due to the lack of prognostic molecular markers to identify high-risk patients and the absence of a common pathogenesis in all patients, treatment selection is often empirical. There is therefore a need to establish a consensus for the treatment of this disease and to provide evidence-based clinical recommendations and algorithms to optimize and individualize the treatment and follow-up for these patients.

The impact of transforming healthcare delivery on cystic fibrosis outcomes: a decade of quality improvement at Cincinnati Children’s Hospital

BackgroundIn 2001, Cincinnati Children's Hospital embarked on a journey to improve healthcare delivery to patients with cystic fibrosis (CF). Data from the Cystic Fibrosis Foundation National Patient Registry revealed our...

Challenging the Evidence Based Medicine Principles Among Clinical Obesity Treatments

Obesity is among the greatest health problems worldwide. However, there is a certain lack in regard to objective evidence-based clinical therapeutic algorithms. The conservative therapy (lifestyle changes, pharmacotherapy) often fails to attain clinically significant weight lost. For this reason, more effective forms of treatment were developed (for example bariatric surgery or newly emerging field of endoscopic gastroenterological devices). The implementation of surgical therapy is marked with relatively narrowly stated indication parameters. The endoscopic methods showed promising results in weight loss, within satisfying safety profiles, although there are no clear defined positions of endoscopic devices in the treatment of obesity. Endoscopic treatment seems to be especially interesting as an alternative to surgery, because of significant surgical risk reduction. This review presents an analysis of the position of invasive treatments of obesity.

Pulse Oximetry in Pediatric Practice

The introduction of pulse oximetry in clinical practice has allowed for simple, noninvasive, and reasonably accurate estimation of arterial oxygen saturation. Pulse oximetry is routinely used in the emergency department, the pediatric ward, and in pediatric intensive and perioperative care. However, clinically relevant principles and inherent limitations of the method are not always well understood by health care professionals caring for children. The calculation of the percentage of arterial oxyhemoglobin is based on the distinct characteristics of light absorption in the red and infrared spectra by oxygenated versus deoxygenated hemoglobin and takes advantage of the variation in light absorption caused by the pulsatility of arterial blood. Computation of oxygen saturation is achieved with the use of calibration algorithms. Safe use of pulse oximetry requires knowledge of its limitations, which include motion artifacts, poor perfusion at the site of measurement, irregular rhythms, ambient light or electromagnetic interference, skin pigmentation, nail polish, calibration assumptions, probe positioning, time lag in detecting hypoxic events, venous pulsation, intravenous dyes, and presence of abnormal hemoglobin molecules. In this review we describe the physiologic principles and limitations of pulse oximetry, discuss normal values, and highlight its importance in common pediatric diseases, in which the principle mechanism of hypoxemia is ventilation/perfusion mismatch (eg, asthma exacerbation, acute bronchiolitis, pneumonia) versus hypoventilation (eg, laryngotracheitis, vocal cord dysfunction, foreign-body aspiration in the larynx or trachea). Additional technologic advancements in pulse oximetry and its incorporation into evidence-based clinical algorithms will improve the efficiency of the method in daily pediatric practice.

Ensuring Diagnostic Accuracy in Pediatric Emergency Medicine

Children often present to the emergency department with undifferentiated complaints, such as abdominal pain. The role of the emergency physician is to make an accurate and efficient assessment leading to diagnosis and management. Physician risk tolerance and decision methods have led to variations in practice and quality of care within the pediatric emergency department (PED). The use of evidence-based clinical algorithms to standardize and improve the quality of care delivered in the PED has increased significantly over the last decade. Using an example of a care map for children with suspected appendicitis, this article will demonstrate the incorporation of clinical prediction rules into clinical practice as a model for quality improvement in the PED.

The Effects of a Nurse Case Manager and a Community Health Worker Team on Diabetic Control, Emergency Department Visits, and Hospitalizations Among Urban African Americans With Type 2 Diabetes Mellitus

Although African American adults bear a disproportionate burden from diabetes mellitus (DM), few randomized controlled trials have tested culturally appropriate interventions to improve DM care. We randomly assigned 542 African Americans with type 2 DM enrolled in an urban managed care organization to either an intensive or minimal intervention group. The intensive intervention group consisted of all components of the minimal intervention plus individualized, culturally tailored care provided by a nurse case manager (NCM) and a community health worker (CHW), using evidence-based clinical algorithms with feedback to primary care providers (eg, physicians, nurse practitioners, or physician assistants). The minimal intervention consisted of mailings and telephone calls every 6 months to remind participants about preventive screenings. Data on diabetic control were collected at baseline and at 24 months by blind observers; data emergency department (ER) visits and hospitalizations were assessed using administrative data. At baseline, participants had a mean age of 58 years, 73% were women, and 50% were living in poverty. At 24 months, compared with the minimal intervention group, those in the intensive intervention group were 23% less likely to have ER visits (rate difference [RD], -14.5; adjusted rate ratio [RR], 0.77; 95% confidence interval [CI], 0.59-1.00). In on-treatment analyses, the rate reduction was strongest for patients who received the most NCM and CHW visits (RD, -31.0; adjusted RR, 0.66; 95% CI, 0.43-1.00; rate reduction downward arrow 34%). These data suggest that a culturally tailored intervention conducted by an NCM/CHW team reduced ER visits in urban African Americans with type 2 DM. clinicaltrials.gov Identifier: NCT00022750.

Intervention in the at-risk state to prevent transition to psychosis

The number of intervention studies aiming to prevent psychosis is still small. Follow-up data of the first studies were published during the last year and neuroprotection has become an important issue. Initially superior effects of pharmacological or cognitive intervention reported by the first studies in the field became less clear about 3 years after cessation of intervention; however, a common problem of these first trials is a small sample size resulting in a lack of sufficient statistical power. The first studies of interventions thought to act as primarily neuroprotective yielded promising findings; however, further studies are needed to evaluate the preventive as well as the neuroprotective efficacy of these approaches. Besides methodologically sound studies, improved enrichment strategies are required as well as risk-adapted intervention strategies, guided by evidence-based clinical staging algorithms. Furthermore, the current concept of psychosis prevention, requiring an intervention to show long-lasting effects even after cessation, needs reconsideration. Approaches as used for relapse prevention in psychosis or for chronic at-risk states in internal medicine may help to maintain the initial superior prophylactic effects.

Toward Improved Implementation of Evidence-based Clinical Algorithms: Clinical Practice Guidelines, Clinical Decision Rules, and Clinical Pathways

This is a summary of the consensus-building workshop entitled "Guideline Implementation and Clinical Pathways," convened May 15, 2007, at the Academic Emergency Medicine Consensus Conference, "Knowledge Translation in Emergency Medicine: Establishing a Research Agenda and Guide Map for Evidence Uptake." A new term, "evidence-based clinical algorithms" is suggested to encompass evidence-based information codified into clinical pathways, clinical practice guidelines, and clinical decision rules. Examples of poor knowledge translation (KT) relevant to the specialty of emergency medicine are identified, followed by brief descriptions of important research and concepts that inform the research recommendations. Four broad themes for research to improve the KT of evidence-based clinical algorithms are suggested: organizational factors, cognitive factors, social factors, and motivational factors. In all cases, research regarding optimizing KT for the subthemes identified by Glasziou and Haynes, "getting the evidence straight," and "getting the evidence used," are interwoven into the thematic research recommendations. Consensus was reached that the majority of research efforts to evaluate means to improve KT need to be centered on the factors that show promise to enhance "getting the evidence used," focused especially on organizational factors.