Evidence-Based Medicine Committee Research Articles

The Indonesian Version of the Skills, Confidence, and Preparedness Index (SCPI) was tested for reliability and validity in type 2 diabetes patients

Although several diabetes self-care management tools have been created, very few provide preparation for diabetes self-care behavior management. Three essential components of diabetes self-care management are measured by the assessment tool "Skills, Confidence & Preparedness Index (LMC) (SCPI)": Knowledge of skills, Confidence in one's ability to use skills, and Readiness to put skills into practice. This study aims to validate, translate, and adapt the SCPI for usage with Indonesian adults with type 2 diabetes. Methods: The American Academy of Orthopedic Surgeons Evidence Based Medicine Committee (AAOS) criteria for modifying the scale were adhered to in this study. Evaluate average variance, Cronbach alpha, and composite reliability to test validity and reliability. Specifically, determinant coefficient testing and model appropriateness testing are used to assess goodness of fit. Examine the valid R-squared statistical value for every relationship to determine the test. If the p-value is less than 0.05, then there is a direct and indirect association to be seen if the variable is significant Result: Cronbach's alpha > 0.60 indicates strong internal consistency for the Indonesian SCPI version or I-SCPI. For every variable, the AVE value is larger than 0.50, while the CR value exceeds 0.70. This indicates that all legitimate indicators converge to form the variables for which they are intended. The R-Square values of 0.312 and 0.536 for the variables of preparedness and confidence are used to calculate the degree of good fit. This number indicates that the Preparedness variable is only partially explained by the Confidence and Preparedness variables (5.36%), with other variables accounting for the remaining 94.64%. Furthermore, the Skill/Knowledge, Confidence, and Preparedness factors account for only 3% of the variance in the Confidence variable, with the remaining 97% explained by variables outside the model. Conclusion: We developed an Indonesian version of SCPI through cross-cultural translation and adaption. The I-SCPI is reliable and valid for assessing the level of self-management in type 2 diabetes patients in Indonesia

Non-Motor Symptom Management: Insights into Adherence to Treatment Guidelines in Parkinson's Disease Patients.

Non-motor symptoms (NMS) reduce quality of life in Parkinson's disease (PD) patients, who experience three times more NMS than individuals without PD. While there are international and national NMS treatment guidelines, their implication in clinical practice remains unclear. This study aimed to investigate the adherence to pharmacological NMS treatment guidelines in patients with mild to moderately severe PD. 220 PD patients with ≥1 NMS based on the Non-Motor Symptom Questionnaire and a Hoehn and Yahr stage ≤4 were randomly selected from the Swedish Parkinson registry and screened for inclusion. NMS were evaluated using the International Parkinson and Movement Disorder Society-Non-Motor Rating Scale (MDS-NMS), Parkinson's Disease Sleep Scale 2, Epworth Sleepiness Scale, and Hospital Anxiety and Depression Scale. Treatment was compared with Swedish national guidelines and international guidelines from the MDS Evidence-Based Medicine Committee. Among 165 included patients, the median number of NMS was 14, and in median 7 symptoms were estimated to require treatment. The most common NMS requiring treatment were pain (69%) and urinary problems (56%). Treatment of depression and constipation demonstrated the highest adherence to guidelines (79% and 77%), while dysphagia and excessive daytime sleepiness exhibited the lowest adherence (0% and 4%). On average, only 32% of NMS were treated in accordance with guidelines. Adherence to pharmacological guidelines for NMS in patients with mild to severe PD was low. This study highlights the need for improved evaluation and treatment of NMS to enhance symptom management and quality of life among PD patients.

Psychometric Properties of the Oral Health Values Scale and Cultural Adaptation in the Indian Population.

The Oral Health Values Scale is a multidimensional instrument that identifies and measures a person's values related to oral health. This scale has been validated in American respondents. This study aims to evaluate the adaptability and validity of the Oral Health Values Scale in the Hindi language (H-OHVS). A total of 240 adults participated in the study that was carried out from July to November 2022. An offline one-to-one survey was carried out to collect data by an investigator blinded to the study protocol. The translation and testing of the OHVS were carried out based on the cross-cultural adaptation guidelines of the American Academy of Orthopedic Surgeons (AAOS) Evidence-Based Medicine Committee. The content validity was assessed by an expert panel. Construct validity was analyzed through Exploratory Factor Analysis (EFA), utilizing principal component analysis with varimax rotation. The internal consistency of the Hindi version of OHVS was evaluated using Cronbach's alpha. The results showed that H-OHVS had an Item-level Construct Validity Index (I-CVI) ranging from 0.82 to 1.00. Two components, compliance and hesitance, were formed on H-OHVS accounting for 63.91% of the cumulative variance. The resulting model fit indices on confirmatory factor analysis presented an adequate fit to the data.The overall Cronbach's alpha coefficient for H-OHVS (α = 0.868) presents excellent internal consistency. The study findings provide a certain degree of evidence in favor of this scale and establish the Oral Health Values Scale (OHVS) as a psychometrically sound measure.

Preliminary test of Polish translation of the Rheumatoid and Arthritis Outcome Score - observational study.

Today, patients with inflammatory joint diseases participate in more physical activities, including sports and recreation. The tools currently used to assess quality of life and functioning in rheumatic diseases, available in Polish, do not address these problems. The Rheumatoid and Arthritis Outcome Score (RAOS) questionnaire was developed but is not available in the Polish language. This tool is used to evaluate the functional limitations of physically active people who suffer from arthritis and associated lower limb disorders. The objective of this study is the translation and cross-cultural adaptation of the RAOS into Polish. The process was carried out following the guidelines of the Evidence-Based Medicine Committee of the American Academy of Orthopaedic Surgeons (AAOS). The translation included forward and back translation, and synthesis of the transcripts. The RAOS was pre-tested in a target setting in 19 patients and final amendments were made to address concerns raised by the patients. The translation, adaptation, and pre-test of the Polish RAOS resulted in the final version of the scale, which can be found in Supplementary material 1. During pre-testing, the scale demonstrated ease of understanding, with patient feedback leading to minor corrections that were incorporated into the questionnaire structure. Before widespread implementation, a crucial step involves validating the scale through rigorous psychometric tests, including assessments of the reliability, validity and stability of the Polish RAOS. The lack of validation of the translated Polish version limits the use of the RAOS in the research environment. To solve this problem, the validation process is planned to be carried out in the next stage.

Translation and psychometric testing of the Chinese version of the Perinatal Missed Care Survey

ObjectiveThis study aimed to translate and evaluate the psychometric properties of the Perinatal Missed Care Survey in China. MethodsThe Perinatal Missed Care Survey was translated according to the guidelines of the cross-cultural debugging scale recommended by the American Academy of Orthopaedic Surgeons Evidence-Based Medicine Committee, including forward translation, back translation, cultural adaption, and content validation, and its Chinese version was used in a cross-sectional study conducted from February to April in 2023. A total of 491 midwives from 14 different level hospitals in southwest China were recruited through a convenience sampling method. The discrimination ability of the items was tested through item analysis, and construct validity was assessed through exploratory factory and confirmatory factor analyses. The content validity index and Cronbach’s α coefficients evaluated content validity and reliability, respectively. ResultsThe Chinese version’s item–total correlation coefficients ranged from 0.641 to 0.866 in part A and from 0.644 to 0.819 in part B (P < 0.001). Parts A and B’s scale-level content validity indexes were 0.95, and the item-level content validity indexes were from 0.86 to 1.00. The three common factors of part A (necessary care, basic care, and postnatal care) and part B (communication, labor resources, and material resources) were extracted, accounting for 70.186% and 71.984% of the total variance, respectively. Confirmatory factor analysis indicated that the good fit of the three-factor models was acceptable. The Cronbach’s α coefficients were 0.968 (part A) and 0.940 (part B). ConclusionThe Chinese version of the Perinatal Missed Care Survey is a reliable and valid instrument for assessing nursing care missed by midwives during labor and birth and the reasons it was missed. Studies with large sample sizes are needed to verify the instrument’s applicability in China.

Reliability and validity of the Chinese version of the LMC Skills, Confidence & Preparedness Index (SCPI) in patients with type 2 diabetes

BackgroundA variety of diabetes self-management instruments have been developed but few of them consist of the preparedness for diabetes self-management behavior. The novel psychometric evaluation tool “the LMC Skills, Confidence & Preparedness Index (SCPI)” measures three key aspects of a patient’s diabetes self-management: knowledge of the skill, confidence in being able to perform skill and preparedness to implement the skill. The objective of this study was to translate, adapt and validate the SCPI for use in Chinese adult patients with type 2 diabetes.MethodsThis study followed the guideline recommended by the American Academy of Orthopaedic Surgeons Evidence Based Medicine Committee (AAOS) to indigenize the scale. Forward and back translation, and cross-cultural language debugging were completed according to the recommended steps. A convenience sample of Chinese patients with type 2 diabetes (n = 375) were recruited from a university-affiliated hospital in Shanghai. The validity (criterion, discriminant validity, and construct validity), reliability (internal consistency and test–retest reliability) and the interpretability of the instrument were examined. The content validity was calculated by experts’ evaluation.ResultsThe Chinese version of SCPI (C-SCPI) has good internal consistency with a Cronbach’s alpha of 0.92. The ceiling effects of the preparedness subscales is 21%. The criterion validity of three dimensions of C-SCPI was established with significantly moderate correlations between the DKT, DES-SF and SDSCA (p < 0.05). The S-CVI of the whole scale was 0.83. Except for entry 21, the I-CVI values of all entries were greater than 0.78. The C-SCPI has also shown good discriminative validity with statistically significant differences between the patients with good and poor glycemic control. Confirmatory factor analysis showed that modified results indicate that the fitting degree of the model is good, χ2/df = 2.775, RMSEA = 0.069, CFI = 0.903, GFI = 0.873, TLI = 0.889, IFI = 0.904. The test–retest reliability coefficient was 0.61 (p < 0.01).ConclusionWe established a Chinese version of SCPI through translation and cross-cultural adaptation. The C-SCPI is reliable and valid for assessment of the level of self-management in Chinese patients with type 2 diabetes.

The Peer Review Process for Clinical Abstracts and Manuscripts: Helpful Tips from the POSNA Evidence Based Medicine Committee

The review of abstracts and manuscripts for presentation or publication is an important part of the peer-review process. Many clinicians and scientists are often asked to review abstracts and manuscripts with little formal training in the process of these reviews. The following stresses the importance of abstract and manuscript review, a recommended process to go through to achieve quality reviews and how to give constructive feedback to authors in a concise yet complete and unbiased way.

Cross-cultural adaptation of the Management of Aggression and Violence Attitude Scale for nurse in emergency department

Abstract Objective To follow the guidelines of intercultural adaptation provided by the American Academy of Orthopedic Surgeons’ (AAOS) Evidence-Based Medicine Committee, translating the original scale and evaluating the reliability and validity, and then to compile the Chinese version of the Management of Aggression and Violence Attitude Scale (MAVAS) for nurses in emergency room in the mainland of China. Methods This study consists of two phases of testing: (1) translation: forward translation, synthesis, back translation, expert committee review, and pretesting; (2) psychometric properties: content and construct validity, internal consistency, and test–retest reliability. Results The Chinese version of MAVAS and the original version showed excellent similarities and equivalence. The average Scale-level Content Validity Index was 0.904, and the Item-level Content Validity Index ranged from 0.80 to 1.00. The construct validity was tested using confirmatory factor analysis by LISREL 8.7; χ2/df of the scale was 4.781&lt;5, NFI, NNFI, CFI, IFI&gt;0.90, indicating that the scale’s factor structure model fitted better. The internal consistency was satisfactory (scale, Cronbach’s α=0.94; subscales, Cronbach’s α=0.74–0.90), and the test–retest reliability over 2 weeks was good (scale, Pearson’s coefficient=0.996; subscales, Pearson’s coefficient=0.801–0.963). Conclusions The Chinese version of MAVAS had an excellent feasibility. It was found to be a valid and reliable tool to assess nurses’ attitude toward patients’ violence in emergency department.

MDS evidence-based review of treatments for essential tremor.

Essential tremor is one of the most prevalent movement disorders. Many treatments for essential tremor have been reported in clinical practice, but it is uncertain which options have the most robust evidence. The International Parkinson and Movement Disorder Society commissioned a task force on tremor to review clinical studies of treatments for essential tremor. To conduct an evidence-based review of current pharmacological and surgical treatments for essential tremor, using standardized criteria defined a priori by the International Parkinson and Movement Disorder Society. We followed the recommendations of the International Parkinson and Movement Disorder Society Evidence Based Medicine Committee. Sixty-four studies of pharmacological and surgical interventions were included in the review. Propranolol and primidone were classified as clinically useful, similar to Topiramate, but only for doses higher than 200 mg/day. Alprazolam and botulinum toxin type A were classified as possibly useful. Unilateral Ventralis intermedius thalamic DBS, radiofrequency thalamotomy, and MRI-guided focused ultrasound thalamotomy were considered possibly useful. All the above recommendations were made for limb tremor in essential tremor. There was insufficient evidence for voice and head tremor as well as for the remaining interventions. Propranolol, primidone, and topiramate (>200 mg/day) are the pharmacological interventions in which the data reviewed robustly supported efficacy. Their safety profile and patient preference may guide the prioritization of these interventions in clinical practice. MRI-guided focused ultrasound thalamotomy was, for the first time, assessed and was considered to be possibly useful. There is a need to improve study design in essential tremor and overcome the limitation of small sample sizes, cross-over studies, short-term follow-up studies, and use of nonvalidated clinical scales. © 2019 International Parkinson and Movement Disorder Society.

Availability of global health opportunities in North American Paediatric Orthopaedic Fellowship Programmes.

PurposeOrthopaedic residents are increasingly seeking international health electives (IHEs) during training, many of which involve providing paediatric orthopaedic care. However, little is known about the availability of IHEs during orthopaedic fellowship training. Our study sought to assess the global health opportunities available to North American paediatric orthopaedic fellows.MethodsWe conducted an online, REDCap-based survey of paediatric orthopaedic fellowship programme directors (PDs) in the United States and Canada. The survey link was sent by the Pediatric Orthopaedic Society of North America (POSNA) Evidence-Based Medicine Committee to all POSNA-approved paediatric orthopaedic fellowship PDs. Follow-up reminder emails were delivered at set time intervals.ResultsThe overall response rate was 55% (26/47). Only three of 26 responding programmes (11.5%) offered a structured global health programme but 42.3% of programmes (11/26) reported fellow IHE participation within the last ten years. In all, 91% of PDs reported that fellows were extremely satisfied with their IHE, and 91% agreed that IHEs are valuable for trainees. Perceived barriers to fellow participation in IHEs included lack of funding, lack of established partner sites, lack of interest among fellows and concerns related to time away compromising clinical/call coverage. In all, 65.4% of PDs agree that IHE participation during training plays a major role in shaping fellows’ future volunteer activities.ConclusionThere are limited global health opportunities among North American paediatric orthopaedic fellowship programmes, with only 11.5% offering a structured global health programme. Greater efforts to establish sustainable funding and international partnerships may increase opportunities for IHEs during paediatric orthopaedic fellowship training.Level of EvidenceLevel II

Diagnosis of Spondylolysis and Spondylolisthesis Is Delayed Six Months After Seeing Nonorthopedic Providers*

Study DesignRetrospective single center. ObjectiveOur purpose was to quantify the time to diagnosis of spondylolysis/spondylolisthesis in symptomatic patients after first seeking medical care. Summary of Background DataSeveral studies have found a high prevalence of pars defects in adolescent athletes with back pain, up to 47%. A review by the Scoliosis Research Society Evidence-Based Medicine Committee reports that both nonsurgical and surgical treatment of symptomatic spondylolysis effectively relieves pain and allows most patients to return to activities. Nonoperative treatment outcomes improve with early diagnosis. MethodsA retrospective chart review was conducted of patients presenting at our institution between 2005 and 2015 with symptomatic spondylolysis or spondylolisthesis with radiographic confirmation. Medical records were reviewed for demographics, date of symptom onset, date of initial presentation to a health care provider, type of provider, and date of diagnosis. ResultsForty-six patients met the inclusion criteria. Average patient age was 14 years (range: 6–19 years). Forty-one percent (19/46) of patients had spondylolysis, and 59% (27/46) of patients had spondylolisthesis. Of those with spondylolisthesis, 20 had grade I, 4 had grade II, 2 had grade III, and 1 had grade IV slips. The average time between onset of symptoms and initial presentation was 24 weeks (orthopedic: 21 weeks, nonorthopedic: 29 weeks, unknown: 18 weeks; p = .26). The average delay between initial presentation to a health care provider and diagnosis was 15 weeks. Time from initial presentation to diagnosis was 1 week for orthopedic surgeons, 25 weeks for nonorthopedic providers, and 10 weeks for unknown providers; this difference was significant (p = .02). ConclusionDiagnosis of spondylolysis/spondylolisthesis was significantly longer after seeing a nonorthopedic versus an orthopedic provider. Education of primary care providers on this topic is warranted. Children suffering from back pain from spondylolysis/spondylolisthesis may benefit from early referral to an orthopedic surgeon. Level of EvidenceLevel II.

International Parkinson and movement disorder society evidence-based medicine review: Update on treatments for the motor symptoms of Parkinson's disease.

The objective of this review was to update evidence-based medicine recommendations for treating motor symptoms of Parkinson's disease (PD). The Movement Disorder Society Evidence-Based Medicine Committee recommendations for treatments of PD were first published in 2002 and updated in 2011, and we continued the review to December 31, 2016. Level I studies of interventions for motor symptoms were reviewed. Criteria for inclusion and quality scoring were as previously reported. Five clinical indications were considered, and conclusions regarding the implications for clinical practice are reported. A total of 143 new studies qualified. There are no clinically useful interventions to prevent/delay disease progression. For monotherapy of early PD, nonergot dopamine agonists, oral levodopa preparations, selegiline, and rasagiline are clinically useful. For adjunct therapy in early/stable PD, nonergot dopamine agonists, rasagiline, and zonisamide are clinically useful. For adjunct therapy in optimized PD for general or specific motor symptoms including gait, rivastigmine is possibly useful and physiotherapy is clinically useful; exercise-based movement strategy training and formalized patterned exercises are possibly useful. There are no new studies and no changes in the conclusions for the prevention/delay of motor complications. For treating motor fluctuations, most nonergot dopamine agonists, pergolide, levodopa ER, levodopa intestinal infusion, entacapone, opicapone, rasagiline, zonisamide, safinamide, and bilateral STN and GPi DBS are clinically useful. For dyskinesia, amantadine, clozapine, and bilateral STN DBS and GPi DBS are clinically useful. The options for treating PD symptoms continues to expand. These recommendations allow the treating physician to determine which intervention to recommend to an individual patient. © 2018 International Parkinson and Movement Disorder Society.

Evaluation of the reliability and validity of Nursing Humanistic Care Experience Scale for Chronic Disease Patients

Objective To cross-cultural adapt and test the reliability and validity of Humanistic Relationship Experience Scale (HRES) made by Boscart. Methods Cross-culture Adaptation was carried out by following American Academy of Orthopaedic Surgeons Evidence Based Medicine Committee (AAOS). A convenience sampling was conducted among 180 patients with chronic disease, and then assessed the reliability and validity of HRES. The internal consistency coefficient and the test-retest were used to assess the reliability of HRES, and the content validity index (CVI) and construct validity were used to assess the validity of HRES. Results In order to understand the purpose and content of the scale easily, the Chinese version title of HRES was revised to Nursing Humanistic Care Experience Scale-Noninfectious Chronic Disease Patients Version (NHCES-NCDP) after soliciting experts′ advice. The CVI of the scale was 1; factor analysis got three factors, which could explain 67.897% of the total variance. A 0.965 Cronbach α of total scale was obtained, and for each dimension range was 0.876-0.948; the test-retest reliability was 0.710 for the overall scale. Conclusion NHCES- NCDP is reliable and valid, which can be used to assess the experience of nursing humanistic care for patients with chronic diseases, and to explore nurses′ implementation of nursing humanistic care. Key words: Chronic disease; Nursing humanistic care; Reliability; Validity

Current Evidence Regarding the Treatment of Pediatric Lumbar Spondylolisthesis: A Report From the Scoliosis Research Society Evidence Based Medicine Committee

Study DesignStructured literature review. ObjectivesThe Scoliosis Research Society requested an assessment of the current state of peer-reviewed evidence regarding pediatric lumbar spondylolisthesis to identify what is known and what research remains essential to further understanding. Summary of Background DataPediatric lumbar spondylolisthesis is common, yet no formal synthesis of the published literature regarding treatment has been previously performed. MethodsA comprehensive literature search was performed. From 6600 initial citations with abstract, 663 articles underwent full-text review. The best available evidence regarding surgical and medical/interventional treatment was provided by 51 studies. None of the studies were graded Level I or II evidence. Eighteen of the studies were Level III, representing the current best available evidence. Thirty-three of the studies were Level IV. ResultsAlthough studies suggest a benign course for “low grade” (<50% slip) isthmic spondylolisthesis, extensive literature suggests that a substantial number of patients present for treatment with pain and activity limitations. Pain resolution and return to activity is common with both medical/interventional and operative treatment. The role of medical/interventional bracing is not well established. Uninstrumented posterolateral fusion has been reported to produce good clinical results, but concerns regarding nonunion exist. Risk of slip progression is a specific concern in the “high grade” or dysplastic type. Although medical/interventional observation has been reported to be reasonable in a small series of asymptomatic high-grade slip patients, surgical treatment is commonly recommended to prevent progression. There is Level III evidence that instrumentation and reduction lowers the risk of nonunion, and that circumferential fusion is superior to posterior-only or anterior-only fusion. There is Level III evidence that patients with a higher slip angle are more likely to fail medical/interventional treatment of high-grade spondylolisthesis. ConclusionsThe current “best available” evidence to guide the treatment of pediatric spondylolisthesis is presented. Level of EvidenceLevel III; review of Level III studies.

Current Evidence Regarding Diagnostic Imaging Methods for Pediatric Lumbar Spondylolysis: A Report From the Scoliosis Research Society Evidence-Based Medicine Committee

BackgroundSpondylolysis is common among the pediatric population, yet no formal systematic literature review regarding diagnostic imaging has been performed. The Scoliosis Research Society (SRS) requested an assessment of the current state of peer reviewed evidence regarding pediatric spondylolysis. MethodsLiterature was searched professionally and citations retrieved. Abstracts were reviewed and analyzed by the SRS Evidence-Based Medicine Committee. Level I studies were considered to provide Good Evidence for the clinical question. Level II or III studies were considered Fair Evidence. Level IV studies were considered Poor Evidence. From 947 abstracts, 383 full texts reviewed. Best available evidence for the questions of diagnostic methods was provided by 27 studies: no Level I sensitivity/specificity studies, five Level II and two Level III evidence, and 19 Level IV evidence. ResultsPain with hyperextension in athletes is the most widely reported finding in history and physical examination. Plain radiography is considered a first-line diagnostic test for suspected spondylolysis, but validation evidence is lacking. There is consistent Level II and III evidence that pars defects are detected by advanced imaging in 32% to 44% of adolescents with spondylolysis based on history and physical. Level III evidence that single-photon emission computed tomography (SPECT) is superior to planar bone scan and plain radiographs but limited by high rates of false-positive and false-negative results and by high radiation dose. Computed tomography (CT) is considered the gold standard and most accurate modality for detecting the bony defect and assessment of osseous healing but exposes the pediatric patient to ionizing radiation. Magnetic resonance imaging (MRI) is reported to be as accurate as CT and useful in detecting early stress reactions of the pars without a fracture. ConclusionPlain radiographs are widely used as screening tools for pediatric spondylolysis. CT scan is considered the gold standard but exposes the patient to a significant amount of ionizing radiation. Evidence is fair and promising that MRI is comparable to CT.

Current Evidence Regarding the Surgical and Nonsurgical Treatment of Pediatric Lumbar Spondylolysis: A Report from the Scoliosis Research Society Evidence-Based Medicine Committee

Study DesignStructured literature review. ObjectivesThe Scoliosis Research Society requested an assessment of the current state of peer-reviewed evidence regarding pediatric spondylolysis with the goal of identifying both what is really known and what research remains essential to further understanding. Summary of Background DataSpondylolysis is common among children and adolescents and no formal synthesis of the published literature regarding treatment has been previously performed. MethodsA comprehensive literature search was performed. The researchers reviewed abstracts and analyzed by committee data from included studies. From 947 initial citations with abstract, 383 articles underwent full text review. The best available evidence for clinical questions regarding surgical and nonsurgical treatment was provided by 58 included studies. None of the studies were graded as level I or level II evidence. Two of the studies were graded as level III evidence. Fifty-six of the studies were graded as level IV evidence. No level V (expert opinion) studies were included in the final list. ResultsAlthough natural history studies suggest a benign, relatively asymptomatic course for spondylolysis in most patients, both nonsurgical and surgical treatment series suggest that a substantial number of patients present with pain and activity limitations attributed to spondylolysis. Pain resolution and return to activity are common with both nonsurgical and surgical treatment (80% to 85%, respectively). Although it is implied that most surgically treated patients have failed nonsurgical treatment, the specific treatment modalities and duration required before failure is declared are not well defined. There is insufficient evidence to know which patients will benefit from specific treatment modalities (both nonsurgical and surgical). ConclusionsBecause of the preponderance of uncontrolled case series and the lack of comparative studies, only low-quality evidence is available to guide the treatment of pediatric spondylolysis.

Current Evidence Regarding Diagnostic Methods for Pediatric Lumbar Spondylolysis: A Report from the Scoliosis Research Society Evidence Based Medicine Committee

The SRS requested an assessment of the current state of peer reviewed evidence regarding pediatric spondylolysis with the goal of identifying both what is really known and what research remains essential to further understanding. Spondylolysis is common among children and adolescents and no formal synthesis of the published literature regarding diagnostic imaging has been previously performed.

The American Association of Hip and Knee Surgeons Evidence-Based Medicine Committee: Background, Resources, and Charges

Evidence-based medicine (EBM) is the practice of formulating best care plans for patients based on the systematic analysis of that evidence in the scientific literature that meets predetermined levels of quality. Many tools have been developed to determine what data are appropriate for inclusion in such meta-analyses, as well as how to pull out of such review meaningful guidance for practice (clinical guidelines). Externally developed guidelines and assessments already influence the practicing surgeon; the pay-for-performance criteria represent one example of guidelines that ideally are formulated by those within the specialty affected by contribution of the most meaningful and persuasive evidence. This makes an EBM committee a vital part of the American Association of Hip and Knee Surgeons (AAHKS).

Evidence-Based Practice: What Constitutes Evidence?

Evidence-based practice, or evidence-based medicine (EBM), has been a buzzword within the health professions for several years, following the business sector’s focus over the past two decades on the need to define best practices in business. It has long been a value that research would ultimately give direction in providing health care that is as effective, safe, and economical as possible. Basic research is far removed from clinical application. For example, basic research might entail the confirmation of a clinical phenomenon, the synthesis of a new molecule, or the identification of a new hormone receptor. It is in the realm of applied research, in which those foundational basic findings are built on and used to achieve desired outcomes, that evidence-based practice is determined. One definition of evidence-based practice is “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. The practice of EBM means integrating individual clinical expertise with the best available external clinical evidence from systematic research” (Sackett, Rosenberg, Gray, Haynes, & Richardson, 1996, pp. 71-72). The Agency for Healthcare Research and Quality (AHRQ), which can be accessed at www.ahcpr.gov, has assumed a leading role in promoting evidencebased practice as a way to reduce what has been described as an epidemic of errors in patient care in the United States. Included in the AHRQ’s legislative mandate is support of synthesis of scientific clinical and behavioral studies on particular treatments and technologies and widespread dissemination of resulting reports. These research findings, syntheses, and guidance are intended to assist providers, clinicians, payers, patients, and policy makers in making evidence-based decisions regarding the quality and effectiveness of health care. One excellent, consumer-friendly example is AHRQ’s Web page on how consumers can reduce the risk that they will be exposed to medical error (20 Tips, 2000). Readers will note that the Web site is not heavily laden with research terminology, yet it is a synthesis of the best information available on this topic. Another AHRQ example pertinent to nurses in HIV/ AIDS care focuses on management of dental patients who are HIV positive (Management of Dental Patients, 2001). Three issues were addressed through an extensive review of literature included within the past 12 months within the MEDLINE and EMBASE databases and the Cochrane Collaboration Library: risks to HIV-positive patients related to invasive oral procedures, oral conditions as markers or indicators of change in HIV status (i.e., seroconversion and immunosuppression), and the efficacy or effectiveness of antifungal treatments (prophylactic and curative) for oral candidiasis in HIV-positive patients. The analysis and conclusions are provided, along with questions for future research. Clinicians are given the best knowledge to date as well as suggestions for where their own research might be focused. This clearly conveys the important concept that knowledge is ever changing. The New York Academy of Medicine in partnership with the Evidence-Based Medicine Committee of the American College of Physicians, New York Chapter, received a grant from the National Institutes of Health