Evidence-based Methods Research Articles

Preliminary Evidence-Based Method of Medical Kit Design for Wilderness Expeditions Modeled by a High-Altitude Expedition to Mount Kilimanjaro

BackgroundWilderness expeditions require extensive planning and the correct medical supplies to ensure clinical care is possible in the event of illness or injury. There are gaps in the literature regarding evidence-based methods for medical kit design. ObjectivesThis report describes a preliminary method for predicting medical events to determine medical supply requirements for a wilderness expedition. The performance of this method was evaluated using data from the 2017 Equal Playing Field (EPF) expedition to Mount Kilimanjaro. MethodsEight reports documenting medical events during wilderness expeditions were reviewed. Incidence data were consolidated into a new dataset, and a subset of data from adventure race expeditions (ARS) was created. The cumulative incidence of medical events was then predicted for the 9-day EPF expedition. The medical supply list was determined based on indication. The effectiveness of the full dataset and ARS to predict the cumulative incidence of medical events by category during the EPF expedition was evaluated using regression analysis. ResultsThe ARS predicted a higher incidence rate of medical events than the full dataset did but underestimated the EPF expedition incidence rate. The full dataset was a weak predictor of the cumulative incidence of medical events by category during the EPF expedition, while the ARS was a strong predictor. The finalized medical kit overestimated all nonreusable supplies. ConclusionsThe medical kit created using this method managed all medical events in the field. This report demonstrates the potential utility of using a tailored, evidence-based approach to design a medical kit for wilderness expeditions.

Intraosseous Regional Administration of Prophylactic Antibiotics in Total Knee Arthroplasty.

Prosthetic joint infection (PJI) after total knee arthroplasty is a devastating complication. With the development of antibiotic resistance, a safe and effective means of delivering antibiotic prophylaxis is needed. Intraosseous regional antibiotics (IORA) achieve higher local concentrations of antibiotics with fewer systemic side effects. Previous studies have proven the safety of IORA, whereas animal models have proven it to be more effective than intravenous antibiotics for preventing infection following surgery. Recently, large-scale retrospective studies have also demonstrated lower PJI rates following TKA when IORA is used when compared to routine intravenous prophylaxis. In this article, we propose an evidence-based method for the administration of intraosseous antibiotics in TKA, cover the up-to-date data supporting its use, and explore future directions for additional research.

Quantitative methods used to evaluate impact of health promotion interventions to prevent HIV infections: a methodological systematic review protocol.

BackgroundCombination prevention is currently considered the best approach to combat HIV epidemic. It is based upon the combination of structural, behavioral, and biomedical interventions. Such interventions are frequently implemented in a health-promoting manner due to their aims, the approach that was adopted, and their complexity. The impact evaluation of these interventions often relies on methods inherited from the biomedical field. However, these methods have limitations and should be adapted to be relevant for these complex interventions. This systematic review aims to map the evidence-based methods used to quantify the impact of these interventions and analyze how these methods are implemented.MethodsThree databases (Web of Science, Scopus, PubMed) will be used to identify impact evaluation studies of health promotion interventions that aimed at reducing the incidence or prevalence of HIV infection. Only studies based on quantitative design assessing intervention impact on HIV prevalence or incidence will be included. Two reviewers will independently screen studies based on titles and abstracts and then on the full text. The information about study characteristics will be extracted to understand the context in which the interventions are implemented. The information specific to quantitative methods of impact evaluation will be extracted using items from the Mixed Methods Appraisal Tool (MMAT), the guidelines for reporting Statistical Analyses and Methods in the Published Literature (SAMPL), and the guidelines for Strengthening The Reporting of Empirical Simulation Studies (STRESS). This review will be conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) statement.DiscussionThe impact evaluation of HIV prevention interventions is a matter of substantial importance given the growing need for evidence of the effectiveness of these interventions, whereas they are increasingly complex. These evaluations allow to identify the most effective strategies to be implemented to fight the epidemic. It is therefore relevant to map the methods to better implement them and adapt them according to the type of intervention to be evaluated.Systematic review registrationPROSPERO CRD42020210825Supplementary InformationThe online version contains supplementary material available at 10.1186/s13643-022-01970-z.

Cellulose Sponge, the Detector of Esophageal Cancer: Innovation for Early Detection of Esophageal Cancer without Biopsy?: A Mini Review

Patients with esophageal cancer each year can reach 400,000 people. Inefficient screening methods and worsening symptoms, patients often come late. Squamous cell carcinoma, which is the cause of esophageal cancer, has percentage of 84% of all cancer incidences. So far, the current screening strategy is endoscopy with biopsy. This screening has the main side effect of bleeding in metaplastic area. Cellulose Sponge, the Detector of Esophageal Cancer (CaSPER), can be used for screening without a biopsy using a cellulose sponge. The method used in this mini review is an evidence-based method that focuses on evaluating pre-existing journals. The result is that CaSPER is able to provide strong cellular results of 98%, specificity of 100%, and sensitivity of 97%. Capsules made of glucose and cytosponge of cellulose will bring the metaplastic cells to the sponge. This screening is feasible, safe, comfortable, and without side effects. Using trefoil factor 3 as biomarker is able to distinguish between goblet and pseudogoblet cells. CaSPER is minimally invasive, cheaper, and easily accepted, so that in the future it is hoped that it can be mass produced, especially for areas with high esophageal cancer.

Sedentary Behaviour Intervention as a Personalised Secondary Prevention Strategy (SIT LESS) for patients with coronary artery disease participating in cardiac rehabilitation: rationale and design of the SIT LESS randomised clinical trial

Patients with coronary artery disease (CAD) are more sedentary compared with the general population, but contemporary cardiac rehabilitation (CR) programmes do not specifically target sedentary behaviour (SB). We developed a...

The Effects of Exercise on the Sport Concussion Assessment Tool 3 (SCAT3)

There are 3.8 million sports‐related concussions reported annually. Although there is a growing number of sports‐related concussions, there is a lack of evidence‐based methods to evaluate, treat, predict, and monitor recovery in athletes. Today, concussions are clinically diagnosed using self‐reported symptoms and by examining posture, neurocognition, ocular/vestibular control, and various imaging techniques. The Sport Concussion Assessment Tool (SCAT) is widely used on the sideline along with other methods to diagnose a concussion. However, current studies use control groups that are rested (i.e baseline) without considering the effect of intense exercise and contact (not related to head) that a player may have experienced during a game. To obtain this data we developed a mobile tent‐based laboratory that permits us to collect data on the field during a rugby match. SCAT3 questionnaires were performed within 3 hours following a rugby match in players who experienced a head injury or completed the match without a head injury. Additional measures included beat‐by‐beat blood pressure (Finometer), heartrate, common and internal carotid blood flow, and end‐tidal CO2 (nasal cannula) during rest, in the seated and supine position. A principal component analysis was performed on the 26 listed symptoms on the SCAT3 and Mann‐Whitney U‐test on the resulting 4 components. There were a total 209 players (67 female, 142 males; 33 ± 13 years) who just played a match, with 80 who experienced a head injury and 129 controls. Self‐reported symptoms were significantly greater in players who experienced a head injury 26.16 ± 17.6 vs control 8.93 ± 11.5, P<.001. A principal component analysis on our entire dataset produced 4 symptom components: (1) Cognitive‐Sensory (2) Emotional‐Affective (3) Hypersensitive (4) Headache. A Mann‐Whitney U‐tests showed significant differences between the concussed and control groups for the following symptom components: Cognitive‐Sensory (p<0.001), Headache (p<0.001), Emotional‐Affective (p<0.004), and Hypersensitive (p<0.001). This data suggests that the SCAT3 symptoms were greater in the players with a head injury, but that some of the control players who just played an intense match also show an increased number of symptoms and severity. Further analysis and violin plots on each of the 4 components showed that the symptom component named “Headache” composed of; Pressure in the Head, Headache, Feeling Slowed down, Dizziness, Don’t Feel Right may provide a better indicator of concussion in players that just played an intense match. Future work is needed to examine how these components can be used along with current physiological measures to better assess a concussion in players that just came off the field.

Review on Smart Factory Operations: A Bibliometric Analysis

Over the last few years, existing and emerging Information and Communication Technologies (ICT) and artificial intelligence have been changing the way that factories conduct their manufacturing activities. Operation system of smart factories has been of great interest to researchers in recent years. However, the research concerning operations for the smart factory is still at the nascent stage. To address this need, we conduct a citation and co-citation analysis on smart factory operation system research published in the 11-year period from 2010-2020. A total of 351 papers were selected from Web of Science database. In the citation analysis, we depend on the degree centrality and betweenness centrality to identify 36 important papers. In addition, our main path analysis reveals the role of ICT in facilitating fast development of operation in smart factory. In the co-citation analysis, we identify four major research themes: resource reconfiguration, predictive production planning model, collaborative scheduling mechanism and technology basis of logistics. This is among the first studies to examine the knowledge structure of smart factory operations research by using evidence-based analysis methods. Recommendations for the future research directions have suggested based on our analysis.

Dental stem cell-conditioned medium for tissue regeneration: Optimization of production and storage.

BACKGROUNDMesenchymal stem cells (MSC) effects on tissue regeneration are mainly mediated by their secreted substances (secretome), inducing their paracrine activity. This Conditioned medium (CM), including soluble factors (proteins, nucleic acids, lipids) and extracellular vesicles is emerging as a potential alternative to cell therapy. However, the manufacturing of CM suffers from variable procedures and protocols leading to varying results between studies. Besides, there is no well-defined optimized procedure targeting specific applications in regenerative medicine.AIMTo focus on conditioned medium produced from dental MSC (DMSC-CM), we reviewed the current parameters and manufacturing protocols, in order to propose a standardization and optimization of these manufacturing procedures. METHODSWe have selected all publications investigating the effects of dental MSC secretome in in vitro and in vivo models of tissue regeneration, in accordance with the PRISMA guidelines.RESULTSA total of 351 results were identified. And based on the inclusion criteria described above, 118 unique articles were included in the systematic review. DMSC-CM production was considered at three stages: before CM recovery (cell sources for CM), during CM production (culture conditions) and after production (CM treatment).CONCLUSIONNo clear consensus could be recovered as evidence-based methods, but we were able to describe the most commonly used protocols: donors under 30 years of age, dental pulp stem cells and exfoliated deciduous tooth stem cells with cell passage between 1 and 5, at a confluence of 70% to 80%. CM were often collected during 48 h, and stored at -80 °C. It is important to point out that the preconditioning environment had a significant impact on DMSC-CM content and efficiency.

Blood pressure and its variability: classic and novel measurement techniques

Current hypertension guidelines recommend using the average values of several blood pressure (BP) readings obtained both in and out of the office for the diagnosis and management of hypertension. In-office BP measurement using an upper-arm cuff constitutes the evidence-based reference method for current BP classification and treatment targets. However, out-of-office BP evaluation using 24 h ambulatory or home BP monitoring is recommended by all major medical associations for obtaining further insights into the BP profile of an individual and how it relates to their daily activities. Importantly, the highly variable nature of office and out-of-office BP readings has been widely acknowledged, including the association of BP variability with cardiovascular outcomes. However, to date, the implications of BP variability on cardiovascular outcomes have largely been ignored, with limited application in clinical practice. Novel cuffless wearable technologies might provide a detailed assessment of the 24 h BP profile and behaviour over weeks or months. These devices offer many advantages for researchers and patients compared with traditional BP monitors, but their accuracy and utility remain uncertain. In this Review, we outline and compare conventional and novel methods and techniques for assessing average BP levels and BP variability, and reflect on the utility and potential of these methods for improving the treatment and management of patients with hypertension.

Validation of a Bayesian Diagnostic and Inferential Model for Evidence-Based Neuropsychological Practice.

Evidence-based diagnostic methods have clinical and research applications in neuropsychology. A flexible Bayesian model was developed to yield diagnostic posttest probabilities from a single person's neuropsychological score profile by utilizing sample descriptive statistics of the test battery across diagnostic populations of interest. Three studies examined the model's performance. One simulation examined estimation accuracy of true z-scores. A diagnostic accuracy simulation utilized descriptive statistics from two popular neuropsychological tests, the Wechsler Adult Intelligence Scale-IV (WAIS-IV) and Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). The final simulation examined posterior predictive accuracy of scores to those reported in the WAIS manual. The model produced minimally biased z-score estimates (root mean square errors: .02-.18) with appropriate credible intervals (95% credible interval empirical coverage rates: .94-1.00). The model correctly classified 80.87% of simulated normal, mild cognitive impairment, and Alzheimer's disease cases using a four subtest WAIS-IV and the RBANS compared to accuracies of 60.67-65.60% from alternative methods. The posterior predictions of raw scores closely aligned to percentile estimates published in the WAIS-IV manual. This model permits estimation of posttest probabilities for various combinations of neuropsychological tests across any number of clinical populations with the principal limitation being the accessibility of applicable reference samples. The model produced minimally biased estimates of true z-scores, high diagnostic classification rates, and accurate predictions of multiple reported percentiles while using only simple descriptive statistics from reference samples. Future nonsimulation research on clinical data is needed to fully explore the utility of such diagnostic prediction models.

An online hazard perception training course reduces heavy braking, speeding, and over-revving rates during everyday driving

In essence, driver training involves learning the skills required to drive safely and avoid dangerous events. However, in traditional on-road driver instruction, drivers virtually never accrue experience of the most significant types of events that they are learning to avoid: crashes. One means of providing this experience safely is to present novice drivers with video clips of real crashes, as part of structured learning exercises. A six-week automated online hazard perception training course for drivers, incorporating evidence-based training methods and over a hundred crash clips, was previously found to improve novice drivers’ hazard perception skill, which is known to be an important attribute for avoiding crashes. However, since hazard perception was measured using computer-based methods, the possibility remained that the training effect might not transfer to actual driving. We report a randomized control trial in which novice drivers were recruited to assess everyday driving behaviour objectively, using g-force triggered dashcams and GPS trackers installed in their vehicles. On-road data were collected for a one-month baseline period, and for a further two months after half of the sample completed the hazard perception training course. Drivers who completed the course significantly reduced their rate of heavy-braking events, their speeding behaviour, and their rate of over-revving events. These findings support the proposal that a relatively inexpensive and highly scalable hazard perception training intervention can improve on-road driving behaviour, with the clear potential to impact real-world driver safety.

‘Curb sitting’: An evidence-based policing practice or an officer safety myth?

ABSTRACT Law enforcement officers across the country are trained in various tactics and techniques intended to increase the overall safety within a police-citizen contact. One common, albeit controversial tactic is referred to as “curb sitting”. The curb-sitting tactic is generally associated with officers requiring criminal suspects to sit on a curb with their legs outstretched in front of them. The tactic is believed to provide officers additional reaction time to defend themselves from an attack but is also considered unnecessarily demeaning. The efficacy of the curb-sitting tactic has not previously been determined. The current study is the first to evaluate three common variations of the curb-sitting tactic to determine which, if any seated position allowed officers more time to respond to an attack when compared to a subject standing five feet away. Our results show that a seated subject with their legs extended is associated with a significant increase in time to cross five feet when compared to a standing subject. Based on these results, the curb-sitting tactic appears to be an evidence-based method of increasing an officer’s time to respond to an attack. Implications for law enforcement training and tactics, as well as recommendations for future research are discussed.

Assessment of sociodemographic indicators of Tobacco expenditure: an application of the censored regression model

ABSTRACT Background The high level of tobacco use in Turkey and across the world, causes a high number of health problems. This study explores the indicators of tobacco expenditure of households, the smallest unit of a society. In this context, the sociodemographic factors affecting household tobacco use were examined, and recommendations are made to reduce tobacco product impact in terms of users and those who are exposed to smoke. Methods This study uses the dataset acquired from the Household Budget Survey. The factors affecting household expenditure on tobacco products were evaluated using the Tobit model. Results Gender, age, educational status, marital status, income level, and social variables were found to be effective indicators of tobacco product expenditure. Conclusion The study aims to bring the following issues to the attention of decision-makers and policymakers: Priority should be given to tobacco control programs, particularly for young, single, male, and lowly educated individuals; raise tobacco taxes in a way that does not adversely affect the financial situation of low-income smokers who use such products; and encourage the implementation of evidence-based smoking cessation methods.

Recommendations for the surveillance of mental health problems in childhood, adolescent, and young adult cancer survivors: a report from the International Late Effects of Childhood Cancer Guideline Harmonization Group.

Survivors of childhood, adolescent, and young adult (diagnosed when <25 years of age) cancer are at risk of mental health problems. The aim of this clinical practice guideline is to harmonise international recommendations for mental health surveillance in survivors of childhood, adolescent, and young adult cancer. This guideline was developed by a multidisciplinary panel of experts under the sponsorship of the International Guideline Harmonization Group. We evaluated concordance among existing survivorship clinical practice guidelines and conducted a systematic review following evidence-based methods. Of 7249 studies identified, 76 articles from 12 countries met the inclusion criteria. Recommendations were formulated on the basis of identified evidence in combination with clinical considerations. This international clinical practice guideline strongly recommends mental health surveillance for all survivors of childhood, adolescent, and young adult cancers at every follow-up visit and prompt referral to mental health specialists when problems are identified. Overall, the recommendations reflect the necessity of mental health surveillance as part of comprehensive survivor-focused health care.

Optimization of evidence-based research in the prevention and treatment of coronary heart disease with traditional Chinese medicine: A comprehensive review

Coronary heart disease (CHD) has severely impacted the lives and health of patients for ages. Although the modern methods used for the prevention and treatment of CHD have been increasingly perfected, clinical problems remain that require solutions. In the prevention and treatment of CHD with traditional Chinese medicine (TCM), great therapeutic advantages have been demonstrated. However, the expression of its advantages relies on scientific evidence-based research and evaluation, which require further optimization and improvement. Therefore, this review aims to comprehensively emphasize our understanding of the current deficiencies in TCM evidence-based studies and the necessity of adopting scientific evidence-based optimization methods for use in research. In this process, evidence should be produced in a standard manner, and the advantages of TCM patterns should be accurately stated because these factors contribute to efficient transformation and proper verification of the obtained evidence. Additionally, focusing on patient-oriented medicine and doctor–patient relationships is also essential. These methods are of great significance to prove the clinical efficacy of TCM and promote its development.

VERIFICATION OF PROPER EXERCISE FOR PREVENTING IATROGENIC STROKE

ABSTRACT Introduction: Iatrogenic stroke is a cerebrovascular clinical event. It quickly leads to localized or diffuse brain dysfunction. After the onset, the patient develops motor dysfunction. Objective: To study the effect of evidence-based physical exercise on the physical function and daily life ability of stroke patients with hemiplegia. Results: The performance of the exercise group was better than that of the control group. The difference between the two groups was statistically significant. Conclusion: Systematic evidence-based exercise and effective rehabilitation methods can alleviate the motor dysfunction of stroke patients with hemiplegia. Level of evidence II; Therapeutic studies - investigation of treatment results.

Examination of Salivary Cortisol as a Biomonitoring of Work-Related Stress

Introduction: Stress is a condition that must bepaid attention to by workers and employers, 87% of the workers from Europe claimed that they suffered from stress in the workplace. In 2015 around 28% of the workers reported suffering from work-related stress, with 33% clinical manifestations of fatigue, 19% sleep disturbances and 18% anxiety. Impacts that can affect workers can be absenteeism, presenteeism, etc. This study aims to investigate salivary cortisol examination to examine work-related stress using the evidence-based case report method. Methods: A literature review was conducted on November 23, 2020 through searches on the PubMed, Cochrane, and Google Scholar databases to find all published observational studies evaluating the relationship between salivary cortisol and work-related stress. Results: After screening using inclusion criteria and reducing the duplication of articles, 5 articles were obtained. Conclusion: it can be concluded that the salivary cortisol test tool can be used as an additional objective examination in order to check stress conditions in workers, in addition to a subjective examination like a questionnaire or anamnesis on workers. It is used for a biomonitoring effect and susceptibility biomonitoring. This salivary cortisol test can also be used to help determine stress levels in workers in order to detect early occupational diseases associated with psychosocial hazards.Keywords: biomonitoring, salivary cortisol, work-related stress

Empirical prediction of variant-activated cryptic splice donors using population-based RNA-Seq data

Predicting which cryptic-donors may be activated by a splicing variant in patient DNA is notoriously difficult. Through analysis of 5145 cryptic-donors (versus 86,963 decoy-donors not used; any GT or GC), we define an empirical method predicting cryptic-donor activation with 87% sensitivity and 95% specificity. Strength (according to four algorithms) and proximity to the annotated-donor appear important determinants of cryptic-donor activation. However, other factors such as splicing regulatory elements, which are difficult to identify, play an important role and are likely responsible for current prediction inaccuracies. We find that the most frequently recurring natural mis-splicing events at each exon-intron junction, summarised over 40,233 RNA-sequencing samples (40K-RNA), predict with accuracy which cryptic-donor will be activated in rare disease. 40K-RNA provides an accurate, evidence-based method to predict variant-activated cryptic-donors in genetic disorders, assisting pathology consideration of possible consequences of a variant for the encoded protein and RNA diagnostic testing strategies.

The effect of the comfort care model on distress, pain, and hemodynamic parameters in infants after congenital heart defect surgery

Backgroundand purpose: Surgery is essential for many infants with heart defects. Pain, mental distress, and hemodynamic instability are among the main complications of these surgeries. This study investigates the effect of the Comfort Theory on pain, distress, and hemodynamic parameters in infants following heart surgery. MethodsIn this clinical trial, 60 infants aged 28 days to two years were selected by convenience sampling and divided into two groups by block randomization. The nursing intervention was implemented based on Kolcaba's Theory of Comfort, and data including demographic details, comfort behaviors, and hemodynamic parameters were collected. ResultsSignificant differences were observed between the two groups in the mean scores of distress, pain, breathing, and heart rate (P < 0.05). No significant differences were observed in the mean scores of body temperature, blood pressure, peripheral blood oxygen saturation, serum lactate level, arterial blood pressure, mean arterial pressure, and central venous pressure 24, 48, and 72 h after the intervention (P > 0.05). ConclusionInterventions based on the Comfort Theory reduce children's distress and relieve their pain as the major comfort needs of this group and can be recommended to nurses working in pediatric surgery wards as an effective evidence-based method. Implication for practiceNurses should consider pediatric patients' comfort after cardiac surgery then comfort theory can be used as a strategy for reducing children's pain, distress and considerate comfort for children. Based on this theory Psychospiritual and sociocultural dimensions should be considered in designing pediatric care. In the results using nursing theories enhances comprehensive children care.

Ethical Issues in ABA-based Service Provision for Autism in Limited-Resource Contexts: A Case Example of the People's Republic of China.

Recommendations for intervention for young children with autism spectrum disorders (ASD) focus on early, intensive, and often individual intervention based on methods of applied behavior analysis. In much of the world, there are few options for early intervention. This article examines this question: in a context where intensive and high staff-to-student ratio intervention is not possible, how can provision of high-quality evidence-based intervention be ensured? We consider the case of China, where intervention for young children with autism is provided at diverse educational organizations, and funding limitations impact teacher-to-student ratio. Due to challenges, rigorous use of evidence-based methods often lags behind best practices. This article presents an ethical analysis of the choices educators face and research-based recommendations consistent with the ethical analysis. Given the current context, we recommend a socially valid approach of systematically using group instruction based on ABA principles to increase the effectiveness and intensity of each aspect of intervention programs. While focused on the case of China, recommendations and analysis have implications for other settings with limited resources.