Evidence-based Practice Guidelines Research Articles

Synopsis of the 2023 U.S. Department of VA and U.S. DoD Clinical Practice Guideline for the Management of Pregnancy

ABSTRACT Introduction This Clinical Practical Guideline provides recommendations based on a systematic review of the evidence to address critical decision points in the management of pregnancy. The guideline is intended to improve patient outcomes and local management of patients who are pregnant. This CPG is based on a systematic review of both clinical and epidemiological evidence and was developed by a panel of multidisciplinary experts. The Work Group provides clear and comprehensive evidence-based recommendations incorporating current information and practices targeting practitioners throughout the DoD and VA Health Care systems. The guideline is intended to improve patient outcomes and local management of patients who are pregnant. This CPG does not address every aspect of routine pregnancy care and is not intended to be a comprehensive guide to all care needed in pregnancy. It also addresses some clinically important and generally accepted standards of pregnancy care interventions that do not have sufficient high-quality evidence to support standalone recommendations. Additionally, it highlights emerging topics that have the potential to impact pregnancy care in the future and identifies gaps in the literature that warrant further research. Materials and Methods The development of all VA/DoD guidelines is directed by the Evidence-Based Practice Guideline Work Group and adheres to the standards for trustworthy guidelines that were set by the National Academy of Medicine. A patient focus group was convened to assess important aspects of treatment for patients and to gain information about patient values and preferences. The Lewin Group, a contracted third party with expertise in CPG development, facilitated meetings and the development of key questions using the population, intervention, comparison, outcome, timing, and setting format. Consensus was achieved among the Work Group through an iterative process involving discussions on conference calls and in person during the recommendation development meeting. An independent third party, ECRI, conducted the systematic evidence review, which the guideline Work Group then used to develop recommendations using the Grading of Recommendations Assessment, Development and Evaluation system (7-9). The search methods and results are detailed in the full guideline. Results This CPG provides 28 clinical practice recommendations that cover selected topics that the Work Group deemed had high priority need for evidence-based standards. The recommendations are divided into 3 main categories: routine care, complicated obstetrics, and mental health. An algorithm delineating recommended interventions and appropriate timing of these interventions over the course of the pregnancy and postpartum period was also created. Conclusion The CPG is not intended to define standards of care nor address all care needed in pregnancy; it does provide comprehensive guidance for routine pregnancy care. It aligns with the VA and DOD’s goal of providing care that is consistent in quality and utilization of resources in efforts to reduce errors and inappropriate variations in practices. In total, the Work Group identified 71 items needing further study, including areas requiring stronger evidence to support current recommendations and newer topics that will guide future guideline development.

American Society for Microbiology evidence-based laboratory medicine practice guidelines to reduce blood culture contamination rates: a systematic review and meta-analysis.

SUMMARYBlood cultures (BCs) are one of the critical tests used to detect bloodstream infections. BC results are not 100% specific. Interpretation of BC results is often complicated by detecting microbial contamination rather than true infection. False positives due to blood culture contamination (BCC) vary from 1% to as high as >10% of all BC results. False-positive BC results may result in patients undergoing unnecessary antimicrobial treatments, increased healthcare costs, and delay in detecting the true cause of infection or other non-infectious illness. Previous guidelines from the Clinical and Laboratory Standards Institute, College of American Pathologists, and others, based on expert opinion and surveys, promoted a limit of ≤3% as acceptable for BCC rates. However, the data supporting such recommendations are controversial. A previous systematic review of BCC examined three practices for reducing BCC rates (venipuncture, phlebotomy teams, and pre-packaged kits). Subsequently, numerous studies on different practices including using diversion devices, disinfectants, and education/training to lower BCC have been published. The goal of the current guideline is to identify beneficial intervention strategies to reduce BCC rates, including devices, practices, and education/training by providers in collaboration with the laboratory. We performed a systematic review of the literature between 2017 and 2022 using numerous databases. Of the 11,319 unique records identified, 311 articles were sought for full-text review, of which 177 were reviewed; 126 of the full-text articles were excluded based on pre-defined inclusion and exclusion criteria. Data were extracted from a total of 49 articles included in the final analysis. An evidenced-based committee's expert panel reviewed all the references as mentioned in Data Collection and determined if the articles met the inclusion criteria. Data from extractions were captured within an extraction template in the US Agency for Healthcare Research and Quality's Systematic Review Data Repository (https://srdr.ahrq.gov/). BCC rates were captured as the number of events (contaminated samples) per arm (standard practice versus improvement practice). Modified versions of the National Heart, Lung, and Blood Institute Study Quality Assessment Tools were used for risk of bias assessment (https://www.nhlbi.nih.gov/health-topics/study-quality-assessment-tools). We used Grading of Recommendations, Assessment, Development and Evaluations to assess strength of evidence. There are several interventions that resulted in significant reduction in BCC rates: chlorhexidine as a disinfectant for skin preparation, using a diversion device prior to drawing BCs, using sterile technique practices, using a phlebotomy team to obtain BCs, and education/training programs. While there were no substantial differences between methods of decreasing BCC, our results indicate that the method of implementation can determine the success or failure of the intervention. Our evidence-based systematic review and meta-analysis support several interventions to effectively reduce BCC by approximately 40%-60%. However, devices alone without an education/training component and buy-in from key stakeholders to implement various interventions would not be as effective in reducing BCC rates.

Making health information understandable: the COVID-19 patient guideline

Abstract Issue Evidence-based practice guidelines offer a reliable source of information, providing recommendations based on the most recent evidence. However, these guidelines are complex and difficult to understand for laypersons. This creates a knowledge gap, affecting shared-decision making, treatment acceptance, understanding of a disease and recommendations of disease prevention. Description of the problem Patient guidelines (PatG) aim to bridge this knowledge-gap by providing simplified versions of practice guidelines in lay language. This is a common practice internationally. An example is the German evidence-based COVID-19 practice guideline, published in 01/2024. In March, a multidisciplinary team, including a patient representative, created and reviewed a PatG outline, prioritising topics based on patient relevance, and discussed relevant information. The authors translated guideline recommendations into lay language, researched additional information, and created supporting graphics. A methodology chapter explaining both guidelines and a short medical term dictionary were also included. Results In 05/2024, the COVID-19 PatG, around 70 pages long, was finalized including information on treatment, diagnostics, intensive care, and support resources. A feedback round was initiated. Comments will be incorporated for the final version to be published in the national guideline registry by end of 05/2024. Updates of the PatG and practice guidelines will occur frequently. Lessons We faced challenges in simplifying medical concepts and interventions and accurately translating recommendations without losing key information. The length of the PatG may discourage readers. Despite these challenges, we are committed to enhancing accessibility, using simpler language, and adding supporting graphics to improve the PatG in the future. Key messages • Despite some challenges, patient guidelines pose as a reliable form of patient information. • The COVID-19 patient guideline is a reliable and evidence-based source of information.

Effectiveness of Mobile Application-Based Intervention on Medication Adherence Among Pulmonary Tuberculosis Patients: A Systematic Review.

To analyze the effectiveness of mobile application-based interventions on medication adherence among pulmonary tuberculosis patients. Intervention articles involving patients with pulmonary tuberculosis and/or their families, utilizing mobile application-based intervention research designs, assessing patients individually or in groups with or without a control group, using mobile application-based interventions that can be accessed via a browser, utilizing adherence to treatment as the primary outcome, and written in English and Indonesian were included. The articles published from 2012 to 2022 were obtained from EBSCO Host, ProQuest, GARUDA, PubMed, Scopus, and Cochrane Online Library databases. The Critical Assessment Standards Program was used to assess the trustworthiness, relevance, and results of the published articles. The quality of the articles was assessed according to Johns Hopkins Nursing Evidence-Based Practice guidelines. Seven studies reported that mobile application-based interventions can improve medication adherence, including treatment success, number of missed drugs, correct intake of medications, adherence to health programs, timeliness, and frequency of clinic visits. This review only analyzed the impact of mobile application-based interventions on patients, and their effects on the family, social, and health services were not covered.

Improving obstructive sleep apnea competency of primary care clinicians through online education

ABSTRACT Background: Obstructive sleep apnea (OSA) is an often overlooked, widespread disease and a public health concern. Evidence-based practice guidelines do not exist to guide primary care clinicians' OSA screening practices. Clinicians must be competent in OSA; however, clinicians lack competency about this disease. Local problem: Elevated rates of undiagnosed OSA potentially exist in two rural and one suburban counties in Kansas, as indicated by the increased weight and elevated chronic disease prevalence in these counties' populations. Methods: A one-cohort, pretest–posttest, quasi-experimental design was used for this quality-improvement project implemented over 11 weeks. Clinicians' competencies on OSA were measured before and after the intervention using the Obstructive Sleep Apnea Knowledge and Attitude Survey. Intervention: A brief educational video on OSA was developed for this project. Definition, risk factors and complications, screening methods, definitive diagnosis, and treatment options were covered in this video. Results: Participants (N = 14) showed improved OSA competency after watching the educational video. Participants improved OSA competency after watching the interventional video (M = 16.3, SE = 0.194) versus preintervention (M = 14.2, SE = 0.318). Participants also improved OSA attitude scores postintervention. Conclusion: Primary care clinician OSA competency scores improved after engaging in a brief educational video intervention when measured using the OSA knowledge and attitude survey. Practicing clinicians can benefit from participating in education about the disease.

The Need to Develop Evidence-based Practice Guidelines for School Nurses in Iran.

The Need to Develop Evidence-based Practice Guidelines for School Nurses in Iran.

Impact of Surgical Technique on Reducing the Incidence of Postoperative Pancreatic Fistula: A Systematic Review and Meta-Analysis

<i>Background</i>: Postoperative pancreatic fistula (POPF), a complication frequently encountered following pancreaticoduodenectomy. Pancreaticojejunostomy (PJ) and pancreaticogastrostomy (PG) are the most frequently utilized reconstructive strategies with different anastomosis techniques. This study was conducted to evaluate the optimal surgical technique to prevent POPF. <i>Methods</i>: The study was conducted using PRISMA guidelines with PROSPERO registration No. CRD42023494393. Patients undergoing pancreaticoduodenectomy includes the use of PJ or PG with different anastomoses techniques and developed POPF were included. We conducted a systematic literature review from January 2019 to December 2023 using a comprehensive search strategy, through Web of Science, ProQuest, Science Direct, PubMed, and Google Scholar databases. Meta-analysis was utilized to analyze the outcomes. The risk of bias was assessed using the Newcastle-Ottawa scale. <i>Results</i>: Eighteen studies with 3343 patients who underwent various anastomoses (including the Modified DuVal, Heidelberg PJ, and Blumgart methods) were included. Postoperative pancreatic fistula (POPF) occurred in 27% of patients. Techniques such as modified Heidelberg, Peng, shark mouth PJ, and Kiguchi PJ were associated with lower POPF rates, whereas modified and classical Blumgart techniques exhibited higher rates. While mortality rates varied among surgical techniques, overall mortality was low. <i>Conclusions</i>: Data from this study can be used to shape future studies and direct physicians to develop strategies to reduce the risk of POPF and thereby reduce morbidity and mortality, leading to improved patient outcomes. Furthermore, this data can inform clinical decision-making and guide the development of evidence-based practice guidelines to optimize surgical outcomes.

Flexible Austerity: Negotiating the Unequal Effects of Resource Shortages in Racialized Organizations

Resource shortages unfold unequally, often affecting the most socially disadvantaged people and exacerbating preexisting inequalities. Given that most resources are obtained through organizations, what role do organizational processes play in amplifying inequalities during shortages? I argue that workers engage in a practice I term flexible austerity. Flexible austerity describes how resource shortages become opportunities for decision-makers to more readily rationalize unequal resource allocation. I develop this concept by drawing on an ethnography of an urban academic hospital and leveraging data from before and during a nationwide shortage of medical intravenous (IV) opioids. I show that prior to this shortage, clinicians disproportionately assessed Black patients’ pain as “undeserving” of IV opioids, but they allocated these resources liberally because they felt constrained by evidence-based clinical best practices guidelines. During the shortage, clinicians constructed resource scarcity as necessitating austerity practices when treating Black patients, yet they exercised flexibility with White patients. This widened care disparities in ways that may have been detrimental to Black patients’ health. Based on these findings, I argue that resource shortages amplify inequalities in organizations because they provide new “colorblind” justifications for withholding resources that allow workers to link ideas of deservingness to allocation decisions.

A - 79 Comparison of Neuropsychological Test Performance between Monolingual Older Adults with Varying Cognitive Profiles

Abstract Objective With the rapid aging and cultural differences of the Latinx population, psychologists have expressed concerns regarding neuropsychological evaluations used for Alzheimer’s disease (ad), including the appropriateness of normative data and misinterpretation of test scores. This study explores various facets of neuropsychological performance between Spanish and English-speaking older adults with ad or normal cognition (NC). Method Participants (N = 17,716) from a de-identified database from the National Alzheimer’s’ Coordinating Center were administered Boston Naming Test-30 items (BNT-30), Animal & Vegetable Verbal Fluency, Digit Symbol, Mini-Mental Status Examination (MMSE), Logical Memory I & II (LM-I & II), and Trail Making Test A & B (TMT-A & B). Correlations, multiple linear hierarchical regressions, and two-factor Analyses of Variance (ANOVAs) were used. Results Significant associations between interest areas (e.g., sex, ethnicity, race, age, education level, and/or age of cognitive onset) and test performances were found in each diagnosis group. Primary language, education level, and diagnosis were found to be significant predictors of LM-I (f2 = 0.19), LM-II (f2 = 0.22), and TMT-B (f2 = 0.15) performance. Significant interactions of primary language and diagnosis group were found among test performances for the MMSE, LM-II, Animals Verbal Fluency, TMT-A, and TMT-B (p < 0.05). Conclusions Further research is warranted to understand the complexity of using neuropsychological assessments to detect ad-related deficits among Spanish-speaking Latinx individuals. Evidence-based neuropsychological practice guidelines must acknowledge the importance of education level and primary language on test performance.

The Current State of the Clinical Utility of Evidence-Based Practice for Ulcer Prevention in Long-Term Care Facilities

Background: Pressure ulcers (PUs) are localized skin injuries that mostly occur over bony prominences. PU prevalence in long-term care (LTC) facilities is currently extremely high despite the availability of evidence-based practice (EBP) guidelines at national and international levels. This narrative review aimed to investigate the current state of the clinical utility of EBP in the prevention of PUs in LTC facilities. Methods: A narrative review approach was used to synthesize studies that offer insights into the current state of clinical utility of EBP guidelines in LTC facilities. Studies were searched on PubMed, Web of Science, ScienceDirect, and Google Scholar. Findings: The findings revealed suboptimal implementation of EBP guidelines in LTC facilities in various countries. Nurses use clinically validated risk assessment tools less often to decide patients who are at risk of developing PUs for tailored interventions. Although scheduled positioning and the use of pressure relieving devices are commonly implemented, they are less documented in care plans. Nutritional assessments and interventions are the least often used. Nurses and other healthcare professionals often involve patients, family, and carers in planning and decision-making processes, but further improvements are still needed. Conclusion: There is a need to integrate into routine care clinically validated instruments for risk assessment for PU prevention in LTC facilities. Also, prioritizing nutritional assessments and interventions should be encouraged in LTC facilities, but there is a need to first understand barriers and facilitators.

Use of Cardiovascular Disease Secondary Prevention Medications in Four Middle East Countries in a Community Setting.

Evidence-based International clinical practice guidelines, universally recommend secondary prevention medications for those with previous cardiovascular disease (CVD). There is limited data on the community use of these medications in the Middle East (ME). This study assesses the use and predictors of evidence based secondary prevention medications in individuals with a history of CVD [coronary heart disease (CHD) or stroke]. Between 2005 and 2015, we enrolled 11,228 individuals aged between 35-70 years from 52 urban and 35 rural communities from four ME countries, United Arab Emirates (n = 1499), Kingdom of Saudi Arabia (n = 2046), Occupied Palestinian Territory (n = 1668) and Islamic Republic of Iran (n = 6013). With standardized questionnaires, we report estimates of medication use in those with CVD at national level and the independent predictors of their utilization through a multivariable analysis model. Results: Of the total ME cohort, 614 (5.5%) had CVD, of which 115 (1.0%) had stroke, 523 (4.7%) had CHD and 24 (0.2%) had both. The mean age of those with CVD was 56.6 ± 8.8 years and 269 (43.8%) were female. Overall, only 23.5% of those with CVD reported using three or more proven secondary prevention medications, and a substantial proportion (stroke 27.8%, CHD 25.8%) did not take any of these medications. In a fully adjusted analysis, increasing age, female gender, higher education, higher wealth in individual household, residence in a higher income country as well as being obese, hypertensive or diabetic were independent predictors of medication use. The use of secondary prevention medication is low in ME and has not reached the modest recommended WHO target of 50% use of 3 or more medications. Independent factors of higher use were, better socioeconomic status (household wealth, country wealth and education) and better contact and accessibility to health care (increasing age, female gender, obesity, diabetes and hypertension).

Reducing 30-day Acute Care Readmissions for Heart Failure Patients Through Implementation of a Discharge Bundle.

Hospital readmissions have been a long-standing problem in the American health care system. Despite many efforts, programs, papers, and interventions identified and studied, 14% of all adult admissions result in a readmission. Readmissions are mostly considered preventable and are considered an indicator of care quality for a hospital. Due to unexpected readmissions, patients are at an increased risk for illness or injury, increased stress, financial strain, and diminished quality of life. Readmissions also negatively impact hospital systems related to decreased bed availability, stretched resources, and potential financial penalties and payment reductions. Patients with an admission related to heart failure are at an increased risk of readmission, with a national readmission rate of 23%. The quality improvement project was implemented on two telemetry units at an acute care hospital. A gap analysis identified procedural and organizational reasons for readmission in the heart failure population at an acute care hospital. Using evidence-based best practice guidelines established by the American Heart Association, American College of Cardiology, and the Heart Failure Society of America, a four-pronged proactive discharge bundle was implemented using the plan-do-study-act framework for continuous improvement. All patients admitted to the telemetry units with a primary or secondary diagnosis of heart failure received the discharge planning bundle: (1) an early assessment by the case management department, (2) patient-centered specialty heart failure education, (3) predischarge medication delivery, and (4) predischarge physician follow-up appointment scheduling within 7days of discharge. A total of 133 patients were evaluated for inclusion in the heart failure cohort. Of those, 52 patients received the evidence-based intervention. The evidence-based project was implemented over 7weeks, September through October of 2023 on the medical telemetry units. Of the 52 patients receiving the evidence-based sample, two of the patients experienced a readmission due to heart failure (3.85%). Incidentally, it was found that patients without a readmission had an average of 2.3 completed interventions, while those with readmissions had an average of 1.5 interventions. Case managers are an integral part of the care transition from the acute care setting back to the community. Often, it is the case manager leading this effort through various interventions. Findings from this quality improvement project suggest the use of the evidence-based, four-pronged approach to discharge planning for the heart failure patient population reduced the risk and rate of heart failure-related readmissions for the involved nursing units. These findings also surmise that there is a correlation between the number of interventions and the rate of readmission.

Factors related to loss of appetite in postoperative cardiac surgery patients: A systematic review

Background Postoperative cardiac surgery patients often experience appetite loss. Although nutritional status is known to be associated with time of recovery, functional status, and length of stay, less is known about factors related to patient’s loss of appetite after cardiac surgery. This review aimed to identify and understand factors related to loss of appetite in postoperative cardiac surgery patients, systematic review with narrative summary design was applied. Data sources including CINAHL, SCOPUS, PubMed, ProQuest, ScienceDirect, ThaiLIS, ThaiJo, and E-Thesis were searched without restriction on publication year through August 2020. Methods We conducted the review following the Joanna Briggs Institute methodology, using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) checklist to categorize methodological quality and the PRISMA flow diagram to record the studies’ factors. Results Six studies reported one or more of 16 factors related to loss of appetite: older age, sex (female), illiteracy, history of chronic disease, not knowing someone in health field, pain score ≥ 7, pain medications containing codeine, constipation, depression, heart-lung machine ≥ 120 minutes, preoperative serum creatinine levels ≥ 179 µmol/L, emergency surgery, perfusion pressure ≤ 40 mmHg, low cardiac output syndrome, mechanical ventilation ≥ 96 hours, and a New York Heart Association class III and IV. Conclusion The small number of publications restrict our conclusions. Future research should focus on multiple factors related to appetite loss in postoperative cardiac surgery patients. Additional research will provide a foundation for evidence-based interventions to reduce appetite loss and improve patient nutritional status after cardiac surgery. Nurses and other health professionals should assess postoperative cardiac surgery patients for the presence of the 16 significant factors. To promote patients’ nutritional status, there should be evidence-based practice guidelines on the management of postoperative symptoms such as pain management, treatment of constipation, and reduction of emotional stress and depression.

A clinical practice guideline for primary care physiotherapy in patients with haemophilia.

As a result of centralisation of haemophilia care to a limited number of intramural settings, many persons with haemophilia have to travel long distances to attend their haemophilia specialised treatment centre. However, regular physiotherapy treatment can be provided by primary care physiotherapists in the person's own region. Due to the rarity of the disease most primary care physiotherapists have limited experience with this population. This study aims to provide a clinical practice guideline for primary care physiotherapists working with persons with bleeding disorders. A list of the most urgent key-questions was derived from a previous study. Literature was summarised using the grading of recommendations assessment, development, and evaluation (GRADE) evidence-to-decision framework. Recommendations were drafted based on four 90min consensus meetings with expert physiotherapists. Recommendations were finalised after feedback and >80% consensus of all stakeholders (including PWH, physiotherapists, haematologists and the corresponding societies). A list of 82 recommendations was formulated to support primary care physiotherapists when treating a person with a bleeding disorder. These recommendations could be divided into 13 categories: two including recommendations on organisation of care, six on therapy for adult patients with bleeding disorders and five on therapy adaptations for paediatric care. Therapy recommendations included treatment after a joint- or muscle bleed, haemophilic arthropathy, chronic synovitis, non-haemophilia related conditions and orthopaedic surgery. An evidence-based practice guideline, based on current evidence from literature and clinical expertise, has been developed for primary care physiotherapists treating a person with haemophilia. To improve care, the recommendations should be implemented in daily practice.

A novel seated repositioning maneuver for geotropic lateral canal BPPV: efficacy and technique.

This study introduces and evaluates the sitting lateral canal maneuver (SLCM), a novel seated repositioning technique for treating geotropic lateral canal benign paroxysmal positional vertigo (BPPV). We conducted a retrospective chart review at the Hospital of Salerno, focusing on 26 patients diagnosed with geotropic LC-BPPV between 2021 and 2022. The SLCM was applied, and its efficacy was assessed based on the resolution of nystagmus and vertigo symptoms. A 95% confidence interval was calculated to estimate the success rate. The SLCM demonstrated a high success rate, with 22 out of 26 patients (approximately 85%, 22/26 patients) showing positive outcomes. The 95% confidence interval for the success rate ranged from approximately 65.02-100%. These findings suggest that SLCM is a potentially effective intervention for LC-BPPV, especially beneficial for patients who find traditional supine or lateral maneuvers uncomfortable. The SLCM represents a promising alternative to traditional BPPV maneuvers, especially for patients requiring a seated approach. While the initial results are encouraging, further research with larger sample sizes and longer follow-up periods is needed to validate its efficacy and explore its full potential in the management of LC-BPPV. This study represents a Level IV source of evidence, as defined by the evidence-based practice guidelines. It is a retrospective chart review that involves a moderate cohort of patients diagnosed with geotropic horizontal positional nystagmus consistent with lateral canal benign paroxysmal positional vertigo (LC-BPPV). While the study provides valuable insights into the efficacy of the sitting lateral canal maneuver (SLCM) and contributes to the existing literature on BPPV management, it is important to note the inherent limitations associated with this level of evidence.

Adoption of an evidence-based practice approach in the child and family care system in Europe: A comparative survey study

The European policy is placing a strong emphasis onadopting an evidence-based practice (EBP) approach. However, this process has not been sufficiently described and comparatively explored between countries with different family policies, delivery systems, target populations and professional cultures of evaluation and intervention. This study proposed a multicomponent model of implementation strategies to empirically examine the degree of adoption of EBP at national, agency, and practitioner levels in a sample of20 member countries of the European family support network: A bottom-up, evidence-based and multidisciplinary approach (EurofamNet), with a great geographical distribution and different political status: 12 EU members, 6 EU candidate members and 2 non-EU members. Consensual responses to the survey (17 questions) were provided by members of EurofamNet national networks made up of entities at the national, regional, and local levels across sectors. Three clusters of responses were identified, Cluster 1 Initial Level (30%, mainly EU candidates), Cluster 2 Medium Level (40%, EU and non-EU members) and Cluster 3 Advance level (30%, EU and non-EU members). Countries at the Initial Level showed a lack of / or less degree of achievement in the implementation strategies. Countries at the Medium and Advance levels showed progressive steps towards EBP adoption through the implementation of collaborative leadership, translational efforts on agreed EBP guidelines, official recognition of services and professional teams applying EBP guidelines, multi-agency and intersectoral EBP adoption, professional training on EBP guidelines, and dissemination strategies. Our findings highlight the complexity of the transformation process and the multiple determinants involved in bringing the quality standards into the practice environment. Lines of improvement are suggested to help countries reinforce the culture of quality assurance in the child and family services.

Optimizing Safe Opioid Prescribing: A Paradigm Shift in Buprenorphine Management for Orthopaedic Surgery

The worsening opioid epidemic in the United States, exacerbated by the COVID-19 pandemic, necessitates innovative approaches to pain management. Buprenorphine, a long-acting opioid, has gained popularity due to its safety profile and accessibility. Orthopaedic surgeons, encountering an increasing number of patients on buprenorphine, face challenges in perioperative management. This article will update orthopaedic surgeons on new developments in the understanding of buprenorphine as a pain reliever and share evidence-based practice guidelines for buprenorphine management. For patients on buprenorphine for opioid use disorder or chronic pain, the updated recommendation is to continue their home dose of buprenorphine through the perioperative period. The patient’s buprenorphine prescriber should be contacted and notified of any impending surgery. The continuation of buprenorphine should be accompanied by a multimodal approach to analgesia, including a preoperative discussion about expectations of pain and pain control, regional anesthesia, standing acetaminophen, Nonsteroidal anti-inflammatory drugs when possible, gabapentinoids at night for patients under 65 years, cryotherapy, elevation, and early mobilization. Patients can also be prescribed short-acting, immediate-release opioids for breakthrough pain. Transdermal buprenorphine is emerging as an excellent option for the management of acute perioperative pain in both elective and nonelective orthopaedic patients. A single patch can provide a steady dose of pain medication for up to 1 week during the postoperative period. A patch delivery method can help combat patient nonadherence and ultimately provide better overall pain control. In the future, transdermal buprenorphine patches could be applied in virtually all fracture surgery, spinal surgery, total joint arthroplasty, ligament reconstructions with bony drilling, etc. As the stigma surrounding buprenorphine decreases, further opportunities for perioperative use may develop.

Management of Urinary Tract Infections and Vesicoureteric Reflux: Key Updates from Revised Indian Society of Pediatric Nephrology Guidelines 2023.

Non-specific symptoms and difficulty in collecting urine specimens make diagnosis of urinary tract infection (UTI) challenging in young children. However, timely diagnosis and initiation of therapy are essential to prevent complications. Children with recurrent UTIs require detailed evaluation and follow-up for optimal management. We report key updates from revised evidence-based practice guidelines of the Indian Society of Pediatric Nephrology for urinary tract infections and primary vesicoureteric reflux.

Characteristics of late preterm infant readmissions: A systematic review.

Prematurity represents a critical health disparity. It is important to note that late preterm (LPT) infants comprise the majority of preterm births, yet they are the least studied within the premature population. Evidence-based practice guidelines are now a decade old, indicating the potential need for review and revision. This systematic review proposed the assessment of sociodemographic characteristics of LPT infants, clinical practice standards, and associated hospital readmission rates, mortality, and morbidity to determine the need for revision of evidence-based practice guidelines for these infants. The Preferred Reporting System Items for Systematic Reviews and Meta Analysis methodology provided the framework for the completion of this review. Literature searches of PubMed/Medline (Ovid), Web of Science, Cumulative Index of Nursing, and Allied Health Literature Plus databases and citation searches included articles published after 2012 using the search terms "late preterm infants," "readmissions," and "readmission rates." The literature search identified 11 studies meeting search criteria. These studies included quasi experimental, retrospective, and prospective cohort studies. These studies highlighted the characteristics of LPT infants that potentially contribute to increased readmission rates, morbidity and mortality rates, health care costs, and long-term health inequities. Overall findings indicate the need for review and revision of evidence-based practice guidelines for these infants. This systematic review manifests the vulnerability of LPT infants and the accompanying need for up-to-date clinical practice guidelines to effectively reduce their morbidity and mortality rates, hospital readmissions rates, and burden of health care costs.

Saudi physiotherapists' attitudes, knowledge, behaviors, and barriers towards evidence-based practice: A cross-sectional study

Background and objective: At present, there is limited knowledge about the determinants of evidence-based practice (EBP) among Saudi physiotherapists. So, this study investigated the attitudes, knowledge, behaviors and perceived barriers of Saudi physiotherapists regarding EBP. Methods: A sample of 323 physiotherapists completed an EBP questionnaire, which was designed to cover six domains of EBP; Attitudes and beliefs, interest, attention to literature, information availability, educational background, and its barriers. Results: The participants concurred that EBP is essential (91%), literature helps practice (75%). EBP enhances patient care (80%), reimbursement rates (82%), and aids in decision-making (75%). They discovered that EBP does not consider patient preferences (37%) or the constraints of the clinical practice (71%). They were interested in enhancing their abilities (80%). They needed to use evidence more frequently in daily work (74%). Seventy-six percent having access to professional publications, and 80% have online access to EBP guidelines. Seventy-one percent disagree that their workplace encouraged the EBP usage. Fifty-one percent had not learned the EBP's fundamentals. Sixty percent had not attended training sessions on finding research, 75% were not confident in their capacity to evaluate professional literature, and locate pertinent research to address clinical concerns (62%). Conclusion: The Saudi physiotherapists have a generally positive attitude toward EBP and are interested in increasing its usage in their practices. However, their attention to literature was relatively low. They need for training sessions for using data base. The lack of time was the most important barrier to EBP.