Evidence-based Techniques Research Articles

Review of diagnosis and treatment of neonatal cardiorespiratory events

: Neonatal cardiorespiratory monitoring is universal in preterm infants. The major problem encountered in this population is apnea or hypoventilation, however, monitoring respiration via impedance fails to identify many episodes. Hence, we are dependent on heart rate and oxygen saturation to ensure safe practice. In recent years the potential consequences of hypoxemic events have generated considerable interest. This has resulted in renewed efforts to optimize management strategies focused primarily on ventilatory support and xanthine therapy. While continuous positive airway pressure (CPAP) remains the mainstay of non-invasive ventilatory support, nasal intermittent positive pressure ventilation (NIPPV) is widely used as an alternative to intubation. Optimizing oxygenation remains a key target and automated oxygen delivery of supplemental oxygen provides great promise. Caffeine therapy is the gold standard to enhance respiratory drive while less evidence-based techniques to stabilize and standardize respiratory control continue to be studied. The term infant, on the other hand, presents a less common, but unique, diagnostic dilemma and clinical judgment must dictate the magnitude of investigation.

Impacted fetal head: A retrospective cohort study of emergency caesarean section

ObjectiveTo investigate risk factors, management and outcomes of impacted fetal head (IFH) at caesarean section (CS). Study designThis is a retrospective cohort study of all women with singleton, cephalic pregnancies who had an emergency CS during one-year (2016) at North Bristol NHS Trust, UK (n = 838).The incidence of caesarean section at full dilatation (CSFD) and IFH were calculated using the annual birth rate. To identify risk factors for IFH, maternal, perinatal and intrapartum characteristics were compared according to the presence or absence of IFH, and separately for first- and second-stage CS. Techniques employed to disimpact the fetal head were described. Univariable and multivariable comparisons of maternal and perinatal outcomes were made between cases with and without an IFH. Characteristics and outcomes were compared using modified Poisson regression. ResultsCSFD accounted for 2.1 % of all births. IFH complicated 1.5 % of all births (11.3 % of emergency CS), with 55.8 % occurring prior to full cervical dilatation.Increased rates of IFH at CS were associated with: oxytocin augmentation (RR = 2.47 [1.61–3.80]), full cervical dilatation (RR = 4.24 [2.96–6.07], mid/low station (RR = 4.14 [2.72–6.32]), moulding (RR = 4.39 [2.55–7.54]) and caput (RR = 6.60 [3.09–14.10]). Junior operators documented IFH more than consultants (RR = 9.61 [1.35–68.2]).The strategies recorded for managing IFH included: tocolysis, reverse breech extraction and vaginal push up (33.7 %, 14.7 % and 11.6 % cases respectively) with two or more techniques used in 21.1 % cases.IFH at CS was independently associated with an increased risk of uterine extensions (RR = 3.09 [1.96–4.87]) and a composite adverse perinatal outcome (RR = 1.66 [1.21–2.28]). ConclusionsIFH is a common and heterogeneous complication associated with increased complications for both mother and baby, independent of those of CSFD. Obstetricians must remain vigilant to the possibility of IFH at all emergency CS, particularly those at full cervical dilatation or with evidence of obstructed labour. There is an urgent need for a standardised management algorithm and training in evidence-based disimpaction techniques.

Improving breast cancer nurses’ management of challenging situations involving family carers: Pilot evaluation of a brief targeted online education module (TRIO-Conflict)

ObjectiveGiven the stressful and emotional nature of cancer, challenging interactions between nurses, patients, and family frequently occur. Nurses are rarely equipped with strategies to avoid or de-escalate stressful situations with carers, which can include displays of conflict, anger, or dominance. A brief online education module (TRIO-Conflict) was developed to provide nurses with management strategies to use in situations of conflict. This study aimed to assess the feasibility, acceptability, and potential efficacy of TRIO-Conflict. MethodsNurses were recruited through an Australian breast cancer organisation (McGrath Foundation). Participants completed pre/post module measures of attitudes towards carers, confidence in their skills to effectively navigate challenging interactions with carers, and applied knowledge of management strategies. Data were analysed using Wilcoxon signed-rank tests. Qualitative feedback was analysed using content analysis. Results52 nurses completed pre-/post- measures, with 4 semi-structured interviews conducted. Significant improvements in attitudes towards carers (p = .010) and confidence in one’s own ability to manage challenging interactions with carers (p < .001) were found, but not knowledge of strategies. Most nurses found TRIO-Conflict very/extremely helpful (87%) and were satisfied with content (94%) and usability (93%). ConclusionTRIO-Conflict utilised evidence-based learning techniques (provision of example phrases, video vignettes, reflective exercises) to improve nurses attitudes and confidence. Practice ImplicationsTRIO-Conflict is a brief, targeted, clinically relevant, and easily accessible online training programme which could be widely disseminated to oncology nurses.

How to Manage the Large Nonpedunculated Colorectal Polyp

How to Manage the Large Nonpedunculated Colorectal Polyp

End-of-Life Care: Improving Communication and Reducing Stress.

This quality improvement initiative originated in the cardiac intensive care unit (CICU) at a 637-bed licensed Magnet teaching hospital with the rating of level 1 trauma center. The CICU has 12 beds, with a staff of 59 nurses (RNs). The nursing staff expressed increased stress and discomfort when communicating with patients and their families when providing end-of-life care. Selected evidence-based techniques for stress reduction and active listening skills were taught in 4- to 5-minute mini sessions during the morning huddle 3 days per week for 4 weeks. The program was evaluated using pretest, posttest, and 2 follow-up surveys composed of 5 statements and 2 open-ended questions. The survey tool was developed by researchers in accordance with the relevant literature. The results showed improved communication as demonstrated by the surveys. Nurses also reported feeling more supported by their colleagues and supervisors. The project was conducted in 1 CICU, therefore limiting the generalizability of the results.

A cost-effective approach to mitigate conflict between ranchers and large predators: A case study with jaguars in the Mayan Forest

Conflicts between humans and large carnivores are exacerbated in poor rural areas where people's livelihood depends on livestock ranching. Here we present a pseudo-experimental and co-participatory approach to test the effectiveness of a program to mitigate conflicts with jaguars (Panthera onca) in Mexico's Mayan Forest. We worked with eleven ranchers with a recent history of livestock predation by jaguars to codesign, implement, and evaluate changes in their husbandry practices intended to reduce the risk of predation and to increase livestock productivity. We used four parameters to evaluate the effectiveness of the program and found that (1) the use of electric fences and night enclosures greatly reduced the rate of predation on the livestock; (2) the cost of building such protection infrastructure was financially offset by the lack of losses to predation; (3) the application of more science-based husbandry practices led to an overall increase in livestock productivity; and (4) jaguar presence in at least seven of the eleven ranches, showing that the lack of predation was not due to jaguar absence. Our neat results show that conflict between local communities and large carnivores can be largely mitigated through ranchers' capacity building and applying evidence-based husbandry techniques. This approach leads to win-win situations for both jaguars and the local communities and hence can be scaled up to promote coexistence between people and large carnivores in the Mayan Forest and elsewhere.

Traumatic Brain Injury Update.

Traumatic brain injury is a devastating, life-changing event in most cases. After the primary brain insult, it is helpful to use evidence-based monitoring techniques to guide implementation of essential interventions to minimize secondary injury and thereby improve patient outcomes. An update on multimodal neuromonitoring is provided in this narrative review, with discussion of tools and techniques currently used in the treatment of patients with brain injury. Neuroprotective treatments, from the well-studied targeted temperature management to new potential therapeutics under investigation, such as glyburide, also are presented.

Hemostatic Strategies in Trauma.

Bleeding is a leading cause of early death from trauma. Consequently, effective hemostasis can improve the odds of survival after severe traumatic injury. Understanding the pathophysiology of trauma-induced coagulopathy can provide insights into effective strategies to assess and halt hemorrhage. Both physical assessment and appropriate laboratory studies are important in the diagnosis and evaluation of coagulopathy to identify the most effective mechanical and pharmacological strategies to achieve hemostasis. This article uses a case study approach to explore evidence-based techniques to evaluate hemorrhage and strategies to promote hemostasis.

Reducing bruising and pain through enhancement of subcutaneous anticoagulant injection techniques: a best practice implementation project.

Subcutaneous delivery of anticoagulant therapy is a common treatment modality across multiple medical disciplines. However, postinjection complications of bruising and pain continues to be a problem that has the propensity to affect patients physically and psychologically. A review of literature revealed a set of recommended injection techniques that have shown to improve these clinical outcomes. The project aims to utilize an evidence implementation framework to introduce evidence-based injection technique, for the reduction of postinjection complications. A best practice implementation project was administered across three adult- cardiology and cardio-thoracic general wards in Singapore from March 2018 to February 2019. The Joanna Briggs Institute (JBI)'s framework of evidence implementation was utilized to enable change. A baseline audit was carried out to ascertain existing injection practices. Guided by the latest evidence, a new subcutaneous injection workflow was created and disseminated. Follow-up audits were held at 1 and 8-month postimplementation to assess compliance to the new subcutaneous injection workflow and the sustainment of change. Data were consolidated and analysed with the aid of JBI Practical Application of Clinical Evidence System. Barriers to change were also identified and addressed with the aid of JBI's Getting Research into Practice tool. A large variation of subcutaneous injection techniques was observed at the baseline audit. At 1-month postimplementation, overall compliance with the new subcutaneous injection workflow was assessed to be 73.3%. Criteria 2 and 3 of the JBI Practical Application of Clinical Evidence System audit criteria improved from the baseline values (9.1-80%; 0-93.3%). At 8-month postimplementation, compliance rate remained high (83%) following strategies to reinforce and sustain change. Participants complied to Criteria 1 at all stages of the project. Correspondingly, the incidence of bruising reduced from baseline, with a relative risk reduction of 52% (1 month) and 29% (8 months). Median pain also decreased from the baseline, with an improvement from 2.0 (1.0-3.0) to 0.0 (0.0-1.0). Introduction and sustainment of change requires careful planning and execution. JBI's framework of evidence implementation is an effective model to guide this process. This project also highlighted the value of continuous learning, clinical update and practice standardization. This is especially important in the current climate of nursing mobility worldwide and the associated practice variations based on nursing education and experience.

Surgical Treatment for the Refractory Allergic Rhinitis: State of the Art

Nasal obstruction is a frequent disorder that interferes with the daily patient’s quality of life. The key element in the pathophysiology of the disorder is the inferior turbinate hypertrophy related to multiple conditions such as allergic rhinitis (AR). Many patients are managed using conventional drug therapies such as antihistamines, decongestants, and intranasal steroid sprays, anticholinergic agents, mast cell stabilizers, and desensitizing vaccines. When traditional therapy failed to relieve AR symptoms, surgical inferior turbinate reduction (ITR) is indicated. A vast variety of surgical techniques have been reported in the literature for AR such as resectioning, coagulating, and laser procedures. We aimed to revise all surgical options in AR management. We confirm that no ideal standard technique for turbinate reduction has been developed so far regarding the multitude of different surgical procedures. Furthermore, no prospective and comparable long-term studies are present in the literature; it is challenging to recommend evidence-based surgical techniques.

Biophilia beyond the Building: Applying the Tools of Urban Biodiversity Planning to Create Biophilic Cities

In response to the widely recognized negative impacts of urbanization on biodiversity, many cities are reimagining urban design to provide better biodiversity support. Some cities have developed urban biodiversity plans, primarily focused on improving biodiversity support and ecosystem function within the built environment through habitat restoration and other types of urban greening projects. The biophilic cities movement seeks to reframe nature as essential infrastructure for cities, seamlessly integrating city and nature to provide abundant, accessible nature for all residents and corresponding health and well-being outcomes. Urban biodiversity planning and biophilic cities have significant synergies in their goals and the means necessary to achieve them. In this paper, we identify three key ways by which the urban biodiversity planning process can support biophilic cities objectives: engaging the local community; identifying science-based, quantitative goals; and setting priorities for action. Urban biodiversity planning provides evidence-based guidance, tools, and techniques needed to design locally appropriate, pragmatic habitat enhancements that support biodiversity, ecological health, and human health and well-being. Developing these multi-functional, multi-benefit strategies that increase the abundance of biodiverse nature in cities has the potential at the same time to deepen and enrich our biophilic experience in daily life.

Current Nutrition Practice in Cardiac Rehabilitation Programs.

This study sought to determine current practice regarding nutrition care within cardiac rehabilitation (CR) programs, including perceived barriers and facilitators to providing nutrition care in this setting. A cross-sectional survey was conducted in October and November 2019. Potential participants were program coordinators, identified through the Australian Cardiovascular Health and Rehabilitation Association program directory and invited to participate via e-mail. Forty-nine respondents (response rate: 13%) are included in this analysis. Programs provided group (n = 42, 86%) and/or individual (n = 25, 51%) nutrition education, and most were supported by a dietitian (63%). However, the availability of dietitians and nutrition care provided at CR was variable. For example, individual education was consistently provided at 13 programs and usually by health professionals other than dietitians. Eight programs (16%) used a formal behavior change framework for nutrition care. Generally, respondents were positive about the role of nutrition; CR coordinators perceived nutrition as a valuable component of the program, and that they had good nutrition knowledge. An identified barrier was the financial resources available to support the provision of nutrition care. To ensure that patients receive the benefits of evidence-based nutrition care, program staff may require additional support, particularly regarding the use of evidence-based behavior change techniques. Key facilitators that may be leveraged to achieve this include the high value and priority that CR program coordinators place on nutrition care.

Evaluating the benefits of a rapport-based approach to investigative interviews: A training study with law enforcement investigators.

Objective: The purpose of this study was to test the effectiveness of a rapport-based approach to interviewing that includes productive questioning skills, conversational rapport, and relational rapport-building tactics. Hypotheses: We predicted that training police investigators in a rapport-based approach would significantly increase the use of rapport-based tactics and that such tactics would directly influence the interviewee's perceptions of rapport and indirectly lead to increased cooperation and disclosure of information. Method: We trained federal, state, and local law enforcement investigators (N = 67) in the use of evidence-based interviewing techniques. Both before and after this training, investigators interviewed semi cooperative subjects (N = 125). Interviews were coded for the use of various interview tactics, as well as subjects' disclosure. Participants also completed a questionnaire regarding their perceptions of the interviewer and their decision to cooperate with the interviewer. Results: Evaluations of the training were positive, with high ratings of learning, preparedness to use tactics, and likelihood of use following the training. In posttraining interviews, investigators significantly increased their use of evidence-based tactics, including productive questioning, conversational rapport, and relational rapport-building tactics. Structural equation modeling demonstrated that investigators' use of the evidence-based interview tactics was directly associated with increased perceptions of rapport and trust and indirectly associated with increased cooperation and information disclosure. Conclusions: We demonstrated that rapport-based interview tactics could be successfully trained and that using such tactics can facilitate perceptions of rapport and trust, reduce individuals' resistance to cooperate, and increase information yield. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Pharmacy Students’ Perception of an Elective Course on Evidence-based Learning Strategies

Objective. To examine pharmacy students' perceptions of an elective course on evidence-based learning strategies.Methods. Pre- and post-course survey questionnaires were administered to students who enrolled in an elective course, to determine the learning strategies they used prior to course attendance, track their use of evidence-based learning strategies and observance of healthy lifestyle habits, and assess their perception of the course. A written assignment was given that required students to reflect on the learning outcomes that resulted from their application of evidence-based learning strategies. Mean scores on the pre- and post-course survey were analyzed using a general linear model repeated measures test.Results. The 59 students in this study predominantly used less-effective strategies (eg, re-reading and re-writing of notes) prior to taking the course. They reported increased use of evidence-based learning strategies, particularly retrieval practice and elaboration, and practice of healthy lifestyle habits (ie, enough sleep, exercise, good nutrition) after course completion. Students believed that using the above learning strategies improved their learning and memory and performance on graded assessments, among other benefits. Students had a positive perception of the course.Conclusion. The elective course was associated with increased use of effective learning strategies, adoption of healthy lifestyle practices that aid learning, and increased appreciation for evidence-based learning strategies by the students. Future studies are needed to examine actual learning outcomes and barriers to implementation of evidence-based learning techniques.

Coexistence of osteoporosis, sarcopenia and obesity in community-dwelling adults – The Yishun Study

ObjectivesTo 1) report prevalence of ‘osteosarcopenia’ (OS) and osteosarcopenic obesity (OSO) entities using evidence-based diagnostic techniques and definitions, 2) examine if OSO offers additional predictive value of functional decline over its components, and 3) identify associated factors in a multi-racial Southeast Asian population. MethodsWe performed a cross-sectional study of a representative sample of 542 community-dwelling adults (21–90 years old), and assessed anthropometry, cognition, functional performance, and self-report sociodemographic, health and lifestyle questionnaires. Low muscle mass, and the Asian Working Group for Sarcopenia (AWGS) 2019 criteria, were used to assess sarcopenia. Obesity was defined using percentage body fat and fat mass index. Osteopenia/osteoporosis was determined using lumbar spinal bone mineral density. Associated factors were examined using logistic regression, and OSO’s value investigated using linear regressions with functional performance. ResultsOS and OSO prevalence were 1.8% and 0% (21–59 years), 12.9% and 2.8% (≥ 60 years), 17.3% and 4.1% (≥ 65 years), and 25.5% and 7.0% (≥75 years), respectively. OSO entity as defined was not a significant predictor (P > 0.05) and did not improve explanations for functional decline over sarcopenia or sarcopenic obesity. Age, sex, race and body mass index (BMI) were associated with OS, while age, sex, race and alcoholism were associated with OSO. ConclusionsOur results do not support OSO as a distinct entity in relation to functional decline. Aside from biological age, sex, and race, amenable lifestyle factors such as BMI and alcohol intake are important variables that can influence the co-existence of osteopenia/osteoporosis, sarcopenia and obesity.

Subluxed Shoulders Need “TLC”: A Pilot Study of T-L-C Elastic Taping to Address Hemiplegic Shoulder Pain, Passive Range of Motion, and Sub-luxation

Shoulder subluxation, abnormal tone, and hemiplegic shoulder pain are common sequelae for patients with neurological conditions. Therapists have used elastic taping to treat these consequential conditions in rehabilitation settings with inconsistent techniques and results. The use of elastic tape to treat shoulder subluxation, abnormal tone, and hemiplegic shoulder pain may result in increased participation in activities of daily living and functional activities; however, evidence-based approaches to guide taping are still emerging. An elastic taping method called the "T-L-C" method has been developed to establish a consistent approach for the assessment and taping to ensure patients are being treated with evidence-based techniques.

It's what's under the hood that counts: comparing therapeutic outcomes when using Australian versus UK-produced clinical materials in an Australian mental health program.

Objective MindStep™ is an Australian low-intensity cognitive behaviour therapy (LICBT) program for individuals with mild-to-moderate symptoms of anxiety and depression. UK-produced LICBT guided self-help (GSH) materials were originally used in the MindStep™ program. In 2017, Australian LICBT GSH materials were developed to better suit Australian users. This study explored whether the Australian-produced materials continued to achieve the benchmark recovery rates established in the UK and maintained in recent Australian studies. Methods Binomial logistic regression was conducted using retrospective client data, including the Patient Health Questionnaire-9 and the Generalised Anxiety Disorder 7-item scale, between 2016 and 2019. Results During time periods in which the Australian-produced materials were used, equivalent rates of reliable recovery and improvement were achieved compared with time periods in which the UK-produced materials were used. Australian-trained LICBT coaches, using Australian-produced LICBT GSH materials, achieve client recovery rates of up to 60%, reliable improvement rates of 58% and reliable recovery rates of 46% (with the probability of recovery increasing with client age). Conclusions These findings are particularly pertinent with COVID-19 changing the landscape of mental health service delivery, requiring greater flexibility in the use of teleservices to ensure access to effective mental health care for populations that may already experience problems with isolation, access and service engagement. What is known about the topic? LICBT is an acceptable, feasible and effective treatment approach for people experiencing mild-to-moderate anxiety and depression in Australia. LICBT GSH materials used with clients in Australia originated from the UK. However, according to guidelines, LICBT GSH materials should be contextualised to suit the audience they are being used with. What does this paper add? This paper demonstrates that LICBT GSH materials tailored to an Australian context can be used in place of UK-produced materials because they yield equivalent and consistent therapeutic outcomes. Although contextualising the LICBT GSH materials for health services users was important, it is likely that the evidence-based cognitive behaviour therapy techniques sitting 'under the hood' of these materials are most important to ensure successful therapeutic outcomes. What are the implications for practitioners? As we face unprecedented challenges following 2020, the physical, social, psychological and economic impacts of life-changing events must not inhibit access to treatments for common mental health conditions. It is anticipated that more non-traditional, alternative providers of mental health services will be needed to scale-up and respond to increasing demand. This paper shows that the provision of telephone-based LICBT in Australia, by trained coaches using Australian-produced GSH materials, is an evidenced-based support pathway that can reduce the access gap to treatments.

Top 20 Evidence-based Humor Techniques for Online Teaching: Building on a Half-century of Research and Practice

The COVID-19 pandemic upended higher education in March 2020 and has continued into 2022. Within days of the international lockdowns, an emergency conversion from face-to-face (F2F) to remote learning occurred. Educators scrambled to convert their in-class teaching into some version of online teaching. The transformations ignited a surge in e-learning platforms. Combining PowerPoint (PPT) or Keynote with those platforms enabled several forms of humor to be presented by any professor in online teaching. The research evidence on the educational benefits of humor is reviewed. The top 20 humor techniques initially tested in F2F classrooms are adapted to hybrid, hyflex, synchronous, and asynchronous delivery. Faculty have the opportunity to change their teaching back to F2F or adopt some form of online. That will involve a new teaching playbook. The intentional use of humor in F2F and online teaching will add value to their students’ academic experiences with restorative and therapeutic effects in addition to all of the instructional benefits. The humor can be a game-changer in their pandemic teaching and after COVID-19.

Engagement with smartphone-delivered behavioural activation interventions: a study of the MoodMission smartphone application.

Despite increased research interest in smartphone mental health applications (MHapps), few studies have examined user engagement and its determinants. MoodMission is a MHapp that targets low mood and anxiety via evidence-based techniques including behavioural activation (BA). The present study aimed to investigate (i) whether BA interventions delivered with visual psychoeducation had greater engagement than BA interventions delivered with solely written psychoeducation, (ii) whether BA interventions targeting mastery would have greater engagement than those targeting pleasure, and (iii) the relationship between level of engagement and MHapp benefit. Participants downloaded MoodMission and completed activities and within-app evaluations over a 30-day period. Data from 238 MoodMission users were analysed via multi-level modelling and linear regression. The average number of app-based activities completed was 5.46 and the average self-reported engagement level was in the low to moderate range. As hypothesized, higher levels of engagement significantly predicted more positive activity appraisal. The results suggest that BA technique beliefs are involved in MHapp engagement and future research examining user appraisals of techniques is warranted.

Practice Patterns of Speech-Language Pathologists Managing Dysphagia in Dementia: A Cross-Sectional Survey in the United States

PurposeThe purpose of this study was to describe the practice patterns of speech-language pathologists (SLPs) managing dysphagia in persons with dementia (PWD) in the United States. We wanted to investigate if clinicians are (a) adequately prepared to manage dysphagia in PWD, (b) confident in their ability to manage dysphagia in PWD, (c) performing comprehensive dysphagia assessments in PWD, and (d) using evidence-based techniques to manage dysphagia in PWD.MethodA web-based survey comprising 32 questions was developed, field-tested, and distributed to members of the American Speech-Language-Hearing Association's Special Interest Groups 13 and 15, as well as members of online SLP forums. Two hundred fifty-one responses were obtained and analyzed using descriptive methods.ResultsRespondents were experienced SLPs working primarily in acute care and skilled nursing facility settings. Their confidence in assessment and treatment was found to significantly increase with years of experience (p&lt; .001). The majority indicated more continuing education opportunities need to be offered related to managing dysphagia in PWD. Most reported using assessments that have not been validated for PWD. Clinical swallow examinations were utilized more frequently than instrumental exams to inform treatment planning. There was variability in the treatment techniques used to manage dysphagia in PWD, with a focus on use of compensatory strategies and providing caregiver training. Respondents listed several barriers to managing dysphagia in PWD and stated influences on their clinical decision making.ConclusionsWhile some trends emerged regarding dysphagia practice patterns among SLPs managing PWD in the United States, a lack of consensus regarding best practices was apparent. The establishment of formal diagnostic standards, the elucidation of the underlying mechanisms of different types of dementia, and the development of evidence-based treatments for managing dysphagia in PWD could help improve SLP management of dysphagia in dementia and reduce the significant burden of this disease.