Evidence For Best Practice Research Articles

Infection prevention and control of Clostridium difficile: a global review of guidelines, strategies, and recommendations.

BackgroundClostridium difficile is the leading cause of health care–associated infections. Given the high incidence of C. difficile infection (CDI) and the lack of primary prevention through immunization, health care professionals should be aware of the most current guidance, as well as strengths and limitations of the evidence base underpinning this guidance.MethodsWe identified publicly available national or organizational guidelines related to CDI infection and prevention control (IPC) published between 2000 and 2015 and for any health care setting through an internet search using the Google search engine. We reviewed CDI–targeted IPC recommendations and describe the assessment of evidence in available guidelines.ResultsWe identified documents from 28 countries/territories, mainly from acute care hospitals in North America, the Western Pacific, and Europe (18 countries). We identified only a few specific recommendations for long–term care facilities (LTCFs) and from countries in South America (Uruguay and Chile), South East Asia (Thailand), and none for Africa or Eastern Mediterranean. Of 10 IPC areas, antimicrobial stewardship was universally recognized as essential and supported by high quality evidence. Five other widely reported “strong” recommendations were: effective environment cleaning (including medical equipment), case isolation, use of personal protective equipment, surveillance, and education. Several unresolved and emerging issues were documented and currently available evidence was classified mainly as of mixed quality.ConclusionOur review underlines the need for targeted CDI IPC guidelines in several countries and for LTCFs. International harmonisation on the assessment of the evidence for best practices is needed as well as more robust evidence to support targeted recommendations.

Evidence and/or Experience-Based Knowledge in Lifestyle Treatment of Patients Diagnosed as Obese?

Proceeding from a phenomenological perspective, this study investigates how physiotherapists’ experience-based knowledge acquires significance in their encounters with patients diagnosed as obese. Presenting the thematic accounts of three physiotherapists, this paper illuminates how they make use of experiences from both their own life as well as experiences from learning and doing physiotherapy. This multifaceted experience-based knowledge is significant for making individual adjustments in a group-based programme. In line with these findings, the authors question whether the therapeutic method itself can be given such a prime position in defining best evidence in evidence-based practice. In concluding, they call for a re-consideration of the term evidence. More precisely, it is argued that what will be “effective” therapy for a person diagnosed as obese cannot be reduced to external evidence.

New apheresis indications in hematological disorders.

Therapeutic apheresis can be used to treat many diseases. The American Society for Apheresis (ASFA) publishes Guidelines on the use of therapeutic apheresis every 3 years with the goal of providing the best available evidence for apheresis practice as well as clinical expertise. The 2016 (7th ed.) ASFA Guidelines contain 87 diseases (up from 78 in the 6th ed.) and 179 indications. This review outlines three new therapeutic apheresis indications for hematological disorders. The three new nonmalignant and nontransplant-related hematological disorders discussed are therapeutic plasma exchange procedures for hemophagocytic syndrome, hemolysis, elevated liver enzymes, and low platelets syndrome, and red blood cell exchange to prevent alloimmunization after exposure to rhesus (D)-positive red blood cells. All three indications are ASFA category III indications (i.e., optimal role of apheresis therapy is not established) with Grade 2C recommendation (weak recommendation, low-quality evidence). Although the three new therapeutic apheresis indications related to hematological disorders are ASFA category III with Grade 2C recommendations, along with other ASFA category III with Grade 2C recommendations, they may form the list of diseases for which basic, translational, and clinical research is needed to provide better evidence for clinical practice.

Consensus Recommendations for Combined Aesthetic Interventions Using Botulinum Toxin, Fillers, and Microfocused Ultrasound in the Neck, Décolletage, Hands, and Other Areas of the Body.

The popularity of aesthetic procedures in the face has led to greater disparity between treated areas and those that still show evidence of true age. Although many areas of the body often require multiple treatment procedures for optimal rejuvenation, combination therapy for specific areas is not yet well defined. To develop recommendations for the optimal combination and ideal sequence of botulinum toxin (BoNT), hyaluronic acid, calcium hydroxylapatite (CaHA), and microfocused ultrasound with visualization in nonfacial areas across all skin phototypes. Fifteen specialists convened under the guidance of a certified moderator. Consensus was defined as approval from 75% to 94% of all participants, whereas agreement of ≥95% denoted a strong consensus. Recommendations have been provided for the neck, décolletage, and hands and include the timing and sequence of specific procedures when used concurrently or over several treatment sessions. Position statements are offered in lieu of consensus for the upper arms, abdomen, buttocks, and knees. Nonfacial rejuvenation often requires multiple procedures for optimal results in individuals with significant age-related changes. Further clinical studies are recommended to raise awareness of non-facial indications and provide clinicians with the best evidence for best treatment practices.

MRSA Transmission in the Neonatal Intensive Care Unit

Methicillin-resistant Staphylococcus aureus colonization is a growing concern among Neonatal Intensive Care Units as it is a known risk factor for developing MRSA infection (Geva et al., 2011). Because of this risk, interventions are needed to prevent transmission to non-infected patients. This paper examines and discusses the best evidence of clinical practice to prevent the spread of Methicillin-resistant Staphylococcus aureus colonization in the Neonatal Intensive Care Unit and the risks associated with Methicillin-resistant Staphylococcus aureus infection. Additionally, this paper identifies inconsistencies and barriers with policies developed used to reduce Methicillin-resistant Staphylococcus aureus transmission in different Neonatal Intensive Care Units, while identifying the evidence for best practice without causing neonatal harm.

Improving palliative care in selected settings in England using quality indicators: a realist evaluation

BackgroundThere is a gap between readily available evidence of best practice and its use in everyday palliative care. The IMPACT study evaluated the potential of facilitated use of Quality Indicators as tools to improve palliative care in different settings in England.Methods1) Modelling palliative care services and selecting a set of Quality Indicators to form the core of an intervention, 2) Case studies of intervention using the Quality Indicator set supported by an expert in service change in selected settings (general practice, community palliative care teams, care homes, hospital wards, in-patient hospices) with a before-and-after evaluation, and 3) realist evaluation of processes and outcomes across settings. Participants in each setting were supported to identify no more than three Quality Indicators to work on over an eight-month period in 2013/2014.ResultsGeneral practices could not be recruited to the study. Care homes were recruited but not retained. Hospital wards were recruited and retained, and using the Quality Indicator (QI) set achieved some of their desired changes. Hospices and community palliative care teams were able to use the QI set to achieve almost all their desired changes, and develop plans for quality improvements. Improvements included: increasing the utility of electronic medical records, writing a manual for end of life care, establishing working relationships with a hospice; standardising information transfer between settings, holding regular multi-disciplinary team meetings, exploration of family carers’ views and experiences; developing referral criteria, and improvement of information transfer at patient discharge to home or to hospital.Realist evaluation suggested that: 1) uptake and use of QIs are determined by organisational orientation towards continuous improvement; 2) the perceived value of a QI package was not powerful enough for GPs and care homes to commit to or sustain involvement; 3) the QI set may have been to narrow in focus, or more specialist than generalist; and 4) the greater the settings’ ‘top-down’ engagement with this change project, the more problematic was its implementation.ConclusionsWhilst use of QIs may facilitate improvements in specialist palliative care services, different QI sets may be needed for generalist care settings.Electronic supplementary materialThe online version of this article (doi:10.1186/s12904-016-0144-1) contains supplementary material, which is available to authorized users.

An overview of antithrombotics in ischemic stroke.

The use of antithrombotic medications is an important component of ischemic stroke treatment and prevention. This article reviews the evidence for best practices for antithrombotic use in stroke with focused discussion on the specific agents used to treat and prevent stroke.

Preconception to postpartum care: the need to maximise the safety of women with epilepsy

Despite advancement in national epilepsy guidelines, which include key recommendations based on evidence for best clinical practice, for women in pregnancy epilepsy continues to be one of the main contributors to maternal mortality; sudden unexpected death in epilepsy (SUDEP) being the major cause. Women with epilepsy need to be counselled about the use of contraception, the need to plan a pregnancy from time of diagnosis, and these issues need to be revisited by health professionals regularly during contact in clinical practice. This article reviews updated national epilepsy guidelines and literature and highlights what constitutes as good clinical practice in the management of women with epilepsy, and what we should be informing women in order to maximise their safety preconception, during pregnancy, labour, and in the postpartum period.

Identifying and assessing the risk of opioid abuse in patients with cancer: an integrative review

BackgroundThe misuse and abuse of opioid medications in many developed nations is a health crisis, leading to increased health-system utilization, emergency department visits, and overdose deaths. There are also increasing concerns about opioid abuse and diversion in patients with cancer, even at the end of life.AimsTo evaluate the current literature on opioid misuse and abuse, and more specifically the identification and assessment of opioid-abuse risk in patients with cancer. Our secondary aim is to offer the most current evidence of best clinical practice and suggest future directions for research.Materials and methodsOur integrative review included a literature search using the key terms “identification and assessment of opioid abuse in cancer”, “advanced cancer and opioid abuse”, “hospice and opioid abuse”, and “palliative care and opioid abuse”. PubMed, PsycInfo, and Embase were supplemented by a manual search.ResultsWe found 691 articles and eliminated 657, because they were predominantly non cancer populations or specifically excluded cancer patients. A total of 34 articles met our criteria, including case studies, case series, retrospective observational studies, and narrative reviews. The studies were categorized into screening questionnaires for opioid abuse or alcohol, urine drug screens to identify opioid misuse or abuse, prescription drug-monitoring programs, and the use of universal precautions.ConclusionScreening questionnaires and urine drug screens indicated at least one in five patients with cancer may be at risk of opioid-use disorder. Several studies demonstrated associations between high-risk patients and clinical outcomes, such as aberrant behavior, prolonged opioid use, higher morphine-equivalent daily dose, greater health care utilization, and symptom burden.

Promoting Awareness of Key Resources for Evidence-Informed Decision-making in Public Health: An Evaluation of a Webinar Series about Knowledge Translation Methods and Tools.

The National Collaborating Centre for Methods and Tools (NCCMT) has developed several resources to support evidence-informed decision-making – the process of distilling and disseminating best available evidence from research, context, and experience – and knowledge translation, applying best evidence in practice. One such resource, the Registry of Methods and Tools, is a free online database of 195 methods and tools to support knowledge translation. Building on the identification of webinars as a strategy to improve the dissemination of information, NCCMT launched the Spotlight on Knowledge Translation Methods and Tools webinar series in 2012 to promote awareness and use of the Registry. To inform continued implementation of this webinar series, NCCMT conducted an evaluation of the series’ potential to improve awareness and use of the methods/tools within the Registry, as well as identify areas for improvement and “what worked.” For this evaluation, the following data were analyzed: electronic follow-up surveys administered immediately following each webinar; an additional electronic survey administered 6 months after two webinars; and Google Analytics for each webinar. As of November 2015, there have been 22 webinars conducted, reaching 2048 people in multiple sectors across Canada and around the world. Evaluation results indicate that the webinars increase awareness about the Registry and stimulate use of the methods/tools. Although webinar attendees were significantly less likely to have used the methods/tools 6 months after webinars, this may be attributed to the lack of an identified opportunity in their work to use the method/tool. Despite technological challenges and requests for further examples of how the methods/tools have been used, there is overwhelming positive feedback that the format, presenters, content, and interaction across webinars “worked.” This evaluation supports that webinars are a valuable strategy for increasing awareness and stimulating use of resources for evidence-informed decision-making and knowledge translation in public health practice.

Youth Gambling Behavior: Novel Approaches to Prevention and Intervention

While gambling has been traditionally viewed as an adult activity there has been a growing body of research suggesting its popularity amongst adolescents. Despite findings that suggest that most youth gamble in a relatively responsible manner and have few negative gambling-related behaviors there is strong evidence that they constitute a vulnerable group for gambling disorders. The current paper addresses our current knowledge concerning the prevention of youth gambling problems and provides new potential strategies for helping young individuals experiencing a gambling disorder. While the research lacks strong evidence for best practices, a number of novel approaches to the prevention and treatment of gambling disorders for youth are discussed.

Implementing and Sustaining Evidence Based Practice Through a Nursing Journal Club

BackgroundThe outcomes based emphasis in nursing and health care delivery requires identification of best available evidence in order to produce quality, safe, and effective patient care. Finding, critiquing, and ultimately implementing the best available evidence for practice is a formidable task for many clinical nurses. Development and implementation of a nursing journal club (NJC) became one organization's successful attempt to help clinical nurses better understand and use best available evidence in actual practice. MethodsThe process and structure for the NJC evolved from an additional activity scheduled outside of work to a fully established endeavor of Nursing Research and Evidence Based Practice Council (NR&EBP). The Nursing Professional Practice Model was foundational to establishing the NJC as a formal component within the NR&EBP Council shared governance structure. Efforts to embed the NJC included taking advantage of resources available at an academic medical center and incorporating them into the council structure. ResultsSuccessful outcomes of the NJC include a quarterly schedule, with topics selected in advance that are based on nursing department as well as organizational driven goals and initiatives. The structure and process in place has eliminated frequently mentioned deterrents to evidence based practice such as not enough time, lack of knowledge, or no immediate application to practice. ConclusionsIncorporating the NJC as a component of NR&EBP Council has provided clinical nurses time away from clinical care that supports scholarship for nursing practice. Committed leadership and garnering of available resources have been key factors for success.

1MDB: The Background

The 1MDB stands for 1Malaysia Development Berhad. It is a company formed in 2009 by the federal government of Malaysia. 1MDB had become such a problem for many by late 2014. And today a year later the sad and debilitating saga continues unabated. The case of the 1MDB should be of a particular interest for students and scholars of auditing, accounting and corporate governance since it involves the following: the alleged disappearance of a huge amount of company’s funds; the apparent hiding of significant amount of real losses year after year with the accounting of paper profits originated from repeated fair revaluations of properties or other assets; the possibility of repeated cases of audit failure; the probe conducted by various parties locally which include the Office of the Auditor General; and, the lack of evidence of best practices in corporate governance being implemented since its formation. Each of these five areas of concern is laid bare in a series of five case studies where the materials come mainly from three news portals which are based inside the country: MalaysiaKini, The Malaysian Insider and Free Malaysia Today. All the published materials of concern are dated up to the end of June 2015. It is also notable that following the completion of these case studies, the work on another series of case studies shall be embarked upon. The new series shall give focus upon what has taken place since early July 2015. The intention behind the writing of these cases is to have them used in classroom discussions to help towards the emergence ofMalaysia tomorrow that so many inside the country has embarked upon so that history is given as little chance as possible in repeating itself!

Analysis of Work-related Injuries among Health Care Workers in Armed Forces Hospital Southern Region, Kingdom of Saudi Arabia

Introduction: Safety of healthcare workers (HCWs) is essential for patients safety. Despite of this fact, HCWs are at high risk of work-related injuries (WRI). Those injuries include falls, musculoskeletal disorders, needle stick injuries (NSIs) and workplace violence. These injuries have a negative impact on HCWs and reduces the quality of care. It is, therefore, important to analyze the occurrence of WRIs aiming the design of better targeted interventions to improve safety environment and work conditions in hospitals, which in turn, can improve the quality and outcomes of patient care. Methods: A retrospective study collected data about WRI reports available in the Armed Forces Hospital Southern Region (AFHSR). Injuries were NSIs that occurred during the period from January 2010 to June 2015 and workplace violence during the period from March 2014 to June 2015. Results: Total NSIs were 338 with a peak incidence of 85 (4.39%) during 2010, while the lowest incidence occurred during 2015 (n= 31, 1.12%). Regarding to workplace violence, 211 incidents Original Research Article Awaji and Alahmary; BJMMR, 15(4): 1-10, 2016; Article no.BJMMR.25056 2 were reported over the period of two years, and there was decreasing from 125 cases (4.73%) in 2014 to 86 cases (3.11%) in 2015. Discussion: The analysis showed that nurses had the highest rate of NSIs and workplace violence as compared to other HCWs. The highest rate of NSIs took place in dental, family and community medicine clinics which are usually crowded and had more activities, but emergency room and other clinics had the highest frequency of workplace violence. Conclusion: Needle stick injuries and workplace violence represent a major occupational challenge to HCWs in the hospital. To prevent those types of WRIs, there is a need for a system of environmental safety, continuous education, skills development, and infection control surveillance that is based on best available evidence of quality and safety best practices.

Malignant Biliary Obstruction: Evidence for Best Practice.

What should be done next? Is the stricture benign? Is it resectable? Should I place a stent? Which one? These are some of the questions one ponders when dealing with biliary strictures. In resectable cases, ongoing questions remain as to whether the biliary tree should be drained prior to surgery. In palliative cases, the relief of obstruction remains the main goal. Options for palliative therapy include surgical bypass, percutaneous drainage, and stenting or endoscopic stenting (transpapillary or via an endoscopic ultrasound approach). This review gathers scientific foundations behind these interventions. For operable cases, preoperative biliary drainage should not be performed unless there is evidence of cholangitis, there is delay in surgical intervention, or intense jaundice is present. For inoperable cases, transpapillary stenting after sphincterotomy is preferable over percutaneous drainage. The use of plastic stents (PS) has no benefit over Self-Expandable Metallic Stents (SEMS). In case transpapillary drainage is not possible, Endoscopic Ultrasonography- (EUS-) guided drainage is still an option over percutaneous means. There is no significant difference between the types of SEMS and its indication should be individualized.

Management dilemma of hepatocellular carcinoma in pregnancy: a case report

Hepatocellular carcinoma is rarely associated with pregnancy and when it does there is poor prognosis for both the mother and the baby.There is paucity of evidence for best practice in hepatocellular carcinoma in pregnancy especially in the background of cirrhosis and decompensation. We present a 36 year old gravida 5 para 4 at 27 weeks gestation with hepatocellular carcinoma and main complaint of abdominal pain. She had chronic hepatitis B infection with hepatocellular carcinoma on a cirrhotic background. There were both clinical and laboratory features suggestive of liver decompensation. The pregnancy outcome was a fresh stillbirth with mother alive. This case report highlights the management dilemma of hepatocellular carcinoma in pregnancy on the background of decompensated liver cirrhosis and chronic hepatitis B infection.

Interventional options for the management of refractory cancer pain--what is the evidence?

Pain is the most common symptom in cancer patients. Standard pain treatment according to the WHO three-step analgesic ladder provides effective pain management in approximately 70-90% of cancer patients. Refractory pain is defined as not responding to "standard" treatments. Interventional analgesic techniques can be used in an attempt to control refractory pain in patients in whom conventional analgesic strategies fail to provide effective pain relief or are intolerable due to severe adverse effects. This systematic review aims to provide the latest evidence on interventional refractory pain management in cancer patients. Systematic literature search in Cochrane, EMBASE and PubMed including reviews and randomised controlled trials (RCTs) and non-randomised controlled trials in the absence of reviews. Neuraxial analgesia may play a role in refractory cancer pain management. Paravertebral blocks decrease the incidence of persistent post-surgical pain after breast cancer. Coeliac plexus blocks improve pain scores in refractory pancreatic cancer pain for up to 4 weeks after the intervention with fewer burdensome side effects as compared to opioids. Cordotomy has mainly been studied in mesothelioma, and the case series suggest possible benefit for pain at the expense of a relatively high risk of side effects. Overall, very few RCTs have been conducted on interventional pain techniques. In reality, it is very difficult to undertake large controlled trials for a number of reasons. Therefore, today's best evidence for practice may be from large case series of comparable patients with careful response and toxicity evaluation and follow-up.

8.G. Oral presentations: Evidence of best public health practice

8.G. Oral presentations: Evidence of best public health practice

Abstract A20: What's in the cancer biology part of Community Health Worker Curricula: A systematic review

Abstract Background: Disparities in cancer treatment and outcomes mirror socio-economical, racial, ethnic, and educational backgrounds. An important approach for closing health disparities is increasing scientific and health cancer literacy in the community. This can be achieved by Community Health Workers (CHWs). CHWs are thus at the frontline of our efforts to close these health care gap. However, the current status of a standardized cancer-biology training module for CHWs is unknown. Hypothesis: If we can identify the material covered in the cancer-biology portion of published CHW training curricula, then a standardized cancer-biology module can be developed based on evidence of best practices and recommendations. Methods: A comprehensive search of the published literature on training of CHWs using Pubmed and following the guidelines established by the Cochrane Collaboration systematic review process was performed. Methods for completing this systematic review included identification of a topic; selection of articles based on specialized criteria; design and implementation of a data extraction form; and systematic data synthesis and appraisal from the selected articles to diminish bias. Results: Using this methodology, 49 articles were selected from an initial Pubmed search that yielded 228 literature entries using “Cancer Education Curriculum Community Health Workers” as search criteria. Using this strategy, we will produce a systematic and comprehensive review of the science behind cancer training portion of published CHW curriculum in the U.S. This approach will aid in improving CHW training. Citation Format: Nicole Offer, Kierstyn Jeffries, Danyell S. Wilson. What's in the cancer biology part of Community Health Worker Curricula: A systematic review. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr A20.

Hospital-based education support for students with chronic health conditions

Objective To examine the evidence for best practice in educational support to hospitalised students and describe the existing supports available across each Australian state and territory. Methods A descriptive approach to the diversity of current practice and a review of the published evidence for best practice. Results We have constructed a model of best-practice in education support to hospitalised students. We found that education support services in each state met some of the criteria for best practice, but no one state service met all of the criteria. Conclusions All Australian states and territories make provision for hospitalised students to continue with their education, however the services in some states are closer to the best-practice model than others. What is known about the topic? It is well known that children and young people living with health conditions are at higher risk of educational underachievement and premature disengagement from school than their healthy peers. Although each state and territory across Australia offers some form of educational support to students during periods of hospitalisation, this support differs widely in each jurisdiction in fundamentals such as which students are eligible for support, where the support is delivered, how it is delivered and who coordinates the support. Published evidence in the literature suggests that the elements of good practice in education support have been well identified but, in practice, lack of policy direction can hinder the implementation of coordinated support. What does this paper add? This paper draws together the different models in place to support students in hospital in each state and territory and identifies the common issues that are faced by hospital education support services, as well as identifying areas where practice differs across settings. It also identifies the elements of good practice from the literature and links the elements of theory and practice to present a model of education support that addresses the needs of students with health conditions in an integrated and child-centred way. What are the implications for practitioners? Education support has developed over many decades in a variety of different forms across the states and territories of Australia. This paper brings together for the first time the published evidence for good practice in this area with existing models of practice to identify ways in which both healthcare professionals and education professionals can work together to improve the health, well being and education of children and young people living with health conditions.