Evidence-based Practice Research Articles

O CUIDADO DA ENFERMAGEM AO PORTADOR DA ANEMIA EM UNIDADE DE TERAPIA INTENSIVA.

The study on nursing care for patients with iron-deficiency anemia in the ICU underscores the relevance of this common and potentially serious condition, caused by insufficient iron levels in the body. This deficiency hampers hemoglobin production, resulting in symptoms such as fatigue, weakness, and difficulty concentrating. Factors such as blood loss, dietary iron deficiency, and underlying conditions contribute to the development of iron-deficiency anemia, especially in critically ill patients in the ICU. The research reviewed biochemical data for anemia in the ICU and highlighted the importance of nursing care in this context. Increased oxygen demand due to physiological stress can exacerbate symptoms of iron-deficiency anemia in critically ill patients, leading to severe complications and prolonged hospitalization. The literature review addressed the methodology used to identify best care practices, including searching electronic databases and analyzing institutional protocols. The discussion of results underscored the severity of iron-deficiency anemia in the ICU, emphasizing the need for effective interventions to improve clinical outcomes. The results and discussions highlighted the crucial role of nursing in caring for patients with iron-deficiency anemia in the ICU. From early symptom detection to appropriate treatment administration, the nursing team plays a crucial role in patient recovery. Challenges such as constant monitoring, iron supplementation administration, and blood transfusions were discussed, emphasizing the need for continuous education and specialized training of the healthcare team. Finally, the concluding remarks emphasized the importance of a coordinated and continuous approach in managing iron-deficiency anemia in the ICU. The implementation of evidence-based practices, along with continuous team training, is essential for providing high-quality care and improving outcomes for patients.

Enhancing academic and professional literacy in Swedish specialist nurse and other professional education programmes: a teacher’s perspective

This opinion piece focuses on the vital integration of academic and professional literacies in specialist nurse education and other professional education programmes within higher education in Sweden. In this opinion piece, we argue that extended learning, practise, and support can enhance the academic and professional literacy competence of specialist nurse students and other students in professional educations. To offer student specific and targeted support, educators, researchers, and policymakers can engage in collaboration, as well as inspire and empower their teachers through ongoing professional development. We also argue that the relationship between these two literacies should be highlighted in higher education to clarify the importance of academic skills within specialist nursing and other professions. We therefore suggest higher education could be more active in implementing and visualising intended learning outcomes with progression and learning activities regarding academic literacy as well as professional literacy curricula in professional educations. This approach, with an emphasis on systematic monitoring and research, ensures proficiency in effective communication, evidence-based practice, ethical responsibility, continuous learning, and quality assurance.

Hybrid, blended, and hyflex learning as future models for education

The education system continuously adapts to address abnormal social fluctuations such as pandemic lockdowns, climate change, disasters, and social distractions during war, migration, and more. Remote learning methods have advantages and disadvantages, a topic of discussion among many educators. Education is a critical part of society, ensuring the well-being of humanity. Future models for education refer to potential changes and advancements in the structure, delivery, and access to education. This includes innovations in teaching methods, learning environments, technology integration, and overall educational systems. Future models for education may involve the adoption of new teaching strategies and approaches that cater to diverse learning styles and preferences. This could include personalized learning, project-based learning, and flipped classrooms, aiming to enhance student engagement, critical thinking skills, and knowledge retention. The future of education may shift towards more dynamic and interactive learning environments, which can involve the use of virtual reality, augmented reality, gamification, and immersive simulations to create attractive educational experiences. Education in the future might incorporate innovative technology as a crucial component of the learning process, the use of artificial intelligence, adaptive learning platforms, online collaboration, and digital e-learning resources for content distribution. Technology integration targets to make education more accessible and flexible to individual student needs. Research plays a crucial role in shaping the future of education by notifying evidence-based practices and guiding decision-making processes. The article is a short review that discusses and analyses the differences and preferences between remote digital methods applying during COVID-19 restrictions.

Updates on Caries Risk Assessment-A Literature Review.

This narrative review aims to provide an update on caries risk assessment (CRA) and the available CRA tools. CRA can be used to monitor the status of oral care, as well as for documentation and research purposes. Caries risk is determined by the interplay of risk and protective factors. Common risk factors include suboptimal oral hygiene practices, previous caries experience, low plaque acidity, frequent snacking, cariogenic diet, enamel defects, reduced salivary flow, polypharmacy, and radiotherapy experience. Caries risk can be reduced through some preventive measures, such as the use of fluoride, gum chewing, dental sealants. The CRA process can be categorized as single or multifactor tools. Single-factor CRA tools include diet analysis questionnaires, cariogenic bacteria testing and saliva testing kits, whereas multifactor CRA tools encompass Caries Management by Risk Assessment (CAMBRA), Cariogram, and PreViser. Some CRA tools may quantify risk and protective factors to compute caries risk. Additionally, they can generate visual and educational presentations that foster success in oral care. Clinicians consider CRA beneficial for developing personalized care plans. However, the literature fails to reflect this and reveals limited studies supporting its use as evidence-based practice for caries management.

Project Lifeline-II: Feasibility of Implementing Screening, Brief Intervention, and Referral to Treatment (SBIRT) in Allegheny County, Pennsylvania.

US community pharmacies are a unique and underused health service setting for identifying and potentially intervening with patients at risk of opioid overdose or opioid use disorder with evidence-based practices such as screening, brief intervention, and referral to treatment (SBIRT). The aim of our study was to assess the feasibility of implementing SBIRT in community pharmacies in an urban county in terms of engagement, reach, and equity across the cascade of pharmacy screening and care. Patients aged 18 years or older receiving a schedule II or III opioid prescription at 1 of 17 participating community pharmacies in Allegheny County, Pennsylvania, were invited to engage in SBIRT as part of Project Lifeline-II from June 2020 through January 2023. Participants completed a prescreen and/or a full screen. We calculated the percentage of patients who participated across the cascade of pharmacy screening and care, overall and by sex (male and female) and race (Black and White). During the study period, 1952 unique adults (79.6%) were screened at least once (52.1% female; 58.0% White, 30.7% Black). Patients who identified as male (vs female) and Black (vs White) were more likely to have a positive prescreen (14.7% male vs 9.8% female; 16.4% Black vs 9.5% White), receive and complete a full screen (82.7% male vs 80.0% female; 83.6% Black vs 78.4% White), and score positively on the full screen (26.6% male vs 20.4% female; 26.8% Black vs 21.9% White). Although additional research is needed to characterize the full effect of Project Lifeline-II on patient outcomes, our findings help reinforce the benefits of multipronged public health initiatives that include community pharmacists to address the substance use disorder crisis in the United States.

Training status in evidence-based practices among in-service special education teachers and its association with teaching in autism educational settings

The present study investigates the adequacy of training, perceived knowledge, and the frequency of use of evidence-based practices (EBPs) among in-service special education teachers and its association with their teaching practices in autism educational settings in Jordan. Additionally, it analyzes the influence of key variables, including gender, age, level of educational qualification, number of years teaching in special education, number of years teaching students with autism, number of students with autism in the classroom, and number of in-service professional development programs attended. Using an analytical descriptive approach utilizing survey-based research, a convenience sample of 121 teachers from seven specialized autism centers reported on their training adequacy, knowledge, and frequency of use of a set of 23 EBPs. The results showed that the adequacy of in-service training was higher than that of pre-service training. Moreover, there was a positive correlation between in-service training, teachers’ knowledge, and the use of EBPs. The number of in-service professional development training programs emerged as the only variable that significantly influenced the teachers’ responses regarding the adequacy of their in-service training. The multiple regression analysis revealed that in-service training programs and years of teaching students with autism were the only predictors of teachers’ knowledge and use of EBPs. The most reported EBPs were reinforcement, task analysis, and modeling, whereas the least reported were video modeling, social narratives, and functional communication. Further enhancements in teacher training in EBPs are needed to improve teacher training programs in Jordan.

School-based consultation and coaching for promoting teachers’ generalized outcomes: A meta-analysis

School-based consultation or coaching may be used to promote teachers' use of various classroom management practices and interventions. An important aspect of school-based consultation and coaching is ensuring teachers generalize their use of evidence-based practices that were trained through consultation. However, the extent to which teachers generalize practices trained through consultation or coaching is somewhat unclear. As such, the purpose of this meta-analysis was twofold: (a) synthesize the existing school-based consultation literature to determine the extent to which teachers generalize practices they learned through consultation and coaching and (b) make a call to action for researchers to collect generalization data in consultation and coaching research. Seventeen studies were identified for review, in which results indicated school-based consultation and coaching to be effective for promoting teachers' generalization of EBPs (LRRi = 0.82) as well as target outcomes (LRRi = 1.15). Specific implementation supports (i.e., in situ training and behavioral skills training) significantly contributed to teachers' generalization, with specific practices (i.e., behavior specific praise) being more generalizable. Furthermore, moderation analyses were conducted to delineate aspects of consultation and coaching that are more likely to promote teachers' generalized outcomes. Limitations, future directions, and implications for research and practice are described.

Complementary Musical Intervention for Patients in Palliative Care in Spain: A Randomized Controlled Trial.

Patients with advanced cancer often endure a heavy burden of symptoms, both in quantity and intensity. Complementary therapies offer potential relief in this challenging scenario. Increasing the number of randomized controlled trials provides a unique opportunity to generate rigorous data, which can be used to establish causal relationships and evaluate interventions; hence, nurses can strengthen evidence-based practices, leading to better patient outcomes and quality of care. Our study aimed to evaluate the impact of a 7-day pre-recorded music intervention on cancer symptoms and satisfaction in advanced-stage cancer patients receiving palliative care at home. This multicenter, double-blind, randomized, controlled clinical trial involved 80 Spanish cancer patients receiving palliative care at home, and was conducted from July 2020 to November 2021. The intervention group (n = 40) received self-selected pre-recorded music for 30 min daily over 7 days. The control group (n = 40) received pre-recorded basic health education sessions of equal duration and frequency. Symptoms and patient satisfaction were assessed before and after the intervention using the Edmonton Symptom Assessment System and the Client Satisfaction Questionnaire, respectively. Comparing the intervention with the control group, significant improvements were observed in various symptoms: total symptom burden (p < 0.001), pain (p = 0.001), fatigue (p = 0.007), depression (p = 0.001), anxiety (p = 0.005), drowsiness (p = 0.006), appetite (p = 0.047), well-being (p ≤ 0.001), and sleep (p < 0.001); additionally, patient satisfaction was higher in the intervention group (p < 0.001). The 7-day pre-recorded music intervention reduced both physical and psychological symptoms in advanced-stage cancer patients receiving home-based palliative care, demonstrating significant alleviation of overall symptom burden and increased satisfaction with healthcare.

Clinical decision-making during childbirth in health facilities from the perspectives of labouring women, relatives, and health care providers: A scoping review

ProblemFor health care providers to ensure appropriate decision-making in clinical settings during childbirth, facilitators and barriers must be identified. BackgroundWomen who experience a sense of control by participating in the decision-making process, are more likely to have a positive birth experience. However, decision-making may involve hierarchies of close observation and control. AimThe aim of the scoping review was to map and summarise existing literature on the process of clinical decision-making during childbirth from the perspective of labouring women, relatives and health care providers. MethodsWe carried out a scoping review in line with Joanna Briggs Institute scoping review methodology. The search identified studies in Scandinavian or English languages from 2010 - Jan 2023 comprising evidence at different levels of the pyramid, resulting in 18.227 hits. Following the PRISMA checklist, the final inclusion comprised 62 papers. FindingsFour main categories summarized the importance of the following factors: 1) Woman-caregiver relationship, with sub-categories The importance of communication and Midwifery care, 2) Consent and legal issues, 3) Organization, with sub-categories Medicalization, Working atmosphere, and Complexity, and 4) Decision-making tools and models, with sub-categories Shared decision-making, and Other tools and models for decision-making. ConclusionBalancing intuition and expertise of caregivers with evidence-based practices, is crucial to ensure women's participation in decision-making. Furthermore, a trusting relationship between the mother, partner, and health care provider is of utmost importance. Shared decision-making, which appeared to be the primary model for clinical decision-making regardless context, requires reflective practice and is a communication strategy.

A class-oriented architecture for designing learning apps

ABSTRACT In the age of Apps, where almost everyone is fast becoming accustomed to using apps in almost every walk of life. Such widespread production, consumption, and burgeoning proliferation of Apps are also frequently seen in the various educational pitches and we call them “Learning Apps” (LAs). Now, approximately everyone is believing in and engaging through these apps as the mandatory future of our educational-organizations. However, their overwhelming nature surprised everyone including learners, parents, and other stockholders. Every day, a thousand apps get published, and continuously adding in educational categories of various app stores. Significantly, most LA developers are targeting preschoolers. And, who knows if they contain true educational values or not? Nevertheless, this scenario seems elusive. We observe the emergence of several de facto design paradigms, having no or little theoretical basis. Moreover, their design features do not scientifically connect with evidence-based teaching practices. Despite the expansion of enterprises and the development of new tools and technology, there is a lack of a sound app design strategy grounded in established didactics. Realizing this, we developed A Class-oriented Architecture of LAs to facilitate the content experts’ design.

What do we know now about evidence-based treatment for psychosis and aggressive behaviour or criminality that we did not know when community care was implemented?

Purpose Community care replaced institutional care for people with psychosis without guidance about what constituted effective treatment. In a Swedish birth cohort, many of those who developed schizophrenia or bipolar disorder as community care was being implemented were subsequently convicted of violent and non-violent crimes. Studies from other countries that were implementing community care at this time also reported elevated proportions of patients acquiring criminal convictions. Since community care was first implemented, much has been learned about factors that promote and treatments that limit aggressive/antisocial behaviour/criminality (AABC) among people with psychosis. Without the benefit of this knowledge, did mental health policy and practices that were in place as the asylums were closed inadvertently contribute to criminality? Material and methods This article provides a narrative review of current evidence of effective treatments and management strategies to reduce AABC among patients with psychosis. Results Reductions in AABC are associated with stable contact with psychiatric services, second-generation antipsychotic medication, clozapine for patients with schizophrenia and elevated levels of hostility and/or a history of childhood conduct disorder, abstinence from substances, avoidance of trauma, and constant monitoring of both illness symptoms and AABC. Conclusions Failure to adopt evidence-based practices allows the problem of AABC to persist, prevents patients from experiencing independent, safe, community tenure, and puts those around them at risk. Many challenges remain, including implementing effective assessment and interventions at first-episode and convincing patients with antisocial attitudes and behaviours to participate in treatment programs to reduce AABC and to learn prosocial behaviours.

Impacts of the Mindset Teams Programme on Teacher Outcomes and Pupil Educational Attainment: Secondary Data Analysis

We evaluated the impact of a growth mindset intervention on pre-specified teacher outcomes and pupil academic attainment and attendance. Delivered over 12 months, the Mindset Teams intervention provides teachers with formal and self-directed online learning, and an opportunity to implement evidence-based growth mindset practice in the classroom setting. The intervention aims to influence teacher practices to improve pupil resilience for learning and bring about positive impacts on pupil attainment and health outcomes. Impacts on teachers were explored through pre- and post-intervention survey data (570 and 301 respectively). Pupil attainment and attendance data from 1220 schools, 72 of which received the intervention, across years 2017–2021 (minus 2020), were analyzed using weighted mixed effects models, using a Difference-in-differences framework. Bayes factors were calculated as a measure of strength of evidence. Results suggest positive impacts of the intervention on teacher outcomes and indicate a moderate effect (+3% (95%CI +1%, +6%)) of programme delivery on writing attainment, but no evidence of effect for other outcomes. Findings highlight important issues for further research, specifically the need to explore programme impacts using pupil or classroom level data.

Design and Development of Virtual Reality Application Implementing Age-Friendly Care and the 4Ms: A Quality Improvement Project.

With an increase in the aging population, the application of evidence-based practice in geriatric education can strengthen knowledge, skills, and clinical experience for healthcare students caring for older adults. The Age-Friendly Health System (AFHS) is one of the frameworks founded on providing evidence-based and low-risk care centered on what matters most to older adults, their families, and caregivers. Virtual reality (VR) platforms are gaining popularity due to their ability to provide an immersive, hands-on learning experience resembling an actual medical practice or care setting. Immersive learning enhances students' sensory perceptions, promoting an innovative and engaging way of acquiring concepts that are difficult to teach in real life. This study aimed to design, develop, implement, and evaluate a case-based training module highlighting AFHS and educating medical students on the 4Ms approach in geriatric care (What Matters, Medication, Mentation, and Mobility). The project was a feasibility study completed in two phases. Phase one included planning and developing a case-based scenario incorporating the 4Ms of AFHS. Phase two included implementing and evaluating the VR training module into the geriatric curriculum for medical students. The final VR case displays a hospital and post-acute setting where an elderly patient is admitted for a hip fracture. Students learn how to triage and treat patients from admission to discharge while demonstrating their knowledge of AFHSs. Approximately 10% of students completed the evaluation survey, and preliminary results indicate significant knowledge change in pre-post scenario-based training on an AFHS. The VR education platform and embedded scenario promise an innovative adaptation of technology in learning the concepts of the 4Ms of AFHSs. However, future studies should explore VR education with clinical assessment evaluation to ensure competence in providing age-friendly care.

Utilizing PPCO and the Mountain Model to Guide Clinical Improvement

This article describes a nurse practitioner–led project that uses PPCO (Problem, Population, Change, and Outcome) and the Mountain Model to guide an evidence-based practice quality improvement–focused initiative. These combined methods form an umbrella framework, guiding searches for relevant external literature and implementing sustainable evidence-based practice quality improvement enterprises. This initiative aims to improve organ and tissue donation outcomes through multidimensional process enhancements at an established donor and transplant hospital in the United States. The article includes search strings and search results, a comparison of evidence-searching questions, and the initial application of the Mountain Model to the selected clinical problem.

Evaluating the discrepancies between evidence-based and community standard practices in the endoscopic diagnosis of esophageal squamous cell carcinoma: a survey study.

The practice of endoscopic diagnosis of esophageal squamous cell carcinoma (ESCC) often diverges from evidence-based standards due to various factors, including inadequate dissemination of evidence or a mismatch between evidence and real-world contexts. This survey aimed to identify discrepancies between evidence-based standard practices and community standard practices for ESCC among endoscopists. An online survey targeting endoscopists who perform upper gastrointestinal endoscopy at least weekly was conducted to collect data on clinical practices related to ESCC diagnosis. The survey, comprising 20 questions, was disseminated through multiple professional networks. Descriptive statistical analysis and logistic regression were performed to analyze the data. Data from 819 endoscopists were included in the analyses. Notably, a significant proportion employed narrow-band imaging/blue-laser imaging over iodine staining, and preferences varied based on risk assessment for ESCC. In total, 64.0% of endoscopists primarily used iodine solution at a concentration of 1% or less, while 96.5% of endoscopists performed an observation of the oral cavity and the pharynx when conducting upper gastrointestinal endoscopies on individuals at high risk of ESCC. The surveillance interval for metachronous multiple ESCCs was most commonly every 6months, followed by every 12months. In addition, most physicians conducted surveillance of metastatic recurrence at 6-month intervals. This survey highlights significant gaps between evidence-based and community standard practices in the endoscopic diagnosis of ESCC. These findings underscore the need for enhanced dissemination of evidence-based guidelines and consideration of real-world clinical contexts to bridge these gaps and optimize patient care.

Systematic Literature Review of Disseminating Health Information to BIPOC Communities

Purpose This study aims to systematically review the literature to examine best practices for disseminating health information and strategies useful for advancing equitable health outcomes in communities of Black, Indigenous, and People of Color (BIPOC). Methods Databases such as Science.gov, Education Resources Information Center (ERIC), Social Science Research Network, and CHAT AI were searched using terms like “health promotion,” “information dissemination/methods,” “minority communities,” “urban health,” “health education/methods,” and “health promotion/methods.” The search focused on qualitative, quantitative, and mixed-methods studies conducted between January 1, 2005, and December 31, 2023. An academic expert evaluated the manuscripts for quality. Dissemination methods were categorized based on cultural, linguistic, and sociodemographic characteristics. Results/Expected results Out of 4,726 articles identified, 23 were included in the full review. The study found that the most effective methods for disseminating health information involved direct community interaction using versatile communication strategies. Real-time engagement and accessibility to public health experts increased community trust and participation. Narrative storytelling, focus groups, workshops, and the use of technology for visual representation were particularly effective. Major obstacles included the lack of stakeholder interaction, language barriers, cultural, educational, and generational differences, and limited funding for human resources. The unavailability of information from previous research also caused frustration among decision-makers. Conclusion Effective engagement with BIPOC communities requires diverse communication methods. Involving community members in selecting settings, language, cultural activities, and other specific aspects helps non-community stakeholders understand evidence-based best practices for health information dissemination, thereby improving healthcare outcomes. Implications This comprehensive literature review enhances understanding of evidence-based best practices for disseminating health information to BIPOC communities. The findings provide valuable insights for policymakers, healthcare providers, community organizations, and researchers to develop targeted and effective health communication strategies.

The Who, What, and How of Interagency Criminal Justice–Behavioral Health Teams: Developing and Sustaining Collaborations

Interagency teams are considered an evidence-based change practice, but there is a paucity of research examining them in criminal justice (CJ) and behavioral health (BH) reform contexts. This study draws on qualitative interviews ( n = 52) and survey data ( n = 791) from BH and CJ leaders across the United States to examine who is on them, what they do, and effective strategies for building and sustaining them. Findings indicated that CJ–BH interagency teams often incorporate agencies from a range of CJ, BH, social service, and health agencies. Teamwork focused on connecting clients to resources or contributing to CJ–BH coalitions and resource centers. Although the team-building strategies learning about/from other agencies and system integration were significantly associated with developing more collaborations, consensus-building activities were not. These findings suggest that interagency teams need not necessarily reach consensus on goals and vision prior to working together, as this can be built through collaboration.

The impact of high intensity training and sports on recipients of solid organ transplants: a narrative review.

High intensity exercise in individuals post solid organ transplant (SOT) remains a largely understudied phenomenon, with potential risks and benefits. Additionally, the optimal training protocols are still unclear. This narrative review aimed to explore the impact of high-intensity exercise training and strenuous sports on solid organ transplant recipients (SOTRs). We conducted a narrative review of intervention studies of any design that included high-intensity exercise training and cross-sectional studies of strenuous sports and activities. Additionally, we reviewed individual reports documenting post-SOT performance at highly competitive or physiological levels. We used MEDLINE to search for relevant articles followed by a manual search for additional articles. Data were extracted and results were summarized. High-intensity and strenuous exercise appears to be safe among stable SOTRs. High-intensity protocols consistently demonstrated improvements in VO2peak and a reduction in coronary artery disease prevalence, though findings related to body composition, health-related quality of life outcomes, and cardiovascular exercise variables were inconsistent. Pre-transplant athletes showcase notable achievements and physiological adaptations post-transplantation, highlighting the capacity for athletic performance among this population. However, caution is warranted in interpreting the findings from these studies due to limitations in generalizability and other methodological limitations. As evidenced by current literature, high intensity exercise emerges as a promising exercise method for safely improving various physiological parameters, and reducing the prevalence of coronary heart disease in SOTRs. It can induce similar or greater effects to moderate intensity exercise, however follow-up studies indicate low retention. Further research of higher methodological rigor is warranted in this field to advance understanding, and to guide evidence-based practice.

Barriers and facilitators of evidence-based practice among lecturers at Makerere University College of Health Sciences, Uganda: a qualitative study

Barriers and facilitators of evidence-based practice among lecturers at Makerere University College of Health Sciences, Uganda: a qualitative study

The Hong Kong Shue Yan University Social Work Research Center—A Case Analysis

Hong Kong Shue Yan University (HKSYU) Center for Social Work Research and Practice was established in 2015, aspiring to collaborate with industry partners to conduct research that enhance the industry's understanding of social issues and develop quality services for the community. HKSYU is a self-financing university without direct subsidies from the HKSAR Government to the Center. In the last couple of years, the Center has implemented 11 research and training projects, jointly organizing with local and overseas universities. Two of them adopted the interdisciplinary approach, collaborating with health and nursing disciplines. Using the extended case method, the Center was found to be aligned with the principles of evidence-based practice and research-mindedness in social work. Moreover, the Center normally adopted the “Translational form of collaboration,” coproducing research projects with industry partners. Upon reflection, the Center should maximize its involvement with social work practitioners to promote research-mindedness in the practice environment.