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Best Practice & Research. Clinical... May 2021Pediatric anesthesia is large part of anesthesia clinical practice. Children, parents and anesthesiologists fear anesthesia because of the risk of acute morbidity and... (Review)
Review
Pediatric anesthesia is large part of anesthesia clinical practice. Children, parents and anesthesiologists fear anesthesia because of the risk of acute morbidity and mortality. Modern anesthesia in otherwise healthy children above 1 year of age in developed countries has become very safe due to recent advance in pharmacology, intensive education, and training as well as centralization of care. In contrast, anesthesia in these children in low-income countries is associated with a high risk of mortality due to lack of basic resources and adequate training of health care providers. Anesthesia for neonates and toddlers is associated with significant morbidity and mortality. Anesthesia-related (near) critical incidents occur in 5% of anesthetic procedures and are largely dependent on the skills and up-to-date knowledge of the whole perioperative team in the specific needs for children. An investment in continuous medical education of the perioperative staff is required and international standard operating protocols for common procedures and critical situations should be defined.
Topics: Anesthesia; Anesthesiology; Biomedical Research; Humans; Pediatrics; Perioperative Care; Practice Guidelines as Topic; Quality of Health Care
PubMed: 33742575
DOI: 10.1016/j.bpa.2020.12.007 -
Muscle & Nerve Apr 2016Inclusion-body myositis (IBM) is a late-onset idiopathic inflammatory myopathy associated with selective and progressive muscle weakness and atrophy. Current clinical... (Review)
Review
INTRODUCTION
Inclusion-body myositis (IBM) is a late-onset idiopathic inflammatory myopathy associated with selective and progressive muscle weakness and atrophy. Current clinical management of IBM is largely supportive due to its uncertain etiology and lack of effective treatment. Establishing a consensus of opinion on questions relating to diagnosis and management of IBM is expected to help reduce inconsistencies in the care and resources allocated to those living with this condition.
METHODS
A protocol has been developed to produce best practice clinical guidelines for IBM based on a combination of published research and expert consensus.
CONCLUSIONS
In this study we describe the proposed protocol for developing methods for producing robust and transparent clinical guidance on aspects of diagnosis, drug treatment, physical and practical management, respiration, nutrition and cardiac management, psychosocial management, and multidisciplinary care.
Topics: Clinical Trials as Topic; Humans; Myositis; Myositis, Inclusion Body; Practice Guidelines as Topic
PubMed: 26800092
DOI: 10.1002/mus.25036 -
BMJ Open Jul 2015To develop and validate a national set of best practice statements for use in post-stroke aphasia rehabilitation. (Review)
Review
OBJECTIVES
To develop and validate a national set of best practice statements for use in post-stroke aphasia rehabilitation.
DESIGN
Literature review and statement validation using the RAND/UCLA Appropriateness Method (RAM).
PARTICIPANTS
A national Community of Practice of over 250 speech pathologists, researchers, consumers and policymakers developed a framework consisting of eight areas of care in aphasia rehabilitation. This framework provided the structure for the development of a care pathway containing aphasia rehabilitation best practice statements. Nine speech pathologists with expertise in aphasia rehabilitation participated in two rounds of RAND/UCLA appropriateness ratings of the statements. Panellists consisted of researchers, service managers, clinicians and policymakers.
MAIN OUTCOME MEASURES
Statements that achieved a high level of agreement and an overall median score of 7-9 on a nine-point scale were rated as 'appropriate'.
RESULTS
74 best practice statements were extracted from the literature and rated across eight areas of care (eg, receiving the right referrals, providing intervention). At the end of Round 1, 71 of the 74 statements were rated as appropriate, no statements were rated as inappropriate, and three statements were rated as uncertain. All 74 statements were then rated again in the face-to-face second round. 16 statements were added through splitting existing items or adding new statements. Seven statements were deleted leaving 83 statements. Agreement was reached for 82 of the final 83 statements.
CONCLUSIONS
This national set of 82 best practice statements across eight care areas for the rehabilitation of people with aphasia is the first to be validated by an expert panel. These statements form a crucial component of the Australian Aphasia Rehabilitation Pathway (AARP) (http://www.aphasiapathway.com.au) and provide the basis for more consistent implementation of evidence-based practice in stroke rehabilitation.
Topics: Aphasia; Australia; Delphi Technique; Evidence-Based Practice; Humans; Practice Guidelines as Topic; Speech-Language Pathology
PubMed: 26137883
DOI: 10.1136/bmjopen-2015-007641 -
Journal of the Chinese Medical... Dec 2017Evidence-based health care informs clinicians of choices regarding the most effective care based on the best available research evidence. However, concepts or... (Review)
Review
Evidence-based health care informs clinicians of choices regarding the most effective care based on the best available research evidence. However, concepts or instruments of evidence-based medicine are still fragmented for most clinicians. Substantial gaps between evidence and clinical practice remain. A knowledge translation roadmap may help clinicians to improve the quality of care by integration of various concepts in evidence-based health care. Improving research transparency and accuracy, conducting an updated systematic review, and shared decision making are the key points to diminish the gaps between research and practice.
Topics: Evidence-Based Practice; Humans; Knowledge; Practice Guidelines as Topic
PubMed: 28969992
DOI: 10.1016/j.jcma.2017.04.010 -
Mayo Clinic Proceedings Mar 2018Although widely recognized as a chronic disease that requires long-term, structured, and multidisciplinary management, obesity remains largely underdiagnosed and... (Review)
Review
Although widely recognized as a chronic disease that requires long-term, structured, and multidisciplinary management, obesity remains largely underdiagnosed and undertreated. The prevalence of obesity continues to increase dramatically, with the highest rates seen in the United States. Despite the availability of several clinical practice guidelines, published studies suggest that health care professionals (HCPs) infrequently and inconsistently follow guideline recommendations. Barriers to HCP participation in obesity management are likely to inhibit obesity counseling in primary care. Improving HCP obesity-related practices and counseling is important. This article discusses current practices, barriers to effective obesity management, and recommendations to improve HCP obesity management and counseling, based on findings from a PubMed search and clinical experience. The aim of the article is to share best-practice strategies for engaging patients.
Topics: Counseling; Health Personnel; Humans; Obesity; Patient Participation; Practice Guidelines as Topic; Primary Health Care; Weight Reduction Programs
PubMed: 29502565
DOI: 10.1016/j.mayocp.2018.01.006 -
Dementia (London, England) Jul 2021The benefits of physical activities for those living with moderate to advanced dementia are well documented and include improved well-being and quality of life. What is... (Observational Study)
Observational Study
From evidence to practice: Developing best practice guidelines for the delivery of activities to people living with moderate to advanced dementia using a pragmatic observational study.
The benefits of physical activities for those living with moderate to advanced dementia are well documented and include improved well-being and quality of life. What is less well known is how best to deliver such activities to make them meaningful for those taking part and, more generally, how to develop good practice guidance for working with this group. This article reports on an observational study of a physical activity programme in a residential care setting, Mobile Me, and on the process used to develop good practice guidance from it, which included input from a range of stakeholders. Learnings from this study conclude that changes in delivery and setting can contribute to a difference in the quality of the experience for participants and their levels of well-being during sessions. The findings from the study were consolidated into four themes for disseminating best practice: promoting the right atmosphere, environment, communication, and adaptations. These form part of a new multimedia best practice guide for delivering physical activities to those living with moderate to advanced dementia.
Topics: Communication; Dementia; Humans; Practice Guidelines as Topic; Quality of Life
PubMed: 32893679
DOI: 10.1177/1471301220957805 -
Critical Care Medicine Feb 2020To determine whether best practice advisories improved sedation protocol compliance and could mitigate potential propofol-related hazardous conditions. (Observational Study)
Observational Study
OBJECTIVES
To determine whether best practice advisories improved sedation protocol compliance and could mitigate potential propofol-related hazardous conditions.
DESIGN
Retrospective observational cohort study.
SETTING
Two adult ICUs at two academic medical centers that share the same sedation protocol.
PATIENTS
Adults 18 years old or older admitted to the ICU between January 1, 2016, and January 31, 2018, who received a continuous infusion of propofol.
INTERVENTIONS
Two concurrent best practice advisories built in the electronic health record as a clinical decision support tool to enforce protocol compliance with triglyceride and lipase level monitoring and mitigate propofol-related hazardous conditions.
MEASUREMENTS AND MAIN RESULTS
The primary outcomes were baseline and day 3 compliance with triglyceride and lipase laboratory monitoring per protocol and time to discontinuation of propofol in the setting of triglyceride and/or lipase levels exceeding protocol cutoffs. A total of 1,394 patients were included in the study cohort (n = 700 in the pre-best practice advisory group; n = 694 in the post-best practice advisory group). In inverse probability weighted regression analyses, implementing the best practice advisory was associated with a 56.6% (95% CI, 52.6-60.9) absolute increase and a 173% relative increase (risk ratio, 2.73; 95% CI, 2.45-3.04) in baseline laboratory monitoring. The best practice advisory was associated with a 34.0% (95% CI, 20.9-47.1) absolute increase and a 74% (95% CI, 1.39-2.19) relative increase in day 3 laboratory monitoring after inverse probability weighted analyses. Among patients with laboratory values exceeding protocol cutoffs, implementation of the best practice advisory resulted in providers discontinuing propofol an average of 16.6 hours (95% CI, 4.8-28.3) sooner than pre-best practice advisory. Findings from alternate analyses using interrupted time series were consistent with the inverse probability weighted analyses.
CONCLUSIONS
Best practice advisories can be effectively used in ICUs to improve sedation protocol compliance and may mitigate potential propofol-related hazardous conditions. Best practice advisories should undergo continuous quality assurance and optimizations to maximize clinical utility and minimize alert fatigue.
Topics: APACHE; Academic Medical Centers; Adult; Aged; Aged, 80 and over; Body Mass Index; Critical Care; Electronic Health Records; Female; Guideline Adherence; Humans; Hypnotics and Sedatives; Intensive Care Units; Interrupted Time Series Analysis; Length of Stay; Lipase; Male; Middle Aged; Practice Guidelines as Topic; Propofol; Retrospective Studies; Triglycerides
PubMed: 31939786
DOI: 10.1097/CCM.0000000000004116 -
Clinical Microbiology and Infection :... Dec 2015
Topics: Codes of Ethics; Conflict of Interest; Practice Guidelines as Topic; Societies, Medical
PubMed: 26408276
DOI: 10.1016/j.cmi.2015.09.010 -
Frontiers in Endocrinology 2023To evaluate the quality of surgical guidelines on bariatric/metabolic surgery. (Review)
Review
OBJECTIVE
To evaluate the quality of surgical guidelines on bariatric/metabolic surgery.
METHODS
Four independent reviewers used the AGREE II (The Appraisal of Guidelines for Research and Evaluation II) tool to assess the methodological quality of the included guidelines and conducted a comparative analysis of the main recommendations for surgical methods of these guidelines.
RESULTS
Nine surgical guidelines were included in this study. Five articles with AGREE II scores over 60% are worthy of clinical recommendation. The field of rigor of development was relatively low, with an average score of 50.82%. Among 15 key recommendations and the corresponding best evidence in the guidelines, only 4 key recommendations were grade A recommendations.
CONCLUSIONS
The quality of metabolic and bariatric guidelines is uneven, and there is much room for improvement.
Topics: Bariatric Surgery; Practice Guidelines as Topic
PubMed: 36967766
DOI: 10.3389/fendo.2023.1118564 -
Journal of Medical Internet Research Dec 2020Technology can be helpful in supporting people with dementia in their daily lives. However, people with dementia are often not fully involved in the development process... (Review)
Review
BACKGROUND
Technology can be helpful in supporting people with dementia in their daily lives. However, people with dementia are often not fully involved in the development process of new technology. This lack of involvement of people with dementia in developing technology-based interventions can lead to the implementation of faulty and less suitable technology.
OBJECTIVE
This systematic review aims to evaluate current approaches and create best practice guidelines for involving people with dementia in developing technology-based interventions.
METHODS
A systematic search was conducted in January 2019 in the following databases: EMBASE (Excerpta Medica database), PsycINFO, MEDLINE (Medical Literature Analysis and Retrieval System Online), CINAHL (Cumulated Index to Nursing and Allied Health Literature), and Web of Science. The search strategy included search terms in 3 categories: dementia, technology, and involvement in development. Narrative synthesis wove the evidence together in a structured approach.
RESULTS
A total of 21 studies met the inclusion criteria. Most studies involved people with dementia in a single phase, such as development (n=10), feasibility and piloting (n=7), or evaluation (n=1). Only 3 studies described involvement in multiple phases. Frequently used methods for assessing involvement included focus groups, interviews, observations, and user tests.
CONCLUSIONS
Most studies concluded that it was both necessary and feasible to involve people with dementia, which can be optimized by having the right prerequisites in place, ensuring that technology meets standards of reliability and stability, and providing a positive research experience for participants. Best practice guidelines for the involvement of people with dementia in developing technology-based interventions are described.
Topics: Dementia; Humans; Internet-Based Intervention; Practice Guidelines as Topic; Reproducibility of Results; Technology
PubMed: 33270034
DOI: 10.2196/17531