International Journal of Evidence-Based Healthcare最新文献

{"title":"Better understanding of ‘don’t confuse absence of evidence with evidence of absence’","authors":"R. Pacheco, L. Fontes, A. Martimbianco, R. Riera","doi":"10.17267/2675-021xevidence.v1i2.2348","DOIUrl":"https://doi.org/10.17267/2675-021xevidence.v1i2.2348","url":null,"abstract":"| INTRODUCTION: In every single lecture or text book of Evidence-based Health-care and research synthesis, we invariably find references to the aphorism “absence of evidence does not mean absence of effect”. However, we have not rarely found those who forget, ignore or put this aphorism aside while interpreting results from research on healthcare. The objective of this text is to clarify the concepts underlying this aphorism, such as absence of evidence and absence of effect.","PeriodicalId":55996,"journal":{"name":"International Journal of Evidence-Based Healthcare","volume":"55 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83402802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of respiratory muscle training session on ankle muscle activity in athletes with chronic low back pain performing overhead squats: a randomized controlled trial.","authors":"B. G. Borujeni, A. Yalfani","doi":"10.1097/XEB.0000000000000204","DOIUrl":"https://doi.org/10.1097/XEB.0000000000000204","url":null,"abstract":"AIM\u0000The current study was conducted to evaluate the effect of a respiratory muscle training session on ankle muscle activity in athletes with chronic low back pain performing overhead squats.\u0000\u0000\u0000METHODS\u0000The current double-blind, randomized, controlled trial was conducted on 24 patients randomly selected as the training group and 23 patients as the control group. The training group received the respiratory muscle training protocol. The electromyography activity of the tibialis anterior, peroneus longus, gastrocnemius medialis and gastrocnemius lateralis muscles of the dominant leg was recorded in the participants.\u0000\u0000\u0000RESULTS\u0000The findings showed that a session of respiratory muscle training reduced the activities of some ankle joint muscles when performing overhead squats, including tibialis anterior in the static and dynamic overhead squat tests and peroneus longus in the ascending phase. In the dynamic test, the angle to reach peak activity changed in tibialis anterior in the descending phase and also in tibialis anterior and peroneus longus in the ascending phase.\u0000\u0000\u0000CONCLUSION\u0000Effects of respiratory muscle training prevented excessive ankle joint muscle activity through stimulating local muscles while performing overhead squats, which had indicated an improved postural control and multisectional proprioception to maintain postural stability and stimulated the local muscles of the core area.","PeriodicalId":55996,"journal":{"name":"International Journal of Evidence-Based Healthcare","volume":"61 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88786229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The current state of heart disease: statins, cholesterol, fat and sugar.","authors":"Chrystyne Olivieri","doi":"10.1097/XEB.0000000000000197","DOIUrl":"https://doi.org/10.1097/XEB.0000000000000197","url":null,"abstract":"After decades of improvement in the outlook for cardiovascular disease (CVD), we are now seeing a plateau. Statins, once believed to be the most important advance in the fight against heart disease, have not mitigated the incidence or prevalence of CVD.\u0000\u0000\u0000AIM\u0000New research into lipid-lowering drugs is not only questioning their usefulness in primary care, but identifying them as harmful, resulting in the development of other diseases. When the original research is critically analyzed, the data do not reveal drugs that significantly reduce the incidence or prevalence for primary prevention of CVD in the United States.\u0000\u0000\u0000METHODS\u0000The current article sheds light on our current beliefs into lipid-lowering to treat potential CVD. Through a discussion of the difference between relative risk reduction and absolute risk reduction, the author suggests lifestyle modifications have been and always will be the best way to fight against this deadly chronic disease.\u0000\u0000\u0000RESULTS\u0000There is over 60 years-worth of scientific research that has been desperately trying to identify sugar as the culprit and driver of CVD disease; however, the medical system continues to fight against fat and cholesterol. This article makes the reader question what the US government, in association with the Medical Establishment (American Heart Association, American Diabetes Association and the American College of Cardiology) have been eschewing for the last 60-70 years as it has NOT been working.\u0000\u0000\u0000CONCLUSION\u0000The time for a culture-wide paradigm change has come. The author suggests this will only happen if Big Pharma and Big Food industries will change their marketing habits from 'purely taste' to 'best for your health'.","PeriodicalId":55996,"journal":{"name":"International Journal of Evidence-Based Healthcare","volume":"35 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81406008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of an opioid weaning protocol to improve pain management, and to prevent or decrease iatrogenic withdrawal syndrome in the neonatal intensive care.","authors":"Renee Muirhead,&nbsp;Kathryn Kynoch","doi":"10.1097/XEB.0000000000000169","DOIUrl":"https://doi.org/10.1097/XEB.0000000000000169","url":null,"abstract":"<p><strong>Aim: </strong>The aim of this evidence implementation project was to improve pain assessment and management of the neonate receiving an opioid infusion, and to prevent or decrease the incidence of iatrogenic withdrawal syndrome (IWS).</p><p><strong>Methods: </strong>The current project was carried out in two intensive care areas of a 79 bed tertiary Neonatal Unit in Australia. A pre/postaudit design was utilized. Patient charts were reviewed to collect baseline audit data on pain assessments and titration of opioids. A weaning protocol was developed and implemented along with targeted staff education to align current practice with best practice recommendations. A postimplementation audit was then conducted to evaluate changes in practice.</p><p><strong>Results: </strong>A total of 32 charts (13 pre/19 post) were reviewed to evaluate pain assessment, titration of opioids, and the identification of any signs and symptoms of IWS. The results demonstrated an improvement in the completion of pain assessments by 34%, and 100% compliance to withdrawal assessment following the introduction of an IWS assessment tool. For neonates receiving analgesics for less than 4 days, adherence to the weaning schedule occurred in 75%. No clinical signs of IWS were seen in this cohort. For neonates receiving analgesics for greater than 4 days, adherence to the weaning schedule occurred in only 55%. Of those neonates where the protocol was not followed, 67% developed clinical signs of IWS.</p><p><strong>Conclusion: </strong>Although this project demonstrated improvements in pain assessment and the identification of IWS, lack of adherence to the pain management policy and weaning tool has increased awareness of the importance of collaboration within the multidisciplinary team to improve outcomes. Several barriers were identified prior to implementation and various methods were employed to overcome these. Despite this, consistency of practice and change-management remain a challenge in clinical care.</p>","PeriodicalId":55996,"journal":{"name":"International Journal of Evidence-Based Healthcare","volume":"17 3","pages":"147-156"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/XEB.0000000000000169","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37305718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of prescribing patterns of nonsteroidal anti-inflammatory agents in a tertiary setting.","authors":"Viviane Khalil,&nbsp;Wei Wang,&nbsp;Lauren Charlson,&nbsp;Samantha Blackley","doi":"10.1097/XEB.0000000000000173","DOIUrl":"https://doi.org/10.1097/XEB.0000000000000173","url":null,"abstract":"<p><strong>Background: </strong>Non steroidal anti-inflammatory agents (NSAIDS) are among the most commonly prescribed analgesics despite their adverse effect profile. The main objective of this pilot study is to assess the prescribing patterns of NSAIDs in an Australian hospital and to examine predictors for prescribing patterns.</p><p><strong>Method: </strong>A retrospective cross sectional study was conducted. Patients' gastrointestinal and cardiovascular comorbidities were recorded for stratifications according to international guidelines. Pharmacist input was recorded to examine its effect on NSAIDs' prescribing patterns. Appropriateness of prescribing patterns was determined according to published international prescribing guidelines for NSAIDs. Univariate and multivariate regression analyses were conducted to determine predictors of patients' variables on prescribing patterns.</p><p><strong>Results: </strong>A total of 300 patients were eligible to be included in the study. Fifty-five percentage of patients audited were prescribed NSAIDs according to the guidelines. There was an association between the type of NSAIDs prescribed and patients' gastrointestinal and cardiovascular risks, P less than 0.01. Multiple logistic regression analysis has shown: age more than 75 years, a history of peptic ulcer disease or a moderate gastrointestinal risk were all predictors for receiving a NSAID with a gastroprotectant agent [odds ratio (OR) = 3.54, 95% confidence interval (CI) (1.10-11.79), P < 0.05; OR = 9.51, 95% CI (3.70-26.72), P < 0.01; and OR = 5.04, 95% CI (51.72-15.54), P < 0.01, respectively]. Naproxen was more likely to be prescribed in patients with moderate-to-high gastrointestinal risk [OR = 16.24, 95% CI (2.70-132.70) and OR = 81.47 95% CI (3.38-2436.53), P < 0.01, respectively]. Patients who had their medications reviewed by a pharmacist were prescribed cyclo-oxygenase-2 inhibitors more frequently [OR = 3.36, 95% CI (1.05-15.34), P < 0.05] than any other agent.</p><p><strong>Conclusion: </strong>About half of the patients audited were prescribed NSAIDs appropriately. Factors affecting the prescribing of NSAIDs included: older age, patients' gastrointestinal risks as well as pharmacist input. This pilot study presents an opportunity for pharmacists to promote adherence to NSAIDs prescribing guidelines.</p>","PeriodicalId":55996,"journal":{"name":"International Journal of Evidence-Based Healthcare","volume":"17 3","pages":"164-172"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/XEB.0000000000000173","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37066110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Developing and evaluating an intervention to improve care and reduce costs of rabies postexposure therapy: an observational quality improvement initiative in selected vaccination units in Sri Lanka.","authors":"Pushpa U Gamalathge,&nbsp;Hannah E Carter,&nbsp;Omala Wimalaratne,&nbsp;Sanjeewa Kularatne","doi":"10.1097/XEB.0000000000000172","DOIUrl":"https://doi.org/10.1097/XEB.0000000000000172","url":null,"abstract":"<p><strong>Background: </strong>Exposure to the rabies virus is fatal unless a patient is treated with a timely, accurate and complete administration of postexposure prophylaxis (PEP). The level of adherence to PEP guidelines by health service providers is therefore critical in providing high-quality care as well as preventing unnecessary costs.</p><p><strong>Methods: </strong>We developed a simple user-friendly decision aid based on Sri Lankan national guidelines for the administration of PEP and trialed it over a 5-month period in three study settings. Pre and post levels of adherence to the national guidelines by service providers was measured in each setting. Changes to per patient cost for rabies medications and hospital admissions were also collected.</p><p><strong>Results: </strong>A significant improvement in adherence to the guidelines was observed in two settings with a nonsignificant improvement observed in the third setting. We estimated a total cost saving of LKR 158 476 across the three sites, comprising LKR 14 418 in admissions cost savings and LKR 144 058 in medication savings.</p><p><strong>Conclusion: </strong>We conclude that the development of a decision aid for the administration of PEP is likely to be an effective and cost-saving intervention in the Sri Lankan setting. Further research is required to inform the generalizability of our findings.</p>","PeriodicalId":55996,"journal":{"name":"International Journal of Evidence-Based Healthcare","volume":"17 3","pages":"157-163"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/XEB.0000000000000172","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37371339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Methodological research: open questions, the need for 'research on research' and its implications for evidence-based health care and reducing research waste.","authors":"L. Puljak","doi":"10.1097/XEB.0000000000000201","DOIUrl":"https://doi.org/10.1097/XEB.0000000000000201","url":null,"abstract":"With the ever increasing pace of research reports published, a new type of study has emerged, in which researchers analyze research practices and provide methodological guidance for the future. The overall aims of such studies are to explore planning, conduct, reporting, dissemination, and evaluation of research, and to provide recommendations for their improvement. A myriad of studies have shown that studies are planned, conducted and reported in a suboptimal way, and that there is ample room for improvement. It has been suggested that studies with inadequate planning, conduct and reporting represent avoidable research waste, causing enormous waste of funds and researchers’ efforts, and yielding suboptimal research reports. Methodological studies represent research efforts that may help in reducing research waste, and therefore should be welcomed as a valuable contribution that may contribute to production of better evidence and justify investments in research. However, there are multiple open questions about what exactly is analyzed in such studies, which collective name we should use for them, what type of study designs can be considered methodological studies, are they synonymous with systematic reviews and metaanalyses (SR/MA), and so on. Methodological studies may be observational or interventional. The unit of analysis in observational methodological studies can be broadly described as a research-related report. Such reports can be very diverse, including, but not limited to, study protocols, datasets, full reports with data analyses, and summary formats such as abstracts, plain language summaries, and so on. These reports may or may not be published in peerreviewed literature. Some of those research-related reports that are not published in peer-reviewed literature are available online, including materials posted in registries and repositories, or organizational web sites. Interventional methodological studies explore various interventions for improving research.","PeriodicalId":55996,"journal":{"name":"International Journal of Evidence-Based Healthcare","volume":"116 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81308303","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis of completeness of reporting utilizing the Reporting Items for practice Guidelines in Healthcare Statement in gastroenterology clinical practice guidelines.","authors":"Benjamin Howard,&nbsp;Chris Chapman,&nbsp;Chase Meyer,&nbsp;Corbin Walters,&nbsp;Matt Vassar","doi":"10.1097/XEB.0000000000000174","DOIUrl":"https://doi.org/10.1097/XEB.0000000000000174","url":null,"abstract":"<p><strong>Aim: </strong>Assessing reporting quality is important as it allows distinctions to be made between poor methodology and poor reporting practices. The Reporting Items for practice Guidelines in Healthcare (RIGHT) Statement checklist was published in 2017 to improve the thoroughness and reporting quality of clinical practice guidelines (CPGs). CPGs are evidence-based recommendations developed to assist clinician decision-making in the diagnosis and management of patients. The aim of this study is to assess the completeness of reporting in CPGs listed by the American College of Gastroenterology (ACG) and their frequency of reporting items listed in the RIGHT Statement.</p><p><strong>Methods: </strong>Using the 22 criteria (35 items) of the RIGHT Statement checklist, two researchers independently documented the adherence to each item for all eligible guidelines listed by the ACG. This study was conducted from 01/10/18 to 05/12/18. Data were recorded onto a prespecified Google data abstraction form and extracted into MS Excel for statistical analysis.</p><p><strong>Results: </strong>Out of 38 eligible guidelines, nine of the 35 RIGHT (25.7%) checklist items were met with less than 50% adherence. The mean adherence was 26.8 (SD ± 9.5); median adherence was 30 (interquartile range 21.5-33.5). The publication dates ranged from 2007 to 2017 with seven of the guidelines (18.4%) published between 2007 and 2009, 11 (29%) published between 2010 and 2013, and 20 (52.6%) published between 2014 and 2017.</p><p><strong>Conclusion: </strong>The completeness of reporting in CPGs listed by the ACG remains inadequate in several key areas. Poor adherence to items of the RIGHT Statement checklist demonstrates that there is area for improvement in reporting quality.</p>","PeriodicalId":55996,"journal":{"name":"International Journal of Evidence-Based Healthcare","volume":"17 3","pages":"173-178"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/XEB.0000000000000174","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37371341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systemic pharmacological treatments for chronic plaque psoriasis: a network meta-analysis.","authors":"Jacqueline Pich","doi":"10.1097/XEB.0000000000000168","DOIUrl":"10.1097/XEB.0000000000000168","url":null,"abstract":"","PeriodicalId":55996,"journal":{"name":"International Journal of Evidence-Based Healthcare","volume":"17 3","pages":"187-188"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37305721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Phosphodiesterase 5 inhibitors for pulmonary hypertension.","authors":"Jacqueline Pich","doi":"10.1097/XEB.0000000000000198","DOIUrl":"https://doi.org/10.1097/XEB.0000000000000198","url":null,"abstract":"","PeriodicalId":55996,"journal":{"name":"International Journal of Evidence-Based Healthcare","volume":"54 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81479106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}