scholarly journals P056: The state of the evidence for emergency medical services (EMS) care of blunt spinal trauma: an analysis of appraised research from the Canadian Prehospital Evidence-based Practice (PEP) Project

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S97-S97
Author(s):  
A. Carter ◽  
J. Greene ◽  
J. Cook ◽  
J. Goldstein ◽  
J. Jensen
Keyword(s):  
Evidence Based Practice ◽  
Spinal Injury ◽  
Spinal Trauma ◽  
Future Research ◽  
Evidence Based ◽  
High Quality ◽  
Level Of Evidence ◽  
Spinal Motion ◽  
Moderate Quality ◽  
Point Level

Introduction: The Canadian Prehospital Evidence-based Practice (PEP) project is an online, freely accessible, continuously updated EMS evidence repository. The summary of research evidence for EMS interventions used to care for blunt spinal trauma is described. Methods: PubMed was systematically searched. One author reviewed titles and abstracts for relevance. Included studies were scored by trained appraisers on a three-point Level of Evidence (LOE) scale (based on study design and quality) and three-point Direction of Evidence (DOE) scale (supportive, neutral, or opposing results). Second party appraisal was conducted for included studies. Interventions were plotted on a 3x3 table (DOE × LOE) for the spinal injury condition based on appraisal scores. The primary outcome was identified for each study and categorized. Results: Seventy-seven studies were included. Evidence for adult and paediatric blunt spinal trauma interventions was: supportive-high quality (n=1, 7 %), supportive-moderate quality (n=3, 21.4%), supportive-low quality (n=1, 7%), neutral-high quality (n=1, 7%), neutral-moderate quality (n=5, 35.7%), neutral-low quality (n=1, 7%), opposing-high quality (n=0, 0%), opposing-moderate quality (n=0, 0%), opposing-low quality (n=1, 7%). One (7%) intervention had no evidence. Interventions with supportive evidence were: steroids, cervical-spine clearance, scoop stretcher, self-extrication and “leaving helmet in place”. The evidence weakly opposed use of short extrication devices. Leading study primary outcomes were spinal motion, diagnostic accuracy, and pressure/discomfort. Conclusion: EMS blunt spinal trauma interventions are informed by moderate quality supportive and neutral evidence. Future research should focus on high quality studies filling identified evidence gaps using patient-oriented outcomes to best inform EMS care of blunt spinal injury.

scholarly journals LO73: The state of the evidence for emergency medical services care of adult patients with sepsis: an analysis of appraised research from the Prehospital Evidence-Based Practice (PEP) program

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S34
Author(s):  
J. Greene ◽  
A. Carter ◽  
J. Goldstein ◽  
J. Jensen ◽  
J. Swain ◽  
...  
Keyword(s):  
Emergency Medical Services ◽  
Evidence Based Practice ◽  
Adult Patients ◽  
Medical Services ◽  
Evidence Based ◽  
High Quality ◽  
Level Of Evidence ◽  
Moderate Quality ◽  
Emergency Medical ◽  
High Flow Oxygen

Introduction: The Prehospital Evidence-Based Practice (PEP) program is an online, freely accessible, continuously updated Emergency Medical Services (EMS) evidence repository. This summary describes the research evidence for the identification and management of adult patients suffering from sepsis syndrome or septic shock. Methods: PubMed was searched in a systematic manner. One author reviewed titles and abstracts for relevance and two authors appraised each study selected for inclusion. Primary outcomes were extracted. Studies were scored by trained appraisers on a three-point Level of Evidence (LOE) scale (based on study design and quality) and a three-point Direction of Evidence (DOE) scale (supportive, neutral, or opposing findings based on the studies’ primary outcome for each intervention). LOE and DOE of each intervention were plotted on an evidence matrix (DOE x LOE). Results: Eighty-eight studies were included for 15 interventions listed in PEP. The interventions with the most evidence were related to identification tools (ID) (n = 26, 30%) and early goal directed therapy (EGDT) (n = 21, 24%). ID tools included Systematic Inflammatory Response Syndrome (SIRS), quick Sequential Organ Failure Assessment (qSOFA) and other unique measures. The most common primary outcomes were related to diagnosis (n = 30, 34%), mortality (n = 40, 45%) and treatment goals (e.g. time to antibiotic) (n = 14, 16%). The evidence rank for the supported interventions were: supportive-high quality (n = 1, 7%) for crystalloid infusion, supportive-moderate quality (n = 7, 47%) for identification tools, prenotification, point of care lactate, titrated oxygen, temperature monitoring, and supportive-low quality (n = 1, 7%) for vasopressors. The benefit of prehospital antibiotics and EGDT remain inconclusive with a neutral DOE. There is moderate level evidence opposing use of high flow oxygen. Conclusion: EMS sepsis interventions are informed primarily by moderate quality supportive evidence. Several standard treatments are well supported by moderate to high quality evidence, as are identification tools. However, some standard in-hospital therapies are not supported by evidence in the prehospital setting, such as antibiotics, and EGDT. Based on primary outcomes, no identification tool appears superior. This evidence analysis can guide selection of appropriate prehospital therapies.

scholarly journals LO18: The state of the evidence for emergency medical services (EMS) care of prehospital hypoglycemia: an analysis of appraised research from the Prehospital Evidence-based Practice Program

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S13-S13
Author(s):  
J. Greene ◽  
J. Goldstein ◽  
R. Brown ◽  
J. Swain ◽  
D. Fidgen ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Assessment Tool ◽  
Evidence Based Practice ◽  
Oral Glucose ◽  
Evidence Based ◽  
High Quality ◽  
Level Of Evidence ◽  
Glucose Testing ◽  
Published Evidence ◽  
Quality Evidence

Introduction: The Prehospital Evidence-based Practice (PEP) program is an online, freely accessible, continuously updated repository of appraised EMS research evidence. This report is an analysis of published evidence for EMS interventions used to assess and treat patients suffering from hypoglycemia. Methods: PubMed was systematically searched in June 2019. One author screened titles, abstracts and full-texts for relevance. Trained appraisers reviewed full text articles, scored each on a three-point Level of Evidence (LOE) scale (based on study design and quality) and three-point Direction of Evidence (DOE) scale (supportive, neutral, or opposing findings for each intervention's primary outcome), abstracted the primary outcome, setting and assigned an outcome category (patient or process). Second party appraisal was conducted for all included studies. The level and direction of each intervention was plotted in an evidence matrix, based on appraisals. Results: Twenty-nine studies were included and appraised for seven interventions: 5 drugs (Dextrose 50% (D50), Dextrose 10% (D10), glucagon, oral glucose and thiamine), one assessment tool (point-of-care (POC) glucose testing) and one call disposition (treat-and-release). The most frequently reported study primary outcomes were related to: clinical improvement (n = 15, 51.7%), feasibility/safety (n = 8, 27.6%), and diagnostics (n = 6, 20.7%). The majority of outcomes were patient focused (n = 18, 62.0%). Conclusion: EMS interventions for treating hypoglycemia are informed by high-quality supportive evidence. Both D50 and D10 are supported by high-quality evidence; suggesting D10 may be an effective alternative to the standard D50. “Treat-and-release” practices for hypoglycemia are supported by moderate-quality evidence for the patient related outcomes of relapse, patient preference and complications. This body of evidence is high-quality, patient-focused and conducted in the prehospital setting thus generalizable paramedic practice.

Evidence-Based Practice & Practice-Based Evidence Applied to Adult, Medical Speech-Language Pathology

2013 ◽  
Vol 18 (1) ◽  
pp. 14-26 ◽  
Author(s):  
Rik Lemoncello ◽  
Bryan Ness
Keyword(s):  
Evidence Based Practice ◽  
Single Case ◽  
Quality Data ◽  
Evidence Based ◽  
Speech Language Pathology ◽  
Clinical Practices ◽  
High Quality ◽  
Randomized Controlled Clinical Trials ◽  
Relative Paucity ◽  
Language Pathology

In this paper, we review concepts of evidence-based practice (EBP), and provide a discussion of the current limitations of EBP in terms of a relative paucity of efficacy evidence and the limitations of applying findings from randomized controlled clinical trials to individual clinical decisions. We will offer a complementary model of practice-based evidence (PBE) to encourage clinical scientists to design, implement, and evaluate our own clinical practices with high-quality evidence. We will describe two models for conducting PBE: the multiple baseline single-case experimental design and a clinical case study enhanced with generalization and control data probes. Gathering, analyzing, and sharing high-quality data can offer additional support through PBE to support EBP in speech-language pathology. It is our hope that these EBP and PBE strategies will empower clinical scientists to persevere in the quest for best practices.

scholarly journals A Systematic Review of Evidence-Based Video Modeling for Students with Emotional and Behavioral Disorders

2018 ◽  
Vol 8 (4) ◽  
pp. 170 ◽  
Author(s):  
Soonhwa Seok ◽  
Boaventura DaCosta ◽  
Mikayla McHenry-Powell ◽  
Linda Heitzman-Powell ◽  
Katrina Ostmeyer
Keyword(s):  
Systematic Review ◽  
Quality Indicators ◽  
Behavioral Disorders ◽  
Video Modeling ◽  
Evidence Based Practice ◽  
Emotional And Behavioral Disorders ◽  
Future Research ◽  
Evidence Based ◽  
K 12 ◽  
Students With Ebd

This systematic review examined eight studies showing that video modeling (VM) can have a positive and significant effect for students with emotional and behavioral disorders (EBD). Building upon meta-analyses that sought evidence of video-based interventions decreasing problem behaviors of students with EBD in K-12 education, the review examined the standards of the Council for Exceptional Children (CEC) for evidence-based practice as well as additional quality indicators, neglected quality indicators, strategies combined with VM, the impact of the independent variables on the dependent variables, and common recommendations offered for future research. Findings revealed that the eight studies met the CEC standards for evidence-based practices as well as other quality indicators. For instance, all studies reported content and setting, participants, intervention agents, description of practice, as well as interobserver agreement and experimental control. According to the findings, fidelity index and effect size were the two most neglected quality indicators. Furthermore, instructions, reinforcement system, and feedback or discussion were the most common strategies used. Finally, generalizability—across settings, populations, treatment agents, target behaviors in the real world, and subject matter—was the most common recommendation for future research. While further investigation is warranted, these findings suggest that VM is an effective evidence-based practice for students with EBD when the CEC standards are met.

The Clinical Practice Model for Persons with Dementia: Application to Music Therapy

2021 ◽  
Author(s):  
Alaine E Reschke-Hernández
Keyword(s):  
Clinical Practice ◽  
Music Therapy ◽  
Behavioral Interventions ◽  
Clinical Decision Making ◽  
Evidence Based Practice ◽  
Intervention Development ◽  
Well Being ◽  
Future Research ◽  
Evidence Based ◽  
Practice Model

Abstract Currently, no drug can cure or effectively mitigate symptoms for the growing number of individuals who live with Alzheimer’s disease and related dementias. As they experience declines in memory, communication, and thinking—symptoms that undermine social initiative, autonomy, and well-being—these individuals become increasingly dependent on others. Evidence regarding the benefits of music therapy for persons with dementia is growing. Nonetheless, limitations in existing research have hindered knowledge regarding the use and appropriate application of music as a form of treatment with this population. This article describes the development of The Clinical Practice Model for Persons with Dementia, which provides a theoretical framework to inform evidence-based practice, illustrated here in application to music therapy. Specifically, the model is intended to prompt purposeful application of strategies documented within a broad literature base within 6 thematic areas (Cognition, Attention, Familiarity, Audibility, Structure, and Autonomy); facilitate clinical decision-making and intervention development, including music interventions; and encourage discourse regarding relationships between characteristics of the intervention, the therapist, the person with dementia, and their response to intervention. The model comprises a set of testable assumptions to provide direction for future research and to facilitate the description and investigation of mechanisms underlying behavioral interventions with this population. Although the model is likely to evolve as knowledge is gained, it offers a foundation for holistically considering an individual’s needs and strengths, guidance for applying music and nonmusic strategies in evidence-based practice, and direction for future research.

Using a Critical Appraisal Assignment to Infuse Evidence-Based Practice into a Therapeutic Modality Course

2014 ◽  
Vol 9 (1) ◽  
pp. 22-28 ◽  
Author(s):  
Mary Beth Zwart ◽  
Bernadette Olson
Keyword(s):  
Clinical Practice ◽  
Athletic Training ◽  
Critical Appraisal ◽  
Evidence Based Practice ◽  
Clinical Findings ◽  
Therapeutic Modality ◽  
Future Research ◽  
Evidence Based ◽  
Clinical Question ◽  
Starting Point

Context It is the responsibility of athletic training educators, through curriculum and clinical experiences, to engage students towards adopting evidence-based practice (EBP) into their practice. The initial task of implementing EBP into a curriculum or course can seem like a large task for educators and students. As a way to start scaffolding EBP concepts across the curriculum, a modified critical appraisal assignment was developed to teach therapeutic modality concepts. Objective The purpose of this action research project was to demonstrate how a modified critical appraisal assignment can be used to introduce the process and aspects of critical appraisal and begin scaffolding the development of critical appraisal skills over time. The objectives of this study were to evaluate the students' ability to (1) successfully locate relevant research needed to answer clinical questions and (2) successfully appraise the literature according to basic EBP strategy. From a program perspective, the modified critical appraisal assignment was a starting point from which to include EBP principles into didactic coursework. Design Seventeen athletic training students completed 3 modified critical appraisal assignments pertaining to the use of therapeutic modalities. Each paper included 5 sections: (1) clinical question, (2) key clinical findings, (3) clinical applicability based on information from the appraisal and significance of results, (4) article comparison table, and (5) implications for clinical practice, patient education, and future research. The instructor evaluated the assignments blind. Conclusions Students were generally able to complete the critical appraisal assignment; however, students had difficulty locating research that answered the clinical question. Students struggled to relate the key clinical findings of the research articles and implications for clinical practice to the given clinical question. Findings from this study have informed faculty teaching, including introducing EBP skills earlier in the curriculum and inserting assignments that stress various aspects of the critical appraisal process.

Clinical studies of incidental intracranial meningiomas—towards high-quality evidence-based practice

2020 ◽  
Vol 162 (3) ◽  
pp. 673-674
Author(s):  
Abdurrahman I. Islim ◽  
Christopher P. Millward ◽  
Kirsty J. Martin-McGill ◽  
Ruwanthi Kolamunnage-Dona ◽  
Thomas Santarius ◽  
...  
Keyword(s):  
Clinical Studies ◽  
Evidence Based Practice ◽  
Evidence Based ◽  
High Quality ◽  
High Quality Evidence ◽  
Intracranial Meningiomas ◽  
Quality Evidence

The Psychology of CSR

2019 ◽  
pp. 17-47
Author(s):  
David A. Jones
Keyword(s):  
Boundary Conditions ◽  
Evidence Based Practice ◽  
Stakeholder Group ◽  
Future Research ◽  
Evidence Based ◽  
Psychological Processes ◽  
Job Seekers ◽  
Scholarly Research ◽  
Psychological Mechanisms ◽  
Stakeholder Groups

This chapter is about the psychological processes through which individuals evaluate and respond to an organization’s CSR practices. To advance scholarly research and evidence-based practice, directions are outlined for future inquiry informed by an integrated review of findings across three independent streams of “micro-CSR” research conducted among employees, job seekers, and consumers. In a section on CSR evaluations, it is described how individuals cognitively process information to form CSR perceptions and CSR appraisals, and the types of CSR initiatives and evaluative-constructs studied among each stakeholder group are summarized. In the next section, research is reviewed on responses to CSR, and recent findings about psychological mechanisms and boundary conditions are organized within three categories of care-based, self-protective, and relational-status (C-S-R) considerations. In a last section, research is described on stakeholders’ CSR awareness, the non-trivial implications that follow from evidence of low CSR awareness among all three stakeholder groups, and suggestions for future research.

scholarly journals Practice Parameter: Diagnosis and prognosis of new onset Parkinson disease (an evidence-based review)

Neurology ◽  
2006 ◽  
Vol 66 (7) ◽  
pp. 968-975 ◽  
Author(s):  
O. Suchowersky ◽  
S. Reich ◽  
J. Perlmutter ◽  
T. Zesiewicz ◽  
G. Gronseth ◽  
...  
Keyword(s):  
Parkinson Disease ◽  
Disease Progression ◽  
Clinical Features ◽  
Predictive Factors ◽  
Age At Onset ◽  
Future Research ◽  
Evidence Based ◽  
Level Of Evidence ◽  
Parkinsonian Syndromes ◽  
Olfactory Testing

Objective: To define key issues in the diagnosis of Parkinson disease (PD), to define features influencing progression, and to make evidence-based recommendations. Two clinical questions were identified: 1) Which clinical features and diagnostic modalities distinguish PD from other parkinsonian syndromes? 2) Which clinical features predict rate of disease progression?Methods: Systematic review of the literature was completed. Articles were classified according to a four-tiered level of evidence scheme. Recommendations were based on the evidence.Results and Conclusions: 1. Early falls, poor response to levodopa, symmetry of motor manifestations, lack of tremor, and early autonomic dysfunction are probably useful in distinguishing other parkinsonian syndromes from Parkinson disease (PD). 2. Levodopa or apomorphine challenge and olfactory testing are probably useful in distinguishing PD from other parkinsonian syndromes. 3. Predictive factors for more rapid motor progression, nursing home placement, and shorter survival time include older age at onset of PD, associated comorbidities, presentation with rigidity and bradykinesia, and decreased dopamine responsiveness. Future research into methods for earlier and more accurate diagnosis of the disease and identification and clarification of predictive factors of rapid disease progression is warranted.

scholarly journals Facilitating a Mentoring Programme for Doctoral Students: Insights from Evidence-Based Practice

10.28945/4594 ◽  
2020 ◽  
Vol 15 ◽  
pp. 415-431
Author(s):  
Joanna Szen-Ziemianska
Keyword(s):  
Doctoral Students ◽  
Evidence Based Practice ◽  
Meaning Making ◽  
Evaluation Studies ◽  
Economic Benefits ◽  
Future Research ◽  
Evidence Based ◽  
Psychosocial Needs ◽  
Case Study Methodology ◽  
Method Approach

Aim/Purpose: One approach to helping doctoral students deal with the many challenges they face is the provision of a structured mentoring programme to complement the more traditional doctoral curriculum and supervisor relationship. This paper reports a mentoring programme containing such activities as individual consultations and peer-mentoring workshops, introduced at one of the non-public universities in Poland and discusses the development of a model of support. In developing the model, two evaluation studies were conducted seeking to discover how participants perceived the mentoring programme, what needs the mentoring programme addressed, and what benefits it provided for doctoral students. Background: With reference to a new paradigm proposed by Kram and Higgins, mentoring emerges in the context of many developmental networks, where the more junior mentors and peer-mentors together discover new roles involved in doctoral education. Methodology: Case study methodology is utilized to gather perceptions of a doctoral mentoring programme. The conceptual framework for a two-part programme is presented and the results of two evaluation studies conducted on-line using a mix-method approach are reported. In total, 42 doctoral students participated in the studies, representing social sciences and the humanities disciplines. Contribution: This paper discusses a novel doctoral mentoring programme which finds its basis in evidence-based practice. This research goes beyond previous studies by undertaking an analysis of doctoral students’ needs, then considering relationships between those needs and structuring a programme to meet them. Findings: Findings showed three main areas of need for doctoral students: the need for social interaction at university; the need for structure in the doctoral journey, and the need for psychological support. Participants distinguished two perspectives that influenced the assessment of programme activities: (a) the meaningfulness of the mentoring programme to the individual; (b) the mentor’s attitude including the general atmosphere of collegiality during meetings. Results presented are supported by a proposed intervention model. Recommendations for Practitioners: The model presented may inspire other universities to implement similar approaches for supporting their own doctoral students. Researcher enablers are also offered as strategies relating to workshop topics, meeting schedules, and programme organization. The main recommendation for practitioners is to be sensitive to the psychosocial needs of students. Recommendation for Researchers: Researchers interested in doctoral students’ needs and ways of supporting them can utilize the proposed model for strategically planning such support. It is recommended that further research into the area of mentoring doctoral students makes use of the mixed-method approach. Such an approach takes cognizance of phenomenological exigencies as they pertain to individual meaning-making. Impact on Society: Supporting the effectiveness of doctoral students is significant as failure comes at great professional and personal cost to the doctoral student. There are also potential costs in terms of faculty disillusionment and impacts on university reputation. Economic benefits to the nation may also be forfeited when doctoral students fail to graduate. Future Research: It would be valuable to corroborate the model presented and extend it through the development of a mentoring support scale which identifies more linearly specific doctoral students’ needs. Longitudinal studies are also required to verify long-term effects of the programme.

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