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Evidence Used (evidence + used)
Selected AbstractsThe evidence-based supply of non-prescription medicines: barriers and beliefsINTERNATIONAL JOURNAL OF PHARMACY PRACTICE, Issue 2 2004Margaret C. Watson MRC fellow ABSTRACT Context The reclassification of prescription only medicines (POMs) to pharmacy only (P) and general sale list (GSL) status is ongoing in the UK. Pharmacy staff need support to ensure the appropriate supply of these non-prescription medicines (NPMs). Objective To investigate the type of evidence used in the decision to supply NPMs and the barriers associated with their supply. Methods A participant observation study was conducted in nine pharmacies in one area of Scotland (Grampian). In-depth interviews were conducted with one pharmacist and one medicine counter assistant (MCA) from each pharmacy to explore and compare their attitudes and beliefs towards evidence-based practice (EBP) and the supply of NPMs. Key findings Most consultations were product requests. Pharmacy staff had little awareness or understanding of the term EBP and no specific evidence was used in the majority of consultations. Pharmacists' attitudes towards EBP varied. Personal experience or feedback from customers were cited as evidence upon which treatment recommendations were based. Many barriers and problems were associated with the supply of NPMs. These included: lack of evidence; MCAs' self-perception of their role; questioning and communication skills; safety; and training needs. There was a gap between pharmacists' and MCAs' perceptions of who should be referred to the pharmacist. Many staff used the WWHAM mnemonic for questioning customers, but this was often used as a matter of rote rather than as a framework to engage the customer in a relevant and constructive consultation. The development of adequate communication skills to allow core information to be obtained to support decision making needs to be addressed. Conclusion An increased awareness of EBP and its role in quality care needs to be promoted to community pharmacists and MCAs. There is currently no formal continuing education provision or requirement for MCAs in the UK. Pharmacy staff, particularly MCAs, require continuing education on the supply of NPMs. [source] Evidence coverage and argument skills: cognitive factors in a juror's verdict choiceJOURNAL OF BEHAVIORAL DECISION MAKING, Issue 3 2004Michael P. Weinstock Abstract Juror reasoning and verdict choice have been explored variously as functions of argument skill and the overall story representation of the evidence on which verdict choices are based. This study investigates the proportion of testimony covered in the justification of a verdict choice and its relationship with argument skill, narrative explanation or evidence-based argument, and certainty about verdict choice. Each of these variables was also compared with the verdict choice. People serving jury duty justified verdict choices in two abridged jury trials. Individuals were consistent in the relative amount of evidence used in both trials. Argument skills, evidence evaluation type, and evidence synthesis type all accounted for variance in the amount of evidence covered. Evidence coverage, along with argument skills, predicted verdict choice. As expected, those most certain about verdict choice did not use the most evidence. Implications regarding mediating factors in story construction and juror decision making are discussed. Copyright © 2004 John Wiley & Sons, Ltd. [source] Economic analysis for clinical practice , the case of 31 national consensus guidelines in the NetherlandsJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 1 2007Louis W. Niessen MD Abstract Rationale, aims and objective, Evidence on the cost-effectiveness of health interventions in the development of practice guidelines has become of interest in many countries. Challenges are the quality of economic data, the use of cost-effectiveness criteria, and the consensus process. Our paper aims to assess the quality and use of economic information in the formulation of consensus guidelines in a Dutch pilot programme and to recommend improvements. Methods, ,Retrospective qualitative review of economic evaluations and formulated recommendations, using a checklist based on international standards. Results, The national programme to support the development of guidelines with economic analysis in multidisciplinary consensus groups run from 1998 to 2002. It has included 31 medical guidelines, addressing 23 conditions across seven International Classification of Diseases (ICD)-disease groups. Experts in health technology assessment have participated in the guidelines groups. Economic information in all guidelines varies by all criteria in the level of evidence used. Information on quality-adjusted life years gained is limited as is statistical analysis in most studies. Highest cost-effectiveness ratios reported are between ,20 000 and ,30 000. However, there is no uniformity in the definitions of acceptable cost-effectiveness ratios. Conclusions, Economic recommendations can be included in guidelines. Interaction between clinicians and health economists promotes a balance between medical and economic arguments. Among panellists there appears to be agreement on the level of the cost-effectiveness ratios that is acceptable. It is recommended that economic analysis is used to strengthen the evidence-base of guidelines. An evidence-grading system should include the quality of economic evaluation. Roles of policymakers and providers need to be defined. [source] The Last Glacial Maximum in the North Sea Basin: micromorphological evidence of extensive glaciation,JOURNAL OF QUATERNARY SCIENCE, Issue 2 2006S. J. Carr Abstract Despite a long history of investigation, critical issues regarding the last glacial cycle in northwest Europe remain unresolved. One of these refers to the extent, timing and dynamics of Late Devensian/Weichselian glaciation of the North Sea Basin, and whether the British and Scandinavian ice sheets were confluent at any time during this period. This has been the result of the lack of the detailed sedimentological data required to reconstruct processes and environment of sediments recovered through coring. This study presents the results of seismic, sedimentological and micromorphological evidence used to reconstruct the depositional processes of regionally extensive seismic units across the North Sea Basin. Thin section micromorphology is used here to provide an effective means of discriminating between subglacial and glacimarine sediments from cored samples and deriving process-based interpretations from sediment cores. On the basis of micromorphology, critical formations from the basin have been reinterpreted, with consequent stratigraphic implications. Within the current stratigraphic understanding of the North Sea Basin, a complex reconstruction is suggested, with a minimum of three major glacial episodes inferred. On at least two occasions during the Weichselian/Devensian, the British and Scandinavian ice sheets were confluent in the central North Sea. Whilst micromorphology can provide much greater confidence in the interpretation of Late Quaternary offshore stratigraphic sequences, it is noted that a much better geochronology is required to resolve key stratigraphic issues between the onshore and offshore stratigraphic records. Copyright © 2006 John Wiley & Sons, Ltd. [source] Organisational theory perspective on process capability measurement scalesJOURNAL OF SOFTWARE MAINTENANCE AND EVOLUTION: RESEARCH AND PRACTICE, Issue 4 2010Tom McBride Abstract Capability and maturity models are widely accepted. Generally, the first three levels of the most capability models have the same general goal, a defined repeatable process, but may differ in their implementation of that goal. In addition, organisations are more likely to involve multiple independent parties in the development or service management processes. Organisation and control theories provide principles that support the first three levels of most capability models. However, different forms of organisational control and coordination require that the evidence used to assess achievement of the different capability levels must broaden from its current focus on activities and tasks to include work products, their characteristics and verification, and skills, competence and training. Copyright © 2009 John Wiley & Sons, Ltd. [source] Statistical evidence and compliance with Title IXNEW DIRECTIONS FOR INSTITUTIONAL RESEARCH, Issue 138 2008John J. Cheslock This chapter examines the statistical evidence used to determine whether an institution's athletic program is in compliance with Title IX. [source] Evaluating evidence-based practice within critical careNURSING IN CRITICAL CARE, Issue 3 2008Helen O'Neal Abstract Background and Aims:, Between 2002-2005 the Trust undertook an action research project to evaluate a corporate practice development strategy. During this period clinicians became practitioner-researchers utilising a variety of methods to evaluate the influence of practice development. One aspect of this focused upon evaluation of evidence based guidelines. This article concentrates upon this process and the learning from this within critical care. Method:, Within critical care it was recognised that the standard of guidelines and protocols varied in terms of the amount of evidence used to underpin decision making. A group was set up to evaluate and appraise these using a structured format such as the Appraisal of Guidelines for Research and Evaluation (AGREE) Instrument. Findings:, The initial evaluation (cycle 1) highlighted learning associated with the process of using the instrument within critical care, as well as where the quality of the guidelines could be improved. The second cycle of evaluation demonstrated that implementation of the action plans as a consequence of cycle 1 resulted in an improvement in the quality of the guidelines. It also resulted in streamlining the process of undertaking guideline appraisal across a Trust. Discussion and Conclusions:, Action resulting from analysis of the findings of cycle 1 led to a cultural change in which the structure of a tool such as the AGREE instrument could be beneficial in the development of future guidelines. This has been sustained both within critical care and Trust wide with various initiatives such as the establishment of critical care multidisciplinary guideline development groups and a Trust wide electronic library management system. [source] The quality of questions and use of resources in self-directed learning: Personal learning projects in the maintenance of certificationTHE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS, Issue 2 2009T. Horsley PhD Abstract Introduction: To engage effectively and efficiently in self-directed learning and knowledge-seeking practices, it is important that physicians construct well-formulated questions; yet, little is known about the quality of good questions and their relationship to self-directed learning or to change in practice behavior. Methods: Personal learning projects (PLPs) submitted to the Canadian Maintenance of Certification program were examined to include underlying characteristics, quality of therapeutic questions (population, intervention, comparator, outcome [PICO] mnemonic), and relationships between stage of change and level of evidence used to resolve questions. Results: We assessed 1989 submissions (from 559 Fellows of the Royal College of Physicians and Surgeons of Canada [RCPSC]). The majority of submissions were by males (69.2%) aged 40,59 (59.4%) with an average of 24.3 (range 6,58, SD 11.1) years since graduation. The most frequent submissions were treatment (36.6%) and diagnosis (22.3%) questions. Half of all questions described ,2 components (PICO), and only 3.7% of questions included all 4 components. Cross tabulations indicated only 1 significant trend for the use of narrative reviews and the outcome "integrating new knowledge' (P < .000). Discussion: Self-directed learning skills comprise an important strategy for specialists maintaining or expanding their expertise in patient care, but an important obstacle to answering patient care questions is the ability to formulate good ones. Engagement in most major learning activities is stimulated by management of a single patient: formal accredited group learning events are of limited value in starting episodes of self-directed learning. Low levels of evidence used to address learning projects. Future research should determine how best to improve the quality of questions submitted and whether or not these changes result in increased efficiencies, more appropriate uses of evidence, and increased changes in practice behaviors. [source] Flaws in the U.S. Food and Drug Administration's Rationale for Supporting the Development and Approval of BiDil as a Treatment for Heart Failure Only in Black PatientsTHE JOURNAL OF LAW, MEDICINE & ETHICS, Issue 3 2008George T. H. Ellison The U.S. Food and Drug Administration's (FDA) rationale for supporting the development and approval of BiDil (a combination of hydralazine hydrochloride and isosorbide dinitrate; H-I) for heart failure specifically in black patients was based on under-powered, post hoc subgroup analyses of two relatively old trials (V-HeFT I and II), which were further complicated by substantial covariate imbalances between racial groups. Indeed, the only statistically significant difference observed between black and white patients was found without any adjustment for potential confounders in samples that were unlikely to have been adequately randomized. Meanwhile, because the accepted baseline therapy for heart failure has substantially improved since these trials took place, their results cannot be combined with data from the more recent trial (A-HeFT) amongst black patients alone. There is therefore little scientific evidence to support the approval of BiDil only for use in black patients, and the FDA's rationale fails to consider the ethical consequences of recognizing racial categories as valid markers of innate biological difference, and permitting the development of group-specific therapies that are subject to commercial incentives rather than scientific evidence or therapeutic imperatives. This paper reviews the limitations in the scientific evidence used to support the approval of BiDil only for use in black patients; calls for further analysis of the V-HeFT I and II data which might clarify whether responses to H-I vary by race; and evaluates the consequences of commercial incentives to develop racialized medicines. We recommend that the FDA revise the procedures they use to examine applications for race-based therapies to ensure that these are based on robust scientific claims and do not undermine the aims of the 1992 Revitalization Act. [source] Social Policy and the Authority of EvidenceAUSTRALIAN JOURNAL OF PUBLIC ADMINISTRATION, Issue 1 2008Julian Neylan The growing call for social policy to be evidence-based implies that ,evidence' possesses an intrinsic authority. Much of the evidence used by governments to formulate or evaluate social policy is signified through statistics and the language of quantification. Evidence presented in this way has the appearance of certainty and a legitimacy that seems beyond challenge. Having an appreciation of the history and sociology of the ,science of the state', as statistics was originally defined, helps demystify the authority of social statistics. This enables policy-makers and program administrators to better discern the policy merit of numerical evidence. [source] Inconsistent Evidence: Analysis of Six National Guidelines for Vaginal Birth After Cesarean SectionBIRTH, Issue 1 2010GradDipClinEpi, Maralyn Foureur BA Abstract:, Background:, Guidelines are increasingly used to direct clinical practice, with the expectation that they improve clinical outcomes and minimize health care expenditure. Several national guidelines for vaginal birth after cesarean section (VBAC) have been released or updated recently, and their range has created dilemmas for clinicians and women. The purpose of this study was to summarize the recommendations of existing guidelines and assess their quality using a standardized and validated instrument to determine which guidelines, if any, are best able to guide clinical practice. Methods:, English language guidelines on VBAC were purposively selected from national and professional organizations in the United Kingdom, United States, Canada, New Zealand, and Australia. The Appraisal of Guidelines for Research and Evaluation (AGREE) instrument was applied to each guideline, and each was analyzed to determine the range and level of evidence on which it was based and the recommendations made. Results:, Six guidelines published or updated between 2004 and 2007 were examined. Only two of the six guidelines scored well overall using the AGREE instrument, and the evidence used demonstrated great variety. Most guidelines cited expert opinion and consensus as evidence for some recommendations. Reported success rates for VBAC ranged from 30 to 85 percent, and reported rates of uterine rupture ranged from 0 to 2.8 percent. Conclusions:, VBAC guidelines are characterized by quasi-experimental evidence and consensus-based recommendations, which lead to wide variability in recommendations and undermine their usefulness in clinical practice. (BIRTH 37:1 March 2010) [source] Toward Improved Implementation of Evidence-based Clinical Algorithms: Clinical Practice Guidelines, Clinical Decision Rules, and Clinical PathwaysACADEMIC EMERGENCY MEDICINE, Issue 11 2007Gary M. Gaddis MD This is a summary of the consensus-building workshop entitled "Guideline Implementation and Clinical Pathways," convened May 15, 2007, at the Academic Emergency Medicine Consensus Conference, "Knowledge Translation in Emergency Medicine: Establishing a Research Agenda and Guide Map for Evidence Uptake." A new term, "evidence-based clinical algorithms" is suggested to encompass evidence-based information codified into clinical pathways, clinical practice guidelines, and clinical decision rules. Examples of poor knowledge translation (KT) relevant to the specialty of emergency medicine are identified, followed by brief descriptions of important research and concepts that inform the research recommendations. Four broad themes for research to improve the KT of evidence-based clinical algorithms are suggested: organizational factors, cognitive factors, social factors, and motivational factors. In all cases, research regarding optimizing KT for the subthemes identified by Glasziou and Haynes, "getting the evidence straight," and "getting the evidence used," are interwoven into the thematic research recommendations. Consensus was reached that the majority of research efforts to evaluate means to improve KT need to be centered on the factors that show promise to enhance "getting the evidence used," focused especially on organizational factors. [source] Knowledge Translation in the Emergency Medical Services: A Research Agenda for Advancing Prehospital CareACADEMIC EMERGENCY MEDICINE, Issue 11 2007David C. Cone MD Little is known about knowledge translation in the practice of out-of-hospital medicine. It is generally accepted that much work is needed regarding "getting the evidence straight" in emergency medical services, given the substantial number of interventions that are performed regularly in the field but lack meaningful scientific support. Additional attention also needs to be given to "getting the evidence used," because there is some evidence that evidence-based practices are being incompletely or incorrectly applied in the field. In an effort to help advance a research agenda for knowledge translation in emergency medical services, nine recommendations are put forth to help address the problems identified. [source] | |||||||||||||