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High Level Evidence (high + level_evidence)
Selected AbstractsChronic pain syndromes in the emergency department: Identifying guidelines for managementEMERGENCY MEDICINE AUSTRALASIA, Issue 1 2005Kylie Baker Abstract Objectives:, To explore current literature on chronic pain syndromes and develop ED recommendations for the management and minimalization of chronic non-cancer pain. Methods:, A focused literature review. Results:, Chronic pain is a common presentation to the ED but is poorly understood and managed. Research into the psychophysiology of chronic pain shows that there are definite changes in the receptive and processing pathways in patients suffering chronic pain syndromes. Evidence shows the effectiveness of early recognition with multimodal treatment, however high level evidence is lacking. All experts recommend balanced drug therapy, cognitive and behavioural interventions. Certain interventions are appropriate to the ED setting. Conclusions:, Emergency Medicine lacks a cohesive, informed strategy for management of chronic pain. The proposed guidelines represent the first step toward establishing consistency in the management of patients with chronic pain syndromes. Further work needs to be undertaken at a national level in developing evidence based guidelines. [source] Nontherapeutic Male Circumcision: Tackling the Difficult IssuesTHE JOURNAL OF SEXUAL MEDICINE, Issue 8 2009Caryn L. Perera BA (Lib & Info Mgt), Grad Cert EBP ABSTRACT Introduction., Male circumcision is the most commonly performed surgical procedure in the world. Circumcision may be performed to treat an underlying pathological process ("therapeutic circumcision"). However there may be religious, cultural, and social indications. Aim., This article addresses the religious, cultural, social, and ethical issues surrounding nontherapeutic male circumcision (NTMC). Main Outcome Measures., Any religious, social, cultural, or ethical issues relating to NTMC. Methods., Because of the absence of high level evidence, a concise literature review was undertaken to identify articles published between January 1990 and February 2009 summarizing current knowledge on NTMC. Results., There are complex religious, cultural, social, and prophylactic incentives for NTMC. The procedure may have associated clinical and psychosocial adverse events and raises such ethical issues as bodily integrity and consent. Because of the strength of the incentives for NTMC, there may be important implications in denying patients the procedure. Several important issues must be considered when introducing mass circumcision as a preventative strategy for HIV/AIDS. Conclusion., When assessing whether NTMC will benefit or harm a patient, clinicians must take his religious, cultural, and social circumstances into account. Males requiring mandatory religious or cultural NTMC are likely to suffer significant harm if they do not receive circumcision and should be considered separately to males in general. Perera CL, Bridgewater FHG, Thavaneswaran P, and Maddern GJ. Nontherapeutic male circumcision: Tackling the difficult issues. J Sex Med 2009;6:2237,2243. [source] Treatment of HCC in Patients Awaiting Liver TransplantationAMERICAN JOURNAL OF TRANSPLANTATION, Issue 8 2007M. Schwartz Liver transplantation (LT) is the treatment of choice for many patients with unresectable hepatocellular carcinoma (HCC), but long waiting time due to the shortage of donor organs can result in tumor progression and drop-out from LT candidacy. Furthermore, even in candidates meeting the restrictive Milan criteria there is risk of HCC recurrence; this risk rises significantly when patients with more advanced HCC are included. In an effort to address these issues, treatment of HCC in patients awaiting LT has become widespread practice. In this review the various modalities employed in the pre-LT setting are presented, and the evidence for benefit with regard to (1) improvement of post-LT survival, (2) down-staging of advanced HCC to within Milan criteria and (3) preventing waiting list drop-out is considered. Chemoembolization, radiofrequency ablation and ethanol injection all have well-documented antitumor activity; however, there is no high level evidence that waiting list HCC treatment with these modalities is effective in achieving any of the three above-mentioned aims. Nevertheless, particularly in the United States, where continued waiting list priority depends on maintaining HCC within Milan criteria, use of nonsurgical HCC treatment will likely continue in an effort to forestall tumor progression and waiting list drop-out. [source] An Australian and New Zealand survey of practice of the use of oxytocin at elective caesarean sectionAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 1 2010Joanne C. MOCKLER Background:, The use of oxytocin to prevent postpartum haemorrhage at elective caesarean section is largely based on evidence derived from vaginal births. Overseas studies indicate wide variation in practice with regard to specific doses of oxytocin administered at caesarean section. No such surveys have been undertaken in Australia or New Zealand. Aims:, To survey and report Australian and New Zealand practice regarding oxytocin administration at elective caesarean section. Methods:, A structured questionnaire was posted to Fellows of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists resident in Australia and New Zealand. Results:, One thousand five hundred and forty-seven questionnaires were distributed, of which 890 (58%) were returned. Of these, 700 Fellows, 600 from Australia and 100 from New Zealand, currently practiced obstetrics. Almost all Fellows, 686 (98%), reported that they administered an oxytocin bolus at elective caesarean section, most commonly 10 IU (n = 460) or 5 IU (n = 220). The choice of bolus dose was related to country, duration and type (private or public) of practice. A majority of Fellows, 683 (98%), used an additional oxytocin infusion, either routinely or selectively. A total of 68 different regimens were reported. The single most common regimen was 40 IU oxytocin in 1000 mL administered over four hours, used by 255 Fellows (37%). Conclusions:, There are wide variations in the usage of oxytocin at elective caesarean section in Australia and New Zealand, most likely due to a lack of high level evidence to guide practice. Appropriately designed clinical trials are needed to provide evidence to support future practice. [source] Developing best practice in critical care nursing: knowledge, evidence and practiceNURSING IN CRITICAL CARE, Issue 3 2003Paul Fulbrook Summary ,Because the current drive towards evidence-based critical care nursing practice is based firmly within the positivist paradigm, experimentally derived research tends to be regarded as ,high level' evidence, whereas other forms of evidence, for example qualitative research or personal knowing, carry less weight ,This poses something of a problem for nursing, as the type of knowledge nurses use most in their practice is often at the so-called ,soft' end of science. Thus, the ,Catch 22' situation is that the evidence base for nursing practice is considered to be weak ,Furthermore, it is argued in this paper that there are several forms of nursing knowledge, which critical care nurses employ, that are difficult to articulate ,The way forward requires a pragmatic approach to evidence, in which all forms of knowledge are considered equal in abstract but are assigned value according to the context of a particular situation ,It is proposed that this can be achieved by adopting an approach to nursing in which practice development is the driving force for change [source] | ||||||||||