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Integrating Evidence (integrating + evidence)
Selected AbstractsIntegrating Evidence-Based Practice in Nurse Practitioner EducationJOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 12 2004APRN-C, FAANP, Mary Jo Goolsby EdD ABSTRACT This column normally focuses on a specific clinical practice guideline (CPG). This month's column deviates from that practice to demonstrate how evidence-based practice (EBP) was integrated into the nurse practitioner (NP) curriculum at the University of Texas at Austin School of Nursing. Processes of EBP were linked to student clinical assignments across core NP clinical courses, culminating in a student-published CPG. When students research and analyze available scientific evidence for a CPG, they learn to critically evaluate and logically organize knowledge for use in clinical practice, and those critical-thinking skills can lead to improved clinical reasoning and decision making. [source] Integrating evidence-based practice into the diabetes nurse curriculum in BergenEUROPEAN DIABETES NURSING, Issue 1 2010Perceived barriers to finding, reading, using research in practice Abstract Background: There is rising international interest in developing healthcare systems that are built on the basis of best evidence. However, it is a challenge to integrate evidence-based practice skills into existing educational courses, in a manner that enables students to interpret and use such skills effectively. Aims: To study students' abilities to find, read and critique research literature and to explore students' perceptions of barriers to implementing evidence-based knowledge and skills into their practice. Methods: An evidence-based approach was integrated into the curriculum of a postgraduate diabetes education programme. At the start of the course and after its completion, questionnaire data were collected to assess students' ability to find, read and critique research literature, and students' perceptions of barriers to implementing new knowledge and skills into practice. Qualitative data on barriers to transferring evidence into practice were also collected. Results: Thirty-three experienced nurses (all female), mean age 40 years (SD 7.7; range 28,52 years), mean work experience 12.8 years (SD 7.9; range 3,30 years) attended the course and completed the initial questionnaire. By the end of the course, three students (9%) had left because of maternity leave or health issues, and six students (18%) did not return the final questionnaires. The remaining students reported greater ability to find and critique research literature (increasing respectively from 6.7% to 40.0% and from 27.3% to 41.7% during the course). Perceived barriers of using research in practice were: lack of time (69.7%); workplace environment (30.4%); structural and organisational problems (25.0%). The qualitative findings indicated that hierarchy, fear of negative judgements, competing demands, and fear of change were perceived barriers. Conclusion: Students commented that the course had provided them with enhanced evidence-based practice skills for finding and interpreting research. However, postgraduate training should be linked very closely to the student's workplace, in order to support the transfer of best evidence into practice. Copyright © 2010 FEND [source] Integrating evidence into clinical practice: an alternative to evidence-based approachesJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 3 2006Mark R. Tonelli MD MA Abstract Evidence-based medicine (EBM) has thus far failed to adequately account for the appropriate incorporation of other potential warrants for medical decision making into clinical practice. In particular, EBM has struggled with the value and integration of other kinds of medical knowledge, such as those derived from clinical experience or based on pathophysiologic rationale. The general priority given to empirical evidence derived from clinical research in all EBM approaches is not epistemically tenable. A casuistic alternative to EBM approaches recognizes that five distinct topics, 1) empirical evidence, 2) experiential evidence, 3) pathophysiologic rationale, 4) patient goals and values, and 5) system features are potentially relevant to any clinical decision. No single topic has a general priority over any other and the relative importance of a topic will depend upon the circumstances of the particular case. The skilled clinician must weigh these potentially conflicting evidentiary and non-evidentiary warrants for action, employing both practical and theoretical reasoning, in order to arrive at the best choice for an individual patient. [source] Evolution and development of the primate limb skeletonEVOLUTIONARY ANTHROPOLOGY, Issue 3 2002Chi-Hua Chiu Abstract The order Primates is composed of many closely related lineages, each having a relatively well established phylogeny supported by both the fossil record and molecular data.1 Primate evolution is characterized by a series of adaptive radiations beginning early in the Cenozoic era. Studies of these radiations have uncovered two major trends. One is that substantial amounts of morphological diversity have been produced over short periods of evolutionary time.2 The other is that consistent and repeated patterns (variational tendencies3) are detected. Taxa within clades, such as the strepsirrhines of Madagascar and the platyrrhines of the Neotropics, have diversified in body size, substrate preference, and diet.2, 4,6 The diversification of adaptive strategies within such clades is accompanied by repeated patterns of change in cheiridial proportions7, 8 (Fig. 1) and tooth-cusp morphology.9 There are obvious adaptive, natural-selection based explanations for these patterns. The hands and feet are in direct contact with a substrate, so their form would be expected to reflect substrate preference, whereas tooth shape is related directly to the functional demands of masticating foods having different mechanical properties. What remains unclear, however, is the role of developmental and genetic processes that underlie the evolutionary diversity of the primate body plan. Are variational tendencies a signature of constraints in developmental pathways? What is the genetic basis for similar morphological transformations among closely related species? These are a sampling of the types of questions we believe can be addressed by future research integrating evidence from paleontology, comparative morphology, and developmental genetics. [source] The role of trout in stream food webs: integrating evidence from field surveys and experimentsJOURNAL OF ANIMAL ECOLOGY, Issue 2 2006KRISTIAN MEISSNER Summary 1We evaluated the effects of brown trout on boreal stream food webs using field surveys and enclosure/exclosure experiments. Experimental results were related to prey preference of uncaged trout in the same stream, as well as to a survey of macroinvertebrate densities in streams with vs. without trout. Finally, we assessed the generality of our findings by examining salmonid predation on three groups of macroinvertebrate prey (chironomid midges, epibenthic grazers, invertebrate predators) in a meta-analysis. 2In a preliminary experiment, invertebrate predators showed a strong negative response to trout, whereas chironomids benefited from trout presence. In the main experiment, trout impact increased with prey size. Trout had the strongest effect on invertebrate predators and cased caddis larvae, whereas Baetis mayfly and chironomid larvae were unaffected. Trout impact on the largest prey seemed mainly consumptive, because prey emigration rates were low and independent of fish presence. Despite strong effects on macroinvertebrates, trout did not induce a trophic cascade on periphyton. Uncaged trout showed a strong preference for the largest prey items (predatory invertebrates and aerial prey), whereas Baetis mayflies and chironomids were avoided by trout. 3Densities of invertebrate predators were significantly higher in troutless streams. Baetis mayflies also were less abundant in trout streams, whereas densities of chironomids were positively, although non-significantly, related to trout presence. Meta-analysis showed a strong negative impact of trout on invertebrate predators, a negative but variable impact on mobile grazers (mainly mayfly larvae) and a slightly positive impact on chironomid larvae. 4Being size-selective predators, salmonid fishes have a strong impact on the largest prey types available, and this effect spans several domains of scale. Discrepancies between our experimental findings and those from the field survey and meta-analysis show, however, that for most lotic prey, small-scale experiments do not reflect fish impact reliably at stream-wide scales. 5Our findings suggest that small-scale experiments will be useful only if the experimental results are evaluated carefully against natural history information about the experimental system and interacting species across a wide array of spatial scales. [source] | |||||||||||||