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PURPOSE The purpose of this study was to examine differences between urban and rural primary care clinics in the use of colorectal cancer (CRC) screening methods and evidence-based interventions to promote CRC screening. METHODS This was a cross-sectional survey of primary care clinics in Nebraska. Surveys in paper form were sent out and followed up with telephone interviews to nonrespondents. Of the 375 facilities, 263 (70.1%) responded to the survey. FINDINGS Over 30% of urban clinics indicated that 80% or more of their patients were meeting the CRC guidelines compared to 18.3% of rural clinics (P = .03). Rural clinics were more likely than urban clinics to prefer the use of colonoscopy alone or in combination with stool tests (P = .02). The most common interventions for CRC screening included one-on-one patient education and use of computer-based pop-ups to remind providers. CONCLUSIONS In conclusion, we found some important differences between rural and urban primary care clinics in the implementation of CRC screening. Given that there is evidence for differences in preference for CRC screening methods (colonoscopy vs stool-based tests) between rural and urban community members, it is important to assess the effectiveness of different types of CRC screening interventions by comparing rural and urban primary care clinic patient populations.

Background Limb preserving surgery for the treatment of diabetic foot complications (DFC) has been shown to yield excellent results and better outcomes when compared to non-surgical standard of care. The quality of the articles reporting the results of limb preserving surgery in treating DFC is quite low. The aim of this study was to evaluate the published systematic reviews and meta-analyses that looked at the efficacy of limb preserving surgery in treating DFC. Methods PubMed, Cochrane Library and Google Scholar were searched for all systematic reviews and meta-analyses on limb preserving surgery in DFC. The Joanna Briggs Institute (JBI) critical appraisal tool for systematic reviews was used to appraise studies’ quality. Results 22 systematic reviews and meta-analyses with a total of 10,559 patients met the inclusion criteria. Five reviews reported on surgical treatment of diabetic Charcot, 5 reviews on bony procedures and 12 reviews on soft tissue procedures for treating DFU. The results of each review were reported. The vast majority of the studies were of Level IV of evidence. The mean JBI score was 9.82. Conclusions There is an underuse of the available limb preserving operations for the treatment of DFC despite excellent results and variety of procedures available in the literature, especially for Charcot neuroarthropathy and diabetic foot and toe ulcers.

Dialectical Behavior Therapy (DBT) is an evidence-based psychotherapy (EBP) for repeated suicidal and nonsuicidal self-injury and Borderline Personality Disorder. There has been little research on the effectiveness or implementation of DBT via telehealth. However, literature has demonstrated that other EBPs delivered via telehealth are just as effective as in person. DBT differs from these EBPs in complexity, inclusion of group sessions, length of treatment, and focus on individuals at high risk for suicide. The coronavirus disease 2019 (COVID-19) pandemic caused mental health care services across the country and Department of Veterans Affairs (VA) to transition to telehealth to reduce infection risk for patients and providers. This transition offered an opportunity to learn about implementing DBT via telehealth on a national scale. We conducted a survey of DBT team points of contact in VA (N = 32) to gather information about how DBT via telehealth was being implemented, challenges and solutions, and provider perceptions. The majority reported that their site continued offering the modes of DBT via telehealth that they had offered in person. The predominant types of challenges in transitioning to telehealth were related to technology on the provider and patient side. Despite challenges, most providers reported their experience was better than expected and had positive perceptions of patient acceptability. Skills group was the more difficult mode to provide via telehealth. Providers endorsed needing additional tools (e.g., means to get diary card data electronically). Multiple benefits of DBT via telehealth were identified, such as addressing barriers to care including distance, transportation issues, and caregiving and work responsibilities. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Objective Dementia prevalence in Latin America (LATAM) is rapidly increasing, contributing to significant family burden. As families are responsible for care, supportive interventions are critical. To understand the state-of-the-science, a scoping review was conducted of non-pharmacologic interventions for caregivers of people living with dementia (PLWD) in LATAM. Design Eight databases were searched (PubMed, Embase, PsycINFO, Scopus, Scielo, Lilacs, Redalyc, Google Scholar) for nonpharmacological intervention studies published up to July, 2021 in LATAM reporting at least 1 caregiver outcome. A qualitative synthesis examined study designs, participants, and outcomes characteristics. Results Forty-five studies were identified from 25.8% (n = 8/31) of LATAM countries (28 = Brazil, 4 = Chile, 4 = Cuba, 4 = Mexico, 2 = Colombia, 1 = Peru, 1 = Ecuador, 1 = Argentina): 29% (n = 17) were randomized clinical trials (RCT), 7% (n = 3) nonrandomized comparison trials, 42% (n = 19) pre-post trials, 9% (n = 4) postintervention analyses, and 4% (n = 2) single case studies, comprising a total of 1,171 caregivers and 817 PLWD. For 20 RCT and nonrandomized comparison trials, 31 interventions were tested of which 48.4% (n = 15) targeted caregivers and 32.3% (n = 10) dyads. Most studies involved daughters with less than 12 years of education and tested multicomponent interventions involving disease education (90%), and cognitive behavioral coping (45%). Half of interventions (51.6%; n = 16/31) tested were adapted from other countries, and reported benefits for caregiver depression, quality of life, and burden. Conclusion Studies were conducted in a limited number of LATAM countries and few were RCTs. Results of RCTs showed benefits for socially vulnerable caregivers on psychosocial outcomes. There is an urgent need to rigorously evaluate more country/culturally specific interventions addressing unmet familial needs beyond psychosocial support.

Thousands of people die or become disabled every year due to illness, disaster, traffic accidents, work and home accidents. According to the researches, 50% of the deaths occur within the first half an hour. In order to prevent the increase in these deaths, first aid knowledge is required. Therefore, evidence-based practices should be included in whole process, from the basic principles and practices of first aid to hospital care of the patient/injured. In the guide published by American Heart Association (AHA) and Red Cross in 2020, the stroke recognizes and cures, the management of hypoglycaemia, anti-coagulant treatment for non-traumatic chest pain, life-threatening bleeding, the use of compressions to be applied in trauma, hyperthermia or heatstroke treatments are emphasized. Including evidence-based practices in first aid possibly reduce mortality and morbidity rates with conscious, quality first aid as soon as possible. Therefore, in order to reduce the risk of harm, to mobilize the society within the scope of disaster preparedness, to contribute to the development of health awareness, to ensure that people are competent in saving their lives and standardizing first aid practices. The recommendations of the guides should be taken into consideration in this process.

Evidence-based practice (EBP) is a foundational approach to clinical decision-making that integrates scientific research; clinical expertise; and patient preferences, values and circumstances. The purpose of this study was to explore the intersection of the three elements of EBP among an interdisciplinary stroke rehabilitation team. An exploratory qualitative descriptive design was used to examine the intersection of elements through a focus group with the allied health members of an interdisciplinary stroke rehabilitation team. Thematic analysis was applied to the data. Three main themes were developed: the patient as the driver, EBP as a fluid process, and EBP as a collaborative team process. While all three elements intersected during care planning, patient preferences, values, and circumstances were the dominant influence in decision-making. EBP was a dynamic process changing over time and context. Collaboration with the patient and between health professionals was an integral part of the approach. Results demonstrated that EBP is a complex and iterative process. Clinicians require skills in integrating each of the three elements for successful application of EBP in stroke rehabilitation.

Question: In patients with previously diagnosed glioblastoma who are suspected of experiencing progression, does repeat cytoreductive surgery improve progression free survival or overall survival compared to alternative interventions?Target population: These recommendations apply to adults with previously diagnosed glioblastoma who are suspected of experiencing progression of the neoplastic process and are amenable to surgical resection.Recommendation:Level II: Repeat cytoreductive surgery is recommended in progressive glioblastoma patients to improve overall survival.

Target populationThese recommendations apply to adult patients diagnosed with progressive glioblastoma (pGBM).Question (Q1):In adult patients with pGBM does the use of temozolomide (TMZ) with alternative dosing or the use of TMZ in combination with other cytotoxic treatments result in increased overall survival compared to other chemotherapy?Recommendation:Level III: Adult patients with pGBM might derive benefit in treatment with TMZ especially those who progress after more than 5 months of TMZ-treatment free interval. Level III: Combination of TMZ with other cytotoxic agents such as nitrosourea, cisplatin, electrohypothermia, or tamoxifen is not suggested in adult patients with pGBM as a stand-alone therapy.There is insufficient data to make a recommendation about which alternative TMZ dosing provides the best benefits.Question (Q2):In adult patients with pGBM does the use of systemic or in situ nitrosourea result in increased overall survival compared to other chemotherapy?Recommendation:Level III: In the setting of pGBM, fotemustine is suggested in elderly patients with methylated MGMT promoter status. There is insufficient evidence to compare fotemustine to other nitrosoureas. There is insufficient evidence to make a suggestion about the use of in situ nitrosourea in patients with pGBM who underwent the Stupp regimen.Question (Q3):In adult patients with pGBM does the use of platinum compounds and topoisomerase result in increased survival compared to other chemotherapy?Recommendation:Level III: Other chemotherapy including platinum compounds and topoisomerase inhibitors are not suggested to be used in adult patients with pGBM.Level III: Other cytotoxic therapies like perillyl acohol and ketogenic diet are not suggested for use in adult patients with pGBM as a stand-alone therapy.Question (Q4):In adult patients with pGBM does the use of tumor treating field (TTF) result in increased overall survival compared to chemotherapy?Recommendation:Level III: The use of TTF with other chemotherapy may be considered when treating adult patients with pGBM.There is insufficient evidence to recommend TTF to increase overall survival in adult patients with pGBM.Question (Q5):In adult patients with pGBM does the use of oncolytic virotherapy result in increased survival compared to chemotherapy?Recommendation:Level III: Oncolytic virotherapy is not suggested in patients with pGBM.

У статті обговорюються проблема лікування при остеоартрозі та нові можливості її розв’язання. В Україні з’явився новий препарат класу SYSADOA Піаскледин® 300, який багато років успішно застосовують у багатьох країнах світу для лікування пацієнтів з остеоартрозом колінних та кульшових суглобів. Наведено європейську доказову базу ефективності препарату Піаскледин® 300 та переваги його застосування в Україні.

Background: Few weight management interventions target young children with obesity from low-income minority families. Objective: To conduct a nonrandomized, pragmatic, pilot study of an adapted, ev...

The topic of sepsis has been realized among the last 20 years. A majority of patients with sepsis enter the health system through the emergency department, and health professionals need to provide evidence-based care. Within the health system, interdepartmental teams were formed with the purpose to set a system-wide standard to meet the evidence-based practice standards for sepsis. Participants were recruited from every department that was involved with the care delivery of emergency department patients with sepsis. The team developed a team charter to state the group objectives. A gap analysis was completed to set group priorities. The first priority was to develop a system-wide sepsis alert process. The Operational Excellence coach conducted direct observations and interviews at each system facility and then a sepsis alert plan was developed. Two hospitals volunteered to pilot the sepsis alert within their emergency departments, and education was completed at each hospital. Informatics nurses developed electronic medical record workflow and outcome elements to help the team with the process. The pilot process showed an increase in compliance for core measures and laid the groundwork for each hospital to develop an individualized process.

The incidence of bladder neck contracture (BNC), or postprostatectomy vesicourethral anastomosis, has declined since the advent of robotic surgery. However, men with peripheral vascular comorbidities, among other factors, still have a high risk of developing this complication after any surgery that involves manipulation of the prostate. The best strategy for BNC management remains uncertain because of inconsistency in success for different approaches across studies. We reviewed the available evidence on BNC, including the results for endoscopic treatments, scar modulation therapies, and open and robotic bladder neck reconstruction. On the basis of these data, we propose a management flowchart. Patient baseline status and subjective goals and preferences remain crucial in management choices. PATIENT SUMMARY: Contracture of the bladder neck can occur as a complication after surgery to the prostate. We reviewed the evidence for various treatment approaches and propose a flowchart for management of this condition.

Hepatorenal syndrome (HRS) is the deadliest complication of cirrhosis. The purpose of this study is to analyze if the use of a protocol for HRS is associated with higher survival in these patients.An evidence-based protocol for the diagnosis and treatment of HRS was instituted in 2013. Data from medical records from 2010 to 2016 were obtained by searching the hospital database for patients who received terlipressin, in the three years before and after the institution of the protocol. Data were reviewed to confirm the diagnosis of HRS and multiple variables were collected. Liver-specific scores were calculated and a stepwise Cox regression approach was used for univariate and multivariate analysis.The study included 46 patients, 20 from the pre-protocol period and 26 from the post-protocol period. Respectively, mortality at 30 days, 90 days and 365 days was 75%, 75% and 90% for the pre-protocol period, and 61%, 69% and 80% for the post-protocol period. In the multivariate analysis, an aspartate aminotransferase (AST) of40U/L, the pre-protocol period and higher Child-Turcotte-Pugh scores were associated with higher 30-day and 90-day mortality. The total mean dose of terlipressin and human albumin used per patient was reduced from 27mg to 22mg and from 236g to 144g, respectively, after the institution of the protocol. This was not associated with higher mortality.The use of an evidence-based protocol for the treatment of HRS translated into a higher survival. The authors suggest that the use of evidence-based protocols for the diagnosis and treatment of HRS could reduce cost and mortality in tertiary hospitals.

There is increasing recognition that the high rates of co-occurring mental disorders among clients of substance use treatment services require alcohol and other drugs (AOD) workers to be skilled in their identification, management, and treatment. Despite advances in e-learning, to our knowledge, based on our review of the literature, there are no training programs with the capacity to build foundational knowledge, attitudes, and confidence in mental health, essential to the provision of evidence-based practice. The current study evaluated an evidence-based online program developed to address this gap, in a pre–post-design. One-hundred-fifteen Australian AOD workers completed pre- and post-training online surveys. Participants rated level of agreement with statements assessing comorbidity-related knowledge, attitudes, and confidence, which were reassessed immediately post-training. The overwhelming majority of participants found the training useful (94%), were satisfied (97%), and reported having gained knowledge that would enable them to work more effectively with comorbidity-related issues (95%); 89% reported having used skills gained in clinical practice. The starkest improvements were observed in relation to improved confidence and knowledge following training completion. Findings illustrate that online training programs, such as this could be used to improve the capacity of the current workforce, as well as the next generation of clinicians, to respond to comorbid mental health conditions.

PURPOSE The American Academy of Orthopaedic Surgeons does not currently provide clinical practice guidelines for management of PAF. Accordingly, this article aims to review and consolidate the relevant historical and recent literature in important topics pertaining to perioperative management of PAF. METHODS A thorough literature review using PubMed, Cochrane and Embase databases was performed to assess preoperative, intraoperative and postoperative management of PAF fracture. Topics reviewed included: time from injury to definitive fixation, the role of inferior vena cava filters (IVCF), tranexamic acid (TXA) use, intraopoperative cell salvage, incisional negative pressure wound therapy (NPWT), intraoperative antibiotic powder use, heterotopic ossification prophylaxis, and pre- and postoperative venous thromboembolism (VTE) prophylaxis. RESULTS A total of 126 articles pertaining to the preoperative, intraoperative and postoperative management of PAF were reviewed. Articles reviewed by topic include 13 articles pertaining to time to fixation, 23 on IVCF use, 14 on VTE prophylaxis, 20 on TXA use, 10 on cell salvage, 10 on iNPWT 14 on intraoperative antibiotic powder and 20 on HO prophylaxis. An additional eight articles were reviewed to describe background information. Five articles provided information for two or more treatment modalities and were therefore included in multiple categories when tabulating the number of articles reviewed per topic. CONCLUSION The literature supports the use of radiation therapy for HO prophylaxis, early (

Hidradenitis Suppurativa (HS) is a chronic inflammatory disease of the skin with a predilection for women. The role of sex hormones, including estrogen and progesterone, is incompletely understood, but alterations in hormone levels may play a role in disease activity for many patients. Specific clinical considerations should be made for women with HS, particularly in the setting of pregnancy, childbirth, breastfeeding, and menopause. Current knowledge gaps regarding HS include the cumulative impact of disease across an individual's lifespan, as well as the mechanistic role of sex hormones in the disease. An improved understanding of the pathophysiologic role of hormones in HS would optimize our ability to utilize targeted therapies for hormonally driven disease. Psychological and psychosexual support for women with HS is an important facet of any holistic management strategy for the disease. This article integrates up to date pathogenic and mechanistic insights with evidence based clinical management to optimize care for women with HS.

Rheumatic heart disease (RHD) remains a leading cause of mortality and morbidity in pregnant patients in low- to middle-income countries. Apart from the clinical challenges, these areas face poor infrastructure and resources to allow for early detection, with many women presenting to medical services for the first time when they deteriorate clinically during the pregnancy. The opportunity for preconception counselling and planning may thus be lost. It is ideal for all women to be seen before conception and risk-stratified according to their clinical state and pathology. The role of the cardio-obstetrics team has emerged over the past decade with the aim of a seamless transition to and from the appropriate levels of care during pregnancy. Severe symptomatic mitral and aortic valve stenoses portend the greatest risk to both mother and fetus. In mitral stenosis, beta-blockers are the cornerstone of therapy and only a small number of patients require balloon valvuloplasty. Regurgitant lesions mostly require diuretics alone for the treatment of heart failure. The mode of delivery is usually vaginal; caesarean section is performed in those with obstetrical indications or in cases with severe stenosis and a poor clinical state. The postpartum period presents a second high-risk period for maternal adverse events, with heart failure and arrhythmias being the most frequent. This review aims to provide a practical evidence-based multi-disciplinary approach to the management of women with RHD in pregnancy.

Despite the high incidence of constipation in people with cancer, there is little research on management strategies for opioid-induced constipation (OIC). This project used the Plan-Do-Study-Act model to examine implementation of the Oncology Nursing Society GuidelinesTM to improve constipation management in patients with cancer. Nurse champions at four sites identified practice gaps, including providing education on OIC for patients who are new to opioids and increasing follow-up assessment. This project demonstrates that multisite, collaborative projects are feasible and may enhance patient quality of life and decrease anticipated complications.

Background Manual prone positioning has been shown to reduce mortality among patients with moderate to severe acute respiratory distress syndrome, but it is associated with a high incidence of pressure injuries and unplanned extubations. This study investigated the feasibility of safely implementing a manual prone positioning protocol that uses a dedicated device. Review of Evidence A search of CINAHL and Medline identified multiple randomized controlled trials and meta-analyses that demonstrated both the reduction of mortality when prone positioning is used for more than 12 hours per day in patients with acute respiratory distress syndrome and the most common complications of this treatment. Implementation An existing safe patient-handling device was modified to enable staff to safely perform manual prone positioning with few complications for patients receiving mechanical ventilation. All staff received training on the protocol and use of the device before implementation. Evaluation This study included 36 consecutive patients who were admitted to the medical intensive care unit at a large academic medical center because of hypoxemic respiratory failure/acute respiratory distress syndrome and received mechanical ventilation and prone positioning. Data were collected on clinical presentation, interventions, and complications. Sustainability Using the robust protocol and the low-cost device, staff can safely perform a low-volume, high-risk maneuver. This method provides cost savings compared with other prone positioning methods. Conclusions Implementing a prone positioning protocol with a dedicated device is feasible, with fewer complications and lower costs than anticipated.

Obesity is a chronic, progressive, and relapsing disease state the management of which includes a comprehensive, long-term management plan. Comprehensive management of obesity includes 4 key components of care: nutrition, behavioral intervention, physical activity, and clinical management. This article reviews current evidence-based treatment of obesity and key components for all clinicians to have knowledge of.

Background: Spinal cord injury is a damage in the spinal cord that communication between brain and the rest of the body is disrupted, resulting in a loss of movement and sensation from below the level of injury. Damage to the spinal cord can be caused by a trauma like an accident, or as a result of infection or disease. Aim This study was to assess the nurses' knowledge and practice regarding caring for patients with spinal cord injury in critical care unit. Research design: A descriptive exploratory design, utilized for the conduction of the study, setting conducted at general intensive care unit and neurological intensive care unit in Ain Shams University hospital. Study sample: A purposive sample of 50 nurses. Tools: Two tools were used for data collection were 1) nurses self-administered questionnaire sheet. It included two parts. part one concerned with the assessment of the demographic characteristics of the studied nurses and part two concerned with nurses knowledge questionnaire regarding caring for patients with spinal cord injury.2) Nurses' observational check list about nursing practice for patients with spinal cord injury to assess nurses practice. Results; the result of the study showed that 54% of the studied nurses had satisfactory total knowledge regarding caring for patients with spinal cord injury in critical care unit and 58%of the studied nurses had an un satisfactory level of total practice regarding caring for patients with spinal cord injury in critical care unit, the study finding revealed that there was statically significant relation between nurses knowledge and their level of practice regarding caring for patients with spinal cord injury. Conclusion: the current study concluded that the studied nurses' knowledge and practice had statistically significant relation between total knowledge and practice. Recommendation: recommended health care setting should provide in-service educational programs and upgrading courses based on evidence based guidelines to improve the nurses knowledge and practice among patients with spinal cord injury in critical care unit.

Cognitive impairment caused by repetitive subconcussion has received increasing attention in recent years. Although the dysfunction of attention has been confirmed by neuropsychological research using scales, there is no event-related potentials (ERPs) research. The Attention Network Test (ANT) has been widely used to evaluate the three separate components of attention processing (alerting, orienting, and executive control). Twenty-seven paratroopers exposed to repetitive subconcussion (subconcussion group) and 25 matched healthy control participants (HCs group) were enrolled, and all of them performed the ANT test while continuous scalp electroencephalography data were recorded. On the behavioral performance level, the subconcussion group showed a slower task response, with an especially significant slower reaction time in alerting. Concerning ERP results, reduction amplitudes of cue-N1 in the alerting network were observed, indicating that this group was less able to make efficient use of cues and maintain an alerting state for incoming information. For the orienting network, no difference in N1 amplitude was observed between the two groups. Moreover, there was a reduced P3 amplitude in the executive control network in the subconcussion group compared with the HCs group, suggesting a dysfunction of attentional resource allocation and inhibition control in the former group. This study is, to our knowledge, the first analysis of the altered attention network caused by repetitive subconcussion from the perspectives of behavioral and neuropsychology levels. These preliminary results revealed the possible damage of the alerting and executive control networks and provided a reference for further research on subconcussion cognitive impairment.

Alcohol use disorder (AUD) is a serious, prevalent disorder that affects millions of people. There are numerous evidence-based treatments and strategies to treat AUD, but they are under-utilized for a variety of reasons, including provider stigma, lack of knowledge, lack of professional support, shortage of willing providers, and patient barriers. Disulfiram, naltrexone, and acamprosate are approved but underused medications for the treatment of AUD. Nonpharmacological strategies and treatments include the use of motivational interviewing when talking to patients about their alcohol use, peer support or mutual help groups, and individualized therapy. Nurses are in a prime position to educate themselves and patients on evidence-based treatments for AUD and to help patients access those treatments. [ Journal of Psychosocial Nursing and Mental Health Services, 59 (12), 7–11.]

Introduction Periprosthetic femoral fractures (PPFs) represent a challenging clinical problem with a fast-rising incidence. Interprosthetic fractures (IPFs) represent one of its most difficult variants. There is a paucity of data regarding the financial burden of PPFs, and none for IPFs. This study aims to estimate the direct medical cost of the surgical treatment of IPFs in NHS, and analyse the factors influencing this when using different methods of surgical treatment. Methods A cohort of patients with IPFs treated in a single academic unit over a period of 8-years with different surgical methods was studied. In-hospital details, as well as outpatient follow-up data, were gathered relevant to their clinical and radiological outcome until discharge. Local and national NHS data were acquired from the financial department, as well as industry-related resources. The economic analysis was structured as a cost identification analysis (CIA) of the overall cohort, but also as a comparative best-case scenario (uncomplicated course till discharge) comparison between the 3 main different management strategies (a) revision arthroplasty (RTHA), b) plate fixation (ORIF), c) combination of implants (COMBO). Results Data from 28 patients (22 females) with IPFs were analysed with a median age of 78.4 years. The overall direct medical cost of treating this cohort of patients was £468,330, with a median of £15.625 (range £10,128 to 33,060). Comparing the three different surgical modalities, the median cost in groups a, b, and c was £20,793 (range £12,110 to £24,116), £12,979 (range £10,128 to £20,555), and £22,316 (range £10,938 to £23,081) respectively. In all groups, the 2/3 of the identified costs were relevant to the inpatient stay. Transfusions were the highest (3 units of cRBC on average) to the patients that received a revision THA vs the other two groups (p=0.022). There was statistically significant higher mean overall cost between the RTHA and the ORIF groups (£19,453 vs. £14,201, p=0.0242), but not when compared with the COMBO cases (£19,453 vs. £18,788, p=0.86). Conclusion The first cost identification study and “best case scenario” comparative analysis for IPFs demonstrated a significant overall direct medical cost, when managing these complex fractures with variable contemporary techniques. Evidence based reimbursement strategies should be developed to allow the sustainability of the clinical service we offer in this challenging patient population.

Background: Head injuries are a regular occurrence in emergency departments around the world, with more than 2 million annual visits in North American EDs and more than 400 000 in the United Kingdom alone. Despite the fact that the mechanism of injury is consistent,, Head injuries are a regular occurrence in emergency departments around the world, with over 2 million visits in North American EDs and over 400 000 in the European Union alone. Regardless of how consistent the injury mechanism is. Objectives: Holds data what nurses already know about the modified LOWA model. 2. Develop and test a protocol using a IOWA model that was adjusted. 3. Assess the updated LOWA model's effectiveness 4.To connect the knowledge score to demographic data. Research Approach: Interventional approach Research design: - One group pre test and post test. Setting of the study: - The study will be conducted in AVBRH Hospital. Sample: - Staff Nurse Sample Size is 50Sampling Technique is Purposive sampling. Setting of the study is The study will be conducted in AVBRH Sample: - Staff Nurse Sampling Technique: - convenient sampling Data Collection: - Field data Will be collected by the use of standardised questionnaires with three key sections: Section A (Standard standards), Section B (Socio-demographics and work history of staff) used the modified LOWA model and check list). Expected Results: Oriented it toward the application of the LOWA model. Those characteristics are what evidence-based practise on trauma care nurses concerning head injury entails, but they may be able to address the issues that Traumatic Brain Injury Nursing faces. Adopting this paradigm into traumatic brain injury nursing units is worth a shot.With the assistance of a specific case, this article will discuss the clinical application of the Lowa Model in traumatic brain injury nursing care. Conclusion: In the light of the study findings, this study shows that, the implementation of LOWA Model evidence based practice has a positive effect on nurse’s knowledge and practices regarding trauma care nurses regarding head injury. There was a significant improvement in the nurses ‘knowledge and practice regarding LOWA Model evidence-based practice implementation compared with that before it. There was positive significant correlation between nurses’ knowledge and their practice before and after program. Nurses’ knowledge and practice about LOWA Model improved after application of this program.

Background Whilst warts and vitiligo are both common skin diseases, their co-morbidity is rare. Here we present a clinical case of warts with vitiligo to illustrate the utility of individualized homeopathic treatment. Method The homeopathic medicine Sepia officinalis was prescribed, based on individualization. During follow-up, changes were documented by photographs. The non-invasive methods ORIDL (Outcome Related to Impact on Daily Living), VASI (Vitiligo Area and Scoring Index), and VETF (Vitiligo European Task Force) were used to assess treatment progress. Possible causal attribution of outcome with treatment was evaluated using the Modified Naranjo Criteria for Homeopathy (MONARCH). Result There was a marked improvement of vitiligo, along with the disappearance of warts, as evidenced photographically. VASI and VETF scores were significantly reduced. Main complaints, as well as overall well-being, improved on the ORIDL scale (+3). The MONARCH score (+9) suggested that the clinical improvement was attributable to the homeopathic intervention. Conclusion The study suggests a significant role for individualized homeopathic treatment in the co-morbidity of warts and vitiligo.

Hyperglycemia in hospitalized patients, either with or without diabetes, is a common, serious, and costly healthcare problem. Evidence accumulated over 20 years has associated hyperglycemia with a significant increase in morbidity and mortality, both in surgical and medical patients. Based on this documented link between hyperglycemia and poor outcomes, clinical guidelines from professional organizations recommend the treatment of hospital hyperglycemia with a therapeutic goal of maintaining blood glucose (BG) levels less than 180 mg/dL. Insulin therapy remains a mainstay of glycemic management in the inpatient setting. The use of non-insulin antidiabetic drugs in the hospital setting is limited because little data are available regarding their safety and efficacy. However, information about the use of incretin-based therapy in inpatients has increased in the past 15 years. This review aims to summarize the different treatment strategies for hyperglycemia in hospitalized noncritical patients that are supported by observational studies or clinical trials with insulin and non-insulin drugs. In addition, we propose a protocol to help with the management of this important clinical problem.

Multiplexed respiratory viral panels (MRVP) have recently been added to the diagnostic work-up of respiratory infections. This review provides a summary of the main literature of MRVP for patients with regard to 3 different topics. Can the results of MRVP reduce the inappropriate use of antibiotics, can they guide the use of appropriate antiviral therapy and do they have an added value with respect to infection control measures? Literature was searched for based on a defined search string using both the PubMed and Embase database. Twenty-five articles report on the impact of MRVP on antibiotic therapy. In all the articles where active antimicrobial stewardship was performed (e.g., education/advice on interpreting results of MRVP) (N = 9), a reduction in antibiotic therapy was shown (with exception of 2 studies). Three studies evaluating the effect of MRVP on antimicrobial use in a population that is not suspected of having bacterial pneumonia (e.g., absence of radiology suggestive for bacterial infection or low PCT) found a positive impact on antibiotic therapy. Eight studies with a short TAT (

Background: The life expectancy of people with intellectual disabilities has increased. The implications of ageing have resulted in changes in their support needs and challenges to support staff. Access to evidence based strategies for support staff providing care to elderly with intellectual disabilities remains scarce. A systematic review was conducted to provide an overview of available psychosocial interventions. Methods: Four databases were searched and assessed according to the PRISMA guidelines. A narrative, integrative method of analysis was conducted to synthesise quantitative and qualitative data. Results: The 36 studies included in the review reported on interventions aimed at either identifying and meeting the needs or perceptions of older individuals or at improving their behaviour and skills. Furthermore, the role of support staff in the implementation of interventions was either active, assisting or undefined. Conclusions: This overview of studies could contribute to the existing body of knowledge and help to optimise psychosocial support for a growing population.

Background: Shoulder pain is one of the most frequent complaints of Paraplegia with a prevalence reported to range from 50% to 60%.It has been attributed to the increase in upper extremity (UE) weight bearing following lower extremity paralysis. Purpose of the study: To develop and Evaluate an Evidence Based Patient Education Booklet in Hindi Language for Prevention of Shoulder Pain in Paraplegia along with pictorial presentation. Design: A methodological study Method: It consist of 4 steps. 1) Literature review and informal interview of 2 doctors, 7 physiotherapists, 5 occupational therapists and 10 patients were used to determine the domains of the education booklet. 2) Development of content of the evidence based patient education booklet according to domains found in step 1 and develop a rough draft of booklet in Hindi Language. 3) Evaluation of the evidence based booklet by expert panel using SAM and to modify the booklet to produce the final booklet draft. 4) Pilot study on patients to take their views regarding the booklet developed. Results: The domains found in step 1 were: Education about pain, Education about the treatment options, Ergonomics modifications, Positioning, Wheel chair selection and transfer techniques, Exercises, General precautions. The content was developed in step 2. In step 3 the SAM score is- 88.13% and final booklet was produced after modification. In step 4 the patient rated the booklet easy to read and understand with an overall rating of 9/10 Conclusion: The developed patient education booklet came out to be easy to read and understand and of superior quality according to Suitability assessment of material questionnaire and hence should be made a part of patient education. Keywords: Patient education booklet, Shoulder pain in paraplegia, Suitability assessment of material questionnaire, booklet in Hindi language, Pain prevention and management, Health education material

Identification of the association between Early Childhood Caries (ECC) and Iron Deficiency Anaemia (IDA) will aid paediatricians and paediatric dentists to enhance health promotion measures to reduce the related morbidity in children. This systematic review aims to determine an evidence-based association between ECC and IDA. A systematic search was carried out from MEDLINE via PubMed, EMBASE, LILACS, Cochrane Oral Health Group’s Specialized Register, CINAHL via EBSCO, Web of Science, and Scopus up to May 2020. Hand searching and grey literature screening were also conducted. Cross-sectional, case-control, and cohort studies in English language which assessed the association was included. Two reviewers independently assessed the study quality and extracted the outcome data. A total of 1,434 studies were identified. Fourteen studies qualified for qualitative review and 7 of them for a meta-analysis. In comparison with children not affected by ECC, those affected had an increased likelihood of IDA (OR = 6.07 [3.61, 10.21]). The meta-analysis showed no statistical difference when comparing blood parameters (Hb, MCV, and serum ferritin) in children with and without ECC. This systematic review demonstrates an association between ECC and increased odds of IDA rather than it being the cause for IDA. Further longitudinal studies with robust methodology are required to determine an evidence-based association.

Background Supporting well-informed decisions about breast cancer screening requires communicating that inconsequential disease may be detected, leading to overdiagnosis and overtreatment. Having previously shown that telling women about overdetection improved informed choice, we investigated effects on screening knowledge and participation over 2 years. Methods We conducted a community-based, parallel-group, randomized controlled trial in Australia. Participants were women aged 48-50 years, without personal or strong family history of breast cancer, who had not undergone mammography in the past 2 years. We randomly assigned 879 women to receive the intervention decision aid (evidence-based information on overdetection, breast cancer mortality reduction, and false-positives) or control decision aid (identical but without overdetection information). We interviewed 838 women postintervention and recontacted them for follow-up at 6 months and 1 and 2 years. Main outcomes for this report are screening knowledge and participation. Results We interviewed 790, 746, and 712 participants at 6 months, 1, and 2 years, respectively. The intervention group demonstrated superior knowledge throughout follow-up. After 2 years, conceptual knowledge was adequate in 123 (34.4%) of 358 women in the intervention group compared with 71 (20.1%) of 354 control participants(odds ratio = 2.04, 95% confidence interval = 1.46 to 2.85). Groups were similar in total screening participation (200 [55.1%] vs 204 [56.0%]; = 0.97, 95% confidence interval = 0.73 to 1.29). Conclusions A brief decision aid produced lasting improvement in women’s understanding of potential consequences of screening, including overdetection, without changing participation rates. These findings support the use of decision aids for breast cancer screening.

Neonatal hemochromatosis (NH) is a rare fatal liver disease accompanied by hepatic and extrahepatic iron overload.1-3 Gestational alloimmune liver disease (GALD) is a materno-fetal alloimmune disorder and leading cause of NH.2,4,5 This condition allows an interplay between the maternal adaptive immune system and the fetus, resulting in an allograft to the mother. The mother becomes sensitized to an alloantigen expressed by the fetus and forms specific reactive antibodies. Immunoglobulin G (IgG) is transported through the placenta and attacks the fetal hepatocytes, resulting in severe loss of hepatocytes and fetal iron overload.3,6 Liver transplantation has been the only definitive treatment for NH for many years, with a survival rate of ±35%. Conventional therapy containing antioxidants and chelation agents reportedly have very poor success, with survival rate of only 10-20%. A new treatment paradigm involving intravenous immunoglobulin (IVIG) and exchange transfusion (ET) therapy has shown significant success in survival rate in NH, decreasing the need for liver transplantation.3,7,8 Here we present a case of NH caused by GALD and treated successfully with a combination of IVIG therapy and ET. We also aimed to evaluate the efficacy of IVIG and ET therapy for NH.

Background A question frequently raised in the field is whether evidence-based interventions have adequate translational capacity for delivery in real-world settings where patients are presumed to be more complex, clinicians less specialized, and multidisciplinary teams less coordinated. The dual purpose of this article is to (a) outline a model for implementing evidence-driven, outpatient treatments for eating disorders in a non-academic clinical setting, and (b) report indicators of feasibility and quality of care. Main Body Since our inception (2015), we have completed nearly 1000 phone intakes, with first-quarter 2021 data suggesting an increase in the context of COVID-19. Our caseload for the practice currently consists of approximately 200 active patients ranging from 6 to 66 years of age. While the center serves a transdiagnostic and trans-developmental eating disorder population, modal concerns for which we receive inquiries are Anorexia Nervosa and Avoidant Restrictive Food Intake Disorder, with the most common age range for prospective patients spanning childhood through late adolescence/emerging adulthood; correspondingly, the modal intervention employed is Family-based treatment. Our team for each case consists, at a minimum, of a primary internal therapist and a physician external to the center. Short Conclusion We will describe our processes of recruiting, training and coordinating team members, of ensuring ongoing fidelity to evidence-based interventions, and of training the next generation of clinicians. Future research will focus on a formal assessment of patient outcomes, with comparison to benchmark outcomes from randomized controlled trials., Plain English summary A question frequently raised in the eating disorders field is whether treatments that were developed and tested in research environments can achieve the same results in real-world clinical settings, where patients’ diagnoses are presumed to be more complex, clinicians less specialized, and multi-professional care teams less coordinated. The purpose of this article is to outline a model for implementing evidence-driven, outpatient treatments for eating disorders in non-academic clinical settings, specifically private practices and specialty programs. We describe the philosophy, infrastructure, training processes, personnel, and procedures utilized to optimize care delivery and to create accountability for both scientifically-adherent practice and positive patient outcomes. We also outline ways to be producers—not just consumers—of research in the private sector, and to train the next generation of scientifically-informed eating disorder specialists, all with the goal to bridge the research-practice divide.

To develop an evidence-based clinical practice guideline for the use of exome and genome sequencing (ES/GS) in the care of pediatric patients with one or more congenital anomalies (CA) with onset prior to age 1 year or developmental delay (DD) or intellectual disability (ID) with onset prior to age 18 years. The Pediatric Exome/Genome Sequencing Evidence-Based Guideline Work Group (n = 10) used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) evidence to decision (EtD) framework based on the recent American College of Medical Genetics and Genomics (ACMG) systematic review, and an Ontario Health Technology Assessment to develop and present evidence summaries and health-care recommendations. The document underwent extensive internal and external peer review, and public comment, before approval by the ACMG Board of Directors. The literature supports the clinical utility and desirable effects of ES/GS on active and long-term clinical management of patients with CA/DD/ID, and on family-focused and reproductive outcomes with relatively few harms. Compared with standard genetic testing, ES/GS has a higher diagnostic yield and may be more cost-effective when ordered early in the diagnostic evaluation. We strongly recommend that ES/GS be considered as a first- or second-tier test for patients with CA/DD/ID.

BACKGROUND Literature shows that large proportions of people with a spinal cord injury (SCI) continue to experience challenges and limitations in weight management (WM) efforts in the health care setting. Despite the need, evidence-based research on effective and practical WM practices for persons with SCI is inconsistent and not widely used by health care providers (HCPs). OBJECTIVE The objectives were twofold: (1) to explore HCP perspectives of the extent of the problem of overweight/obesity in individuals with SCI and (2) HCPs awareness of and beliefs about availability of literature or evidence-based guidelines that discuss WM in SCI. DESIGN Qualitative study using semistructured interviews with HCPs and thematic analysis to identify themes. PARTICIPANTS/SETTING SCI HCPs (n = 25) from Veterans Health Administration and Midwest Regional SCI Care System. INTERVENTION Not applicable. RESULTS SCI HCPs (88%) emphasized the large scope of the problem of overweight and obesity in persons with SCI. HCPs noted the multiple associated negative consequences, specifically 84% highlighted the impact on chronic conditions (cardiometabolic, respiratory) and 48% discussed the impact on secondary/associated conditions (skin, bowel, bladder, musculoskeletal). HCPs noted other impacts of excess weight as greater disability in later life (28%), challenges with mobility and function (60%), self-care (24%), and equipment safety (28%). This sample of HCPs (76%) indicated being unaware of published or available information about WM efforts that work in SCI populations. CONCLUSION Our findings indicate that HCPs believe that overweight and obesity is a significant problem in persons with SCI but that this sample of HCPs are not aware of published work and easily accessible SCI-specific WM evidence-based guidance. This suggests the need for more education and proactive efforts to improve awareness of appropriate information within interprofessional HCPs.

Objectives Ventilator-associated pneumonia (VAP) is the most common nosocomial infection in patients requiring mechanical ventilation in intensive care units (ICUs). VAP is associated with delayed extubation, prolonged hospital stays, increased healthcare costs and mortality rates. The aims of this study to evaluate the level of knowledge for the prevention of VAP among healthcare workers (HCWs) in ICUs and to assess their knowledge in relation to their socio-demographic characteristics. Methods A descriptive, cross-sectional design was conducted to assess HCWs’ knowledge of the guidelines for prevention of VAP in the ICUs of public and private hospitals in Hodeida city, Yemen. Around 140 self-administered multiple-choice questionnaires were distributed between April and July 2017. Results A total of 120 (85.6%) HCWs completed questionnaire were obtained (20 physicians, 20 anesthesia technicians and 80 nurses) in this study. The total mean score of the HCWs’ knowledge was low (41 ± 18). A statistically significant difference was found in the HCWs’ knowledge scores according to their specialties and gender. Anesthesia technicians had the highest knowledge score followed by physicians and nurses (52.2 ± 16.2, 45.6 ± 21.2 and 37.1 ± 16.9, respectively, p=0.002). Males had higher scores than females (Median [IQR] 4 [3–5] vs. 3 [2–4], p Conclusions HCWs had a low knowledge level of the guidelines for the prevention of VAP, which may affect their practice. HCWs’ knowledge was affected by their previous received information that increases the necessity to provide them with regular in-service education and training programs.

Introduction The management of glioblastoma at the time of progression is an important facet of all physicians involved in neuro-oncology. This is an update of the evidence-based guidelines for management of progressive glioblastoma published by the Congress of Neurological Surgeons and American Association of Neurological Surgeons in 2014. Methods The medical literature from July 1, 2012 through March 31, 2019 was searched in MEDLINE® and Embase® and the Cochrane Database of Systematic Reviews, Cochrane Controlled Trials Registry, and Cochrane Database of Abstracts of Reviews of Effects to determine if information was available to update, modify or create new recommendations related to imaging, cytoreductive surgery, neuropathology, radiotherapy, cytotoxic chemotherapy, targeted therapy, and immunotherapy. Results The writing group utilized the information from the updated literature search to formulate recommendations that were exclusively evidence based and not founded on potentially biased consensus or expert opinion. Conclusion The series of guideline documents provides an update of the information and recommendations that could be derived in the 2014 version. It sets a benchmark as to what we really know about the management of this difficult disease. It also provides clues to key investigations that are necessary to move us toward truly effective disease control.

In DPP v O’Neill, the Victorian Court of Appeal excluded personality disorders from the scope of the sentencing principles that apply to offenders with mental health problems around Australia (the ‘Verdins principles’). This decision was based on a fundamental misunderstanding of the nature of personality disorders, and had the potential to create serious injustice for many marginalised people. To redress this problem, the authors engaged in a unique process of strategic advocacy, which resulted in the Victorian Court of Appeal overturning O’Neill in the recent case of Brown v The Queen. This article examines the evolution of the Verdins principles, the problems that arose in O’Neill, the collaborative strategy used to address those problems, and the successful outcome of that interdisciplinary strategy.

Many evidence-based treatments (EBTs) have been identified for specific child mental health disorders, but there is limited research on the use of EBTs in community-based settings. This study used administrative data from a statewide system of care to examine 1) the extent to which EBTs were provided congruent with the child’s primary diagnosis, 2) whether there were differences in effectiveness of EBTs that were congruent or incongruent with the child’s primary diagnosis, and 3) whether comorbidity moderated the effectiveness of EBTs for children based on congruence with their primary diagnosis. The sample consisted of 23,895 children ages 3–17 with at least one of the most common diagnoses (attention-deficit/hyperactivity disorder, conduct problems, depressive disorders, anxiety disorders, and post-traumatic stress disorder) who received outpatient psychotherapy. Data were collected as part of routine care, including child demographic characteristics, diagnosis, treatment type, and problem severity. Forty-two percent of children received an EBT congruent with their diagnosis, and these children showed greater improvement than the 35% of children who received no EBT (ES = 0.14–0.16) or the 23% who received an EBT incongruent with their diagnosis (ES = 0.06–0.15). For children with comorbid diagnoses, the use of EBTs congruent with the primary diagnosis was also associated with the greatest improvement, especially when compared to no EBT (ES = 0.22–0.24). Results of the current study support the use of EBTs in community-based settings, and suggest that clinicians should select EBTs that match the child’s primary diagnosis to optimize treatment outcomes, especially for children with comorbidity.

Children from diverse backgrounds are more likely to receive special education services for emotional or behavioral disorders. These data validate the research that advocates for practitioners to use evidence-based and culturally sustaining practices. This article discusses how strategically implemented, evidence-based, and culturally sustaining practices can assist in preventing inaccurate referrals for special education services.

Musculoskeletal conditions are the leading contributors to disability worldwide, typically characterized by pain, decreased mobility, dexterity, and functional ability. After back pain, neck pain is the most frequent musculoskeletal cause of consultation in primary care worldwide. Cervical spondylosis is a chronic degenerative process of the cervical spine characterized by pain in the neck, degenerative changes in the intervertebral disc, and osteophyte formation. This condition is known as wajaʹur raqaba in the Unānī system of medicine. Its rate is 3.3 patients per 1000 people in the general population. Its increasing prevalence is drawing the attention of the medical fraternity. Due to the limited efficacy of conventional treatment and potential side effects of long-term use, patients seek alternative treatment options. Unānī physicians claimed the management of various joint disorders with the help of several tadābīr. The objective of this critical review is to address the claims of Unānī physicians and clinical studies conducted on the efficacy of various Regimenal modalities in the management of joint pain. Classical Unānī literature, peer-reviewed journal articles, and RCTs that predominantly focused on the use of Regimenal modalities in joint pain were included in this review. It was extracted that several Regimenal modalities are effective in the management of various joint disorders including cervical spondylosis. Despite the long history of the use of various Regimenal modalities in several painful conditions, more systematic, well designed, rigorous, randomized, controlled clinical trials are needed to determine which approaches have merit.

Background: vitamin D has an important influence on the host’s immune system by modulating both innate and adaptive immunity and regulating the inflammatory cascade. Vitamin D deficiency may be related with reduced immunomodulation, specifically in preventing the occurrence of chronic tonsillitis. Objective: to identify the association between vitamin D deficiency with chronic tonsillitis in pediatric patients. Methods: the search was conducted with advanced searching on PubMed® and Cochrane® according to the clinical question. The screening of title and abstract using inclusion and exclusion criteria, double filter, and reading full text led to six useful articles. The selected studies were critically appraised for validity, importance, and applicability. Results: three original articles were eligible for this evidence-based case report. All studies were considered to have good validity. All three studies reported an increased risk of chronic tonsillitis with the vitamin D deficiency and/or insufficiency. Conclusion: Vitamin D deficiency may be associated with the increased risk of chronic or recurrent tonsillitis in children.

The main aim of this review article is to identify the evidence-based diagnosis and physiotherapy management of musculoskeletal disorder of cervical spine. Neck pain from cervical spine disorders is the most common cause of musculoskeletal disorders. Neck pain can exist alone or with the presence of upper-extremity symptoms. Key words: Neck Pain, Cervical Spine, Joint mobilization, Massage.

Background: Clinical Practice Guidelines (CPGs) are systematically developed statements to assist practitioners and patients with appropriate health care for specific clinical circumstances. However, evidence suggests that the uptake of these recommendations in routine care is still limited, particularly in resource-constrained countries. Objectives: This article aimed to (1) identify current CPGs for the pharmacological management of MDD that address and are compatible with the needs of Malaysian psychiatrists (2) collate and summarise these CPG recommendations to produce a more culturally sensitive and end-user friendly guideline summary. Materials and Methods: A multidisciplinary steering group followed an adapted development approach that included; (1) searching for guidelines on the pharmacological management of adults with depression, (2) screening them for relevant recommendations, (3) critical appraising these guidelines, and (4) extracting the required information. A panel of experts then reviewed the developed guideline summary. Results: Six potentially relevant guidelines for the pharmacological management of depression in adults were identified. The developed summary included a decision algorithm to guide the selection of antidepressant therapy based on clinical factors, potential drug-drug interaction, tolerability, and cost of the medications. The review panel considered the summary recommendations easy to use and had the potential for uptake by busy psychiatrists. Conclusion: A CPG summary for the pharmacological management of depression was developed that focuses on evidence-based, contextually relevant recommendations that are feasible for implementation within the local healthcare settings in Malaysia. Practical Implications: The developed guideline summary has the potential to enhance the implementation of evidence-based practice in the management of Major Depressive Disorder within the Malaysian context.