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Background: The doctor-patient relationship has always been at the core of health care, and this relationship remains of paramount importance, regardless of treatment location or the patient's condition. The hospital emergency department (ED) plays a major role in this relationship by providing access to board-certified, residency-trained emergency physicians capable of rapid diagnosis and treatment of urgent, emergent, and life-threatening conditions. U.S. EDs also serve as the nation's safety net for the care of uninsured and underinsured patients. Discussion: As the ED has become a major profit center in the multi-trillion-dollar health care industry, business-centric pressures on ED care pose major threats to the doctor-patient relationship. This article describes and evaluates business-imposed practices that can undermine this relationship in the ED. Conclusions: Health systems should strive to enhance relationships between emergency physicians and their patients and to avoid business practices that undermine them.

Penetrating injury to the head and neck accounts for a minority of trauma but significant morbidity in the US civilian population. The 3-zone anatomical framework has historically guided evaluation and management; however, the most current evidence-based protocols favor a no-zone, systems-based approach. In stable patients, a thorough physical examination and noninvasive imaging should be prioritized, with surgical exploration of the head and neck reserved for certain circumstances. Diagnostic and management decisions should be tailored to the mechanism of injury, history, physical examination, experience of personnel, availability of equipment, and clinical judgment., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Nutrition continues to be a concern for the older adult in the intensive care setting despite widespread knowledge of the benefits of adequate nutrition and existing evidence-based protocols. The incidence of malnutrition in hospitalized patients ranges between 22% and 43% with the highest probability of occurrence, 50% or more, in the intensive care unit patient. The deleterious effects of malnutrition for the critically ill older adult are described with suggested and accepted screening tools for existing or acquired malnutrition. A discussion of early oral and enteral feeding interventions and strategies for overcoming barriers is explored. Enteral feeding complications are delineated, and perceived barriers or risks are disputed. This paper concludes with suggestions for future research and a definitive role for advanced nursing nutrition champions. [ABSTRACT FROM AUTHOR]

In this paper, I will attempt to discuss the future of psychoanalytic practice in the wake of the National Institute of Health and Clinical Excellence’s (NICE) embrace of ‘evidence’-based practice. In 2005, NICE, whose task is to regulate the provision of health care across the National Health Service, adopted positivistic evidence-based protocols as the sole proof of the effectiveness of psychotherapy. Despite the success over the past 40 years of psychoanalytic and humanistic therapies in primary care and psychotherapy departments of psychiatric hospitals, NICE insists on restricting therapy, to those who can claim effectiveness as a result of using the data from client questionnaires commonly described as ‘outcome measures’ and it has gone on to promoting new modalities many of which have been imported from the States. As a consequence, most of the provision of psychotherapy in the public sector currently, whether as part of the National Health Service or the voluntary sector, has embraced evidence-based practice’ and many training organisations are promoting it, which will, in time, have an effect on private practice. I use some of the threads of the work of the feminist psychoanalyst Irigaray and others to understand this turn to positivistic science and how it can be understood as an instance of the retrenchment of the ‘male imaginary’ and a re-installation of the values of detachment and mastery. I query whether there are some problems within current theory, practice and institutionalisation which interfere with the emergence of a more progressive psychoanalytic practice. [ABSTRACT FROM AUTHOR]

Ayurveda offers a unique opportunity to evolve a science of healthy, harmonious and long life. Its holistic approach to health and disease, involving body, mind and spirit, can provide a broader framework to understand research data emerging from reductionist biomedical sciences. This overview of a journey of a basic scientist into evidence-based Ayurveda suggests that a holistic gestalt and reductionist mechanisms are mutually complementary. However, such complementarity needs paradigm-shifting new research approaches. Over the past few decades, the outcome and unique lessons learned through network endeavours have given rise to integrative research programmes employing several trans-disciplines. Judicious applications have emerged: ethnopharmacology, botanical drug development, observational therapeutics, Ayurvedic pharmacoepidemiology, reverse pharmacology, Ayusoft, Ayugenomics, Rasayana, Systems Ayurveda and integrative medicine. Several hits, leads and ready-for-application products and processes have emerged. This article provides an account of the research journey, including some detours, towards the destination of several innovative projects, evidencebased Ayurveda and global acceptance of integrative medicine. [ABSTRACT FROM AUTHOR]

Scoping reviews are used to assess the extent of a body of literature on a particular topic, usually in order to ensure that further research in that area is a beneficial addition to world knowledge. It is typically the first stage of a research project, informing the following work, and so can have a significant impact on both methods and results. Without systematic methods, reviews are subject to personal and community biases, whether intended or not. Evidence-based science is a broad collection of techniques intended to improve research quality by methodically analysing documented relevant facts, rather than relying on expert opinion. Systematic reviews are a key element and are used in many fields from medicine to public policy to engineering. We propose a repeatable, documented, evidence-based approach to search and manage the literature, in order to assure demonstrated objectivity of the resulting review. Software tools are prototyped, issues identified and some resolved. It is not clear from the three test cases whether the effort spent in researching, designing and developing the guidelines directly outweighs expert-based reviews. Further applications of the guidelines and comparative tests are needed. [ABSTRACT FROM AUTHOR]

The article discusses the implementation of a collaborative approach to the use of oxytocin during labor. The three areas that form the basis of a collaborative approach to oxytocin management are multidisciplinary input and consensus, clinical understanding of physiology and research, and physiological appropriate dosage and titration.