Brazilian women's use of evidence-based practices in childbirth after participating in the Senses of Birth intervention: A mixed-methods study.

Brazil has a cesarean rate of 56% and low use of Intrapartum Evidence-based Practices (IEBP) of 3.4%, reflecting a medically centered and highly interventionist maternal health care model. The Senses of Birth (SoB) is a health education intervention created to promote normal birth, use of EBP, and reduce unnecessary c-sections. This study aimed to understand the use of intrapartum EBP by Brazilian women who participated in the SoB intervention. 555 women answered the questionnaire between 2015 and 2016. Bivariate analysis and ANOVA test were used to identify if social-demographic factors, childbirth information, and perceived knowledge were associated with the use of EBP. A qualitative analysis was performed to explore women's experiences. Research participants used the following EBP: birth plan (55.2%), companionship during childbirth (81.6%), midwife care (54.2%), freedom of mobility during labor (57.7%), choice of position during delivery (57.2%), and non-pharmacological pain relief methods (74.2%). Doula support was low (26.9%). Being a black woman was associated with not using a birth plan or having doula support. Women who gave birth in private hospitals were more likely not to use the EBP. Barriers to the use of EBP identified by women were an absence of individualized care, non-respect for their choices or provision of EBP by health care providers, inadequate structure and ambiance in hospitals to use EBP, and rigid protocols not centered on women's needs. The SoB intervention was identified as a potential facilitator. Women who used EBP described a sense of control over their bodies and perceived self-efficacy to advocate for their chosen practices. Women saw the strategies to overcome barriers as a path to become their childbirth protagonist. Health education is essential to increase the use of EBP; however, it should be implemented combined with changes in the maternal care system, promoting woman-centered and evidence-based models.

Evidence-Based Recommendations for Medical Management of Peripheral Artery Disease.

Patients with lower limb artery stenosis or occlusion (peripheral artery disease; PAD) have been determined to be at very high risk of both major adverse cardiovascular events, such as myocardial infarction and stroke, and major adverse limb events, such as amputation and requirement for artery surgery.Effective medical management has been identified as key in reducing this risk; however, this is often poorly implemented in clinical practice. Thus, the aim of this narrative review was to summarize the current evidence on the medical management of PAD in order to inform clinicians and highlight recommendations for clinical practice. International guidelines, randomized controlled trials, and relevant systematic reviews and meta-analyses have been included in this study. The focus was the management of the key modifiable risk factors to mitigate possible adverse events through prescription of anti-platelet and anticoagulation drugs and medications to control low-density lipoprotein cholesterol, blood pressure, and diabetes and aid smoking cessation. The available evidence from randomized clinical trials provide a strong rationale for the need for holistic medical management programs that are effective in achieving uptake of these medical therapies in patients with PAD. In conclusion, people with PAD have some of the highest adverse event rates among those with cardiovascular diseases. Secondary preventive measures have been proven effective in reducing these adverse events; however, they remain to be adequately implemented. Thus, the need for an effective implementation program has emerged to reduce adverse events in this patient group.

Using Nonparticipant Observation as a Method to Understand Implementation Context in Evidence-Based Practice.

BACKGROUND: The uptake of evidence-based knowledge in practice is influenced by context. Observations are suggested as a valuable but under-used approach in implementation research for gaining a holistic understanding of contexts. AIM: The aim of this paper is to demonstrate how data from observations can provide insights about context and evidence use in implementation research. METHODS: Data were collected over 24 months in a randomised trial with an embedded realist evaluation in 24 nursing homes across four European countries; notes from 183 observations (representing 335 hours) were triangulated with interview transcripts and context survey data (from 357 staff interviews and 725 questionnaire responses, respectively). RESULTS: Although there were similarities in several elements of context within survey, interview and observation data, the observations provided additional features of the implementation context. In particular, observations demonstrated if and how the resources (staffing and supplies) and leadership (formal and informal, teamwork, and professional autonomy) affected knowledge use and implementation. Further, the observations illuminated the influence of standards and the physical nursing environment on evidence-based practice, and the dynamic interaction between different aspects of context. LINKING EVIDENCE TO ACTION: Although qualitative observations are resource-intensive, they add value when used with other data collection methods, further enlightening the understanding of the implementation context and how evidence use and sharing are influenced by context elements. Observations can enhance an understanding of the context, evidence use and knowledge-sharing triad in implementation research.

Emerging role of vitamin D in autoimmune diseases: An update on evidence and therapeutic implications.

Vitamin D plays a key role in in calcium homeostasis and, thus, provides an important support in bone growth by aiding in the mineralization of the collagen matrix. However, vitamin D performs various immunomodulatory, anti-inflammatory, antioxidant and anti-fibrotic actions. Autoimmune diseases result from an aberrant activation of the immune system, whereby the immune response is directed against harmless self-antigens. Does vitamin D play a role in the pathophysiology of autoimmune diseases? And, if so, what is its role? In the last decade, researchers' interest in vitamin D and its correlations with autoimmune diseases has considerably increased. We conducted a literature review, covering the period January 1, 2009 through March 30, 2019, in PubMed. We analyzed more than 130 studies in order to find a correlation between vitamin D levels and its effect upon several autoimmune diseases. The analysis demonstrated an inverse association between vitamin D and the development of several autoimmune diseases, such as SLE, thyrotoxicosis, type 1 DM, MS, iridocyclitis, Crohn's disease, ulcerative colitis, psoriasis vulgaris, seropositive RA, polymyalgia rheumatica. International multicenter study could allow us to confirm the data already present in the literature in the single clinical studies and to evaluate when to effectively supplement vitamin D in patients who do not take corticosteroids.

Process outcomes of a multifaceted, interdisciplinary knowledge translation intervention in aged care: results from the vitamin D implementation (ViDAus) study.

BACKGROUND: Vitamin D supplement use is recommended best practice in residential aged care facilities (RACFs) for the prevention of falls, however has experienced delays in uptake. Following successful international efforts at implementing this evidence into practice, the ViDAus study sought to replicate this success for the Australian context. The aim of this paper is to report on the process outcomes of implementing this intervention. METHODS: Forty-one RACFs were engaged in a multifaceted, interdisciplinary knowledge translation intervention. This focused on raising awareness to improve knowledge on vitamin D, and supporting facilities to identify barriers and implement locally devised strategies to improve the uptake of evidence based practice (EBP). RESULTS: Staff members of participating facilities (n = 509 including nursing, care and allied health staff) were well engaged and accepting of the intervention, though engagement of servicing general practitioners (GPs) (n = 497) and pharmacists (n = 9) was poor. Facilities each identified between three and eight strategies focused on raising awareness, identifying residents to target for vitamin D and creating referral pathways depending upon their own locally identified barriers and capacity. There was variable success at implementing these over the 12-month intervention period. Whilst this study successfully raised awareness among staff, residents and their family members, barriers were identified that hindered engagement of GPs. CONCLUSIONS: The intervention was overall feasible to implement and perceived as appropriate by GPs, pharmacists, facility staff, residents and family members. More facilitation, higher-level organisational support and strategies to improve RACF access to GPs however were identified as important improvements for the implementation of vitamin D supplement use. TRIAL REGISTRATION: Retrospectively registered (ANZCTR ID: ACTRN12616000782437 ) on 15 June 2016.

Evidence for personalised medicine: mechanisms, correlation, and new kinds of black box.

Personalised medicine (PM) has been discussed as a medical paradigm shift that will improve health while reducing inefficiency and waste. At the same time, it raises new practical, regulatory, and ethical challenges. In this paper, we examine PM strategies epistemologically in order to develop capacities to address these challenges, focusing on a recently proposed strategy for developing patient-specific models from induced pluripotent stem cells (iPSCs) so as to make individualised treatment predictions. We compare this strategy to two main PM strategies-stratified medicine and computational models. Drawing on epistemological work in the philosophy of medicine, we explain why these two methods, while powerful, are neither truly personalised nor, epistemologically speaking, novel strategies. Both are forms of correlational black box. We then argue that the iPSC models would count as a new kind of black box. They would not rely entirely on mechanistic knowledge, and they would utilise correlational evidence in a different way from other strategies-a way that would enable personalised predictions. In arguing that the iPSC models would present a novel method of gaining evidence for clinical practice, we provide an epistemic analysis that can help to inform the practical, regulatory, and ethical challenges of developing an iPSC system.

Towards evidence-based practices in voice pedagogy / Prácticas vocales basadas en la evidencia

Voice pedagogy was initially based on an orally transmitted master-apprentice teaching-learning model, applying observational type of learning centred in the final artistic product. Since then, this model has been continuously replaced. Nowadays, the social organization of work in globalized economies has called for the need of rethinking education so that future generations can meet the demands of lifelong learners, who are skilful at using systems of information, who are flexible and adapt to the lack of stability at work, and who are able to make their own career opportunities. How can this be applied to voice pedagogy? This work aims at finding answers to these questions, further contributing to the discussion raised at the voice pedagogy round table of the 10th Pan-European Voice Conference, "Vocal Pedagogy - What do we need?". The rationale for reflective practices in voice education and for enhancing metacognitive skills in student's using evidence-based guided awareness is discussed. The provision of meaningful feedback and the use of a holistic approach to voice teaching are presented as means to meet individual needs of different types of learners. Problem-solving and student-centred teaching–learning models are proposed as key elements in developing reflective voice practitioners (AU)

Tradicionalmente la pedagogía de la voz se ha basado en un modelo de enseñanza-aprendizaje a partir de dominar la práctica transmitida oralmente, en la que se aplicaba un tipo de aprendizaje observacional centrado en el producto artístico final. Este modelo se ha ido sustituyendo constantemente con el tiempo. Actualmente, la organización social del trabajo en las economías globalizadas ha visto la necesidad de replantear la educación de forma que las generaciones futuras pueden responder a las necesidades de alumnos que aprenden de por vida, que destacan en el uso de habilidades de sistemas de información, que son flexibles y se adaptan a la falta de estabilidad en el trabajo, y que son capaces de manejar sus propias oportunidades de emprendimiento. ¿Cómo se puede aplicar todo esto a la pedagogía vocal? Este trabajo tiene como objetivo la búsqueda de respuestas a estas cuestiones, además de contribuir a la discusión que se generó en la 10th Pan European Voice Conference, «Pedagogía Vocal. ¿Qué necesitamos?». Se expone la lógica de usar prácticas reflexivas en la educación vocal y que realcen las habilidades metacognitivas del estudiante, al utilizar el conocimiento basado en la evidencia. La provisión de feedback significativo y el uso de un enfoque holístico en la enseñanza de la voz se presentan como los medios necesarios para responder a las necesidades individuales de los distintos aprendices. Los modelos de enseñanza basados en la resolución de problemas y en el aprendizaje centrado en el alumno se proponen como elementos clave a la hora de desarrollar profesionales de la voz conscientes, que son los que mejor cumplen con las demandas de conocimiento de las sociedades del siglo xxi (AU)

Primera guía clínica basada en la evidencia médica para la suplementación con probióticos en la farmacia comunitaria española / First clinical guide based on medical evidence for probiotic supplementation in Spanish community pharmacies

Se ha elaborado la primera guía clínica española que permitirá a los farmacéuticos comunitarios y demás profesionales de la salud seleccionar, para cada indicación específica, el producto con probióticos adecuado, la dosis y la vía de administración. Con ello se pretende lograr que la práctica diaria de indicación farmacéutica de los suplementos probióticos esté basada en las mejores evidencias científicas disponibles

We have developed the first Spanish clinical guide that will allow the community pharmacists and other health care professionals easily select the right product with probiotics, dosage and format for each specific indication. With the proposed guide, it is our goal that the daily pharmaceutical practice of probiotics supplementation in community pharmacy is based on the best scientific evidence available (AU)

Adaptation of an Evidence-Based Colorectal Cancer Screening Program Using the Consolidated Framework for Implementation Research.

INTRODUCTION: Federally Qualified Health Centers (FQHCs) provide primary care to low-income and uninsured patients in the United States. FQHCs are required to report annual measurements and provide evidence of improvement for quality measures; effective methods to improve quality in FQHCs are needed. Systems of Support (SOS) is a proactive, mail-based, colorectal cancer screening program that was developed and tested in an integrated health care system. The objective of this study was to adapt SOS for use in an FQHC system, guided by the Consolidated Framework for Implementation Research (CFIR). METHODS: We conducted qualitative semi-structured interviews in 2014 with organizational leadership, medical staff, and nursing staff to identify facilitators of and barriers to implementation of SOS in an FQHC system. The interview guide was based on the CFIR framework. Interview transcripts were analyzed using Template Analysis. We adapted SOS and planned implementation strategies to address identified barriers. RESULTS: Facilitators of implementation of SOS were previous quality improvement experience and engagement of clinic and administrative leadership. Barriers to implementation were a more diverse patient population, a decentralized administrative structure, and communication challenges throughout the organization. Program adaptations focused on patient instructions and educational materials as well as elimination of follow-up phone calls. Implementation strategies included early and frequent engagement with organizational leadership and a smaller pilot program before organization-wide implementation. CONCLUSIONS: Use of CFIR identified facilitators of and barriers to implementation of the evidence-based colorectal cancer screening program. Program adaptations and implementation strategies based on this study may generalize to other FQHC systems that are considering implementation of a proactive, mail-based colorectal cancer screening program.

Comentario a: “Hidrosadenitis supurativa: nuevas oportunidades para una enfermedad dermatológica huérfana” / Comment on “Hidradenitis Suppurativa: New Opportunities for an Orphan Skin Disease”

No disponible

Utilidad de las vías clínicas en el tratamiento del anciano con fractura de cadera / Usefulness of clinical pathways in the treatment of hip fracture in the elderly

No disponible

Developing nursing and midwifery research priorities: a Health Service Executive (HSE) North West study.

AIM: The primary purpose of this study was to identify research priorities for nurses and midwives across the Health Service Executive (HSE) North West region. The rationale for the study was underlined during meetings of HSE North West Directors of Nursing and Midwifery in January 2011. It was agreed that a more strategic approach to generating synergy among nursing and midwifery research, evaluation, and evidence-based practice should be developed through the Nursing and Midwifery Planning and Development Unit. METHODS: The research design was founded upon collaborative processes for consensus building that included the Delphi technique and nominal group technique. The study sample included a panel of experts. Data were collected between March 2011 and December 2011. FINDINGS: Findings from this study validate the efficacy of the research methodology in enabling the effective identification of priority areas for research. These include: (a) an evaluation of the impact of postgraduate nursing and midwifery education programs focusing upon patient, professional, and organizational outcomes; (b) development and evaluation of an effective culture of nurse- and midwife-led audit across all services within a Regional Health Trust in Ireland; (c) an examination of the efficacy of approaches to clinical supervision within the context of the Irish health system; (d) an evaluation of the impact of an Advanced Nurse Practitioner role in supporting the effective management of long-term conditions within the context of Regional Health Trust primary care settings in Ireland; and (e) Supporting and developing an ethical framework for nursing and midwifery research within a Regional Health Trust in Ireland. LINKING EVIDENCE TO ACTION: It is anticipated that future work, outlined within this paper, will lead to important improvements in patient care and outcomes. Furthermore, this study provides evidence that a strong nursing and midwifery research agenda can be established upon genuine collaborations and partnerships across varying levels of research knowledge and skills, but with a shared purpose and shared values.

Towards a new paradigm in health research and practice? Collaborations for Leadership in Applied Health Research and Care.

PURPOSE: Collaborations for Leadership in Applied Health Research and Care (CLAHRCs) are a new UK initiative to promote collaboration between universities and healthcare organisations in carrying out and applying the findings of applied health research. But they face significant, institutionalised barriers to their success. This paper seeks to analyse these challenges and discuss prospects for overcoming them. DESIGN/METHODOLOGY/APPROACH: The paper draws on in-depth qualitative interview data from the first round of an ongoing evaluation of one CLAHRC to understand the views of different stakeholders on its progress so far, challenges faced, and emergent solutions. FINDINGS: The breadth of CLAHRCs' missions seems crucial to mobilise the diverse stakeholders needed to succeed, but also produces disagreement about what the prime goal of the Collaborations should be. A process of consensus building is necessary to instil a common vision among CLAHRC members, but deep-seated institutional divisions continue to orient them in divergent directions, which may need to be overcome through other means. ORIGINALITY/VALUE: This analysis suggests some of the key means by which those involved in joint enterprises such as CLAHRCs can achieve consensus and action towards a current goal, and offers recommendations for those involved in their design, commissioning and performance management.

Manejo de la recidiva bioquímica en el cáncer de próstata según la Guías de Práctica Clínica / Management of prostate cancer biochemical recurrence in the clinical guidelines

OBJETIVO: Revisión de las Guías Clínicas que consideramos tienen un mayor impacto en la actividad urológica, para conocer y comparar sus recomendaciones en el diagnóstico y manejo de la recidiva bioquímica después de un tratamiento con intención curativa en el cáncer prostático ( prostatectomía radical o radioterapia). MÉTODOS: Hemos revisado las Guías Clínicas de la European Urological Assciation (EAU), American Urological Association (AUA), National Comprehensive Cancer Network (NCCN) y del National Institute for Health and Clinical Excellence (NICE), así como la evidencia científica en la que se basan. RESULTADOS: Ponemos de manifiesto en este artículo la complejidad del tema a tratar y las similitudes y disparidades entre ellas. La definición de recidiva varía si se trata de pacientes que han sido sometidos a prostatectomía radical o a radioterapia. En cuanto a los tratamientos, en el primer caso se decantan hacia la radioterapia precoz siendo en cambio más dispersas las recomendaciones en la recidiva bioquímica después de radioterapia. CONCLUSIÓN: Las Guías Clínicas suponen una magnífica ayuda al profesional para la toma de decisiones. Las Guías Clínicas formulan recomendaciones, con mayor o menor grado de evidencia y que han de ser periódicamente reevaluadas incorporando la evidencia científica que vaya apareciendo(AU)

OBJECTIVE: Review of the Guidelines which have major impact on the urological field, in order to compare and to know their recommendations in the diagnosis and management of biochemical relapse after a healing treatment of prostate cancer (radical prostatectomy or radiotherapy). METHODS: We review the Guidelines of the European Urological Association (EAU), the American Urological Association (AUA), of the National Comprehensive Cancer Network (NCCN) and those of the National Institute for Health and Clinical Excellence (NICE), as well as the scientific evidence on which they are based. RESULTS: In this paper we state the complexity of the subject being dealt with and coincidences and differences among them. The definition of relapse varies depending on whether the patient has undergone either radical prostatectomy or radiotherapy. Regarding treatment, in the first case early radiotherapy is the treatment of choice, but recommendations after radiotherapy are not so specific. CONCLUSION: Clinical Guidelines represent a great aid in decision making for the professional. Guidelines give recommendations with a higher o lower degree of scientific evidence and must be evaluated regularly to include new evidences which are coming through(AU)

Prácticas para estimular el parto normal / Practices to stimulate normal childbirth

Este artículo lleva a una reflexión sobre las prácticas del estímulo al parto normal, con la fundamentación teórica de cada una de ellas. Las prácticas incluidas en este estudio fueron el ayuno, enemas, spray y baños de inmersión, caminatas, movimientos pélvicos y masaje. En un contexto de revalorización del parto normal, ofrecer a la mujer durante el parto opciones de comodidad basadas en evidencias puede ser una forma de preservar el curso fisiológico del parto (AU)

This article leads to a reflection about the practices of encouraging normal childbirth, with the theoretical foundation for each one of them. The practices included in this study were fasting, enema, shower and immersion baths, walking, pelvic movements and massage. In a context of revaluation of normal birth, providing evidence-based comfort options for women during childbirth can be a way to preserve the physiological course of labour (AU)

In conclusion: looking to the future of comprehensive cancer control.

The articles in this monograph illustrate the progress and successes of comprehensive cancer control (CCC) since our 2005 publication. The strides made in CCC demonstrate the energy and commitment of this nationwide movement to reduce the burden of cancer for all people. The purpose of this conclusion paper is to discuss the future of CCC, which promises a new emphasis on policy, primary prevention, public health, evidence-based interventions, and global health supported by advanced communication tools.

Consensus statements from the Workshop 'Probiotics and Health: Scientific Evidence' / Declaraciones consensuadas del Workshop: “Probióticos y Salud: Evidencia Científica”

This report shows the level of scientific consensus on definition, characteristics and health benefits of probiotics. The content of the report has derived from the scientific meeting: Workshop on Probiotics and Health. Scientific evidence, that congregated several Spanish experts, including gastroenterologists, microbiologists, nutritionists, immunologists and food technologists, among others, who have agreed with the statements shown in this document. Each statement has been sustained with the most relevant scientific aspects that were discussed during the Workshop and the following evaluation of there port by all experts who approved and signed it (AU)

En este documento se muestra una base de consenso entorno a la definición, características y propiedades beneficiosas de los probióticos. El contenido fue generado a partir de la reunión científica Workshop Probióticos y Salud. Evidencia Científica, que agrupó a una variedad de expertos españoles gastroenterólogos, microbiólogos, nutricionistas, inmunólogos y tecnólogos de alimentos, entre otros, que se han adherido en su mayoría a las sentencias que constituyen este documento. Para cada sentencia se establecen las aspectos científicos más relevantes que la respaldan y que son consecuencia del acuerdo al que se ha llegado tras el debate surgido en la reunión y la evaluación posterior del contenido por todos los expertos que han firmado este documento (AU)