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1.
Ann Glob Health ; 86(1): 104, 2020 08 19.
Artigo em Inglês | MEDLINE | ID: mdl-32874935

RESUMO

Despite predictions that the number of deaths in Africa due to COVID-19 will reach 10 million, overall, the continent has reported relatively few cases compared to the rest of the world. Many African countries have been successful in containing initial outbreaks by rapidly using evidence-based interventions through implementation strategies adapted from other countries' COVID-19 response as well as from prior epidemics. However, it is unclear whether these interventions will lead to long-term and complete success in stopping COVID-19 spread. Implementation research is a tool that can be used by countries to learn how to identify and understand contextual factors impacting COVID-19 prevention and control and select evidence-based interventions and strategies known to reduce spread of the virus. We identify seven key contextual factors that are facilitators or barriers to implementation of these interventions, and several strategies that can be leveraged if the factor is present or ones to strengthen if weak to improve implementation. These factors are: a culture of accountability, national coordination, financial stability of the population, culture of innovation, culture and capacity for research, health systems strength, and cross-border economies. Implementation science methods can serve to develop knowledge at a country and regional level on how to identify, utilize, and address these and other contextual factors, and inform relevant evidence-based interventions and implementation strategies. This approach can support African countries' ability to address key challenges as they arise, both in fighting COVID-19 and future health systems challenges.


Assuntos
Controle de Doenças Transmissíveis , Infecções por Coronavirus , Prática Clínica Baseada em Evidências , Pandemias , Pneumonia Viral , Pesquisa/organização & administração , Organizações de Assistência Responsáveis , África/epidemiologia , Betacoronavirus/isolamento & purificação , Controle de Doenças Transmissíveis/métodos , Controle de Doenças Transmissíveis/organização & administração , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Difusão de Inovações , Transmissão de Doença Infecciosa/prevenção & controle , Prática Clínica Baseada em Evidências/métodos , Prática Clínica Baseada em Evidências/normas , Humanos , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Fatores Socioeconômicos
2.
Medicine (Baltimore) ; 99(34): e21926, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32846861

RESUMO

BACKGROUND: Intensive care unit-acquired weakness (ICU-AW) is an acquired neuromuscular lesion and a common occurrence in patients who are critically ill. There are already systematic reviews on ICU-AW. Therefore, we provide a protocol for an overview of systematic reviews to improve the effectiveness of the construction of an evidence-based practice for prevention of ICU-AW. METHODS: We will search the PubMed, CINAHL, EMBASE, and the Cochrane Library for the relevant systematic review or meta-analyses about ICU-AW. Study selection, data extraction, and the quality assessment of the included studies will be performed independently by 2 reviewers. And the methodological quality, report quality and evidence quality will be evaluated by Assessment of Multiple Systematic Reviews-2 tool, Preferred Reporting Items for Systematic Reviews and Meta Analyses Statement checklist and Grading of Recommendations Assessment, Development and Evaluation system, respectively. RESULTS: This overview of systematic reviews and meta-analysis will collect the evidence published about the ICU-AW. CONCLUSION: We hope that our research will contribute to clinicians and public decision making about the ICU-AW. REGISTRATION NUMBER: INPLASY202070067.


Assuntos
Unidades de Terapia Intensiva/estatística & dados numéricos , Debilidade Muscular/etiologia , Debilidade Muscular/prevenção & controle , Estado Terminal/enfermagem , Tomada de Decisões , Estudos de Avaliação como Assunto , Prática Clínica Baseada em Evidências/métodos , Feminino , Diretrizes para o Planejamento em Saúde , Humanos , Masculino , Debilidade Muscular/epidemiologia , Prevalência , Fatores de Risco
3.
Gerokomos (Madr., Ed. impr.) ; 31(2): 119-124, jun. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-193894

RESUMO

Las úlceras de la extremidad inferior siguen siendo en la actualidad un problema global. Las opciones analgésicas para el control del dolor se basan generalmente en medidas farmacológicas con acción local y/o sistémica. El sevoflurano es un anestésico general inhalatorio, asociado a sus efectos sobre el sistema nervioso central, y tradicionalmente no se emplea por otras vías que no sea inhalado. Sin embargo, hoy en día se le conoce una acción analgésica a nivel central y también periférico. Actualmente, su uso clínico ha llevado a algunos autores a considerar la posibilidad de nuevos efectos del sevoflurano a través de la vía tópica. OBJETIVO: Sintetizar las evidencias científicas disponibles sobre el uso del sevoflurano aplicado de forma tópica en úlceras de la extremidad inferior. METODOLOGÍA: Revisión sistematizada de la literatura científica, siguiendo la guía PRISMA. La búsqueda de estudios se realizó en las principales bases de datos bibliográficas, sin límite de fechas ni de idiomas. También se realizó una búsqueda incluyendo resúmenes de congresos. RESULTADOS: Se obtuvieron un total de 120 referencias. Finalmente, ocho de ellas correspondían a los estudios incluidos para la síntesis cualitativa. En la mayoría de los estudios se encontró una disminución del dolor de 8 a 2 puntos en las escalas empleadas. CONCLUSIONES: Los escasos estudios parecen sugerir un importante efecto analgésico aplicado de forma tópica, un probable efecto antibacteriano y un posible efecto promotor de la cicatrización. Sin embargo, son necesarios más estudios comparativos con un tamaño de muestra mayor, con mejor calidad en sus diseños


Leg ulcers are a global problem daily. The analgesic options for pain control are generally based on pharmacological measures with local and / or systemic action. Sevoflurane is a general inhalation anesthetic, associated with its effects on the central nervous system, its use not being traditional by other routes that are not inhaled. However, today it is known an analgesic action at the central level and at the peripheral level. Actually, the clinical use of this product has led some authors to consider the possibility of new effects of Sevoflurane topically. OBJECTIVE: To synthesize the available scientific evidences about the use of Sevoflurane topically on leg ulcers. METHODOLOGY: Systematized review of the scientific literature, following the PRISMA guide. The main bibliographic databases were searched without date or language limits. Also references lists and congress abstracts were searched. RESULTS: 120 references were identified. Finally, 8 of them were selected for qualitative synthesis. In most studies, was found a decrease in pain of 8 to 2 points in the scales used. CONCLUSIONS: The few studies suggest an analgesic effect applied topically, a probable antibacterial effect and a possible healing promoting effect. However, comparative studies of large sample are needed, with a better quality designs


Assuntos
Humanos , Sevoflurano/uso terapêutico , Extremidade Inferior/lesões , Úlcera do Pé/tratamento farmacológico , Administração Tópica , Prática Clínica Baseada em Evidências/métodos , Enfermagem Baseada em Evidências/métodos , Cicatrização/efeitos dos fármacos
4.
Enferm. actual Costa Rica (Online) ; (38): 1-17, Jan.-Jun. 2020. tab, graf
Artigo em Inglês | LILACS, BDENF - Enfermagem | ID: biblio-1090083

RESUMO

Abstract The objective of this study is to translate and culturally adapt to European Portuguese "EBP Beliefs Scale for Educators" (EBPB-E), "EBP Implementation Scale for Educators" (EBPI-E) and "Organizational Culture & Readiness for School-wide Integration of Evidence-based Practice Survey" for Educators (OCRSIEP-E); and to provide preliminary validation data. The study was carried out in two phases: translation and transcultural adaptation; and preliminary validation in nursing educators of nine nursing schools in Portugal. Pre-final versions of the instruments were considered easy to understand. But, the participants suggested including the possibility of "I don't know" response and increasing the recall period in the EBPI-E. 68 educators participated in phase II. The α for EBPB-E, EBPI-E and OCRSIEP-E was 0.88, 0.95 and 0.94 and the corrected element-total correlations between the items and the total score ranged from 0.20 to 0.75, 0.59 to 0.84 and -0.06 to 0.78, respectively. Preliminary findings showed a strong internal consistency. It is concluded that other validation studies with more robust samples are needed to prove the reliability and validity of the instruments.


Resumen El objetivo de este estudio es traducir y adaptar culturalmente al portugués europeo "EBP Beliefs Scale for Educators" (EBPB-E), "EBP Implementation Scale for Educators" (EBPI-E) y "Organizational Culture & Readiness for School-wide Integration of Evidence-based Practice Survey" para docentes (OCRSIEP-E); y presentar datos preliminares de validación. El estudio se realizó en dos fases: traducción y adaptación transcultural; y validación preliminar en docentes de enfermería de nueve escuelas de enfermería de Portugal. Las versiones prefínales de los instrumentos se consideraron de fácil comprensión. Pero, los participantes sugirieron incluir la posibilidad de respuesta "no sé" y aumentar el período de recuerdo en el EBPI-E. 68 educadores participaron en la fase II. El α para EBPB-E, EBPI-E y OCRSIEP-E fue 0,88, 0,95 y 0,94 y las correlaciones elemento-total corregidas entre los ítems y la puntuación total variaron de 0,20 a 0,75, 0,59 a 0,84 y -0,06 a 0,78, respectivamente. Los hallazgos preliminares mostraron una fuerte consistencia interna. Se concluye que se necesitan otros estudios de validación con muestras más robustas para probar la confiabilidad y la validez de los instrumentos.


Resumo O objetivo deste estudo é traduzir e adaptar culturalmente o português europeu "Escala de Crenças EBP para Educadores" (EBPB-E), "Escala de Implementação EBP para Educadores" (EBPI-E) e "Cultura Organizacional e Prontidão para Integração em toda a Escola de Pesquisa Prática Baseada em Evidências" para profesores (OCRSIEP-E); e fornecer dados preliminares de validação. O estudo foi realizado em duas fases: tradução e adaptação transcultural; e validação preliminar em professores de enfermagem de nove escolas de enfermagem em Portugal. As versões prefinais dos instrumentos foram consideradas fáceis de entender. Porém, os participantes sugeriram incluir a possibilidade de resposta "não sei" e aumentar o período de recall no EBPI-E. 68 educadores participaram da fase II. O α para EBPB-E, EBPI-E e OCRSIEP-E foi de 0,88, 0,95 e 0,94 e as correlações elementototal corrigidas entre os itens e a pontuação total variaram de 0,20 a 0,75, 0,59 a 0,84 e -0,06 a 0,78, respetivamente. Os resultados preliminares mostraram uma forte consistência interna. Conclui-se que outros estudos de validação com amostras mais robustas são necessários para comprovar a confiabilidade e validade dos instrumentos.


Assuntos
Enfermagem , Estudo de Validação , Educação em Enfermagem , Prática Clínica Baseada em Evidências/métodos
6.
s.l; s.n; 14 maio 2020. ilus.
Não convencional em Português | LILACS, BRISA/RedTESA | ID: biblio-1097790

RESUMO

CONTEXTO: Publicações recentes têm chamado a atenção para o possível benefício da associação hidroxicloroquina/cloroquina e azitromicina no tratamento de pacientes infectados pelo novo coronavírus emergente (SARS-CoV-2). OBJETIVOS: Identificar, avaliar sistematicamente e sumarizar as melhores evidências científicas disponíveis sobre a eficácia e a segurança da associação hidroxicloroquina/cloroquina e azitromicina para Covid-19. MÉTODOS: Revisão sistemática rápida (rapid review methodology) com buscas em 28 de abril de 2020. RESULTADOS: Após o processo de seleção, foram identificados 11 estudos e 13 protocolos de estudos clínicos em andamento. O benefício documentado da associação hidroxicloroquina/cloroquina e azitromicina ainda é bastante limitado. CONCLUSÃO: Até o momento, a eficácia e a segurança dessa associação para pacientes com infecção por SARS-CoV-2 ainda são consideradas incertas.


Assuntos
Humanos , Cloroquina/uso terapêutico , Infecções por Coronavirus/tratamento farmacológico , Azitromicina/uso terapêutico , Betacoronavirus/efeitos dos fármacos , Hidroxicloroquina/uso terapêutico , Avaliação da Tecnologia Biomédica , Análise Custo-Benefício , Prática Clínica Baseada em Evidências/métodos
7.
Pap. psicol ; 41(1): 16-26, ene.-abr. 2020. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-190928

RESUMO

En la actualidad existe una amplia concienciación para personalizar los tratamientos psicológicos en función de las características individuales del paciente y de la singularidad de su contexto vital. Utilizar el mismo tratamiento para cada paciente y para cada trastorno es una práctica clínica contraindicada y una conducta poco ética. En el presente trabajo se revisan siete factores importantes en este ámbito: el grado de reactancia con respecto al cambio, la fase del cambio en la que se encuentra el cliente, la cultura, el estilo de afrontamiento, el estilo de apego, las preferencias terapéuticas y los sentimientos religiosos y espirituales. Los resultados de diversos estudios metanalíticos sugieren que dichos factores influyen sensiblemente en la eficacia de los tratamientos psicológicos, y que su aplicación deja un amplio margen de mejora para la eficacia de los tratamientos psicológicos


Today therapists are more aware of the importance of personalizing psychological treatments according to patients' individual characteristics and the singularity of their life contexts. Using the same treatment for every patient and every disorder is not advisable and it is a poor ethical behavior. In this study, seven important personalizing factors are reviewed: patient reactance level, stage of change phase, culture, coping style, attachment style, therapeutic preferences, and religious and spiritual dimension. Meta-analytic studies suggest that these factors notably affect the efficacy of psychological treatments, and that their application will allow for further improvement in psychotherapy efficacy


Assuntos
Humanos , Psicoterapia Centrada na Pessoa/tendências , Prática Clínica Baseada em Evidências/métodos , Resultado do Tratamento , Adaptação Psicológica , Psicoterapia Centrada na Pessoa/métodos , Psicoterapia/métodos , Apego ao Objeto
8.
J Laryngol Otol ; 134(3): 205-212, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32122408

RESUMO

OBJECTIVE: To review the management of temporal bone fractures at a major trauma centre and introduce an evidence-based protocol. METHODS: A review of reports of head computed tomography performed for trauma from January 2012 to July 2018 was conducted. Recorded data fields included: mode of trauma, patient age, associated intracranial injury, mortality, temporal bone fracture pattern, symptoms and intervention. RESULTS: Of 815 temporal bone fracture cases, records for 165 patients met the inclusion criteria; detailed analysis was performed on the records of these patients. CONCLUSION: Temporal bone fractures represent high-energy trauma. Initial management focuses on stabilisation of the patient and treatment of associated intracranial injury. Acute ENT intervention is directed towards the management of facial palsy and cerebrospinal fluid leak, and often requires multidisciplinary team input. The role of nerve conduction assessment for immediate facial palsy is variable across the UK. The administration of high-dose steroids in patients with temporal bone fracture and intracranial injury is not advised. A robust evidence-based approach is introduced for the management of significant ENT complications associated with temporal bone fractures.


Assuntos
Prática Clínica Baseada em Evidências/métodos , Equipe de Assistência ao Paciente , Fraturas Cranianas/terapia , Osso Temporal/lesões , Adulto , Vazamento de Líquido Cefalorraquidiano/etiologia , Vazamento de Líquido Cefalorraquidiano/terapia , Criança , Protocolos Clínicos , Paralisia Facial/etiologia , Paralisia Facial/terapia , Feminino , Humanos , Masculino , Estudos Retrospectivos , Fraturas Cranianas/complicações , Fraturas Cranianas/diagnóstico por imagem , Osso Temporal/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Centros de Traumatologia , Reino Unido
9.
Am J Occup Ther ; 74(2): 7402170020p1-7402170020p7, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32204771

RESUMO

This special issue of the American Journal of Occupational Therapy on interventions for children and youth highlights the current developments in and evidence for the effectiveness of occupational therapy interventions and psychometric properties of assessments for children and youth. In this guest editorial, we identify various factors that challenge the implementation of evidence-based strategies in daily clinical practice. We assert that scholars, educators, and practitioners need to address several strategic steps. To facilitate critical consumption of evidence in practice, efforts need to be made to build capacity for evidence production and evidence use through implementation science and to ensure that evidence-based practice is not only taught but also reflectively applied across the educational curriculum and that clinicians are given more access to resources that are easy to translate to daily clinical practice.


Assuntos
Terapia Ocupacional , Adolescente , Criança , Currículo , Prática Clínica Baseada em Evidências/métodos , Humanos
10.
Psicosom. psiquiatr ; (12): 35-45, ene.-mar. 2020.
Artigo em Inglês | IBECS | ID: ibc-193132

RESUMO

INTRODUCTION: Fibromyalgia (FM) is a clinical condition characterized by chronic widespread pain, fatigue, non refreshing sleep, mood disturbance and cognitive impairment with accompanying functional disability. It's etiology and even it's existence as a clinical entity have been discussed over the last decades. The lack of understanding of it's physiopathology and the fact that, to this date, there is no strong effective treatment for it makes this discussion even more relevant for clinicians. We here try to revise some of the clinical relevant data available to this day.METHODS: This paper is a narrative revision which gathers information based on a PubMed database search from the last 6 years (2012-2018), in Portuguese or English, for clinical trials or reviews, on the term "Fibromyalgia treatment".Results and discussion: Although there isn't a single strong intervention for FM patients, there is enough evidence suggesting that patient education on the symptoms, on the disease itself and on the realistic treatment goals can benefit these patients. Exercise is also evidence based and should be appropriately suggested. Classical and new Cognitive Behavioural Therapy (CBT) interventions should be seen as the corner stone of treatment in these patients, specially if having co-morbid affective disorders. Many drugs have been studied in the hopes of helping FM patients but few have evidence to support its recommendation


INTRODUCCIÓN: La fibromialgia (FM) es una condición clínica caracterizada por dolor crónico generalizado, fatiga, sueño no reparador, alteraciones del estado de ánimo y deterioro cognitivo con discapacidad asiciada, en casis extremis. Su etiología, e incluso su existencia como entidad clínica, se han debatido en las últimas décadas. La falta de comprensión de su fisiopatología y el hecho de que, hasta la fecha, no exista un tratamiento suficientmente efectivo, convierte el debate en muy relevante para los clínicos. METODOLOGÍA: Este documento revisa información basada en una búsqueda en la base de datos de PubMed de los últimos 6 años (2012-2018), en portugués o inglés, para ensayos clínicos o revisiones, en los términos " Fybromialgia Treatment". Resultados y DISCUSIÓN: Aunque no existe una sola intervención suficientemente sólida para pacientes con FM, gozamos de evidencias suficientes que sugieren que la educación del paciente sobre los síntomas, la enfermedad misma y los objetivos del tratamiento realistas pueden beneficiarlos El ejercicio también se basa en la evidencia debe sugerirse de manera apropiada. Las intervenciones clásicas y de segunda y tercera generación de la Terapia Cognitivo Conductual (TCC) , deben considerarse la piedra angular del tratamiento en estos pacientes, especialmente si se asocian trastornos afectivos comorbidos. Muchos fármacos se han estudiado con la esperanza de ayudar a los pacientes con FM, pero pocos tienen evidencia para sostener su recomendación


Assuntos
Humanos , Fibromialgia/terapia , Prática Clínica Baseada em Evidências/métodos , Dor Crônica/terapia , Transtornos Psicofisiológicos/terapia , Terapia Cognitivo-Comportamental , Educação de Pacientes como Assunto , Exercício Físico , Psicoterapia
11.
J Wound Ostomy Continence Nurs ; 47(2): 140-165, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32118802

RESUMO

PURPOSE: The purpose was to summarize evidence related to adherence to intermittent catheterization (IC), complication rates, satisfaction with IC, and its effect on health-related quality of life. PROBLEM: Intermittent catheterization is frequently used to manage lower urinary tract dysfunctions including urinary retention and urinary incontinence, but research suggests that care for patients using IC may not always be based on evidence. METHODS: Scoping review. SEARCH STRATEGY: We searched the PubMed, EMBASE, CINAHL databases, and the Cochrane Database for Systematic Reviews to identify studies published between January 2009 and March 2019. Seventy studies met inclusion criteria and were evaluated for adherence, complication rates, satisfaction, and health-related quality in adults and children using IC for bladder management. FINDINGS: Recent research was variable in both quantity and quality. The evidence suggests that (1) most patients can successfully master IC and that functional status is likely the most important predictor of success; (2) adherence to IC probably decreases over time; (3) urinary tract infections (UTIs) are the most common complication of IC and that prophylactic antibiotic therapy may reduce the risk of recurrent UTIs; (4) urinary incontinence is also a common complication; and (5) other complications such as urethral strictures, bladder stones, hematuria, and urethral false passage do occur but are less prevalent than UTIs and incontinence between catheterizations. Our review also revealed multiple gaps in the evidence to support care for patients using IC. CONCLUSIONS: Research priorities include a need for prospective studies of the epidemiology and risk factors for IC-related complications, along with intervention studies to determine how to improve outcomes for patients using IC to manage bladder function.


Assuntos
Cateterismo Uretral Intermitente/efeitos adversos , Infecções Urinárias/etiologia , Prática Clínica Baseada em Evidências/métodos , Feminino , Humanos , Satisfação do Paciente , Qualidade de Vida , Infecções Urinárias/fisiopatologia
12.
West J Emerg Med ; 21(2): 412-422, 2020 Feb 21.
Artigo em Inglês | MEDLINE | ID: mdl-32191199

RESUMO

Initiatives for addressing resident wellness are a recent requirement of the Accreditation Council for Graduate Medical Education in response to high rates of resident burnout nationally. We review the literature on wellness and burnout in residency education with a focus on assessment, individual-level interventions, and systemic or organizational interventions.


Assuntos
Esgotamento Profissional/prevenção & controle , Medicina de Emergência/educação , Internato e Residência , Prática Clínica Baseada em Evidências/métodos , Humanos , Internato e Residência/métodos , Internato e Residência/normas , Internato e Residência/tendências
14.
NeuroRehabilitation ; 46(2): 213-225, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32083604

RESUMO

BACKGROUND: Today, there exists a need for a practical counseling approach for patients with brain disorders based on an empirical measure that can be used to objectify procedural adequacy. Clinical neuropsychology, which focuses on developing knowledge about human brain-behavioral relationships and applying this information to clinical problems, is the ideal discipline to address this issue. Unlike other methods of appraisal and current counseling approaches, medical adjustment counseling (MAC) for patients with cognitive and behavioral changes due to brain disorders is based on the application of neuropsychological principles and evidence-based practices. OBJECTIVE: In this review, I discuss the neuropsychological principles underlying MAC, differentiation from conventional clinical psychology systems, and the specifics of the treatment stages. Transtheoretical analytic points of inclusion and a clinical case example are also discussed. METHODOLOGY: MAC involves an interactive exchange between the neuropsychologist and patient based on the neuropsychological examination (NPE). The resulting neuropsychological profile facilitates the conversion of empirical objective evidence into practical biopsychosocial adaptive strategies that can be modified according to each patient's diagnosis and level of impairment. MAC is delivered in four stages (validation, education, accommodation, and reintegration) that require an understanding of the ecological applicability of the NPE to the real-life situation of the patient, a knowledge base of the neurobehavioral consequences of the medical diagnosis, integration of medical disciplines regarding additional diagnostics, psychological crisis systems and patient/family reactions. CONCLUSION: Without the objective neuropsychological evidence provided by the NPE and MAC, the clinical judgment of the psychologist is based on something more akin to witchcraft and magic than science.


Assuntos
Concussão Encefálica/psicologia , Concussão Encefálica/terapia , Aconselhamento/métodos , Prática Clínica Baseada em Evidências/métodos , Testes Neuropsicológicos , Concussão Encefálica/diagnóstico , Encefalopatias/psicologia , Encefalopatias/terapia , Feminino , Humanos , Pessoa de Meia-Idade , Neuropsicologia/métodos
15.
Crit. care ; 24(65): [1-16], Feb. 24, 2020.
Artigo em Inglês | BIGG | ID: biblio-1117218

RESUMO

Point-of-care ultrasound (POCUS) is nowadays an essential tool in critical care. Its role seems more important in neonates and children where other monitoring techniques may be unavailable. POCUS Working Group of the European Society of Paediatric and Neonatal Intensive Care (ESPNIC) aimed to provide evidence-based clinical guidelines for the use of POCUS in critically ill neonates and children. Creation of an international Euro-American panel of paediatric and neonatal intensivists expert in POCUS and systematic review of relevant literature. A literature search was performed, and the level of evidence was assessed according to a GRADE method. Recommendations were developed through discussions managed following a Quaker-based consensus technique and evaluating appropriateness using a modified blind RAND/UCLAvoting method. AGREE statement was followed to prepare this document. Panellists agreed on 39 out of 41 recommendations for the use of cardiac, lung, vascular, cerebral and abdominal POCUS in critically ill neonates and children. Recommendations were mostly (28 out of 39) based on moderate quality of evidence (B and C). Evidence-based guidelines for the use of POCUS in critically ill neonates and children are now available. They will be useful to optimise the use of POCUS, training programs and further research, which are urgently needed given the weak quality of evidence available.


Assuntos
Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal/organização & administração , Serviços de Saúde da Criança/organização & administração , Testes Imediatos , Prática Clínica Baseada em Evidências/métodos
16.
Worldviews Evid Based Nurs ; 17(1): 71-81, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32017438

RESUMO

BACKGROUND AND SIGNIFICANCE: Evidence-based practice (EBP) is a systematic problem-solving approach to the delivery of health care that improves quality and population health outcomes as well as reduces costs and empowers clinicians to fully engage in their role, otherwise known as the quadruple aim in health care. The Helene Fuld Health Trust National Institute for Evidence-based Practice in Nursing and Healthcare at The Ohio State University College of Nursing has been offering 5-day EBP immersion programs since 2012. The goal of the program is for the participants to acquire EBP competence (e.g., knowledge, skills, and attitude) and sustain it over time. PURPOSE AND AIMS: The purpose of this study was to evaluate the effects of the 5-day EBP immersion (i.e., an education and skills building program) on EBP attributes and competence over time. METHOD AND DESIGN: A longitudinal pre-experimental study was conducted that gathered data with an anonymous online survey from 400 program attendees who attended 16 5-day immersions between September 2014 and May 2016. Participants completed five valid and reliable instruments at four points over 12 months, including EBP beliefs, implementation, competency, knowledge, and perception of organizational readiness and culture. RESULTS: Findings indicated statistically significant improvements in EBP attributes and competency over time. The results of this study support the hypotheses that EBP competency and attributes can be significantly improved and sustained by attending an intensive 5-day EBP educational and skills building program such as the one described in this study. This study can help leaders and organizations to mitigate many of the traditional barriers to EBP. LINKING EVIDENCE TO ACTION: The results of this study indicate that EBP attributes and competencies can be improved and sustained by attending an intensive 5-day EBP immersion, regardless of clinicians' prior educational preparation.


Assuntos
Prática Clínica Baseada em Evidências/normas , Desenvolvimento de Pessoal/normas , Adulto , Competência Clínica/normas , Competência Clínica/estatística & dados numéricos , Prática Clínica Baseada em Evidências/métodos , Prática Clínica Baseada em Evidências/estatística & dados numéricos , Feminino , Humanos , Internet , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Desenvolvimento de Pessoal/métodos , Desenvolvimento de Pessoal/estatística & dados numéricos , Inquéritos e Questionários
17.
Mil Med ; 185(Suppl 1): 303-310, 2020 01 07.
Artigo em Inglês | MEDLINE | ID: mdl-32074319

RESUMO

INTRODUCTION: Mental health treatment utilization among persons with posttraumatic stress disorder (PTSD) tends to be low but may be improved by aligning treatment with patient preferences. Our objective was to characterize the reasons that drive a person's selection of a specific evidence-based PTSD treatment. MATERIALS AND METHODS: Data were collected using an online survey of adults who screened positive for PTSD. Participants viewed descriptions of five evidence-based PTSD treatments (cognitive processing therapy, prolonged exposure, eye movement desensitization and reprocessing, stress inoculation training, antidepressant medication) and identified their most preferred treatment. Participants then explained why they selected their top choice. These free-text responses (n = 249) were analyzed using thematic coding and constant comparative methods. RESULTS: Identified themes included (1) perceived effectiveness, (2) perceived suitability, (3) requirements of participation, (4) familiarity with the modality, (5) perception of the option as 'better than alternatives,' (6) perception of the option as 'not harmful,' (7) accessibility, and (8) delivery format. Differences in themes were also examined by treatment modality. CONCLUSIONS: By highlighting which pieces of information may be most important to detail when presenting different treatment options, these results can help guide treatment planning conversations, as well as the development of shared decision-making tools.


Assuntos
Prática Clínica Baseada em Evidências/instrumentação , Preferência do Paciente/psicologia , Transtornos de Estresse Pós-Traumáticos/terapia , Adulto , Antidepressivos/uso terapêutico , Prática Clínica Baseada em Evidências/métodos , Prática Clínica Baseada em Evidências/estatística & dados numéricos , Feminino , Humanos , Masculino , Preferência do Paciente/estatística & dados numéricos , Psicoterapia/métodos , Pesquisa Qualitativa , Transtornos de Estresse Pós-Traumáticos/psicologia , Inquéritos e Questionários
18.
Mil Med ; 185(Suppl 1): 286-295, 2020 01 07.
Artigo em Inglês | MEDLINE | ID: mdl-32074365

RESUMO

INTRODUCTION: Web-based interventions hold great promise for the dissemination of best practices to clinicians, and investment in these resources has grown exponentially. Yet, little research exists to understand their impact on intended objectives. MATERIALS & METHODS: The Post-Traumatic Stress Disorder (PTSD) Clinicians Exchange is a website to support clinicians treating veterans and active duty military personnel with PTSD, evaluated in a randomized controlled trial (N = 605). This manuscript explores how a subset of clinicians, those who utilized the intervention (N = 148), engaged with it by examining detailed individual-level web analytics and qualitative feedback. Stanford University and New England Research Institutes Institutional Review Boards approved this study. RESULTS: Only 32.7% of clinicians randomized to the intervention ever accessed the website. The number of pages viewed was positively associated with changes from baseline to 12 months in familiarity (P = 0.03) and perceived benefit of practices (P = 0.02). Thus, engagement with the website did predict an improvement in practice familiarity and benefit outcomes despite low rates of use. CONCLUSIONS: This study demonstrates the importance of methodologically rigorous evaluations of participant engagement with web-based interventions. These approaches provide insight into who accesses these tools, when, how, and with what results, which can be translated into their strategic design, evaluation, and dissemination.


Assuntos
Prática Clínica Baseada em Evidências/métodos , Padrões de Prática Médica/normas , Transtornos de Estresse Pós-Traumáticos/terapia , Navegador/tendências , Adulto , Prática Clínica Baseada em Evidências/tendências , Feminino , Humanos , Internet , Entrevistas como Assunto/métodos , Masculino , Pessoa de Meia-Idade , New England , Padrões de Prática Médica/tendências , Pesquisa Qualitativa , Transtornos de Estresse Pós-Traumáticos/psicologia
19.
Interv. psicosoc. (Internet) ; 29(1): 39-48, ene. 2020. tab
Artigo em Inglês | IBECS | ID: ibc-190384

RESUMO

Research has highlighted that no instrument with adequate evidence of validity and reliability currently exists to assess quality of life (QoL) in children with Down syndrome (DS). Important limitations have been pointed out when existingQoL instruments for children with intellectual disability are applied to this population. The main goal of this research is to adapt the KidsLife scale by selecting the most reliable and discriminant items for children and youth with DS. The sample was composed of 405 children with DS, aged between 4 and 21 years old, attending organizations that provide educational, social, and health services. The field-test version of the KidsLife scale was administered as an informantreport, completed by someone who knew the child well, and who had opportunities to observe him/her over long periods of time in different situations. Evidence of reliability and validity based on the internal structure of the scale is provided. According to the QoL model used to develop the scale, the solution showing the best fit to the data was the one with eight intercorrelated domains. Finally, the implications of the study, its limitations and suggestions for future researchare discussed


La investigación ha puesto de manifiesto que actualmente no existen instrumentos que presenten una adecuada evidencia de validez y fiabilidad para evaluar la calidad de vida (CV) de los niños con síndrome de Down (SD). De hecho, se encuentran importantes limitaciones cuando se aplican a esta población instrumentos de CV diseñados para personas con discapacidad intelectual. El principal objetivo de este trabajo es adaptar la escala KidsLife seleccionando los ítems más fiables y con mayor poder discriminativo para los jóvenes con SD. La muestra estaba formada por 405 jóvenes con SD, con edades comprendidas entre los 4 y los 21 años que asistían a organizaciones proveedoras de servicios educativos, sociales y de salud. La versión piloto de la escala KidsLife la contestó un informante que conocía al joven o a la joven bien, teniendo la oportunidad de observarle durante periodos prolongados de tiempo en diferentes situaciones. Se proporcionan pruebas de la fiabilidad y validez basadas en la estructura interna de la escala. De acuerdo con el modelo de CV utilizado para el desarrollo de la escala, la solución que mostró mejor ajuste a los datos fue la de ocho dimensiones correlacionadas. Finalmente, se discuten las implicaciones del estudio, sus limitaciones y se hacen sugerencias para la investigación futura


Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Adulto Jovem , Adulto , Qualidade de Vida/psicologia , Síndrome de Down/psicologia , Psicometria/métodos , Prática Clínica Baseada em Evidências/métodos , Projetos Piloto
20.
Int J Psychol ; 55 Suppl 1: 16-25, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30779343

RESUMO

The evidence-based movement (EBM) is grounded in a well-intentioned desire to ensure resources are invested in high quality initiatives that generate the intended impact. Nevertheless, recent critiques contest the appropriateness of translating an approach rooted in a medical model to socially complex initiatives. Globalised notions of evidence can also be damaging for programs operating in small, culturally diverse countries with limited resources. Given these polemic views, our aim was to examine local perceptions of the EBM in New Zealand, a small, vibrant, bicultural society with a mix of homegrown and imported programs. Using a snowball sampling approach, 79 professionals working in the education and social sectors completed an anonymous online survey that contained a series of closed and open-ended questions. The results show that although participants positively endorsed a variety of quality evidence markers, traditionally positivist methodological leanings received lower and more varied endorsements compared to more inclusive and pluralistic approaches. Many also expressed concern that the EBM emphasises a narrow and colonised view of evidence that does not align with Maori and Pacific worldviews, and undermines innovation. We discuss the implications as an avenue for advancing intervention and social programming research in an increasingly multicultural and globalised world.


Assuntos
Diversidade Cultural , Prática Clínica Baseada em Evidências/métodos , Saúde Global/normas , Feminino , Humanos , Masculino , Nova Zelândia , Inquéritos e Questionários
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