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1
Glenny, Anne-Marie. "Evidence-based guidelines in dentistry." Thesis, University of Manchester, 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.527588.
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Background: Clinical guidelines have an important role to play in helping to close the gap between research evidence and clinical practice. In order to fulfill this role, guidelines need to be valid, relevant and comprehensive. Despite advances in chemotherapy and radiotherapy, cancer treatment still remains associated with clinically important oral complications that can impact severely on a patient's quality of life. No clear guidelines exist outlining the optimal oral care strategy for children, teenagers and young adults treated for cancer. Aims: (i) To assess the quality of current clinical guidelines for those working within dentistry; (ii) To develop evidence-based guidelines on mouth care for children, teenagers and young adults being treated for cancer; (iii) To compare the quality of published guidelines and their recommendations in light of supporting research evidence. Methods: (i) Dental guidelines, published in English between 1997-2004, were appraised using the Appraisal of Guidelines Research and Evaluation (AGREE) instrument; (ii) A telephone survey of UK cancer centres was undertaken to establish current practice with regard to mouth care for children treated for cancer. National, evidence-based guidelines were developed following, where appropriate, the established methodology of the Scottish Intercollegiate Guidelines Network (SIGN); (iii) A qualitative assessment of previously published guidelines on mouth care for cancer patients was undertaken. Results: (i) The AGREE instrument identified few examples of good quality dental guidelines; (ii) There is diversity in the mouth care provided to children being treated for cancer in the UK, particularly with regard to the use of routine, preventative oral care therapies. The guideline development process required a combination of an evaluation of research evidence and a formal opinion gathering process. A variety of interventions have been used for the management of oral mucositis, candidiasis, xerostomia and herpes simplex virus; few are supported by the research evidence; (iii) Variation exists in the methods used to produce previously published guidelines on mouth care for cancer patients. Recommendations vary irrespective of the supporting evidence-base. Conclusion: Guidelines need to be assessed for quality before being applied in practice. The guideline development process needs to be transparent, with clear links between recommendations and supporting evidence. There is currently variation in the mouth care provided to children, teenagers and young adults being treated for cancer in the UK. National, evidence-based guidelines may help to reduce this variation. Further research is required into the most effective methods of dissemination and implementation, exploring the role of psychological models of behavioural change.
2
Lam, Kwun-yu, and 林冠羽. "Evidence-based exercise guidelines for adult cancer patients." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2011. http://hub.hku.hk/bib/B46581984.
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Baldwin, David S., Ian M. Anderson, David J. Nutt, Borwin Bandelow, Alyson Bond, Jonathan R. T. Davidson, Boer Johan A. den, et al. "Evidence-based guidelines for pharmacological treatment of anxiety disorders." Saechsische Landesbibliothek- Staats- und Universitaetsbibliothek Dresden, 2013. http://nbn-resolving.de/urn:nbn:de:bsz:14-qucosa-103753.
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These British Association for Psychopharmacology guidelines cover the range and aims of treatment for anxiety disorders. They are based explicitly on the available evidence and are presented as recommendations to aid clinical decision making in primary and secondary medical care. They may also serve as a source of information for patients and their carers. The recommendations are presented together with a more detailed review of the available evidence. A consensus meeting involving experts in anxiety disorders reviewed the main subject areas and considered the strength of evidence and its clinical implications. The guidelines were constructed after extensive feedback from participants and interested parties. The strength of supporting evidence for recommendations was rated. The guidelines cover the diagnosis of anxiety disorders and key steps in clinical management, including acute treatment, relapse prevention and approaches for patients who do not respond to first-line treatments.
4
Hilbert, Anja, Hans Hoek, and Ricarda Schmidt. "Evidence-based Clinical Guidelines for Eating Disorders: International Comparison." Lippincott Williams & Wilkins, 2017. https://ul.qucosa.de/id/qucosa%3A33730.
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Purpose of review – This systematic review sought to compare available evidence-based clinical treatment guidelines for all specific eating disorders.
Recent findings – Nine evidence-based clinical treatment guidelines were located through a systematic search. The international comparison demonstrated notable commonalities and differences among current evidence-based clinical guidelines for eating disorders. Consistency across guidelines was greatest for treatments with a larger evidence base, while those with a lower evidence base had recommendations that varied considerably.
Summary – Evidence-based clinical guidelines represent an important step toward the dissemination and implementation of evidence-based treatments into clinical practice. Despite advances in clinical research on eating disorders, a growing body of literature demonstrates that individuals with eating disorders often do not receive an evidence-based treatment for their disorder. Regarding the dissemination and implementation of evidence-based treatments, current guidelines do endorse the main empirically validated treatment approaches with considerable agreement, but additional recommendations are largely inconsistent. An increased evidence base is critical in offering clinically reliable and consistent guidance for the treatment of eating disorders. Because developing and updating clinical guidelines is time-consuming and complex, an international coordination of guideline development, for example, across the European Union, would be desirable.
5
Cocks, Kim. "Evidence-based interpretation guidelines for quality of life measures." Thesis, University of Leeds, 2011. http://etheses.whiterose.ac.uk/15227/.
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Aim: To use published literature to obtain estimates of large, medium and small differences in quality of life (QOL) data for the European Organisation for the Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30). Methods: An innovative method combining systematic review of published studies, expert opinions and meta-analysis was used to obtain estimates of large, medium and small differences for QLQ-C30 scores. Published mean data were identified from the literature. Differences between groups of patients and over time within patients were reviewed by 34 experts in QOL measurement and cancer treatment. The experts, blinded to QOL results, were asked to predict these differences. Differences were combined using meta-analytic techniques to obtain estimates of small, medium and large effects. Qualitative interviews with patients and experts were used to assess the new methodology. Results: 911 articles were identified, with 211 relevant articles (3444 contrasts) for the analysis. Our systematic reviewof the randomised controlled trials (RCTs) showed that the clinical relevance of QOL differences was rarely discussed. Our meta-analysis estimates varied depending on the subscale and on whether QOL was improving or deteriorating. Thus, the recommended minimum to detect medium differences between groups ranges from 7 (diarrhoea) to 19 points (role functioning). When interpreting differences over time a minimum of 7 points represents a medium difference but for most subscales a larger difference is required for a medium deterioration compared with a medium improvement. Conclusion: Guidelines for interpreting the size of effects are provided for the QLQ- C30 subscales. These guidelines can be used for sample size calculations for clinical trials and to interpret differences in QLQ-C30 scores. The novel methodology was shown to be robust in sensitivity analyses but benefitted from a thorough quality assessment and using only the best quality evidence to derive the guidelines.
6
Santana, Sondra Michelle Phipps. "Practitioners' Use of Clinical Practice Guidelines: An Evidence-Based Approach." UNF Digital Commons, 2013. http://digitalcommons.unf.edu/etd/462.
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Pre-diabetes is a serious health problem in the United States. Distinguished by plasma glucose levels that are above the normal threshold, patients with pre-diabetes are 10 times more likely to develop type 2 diabetes. Patients with pre-diabetes suffer the same complications as patients with diabetes including diabetic retinopathy, nephropathy, and microalbuminuria.
There is considerable evidence to support the idea that early identification and aggressive treatment of pre-diabetes has the potential to delay disease progression. The American Diabetes Association’s clinical practice guideline recommends management of with lifestyle modification and metformin for patients who are at risk for developing type 2 diabetes. The purpose of this project was to evaluate the implementation of the 2012 ADA clinical practice guidelines regarding the management of patients with pre-diabetes by the health care providers at a volunteer-run clinic located in a large metropolitan area in the southeastern United States.
This study, even with a small sample size (n=26) revealed that the providers at the clinic had not implemented the 2012 ADA clinical practice guidelines. Clinical practice guidelines promote health care interventions that have proven benefits and improve the consistency of care provided to patients. The greatest benefits of implementing clinical practice guidelines for patients with pre-diabetes are early diagnosis and aggressive disease management. This would improve patient outcomes and in the long run, decrease the cost of medical care.
7
Armon, Kate. "Evidence based and consensus refined guidelines for acute childhood illness." Thesis, University of Nottingham, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.440662.
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Gravas, Stavros. "TUMT treatment of BPH from evidence based guidelines to clinical practice /." [S.l. : Amsterdam : s.n.] ; Universiteit van Amsterdam [Host], 2007. http://dare.uva.nl/document/45890.
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Wong, Siu-ling, and 黃少玲. "Evidence-based clinical guidelines for pressure ulcer prevention in elderly patients." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2012. http://hub.hku.hk/bib/B48339337.
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Older adults are particularly vulnerable to the development of pressure ulcers (PUs) as a result of skin changes and reduced mobility (Knox, Anderson & Anderson, 1994; Russell et al., 2003). This is associated with diminished quality of life, longer hospitalisations and increased morbidity and mortality (Margolis et al., 2002).In view of the high incidence of PUs (grade 1-4) occurring in elderly patients in acute care, a systematic review of related studies was conducted in August 2011. The optimal frequency and methods of repositioning are described in the literature. With well-designed implementation and evaluation plans, the proposed repositioning guidelines are likely to reduce the incidence of PUs (grade 1-4), while in turn lessening the healthcare burden and preserving patients’ quality of life.
Pilot testing, a trial run to test the feasibility of the innovation, will be carried out in the proposed medical ward, and training provided to all staff before the intervention. To proceed with the change, the intervention must be cost-effective and beneficial to all stakeholders. Outcome evaluation determines the number of goals achieved by the innovation and to what degree, and is very important (Melnyk & Fineout-Overholt, 2005).The PU incidence (grade 1-4) is expected to be different after the implementation of the innovation.published_or_final_version
Nursing Studies
Master
Master of Nursing
10
Law, Man-wai, and 羅敏慧. "Evidence-based guidelines of fall prevention programme for hospitalized older patients." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2013. http://hdl.handle.net/10722/193074.
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Background: Falls are one of the most common and serious problems facing the elderly and are known to be associated with significant mortality, morbidity, decreased functioning and premature institutionalization. In Hong Kong, the prevalence of falls among community-dwelling older adults is 19.3%. Moreover, the incidence of falls among older people in institutions is almost three times the fall rates for the community-dwelling elderly. Institutional falls are regarded as common adverse events in hospitalized older patients. Significant mortality, morbidity and healthcare costs associated with institutional falls led institutions to recognize falls as a high-priority safety risk for hospitalized patients. This demonstrated the significance of providing the health care providers with an evidenced-based practice guideline of an effective multifactorial fall prevention programme in order to prevent in-patient falls.
Objectives: The objectives of the study are to systematically review and present the best evidence for the effectiveness of multifactorial fall prevention interventions in reducing falls in hospitals, to translate the reviewed evidence and to develop evidence-based practice guidelines for the multifactorial fall prevention programme as well as to develop a plan for implementing and evaluating the multifactorial fall prevention programme.
Methods: The relevant literature was searched by several electronic databases. The related literature was then retrieved, reviewed and synthesized. The quality assessment of the studies was performed according to the methodological checklist for controlled trials designed by the Scottish intercollegiate Guideline Network (SIGN). Evidenced-based practice guidelines for the multifactorial fall prevention programme were then synthesized according to the findings of the reviewed literature, while the implementation potential being assessed in terms of transferability, feasibility and the cost-benefit ratio.
Results: Five studies were identified according to the inclusion and exclusion criteria set. “Evidence-based guidelines of fall prevention programme for hospitalized older patients” were formulated based on the review of the selected studies. Fourteen recommendations of the evidence-based guidelines are formulated and graded according to the grading system of Scottish Intercollegiate Guidelines Network (SIGN). The evidence-based recommendations can offer nurses and other health care professionals the standards and strategies required for implementing multifactorial fall risk assessment and multifactorial fall prevention interventions, including environmental modifications, knowledge, medication reviews and exercise. A communication plan for various parties in hospitals including a pilot test for determining the feasibility of the innovation and an evaluation plan to determine the effectiveness of the fall prevention programme were subsequently developed.
Conclusion: This study reviewed evidence for the effectiveness of the multifactorial fall prevention programme in reducing the incidence of falls, translated the reviewed evidence and developed evidence-based guidelines for a multifactorial fall prevention programme, which can provide the health care practitioners with an evidence-based approach in fall risk assessment and management so as to prevent in-patient falls.published_or_final_version
Nursing Studies
Master
Master of Nursing
11
Sinclair, David Jonathan. "Towards evidence-based malaria guidelines in low- and middle-income countries." Thesis, University of Warwick, 2017. http://wrap.warwick.ac.uk/98542/.
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This PhD submission presents a case study of an academic group working as infomediaries at the interface between research and global policy, and at the interface between global policy and national decisions: advising on methodological issues, conducting systematic evidence reviews in response to information needs, and developing approaches for reinterpreting global guidance for national decision-making. The included systematic reviews were among the first to adopt innovative elements such as: summary of findings tables, standardized language reflecting the level of certainty in effect estimates, logic frameworks, and brief economic summaries; and have contributed to the further development of these methods. This work has helped to establish formal and transparent methods within global malaria guidance, and contributed to improved standards in global guidance more broadly.
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Morrison, April H. "Breastfeeding: Evidence-Based Clinical Guidelines Every Health Care Provider Should Know." Digital Commons @ East Tennessee State University, 2016. https://dc.etsu.edu/etsu-works/7123.
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尹艷麗 and Yim-lai Wan. "Evidence-based fall prevention guidelines for hospitalized patients aged 65 or above." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2009. http://hub.hku.hk/bib/B43251602.
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Chun, Wai-chun, and 秦惠珍. "Evidence based smoking cessation guidelines for hospitalized chronic obstructive pulmonary disease smokers." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2010. http://hub.hku.hk/bib/B44623264.
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Yeung, Mei-yan, and 楊美恩. "Evidence-based guidelines on ventilator-associated pneumonia prevention for mechanically ventilated patients." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2010. http://hub.hku.hk/bib/B44626885.
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Fung, Yiu-ting Tina, and 馮耀婷. "Evidence-based clinical practice guidelines of smoking cessation programs for COPD patients." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2011. http://hub.hku.hk/bib/B46581856.
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Wan, Yim-lai. "Evidence-based fall prevention guidelines for hospitalized patients aged 65 or above." Click to view the E-thesis via HKUTO, 2009. http://sunzi.lib.hku.hk/hkuto/record/B43251602.
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Aziz, Ayesha. "A service oriented architecture to implement clinical guidelines for evidence-based medical practice." Thesis, University of Sussex, 2015. http://sro.sussex.ac.uk/id/eprint/53223/.
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Health information technology (HIT) has been identified as the fundamental driver to streamline the healthcare delivery processes to improve care quality and reduce operational costs. Of the many facets of HIT is Clinical Decision Support (CDS) which provides the physician with patient-specific inferences, intelligently filtered and organized, at appropriate times. This research has been conducted to develop an agile solution to Clinical Decision Support at the point of care in a healthcare setting as a potential solution to the challenges of interoperability and the complexity of possible solutions. The capabilities of Business Process Management (BPM) and Workflow Management systems are leveraged to support a Service Oriented Architecture development approach for ensuring evidence based medical practice. The aim of this study is to present an architecture solution that is based on SOA principles and embeds clinical guidelines within a healthcare setting. Since the solution is designed to implement real life healthcare scenarios, it essentially supports evidence-based clinical guidelines that are liable to change over a period of time. The thesis is divided into four parts. The first part consists of an Introduction to the study and a background to existing approaches for development and integration of Clinical Decision Support Systems. The second part focuses on the development of a Clinical Decision Support Framework based on Service Oriented Architecture. The CDS Framework is composed of standards based open source technologies including JBoss SwitchYard (enterprise service bus), rule-based CDS enabled by JBoss Drools, process modelling using Business Process Modelling and Notation. To ensure interoperability among various components, healthcare standards by HL7 and OMG are implemented. The third part provides implementation of this CDS Framework in healthcare scenarios. Two scenarios are concerned with the medical practice for diagnosis and early intervention (Chronic Obstructive Pulmonary Disease and Lung Cancer), one case study for Genetic data enablement of CDS systems (New born screening for Cystic Fibrosis) and the last case study is about using BPM techniques for managing healthcare organizational perspectives including human interaction with automated clinical workflows. The last part concludes the research with contributions in design and architecture of CDS systems. This thesis has primarily adopted the Design Science Research Methodology for Information Systems. Additionally, Business Process Management Life Cycle, Agile Business Rules Development methodology and Pattern-Based Cycle for E-Workflow Design for individual case studies are used. Using evidence-based clinical guidelines published by UK's National Institute of Health and Care Excellence, the integration of latest research in clinical practice has been employed in the automated workflows. The case studies implemented using the CDS Framework are evaluated against implementation requirements, conformance to SOA principles and response time using load testing strategy. For a healthcare organization to achieve its strategic goals in administrative and clinical practice, this research has provided a standards based integration solution in the field of clinical decision support. A SOA based CDS can serve as a potential solution to complexities in IT interventions as the core data and business logic functions are loosely coupled from the presentation. Additionally, the results of this this research can serve as an exemplar for other industrial domains requiring rapid response to evolving business processes.
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O'Connor, Suzanne M. "Development of an evidence-based toolkit to support safe design for children." Thesis, Loughborough University, 2018. https://dspace.lboro.ac.uk/2134/33519.
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This thesis contributes to developing an evidence-based toolkit for designers when designing products based on theoretical inputs from human-factors study. Theoretical and developmental knowledge, relevant to the design of warning and risk communications and the area of design for child safety, is translated into support for reflections to practitioners. The risk management framework derived from this study aims to increase awareness of the implications of the aspects involved and as a reference point for groups involved in design for child safety. The thesis covers a shift from risk communications with children to information about children (including physical dimensions etc.) for designers. The final output is a collation of this knowledge base and some conceptual tools that can be applied to a specific design context whether that context be in risk communications or the area of general safety design considerations. Designers with little experience in managing design for children can benefit from this study when deciding on their design strategies. This reflective support is the result of a study of risk communication as a complex and unique activity in which various groups and domains are involved. The process of building an understanding started with an analysis of the literature in the field and with the direct experience of the researcher, who worked directly within ergonomics as part of a design-innovation team. The framework presented in this thesis follows a more structured approach to risk communications. It is conceived as an aid to help practitioners reflect on the implications each stage of the development process has on the experience of developing appropriate risk communications and appropriate products. In this way, it is thought of as a dynamic and flexible reference that can be adapted by design researchers when planning and coordinating design to suit different design situations. The use of this tool in the childsafety, design, and study communities would provide validation of the effectiveness of the framework and its continuous improvement. The purpose of this study is twofold: to contribute to study and practice with the aim of providing fundamental guidance to designers. The research detailed in this thesis brings readers up-to-date with the current literature on theories of risk communications. It then highlights methodologies, tools, guidelines and requirements for risk communication advances in study and practice. A framework for risk communication for young children has been developed out of a resource review based on previous work in the area by McLaughlin and Mayhorn, (2014). The information accumulated in this study has been used to develop initial prototype tools for designers who are considering young children. The developed platform supports practitioners from two different angles: theoretical and practical. Designers engaged in the core activity of design for child safety need methods that support the consideration of ergonomics and other product requirements, such as risk communications. This study contributes to developing methods and tools that can be used by designers and other relevant groups when designing risk communications for young children. Available knowledge is collated and integrated into the framework with the intention that it will be developed further throughout the thesis to consider effective use within the design cycle. This study aims to contribute to child safety by providing the first development of tools/decision supports aimed at designers who are designing for young children and are accordingly evaluating human-factors methods in design for child safety. The aim of this study is to gather the requirements of a collaborative design tool for use by industrial designers, engineers and other groups involved in design for child safety. This thesis aims to address these needs. When considering the needs, limitations and capabilities, ( mental model ) of the intended users (i.e., children), important aspects such as safety have been considered. The general need for support methods are addressed through a review of the safety, design and ergonomics literature. After this, empirical study through interviews and observations is used to outline some problem areas: the development and implementation of human-factors methods in design, lack of available resources and inaccessibility of data. Three empirical studies were conducted to meet the requirements of this study: Study 1 in Chapter 4 involves documentary analysis of existing models and methods, Study 2 in Chapter 5 involves formal interviews with designers (N = 30), and Study 3 in Chapter 7 involves an online survey for initial feedback about the prototype-persona (N = 50) respondents. The first section outlines the study questions. It discusses the outputs of the three main studies contained within this thesis.
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Cogil, Christine. "Implementing evidence-based oral health guidelines| An evaluation of health care provider behavior change." Thesis, New Mexico State University, 2015. http://pqdtopen.proquest.com/#viewpdf?dispub=3663311.
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Primary care providers have not customarily provided oral assessments or offered anticipatory guidance about oral health care; dentists manage that task. Myths and access-to-care issues often result in limited or no dental care during pregnancy. Improving the oral health of pregnant women has a positive correlation with fewer dental caries in their children. Currently, evidence-based practice (EBP) oral health guidelines exist for pregnant women and children. While health care providers (HCPs) want to implement best practices, they find practice change challenging.
This project utilizes a planned change theory to guide the implementation of oral health guidelines with a methodical approach. Retrospective and prospective chart audits evaluate HCP behavior change. The chart audits reveal HCPs change behaviors after a practice intervention with a Primary Care Oral Assessment Tool (PCOAT), and again after introduction of EBP guidelines. Some changes in provider behavior were statistically and clinically significant.
Keywords: pregnancy, pregnant, prenatal, antenatal, dental care, oral health, and practice guidelines
21
Sin, Tak-nam, and 冼德藍. "Evidence-based clinical practice guidelines for care of skeletal pin sites in orthopaedic patients." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2010. http://hub.hku.hk/bib/B44626332.
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麥寶晶 and Po-ching Mak. "Evidence-based guidelines for deep vein thrombosis prophylaxis in a surgical intensive care unit." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2013. http://hdl.handle.net/10722/193031.
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Deep vein thrombosis (DVT) and pulmonary embolism (PE) are together known as venous thrombo-embolism (VTE), one of the most common complications after surgery and trauma injury. In the case of critically ill patients, it is also a significant medical and financial burden, associated with high mortality and morbidity. In recent years, much evidence has come to light showing that DVT prophylaxis can effectively reduce DVT, and it has been incorporated into various evidenced-based guidelines (Geerts et al., 2008; Nicolaides et al., 2006).
The objectives of this study are to examine, through a comprehensive literature review of published studies, the effectiveness of various means of DVT prophylaxis aimed at reducing DVT, and to develop an evidence-based guideline for the use of DVT prophylaxis in surgical intensive care unit (ICU) settings.
Keywords related to DVT prophylaxis were used in conducting the search in electronic bibliographic databases like MEDLlNE, CINAHL, PubMed and the Cochrane Library. A total of 110 articles were identified, and seven studies fulfilled the inclusion criteria of the study. Data from the seven studies have been extracted to form tables of evidence; the qualities of the studies were then rated, and the levels of evidence assigned according to SIGN 50: A guideline developer’s handbook (Network, Harbour & Forsyth, 2011). Three studies attained a higher level of evidence with strong methodological design and demonstrated a statistically significant reduction in the incidence of DVT.
The implementation potential of DVT prophylaxis was examined in terms of target setting, target audience, transferability of findings, feasibility and cost-benefit ratio. And it was found that the development of evidence-based guidelines for DVT prophylaxis was feasible, cost-beneficial and transferable in current settings. The findings of the seven reviewed studies have been translated into an evidence-based DVT prophylaxis guideline.
The main focuses of the guideline are the choice of prophylaxis used with surgical ICU patients and the strategies for improving adherence and prophylaxis monitoring. Combined pharmacological and mechanical DVT prophylaxis is recommended for ICU patients who are at high risk of DVT. For patients with active bleeding or high risk of bleeding, mechanical prophylaxis like intermittent pneumatic compressor (IPC) or gradual compression stocking (GCS) should be used first, followed by a review for pharmacological prophylaxis when the risk of bleeding has decreased. In addition, routine assessment of thrombosis and bleeding risk for high-risk ICU patients and regular checking of fitting and functioning of the DVT prophylaxis are recommended.
An implementation plan consisting of communication, pilot and evaluation plan was developed. A 12-month programme including communication with stakeholders, marketing of the innovation, training of frontline staff, a five-week pilot study and implementation of the guideline followed by evaluation will be carried out. In the evaluation, programme effectiveness was assessed in terms of patient outcome (e.g. incidence of DVT), process outcomes (e.g. level of knowledge related to DVT, compliance with the guideline and level of staff satisfaction) and system outcome (e.g. financial cost reduction).published_or_final_version
Nursing Studies
Master
Master of Nursing
23
Francis, Ross H., Jordan A. Mudery, Phi Tran, Carol Howe, and Abraham Jacob. "The Case for Using Evidence-Based Guidelines in Setting Hospital and Public Health Policy." Frontiers Media, 2016. http://hdl.handle.net/10150/615648.
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OBJECTIVE:
Hospital systems and regulating agencies enforce strict guidelines barring personal items from entering the operating room (OR) - touting surgical site infections (SSIs) and patient safety as the rationale. We sought to determine whether or not evidence supporting this recommendation exists by reviewing available literature.
BACKGROUND DATA:
Rules and guidelines that are not evidence based may lead to increased hospital expenses and limitations on healthcare provider autonomy.
METHODS:
PubMed, Embase, Scopus, Cochrane Library, Web of Science, and CINAHL were searched in order to find articles that correlated personal items in the OR to documented SSIs. Articles that satisfied the following criteria were included: (1) studies looking at personal items in the OR, such as handbags, purses, badges, pagers, backpacks, jewelry phones, and eyeglasses, but not just OR equipment; and (2) the primary outcome measure was infection at the surgical site.
RESULTS:
Seventeen articles met inclusion criteria and were evaluated. Of the 17, the majority did not determine if personal items increased risk for SSIs. Only one article examined the correlation between a personal item near the operative site and SSI, concluding that wedding rings worn in the OR had no impact on SSIs. Most studies examined colonization rates on personal items as potential infection risk; however, no personal items were causally linked to SSI in any of these studies.
CONCLUSION:
There is no objective evidence to suggest that personal items in the OR increase risk for SSIs.
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Knaapen, Anne-Loes. "In search of standards that avoid standardization: the production and regulation of evidence based guidelines." Thesis, McGill University, 2013. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=116841.
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This dissertation examines a novel type of standardization in medicine by investigating the production and regulation of clinical practice guidelines. As an important tool of the Evidence Based Medicine (EBM) movement, guidelines have been at the center of polarized debates in which they are praised for rationalizing medicine and criticized for undermining humanism in health care. Based on document analysis, interviews and (participant) observation, this dissertation examines how 'evidence based' guideline developers respond to such contradictory demands and critiques. In doing so, I present an empirical examination of the way EBM practices construct, avoid or reconcile tensions between supposed binaries such as universal/local, evidence/values, standards/individuality, science/care. After the introduction and a review of the existing literature on the epistemological basis and regulatory impact of EBM guidelines, the findings are presented in two parts. The first part analyzes how formal EBM principles are understood and performed during guideline production, with Chapter three highlighting the diversity of knowledge, procedures and materials required to classify Evidence and formulate the guideline text. Chapter four analyzes how an absence of Evidence is handled and proposes the term 'Evidence Searched Guidelines' to capture the distinctive character of EBM guidelines. The second part focuses on 'guidelines for guidelines' that regulate guideline development. Chapter five presents the Guidelines International Network, which aims for a 'universal' procedure for standard-setting, but objects to the standardization of guidelines. Chapter six presents four models of Patient & Public Involvement that aim to integrate evidence with 'values' and 'context', making guidelines more personalized, democratic, locally relevant and/or objective. In aiming for Gold Standards that avoid standardization, EBM guideline developers challenge the accounts of EBM proponents and critics alike. The contested relation between the standardized (or universal) and the individualized (or local) at the heart of Evidence Based Medicine is managed not by the quantity, quality or universality of evidence, but by standardization of procedures.Cette thèse étudie la production et la réglementation des lignes directrices pour la pratique clinique, afin d'examiner un type de standardisation médicale novateur. Servant d'outil important dans le mouvement de la médecine basée sur les données probantes (Evidence Based Medicine ou EBM), les lignes directrices ont été au centre de débats polarisés dans lesquels on fait l'éloge d'elles pour avoir rationalisées la médecine et on les critique d'avoir minées l'humanisme dans les soins de santé. Basée sur l'analyse de documents, des interviews et l'observation (participative), cette thèse examine comment les développeurs des lignes directrices répondent aux telles demandes et critiques contradictoires. Ce faisant, je présente un examen empirique des façons que les pratiques de la EBM construisent, évitent et réconcilient les tensions entre de présumés binaires, tels universel/local, données probantes/valeurs, standards/individualité et sciences/soins. Après l'introduction et l'analyse de la littérature existante sur les bases épistémologiques et l'impact de la réglementation des lignes directrices de la EBM, les résultats sont présentés en deux parties. La première partie analyse la compréhension et la performance des principes formels de la EBM durant la production des lignes directrices, le troisième chapitre mettant l'accent sur la diversité des connaissances, des procédures et des matériels nécessaires pour classifier les données probantes et formuler le texte des lignes directrices. Le quatrième chapitre analyse comment l'absence de données probantes est gérée et propose le terme «Evidence Searched Guidelines» (lignes directrices cherchantes les données probantes) pour saisir le caractère distinctif des lignes directrices de la EBM. La deuxième partie met l'accent sur les «lignes directrices pour les lignes directrices», qui régularisent le développement des lignes directrices. Le cinquième chapitre présente le Guidelines International Network, visant une procédure universelle pour l'établissement des normes, mais s'opposant à la standardisation des lignes directrices. Le sixième chapitre présente quatre modèles d'Implication du Public visant à intégrer les données probantes à des «valeurs» et des «contextes», afin de rendre les lignes directrices plus personnalisées, démocratiques, pertinentes et/ou objectives. Visant des Étalons-or qui évitent la standardisation, les développeurs des lignes directrices de la EBM mettent au défi à la fois les explications des défenseurs de la EBM et celles des détracteurs. Le rapport contesté entre standardisé (ou universel) et personnalisé (ou local) au cœur de la médecine fondée sur les données probantes n'est pas gouverné par la quantité, la qualité ou l'universalité des données probantes, mais par la standardisation des procédures.
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Akalu, Masresha. "Adherence to Evidence-Based Pharmacological Guidelines and Outcomes for Heart Failure in Primary Care Providers." Diss., The University of Arizona, 2014. http://hdl.handle.net/10150/347052.
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Background: Heart failure (HF) is a major public health problem in the United States and accounts for a large burden in rising health care expenditures. Appropriate use of evidence-based pharmacological treatment, including the use of renin-angiotensin-aldosterone inhibitors and beta-blockers can slow progression of the disease and reduce the need for hospitalization. Objectives: In a sample of individuals with HF in a primary care setting, the objectives of this study were to determine the level of providers' adherence to evidence-based pharmacological guidelines and the rate of cardiovascular-related emergency department or hospital visits. Methods: A convenience sample of patients 18 years of age and older with a diagnosis of HF was included. A retrospective chart review of 54 HF subjects was done between April and September 2014, using the American College of Cardiology Foundation and American Heart Association outpatient performance measurement set for HF. Results: Adherence to guideline recommendations for beta-blocker, angiotensin converting enzyme inhibitor (ACEI)/angiotensin receptor blocker ARB), anticoagulation for atrial fibrillation, statin, and aldosterone receptor antagonist therapy was present in 81%, 77.8%, 78%, 80.7% and 23.1% of eligible subjects, respectively. The use of ACEIs/ARBs (OR=8.853, CI 1.212-64.66, p= 0.032) and beta-blockers (OR= 9.24, CI 1.212-70.438, p =0.031) was significantly associated with reduced number of (<1) cardiovascular-related emergency department or hospital visits after adjusted for confounders including age, sex, body mass index, and comorbidities. Conclusion: The use of ACEIs/ARBs and beta-blockers among primary care providers was comparable or higher than similar studies conducted in the primary care settings. However, despite the available evidence and recommendations, the use of aldosterone receptor antagonists in HF patients with myocardial infarction and diabetes mellitus was still low in the absence of any contraindications. These findings can be used by primary care providers to assess the existing gap in the use of HF guideline-recommended therapy and develop interventions to improve the utilization of evidence-based guidelines.
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Chan, Yue-sin, and 陳如倩. "Evidence-based clinical guidelines for applying topical anaesthetics to reduce injection pain in healthy children." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2013. http://hdl.handle.net/10722/193045.
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According to the World Health Organization, life-threatening infectious diseases, even in remote and vulnerable locations, can be minimised through immunisation. Vaccines interact with the immune system to produce an immune response similar to that produced by natural infection. However, about 10% of the population avoid vaccination and other needle procedures because of “needle fear”. Because of the prevalence of injection pain and more concern about the adequacy of pain management, and with the steadily increasing number of recommended childhood immunisation, we identified a need for evidence-based guidelines on pain management to be developed in our local setting through translational nursing practice.
After a critical appraisal of randomised controlled trials and systematic reviews, it is highly recommended that “topical anaesthetics are effective in reducing vaccination pain” (Grade A recommendation, based on level I evidence by SIGN). In order to facilitate practice from evidence, the implementation potential, transferability, feasibility and cost-benefit ratio - has been examined, and an evidence-based guideline has been developed simultaneously for the new practice. With the identification of stakeholders and the development of a communication plan, potential users of the guideline and pilot testing are discussed. Innovation outcomes and their effectiveness are examined and explored. It is expected that, through this translational nursing practice, vaccination induced pain and distress among healthy children can be managed well, according to the best evidence and up-to-date recommendations.published_or_final_version
Nursing Studies
Master
Master of Nursing
27
Ledward, Alison. "The interface between evidence-based maternity care clinical practice guidelines and the pregnant woman's autonomy." Thesis, University of Leicester, 2017. http://hdl.handle.net/2381/40446.
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The importance of the pregnant woman’s autonomy and the role of increased choice in decision-making relating to her maternity care have gained widespread recognition. This is borne out in the healthcare and bioethics literature, key initiatives in policy documents and clinical guidelines. Although guidelines are a central feature of maternity care, little is known about how their recommendations are experienced by women and the impact on their autonomy. This thesis addresses that gap in knowledge. The methods I used in this research comprised a literature review and an empirical study consisting of semi-structured interviews with 20 participants in an inner-city teaching hospital. Data collection, transcription and analysis were informed by adaptation of the Constructivist Grounded Theory approach (Charmaz: 2006). My analysis generated two main thematic categories. First, women lack the appropriate in-depth pregnancy and birth knowledge to make decisions independently. Second, interactions with trusted professional carers were highly valued. Analysis suggested new insights, namely that the meaning of autonomy to women is more complex than self- government, a range of options and relational responsibilities can account for. Women felt empowered by being a genuine participant in the decision-making process. They expressed their autonomy by being invited to share their previous experiences, current expectations and concerns and request information in a manner consistent and timely with their own agendas. Women’s responses were also shaped by considered reflection of the impact of their decisions on others. My analysis revealed that some level of interdependence may be a precondition for women to exercise their autonomy. It is a paradox that the recommendation professionals should follow guidelines and be non-directive may result in the unintended consequence of women exercising their autonomy by in part reinstating authority to professional carers. Interpretation of findings led to the development of my grounded theory, ’Choosing when to choose’.
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Heiman, Diana L. "Clinical Guidelines That Can Improve Your Care Evidence-based Guideline: Treatment of Painful Diabetic Neuropathy." Digital Commons @ East Tennessee State University, 2012. https://dc.etsu.edu/etsu-works/8149.
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談詠珊 and Wing-shan Tam. "Evidence-based guidelines of breastfeeding focused on skill training for improving duration and exclusiveness of breastfeeding." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2011. http://hdl.handle.net/10722/193037.
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Breast milk provides optimal nutrition for babies and exhibits short and long-term health benefits for mothers and babies. Comparing the breastfeeding figures worldwide, Hong Kong has lower breastfeeding rates compared with other developed countries. Clinically and locally, inadequate skill support from nurses decreases breastfeeding rates.
This thesis introduces evidenced-based guidelines of breastfeeding focused on skill training for improving duration and exclusiveness of breastfeeding. Based on available evidence, the guidelines aim to improve breastfeeding rates. The guidelines focus on skill training (position and attachment) as major component. Transferability and feasibility to apply the guidelines clinically was assessed. Lastly, an implementation plan was discussed.published_or_final_version
Nursing Studies
Master
Master of Nursing
30
Baldwin, David S., Ian M. Anderson, David J. Nutt, Borwin Bandelow, Alyson Bond, Jonathan R. T. Davidson, Boer Johan A. den, et al. "Evidence-based guidelines for pharmacological treatment of anxiety disorders: Recommendations from the British Association for Psychopharmacology." SAGE Publications Ltd, 2005. https://tud.qucosa.de/id/qucosa%3A26469.
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These British Association for Psychopharmacology guidelines cover the range and aims of treatment for anxiety disorders. They are based explicitly on the available evidence and are presented as recommendations to aid clinical decision making in primary and secondary medical care. They may also serve as a source of information for patients and their carers. The recommendations are presented together with a more detailed review of the available evidence. A consensus meeting involving experts in anxiety disorders reviewed the main subject areas and considered the strength of evidence and its clinical implications. The guidelines were constructed after extensive feedback from participants and interested parties. The strength of supporting evidence for recommendations was rated. The guidelines cover the diagnosis of anxiety disorders and key steps in clinical management, including acute treatment, relapse prevention and approaches for patients who do not respond to first-line treatments.
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Jansen, Friso Johannes. "The shifting sands of evidence : a socio-legal enquiry into the development of medical guidelines." Thesis, University of Oxford, 2017. https://ora.ox.ac.uk/objects/uuid:efd9b784-3df7-400e-bb0a-8f898578bc91.
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Medical guidelines on the same medical condition differ between England and the Netherlands. These guidelines are referred to as evidence-based because they are supposedly based on a systematic searching for and appraisal of medical studies to drive recommendations for appropriate care for specific clinical circumstances. This comparative study interrogates what causes these differences and similarities between guidelines and tries to uncover the mechanisms behind the development of medical practice guidelines. Four case studies, on lower back pain and on type 2 diabetes in both countries, are used to provide a detailed empirical account of the development of medical guidelines. Interviews with guideline developers are combined with a detailed analysis of available guideline documents. The overarching finding of this thesis is that medical evidence plays a more limited and nuanced role in guideline construction than might be expected and that guidelines are manifestations of professional (self-) regulation. Importantly, the research also finds that institutions shape guidelines in a multitude of ways. This study has endeavoured to add to a more nuanced understanding of evidence within the literature: conceptualising evidence as part of a process of a social and institutional construction. This construction is used within a collaborative and communicative process aimed at creating 'objective facts'. Contrary to existing scholarship, this thesis argues that evidence merely informs the understanding of members of guideline groups while a range of economic, cultural, institutional, and political factors, that together form cognitive frames, provide the driving force behind the development of guidelines. Institutional factors have shown to be essential elements in guideline development, influencing all aspects of development through institutional cultures of practice. This study concludes that calling guidelines evidence-based is an important rhetorical instrument, which helps to conceal and legitimize some of the normative choices that are inherent in guideline making.
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Managbanag, Jenny Ann Salve. "Evidence-Based Practice Guideline for Peripheral Artery Disease." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/5570.
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The absence of a practice guideline for peripheral artery disease (PAD) in the cardiology department creates differing practice preferences among providers, leading to deviations in practice among staff. Variations in practice can affect the quality of care that is provided to patients. This project was guided by research statements indicating that there was a difference in the screening approach for PAD among health practitioners at preimplementation and postimplementation and that an 85% compliance with the guideline would signify consistency in the provision of care. Rogers' theory of diffusion of innovations was used to facilitate the adoption of the guideline. This project helped close the gap between research (adoption of a guideline) and practice (compliance in the use of evidence in clinical practice). Using random medical record reviews and pretest-posttest design, the results of the project showed that patterns of using the PAD guideline in practice at preimplementation significantly differed compared to postimplementation. The rates of screening for the compliance of the PAD guideline showed approximately an eightfold increase. The adoption of the PAD guideline has implications for policy, because adopting the PAD guideline helped standardize the care, improve effectiveness of care in nursing practice, evaluate quality through use of research, and promote social change by improving patient outcomes.
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Richter, Sundberg Linda. "Mind the Gap : exploring evidence-based policymaking for improved preventive and mental health services in the Swedish health system." Doctoral thesis, Umeå universitet, Epidemiologi och global hälsa, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-118179.
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Background: The challenges in the utilization of scientific findings in the fields of prevention and mental health are well documented. Scholars have found significant gaps between the knowledge available and the knowledge applied in healthcare. Studies have suggested that about half of the patients receive the recommended care for their medical condition. In order to address this gap, health systems at global, national, regional and local levels have made diverse efforts to facilitate the uptake of research for example through evidence-based health policy processes. In Sweden, government agencies and health policy actors such as the National Board of Health and Welfare support and control the health care system through evidence-based policies amongst other steering tools. The overall aim of this thesis is to explore evidence-based policy processes, and to further understand barriers to implementation of policies in the fields of preventive and mental health services. Methods: A multiple case study approach was used, and data were collected from several sources. Qualitative content analysis methodology was used. Case 1 comprises the development and early implementation of national guidelines for methods of preventing disease managed by the National Board of Health and Welfare during 2007–2014. Case 2 covers the effort to improve health care for the older population that was undertaken through an agreement between the Swedish government and the Swedish Association of Local Authorities and Regions during 2009–2014. Case 3 involves an effort to implement an adapted version of a systematic review from the Swedish agency for health technology assessment and assessment of social services on treatment of depression in primary health care. Data was collected between 2007 and 2010. In Paper 1, the policies from Case 1 and 2 were studied using a longitudinal, comparative case study approach. Data were collected through interviews, documents and observations. A conceptual model was developed based on prior frameworks. The model was used to organize and analyse the data. In Paper 2, the guideline development process (Case 1) was studied through interviews and the collection of documents. A prior framework on guideline quality was used in order to organize the data. Paper 3 investigated decision-making processes during guideline development using a longitudinal approach. Qualitative data were collected from questionnaires, documents and observations and analysed using conventional and summative content analysis. In Paper 4, the barriers to implementation were investigated through interviews and the collection of documents. Data were analysed using qualitative content analysis with a conceptual model to structure the analysis. Results: The sources and procedures for policy formulation differed in Case 1 and 2, as did the approaches to promote the implementation of the policies. The policy processes were cyclical, and phases overlapped to a large degree. The policy actors intended to promote implementation, both during and after the policy formulation process. The thesis shows variation in how the key policy actors defined and used research evidence in the policy processes. In addition, other types of knowledge (e.g. politics, context, experience) served as alternative or multiple sources to inform the health policies. The composition of sources that informed the policies changed over time in Cases 1 and B. During the policy formulation and implementation process, efforts to integrate research evidence with clinical experiences and values were associated with tension and recurrent dilemmas. On the local level (i.e. primary health care centres), barriers to implementation were found related to the innovation and among health professionals, patients, in social networks as well as in the organizational, economic and political contexts. Conclusion: The concept of evidence holds a key position in terms of goals and means for knowledge based policymaking in the Swedish health system. Broad definitions of evidence – including research and non-research evidence - were requested and to various extents utilized by the policy actors in the studied cases. An explicit terminology and systematic, transparent methodology to define, identify, and assess also non-research evidence in policy processes would potentially strengthen the clarity and validity of these processes and also enhance policy implementation. Particular determinants to implementation, such as the interventions characteristic, are to a considerable degree established early in the policy process, during agenda setting and policy formulation. This early phase offers unique opportunities to assess and build capacity, initiate and facilitate implementation. Early analysis and considerations of target populations and contexts and other implementation determinants related to the specific policy scope (e.g. disease preventive guidelines) could enhance the forth-coming implementation of the policy.
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Schmidt, Fran. "Management of acute gastroenteritis in young children, a project to increase nurses' knowledge of evidence-based guidelines." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2000. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape4/PQDD_0010/MQ53222.pdf.
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鄧兆庭 and Siu-ting Alvin Tang. "Implementation and evaluation of evidence-based practice guidelines for open endotracheal suctioning in mechanically-ventilated adult patients." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2013. http://hdl.handle.net/10722/193027.
Full textAbstract:
Endotracheal suctioning is a procedure performed on a daily basis in hospitals, and is mostly take place in intensive care units (ICUs). (Annapoorna, 2005; Day et al, 2009). It helps removing sputum or secretion out from patients’ trachea. For patients who are under mechanical ventilation, this procedure is vital to maintain their airway patency when they are intubated with endotracheal tube or tracheostomized (Finucane & Santora, 2003). However, the procedure has its own risk and complications such as hypoxaemia, atelectasis, cardiovascular instability and more (Thomson, 2000). There are in general two types of endotracheal suctioning: open and closed system. As disconnection of mechanical ventilation from patients is needed for open endotracheal suctioning (OES), it has a higher risk of complications. However, the cost for OES is much cheaper compared to the closed system. Although OES is widely used in Hong Kong, there is no evidence-based guideline for nurses to follow. The guideline developed by American Association of Respiratory Care (2010) is lack of specificity on the target population and its recommendations were based on mixed literatures targeting on adult and infant patients. Therefore, the aim of this dissertation is to develop an evidence-based guideline for OES in adult patients under mechanical ventilation in ICU.
To develop a guideline for OES, search was performed in multiple electronic databases (British Nursing Index, CINAHL, Cochrane Library, Ovid MEDLINE, and PubMed) with keywords related to OES and its complications. A total of 457 studies fulfilled the inclusion criteria and 11 of them were selected. The selected studies were evaluated by quality appraisal checklists, which are developed by Scottish Intercollegiate Guidelines Network (SIGN). Data were extracted for developing the guideline.
Evidence have shown that the incidence of post-OES hypoxemia can be reduced by performing hyperoxygenation with 100% oxygen for 4-6 breaths prior and after each open endotracheal suction, accompanying with hyperinflation with 150% of patient’s tidal volume at most 8 breaths/40 seconds delivered by ventilator and prohibiting normal saline instillation into trachea for diluting the sputum. The grades of the recommendations in the guideline were rated with using of the SIGN grading system. The implementation potential was analyzed by the patients’ characteristics, transferability of the findings, feasibility of implementation and cost-benefit ratio.
A 12-month implementation program was developed including communication with stakeholders, 4-week pilot testing, and training of ICU staffs, and implementation of OES guideline. The effectiveness of the guideline will be evaluated based on the primary outcome (i.e. oxygen level in blood) for detecting the incidence of hypoxemia. Also, the acceptability of the guideline, compliance of the guideline, financial cost reduction and better quality of service will be used as other evaluation indicators.published_or_final_version
Nursing Studies
Master
Master of Nursing
36
黃美婷 and Mei-ting Wong. "Evidence-based guidelines for the prevention of pressure ulcers using pressure-relieving support surface for bedbound elderly." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2013. http://hdl.handle.net/10722/193060.
Full textAbstract:
Background
Pressure ulcer prevention has been an important and a common health care problem in every health care setting. Pressure ulcers are the clinical situation that can be avoided. To prevent pressure ulcer, the main strategy is to reduce either the pressure contact time, or magnitude of pressure, between a patient and his or her support surface. Pressure-relieving support surfaces are shown to be effective in preventing the development of pressure ulcer with strong evidence support.
In Hong Kong, the low compliance of the ward staff to apply pressure-relieving support surfaces for at risk patients is compared with other countries. Therefore, a feasible evidence-based guideline of using pressure-relieving support surfaces to prevent pressure ulcers stands out from the multi-interventions pressure ulcer prevention guideline to maximize its effectiveness in this clinical issue.
Purpose
Reviewing the needs in modifying the current clinical practice and guidelines in local setting, the aim of the dissertation is to develop evidence-based guidelines for prevention of pressure ulcers using pressure‐relieving support surface for bedbound elderly. The findings are used to develop recommendations for nursing guideline to prevent pressure ulcers through the utilization of pressure‐relieving support surface in Hong Kong public hospital setting.
Methods
Four electronic databases published from 1937 to 2012 were searched. All the studies extracted were randomised controlled trials while focusing on using pressure-relieving support surfaces to prevent pressure ulcers of adult patients. The quality of each study was assessed by a methodology checklist, the Scottish Intercollegiate Guideline Network in order to justify the level of evidence of the studies’ internal validity.
Conclusion
From the evidence, the clearest conclusion that can be drawn is that a range of pressure‐relieving mattresses and overlays in the prevention of pressure ulcers can outperform the standard hospital mattress. It can be applied to any health care settings. The reviewed studies have shown that pressure‐relieving mattresses are effective on at risk patients, especially they are in advanced age with low mobility. Therefore, this evidence-based guidelines will serve in the medical rehabilitation wards to reduce the number of elderly from developing pressure ulcer after using the pressure‐relieving supporting surfaces.published_or_final_version
Nursing Studies
Master
Master of Nursing
37
Dandees, Husam. "Evidence-based physiotherapeutic management for knee osteoarthritis: A knowledge translation study." Thesis, Stellenbosch : Stellenbosch University, 2012. http://hdl.handle.net/10019.1/20161.
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Thesis (MScPhysio)--Stellenbosch University, 2012.Background: Evidence for the effectiveness of physiotherapeutic interventions in the management of knee osteoarthritis (OA) is synthesised in the current clinical guidelines (CGs), providing clinicians with readily accessible and interpretable practice guidelines. However, CGs are often not specific to the local context of the target users, therefore hindering successful implementation of evidence into clinical practice. Formulating succinct and composite recommendations by synthesising the current CGs reporting on the evidence-based (EB) management of knee OA may assure contextual relevance and facilitate implementation of evidence into clinical practice. In addition, multifaceted interventions, such as evidence-based practice (EBP) workshops, are also postulated to promote the implementation of guideline recommendations, thereby enhancing clinical outcomes. Objectives: The primary objectives of this study were to: 1) describe the range of EB physiotherapeutic interventions in the management of knee OA as documented in the current CGs; and 2) develop composite clinical recommendations for a specific group of users working in Jerusalem. A secondary study objective was to ascertain the effect of translating the knowledge through a specifically-designed EBP workshop on the uptake of knowledge and implementation of EBP into clinical practice by physiotherapists working in Jerusalem. The EBP workshop was aimed at educating physiotherapists about the EB physiotherapeutic techniques for knee OA management. Study design: Two studies were conducted. A systematic review (SR) into EB clinical guidelines was conducted to describe and synthesise the available evidence and formulate composite recommendations for knee OA. The results of the SR were used to design an EBP workshop aimed at educating physiotherapists about EB physiotherapeutic techniques for treating knee OA patients. A pre-post quasi-experimental design was then conducted to assess the effect of this EBP workshop on the uptake and implementation of EBP into clinical practice amongst public sector physiotherapists working in Jerusalem. Methodology for quasi experimental study: Physiotherapists who regularly treat knee OA patients were recruited from a list of members registered with the Palestinian Physiotherapy Association Jerusalem. A three-month retrospective audit (initial audit) of knee OA patients’ physiotherapy records kept by the participating physiotherapists was conducted to establish current management patterns. EB strategies for knee OA was presented to the participating physiotherapists during a one-day workshop. A second audit of physiotherapy records was conducted three months after the EBP workshop to establish changes in the selection of physiotherapeutic management techniques for knee OA. Results: The initial audit revealed that the participating physiotherapists utilized one high EB modality namely, exercises, as a core management strategy in knee OA, but did not frequently implement other high EB modalities such as self-management and weight-loss programs. Following the EBP workshop, a statistically significant increase (p=0.008) in the implementation of weight-loss and self-management strategies in the management of knee OA was noted. Conversely, a statistically significant decrease was noticed in using patellar taping (low EB modality) in the management of knee OA (p=0.04). No significant changes were noticed in the utilization of other physiotherapy modalities supported by weak or modest EB recommendations. Conclusion: The study concluded that physiotherapists inherently prescribed exercise as a core management strategy for knee OA. Modalities supported by modest levels of evidence were used as adjunct treatments. The EBP workshop facilitated the increased application of high EB modalities such as weight-loss and self-management programs. The results of this study illustrate that an EBP workshop may be effective in promoting the implementation of EB physiotherapeutic modalities in the management of knee OA. However, larger studies with longer follow-up periods are required.
No Afrikaans abstract available
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Fister-Hull, Elaine. "Using Evidence-Based Guidelines to Evaluate Research Support for the Use of Social Stories with Children with Autism." TopSCHOLAR®, 2008. http://digitalcommons.wku.edu/theses/365.
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Social Stories have gained wide acceptance and popularity as an intervention for children with autism and autism spectrum disorders, yet it is unclear whether this intervention method meets the standards of an evidence-based intervention. With a push in educational and mental health fields to use only evidence-based interventions, there is a need to determine whether or not this popular method meets this standard. The research literature on Social Stories has been reviewed for this project. An analysis of each article was conducted to evaluate clinical utility and treatment efficacy. Using the clinical utility and treatment efficacy information, as well as additional criteria, each article was evaluated to determine if it met the criteria deemed necessary by the No Child Left Behind Act (NCLB) for evidence-based research. Based on the findings gathered from the analysis of the studies, only three of the 18 studies (16.7%) meet all NCLB criteria for evidence-based research. Because such a small percentage of the studies reviewed met all criteria, Social Stories cannot yet be considered an evidence-based intervention for children with autism.
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Keller, Linda. "Assessment of Evidence-Based Practice Readiness and Plan for Implementation of Clinical Practice Guidelines in a Tertiary Hospital." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/5208.
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Using evidence-based practice (EBP) to deliver patient care in a hospital setting improves patients' care and their outcomes. The use of clinical practice guidelines (CPG) enables nurses and other healthcare professionals to translate current evidence into bedside care. However, there continue to be barriers for hospitals in adopting and implementing evidence-based care using CPGs, including a lack of understanding about EBP by nursing staff. The purpose of this project was to explore readiness of registered nurses in a tertiary hospital to use EBP and provide recommendations for a plan to implement CPGs successfully. Melnyk's research identified EBP as an approach to care, and the concept of using CPGs to shape patient care served as a foundation for the project. In addition, Kotter's theory of change was used to guide the recommendations to promote implementation. The Academic Center for Evidence-Based Practice-Readiness Inventory (ACE-ERI) created by Stevens was used to survey nurses' EBP readiness and knowledge at one Florida tertiary hospital. Data were analyzed using descriptive and inferential statistics. Survey results revealed the nurses' overall moderate level of confidence in using EBP, but limited EBP knowledge. Therefore, recommendations to develop education programs for EBP as well as guidance on follow-up assessments were proposed to nursing leadership. Educating the nurses will increase the likelihood of adoption of the CPGs, which will promote positive social change by improving the bedside care delivered by hospital nurses, which will result in better patient outcomes.
40
Fung, Ching-shan, and 馮清珊. "Evidence-based clinical practice guidelines on the frequency of central venous catheter (CVC) dressing change for hematologicalmalignancy adult patients." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2011. http://hub.hku.hk/bib/B46581686.
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Scarlett, Marjorie V. "Evidence-Based Diabetic Discharge Guideline: A Standardized Initiative to Promote Nurses' Adherence." NSUWorks, 2017. https://nsuworks.nova.edu/hpd_con_stuetd/51.
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Background: Diabetes mellitus (DM) affects more than 29.1 million Americans. Standardized clinical practice guidelines recommended by regulatory healthcare agencies are the standard of care for diabetic patients and must be adhered to by healthcare professionals providing care. Purpose: The purpose of this quality improvement project was to identify Centers for Medicare and Medicaid Services’, Joint Commission on Accreditation of Healthcare Organization’s, and other professional healthcare organizations’ guidelines for nurses’ knowledge of evidence-based discharge practices; determine level of nurses’ knowledge on evidence-based discharge practice process; develop a quality improvement plan, including development of an evidence-based guideline for diabetic discharge instructions; present guideline to stakeholders; implement the guideline in fall of 2017; and evaluate nursing compliance with the guideline at a for-profit adult care hospital in South Florida. Theoretical Framework: The chronic care model was utilized as the framework. This model has been used for improving practice and preventing many chronic illnesses. Methods: Two quantitative nonparametric descriptive designs were used, the Wilcoxon signed- rank test and a paired t test. An online demographic survey and pre- and posttest surveys were administered to determine nurses’ knowledge of diabetes discharge guideline practices. The Appraisal of Guidelines for Research and Evaluation II (AGREE II) evaluation tool evaluated the guideline, and data were analyzed with Wilcoxon and paired t tests. Results: A statistically significant difference was found in the pre-posttest survey responses for question 5 (p=0.046 Wilcoxon; p=0.041t test), and question 13 (p= 0.022 Wilcoxon; p=0.018 t test), indicating improvement. With the AGREE II tool, the multidisciplinary team evaluated the guideline at 100%, and 76% of Advanced Practice Registered Nurses (APRNs) and Registered Nurses (RNs) demonstrated compliance with guideline use. Conclusion: A standardized diabetic discharge guideline incorporated into the hospital’s discharge process provided APRNs and RNs with tools for educating and providing diabetic patients for increase in quality of life after discharge. The guideline was recommended by the administrative team for continued use throughout the hospital. Implementation of an evidence-based standardized diabetic discharge guideline to promote nurses’ adherence results in effective nursing practices and an informed patient population.
42
Rolland, Elizabeth. "Comparing dental care prescribed by private practitioners and by dental directors exposed to continuing education in evidence-based guidelines." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2001. http://www.collectionscanada.ca/obj/s4/f2/dsk3/ftp05/MQ62933.pdf.
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唐海寧 and Hoi-ning Mandy Tong. "Evidence-based practice guidelines: nurses' interventions for care-takers of paediatric in-patients to reducechildren's environmental tobacco smoke exposure." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2009. http://hub.hku.hk/bib/B43251547.
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Lo, Ming-yan, and 盧銘恩. "Evidence based guidelines of using music therapy in minimizing postoperative pain and promoting rehabilitation for patients aftertotal joint replacement." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2012. http://hub.hku.hk/bib/B48335794.
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Introduction: Patients having total joint replacement often experience moderate to severe pain postoperatively. Postoperative pain can reduce patients’ mobility, affecting their motivation to participate in any rehabilitation activities. For patients having total join replacement, rehabilitation plays an important role in promoting their early recovery. Therefore, it is crucial for healthcare professionals to develop and evaluate intervention that can better control patients’ post-operative pain. In the clinical setting that I am working, pharmacological method is the major means of postoperative pain management. However, many Chinese patients are reluctant to use analgesic to control their post-operative pain because of the side effects and adverse reactions of the drugs. In this dissertation, music therapy, a non-pharmacological method that can be managed by nurses, is adopted for postoperative pain control. It is used to promote rehabilitation for patients who have undergone total joint replacement.
Objectives: The objectives of this study are (1) to review the published research articles that investigated the effects of music therapy in reducing the post-operative pain and promoting rehabilitation for patients having total joint replacement; and (2) to establish an evidence-based guideline for the use of music therapy by nurses to control postoperative pain and to facilitate rehabilitation for patients having total joint replacement.
Methods: A comprehensive literature search on four electronic databases including CHINAL, Medline (OvidSP), PubMed and the British Nursing Index were conducted. A total of eight RCTs and two non-randomized controlled trials were eventually identified.
Results: All the reviewed studies showed that music therapy has a statistically significant effect on reducing postoperative pain. Sedative or relaxation music (music which has no lyrics, sustained melodic quality; rate of 60-80 beats per minutes; absence of strong rhythms or percussion) are recommended in the guideline. The target setting is a total joint replacement centre in a public hospital of Hong Kong. The target clients are adult patients (aged 19 or above) that are referred by the orthopedic out-patient department and are pending for their total knee/ hip replacement in the center. The transferability and feasibility of the literature are high. The guideline is developed based on the evidence in reviewed literature. A pilot testing plan is established to detect the potential barrier and friction of the guideline before the implementation. After that, an evaluation plan for patients, healthcare providers and system outcomes was also proposed.
Conclusion: An evidence based guideline is developed for the total joint replacement center. It is anticipated that, with the use of this guideline by nurses, it will not only facilitate better rehabilitation for patients having total joint replacement, but also enhances nurses’ autonomy in their nursing practice.published_or_final_version
Nursing Studies
Master
Master of Nursing
45
Jones, Georden. "Untangling and Addressing Cancer-Related Fatigue Guidelines Implementation Gaps: A Knowledge Translation Perspective." Thesis, Université d'Ottawa / University of Ottawa, 2020. http://hdl.handle.net/10393/41459.
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Cancer-related fatigue (CRF) as a distressing, persistent, subjective sense of physical, emotional, and/or cognitive tiredness or exhaustion related to cancer and cancer treatment that is not proportional to recent activity, such as physical activity, that interferes with usual functioning (Howell et al., 2015; National Comprehensive Cancer Network, 2020). CRF is one of the most common symptoms experienced by cancer patients at all stages of the cancer trajectory which significantly impacts patient’s quality of life, return to work, mental health, and can lead to disability (Bower, 2014b; Jones et al., 2016). Much research has focused on the development of CRF assessment and intervention strategies which have promoted the development of comprehensive evidence-based guidelines (Howell et al., 2015; National Comprehensive Cancer Network, 2020). However, previous research has identified many practice gaps in their implementation (Berger et al., 2015; Borneman et al., 2007; Pearson et al., 2015a, 2017b). This thesis’ objectives were to gain a deeper understanding of potential barriers to CRF clinical guideline implementation to identify potential knowledge translation strategies of CRF guidelines into practice following a Knowledge-To-Action (KTA) framework perspective (Graham et al., 2006; Straus et al., 2013).
In Study 1, a qualitative research design was used to recruit a total of 62 participants—16 patients, 32 healthcare providers (HCPs), and 15 community support providers (CSPs). Drawing on the KTA model, the goal of the study was to explore key stakeholders’ (patients, HCPs, CSPs) experiences and opinions on CRF assessment and management and to explore underlying causes of CRF treatment gaps. No specific hypothesis were determined given the exploratory nature of the study. The results of this study highlight CRF guideline implementation gaps, patient dissatisfaction with CRF care, and challenges contributing to CRF assessment and management gaps. The results also suggested the presence of two underlying mechanisms contributing to treatment gaps: A Perfect Storm and Patient-Provider Communication Gaps. Understanding these mechanisms provides clarity on the potential causes maintaining CRF treatment gaps and can help direct targeted knowledge translation strategies to improve the implementation of CAPO CRF guidelines into practice. Consistent with a recent Delphi study (Pearson et al., 2017b), the results supported the need for professionals’ training on CRF guidelines to fill knowledge gaps.
In Study 2, a mixed-methods pilot study with 18 HCPs and CSPs was used to develop and evaluate the acceptability and feasibility of a one-time training session for HCPs and CSPs on CAPO CRF guidelines, once again flowing the KTA framework (Graham et al., 2006; Straus, 2011). A secondary objective was to evaluate the learning outcomes of the training session including CAPO CRF guidelines knowledge, self-efficacy, and intent to apply CAPO CRF guidelines in practice. Overall, results suggest that offering a brief one-time training for HCPs and CSPs on CRF guidelines may be effective in increasing knowledge, self-efficacy, and intent to apply guidelines into practice. Similarly, that KT tools are appreciated by HCPs/CSPs and may be used in practice to supplement and sustain the knowledge and skills gained in training.
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Bridges, Margie Allyn. "Cesarean Births Rates After Implementation of Labor Management Guidelines." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/4776.
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Cesarean birth rates are associated with increased maternal morbidity. This project evaluated a quality improvement (QI) initiative implemented to reduce cesarean births among Nulliparous Term Singleton Vertex (NTSV) obstetric populations, the largest contributor to cesarean births. Variations in labor management practice contribute to cesarean birth rate; implementation of labor management bundles have been endorsed to influence practice- and system-level changes in the promotion of vaginal births. The problem addressed in this project was an organizational NTSV cesarean section rate of 30%. The purpose of the project was to use secondary data to evaluate a previously implemented labor management bundle at a large hospital in the northwestern United States. The model of improvement was used as a framework for the QI initiative and this evaluation project. The practice-focused question asked in this project was: Did NTSV cesarean birth rates change after implementation of an evidenced-based standardized labor management bundle? Archived data were collected on cesarean birth rates for 3 time periods: prebaseline, 1 year postimplementation, and 2 years postimplementation. Chi-squareï? tests compared the differences between observed and expected results of data following implementation of labor management bundles. Results show no statistically significant difference between the pre- and post- implementation periods in the NTSV laboring population. Results suggest use of labor management practice bundles alone may not lead to expected outcomes improvements and that operationalization of such practices are sensitive to institutional and/or patient population contexts. This project may serve to promote positive social change by framing evidence-based practice as a process that must attend to contextual considerations.
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Ammendolia, Carlo. "Implementing evidence-based guidelines for x-ray use in acute low back pain, a pilot study in a chiropractic community." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1999. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape9/PQDD_0003/MQ45505.pdf.
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Lai, Shuk-tin, and 黎淑鈿. "Evidence-based guidelines for chlorhexidine gluconate in preoperative skin preparation to reduce surgical site infection in patients undergoing general surgery." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2013. http://hdl.handle.net/10722/193047.
Full textAbstract:
Surgical site infection not only brings morbidity and mortality to patients, but it also bring substantial financial burden to the hospital and the healthcare system. To minimize the clinical consequences of surgical site infection, it is crucial that all appropriate measures for reduction of surgical site infection should be implemented. Since patient’s skin is a potential source of pathogens, normal skin flora is a common cause of surgical site infections. Preoperative skin disinfection of the surgical site with an antiseptic agent is an effective method to remove the soil and transient organisms from the skin. Currently, there are different skin antiseptics available and the most commonly used agents are povidone iodine and chlorhexidine gluconate. Although povidone iodine has a long-standing recommendation and it is widely used in various surgical procedures, it has several limitations. On the other hand, there is an increasing interest of the use of chlorhexidine in indwelling catheter placement and care, surgical hand scrubbing, as well as wound dressing.
In view of this, there is a potential of replacing povidone iodine by chlorhexidine as preoperative skin antiseptic agent. As there is no existing guideline supportingthis innovative movement, this dissertation aimed to review the currently available evidence on preoperative skin preparation and to develop an evidence-based guideline of using chlorhexidine in preoperative skin preparation for reducing surgical site infection in patients undergoing general surgery.
Five randomized controlled studies were identified from MEDLINE, CINAHL and PUBMED and evaluated by a critical appraisal tool, the Scottish Intercollegiate Guidelines Network. All studies reported that preoperative skin preparation with chlorhexidine is more effective than the use of povidone iodine in reducing surgical site infection. An evidence-based guideline is developed according to the guideline development process from the Scottish Intercollegiate Guideline Network. Patient characteristics, local clinical setting, organizational infrastructure and staff competency is congruent with the proposed innovation. The new protocol not only can minimize the risk of postoperative surgical site infection but also save costs. The cost-benefit analysis showed that the new protocol can help to save $675,552 to $1,097,772 (HK dollars) in six-month period after implementation.
To facilitate a more comprehensive plan in actual implementation of the proposed guideline, stakeholders at administrative, managerial, and operational levels would be invited to take part in the 12-week pilot test. Surgical site infection, staff satisfaction and compliance, as well as cost and benefit ratio of the guideline would be measured in the evaluation plan. The refined guidelines would then be implemented for one year. The effectiveness of the guideline would be determined by reduction in postoperative surgical site infection, increase in staff knowledge and satisfaction, and the overall expenditure.published_or_final_version
Nursing Studies
Master
Master of Nursing
49
Tong, Hoi-ning Mandy. "Evidence-based practice guidelines nurses' interventions for care-takers of paediatric in-patients to reduce children's environmental tobacco smoke exposure /." Click to view the E-thesis via HKUTO, 2009. http://sunzi.lib.hku.hk/hkuto/record/B43251547.
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Booth, Christopher. "Creating evidence-based guidelines for healthy eating educational campaigns aimed at low-income South Africans: a case study of Grahamstown." Thesis, Rhodes University, 2016. http://hdl.handle.net/10962/3336.
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Through a literature review and qualitative research, this study explores what a media-centric nutritional intervention needs to include in order to be effective amongst those whose health is most impacted by poor nutrition – poorer and mostly black South Africans. The study sketches the current nutritional landscape of South Africa, and draws on both Behaviour Change Communication and Media Effect theories to hypothesise how a campaign might be devised to change popular understandings of the relationship between health and nutrition, and inspire some change in food consumption behaviours and choices. The study explores the key factors that drive nutritional behaviours (including the environmental constraint of cost, the peer pressure and socialisation of food, and the desire for knowledge and change) and explores how media-based interventions could be more effective. To do this, this study creates three layers of an idealised and hypothetical “Super 7” fruit and vegetable consumption promotion campaign. From this data, and the insights developed, new guidelines for possible future nutritional education campaigns are suggested and developed.