scholarly journals Is the contemporary care of the older persons with acute coronary syndrome evidence-based?

2021 ◽  
Author(s):  
Greg B Mills ◽  
Hanna Ratcovich ◽  
Jennifer Adams-Hall ◽  
Benjamin Beska ◽  
Emma Kirkup ◽  
...  
Keyword(s):  
Older Patients ◽  
Large Scale ◽  
Evidence Base ◽  
Adverse Outcomes ◽  
Current Evidence ◽  
Evidence Based ◽  
Coronary Syndrome ◽  
Current Evidence Base ◽  
Coronary Syndromes ◽  
To Receive

Abstract Globally, ischaemic heart disease is the leading cause of death, with a higher mortality burden amongst older adults. Although advancing age is associated with a higher risk of adverse outcomes following acute coronary syndromes (ACS), older patients are less likely to receive evidence-based medications and coronary angiography. Guideline recommendations for managing ACS are often based on studies that exclude older patients, and more contemporary trials have been underpowered and produced inconsistent findings. There is also limited evidence for how frailty and comorbidity should influence management decisions. This review focuses on the current evidence base for the medical and percutaneous management of ACS in older patients and highlights the distinct need to enrol older patients with ACS into well-powered, large-scale randomised trials.

scholarly journals (A118) Evidence-Based Disaster Medicine: What Can We Learn from a “Science” Spread across 900 Journals?

2011 ◽  
Vol 26 (S1) ◽  
pp. s33-s33 ◽  
Author(s):  
E. Smith ◽  
F.M. Burkle ◽  
P. Aitken ◽  
F. Archer
Keyword(s):  
Hurricane Katrina ◽  
Large Scale ◽  
Search Strategy ◽  
Evidence Base ◽  
Disaster Medicine ◽  
Indian Ocean Tsunami ◽  
Current Evidence ◽  
Evidence Based ◽  
Current Evidence Base ◽  
Qualitative Methodologies

IntroductionDisasters and large-scale crises continue to increase in frequency. To mitigate the potential catastrophes that confront humanity in the new millennium, an evidence-based approach to disaster medicine is required urgently. This paper moves towards such an approach by identifying the current evidence-base for disaster medicine.MethodsUsing a search strategy developed by the Cochrane Prehospital and Emergency Health Field, three independent reviewers searched the electronically indexed database MEDLINE (January 2000 – August 2010) to identify peer-reviewed literature relevant to disaster medicine. Reviewers screened the titles and abstracts identified by the search strategy and applied predetermined criteria to classify the reported publications for date, source and study type and topic.ResultsA total of 8149 publications were identified. Of these, 8% focused on mitigation, 22% on preparedness, 19% on response and 51% on recovery. The publications were overwhelmingly anecdotal or descriptive (89%) while 5% were quantitative studies and 6% used qualitative methodologies. Only 66 of these publications were classified as being high level evidence. The publications were published in 928 journals, of which 34% were mental health related journals and 28% were public health journals. The journal “Prehospital and Disaster Medicine” had the greatest number of publications (5%) of all journals publishing on issues within the scope of disaster medicine. The events with the greatest numbers of publications were the 9/11 terrorist attacks, Hurricane Katrina, the Indian Ocean Tsunami, and the conflict in Iraq. Of note, this search highlights the lack of publications reporting on the application of evaluation tools or frameworks.ConclusionGiven that the “science” of disaster medicine is spread across over 900 different journals, keeping on top of the evolving evidence-base of this emerging discipline will continue to be a challenge. Furthermore, the overall low quality of the evidence is an ongoing concern.

Couple and Family Therapy

2017 ◽  
Author(s):  
Jessica ChenFeng ◽  
Diane Gehart
Keyword(s):  
Eating Disorders ◽  
Substance Use ◽  
Family Therapy ◽  
Couples Therapy ◽  
Evidence Base ◽  
Current Evidence ◽  
Evidence Based ◽  
Couple And Family Therapy ◽  
Current Evidence Base ◽  
Cord Injury

Evidence-based couple and family therapies have a robust and well-established evidence base as a cost-effective treatment for numerous conditions and are the treatment of choice for several childhood and adult mental health issues. This review provides a brief overview of systemic couple and family therapy principles and then reviews the evidence base for using these methods with specific disorders. Family therapy treatments have been identified as a primary intervention for several childhood and adolescent disorders, including conduct, alcohol and substance use, attention-deficit, autism, psychotic, mood, anxiety, and eating disorders, as well as certain physical disorders, including diabetes, enuresis, and asthma. For adults, the current evidence base supports couples therapy for major depressive disorder with couple distress, alcohol and substance use disorders, anxiety disorders, distressed couples, and interpersonal violence with certain batterers. In addition, couple and family therapy is indicated for certain adult chronic health conditions, including stroke, traumatic brain injury, spinal cord injury, cardiovascular diseases, cancer, dementia, and diabetes. The review concludes with a discussion of effective referral for and training in evidence-based family therapy approaches. This review contains 6 figures, 5 tables, and 53 references. Key words: ADD/ADHD, adolescent, childhood trauma, conduct disorder, couples therapy, depression, eating disorders, family therapy,  marital therapy, mood disorder

scholarly journals The evolution of an evidence based intervention designed to improve prescribing and reduce polypharmacy in older people with multimorbidity and significant polypharmacy in primary care (SPPiRE)

2020 ◽  
Vol 10 ◽  
pp. 2235042X2094624
Author(s):  
Caroline McCarthy ◽  
Frank Moriarty ◽  
Emma Wallace ◽  
Susan M Smith ◽  
Keyword(s):  
Older People ◽  
Medication Review ◽  
Patient Reported Outcome Measures ◽  
Evidence Base ◽  
Public Health Research ◽  
Primary Outcome Measure ◽  
Current Evidence ◽  
Evidence Based ◽  
Current Evidence Base ◽  
Patient Reported

Introduction: By the time an intervention is ready for evaluation in a definitive RCT the context of the evidence base may have evolved. To avoid research waste, it is imperative that intervention design and evaluation is an adaptive process incorporating emerging evidence and novel concepts. The aim of this study is to describe changes that were made to an evidence based intervention at the protocol stage of the definitive RCT to incorporate emerging evidence. Methods: The original evidence based intervention, a GP delivered web guided medication review, was modified in a five step process: Identification of core components of the original intervention. Literature review. Modification of the intervention. Pilot study. Final refinements. A framework, developed in public health research, was utilised to describe the modification process. Results: The population under investigation changed from older people with a potentially inappropriate prescription (PIP) to older people with significant polypharmacy, a proxy marker for complex multimorbidity. An assessment of treatment priorities and brown bag medication review, with a focus on deprescribing were incorporated into the original intervention. The number of repeat medicines was added as a primary outcome measure as were additional secondary patient reported outcome measures to assess treatment burden and attitudes towards deprescribing. Conclusions: A framework was used to systematically describe how and why the original intervention was modified, allowing the new intervention to build upon an effective and robustly developed intervention but also to be relevant in the context of the current evidence base.

The Oxford Handbook of Autism and Co-Occurring Psychiatric Conditions

2020 ◽  
Keyword(s):  
Sleep Problems ◽  
Evidence Base ◽  
Autism Spectrum ◽  
Current Evidence ◽  
Future Research ◽  
Evidence Based ◽  
Evidence Based Treatment ◽  
Current Evidence Base ◽  
Psychiatric Conditions ◽  
Adults With Asd

People with autism spectrum disorder (ASD) are often diagnosed, and treated for, co-occurring mental health disorders. Co-occurring problems are, in fact, a primary reason for referral and treatment-seeking. Research on comorbidity and its management in youth and adults with ASD has expanded at a rapid rate over the last decade. This is the first comprehensive volume on the topic of co-occurring psychiatric conditions and symptoms in ASD. In this Handbook, internationally recognized clinical scientists synthesize the research on assessment and evidence-based treatment for a broad range of conditions as they present in ASD, from childhood through adulthood. In addition to coverage of formal diagnoses that frequently present in ASD (e.g., mood and anxiety disorders), common behavioural concerns (e.g., psychosexual and sleep problems) are also addressed. Each chapter summarizes the condition or disorder as it presents in ASD, and presents the extant research on its prevalence, developmental course, etiology, and assessment and diagnosis in the context of ASD. Each chapter also includes a summary of evidence-based treatment approaches or current best practices for intervention, as well as a case example to demonstrate application. Chapters are also included to synthesize broader issues related to co-occurring psychiatric conditions in ASD, including a historical overview and conceptual framework for co-occurring conditions in ASD, crisis management, and psychopharmacology. In sum, this handbook is comprehensive compilation of the current evidence-base and recommendations for future research to inform clinical practice related to co-occurring psychiatric conditions and symptoms in ASD.

scholarly journals Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines for the Treatment of Adults With Metastatic Brain Tumors: Executive Summary

Neurosurgery ◽  
2019 ◽  
Vol 84 (3) ◽  
pp. 550-552 ◽  
Author(s):  
Jeffrey J Olson ◽  
Steven N Kalkanis ◽  
Timothy C Ryken
Keyword(s):  
Systematic Review ◽  
Brain Tumors ◽  
Evidence Base ◽  
Treatment Modalities ◽  
Current Evidence ◽  
Evidence Based ◽  
Metastatic Brain Tumors ◽  
Executive Summary ◽  
Relevant Evidence ◽  
Current Evidence Base

Abstract BACKGROUND The Congress of Neurological Surgeons systematic review and evidence-based clinical practice parameter guidelines for the treatment of adults with metastatic brain tumors was first published in 2010. Because of the time elapsed since that publication, an update of this set of guidelines based on literature published since is now indicated. OBJECTIVE To establish the best evidence-based management of metastatic brain tumors over all commonly used diagnostic and treatment modalities in regularly encountered clinical situations. METHODS Literature searches regarding management of metastatic brain tumors with whole brain radiation therapy, surgery, stereotactic radiosurgery, chemotherapy, prophylactic anticonvulsants, steroids, instances of multiple brain metastases, and emerging and investigational therapies were carried out to answer questions designed by consensus of a multidisciplinary writing group. RESULTS Recommendations were created and their strength linked to the quality of the literature data available thus creating an evidence-based guideline. Importantly, shortcomings and biases to the literature data are brought out so as to provide guidance for future investigation and improvements in the management of patients with metastatic brain tumors. CONCLUSION This series of guidelines was constructed to assess the most current and clinically relevant evidence for management of metastatic brain tumors. They set a benchmark regarding the current evidence base for this management while also highlighting important key areas for future basic and clinical research, particularly on those topics for which no recommendations could be formulated. The full guideline can be found at: https://www.cns.org/guidelines-treatment-adults-metastatic-brain-tumors/chapter_1.

scholarly journals A Review of Applications of Machine Learning in Mammography and Future Challenges

Oncology ◽  
2021 ◽  
pp. 1-8
Author(s):  
Sai Batchu ◽  
Fan Liu ◽  
Ahmad Amireh ◽  
Joseph Waller ◽  
Muhammad Umair
Keyword(s):  
Clinical Utility ◽  
Large Scale ◽  
Performance Metrics ◽  
Relevant Literature ◽  
Evidence Base ◽  
Current Evidence ◽  
Study Evaluation ◽  
Current Evidence Base ◽  
Future Challenges ◽  
Applications Of Machine Learning

<b><i>Background:</i></b> The aim of this study is to systematically review the literature to summarize the evidence surrounding the clinical utility of artificial intelligence (AI) in the field of mammography. Databases from PubMed, IEEE Xplore, and Scopus were searched for relevant literature. Studies evaluating AI models in the context of prediction and diagnosis of breast malignancies that also reported conventional performance metrics were deemed suitable for inclusion. From 90 unique citations, 21 studies were considered suitable for our examination. Data was not pooled due to heterogeneity in study evaluation methods. <b><i>Summary:</i></b> Three studies showed the applicability of AI in reducing workload. Six studies demonstrated that AI can aid in diagnosis, with up to 69% reduction in false positives and an increase in sensitivity ranging from 84 to 91%. Five studies show how AI models can independently mark and classify suspicious findings on conventional scans, with abilities comparable with radiologists. Seven studies examined AI predictive potential for breast cancer and risk score calculation. <b><i>Key Messages:</i></b> Despite limitations in the current evidence base and technical obstacles, this review suggests AI has marked potential for extensive use in mammography. Additional works, including large-scale prospective studies, are warranted to elucidate the clinical utility of AI.

A Social Vision Account of Facial Expression Perception

2017 ◽  
Author(s):  
Reginald B. Adams ◽  
Daniel N. Albohn ◽  
Kestutis Kveraga
Keyword(s):  
Large Scale ◽  
Computational Models ◽  
Neuropsychological Testing ◽  
Cognitive Remediation ◽  
Evidence Base ◽  
Assessment Process ◽  
Current Evidence ◽  
Self Monitoring ◽  
New Findings ◽  
Current Evidence Base

In this chapter, we discuss prospects for a future computational neuropsychology. Computerized approaches to assessment, the ability to implement life-like scenarios in a controlled virtual environment, and teleneuropsychology offer promise for expanding available approaches to cognitive remediation and self-monitoring. Computational models are also available increasingly for integrating neuroimaging into the assessment process. Neuropsychologists can use neuroimaging to develop new frameworks for neuropsychological testing that are rooted in the current evidence base on large-scale brain system interactions. This will allow for traditional assessment of discrete areas of neurocognitive functioning to be brought in line with recent findings that highly nuanced relations exist among brain networks. Furthermore, the new findings from systems neuroscience may allow for the development of neuropsychological assessments with greater accuracy and increased targeted testing. Neuroinfomatic approaches offer computational neuropsychology an approach to knowledge sharing via well-defined neuropsychological ontologies and collaborative knowledgebases.

scholarly journals The Use of Preference Based Measures in Haemophilia: Is the Current Evidence Base Useful for Evidence Based Decision Making?

2013 ◽  
Vol 16 (7) ◽  
pp. A386-A387
Author(s):  
K. Tolley ◽  
A. Miners ◽  
J. Brazier ◽  
L.M. Pericleous ◽  
T. Sharma ◽  
...  
Keyword(s):  
Decision Making ◽  
Evidence Base ◽  
Current Evidence ◽  
Evidence Based ◽  
Current Evidence Base ◽  
Evidence Based Decision Making

A Systematic Review of the Evidence Base for Instructional Choice in K–12 Settings

2017 ◽  
Vol 42 (3) ◽  
pp. 89-107 ◽  
Author(s):  
David J. Royer ◽  
Kathleen Lynne Lane ◽  
Emily D. Cantwell ◽  
Mallory L. Messenger
Keyword(s):  
Disruptive Behavior ◽  
Challenging Behaviors ◽  
Evidence Base ◽  
Current Evidence ◽  
Evidence Based ◽  
Time On Task ◽  
Exceptional Children ◽  
School Based ◽  
Current Evidence Base ◽  
K 12

We conducted this systematic literature review to explore the current evidence base of instructional choice, a low-intensity, teacher-delivered strategy to support academic engagement and decrease challenging behaviors. Specifically, we focused on school-based settings, applying quality indicators (QIs) and evidence-based standards of the Council for Exceptional Children (CEC). Included articles met five criteria: (a) independent variables included instructional choice; (b) dependent variables included behavior (e.g., disruptive behavior, problem behavior, aggression), time on task/academic engaged time, and/or academic performance (e.g., task initiation, completion, accuracy, fluency); (c) interventions occurred with school-age students in traditional school settings; (d) the study followed an experimental design; and (e) the article was published in English in a refereed journal. Twenty-five articles (26 studies) from 13 journals met inclusion criteria. Findings indicated providing students instructional choices increased desired academic behavior while decreasing instances of disruptive behavior. Of the 26 studies, three met all QIs, with nine additional studies addressing 80% or more. Due to small participant numbers, effect sizes, and other factors in these studies, we classified instructional choice into the CEC evidence-based category of insufficient evidence. We conclude with a discussion of limitations and directions for future inquiry.

Routine Postoperative Management of Blepharoplasty: A Review of Current Evidence-Based Practice

2021 ◽  
Author(s):  
Mohsan Malik ◽  
Eamon Shamil ◽  
Alwyn Ray D'Souza
Keyword(s):  
Case Series ◽  
Evidence Base ◽  
Postoperative Management ◽  
Current Evidence ◽  
Evidence Based ◽  
Level Of Evidence ◽  
Search Criterion ◽  
Current Evidence Base ◽  
Facial Plastic ◽  
Based Medicine

Abstract Introduction Advances in blepharoplasty have resulted in an improved understanding of preoperative risk factors, intraoperative hemostasis, and wound closure. This has reduced the risk of severe adverse events. The aim of this review is to determine the current evidence base for routine postblepharoplasty management. Method A literature review was performed using MEDLINE, PUBMED, and EMBASE databases. Expanded search criterion “bleph*” was combined with individual terms assessing postoperative management. Articles were assessed and qualified as per Oxford Centre of Evidence-Based Medicine levels 1 to 5 (1 = highest level of evidence). Results A total of 47 unique articles matched our search strategy. Most articles were a description of individual expert opinion, surveys of practice, or case series (level 4–5 evidence). Few randomized controlled trials were performed (level 2). Conclusion Many articles describe the clinical experience of senior facial plastic surgeons. Our review found some evidence for postoperative cooling and preincision antisepsis to be effective. This review highlights the need for higher-quality studies to improve the evidence base for routine postoperative management.

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