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Real-time EBM: from bed board to keyboard and back.

ABSTRACT: BACKGROUND: To practice Evidence-Based Medicine (EBM), physicians must quickly retrieve evidence to inform medical decisions. Internal Medicine (IM) residents receive little formal education in electronic database searching, and have identified poor searching skills as a barrier to practicing EBM. OBJECTIVE: To design and implement a database searching tutorial for IM residents on inpatient rotations and to evaluate its impact on residents' skill and comfort searching MEDLINE and filtered EBM resources. DESIGN: Randomized controlled trial. Residents randomized to the searching tutorial met for up to 6 1-hour small group sessions to search for answers to questions about current hospitalized patients. PARTICIPANTS: Second- and 3rd-year IM residents. MEASUREMENTS: Residents in both groups completed an Objective Structured Searching Evaluation (OSSE), searching for primary evidence to answer 5 clinical questions. OSSE outcomes were the number of successful searches, search times, and techniques utilized. Participants also completed self-assessment surveys measuring frequency and comfort using EBM databases. RESULTS: During the OSSE, residents who participated in the intervention utilized more searching techniques overall (p < .01) and used PubMed's Clinical Queries more often (p < .001) than control residents. Searching "success" and time per completed search did not differ between groups. Compared with controls, intervention residents reported greater comfort using MEDLINE (p < .05) and the Cochrane Library (p < .05) on post-intervention surveys. The groups did not differ in comfort using ACP Journal Club, or in self-reported frequency of use of any databases. CONCLUSIONS: An inpatient EBM searching tutorial improved searching techniques of IM residents and resulted in increased comfort with MEDLINE and the Cochrane Library, but did not impact overall searching success.

SUBMITTER: Stark R

PROVIDER: S-EPMC2219829 | biostudies-other | 2007 Dec

REPOSITORIES: biostudies-other

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Project description:BackgroundPatients should be encouraged to mobilize with 24 h of caesarean section. However, the time of the first off-bed activity after surgery is usually 24 ~ 48 h in China. Due to the lack of knowledge of early off-bed activities, lack of attention to medical pain, and the absence of systematic evidence for the clinical transformation process. the aim of this study was showed that the application of evidence needs to be embedding in the real setting to construct the localization plan and achieve the effective result.MethodsTo establish evidence of the benefits of early postoperative off-bed activities on patients' well-being based on a literature review. An interrupted time series analysis was used to evaluate the effectiveness of the intervention. The first and third periods were both five months (from February 1st, 2019 to January 31st, 2020), with a two-month interrupted time (from July 1st, 2019 to August 31st, 2019).ResultsEight clinical practices were retrieved from the literature and incorporated into the intervention. A total of 465 patients were included: 226 patients before and 239 patients after implementing the intervention. The average onset time of postoperative off-bed activities was significantly earlier after the intervention than before the intervention (20.01 vs. 31.89 h after the operation, P < 0.001). The 24-h off-bed rate increased from 30.94% before to 91.21% after the intervention (P < 0.001). The average pain score of patients decreased from 5.23 points before to 3.82 points after the intervention (P = 0.032). The average postoperative hospital stay was shortened from 5.06 days before to 3.51 days after the intervention (P < 0.001). In addition, the incidence rates of postoperative ileus (POI) and infection decreased from 5.38% and 2.65% before to 1.67% and 0.84% after the intervention, respectively (P < 0.001).ConclusionsWe established an evidence-based nursing intervention. Evaluation of the effect of evidence-based practices should be considered in the clinical setting and include preoperative health education, effective analgesia management, and safety management.

Project description:For more than two decades, the International Narcotic Control Board (INCB) has tried to stop harm reduction and its HIV prevention programs. This posture is based on a fundamental misunderstanding of their responsibilities and of drug addiction itself--i.e. as a public health and clinical care matter made criminal by decree. A recent focal point for the Board's action has been rejecting the use of supervised injection facilities to reduce morbidity and mortality of drug injectors. They single out individual countries and attempt to bully them into rejecting such programs under the banner of the United Nations (falsely) and in the name of international treaties. Their unrelenting and unjustified badgering of signatories to the international treaties that established the INCB is not only unjustified; it is an affront to one of the core purposes of the Board itself: to ensure adequate medical supplies and safe use of controlled substances. The INCB's ill-conceived obsession with intravenous addiction as a crime flies in the face of the medical view and policies of the World Health Organization and the universally endorsed principles of the General Assembly of the United Nations. The latest target of the INCB is North America's only supervised injection facility, Insite, located in the inner city of Vancouver, Canada. Using the power of their office to meddle in matters of public health for individual nations is without medical, scientific or legal justification. But, most importantly, it is a matter of life and death for these most marginalized of citizens. The empirical evidence remains that a significant portion of the continued growth of the AIDS pandemic is due to injecting drug use, and the INCB's intrusion will inevitably result in additional deaths due to preventable HIV infections and drug overdoses. So we are very pleased to call to our readers' attention to a recent report produced by the Canadian HIV/AIDS Legal Network and the International Harm Reduction Development Program (IHRD) joined by former United Nations Special Envoy for HIV/AIDS in Africa, the respected Canadian statesman Stephen Lewis. The full report, "Closed to Reason: The International Narcotics Control Board and HIV/AIDS" is attached along [see Additional file 1] with a Russian translation of the key findings of the authors [see Additional files 2] as well as Russian and Chinese translations of this abstract [see Additional 3 and 4]. As the report makes very clear, the time to inject some accountability and reason into the INCB is now.

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Real-time EBM: from bed board to keyboard and back.

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