Evidence-based practice: the relevance of systematic reviews.

Aim:
To demonstrate how systematic reviews provide robust evidence to inform clinical decision making in practice.

Background
Systematic reviews collate findings from a number of research studies in order to provide a comprehensive and reliable summary of the best available evidence. The use of systematic reviews to inform practice based decisions has increased as a result of the overwhelming amount of research literature available, poor quality of research evidence and the need to ensure practice is based upon the best available evidence. Systematic reviews are an efficient way of coping with large volumes of data to answer focused research questions. They differ from traditional literature reviews as they adhere to an explicit scientific process. The use of explicit and rigorous methods to identify, appraise and synthesise relevant studies minimises bias and provides a reliable basis for decision making. As a result systematic reviews provide clear evidence on the effectiveness of a healthcare intervention to inform policy and decision making across healthcare systems. An example of how the findings from systematic reviews can provide reliable evidence to inform healthcare decisions will be provided in this presentation1. This will demonstrate how focused clinical questions can be answered by systematic reviews and translated into practice.

Reference:
1. McGaughey J, Alderdice F, Fowler R, Kapila A, Moutray M. (2007) Outreach and Early Warning Systems (EWS) for the prevention of Intensive Care admission admission and death of critically ill adult patients on general hospital wards (REVIEW). The Cochrane Database of Systematic Reviews 3. art no CD005529

Mineralogy, chemistry and biological contingents of an early-middle Miocene Antarctic paleosol and its relevance as a Martian analogue

Fossil mesofauna and bacteria recovered from a paleosol in a moraine situated adjacent to the inland ice, Antarctica, and dating to the earliest glacial event in the Antarctic Dry Valleys opens several questions. The most important relates to understanding of the mineralogy and chemistry of the weathered substrate habitat in which Coleoptera apparently thrived at some point in the Early/Middle Miocene and perhaps earlier. Here, Coleoptera remains are only located in one of six horizons in a paleosol formed in moraine deposited during the alpine glacial event (> 15 Ma). A tendency for quartz to decrease upward in the section may be a detrital effect or a product of dissolution in the early stage of profile morphogenesis when climate was presumably milder and the depositing glacier of temperate type. Discontinuous distributions of smectite, laumontite, and hexahydrite may have provided nutrients and water to mesofauna and bacteria during the early stage of biotic colonization of the profile. Because the mesofauna were members of burrowing Coleoptera species, future work should assess the degree to which the organisms occupied other sites in the Dry Valleys in the past. Whereas there is no reasonable expectations of finding Coleoptera/insect remains on Mars, the chemistry and mineralogy of the paleosol is within a life expectancy window for the presence of microorganisms, principally bacteria and fungi. Thus, parameters discussed here within this Antarctic paleosol could provide an analogue to identifying similar fossil or life-bearing weathered regolith on Mars.

Auditory cueing in Parkinson's patients with freezing of gait. What matters most: action-relevance or cue-continuity?

Gait disturbances are a common feature of Parkinson’s disease, one of the most severe being freezing of gait. Sensory cueing is a common method used to facilitate stepping in people with Parkinson’s. Recent work has shown that, compared to walking to a metronome, Parkinson’s patients without freezing of gait (nFOG) showed reduced gait variability when imitating recorded sounds of footsteps made on gravel. However, it is not known if these benefits are realised through the continuity of the acoustic information or the action-relevance. Furthermore, no study has examined if these benefits extend to PD with freezing of gait. We prepared four different auditory cues (varying in action-relevance and acoustic continuity) and asked 19 Parkinson’s patients (10 nFOG, 9 with freezing of gait (FOG)) to step in place to each cue. Results showed a superiority of action-relevant cues (regardless of cue-continuity) for inducing reductions in Step coefficient of variation (CV). Acoustic continuity was associated with a significant reduction in Swing CV. Neither cue-continuity nor action-relevance was independently sufficient to increase the time spent stepping before freezing. However, combining both attributes in the same cue did yield significant improvements. This study demonstrates the potential of using action-sounds as sensory cues for Parkinson’s patients with freezing of gait. We suggest that the improvements shown might be considered audio-motor ‘priming’ (i.e., listening to the sounds of footsteps will engage sensorimotor circuitry relevant to the production of that same action, thus effectively bypassing the defective basal ganglia).