How can we use systematic reviews to inform clinical practice?

Aims/purpose: Systematic reviews provide the highest quality evidence and inform clinical practice. For patient benefit, it is imperative that nurses keep abreast of evidence-based practice. This presentation highlights where to find systematic reviews and how the information presented can be used to inform care.
Presentation description: Clinical research is increasing at an incredible rate. In the clinical trials database alone, more than 2000 new studies are registered/month and this does not include qualitative studies that do not require registration. Keeping abreast of current evidence can not only be a time consuming process, but can be problematic when studies produce conflicting results. Systematic reviews can be useful for summarizing the increasing amount of knowledge that is gained from scientific papers. In addition, combining individual studies in a meta-analysis increases statistical power, resulting in more precise effect estimates. This presentation draws upon a few systematic reviews relevant to ICU nursing practice, highlights their findings and demonstrates how the information can be used to inform translation of evidence into practice. Additionally, although these reviews include steps to minimize bias, nurses should be aware of some of the biases that may reduce confidence in the findings.
Conclusion: Systematic reviews can be useful tools for informing evidence based practice, although careful interpretation is necessary for understanding their relevance to local practice.

Contexts That Inform Racial Awareness and Affect Teaching Practice: A Study of White Bilingual Teachers

Thesis (Ph.D.)--University of Washington, 2016-08

Indigenous Māori values and perspectives to inform freshwater management in Aotearoa-New Zealand

In response to widespread water quality and quantity issues, the New Zealand Government has recently embarked on a number of comprehensive freshwater management reforms, developing a raft of national discussion and policy documents such as “Freshwater Reform 2013 and Beyond” and a National Policy Statement for freshwater management (NPS-FM 2014). Recent resource management reforms and amendments (RMA 2014), based on previous overarching resource management legislation (RMA 1991), set out a new approach and pathway to manage freshwater nationwide. Internationally, there is an increasing trend to engage with indigenous communities for research and collaboration, including indigenous groups as active participants in resource management decision making. What is driving this change toward more engagement and collaboration with indigenous communities is different for each country, and we document the progress and innovation made in this area in New Zealand. The indigenous rights of Māori in New Zealand are stated in the 1840 Treaty of Waitangi and in many forms of New Zealand's legislation. Local and central governments are eager to include local indigenous Māori groups (iwi/hapū) in freshwater management planning processes through meaningful engagement and collaboration. Key to the success of collaborative planning processes for Māori are enduring relationships between local government and Māori, along with adequate resourcing for all partners contributing to the collaborative process. A large number of shared governance and management models for natural resource management have emerged in New Zealand over the past 20 years, and some recent examples are reviewed. We provide some discussion to improve understanding and use of the terms used in these management models such as cogovernance, comanagement, and coplanning, and describe some of the more important frameworks and tools being developed with Māori groups (e.g., iwi/hapū), to strengthen Māori capacity in freshwater management and to support good collaborative process and planning.

Mining Police-Recorded Offence and Incident Data to Inform a Definition of Repeat Domestic Abuse Victimization for Statistical Reporting

Following inspections in 2013 of all police forces, Her Majesty’s Inspectorate of Constabulary found that one-third of forces could not provide data on repeat victims of domestic abuse (DA) and concluded that in general there were ambiguities around the term ‘repeat victim’ and that there was a need for consistent and comparable statistics on DA. Using an analysis of police-recorded DA data from two forces, an argument is made for including both offences and non-crime incidents when identifying repeat victims of DA. Furthermore, for statistical purposes the counting period for repeat victimizations should be taken as a rolling 12 months from first recorded victimization. Examples are given of summary statistics that can be derived from these data down to Community Safety Partnership level. To reinforce the need to include both offences and incidents in analyses, repeat victim chronologies from policerecorded data are also used to briefly examine cases of escalation to homicide as an example of how they can offer new insights and greater scope for evaluating risk and effectiveness of interventions.

How can geographical information systems and spatial analysis inform a response to prescription opioid misuse? a discussion in the context of existing literature

Feasibility study to inform the design of a UK multi-centre randomised controlled trial of prophylactic antibiotics for the prevention of recurrent cellulitis of the leg

Background: This paper describes the results of a feasibility study for a randomised controlled trial (RCT). Methods: Twenty-nine members of the UK Dermatology Clinical Trials Network (UK DCTN) expressed an interest in recruiting for this study. Of these, 17 obtained full ethics and Research & Development (R&D) approval, and 15 successfully recruited patients into the study. A total of 70 participants with a diagnosis of cellulitis of the leg were enrolled over a 5-month period. These participants were largely recruited from medical admissions wards, although some were identified from dermatology, orthopaedic, geriatric and general surgery wards. Data were collected on patient demographics, clinical features and willingness to take part in a future RCT. Results: Despite being a relatively common condition, cellulitis patients were difficult to locate through our network of UK DCTN clinicians. This was largely because patients were rarely seen by dermatologists, and admissions were not co-ordinated centrally. In addition, the impact of the proposed exclusion criteria was high; only 26 (37%) of those enrolled in the study fulfilled all of the inclusion criteria for the subsequent RCT, and were willing to be randomised to treatment. Of the 70 participants identified during the study as having cellulitis of the leg (as confirmed by a dermatologist), only 59 (84%) had all 3 of the defining features of: i) erythema, ii) oedema, and iii) warmth with acute pain/tenderness upon examination. Twenty-two (32%) patients experienced a previous episode of cellulitis within the last 3 years. The median time to recurrence (estimated as the time since the most recent previous attack) was 205 days (95% CI 102 to 308). Service users were generally supportive of the trial, although several expressed concerns about taking antibiotics for lengthy periods, and felt that multiple morbidity/old age would limit entry into a 3-year study. Conclusion: This pilot study has been crucial in highlighting some key issues for the conduct of a future RCT. As a result of these findings, changes have been made to i) the planned recruitment strategy, ii) the proposed inclusion criteria and ii) the definition of cellulitis for use in the future trial.

Using satellite telemetry and environmental niche modelling to inform conservation targets for a long-distance migratory raptor in its wintering grounds

Understanding the ecology of migratory birds during the non-breeding season is necessary for ensuring their conservation. Using satellite telemetry data we describe winter ranging behaviour and movements of pallid harriers Circus macrourus that bred in Kazakhstan. We developed an ecological niche model for the species in Africa, to identify the most suitable wintering areas for pallid harriers and the importance of habitat in determining the location of those areas. We also assessed how well represented suitable areas are in the network of protected areas. Individual harriers showed relatively high fidelity to wintering areas but with potential for interannual changes. The ecological niche model highlighted the importance of open habitats with natural vegetation. Most suitable areas for the species were located in eastern Africa. Suitable areas had a patchy distribution but were relatively well included in the network of protected areas. The preferential use of habitats with natural vegetation by wintering pallid harriers and the patchiness of the most suitable areas highlight the harrier's vulnerability to land-use changes and the associated loss of natural vegetation in Africa. Conservation of harriers could be enhanced by preserving natural grasslands within protected areas and improving habitat management in the human-influenced portions of the species’ core wintering areas.

[recommendations For Physical Exercise Practice During Pregnancy: A Critical Review].

Physical exercise is recommended for all healthy pregnant women. Regular practice of exercises during pregnancy can provide many physical and psychological benefits, with no evidence of adverse outcomes for the fetus or the newborn when exercise is performed at mild to moderate intensity. However, few pregnant women engage in this practice and many still have fears and doubts about the safety of exercise. The objective of the present study was to inform the professionals who provide care for Brazilian pregnant women about the current recommendations regarding physical exercise during pregnancy based on the best scientific evidence available. In view of the perception that few systematic models are available about this topic and after performing several studies in this specific area, we assembled practical information of interest to both the professionals and the pregnant women. We also provide recommendations about the indications, contraindications, modalities (aerobics, resistance training, stretching and pelvic floor training), frequency, intensity and duration indicated for each gestational trimester. The review addresses physical exercise recommendation both for low risk pregnant women and for special populations, such as athletes and obese, hypertensive and diabetic subjects. The advantages of an active and healthy lifestyle should be always reinforced during and after gestation since pregnancy is an appropriate period to introduce new habits because pregnant women are usually more motivated to adhere to recommendations. Thus, routine exams, frequent returns and supervision are recommended in order to provide new guidelines that will have long-term beneficial effects for both mother and child.

Delivery Of A Urology Online Course Using Moodle Versus Didactic Lectures Methods.

To subjectively and objectively compare an accessible interactive electronic library using Moodle with lectures for urology teaching of medical students. Forty consecutive fourth-year medical students and one urology teacher were exposed to two teaching methods (4 weeks each) in the form of problem-based learning: - lectures and - student-centered group discussion based on Moodle (modular object-oriented dynamic learning environment) full time online delivered (24/7) with video surgeries, electronic urology cases and additional basic principles of the disease process. All 40 students completed the study. While 30% were moderately dissatisfied with their current knowledge base, online learning course delivery using Moodle was considered superior to the lectures by 86% of the students. The study found the following observations: (1) the increment in learning grades ranged from 7.0 to 9.7 for students in the online Moodle course compared to 4.0-9.6 to didactic lectures; (2) the self-reported student involvement in the online course was characterized as large by over 60%; (3) the teacher-student interaction was described as very frequent (50%) and moderately frequent (50%); and (4) more inquiries and requisitions by students as well as peer assisting were observed from the students using the Moodle platform. The Moodle platform is feasible and effective, enthusing medical students to learn, improving immersion in the urology clinical rotation and encouraging the spontaneous peer assisted learning. Future studies should expand objective evaluations of knowledge acquisition and retention.

Innovation and entrepreneurship in scientific research

This research wants to lay emphasis on topics that historicize and rescue concepts, in addition, shows the relation between innovation and socioeconomic development resulted; reviews the legal framework to stimulate new innovation into Brazilian society; considers the definition and the entrepreneur university's new paradigm; and finally, this research highlights the importance of teaching entrepreneur at universities, with straight society benefits. The results suggests that innovation is directly enrolled with a successful development of certain society, as well, is actually the biggest business competitive differential into corporative universe. In one way of getting results of social advancement to inform entrepreneur research practice, it appears that entrepreneurs concepts, necessarily, must be incorporated into the array of Science/Technology/Innovation for the effective development of supported formula. This article develops a thought about actual scientific researches paradigm, the way that is built on today, and if it's sufficient to effectively get the results that society expects from main bodies to create human resource and researches, especially those with innovation aspects, at Brazilian economic improvement.

Short report: historical analysis of a near disaster: Anopheles gambiae in Brazil

Attributed to human-mediated dispersal, a species of the Anopheles gambiae complex invaded northeastern Brazil in 1930. This event is considered unique among the intercontinental introductions of disease vectors and the most serious one: "Few threats to the future health of the Americas have equalled that inherent in the invasion of Brazil, in 1930, by Anopheles gambiae." Because it was only in the 1960s that An. gambiae was recognized as a species complex now including seven species, the precise species identity of the Brazilian invader remains a mystery. Here we used historical DNA analysis of museum specimens, collected at the time of invasion from Brazil, and aimed at the identification of the Brazilian invader. Our results identify the arid-adapted Anopheles arabiensis as being the actual invading species. Establishing the identity of the species, in addition to being of intrinsic historical interest, can inform future threats of this sort especially in a changing environment. Furthermore, these results highlight the potential danger of human-mediated range expansions of insect disease vectors and the importance of museum collections in retrieving historical information

Influências metodológicas na mensuração de impacto: o caso das Memórias do Instituto Oswaldo Cruz e sua "qualificação"

In recent years, the availabity of citation indexes for evaluation of Brazilian scientific production has increased. The comparison between the results of the methodologies used to estimate indicators in the citation reports of SciELO database and in Journal Citation Reports (ISI-Thomson Scientific) made it possible to evaluate implications associated to the Brazilian scientific policy (Qualis), regarding some specific criteria. A period of 10 years was considered, taking into account two bibliometric indicators (the total of citations in a year and the Impact Factor) of the journal Memorias do Instituto Oswaldo Cruz, which is indexed in both indexes. The correction of the indicators associated to this journal showed that the differences in the citation indexed were more expressive in 2001, having decreased in the last years. This reduction gives credibility to both databases, validating their systems for the production of bibliometric indicators.

Documentos convencionais e não convencionais em administração, ciências contábeis e economia: estudo sobre sua utilização pelos alunos de graduação

The recommended bibliographical references for the development of scientific research are those published by scientific journals. In spite of this recommendation, the use of non conventional documents by undergraduate students has been increasing. This paper, developed as a survey with 145 students of Administration, Accounting and Economics, characterizes the use these documents and analyzes teaching strategies supported in the use of non conventional documents.