Clinical practice guidelines for management of parkinson’s disease : a systematic critical appraisal

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2014

Clinical practice guidelines for the psychosocial care of adults with cancer

Clinical practice guidelines are increasingly being developed in medical settings to provide evidence-based recommendations to guide the clinical care of patients. The development of Clinical practice guidelines for the psychosocial care of patients with medical illness is a newer initiative, and more complex as the target audience includes health care professionals from diverse backgrounds. In Australia, the National Breast Cancer Centre and National Cancer Control Initiative have collaborated to develop Clinical practice guidelines for the psychosocial care of adults with cancer, funded by the Australian Government Department of Health and Ageing. This paper outlines the development of these guidelines in the international context, gives an overview of their content, and describes strategies for their implementation and evaluation. Copyright (c) 2005 John Wiley C Sons, Ltd.

Evidence-based medicine is affordable: The cost-effectiveness of current compared with optimal treatment in rheumatoid and osteoarthritis

Objective. To determine the cost-effectiveness of averting the burden of disease. We used secondary population data and metaanalyses of various government-funded services and interventions to investigate the costs and benefits of various levels of treatment for rheumatoid arthritis (RA) and osteoarthritis (OA) in adults using a burden of disease framework. Method. Population burden was calculated for both diseases in the absence of any treatment as years lived with disability (YLD), ignoring the years of life lost. We then estimated the proportion of burden averted with current interventions, the proportion that could be averted with optimally implemented cut-rent evidence-based guidelines, and the direct treatment cost-effectiveness ratio in dollars per YLD averted for both treatment levels. Results. The majority of people with arthritis sought medical treatment. Current treatment for RA averted 26% of the burden, with a cost-effectiveness ratio of $19,000 per YLD averted. Optimal, evidence-based treatment would avert 48% of the burden. with a cost-effectiveness ratio of $12,000 per YLD averted. Current treatment of OA in Australia averted 27% of the burden, with a cost-effectiveness ratio of $25,000 per YLD averted. Optimal, evidence-based treatment would avert 39% of the burden, with an unchanged cost-effectiveness ratio of $25,000 per YLD averted. Conclusion. While the precise dollar costs in each country will differ, the relativities at this level of coverage should remain the same. There is no evidence that closing the gap between evidence and practice would result in a drop in efficiency.

Towards evidence-based guidelines for wise use of computers by children

This paper argues for the systematic development and presentation of evidence-based guidelines for appropriate use of computers by children. The currently available guidelines are characterised and a proposed conceptual model presented. Five principles are presented as a foundation to the guidelines. The paper concludes with a framework for the guidelines, key evidence for and against guidelines, and gaps in the available evidence, with the aim of facilitating further discussion. Relevance to industry The current generation of children in affluent countries will typically have over 10 years of computer experience before they enter the workforce. Consequently, the primary prevention of computer-related health disorders and the development of good productivity skills for the next generation of workers needs to occur during childhood. (c) 2006 Elsevier B.V. All rights reserved.

Proof in the pedagogic pudding? The challenges of promoting evidence-based teaching practice in a research-focused institution

Drawing upon the findings of a mixed methodological study, this paper critically analyses the cultural, pedagogical, and organisational issues encountered by academics and support staff working within a newly established Centre for Learning Innovation and Professional Practice tasked with facilitating a new teaching-focused policy in a previously research-led institution. The aim of this policy is to assure that, across the institution, teaching is given the same priority and kudos as research. Focusing specifically staff perceptions of the impact of the new policy on various aspects of academic life including, pedagogic practice, student support, staff training, and organisational management, the paper critically addresses the cultural and attitudinal challenges of change management (Kotter, 1996) within a ‘grey-brick’ university. In doing so it makes a significant contribution to current academic theory and debate in the areas of pedagogic practice and organisational management.

French good practice guidelines for medical and occupational surveillance of the low back pain risk among workers exposed to manual handling of loads

International audience

French good practice guidelines for management of the risk of low back pain among workers exposed to manual material handling: Hierarchical strategy of risk assessment of work situations

International audience

Development and use of clinical guidelines

The purpose of this chapter is to provide an overview of the development and use of clinical guidelines as a tool for decision making in clinical practice. Nurses have always developed and used tools to guide clinical decision making related to interventions in practice. Since Florence Nightingale (Nightingale 1860) gave us ‘notes’ on nursing in the late 1800s, nurses have continued to use tools, such as standards, policies and procedures, protocols, algorithms, clinical pathways and clinical guidelines, to assist them in making appropriate decisions about patient care that eventuate in the best desired patient outcomes. Clinical guidelines have enjoyed growing popularity as a comprehensive tool for synthesising clinical evidence and information into user-friendly recommendations for practice. Historically, clinical guidelines were developed by individual experts or groups of experts by consensus, with no transparent process for the user to determine the validity and reliability of the recommendations. The acceptance of the evidence-based practice (EBP) movement as a paradigm for clinical decision making underscores the imperative for clinical guidelines to be systematically developed and based on the best available research evidence. Clinicians are faced with the dilemma of choosing from an abundance of guidelines of variable quality, or developing new guidelines. Where do you start? How do you find an existing guideline to fit your practice? How do you know if a guideline is evidence-based, valid and reliable? Should you apply an existing guideline in your practice or develop a new guideline? How do you get clinicians to use the guidelines? How do you know if using the guideline will make any difference in care delivery or patient outcomes? Whatever the choice, the challenge lies in choosing or developing a clinical guideline that is credible as a decision-making tool for the delivery of quality, efficient and effective care. This chapter will address the posed questions through an exploration of the ins and outs of clinical guidelines, from development to application to evaluation.

Infant wrapping as an evidence-based strategy to encourage settling and the utilisation of the supine sleep position

Objective: To identify knowledge, attitudes and practices of child health nurses relating to infant wrapping as an effective settling/sleep strategy. Methods: A pre-test/post-test intervention design was used to explore knowledge, attitudes and practices relating to wrapping in a sample of child health nurses (n=182): a) pre-test survey; b) educational intervention incorporating evidence relating to infant wrapping; SIDS&KIDS endorsed infant wrapping pamphlet; Safe Sleeping recommendations. Emphasis was placed on infant wrapping as an effective settling strategy for parents to use as an alternative to prone positioning; c) post-test survey to evaluate intervention effectiveness. Results: Pretest results identified wide variation in nurses’ knowledge, attitudes and practices of infant wrapping as a settling/sleep strategy. The intervention increased awareness of wrapping guidelines and self-reported practices relating to parent advice. Significant positive changes in nurses’ awareness of wrapping guidelines (p<0.001); to wrap in supine position only (p<0.001); and parental advice to use wrapping as an alternative strategy to prone positioning to assist settling/sleep (p<0.01), were achieved post-test. Conclusions: Managing unsettled infants and promoting safe sleeping practices are issues routinely addressed by child health nurses working with parents of young infants. Queensland has a high incidence of prone sleeping. Infant wrapping is an evidence-based strategy to improve settling and promote supine sleep consistent with public health recommendations. Infant wrapping guidelines are now included in Queensland Health’s state policy and Australian SIDSandKids information relating to safe infant sleeping. In communicating complex health messages to parents, health professionals have a key role in reinforcing safe sleeping recommendations and offering safe, effective settling/sleep strategies to address the non-recommended use of prone positioning for unsettled infants.

Library and information science education 2.0 : guiding principles and models of best practice ALTC Fellowship Report

This ALTC Teaching Fellowship aimed to establish Guiding Principles for Library and Information Science Education 2.0. The aim was achieved by (i) identifying the current and anticipated skills and knowledge required by successful library and information science (LIS) professionals in the age of web 2.0 (and beyond), (ii) establishing the current state of LIS education in Australia in supporting the development of librarian 2.0, and in doing so, identify models of best practice. The fellowship has contributed to curriculum renewal in the LIS profession. It has helped to ensure that LIS education in Australia continues to meet the changing skills and knowledge requirements of the profession it supports. It has also provided a vehicle through which LIS professionals and LIS educators may find opportunities for greater collaboration and more open communication. This will help bridge the gap between LIS theory and practice and will foster more authentic engagement between LIS education and other parts of the LIS industry in the education of the next generation of professionals. Through this fellowship the LIS discipline has become a role model for other disciplines who will be facing similar issues in the coming years. Eighty-one members of the Australian LIS profession participated in a series of focus groups exploring the current and anticipated skills and knowledge needed by the LIS professional in the web 2.0 world and beyond. Whilst each focus group tended to draw on specific themes of interest to that particular group of people, there was a great deal of common ground. Eight key themes emerged: technology, learning and education, research or evidence-based practice, communication, collaboration and team work, user focus, business savvy and personal traits. It was acknowledged that the need for successful LIS professionals to possess transferable skills and interpersonal attributes was not new. It was noted however that the speed with which things are changing in the web 2.0 world was having a significant impact and that this faster pace is placing a new and unexpected emphasis on the transferable skills and knowledge. It was also acknowledged that all librarians need to possess these skills, knowledge and attributes and not just the one or two role models who lead the way. The most interesting finding however was that web 2.0, library 2.0 and librarian 2.0 represented a ‘watershed’ for the LIS profession. Almost all the focus groups spoke about how they are seeing and experiencing a culture change in the profession. Librarian 2.0 requires a ‘different mindset or attitude’. The Levels of Perspective model by Daniel Kim provides one lens by which to view this finding. The focus group findings suggest that we are witnessing a re-awaking of the Australian LIS profession as it begins to move towards the higher levels of Kim’s model (ie mental models, vision). Thirty-six LIS educators participated in telephone interviews aimed at exploring the current state of LIS education in supporting the development of librarian 2.0. Skills and knowledge of LIS professionals in a web 2.0 world that were identified and discussed by the LIS educators mirrored those highlighted in the focus group discussions with LIS professionals. Similarly it was noted that librarian 2.0 needed a focus less on skills and knowledge and more on attitude. However, whilst LIS professionals felt that there was a paradigm shift within the profession. LIS educators did not speak with one voice on this matter with quite a number of the educators suggesting that this might be ‘overstating it a bit’. This study provides evidence for “disparate viewpoints” (Hallam, 2007) between LIS educators and LIS professionals that can have a significant implications for the future of not just LIS professional education specifically but for the profession generally. Library and information science education 2.0: guiding principles and models of best practice 1 Inviting the LIS academics to discuss how their teaching and learning activities support the development of librarian 2.0 was a core part of the interviews conducted. The strategies used and the challenges faced by LIS educators in developing their teaching and learning approaches to support the formation of librarian 2.0 are identified and discussed. A core part of the fellowship was the identification of best practice examples on how LIS educators were developing librarian 2.0. Twelve best practice examples were identified. Each educator was recorded discussing his or her approach to teaching and learning. Videos of these interviews are available via the Fellowship blog at .The LIS educators involved in making the videos felt uncomfortable with the term ‘best practice’. Many acknowledged that there simply seeking to do the best by their students and that there was always room for improvement. For this reason these videos are offered as examples of “great practice”. The videos are a tool for other educators to use, regardless of discipline, in developing their teaching and learning approaches to supporting web 2.0 professionals. It has been argued that the main purpose of professional education is transformation (Dall’ Alba, 2009; Dall’Alba & Barnacle, 2007). As such professional education should focus not just on skills and knowledge acquisition but also on helping students to develop ways of being the professionals in question (ie LIS professionals, teachers, lawyers, engineers).The aim of this fellowship was to establish Guidelines for Library and Information Science Education 2.0 it has however become apparent that at this point in time it is not yet possible to fulfil this aim. The fellowship has clearly identified skills and knowledge needed by the LIS professional in web 2.0 world (and beyond). It has also identified examples of ‘great practice’ by LIS educators as they endeavour to develop LIS professionals who will be successful in a web 20 world. The fellowship however has also shown that the LIS profession is currently undergoing significant attitudinal and conceptual change. Consequently, before a philosophy of LIS education 2.0 can be expressed, the Australian LIS profession must first explore and articulate what it means to be an LIS professional in the 21st century (ie a world of web 2.0 and beyond). In short, the LIS profession in Australia must take stock not of “what we know and can do” but on “who we are becoming” (Dall’Alba, 2009, p 34).