The information specialist in the clinical team: Building expertise in evidence-based healthcare

The Clinician Development Program (CDP) is an initiative of Queensland Health’s Quality Improvement and Enhancement Program. At the Royal Brisbane & Royal Women's Hospital Health Service Districts, evidence-base practice (EBP) is an important CDP area in which several projects were carried out in 2002. This paper describes one such project. A medical librarian was invited to accompany the clinical team on morning rounds in the Medical Assessment & Planning Unit (MAPU). The librarian conducted information skills training in the ward and helped clinicians to answer questions directly related to patient care. Questions not answered during the round were followed-up, usually within 48 hours, and responses emailed to the consultant who led the rounds. At the project’s conclusion the librarian was invited to continue as a member of the MAPU clinical team, thus acknowledging the valuable role an information specialist can play in incorporating research evidence into patient care. Clinical librarianship (CL) creates a space, albeit a contentious one, for the health librarian at the bedside. This paper describes an Australian CL project and attempts to demystify the role of an information specialist in EBP. It also highlights some of the challenges facing librarians and clinicians attempting to embed EBP in clinical settings.

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.

The development and evaluation of an evidence-based drug information service

DUE TO COPYRIGHT RESTRICTIONS ONLY AVAILABLE FOR CONSULTATION AT ASTON UNIVERSITY LIBRARY AND INFORMATION SERVICES WITH PRIOR ARRANGEMENT

Evidence based pharmacogenetics study of the use of anti-psychotics in treatment of schizophrenia

DUE TO COPYRIGHT RESTRICTIONS ONLY AVAILABLE FOR CONSULTATION AT ASTON UNIVERSITY LIBRARY AND INFORMATION SERVICES WITH PRIOR ARRANGEMENT

Evidence based assessment of the cardiovascular adverse effects of specific cyclooxy-genase-2 inhibitors

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Expanding the evidence within evidence-based healthcare:thinking about the context, acceptability and feasibility of interventions

Evidence-based medicine is crucial to contemporary healthcare. It is dependent on systematic review methodology modelled on an arguably inadequate hierarchy of evidence. There has been a significant increase in medical and health research using qualitative and mixed method designs. The perspective taken in this article is that we need to broaden our evidence base if we are to fully take account of issues of context, acceptability and feasibility in the development and implementation of healthcare interventions. One way of doing this is to use a range of methods that better fit the different aspects of intervention development and implementation. Methods for the systematic review of evidence, other than randomised-controlled trials, are available and there is a readiness to incorporate these other types of evidence into good-practice guidance, but we need a clear methodology to translate these advances in research into the world of policy.

Evidence-based nanoscopic and molecular framework for excipient functionality in compressed orally disintegrating tablets

The work investigates the adhesive/cohesive molecular and physical interactions together with nanoscopic features of commonly used orally disintegrating tablet (ODT) excipients microcrystalline cellulose (MCC) and D-mannitol. This helps to elucidate the underlying physico-chemical and mechanical mechanisms responsible for powder densification and optimum product functionality. Atomic force microscopy (AFM) contact mode analysis was performed to measure nano-adhesion forces and surface energies between excipient-drug particles (6-10 different particles per each pair). Moreover, surface topography images (100 nm2-10 μm2) and roughness data were acquired from AFM tapping mode. AFM data were related to ODT macro/microscopic properties obtained from SEM, FTIR, XRD, thermal analysis using DSC and TGA, disintegration testing, Heckel and tabletability profiles. The study results showed a good association between the adhesive molecular and physical forces of paired particles and the resultant densification mechanisms responsible for mechanical strength of tablets. MCC micro roughness was 3 times that of D-mannitol which explains the high hardness of MCC ODTs due to mechanical interlocking. Hydrogen bonding between MCC particles could not be established from both AFM and FTIR solid state investigation. On the contrary, D-mannitol produced fragile ODTs due to fragmentation of surface crystallites during compression attained from its weak crystal structure. Furthermore, AFM analysis has shown the presence of extensive micro fibril structures inhabiting nano pores which further supports the use of MCC as a disintegrant. Overall, excipients (and model drugs) showed mechanistic behaviour on the nano/micro scale that could be related to the functionality of materials on the macro scale. © 2014 Al-khattawi et al.

Testing the assertion that 'local food is best':the challenges of an evidence-based approach

Advocates of ‘local food’ claim it serves to reduce food miles and greenhouse gas emissions, improve food safety and quality, strengthen local economies and enhance social capital. We critically review the philosophical and scientific rationale for this assertion, and consider whether conventional scientific approaches can help resolve the debate. We conclude that food miles are a poor indicator of the environmental and ethical impacts of food production. Only through combining spatially explicit life cycle assessment with analysis of social issues can the benefits of local food be assessed. This type of analysis is currently lacking for nearly all food chains.

The impact of standards -based practices in mathematics on the achievement of low -performing students

This study examined standards-based mathematics reform initiatives to determine if they would improve student achievement on the part of low-performing students. New curricula, the Carnegie Learning Cognitive Tutor®, were provided for algebra and geometry students. The new instructional strategy relied on both the teacher-led instruction and the use of computers to differentiate instruction for individual students. Mathematics teachers received ongoing professional development to help them implement the new curricula. In addition, teachers were provided with ongoing support to assist them with the transformation of the learning environments for students using standards-based practices. This quasi-experimental (nonrandomized) study involved teachers in two matched urban high schools. Analyses (ANCOVAs) revealed that the experimental group with an appropriately implemented program had significantly higher learning gains than the comparison group as determined by the students' 2007 mathematics Developmental Scale Score (DSS). In addition, the experimental group's adjusted mean for the second interim mathematics assessment was significantly higher than the comparison group's mean. The findings support the idea that if the traditional curriculum is replaced with standards-based curriculum, and the curriculum is implemented as intended, low-performing students may make significant learning gains. With respect to the teaching practices as observed with the Classroom Observation Protocol (COP), t-tests were conducted on four constructs. The results for both the algebra and geometry teachers on the constructs were not significant. The COP indicated that teachers in both the experimental and comparison groups used traditional instruction strategies in their classrooms. The analyses of covariance (ANCOVA) on the use of technology revealed no significant main effects for computer use.

The impact of standards-based practices in mathematics on the achievement of low-performing students

This study examined standards-based mathematics reform initiatives to determine if they would improve student achievement on the part of low-performing students. New curricula, the Carnegie Learning Cognitive Tutor®, were provided for algebra and geometry students. The new instructional strategy relied on both the teacher-led instruction and the use of computers to differentiate instruction for individual students. Mathematics teachers received ongoing professional development to help them implement the new curricula. In addition, teachers were provided with ongoing support to assist them with the transformation of the learning environments for students using standards-based practices. This quasi-experimental (nonrandomized) study involved teachers in two matched urban high schools. Analyses (ANCOVAs) revealed that the experimental group with an appropriately implemented program had significantly higher learning gains than the comparison group as determined by the students' 2007 mathematics Developmental Scale Score (DSS). In addition, the experimental group's adjusted mean for the second interim mathematics assessment was significantly higher than the comparison group's mean. The findings support the idea that if the traditional curriculum is replaced with standards-based curriculum, and the curriculum is implemented as intended, low-performing students may make significant learning gains. With respect to the teaching practices as observed with the Classroom Observation Protocol (COP), t-tests were conducted on four constructs. The results for both the algebra and geometry teachers on the constructs were not significant. The COP indicated that teachers in both the experimental and comparison groups used traditional instruction strategies in their classrooms. The analyses of covariance (ANCOVA) on the use of technology revealed no significant main effects for computer use.

Complete denture occlusion: an evidence-based approach

Purpose: This study involved an extensive search for randomized controlled clinical trials comparing bilateral balanced and canine-guided dentures, and questioned whether a bilateral balanced occlusion is imperative for successful denture treatment. Materials and Methods: Studies were identified by searching electronic databases (PubMed/MEDLINE, ISI Web of Science, LILACS, and BBD). The keywords “denture” and “occlusion” were used. The minimum inclusion requirements were (1) randomized controlled trials with patients of any age wearing both maxillary and mandibular conventional complete dentures (CDs), (2) comparison between bilateral balanced and canine-guided dentures, and (3) assessment of masticatory function and/or patients’ satisfaction. Results: The search resulted in the identification of 5166 articles. Subsequently, 5156 articles were excluded on the basis of title and abstract. By the end of the search phase, seven randomized controlled trials were considered eligible. Conclusions: Current scientific evidence suggests that bilateral balanced occlusion is not imperative for successful treatment with conventional CDs in average patients. More studies are necessary to identify if specific clinical conditions may benefit from a balanced occlusion.