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

New approaches for the diagnosis of human papillomavirus infection:relevance for clinical practice and cancer prevention

Tese de doutoramento, Biologia (Microbiologia), Universidade de Lisboa, Faculdade de Ciências, 2014

Challenging librarians : the relevance of the doctorate in professional practice

We, as librarians, are adept at challenging academics, students and administrators about the crucial role of information literacy in higher education and lifelong learning. Consequently, the push for strategic partnerships with academics is frequently in the foreground of our thinking. Concomitantly, the push for academic status for librarians is raised occasionally, particularly as a pay and equity issue. Yet, our purposes may appear somewhat misguided or rhetorical when contrasted to the nominal prerequisites required for professional practice, especially when compared with those of academics. The issues of information literacy and knowledge production within a knowledge economy compound such debate. This paper argues that ‘credential creep’ is catching up with librarians in the university sector. In order to be regarded as integral to academic endeavour, those of us who ‘teach’ information literacy may need to match the qualifications normally required by academics. Consonant with this proposal is the Australian and New Zealand Information Literacy Framework: Principles, Standards and Practice (Bundy, 2004) of the Australian and New Zealand Institute for Information Literacy (ANZIIL) and the Council of Australian University Librarians (CAUL). The Framework mirrors many of the desired outcomes of a doctoral degree, a degree possessed by approximately one per cent of Australian librarians but, in comparison, by more than fi fty-four per cent of Australian academics. This paper challenges—not academics—but librarians, to embrace the notion of undertaking doctoral study to enhance our professional (or amateur) practice and our information literacy. The recommendation is derived in essence from my study on doctoral research and information literacy (Macauley, 2001). It also incorporates the current discourse on these issues and uses personal narrative to articulate the findings. It seeks also to explore those tensions and contradictions commensurate with practising what we preach.

A role for glutathione in the pathophysiology of bipolar disorder and schizophrenia? Animal models and relevance to clinical practice.

The tripeptide, glutathione (glutamylcysteinylglycine) is the primary endogenous free radical scavenger in the human body. When glutathione (GSH) levels are reduced there is an increased potential for cellular oxidative stress, characterised by an increase and accruement of reactive oxygen species (ROS). Oxidative stress has been implicated in the pathology of schizophrenia and bipolar disorder. This could partly be caused by alterations in dopaminergic and glutamatergic activity that are implicated in these illnesses. Glutamate and dopamine are highly redox reactive molecules and produce ROS during normal neurotransmission. Alterations to these neurotransmitter pathways may therefore increase the oxidative burden in the brain. Furthermore, mitochondrial dysfunction, as a source of oxidative stress, has been documented in both schizophrenia and bipolar disorder. The combination of altered neurotransmission and this mitochondrial dysfunction leading to oxidative damage may ultimately contribute to illness symptoms. Animal models have been established to investigate the involvement of glutathione depletion in aspects of schizophrenia and bipolar disorder to further characterise the role of oxidative stress in psychopathology. Stemming from preclinical evidence, clinical studies have recently shown antioxidant precursor treatment to be effective in schizophrenia and bipolar disorder, providing a novel clinical angle to augment often suboptimal conventional treatments.

Platelet chemokines and their receptors: what is their relevance to platelet storage and transfusion practice?

The role of platelets as inflammatory cells is demonstrated by the fact that they can release many growth factors and inflammatory mediators, including chemokines, when they are activated. The best known platelet chemokine family members are platelet factor 4 (PF4) and beta-thromboglobulin (beta-TG), which are synthesized in megakaryocytes, stored as preformed proteins in alpha-granules and released from activated platelets. However, platelets also contain many other chemokines such as interleukin-8 (IL-8), growth-regulating oncogene-alpha(GRO-alpha), epithelial neutrophil-activating protein 78 (ENA-78), regulated on activation normal T expressed and secreted (RANTES), macrophage inflammatory protein-1alpha (MIP-1alpha), and monocyte chemotactic protein-3 (MCP-3). They also express chemokine receptors such as CCR4, CXCR4, CCR1 and CCR3. Platelet activation is a feature of many inflammatory diseases such as heparin-induced thrombocytopenia, acquired immunodeficiency syndrome, and congestive heart failure. Substantial amounts of PF4, beta-TG and RANTES are released from platelets on activation, which may occur during storage. Although very few data are available on the in vivo effects of transfused chemokines, it has been suggested that the high incidence of adverse reactions often observed after platelet transfusions may be attributed to the chemokines present in the plasma of stored platelet concentrates.

The relevance of prepaid group practice to the effective delivery of health services.

Mode of access: Internet.

On bridging the gap: The relevance of theory to the practice of conflict resolution

It is often claimed that policy makers and scholars inhabit different worlds and have little for each other. We challenge this perception and claim that there is a strong symbiotic relationship between the two. This relationship is particularly strong in the field of conflict where policy makers may be in desperate need of guidelines, advice and analysis on how to transform complex conflict situations into more peaceful ones. We suggest that policy makers may think in terms of macro and micro-level theories and ideas if they wish to embrace better strategies of conflict resolution.

Relevance of anatomy to medical education and clinical practice: perspectives of medical students, clinicians, and educators

Introduction: Against a backdrop of ever-changing diagnostic and treatment modalities, stakeholder perceptions (medical students, clinicians, anatomy educators) are crucial for the design of an anatomy curriculum which fulfils the criteria required for safe medical practice. This study compared perceptions of students, practising clinicians, and anatomy educators with respect to the relevance of anatomy education to medicine. Methods: A quantitative survey was administered to undergraduate entry (n = 352) and graduate entry students (n = 219) at two Irish medical schools, recently graduated Irish clinicians (n = 146), and anatomy educators based in Irish and British medical schools (n = 30). Areas addressed included the association of anatomy with medical education and clinical practice, mode of instruction, and curriculum duration. Results: Graduate-entry students were less likely to associate anatomy with the development of professionalism, teamwork skills, or improved awareness of ethics in medicine. Clinicians highlighted the challenge of tailoring anatomy education to increase student readiness to function effectively in a clinical role. Anatomy educators indicated dissatisfaction with the time available for anatomy within medical curricula, and were equivocal about whether curriculum content should be responsive to societal feedback. Conclusions: The group differences identified in the current study highlight areas and requirements which medical education curriculum developers should be sensitive to when designing anatomy courses.

Linking Theory and Practice: Performing a Reality Check on a Model of IS Success

The issue of ‘rigour vs. relevance’ in IS research has generated an intense, heated debate for over a decade. It is possible to identify, however, only a limited number of contributions on how to increase the relevance of IS research without compromising its rigour. Based on a lifecycle view of IS research, we propose the notion of ‘reality checks’ in order to review IS research outcomes in the light of actual industry demands. We assume that five barriers impact the efficient transfer of IS research outcomes; they are lack of awareness, lack of understandability, lack of relevance, lack of timeliness, and lack of applicability. In seeking to understand the effect of these barriers on the transfer of mature IS research into practice, we used focus groups. We chose DeLone and McLean’s IS success model as our stimulus because it is one of the more widely researched areas of IS.

Consumer protection in the banking sector : reviewing the Code of Banking Practice

This article explains the relevance of the Code and its place in the regulatory framework, discusses some of the key issues arising in the recent review (as identified by consumer advocates1), and explains the relationship between the Code and the Financial Ombudsman Service.

Modernist 16-19 Business Education in a Postmodern world - critical evidence of business practice and business education in the cultural industries

This article examines the continued relevance of the 16-19 business education curriculum in the UK, stimulated by doubts expressed by Thomas (1996), over its continued relevance. We express a concern that business education needs, but is struggling, to respond to significant societal shifts in consumption and production strategies that do not sit easily within traditional theories of business practice currently underpinning 16-19 business education. We examine firstly, the extent to which a formal body of knowledge couched in a modernist discourse of facts and objectivity can cope with the changing and fluid developments in much current business practice that is rooted in the cultural and symbolic. Secondly, the extent to which both academic and vocational competences provide the means for students to develop a framework of critical understanding that can respond effectively to rapidly changing business environments.Findings are based on research conducted jointly by the University of Manchester and the Manchester Institute for Popular Culture at Manchester Metropolitan University. The growth of dynamism of the cultural industries sector - largely micro-businesses and small and medium sized enterprises (SMEs) -encapsulates forms of business knowledge, business language and business practice which may not immediately fit with the models provided within business education. Results suggest increasingly reflexive forms of consumption being met by similarly reflexive and flexible modes of production.Our evidence suggests that whilst modernist business knowledge is often the foundation for many 16-19 business education courses, these programmes of study/training do not usually reflect the activities of SME and micro-business practitioners in the cultural industries. Given the importance of cultural industries in terms of the production strategies required to meet increasingly reflexive markets, it is suggested that there may be a need to incorporate a postmodern approach to the current content and pedagogy; one that is contextual, cultural and discursive.