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Translational Science and Evidence-Based Healthcare: A Clarification and Reconceptualization of How Knowledge Is Generated and Used in Healthcare  [PDF]
Alan Pearson,Zoe Jordan,Zachary Munn
Nursing Research and Practice , 2012, DOI: 10.1155/2012/792519
Abstract: The importance of basing health policy and health care practices on the best available international evidence (“evidence-based health care”) and on translating knowledge or evidence into action (“translation science” or “translational research”) is increasingly being emphasized across all health sectors inmost countries. Evidence-based healthcare is a process that identifies policy or clinical questions and addresses these questions by generating knowledge and evidence to effectively and appropriately deliver healthcare in ways that are effective, feasible, and meaningful to specific populations, cultures, and settings. This evidence is then appraised, synthesized, and transferred to service delivery settings and health professionals who then utilize it and evaluate its impact on health outcomes, health systems, and professional practice. Many of the common theories that address this translational process place it apart from the evidence-based practice cycle and most recognise only two translational gaps. This paper seeks to clarify the nature of evidence-based healthcare and translation science and proposes a reconceptualization that both brings together these two dominant ideas in modern healthcare and asserts the existence of a third fundamental gap that is rarely addressed the gap between knowledge need and discovery. 1. Introduction The challenges related to facilitating the cycle of scientific discovery through to the widespread adoption of a healthcare innovation have become of central concern to individuals and communities who seek or need healthcare; health professionals; policy makers; the funders of health services. Indeed, the interface between identifying knowledge needs for health improvement, pure scientific bench research, clinical trial based research, and, ultimately, the implementation of the results of research into some form of pragmatic outcome is a growing source of ongoing angst in both the research and clinical communities. It is a vital enterprise that, if achieved successfully, has the potential to result in dramatic improvements in global health outcomes. Whilst the translation of evidence into action is the raison d’être of the evidence-based practice movement, so, too, is it the core interest of translation science. Clarifying the nature and components of these two seemingly different (but, in our view, clearly complimentary) fields of endeavour and reconceptualizing this complementarity is important in advancing health policy and practice towards improving the health of people globally. Nursing in central to the delivery
Does the world need a scientific society for research on how to improve healthcare?
Michel Wensing, Jeremy M Grimshaw, Martin P Eccles
Implementation Science , 2012, DOI: 10.1186/1748-5908-7-10
Abstract: In the previous decades, scientific research on "how to improve healthcare" has been increasingly recognized as a legitimate field of research [1,2]. It has evolved under various names, including implementation science, knowledge translation (KT) research, improvement science, evidence-based practice, research utilization, delivery science, and patient safety science [3]. Also across a range of other academic fields, such as clinical epidemiology, medical education, and clinical sciences, researchers have started to pay attention to questions concerning how to improve healthcare. Dedicated scientific journals have emerged, such as Implementation Science, BMJ Quality and Safety, and the International Journal for Quality in Health Care. These developments have occurred across the world, although not at equal speed and shape across countries, facilitated by major health-research funders, such as the Canadian Institutes of Health Research, ZonMW in The Netherlands, the Agency for Healthcare Research and Quality, and (more recently) the National Institutes of Health in the United States [4]. Policy makers at the highest level are calling for more and better research in the area [5-7].From our perspective, as academics engaged with improving healthcare, these developments are very positive. Whilst we continue to have debates on the nomenclature, epistemology, concepts, methods, and ways forward for the field, we share the same ambition. Our core idea is that we need to use a scientific process to understand how knowledge is translated into healthcare practice, management, and policy to achieve the best possible (health) outcomes at the optimum value. This implies that we want to learn about the needs of research users and address those needs. Implementation science has been defined as "the study of the methods and results of the implementation of proven treatments, practices, organizational and management interventions into routine practice" [8]. The variety of other name
Clues to the Puzzle of Scientific Evidence
Susan Haack
Principia : an International Journal of Epistemology , 2001,
Abstract: The evidence with respect to scientific claims is like ernpirical eviderwe generally — only more so: more complex, more dependent on instruments, etc., and usually a shared resource. Warranted scientific claims are always warranted by somebody's, or somebodies’, experience, and somebody's or, somebodies', reasoning; so a theory of warrant must begin with the personal and then move to the social before it can get to grips with the impersonal sense in which we speak of a well-warranted claim or ill-founded conjecture.
Scientific Evidence for Hydrostatic Shock  [PDF]
Michael Courtney,Amy Courtney
Physics , 2008,
Abstract: This paper reviews the scientific support for a ballistic pressure wave radiating outward from a penetrating projectile and causing injury and incapacitation. This phenomenon is known colloquially as "hydrostatic shock." The idea apparently originates with Col. Frank Chamberlin, a World War II trauma surgeon and wound ballistics researcher. The paper reviews claims that hydrostatic shock is a myth and considers supporting evidence through parallels with blast, describing the physics of the pressure wave, evidence for remote cerebral effects, and remote effects in the spine and other internal organs. Finally, the review considers the levels of energy transfer required for the phenomenon to be readily observed.
Emergency Department Triage Scales and Their Components: A Systematic Review of the Scientific Evidence
Nasim Farrohknia, Maaret Castrén, Anna Ehrenberg, Lars Lind, Sven Oredsson, H?kan Jonsson, Kjell Asplund, Katarina E G?ransson
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine , 2011, DOI: 10.1186/1757-7241-19-42
Abstract: 1. Does assessment of individual vital signs or chief complaints affect mortality during the hospital stay or within 30 days after arrival at the ED?2. What is the level of agreement between clinicians' triage decisions compared to each other or to a gold standard for each scale (reliability)?3. How valid is each triage scale in predicting hospitalization and hospital mortality?A systematic search of the international literature published from 1966 through March 31, 2009 explored the British Nursing Index, Business Source Premier, CINAHL, Cochrane Library, EMBASE, and PubMed. Inclusion was limited to controlled studies of adult patients (≥15 years) visiting EDs for somatic reasons. Outcome variables were death in ED or hospital and need for hospitalization (validity). Methodological quality and clinical relevance of each study were rated as high, medium, or low. The results from the studies that met the inclusion criteria and quality standards were synthesized applying the internationally developed GRADE system. Each conclusion was then assessed as having strong, moderately strong, limited, or insufficient scientific evidence. If studies were not available, this was also noted.We found ED triage scales to be supported, at best, by limited and often insufficient evidence.The ability of the individual vital signs included in the different scales to predict outcome is seldom, if at all, studied in the ED setting. The scientific evidence to assess interrater agreement (reliability) was limited for one triage scale and insufficient or lacking for all other scales. Two of the scales yielded limited scientific evidence, and one scale yielded insufficient evidence, on which to assess the risk of early death or hospitalization in patients assigned to the two lowest triage levels on a 5-level scale (validity).Triage is a central task in an emergency department (ED). In this context, triage is viewed as the rating of patients' clinical urgency [1]. Rating is necessary to ident
Institutionalization of evidence-informed practices in healthcare settings
Novotná Gabriela,Dobbins Maureen,Henderson Joanna
Implementation Science , 2012, DOI: 10.1186/1748-5908-7-112
Abstract: Background The effective and timely integration of the best available research evidence into healthcare practice has considerable potential to improve the quality of provided care. Knowledge translation (KT) approaches aim to develop, implement, and evaluate strategies to address the research-practice gap. However, most KT research has been directed toward implementation strategies that apply cognitive, behavioral, and, to a lesser extent, organizational theories. In this paper, we discuss the potential of institutional theory to inform KT-related research. Discussion Despite significant research, there is still much to learn about how to achieve KT within healthcare systems and practices. Institutional theory, focusing on the processes by which new ideas and concepts become accepted within their institutional environments, holds promise for advancing KT efforts and research. To propose new directions for future KT research, we present some of the main concepts of institutional theory and discuss their application to KT research by outlining how institutionalization of new practices can lead to their ongoing use in organizations. In addition, we discuss the circumstances under which institutionalized practices dissipate and give way to new insights and ideas that can lead to new, more effective practices. Summary KT research informed by institutional theory can provide important insights into how knowledge becomes implemented, routinized, and accepted as institutionalized practices. Future KT research should employ both quantitative and qualitative research designs to examine the specifics of sustainability, institutionalization, and deinstitutionalization of practices to enhance our understanding of these complex constructs.
Evidence based practice in postgraduate healthcare education: A systematic review
Gemma Flores-Mateo, Josep M Argimon
BMC Health Services Research , 2007, DOI: 10.1186/1472-6963-7-119
Abstract: The design is a systematic review of randomized, non-randomized, and before-after studies. The data sources were MEDLINE, Cochrane Library, EMBASE, CINAHL and ERIC between 1966 and 2006. Main outcomes were knowledge, skills, attitudes and behavior towards EBP. Standardized effect sizes (E-S) were calculated. The E-S was categorized as small (E-S < 0.2), small to moderate (E-S between 0.2 and 0.5), moderate to large (E-S between 0.51 and 0.79), large (E-S > 0.79). Reliability and validity of instruments for evaluating education were assessed. Studies excluded were those that were not original, performed in medical students, focused on prescribing practices, specific health problems, theoretical reviews of different components of EBP, continuing medical education, and testing the effectiveness of implementing guidelines.Twenty-four studies met our inclusion criteria. There were 15 outcomes within the 10 studies for which E-S could be calculated. The E-S ranged from 0.27 (95%CI: -0.05 to 0.59) to 1.32 (95%CI: 1.11 to 1.53). Studies assessing skills, behavior and/or attitudes had a "small to moderate" E-S. Only 1 of the 2 studies assessing knowledge had E-S of 0.57 (95 CI: 0.32 to 0.82) and 2 of the 4 studies that assessed total test score outcomes had "large" E-S. There were 22 instruments used, but only 10 had 2 or more types of validity or reliability evidence.Small improvements in knowledge, skills, attitudes or behavior are noted when measured alone. A large improvement in skills and knowledge in EBP is noted when measured together in a total test score. Very few studies used validated measures tests.One of the most consistent findings in health-service research is the gap between best practice (as determined by scientific evidence) on the one hand and actual clinical care on the other [1,2]. Over the past decade, evidence-based clinical guidelines have become a major feature of healthcare provision. Biomedical researchers in many countries have established program
Applying Evidence in Practice: What We Can Learn from Healthcare  [cached]
Prudence W. Dalrymple
Evidence Based Library and Information Practice , 2010,
Abstract: Applying research findings to practice is the foundation of evidence based practice. In healthcare, evidence based practice depends upon the development, promulgation and application of clinical guidelines. While evidence based medicine (EBM) has been enthusiastically embraced by many, gaps persist, and transmission from research to practice remains slow and uneven. The perception that EBM threatens professional autonomy accounts for some resistance, but even among practitioners who support EBM in concept, the uptake of guidelines has encountered numerous barriers. A recent study of guideline implementation by residents in a tertiary care medical center provides insight into the barriers to guideline adoption, and draws parallels between the uptake of EBM in the healthcare sector and the uptake of evidence based library and information practice (EBLIP) in the library and information field. Through increased understanding of the diffusion of evidence based practice in one field, LIS practitioners can position themselves to avoid similar impediments.
The human proteome – a scientific opportunity for transforming diagnostics, therapeutics, and healthcare
Marc Vidal, Daniel W Chan, Mark Gerstein, Matthias Mann, Gilbert S Omenn, Danilo Tagle, Salvatore Sechi, Workshop Participants
Clinical Proteomics , 2012, DOI: 10.1186/1559-0275-9-6
Abstract: A National Institutes of Health (NIH) workshop was convened in Bethesda, MD on September 26–27, 2011, with representative scientific leaders in the field of proteomics and its applications to clinical settings. The main purpose of this workshop was to articulate ways in which the biomedical research community can capitalize on recent technology advances and synergize with ongoing efforts to advance the field of human proteomics.Proteins are the major components of biological networks and molecular machines, and proteins are the targets for the large majority of drugs available today. Participants in this Workshop recognized that a deeper knowledge of the human proteome could help fill the gap between genomes and phenotypes, transform the way we develop diagnostics and therapeutics, and thereby enhance overall biomedical research and future healthcare. The Human Genome Project and its many follow-on initiatives, including the HapMap and ENCODE, together with advances in protein sciences, have provided a foundation for proteomic technologies and informatics resources. Several major initiatives are already moving toward deep characterization of the human proteome, including the antibody-based Human Protein Atlas, the NIH Common Fund Protein Capture Reagents, the mass spectrometry-based Peptide Atlas and Selected Reaction Monitoring (SRM) Atlas, and the Human Proteome Project organized by the Human Proteome Organization. Several leading laboratories have demonstrated that about 10,000 protein products, of the about 20,000 protein-coding human genes, can be identified and quantified in a single experimental specimen; this figure may represent nearly the complete complement of proteins actually expressed in a single cell type. In yeast the complete expressed proteome has been identified. Even though a more comprehensive characterization of the dynamic aspect of the proteome will require further technology development, it is a disruptive concept that almost all of the prim
Supporting smoking cessation in healthcare: obstacles in scientific understanding and tobacco addiction management  [PDF]
Dianne de Korte, Onno C. P. van Schayck, Paul van Spiegel, Ad A. Kaptein, Alfred Sachs, Maureen Rutten-van M?lken, Niels Chavannes, Trudi Tromp-Beelen, Rik Bes, Remi Allard, Gerard Peeters, Leo Kliphuis, Jan Willem Schouten, Lies van Gennip, René van Ommen, Javier Asin
Health (Health) , 2010, DOI: 10.4236/health.2010.211189
Abstract: Despite ongoing efforts to reduce tobacco smoking, the smoking prevalence in many countries has remained stable for years. This may be a consequence of either lack of knowledge about effective ways to reduce smoking, or failing treatment of tobacco addiction in healthcare. This study explored gaps in the current understanding of smoking cessation and the challenges facing tobacco addiction management in order to formulate recommendations for future research and healthcare practice. A narrative review was written to determine areas in which more research is needed as well as areas in which sufficient knowledge is already available. Recommendations for future research were prioritised using a Delphi-procedure. Recommendations for healthcare practice were confirmed by expert’s assessment. Smoking is not widely acknowledged as an addiction and a relatively small number of smokers ask help from a healthcare professional when trying to stop smoking. Most healthcare professionals recognise the importance of advising patients to stop smoking, but experience certain barriers to actually do this. Overall, healthcare professionals need to be convinced that tobacco smoking is an addiction and should be treated likewise. If all healthcare professionals systematically advise their patients to give up smoking, eventually more smokers will successfully stop smoking.
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