Evidence-based best practices

There may also be regulatory and even legal impediments to evidence-based, cost-effective best practice, which undermine one of the main advantages of demand-side subsidies. Ministries of health frequendy have norms for treating health problems—norms that do not always represent evidence-based best practice or the most cost-effective way of addressing a problem. In some cases, the norms may not have kept up with new technologies. Ministerial norms do not always apply to the private sector. Al-... 

Demand-side subsidies allow standardized, evidence-based, best-practice management protocols to be enforced in the private sector. 

Developing and Enhancing Teamwork in Organizations Evidence-Based Best Practices and Guidelines Eduardo Salas, Scott I. Tannenbaum, Debra J. Cohen, Gary Latham, Editors... 

Revision and update of evidence-based best practices (EBBP), using formal and informal formats, to answer high prevalence, high impact clinical questions that update knowledge and collaboration... 

Abbreviations. EBBP, evidence-based best practices DVT, deep vein thrombosis VAP, ventilatory-associated pneumonia. 

This bias—a tendency to place high value on a small sample that is flawed due to inadequate sampling technique—underlies much of the argument about evidence-based medicine and best practice guidelines. Those who strongly support the evidence-based/best practice approach see those who resist it as tending to rely too heavily on their individual clinical experience. Another place where sample bias frequently shows up is in the exclusive use of outcome measures as a proxy with which to monitor month-to-month or quarter-to-quarter exposure. Outcome data usually provide an inadequate sample of exposure, because severe adverse events... 

This is the tendency to look back and remember the "good ol days." We recall our successes with a procedure or system more readily than we recall our failures. This predisposition distorts our judgment when we contemplate giving up a familiar procedure in favor of a new one such as an evidence-based best practice. It may even blind us to the failure of the familiar procedure to produce the outcomes we ascribe to it. It is part of what motivates resistance to change. 

A care bundle is the term used for a group of evidence based clinical practices that, when used on their own, are shown to improve care, but when applied together they result in substantially greater improvements. The challenge for healthcare is to apply these best practices reliably on every patient who needs them, every day, measuring comphance and monitoring the outcome. 

The second component of evidence-based medicine is clinical practice (see also Mayer, 2004 Straus et al., 2005). Clinicians have the responsibility of providing the best possible care to each of their individual patients. One part of being able to provide this optimum care is remaining aware of pertinent evidence that is published in clinical communications (as mentioned in the previous section, this is no small task). It is also incumbent on clinicians to be able to decide for themselves if the evidence presented in a clinical communication is good evidence and if the message of a systematic review or a meta-analysis is justified based on the quality of the report. As Katz (2001) commented ... 

Ideally, this book represents the foundation for best practice in disaster nursing and emergency preparedness, and is a stepping stone for the discipline of disaster nursing research. Chapters in this book were based on empirical evidence whenever it was available. However, the amount of research in existence addressing disaster nursing and health outcomes is limited, and much work remains to be done. The editor welcomes constructive comments regarding the content of this text. 

AMH content is written after consideration of best available scientific evidence, the Product Information, standard international reference sources, and Australian evidence-based and consensus guidelines from government and nongovernment agencies. Information is concise and clinically relevant for Australian practice, providing comparisons between drugs and between drug classes, with a focus on comparative efficacy, safety, and cost. Key advice for patients about how to use medicines safely and effectively is included. 

In 1992, a group led by Gordon Guyatt at McMaster University in Canada first articulated the term evidence based medicine. Evidence-based medicine (EBM) was defined more recently as the integration of best research evidence with clinical expertise and patient values. Despite its recent recognition, EBM has probably always been practiced by health professionals, but what has changed is that the quality of evidence and the clinical benefit of applying it, are now looked at critically and systematically. 

The first stage in practicing EBM is to define the precise question to which an evidence-based answer is required. A carefully focused question will inform the search for relevant evidence, and should (hopefully) avoid excessive retrieval of irrelevant publications and other information sources. For example, a clinician who wishes to know whether it is best to use oral or topical antifungals for the treatment of vaginal candidiasis could articulate the question as What is the relative effectiveness of oral versus intra-vaginal antifungals for the treatment of uncomplicated vulvovaginal candidiasis ... 

Evidence-based practice is increasingly recognized as the best way to maximize the chances of individual... 

Benefit policies are particularly important if health gain/effectiveness is a key objective of the voucher scheme. Benefit policies allow policymakers to define a package of services or a patient management protocol that is derived from evidence-based, cost-effective best practice. The more effective the services covered by the benefit policy, the greater the health gain produced by the scheme. The process of determining the benefit policy... 

Pain is the other cardinal symptom of chronic pancreatitis. The rationale for its treatment with pancreatic enzymes is based on the principle of negative feedback inhibition of the pancreas by the presence of duodenal proteases. The release of cholecystokinin (CCK), the principal secreta-gogue for pancreatic enzymes, is triggered by CCK-releas-ing monitor peptide in the duodenum, which normally is denatured by pancreatic trypsin. In chronic pancreatitis, trypsin insufficiency leads to persistent activation of this peptide and an increased release of CCK, which is thought to cause pancreatic pain because of continuous stimulation of pancreatic enzyme output and increased intraductal pressure. Delivery of active proteases to the duodenum (which can be done reliably only with uncoated preparations) therefore is important for the interruption of this loop. Although enzymatic therapy has become firmly entrenched for the treatment of painful pancreatitis, the evidence supporting this practice is equivocal at best. 

Pain is the other cardinal symptom of chronic pancreatitis. The rationale for its treatment with pancreatic enzymes is based on the principle of negative feedback inhibition of the pancreas by the presence of duodenal proteases. The evidence supporting this practice is equivocal at best. 

---