• Title/Summary/Keyword: Evidence-based protocol

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Variation of Practice in Prophylactic Protocol to Reduce Prosthetic Joint Infection in Primary Hip and Knee Arthroplasty: A National Survey in the United Kingdom

  • James Morris;Lee Hoggett;Sophie Rogers;John Ranson;Andrew Sloan
    • Hip & pelvis
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    • v.35 no.4
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    • pp.228-232
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    • 2023
  • Purpose: Prosthetic joint infection (PJI) has an enormous physiological and psychological burden on patients. Surgeons rightly wish to minimise this risk. It has been shown that a standardised, evidence-based approach to perioperative care leads to better patient outcomes. A review of current practice was conducted using a cross-sectional survey among surgeons at multiple centers nationwide. Materials and Methods: An 11-question electronic survey was circulated to hip and knee arthroplasty consultants nationally via the BOA (British Orthopaedic Association) e-newsletter. Results: The respondents included 56 consultants working across 19 different trusts. Thirty-four (60.7%) screen patients for asymptomatic bacteriuria (ASB) preoperatively, with 19 (55.9%) would treating with antibiotics. Fifty-six (100%) screen for methicillin-resistant Staphylococcus aureus and treat if positive. Only 15 (26.8%) screen for methicillin-sensitive S. aureus (MSSA) or empirically eradicate. Zero (0%) routinely catheterize patients perioperatively. Forty-one (73.2%) would give intramuscular or intravenous gentamicin for a perioperative catheterisation. All surgeons use laminar flow theatres. Twenty-six (46.4%) use only an impervious gown, 6 (10.7%) exhaust pipes, and 24 (42.3%) surgical helmet system. Five different antimicrobial prophylaxis regimens are used 9 (16.1%) cefuroxime, 2 (3.6%) flucloxacillin, 19 (33.9%) flucloxacillin and gentamicin, 10 (17.9%) teicoplanin, 16 (28.6%) teicoplanin and gentamicin. Twenty-two (39.3%) routinely give further doses. Conclusion: ASB screening, treatment and intramuscular gentamicin for perioperative catheterisation is routinely practiced despite no supporting evidence base. MSSA screening and treatment is underutilised. Multiple antibiotic regimens exist despite little variation in organisms in PJI. Practice varies between surgeons and centers, we should all be practicing evidence-based medicine.

Review of Studies Using a Rhythm Task Intervention and the Rationale for its Formulation (국내 리듬 중재 연구의 중재 구성 및 논거에 대한 고찰)

  • Chong, Hyun Ju;Lim, Jeong Hyeon;Hwang, Soo Yeon
    • Journal of Music and Human Behavior
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    • v.15 no.1
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    • pp.95-118
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    • 2018
  • With the recent emphasis on evidence-based research and practice, the field of music therapy has called for rigorous reviews of the scientific data and for therapeutic rationales for research procedures. The purpose of this study was to review studies that used a rhythm task as a therapy intervention in terms of whether they provided a rationale for the components related to the intervention. The components included activity rationale, music rationale, intervention validity, intervention format (individual or group), intervention development (contour), duration, and intervention provider. A total of 41 studies were selected: 22 studies were implemented by music therapists and 19 by professionals in other related fields. In terms of seven assessment categories, only 10 studies were found to report more than four items which are related to a rationale of interventions. The 10 studies identified were further examined to determine if their intervention rationale differed depending on whether the study included a researcher-formulated intervention or an existing music therapy protocol. Of the 10 studies, six used a researcher-formulated rhythm intervention, and four used an existing music therapy protocol. Those studies that used an existing music therapy protocol also provided a clear rationale for music selection, whereas those that used a researcher-formulated rhythm task tended to provide an activity rationale. The results of this study suggest that researchers need to be clearer about their interventions and provide an evidence-based rationale for why and how they use a rhythm task.

Mandibular Mini-Implants Supported Overdentures: A Case Report (미니 임플란트를 이용한 하악의 임플란트 지지 피개의치: 증례보고)

  • Park, Jin-Hong;Lee, Jeong-Yol;Shin, Sang-Wan
    • Implantology
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    • v.19 no.3
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    • pp.146-152
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    • 2015
  • Mini-dental implants for overdenture applications are increasingly popular due to their ease in placement with simplified, less traumatic surgical protocols in limited-width alveolar ridges. However, the clinical decisions including implant number, position, and loading protocol must be based on a thorough evaluation and evidence-based diagnosis. Herein, we reported a case treated with the current method of mandibular mini-implant supported overdenture.

Cervico-stylo-mandibular complex fracture: a critical review of literature along with a protocol to recognize and proposal of a new classification

  • Donepudi, Nanda Kishore;Naik, Vinayak Gourish;Rai, Kirthi Kumar
    • Journal of the Korean Association of Oral and Maxillofacial Surgeons
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    • v.45 no.6
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    • pp.302-308
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    • 2019
  • Fractures of the styloid process of the temporal bone may occur with or without an obvious relation to trauma. The incidence of either isolated styloid process fracture or in combination with mandibular fractures is rare, and such occurrences are often misdiagnosed or neglected. A fractured styloid when displaced may impinge on adjacent vital structures, leading to neurological or vascular symptoms that vary according to the anatomical structure compressed. Styloid process fractures associated with atlas/C1 fractures have also been rarely reported in the literature. In this review of literature, the majority of patients was treated conservatively, as few demonstrated the necessity of surgical intervention. There is a definitive need for a protocol to recognize and classify styloid fractures to plan for further treatment. The aim of this review was to achieve a comprehensive understanding of all types of styloid fractures, determine the clinical severity of symptoms, and to consider management and prognosis. In addition, a new classification of cervico-stylo-mandibular fractures is proposed based on important evidence in the literature regarding clinical and radiographic factors that might influence the treatment and prognosis of such fractures.

Development of a Occupation-Based Bilateral Upper Extremity Training Protocol in a Medical Setting for Stroke Patients (뇌졸중 환자를 대상으로 한 병원 환경에서의 작업 기반 양측성 상지 훈련 프로토콜 개발)

  • Kim, Sun-Ho;Kim, Jung Ran;Park, Hae Yean;Han, A-Reum;Kim, Jong-Bae;Park, Ji-Hyuk
    • Therapeutic Science for Rehabilitation
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    • v.9 no.1
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    • pp.24-44
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    • 2020
  • Objective : To develop an occupation-based bilateral upper extremity training protocol that can be effectively applied in a medical setting Methods : The research process using the delphi technique was carried out in 3 stages. The first stage was an open questionnaire development stage, The first draft is prepared through literature review and open questions were developed through preliminary research based on the draft. The second stage was the delphi survey. Based on the responses of the experts obtained through the open Delphi survey, the adequacy of the training protocol was shown on a Likert 5 point scale. The items were edited and deleted, reconstructed by analyzing the mean and standard deviation, stability, convergence degree, consensus, and content validity ratio through the questionnaire. The third step was the completion of the protocol. After discussions between researchers, the finalized protocol contents were reorganized to complete the occupation-based bilateral upper extremity training protocol for medical setting. Results : The final protocol consisted of 9 items across 3 areas in the occupation-based intervention selection domain and 81 items across 4 areas in the bilateral upper extremity training domain, intervention period, and evaluation. Conclusions : This study suggests an evidence-based method that collects the opinions of occupational therapists in order to use occupation-based activities as interventions in a situation that currently sees occupational therapy primarily performed in hospitals. It is also meaningful that the bilateral upper extremity training can be applied effectively in clinical situations by concretely presenting.

Physical Therapy Approaches for Respiratory Diseases (호흡계 질환의 물리치료적 접근방법)

  • Kim, Ki-Song
    • Journal of Korean Physical Therapy Science
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    • v.16 no.3
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    • pp.67-74
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    • 2009
  • Background: Various functional factors should be incorporated during assessment and intervention for patient rehabilitation. Stable respiratory function is one of required factors for functional restoration. To maximize respiratory physical therapy intervention outcome, it is required to understand clinical features of respiratory diseases and physical therapy approaches. Methods: Previous studies were systematically reviewed through computerized search. Methodological qualities of selected studies were evaluated and the levels of recommendations were determined. Results: Assessment for respiratory pattern and thoracic mobility is of importance to improve cardiopulmonary fitness during physical reconditioning. Application of optimal therapeutic protocol can increase thoracic mobility and respiratory function. Interdisciplinary communication is critical during rehabilitation for respiratory patients. Health care provider should have professional knowledge and experience for cardiopulmonary fitness and obligation to endeavor for patients' respiratory rehabilitation. It is necessary to standardize therapeutic intervention, and rehabilitative respiratory exercise should be applied to confirm the effects of intervention. Conclusion: Respiratory diseases that may reduce patients' quality of life and cardiopulmonary fitness should be resolved through physical therapy approaches. Through conducting research, effect of evidence-based and patients' function-oriented intervention can be determined.

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Myofascial Orofacial Pain Exacerbated after Masseteric Nerve Neurectomy

  • Nam, Hyun;Ko, Daeun;Kang, Jin-Kyu;Shim, YoungJoo
    • Journal of Oral Medicine and Pain
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    • v.45 no.4
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    • pp.110-114
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    • 2020
  • Myofascial pain (MFP) is one of the most common causes of persistent orofacial pain. Patients with chronic myofascial orofacial pain may present with diffuse heterotopic pain, complicating the correct diagnosis. Treatment of chronic MFP should focus on the elimination of aetiologic factors. This article describes two cases of chronic MFP of the masticatory muscles, whose symptoms were exacerbated after masseteric nerve neurectomy. The patients had suffered from irrelevant treatment which did not resolve the symptom. Their symptom was managed by conventional treatment protocol. These cases emphasize the importance of correct diagnosis and evidence-based approach.

One-probe P300 based concealed information test with machine learning (기계학습을 이용한 단일 관련자극 P300기반 숨김정보검사)

  • Hyuk Kim;Hyun-Taek Kim
    • Korean Journal of Cognitive Science
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    • v.35 no.1
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    • pp.49-95
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    • 2024
  • Polygraph examination, statement validity analysis and P300-based concealed information test are major three examination tools, which are use to determine a person's truthfulness and credibility in criminal procedure. Although polygraph examination is most common in criminal procedure, but it has little admissibility of evidence due to the weakness of scientific basis. In 1990s to support the weakness of scientific basis about polygraph, Farwell and Donchin proposed the P300-based concealed information test technique. The P300-based concealed information test has two strong points. First, the P300-based concealed information test is easy to conduct with polygraph. Second, the P300-based concealed information test has plentiful scientific basis. Nevertheless, the utilization of P300-based concealed information test is infrequent, because of the quantity of probe stimulus. The probe stimulus contains closed information that is relevant to the crime or other investigated situation. In tradition P300-based concealed information test protocol, three or more probe stimuli are necessarily needed. But it is hard to acquire three or more probe stimuli, because most of the crime relevant information is opened in investigative situation. In addition, P300-based concealed information test uses oddball paradigm, and oddball paradigm makes imbalance between the number of probe and irrelevant stimulus. Thus, there is a possibility that the unbalanced number of probe and irrelevant stimulus caused systematic underestimation of P300 amplitude of irrelevant stimuli. To overcome the these two limitation of P300-based concealed information test, one-probe P300-based concealed information test protocol is explored with various machine learning algorithms. According to this study, parameters of the modified one-probe protocol are as follows. In the condition of female and male face stimuli, the duration of stimuli are encouraged 400ms, the repetition of stimuli are encouraged 60 times, the analysis method of P300 amplitude is encouraged peak to peak method, the cut-off of guilty condition is encouraged 90% and the cut-off of innocent condition is encouraged 30%. In the condition of two-syllable word stimulus, the duration of stimulus is encouraged 300ms, the repetition of stimulus is encouraged 60 times, the analysis method of P300 amplitude is encouraged peak to peak method, the cut-off of guilty condition is encouraged 90% and the cut-off of innocent condition is encouraged 30%. It was also conformed that the logistic regression (LR), linear discriminant analysis (LDA), K Neighbors (KNN) algorithms were probable methods for analysis of P300 amplitude. The one-probe P300-based concealed information test with machine learning protocol is helpful to increase utilization of P300-based concealed information test, and supports to determine a person's truthfulness and credibility with the polygraph examination in criminal procedure.

Development and Application of the Constipation Assessment Tool for Patients with Terminal Cancers (말기 암환자의 변비 사정도구 개발 및 적용)

  • Kim, Myung Ok;Park, Myung Hee;Rye, Min Ae
    • Journal of Korean Clinical Nursing Research
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    • v.18 no.2
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    • pp.205-214
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    • 2012
  • Purpose: The purposes of this study were to develop the constipation assessment tool for identifying their bowel movement patterns, and to provide basic information for the assessment and intervention protocol on constipation for patients with terminal cancers. Methods: The study followed the steps: the first step was to build a conceptual framework based on literature review; the second step was to develop a tentative instrument by analyzing the conceptual framework and existing instruments; the third step was to test content validity and reliability; and the final step was to apply the tool to patients with terminal cancers (N=112). Results: The constipation assessment tool was consisted of total nine items; under the categories of subjective and objective data for diagnosis had 4 items, and under the initial assessment category which includes stool type, physical examination, and abdomen X-ray had 5 items. Conclusion: The constipation assessment tool developed in this study is very easy to use and useful in nursing practice, especially in hospice and palliative care setting. Particularly this tool has items on patient assessment which would be considered as an evidence for choosing nursing interventions. Based on the constipation assessment tool, the development and application of intervention protocol on constipation for patients with terminal cancers is warranted in future research.

Structural Change in CO2 Emissions of Annex B Countries Under the Kyoto Protocol (교토의정서 Annex B 국가의 CO2 배출량 구조변화 분석)

  • Kim, Min Jung;Yang, Ji Hye;Kim, Hyun Seok
    • Environmental and Resource Economics Review
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    • v.26 no.2
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    • pp.123-138
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    • 2017
  • This study estimates the effect of the Kyoto Protocol on $CO_2$ emissions with a Quandt-Andrews test for detection of structural break with Annex B counties data. The structural break on $CO_2$ emissions took place in 2008 which is 3 year after ratification of the Kyoto Protocol. According to the empirical results, 1% increase in energy consumption leads to 1% and 0.31% increases in income before and after the structural break, respectively. This study also finds the monotonic increase relationship between $CO_2$ emission and income. Regarding to the relationship between renewable energy use and $CO_2$ emissions, 1% increase in renewable energy consumption leads to 0.1% decrease in $CO_2$ emissions until year 2007 and 0.09% decreases after year 2008, respectively. Based on the results of empirical study, we find little evidence of the effect of the Kyoto Protocol on reduction of $CO_2$ emissions for Annex B countries.