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Abstract
Many research initiatives have been employed in upper limb prosthetics (ULP) in the last few decades. The body of knowledge is growing and inspired by new and interesting technology that has been brought to the market to facilitate functioning of people with upper limb defects. However, a lot of research initiatives do not reach the target population. Several reasons can be identified as to why research does not move beyond the lab, such as lack of research quality, disappointing results of new initiatives, lack of funding to further develop promising initiatives, and poor implementation or dissemination of results. In this paper, we will appraise the current status of the research in ULP. Furthermore, we will try to provide food for thought to scale up research in ULP, focusing on (1) translation of research findings, (2) the quality of innovations in the light of evidence-based medicine and evidence-based practice, (3) patient involvement, and (4) spreading of research findings by focusing on implementation and dissemination of results and collaboration in a national and international perspective. With this paper, we aim to open the discussion on scaling up research in the community of professionals working in the field of ULP.
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Paez A. The "architect analogy" of evidence-based practice: Reconsidering the role of clinical expertise and clinician experience in evidence-based health care. J Evid Based Med 2018; 11:219-226. [PMID: 30444073 DOI: 10.1111/jebm.12321] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/29/2018] [Indexed: 01/11/2023]
Abstract
The role of expertise in evidence-based medicine (EBM) and practice (EBP) has long been debated. In the early years of the EBP movement, the role of expertise and experience were diminished in clinical decision-making. However, the concepts of EBP are evolving. A more nuanced view of the value of clinician expertise, based on experience and clinical judgement, has emerged. This article proposes that clinical expertise does not belong within the evidence hierarchy's decision-making pyramid as the lowest form of evidence, but rather alongside it, representing a complementary source of knowledge that supports the processes of EBP. An "Architect Analogy of EBP" is proposed as a new model by which to describe this relationship. In this analogy, the clinician's use of expertise is likened to the role of an architect, using evidence as building blocks in the construction of the client's edifice, representing the patients' health and wellbeing. Much as an architect carefully designs the edifice in consultation with the client's needs and preferences, choosing appropriate material (evidence), rejecting faulty material, and ensuring construction stays on course, the clinician must sort through a plethora of sometimes contradictory evidence, evaluate its merits and appropriateness for the patients' unique biopsychosocial circumstances and values, and monitor the effects of interventions on patients' health and wellbeing. The expertise of practitioners, as the architects of EBP, is an important supporting source of knowledge that facilitates the "Five Steps of EBP," informs and facilitates EBP, and supports patient-centred care.
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Affiliation(s)
- Arsenio Paez
- Nuffield Department of Primary Care Health Sciences, Department for Continuing Education, The University of Oxford, Oxford, UK
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Tsao MW, Cornacchi SD, Hodgson N, Simunovic M, Thabane L, Cheng J, O'Brien MA, Strang B, Mukherjee SD, Lovrics PJ. A Population-Based Study of the Effects of a Regional Guideline for Completion Axillary Lymph Node Dissection on Axillary Surgery in Patients with Breast Cancer. Ann Surg Oncol 2016; 23:3354-64. [PMID: 27342830 DOI: 10.1245/s10434-016-5310-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Evidence from the American College of Surgeons Oncology Group (ACOSOG) Z0011 trial suggests completion axillary lymph node dissection (cALND) after positive sentinel lymph node biopsy (+SLNB) does not improve outcomes in select patients, leading to practice variation. A multidisciplinary group of surgeons, oncologists, and pathologists developed a regional guideline for cALND which was disseminated in August 2012. We assessed the impact of Z0011 and the regional guideline on cALND rates. METHODS Consecutive invasive breast cancer cases undergoing SLNB were reviewed at 12 hospitals. Patient, tumor, and process measures were collected for three time periods: TP1, before publication of Z0011 (May 2009-August 2010); TP2, after publication of Z0011 (March 2011-June 2012); and TP3, after guideline dissemination (January 2013-April 2014). Cases were categorized by whether they met the guideline criteria for cALND (i.e. ≤50 years, mastectomy, T3 tumor, three or more positive sentinel lymph nodes [SLNs]) or not (e.g. age > 50 years, breast-conserving surgery, T1/T2 tumor, and one to two positive SLNs). RESULTS The SLNB rate increased from 56 % (n = 620), to 70 % (n = 774), to 78 % (n = 844) in TP1, TP2, and TP3, respectively. Among cases not recommended for cALND using the guideline criteria, cALND rates decreased significantly over time (TP1, 71 %; TP2, 43 %; TP3, 17 %) [p < 0.001]. The cALND rate also decreased over time among cases recommended to have cALND using the guideline criteria (TP1, 92 %; TP2, 69 %; TP3, 58 %) [p < 0.001]. Based on multivariable analysis, age and nodal factors appeared to be significant factors for cALND decision making. CONCLUSION Publication of ACOSOG Z0011 and regional guideline dissemination were associated with a marked decrease in cALND after +SLNB, even among several cases in which the guideline recommended cALND.
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Affiliation(s)
- Miriam W Tsao
- Department of Surgery, McMaster University, Hamilton, ON, Canada
| | | | - Nicole Hodgson
- Department of Surgery, McMaster University, Hamilton, ON, Canada.,Department of Surgical Oncology, Hamilton Health Sciences and Juravinski Hospital and Cancer Centre, Hamilton, ON, Canada
| | - Marko Simunovic
- Department of Surgery, McMaster University, Hamilton, ON, Canada.,Department of Surgical Oncology, Hamilton Health Sciences and Juravinski Hospital and Cancer Centre, Hamilton, ON, Canada.,Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Lehana Thabane
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.,Biostatistics Unit, St. Joseph's Healthcare, Hamilton, ON, Canada
| | - Ji Cheng
- Biostatistics Unit, St. Joseph's Healthcare, Hamilton, ON, Canada
| | - Mary Ann O'Brien
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Barbara Strang
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - Som D Mukherjee
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - Peter J Lovrics
- Department of Surgery, McMaster University, Hamilton, ON, Canada. .,Department of Surgical Oncology, Hamilton Health Sciences and Juravinski Hospital and Cancer Centre, Hamilton, ON, Canada. .,Department of Surgery, St. Joseph's Healthcare, Hamilton, ON, Canada.
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Gugiu PC. Hierarchy of evidence and appraisal of limitations (HEAL) grading system. EVALUATION AND PROGRAM PLANNING 2015; 48:149-159. [PMID: 25245705 DOI: 10.1016/j.evalprogplan.2014.08.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Despite more than 30 years of effort that has been dedicated to the improvement of grading systems for evaluating the quality of research study designs considerable shortcomings continue. These shortcomings include the failure to define key terms, provide a comprehensive list of design flaws, demonstrate the reliability of such grading systems, properly value non-randomized controlled trials, and develop theoretically-derived systems for penalizing and promoting the evidence generated by a study. Consequently, in light of the importance of grading guidelines in evidence-based medicine, steps must be taken to remedy these deficiencies. This article presents two methods--a grading system and a measure of methodological bias--for evaluating the quality of evidence produced by an efficacy study.
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Affiliation(s)
- P Cristian Gugiu
- Quantitative Research, Evaluation, and Measurement Department of Educational Studies, The Ohio State University, Columbus, OH, United States.
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Genuis SJ, Liu Y, Genuis QIT, Martin JW. Phlebotomy treatment for elimination of perfluoroalkyl acids in a highly exposed family: a retrospective case-series. PLoS One 2014; 9:e114295. [PMID: 25504057 PMCID: PMC4264749 DOI: 10.1371/journal.pone.0114295] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 11/07/2014] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Perfluoroalkyl acids (PFAAs) are a family of commonly used synthetic chemicals that have become widespread environmental contaminants. In human serum, perfluorohexane sulfonate (PFHxS), perflurooctane sulfonate (PFOS), and perfluorooctanoate (PFOA) are most frequently detected, in part owing to their long elimination half-lives of between 3.8 yrs (PFOA) and 8.5 yrs (PFHxS). These PFAAs also cross the placenta and have been associated with developmental toxicity, and some are considered likely human carcinogens. Interventions to eliminate PFAAs in highly contaminated individuals would reduce future health risks, but minimal research has been conducted on methods to facilitate accelerated human clearance of these persistent substances. METHODS Six patients with elevated serum concentrations from a single family were treated by intermittent phlebotomy over a 4-5 year period at intervals similar to, or less frequent than what is done for routine blood donation at Canadian Blood Services. The apparent elimination half-life (HLapp) for PFHxS, PFOS, and PFOA in this treated population was calculated in each patient and compared to the intrinsic elimination half-lives (HLin) from a literature reference population of untreated fluorochemical manufacturing plant retirees (n = 26, age >55 yrs). RESULTS For all three PFAAs monitored during phlebotomy, HLapp in each of the family members (except the mother, who had a low rate of venesection) was significantly shorter than the geometric mean HL measured in the reference population, and in some cases were even shorter compared to the fastest eliminator in the reference population. CONCLUSION This study suggests significantly accelerated PFAA clearance with regular phlebotomy treatment, but the small sample size and the lack of controls in this clinical intervention precludes drawing firm conclusions. Given the minimal risks of intermittent phlebotomy, this may be an effective and safe clinical intervention to diminish the body burden of PFAAs in highly exposed people.
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Affiliation(s)
- Stephen J. Genuis
- Faculty of Medicine and Dentistry. University of Alberta, Edmonton, Alberta, Canada
| | - Yanna Liu
- Division of Analytical & Environmental Toxicology, Department of Laboratory Medicine & Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Quentin I. T. Genuis
- MD Program, Faculty of Medicine and Dentistry. University of Alberta, Edmonton, Alberta, Canada
| | - Jonathan W. Martin
- Division of Analytical & Environmental Toxicology, Department of Laboratory Medicine & Pathology, University of Alberta, Edmonton, Alberta, Canada
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Keyes GR, Nahai F, Iverson RE, Singer R. Evidence-based medicine and data sharing in outpatient plastic surgery. Clin Plast Surg 2013; 40:453-63. [PMID: 23830754 DOI: 10.1016/j.cps.2013.04.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The Authors discuss the importance of evidence based medicine (EBM) as related particularly to outpatient surgery. They discuss the five core steps in current EBM and take the reader through each of the steps, listing methods the surgeon can follow to achieve a thorough and relevant evidence based plan. Challenges of EBM such as reporting bias and evidence grading are discussed along with solutions and tools to meet those challenges. The article concludes with a look at data sharing as a means of enabling surgeons to access outcomes and specific aspects of care for a surgical procedure.
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Affiliation(s)
- Geoffrey R Keyes
- Accreditation of Ambulatory Surgery Facilities, Inc., 5101 Washington Street, 2F Gurnee, IL 60031, USA.
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Sears ME, Genuis SJ. Environmental determinants of chronic disease and medical approaches: recognition, avoidance, supportive therapy, and detoxification. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2012; 2012:356798. [PMID: 22315626 PMCID: PMC3270432 DOI: 10.1155/2012/356798] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/16/2011] [Accepted: 10/19/2011] [Indexed: 12/24/2022]
Abstract
The World Health Organization warns that chronic, noncommunicable diseases are rapidly becoming epidemic worldwide. Escalating rates of neurocognitive, metabolic, autoimmune and cardiovascular diseases cannot be ascribed only to genetics, lifestyle, and nutrition; early life and ongoing exposures, and bioaccumulated toxicants may also cause chronic disease. Contributors to ill health are summarized from multiple perspectives--biological effects of classes of toxicants, mechanisms of toxicity, and a synthesis of toxic contributors to major diseases. Healthcare practitioners have wide-ranging roles in addressing environmental factors in policy and public health and clinical practice. Public health initiatives include risk recognition and chemical assessment then exposure reduction, remediation, monitoring, and avoidance. The complex web of disease and environmental contributors is amenable to some straightforward clinical approaches addressing multiple toxicants. Widely applicable strategies include nutrition and supplements to counter toxic effects and to support metabolism; as well as exercise and sweating, and possibly medication to enhance excretion. Addressing environmental health and contributors to chronic disease has broad implications for society, with large potential benefits from improved health and productivity.
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Affiliation(s)
- Margaret E Sears
- Children's Hospital of Eastern Ontario Research Institute, Ottawa Hospital Research Institute, Ottawa, ON, Canada K1H 8L1.
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Genuis SJ, Lipp CT. Electromagnetic hypersensitivity: fact or fiction? THE SCIENCE OF THE TOTAL ENVIRONMENT 2012; 414:103-112. [PMID: 22153604 DOI: 10.1016/j.scitotenv.2011.11.008] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2011] [Revised: 11/01/2011] [Accepted: 11/01/2011] [Indexed: 05/31/2023]
Abstract
As the prevalence of wireless telecommunication escalates throughout the world, health professionals are faced with the challenge of patients who report symptoms they claim are connected with exposure to some frequencies of electromagnetic radiation (EMR). Some scientists and clinicians acknowledge the phenomenon of hypersensitivity to EMR resulting from common exposures such as wireless systems and electrical devices in the home or workplace; others suggest that electromagnetic hypersensitivity (EHS) is psychosomatic or fictitious. Various organizations including the World Health Organization as well as some nation states are carefully exploring this clinical phenomenon in order to better explain the rising prevalence of non-specific, multi-system, often debilitating symptoms associated with non-ionizing EMR exposure. As well as an assortment of physiological complaints, patients diagnosed with EHS also report profound social and personal challenges, impairing their ability to function normally in society. This paper offers a review of the sparse literature on this perplexing condition and a discussion of the controversy surrounding the legitimacy of the EHS diagnosis. Recommendations are provided to assist health professionals in caring for individuals complaining of EHS.
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What's out there making us sick? JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2011; 2012:605137. [PMID: 22262979 PMCID: PMC3202108 DOI: 10.1155/2012/605137] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2011] [Accepted: 07/26/2011] [Indexed: 02/08/2023]
Abstract
Throughout the continuum of medical and scientific history, repeated evidence has confirmed that the main etiological determinants of disease are nutritional deficiency, toxicant exposures, genetic predisposition, infectious agents, and psychological dysfunction. Contemporary conventional medicine generally operates within a genetic predestination paradigm, attributing most chronic and degenerative illness to genomic factors, while incorporating pathogens and psychological disorder in specific situations. Toxicity and deficiency states often receive insufficient attention as common source causes of chronic disease in the developed world. Recent scientific evidence in health disciplines including molecular medicine, epigenetics, and environmental health sciences, however, reveal ineluctable evidence that deficiency and toxicity states feature prominently as common etiological determinants of contemporary ill-health. Incorporating evidence from historical and emerging science, it is evident that a reevaluation of conventional wisdom on the current construct of disease origins should be considered and that new knowledge should receive expeditious translation into clinical strategies for disease management and health promotion. An analysis of almost any scientific problem leads automatically to a study of its history. —Ernst Mayr
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Investigación documental en el ámbito de la dietética y nutrición. REVISTA ESPAÑOLA DE NUTRICIÓN HUMANA Y DIETÉTICA 2011. [DOI: 10.1016/s2173-1292(11)70031-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] Open
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Puljak L, Sapunar D. Web-based elective courses for medical students: an example in pain. PAIN MEDICINE 2011; 12:854-63. [PMID: 21481172 DOI: 10.1111/j.1526-4637.2011.01104.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Online learning is an efficient new educational method that is able to link teachers with geographically dispersed students and capture the interest of students with interactive materials. Our objective was to describe curricula of new Web-based electives about pain for undergraduate medical education. DESIGN We created three interactive Web-based elective courses about pain targeted to medical and dental students. "The Puzzle of Pain" course introduced basic concepts of pain and neurobiology of pain. The humanities-based curriculum of "Empathy and Pain" taught students about emotional aspects of pain and empathetic responses. "The Cochrane Library and Pain" course introduced students to the concept of evidence-based medicine, critical appraisal of the literature, and the hierarchy of evidence in medicine. OUTCOME MEASURES We measured program effectiveness with a pretest/posttest instrument and student satisfaction survey. RESULTS Mean knowledge scores increased significantly after the program and overall evaluations were positive. CONCLUSIONS Delivering the pain electives for medical students in an online format was an efficient educational method, with high student satisfaction scores. Medical educators should consider online electives for medical students in pain studies as well as in other content areas.
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Affiliation(s)
- Livia Puljak
- Department of Anatomy, University of Split School of Medicine, Split, Croatia.
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Genuis SJ. Sensitivity-related illness: the escalating pandemic of allergy, food intolerance and chemical sensitivity. THE SCIENCE OF THE TOTAL ENVIRONMENT 2010; 408:6047-6061. [PMID: 20920818 DOI: 10.1016/j.scitotenv.2010.08.047] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2010] [Revised: 08/21/2010] [Accepted: 08/26/2010] [Indexed: 05/29/2023]
Abstract
The prevalence of allergic-related diseases, food intolerance, and chemical sensitivities in both the pediatric and adult population has increased dramatically over the last two decades, with escalating rates of associated morbidity. Conditions of acquired allergy, food intolerance and chemical hypersensitivity are frequently the direct sequelae of a toxicant induced loss of tolerance (TILT) in response to a significant initiating toxic exposure. Following the primary toxicant insult, the individuals become sensitive to low levels of diverse and unrelated triggers in their environment such as commonly encountered chemical, inhalant or food antigens. Among sensitized individuals, exposure to assorted inciting stimuli may precipitate diverse clinical and/or immune sequelae as may be evidenced by clinical symptoms as well as varied lymphocyte, antibody, or cytokine responses in some cases. Recently recognized as a mechanism of disease development, TILT and resultant sensitivity-related illness (SRI) may involve various organ systems and evoke wide-ranging physical or neuropsychological manifestations. With escalating rates of toxicant exposure and bioaccumulation in the population-at-large, an increasing proportion of contemporary illness is the direct result of TILT and ensuing SRI. Avoidance of triggers will preclude symptoms, and desensitization immunotherapy or immune suppression may ameliorate symptomatology in some cases. Resolution of SRI generally occurs on a gradual basis following the elimination of bioaccumulated toxicity and avoidance of further initiating adverse environmental exposures. As has usually been the case throughout medical history whenever new evidence regarding disease mechanisms emerges, resistance to the translation of knowledge abounds.
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Affiliation(s)
- Stephen J Genuis
- Environmental Health Sciences, Faculty Of Medicine, University Of alberta, Canada.
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Abstract
Evidence-based medicine is defined as the conscientious, explicit, and judicious use of current best evidence, combined with individual clinical expertise and patient preferences and values, in making decisions about the care of individual patients. In an effort to emphasize the importance of evidence-based medicine in plastic surgery, the American Society of Plastic Surgeons and Plastic and Reconstructive Surgery have launched an initiative to improve the understanding of evidence-based medicine concepts and provide tools for implementing evidence-based medicine in practice. Through a series of special articles aimed at educating plastic surgeons, the authors' hope is that readers will be compelled to learn more about evidence-based medicine and incorporate its principles into their own practices. As the first of the series, this article provides a brief overview of the evolution, current application, and practice of evidence-based medicine.
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Affiliation(s)
- Jennifer A. Swanson
- Senior Associate of Evidence Based Projects, The American Society of Plastic Surgeons; Arlington Heights, IL
| | - DeLaine Schmitz
- Senior Director of Quality Initiatives, The American Society of Plastic Surgeons; Arlington Heights, IL
| | - Kevin C. Chung
- Professor of Surgery, Section of Plastic Surgery, Department of Surgery, The University of Michigan Health System; Ann Arbor, MI
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Abstract
There is compelling evidence that various chemical agents are important determinants of myriad health afflictions--several xenobiotics have the potential to disrupt reproductive, developmental, and neurological processes and some agents in common use have carcinogenic, epigenetic, endocrine-disrupting, and immune-altering action. Some toxicants appear to have biological effect at miniscule levels and certain chemical compounds are persistent and bioaccumulative within the human body. Despite escalating public health measures to preclude further exposures, many people throughout the world have already accrued a significant body burden of toxicants, placing them at potential health risk. As a result, increasing discussion is underway about possible interventions to facilitate elimination of persistent toxicants from the human organism in order to obviate health affliction and to potentially ameliorate chronic degenerative illness. An overview of the clinical aspects of detoxification is presented with discussion of established and emerging interventions for the elimination of persistent xenobiotics. Potential therapies to circumvent enterohepatic recirculation and a case report highlighting a clinical outcome associated with detoxification are also presented for consideration.
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Affiliation(s)
- Stephen J Genuis
- University of Alberta, 2935-66 Street, Edmonton, Alberta, Canada.
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Whelan E. Negotiating science and experience in medical knowledge: Gynaecologists on endometriosis. Soc Sci Med 2009; 68:1489-97. [DOI: 10.1016/j.socscimed.2009.01.032] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2008] [Indexed: 11/25/2022]
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Martin CS. The Challenge of Integrating Evidence-Based Design. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2009; 2:29-50. [DOI: 10.1177/193758670900200303] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This paper discusses the integration of evidence-based design (EBD) into the design process as an innovation, illuminates the significance and progress of the diffusion of this innovation, and identifies EBD advocates and the consequences of meeting the EBD challenge. A free tool for engaging in EBD is explored. Healthcare designers are leading the EBD charge, because their clients depend on it. But not all designers engage in EBD, because it may be beyond the resources of a firm or outside its culture. However, as with other meaningful design innovations, designers who do not practice EBD could fall by the wayside. EBD is a product of the diffusion of the innovation of evidence-based medicine. The academy (i.e., the collective of institutions of higher education), design organizations, design communities, and the media all contribute to the diffusion of EBD. However, the quantity, quality, and understandability of evidence continue to challenge its broad adoption. InformeDesign®, a free, Internet-based tool, presents information to designers in a concise, understandable way. Firms must invest in EBD incrementally as a value-added component of design to meet current and future challenges. It is important for designers to realize that engaging in EBD is not a rejection of creativity, but a means by which to elevate their design solutions.
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Vitamin D status of clinical practice populations at higher latitudes: analysis and applications. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2009; 6:151-73. [PMID: 19440275 PMCID: PMC2672339 DOI: 10.3390/ijerph6010151] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/18/2008] [Accepted: 12/30/2008] [Indexed: 12/22/2022]
Abstract
BACKGROUND Inadequate levels of vitamin D (VTD) throughout the life cycle from the fetal stage to adulthood have been correlated with elevated risk for assorted health afflictions. The purpose of this study was to ascertain VTD status and associated determinants in three clinical practice populations living in Edmonton, Alberta, Canada--a locale with latitude of 53 degrees 30'N, where sun exposure from October through March is often inadequate to generate sufficient vitamin D. METHODS To determine VTD status, 1,433 patients from three independent medical offices in Edmonton had levels drawn for 25(OH)D as part of their medical assessment between Jun 2001 and Mar 2007. The relationship between demographic data and lifestyle parameters with VTD status was explored. 25(OH)D levels were categorized as follows: (1) Deficient: <40 nmol/L; (2) Insufficient (moderate to mild): 40 to <80 nmol/L; and (3) Adequate: 80-250 nmol/L. Any cases <25 nmol/L were subcategorized as severely deficient for purposes of further analysis. RESULTS 240 (16.75% of the total sample) of 1,433 patients were found to be VTD 'deficient' of which 48 (3.35% of the overall sample) had levels consistent with severe deficiency. 738 (51.5% of the overall sample) had 'insufficiency' (moderate to mild) while only 31.75% had 'adequate' 25(OH)D levels. The overall mean for 25(OH) D was 68.3 with SD=28.95. VTD status was significantly linked with demographic and lifestyle parameters including skin tone, fish consumption, milk intake, sun exposure, tanning bed use and nutritional supplementation. CONCLUSION A high prevalence of hypovitaminosis-D was found in three clinical practice populations living in Edmonton. In view of the potential health sequelae associated with widespread VTD inadequacy, strategies to facilitate translation of emerging epidemiological information into clinical intervention need to be considered in order to address this public health issue. A suggested VTD supplemental intake level is presented for consideration.
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Pappano D, Conners G, McIntosh S, Humiston S, Roma D. Sources of knowledge transfer among primary care pediatric health care providers. Clin Pediatr (Phila) 2008; 47:930-4. [PMID: 18626107 DOI: 10.1177/0009922808320600] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The authors sought to understand which informational sources pediatric health care providers perceive as most influential in how they stay current with health care innovations. METHODS Rochester, New York, area pediatric health care providers were surveyed using a self-administered questionnaire. Two items pertained to the health care provider's ability to interpret primary research, and 9 items pertained to the influence and relative importance of various sources of information. RESULTS A 61% response rate was obtained. Most (83%) respondents felt adequately trained to interpret primary research, fewer (31%) felt they have the time to do so. Almost all respondents (92%) felt that American Academy of Pediatrics (AAP) guidelines were a major influence, and 44% felt that AAP guidelines were the single most influential source of information in how they altered their practice over time. CONCLUSIONS In the setting of time constraints, and the volume and complexity of published therapeutic research, AAP guidelines are playing an increasing role in knowledge transfer.
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Affiliation(s)
- Dante Pappano
- Eastern Tennessee Children's Hospital, Knoxville, Tennessee, USA.
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Pappano D, Conners G, McIntosh S, Humiston S, Roma D. Why Pediatric Health Care Providers Are Not Using Homeopathic Antidiarrheal Agents. J Altern Complement Med 2007; 13:1071-6. [DOI: 10.1089/acm.2007.0651] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Dante Pappano
- Department of Emergency Medicine, Eastern Tennessee Children's Hospital, Knoxville, TN
| | - Gregory Conners
- Department of Emergency Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Scott McIntosh
- Department of Community and Preventive Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Sharon Humiston
- Department of Emergency Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Domenick Roma
- Department of Emergency Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY
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