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Appraised evidence and decision making in clinical practice
Get PDFBackground
The use of evidence in decision making in clinical practice may vary significantly from practice to practice. Research suggests that clinicians may ignore research-based evidence in their practice or use research evidence indirectly. The aim of this systematic review is to explore using an online independent learning approach for clinicians making evidence-based decisions using research and evidence.
Methodology
This systematic literature review was conducted across MEDLINE, PUBMED, SCIENCE Direct, APA PSYCINFO and CINHAL databases. The use of a search strategy employed to conduct searches on the individual database. Using the MMAT criteria by Hong et al., 2018) studies were screened and reviewed.
Results
The findings from each study were thematically analysed and organised in the following thematic areas: (1) Searching for an answer to the clinical question or problem; (2) Expanding on the evidence to address the clinical question or problem; (3) Recording the available evidence to the clinical problem; (4) Validating the evidence, whether research-based or tacit knowledge; (5) Inspecting the evidence for its potential to improve current practice; (6) Cascading the evidence appropriately and possibly adopting the evidence in the decision; and (7) Evaluating the outcome of the clinical decision.
Conclusions
This systematic literature review found there is a lack of an online independent learning approach for clinicians making evidence-based decision using research and evidence which highlights a gap in the literature
Characterization of pain in lipedema: reliability and validity of pain pressure thresholds and hand-held sphygmomanometer assessments in people with lipedema
No full textBackground: Lipedema is a chronic condition characterized by abnormal deposition of subcutaneous adipose tissue, leading to pain. The lack of internationally recognized diagnostic criteria complicates the characterization of pain. Physiological parameters such as pain pressure threshold (PPT) represent promising prognostic markers for diagnosing lipedema, yet they remain understudied. This study aimed to evaluate the reliability and validity of two pain pressure measurements, PPT and the hand-held sphygmomanometer (HHS) in lipedema.
Methods: A total of 28 adult females diagnosed with lipedema were recruited. Both PPT, using a digital algometer, and HHS, using a manual aneroid HHS, were performed to assess pain in the lower limbs. The testing was performed in a standing position with PPT and HHS placed on the calf. Intraclass correlation coefficient (ICC) and coefficient of variation (CV) were employed to assess the within session reliability, while the validity between PPT and HHS was analyzed using R2 in a linear regression model.
Results: The results showed excellent reliability for both PPT and HHS, with ICC indicating high consistency (ICC = 0.93 to 0.97) and CV showing acceptable scores (CV = 3.62% to 9.06%). In addition, good validity between PPT and HHS was also observed (R2 = 0.69 to 0.74), suggesting that HHS can be a reliable alternative to PPT for pain assessment in lipedema.
Conclusion: These findings have important clinical implications, as they expand the knowledge of pain characterization in people with lipedema, potentially aiding in diagnostic refinement. In addition, a cost-effective and accessible method for assessing pain was examined (i.e., HHS), showing promising findings and providing an objective method to help diagnose lipedema
The Universal Declaration of Human Rights and the voices of the Global South
No full textThe peoples of the Global South were inadequately represented in the early years of the United Nations when the Universal Declaration of Human Rights was being drafted. Nevertheless, important contributions were made, notably by delegates from India and Haiti. Accounts of the drafting have tended to overlook the role of the Global South
Le couloir de la mort: à la recherche d’une définition juridique
No full textOnly about thirty countries continue to apply the death penalty in their criminal justice systems. One aspect of this fundamentally positive development is that there are a large number of countries in a period of transition. Some fifty states appear to have ended the practice of executions without, however, formally abolishing the death penalty in law. For several of them, courts continue to sentence offenders to death, although there seems to be very little chance that the sentence will actually be carried out. In a number of states that no longer appear to employ the death penalty, there is nevertheless a refusal to acknowledge the existence of a moratorium. As a result, a large number of people have been sentenced to death and are awaiting their execution, in principle, for many years, despite the likelihood that they will never be executed. This article explores the concept of the ’death row phenomenon’, recognized by the European Court of Human Rights in the celebrated Soering v. United Kingdom judgment
We Will Become Mars
No full text'We Will Become Mars' is a speculative prose poem by A. J. Dalton which appeared in the Sept 2024 issue of Carmina Magazine. The Author's Note reads as follows: 'I produced the prose poem 'We Will Become Mars' as a response to how I fear we're stripping the Earth of all its natural life, just as Mars may once have been stripped. We will end up as space-refugees searching for a new planet...perhaps as Martians were once refugees who came and settled Earth. How many planets must be exhausted like this before the cycle is broken? It's a story as old as our origins, one that is told anew as 'mythology for the modern day'.
Unlocking equal pay [Panel discussion]
No full textThe new book, 'Bridging the Gender Pay Gap through Transparency' analyzes pay equity legislation in a wide range of European jurisdictions as well as the Pay Transparency Directive’s content, goals, and potential impact. The book is edited by Sara Benedi Lahuerta (University College Dublin), Katharina Miller (IE Law School) and Laura Carlson (University of Stockholm), the latter two being the former and current Presidents of EWLA (The European Women Lawyers Association). Expert authors will discuss their findings in an exclusive book presentation at the Women in Law Conference. This timely book evaluates the advantages and challenges of adopting pay transparency legislation (PTL) to address the ongoing issues of the gender pay gap. Chapters contextually examine whether PTL can help reduce the gender pay gap and discuss which factors should be considered to potentially boost the effects of this legal intervention.
After the book presentation, an expert panel discussion will evaluate how legal professionals can effectively contribute to closing the gap
The efficacy of gemcitabine and docetaxel chemotherapy for the treatment of relapsed and refractory osteosarcoma: a systematic review and pre‐clinical study
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Osteosarcoma is the most common primary malignancy of the bone. There is a lack of effective treatments for patients who experience relapsed osteosarcoma. One treatment for relapsed patients is gemcitabine and docetaxel combination chemotherapy (GEMDOX). This systematic review aimed to establish the efficacy of this chemotherapy regimen, as well as identify the common severe toxicities that are associated with it. Resistant osteosarcoma cell lines developed from MG-63 and HOS-143B were used to represent relapsed osteosarcoma patients in a pre-clinical study.
Results
We identified 11 retrospective and Phase II studies that were suitable for inclusion in our review. 10.65% of patients had a response to gemcitabine and docetaxel combination therapy and the disease control rate was 35% (n = 197). 36%, 35.3% and 18.04% of patients experienced grade 3 or 4 neutropenia, thrombocytopenia and anaemia respectively (n = 133). Male patients (X2 = 9.14, p < 0.05) and those below the age of 18 (X 2 = 10.94, p < 0.05) responded better to GEMDOX treatment than females and patients older than 18 years. The resistant osteosarcoma cell lines remained sensitive to either single-agent gemcitabine, docetaxel, and the combination of both. Cisplatin-resistant models (MG-63/CISR8 & HOS-143B/CISR8) were the most responsive to GEMDOX treatment compared to doxorubicin, methotrexate, and triple-combination resistant models.
Conclusion
GEMDOX treatment has potential efficacy in relapsed osteosarcoma patients especially those with cisplatin resistance. To directly compare the efficacy of GEMDOX therapy against other therapies randomised phase III clinical trials with adequate patient follow up must be performed to improve treatment options for osteosarcoma
Revised approach for the calculation of groundwater flooding annual average damages: establishing a probability-based relationship for groundwater flooding
No full textProject Groundwater Greater Lincolnshire, as part of the Department for Environment, Food & Rural Affairs (Defra) and the Environment Agency (EA) Flood and Coastal Resilience Innovation Programme, seeks to enhance understanding and resilience to groundwater flooding. Existing economic appraisal methodologies and datasets within the Multi-Coloured Manual (MCM) are predominantly tailored to fluvial, pluvial, coastal flooding. The Flood Hazard Research Centre (FHRC) delivered a scoping report to Lincolnshire County Council (LCC) in July 2023, highlighting the need for groundwater-specific appraisal methodologies. A significant gap was identified regarding methods for estimating Expected Annual Damages from groundwater flooding due to the different flood mechanisms and impacts compared to other flood types.
This report outlines key considerations for developing a probability-based relationship for groundwater flooding, focusing on different types of groundwater flooding relevant to proposed Lincolnshire case study areas (Grimsby, Scopwick, Barton/Barrow-upon-Humber). Traditional methods such as the development of a probability-discharge relationship, as done for fluvial flooding, are not applicable due to the lack of discharge record data for groundwater events. Instead, the use of groundwater borehole levels (annual maximum level) has been identified as a more suitable dependent variable, though difficulties such as limited data and non-stationary time-series data due to changing abstraction rates exist.
Flood duration has been identified as a critical variable for evaluation of economic damages. Groundwater flood frequency analysis must therefore consider the likelihood of prolonged periods of high groundwater levels. This report considers that this may be addressed through the use of a Standardized Groundwater Flood Index (SGFI) or using maximum winter effective rainfall data to develop discrete event probability curves.
The final proposed approach for estimation of the frequency of groundwater flooding involves defining a benefitting area, identifying a relevant borehole and establishing the relationship between the receptors at risk and the borehole, and conducting a frequency analysis to establish event probabilities. The feasibility of this proposed approach will be further investigated and discussed for the selected case study areas within the second phase of this project. As groundwater flooding contexts and mechanisms vary, the approaches used for economic appraisal are also likely to be adapted to the context. Groundwater appraisal will likely require significant local survey and expertise to fully define the most suitable approach for each study area
Angiogenesis in breast cancer: insights and innovations
Get PDFThis review explores the pivotal role of angiogenesis in breast cancer progression and treatment. It covers biomarkers, imaging techniques, therapeutic approaches, resistance mechanisms, and clinical implications. Key topics include Vascular Endothelial Growth Factors, angiopoietins, microRNA signatures, and circulating endothelial cells as biomarkers, along with Magnetic Resonance Imaging, Computed Tomography Angiography, Ultrasound, and Positron Emission Tomography for imaging. Therapeutic strategies targeting VEGF, tyrosine kinase inhibitors, and the intersection of angiogenesis with immunotherapy are discussed. Challenges such as resistance mechanisms and personalized medicine approaches are addressed. Clinical implications, prognostic value, and the future direction of angiogenesis-targeted therapies are highlighted. The article concludes with reflections on the transformative potential of understanding angiogenesis
Parameter tuning of the Firefly Algorithm by standard Monte Carlo and Quasi-Monte Carlo methods
Get PDFAlmost all optimization algorithms have algorithm-dependent parameters, and the setting of such parameter values can significantly influence the behavior of the algorithm under consideration. Thus, proper parameter tuning should be carried out to ensure that the algorithm used for optimization performs well and is sufficiently robust for solving different types of optimization problems. In this study, the Firefly Algorithm (FA) is used to evaluate the influence of its parameter values on its efficiency. Parameter values are randomly initialized using both the standard Monte Carlo method and the Quasi Monte-Carlo method. The values are then used for tuning the FA. Two benchmark functions and a spring design problem are used to test the robustness of the tuned FA. From the preliminary findings, it can be deduced that both the Monte Carlo method and Quasi-Monte Carlo method produce similar results in terms of optimal fitness values. Numerical experiments using the two different methods on both benchmark functions and the spring design problem showed no major variations in the final fitness values, irrespective of the different sample values selected during the simulations. This insensitivity indicates the robustness of the FA