Resources For Evidence-Based Health Care: Accessibility And Availability

Evidence – Based Practice (EBP) is a problem solving approach to clinical care that incorporates the conscientious use of current best evidence from well-designed studies,  clinician’s expertise, and patient values and preferences (Melnyk & Fineout-Overholt, 2005; Sackett, Straus, Richardson, Rosenberg, &Haynes, 2000). It is important to see clinical expertise as the ability to integrate research evidence and patients' circumstances and preferences to help patients arrive at optimal decisions (Guyatt, Cook,& Haynes, 2004). Research has shown that patient outcomes are 28% better when clinical care is based upon evidence, versus clinical practice steeped in tradition (Heater, Becker, & Olsen, 1998).   The process of EBP minimizes the translation time needed for incorporating research findings into practice and clarifies the differences between ritualistic practice, habitual approaches, personal preferences, anecdotal experiences, empirical data, and statistical significance to support nursing practice (Alspach, 2006). The availability of evidence based practice tools and methods helps in faster identification of the best available evidence to provide care at the point it matters most.   Implementing EBP in health care is complex and challenging. One of the main components of EBP is retrieving evidence from different sources. Information explosion with thousands of health literature and research papers published every year has created a need to expand the knowledge base for providing evidence based health care worldwide. Retrieval of evidence from various sources may be difficult due to several reasons. It may be difficult for health professionals to find the best available evidence due to time constraints (Ervin, 2002) or lack of knowledge among health professionals to effectively search for evidence (Sitzia, 2002). It is even difficult to find authentic sources of evidence

Resources for Evidence-Based Health Care: Accessibility and Availability

Evidence – Based Practice (EBP) is a problem solving approach to clinical care that incorporates the conscientious use of current best evidence from well-designed studies, clinician’s expertise, and patient values and preferences (Melnyk & Fineout-Overholt, 2005; Sackett, Straus, Richardson, Rosenberg, &Haynes, 2000). It is important to see clinical expertise as the ability to integrate research evidence and patients' circumstances and preferences to help patients arrive at optimal decisions (Guyatt, Cook,& Haynes, 2004). Research has shown that patient outcomes are 28% better when clinical care is based upon evidence, versus clinical practice steeped in tradition (Heater, Becker, & Olsen, 1998). The process of EBP minimizes the translation time needed for incorporating research findings into practice and clarifies the differences between ritualistic practice, habitual approaches, personal preferences, anecdotal experiences, empirical data, and statistical significance to support nursing practice (Alspach, 2006). The availability of evidence based practice tools and methods helps in faster identification of the best available evidence to provide care at the point it matters most. Implementing EBP in health care is complex and challenging. One of the main components of EBP is retrieving evidence from different sources. Information explosion with thousands of health literature and research papers published every year has created a need to expand the knowledge base for providing evidence based health care worldwide. Retrieval of evidence from various sources may be difficult due to several reasons. It may be difficult for health professionals to find the best available evidence due to time constraints (Ervin, 2002) or lack of knowledge among health professionals to effectively search for evidence (Sitzia, 2002). It is even difficult to find authentic sources of evidence

Spatio-temporal dynamics of anisotropic emission from nano second laser produced aluminium plasma

Polarized emission carries captivating information and can help understand various elementary processes involving collisions within the plasma as well as in radiative transitions. In this work, we investigate the spatio-temporal dependence of the emission anisotropy of a nanosecond laser produced aluminium plasma at 100 mbar background pressure. We observe that the anisotropy of the emission spectra exhibits interesting spatio-temporal characteristics which in turn depend on the charge state of the emitting species. The degree of polarization (DOP) is found to reverse its sign along the plume propagation direction. Observed behaviour in DOP appears to be due to the contribution from various involved atomic processes. However, closer to the sample the contribution from the self-generated magnetic field predominantly affect the polarization. On the other hand, the effect of the self generated magnetic field on the observed polarized emission is insignificant as the plume propagates away from the sample. This is of particular interest in polarization resolved laser induced breakdown spectroscopy as spatio-temporal profile of the degree of polarization has to be properly taken into account prior to the spectral analysis

Stock structure analysis of Nemipterus bipunctatus (Valenciennes, 1830) from three locations along the Indian coast

1888-1895Present study was done to identify the occurrence of various stocks of Nemipterus bipunctatus along the Indian coast, based on their body and skull shape morphometrics. Fish samples were collected from three locations along the Indian coast viz. Chennai along the East coast and Mumbai and Veraval on the West coast. Twenty truss distances from nine-point truss network of body and twenty-one truss distances from eleven-point truss network of the skull were measured from each fish sample. The canonical discriminant analysis showed that the truss distances belong to the anterior region and caudal peduncle of body and olfactory region of skull were significant in separating the fish stocks. The artificial neural network analysis revealed 91.4 % and 86.14 % well classification of the specimen, based on the truss distances of body and skull respectively. The results from the study indicated that there is a significant difference among the stocks of N. bipunctatus

Effect of monsoon on coastal fish diversity of Goa: an example from the gillnet fishery

The dynamics of fauna in coastal ecosystems are influenced by seasonal patterns in the oceanographic environment. It is well known that the monsoon along south-west coast of India influences the movement and spawning of fishes. Thus, they have direct effect on the richness, abundance and evenness of fish diversity in the ecosystem. This study investigates how the monsoon affects the commercial gillnet fishery along the coast of Goa. Fishing experiments were conducted in popular gillnet fishing grounds and the temporal pattern in diversity indices between October 2013 and September 2014 was assessed. A total of 124 fish species (40 families), 16 crustacean species (4 families) and 9 molluscan species (8 families) were recorded. The species diversity was found to be significantly different during the monsoon season and the species abundance distribution followed a geometric series during this period indicating signs of ecosystem perturbations. The economic and biological aspects of gillnet fishing in relation to the monsoon season in Goa are also discussed

The Influence Of Maternal Infections On Congenital Heart Defect

ABSTRACT Congenital heart defects (CHDs) contribute significantly to heightened infant mortality rates. This review explores the intricate link between maternal infections and CHDs, emphasizing diverse factors influencing fetal development, such as bacterial, fungal, protozoan and viral agents. These infections pose reproductive health risks, potentially leading to complications like prematurity, stillbirth and heart defect to the fetus. The TORCH acronym (Toxoplasma, Other infections, Rubella, Cytomegalovirus, Herpes simplex) identifies infectious teratogens related to congenital issues, emphasizing vertical transmission through the placenta or ascending from the vagina. Rubella and Cytomegalovirus play a significant role in heart defects, particularly when maternal infections amplify CHD risk during pregnancy. Specific scrutiny is placed on Rubella and Cytomegalovirus for their impact on pregnancy outcomes and potential links to congenital heart defects, with preventive strategies discussed, including vaccination and antiviral therapy. The timing and severity of these infections are pivotal in determining their impact on fetal heart development. Environmental exposures and maternal nutrition are critical factors influencing fetal development. Maternal undernutrition in low- and middle-income countries associates with adverse pregnancy outcomes, including congenital heart defects. Emphasizing the importance of maintaining a nutritious maternal diet, rich in essential nutrients, is crucial for improved fetal health and successful pregnancy outcomes. This review offers insights into preventive measures and underscores the need for continued research to enhance prenatal care strategies

An overview of anti-diabetic plants used in Gabon: Pharmacology and Toxicology

© 2017 Elsevier B.V. All rights reserved.Ethnopharmacological relevance: The management of diabetes mellitus management in African communities, especially in Gabon, is not well established as more than 60% of population rely on traditional treatments as primary healthcare. The aim of this review was to collect and present the scientific evidence for the use of medicinal plants that are in currect by Gabonese traditional healers to manage diabetes or hyperglycaemia based here on the pharmacological and toxicological profiles of plants with anti-diabetic activity. There are presented in order to promote their therapeutic value, ensure a safer use by population and provide some bases for further study on high potential plants reviewed. Materials and methods: Ethnobotanical studies were sourced using databases such as Online Wiley library, Pubmed, Google Scholar, PROTA, books and unpublished data including Ph.D. and Master thesis, African and Asian journals. Keywords including ‘Diabetes’ ‘Gabon’ ‘Toxicity’ ‘Constituents’ ‘hyperglycaemia’ were used. Results: A total of 69 plants currently used in Gabon with potential anti-diabetic activity have been identified in the literature, all of which have been used in in vivo or in vitro studies. Most of the plants have been studied in human or animal models for their ability to reduce blood glucose, stimulate insulin secretion or inhibit carbohydrates enzymes. Active substances have been identified in 12 out of 69 plants outlined in this review, these include Allium cepa and Tabernanthe iboga. Only eight plants have their active substances tested for anti-diabetic activity and are suitables for further investigation. Toxicological data is scarce and is dose-related to the functional parameters of major organs such as kidney and liver. Conclusion: An in-depth understanding on the pharmacology and toxicology of Gabonese anti-diabetic plants is lacking yet there is a great scope for new treatments. With further research, the use of Gabonese anti-diabetic plants is important to ensure the safety of the diabetic patients in Gabon.Peer reviewedFinal Accepted Versio

Mapping subnational HIV mortality in six Latin American countries with incomplete vital registration systems

Background: Human immunodeficiency virus (HIV) remains a public health priority in Latin America. While the burden of HIV is historically concentrated in urban areas and high-risk groups, subnational estimates that cover multiple countries and years are missing. This paucity is partially due to incomplete vital registration (VR) systems and statistical challenges related to estimating mortality rates in areas with low numbers of HIV deaths. In this analysis, we address this gap and provide novel estimates of the HIV mortality rate and the number of HIV deaths by age group, sex, and municipality in Brazil, Colombia, Costa Rica, Ecuador, Guatemala, and Mexico. Methods: We performed an ecological study using VR data ranging from 2000 to 2017, dependent on individual country data availability. We modeled HIV mortality using a Bayesian spatially explicit mixed-effects regression model that incorporates prior information on VR completeness. We calibrated our results to the Global Burden of Disease Study 2017. Results: All countries displayed over a 40-fold difference in HIV mortality between municipalities with the highest and lowest age-standardized HIV mortality rate in the last year of study for men, and over a 20-fold difference for women. Despite decreases in national HIV mortality in all countries—apart from Ecuador—across the period of study, we found broad variation in relative changes in HIV mortality at the municipality level and increasing relative inequality over time in all countries. In all six countries included in this analysis, 50% or more HIV deaths were concentrated in fewer than 10% of municipalities in the latest year of study. In addition, national age patterns reflected shifts in mortality to older age groups—the median age group among decedents ranged from 30 to 45 years of age at the municipality level in Brazil, Colombia, and Mexico in 2017. Conclusions: Our subnational estimates of HIV mortality revealed significant spatial variation and diverging local trends in HIV mortality over time and by age. This analysis provides a framework for incorporating data and uncertainty from incomplete VR systems and can help guide more geographically precise public health intervention to support HIV-related care and reduce HIV-related deaths

Global, regional, and national incidence, prevalence, and mortality of HIV, 1980–2017, and forecasts to 2030, for 195 countries and territories: a systematic analysis for the Global Burden of Diseases, Injuries, and Risk Factors Study 2017

Background Understanding the patterns of HIV/AIDS epidemics is crucial to tracking and monitoring the progress of prevention and control efforts in countries. We provide a comprehensive assessment of the levels and trends of HIV/AIDS incidence, prevalence, mortality, and coverage of antiretroviral therapy (ART) for 1980–2017 and forecast these estimates to 2030 for 195 countries and territories. Methods We determined a modelling strategy for each country on the basis of the availability and quality of data. For countries and territories with data from population-based seroprevalence surveys or antenatal care clinics, we estimated prevalence and incidence using an open-source version of the Estimation and Projection Package—a natural history model originally developed by the UNAIDS Reference Group on Estimates, Modelling, and Projections. For countries with cause-specific vital registration data, we corrected data for garbage coding (ie, deaths coded to an intermediate, immediate, or poorly defined cause) and HIV misclassification. We developed a process of cohort incidence bias adjustment to use information on survival and deaths recorded in vital registration to back-calculate HIV incidence. For countries without any representative data on HIV, we produced incidence estimates by pulling information from observed bias in the geographical region. We used a re-coded version of the Spectrum model (a cohort component model that uses rates of disease progression and HIV mortality on and off ART) to produce age-sex-specific incidence, prevalence, and mortality, and treatment coverage results for all countries, and forecast these measures to 2030 using Spectrum with inputs that were extended on the basis of past trends in treatment scale-up and new infections. Findings Global HIV mortality peaked in 2006 with 1·95 million deaths (95% uncertainty interval 1·87–2·04) and has since decreased to 0·95 million deaths (0·91–1·01) in 2017. New cases of HIV globally peaked in 1999 (3·16 million, 2·79–3·67) and since then have gradually decreased to 1·94 million (1·63–2·29) in 2017. These trends, along with ART scale-up, have globally resulted in increased prevalence, with 36·8 million (34·8–39·2) people living with HIV in 2017. Prevalence of HIV was highest in southern sub-Saharan Africa in 2017, and countries in the region had ART coverage ranging from 65·7% in Lesotho to 85·7% in eSwatini. Our forecasts showed that 54 countries will meet the UNAIDS target of 81% ART coverage by 2020 and 12 countries are on track to meet 90% ART coverage by 2030. Forecasted results estimate that few countries will meet the UNAIDS 2020 and 2030 mortality and incidence targets. Interpretation Despite progress in reducing HIV-related mortality over the past decade, slow decreases in incidence, combined with the current context of stagnated funding for related interventions, mean that many countries are not on track to reach the 2020 and 2030 global targets for reduction in incidence and mortality. With a growing population of people living with HIV, it will continue to be a major threat to public health for years to come. The pace of progress needs to be hastened by continuing to expand access to ART and increasing investments in proven HIV prevention initiatives that can be scaled up to have population-level impact