bluuebunny/crossref_metadata_2025_split huggingface dataset:
Spatial scale of observation affects α, β and γ diversity of cavity‐nesting bees and wasps across a tropical land‐use gradient
Authors: Tylianakis Jason M. , Klein Alexandra‐Maria , Lozada Tannya , Tscharntke Teja 
Published: May 2006

AbstractAim  Anthropogenic changes in land use may have major consequences for global biodiversity. However, species diversity is determined by a suite of factors that may affect species differently at different spatial scales. We tested the combined effects of land use and spatial scale on α, β and γ diversity in the tropics using experimental communities of cavity‐nesting bees and waSPS (Hymenoptera: Aculeata). We aimed to determine whether: (1) land‐use intensity negatively affects species richness of cavity‐nesting Hymenoptera, (2) β diversity, both within and between plots, is higher in more natural systems, (3) species richness of flowering herbs correlates positively with species richness of Hymenoptera within and across habitats, (4) richness of cavity‐nesting Hymenoptera in highly modified habitats declines with increasing distance from natural or semi‐natural habitats, (5) the effects of land use, herb diversity and forest distance on Hymenoptera α and β diversity vary at different spatial scales, and (6) bees and waSPS respond to land use in a similar way.Location  Manabi, south‐west Ecuador.Methods  We examined diversity (species richness) within 48 plots of five habitat types that comprised a gradient of decreasing agricultural intensity from rice and pasture to coffee agroforests, unmanaged abandoned agroforests and forest fragments, using standardized nesting resources for reproducing communities of cavity‐nesting bees and waSPS.Results  (1) Land use significantly affected α diversity of trap‐nesting bees and waSPS at the subplot (per trap) scale, but not subplot β diversity or plot‐scale species richness (γ diversity). (2) Beta diversity was surprisingly higher between plots within a land‐use type than between land‐use types. (3) Species richness of bees and waSPS increased with diversity of flowering herbs at the subplot (trap) scale only. (4) Forest distance correlated positively with bee species richness at the plot scale only. (5) Land use, herb diversity and forest distance each showed significant correlations with bee and wasp diversity at only one spatial scale. (6) Despite differences in life history, bees and waSPS responded to land‐use intensity in a similar way.Main conclusions  The effects of land use on species richness were highly dependent on spatial scale. Subplot‐scale analyses showed that rice and pasture contained the highest species diversity, whereas plot‐scale analyses showed no significant difference in the diversity of different land‐use types. We emphasize caution in the estimation of biodiversity at only one spatial scale, and highlight the surprisingly large contribution of managed land to the regional biodiversity of these species.
Integrating evidence into clinical practice: an alternative to evidence‐based approaches
Authors: Tonelli Mark R. 
Published: May 2006

AbstractEvidence‐based medicine (EBM) has thus far failed to adequately account for the appropriate incorporation of other potential warrants for medical decision making into clinical practice. In particular, EBM has struggled with the value and integration of other kinds of medical knowledge, such as those derived from clinical experience or based on pathophysiologic rationale. The general priority given to empirical evidence derived from clinical research in all EBM approaches is not epistemically tenable. A casuistic alternative to EBM approaches recognizes that five distinct topics, 1) empirical evidence, 2) experiential evidence, 3) pathophysiologic rationale, 4) patient goals and values, and 5) system features are potentially relevant to any clinical decision. No single topic has a general priority over any other and the relative importance of a topic will depend upon the circumstances of the particular case. The skilled clinician must weigh these potentially conflicting evidentiary and non‐evidentiary warrants for action, employing both practical and theoretical reasoning, in order to arrive at the best choice for an individual patient.
Improving the implementation of evidence‐based practice: a knowledge management perspective
Authors: Sandars John , Heller Richard 
Published: May 2006

AbstractExperience of knowledge management initiatives in non‐health care organizations can offer useful insights, and strategies, to implement evidence‐based practice in health care. Knowledge management offers a structured process for the generation, storage, distribution and application of knowledge in organizations. This includes both tacit knowledge (personal experience) and explicit knowledge (evidence). Communities of practice are a key component of knowledge management and have been recognized to be essential for the implementation of change in organizations. It is within communities of practice that tacit knowledge is actively integrated with explicit knowledge. Organizational factors that limit the development of knowledge management, including communities of practice, in non‐health care organizations need to be overcome if the potential is to be achieved within health care.
Evidence‐based treatment and quality of life in heart failure
Authors: Dobre Daniela , Van Jaarsveld Cornelia H. M. , Ranchor Adelita V. , Arnold Rosemarie , De Jongste Mike J. L. , Haaijer Ruskamp Flora M. 
Published: May 2006

Abstract
Objectives  To explore whether prescription of evidence‐based drug therapy is associated with better quality of life (QoL) in patients with heart failure (HF).
Methods  Patients (n = 62) were recruited in the outpatient clinic of Groningen University Hospital. Inclusion criteria were previous diagnosis of HF, age 40–80 years; ejection fraction of less than 45%, free from other serious disease (such as cancer) and psychiatric problems in the last year. QoL was assessed with the RAND 36‐item health survey questionnaire, on five scales: physical functioning, mental health, social functioning, vitality and general health perception. Medication prescribed for 1 to 6 months before the QoL assessment was classified as either evidence‐based treatment or under‐treatment, according to the 2001 European guidelines on optimal HF treatment. The study had a cross‐sectional design.
Results  QoL did not differ significantly between evidence‐based and under‐treated patients, unadjusted or after adjustment for significant patient imbalances.
Conclusions  Conventional step‐up medication approach in HF may have a positive impact on survival or morbidity, but it seems not beneficial in relation to QoL. Other interventions should be designed to improve QoL of patients with HF.
Does physiotherapy management of low back pain change as a result of an evidence‐based educational programme?
Authors: Stevenson Kay , Lewis Martyn , Hay Elaine 
Published: May 2006

Abstract
Rationale  The concept of evidence‐based medicine is important in providing efficient health care. The process uses research findings as the basis for clinical decision making. Evidence‐based practice helps optimize current health care and enables the practitioners to be suitably accountable for the interventions they provide. Little work has been undertaken to examine how allied health professionals change their clinical practice in light of the latest evidence. The use of opinion leaders to disseminate new evidence around the management of low back pain into practice has been proposed.
Aims  The aim of this study was to investigate if physiotherapists’ clinical management of patients with low back pain would change following an evidence‐based education package, which utilized local opinion leaders and delivered the best evidence.
Method  Thirty musculoskeletal physiotherapists from a Community Trust in North Staffordshire were cluster randomized by location of work, to two groups. The intervention group received an evidence‐based programme on the management of low back pain, including advice regarding increasing activity levels and return to normal activity and challenging patients’ fears and beliefs about their pain. The control group received a standard in‐service training package on the management of common knee pathologies. The physiotherapists’ clinical management of patients with low back pain was measured prior to training and 6 months post training. Outcome measures were based on physiotherapists completing ‘discharge summary’ questionnaires, which included information relating to the use and importance of therapies for treating their low back pain patients.
Results  There were few significant differences in treatment options between the intervention and control groups post training. Whilst there was some indication that physiotherapists were already utilizing aspects of psychosocial management for patients with low back pain, there was little change in what physiotherapists perceived to be important to patient recovery and actual clinical practice following the intervention.
Conclusions  Psychosocial factors have been identified as an important factor in the recovery of patients with low back pain. This project incorporated the latest evidence on the management of low back pain and utilized the theory of opinion leaders to disseminate this evidence into clinical practice. Whilst there were some limitations in the overall size of the study, the results help to give an insight into the challenges faced by the health care system and researchers alike to ensure quality evidence is actually utilized by practitioners for the benefits of patient care.
Evidence‐based medical education –quo vadis?
Authors: Leung Gabriel M. , Johnston Janice M. 
Published: May 2006

AbstractThe evidence base for most educational initiatives, at least until very recently, is largely composed of low‐level evidence. Four major barriers underlie this historical observation, namely: (1) perceived ethical and acceptability problems arising from the unequal treatment of learners in experimental designs; (2) limited choice of outcome measures and validated instruments; (3) time and resource constraints; and (4) methodological issues concerning contextual confounding and small sample sizes. We advocate the adoption of a ‘balanced scorecard’ approach in the evaluation of education interventions that brings together a comprehensive panel of outcomes under one framework. We require a diversity of rigorously applied methods to generate these outcomes, drawing from the quantitative and qualitative disciplines of epidemiology, psychology and economics. We further suggest that the research community discuss and agree on a standardized set of common metrics or benchmarks. We conclude with a case study examining whether a hand‐held computer clinical decision support tool improves clerkship learning of evidence‐based medicine. The era of Brownian motion in health education research is over. What we demand in terms of burden of proof for educational effectiveness should be no less rigorous than our call for an ever escalating threshold concerning evidence of clinical care.
Knowledge and use of evidence‐based practice of GPs and hospital doctors
Authors: Upton Dominic , Upton Penney 
Published: May 2006

Abstract
Rationale, aims and objectives  Clinical effectiveness and evidence‐based practice (EBP) are the cornerstone of modern day health care. Although many studies have explored attitudes and perceived knowledge of individual professions few have compared the factors between professional groups and in particular in the medical profession. We report a study comparing the views, knowledge and practice of hospital doctors with their general practitioner (GP) counterparts in terms of EBP and clinical effectiveness. In this way it was hoped to highlight not only any differences between these groups but also the needs of these groups and suggest some ways of fulfilling these.
Methods  A postal questionnaire survey was completed by a random sample of 500 GPs and 500 hospital medics.
Results  There was a significant difference between the groups with the GPs rating their skill level as lower that their medical doctor counterparts. Similarly, GPs reported using EBP steps less frequently than hospital doctors. Barriers to implementing EBP differed between the groups with GPs reporting difficulty with accessing a library and making time available.
Conclusion  A number of differences between GPs and their hospital counterparts were recorded which highlights the difference in educational and policy approach required for greater uptake of EBP.
Evidence‐based psychiatry: understanding the limitations of a method
Authors: Maier Thomas 
Published: May 2006

AbstractEvidence‐based psychiatry (EBP) is an important and useful method. However, it covers only a limited range of clinical problems psychiatrists and psychotherapists encounter in daily work. This is due to some particularities of psychiatric diagnoses and therapeutic practice. (i) The validity of psychiatric diagnoses is limited. EBP is entirely depending on diagnoses, so one of its core assumptions is of doubtful applicability in the field of psychiatry and psychotherapy. (ii) Effects of complexity are more obvious in psychiatric and psychotherapeutic cases. Owing to its conceptual bases, EBP cannot sufficiently consider such effects and is therefore of limited usefulness addressing particular problems in fluctuating or symptomatically shifting diseases. (iii) EBP’s strong focusing on decision making does not reflect appropriately the clinical reality of psychiatrists and psychotherapists. Diagnostic and therapeutic procedures are in fact more iterative, and decisions are constantly re‐evaluated. EBP is not helpful to adjust this type of individual approach, which is needed to treat individual patients.
The patient experience of community hospital – the process of care as a determinant of satisfaction
Authors: Small Neil , Green John , Spink Joanna , Forster Anne , Lowson Karin , Young John 
Published: May 2006

AbstractAims and objectives  We report findings from a qualitative study to identify patient views of community hospital care. We consider how far these were in accord with the hospital staffs’ views. This constituted part of a wider randomized controlled trial (RCT). The methodological challenges in seeking to identify patient satisfaction and in linking qualitative findings with trial results are explored.Design  A sample of 13 patients randomized to the community hospital arm of the RCT joined the qualitative study. Official documentation from the hospital were accessed and six staff interviewed to identify assumptions underlying practice.Results  Analysis of interviews identified a complex picture concerning expectations These could be classified as ideal, realistic, normative and unformed. The hospital philosophy and staff views about service delivery were closely in harmony, they delivered rehabilitation in a home‐based atmosphere. The formal, or ‘hard’, process of rehabilitation was not well understood by patients. They were primarily concerned with ‘soft’ or process issues – where and how care was delivered.Conclusions  We identify a model of community hospital care that incorporates technical aspects of rehabilitation within a human approach that is welcomed by patients. If patients are to be able to participate in making informed decisions about care, the rationale for the activities of staff need to be more clearly explained. Recommendations are made about the appropriate scope of qualitative findings in the context of trials and about techniques to access patient views in areas where they have difficulty in expressing critical impressions.
Preliminary development of the new individualized HDQoL questionnaire measuring quality of life in adult hypopituitarism
Authors: McMillan Carolyn V. , Bradley Clare , Gibney James , Russell‐Jones David L. , Sönksen Peter H. 
Published: May 2006

AbstractObjectives  The objectives were (1) to report the preliminary development of the Hormone Deficiency‐dependent Quality of Life (HDQoL) questionnaire, a new individualized questionnaire in which respondents rate personally applicable domains for importance and impact of hormonal deficiency and its treatment; (2) to evaluate the HDQoL’s psychometric properties for adults with hypopituitarism including growth hormone deficiency (GHD).Methods  Internal consistency reliability, aspects of validity, and sensitivity to change of the HDQoL were investigated in: (1) a cross‐sectional survey of 157 adults with treated or untreated GHD; (2) a randomized, placebo‐controlled study of 3 months’ growth hormone (GH) withdrawal from 12 of 21 GH‐treated adults.Results  Thirteen of the original 18 HDQoL domains were relevant and important for GH‐deficient adults. The shorter 13‐item HDQoL had excellent internal reliability (Cronbach’s alpha coefficient = 0.914, n = 109), and was sensitive to sex differences (cross‐sectional study): women perceived worse present QoL than men [t(149.8) = 2.33, P = 0.021]. The HDQoL was sensitive to change (GH‐withdrawal study) with a significant between‐group difference in change in domain scores for things I can do physically[t(16) = 2.47, P = 0.025, 2‐tailed], patients withdrawn from GH reporting greater negative impact of hormone deficiency on this domain at end‐point. Qualitative work resulted in the addition of seven new HDQoL domains, including energy and bodily pain.Conclusion  The HDQoL, although at an early stage of development, proved useful in identifying expected changes following GH withdrawal. The extended 20‐item version is recommended for further evaluation in assessing the impact of hypopituitarism on QoL.
Evaluation of a service development to implement the top three process indicators for quality stroke care
Authors: Power Maxine L. , Cross Stephen P. , Roberts Sarah , Tyrrell Pippa J. 
Published: May 2006

AbstractRationale, aim and objective  Stroke mortality remains unacceptably high with up to 30% of patients dying within 1 month. Early swallow screen and computerized tomography (CT) brain scan, facilitate delivery of aspirin, which together are recognized as the top three process indicators for quality stroke care. Evidence indicates that treatment with aspirin (300 mg) saves lives and should commence within 48 h of stroke onset. However, many hospitals find it difficult to meet this timescale. We aimed to evaluate whether reorganization of services could improve aspirin delivery following acute ischaemic stroke.Method  A retrospective audit was carried out to determine the time to swallow screen, CT scan and aspirin administration. A service review was conducted and the findings disseminated. A decision was made to reorganize services by enhancing the role of senior nursing staff to: (1) admit patients, (2) request CT brain scans, (3) screen for swallowing abnormality, and (4) prescribe the first dose of aspirin. A second audit was conducted to evaluate the impact of the new service.Results  Before reorganization, 30% had swallowing screened and 38% had CT scans within 24 h. Thirty‐one per cent received their first dose of aspirin within 48 h. After reorganization, 68% had their swallowing screened and 80% had a CT scan within 24 h. Ninety per cent of patients received their first dose of aspirin within 48 h.Conclusions  Modernizing service delivery by changing traditional roles can offer quality solutions ensuring that aspirin delivery is expedited by early swallow screen and CT scan. These initiatives could be used more widely to improve patient care and implement the top three process indicators for stroke.
What do primary care nurses and radiation therapists in a Canadian cancer centre think about clinical trials?
Authors: Sale Joanna E. M. 
Published: May 2006

AbstractRationale, aims and objectives  Clinical trials are integral to progress in cancer management. While doctors’ attitudes to clinical trials have been documented, there is little or no literature on the perception of trials from the perspective of other clinicians who treat trial patients. The purpose of this phenomenological study was to explore nurses’ and radiation therapists’ (RTs) perceptions of clinical trials in their cancer centre.Methods  This study was conducted in a Canadian cancer centre where over 50 clinical trials actively recruit patients at any one time. Nurses and RTs were interviewed to explore their perceptions of clinical trials.Results  The following themes emerged from the analysis: (1) nurses and RTs perceived a variety of ethical concerns associated with clinical trials; (2) treating patients enrolled in clinical trials was perceived to add to the workload of RTs; (3) nurses and RTs did not perceive meaningful involvement in clinical trials as an option; and (4) the additional workload and ethical concerns associated with trials were off‐set by the view that patients’ interests outweighed those of nurses and RTs.Discussion  Nurses and RTs should be invited to provide input regarding trial procedures and be acknowledged for their work associated with clinical trials.
Ontario doctors’ attitudes toward and use of clinical practice guidelines in oncology
Authors: Graham Ian D. , Brouwers Melissa , Davies Christine , Tetroe Jacqueline 
Published: May 2006

Abstract
Background  Clinical practice guidelines are intended to improve patient care and outcomes. Controversy exists about the utility of guidelines and doctors’ attitudes toward them. The purpose of the survey was to determine Ontario doctors’ attitudes toward practice guidelines in general, awareness of, and attitudes about, Cancer Care Ontario’s Practice Guideline Initiative and the evidence‐based guidelines it produces, self‐reported use of guidelines and, factors related to guideline use.
Methods  We conducted a cross‐sectional, self‐administered postal survey of 1034 Ontario doctors who treat cancer. Main outcome measures were attitudes toward practice guidelines in general, attitudes towards those developed by Cancer Care Ontario’s Practice Guideline Initiative, and self‐reported use of practice guidelines.
Findings  A total of 520 doctors responded producing a 57% survey response rate. Ontario doctors are quite positive about practice guidelines in general and those developed by Cancer Care Ontario. Forty‐four per cent reported using guidelines routinely or most of the time. Positive attitudes towards guidelines in general and the Ontario cancer guidelines specifically were related to more frequent reported use of guidelines. Other factors related to frequent reported use of guidelines included being a medical oncologist, treating gynaecological cancers and not other types of cancers.
Interpretation  Ontario doctors have positive attitudes toward practice guidelines and report frequent use of them. By understanding the relationship between doctors’ perceptions of specific guidelines and their subsequent adherence to them, guideline developers will be better positioned to produce quality evidence‐based guidelines that doctors will find acceptable, and therefore, be more predisposed to use.