The document discusses the hierarchy of evidence, which ranks different types of studies based on how reliably they can answer questions about causes and effects. Randomized controlled trials are at the top of the hierarchy as they can best establish whether a cause-effect relationship exists between an intervention and an outcome. Systematic reviews that synthesize multiple randomized trials provide the highest level of evidence for making clinical decisions and identifying gaps in research.
"Hierarchies of Evidence" is an important but problematic concept for medical professionals to understand as it underpins their capacity to be effective practitioners and researchers.
This workshop is meant to be an introduction to the systematic review process. Further information about systematic reviews was available through a research guide. http://libguides.ucalgary.ca/content.php?pid=593664
"Hierarchies of Evidence" is an important but problematic concept for medical professionals to understand as it underpins their capacity to be effective practitioners and researchers.
This workshop is meant to be an introduction to the systematic review process. Further information about systematic reviews was available through a research guide. http://libguides.ucalgary.ca/content.php?pid=593664
This ppt is all about Biostatistics for Medical, Nursing and Pharmacy Students...
The Essentials of Biostatistics for Physicians, Nurses, and Clinicians
Biostatistics – Lecture Notes/Book (PDF) Nursing
Biostatistics are the development and application of statistical methods to a wide range of topics in biology. It encompasses the design of biological experiments, the collection and analysis of data from those experiments and the interpretation of the results.
The following topics are discussed in this presentation:
Research
Components of Research;
Why should We Publish?
Where to Publish?
Choosing journal
How to publish?
Writing a scientific paper
The structure of scientific papers
The submission and next steps
What to do if your manuscript is rejected?
Writing Skills
Researcher KnowHow session at the University of Liverpool from 15th March 2021 presented by Ruaraidh Hill, Angela Boland, Michelle Maden.
The session provided advice on conducting key activities in a systematic review. It can also provide a ‘top-up’ to the 3 part series of workshops about systematic reviews which ran earlier in the academic session. Suitable for postgraduates and staff planning or doing a systematic review for the first time or who wish to brush up on their knowledge.
It focuses on key steps in doing a systematic review. It offers brief practical advice, showcase tools and share top tips for progressing your review.
An introduction on how to go about a meta-analysis. Primarily designed for people with non statistical background. Heavily borrows from Cochrane Handbook of Systematic Reviews of Interventions.
This ppt is all about Biostatistics for Medical, Nursing and Pharmacy Students...
The Essentials of Biostatistics for Physicians, Nurses, and Clinicians
Biostatistics – Lecture Notes/Book (PDF) Nursing
Biostatistics are the development and application of statistical methods to a wide range of topics in biology. It encompasses the design of biological experiments, the collection and analysis of data from those experiments and the interpretation of the results.
The following topics are discussed in this presentation:
Research
Components of Research;
Why should We Publish?
Where to Publish?
Choosing journal
How to publish?
Writing a scientific paper
The structure of scientific papers
The submission and next steps
What to do if your manuscript is rejected?
Writing Skills
Researcher KnowHow session at the University of Liverpool from 15th March 2021 presented by Ruaraidh Hill, Angela Boland, Michelle Maden.
The session provided advice on conducting key activities in a systematic review. It can also provide a ‘top-up’ to the 3 part series of workshops about systematic reviews which ran earlier in the academic session. Suitable for postgraduates and staff planning or doing a systematic review for the first time or who wish to brush up on their knowledge.
It focuses on key steps in doing a systematic review. It offers brief practical advice, showcase tools and share top tips for progressing your review.
An introduction on how to go about a meta-analysis. Primarily designed for people with non statistical background. Heavily borrows from Cochrane Handbook of Systematic Reviews of Interventions.
Whether you are preparing for an upcoming nursing exam or struggling with a specific topic, our service is designed to cater to your unique needs. We offer personalized tutoring and support to help you overcome your challenges and achieve your academic goals. With our take my nursing exam, you can improve your nursing knowledge and skills and feel confident when taking your nursing exams. For more information visit us at https://www.liveexamhelper.com/take-my-nursing-exam.html or email support@liveexamhelper.com. You can also call +1 (315) 557-6473 for assistance with nursing exams.
This presentation was funded by CDC and PEPFAR through the SUCCEED project at Stellenbosch University. The presentation was delivered by Ms Lynn Hendricks from the Centre for Evidence Based Health Care in July 2017
This slideshare is from a lecture given to DENT4104 students beginning UWA's Doctor of Medical Dentistry. It introduces some basis OneSearch Library catalogue functions and introduces the notion of Evidence Based Practice.
PHAR1101: Broadening Search in OneSearchLucia Ravi
This presentation aims to support PHAR1101 students in searching for general resources about their Drug Pioneer within the UWA Library OneSearch catalogue.
PsychINFO database searching, gender dysphoria 2017Lucia Ravi
A basic introduction to constructing a simple search within the the PsycINFO Database on the Ovid platform. Sample search on "Gender Dysphoria" as a topic created for the IMED1108, Sem2, 2017.
HealthMed Complete database searching, female fetus 2017Lucia Ravi
A basic introduction to constructing a simple search within the Health and Medical Complete Database. Sample search on "Female fetus" as a topic created for the IMED1108, Sem2, 2017.
Scopus database searching, topic or author search Aug2017Lucia Ravi
A short introduction to Scopus - one of the specialist citation tracking database provided through the UWA Library. Provides tips for constructing a topic and author search in Scopus and running some of the analysis reporting features availalbe.
This presentation will introduce you to the basics of starting a search in UWA's OneSearch catalogue.
It was created by the UWA Library to support student's researching for their IMED1108 assessment.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
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TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
2. The purpose of a literature review is to identify the
existing body of research that has addressed a
problem and clarify the gaps in knowledge that
require further research. 1
The term levels of evidence refers to what degree
that information can be trusted. 1
1
Buckingham JB Greenhalgh T. Searching the literature. In: Greenhalgh T.
How to read a paper: the basics of evidence-based medicine.5th
ed. Hoboken: John Wiley
& Sons; 2014.
Levels of Evidence
3. The Hierarchy of Evidence
Decision support systemsProblem focused,
multiple questions
Simple, single
questions
6. Hierarchy of Evidence
The hierarchy of evidence is:
•A hierarchy of the likely best evidence
•Designed to be used as a shortcut by busy
clinicians and researchers to find the best evidence
•Assists researchers to conduct their own rapid appraisal
University of Oxford, Centre for Evidence Based Medicine. (2011). The 2011 Oxford CEBM levels of evidence: introductory
document. Retrieved from:
http://www.cebm.net/wp-content/uploads/2014/06/CEBM-Levels-of-Evidence-Introduction-2.1.pdf
10. Evidence-based guidelines
& summaries
• Developed by synthesising the highest level of
evidence available on treatment choices
• Guidelines provide recommendations
supported by that evidence
• May take into account resources and practices
relevant to the organisation
• Concise and clinically relevant
11. Where do I find evidence?
• PubMed/MEDLINE
• Embase/PsychInfo
• Cochrane/JBI
• TRIP/OvidMD
• BMJ Best Practice
• ClinicalKey
• UpToDate
• ETG Complete
See: Resources for Answering Clinical Questions
13. Contact the University Library
http://library.uwa.edu.au
9346 7570 – Medical and Dental Library
hmslibrarians-lib@uwa.edu.au
http://facebook.com/UWALibrary
@UWALibrary
Editor's Notes
Show of hands. Who feels confident with their understanding of the hierarchy of evidence and how to find research at different levels of evidence?
There is so much medical literature published you need to know how it is organised and the quickest way to find the information you need.
In Medical research it is particularly important to you are familiar with notions of evidenced based practice – that you base your practice decisions on the most up to date and high quality research on the population focus group you are working with in order to determine the best treatment.
Click link to OneSearch record of this eBook (will need Pheme credentials to read it), also shows the Multiple Versions feature.
Show contents and discuss briefly use of ebook platforms and of bookshelf.
Look at contents.. Focus particularly on break down of how to assess different papers that evaluate particular studies and in particular systematic reviews and guidelines.
Ask if students are familiar systematic reviews and Evidence based guidelines (hands up) and then to discuss some of the differences between them? Ask for feedback on these?
Greenhalgh, Trisha. 2014. How to read a paper: the basics of evidence-based medicine. BMJ Books: Hoboken.)
“The term ‘level of evidence’ refers to what degree that information can be trusted based on study design”. (Greenhalgh 2014)
As you can see from this pyramid the higher the corroboration of different types of evidence, the higher it is on the hierarchy.
You will come across many different forms of the hierarchy as it is continually being contested and evolving – so you will have to get used to interpreting it at a critical level.
This is the pyramid at its most basic level.. With single studies being considered the least reliable, moving to systematic reviews that undertake a robust review of studies undertaken on specific interventions, through to evidence based guidelines.. (however need to question if these latter do belong at the top of the hierarchy – in trying to provide an overview of current best practice of a condition as a whole)
We don’t have access to decision support systems at this time. They are systems that directly link to patient records.
Do have a EBM Lib Guide that provides links to the resources we offer to support EBM.
The bottom layer of the main hierarchy – single studies – has its own hierarchy depending on the original type of study performed.
This is where – if you are doing your own literature search or systematic review of treatment/disease research for a specific cohort – you would need to critically assess the research/studies/case focus for their research vigour and relevance to your area of health and cohort.
For single studies RCT are considered the most robust and unbiased and they are often the focus on systematic reviews.
Here is a new revised pyramid, (Developed by Dr Murad and his team at the Evidence Based Practice Centre, Mayo Clinic in Rochester USA.)
to take into account the need to think critically about the design and development of individual studies – replacing a straight line with a wavy one to indicate that some research lower down the hierarchy may actually be better if designed better than RCTs. The separation of systematic reviews from the pyramid emphasises that they themselves are a filter through which evidence is viewed and also subject to critical review in their overall design and development. The studies into your specific intervention or research focus area need to be available in order to undertake a systematic review.
The proposed new evidence-based medicine pyramid. (A) The traditional pyramid. (B) Revising the pyramid: (1) lines separating the study designs become wavy (Grading of Recommendations Assessment, Development and Evaluation), (2) systematic reviews are ‘chopped off’ the pyramid. (C) The revised pyramid: systematic reviews are a lens through which evidence is viewed (applied).
This pyramid represents the hierarchy of evidence that can be used to answer clinical questions. It will help lead you to the best resources where you can find evidence for your question. The higher the level of evidence (clinical importance) the less information out there for you to find. Higher levels of evidence are problem focused.
In your exploration of EBP and hierarchies of evidence you may come across slightly different hierarchies, this is the UWA FMDHS endorsed hierarchy of evidence.
Middle level: Systematic Reviews.
Systematic reviews analyse and appraise primary studies on the same question.
This is a simplified version of the process. (There are UWA as a well as a number of resources for this)
The final report will include their search strategies, keywords, subject headings. It is good to look at this to enhance your own learning/searching on your topic.
Finding a systematic review on a topic can save you a lot of time.
A well structured systematic review will include the databases searched, search strategies used and a detailed analysis of studies included in the review – their quality and strengths, can see also the reasons why certain studies were excluded or considered questionable.
One consideration in the evaluation of evidence is who has produced it and how good their methodology is? One of the key highly reputed players in Australia is The Joanna Briggs Institute who collaborate with Australian and international research institutes to produce systematic reviews and from these best practice guidelines available through their library JBI Connect.
They also produce methodology guides and software to support critical appraisal. This link is a good one for quick checklists on how to appraise different types of studies as well as systematic reviews.
One of the most robust and trusted producers of systematic reviews is the Cochrane Collaboration. Because systematic reviews have traditionally been built on RCT’s they have Cochrane Central which aims to bring together all randomized controlled trials from core databases such as Medline and Embase and from other sources.
The Cochrane Reviews (like JBI) also work in collaboration with International research bodies to produce systematic reviews and have a number of specialist resource databases such as their SR Database and database of Randomised control trials.
Like JBI they also produce and collate methodology reviews and critical appraisal of research tools which have been collated into a number of Handbooks.
This link is a good one for quick checklists on how to appraise different types of studies as well as systematic reviews.
The top levels
This section of the literature will become important later in your course when you begin clinical practice.
Can you trust the synthesis of the evidence that has been completed – who has been involved in it, how recent?
Is it comprehensive and based on appraised high level studies and systematic reviews or in providing a comprehensive overview of current best practice is it compromised.
http://ebm.bmj.com/content/21/4/121.full
Pyramids are Guides not rules: the evolution of the evidence pyramid.
These are the key databases where you can find studies and systematic reviews, guidelines and individual studies
See our guide for access to them: Resources for Answering Clinical Questions: http://guides.is.uwa.edu.au/ACQresources?hs=a
Go to this site and
And Dentistry – EBM tab http://guides.is.uwa.edu.au/c.php?g=324873&p=2177834
We will be looking at some of these in more detail in the upcoming workshop.
Take a bit of stretch and break now or have a look at the websites of the Joanna Briggs Institute or Cochrane Collaboration or our LibGuide link here.
Shown them how to navigate to this Guide from the UWA website.
Library’s guide to resources for answering clinical questions. The second tab in the guide that you can see here lists EBP resources available through the library catalogue, and tells which level of evidence you will find within.
You can see a table of different resources we have, and the level of evidence you can find in each. The green button next to each connects to a database-specific guide that lists tips for searching, tips on how to broaden or narrow your search, the best clinical use of the information, and positives and negatives of that particular resource. Includes tips on how to broaden your search and how to narrow your search, and tips on using truncation and wildcards.