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Burmese Pythons in the Everglades. They followed their ears to a duel between an alligator and a huge Burmese Python. The alligator clamped his jaws around the xiv versailles, snake. And Peter Iii? The snake wrapped its body around the xiv versailles, alligator. The tourists wasted no time in whipping out their camera phones or video cameras, and within days the video was viral. Essay On Michigan Court Case: Toussaint Shiled? Millions were enthralled by the odd match-up, but to scientists, it was a sign of what could be a very serious problem.

The fight between an American alligator and a Burmese Python is louis, unusual, and Salt Environment, pretty intriguing, because the Burmese Python is not native to Florida. We will write a custom essay sample. on Burmese Pythons in xiv versailles, the Everglades or any similar. topic specifically for first laptop invented you. In fact, people barely noticed they were there until the early 1990s. The accidental introduction of an louis xiv versailles, invasive species to an ecosystem can be absolutely devastating. They can wipe out other species, destroy habitats, and throw the whole system out of personal, whack. We’ve seen it before. The introduction of the Brown treesnake to Guam, for louis example, caused major ecological and socioeconomic problems since its introduction to Guam shortly after World War II.

The tree snakes clearly thrived in the environment of Guam over that of Australia; Specimens from Guam were significantly larger, Dobson 2 nd reproduced year round, as compared to on Michigan Charles Toussaint Shiled, those found living in Australia, which reproduce seasonally. As the snakes thrived in a new home, the xiv versailles, island could not quite handle them as their native lands could. The brown treesnake caused a severe decline in native forest bird species, the loss of two lizard species, and declines in goods example, the Marianna fruit bat. Xiv Versailles? It is now recognized as a public health threat, as well as a substantial drain on when Guam’s economy. What has happened to Guam at the hand of a foreign, invasive species which should never have been introduced could easily happen to Florida too. If we allow the louis xiv versailles, Burmese Python to take over and deplete the diverse everglades, there is no telling what could be the Comparing Punishments for Sodomy: and the Eighteenth Century, long term effect. Like the Brown Treesnake to Guam, the Burmese Python survives better in the Everglades than its own natural environment. Louis? In Southeast Asia, the pythons may beprey to jackals, monitor lizards, parasites, and diseases. “By the time they reach two years old, not much can eat them in the Everglades” says USGS biologist Kristen Hart, quoted by Michael Tennessen (6). These animals are large: up to 20 feet long, and 200 pounds heavy. Personal Definition? Page 2 Burmese Pythons in the Everglades Essay. Louis? They aresneaky: they’re often underground, in trees, underwater, or just blending into their surroundings with their brown and green-ish markings.

They’re fast: “Relocated Pythons have demonstrated a homing ability, returning up to 48 miles from where they were captured. ” (Tennessen, 5) Most native species of the Everglades don’t stand a chance against these monsters. Some experts estimate that there are tens of thousands of Burmese Pythons living free in Florida today. Some eighteen hundred specimens have been removed and Effects of Road to the Essay, recorded in and around the louis, Everglades since 2005. Their numbers have risen dramatically. Two Burmese Dobson 3 Pythons were captured in the Everglades in 2000. In 2008, the goods example, number captured hit 343 (Tennesen, 3). Long ago, water from the xiv versailles, Kissimmee River was free to laptop invented, flow to Lake Okeechobee and xiv versailles, southward, over the lowlands of Biscayne Bay, the Ten Thousand Islands, and definition, Florida Bay. It was a shallow layer of water moving slowly across nearly 11,000 square miles. It created the swamps, sloughs, ponds, marshes and forests which now make up the remaining wilderness of southern Florida.

Many of those species are native, but many have been introduced to the environment, usually as stowaways on other imports, or pets that have been released. The Burmese Python is one of the most invasive of these non-native species. The snakes originate from Southeast Asia, so they thrive in xiv versailles, Florida’s similar environment. The Everglades became sort of of Road Environment Essay, a paradise to the pythons, since their introduction in the early 1990’s. Louis? A female Burmese Python will lay up to 207 eggs at catherine, once. Inside her nest, she will coil her body around the eggs to maintain a temperature of about ninety degrees Fahrenheit. Incubation takes around two months. The python has only just recently been observed engaging in shivering thermo genesis for louis the first time outside of captivity. This is the production of body heat through muscle contractions.

The mother snake does this to raise the temperature of her nest and eggs- the warmer the incubation, the quicker they will hatch, and slither free throughout the forest, carrying on its destructive path. With this sort of reproduction, it’s no wonder they’re so easily taking over the Everglades. Dobson 4 One of the first big releases of the Burmese Python in Florida took place in 1992. Hurricane Andrew, a category 5 hurricane, took down a large snake importer’s warehouse, as well as causing many billions of dollars of damage. Each year, Miami receives 12,000 exotic pet shipments, many of which are the Burmese Python. A person who takes in a 20-inch baby python might be understandably surprised when it becomes a 12-foot, 200 pound beast within a couple years, and many will end up releasing it into the wild. Most likely they are unaware that the personal effectiveness, reptile is louis xiv versailles, about to Essay Court Charles Toussaint vs BlueCross Shiled, wreak havoc on xiv versailles the ecosystem, gobbling native small to medium-sized species of all kinds, if they are unlucky enough to fall into its path. A Burmese Python will eat anything from birds and rodents to bobcats and deer- it will even swallow one of Florida’s iconic American Alligators like the one the Essay Court Charles vs BlueCross Blued, tourists captured. Scientists who are worried about conservation of The Everglade’s native species have been recording numbers of medium-sized animal sightings and comparing them to numbers taken during 1996 and 1997. The recordings for most species were down by xiv versailles close to 99 percent!

Obviously there are other factors that have surely had an effect on the animals, like climate change, pollution, hurricanes, and whatever else, but there is a pretty definite link between the time of introduction of the to the Essay, Bermuda Python to wild Florida, and the sharp decrease in sightings of native species. Louis Xiv Versailles? The solution for such an issue is a tricky debate. How do you get rid of such a large population entirely? It may not seem especially “eco-friendly” or humane to on Michigan Court Toussaint Shiled, run around capturing and killing as many Burmese Pythons as we can get our hands on, but neither is. Dobson 5 allowing these creatures that humans are responsible for bringing to Southern Florida, deplete the natural ecosystem and force native species into endangerment or extinction. So far nobody has thought up a good alternative, and permits to catch/kill Burmese Pythons found in and around the Everglades are now distributed. In 2003, the Task Force established an interagency team (FIATT) that will focus its efforts on non-native species. Their goal is to figure out how to assess and control the numbers of these threatening species (National Resource Council, 53).

The largest subtropical wilderness here in the United States has also been designated as a World Heritage Site, an xiv versailles, International Biosphere Reserve, and Wetland of International Importance. It is naturally home to a wide spectrum of species, some which cannot even be found anywhere else. Needless to say, the preservation of this landmark is hugely important. Definition? Besides the Pythons there are Nile Monitor Lizards, African Sacred Ibis, Old World Climbing Ferns, and god knows what else threatening a fragile ecosystem. There is xiv versailles, no quick or easy way of personal effectiveness definition, stopping the Burmese Python from destroying the Everglades. We will have to work tirelessly and with dedication, because this problem will not take care of itself.

One by one, each Burmese python will have to be captured and dealt with by louis relocation, or extermination. In all of goods example, my research, I found no alternative solution proposed, besides killing off most of the snakes. Maybe, more humanely, we could arrange some sort of python sanctuary in which Burmese Pythons are captured, sterilized, and cared for until their natural deaths.

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How to Write an Evidence-Based Clinical Review Article. JAY SIWEK, M.D., and MARGARET L. GOURLAY, M.D., Georgetown University Medical Center, Washington D.C. DAVID C. SLAWSON, M.D., University of Virginia Health System, Charlottesville, Virginia. ALLEN F. Xiv Versailles. SHAUGHNESSY, PHARM.D., Harrisburg Family Practice Residency, Harrisburg, Pennsylvania. Am Fam Physician. Personal Effectiveness Definition. 2002 Jan 15;65(2):251-258.

Traditional clinical review articles, also known as updates, differ from systematic reviews and meta-analyses. Louis Xiv Versailles. Updates selectively review the medical literature while discussing a topic broadly. Nonquantitative systematic reviews comprehensively examine the medical literature, seeking to identify and goods example synthesize all relevant information to formulate the best approach to xiv versailles, diagnosis or treatment. Punishments For Sodomy: England And The Eighteenth Century. Meta-analyses (quantitative systematic reviews) seek to answer a focused clinical question, using rigorous statistical analysis of pooled research studies. This article presents guidelines for xiv versailles, writing an evidence-based clinical review article for Court Charles Toussaint Blued Shiled, American Family Physician . First, the topic should be of louis common interest and relevance to family practice. Include a table of the continuing medical education objectives of the review. State how the literature search was done and include several sources of evidence-based reviews, such as the Cochrane Collaboration, BMJ's Clinical Evidence , or the InfoRetriever Web site. Where possible, use evidence based on clinical outcomes relating to morbidity, mortality, or quality of life, and studies of primary care populations. In articles submitted to American Family Physician , rate the level of evidence for key recommendations according to the great and peter iii, the following scale: level A (randomized controlled trial [RCT], meta-analysis); level B (other evidence); level C (consensus/expert opinion). Finally, provide a table of key summary points.

American Family Physician is xiv versailles, particularly interested in receiving clinical review articles that follow an evidence-based format. Punishments For Sodomy: English In The. Clinical review articles, also known as updates, differ from systematic reviews and louis meta-analyses in important ways.1 Updates selectively review the medical literature while discussing a topic broadly. An example of such a topic is, #x201c;The diagnosis and treatment of myocardial ischemia.#x201d; Systematic reviews comprehensively examine the medical literature, seeking to identify and synthesize all relevant information to formulate the best approach to Punishments England and the English Navy Century, diagnosis or treatment. Examples are many of the systematic reviews of the Cochrane Collaboration or BMJ's Clinical Evidence compendium. Xiv Versailles. Meta-analyses are a special type of systematic review. They use quantitative methods to analyze the Punishments for Sodomy: England and the Navy Century literature and seek to answer a focused clinical question, using rigorous statistical analysis of pooled research studies. An example is, #x201c;Do beta blockers reduce mortality following myocardial infarction?#x201d; The best clinical review articles base the xiv versailles discussion on when first laptop invented existing systematic reviews and xiv versailles meta-analyses, and incorporate all relevant research findings about the management of a given disorder. Such evidence-based updates provide readers with powerful summaries and sound clinical guidance. In this article, we present guidelines for writing an evidence-based clinical review article, especially one designed for continuing medical education (CME) and of Road Salt to the Environment incorporating CME objectives into its format. Xiv Versailles. This article may be read as a companion piece to a previous article and accompanying editorial about personal, reading and evaluating clinical review articles.1 , 2 Some articles may not be appropriate for xiv versailles, an evidence-based format because of the nature of the topic, the slant of the on Michigan Court Case: Toussaint vs BlueCross article, a lack of sufficient supporting evidence, or other factors.

We encourage authors to review the literature and, wherever possible, rate key points of louis xiv versailles evidence. Of Road Salt To The Environment. This process will help emphasize the summary points of the louis xiv versailles article and strengthen its teaching value. Choose a common clinical problem and avoid topics that are rarities or unusual manifestations of disease or that have curiosity value only. Whenever possible, choose common problems for which there is new information about diagnosis or treatment. Emphasize new information that, if valid, should prompt a change in clinical practice, such as the goods example recent evidence that spironolactone therapy improves survival in patients who have severe congestive heart failure.3 Similarly, new evidence showing that a standard treatment is no longer helpful, but may be harmful, would also be important to report. For example, patching most traumatic corneal abrasions may actually cause more symptoms and delay healing compared with no patching.4. When searching the louis xiv versailles literature on your topic, please consult several sources of evidence-based reviews (Table 1) . Catherine The Great And Peter. Look for pertinent guidelines on louis the diagnosis, treatment, or prevention of the disorder being discussed. Incorporate all high-quality recommendations that are relevant to the topic. When reviewing the first draft, look for invented, all key recommendations about diagnosis and, especially, treatment.

Try to ensure that all recommendations are based on the highest level of evidence available. If you are not sure about the source or strength of the recommendation, return to the literature, seeking out the louis xiv versailles basis for the recommendation. Some Sources of Evidence-Based Medicine. Agency for Healthcare Research and Comparing and the English in the Eighteenth Quality (AHRQ), formerly known as the Agency for Health Care Policy and Research (AHCPR): Clinical Guidelines and Evidence Reports* The AHRQ Web site includes links to the National Guideline Clearinghouse, Evidence Reports from the AHRQ's 12 Evidence-based Practice Centers (EPC), and Preventive Services. The AHCPR released 19 Clinical Practice Guidelines between 1992 and1996 that were not subsequently updated. American College of Physicians Journal Club (ACPJC) ACP Journal Club evaluates evidence in individual articles.

Commentary by ACP author offers clinical recommendations. Access to louis, the online version of ACPJC is a benefit for members of the ACP-ASIM, but will be open to all until at least the end of Effects of Road to the Environment Essay 2001. Features short evaluations/discussions of individual articles dealing with evidence-based clinical practice. Centre for xiv versailles, Evidence Based Medicine (CEBM) The University of Oxford/Oxford Radcliffe Hospital Clinical School Web site includes links to CEBM within the Effects Salt Faculty of Medicine, a CATbank (Critically Appraised Topics), links to evidence-based journals, and EBM-related teaching materials. Center for Research Support, TRIP Database. The AHRQ began the Translating Research into Practice (TRIP) initiative in 1990 to implement evidence-based tools and xiv versailles information. The TRIP Database features hyperlinks to the largest collection of EBM materials on the internet, including NGC, POEM, DARE, Cochrane Library, CATbank, and individual articles. A good starting place for an EBM literature search. Clinical Evidence , BMJ Publishing Group*

Searches BMJ's Clinical Evidence compendium for up-to-date evidence regarding effective health care. Lists available topics and describes the Case: vs BlueCross Shiled supporting body of louis evidence to date (e.g., number of relevant randomized controlled trials published to date). Concludes with interventions #x201c;likely to be beneficial#x201d; versus those with #x201c;unknown effectiveness.#x201d; Individuals who have received a free copy of Clinical Evidence Issue 5 from the United Health Foundation are also entitled to free access to the full online content. Cochrane Database of Systematic Reviews* Systematic evidence reviews that are updated periodically by for Sodomy: England English Navy Eighteenth Century, the Cochrane Group. Reviewers discuss whether adequate data are available for the development of EBM guidelines for diagnosis or management.

Database of Abstracts of xiv versailles Reviews of Effectiveness (DARE)* Structured abstracts written by University of York CRD reviewers (see NHS CRD). Abstract summaries review articles on diagnostic or treatment interventions and discuss clinical implications. Effective Health Care* Bi-monthly, peer-reviewed bulletin for was the first laptop invented, medical decision-makers. Based on systematic reviews and synthesis of research on the clinical effectiveness, cost-effectiveness and acceptability of health service interventions. Bimonthly publication launched in 1995 by louis, the BMJ Publishing Group. Article summaries include commentaries by clinical experts. Subscription is required. Evidence-Based Practice Newsletter (including JFP Patient-Oriented Evidence that Matters [POEM])*

This JFP newsletter features up-to-date POEM, Disease-Oriented Evidence (DOE), and tests approved for Category 1 CME credit. Subscription required. Includes the InfoRetriever search system for effectiveness, the complete POEMs database and louis six additional evidence-based databases. Subscription is required. Institute for Clinical Systems Improvement (ICSI)* ICSI is an independent, nonprofit collaboration of health care organizations, including the Mayo Clinic, Rochester, Minn. Web site includes the ICSI guidelines for Comparing England and the English Navy Eighteenth Century, preventive services and disease management. National Guideline Clearinghouse (NGC) Comprehensive database of evidence-based clinical practice guidelines from government agencies and health care organizations.

Describes and compares guideline statements with respect to objectives, methods, outcomes, evidence rating scheme, and major recommendations. National Health Service (NHS) Centre for Reviews and Dissemination (CRD) Searches CRD Databases (includes DARE, NHS Economic Evaluation Database, Health Technology Assessment Database) for EBM reviews. Xiv Versailles. More limited than TRIP Database. Primary Care Clinical Practice Guidelines.

University of California, San Francisco, Web site that includes links to NGC, CEBM, AHRQ, individual articles, and organizations. U.S. Preventive Services Task Force (USPSTF)* This Web site features updated recommendations for clinical preventive services based on systematic evidence reviews by the U.S. Preventive Services Task Force. EBM = evidence-based medicine . *#x2014; These Web sites are AAFP-approved sources of systematic evidence reviews. When these sources are used to prepare continuing medical education clinical content according to guidelines issued by the AAFP Commission of Continuing Medical Education, the content will qualify for the special designation of evidence-based CME. Effects Of Road Essay. See the AAFP Web site for additional information about preparing evidence-based CME . Some Sources of Evidence-Based Medicine.

Agency for Healthcare Research and Quality (AHRQ), formerly known as the Agency for louis xiv versailles, Health Care Policy and Research (AHCPR): Clinical Guidelines and Evidence Reports* The AHRQ Web site includes links to the National Guideline Clearinghouse, Evidence Reports from the AHRQ's 12 Evidence-based Practice Centers (EPC), and Preventive Services. The AHCPR released 19 Clinical Practice Guidelines between 1992 and1996 that were not subsequently updated. American College of Effects of Road Essay Physicians Journal Club (ACPJC) ACP Journal Club evaluates evidence in individual articles. Louis Xiv Versailles. Commentary by ACP author offers clinical recommendations. Access to the online version of Punishments for Sodomy: England and the English ACPJC is a benefit for louis xiv versailles, members of the ACP-ASIM, but will be open to all until at least the end of 2001. Features short evaluations/discussions of individual articles dealing with evidence-based clinical practice.

Centre for Evidence Based Medicine (CEBM) The University of Essay on Michigan Blued Oxford/Oxford Radcliffe Hospital Clinical School Web site includes links to louis, CEBM within the goods example Faculty of Medicine, a CATbank (Critically Appraised Topics), links to evidence-based journals, and EBM-related teaching materials. Center for louis, Research Support, TRIP Database. The AHRQ began the Translating Research into Essay on Michigan Case: Charles vs BlueCross Practice (TRIP) initiative in 1990 to implement evidence-based tools and information. The TRIP Database features hyperlinks to the largest collection of EBM materials on the internet, including NGC, POEM, DARE, Cochrane Library, CATbank, and individual articles. A good starting place for an EBM literature search.

Clinical Evidence , BMJ Publishing Group* Searches BMJ's Clinical Evidence compendium for up-to-date evidence regarding effective health care. Louis. Lists available topics and describes the Essay Case: Charles Toussaint Blued Shiled supporting body of evidence to xiv versailles, date (e.g., number of relevant randomized controlled trials published to date). Goods Example. Concludes with interventions #x201c;likely to louis, be beneficial#x201d; versus those with #x201c;unknown effectiveness.#x201d; Individuals who have received a free copy of Clinical Evidence Issue 5 from the definition United Health Foundation are also entitled to louis xiv versailles, free access to the full online content. Cochrane Database of when first Systematic Reviews* Systematic evidence reviews that are updated periodically by the Cochrane Group. Reviewers discuss whether adequate data are available for the development of EBM guidelines for diagnosis or management. Database of louis Abstracts of catherine the great and peter Reviews of Effectiveness (DARE)* Structured abstracts written by University of York CRD reviewers (see NHS CRD). Abstract summaries review articles on diagnostic or treatment interventions and discuss clinical implications. Effective Health Care*

Bi-monthly, peer-reviewed bulletin for medical decision-makers. Based on systematic reviews and synthesis of research on louis xiv versailles the clinical effectiveness, cost-effectiveness and personal effectiveness acceptability of health service interventions. Bimonthly publication launched in 1995 by the BMJ Publishing Group. Article summaries include commentaries by clinical experts. Subscription is required. Evidence-Based Practice Newsletter (including JFP Patient-Oriented Evidence that Matters [POEM])* This JFP newsletter features up-to-date POEM, Disease-Oriented Evidence (DOE), and louis xiv versailles tests approved for Category 1 CME credit. Subscription required. Includes the InfoRetriever search system for the complete POEMs database and six additional evidence-based databases. Subscription is Case: vs BlueCross Blued Shiled, required.

Institute for Clinical Systems Improvement (ICSI)* ICSI is an independent, nonprofit collaboration of health care organizations, including the Mayo Clinic, Rochester, Minn. Web site includes the ICSI guidelines for preventive services and louis disease management. National Guideline Clearinghouse (NGC) Comprehensive database of evidence-based clinical practice guidelines from the great and peter, government agencies and health care organizations. Xiv Versailles. Describes and compares guideline statements with respect to objectives, methods, outcomes, evidence rating scheme, and major recommendations. National Health Service (NHS) Centre for Reviews and Charles vs BlueCross Dissemination (CRD) Searches CRD Databases (includes DARE, NHS Economic Evaluation Database, Health Technology Assessment Database) for EBM reviews. More limited than TRIP Database. Primary Care Clinical Practice Guidelines. University of California, San Francisco, Web site that includes links to NGC, CEBM, AHRQ, individual articles, and organizations.

U.S. Preventive Services Task Force (USPSTF)* This Web site features updated recommendations for clinical preventive services based on systematic evidence reviews by the U.S. Preventive Services Task Force. EBM = evidence-based medicine . *#x2014; These Web sites are AAFP-approved sources of systematic evidence reviews.

When these sources are used to prepare continuing medical education clinical content according to louis, guidelines issued by the AAFP Commission of personal effectiveness definition Continuing Medical Education, the content will qualify for the special designation of louis xiv versailles evidence-based CME. See the AAFP Web site for additional information about preparing evidence-based CME . In particular, try to personal, find the louis xiv versailles answer in an authoritative compendium of evidence-based reviews, or at least try to find a meta-analysis or well-designed randomized controlled trial (RCT) to support it. If none appears to be available, try to cite an authoritative consensus statement or clinical guideline, such as a National Institutes of Health Consensus Development Conference statement or a clinical guideline published by a major medical organization. Catherine The Great And Peter Iii. If no strong evidence exists to louis xiv versailles, support the conventional approach to managing a given clinical situation, point this out in Comparing for Sodomy: and the Century, the text, especially for key recommendations. Keep in mind that much of xiv versailles traditional medical practice has not yet undergone rigorous scientific study, and high-quality evidence may not exist to support conventional knowledge or practice.

Patient-Oriented vs. Disease-Oriented Evidence. With regard to to the Environment, types of evidence, Shaughnessy and Slawson5 #x2013; 7 developed the concept of louis Patient-Oriented Evidence that Matters (POEM), in distinction to Disease-Oriented Evidence (DOE). POEM deals with outcomes of importance to the great iii, patients, such as changes in morbidity, mortality, or quality of life. DOE deals with surrogate end points, such as changes in laboratory values or other measures of response. Although the results of DOE sometimes parallel the results of POEM, they do not always correspond (Table 2) .2 When possible, use POEM-type evidence rather than DOE. When DOE is the only guidance available, indicate that key clinical recommendations lack the support of outcomes evidence. Here is an xiv versailles example of how the latter situation might appear in the text: #x201c;Although prostate-specific antigen (PSA) testing identifies prostate cancer at England and the Navy Eighteenth Century an early stage, it has not yet been proved that PSA screening improves patient survival.#x201d; (Note: PSA testing is an example of DOE, a surrogate marker for the true outcomes of importance#x2014;improved survival, decreased morbidity, and improved quality of life.) Antiarrhythmic drug X decreases the incidence of PVCs on ECGs.

Antiarrhythmic drug X is associated with an louis increase in personal effectiveness definition, mortality. POEM results are contrary to DOE implications. Antihypertensive drug treatment lowers blood pressure. Antihypertensive drug treatment is associated with a decrease in mortality. POEM results are in concordance with DOE implications.

Screening for prostate cancer. PSA screening detects prostate cancer at an early stage. Whether PSA screening reduces mortality from prostate cancer is currently unknown. Although DOE exists, the important POEM is xiv versailles, currently unknown. DOE = disease-oriented evidence; POEM = patient-oriented evidence that matters; PVCs = premature ventricular contractions; ECGs = electrocardiograms; PSA = prostate-specific antigen . Adapted with permission from the great iii, Shaughnessy AF, Slawson DC. Getting the most from louis, review articles: a guide for readers and writers. Am Fam Physician 1997;55:2155#x2013;60 . Antiarrhythmic drug X decreases the Essay Court Charles incidence of PVCs on ECGs. Antiarrhythmic drug X is associated with an increase in mortality.

POEM results are contrary to DOE implications. Antihypertensive drug treatment lowers blood pressure. Antihypertensive drug treatment is associated with a decrease in mortality. POEM results are in concordance with DOE implications. Screening for prostate cancer. PSA screening detects prostate cancer at an early stage. Whether PSA screening reduces mortality from prostate cancer is currently unknown. Although DOE exists, the important POEM is currently unknown.

DOE = disease-oriented evidence; POEM = patient-oriented evidence that matters; PVCs = premature ventricular contractions; ECGs = electrocardiograms; PSA = prostate-specific antigen . Adapted with permission from xiv versailles, Shaughnessy AF, Slawson DC. Getting the most from review articles: a guide for readers and writers. Am Fam Physician 1997;55:2155#x2013;60 . Evaluate the strength and validity of the literature that supports the discussion (see the following section, Levels of Evidence). Comparing Punishments And The Navy Eighteenth. Look for meta-analyses, high-quality, randomized clinical trials with important outcomes (POEM), or well-designed, nonrandomized clinical trials, clinical cohort studies, or case-controlled studies with consistent findings. In some cases, high-quality, historical, uncontrolled studies are appropriate (e.g., the louis evidence supporting the efficacy of Papanicolaou smear screening). Avoid anecdotal reports or repeating the hearsay of catherine conventional wisdom, which may not stand up to the scrutiny of scientific study (e.g., prescribing prolonged bed rest for low back pain). Look for studies that describe patient populations that are likely to be seen in primary care rather than subspecialty referral populations.

Shaughnessy and xiv versailles Slawson's guide for writers of clinical review articles includes a section on information and validity traps to avoid.2. Readers need to know the strength of the evidence supporting the key clinical recommendations on diagnosis and treatment. Many different rating systems of varying complexity and on Michigan Case: Blued clinical relevance are described in the medical literature. Recently, the xiv versailles third U.S. Preventive Services Task Force (USPSTF) emphasized the Essay on Michigan Case: Charles Toussaint Shiled importance of rating not only the louis study type (RCT, cohort study, case-control study, etc.), but also the study quality as measured by internal validity and the quality of the entire body of evidence on a topic.8.

While it is important to Essay on Michigan Charles, appreciate these evolving concepts, we find that a simplified grading system is more useful in AFP . Xiv Versailles. We have adopted the following convention, using an ABC rating scale. Criteria for Essay on Michigan Court Charles Toussaint vs BlueCross Blued Shiled, high-quality studies are discussed in several sources.8 , 9 See the AFP Web site (www.aafp.org/afp/authors) for additional information about levels of evidence and see the louis xiv versailles accompanying editorial in this issue discussing the potential pitfalls and limitations of any rating system. Level A (randomized controlled trial/meta-analysis): High-quality randomized controlled trial (RCT) that considers all important outcomes. High-quality meta-analysis (quantitative systematic review) using comprehensive search strategies. Level B (other evidence): A well-designed, nonrandomized clinical trial.

A nonquantitative systematic review with appropriate search strategies and well-substantiated conclusions. Includes lower quality RCTs, clinical cohort studies, and case-controlled studies with non-biased selection of study participants and consistent findings. Other evidence, such as high-quality, historical, uncontrolled studies, or well-designed epidemiologic studies with compelling findings, is also included. Level C (consensus/expert opinion): Consensus viewpoint or expert opinion. Each rating is applied to iii, a single reference in the article, not to the entire body of louis evidence that exists on a topic. Each label should include the letter rating (A, B, C), followed by vs BlueCross, the specific type of study for that reference. For example, following a level B rating, include one of these descriptors: (1) nonrandomized clinical trial; (2) nonquantitative systematic review; (3) lower quality RCT; (4) clinical cohort study; (5) case-controlled study; (6) historical uncontrolled study; (7) epidemiologic study. Here are some examples of the way evidence ratings should appear in xiv versailles, the text: #x201c;To improve morbidity and mortality, most patients in congestive heart failure should be treated with an angiotensin-converting enzyme inhibitor. [Evidence level A, RCT]#x201d; #x201c;The USPSTF recommends that clinicians routinely screen asymptomatic pregnant women 25 years and younger for chlamydial infection. [Evidence level B, non-randomized clinical trial]#x201d; #x201c;The American Diabetes Association recommends screening for diabetes every three years in personal effectiveness definition, all patients at high risk of the disease, including all adults 45 years and xiv versailles older. [Evidence level C, expert opinion]#x201d; When scientifically strong evidence does not exist to support a given clinical recommendation, you can point this out in the following way: #x201c;Physical therapy is traditionally prescribed for the treatment of adhesive capsulitis (frozen shoulder), although there are no randomized outcomes studies of this approach.#x201d; The introduction should define the topic and Essay Court Toussaint vs BlueCross Blued purpose of the review and describe its relevance to family practice.

The traditional way of doing this is to discuss the epidemiology of the condition, stating how many people have it at one point in time (prevalence) or what percentage of the population is xiv versailles, expected to develop it over a given period of time (incidence). A more engaging way of the great doing this is to indicate how often a typical family physician is likely to encounter this problem during a week, month, year, or career. Xiv Versailles. Emphasize the catherine the great key CME objectives of the review and summarize them in a separate table entitled #x201c;CME Objectives.#x201d; The methods section should briefly indicate how the literature search was conducted and what major sources of evidence were used. Ideally, indicate what predetermined criteria were used to include or exclude studies (e.g., studies had to be independently rated as being high quality by an established evaluation process, such as the Cochrane Collaboration). Be comprehensive in trying to identify all major relevant research. Critically evaluate the quality of research reviewed. Louis Xiv Versailles. Avoid selective referencing of only information that supports your conclusions.

If there is the great and peter iii, controversy on a topic, address the full scope of the controversy. The discussion can then follow the typical format of a clinical review article. Louis. It should touch on one or more of the following subtopics: etiology, pathophysiology, clinical presentation (signs and symptoms), diagnostic evaluation (history, physical examination, laboratory evaluation, and of Road Salt to the Environment diagnostic imaging), differential diagnosis, treatment (goals, medical/surgical therapy, laboratory testing, patient education, and louis xiv versailles follow-up), prognosis, prevention, and future directions. The review will be comprehensive and balanced if it acknowledges controversies, unresolved questions, recent developments, other viewpoints, and any apparent conflicts of when was the interest or instances of bias that might affect the xiv versailles strength of the evidence presented. Emphasize an Comparing Punishments England in the Century evidence-supported approach or, where little evidence exists, a consensus viewpoint. In the absence of a consensus viewpoint, you may describe generally accepted practices or discuss one or more reasoned approaches, but acknowledge that solid support for these recommendations is lacking. In some cases, cost-effectiveness analyses may be important in deciding how to implement health care services, especially preventive services.10 When relevant, mention high-quality cost-effectiveness analyses to xiv versailles, help clarify the costs and Effects health benefits associated with alternative interventions to achieve a given health outcome. Highlight key points about diagnosis and treatment in the discussion and include a summary table of the key take-home points. These points are not necessarily the same as the key recommendations, whose level of evidence is rated, although some of them will be.

Use tables, figures, and illustrations to highlight key points, and present a step-wise, algorithmic approach to diagnosis or treatment when possible. Rate the evidence for louis xiv versailles, key statements, especially treatment recommendations. We expect that most articles will have at most two to four key statements; some will have none. Goods Example. Rate only those statements that have corresponding references and base the rating on xiv versailles the quality and level of evidence presented in the supporting citations. Use primary sources (original research, RCTs, meta-analyses, and systematic reviews) as the basis for determining the level of evidence. In other words, the supporting citation should be a primary research source of the information, not a secondary source (such as a nonsystematic review article or a textbook) that simply cites the original source. When First Laptop. Systematic reviews that analyze multiple RCTs are good sources for louis, determining ratings of evidence. The references should include the most current and important sources of support for goods example, key statements (i.e., studies referred to, new information, controversial material, specific quantitative data, and xiv versailles information that would not usually be found in most general reference textbooks).

Generally, these references will be key evidence-based recommendations, meta-analyses, or landmark articles. Although some journals publish exhaustive lists of reference citations, AFP prefers to Essay on Michigan Court Charles Toussaint vs BlueCross, include a succinct list of key references. (We will make more extensive reference lists available on our Web site or provide links to your personal reference list.) You may use the louis xiv versailles following checklist to ensure the completeness of effectiveness definition your evidence-based review article; use the louis xiv versailles source list of reviews to identify important sources of evidence-based medicine materials. Checklist for an Evidence-Based Clinical Review Article. The topic is common in family practice, especially topics in which there is new, important information about diagnosis or treatment. The introduction defines the topic and the purpose of the review, and describes its relevance to family practice. A table of CME objectives for of Road Salt Essay, the review is included. The review states how you did your literature search and indicates what sources you checked to louis xiv versailles, ensure a comprehensive assessment of relevant studies (e.g., MEDLINE, the Cochrane Collaboration Database, the Center for Research Support, TRIP Database). Several sources of evidence-based reviews on the topic are evaluated (Table 1) . Where possible, POEM (dealing with changes in morbidity, mortality, or quality of life) rather than DOE (dealing with mechanistic explanations or surrogate end points, such as changes in laboratory tests) is used to support key clinical recommendations (Table 2) . Studies of patients likely to be representative of when those in primary care practices, rather than subspecialty referral centers, are emphasized. Studies that are not only statistically significant but also clinically significant are emphasized; e.g., interventions with meaningful changes in absolute risk reduction and low numbers needed to treat. Louis Xiv Versailles. (Seehttp://www.cebm.net/index.aspx?o=1116.)11. The level of evidence for key clinical recommendations is labeled using the following rating scale: level A (RCT/meta-analysis), level B (other evidence), and goods example level C (consensus/expert opinion).

Acknowledge controversies, recent developments, other viewpoints, and any apparent conflicts of interest or instances of bias that might affect the xiv versailles strength of the evidence presented. Highlight key points about diagnosis and treatment in Court Case: Toussaint Blued Shiled, the discussion and include a summary table of key take-home points. Use tables, figures, and illustrations to highlight key points and present a step-wise, algorithmic approach to diagnosis or treatment when possible. Emphasize evidence-based guidelines and primary research studies, rather than other review articles, unless they are systematic reviews. The essential elements of louis this checklist are summarized in on Michigan Court Case: vs BlueCross Blued, Table 3 . Essential Steps in louis xiv versailles, Writing an Evidence-Based Clinical Review Article.

Choose a common, important topic in family practice. Provide a table with a list of goods example continuing medical education (CME) objectives for the review. State how the literature search and reference selection were done. Use several sources of evidence-based reviews on xiv versailles the topic. Rate the level of evidence for key recommendations in the text. Provide a table of key summary points (not necessarily the same as key recommendations that are rated). Essential Steps in Comparing Punishments and the English Navy in the Eighteenth Century, Writing an Evidence-Based Clinical Review Article. Choose a common, important topic in xiv versailles, family practice. Provide a table with a list of continuing medical education (CME) objectives for the review. State how the literature search and reference selection were done. Use several sources of evidence-based reviews on the topic.

Rate the level of evidence for key recommendations in the text. Provide a table of personal definition key summary points (not necessarily the same as key recommendations that are rated). Read the full article. Get immediate access, anytime, anywhere. Choose a single article, issue, or full-access subscription. Louis Xiv Versailles. Earn up to 6 CME credits per issue. Already a member or subscriber? Log in.

Get Full Access. Includes: Immediate, unlimited access to all AFP content More than 130 CME credits per year Access to the AFP app Print delivery option. Access This Issue. Includes: Immediate access to catherine the great and peter iii, this issue CME credits in this issue. Access This Article. JAY SIWEK, M.D., is professor and chair of the Department of Family Medicine at Georgetown University Medical Center, Washington, D.C.

He is xiv versailles, also editor of American Family Physician. A graduate of when was the laptop Georgetown University School of Medicine, Dr. Siwek completed his family practice residency at Middlesex Hospital in Middletown, Conn. . MARGARET L. GOURLAY, M.D., is currently the American Family Physician Medical Editing Fellow at Georgetown University Medical Center. A graduate of Rush Medical College, Chicago, she completed a residency in family medicine at the University of California, San Diego, Medical Center. DAVID C. SLAWSON, M.D., is the B. Lewis Barnett, Jr. professor of family medicine at the University of Virginia Health System in Charlottesville, Va. He is director and founder of the louis xiv versailles Center for Information Mastery and serves as section editor for The Journal of Family Practice POEMs. Dr. Slawson is goods example, a graduate of the louis xiv versailles University of Michigan School of Medicine, Ann Arbor, Mich., and he completed postdoctoral training in catherine and peter, family medicine at the University of Virginia. ALLEN F. SHAUGHNESSY, PHARM.D., is director of louis xiv versailles research and associate director of the goods example Harrisburg Family Practice Residency, Harrisburg, Pa.

He completed his doctorate and louis fellowship training at Comparing for Sodomy: and the in the Eighteenth the Medical University of South Carolina, Charleston. Address correspondence to Jay Siwek, M.D., Department of Family Medicine, Georgetown University Medical Center, 215 Kober-Cogan Hall, 3750 Reservoir Rd. NW, Washington DC 20007 (e-mail:afp@family.georgetown.edu). Reprints are not available from the authors . The authors thank Ted Ganiats, M.D. for a helpful review and conceptual contributions to the manuscript . The authors indicate that they do not have any conflicts of interest. Sources of funding: none reported . 1. Siwek J. Reading and evaluating clinical review articles. Am Fam Physician . 1997;55:2064,2069#x2013;70,2072. . 2. Shaughnessy AF, Slawson DC. Getting the most from review articles: a guide for readers and writers. Am Fam Physician . 1997;55:2155#x2013;60. 3. Pitt B, Zannad F, Remme WJ, Cody R, Castaigne A, Perez A, et al. for the Randomized Aldactone Evaluation Study Investigators.

The effect of spironolactone on morbidity and mortality in patients with severe heart failure. Louis Xiv Versailles. N Engl J Med . Effectiveness. 1999;341:709#x2013;17. 4. Flynn CA, D'Amico F, Smith G. Should we patch corneal abrasions? A meta-analysis. J Fam Pract . 1998;47:264#x2013;70.

5. Louis Xiv Versailles. Slawson DC, Shaughnessy AF, Bennett JH. Becoming a medical information master: feeling good about not knowing everything. J Fam Pract . Catherine The Great And Peter Iii. 1994;38:505#x2013;13. 6. Shaughnessy AF, Slawson DC, Bennett JH. Becoming an information master: a guidebook to the medical information jungle. J Fam Pract . 1994;39:489#x2013;99. 7. Slawson DC, Shaughnessy AF.

Becoming an louis xiv versailles information master: using POEMs to England and the English Eighteenth Century, change practice with confidence. Louis Xiv Versailles. Patient-oriented evidence that matters. J Fam Pract . 2000;49:63#x2013;7. 8. Harris RP, Helfand M, Woolf SH, Lohr KN, Mulrow CD, Teutsch SM, et al. Methods Work Group, Third U.S. Environment. Preventive Services Task Force.

Current methods of the U.S. Xiv Versailles. Preventive Services Task Force. A review of the process. Am J Prev Med . 2001;20(3 suppl):21#x2013;35. 9. CATbank topics: levels of evidence and grades of goods example recommendations. Xiv Versailles. Retrieved November 2001, from: http://www.cebm.net/. 10. Saha S, Hoerger TJ, Pignone MP, Teutsch SM, Helfand M, Mandelblatt JS. for the Cost Work Group of the Third U.S. Preventive Services Task Force.

The art and Essay Blued science of incorporating cost effectiveness into evidence-based recommendations for xiv versailles, clinical preventive services. Am J Prev Med . 2001;20(3 suppl):36#x2013;43. 11. Evidence-based medicine glossary. Retrieved November 2001, from: http://www.cebm.net/index.aspx?o=1116. Copyright © 2002 by the American Academy of Family Physicians. This content is owned by the AAFP. Goods Example. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference.

This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by louis xiv versailles, the AAFP. Contact afpserv@aafp.org for copyright questions and/or permission requests. This page will be removed from your Favorites Links. For Sodomy: England English In The. Are you sure? Want to use this article elsewhere? Get Permissions.

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Essay On My Book Essays and Research Papers. April 11, 2013 Period 2 English 3 Honors Today I am going to explain to you about Judy Blume and xiv versailles, her childhood, education, and all . of her great achievements. I chose Judy Blume to write my paper on because she is an amazing writer and I was intrigued to learn more about her. Goods Example. She is an inspiration to a lot of people and is very successful. Judy Blume was born on February 12, 1938 in Elizabeth, New Jersey. Her parent’s names are Rudolph Sussman, a dentist, and Esther.

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rigged her laptop to announce that it would self-destruct in five seconds. While Donna was on her laptop, he activated the computers announcement. The . The Great And Peter. computer said “five… four… three… two… and up the louis xiv versailles stairs she ran screaming “HIT THE DECK! HIT THE DECK, MY COMPUTER IS GOING TO BLOW UP!!” He told her what he did and and peter iii, she bit him. Xiv Versailles. Later on, Randi, Donna, and Mark had decided to make videos. At first he wanted to make up a movie, but then they used Star Wars Trilogy but called it the “Star Wars Sill-Ogy”. Computer , Dustin Moskovitz , Eduardo Saverin 837 Words | 3 Pages. Essay about Red Nose Day The purpose is to entertain and goods example, change lives in the UK and louis xiv versailles, Africa.

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individual has to suffer. This is shown in The Book of Negroes. Was The Laptop Invented. The Book of Negroes by Lawrence Hill is a fictionalized, . historical account that explores the story of the protagonist, Aminata, who is louis xiv versailles, separated from her home, family, culture and faith. This book demonstrates the catherine the great effectiveness of Hill's ability to xiv versailles, portray imagery. Hill uses effective imagery to definition, emphasize the fact that often loss is louis xiv versailles, worse than death itself. This is shown through the book when Aminata loses her parents, her child and.

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