Biologic Mesh in Hiatal Hernia Repair: Evidence Review
Intro
Hiatal hernia is a condition where part of the stomach pushes through the diaphragm into the chest cavity. Surgical repair is often necessary, and the choice of materials utilized in this process can significantly impact outcomes. Biologic mesh has emerged as a topic of interest in the realm of hiatal hernia repair, topped with unique properties that distinguish it from synthetic alternatives. This article aims to explore the use of biologic mesh in this surgical context by evaluating evidence of its efficacy, safety, and clinical outcomes.
Research Highlights
Key Findings
Recent studies indicate that biologic mesh can offer advantages in terms of tissue integration and reduced foreign body response when compared to traditional synthetic meshes. Several trials have shown promising outcomes regarding postoperative complications, including fewer incidences of mesh infection. In addition, the long-term success rates in patients who underwent repair with biologic mesh are gaining attention, demonstrating satisfactory symptom relief and overall patient satisfaction.
Implications and Applications
The implications of these findings are substantial. With proven clinical benefits, biologic mesh could redefine best practices in thoracic surgery. Surgeons may have to weigh the benefits against cost factors, as biologic meshes tend to be pricier than their synthetic counterparts. The ongoing discussions within the surgical community reflect a necessity for further studies, ensuring the optimization of patient care during hiatal hernia repair.
Methodology Overview
Research Design
A systematic review of the literature was conducted, focusing on randomized controlled trials and cohort studies specifically addressing the use of biologic mesh in hiatal hernia surgeries. The criteria for inclusion emphasized studies that reported on clinical efficacy, safety outcomes, and any adverse effects linked with the mesh materials used.
Experimental Procedures
Throughout the selected studies, various surgical techniques were employed, including laparoscopic and open approaches. The participants’ demographics, types of hiatal hernias, and specific biologic mesh products used were thoroughly documented. Data on postoperative complications like reherniation, dysphagia, and overall complications were aggregated to form a comprehensive understanding of the implications of biologic mesh usage.
"Understanding the evidence is crucial for making informed decisions about surgical options in hiatal hernia repair."
The meta-analysis consolidated findings across different settings and motivations, revealing trends in outcomes based on technique and material selection. This stage of research sets the groundwork for additional inquiries into optimizing hernia repair procedures.
Prologue to Hiatal Hernia and Its Repair
Hiatal hernias present a significant clinical challenge, characterized by the protrusion of a portion of the stomach into the thoracic cavity through the diaphragm. Understanding hiatal hernia is crucial for both effective treatment and patient care. This article examines the role of biologic mesh in the repair of hiatal hernias, focusing on its potential benefits over synthetic alternatives.
The prevalence of hiatal hernias is rising globally, often correlating with factors such as obesity and age. The implications for quality of life are profound, as patients may experience symptoms ranging from gastroesophageal reflux to more severe complications. Therefore, recognizing the types of hiatal hernias and their surgical management options is vital for healthcare practices.
Surgical intervention remains the primary approach to address hiatal hernias, aiming not just at symptom relief but also at preventing recurrence. The choice of repair materials has a significant bearing on outcomes, making the study of biologic mesh particularly relevant. Recent trends suggest a growing preference for biologic mesh due to its purported advantages in terms of biocompatibility and lower inflammatory responses, characteristics that are crucial for surgical success.
In this section, we will define hiatal hernias and review the different types, followed by the surgical options available for repair. By establishing this groundwork, we aim to illuminate the complexities of hiatal hernia repair and the emerging role of biologic mesh.
Definition and Types of Hiatal Hernia
A hiatal hernia can be broadly classified into two main types: sliding hiatal hernia and paraesophageal hiatal hernia.
- Sliding Hiatal Hernia: This is the most common form. In a sliding hiatal hernia, the gastroesophageal junction and a portion of the stomach slide up into the thoracic cavity during certain movements, such as bending or straining. This type often leads to reflux symptoms due to the displacement of the gastric junction.
- Paraesophageal Hiatal Hernia: This occurs when a portion of the stomach pushes through the diaphragm alongside the esophagus while the gastroesophageal junction remains in place. Although less common, paraesophageal hernias can lead to severe complications such as strangulation of the stomach.
Understanding these definitions and types is critical for tailoring surgical solutions and optimizing patient outcomes.
Surgical Options for Hiatal Hernia Correction
The primary surgical method for fixing hiatal hernias is called fundoplication. In this procedure, the upper part of the stomach is wrapped around the esophagus to reinforce the lower esophageal sphincter, thereby preventing reflux. Specific surgical options include:
- Laparoscopic Fundoplication: This minimally invasive approach offers quicker recovery times and reduced postoperative pain, making it increasingly popular among surgeons and patients.
- Open Fundoplication: Though more traditional, this method involves a larger incision and generally has a longer recovery time. It may be necessary in complex cases.
In addition to fundoplication, other surgical techniques may involve the placement of mesh to provide additional support and reduce recurrence rates. The use of biologic mesh in these procedures is a developing area of research, focusing on its effectiveness compared to synthetic materials.
As we delve deeper into the specific advantages of biologic mesh, examining its composition and mechanism of action will provide further insights into its application in hiatal hernia repair.
Understanding Biologic Mesh: An Overview
The use of biologic mesh in surgical procedures, particularly for hiatal hernia repair, is gaining recognition in the medical field. This section delves into the significance of biologic mesh, examining its unique attributes, benefits, and considerations that are pertinent to the clinical landscape. Biologic mesh, derived from natural tissue, offers distinct advantages over synthetic alternatives. The material closely resembles human anatomy, promoting better integration within the body. This promotes healing and reduces the risk of rejection or other complications.
Researchers and clinicians are increasingly exploring the role of biologic mesh in surgical techniques. Its applications extend beyond hiatal hernia, being utilized in various conditions requiring tissue reinforcement. An understanding of its composition and sources is essential for practitioners aiming to make informed decisions regarding patient care.
Another important aspect of biologic mesh is its mechanisms of action during surgical repair. Recognizing how it functions within the body helps tailor surgical approaches to individual patient needs. Thus, educating professionals about biologic mesh plays a critical role in optimizing patient outcomes and enhancing the quality of surgical practices.
Biologic mesh presents an appealing alternative by leveraging the body’s own biological properties to facilitate healing and minimize complications.
Composition and Sources of Biologic Mesh
Biologic mesh is crafted from materials that are biologically sourced, often derived from human or animal tissues. Common sources include fascia, skin, and pericardium, all of which are processed to remove cells and debris, ensuring safety for surgical use. The processing usually involves decellularization, where cellular material is eliminated, leaving only the extracellular matrix. This matrix serves as a scaffold fostering cellular infiltration and tissue regeneration.
The characteristics of biologic mesh may vary depending on its source. For instance, porcine dermis is often used due to its structural similarities to human tissue, whereas human-derived materials may offer immune compatibility advantages. It's essential that healthcare professionals are aware of the sourcing and methods involved to appreciate the nuances and potential implications for their patients.
Additionally, the biocompatibility of these materials often leads to a favorable inflammatory response. Compared to synthetic materials, which may provoke a significant immune response, biologic mesh presents a more harmonious option that may facilitate better integration into surrounding tissues.
Mechanisms of Action in Surgical Repair
The mechanisms through which biologic mesh contributes to surgical repair are multi-faceted. Upon implantation, biologic mesh acts primarily as a scaffold. This scaffold provides support for new tissue formation while allowing for gradual absorption over time, minimizing the need for permanent foreign materials in the body.
- Tissue Integration: As the host tissue grows and remodels, the biologic mesh integrates into the surrounding tissues, providing structural support. It encourages cellular migration and proliferation.
- Regenerative Support: The extracellular matrix's inherent properties facilitate the healing process by providing biochemical signals that promote cell adhesion and growth. This assists in the repair of damaged tissues.
- Reduced Risk of Complications: Given the biocompatible nature of the mesh, the risk of rejection or excessive inflammation is often lower than with synthetic materials. This may lead to improved outcomes for patients undergoing hernia repair.
In summary, understanding the composition and mechanisms of action of biologic mesh is essential for its successful application in hiatal hernia repair. This comprehension aids in the selection of appropriate materials and techniques, ultimately enhancing patient care.
Clinical Evidence Supporting Biologic Mesh Usage
The clinical evidence supporting the use of biologic mesh in hiatal hernia repair is pivotal in understanding its role relative to traditional synthetic options. Clinical studies have been conducted to evaluate various parameters like effectiveness, safety, and complications associated with biologic mesh. These studies aim to provide a solid foundation for surgical decisions and patient education.
Comparative Studies: Biologic vs. Synthetic Mesh
The comparison between biologic and synthetic mesh is a frequently debated topic in surgical literature. Biologic mesh is derived from human or animal tissues, which theoretically makes it more compatible with the human body. In contrast, synthetic mesh is typically manufactured from materials like polypropylene or polyester. While synthetic options have shown effectiveness in hernia repair, they can also lead to complications such as chronic pain or infection.
Recent studies, including randomized control trials, have assessed these factors. Findings indicate that biologic mesh can result in lower rates of complications, particularly in patients who might be at higher risks, such as the elderly or those with prior surgical history. Therefore, many surgeons are becoming increasingly inclined to recommend biologic mesh for specific patient profiles.
"Understanding these distinct differences is crucial for informed surgical choices."
Outcomes of Recent Clinical Trials
Several recent clinical trials have explored the long-term outcomes associated with biologic mesh use in hernia repair. One notable trial assessed the effectiveness of biologic mesh over a three-year period. The data revealed that patients experiencing repair with biologic mesh had lower rates of recurrence when compared to those using synthetic materials. Furthermore, patients reported improved quality of life and satisfaction post-surgery.
Another area of focus in these trials is the inflammatory response elicited by different mesh types. Biologic mesh typically exhibits a milder inflammatory response compared to its synthetic counterparts. This reduced inflammation can lead to quicker recovery times and ultimately better patient outcomes.
Advantages of Biologic Mesh in Hiatal Hernia Repair
The use of biologic mesh in hiatal hernia repair presents several compelling advantages that impact surgical outcomes. One of the most significant benefits of biologic mesh is its superior biocompatibility, which allows for a more harmonious integration into the human body. This characteristic leads to a reduced inflammatory response compared to synthetic alternatives, decreasing the likelihood of complications such as chronic pain or adhesion formation. Understanding these advantages is crucial for healthcare professionals when considering the best surgical options for their patients.
Biocompatibility and Reduced Inflammatory Response
Biologic mesh is generally derived from human or animal tissues, which closely resembles the natural components of the human body. This similarity enhances its biocompatibility, minimizing the immune reaction that could arise from foreign materials. Studies have indicated that patients receiving biologic mesh experience lower levels of acute and chronic inflammation. This reduced inflammatory response is important as it can lead to shorter recovery times and lower rates of postoperative complications.
Moreover, the integration of biologic mesh often aligns closely with the healing processes in the body. As the mesh becomes integrated into the surrounding tissues, its structure supports tissue ingrowth, promoting repair at the surgical site. This quality is particularly vital in the context of hiatal hernia repairs, where maintaining the integrity of the esophagus and surrounding structures is essential.
"The biocompatibility of biologic mesh is pivotal in engendering favorable surgical outcomes, mitigating complications associated with biopersistent foreign materials."
Long-Term Durability and Efficacy
While immediate biocompatibility is critical, the long-term durability of biologic mesh also warrants attention. Clinical studies suggest that the use of biologic mesh can lead to more favorable long-term outcomes with respect to recurrence rates and overall effectiveness of hiatal hernia repairs. Unlike synthetic meshes, biologic materials are designed not only to support the closure of the hernia but also to encourage tissue remodeling and repair over time.
The long-term efficacy of biologic mesh can be attributed to its gradual degradation and replacement by host tissue, allowing for a dynamic healing process. This ability to support natural tissue regeneration helps maintain the functionality of the operative site, reducing the chances of hernia recurrence. Furthermore, the studies suggest a potential for better patient satisfaction and quality of life post-surgery, as discomfort often associated with synthetic meshes is less prevalent with biologic options.
Potential Risks and Considerations
Understanding the risks associated with the use of biologic mesh in hiatal hernia repair is crucial for clinicians and patients alike. A comprehensive evaluation of potential complications can assist in informed decision-making and help mitigate adverse outcomes. Various factors influence the success of the surgery and the long-term effects on patients. This section will discuss two critical aspects of consideration: infection risks and patient selection criteria.
Infection and Other Complications
Infection presents a significant risk in any surgical procedure, and the use of biologic mesh is no exception. The integrity of biologic materials may be compromised by infection, leading to inflammation and impaired healing. Reports suggest that postoperative infections can occur due to the mesh's interaction with the body’s tissues. This risk is particularly pertinent considering that the mesh is often placed in contaminated or potentially infected sites.
Surgeons must recognize the signs of infection early. Symptoms may include increased pain at the site, fever, or fluid accumulation. To mitigate these risks, preoperative assessment and stringent aseptic techniques during surgery are essential. Using antibiotic prophylaxis is also recommended to lower the chance of infection, especially in high-risk patients.
Moreover, there are other complications that can arise from the use of biologic mesh. These may include:
- Seromas: Fluid accumulation around the mesh, possibly leading to discomfort and delayed recovery.
- Allergic Reactions: Although rare, some patients may exhibit hypersensitivity to the materials in the mesh.
- Migration of Mesh: Incorrect placement can result in movement, causing further intra-abdominal complications.
Patient Selection Criteria
Careful patient selection is vital to optimize outcomes and minimize risks associated with using biologic mesh. Not all patients are ideal candidates for biologic mesh implantation. Factors influencing selection include:
- Age and Overall Health: Younger, healthier patients typically recover better. Older patients or those with comorbidities may face higher risks of complications.
- Type of Hiatal Hernia: The complexity and size of the hernia also dictate the appropriateness of biologic mesh. Large or recurrent hernias might require alternative solutions.
- Prior Surgical History: Patients with extensive surgical history may have adhesions, raising the risk of complications post-surgery.
The surgical team should perform thorough evaluations, including imaging studies and physical assessments, to determine the best approach for each individual.
"Understanding both potential risks and patient selection criteria allows for tailored surgical interventions, ensuring improved patient outcomes."
In summary, a critical analysis of infection risks and careful consideration of patient selection criteria can significantly enhance the success of hiatal hernia repairs utilizing biologic mesh. This approach fosters both safety and efficacy in surgical practices.
Comparative Analysis with Synthetic Mesh Options
The integration of biologic mesh into hiatal hernia repair has prompted a significant discourse in surgical practice. Understanding the comparative advantages and drawbacks associated with synthetic mesh options is essential for clinicians to make informed decisions. This section will explore key factors such as costs, patient outcomes, and overall implications for surgical success.
Cost Implications and Economic Analysis
The economic assessment of biologic versus synthetic mesh remains a crucial factor in surgical decision-making. Biologic mesh tends to have a higher upfront cost compared to synthetic alternatives. However, this needs consideration beyond just the initial price tag.
- Total Cost of Treatment: Studies show that using biologic mesh may potentially decrease long-term complications, thus lowering the total lifetime cost of patient care.
- Hospital Stay: Patients utilizing biologic materials may experience reduced hospital stays post-surgery, contributing to overall cost savings.
- Reoperation Rates: Reoperation costs associated with complications from synthetic mesh could offset initial savings. Higher recurrence rates linked to synthetic options can lead to additional surgical interventions.
"The financial considerations need to factor in the holistic view of patient care, including short- and long-term health outcomes."
These elements highlight that while the initial price of biologic mesh is higher, the potential for reduced complications and better outcomes can lead to an overall cost-effective solution in the long run.
Patient Outcomes: Satisfaction and Recurrence
Evaluating patient outcomes after hernia repair is complex and multi-faceted. The choice between biologic and synthetic mesh can influence patient satisfaction and recurrence rates significantly.
- Satisfaction Levels: Many studies suggest that patients with biologic mesh report higher satisfaction due to fewer complications and a smoother recovery process. Patient quality of life post-operation is often found to be better with biologic materials.
- Recurrence Rates: Evidence suggests that while synthetic meshes can have lower initial costs, they are often associated with higher recurrence rates. Patients undergoing repairs with biologic mesh show a trend towards lower recurrence, minimizing the need for additional surgeries.
- Long-Term Effects: The long-term effectiveness of biologic mesh is often highlighted in literature as superior, reinforcing its advantages in ensuring patient wellness.
This section underscores the necessity of a detailed comparison between biologic and synthetic mesh to optimize patient care in hiatal hernia repair. Understanding the long-term implications on patient health and costs can guide clinicians in making strategic decisions.
Current Best Practices and Surgical Techniques
In the realm of hiatal hernia repair, understanding the current best practices and surgical techniques is essential. Surgeons must navigate a landscape that includes the choice between laparoscopic and open techniques, each bearing its own set of advantages and challenges. The selection of the surgical method often depends on the specific case, surgeon preference, and patient condition.
Laparoscopic vs. Open Techniques
Laparoscopic techniques have gained prominence in recent years. This method employs small incisions, leading to less postoperative pain and quicker recovery times. Benefits include:
- Reduced scarring: Smaller incisions result in less visible scars, which may be preferable for many patients.
- Shorter hospital stays: Patients typically spend less time in the hospital, contributing to lower healthcare costs.
- Faster return to normal activities: Most patients can resume their daily routines sooner than with open surgery.
However, laparoscopic surgery may not be suitable for all cases. In certain instances, patients might have complex anatomical variations or comorbidities that warrant an open approach. The open technique allows for greater visibility and access during the operation.
- Greater operational visibility: Surgeons can see more of the anatomical structures, which may help in complex cases.
- Direct access to underlying issues: Open techniques can provide better access for addressing additional abnormalities during surgery.
Thus, surgeon expertise and the complexity of the hernia dictate the choice. Reviewing the patient's specific scenario, along with pre-operative imaging, guides surgeons in deciding the best surgical approach.
Post-Operative Care and Management
Post-operative care plays a critical role in the overall success of hiatal hernia repair. Effective management of the recovery phase can significantly reduce potential complications and enhance healing.
Key components of post-operative care include:
- Pain management: Addressing pain effectively can improve patient comfort and compliance with rehabilitation protocols. Strategies may range from medication to physical therapy.
- Dietary modifications: Initially, patients may need to adopt a liquid diet, gradually transitioning to solid food as they heal.
- Monitoring for complications: Close observation for any signs of infection or recurrence is vital. Regular follow-up appointments allow healthcare providers to catch potential issues early.
Education for the patient is equally important. Discussing what symptoms to watch for and how to properly care for their surgical site minimizes risks. The goal is to return patients to their daily lives while preventing unnecessary complications.
"A well-managed post-operative process significantly influences the patient's recovery and satisfaction with the procedure."
Emerging Innovations in Biologic Mesh Development
The field of hernia repair is evolving, particularly in the context of biologic mesh. As more research is conducted, innovations emerge that enhance both functionality and patient outcomes. These developments promise to address some of the challenges faced by surgeons, such as potential complications and variable patient responses to existing materials. Understanding these innovations is vital since they represent the future landscape of hiatal hernia repair.
Biologic Scaffold Engineering
Biologic scaffold engineering refers to the design and fabrication of support structures that can assist in tissue regeneration. These scaffolds are made from materials derived from natural sources, such as decellularized tissues. Their architecture is tailored to mimic the structure of human tissue, facilitating cellular growth and integration within the host.
Recent advancements have focused on optimizing porosity and mechanical properties of these scaffolds. Enhanced porosity allows for better vascularization, which is crucial for healing. This factor can significantly improve the rates of integration and minimize the risk of complications during recovery. Moreover, the ability to modify mechanical strength enables these scaffolds to provide adequate support without compromising flexibility.
"Biologic scaffolds that closely mimic the natural extracellular matrix hold the key to better surgical outcomes, particularly in hiatal hernia repairs."
Key Benefits of Biologic Scaffold Engineering:
- Improved integration with host tissue
- Enhanced mechanical properties adaptable to patient needs
- Potential for reduced list of complications compared to synthetic options
- Contributions to long-term healing and sustainability of the repair process
Integration with Regenerative Medicine Techniques
The integration of biologic mesh with regenerative medicine techniques marks a significant advancement in surgical practices. Regenerative medicine focuses on harnessing the body’s inherent repair mechanisms, promoting tissue regeneration and repair. By combining biologic mesh with these techniques, surgeons can leverage the mesh to not only support but also actively enhance tissue healing.
Techniques such as stem cell therapy and growth factor application are gaining attention. These methods can be applied alongside biologic meshes to optimize healing environments. For instance, introducing growth factors at the surgical site can accelerate cellular proliferation and improve vascularity. Likewise, stem cell treatments can drive the regeneration of tissues, facilitating a more robust recovery.
Considerations for Integration:
- Selection of appropriate regenerative strategies based on patient’s clinical profile
- Understanding the timing of mesh implantation and regenerative therapy for optimized results
- Continuous monitoring for efficacy and possible interactions between the mesh and introduced therapies
These emerging innovations in biologic mesh development illustrate a commitment to advancing surgical techniques, tailoring them to meet the diverse needs of patients undergoing hiatal hernia repairs. As these technologies mature, they promise to enhance both safety and effectiveness in surgical practice.
Future Directions in Hiatal Hernia Repair
The exploration of future directions in hiatal hernia repair is essential not only for the advancement of surgical practices but also for improving patient outcomes. The ongoing developments in biologic mesh and related surgical techniques promise to enhance the efficacy and safety of hernia repairs. A focus on innovative technologies and methods can lead to a more comprehensive understanding of how to best address hiatal hernias. This section discusses the nuances and implications of the latest research and regulatory trends that could influence future repair strategies.
Ongoing Research and Trials
There is a significant amount of active research exploring the effectiveness of biologic mesh in surgical repair for hiatal hernias. Clinical trials are focusing on several key areas:
- Efficacy of New Materials: Studies are assessing new biologic mesh materials, which may offer improved compatibility and durability. Comparing these with traditional options can shed light on which materials yield better long-term results.
- Patient-Centric Approaches: Trials are increasingly prioritizing patient satisfaction and quality of life post-surgery. Measures such as pain levels, recovery times, and recurrence rates are under close scrutiny.
- Integration with Advanced Techniques: There is some promising research into combining biologic mesh with laparoscopic techniques, which may minimize trauma and hasten recovery.
Such research not only deepens our understanding but also fuels the debates on best practices within the surgical community. Continued patient trials will be key for establishing standardized protocols in using biologic mesh for hiatal hernias.
Potential Regulatory Changes and Impacts
As evidence accumulates concerning the performance of biologic mesh in hiatal hernia repairs, regulatory frameworks may evolve. The following elements are particularly noteworthy:
- Regulatory Scrutiny: With increased applications of biologic mesh, regulatory bodies like the FDA may impose more stringent assessment protocols. Data from ongoing trials will likely influence these changes, leading to stricter guidelines.
- Market Dynamics: As new products emerge and existing ones are reevaluated, market competition can affect pricing, accessibility, and the overall economics of care. Patients and healthcare providers could see shifts in available options and costs, based on regulatory outcomes.
- Patient Safety: Enhanced regulations could bolster safety standards, ensuring patients receive the best possible materials and practices. Improved oversight may also make it easier to track complications and refine methodologies in real-time.
Overall, the significance of these potential changes indicates a responsiveness to evolving data and a commitment to patient-centered care, shaping the landscape of hiatal hernia repair.
Summary and End
The significance of biologic mesh in hiatal hernia repair is profound, encompassing various factors that impact surgical outcomes and patient well-being. This article has provided an in-depth exploration of the clinical efficacy and safety profile of biologic mesh compared to synthetic alternatives. The importance of understanding these elements cannot be overstated, as they hold direct implications for surgical practices and patient care.
Key Takeaways on Biologic Mesh in Surgery
- Clinical Efficacy: Biologic mesh demonstrates favorable outcomes in terms of biocompatibility and lower instances of chronic pain and recurrence of hernias when compared with synthetic options.
- Safety and Risks: While there are potential risks associated with biologic mesh use, such as infection or rejection, careful patient selection can mitigate these concerns.
- Long-Term Outcomes: Studies have shown promising data regarding the durability of repairs using biologic mesh, suggesting that this material may promote better healing responses over time.
- Mechanisms of Action: The unique biological properties of these meshes contribute to their effectiveness, facilitating natural tissue integration.
Implications for Clinical Practice
Healthcare professionals must recognize the advancements in biologic mesh technologies and integrate this knowledge into their surgical practices. Considerations include:
- Patient Selection: Surgeons should evaluate each patient’s unique anatomy and medical history to determine the appropriateness of biologic mesh. Understanding when to opt for biologic versus synthetic mesh is crucial.
- Guideline Development: Ongoing discussions among surgical communities need to shape evolving guidelines that outline indications for biologic mesh use and best practices in sergery.
- Further Research: There is an essential need for continued research to gather more extensive data on long-term outcomes and patient satisfaction concerning biologic mesh usage in surgical repairs.
"The evolving landscape of hiatal hernia repair underscores the importance of adopting evidence-based practices that prioritize patient outcomes."
