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Cokljat M, Cruz CV, Carrara VI, Puttaraska K, Capriglioni C, Insaurralde SM, Rousseau-Portalis M, Roldan A, Watson JA, Tarning J, White NJ, Guerin PJ. Comparison of WHO versus national COVID-19 therapeutic guidelines across the world: not exactly a perfect match. BMJ Glob Health 2024; 9:e014188. [PMID: 38649182 PMCID: PMC11043689 DOI: 10.1136/bmjgh-2023-014188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 02/26/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic affected all WHO member states. We compared and contrasted the COVID-19 treatment guidelines of each member state with the WHO COVID-19 therapeutic guidelines. METHODS Ministries of Health or accessed National Infectious Disease websites and other relevant bodies and experts were contacted to obtain national guidelines (NGs) for COVID-19 treatment. NGs were included only if they delineated specific pharmacological treatments for COVID-19, which were stratified by disease severity. We conducted a retrospective review using the adapted Reporting Checklist for Public Versions of Guidelines (RIGHT-PVG) survey checklist and a derived comparative metric based on the WHO guidelines was performed. RESULTS COVID-19 therapeutics NGs could be obtained from 109 of the 194 WHO member states. There was considerable variation in guidelines and in disease severity stratifications. Therapeutic recommendations in many NGs differed substantially from the WHO guidelines. Overall in late 2022, 93% of NGs were recommending at least one treatment which had proved to be ineffective in large randomised trials, and was not recommended by WHO. Corticosteroids were not recommended in severe disease in nearly 10% of NGs despite overwhelming evidence of their benefit. NGs from countries with low-resource settings showed the greatest divergence when stratified by gross domestic product per year, Human Development Index and the Global Health Security Index. DISCUSSION Our study is limited to NGs that were readily accessible, and it does not reflect the availability of recommended medicines in the field. Three years after the start of the SARS-CoV-2 pandemic, available COVID-19 NGs vary substantially in their therapeutic recommendations, often differ from the WHO guidelines, and commonly recommend ineffective, unaffordable or unavailable medicines.
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Affiliation(s)
- Mia Cokljat
- Infectious Diseases Data Observatory (IDDO), University of Oxford, Oxford, UK
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Cintia Valeria Cruz
- Infectious Diseases Data Observatory (IDDO), University of Oxford, Oxford, UK
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Verena Ilona Carrara
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneve, Switzerland
| | - Kanoktip Puttaraska
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Camila Capriglioni
- Laboratorio de Estadistica Aplicada a Ciencias de la Salud (LEACS), Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | | | - Maximo Rousseau-Portalis
- Laboratorio de Estadistica Aplicada a Ciencias de la Salud (LEACS), Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Agustina Roldan
- Laboratorio de Estadistica Aplicada a Ciencias de la Salud (LEACS), Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - James A Watson
- Infectious Diseases Data Observatory (IDDO), University of Oxford, Oxford, UK
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Joel Tarning
- Infectious Diseases Data Observatory (IDDO), University of Oxford, Oxford, UK
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Nicholas J White
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Philippe J Guerin
- Infectious Diseases Data Observatory (IDDO), University of Oxford, Oxford, UK
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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2
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Colwill M, Baillie S, Pollok R, Poullis A. Using clinical cases to guide healthcare. World J Clin Cases 2024; 12:1555-1559. [PMID: 38576735 PMCID: PMC10989429 DOI: 10.12998/wjcc.v12.i9.1555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 01/26/2024] [Accepted: 02/27/2024] [Indexed: 03/25/2024] Open
Abstract
Evidence-based practice (EBP) has been the gold standard in healthcare for nearly three centuries and aims to assist physicians in providing the safest and most effective healthcare for their patients. The well-established hierarchy of evidence lists systematic reviews and meta-analyses at the top however these methodologies are not always appropriate or possible and in these instances case-control studies, case series and case reports are utilised to support EBP. Case-control studies allow simultaneous study of multiple risk factors and can be performed rapidly and relatively cheaply. A recent example was during the Coronavirus pandemic where case-control studies were used to assess the efficacy of personal protective equipment for healthcare workers. Case series and case reports also play a role in EBP and are particularly useful to study rare diseases such as inflammatory bowel disease in transgender and gender non-conforming individuals. They are also vital in generating and disseminating early signals and encouraging further research. Whilst these methodologies have weaknesses, particularly with regards to bias and loss of patient confidentiality for rare pathologies, they have an important part to play in EBP and when appropriately utilised can significantly impact upon clinical practice.
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Affiliation(s)
- Michael Colwill
- Department of Gastroenterology, St George's University Hospital NHS Foundation Trust, London SW17 0QT, United Kingdom
| | - Samantha Baillie
- Department of Gastroenterology, St George's University Hospital NHS Foundation Trust, London SW17 0QT, United Kingdom
| | - Richard Pollok
- Department of Gastroenterology, St George's University Hospital NHS Foundation Trust, London SW17 0QT, United Kingdom
| | - Andrew Poullis
- Department of Gastroenterology, St George's University Hospital NHS Foundation Trust, London SW17 0QT, United Kingdom
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3
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Jacaruso L. Insights into the nutritional prevention of macular degeneration based on a comparative topic modeling approach. PeerJ Comput Sci 2024; 10:e1940. [PMID: 38660183 PMCID: PMC11042009 DOI: 10.7717/peerj-cs.1940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 02/22/2024] [Indexed: 04/26/2024]
Abstract
Topic modeling and text mining are subsets of natural language processing (NLP) with relevance for conducting meta-analysis (MA) and systematic review (SR). For evidence synthesis, the above NLP methods are conventionally used for topic-specific literature searches or extracting values from reports to automate essential phases of SR and MA. Instead, this work proposes a comparative topic modeling approach to analyze reports of contradictory results on the same general research question. Specifically, the objective is to identify topics exhibiting distinct associations with significant results for an outcome of interest by ranking them according to their proportional occurrence in (and consistency of distribution across) reports of significant effects. Macular degeneration (MD) is a disease that affects millions of people annually, causing vision loss. Augmenting evidence synthesis to provide insight into MD prevention is therefore of central interest in this article. The proposed method was tested on broad-scope studies addressing whether supplemental nutritional compounds significantly benefit macular degeneration. Six compounds were identified as having a particular association with reports of significant results for benefiting MD. Four of these were further supported in terms of effectiveness upon conducting a follow-up literature search for validation (omega-3 fatty acids, copper, zeaxanthin, and nitrates). The two not supported by the follow-up literature search (niacin and molybdenum) also had scores in the lowest range under the proposed scoring system. Results therefore suggest that the proposed method's score for a given topic may be a viable proxy for its degree of association with the outcome of interest, and can be helpful in the systematic search for potentially causal relationships. Further, the compounds identified by the proposed method were not simultaneously captured as salient topics by state-of-the-art topic models that leverage document and word embeddings (Top2Vec) and transformer models (BERTopic). These results underpin the proposed method's potential to add specificity in understanding effects from broad-scope reports, elucidate topics of interest for future research, and guide evidence synthesis in a scalable way. All of this is accomplished while yielding valuable and actionable insights into the prevention of MD.
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Affiliation(s)
- Lucas Jacaruso
- University of Southern California, Los Angeles, CA, United States of America
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4
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Choudhrie L. Cytology Ode. Acta Cytol 2024; 68:4-5. [PMID: 38412848 DOI: 10.1159/000535695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 12/04/2023] [Indexed: 02/29/2024]
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Carvallo A, Parra D, Lobel H, Rada G. A comparative dataset: Bridging COVID-19 and other diseases through epistemonikos and CORD-19 evidence. Data Brief 2023; 51:109720. [PMID: 37965606 PMCID: PMC10641139 DOI: 10.1016/j.dib.2023.109720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 09/12/2023] [Accepted: 10/19/2023] [Indexed: 11/16/2023] Open
Abstract
The COVID-19 pandemic has underlined the need for reliable information for clinical decision-making and public health policies. As such, evidence-based medicine (EBM) is essential in identifying and evaluating scientific documents pertinent to novel diseases, and the accurate classification of biomedical text is integral to this process. Given this context, we introduce a comprehensive, curated dataset composed of COVID-19-related documents. This dataset includes 20,047 labeled documents that were meticulously classified into five distinct categories: systematic reviews (SR), primary study randomized controlled trials (PS-RCT), primary study non-randomized controlled trials (PS-NRCT), broad synthesis (BS), and excluded (EXC). The documents, labeled by collaborators from the Epistemonikos Foundation, incorporate information such as document type, title, abstract, and metadata, including PubMed id, authors, journal, and publication date. Uniquely, this dataset has been curated by the Epistemonikos Foundation and is not readily accessible through conventional web-scraping methods, thereby attesting to its distinctive value in this field of research. In addition to this, the dataset also includes a vast evidence repository comprising 427,870 non-COVID-19 documents, also categorized into SR, PS-RCT, PS-NRCT, BS, and EXC. This additional collection can serve as a valuable benchmark for subsequent research. The comprehensive nature of this open-access dataset and its accompanying resources is poised to significantly advance evidence-based medicine and facilitate further research in the domain.
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Affiliation(s)
- Andrés Carvallo
- Centro Nacional de Inteligencia Artificial, Vicuña Mackenna 4686, Macul, Santiago, Región Metropolitana, Chile
| | - Denis Parra
- Pontificia Universidad Católica de Chile, School of Engineering, Department of Computer Science, Vicuña Mackenna 4860, Macul 7820436, Región Metropolitana, Chile
| | - Hans Lobel
- Pontificia Universidad Católica de Chile, School of Engineering, Department of Computer Science, Vicuña Mackenna 4860, Macul 7820436, Región Metropolitana, Chile
| | - Gabriel Rada
- Pontificia Universidad Católica de Chile, School of Medicine, Avda. Libertador Bernando O'Higgins 340, Santiago 9170464, Región Metropolitana, Chile
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Kabir KI, Satapathy AK, Gullla KM, John J, Dwibedi B, Mahapatro S, Das RR. Macrolides versus other antibiotics in pediatric scrub typhus: A meta-analysis. Indian J Med Microbiol 2023; 46:100460. [PMID: 37945110 DOI: 10.1016/j.ijmmb.2023.100460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 07/02/2023] [Accepted: 08/03/2023] [Indexed: 09/18/2023]
Abstract
BACKGROUND While Doxycycline is the recommended drug for treating scrub typhus, there is a growing trend of using Macrolides and Other antibiotics due to their perceived advantages. In this study, we compared the efficacy of Macrolides versus Other antibiotics in the treatment of pediatric scrub typhus. METHODS Meta-analysis of randomized controlled trials (RCTs) with GRADE (Grading of Recommendations, Assessment, Development and Evaluation) application. Major databases were searched till 30th December 2022. Children of all age groups were included. Primary outcomes included mortality rate and time to defervescence (h). RESULTS Of the 103 citations retrieved, 5 trials, including 383 children up to 15 years of age with probable and confirmed cases of scrub typhus, were included. None of the trials reported mortality rate. The pooled results from the trials found no significant difference between Azithromycin and Other antibiotics for any of the outcome measures. The certainty of evidence for the primary outcome was deemed to be of "very low certainty", while the certainty of evidence for the secondary outcomes ranged from "low to moderate certainty". CONCLUSIONS The current meta-analysis revealed that there was no significant difference between Azithromycin and Other antibiotics (such as Doxycycline and Chloramphenicol) in the treatment of scrub typhus in children. However, it's important to note that the evidence generated for the primary outcome was of "very low certainty". PROSPERO REGISTRATION NUMBER CRD42021276577.
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Affiliation(s)
| | | | | | - Joseph John
- Department of Pediatrics, AIIMS, Bhubaneswar, 751019, India.
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Saugstad OD, Kirpalani H. Searching for Evidence in Neonatology. Acta Paediatr 2023. [PMID: 37151193 DOI: 10.1111/apa.16815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/12/2023] [Accepted: 05/04/2023] [Indexed: 05/09/2023]
Abstract
Evidence based medicine has changed clinical practice by incorporating data from randomized controlled trials (RCTs). While some biases in RCTs are well recognized, we discuss some less acknowledged. Selection bias may arise in the consent stage. Industry funded studies more often report a positive outcome. Post-hoc changes of outcome measures and other mis-reporting lowers the reliability of outcome data. Finally even the GRADE system retains subjectivity. CONCLUSION: Moving from "intuition" into "evidence based" medicine involves grappling with several pitfalls. These pose challenges for authors, editors, reviewers, and readers. All require vigilance before drawing conclusions from presented data.
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Affiliation(s)
- Ola Didrik Saugstad
- Department of Pediatric Research, University of Oslo, Norway
- Division of Neonatology, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, USA
| | - Haresh Kirpalani
- Emeritus, Pediatrics, University Philadelphia, Pennsylvania, USA
- Emeritus, Pediatrics, McMaster University, Hamilton, Ontario, Canada
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8
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Moss N, Bueno-Cavanillas A, Cano-Ibáñez N, Khan KS. Evidence-based medicine needs patient and public involvement to remain relevant: A proposal for a new curriculum. Semergen 2023; 49:101877. [PMID: 36434965 DOI: 10.1016/j.semerg.2022.101877] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 10/18/2022] [Accepted: 10/19/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Public partnerships, a route to sharing expertise, networks and resources anchored in the United Nations Sustainable Development Goals, has been championed by multiple stakeholders. OBJECTIVE To propose a new evidence-based medicine (EBM) curriculum for harnessing patient and public expertise to ensure that EBM teaching and learning can become more relevant and impactful. METHODS A curriculum development group comprising of EBM teachers, patient and public involvement representatives, clinicians, clinical epidemiologists, public health experts and educationalists, with experience of delivering and evaluating face-to-face and online EBM courses across many countries and continents, prepared a new EBM course. RESULTS A student-centred, problem-based and clinically integrated course for teaching and learning EBM was developed. In the spirit of shared decision-making, practitioners can learn to support patients, articulate their perspectives, recognise the need for their contribution and ensure community involvement when generating and applying evidence. With end users in mind, the application of research findings, delivery of care and EBM effectiveness in the workplace would carry increased priority. CONCLUSIONS Embracing patients as EBM collaborators can help deliver cognitive diversity and inspire different ways of thinking and working. Adopting the proposed approach in EBM education lays the foundations for a joint practitioner-patient partnership to ask, acquire, appraise and apply EBM in a more holistic context which will strengthen the EBM proposition.
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Affiliation(s)
- N Moss
- Katie's Team Patient and Public Involvement Advisory Group, Wolfson Institute of Population Health, Queen Mary University of London, United Kingdom; Elly Charity, East London International Women's Health Charity, United Kingdom
| | - A Bueno-Cavanillas
- Department of Preventive Medicine and Public Health; University of Granada, Granada, Spain; Centro de Investigación Biomédica en Red Epidemiología y Salud Pública (CIBERESP), Institute of Health Carlos III, Madrid, Spain; Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Granada, Spain
| | - N Cano-Ibáñez
- Department of Preventive Medicine and Public Health; University of Granada, Granada, Spain; Centro de Investigación Biomédica en Red Epidemiología y Salud Pública (CIBERESP), Institute of Health Carlos III, Madrid, Spain; Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Granada, Spain.
| | - K S Khan
- Department of Preventive Medicine and Public Health; University of Granada, Granada, Spain
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9
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Rintala S, Dahlstrom KR, Franco EL, Louvanto K. A synthesis of evidence for cancer-specific screening interventions: A Preventive Medicine Golden Jubilee Review. Prev Med 2023; 167:107395. [PMID: 36565859 DOI: 10.1016/j.ypmed.2022.107395] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 12/15/2022] [Accepted: 12/17/2022] [Indexed: 12/24/2022]
Abstract
The goal of cancer screening guidelines is to inform health practitioners to practice evidence-based cancer prevention. Cancer screening aims to detect treatable precancerous lesions or early-stage disease to enable actions aimed at decreasing morbidity and mortality. Continuous assessment of the available evidence for or against screening interventions by various organizations often results in conflicting recommendations and create challenges for providers and policymakers. Here we have summarized the current cancer screening recommendations by five leading organizations in North America and Europe: the National Cancer Institute's Physician Data Query (PDQ), the U.S. Preventive Services Task Force (USPSTF), the Canadian Task Force on Preventive Health Care (CTFPHC), the Cochrane Database of Systematic Reviews (CDSR), and the UK National Screening Committee for the National Health Service (UK NSC). All organizations assess evidence based on strength, quality, and quantity, and recommendations are similar although with differences with respect to screening start and stop ages. Recommendations are consistent for colorectal cancer screening with fecal occult blood test or fecal immunochemical test, cervical cancer screening with Pap-test, HPV-test, or co-testing, and breast cancer screening with mammography. However, guidelines vary with respect to age to start and end screening and testing frequency. Tests that have proven to be inefficient or whose use is capable of causing harm are routinely recommended against. Continuous review of screening guidelines is necessary to evaluate the many promising screening tests currently under investigation.
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Affiliation(s)
- Suvi Rintala
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health Technology, Tampere University, Finn-Medi1, Biokatu 6, 33100 Tampere, Finland.
| | - Kristina R Dahlstrom
- Section of Epidemiology & Population Sciences, Department of Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA.
| | - Eduardo L Franco
- Division of Cancer Epidemiology, McGill University, 5100 Maisonneuve Blvd West, Suite 720, Montreal, Quebec H4A 3T2, Canada.
| | - Karolina Louvanto
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health Technology, Tampere University, Finn-Medi1, Biokatu 6, 33100 Tampere, Finland; Department of Obstetrics and Gynecology, Tampere University Hospital, Elämänaukio 2, 33520 Tampere, Finland.
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10
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van Ophoven A. [Therapeutic value of neuromodulation in women]. Urologie 2023; 62:153-164. [PMID: 36690725 DOI: 10.1007/s00120-022-02018-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/19/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND Neuromodulative treatment for the treatment of overactive bladder has been used in clinical practice since its introduction in the early 1980s. OBJECTIVES Description and update of the various neuromodulative techniques (tibial nerve stimulation, sacral and pudendal neuromodulation), presentation of their effectiveness and safety, and evaluation of their evidence for clinical practice. MATERIALS AND METHODS Literature search in PubMed and Embase, inclusion of studies according to the following criteria: evidence level, timeliness, length of follow-up and number of female patients according to the author's preference. RESULTS The efficacy and safety of both percutaneous tibial nerve stimulation (PTNS) and sacral neuromodulation (SNM) has been proven by studies with an evidence level of 1. Long-term data of up to 20 years are available for SNM, while long-term data for PTNS are limited. Permanent implants for tibial nerve stimulation are promising new developments. Pudendal neuromodulation (PNM) is suitable for more complex indications but is surgically more challenging. CONCLUSIONS Both PTNS and SNM are suitable for broad application in clinical practice. PTNS can be offered as an alternative to pharmacotherapy, while SNM provides the most convincing clinical data of all neuromodulative therapies.
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Affiliation(s)
- Arndt van Ophoven
- Abteilung für Neuro-Urologie, Marien Hospital Herne, Universitätsklinikum der Ruhr-Universität Bochum, Hölkeskampring 40, 44625, Herne, Deutschland.
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11
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Brook C. Evidence for significant misdiagnosis of abusive head trauma in pediBIRN data. Forensic Sci Int Synerg 2023; 6:100314. [PMID: 36691664 PMCID: PMC9860097 DOI: 10.1016/j.fsisyn.2023.100314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/04/2023] [Accepted: 01/04/2023] [Indexed: 01/11/2023]
Abstract
Independently witnessed events are used as a reference standard to robustly categorize accidental or non-abusive head trauma (non-AHT) cases in the pediBIRN data set of acutely symptomatic infants with closed head injuries. Findings in such independently witnessed non-AHT cases are compared to findings in cases that were diagnosed as AHT but were not independently witnessed. The data shows that 14% of independently witnessed non-AHT cases are misdiagnosed as AHT, and that risk factors for misdiagnosis include acute encephalopathy, bilateral or interhemispheric SDH, and/or severe retinal hemorrhages, findings that are commonly associated with AHT. The data also shows that "dense retinal hemorrhages extending to the periphery" are not highly suggestive of AHT, as they also occur in independently witnessed non-AHT cases.
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Patel H, Sheikh A, Medarametla GD, Selvam SA, Mahmood SN, Johal G, Arunachalam J, Radhakrishnan H, Shah V, Vallath AL, Patel D, Palasamudram Shekar S, Patel U, Changawala N. Uncommon Presentation of Undiagnosed B-Cell Lymphoproliferative Disorder as Nodular Pulmonary Amyloidosis. J Med Cases 2023; 14:36-43. [PMID: 36755997 PMCID: PMC9881482 DOI: 10.14740/jmc4026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 01/11/2023] [Indexed: 01/20/2023] Open
Abstract
B-cell lymphoproliferative disorders are characterized by the accumulation of mature B lymphocytes in the bone marrow, lymphoid tissues, and/or peripheral blood. They can cause amyloid deposits in the lungs. In rare cases, lung nodules can be the first sign of this disorder. We present the case of an 89-year-old woman with stable shortness of breath and lung nodules on imaging. A positron emission tomography-computed tomography (PET-CT) scan showed the most intense hypermetabolic nodule in the patient's lung, which was 1.5 × 1.4 cm. A biopsy of this nodule showed amyloid material with trapped plasma cell infiltrate on microscopy. Congo red stain under polarizing microscopy showed apple-green birefringence, which is diagnostic for amyloidosis. Immunohistochemistry showed a mixture of kappa-positive and lambda-positive cells. B-cell gene rearrangement-clonal gene rearrangements were detected in the immunoglobulin heavy chain (IgH) gene and the kappa light chain (IGK). These findings suggest a B-cell lymphoproliferative disorder, such as a plasmacytoma or a marginal cell lymphoma with plasma cell differentiation. The patient was diagnosed with a B-cell lymphoproliferative disorder and pulmonary amyloidosis. Isolated amyloidosis in the lungs usually has a good prognosis, but it can be a sign of autoimmune diseases or B-cell lymphoproliferative disorders, as in this case. Early diagnosis of B-cell lymphoproliferative disorder can lead to successful treatment and prevents complications.
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Affiliation(s)
- Harsh Patel
- Department of Family Medicine, Central Jersey Urgent Care, Green Brook, NJ 08812, USA,Corresponding Author: Harsh Patel, Department of Family Medicine, Central Jersey Urgent Care, Green Brook, NJ 08812, USA.
| | - Aaiyat Sheikh
- Era’s Lucknow Medical College, Lucknow, Uttar Pradesh 226003, India
| | | | - Sri Abirami Selvam
- Department of Internal Medicine, St Mary Medical Center, Langhorne, PA 19047, USA
| | - Syed Nazeer Mahmood
- Department of Medicine, Section of Pulmonary/Critical Care, MedStar Washington Hospital Center, Washington, DC 20770, USA
| | - Gurleen Johal
- Department of Medicine, Hackensack Meridian Palisades Medical Center, North Bergen, NJ 07047, USA
| | - Janani Arunachalam
- Department of Biomedical Engineering, University of Houston, Houston, TX 77021, USA
| | | | - Viray Shah
- Department of Hospital Medicine, Medstar Good Samaritan Hospital, Baltimore, MD 21239, USA
| | - Aditya Lal Vallath
- Department of Emergency Medicine, Peerless Hospital and BK Roy Research Center, Kolkata, West Bengal 700094, India
| | | | - Saketh Palasamudram Shekar
- Interventional Pulmonology, Department of Pulmonary and Critical care Medicine, Pulmonary and Sleep Associates of Huntsville, Huntsville Hospital, Huntsville, AL 35801, USA
| | - Urvish Patel
- Department of Public Health and Neurology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
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Marshall IJ, Trikalinos TA, Soboczenski F, Yun HS, Kell G, Marshall R, Wallace BC. In a pilot study, automated real-time systematic review updates were feasible, accurate, and work-saving. J Clin Epidemiol 2023; 153:26-33. [PMID: 36150548 DOI: 10.1016/j.jclinepi.2022.08.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 08/22/2022] [Accepted: 08/29/2022] [Indexed: 01/31/2023]
Abstract
OBJECTIVES The aim of this study is to describe and pilot a novel method for continuously identifying newly published trials relevant to a systematic review, enabled by combining artificial intelligence (AI) with human expertise. STUDY DESIGN AND SETTING We used RobotReviewer LIVE to keep a review of COVID-19 vaccination trials updated from February to August 2021. We compared the papers identified by the system with those found by the conventional manual process by the review team. RESULTS The manual update searches (last search date July 2021) retrieved 135 abstracts, of which 31 were included after screening (23% precision, 100% recall). By the same date, the automated system retrieved 56 abstracts, of which 31 were included after manual screening (55% precision, 100% recall). Key limitations of the system include that it is limited to searches of PubMed/MEDLINE, and considers only randomized controlled trial reports. We aim to address these limitations in future. The system is available as open-source software for further piloting and evaluation. CONCLUSION Our system identified all relevant studies, reduced manual screening work, and enabled rolling updates on publication of new primary research.
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Affiliation(s)
- Iain J Marshall
- School of Life Course and Population Sciences, King's College London, London, UK.
| | - Thomas A Trikalinos
- Center for Evidence Synthesis in Health, Brown University, Providence, RI, USA
| | - Frank Soboczenski
- School of Life Course and Population Sciences, King's College London, London, UK
| | - Hye Sun Yun
- Khoury College of Computer Sciences, Northeastern University, Boston, MA, USA
| | - Gregory Kell
- School of Life Course and Population Sciences, King's College London, London, UK
| | | | - Byron C Wallace
- Khoury College of Computer Sciences, Northeastern University, Boston, MA, USA
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Eddison N, Healy A, Buchanan D, Chockalingam N. Standardised classification system for bespoke thermoplastic ankle foot orthoses. Foot (Edinb) 2022; 53:101924. [PMID: 36037775 DOI: 10.1016/j.foot.2022.101924] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 03/13/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE To validate a new classification system for bespoke thermoplastic ankle foot orthoses (AFOs). METHODS Inter- and intra-observer reliability study. A classification system based on the design and function of AFOs was created. Sixty-three independent observers classified thirty-six photographs of different AFOs, according to the proposed classification system via an online questionnaire. Approximately two weeks later, the same AFOs were classified again by fifty-three of the same participants. All participants were health care professionals, researchers, or technicians with experience in referring for, prescribing, fitting, reviewing, researching or manufacturing AFOs. RESULTS The mean inter- and intra-observer agreement Fleiss' kappa was 0.932 and 0.944, respectively. 98.3% of participants reported that the classification system was very easy or moderately easy to use, with 85.7% reporting they would use the classification system. 90.5% of participants reported that the proposed AFO classification system was clear, with 84% stating it was useful. CONCLUSION The proposed classification system for bespoke thermoplastic AFOs, has an excellent inter- and intra-observer agreement. It will reduce the ambiguity of the description of the type of AFOs used in clinical practice and research. Furthermore, it makes reproducible comparisons between groups possible, which are essential for future evaluations of evidence-based orthotic care.
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15
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Kohanzadeh A, Somogyi DZ, Kravitz MB. Tonsillectomy and poliomyelitis: Development of causality. Int J Pediatr Otorhinolaryngol 2022; 162:111290. [PMID: 36067711 DOI: 10.1016/j.ijporl.2022.111290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 08/07/2022] [Accepted: 08/14/2022] [Indexed: 10/31/2022]
Abstract
OBJECTIVE This paper serves to review the historical progression of clinical, epidemiological and immunological evidence on the relationship between tonsillectomy and poliomyelitis and its influence on clinical medicine. METHODS A literature review was conducted using terms relating to poliomyelitis, tonsillectomy, and immunology. Primary sources published between 1900 and 2000 were reviewed, analyzed and evaluated based on their historical, clinical, epidemiological, scientific and immunological pertinence towards the relationship between tonsillectomy, and poliomyelitis during epidemics. RESULTS The first study proposing a relationship between poliomyelitis and tonsillectomy was a case report published in 1910 by Phillip Sheppard. In response, other physicians began conducting clinical and epidemiological studies investigating the relationship between recent tonsillectomy and poliomyelitis in children. While the results of many of these studies demonstrated an increased morbidity and mortality rate associated with poliomyelitis in children who underwent recent tonsillectomy, other studies claimed there was no connection. Opposing study results and diverging physician views on this relationship left the medical community divided on whether to recommend against elective tonsillectomies during poliomyelitis outbreaks. The relationship between tonsillectomy and poliomyelitis was established after many years of clinical and epidemiological studies. Further scientific and immunological investigations revealed the causal nature of this relationship.
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Affiliation(s)
- Avraham Kohanzadeh
- Albert Einstein College of Medicine, Bronx, New York, USA; Department of Otorhinolaryngology - Head and Neck Surgery, Montefiore Medical Center, Bronx, New York, USA.
| | | | - Meryl B Kravitz
- Albert Einstein College of Medicine, Bronx, New York, USA; Department of Otorhinolaryngology - Head and Neck Surgery, Montefiore Medical Center, Bronx, New York, USA
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16
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Shim SR. Meta-analysis of diagnostic test accuracy studies with multiple thresholds for data integration. Epidemiol Health 2022; 44:e2022083. [PMID: 36228672 PMCID: PMC10106543 DOI: 10.4178/epih.e2022083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 09/28/2022] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES The objective of this study is to introduce methods to use all of the information without omission when individual studies provide multiple effect sizes according to multiple cut-off values (thresholds) during diagnostic test accuracy (DTA) for data integration. For diagnostic test meta-analysis, a general performance method for synthesizing data according to one cut value in one study and a performance method for synthesizing data according to two or more cut values in one study were compared and analyzed. METHODS As sample data for meta-analysis of DTA studies, 13 DTA studies on prostate cancer (34 effect sizes including total cut-offs) were collected. The summary statistics were calculated and the summary line was analyzed using the "meta", "mada", and "diagmeta" packagesof the R software. RESULTS The summary statistics of the random effect model univariate analysis of the "meta" package with a single cut-off corresponding to the highest Youden index in a single study and those of the bivariate analysis of the "mada" package were highly similar. However, in the bivariate analysis of the "diagmeta" package including all cut-off values, the sensitivity decreased and the specificity increased as the amount of data increased. CONCLUSIONS Considering the heterogeneity of the summary receiver op erating characteristic curve and the use of all given cut-offs, the use of the bivariate analysis model of the "diagmeta" package is recommended. This study focused on practical methods of DTA rather than theoretical concepts for use by researchers whose fields of study are non-statistics related. By performing this study, we hope that many researchers will use R software to determine the DTA more easily, and that there will be greater interest in related research.
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Affiliation(s)
- Sung Ryul Shim
- Department of Health and Medical Informatics, Kyungnam University College of Health Sciences, Changwon, Korea
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17
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Muralidharan H, Venkatesan A, Venati R, Dhanasekaran ID, Suthahar T, Ahmed A, Salhotra A, Nair BB, Krishnan M, Rajanandh MG. Barriers of healthcare professionals in utilizing the service of drugs and poison information Centre: A cross-sectional study. Explor Res Clin Soc Pharm 2022; 6:100142. [PMID: 35586749 PMCID: PMC9108987 DOI: 10.1016/j.rcsop.2022.100142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 04/25/2022] [Accepted: 04/25/2022] [Indexed: 11/24/2022] Open
Abstract
Background Health care professionals (HCPs) have been using drugs and poison information centre (DIC) less frequently in recent years. The purpose of this study was to identify the barriers that inhibit HCPs from using the DIC service in a tertiary care hospital, as well as the factors that assist HCPs in using DIC more effectively. Methods A cross-sectional study was conducted among HCPs in Sri Ramachandra Institute of Higher Education and Research, Chennai. HCPs were given a semi-structured questionnaire that was developed and validated by a subject expert, a public health expert, and a clinical psychologist, and their barriers and facilitators in accessing drug information services were recorded. Findings A total of 405 HCPs responded to the survey. Among the identified barriers, the top 3 were: HCPs found it easier to use mobile internet (31%) and the department's reference library (25%) instead of contacting DIC for any drug/poison information. In addition, 17% of HCPs stated that they were too busy. The factors that may assist HCPs utilize DIC more effectively were more awareness is required to demonstrate the functionalities of DIC (24%), and a mobile application is required (23%). Conclusion Today's HCPs have easy access to a variety of drug information resources, and many prefer to do their own drug/poison research. As current generation HCPs find it more convenient to use mobile internet than contacting DIC, the creation of a mobile application for drug information service may enhance the number of questions from HCPs.
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Affiliation(s)
- Harini Muralidharan
- Department of Pharmacy Practice, Sri Ramachandra Faculty of Pharmacy, Sri Ramachandra Institute of Higher Education and Research, Deemed to be University, Porur, Chennai, India
| | - Arthi Venkatesan
- Department of Pharmacy Practice, Sri Ramachandra Faculty of Pharmacy, Sri Ramachandra Institute of Higher Education and Research, Deemed to be University, Porur, Chennai, India
| | - Rishitha Venati
- Department of Pharmacy Practice, Sri Ramachandra Faculty of Pharmacy, Sri Ramachandra Institute of Higher Education and Research, Deemed to be University, Porur, Chennai, India
| | - Indrani Devi Dhanasekaran
- Department of Pharmacy Practice, Sri Ramachandra Faculty of Pharmacy, Sri Ramachandra Institute of Higher Education and Research, Deemed to be University, Porur, Chennai, India
| | - Teshini Suthahar
- Department of Pharmacy Practice, Sri Ramachandra Faculty of Pharmacy, Sri Ramachandra Institute of Higher Education and Research, Deemed to be University, Porur, Chennai, India
| | - Abrar Ahmed
- Department of Pharmacy Practice, Sri Ramachandra Faculty of Pharmacy, Sri Ramachandra Institute of Higher Education and Research, Deemed to be University, Porur, Chennai, India
| | - Arushi Salhotra
- Department of Pharmacy Practice, Sri Ramachandra Faculty of Pharmacy, Sri Ramachandra Institute of Higher Education and Research, Deemed to be University, Porur, Chennai, India
| | - Bijisha Baburaj Nair
- Department of Pharmacy Practice, Sri Ramachandra Faculty of Pharmacy, Sri Ramachandra Institute of Higher Education and Research, Deemed to be University, Porur, Chennai, India
| | - Mohana Krishnan
- Department of Pharmacy Practice, Sri Ramachandra Faculty of Pharmacy, Sri Ramachandra Institute of Higher Education and Research, Deemed to be University, Porur, Chennai, India
| | - Muhasaparur Ganesan Rajanandh
- Department of Pharmacy Practice, Sri Ramachandra Faculty of Pharmacy, Sri Ramachandra Institute of Higher Education and Research, Deemed to be University, Porur, Chennai, India
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Abstract
The Evidence-Based Medicine (EBM) movement, undoubtably one of the most successful movements in medicine, questions dogma and "clinical authority" and combines the "best available evidence" with clinical expertise and patient values in order to provide the best care for the individual patient. Although since its inception in the 1990s its strong theoretical foundations remain unaltered, a lot has changed in its practical implementation due to the electronic explosion of information and the unprecedented COVID-19 crisis. The purpose of this article is to succinctly provide the reader with an update on the major changes in EBM, including the important most recent ones that were "fast-tracked" due to the COVID-19 challenge.
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Affiliation(s)
- George D. Chloros
- Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, Clarendon Wing, Floor D, Great George Street, Leeds General Infirmary, LS1 3EX, Leeds, United Kingdom,Corresponding author
| | - Apostolos D. Prodromidis
- Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, Clarendon Wing, Floor D, Great George Street, Leeds General Infirmary, LS1 3EX, Leeds, United Kingdom
| | - Peter V. Giannoudis
- Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, Clarendon Wing, Floor D, Great George Street, Leeds General Infirmary, LS1 3EX, Leeds, United Kingdom,NIHR Leeds Biomedical Research Center, Chapel Allerton Hospital, Leeds, United Kingdom
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19
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Brown RCH, de Barra M, Earp BD. Broad Medical Uncertainty and the ethical obligation for openness. Synthese 2022; 200:121. [PMID: 35431349 PMCID: PMC8994926 DOI: 10.1007/s11229-022-03666-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 03/20/2022] [Indexed: 06/14/2023]
Abstract
This paper argues that there exists a collective epistemic state of 'Broad Medical Uncertainty' (BMU) regarding the effectiveness of many medical interventions. We outline the features of BMU, and describe some of the main contributing factors. These include flaws in medical research methodologies, bias in publication practices, financial and other conflicts of interest, and features of how evidence is translated into practice. These result in a significant degree of uncertainty regarding the effectiveness of many medical treatments and unduly optimistic beliefs about the benefit/harm profiles of such treatments. We argue for an ethical presumption in favour of openness regarding BMU as part of a 'Corrective Response'. We then consider some objections to this position (the 'Anti-Corrective Response'), including concerns that public honesty about flaws in medical research could undermine trust in healthcare institutions. We suggest that, as it stands, the Anti-Corrective Response is unconvincing.
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Affiliation(s)
| | - Mícheál de Barra
- Centre for Culture and Evolution, Brunel University London, London, UK
| | - Brian D. Earp
- Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK
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20
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Abstract
Propensity score methods are increasingly used as a tool to control for confounding bias in pharmacoepidemiologic studies. The propensity score is a dimension reducing balancing score, creating treatment and reference groups that have comparable distributions of measured covariates. The purpose of this methods review is to provide an overview of the use of propensity score methods, including a summary of important data assumptions, various applications of the propensity score, and how to evaluate covariate balance. This article is intended for pharmacists and researchers who wish to receive an introduction to propensity score methods and be able to engage in high-level discussions on application and reporting.
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Affiliation(s)
- Dominique Medaglio
- Center for Pharmacoepidemiology Research and Training, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania (Philadelphia, PA).,Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania (Philadelphia, PA)
| | - Alisa J Stephens-Shields
- Center for Pharmacoepidemiology Research and Training, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania (Philadelphia, PA).,Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania (Philadelphia, PA).,Leonard Davis Institute of Health Economics, University of Pennsylvania (Philadelphia, PA).,Department of Biostatistics, T.H. Chan School of Public Health, Harvard University (Boston, MA)
| | - Charles E Leonard
- Center for Pharmacoepidemiology Research and Training, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania (Philadelphia, PA).,Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania (Philadelphia, PA).,Leonard Davis Institute of Health Economics, University of Pennsylvania (Philadelphia, PA)
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21
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Driever EM, Tolhuizen IM, Duvivier RJ, Stiggelbout AM, Brand PLP. Why do medical residents prefer paternalistic decision making? An interview study. BMC Med Educ 2022; 22:155. [PMID: 35260146 PMCID: PMC8903731 DOI: 10.1186/s12909-022-03203-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 01/19/2022] [Indexed: 05/19/2023]
Abstract
BACKGROUND Although shared decision making is championed as the preferred model for patient care by patient organizations, researchers and medical professionals, its application in daily practice remains limited. We previously showed that residents more often prefer paternalistic decision making than their supervisors. Because both the views of residents on the decision-making process in medical consultations and the reasons for their 'paternalism preference' are unknown, this study explored residents' views on the decision-making process in medical encounters and the factors affecting it. METHODS We interviewed 12 residents from various specialties at a large Dutch teaching hospital in 2019-2020, exploring how they involved patients in decisions. All participating residents provided written informed consent. Data analysis occurred concurrently with data collection in an iterative process informing adaptations to the interview topic guide when deemed necessary. Constant comparative analysis was used to develop themes. We ceased data collection when information sufficiency was achieved. RESULTS Participants described how active engagement of patients in discussing options and decision making was influenced by contextual factors (patient characteristics, logistical factors such as available time, and supervisors' recommendations) and by limitations in their medical and shared decision-making knowledge. The residents' decision-making behavior appeared strongly affected by their conviction that they are responsible for arriving at the correct diagnosis and providing the best evidence-based treatment. They described shared decision making as the process of patients consenting with physician-recommended treatment or patients choosing their preferred option when no best evidence-based option was available. CONCLUSIONS Residents' decision making appears to be affected by contextual factors, their medical knowledge, their knowledge about SDM, and by their beliefs and convictions about their professional responsibilities as a doctor, ensuring that patients receive the best possible evidence-based treatment. They confuse SDM with acquiring informed consent with the physician's treatment recommendations and with letting patients decide which treatment they prefer in case no evidence based guideline recommendation is available. Teaching SDM to residents should not only include skills training, but also target residents' perceptions and convictions regarding their role in the decision-making process in consultations.
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Affiliation(s)
- Ellen M Driever
- Department of Innovation and Research, Isala Hospital, Dokter van Heesweg 2, 8025, AB, Zwolle, the Netherlands.
- Lifelong Learning Education and Assessment Research Network (LEARN), University Medical Centre Groningen, Groningen, the Netherlands.
| | - Ivo M Tolhuizen
- Faculty of Medical Science, University Medical Centre of Groningen, Groningen, the Netherlands
| | - Robbert J Duvivier
- Centre for Education Development and Research in Health Professions (CEDAR), University Medical Centre Groningen, Groningen, the Netherlands
- Parnassia Psychiatric Institute, The Hague, the Netherlands
| | - Anne M Stiggelbout
- Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Centre, Leiden, the Netherlands
| | - Paul L P Brand
- Lifelong Learning Education and Assessment Research Network (LEARN), University Medical Centre Groningen, Groningen, the Netherlands
- Department of Medical Education and Faculty Development, Isala Hospital, Zwolle, the Netherlands
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22
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Iyngkaran P, Hanna F, Horowitz JD, de Courten MP. Contextualising evidence based medicine in determining the key root for translational effectiveness for chronic disease self-management and heart failure. Rev Cardiovasc Med 2022; 23:37. [PMID: 35092229 DOI: 10.31083/j.rcm2301037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/09/2021] [Accepted: 11/16/2021] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Congestive heart failure (CHF) management has proven devastating on morbidity, mortality, quality of life and also costly to health systems. Therapeutics for CHF have advanced and benefited greatly due to large multicentre randomised controlled trials and the evidence obtained from them. Management for chronic diseases and nonpharmaceutical therapies such as chronic disease self-management has lagged, and for CHF the evidence base has even been questioned. METHODS Perspective and non systematic mini review. CONCLUSIONS Advancing translational research standards is important to achieve optimal cost effectiveness. Importantly is understanding evidence generation in medicine, identifying the primary roots for management and its translation.
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Affiliation(s)
- Pupalan Iyngkaran
- Mitchell Institute for Education and Health Policy, Victoria University, 3000 Melbourne, Australia
- School of Medicine Sydney, Werribee Mercy Sub School, University of Notre Dame, 3030 Victoria, Australia
| | - Fahad Hanna
- Department of Public Health, Torrens University, 3000 Melbourne, Australia
| | - John D Horowitz
- Basil Hetzel Institute, University of Adelaide, 5011 Woodville South, South Australia, Australia
| | - Maximilian P de Courten
- Mitchell Institute for Education and Health Policy, Victoria University, 3000 Melbourne, Australia
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Qadhi I, AlSaidan L, AlSomali H, Younes S, AlHamly H, Kenawy M. Knowledge, attitude, practice, and barriers of evidence-based medicine among physicians in general hospitals in Kuwait: A cross-sectional study. Ann Med Surg (Lond) 2021; 72:103081. [PMID: 34876981 PMCID: PMC8633571 DOI: 10.1016/j.amsu.2021.103081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 11/16/2021] [Indexed: 11/29/2022] Open
Abstract
Background Evidence-based medicine (EBM) is renovating the field of medicine as it is being acknowledged as the standard and basis of clinical judgment. As general governmental hospitals are at the forefront of health-care in Kuwait, the practice of EBM among physicians could improve the health of the population. The aim was to assess the knowledge, attitude, practice, and barriers of EBM among physicians practicing in general governmental hospitals in Kuwait. Methods A cross-sectional study with self-reported questionnaires was used to survey 439 physicians in Kuwait's 6 general hospitals with a response rate of 74%. Results Respondent's knowledge of EBM was considerably low with a median knowledge score of 13 out of 20. Overall female physicians, undergraduates from Kuwait and Ireland, and those that received formal EBM training scored higher knowledge scores. Most respondents were unaware of well-known EBM resources, however more than half (69.3%) were aware of ‘Up-to-date’ and used it for clinical decisions. Most of the respondents had positive attitudes towards EBM: 88.2% either ‘strongly welcomed’ or ‘welcomed’ the promotion of EBM. Lack of investment by health-care authorities was the main perceived barrier to EBM. Conclusion Overall, even though participants were not well-informed in regards to EBM, half of them claim that their practice is EBM-based and use EBM resources to support clinical decisions. Formal EBM training and integration of EBM in undergraduate programs considerably promotes EBM practice. EBM courses in undergraduate programs, or formal training highly influences EBM knowledge. Participants were relatively knowledgeable regarding EBM, compared to other international studies. 30% of the physicians had ‘some understanding’ of technical terms used in EBM literature.
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Affiliation(s)
- Iman Qadhi
- Mubarak Al Kabeer Hospital, Kuwait City, Kuwait
- Corresponding author. Mubarak Al Kabeer Hospital, Kuwait University, Kuwait.
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24
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Woschek M, Schindler CR, Sterz J, Störmann P, Willems L, Marzi I, Verboket RD. [Admission diagnosis contusion: etiology, epidemiology and cost-causing factors]. Z Gerontol Geriatr 2021; 54:802-809. [PMID: 33337522 PMCID: PMC8636411 DOI: 10.1007/s00391-020-01828-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 11/26/2020] [Indexed: 10/30/2022]
Abstract
BACKGROUND The admission of patients with minor injuries, such as contusions is a regular practice in acute care hospitals. The pathophysiological changes resulting from the accident are seldom the primary reason for hospitalization. The aim of this retrospective monocentric study was therefore to examine the etiology as well as the cost-causing factors and refinancing on admission. METHODS Patients were identified due to a retrospective query in the hospital information system (HIS) according to the ICD-10 German modification codes at discharge. A total of 117 patients were enrolled over a period of 2 years. The classification was carried out according to the accident mechanism and the division into age groups. In addition, the cost calculation was based on department and clinic-specific daily rates. RESULTS In terms of etiology low impact falls in the domestic environment were the most common cause (48.7%), followed by high-energy trauma (22.8%). Within the group with domestic falls, the mean age was 77.8 years. This group also showed the longest length of stay (LOS) with 5.2 days. As part of the calculated costs, the group of domestic falls showed the highest costs of 2596.24 € with an average DRG cost revenue of 1464.51 €. DISCUSSION The evaluation of the clinic internal data confirmed the subjective perception that the majority of patients admitted with the diagnosis of contusions came from the age group >65 years. Admission is primarily based on the increasing comorbidities and to avert secondary diseases and the consequences of immobilization. It could also be shown that the resulting costs are relevant to health economics and that the treatment does not appear to cover the costs.
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Affiliation(s)
- Mathias Woschek
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Goethe Universität Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland.
| | - Cora R Schindler
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Goethe Universität Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland
| | - Jasmina Sterz
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Goethe Universität Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland
| | - Philipp Störmann
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Goethe Universität Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland
| | - Laurent Willems
- Epilepsiezentrum Frankfurt Rhein-Main und Klinik für Neurologie, Goethe Universität Frankfurt, Frankfurt am Main, Deutschland
| | - Ingo Marzi
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Goethe Universität Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland
| | - René D Verboket
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Goethe Universität Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland
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25
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John S. Science, politics and regulation: The trust-based approach to the demarcation problem. Stud Hist Philos Sci 2021; 90:1-9. [PMID: 34500262 DOI: 10.1016/j.shpsa.2021.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 08/06/2021] [Accepted: 08/13/2021] [Indexed: 06/13/2023]
Abstract
Drawing on literature on values in science and a case-study of UK cancer policy, this paper argues for a novel account of the demarcation project in terms of trustworthiness. The first part of the paper addresses the relationship between science, politics and demarcation. In 2010, the UK government decided to pay more for cancer drugs than for drugs for other diseases; in 2016, this Cancer Drugs Fund was reformed so as to lower the evidential standards for approving cancer drugs, rather than paying more for them. Are these two ways of treating cancer as "special" importantly different? This paper argues that, if we the argument from inductive risk seriously, they seem equivalent. This result provides further reason to doubt the notion of demarcating science from non-science. However, the second part of the paper complicates this story, arguing that considerations of epistemic trust might give us reasons to prefer epistemic communities centred around "broadly acceptable" standards, and which are "sociologically well-ordered", regardless of inductive risk concerns. After developing these claims through the cancer case-study, the final section suggests how these concerns might motivate novel versions of the demarcation project.
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Affiliation(s)
- Stephen John
- Department of History and Philosophy of Science, University of Cambridge, Cambridge, CB2 3RH, UK.
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26
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Røst TB, Slaughter L, Nytrø Ø, Muller AE, Vist GE. Using neural networks to support high-quality evidence mapping. BMC Bioinformatics 2021; 22:496. [PMID: 34674636 PMCID: PMC8529368 DOI: 10.1186/s12859-021-04396-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 08/23/2021] [Indexed: 11/29/2022] Open
Abstract
Background The Living Evidence Map Project at the Norwegian Institute of Public Health (NIPH) gives an updated overview of research results and publications. As part of NIPH’s mandate to inform evidence-based infection prevention, control and treatment, a large group of experts are continously monitoring, assessing, coding and summarising new COVID-19 publications. Screening tools, coding practice and workflow are incrementally improved, but remain largely manual. Results This paper describes how deep learning methods have been employed to learn classification and coding from the steadily growing NIPH COVID-19 dashboard data, so as to aid manual classification, screening and preprocessing of the rapidly growing influx of new papers on the subject. Our main objective is to make manual screening scalable through semi-automation, while ensuring high-quality Evidence Map content. Conclusions We report early results on classifying publication topic and type from titles and abstracts, showing that even simple neural network architectures and text representations can yield acceptable performance.
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Affiliation(s)
- Thomas B Røst
- Department of Computer Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
| | - Laura Slaughter
- Department of Computer Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Øystein Nytrø
- Department of Computer Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Ashley E Muller
- Reviews and Health Technology Assessments, Norwegian Institute of Public Health (NIPH), Oslo, Norway
| | - Gunn E Vist
- Reviews and Health Technology Assessments, Norwegian Institute of Public Health (NIPH), Oslo, Norway
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27
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Werter DE, Dehaene I, Gurney L, Vargas Buján M, Kazemier BM. Differences in clinical practice regarding screening and treatment of infections associated with spontaneous preterm birth: An international survey. Eur J Obstet Gynecol Reprod Biol 2021; 266:83-88. [PMID: 34600189 DOI: 10.1016/j.ejogrb.2021.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 09/08/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE An association between infections in pregnancy and increased risk of preterm birth (PTB) is described in the literature. We anticipated that differences may exist in screening and treatment approaches for infections associated with PTB, within and between European countries. The aim of this study was to examine and analyse these differences in clinical practice in greater detail. STUDY DESIGN We created a descriptive survey examining the screening and treatment of infections in pregnancy. The survey was sent to European representatives of the International Spontaneous Preterm Birth Young Investigators (I-SPY) group in Europe, who sent it to their network. Finally, we had 50 respondents from ten European countries. RESULTS We found substantial differences in screening for bacterial vaginosis and asymptomatic bacteriuria, administration of antibiotics to women with preterm prelabour rupture of membranes (PPROM), and timing of induction of labour after PPROM. These differences in clinical practice were present both within, and between countries. CONCLUSIONS Approaches for screening and treatment of infections associated with PTB differ between European countries. There is a lack of robust evidence, which is reflected in a lack of uniformity in international guidelines. International collaboration is paramount to enlarge sample sizes in obstetric studies and to facilitate the process of developing, updating, and implementing consistent guidelines across Europe and beyond.
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Affiliation(s)
- Dominique E Werter
- Amsterdam UMC, University of Amsterdam, Department of Obstetrics and Gynaecology, Meibergdreef 9, Amsterdam, The Netherlands.
| | - Isabelle Dehaene
- Ghent University Hospital, Department of Obstetrics and Gynaecology, C. Heymanslaan 10, 9000 Ghent, Belgium.
| | - Leo Gurney
- Birmingham Women's Hospital, Fetal Medicine Department, Mendelsohn Road, Edgbaston, Birmingham, United Kingdom.
| | - Mireia Vargas Buján
- Hospital Universitari Vall d'Hebron, Department of Obstetrics and Gynaecology, Passeig de la Vall d'Hebron, 119, 08035 Barcelona, Spain.
| | - Brenda M Kazemier
- Amsterdam UMC, University of Amsterdam, Department of Obstetrics and Gynaecology, Meibergdreef 9, Amsterdam, The Netherlands.
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Evans L, Rhodes A, Alhazzani W, Antonelli M, Coopersmith CM, French C, Machado FR, Mcintyre L, Ostermann M, Prescott HC, Schorr C, Simpson S, Wiersinga WJ, Alshamsi F, Angus DC, Arabi Y, Azevedo L, Beale R, Beilman G, Belley-Cote E, Burry L, Cecconi M, Centofanti J, Coz Yataco A, De Waele J, Dellinger RP, Doi K, Du B, Estenssoro E, Ferrer R, Gomersall C, Hodgson C, Møller MH, Iwashyna T, Jacob S, Kleinpell R, Klompas M, Koh Y, Kumar A, Kwizera A, Lobo S, Masur H, McGloughlin S, Mehta S, Mehta Y, Mer M, Nunnally M, Oczkowski S, Osborn T, Papathanassoglou E, Perner A, Puskarich M, Roberts J, Schweickert W, Seckel M, Sevransky J, Sprung CL, Welte T, Zimmerman J, Levy M. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med 2021; 47:1181-1247. [PMID: 34599691 PMCID: PMC8486643 DOI: 10.1007/s00134-021-06506-y] [Citation(s) in RCA: 1195] [Impact Index Per Article: 398.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 08/05/2021] [Indexed: 02/07/2023]
Affiliation(s)
- Laura Evans
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA, USA.
| | - Andrew Rhodes
- Adult Critical Care, St George's University Hospitals NHS Foundation Trust & St George's University of London, London, UK
| | - Waleed Alhazzani
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Massimo Antonelli
- Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | | | - Flávia R Machado
- Anesthesiology, Pain and Intensive Care Department, Federal University of São Paulo, Hospital of São Paulo, São Paulo, Brazil
| | | | | | - Hallie C Prescott
- University of Michigan and VA Center for Clinical Management Research, Ann Arbor, MI, USA
| | | | - Steven Simpson
- University of Kansas Medical Center, Kansas City, KS, USA
| | - W Joost Wiersinga
- ESCMID Study Group for Bloodstream Infections, Endocarditis and Sepsis, Division of Infectious Diseases, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Fayez Alshamsi
- Department of Internal Medicine, College of Medicine and Health Sciences, Emirates University, Al Ain, United Arab Emirates
| | - Derek C Angus
- University of Pittsburgh Critical Care Medicine CRISMA Laboratory, Pittsburgh, PA, USA
| | - Yaseen Arabi
- Intensive Care Department, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Luciano Azevedo
- School of Medicine, University of Sao Paulo, São Paulo, Brazil
| | | | | | | | - Lisa Burry
- Mount Sinai Hospital & University of Toronto (Leslie Dan Faculty of Pharmacy), Toronto, ON, Canada
| | - Maurizio Cecconi
- Department of Biomedical Sciences, Humanitas University Pieve Emanuele, Milan, Italy.,Department of Anaesthesia and Intensive Care, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - John Centofanti
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada
| | - Angel Coz Yataco
- Lexington Veterans Affairs Medical Center/University of Kentucky College of Medicine, Lexington, KY, USA
| | | | | | - Kent Doi
- The University of Tokyo, Tokyo, Japan
| | - Bin Du
- Medical ICU, Peking Union Medical College Hospital, Beijing, China
| | - Elisa Estenssoro
- Hospital Interzonal de Agudos San Martin de La Plata, Buenos Aires, Argentina
| | - Ricard Ferrer
- Intensive Care Department, Vall d'Hebron University Hospital, Vall d'Hebron Institut de Recerca, Barcelona, Spain
| | | | - Carol Hodgson
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia
| | - Morten Hylander Møller
- Department of Intensive Care 4131, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | | | - Shevin Jacob
- Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Michael Klompas
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Younsuck Koh
- ASAN Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Anand Kumar
- University of Manitoba, Winnipeg, MB, Canada
| | - Arthur Kwizera
- Makerere University College of Health Sciences, Kampala, Uganda
| | - Suzana Lobo
- Intensive Care Division, Faculdade de Medicina de São José do Rio Preto, São Paulo, Brazil
| | - Henry Masur
- Critical Care Medicine Department, NIH Clinical Center, Bethesda, MD, USA
| | | | | | - Yatin Mehta
- Medanta the Medicity, Gurugram, Haryana, India
| | - Mervyn Mer
- Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mark Nunnally
- New York University School of Medicine, New York, NY, USA
| | - Simon Oczkowski
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Tiffany Osborn
- Washington University School of Medicine, St. Louis, MO, USA
| | | | | | - Michael Puskarich
- University of Minnesota/Hennepin County Medical Center, Minneapolis, MN, USA
| | - Jason Roberts
- Faculty of Medicine, University of Queensland Centre for Clinical Research, The University of Queensland, Brisbane, Australia.,Department of Pharmacy, Royal Brisbane and Women's Hospital, Brisbane, Australia.,Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia.,Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, Nîmes, France
| | | | | | | | - Charles L Sprung
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.,Department of Anesthesiology, Critical Care and Pain Medicine, Hadassah Medical Center, Jerusalem, Israel
| | - Tobias Welte
- Medizinische Hochschule Hannover and German Center of Lung Research (DZL), Hannover, Germany
| | - Janice Zimmerman
- World Federation of Intensive and Critical Care, Brussels, Belgium
| | - Mitchell Levy
- Warren Alpert School of Medicine at Brown University, Providence, Rhode Island & Rhode Island Hospital, Providence, RI, USA
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Seeber C, Popp M, Meerpohl JJ, Fichtner F, Werner A, Schmaderer C, Holzmann-Littig C, Dickel S, Grimm C, Moerer O, Kranke P. [COVID-19 pandemic: preferences and barriers for dissemination of evidence syntheses : Survey of intensive care personnel in Germany]. Anaesthesist 2021; 71:281-290. [PMID: 34546394 PMCID: PMC8454015 DOI: 10.1007/s00101-021-01037-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/26/2021] [Accepted: 08/04/2021] [Indexed: 11/28/2022]
Abstract
Hintergrund Das COVID-19-Evidenz-Ökosystem (CEOsys) identifiziert, bewertet und fasst Ergebnisse wissenschaftlicher Studien in Evidenzsynthesen im Kontext von COVID-19 zusammen. Diese Evidenzsynthesen werden genutzt, um konkrete Handlungsempfehlungen abzuleiten und Leitlinien zu erstellen. Zielsetzung Vorbereitung der am besten geeigneten Verteilung von Evidenzsynthesen im Rahmen der Aufgaben des CEOsys-Projekts. Methode Für Deutschland wurde eine Befragung hinsichtlich des intensivmedizinischen Personals priorisierter Themenbereiche, Wünschen zu Layout, Plattform der Bekanntmachung von Evidenzsynthesen und Vertrauenswürdigkeit von Institutionen mit kategorialen Antwortmöglichkeiten durchgeführt. Die Umfrage erfolgte online und wurde per E‑Mail lokal und über die DIVI verteilt. Ergebnisse Von 317 Befragten, die die Umfrage starteten, vervollständigten 200 den Fragebogen. Knappe Zeit und fehlender Zugriff, unzureichende Erfahrung bzw. Unsicherheit im Umgang mit Evidenzsynthesen wurden als Barriere für Wissenserwerb benannt. Das aktive Herantragen von Informationen wird bevorzugt („Push-Strategie“). Als Format werden Kurzversion, Übersichten mit Algorithmen und Webinare prioritär gewünscht. Webseiten öffentlicher Einrichtungen, Fachjournalartikel und E‑Mail-Newsletter sollen auf neue Evidenz aufmerksam machen. Fachgesellschaften und dem Robert Koch Institut werden in der Pandemie mehrheitlich Vertrauen geschenkt. Priorisierte Themen der Befragten sind Langzeitfolgen der Erkrankung, Schutz des medizinischen Personals und Invasivität der Beatmungstherapie. Schlussfolgerung Evidenzsynthesen sollten aktiv an Zielgruppen herangetragen werden. Inhalte sollten übersichtlich, kurz (Algorithmen, Kurzversion, Webinare) und frei verfügbar sein. Webseiten, E‑Mail-Newsletter und medizinische Journale, aber auch Fachgesellschaften und das Robert Koch-Institut sollten auf Evidenzsynthesen hinweisen. Zusatzmaterial online Zusätzliche Informationen sind in der Online-Version dieses Artikels (10.1007/s00101-021-01037-z) enthalten.
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Affiliation(s)
- Christian Seeber
- Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, Universitätsklinikum Leipzig AöR, Liebigstraße 20, 04103, Leipzig, Deutschland.
| | - Maria Popp
- Klinik und Poliklinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Joerg J Meerpohl
- Institut für Evidenz in der Medizin, Universitätsklinikum Freiburg & Medizinische Fakultät, Universität Freiburg, Freiburg, Deutschland.,Cochrane Deutschland, Cochrane Deutschland Stiftung, Freiburg, Deutschland
| | - Falk Fichtner
- Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, Universitätsklinikum Leipzig AöR, Liebigstraße 20, 04103, Leipzig, Deutschland
| | - Anne Werner
- Abteilung für Medizinische Psychologie und Medizinische Soziologie, Universitätsklinikum Leipzig AöR, Leipzig, Deutschland
| | - Christoph Schmaderer
- Fakultät für Medizin, Klinikum rechts der Isar, Abteilung für Nephrologie, Technische Universität München, München, Deutschland
| | - Christopher Holzmann-Littig
- Fakultät für Medizin, Klinikum rechts der Isar, Abteilung für Nephrologie, Technische Universität München, München, Deutschland.,Fakultät für Medizin, TUM Medical Education Center, Technische Universität München, München, Deutschland
| | - Steffen Dickel
- Klinik für Anästhesiologie, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - Clemens Grimm
- Klinik für Anästhesiologie, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - Onnen Moerer
- Klinik für Anästhesiologie, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - Peter Kranke
- Klinik und Poliklinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Universitätsklinikum Würzburg, Würzburg, Deutschland
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Helmer P, Skazel T, Wenk M, von Kaisenberg C, Abou-Dakn M, Papsdorf M, Abu Hmeidan F, Kehl S, Meybohm P, Kranke P. [S3 guidelines on "full-term vaginal birth" from an anesthesiological perspective : Worthwhile knowledge for anesthesiologists]. Anaesthesist 2021; 70:1031-9. [PMID: 34487216 DOI: 10.1007/s00101-021-01024-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2021] [Indexed: 10/20/2022]
Abstract
The publication of the new S3 guidelines on "full-term vaginal birth" and the guidelines on cesarean section, also published in 2020, provide further steps towards the promotion of evidence-based medicine in obstetrics, even if the exact configuration of neonatal monitoring during birth, in particular, is still the subject of current discussions. The multiprofessionality in the medical supervision of a birth is also fundamentally well-represented in the compilation of the S3 guidelines by the participating actors and specialist societies. Important from an anesthesiological perspective is the fact that neuraxial procedures still represent the gold standard in obstetric analgesia. With remifentanil PCA an alternative option is available that enables a reliable analgesia to be accomplished, e.g. when there are contraindications to performing neuraxial methods, if this is appropriate under the prevailing circumstances (1:1 support and appropriate monitoring). During an uncomplicated birth the strict fasting rules are relaxed. Overall, the guidelines underline the importance of self-determination and self-control for the expectant mother and give the highest priority to the safety and well-being of mother and child; however, this presupposes that the expectant mother is sufficiently informed about the value of neuraxial analgesia. For this it appears to be of importance to initiate information proposals, which go beyond the usual information sessions for parents that are often organized exclusively by midwives.
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31
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Horwitz RI, Lobitz G, Mawn M, Conroy AH, Cullen MR, Sim I, Singer BH. Biosocial medicine: Biology, biography, and the tailored care of the patient. SSM Popul Health 2021; 15:100863. [PMID: 34430699 PMCID: PMC8374477 DOI: 10.1016/j.ssmph.2021.100863] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 06/28/2021] [Accepted: 06/30/2021] [Indexed: 12/12/2022] Open
Abstract
Biosocial Medicine, with its emphasis on the full integration of the person's biology and biography, proposes a strategy for clinical research and the practice of medicine that is transformative for the care of individual patients. In this paper, we argue that Biology is one component of what makes a person unique, but it does not do so alone. Biography, the lived experience of the person, integrates with biology to create a unique signature for each individual and is the foundational concept on which Biosocial Medicine is based. Biosocial Medicine starts with the premise that the individual patient is the focus of clinical care, and that average results for "ideal" patients in population level research cannot substitute for the "real" patient for whom clinical decisions are needed. The paper begins with a description of the case-based method of clinical reasoning, considers the strengths and limitations of Randomized Controlled Trials and Evidence Based Medicine, reviews the increasing focus on precision medicine and then explores the neglected role of biography as part of a new approach to the tailored care of patients. After a review of the analytical challenges in Biosocial Medicine, the paper concludes by linking the physician's commitment to understanding the patient's biography as a critical element in developing trust with the patient.
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Affiliation(s)
- Ralph I. Horwitz
- Department of Medicine at Temple, University Lewis Katz School of Medicine, USA
| | | | - McKayla Mawn
- Temple University Lewis Katz School of Medicine, USA
| | | | - Mark R. Cullen
- Stanford Center for Population Health Sciences (retired), USA
| | - Ida Sim
- Division of General Internal Medicine at University of California San Francisco, USA
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Heiligenhaus A, Rothaus K, Pleyer U. [Development of classification criteria for uveitis by the standardization of uveitis nomenclature (SUN) working group]. Ophthalmologe 2021; 118:913-918. [PMID: 34459962 PMCID: PMC8413183 DOI: 10.1007/s00347-021-01486-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2021] [Indexed: 12/19/2022]
Abstract
Hintergrund Die Standardization of Uveitis Nomenclature (SUN) Working Group ist eine internationale Expertenkommission, die das Ziel verfolgt, eine standardisierte und international anerkannte Terminologie für das Gebiet der Uveitis zu erarbeiten. Dies erscheint angesichts der Forderung nach evidenzbasierter Medizin gerade bei relativ seltenen Erkrankungen wie der Uveitis wichtig. Methoden Unter Verwendung formaler Konsensustechniken wurde eine Datenbank von > 4000 Uveitispatienten erstellt, bei denen zuvor eine Mehrheitsübereinstimmung in der Diagnose erzielt wurde. Die Patientendaten wurden innerhalb der Uveitissubklasse analysiert und in einen Trainingssatz und einen Validierungssatz aufgeteilt. Mit maschinellem Lernen (ML) wurden multinomiale logistische Regressionen mit Lasso-Regularisierung auf dem Trainingssatz durchgeführt. Die Genauigkeit der Regeln, die entwickelt wurden, um die Kriterien des maschinellen Lernens auszudrücken, wurde von einem maskierten Beobachter in einer 10 %igen Zufallsstichprobe bewertet. Ergebnisse Die Schätzungen der Gesamtgenauigkeit nach Uveitisklassen im Validierungsset waren für alle Uveitisformen hoch: anteriore Uveitiden 96,7 % (95 %-Konfidenzintervall [CI] 92,4–98,6); intermediäre Uveitiden 99,3 % (95 %-CI 96,1–99,9); posteriore Uveitiden 98,0 % (95 %-CI 94,3–99,3); Panuveitiden 94,0 % (95 %-CI 89,0–96,8) und infektiöse posteriore Uveitiden/Panuveitiden 93,3 % (95 %-CI 89,1–96,3). Schlussfolgerungen Es werden Klassifikationskriterien präsentiert, die einen hohen Grad an Genauigkeit (geringe Fehlklassifikationsraten) aufweisen und sich daher gut für die künftige klinische und translationale Forschung eignen.
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Affiliation(s)
- Arnd Heiligenhaus
- Augenzentrum, St. Franziskus-Hospital, Hohenzollernring 74, 48145, Münster, Deutschland. .,Universität Duisburg-Essen, Essen, Deutschland.
| | - Kai Rothaus
- Augenzentrum, St. Franziskus-Hospital, Hohenzollernring 74, 48145, Münster, Deutschland
| | - Uwe Pleyer
- Berliner Institut für Gesundheitsforschung in der Charité (BIH), Campus Virchow Klinikum, Augenklinik, Charité - Universitätsmedizin Berlin, Gliedkörperschaft der Freien Universität Berlin und der Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland.
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Chvetzoff R, Laurent B, Baylot D, Chvetzoff G. [Scientific medicine and care relationship: From the therapeutic alliance to the therapeutic effect of the alliance]. Bull Cancer 2021; 108:837-842. [PMID: 34246457 DOI: 10.1016/j.bulcan.2021.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 02/01/2021] [Accepted: 02/11/2021] [Indexed: 10/20/2022]
Abstract
The new paradigm of precision medicine in oncology questions today the respective place of evidence-based medicine and doctor-patient relationship. Based on the results of a randomized study comparing the efficacy of a homeopathic molecule in the prevention of nausea and vomiting induced by chemotherapy in non-metastatic breast cancer, this article extends and develops the discussion of maintaining an unresolved tension between medical art and medical science, between care and cure. This tension sets a base for the authors of the therapeutic alliance in medicine, defined as a dialectic constantly adjourned between the alliance of the doctor with the patient and his therapy, and the therapeutic effect of this alliance. Because if a policy or a public opinion were to promote an exclusively rational medicine deprived of the field of relation to care, or on the contrary a medicine based only on clinical sense and intuition, then respectively the ethics of care and the progress of therapy would be threatened. It is advisable to be aware of erring from the truth, amplified today by social networks, as much due to a tide of scientific positivism, as an excess of the "good caring soul". Taking into account the therapeutic alliance makes it possible to no longer oppose scientific medicine and care relationship.
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Affiliation(s)
- Roland Chvetzoff
- Cabinet Latitude Santé, 38460 Trept, France; Département de Sciences Humaines en santé (DESIH), UFR Lyon-Sud, Université Lyon 1, France.
| | - Bernard Laurent
- Centre Léon-Bérard, Département interdisciplinaire de soins de support du patient en oncologie (DISSPO), Université Claude-Bernard Lyon 1-UMR 1290, 69373 Lyon, France; Lyon Neuroscience Research Center, U1028 ; CNRS, UMR5292, Neuropain team, Inserm, 69500 Lyon, France
| | - Denis Baylot
- Centre Léon-Bérard, Département interdisciplinaire de soins de support du patient en oncologie (DISSPO), Université Claude-Bernard Lyon 1-UMR 1290, 69373 Lyon, France
| | - Gisèle Chvetzoff
- Centre Léon-Bérard, Département interdisciplinaire de soins de support du patient en oncologie (DISSPO), Université Claude-Bernard Lyon 1-UMR 1290, 69373 Lyon, France
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Schittek GA, Simonis H, Bornemann-Cimenti H. Pain, nausea, vomiting, thirst, cold, … the challenge of well-being in post-operative patients. Intensive Crit Care Nurs 2021; 66:103090. [PMID: 34119406 DOI: 10.1016/j.iccn.2021.103090] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Gregor Alexander Schittek
- Department of Anesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, Austria.
| | - Holger Simonis
- Department of Anesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, Austria
| | - Helmar Bornemann-Cimenti
- Department of Anesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, Austria
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Rooij NABD, Verhoeff M, Lindeboom R, Linden CMJVD, Munster BCV. [How "elderly-proof" are the current medical specialist guidelines in the Netherlands?]. Tijdschr Gerontol Geriatr 2021; 52. [PMID: 34498440 DOI: 10.36613/tgg.1875-6832/2021.02.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The prevalence of multimorbidity increases with age, with over 70% of people aged 75 years and over having three or more chronic conditions, often combined with frailty. In current medical practice, evidence-based medicine with evidence-based guidelines forms the basis for treatment. The aim of this study is to determine the practical applicability of the current medical specialist guidelines for the treatment of the heterogeneous group of older patients. All guidelines from the Dutch guidelines database were examined. Twelve guidelines identified as elderly-specific were compared with the recommendations from the 'methodology for the development of guidelines tailored to the elderly'. In 117 guidelines (54%) general terms such as 'older' or 'elderly' were found. An age limit was mentioned in 26 guidelines (12%). The term 'frailty' was mentioned in 38 guidelines (18%), the term 'comorbidity' in 107 (50%) and cognitive problems in eight (4%). Five age-specific guidelines distinguished frail from non-frail older people. Three guidelines discussed relevant outcome measures for the elderly. The results show that the practical applicability of current guidelines is not optimal for the various groups of older people. In our opinion, the improvement of the guidelines preferably by implementation of the Dutch methodology for senior-proof guidelines is a necessary first step in making the current second-line evidence-based guidelines in the Netherlands usable for the growing group of frail and multimorbid elderly.
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Affiliation(s)
| | | | | | | | - Barbara C van Munster
- Universitair Centrum Ouderengeneeskunde, Universitair Medisch Centrum Groningen, Rijksuniversiteit Groningen
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Moosapour H, Saeidifard F, Aalaa M, Soltani A, Larijani B. The rationale behind systematic reviews in clinical medicine: a conceptual framework. J Diabetes Metab Disord 2021; 20:919-929. [PMID: 34178868 DOI: 10.1007/s40200-021-00773-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 03/18/2021] [Indexed: 11/29/2022]
Abstract
A systematic review (SR) is a type of review that uses a systematic method to provide a valid summary of existing literature addressing a clear and specific question. In clinical medicine (CM), the concept of SR is well recognized, especially after the introduction of evidence-based medicine; The SR of randomized clinical trials (RCTs) is considered the highest level of evidence on therapeutic effectiveness. Despite the popularity of the SRs and the increasing publication rate of SRs in CM and other healthcare literature, the concept has raised criticisms. Many of proper criticisms can be due to the deviation of some existing SRs from the original philosophy and well-established rationale behind the concept of SR. On the other hand, many criticisms are misconceptions about SRs which still exist even several decades after introducing the concept. This article presents a conceptual framework for clarifying the rationale behind SR in CM by providing the relevant concepts and their inter-relations, explaining how methodological standards of an SR and its rationale are connected, and discussing the rationale under the three-section: SR as a type of synthetic research, SR as a more informed and less biased review, and SR as an efficient scientific tool.
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Affiliation(s)
- Hamideh Moosapour
- Evidence Based Medicine Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farzane Saeidifard
- Department of Medicine, Northwell Health-Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, New York, NY USA.,Division of Preventive Cardiology, Department of Cardiovascular Disease, Mayo Clinic, Rochester, MN USA
| | - Maryam Aalaa
- Evidence Based Medicine Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.,Center for Educational Research in Medical Sciences, Department of Medical Education, School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Akbar Soltani
- Evidence Based Medicine Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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Lindström M. The New Totalitarians: The Swedish COVID-19 strategy and the implications of consensus culture and media policy for public health. SSM Popul Health 2021; 14:100788. [PMID: 34136630 PMCID: PMC8182112 DOI: 10.1016/j.ssmph.2021.100788] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 03/22/2021] [Accepted: 03/28/2021] [Indexed: 11/20/2022] Open
Abstract
Aims The aim is to discuss implications of consensus culture in combination with media policy in Sweden with regard to the Swedish COVID-19 strategy in the spring of 2020. Methods Investigation of prerequisites for scrutiny by the Swedish mass media of the Swedish strategy in the spring of 2020 based on discussion regarding consensus culture, media structure and postmodernism in science, politics and administration. Results The Swedish strategy entailed strong initial confidence in herd immunity (although not officially stated), individual responsibility, evidence based medicine and substantial neglect to cooperate internationally. The strategy may be regarded partly as a result of the postmodern view of science and society predominant in Sweden. A tradition of top down consensus culture combined with mass media's financial and partly structural dependence of the state may help explain the comparative lack of critical questions regarding the strategy at the press conferences in the spring of 2020. Conclusions Mass media in Sweden should become more financially and structurally independent of the state. The reporting by Swedish media in the spring of 2020 should be subject to peer-reviewed research.
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Stylianou N, Vlahavas I. TransforMED: End-to-Εnd Transformers for Evidence-Based Medicine and Argument Mining in medical literature. J Biomed Inform 2021; 117:103767. [PMID: 33811985 DOI: 10.1016/j.jbi.2021.103767] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 03/03/2021] [Accepted: 03/28/2021] [Indexed: 11/16/2022]
Abstract
Argument Mining (AM) refers to the task of automatically identifying arguments in a text and finding their relations. In medical literature this is done by identifying Claims and Premises and classifying their relations as either Support or Attack. Evidence-Based Medicine (EBM) refers to the task of identifying all related evidence in medical literature to allow medical practitioners to make informed choices and form accurate treatment plans. This is achieved through the automatic identification of Population, Intervention, Comparator and Outcome entities (PICO) in the literature to limit the collection to only the most relevant documents. In this work, we combine EBM with AM in medical literature to increase the performance of the individual models and create high quality argument graphs, annotated with PICO entities. To that end, we introduce a state-of-the-art EBM model, used to predict the PICO entities and two novel Argument Identification and Argument Relation classification models that utilize the PICO entities to enhance their performance. Our final system works in a pipeline and is able to identify all PICO entities in a medical publication, the arguments presented in them and their relations.
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Affiliation(s)
| | - Ioannis Vlahavas
- School of Informatics, Aristotle University of Thessaloniki, Greece.
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Abstract
BACKGROUND The current research-care separation was introduced to protect patients from explanatory studies designed to gain knowledge for future patients. Care trials are all-inclusive pragmatic trials integrated into medical practice, with no extra tests, risks, or cost, and have been designed to guide practice under uncertainty in the best medical interest of the patient. PROPOSED REVISION Patients need a distinction between validated care, previously verified to provide better outcomes, and promising but unvalidated care, which may include unnecessary or even harmful interventions. While validated care can be practiced normally, unvalidated care should only be offered within declared pragmatic care research, designed to protect patients from harm. The validated/unvalidated care distinction is normative, necessary to the ethics of medical practice. Care trials, which mark the distinction and allow the tentative use of promising interventions necessarily involve patients, and thus the design and conduct of pragmatic care research must respect the overarching rule of care ethics "to always act in the best medical interest of the patient." Yet, unvalidated interventions offered in contexts of medical uncertainty cannot be prescribed or practiced as if they were validated care. The medical interests of current patients are best protected when unvalidated practices are restricted to a care trial protocol, with 1:1 random allocation (or "hemi-prescription") versus previously validated care, to optimize potential benefits and minimize risks for each patient. CONCLUSION Pragmatic trials can regulate medical practice by providing (i) a transparent demarcation between unvalidated and validated care; (ii) norms of medical conduct when using tests and interventions of yet unknown benefits in practice; and eventually (iii) a verdict regarding optimal care.
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Affiliation(s)
- Tim E. Darsaut
- Mackenzie Health Sciences Centre, Department of Surgery, Division of Neurosurgery, University of Alberta Hospital, 8440 - 112 Street, Edmonton, Alberta T6G 2B7 Canada
| | - Jean Raymond
- Department of Radiology, Service of Interventional Neuroradiology, Centre Hospitalier de l’Université de Montréal – CHUM, 1000 St-Denis, room D03-5462B, Montreal, QC H2X 0C1 Canada
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40
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Zhu LG, Qiu GX. [Adhere to both Chinese and western medicine and improve the level of evidence-based research in TCM orthopedics]. Zhongguo Gu Shang 2021; 34:1-4. [PMID: 33666011 DOI: 10.12200/j.issn.1003-0034.2021.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Li-Guo Zhu
- Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing 100102, China
| | - Gui-Xing Qiu
- Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing 100102, China
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Bencko V. Principles of evidence-based medicine: from Robert Kochs postulates to a current EBM concept. Cas Lek Cesk 2021; 160:93-96. [PMID: 34134498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The aim of the article is to describe the development of the principles of medicine based on the evidence (EBM) based on postulates of Robert Koch, Nobel prize winner, protagonist of the "Golden Age" medical bacteriology, founder of a concept of modern microbiology and infectology. Kochs work led to the discovery of a causal relationship between exposure to a specific pathogen and disease on the example of identifying the cause of anthrax - Bacillus anthracis, a disease whose symptoms vary depending on the mode of transmission (gastrointestinal ingestion, cutaneous form on contact and pulmonary manifestations when inhaled). Tuberculosis caused by Kochs bacillus, Mycobacterium tuberculosis, yet still affecting 1.7 billion people (about 25 % of the world's population), in 95 % of cases in developing countries, where poverty and high prevalence of HIV are part of everyday life. Koch also discovered Vibrio cholerae, the pathogen responsible for seven recorded pandemics, and hitherto sporadic epidemics in recent years. The main contribution of the Kochs four postulates formulation was the principle, which helped to reveal the causal relationship between the pathogenic microbe to protrude infectious disease and obtain reliable evidence in improving credibility of diagnosis of infectious diseases. Other stages in the development of EBM were formulated by Bradford Hill in his nine principles, which are valid as well for noncommunicable diseases. The subjects of discussion are limitations and restrictions of present EBM and its essentials and the use in rational preventive, diagnostic and treatment strategies.
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van de Wall BJM, Beeres FJP, Knobe M, Link BC, Babst R. Minimally invasive plate osteosynthesis: An update of practise. Injury 2021; 52:37-42. [PMID: 33228999 DOI: 10.1016/j.injury.2020.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/22/2020] [Accepted: 11/01/2020] [Indexed: 02/02/2023]
Abstract
Since its conception in 1989, minimally invasive plate osteosynthesis (MIPO) has gained widespread popularity. It has been studied in over forty countries with most of the publications originating from Asia, Europe and North America. This review aims to describe the scientific path of MIPO from the very beginning to where it stands in current day times; study the pattern and contributing factors influencing its global spread. Finally, the up to date evidence is discussed with regard to several anatomical regions in which MIPO is mostly used. In the meantime, MIPO treads steadily towards accomplishing the same or better outcomes for more and more indications with the goal to leave a smaller surgical footprint to allow for undisturbed bone healing.
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Affiliation(s)
- Bryan J M van de Wall
- Lucerne Cantonal Hospital, Department of Orthopaedic and Trauma Surgery, Spitalstrasse 16, 6000 Luzern, Switzerland.
| | - Frank J P Beeres
- Lucerne Cantonal Hospital, Department of Orthopaedic and Trauma Surgery, Spitalstrasse 16, 6000 Luzern, Switzerland
| | - Matthias Knobe
- Lucerne Cantonal Hospital, Department of Orthopaedic and Trauma Surgery, Spitalstrasse 16, 6000 Luzern, Switzerland
| | - Björn C Link
- Lucerne Cantonal Hospital, Department of Orthopaedic and Trauma Surgery, Spitalstrasse 16, 6000 Luzern, Switzerland
| | - Reto Babst
- Lucerne Cantonal Hospital, Department of Orthopaedic and Trauma Surgery, Spitalstrasse 16, 6000 Luzern, Switzerland
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Schlomm T, Rödiger T, Graalmann J. [Precision oncology : How can high-quality healthcare remain affordable for all in the face of diagnostic and therapeutic costs?]. Urologe A 2020; 60:3-7. [PMID: 33315135 DOI: 10.1007/s00120-020-01416-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2020] [Indexed: 10/22/2022]
Abstract
Medicine is becoming increasingly precise. This is particularly evident in the field of pharmaceuticals and especially in oncology. Driven by the steadily growing understanding of biomedical interrelationships and the resulting increase in precision, we are currently experiencing a paradigm shift from a one-drug-fits-all model towards an individualized biomarker-driven approach. This essentially enables the transition from efficacy to effectiveness. In order to ensure that the promise of high-quality, affordable precision medicine for all remains valid in the future, the step from efficacy in clinical studies to effectiveness in the practice of care is crucial in the next decade. This will be achieved with end-to-end precision from diagnostics to real-world evidence.
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Affiliation(s)
- T Schlomm
- Klinik für Urologie, Charité - Universitätsmedizin Berlin, Charité Platz 1, 10117, Berlin, Deutschland.
| | - T Rödiger
- Die Brückenköpfe GmbH, Mohrenstraße 34, 10117, Berlin, Deutschland
| | - J Graalmann
- Die Brückenköpfe GmbH, Mohrenstraße 34, 10117, Berlin, Deutschland
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Asai N, Sakanashi D, Suematsu H, Kato H, Hagihara M, Shiota A, Koizumi Y, Yamagishi Y, Mikamo H. To what degree could clinical trials in evidence based medicine reflect reality in the treatment of candidemia? J Microbiol Immunol Infect 2020; 55:147-153. [PMID: 33339744 DOI: 10.1016/j.jmii.2020.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 11/03/2020] [Accepted: 11/23/2020] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Evidenced based medicine (EBM) is necessary to standardize or treatment for infection since EBM is established based on the results of clinical trials. Entry criteria for clinical trials are very strict, and many patients have difficulties in being enrolled in any clinical trials regarding candidemia. It is questionable if the results of clinical trials reflect the real world of general medicine in this case. PATIENTS AND METHODS For the purpose of examining how many patients could join any randomized clinical trials for the treatment of candidemia, we reviewed all the candidemia patients in our institute during 2014-2018. The patients were divided into two groups: patients who were eligible for clinical trials (participation possible group), and those who were not (participation impossible group). Exclusion criteria for clinical trials were set based on previous clinical trials. RESULTS A total of 70 patients was enrolled in this study. The median age was 73 years (range 36-93 years). Of these, 41 patients (59%) were male. As for site of infections, catheter related blood stream infection was most frequently seen in 37 (53%). Seventeen patients (24%) were classified as participation possible group and 53 patients (76%) were participation impossible group. Comparing the two groups, participation possible group patients have much better performance status, have less comorbidities and have longer overall survival times than participation impossible group patients. CONCLUSION Only 24% of candidemia patients were eligible for the clinical trials. Thus, we can see that clinical trials might not correctly reflect the real world among candidemia patients.
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Affiliation(s)
- Nobuhiro Asai
- Department of Clinical Infectious Diseases, Aichi Medical University Hospital, Aichi, Japan; Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan
| | - Daisuke Sakanashi
- Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan
| | - Hiroyuki Suematsu
- Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan
| | - Hideo Kato
- Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan
| | - Mao Hagihara
- Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan
| | - Arufumi Shiota
- Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan
| | - Yusuke Koizumi
- Department of Clinical Infectious Diseases, Aichi Medical University Hospital, Aichi, Japan; Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan
| | - Yuka Yamagishi
- Department of Clinical Infectious Diseases, Aichi Medical University Hospital, Aichi, Japan; Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan
| | - Hiroshige Mikamo
- Department of Clinical Infectious Diseases, Aichi Medical University Hospital, Aichi, Japan; Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan.
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Affiliation(s)
- Joanna K Fadyl
- Centre for Person Centred Research, Auckland University of Technology , Auckland, New Zealand
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46
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Keay S, Sargeant JM, O'Connor A, Friendship R, O'Sullivan T, Poljak Z. Veterinarian barriers to knowledge translation (KT) within the context of swine infectious disease research: an international survey of swine veterinarians. BMC Vet Res 2020; 16:416. [PMID: 33138811 PMCID: PMC7607664 DOI: 10.1186/s12917-020-02617-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 10/09/2020] [Indexed: 11/12/2022] Open
Abstract
Background Food animal veterinarians face commodity specific and urgent global challenges yet conditions preventing use of best available knowledge have been sparsely studied. The American Association of Swine Veterinarians (AASV) membership (N = 1289) was surveyed online to benchmark their information priorities and their motivations and sources for keeping current with infectious disease research, and to describe their reported time, skill, access, and process as barriers to knowledge translation (KT). Results Respondents (n = 80) were mostly from Canada (n = 40) and the U.S.A (n = 31) and demographics approximated the AASV’s. Colleagues are the first choice for information on difficult cases (49%, 95%CI: 38–61). Half of respondents (53%, 95%CI: 41–64) spend an hour or less per week keeping up with infectious disease research. The majority reported moderate or less than moderate efficiency (62%, 95%CI: 51–72), and moderate or greater stress (59%, 95%CI: 48–70) with their process for keeping up. Journal article methods sections are commonly not read, almost a third (32%, 95% CI: 22–43) reported either they do not evaluate statistical methods or that they had poor confidence to do so, and half (52, 95%CI: 41–63) could not explain ‘confounding bias’. Approximately half (55%, 95%CI: 41-69) with direct oversight of swine herds had full access to 2 or fewer academic journals. Approximately a third of respondents (34%, 95%CI: 24–46) selected only formats involving single research studies (either full text or summaries) as preferred reading materials for keeping current over expert summaries of the body of evidence. Conclusion KT barriers are considerable and a source of stress for many swine veterinarians. Sub-optimal efficiency with keeping up and low confidence to appraise aspects of research are concerns. Results are consistent with previous literature and illustrate need for improved KT infrastructure and for additional training in statistical methods and interpretation of primary research. Further evaluation is warranted of why approximately a third of veterinarians in this study, for the purpose of keeping up, preferentially choose to review individual research studies over choices that would include an expert summary of the body of evidence. Consideration of reasons for this preference will be important in the planning of KT infrastructure improvements. Supplementary information Supplementary information accompanies this paper at 10.1186/s12917-020-02617-8.
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Affiliation(s)
- Sheila Keay
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, Canada.
| | - Jan M Sargeant
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, Canada.,Centre for Public Health and Zoonoses, Ontario Veterinary College, University of Guelph, Guelph, Canada
| | - Annette O'Connor
- Department of Large Animal Clincal Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Robert Friendship
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, Canada
| | - Terri O'Sullivan
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, Canada
| | - Zvonimir Poljak
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, Canada
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Tudrej BV, Favard D, Vaillant-Roussel H, Pouchain D, Jaafari N, Boussageon R. Validity of the Good Practice Guidelines: The example of type 2 diabetes. Diabetes Res Clin Pract 2020; 169:108459. [PMID: 32956744 DOI: 10.1016/j.diabres.2020.108459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 09/02/2020] [Accepted: 09/14/2020] [Indexed: 01/09/2023]
Abstract
AIMS To assess the methodological quality of the systematic reviews of the literature for Good Practice Guidelines (GPGs) for treatment of type 2 diabetes (T2D). METHODS The GPGs on treatment of T2D from May 2012 onwards were searched on PubMed, the Guidelines International Network, the National Guidelines Clearing House and the Infobanque des guides de pratique clinique. Quality of the GPGs was assessed by means of grading of levels of evidence, strength of recommendations, statements pertaining to systematic reviews, description of their methods, search for Randomized Controlled Trials meta-analyses, and citations from three meta-analyses which contested the strategy of intensive glycemic control and metformin as first-line treatment. RESULTS Fiflty-two GPGs were included; half of them had and applied a system of grading and strength of recommendation and 58% stated they had carried out a systematic review. Only one GPG cited the three meta-analyses. Three quarters of the GPGs failed to detail their bibliographic research methods. CONCLUSION The GPGs for treatment of T2D were of poor quality and their methodological rigor was insufficient. Even though the meta-analyses had a higher level of evidence, they were seldom cited.
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Affiliation(s)
- Benoit V Tudrej
- Universite de Poitiers UFR Medecine et Pharmacie, General Practice Department, 6 rue de la miletrie, Poitiers, Nouvelle Aquitaine FR 86073, France; Société Française et Francophone d'Ethique Médicale, SFFEM, 45 Rue des Saints-Pères, Paris FR 75006, France; Universite Claude Bernard Lyon 1, University College of General Medicine, 8 Avenue Rockefeller, 69008 Lyon, France.
| | - Delphine Favard
- Universite de Poitiers UFR Medecine et Pharmacie, General Practice Department, 6 rue de la miletrie, Poitiers, Nouvelle Aquitaine FR 86073, France
| | - Hélène Vaillant-Roussel
- Department of General Practice, Faculty of Medicine, Clermont Auvergne University, 28 place Henri Dunant, 63001 Clermont-Ferrand, France; UPU, ACCePPT, Clermont Auvergne University, 28 place Henri Dunant, 63001 Clermont-Ferrand, France
| | - Denis Pouchain
- Département universitaire de médecine générale - Faculté de médecine de Tours, 10 Boulevard Tonnellé - BP 3223, 37032 Tours, France
| | - Nemat Jaafari
- Centre Hospitalier Henri Laborit, Unité de recherché clinique Pierre Deniker, INSERM CIC-P 1402, France
| | - Rémy Boussageon
- Universite Claude Bernard Lyon 1, University College of General Medicine, 8 Avenue Rockefeller, 69008 Lyon, France; Universite Claude Bernard Lyon 1, UMR 5558, LBBE CNRS, 8 Avenue Rockefeller, 69008 Lyon, France
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Saraswat N, Sachan N, Chandra P. Anti-diabetic, diabetic neuropathy protective action and mechanism of action involving oxidative pathway of chlorogenic acid isolated from Selinum vaginatum roots in rats. Heliyon 2020; 6:e05137. [PMID: 33088940 PMCID: PMC7566111 DOI: 10.1016/j.heliyon.2020.e05137] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 08/09/2020] [Accepted: 09/29/2020] [Indexed: 12/15/2022] Open
Abstract
Phytopharmaceuticals have always reported vital roles in the field of medicine hence the need to investigate safe and efficient drugs for treating metabolic disorders is very significant. Roots of Selinum vaginatum have therapeutic benefits and are widely used by the people of the Rohtang region for treating diabetes and its associated complications. The present study focusses on the isolation of the bioactive from the S. vaginatum roots for estimating acute toxicity studies, anti-diabetic and diabetic neuropathy protective action along with the mechanism of action in STZ induced Wistar rats. The Selinum vaginatum roots were collected from the Rohtang region, Himalayas. Chlorogenic acid was isolated and underwent identification by UV, HPLC, 1H NMR, C13 NMR, Mass, and FTIR spectroscopy methods. Chlorogenic acid was dosed at 10 and 20 mg/kg to observe the effects on experimentally induced diabetes and with time generated diabetic neuropathic complications. Biomarkers TNF-α, superoxide dismutase, nitrosative stress, lipid peroxide profile, and membrane-bound inorganic phosphate were analyzed. Histopathological evaluation of the liver and sciatic nerve was performed for all groups. Parameters like blood glucose levels, body weight, food intake, Thermal Hyperalgesia, Writhing, Cold Hyperalgesia Responses, Mechanical hyperalgesia, Grip Strength, Spontaneous Locomotor (Exploratory) Test, Neuromuscular Coordination tests, and lipid profile analysis showcased the anti-diabetic and diabetic neuropathy protective action of the drug. Inflammation, degradation, and necrosis were found to be reduced in the liver and sciatic nerve cells of treated groups. All the biomarkers used to analyze the oxidative pathway were significantly replenished indicates that chlorogenic acid produces these effects through this pathway.
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Affiliation(s)
- Nikita Saraswat
- Institute of Pharmacy, Pranveer Singh Institute of Technology, Kanpur-Agra-Delhi National Highway-2, Bhauti, Kanpur (UP), 209 305, India
| | - Neetu Sachan
- School of Pharmaceutical Sciences, IFTM University, Lodhipur Rajput, Delhi Road (NH-24), Moradabad (UP), 244 102, India
| | - Phool Chandra
- School of Pharmaceutical Sciences, IFTM University, Lodhipur Rajput, Delhi Road (NH-24), Moradabad (UP), 244 102, India
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49
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Abstract
BACKGROUND On June 30, 2020, the WHO reported over 10 millions of COVID-19 cases worldwide with over half a million deaths. In severe cases the disease progresses into an Acute Respiratory Distress Syndrome (ARDS), which in turn depends on an overproduction of cytokines (IL-6, TNFα, IL-12, IL-8, CCL-2 and IL1) that causes alveolar and vascular lung damage. Clearly, it is essential to find an immunological treatment that controls the "cytokine storm". In the meantime, however, it is essential to have effective antiviral and anti-inflammatory drugs available immediately. PHARMACOLOGIC THERAPY FOR COVID-19 Hydroxychloroquine or chloroquine have been widely adopted worldwide for the treatment of SARS-CoV-2 pneumonia. However, the choice of this treatment was based on low quality of evidence, i.e. retrospective, non-randomized controlled studies. Recently, four large Randomized Controlled Trials (RCTs) have been performed in record time delivering reliable data: (1) the National Institutes of Health (NIH) RCT included 60 hospitals participating all over the world and showed the efficacy of remdesivir in reducing the recovery time in hospitalized adults with COVID-19 pneumonia; (2) three large RCTs already completed, for hydroxychloroquine, dexamethasone and Lopinavir and Ritonavir respectively. These trials were done under the umbrella of the 'Recovery' project, headed by the University of Oxford. The project includes 176 participating hospitals in the UK and was set up to verify the efficacy of some of the treatments used for COVID-19. These three 'Recovery' RCTs concluded definitely: (a) that treatment with hydroxychloroquine provides no benefits in patients hospitalized with COVID-19; (b) that treatment with dexamethasone reduced deaths by one-third in COVID-19 patients that were mechanically ventilated, and by one-fifth in patients receiving oxygen only; (c) that the combination of Lopinavir and Ritonavir is not effective in reducing mortality in COVID-19 hospitalized patients. CONCLUSIONS The results of these four large RCTs have provided sound indications to doctors for the treatment of patients with COVID-19 and prompted the correction of many institutional provisions and guidelines on COVID-19 treatments (i.e. FDA, NIH, UK Health Service, etc.). Even though a definitive treatment for COVID-19 has not yet been found, large RCTs stand as the Gold Standards for COVID-19 therapy and offer a solid scientific base on which to base treatment decisions.
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Affiliation(s)
- Claudio Ortolani
- Istituto Allergologico Lombardo. Casa Di Cura Ambrosiana, Cesano Boscone, Milano, Italy
| | - Elide A. Pastorello
- Unit of Allergy and Immunology, Università Degli Studi Di Milano, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
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50
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Abstract
In the era of evidence-based medicine, healthcare professionals are bombarded with plenty of trials and articles of which randomized control trial is considered as the epitome of all in terms of level of evidence. It is very crucial to learn the skill of balancing knowledge of randomized control trial and to avoid misinterpretation of trial result in clinical practice. There are various methods and steps to critically appraise the randomized control trial, but those are overly complex to interpret. There should be more simplified and pragmatic approach for analysis of randomized controlled trial. In this article, we like to summarize few of the practical points under 5 headings: "5 'Rs' of critical analysis of randomized control trial" which encompass Right Question, Right Population, Right Study Design, Right Data, and Right Interpretation. This article gives us insight that analysis of randomized control trial should not only based on statistical findings or results but also on systematically reviewing its core question, relevant population selection, robustness of study design, and right interpretation of outcome. How to cite this article: Nimavat BD, Zirpe KG, Gurav SK. Critical Analysis of a Randomized Controlled Trial. Indian J Crit Care Med 2020;24(Suppl 4):S215-S222.
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Affiliation(s)
| | - Kapil G Zirpe
- Department of Neuro Trauma Unit, Grant Medical Foundation, Pune, Maharashtra, India
| | - Sushma K Gurav
- Department of Neuro Trauma Unit, Grant Medical Foundation, Pune, Maharashtra, India
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