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Evidence-based medicine

Oren Schwartz, Boris Kanevsky, M A J Sergey Kutikov, Cara H Olsen, Israel Dudkiewicz
Introduction: Attrition from training is associated with substantial financial and personnel loss. There is a plethora of medical literature and research of attrition rates related to initial/phase 1 training (basic combat training); however, the analysis of second phase training (commanders training, consisting of schools that qualify junior commanders and officers for infantry and non-infantry combat units) is limited. The purpose of this study is to perform a comprehensive survey regarding to medical attrition from commanders training in the IDF (Israeli Defense Forces) in order to present the commanders of the IDF a detailed situation report that will serve as an evidence-based platform for future policy planning and implementation...
March 14, 2018: Military Medicine
Pavani Rangachari
In 1999, the Institute of Medicine reported that 98,000 people die each year due to medical errors. In the following years, the focus on hospital quality was intensified nationally, with policymakers providing evidence-based practice guidelines for improving health care quality. However, these innovations (evidence-based guidelines) that were being produced at policy levels were not translating to clinical practice at the hospital organizational level easily, and stark variations continued to persist, in the quality of health care...
2018: Innov Entrep Health
Jean Louis Trouillet, Olivier Collange, Fouad Belafia, François Blot, Gilles Capellier, Eric Cesareo, Jean-Michel Constantin, Alexandre Demoule, Jean-Luc Diehl, Pierre-Grégoire Guinot, Franck Jegoux, Erwan L'Her, Charles-Edouard Luyt, Yazine Mahjoub, Julien Mayaux, Hervé Quintard, François Ravat, Sebastien Vergez, Julien Amour, Max Guillot
Tracheotomy is widely used in intensive care units, albeit with great disparities between medical teams in terms of frequency and modality. Indications and techniques are, however, associated with variable levels of evidence based on inhomogeneous or even contradictory literature. Our aim was to conduct a systematic analysis of the published data in order to provide guidelines. We present herein recommendations for the use of tracheotomy in adult critically ill patients developed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method...
March 15, 2018: Annals of Intensive Care
Nicholas M Pantelides, Jeyaram R Srinivasan
BACKGROUND: Implant rippling is a frequent complication following breast augmentation or implant-based reconstruction and results in significant patient dissatisfaction. Traditionally, the treatment has been to replace the implant, often placing it in a subpectoral pocket to reduce the risk of recurrence. Other techniques, such as increasing the implant size or tightening the capsule, can also be used. Recently, however, there has been much interest in alternative treatments, including fat grafting or insertion of an acellular dermal matrix...
March 15, 2018: Aesthetic Plastic Surgery
William J Meurer, Bradley Barth, Michael Abraham, Jerome Hoffman, Gary M Vilke, Gerard DeMers
BACKGROUND: Stroke treatment is a continuum that begins with the rapid identification of symptoms and treatment with transition to successful rehabilitation. Therapies for acute ischemic stroke (AIS) may vary based on anatomic location, interval from symptom onset, and coexisting health conditions. Successful therapy requires a seamless systematic approach with coordination from prehospital environment through acute management at medical facilities to disposition and long-term care of the patient...
March 12, 2018: Journal of Emergency Medicine
Sabine Salloch, Ina C Otte, Anke Reinacher-Schick, Jochen Vollmann
The impact of patient preferences in evidence-based medicine is a complex issue which touches on theoretical questions as well as medical practice in the clinical context. The interaction between evidence-based recommendations and value-related patient preferences in clinical practice is, however, highly complex and requires not only medical knowledge but social, psychological and communicative competencies on the side of the physician. The multi-layered process of oncology physicians' clinical decision-making was explored in 14 semi-structured interviews with respect to a first diagnosis of a pancreatic adenocarcinoma...
March 12, 2018: Zeitschrift Für Evidenz, Fortbildung und Qualität Im Gesundheitswesen
Júlia Perera-Bel, Barbara Hutter, Christoph Heining, Annalen Bleckmann, Martina Fröhlich, Stefan Fröhling, Hanno Glimm, Benedikt Brors, Tim Beißbarth
BACKGROUND: A comprehensive understanding of cancer has been furthered with technological improvements and decreasing costs of next-generation sequencing (NGS). However, the complexity of interpreting genomic data is hindering the implementation of high-throughput technologies in the clinical context: increasing evidence on gene-drug interactions complicates the task of assigning clinical significance to genomic variants. METHODS: Here we present a method that automatically matches patient-specific genomic alterations to treatment options...
March 15, 2018: Genome Medicine
Daniel Deimel
Clinical social work has established itself as a health-specific profession in Germany over the past 15 years. It refers to a bio-psycho-social health understanding and is particularly focused on hard-to-reach client groups. The concept of evidence-based practice is often criticized and rejected by parts of the profession and discipline of social work. The concepts of evidence-based medicine and clinical social work are associated with positive outcomes for clinical practice and professional development.
March 15, 2018: Das Gesundheitswesen
Behjat Javadi
Cancer is the second leading cause of death with profound socio-economic consequences worldwide. Growing evidence suggests the crucial role of diet on cancer prevention and treatment. In Traditional Persian Medicine (TPM) there is a major focus on contribution of special diet and foods to cancer management. In the present article, the cytotoxic and antitumor activities of several food items including plants and animal products recommended by TPM as anticancer agents are discussed. Strong evidence supports the anticancer effects of beetroot (Beta vulgris) and its major compound betanin, cinnamon and cinnamaldehyde, barley (H...
March 15, 2018: Nutrition and Cancer
A V Moskalev, V S Gladkikh, A A Al'shevskaya, A P Kovalevskiy, A I Sakhanenko, K Yu Orlov, N A Konovalov, A V Krut'ko
To date, a large amount of retrospectively collected data about treatment of neurosurgical pathology have been accumulated. Modern methods of medical statistics are necessary for correct interpretation of the data. The article purpose is to demonstrate application of one of the modern methods, Propensity Score Matching (PSM), in neurosurgery. The use of PSM avoids misinterpretation of retrospectively collected data and obviates errors in planning further prospective studies. For the past 10 years, the number of published international PSM-based studies has increased more than 10-fold, with the number of articles by Russian authors accounting for less than 0...
2018: Zhurnal Voprosy Neĭrokhirurgii Imeni N. N. Burdenko
Matheus Roque, Sandro C Esteves
Varicocele, the leading cause of male infertility, can impair sperm quality and fertility via various oxidative stress mechanisms. An imbalance between excessive reactive oxygen species production and antioxidant protection causes alterations in nuclear and mitochondrial sperm DNA, thus rendering a subset of varicocele men less fertile. In particular, sperm DNA fragmentation is usually elevated in men with clinical varicocele in both abnormal and normal semen parameters by the current World Health Organization criteria...
March 14, 2018: International Urology and Nephrology
Jia-Bo Wang, Yun Zhu, Zhao-Fang Bai, Fu-Sheng Wang, Xiu-Hui Li, Xiao-He Xiao
Herb-induced liver injury (HILI) is a type of adverse drug reactions related to using Chinese medicine (CM) or herbal medicine (HM), and is now a growing segment of drug-induced liver injury (DILI) worldwide. Owing to the complicated compositions and miscellaneous risk factors associated with the clinical usage of CM or HM, it is more challenging to diagnose and manage HILI than DILI. In the present guideline issued by the China Association of Chinese Medicine (CACM), the authors present an evidence chain-based workflow with 9 structured judgment criteria for diagnosing HILI...
March 15, 2018: Chinese Journal of Integrative Medicine
Evidence-Based Complementary And Alternative Medicine
[This retracts the article DOI: 10.1155/2011/724743.].
2018: Evidence-based Complementary and Alternative Medicine: ECAM
George Zaharias
OBJECTIVE: To raise awareness of narrative-based medicine (NBM) as a valuable approach to the consultation, which, if practised more widely by GPs, would convey considerable benefits to both patients and physicians. SOURCES OF INFORMATION: Principally, the perspectives of 2 of NBM's key proponents, Rita Charon and John Launer. MAIN MESSAGE: This first in a series of 3 articles outlines what NBM is and its benefits. In holding the patient story as central, NBM shifts the doctor's focus from the need to problem solve to the need to understand...
March 2018: Canadian Family Physician Médecin de Famille Canadien
David L Chan, Lesley Moody, Eva Segelov, David Metz, Jonathan Strosberg, Nick Pavlakis, Simron Singh
<br>Objectives: There is no consensus regarding optimal follow-up in resected GEP-NETS. We aimed to perform a practice survey to ascertain follow-up patterns by health care practitioners and highlight areas of variation that may benefit from further quantitative research. METHODS: A web-based survey targeted at NET health care providers in Australia, New Zealand, Canada and the United States was developed by a steering committee of medical oncologists and a research methodologist...
March 14, 2018: Neuroendocrinology
Sergio Buccheri, Gottfried H Sodeck, Davide Capodanno
In modern medicine, the results of a comprehensive and methodologically sound meta-analysis bring the most robust, high-quality information to support evidence-based decision-making. With recent developments in newer meta-analytic approaches, iteration of statistical paradigms and software implementations, network and patient-level meta-analyses have recently gained popularity alongside conventional pairwise study-level meta-analyses. However, pitfalls are common in this challenging and rapidly evolving field of statistics...
April 1, 2018: European Journal of Cardio-thoracic Surgery
Kathrine Vauvert R Hviid, Sara Sofia Malchau, Anja Pinborg, Henriette Svarre Nielsen
BACKGROUND: The incidence of monozygotic twins (MZT) after ART appears to be higher than the incidence after spontaneous conceptions contradicting the aim of ART to avoid multiple pregnancies because of the associated risks. OBJECTIVE AND RATIONALE: The aim was to study the frequency of MZT after IVF and ICSI and how it is influenced by the day of embryo transfer, maternal age, zona pellucida manipulation, controlled ovarian stimulation, stimulation protocol, culture media and embryo quality...
March 12, 2018: Human Reproduction Update
F Popescu, C R Jaslow, W H Kutteh
STUDY QUESTION: Will the addition of 24-chromosome microarray analysis on miscarriage tissue combined with the standard American Society for Reproductive Medicine (ASRM) evaluation for recurrent miscarriage explain most losses? SUMMARY ANSWER: Over 90% of patients with recurrent pregnancy loss (RPL) will have a probable or definitive cause identified when combining genetic testing on miscarriage tissue with the standard ASRM evaluation for recurrent miscarriage...
March 12, 2018: Human Reproduction
Katherine Rouleau, Monique Bourget, Patrick Chege, Francois Couturier, Paula Godoy-Ruiz, Paul H Grand'Maison, Melanie Henry, Kerling Israel, Videsh Kapoor, Hendra Kurniawan, Louella Lobo, Mahamane Maiga, Samantha Pereira Franca, Lynda Redwood-Campbell, Jamie Rodas, Raman Sohal, Dawit Wondimagegn, Robert Woolard
BACKGROUND AND OBJECTIVES: There is a limited evidentiary base on the development of family medicine in different contexts and countries. The lack of evidence impedes our ability to compare and characterize family medicine models and identify areas of success that have led to the effective provision of care. This paper offers a comparative compilation and analysis of the development of family medicine training programs in seven countries: Brazil, Canada, Ethiopia, Haiti, Indonesia, Kenya, and Mali...
March 8, 2018: Family Medicine
J S Minhas, T G Robinson
Stroke medicine has seen rapid developments in diagnosis and management, and consequently improved prognosis. Management of ischaemic stroke, in particular, has benefited from these advances. The approach to management has evolved from one of historical passivity to active intervention with time of the essence following stroke onset. The last decade has seen the comparative effectiveness of several pharmacological agents being tested, creating significant randomised controlled trial evidence to support the management of common clinical problems following acute stroke...
December 2017: Journal of the Royal College of Physicians of Edinburgh
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