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Evidence-based medicine

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https://www.readbyqxmd.com/read/28086871/the-integrated-care-pathway-for-post-stroke-patients-icapps-a-shared-care-approach-between-stakeholders-in-areas-with-limited-access-to-specialist-stroke-care-services
#1
Aznida Firzah Abdul Aziz, Nor Azlin Mohd Nordin, Mohd Fairuz Ali, Noor Azah Abd Aziz, Saperi Sulong, Syed Mohamed Aljunid
BACKGROUND: Lack of intersectoral collaboration within public health sectors compound efforts to promote effective multidisciplinary post stroke care after discharge following acute phase. A coordinated, primary care-led care pathway to manage post stroke patients residing at home in the community was designed by an expert panel of specialist stroke care providers to help overcome fragmented post stroke care in areas where access is limited or lacking. METHODS: Expert panel discussions comprising Family Medicine Specialists, Neurologists, Rehabilitation Physicians and Therapists, and Nurse Managers from Ministry of Health and acadaemia were conducted...
January 13, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28086761/is-treatment-resistant-schizophrenia-categorically-distinct-from-treatment-responsive-schizophrenia-a-systematic-review
#2
Amy L Gillespie, Ruta Samanaite, Jonathan Mill, Alice Egerton, James H MacCabe
BACKGROUND: Schizophrenia is a highly heterogeneous disorder, and around a third of patients are treatment-resistant. The only evidence-based treatment for these patients is clozapine, an atypical antipsychotic with relatively weak dopamine antagonism. It is plausible that varying degrees of response to antipsychotics reflect categorically distinct illness subtypes, which would have significant implications for research and clinical practice. If these subtypes could be distinguished at illness onset, this could represent a first step towards personalised medicine in psychiatry...
January 13, 2017: BMC Psychiatry
https://www.readbyqxmd.com/read/28080206/probiotics-d-lactic-acidosis-oxidative-stress-and-strain-specificity
#3
Luis Vitetta, Samantha Coulson, Michael Thomsen, Tony Nguyen, Sean Hall
1. The existence of an implicit living microscopic world, composed primarily of bacteria, has been known for centuries. The exact mechanisms that govern the contribution of bacteria to human health and disease have only recently become the subject of intense research efforts. Within this very evident shift in paradigms, the rational design of probiotic formulations has led to the creation of an industry that seeks to progress the engineering of probiotic bacteria that produce metabolites that may enhance human host health and prevent disease...
January 12, 2017: Gut Microbes
https://www.readbyqxmd.com/read/28079900/a-curated-gene-list-for-reporting-results-of-newborn-genomic-sequencing
#4
Ozge Ceyhan-Birsoy, Kalotina Machini, Matthew S Lebo, Tim W Yu, Pankaj B Agrawal, Richard B Parad, Ingrid A Holm, Amy McGuire, Robert C Green, Alan H Beggs, Heidi L Rehm
PURPOSE: Genomic sequencing (GS) for newborns may enable detection of conditions for which early knowledge can improve health outcomes. One of the major challenges hindering its broader application is the time it takes to assess the clinical relevance of detected variants and the genes they impact so that disease risk is reported appropriately. METHODS: To facilitate rapid interpretation of GS results in newborns, we curated a catalog of genes with putative pediatric relevance for their validity based on the ClinGen clinical validity classification framework criteria, age of onset, penetrance, and mode of inheritance through systematic evaluation of published evidence...
January 12, 2017: Genetics in Medicine: Official Journal of the American College of Medical Genetics
https://www.readbyqxmd.com/read/28078766/lost-in-transformation-reviving-ethics-of-care-in-hospital-cultures-of-evidence-based-healthcare
#5
Annelise Norlyk, Anita Haahr, Pia Dreyer, Bente Martinsen
Drawing on previous empirical research, we provide an exemplary narrative to illustrate how patients have experienced hospital care organized according to evidence-based fast-track programmes. The aim of this paper was to analyse and discuss if and how it is possible to include patients' individual perspectives in an evidence-based practice as seen from the point of view of nursing theory. The paper highlights two conflicting courses of development. One is a course of standardization founded on evidence-based recommendations, which specify a set of rules that the patient must follow rigorously...
January 12, 2017: Nursing Inquiry
https://www.readbyqxmd.com/read/28078656/biosimilars-for-the-treatment-of-cancer-a-systematic-review-of-published-evidence
#6
REVIEW
Ira Jacobs, Reginald Ewesuedo, Sadiq Lula, Charles Zacharchuk
BACKGROUND: Biologic treatments for cancer continue to place a significant economic burden on healthcare stakeholders. Biosimilar therapies may help reduce this burden through cost savings, thereby increasing patient access. OBJECTIVES: The purpose of this study was to collate all published data to assess the weight of available evidence (quantity and quality) for proposed monoclonal antibody biosimilars and intended copies, for the treatment of cancer. METHODS: MEDLINE(®), Embase(®), and ISI Web of Science(®) databases were searched to September 2015...
January 11, 2017: BioDrugs: Clinical Immunotherapeutics, Biopharmaceuticals and Gene Therapy
https://www.readbyqxmd.com/read/28077195/evidence-based-medicine-in-the-era-of-social-media-scholarly-engagement-through-participation-and-online-interaction
#7
Teresa Chan, N Seth Trueger, Damian Roland, Brent Thoma
The integration of new knowledge into clinical practice continues to lag behind discovery. The use of Free Open Access Medical education (FOAM) has disrupted communication between emergency physicians, making it easy for practicing clinicians to interact with colleagues from around the world to discuss the latest and highest impact research. FOAM has the potential to decrease the knowledge translation gap, but the concerns raised about its growing influence are 1) research that is translated too quickly may cause harm if its findings are incorrect; 2) there is little editorial oversight of online material; and 3) eminent online individuals may develop an outsized influence on clinical practice...
January 12, 2017: CJEM
https://www.readbyqxmd.com/read/28077162/a-fixed-inhaled-nitrous-oxide-oxygen-mixture-as-an-analgesic-for-adult-cancer-patients-with-breakthrough-pain-study-protocol-for-a-randomized-controlled-trial
#8
Qiang Liu, Yu Wang, Xiang-Jiang Luo, Ning-Ju Wang, Ping Chen, Xin Jin, Guo-Xia Mu, Xiao-Min Chai, Yue-Juan Zhang, Yu-Xiang Li, Jian-Qiang Yu
BACKGROUND: The management of breakthrough pain in cancer patients is always a challenge for medical professions. Occurring in 80% of cancer patients with advanced disease, breakthrough pain significantly decreases both patient's and caregiver's quality of life. The aim of this study is to assess the analgesic efficacy of a fixed inhaled nitrous oxide/oxygen mixture for adult cancer patients with breakthrough pain. METHODS/DESIGN: This is a randomized, placebo-controlled, double-blind study; it will be conducted in the General Hospital of Ningxia Medical University...
January 11, 2017: Trials
https://www.readbyqxmd.com/read/28076656/combined-inhaled-beta-agonist-and-anticholinergic-agents-for-emergency-management-in-adults-with-asthma
#9
REVIEW
Scott W Kirkland, Christine Vandenberghe, Britt Voaklander, Taylor Nikel, Sandra Campbell, Brian H Rowe
BACKGROUND: Inhaled short-acting anticholinergics (SAAC) and short-acting beta₂-agonists (SABA) are effective therapies for adult patients with acute asthma who present to the emergency department (ED). It is unclear, however, whether the combination of SAAC and SABA treatment is more effective in reducing hospitalisations compared to treatment with SABA alone. OBJECTIVES: To conduct an up-to-date systematic search and meta-analysis on the effectiveness of combined inhaled therapy (SAAC + SABA agents) vs...
January 11, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28074297/-delirium-analgesia-and-sedation-in-intensive-care-medicine-development-of-a-protocol-based-management-approach
#10
A Wolf, R Mörgeli, A Müller, B Weiss, C Spies
Intensive care treatment has long-term consequences that are often not immediately apparent to the health care providers. The combination of muscle weakness, cognitive damage, and psychological disorders is comprised under the term post-intensive care syndrome (PICS). Analgesia and sedation protocols, as well as nonpharmacological preventive and therapeutic approaches, are effective tools for avoiding complications and improving long-term survival. The principle of "early goal-directed therapy" is fundamental...
January 10, 2017: Medizinische Klinik, Intensivmedizin und Notfallmedizin
https://www.readbyqxmd.com/read/28073580/drug-information-by-public-health-and-regulatory-institutions-results-of-an-8-country-survey-in-europe
#11
Giulio Formoso, Maria Font-Pous, Wolf-Dieter Ludwig, David Phizackerley, Dick Bijl, Juan Erviti, Blanka Pospíšilová, Jean Louis Montastruc
PURPOSE: To evaluate the framework of drug information produced by public health and regulatory institutions in Europe. MATERIALS AND METHODS: We carried out a short survey asking editors of ISDB bulletins of the European region to indicate the main sources of drug information provided by public health and regulatory authorities in their countries, the specific kind of information produced and their opinions about strengths and weaknesses of such information. The availability of evaluations about the added therapeutic value of drugs and of tools facilitating the implementation of such information were particularly addressed and checked on the websites of those institutions...
December 29, 2016: Health Policy
https://www.readbyqxmd.com/read/28069712/an-evidence-based-medicine-approach-to-antihyperglycemic-therapy-in-diabetes-mellitus-to-overcome-overtreatment
#12
Anil N Makam, Oanh K Nguyen
Overtreatment is pervasive in medicine and leads to potential patient harms and excessive costs in health care. Although evidence-based medicine is often derided as practice by rote algorithmic medicine, the appropriate application of key evidence-based medicine principles in clinical decision making is fundamental to preventing overtreatment and promoting high-value, individualized patient-centered care. Specifically, this article discusses the importance of (1) using absolute rather than relative estimates of benefits to inform treatment decisions; (2) considering the time horizon to benefit of treatments; (3) balancing potential harms and benefits; and (4) using shared decision making by physicians to incorporate the patient's values and preferences into treatment decisions...
January 10, 2017: Circulation
https://www.readbyqxmd.com/read/28068362/conflict-of-interest-policies-at-french-medical-schools-starting-from-the-bottom
#13
Paul Scheffer, Christian Guy-Coichard, David Outh-Gauer, Zoéline Calet-Froissart, Mathilde Boursier, Barbara Mintzes, Jean-Sébastien Borde
BACKGROUND: Medical faculties have a role in ensuring that their students are protected from undue commercial influence during their training, and are educated about professional-industry interactions. In North America, many medical faculties have introduced more stringent conflict of interest (COI) policies during the last decade. We asked whether similar steps had been taken in France. We hypothesized that such policies may have been introduced following a 2009-2010 drug safety scandal (benfluorex, Mediator) in which COIs in medicine received prominent press attention...
2017: PloS One
https://www.readbyqxmd.com/read/28067704/intravenous-ketamine-infusions-for-neuropathic-pain-management-a-promising-therapy-in-need-of-optimization
#14
Dermot P Maher, Lucy Chen, Jianren Mao
Intravenous ketamine infusions have been used extensively to treat often-intractable neuropathic pain conditions. Because there are many widely divergent ketamine infusion protocols described in the literature, the variation in these protocols presents a challenge for direct comparison of one protocol with another and in discerning an optimal protocol. Careful examination of the published literature suggests that ketamine infusions can be useful to treat neuropathic pain and that certain characteristics of ketamine infusions may be associated with better clinical outcomes...
January 5, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28067194/mapping-actions-to-improve-access-to-medicines-for-mental-disorders-in-low-and-middle-income-countries
#15
C Barbui, T Dua, K Kolappa, B Saraceno, S Saxena
AIMS: In recent years a number of intergovernmental initiatives have been activated in order to enhance the capacity of countries to improve access to essential medicines, particularly for mental disorders. In May 2013 the 66th World Health Assembly adopted the World Health Organization (WHO) Comprehensive Mental Health Action Plan 2013-2020, which builds upon the work of WHO's Mental Health Gap Action Programme. Within this programme, evidence-based guidelines for mental disorders were developed, including recommendations on appropriate use of medicines...
January 9, 2017: Epidemiology and Psychiatric Sciences
https://www.readbyqxmd.com/read/28067181/pediatric-information-seeking-behaviour-information-needs-and-information-preferences-of-health-care-professionals-in-general-emergency-departments-results-from-the-translating-emergency-knowledge-for-kids-trekk-needs-assessment
#16
Shannon D Scott, Lauren Albrecht, Lisa M Given, Lisa Hartling, David W Johnson, Mona Jabbour, Terry P Klassen
: The majority of children requiring emergency care are treated in general emergency departments (EDs) with variable levels of pediatric care expertise. The goal of the Translating Emergency Knowledge for Kids (TREKK) initiative is to implement the latest research in pediatric emergency medicine in general EDs to reduce clinical variation. OBJECTIVES: To determine national pediatric information needs, seeking behaviours, and preferences of health care professionals working in general EDs...
January 9, 2017: CJEM
https://www.readbyqxmd.com/read/28065992/challenges-surrounding-return-to-play-rtp-for-the-sports-clinician-a-case-highlighting-the-need-for-a-thorough-three-step-rtp-model
#17
Roger Menta, Kevin D'Angelo
Return-to-play (RTP) is a multifactorial process of retuning an injured athlete back to competition when risk for re-injury is minimized. Traditionally, these decisions are made by medical practitioners based on experience or anecdotal evidence. RTP decisions continue to be a challenging task for the medical practitioner. In the interest of advancing sports medicine for the betterment of athletes, improving the RTP decision-making process with a new paradigm has been suggested.1 It stands to clarify the intricacies used by clinicians when making RTP decisions by providing insight into the multiple factors that must be considered; not only by the athlete and medical practitioner, but all relevant parties (i...
December 2016: Journal of the Canadian Chiropractic Association
https://www.readbyqxmd.com/read/28064562/new-interpretive-criteria-for-danofloxacin-antibacterial-susceptibility-testing-against-mannheimia-haemolytica-and-pasteurella-multocida-associated-with-bovine-respiratory-disease
#18
Michael T Sweeney, Mark G Papich, Jeffrey L Watts
Danofloxacin is a fluoroquinolone antibacterial agent approved for use in veterinary medicine to treat and control bovine respiratory disease caused by Mannheimia haemolytica or Pasteurella multocida. Susceptible minimal inhibitory concentration (MIC) breakpoint (≤0.25 µg/mL) and disk diffusion interpretive criteria (≥22 mm) values for danofloxacin against M. haemolytica and P. multocida were first approved by the Clinical and Laboratory Standards Institute (CLSI) in 2003. However, intermediate and resistant breakpoint values were not established because only susceptible wild-type populations were evident at the time of breakpoint approvals...
January 1, 2017: Journal of Veterinary Diagnostic Investigation
https://www.readbyqxmd.com/read/28063134/how-can-pricing-and-reimbursement-policies-improve-affordable-access-to-medicines-lessons-learned-from-european-countries
#19
REVIEW
Sabine Vogler, Valérie Paris, Alessandra Ferrario, Veronika J Wirtz, Kees de Joncheere, Peter Schneider, Hanne Bak Pedersen, Guillaume Dedet, Zaheer-Ud-Din Babar
This article discusses pharmaceutical pricing and reimbursement policies in European countries with regard to their ability to ensure affordable access to medicines. A frequently applied pricing policy is external price referencing. While it provides some benchmark for policy-makers and has been shown to be able to generate savings, it may also contribute to delay in product launch in countries where medicine prices are low. Value-based pricing has been proposed as a policy that promotes access while rewarding useful innovation; however, implementing it has proven quite challenging...
January 6, 2017: Applied Health Economics and Health Policy
https://www.readbyqxmd.com/read/28062967/septal-cartilage-ethmoid-bone-composite-graft-a-new-and-improved-method-for-the-correction-underdeveloped-nasal-septum-in-patients-with-short-noses
#20
Soo Hyang Lee, Mun Geun Koo, Eun Taek Kang
BACKGROUND: Septal extension grafts are an effective means of extending nasal length in patients with a short nose. However, such grafts can be challenging in patients who only have small quantities of weak septal cartilage, such as some East Asian patients. We developed a rhinoplasty technique using ethmoid bone to create a cartilage-bone complex to overcome this issue, allowing adequate nasal lengthening. METHODS: Sixty-four women with short noses and inadequate septal cartilage determined by preoperative computed tomography underwent septal extension grafting with a cartilage-bone complex between January 2009 and December 2014...
January 7, 2017: Aesthetic Plastic Surgery
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