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Evidence Based Medicine (evidence + based_medicine)

Distribution by Scientific Domains
Medical Sciences80%

Terms modified by Evidence Based Medicine

  • evidence based medicine review
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    Selected Abstracts

    Volvulus of the sigmoid colon

    COLORECTAL DISEASE, Issue 7Online 2010
    V. Raveenthiran
    Abstract Aims, The current status of sigmoid volvulus (SV) was reviewed to assess trends in management and to assess the literature. Method, The literature on SV was retrieved using PubMed, Embase, Scopus, Pakmedinet, African Journals online (AJOL), Indmed and Google scholar. These databases were searched for text words including ,sigmoid', ,colon' and ,volvulus'. Relevant nonindexed surgical journals published from endemic countries were also manually searched. We focused on original articles published within the last 10 years; but classical references prior to this period were also included. Seminal papers published in non-English languages were also included. Results, Sigmoid volvulus is a leading cause of acute colonic obstruction in South America, Africa, Eastern Europe and Asia. It is rare in developed countries such as USA, UK, Japan and Australia. Characteristic geographic variations in the incidence, clinical features, prognosis and comorbidity of SV justify recognition of endemic and sporadic subtypes. Controversy on aetiologic agents can be minimized by classifying them into ,predisposing' and ,precipitating' factors. Modern imaging systems, although more effective than plain radiographs, are yet to gain popularity. Emergency endoscopic reduction is the treatment of choice in uncomplicated patients. But it is only a temporizing procedure, and it should be followed in most cases by elective definitive surgery. Resection of the redundant sigmoid colon is the gold standard operation. The role of newer nonresective alternatives is yet to be ascertained. Although emergency resection with primary anastomosis (ERPA) has been controversial in the past, it is now increasingly accepted as a safe option with superior results. Management in elderly debilitated patients is extremely difficult. Paediatric SV significantly differs from that in adults. SV is frequently associated with neuropsychiatric diseases, diabetes mellitus and Chagas disease. The overall mortality in recent studies is < 5%. Conclusion, There are almost no randomised controlled studies. According to the grading system of Oxford Center for Evidence Based Medicine (CEVM), available published evidence is at level 4. The recommendations resulting form this review are of ,C' grade. [source]

    IN BETWEEN CURING AND COUNTING: PERFORMATIVE EFFECTS OF EXPERIMENTS WITH HEALTHCARE INFORMATION INFRASTRUCTURE

    FINANCIAL ACCOUNTABILITY & MANAGEMENT, Issue 3 2007
    Signe Vikkelsř
    Performance standards and accountability pervade modern healthcare. According to Michael Power, this may signify a new rationality of governance characterized by control of controls, which affects practices not by direct intervention, but through the processes by which practices are made auditable. The paper addresses this thesis by exploring the construction of a Danish standard for electronic patient records. It is shown that making healthcare auditable activates deep tensions between programs of clinical practice, quality control, evidence based medicine, and casemix funding, resulting in an ambiguous and unstable standard. During this process, however, particular notions of patients, diseases, and diagnoses emerge as undisputed innovations, which may come to survive the subsequent career of the standard. The paper discusses the performative effects of these innovations and argues that information infrastructure has become an analytically important site for exploring the substantial effects of new rationalities of governance in healthcare. [source]

    CHRONIC KIDNEY DISEASE,MINERAL AND BONE DISORDER (CKD-MBD): A NEW TERM FOR A COMPLEX APPROACH

    JOURNAL OF RENAL CARE, Issue 2009
    Franti, vára MD
    SUMMARY The global widespread of the chronic kidney disease (CKD) is a worldwide health problem. Its increasing incidence and prevalence and adverse outcomes (including decreased quality of life, increased morbidity and mortality) represents a huge challenge for all recent health are systems. Reflecting this situation, the new, global initiative (KDIGO) was established to enhance communication and clinical decision-making, promote the use of evidence based medicine and facilitate clinical research. The new definition, evaluation and classification of "renal osteodystrophy"; has been one of the first outcome of this initiative, suggesting the topic of chronic kidney disease,mineral and bone disorder (CKD-MBD) to be a hot problem of recent nephrology. The new terminology is consistent with a recent view on this topic and describes CKD-MBD as a complex syndrome, including abnormal mineral and PTH metabolism, altered bone structure as far as extra-skeletal calcifications. [source]

    Do UK cardiac centres use evidence based medicine in glucose control?

    ANAESTHESIA, Issue 3 2003
    A.M. Walton
    First page of article [source]

    A critical review of irrigation techniques in acute wounds

    INTERNATIONAL WOUND JOURNAL, Issue 3 2005
    Article first published online: 7 SEP 200
    Revue critique des techniques d'irrigation dans les plaies aigües L'irrigation est un concept fondamental dans la prise en charge des plaies aigües et de ce fait d'une importance capitale dans toutes les spécialités chirurgicales. Une grande quantité de travaux de recherche ont été développés depuis trente ans dans le but de définir la technique d'irrigation la plus efficace. Les preuves du bénéfice de l'irrigation dans la prise en charge des plaies traumatiques aigűes et spécifiques existent mais il reste ŕ définir la meilleure technique et les pressions d'irrigation précises pour optimiser les résultats. Un grand nombre d'études actuellement disponibles manquent encore des bases scientifiques rigoureuses indispensables ŕ la médecine basée sur les preuves. On trouve des biais méthodologiques non négligeables et une absence de standardisation entre les nombreuses études empęchant de tirer des conclusions scientifiques et de comparer les différentes études. Il existe peu d'études randomisées contrôlées sur les plaies humaines et l'extrapolation ŕ partir des études animales doit ętre faite avec précautions. La determination des différentes pressions d'irrigation pour different niveaux de contamination manque encore. Ceci pourrait aboutir ŕ une approche plus logique dans la prise en charge des plaies aigües qu'un traitement "couverture" appliquéŕ toutes les plaies aigües quelle que soit le degré de contamination. Des études complémentaires dans cette direction sont nécessaires en portant attention ŕ la méthodologie scientifique utilisée. Spültechniken in der Behandlung akuter Wunden- eine kritische Bewertung In der Behandlung akuter Wunden hat sich die Spülung als grundlegende Methode herausgestellt und deren Bedeutung in allen chirurgischen Bereichen etabliert. Eine bedeutende Anzahl von Forschungsarbeiten hat sich in den vergangenen 3 Jahrzehnten mit der Suche nach der besten Spültechnik beschäftigt. Dabei wurde immer die Bedeutung der Spülung in der Behandlung akuter traumatischer als auch elektiver Wunden hervorgehoben, aber welche Technik des Spülens und mit welchem Druck diese angewandt werden müssen um ein optimales Ergebnis zu erzielen, bleibt weiterhin offen. Einer Großzahl der bis heute vorliegenden Studien mangelt es an einem festgelegten Studiendesign welches gerade im Zeitalter der evidenzbasierten Medizin unbedingt von Nöten wäre. Substantielle methodische Mängel sowie eine unzureichende Standardisierung der verschiedenen Studien lassen weder einen Vergleich noch eine abschließende wissenschaftliche Schlussfolgerung zu. Es finden sich nur wenige randomisierte Studien in den Wunden beim Menschen Gegenstand der Untersuchung waren, eine Übertragung der Ergebnisse von Tierexperimenten muss unter besonderer Berücksichtigung und nur mit Vorsicht erfolgen. Die Anwendung verschiedener Drücke in der Spülbehandlung bei unterschiedlich stark kontaminierten Wunden wurde bisher nicht untersucht. Dies würde ein differenziertes Vorgehen in der Behandlung akuter Wunden in Abhängigkeit der Wundstadien und des Infektionsstaus ermöglichen. Diesbezüglich sind weitere Studien unter besonderer Berücksichtigung der wissenschaftlichen Methodik und eines einheitlichen Studiendesigns vonnöten. Una revisione critica delle tecniche di irrigazione nelle ferite acute L'irrigazione č un concetto fondamentale nella cura delle ferite acute e quindi di primaria importanza in tutte le specialitŕ chirurgiche. Una quantitŕ significativa di ricerca č stata condotta con l'obiettivo di individuare la tecnica piů efficace di irrigazione durante le ultime tre decadi. Esiste una evidenza per mostrare che l'irrigazione č vantaggiosa nella gestione di lesioni acute traumatiche e di ferite elettive, ma esattamente quale tecnica e quale pressione di irrigazione sia necessaria per ottenere un ottimo risultato rimane ancora da stabilire. Ad oggi un numero significativo di studi sono carenti per quanto riguarda la medicina basata sull'evidenza. Sono presenti un numero rilevante di errori metodologici ed una carenza di standardizzazione tra molti studi al punto di impedire di tracciare delle conclusioni e comparare i differenti studi. Esistono pochi studi randomizzati controllati su ferite sull'uomo e l'estrapolazione da studi animali deve essere utilizzata con cautela. Le ricerche su differenti pressioni di irrigazione per differenti livelli di contaminazione sono carenti. Questo potrebbe produrre un approccio piů logico per gestire clinicamente ferite acute piuttosto che avere un trattamento generale per tutte lesioni acute non rispondente al livello di contaminazione. Sono necessarie ulteriori ricerche in questa direzione e con maggiore attenzione alla metodologia scientifica. Revisión crítica de técnicas de irrigación en heridas agudas La irrigación es un concepto fundamental para el cuidado de heridas agudas y, por tanto, de importancia primordial en todas las especialidades quirúrgicas. En el curso de las tres últimas décadas se ha realizado una investigación en búsqueda de la técnica de irrigación más eficaz. Se dispone de pruebas demostrativas de que la irrigación es beneficiosa en el tratamiento de heridas traumáticas agudas y electivas; sin embargo, todavía no se ha determinado qué técnicas y presiones de irrigación son necesarias para obtener resultados óptimos. Un número significativo de los estudios realizados hasta la fecha carecen del diseńo científico estricto, indispensable en un contexto de medicina científico , estadística. Existen imperfecciones metodológicas considerables y una falta de estandarización entre numerosos estudios, lo que dificulta la capacidad de llegar a conclusiones científicas y comparar estudios diferentes. Se dispone de pocos estudios aleatorizados, controlados, en heridas humanas, y la extrapolación de estudios de experimentación animal debe efectuarse con precaución. No se dispone de investigación sobre presiones de irrigación diferentes para niveles de contaminación diferentes. Esto generaría posiblemente un enfoque más lógico de tratamiento clínico de heridas agudas en lugar de un tratamiento general para todas las heridas agudas independientemente del nivel de contaminación. Es indispensable una investigación ulterior en este sentido, prestando mayor atención a la metodología y diseńo científicos. En Kritisk Utvärdering av Spolningstekniker för Akuta Sĺr Spolning är ett fundamentalt koncept i akut sĺrvĺrd och därför av största betydelse i alla kirurgiska specialiteter. Betydande forskning har idkats under de tre senaste ĺrtiondena för att hitta den mest effektiva spolningstekniken. Det föreligger bevis för att spolning är nyttigt i vĺrden av akuta traumatiska och elektiva sĺr men exakt vilken teknik och vilket spolningstryck som behövs för ett optimalt resultat har ännu inte fastställts. Ett märkbart antal av de förhandenvarande studierna saknar den vetenskapliga rigör i studiedesignen som behövs i ett klimat av ,evidence based medicine'. Det föreligger märkbara brister i metodologin och en brist pĺ standardisering mellan mĺnga av studierna som hindrar möjligheten att dra vetenskapliga slutsatser och jämföra olika studier. Det finns fĺ randomiserade kontrollerade studier i humana sĺr och man bör vara försiktig med härledningar frĺn djur studier. Undersökning av olika spolningstryck för olika nivĺer av kontaminering saknas. Detta kunde möjligen utgöra ett mera logiskt tillvägagĺngssätt för att kliniskt sköta akuta sĺr snarare än en generell behandling för alla akuta sĺr oberoende av kontamineringsnivĺ. Fortsatta studier i den här riktningen och större akt pĺ vetenskaplig metodologi behövs. [source]