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High Quality Evidence (high + quality_evidence)
Selected AbstractsAtypical antipsychotics and anorexia nervosa: A reviewEUROPEAN EATING DISORDERS REVIEW, Issue 1 2010Rebecca F. McKnight Abstract Background There is currently mixed opinion regarding the value of using atypical antipsychotics to treat anorexia nervosa (AN). Aims To evaluate the literature on the use of atypical antipsychotics in AN. Method A review of all studies and clinical guidelines published before September 2009 involving use of an atypical antipsychotic in patients with AN. Analysis is by narrative synthesis. Results Forty-three publications or study protocols were found, including four randomized-controlled trials, five open-label trials and 26 case reports. The most studied drugs were olanzapine, quetiapine and risperidone. Atypical antipsychotics appear safe and there is some evidence of positive effects on depression, anxiety and core eating disordered psychopathology in patients with anorexia nervosa. Currently there is insufficient evidence to confirm atypical antipsychotics enhance weight gain in this setting. Conclusions Further high quality evidence is needed in this area in order to provide practical guidance to clinicians. However, the main challenge is to persuade adequate numbers of AN patients to participate in research trials. Copyright © 2010 John Wiley & Sons, Ltd and Eating Disorders Association. [source] A review of the effectiveness of oral health promotion activities among elderly peopleGERODONTOLOGY, Issue 2 2009Colman McGrath Objectives:, This study aimed to review the effectiveness of oral health promotion studies conducted among elderly people between 1997 and 2007. Methods:, Four electronic databases were searched and papers were rated for level of evidence and scientific quality. Key findings of the papers were summarised. Results:, Thirteen thousand nine hundred and four papers were retrieved and 17 studies (18 papers) met the criteria for the review: 13 were randomised controlled studies, three were quasi-experimental studies and one was a pre-/post-single group intervention study. According to the Levels of Evidence, 11 studies could be categorised as 1b and six studies could be categorised as 2b. The quality of the evidence of the 17 studies ranged from 12 to 19; 13 of the studies had a score of 15 or above; four of the studies ranged from 12 to 14. Evidence from oral health promotion activities aimed at preventing caries, improving periodontal health and altering oral health behaviours were reviewed. The use of fluoride, antimicrobial agents and health-care provider education has important roles within oral health promotion activities for elderly people. Studies have tended to be of short-term duration and rely on surrogate outcome measures of oral health. Conclusion:, In the last 10 years, increasing attention has been paid to oral health promotion activities among the elderly population and high quality evidence has emerged. However, there is a need for even higher-quality research to provide more definitive guidelines on oral health promotion practices for elderly people. [source] Review article: fructose malabsorption and the bigger pictureALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 4 2007P. R. GIBSON Summary Fructose is found widely in the diet as a free hexose, as the disaccharide, sucrose and in a polymerized form (fructans). Free fructose has limited absorption in the small intestine, with up to one half of the population unable to completely absorb a load of 25 g. Average daily intake of fructose varies from 11 to 54 g around the world. Fructans are not hydrolysed or absorbed in the small intestine. The physiological consequences of their malabsorption include increasing osmotic load, providing substrate for rapid bacterial fermentation, changing gastrointestinal motility, promoting mucosal biofilm and altering the profile of bacteria. These effects are additive with other short-chain poorly absorbed carbohydrates such as sorbitol. The clinical significance of these events depends upon the response of the bowel to such changes; they have a higher chance of inducing symptoms in patients with functional gut disorders than asymptomatic subjects. Restricting dietary intake of free fructose and/or fructans may have durable symptomatic benefits in a high proportion of patients with functional gut disorders, but high quality evidence is lacking. It is proposed that confusion over the clinical relevance of fructose malabsorption may be reduced by regarding it not as an abnormality but as a physiological process offering an opportunity to improve functional gastrointestinal symptoms by dietary change. [source] Grading quality of evidence and strength of recommendations in clinical practice guidelines: Part 2 of 3.ALLERGY, Issue 8 2009The GRADE approach to grading quality of evidence about diagnostic tests, strategies The GRADE approach to grading the quality of evidence and strength of recommendations provides a comprehensive and transparent approach for developing clinical recommendations about using diagnostic tests or diagnostic strategies. Although grading the quality of evidence and strength of recommendations about using tests shares the logic of grading recommendations for treatment, it presents unique challenges. Guideline panels and clinicians should be alert to these special challenges when using the evidence about the accuracy of tests as the basis for clinical decisions. In the GRADE system, valid diagnostic accuracy studies can provide high quality evidence of test accuracy. However, such studies often provide only low quality evidence for the development of recommendations about diagnostic testing, as test accuracy is a surrogate for patient-important outcomes at best. Inferring from data on accuracy that using a test improves outcomes that are important to patients requires availability of an effective treatment, improved patients' wellbeing through prognostic information, or , by excluding an ominous diagnosis , reduction of anxiety and the opportunity for earlier search for an alternative diagnosis for which beneficial treatment can be available. Assessing the directness of evidence supporting the use of a diagnostic test requires judgments about the relationship between test results and patient-important consequences. Well-designed and conducted studies of allergy tests in parallel with efforts to evaluate allergy treatments critically will encourage improved guideline development for allergic diseases. [source] Consensus guidelines for sustained neuromuscular blockade in critically ill childrenPEDIATRIC ANESTHESIA, Issue 9 2007STEPHEN PLAYFOR Summary Background:, The United Kingdom Paediatric Intensive Care Society Sedation, Analgesia and Neuromuscular Blockade Working Group is a multidisciplinary expert panel created to produce consensus guidelines on sedation, analgesia and neuromuscular blockade in critically ill children and forward knowledge in these areas. Neuromuscular blockade is recognized as an important element in the care of the critically ill and adult clinical practice guidelines in this area have been available for several years. However, similar clinical practice guidelines have not previously been produced for the critically ill pediatric patient. Methods:, A modified Delphi technique was employed to allow the Working Group to anonymously consider draft recommendations in up to three Delphi rounds with predetermined levels of agreement. This process was supported by a total of four consensus conferences and once consensus had been achieved, a systematic review of the available literature was carried out. Results:, A set of consensus guidelines was produced including six key recommendations. An evaluation of the existing literature supporting these recommendations is provided. Conclusions:, Multidisciplinary consensus guidelines for maintenance neuromuscular blockade in critically ill children (excluding neonates) have been successfully produced and are supported by levels of evidence. The Working Group has highlighted the paucity of high quality evidence in these important clinical areas and this emphasizes the need for further randomized clinical trials in this area. [source] 13 Knowledge Translation ShiftACADEMIC EMERGENCY MEDICINE, Issue 2008Rawle Seupaul Health care providers have demonstrated difficulty in adopting the latest information into their clinical practice patterns. This gap in "Knowledge Translation" (KT) is currently under broad discussion within the medical community and was the focus of SAEM's Consensus Conference in 2007. In an effort to bridge this gap, we implemented a novel "KT shift" for our PGY-2 residents. PGY-2 emergency medicine (EM) residents are required to work a nine hour KT shift during their scheduled EM rotation at one of two large urban training emergency departments (EDs). This shift has reduced patient responsibilities to allow for the development of clinical queries that are answered by searching for the best evidence to be applied to patient care. This process is summarized on a "KT Shift Log" that records the PICO question, databases searched, and level of evidence found to answer clinical questions. KT shift log sheets and search strategies are reviewed by EM faculty with expertise in evidence-based medicine and KT principles. We believe that the implementation of a KT shift will improve residents' ability to obtain high quality evidence to answer real-time clinical questions. This may serve as an important measure in closing the knowledge to practice gap. [source] Hoarse voice in adults: an evidence-based approach to the 12 minute consultationCLINICAL OTOLARYNGOLOGY, Issue 1 2009I. Syed Background:, The hoarse voice is a common presentation in the adult ENT clinic. It is estimated that otolaryngology/voice clinics receive over 50 000 patients with dysphonia each year. Good vocal function is estimated to be required for around 1/3 of the labour force to fulfil their job requirements. The assessment and management of the patient with a hoarse voice is potentially a complex and protracted process as the aetiology is often multi-factorial. This article provides a guide for the clinician in the general ENT clinic to make a concise, thorough assessment of the hoarse patient and engage in an evidence based approach to investigation and management. Method:, Literature search performed on 4 October 2008 using EMBASE, MEDLINE, Cochrane databases using subject headings hoarse voice or dysphonia in combination with diagnosis, management, investigation, treatment, intervention and surgery. Results:, General vocal hygiene is beneficial for non organic dysphonia but the evidence base for individual components is poor. There is a good evidence base for the use of voice therapy as first line treatment of organic dysphonia such as vocal fold nodules and polyps. There is little evidence for surgical intervention as first line therapy for most common benign vocal fold lesions. Surgery is, however, the treatment of choice for hoarseness due to papillomatosis. Both CO2 laser and microdissection are equally acceptable modalities for surgical resection of common benign vocal fold lesions. Laryngopharyngeal reflux is commonly cited as a cause of hoarseness but the evidence base for treatment with gastric acid suppression is poor. Despite the widespread use of proton pump inhibitors for treating laryngopharyngeal reflux, there is high quality evidence to suggest that they are no more effective than placebo. Conclusion:, A concise and thorough approach to assessment in the general ENT clinic will provide the diagnosis and facilitate the management of the hoarse voice in the majority of cases. Voice therapy is an important tool that should be utilised in the general ENT clinic and should not be restricted to the specialist voice clinic. If there is no improvement after initial measures, the larynx appears normal and/or the patient has failed initial speech & language therapy, referral to a specialist voice clinic may be helpful. More research is still required particularly with regard to laryngopharyngeal reflux which is often cited as an important cause of hoarseness but is still poorly understood. [source] | ||||||||||