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Reasonable Evidence (reasonable + evidence)
Selected AbstractsThe case for venous rather than arterial blood gases in diabetic ketoacidosisEMERGENCY MEDICINE AUSTRALASIA, Issue 1 2006Anne-Maree Kelly Abstract Objectives:, For patients with diabetic ketoacidosis (DKA), arterial blood gas (BG) sampling for measurement of pH and bicarbonate has been considered an essential part of initial evaluation and monitoring of progress. There is growing evidence that venous values can be clinically acceptable alternatives to arterial measurements. This article summarizes the recent evidence regarding the validity of venous BG sampling in DKA. Methods:, Medline search for the years 1995 to present, hand search of reference lists, search of on-line evidence-based medicine sites. Results:, In patients with DKA the weighted average difference between arterial and venous pH was 0.02 pH units (95% limits of agreement ,0.009 to +0.021 pH units) and between arterial and venous bicarbonate was ,1.88 mEq/L. Conclusions:, There is reasonable evidence that venous and arterial pH have sufficient agreement as to be clinically interchangeable in patients with DKA who are haemodynamically stable and without respiratory failure. There is some evidence that venous and arterial bicarbonate also agree closely in DKA but this requires confirmation. [source] An alternative response to "The best interests of the child thesis: some thoughts from Australia"INTERNATIONAL JOURNAL OF SOCIAL WELFARE, Issue 4 2009Richard P. BarthArticle first published online: 10 SEP 200 Many of the concerns about recent changes in child welfare services practice in Australia have also been raised in the USA. Although it certainly may be the case that mandatory reporting is causing a broadening of child welfare services in Australia, close data-informed scrutiny suggests that this is not the case in the USA. Further, there are positive alternatives to overly intrusive child welfare service interventions that are arising in the USA. There is reasonable evidence to suggest that too little protection rather than too much intrusion remains the more significant problem in the USA; this may also be true elsewhere. The quality and range of services certainly determines whether intrusion is helpful to children and families. In some cases, for example life-threatening health problems that parents will not or cannot treat, engaging the assistance of child welfare services should not be ruled out for ideological reasons. [source] Life events as a risk factor for psychological problems in individuals with intellectual disabilities: a critical reviewJOURNAL OF INTELLECTUAL DISABILITY RESEARCH, Issue 11 2008L. Hulbert-Williams Abstract Background Stressful life events such as bereavement, moving house and changing jobs have repeatedly been implicated as risk factors for mental and physical ill health. Since the 1940s, researchers have demonstrated the negative effects of stressful life events, refined methods of recording such events and investigated the relative impact of different types of event. These investigations have generally not extended to include people with intellectual disabilities. Methods We conducted a narrative review of research on life events as they occur to people with intellectual disabilities and critically assessed the evidence that life events function as a risk factor for psychological problems. Evidence was reviewed for an association between life events and a range of outcome variables, including affective disorders, challenging behaviour, psychosis and psychological problems more generally. We also critiqued the methodology behind the current evidence base and discussed a number of methodological advances that would help to strengthen it. Conclusions There is reasonable evidence that life events are associated with psychological problems, and that there is some tentative evidence that life events play a causal role, although to date, no relationship with psychosis in people with intellectual disabilities has been demonstrated. Life events are likely to be pertinent in clinical work with people with intellectual disabilities. [source] Health-related quality of life among persons with irritable bowel syndrome: a systematic reviewALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 6 2002H. B. El-Serag Summary Aim : To perform a systematic review of the literature with three objectives: (1) to compare the health related quality of life (HRQoL) of patients with irritable bowel syndrome with that of healthy controls; (2) to compare the HRQoL of irritable bowel syndrome patients to those with other diseases; and (3) to examine therapy-associated changes in HRQoL of irritable bowel syndrome patients. Methods : Searches of all English and non-English articles from 1980 to 2001 were performed in Medline and Embase, and two investigators performed independent data abstraction. Results : Seventeen articles met our selection criteria. 13 studies addressed objective no. 1; 11 showed a significant reduction in HRQoL among irritable bowel syndrome patients. Of these, only one study was considered of high quality. Four studies addressed objective no. 2, none of which was considered to be high quality in addressing this objective. Four trials (three of high quality) addressed objective no. 3. One showed that symptomatic improvement with Leupron compared to placebo was accompanied an improvement only in the comparative health domain of the HRQoL. The second study reported significant positive changes in HRQoL after 12 weeks of cognitive behavioural therapy. The third report of two placebo-controlled studies indicated significant improvement with alosetron on most domains of Irritable Bowel Syndrome Quality of Life Questionnaire. Conclusions : (i) There is reasonable evidence for a decrease in HRQoL in patients with moderate to severe irritable bowel syndrome; however, the data are conflicting regarding the impact of irritable bowel syndrome on HRQoL in population-based studies of nonconsulters. (ii) HRQoL in irritable bowel syndrome patients is impaired to a degree comparable to other chronic disorders such as GERD and depression. (iii) A therapeutic response in irritable bowel syndrome-related pain has a corresponding improvement in HRQoL. (iv) Limitations of the literature include focusing on moderate-severe irritable bowel syndrome in referral centres, and lack of appropriate controls [source] Risk factors for work-related musculoskeletal disorders: a systematic review of recent longitudinal studiesAMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 3 2010Bruno R. da Costa PT Abstract Objective This systematic review was designed and conducted in an effort to evaluate the evidence currently available for the many suggested risk factors for work-related musculoskeletal disorders. Methods To identify pertinent literature we searched four electronic databases (Cinahl, Embase, Medline, and The Cochrane Library). The search strategies combined terms for musculoskeletal disorders, work, and risk factors. Only case,control or cohort studies were included. Results A total of 1,761 non-duplicated articles were identified and screened, and 63 studies were reviewed and integrated in this article. The risk factors identified for the development of work-related musculoskeletal disorders were divided and organized according to the affected body part, type of risk factor (biomechanical, psychosocial, or individual) and level of evidence (strong, reasonable, or insufficient evidence). Conclusions Risk factors with at least reasonable evidence of a causal relationship for the development of work-related musculoskeletal disorders include: heavy physical work, smoking, high body mass index, high psychosocial work demands, and the presence of co-morbidities. The most commonly reported biomechanical risk factors with at least reasonable evidence for causing WMSD include excessive repetition, awkward postures, and heavy lifting. Additional high methodological quality studies are needed to further understand and provide stronger evidence of the causal relationship between risk factors and work-related musculoskeletal disorders. The information provided in this article may be useful to healthcare providers, researchers, and ergonomists interested on risk identification and design of interventions to reduce the rates of work-related musculoskeletal disorders. Am. J. Ind. Med. 53:285,323, 2010. © 2009 Wiley-Liss, Inc. [source] Evaluating conflicts of interest in research presented in CME venuesTHE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS, Issue 4 2008Nancy L. Davis PhD Abstract Introduction: There is much in the literature regarding the potential for commercial bias in clinical research and in continuing medical education (CME), but no studies were found regarding the potential for bias in reporting original research in CME venues. This pilot study investigated the presence of perceived bias in oral and print content of research findings presented in certified CME activities. Methods: Research presentations at two national primary care CME activities, where authors had self-reported potential conflicts of interest, were peer reviewed and monitored for perceived commercial bias. Blinded and unblinded peer reviewers' and monitors' analyses of bias were compared to assess whether knowledge of potential conflicts of interest affected perceptions of bias. Results: Knowledge of potential conflicts of interest appeared to increase awareness of potential commercial bias with regard to use of a single product in care and assurance that there was reasonable evidence to support the practice recommendation. A perception of the presenter's strong opinion regarding care did not appear to be influenced by knowledge of a potential conflict of interest. Discussion: While limited, by study design, this research detected subjectivity and variability in perceiving commercial bias within research findings presented in CME venues. Further study of these questions is required to guide the resolution of conflicts of interest in research and CME. [source] POST-SURGICAL NEUROPATHIC PAINANZ JOURNAL OF SURGERY, Issue 7 2008Edward Shipton Surgeons and anaesthetists are involved in Pain Medicine, as they have a responsibility to contribute to postoperative pain management and are often consulted about longer-term pain problems as well. A large component of persistent pain after surgery can be defined as neuropathic pain (NP). Nerves are injured during surgery and pain can persist after the surgical wound has healed. NP is because of a primary lesion or dysfunction of the peripheral or central nervous system. Prevalence estimates indicate that 2,3% of the population in the developed world experience NP. Persistent post-surgical NP is a mostly unrecognized clinical problem. The chronicity and persistence of post-surgical NP is often severely debilitating and impinges on the psychosocial, physical, economic and emotional well-being of patients. Options for treatment of any neuropathic factors are based on understanding the pain mechanisms involved. The current understandings of the mechanisms involved are presented. There is reasonable evidence for the efficacy of pharmacological management for NP. The aim of this article was to appraise the prevention, diagnostic work-up, the physical and particularly the pharmacological management of post-surgical NP and to provide a glimpse of advances in the field. It is a practical approach to post-surgical NP for all surgeons and anaesthetists. The take-home message is that prevention is better than waiting for post-surgical NP to become persistent. [source] | ||||||||||